A text message intervention aimed at nurturing peer outreach to help meet drinking limit goals: A remote pilot randomized trial in non-collegiate young adults.

OBJECTIVE: Scalable interventions attempting to nurture peer outreach to help young adults meet drinking limit goals remain under-developed. To address this gap, we developed ASPIRE, a text message intervention focused on coaching individuals to engage with close peers to assist them in meeting drinking limit goals. METHOD: Non-collegiate young adults who had reported one or more heavy drinking days in the preceding month and were at least contemplating change were recruited through social media. Participants were randomly assigned to one of three 6-week text message interventions: Control, Goal Support, or ASPIRE. All groups completed baseline assessments and received weekly text message assessments on Thursdays and Sundays. Control and ASPIRE groups were prompted to complete web-based outcome assessments at 6- and 12-weeks. RESULTS: We enrolled 92 young adults from 31 US states (65% female; 73% White). All groups had high text response rates but intervention usability was sub-optimal. Follow-up rates were 87% at 6-weeks and 79% at 12-weeks. Compared to Control, ASPIRE participants reported significantly more peer support and less peer pressure to drink. ASPIRE exhibited higher goal confidence compared to the Goal Support group. Using multiple imputation, there were no significant differences in drinking outcomes between groups. CONCLUSIONS: Preliminary findings from this pilot study suggest that a text message intervention focused on nurturing peer outreach to help meet drinking limit goals holds promise in altering peer support and pressure as well as boosting drinking limit goal confidence. Design improvements are needed to reduce alcohol consumption.

A prevention program for binge drinking among students based on mindfulness and implementation intention (ALCOMEDIIT): a randomized controlled trial.

BACKGROUND: The emergence of new problematic alcohol consumption practices among young people requires new dynamics in prevention strategies. In this context, the ADUC project (Alcohol and Drugs at the University of Caen) aims to develop a better understanding of alcohol consumption, and in particular the practice of binge drinking (BD) in students, in order to develop relevant and adapted prevention tools. The ALCOMEDIIT study (Rin Normandie and IRESP funding; Agreement 20II31-00 - ADUC part 3) is a randomized controlled trial that focuses on the specific determinant of impulsivity. The main objective of this experiment is to assess a program for the prevention of BD practices based on motivational interviewing (MI) associated with implementation intention (II) and mindfulness meditation (MBM) in a student environment. METHODS: This study will include 170 healthy subjects who will be students at the university, alcohol users, with a BD score > 1 in the month preceding the inclusion but not presenting any specific disorder. The trial will be proposed by e-mail and students who meet the inclusion criteria will join either a control group which will benefit from a MI or an experimental group which will additionally benefit from an initiation to MBM with II (initial visit T0). In order to measure the effectiveness of the prevention program in terms of BD decrease, a follow-up at 1 month (T1) as well as a follow-up at 6 months (T6; exploratory) will be proposed to all participants. The total duration of this research protocol is 21 months. DISCUSSION: The purpose of this study is to evaluate the interest of associating mindfulness meditation practices and implementation of self-regulation strategies to optimize their use, with a motivational interview in an innovative prevention program aiming at reducing alcohol use and BD practice in the student population. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05565989, September 30, 2022. https://clinicaltrials.gov/study/NCT05565989 Protocol version 2.0 (September 2022) No. ID-RCB: 2022-A00983-40.

State Alcohol Policy Environments of U.S. Colleges: Predictors of Sexual Assault and Alcohol-Related Arrest and Disciplinary Action.

INTRODUCTION: Binge drinking and sexual assault are serious inter-related public health problems faced by college students. State-level alcohol policy restrictiveness has been found to decrease binge drinking among college students and, therefore, may also reduce occurrences of alcohol-related criminal offenses. It was hypothesized that more restrictive state alcohol policy environments would be associated with fewer liquor law violations and sexual assault offenses on U.S. college campuses. METHODS: Data were aggregated across 3 academic years (2016-2017, 2017-2018, and 2018-2019) and represented n=1,290 institutions. Zero-inflated negative binomial regression modeling was performed in 2022-2023 to evaluate associations of state-level young adult binge drinking and the Alcohol Policy Scale (APS) with the numbers of campus-level alcohol-related arrests, alcohol-related disciplinary actions, rape offenses, and fondling offenses reported in national Campus Safety and Security data. RESULTS: Higher APS scores had direct associations with fewer alcohol-related arrests (1.79% decrease per one-unit increase in APS, p=0.05), alcohol-related disciplinary actions (2.27% decrease per one-unit increase in APS, p=0.027), and rape offenses (0.85% decrease per one-unit increase in APS, p=0.021). The associations APS scores had with disciplinary actions and rape offenses were partially and fully mediated, respectively, by state-level young adult binge drinking. No associations were found between APS and fondling offenses. CONCLUSIONS: This cross-sectional study presents evidence that more restrictive state alcohol policies are associated with fewer alcohol-related arrests and disciplinary actions, and rape offenses on college campuses. Future research should identify the alcohol policy domains that are most protective against these outcomes.

Binge drinking and condom negotiation behaviours among adolescent girls and young women living in Cape Town, South Africa: sexual control and perceived personal power.

BACKGROUND: Condom use among young people in South Africa has declined in recent years and adolescent girls and young women continue to bear the highest incidence of HIV in the country. Young women who have dropped out of school may be more at risk because of traditional gender norms that create substantial power imbalances and a lack of power to negotiate condom use with their male partners, especially when using alcohol and other drugs. METHODS: This study presents an analysis of baseline data provided by 500 adolescent girls and young women (AGYW) from Cape Town communities between November 2016 and November 2018 who were reached for a cluster-randomised trial conducted to assess the efficacy of an evidence-based, young woman-focused intervention seeking to reduce HIV risk and substance use behaviours. The analysis focuses on associations between binge drinking, condom use, and sexual negotiation, including impaired sex (any substance use at last sex). RESULTS: AGYW who reported frequent condom negotiation with their partners were 8.92 times (95% CI: [4.36, 18.24]) as likely to use a condom when alcohol or other drugs were not used at last sex and 5.50 times (95% CI: [2.06, 14.72]) as likely when alcohol or other drugs were used at last sex (p < 0.05). AGYW who reported frequent binge drinking in the past month (n = 177) had significantly reduced odds of condom use at last sex, irrespective of whether the sex was impaired (OR 0.60, 95% CI: [0.49, 0.73]) or not impaired (OR 0.69, 95% CI: [0.60, 0.81]). DISCUSSION: The findings highlight the need for interventions that reach AGYW in South Africa by specifically aiming to educate AGYW about the effect of binge drinking on negotiating power in their relationships, thus providing them with the knowledge and skills to increase agency regarding condom use. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02974998 (recruitment completed). 29/11/2016.

Peer-led BASICS intervention to reduce alcohol consumption and alcohol-related consequences among university students: a randomized controlled trial.

Introduction: Alcohol consumption is the main substance abused during university and is associated with physical, legal, emotional, social, and cognitive consequences. The peer-led BASICS intervention has been shown to be effective in decreasing the quantity and frequency of drinking, the estimated peak blood alcohol concentration (BAC), and the number of binge drinking episodes among this population. Objective: This study evaluated the effectiveness of the peer-led BASICS intervention to reduce risky alcohol consumption among university students in the Spanish context. Materials and methods: A two-arm randomized controlled trial in a university in northern Spain including 308 first- and second-year university students recruited between October 2022 to March 2023. The intervention was a 30-min in-person peer-led motivational interview. Participants were assessed at baseline and 1-month postintervention. The primary outcome was the quantity and frequency of alcohol consumption during a typical week. The intervention effect was verified using a mixed factorial ANOVA model. Results: Compared with students in the control group, students who received the intervention reduced the number of drinks per week by 5.7 (95% CI 5.54, 5.86); the number of drinks consumed in a typical weekend by 5.2 (95% CI 5.07, 5.33); the number of drinks consumed on the occasion of greatest consumption by 4.9 (95% CI 4.78, 5.02); the number of binge drinking episodes by 1.4 (95% CI 1.37, 1.43); the peak BAC on a typical week and on the occasion of greatest consumption decreased by 0.06 (95% CI 0.058, 0.062) and 0.09 (95% CI 0.088, 0.092); the number of alcohol-related consequences by 5.8 (95% CI 5.67, 5.93); and the motivation to change their alcohol use increased by -0.8 (95% CI -0.85, -0.75). Conclusion: The peer-led BASICS intervention is effective in changing alcohol consumption and its related consequences among Spanish university students in the short term. The action of nursing students as counselors positively impacted drinking patterns among their peers. Clinical trial registration: https://clinicaltrials.gov/study/NCT05639374?intr=Effectiveness%20of%20a%20Peer-led%20Program%20to%20Prevent%20Alcohol%20Consumption&rank=1&page=1&limit=10, identifier: NCT05639374.

Examining engagement effects in an adaptive preventive intervention for college student drinking.

OBJECTIVE: This study determined the characteristics of engagement and whether engagement in an adaptive preventive intervention (API) was associated with reduced binge drinking and alcohol-related consequences. METHOD: Incoming students were recruited for a sequential multiple assignment randomized trial (SMART; N = 891, 62.4% female, 76.8% non-Hispanic White) with an assessment-only control group. The API occurred during the first semester of college, with outcomes assessed at the end of the semester. The API involved two stages. Stage 1 included universal intervention components (personalized normative feedback [PNF] and self-monitoring). Stage 2 bridged heavy drinkers to access additional resources. We estimated the effect of engagement in Stage 1 only and in the whole API (Stages 1 and 2) among the intervention group, and the effect of the API versus control had all students assigned an API engaged, on alcohol-related outcomes. RESULTS: Precollege binge drinking, intention to pledge a fraternity/sorority, and higher conformity motives were most associated with lower odds of Stage 1 engagement. Action (readiness to change) and PNF engagement were associated with Stage 2 engagement. API engagement was associated with significant reductions in alcohol-related consequences among heavy drinkers. Compared to the control, we estimated the API would reduce the relative increase in alcohol-related consequences from baseline to follow-up by 25%, had all API students engaged. CONCLUSIONS: Even partial engagement in each component of the "light-touch" API rendered benefits. Analyses suggested that had all students in the intervention group engaged, the API would significantly reduce the change in alcohol-related consequences over the first semester in college. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

An example of implementing a safety protocol in remote intervention and survey research with college students.

INTRODUCTION: This article draws attention to the need for open evaluation and reporting on safety protocols in survey and intervention research. We describe a protocol for responding to those who indicate increased risk of self-harm (i.e. suicidality or potentially lethal alcohol use) as an example and report on the outcome of our procedures. METHODS: Participants were first-year college students (n = 891) participating in an intervention trial for binge drinking. We describe the protocol, provide descriptive outcomes, and examine whether participant sex, attrition, or study intervention condition were related to endorsing items that indicated risk for suicidality or potentially lethal alcohol use. RESULTS: Of the 891 participants, 167 (18.7%) were identified as being at risk in one or more study wave. Of those, we were able to successfully contact 100 (59.9%), 76 (45.5%) by phone, and 24 (14.4%) by email. Of those 100, 78 accepted mental health resources as a result of outreach. Participant sex, attrition, and intervention condition were not related to risk. DISCUSSION: This article may aid other research teams in developing similar protocols. Strategies to reach an even greater proportion of high-risk participants are needed. A body of literature documenting published safety protocols in research and the associated outcomes would help to identify opportunities for improvement.

Desire to get drunk partially mediates effects of a combined text message-based alcohol intervention for young adults.

BACKGROUND: This study aimed to test the causal effect of different text message interventions on reducing alcohol consumption indirectly by altering desire to get drunk. METHODS: Participants were young adults randomized to interventions with different behavior change techniques: self-monitoring alone (TRACK); pre-drinking plan feedback (PLAN); post-drinking alcohol consumption feedback (USE); pre- and post-drinking goal feedback (GOAL); and a combination of techniques (COMBO) who completed at least 2 days of both pre- and post-drinking assessments over 12 weeks of intervention exposure. On the two days per week they planned to drank alcohol, participants were asked to report desire to get drunk (0 "none" to 8 "completely"). The next day, participants reported drinking quantity. Outcomes included binge drinking (defined as 4+ drinks for a woman and 5+ drinks for a man) and drinks per drinking day. Mediation was tested using path models of simultaneous between-person and within-person effects using maximum likelihood estimation. RESULTS: At the between-person level, controlling for race and baseline AUDIT-C and within-person associations, 35.9 % of the effects of USE and 34.4 % of the effects of COMBO on reducing binge drinking were mediated through desire to get drunk. 60.8 % of the effects of COMBO on reducing drinks per drinking day were mediated through desire to get drunk. We did not find significant indirect effects for any other text-message intervention. DISCUSSION: Findings support the hypothesized mediation model where desire to get drunk partially mediates the effects of a text message intervention using a combination of behavior change techniques on reducing alcohol consumption.

A randomized controlled trial of an online alcohol and sexual risk prevention program for college students studying abroad.

INTRODUCTION: American college students who study abroad experience increases in their drinking behavior, concerning risky sexual behaviors, and high rates of sexual violence while abroad. Despite these concerns, institutions offer limited programming to students prior to departure to address these risks and no empirically supported interventions currently exist that are targeted toward preventing increased drinking, risky sexual behavior, and sexual violence abroad. To help address alcohol and sexual risk abroad, we designed a brief, single-session online predeparture intervention focused on risk and protective factors known to associate with alcohol and sexual risk abroad. METHODS: Using a sample of 650 college students from 40 home institutions, we conducted a randomized controlled trial of the intervention and tested its effects on drinking (drinks per week, binge drinking frequency, alcohol related-consequences), risky sexual behaviors, and sexual violence victimization during the trip abroad (first month, last month abroad) and one-month and three-months after return home. RESULTS: We observed small, but nonsignificant, intervention effects on drinks per week and binge drinking days during the first month abroad and three months after they had returned home to the United States, and small, significant effects on risky sexual behaviors during the first month abroad. The study found no observable effects at any time point for alcohol-related consequences or for sexual violence victimization abroad. CONCLUSIONS: Though mostly nonsignificant, small initial intervention effects were promising in this first empirical test of an alcohol and sexual risk prevention program for study abroad students. However, students may need more intensive programming with booster sessions to experience lasting intervention effects during this particularly high-risk period. GOV IDENTIFIER: NCT03928067.

Alcohol Misuse Among Youth Living With and at High Risk for Acquiring HIV During the COVID-19 Stay-at-Home Orders: A Study in Los Angeles and New Orleans.

BACKGROUND: To slow the spread of the COVID-19 virus, governments across the globe instituted stay-at-home orders leading to increased stress and social isolation. Not surprisingly, alcohol sales increased during this period. While most studies primarily focused on alcohol consumption among college students or adults, this study investigates alcohol misuse among marginalized youth in the USA. We examined risk factors associated with hazardous alcohol use and binge drinking including risk behaviors, life stressors and demographic characteristics. METHODS: In October 2020, youth living with or at high risk for acquiring human immunodeficiency virus (HIV), participating in community-based research to improve HIV prevention and care, were invited to complete an online survey to assess the impact of the stay-at-home orders on multiple aspects of their daily life. RESULTS: Respondents (n = 478) were on average 23 years old; cisgender (84%), not-heterosexual (86.6%), Latino or Black/African American (73%) and assigned male at birth (83%); 52% reported being employed and 14% reported living with HIV. White participants and those who use drugs had higher odds of hazardous alcohol use and binge drinking, compared with other race categories and non-drug users, respectively. CONCLUSION: Contrary to findings from adult studies, we did not observe an increase in hazardous or binge drinking among youth at risk for HIV. Hazardous alcohol use and binge drinking was more likely among White participants, those who use drugs and those who were hazardous/binge drinkers prior to the COVID-19 lockdown, which points to the importance of identifying and treating youth who misuse alcohol early to prevent future alcohol misuse.

Cost-effectiveness and cost-utility analyses of a web-based computer-tailored intervention for prevention of binge drinking among Spanish adolescents.

BACKGROUND: Binge drinking (BD) among adolescents is a public health concern worldwide. This study assessed the cost-effectiveness and cost-utility of a web-based computer-tailored intervention to prevent BD in adolescence. METHODS: The sample was drawn from a study evaluating the Alerta Alcohol program. The population consisted of adolescents 15 to 19 years of age. Data were recorded at baseline (January to February 2016) and after 4 months (May to June 2017) and were used to estimate costs and health outcomes, as measured by the number of BD occasions and quality-adjusted life years (QALYs). Incremental cost-effectiveness and cost-utility ratios were calculated from National Health Service (NHS) and societal perspectives and for a time horizon of 4 months. A multivariate deterministic sensitivity analysis of best/worst scenarios by subgroups was used to account for uncertainty. RESULTS: The cost of reducing BD occasions by one per month was €16.63 from the NHS perspective, which from the societal perspective resulted in savings of €7986.37. From the societal perspective, the intervention resulted in an incremental cost of €71.05 per QALY gained from the NHS perspective and this was dominant, resulting in savings of €34,126.64 per QALY gained in comparison with the control group. Subgroup analyses showed that the intervention was dominant for girls from both the perspectives and for individuals 17 years or older from the NHS perspective. CONCLUSIONS: Computer-tailored feedback is a cost-effective way to reduce BD and increase QALYs among adolescents. However, long-term follow-up is needed to evaluate more fully changes in both BD and health-related quality of life.

Comparing self-affirmation manipulations to reduce alcohol consumption in university students.

Objective: Self-affirmation theory proposes that defensive processing prevents people from accepting health-risk messages, which may explain university students' dismissal of risk-information about binge drinking. SA-interventions may encourage non-biased processing of such information through impacting on interpersonal feelings and self-esteem. This study compared two self-affirmation manipulations on interpersonal feelings, self-esteem, message processing, message acceptance and subsequent alcohol consumption.Participants: UK university students (N = 454).Methods: Participants were randomly allocated to one of three conditions (Self-affirmation Implementation Intention, Kindness Questionnaire, Control) before reading health-risk information about binge drinking. This was followed by measures of interpersonal feelings, self-esteem, message processing, acceptance and behavioral intentions. Alcohol consumption was assessed one week later.Results: The self-affirmation manipulations had non-significant effects on all outcome variables.Conclusion: Consistent with previous research, the results indicate that self-affirmation interventions are not effective for reducing alcohol consumption in university students.

Effectiveness of text message interventions with different behavior change techniques on alcohol consumption among young adults: a five-arm randomized controlled trial.

AIMS: This studys aim is to test the effectiveness of five interventions each utilizing a unique set of behavior change techniques on reducing alcohol consumption at 3 and 6 months among young adults with hazardous drinking. DESIGN, SETTING AND PARTICIPANTS: This study used a five-arm parallel randomized controlled trial with 3- and 6-month follow-ups. Recruitment occurred at four emergency departments in Pittsburgh, PA, USA. Participants were non-treatment-seeking young adults (mean age = 22.1 years; 68.5% female; 37.1% black) who reported hazardous drinking. INTERVENTIONS: Participants were randomized to one of five automated text message interventions for 12 weeks that interacted with participants on the 2 days per week that they typically drank: assisted self-monitoring (TRACK: control condition; n = 245), pre-drinking cognition feedback (PLAN; n = 226), alcohol consumption feedback (USE; n = 235), adaptive goal support (GOAL; n = 214) and a combination of interventions (COMBO; n = 221). MEASUREMENTS: Primary outcome was number of past month binge drinking days at 3-month post-randomization calculated from a 30-day time-line follow-back. Primary intention-to-treat analysis compared PLAN, USE, GOAL and COMBO against TRACK (control condition). The four active conditions were not compared against each other. A secondary outcome, durability of effects, was measured at 6 months. FINDINGS: From baseline to 3-month follow-up (retention = 81.1%), compared with TRACK, in which past-month mean binge drinking days increased from 2.7 to 3.4, mean binge drinking days decreased in COMBO from 3.0 to 2.3 [adjusted ß = -0.52; 95% confidence interval (CI) = -0.77, -0.26], GOAL from 3.0 to 2.6 (adjusted ß = -0.34; 95% CI = -0.59, -0.10) and USE from 3.3 to 2.9 (adjusted ß = -0.38; 95% CI = -0.62, -0.14). At 6 months (retention = 73.8%), COMBO, GOAL, USE and PLAN had significantly lower mean binge drinking days compared with TRACK. CONCLUSION: Text message interventions incorporating feedback on either drinking plans and/or alcohol consumption and/or drinking limit goal support produced small yet durable reductions in binge drinking days in non-treatment-seeking young adults with hazardous drinking.

Efficacy of theory-based interventions aimed at reducing binge drinking in adolescents: A systematic review and meta-analysis of randomised controlled trials.

BACKGROUND AND AIMS: Binge drinking is a widespread practice among adolescents worldwide and is associated with various harmful consequences. Theory-based interventions are a promising approach to prevent this drinking behaviour in this population. The aim of the present review was to determine: (1) the characteristics of theory-based interventions targeting binge drinking in adolescents, (2) the impact of such interventions on binge drinking, and (3) the quality of theoretical implementation. METHODS: For this systematic review, randomised controlled trials were eligible for inclusion if the binge drinking-targeting intervention was based at least on one theoretical framework, and if the population's mean age was between 10 and 18 years. Two authors extracted relevant data. A meta-analysis was conducted to evaluate the effect of interventions on binge drinking. Effect sizes were calculated with the Hedges's g. Binge drinking was measured as a continuous or dichotomous outcome. The quality of theoretical implementation of interventions was measured using an existing "theory coding scheme". RESULTS: Sixteen studies were identified. Ten were based on a single theory, and six on a combination of theories. The number and type of behaviour change techniques used in each intervention varied greatly. Theory-based interventions led to a small but significant decrease in binge drinking (Hedges's g = 0.10; 95% confidence interval = 0.04, 0.16). The quality of theoretical implementation was globally low, and the reciprocal link between behaviour change techniques and theoretical constructs was unclear for most studies. CONCLUSIONS: Theory-based interventions have a small but significant beneficial impact on decreasing binge drinking in adolescents. Future research should try to be more effective in matching theoretical determinants of behaviour with the content of the intervention.

Changes in alcohol beliefs mediate the effects of a school-based prevention program on alcohol use among Brazilian adolescents.

OBJECTIVE: To investigate the mechanisms of the #Tamojunto2.0 program that mediated the prevention of lifetime alcohol and drug use, including drug knowledge, behavioral beliefs, attitudes, decision-making skills, and refusal skills. METHODS: A cluster-randomized controlled trial was conducted in 73 public middle schools in three Brazilian cities. The sample included 5208 students (49.4 % girls; Mage = 13.2 years). The intervention group attended twelve #Tamojunto2.0 lessons conducted by their previously trained teachers. The control group did not receive any intervention. Data were collected pre-intervention and at the 9-months follow-up. We performed multiple mediation models (for the whole sample, users, and non-users) with a post-estimation adjustment to standard errors to account for nesting. We analyzed all available mediators simultaneously according to each drug: alcohol, binge drinking, tobacco, marijuana, and inhalant lifetime use. To handle missing data, we used the "full-information maximum-likelihood" paradigm. RESULTS: Outcomes in the whole sample and among non-users showed that #Tamojunto2.0 indirectly prevented lifetime alcohol use and binge drinking by increasing negative and non-positive alcohol beliefs. Only the direct effect on decreasing lifetime alcohol consumption was statistically significant. However, an indirect increase in binge drinking was observed through knowledge about alcohol, but the direct effect was not statistically significant. No effects were reported for marijuana, tobacco, or inhalants. Among users, no statistically significant effects were found for alcohol or drug use. CONCLUSIONS: The results suggest that the #Tamojunto2.0 program was only effective in delaying alcohol consumption via increasing negative and non-positive alcohol beliefs. It seems that mediating mechanisms vary depending on contextual characteristics, differences in socializing among adolescents, features of the educational systems, psychosocial conditions, or, fidelity issues of program implementation.

Seguimiento domiciliario de mujeres con consumo problemático de sustancias durante el puerperio y los primeros años de crianza / Home follow-up of women with substance abuse during the puerperium and early years of parenting

El consumo problemático de sustancias es una problemática de abordaje complejo que afecta no sólo la salud individual, también tiene una repercusión a nivel poblacional, y el estigma social del consumo durante el embarazo y el puerperio hace que la aproximación a las pacientes que lo padecen sea aún más difícil. En este artículo la autora realiza una búsqueda bibliográfica acerca de los potenciales beneficios de las estrategias orientadas al seguimiento domiciliario de mujeres puérperas con consumo problemático y sus hijos/as a partir de una consulta en un centro periférico de salud. (AU)

Problematic substance use is a problem of complex approach that affects not only individual health, but also has repercussions at a population level, and the social stigma of substance abuse during pregnancy and puerperium makes the approach to patients who suffer from it even more difficult. In this article, the author conducts a literature search on the potential benefits of strategies aimed at home follow-up of postpartum women with problematic substance use and their children based on a consultation in a peripheral health center. (AU)

Effect of Selective Personality-Targeted Alcohol Use Prevention on 7-Year Alcohol-Related Outcomes Among High-risk Adolescents: A Secondary Analysis of a Cluster Randomized Clinical Trial.

Importance: Alcohol consumption is one of the leading preventable causes of burden of disease worldwide. Selective prevention of alcohol use can be effective in delaying the uptake and reducing harmful use of alcohol during the school years; however, little is known about the durability of these effects across the significant transition from early adolescence into late adolescence and early adulthood. Objective: To examine the sustained effects of a selective personality-targeted alcohol use prevention program on alcohol outcomes among adolescents who report high levels of 1 of 4 personality traits associated with substance use. Design, Setting, and Participants: A cluster randomized clinical trial was conducted to assess the effectiveness of the selective personality-targeted PreVenture program on reducing the growth of risky alcohol use and related harms from early to late adolescence and early adulthood. Participants included grade 8 students attending 14 secondary schools across New South Wales and Victoria, Australia, in 2012 who screened as having high levels of anxiety sensitivity, negative thinking, impulsivity, and/or sensation seeking. Schools were block randomized to either the PreVenture group (7 schools) or the control group (7 schools). The primary end point of the original trial was 2 years post baseline; the present study extends the follow-up period from July 1, 2017, to December 1, 2019, 7 years post baseline. Data were analyzed from July 22, 2021, to August 2, 2022. Interventions: The PreVenture program is a 2-session, personality-targeted intervention designed to upskill adolescents to better cope with their emotions and behaviors. Main Outcomes and Measures: Self-reported monthly binge drinking, alcohol-related harms, and hazardous alcohol use measured by the Alcohol Use Disorders Identification Test-Concise consumption screener. Results: Of 438 participants (249 male [56.8%]; mean [SD] age, 13.4 [0.5] years) from 14 schools, 377 (86.2%) provided follow-up data on at least 2 occasions, and among those eligible, 216 (54.0%) participated in the long-term follow-up. Compared with the control condition, the PreVenture intervention was associated with reduced odds of any alcohol-related harm (odds ratio [OR], 0.81 [95% CI, 0.70-0.94]) and a greater mean reduction in the frequency of alcohol-related harms (ß = -0.22 [95% CI, -0.44 to -0.003]) at the 7.0-year follow-up. There were no differences in the odds of monthly binge drinking (OR, 0.80 [95% CI, 0.56-1.13]) or hazardous alcohol use (OR, 0.87 [95% CI, 0.59-1.27]) at the 7.0-year follow-up. Exploratory analyses at the 5.5-year follow-up showed that compared with the control condition, the PreVenture intervention was also associated with reduced odds of monthly binge drinking (OR, 0.87, [95% CI, 0.77-0.99]) and hazardous alcohol use (OR, 0.91 [95% CI, 0.84-0.99]), but this was not sustained. Conclusions and Relevance: This study demonstrated that a brief selective personality-targeted alcohol use prevention intervention delivered in the middle school years can have sustained effects into early adulthood. Trial Registration: anzctr.org.au Identifier: ACTRN12612000026820.

Perceptions of and adherence to early COVID-19-related restrictions and associations with substance use among youth in Canada. / Perceptions et respect des premières restrictions liées à la COVID-19 et associations avec la consommation de substances chez les jeunes au Canada.

INTRODUCTION: As a largely social behaviour, substance use may have decreased for some youth overall in Canada during the COVID-19 pandemic; however, continued use may indicate nonadherence to pandemic-related restrictions and social distancing measures. In a sample of Canadian adolescents (aged 12-19 years), our objective was to examine how substance use (cannabis, binge drinking, cigarettes, vaping) is associated with perceptions of, and adherence to, early COVID-19-related public health measures, taking into consideration sociodemographic factors. METHODS: Cross-sectional data were retrieved from online data collected during Year 8 of the COMPASS school-based study, during the early months of the COVID-19 pandemic (May-July 2020) in British Columbia, Ontario and Quebec. We fitted two models using generalized estimating equations to examine how substance use was associated with separate measures of (1) perceptions of, and (2) adherence to early COVID-19 restrictions. RESULTS: In our sample, 10% of adolescents perceived COVID-19 restrictions as too weak and 14% perceived them as too strict. Nearly half (46%) reported taking restrictions very seriously, and 5% did not take them seriously at all. Binge drinking, cigarette use and vaping were associated with perceptions that restrictions were too strict and with nonadherence. However, adolescents who used cannabis were less likely to perceive COVID-19-related restrictions as too strict. CONCLUSION: This study highlights the association of adolescent substance use with perceptions of, and adherence to, COVID-19-related public health restrictions in Canada. Our findings emphasize a need for continual monitoring of substance use behaviours during the COVID-19 pandemic to better characterize adolescent risk and further inform targeted public health strategies accordingly.

Deeply Tailored Adaptive Interventions to Reduce College Student Drinking: a Real-World Application of Q-Learning for SMART Studies.

M-bridge was a sequential multiple assignment randomized trial (SMART) that aimed to develop a resource-efficient adaptive preventive intervention (API) to reduce binge drinking in first-year college students. The main results of M-bridge suggested no difference, on average, in binge drinking between students randomized to APIs versus assessment-only control, but certain elements of the API were beneficial for at-risk subgroups. This paper extends the main results of M-bridge through an exploratory analysis using Q-learning, a novel algorithm from the computer science literature. Specifically, we sought to further tailor the two aspects of the M-bridge APIs to an individual and test whether deep tailoring offers a benefit over assessment-only control. Q-learning is a method to estimate decision rules that assign optimal treatment (i.e., to minimize binge drinking) based on student characteristics. For the first aspect of the M-bridge API (when to offer), we identified the optimal tailoring characteristic post hoc from a set of 20 candidate variables. For the second (how to bridge), we used a known effect modifier from the trial. The results of our analysis are two rules that optimize (1) the timing of universal intervention for each student based on their motives for drinking and (2) the bridging strategy to indicated interventions (i.e., among those who continue to drink heavily mid-semester) based on mid-semester binge drinking frequency. We estimate that this newly tailored API, if offered to all first-year students, would reduce binge drinking by 1 occasion per 2.5 months (95% CI: decrease of 1.45 to 0.28 occasions, p < 0.01) on average. Our analyses demonstrate a real-world implementation of Q-learning for a substantive purpose, and, if replicable in future trials, our results have practical implications for college campuses aiming to reduce student binge drinking.

Change in Alcohol Consumption and Binge Drinking in University Students During the Early COVID-19 Pandemic.

Objectives: Young adults have been overly affected by the containment measures against COVID-19 and, consequently, worsening in mental health and change in health behavior have been reported. Because the life phase of emerging adulthood is crucial for developing health behaviors, this study aims to examine increase in alcohol consumption, single and multiple binge drinking, and associated factors in students during lockdown and post-lockdown periods. Methods: A prospective open cohort study design with nine survey time points between April 2020 and June 2021 was conducted. The present study uses pooled data from the first survey T0 (3 April to 14 April) and follow-ups at T1 (30 April to 11 May 2020) and T2 (28 May to 8 June 2020). Students from all faculties of the Zurich University of Applied Sciences (ZHAW) (N = 12'431) were invited. Of the 1,300 students who participated at baseline and in at least one follow-up, 1,278 (98.3%) completed the questionnaires, final net sample size was 947. Generalized Estimating Equations (GEE) models were used to investigate the factors associated with increases in alcohol consumption based on number of occasions/last 30 days; drinks/week, and binge drinking at T0, and respective changes at T1 and T2 (increases, decreases, no change). Results: Overall, 20% of Swiss university students reported an increased alcohol consumption and 26% engaged in binge drinking. Number of drinks at baseline was associated with a higher probability of increased alcohol consumption, as well as engaging in single and multiple binge drinking events. Higher anxiety scores were associated with a higher probability to increase the alcohol consumption and engaging at least once in binge drinking. Additional factors associated with any binge drinking were male gender, younger age and not living with parents. Higher perceived social support was only associated with engaging in heavy binge drinking. Conclusions: A substantial number of students developed a more risky health behavior regarding alcohol consumption. It is important to identify at risk students and design target prevention including factors such as age, gender and social norms. Further, health behavior and determinants of health behaviors of students should be carefully monitored during the further course of the pandemic.