A pragmatic randomised trial of two counselling models at the Swedish national alcohol helpline.

BACKGROUND: Alcohol telephone helplines targeting alcohol consumers in the general population can extend the reach of brief interventions while preserving in-person counselling. So far, studies of client outcomes in the setting of alcohol helplines are scarce. This study aims to compare the 6-months alcohol-related outcomes of two counselling models delivered at the Swedish National Alcohol Helpline. METHODS: A pragmatic randomised trial was set up at the Swedish National Alcohol Helpline. First-time callers with current hazardous or harmful alcohol use who contacted the helpline, from May 2015 to December 2017, were invited to participate. Clients were allocated with 1:1 ratio to two groups: (1) brief, structured intervention (n = 128), including self-help material and one counsellor-initiated call, and (2) usual care (n = 133), i.e. multiple-session counselling using Motivational Interviewing (MI). The primary outcome was a downward change in AUDIT risk-zone between baseline and 6-months follow-up. The analysis followed an intention-to-treat approach. RESULTS: Recruitment ended in December 2017. At 6-months follow-up, 70% of the enrolled participants had data on the outcome. In the brief, structured intervention (n = 107) 68% changed to a lower risk-level, compared to 61% in the usual care group (n = 117), yielding a risk ratio (RR) of 1.12 (95% CI 0.93 to 1.37) and risk difference of 0.08 (95% CI -0.05 to 0.20). The total AUDIT score and the scores from the AUDIT consumption questions (AUDIT-C) did not reveal any between-group differences in the mean change at follow-up. CONCLUSIONS: The counselling at the Swedish National Alcohol Helpline was followed by a significant decrease in alcohol use among clients, without clear superiority for either counselling model. TRIAL REGISTRATION: This trial was retrospectively registered with ISRCNT.com (ID: ISRCTN13160878 ) 18/01/2016.

Health behaviours as a predictor of quitting hazardous alcohol use in the Stockholm Public Health Cohort.

Background: Adopting healthy behaviours may facilitate the transition from hazardous to non-hazardous use of alcohol, yet, longitudinal studies of health behaviours in relation to the cessation of hazardous alcohol use are rare. We addressed this question using data from a large population-based cohort of adults in Sweden (Stockholm Public Health Cohort). Methods: Participants from two sub-cohorts (inception in 2002 and 2010), with follow-up until the year 2014 were included. Health behaviours (tobacco use, diet and physical activity) and alcohol use were self-reported in questionnaire-based surveys. Hazardous alcohol use was defined as either usual weekly consumption (2002 sub-cohort) or heavy occasional alcohol consumption (2010 sub-cohort). Baseline hazardous drinkers with complete data constituted the analytical sample (n = 8946). Logistic regression was used to calculate the Odds Ratios and their 95% confidence intervals of quitting hazardous alcohol use, with tobacco use, diet and physical activity as predictors of change. Results: In the 2002 sub-cohort, 28% reported non-hazardous use sustained through two consecutive follow-up points. In the 2010 sub-cohort, 36% of the participants reported non-hazardous use of alcohol at follow-up. Favourable health behaviours at baseline (e.g. no tobacco use, sufficient fruit intake and physical activity) were associated with a 19% to 75% higher of odds quitting hazardous alcohol use. Further, favourable changes in diet and tobacco cessation were associated with non-hazardous alcohol use at follow-up. Conclusions: As many as one-third of hazardous alcohol users may quit this drinking pattern in a medium-long term. Holding or achieving a healthy lifestyle may facilitate this transition.

The intake of selected foods by six-year-old Swedish children differs according to parental education and migration status.

AIM: Little is known about how parental migration status may be associated with children's diets. We examined whether the intake of selected foods by six-year-old children differed according to their parents' migration status, taking education level into account. METHODS: This study used pooled baseline data from two clustered randomised controlled trials of A Healthy School Start, conducted in municipalities of low-to-medium socio-economic status in Stockholm County, Sweden. The children's intake of selected healthy and unhealthy foods was reported by parents using the Eating and Physical Activity Questionnaire, and the children's height and weight were measured. Parental education and country of birth were self-reported. RESULTS: Data were available for 520 children. Low parental education was associated with significantly higher intakes of fruit, higher intakes of several unhealthy foods and lower intakes of vegetables. Children of parents born outside the Nordic region had higher intakes of all unhealthy foods as well as fruit and vegetables, even when adjusted for education. A negative association between high education and overweight was only seen in children of Nordic-born parents. CONCLUSION: Parental migration status was a strong predictor of the intake of selected foods and was a stronger predictor than parental education.

Randomised controlled study of two counselling models at the Swedish alcohol helpline: Effectiveness and sustainability outcomes at 12-month follow-up.

Aim: This two-arm parallel randomised controlled trial explored the effectiveness of a brief counselling model compared with the usual multi-session counselling at an alcohol telephone helpline. Methods: A total of 320 callers who contacted the Swedish Alcohol Helpline (SAH) because of hazardous or harmful alcohol use were randomised to either brief structured intervention (self-help booklet plus one proactive call) or usual care (multi-session telephone counselling). The primary outcome was a downward shift in risk level at 12-month follow-up compared with baseline, based on self-reports. Sustained risk level reduction throughout the whole follow-up was also assessed as secondary outcome. Results: Both interventions were significantly associated with a shift to a lower level of risky alcohol use (75% among participants in the brief structured intervention, and 70% in the usual care group) after 12 months. There was no difference between the two interventions in the proportions changing alcohol use or sustaining risk level reduction. Conclusion: In the context of telephone helplines, minimal and extended interventions appear to be equally effective in promoting long-term change in alcohol use.

Comparing counselling models for the hazardous use of alcohol at the Swedish National Alcohol Helpline: study protocol for a randomised controlled trial.

BACKGROUND: Hazardous and harmful consumption of alcohol is a leading cause of preventable disease and premature deaths. Modifying the amount and pattern of risky alcohol consumption conveys substantial benefits to individuals and to society at large. Telephone helplines provide a feasible alternative to face-to-face counselling in order to increase the reach of brief interventions aiming at modifying the hazardous and harmful use of alcohol. However, there is a lack of studies on the implementation and evaluation of population-based telephone services for the prevention and treatment of alcohol misuse. METHODS/DESIGN: A randomised controlled trial was designed to compare a brief, structured intervention to usual care within the Swedish National Alcohol Helpline (SAH), concerning their effectiveness on decreasing the hazardous use of alcohol. Between May 2015 and December 2017, about 300 callers are to be individually randomised with a 1:1 ratio to a brief, structured intervention (n = 150) or to usual care (n = 150). The brief, structured intervention consists of the delivery of a self-help booklet followed by one proactive call from SAH counsellors to monitor and give feedback about the client's progression. Callers assigned to usual care receive telephone counselling according to existing practice, i.e., motivational interviewing in a tailored and client-driven combination of proactive and reactive calls. The primary outcome is defined as a change from a higher to a lower AUDIT risk-level category between baseline and follow-up. General linear modeling will be used to calculate risk ratios of the outcome events. The primary analysis will follow an intention-to-treat (ITT) approach. DISCUSSION: The trial is designed to evaluate the effectiveness in decreasing the hazardous and harmful consumption of alcohol of a brief, structured intervention compared to usual care when delivered at the SAH. The results of the study will be used locally to improve the effectiveness of the service provided at the SAH. Additionally, they will expand the evidence base about optimal counselling models in population-based telephone services for alcohol misuse prevention and treatment. TRIAL REGISTRATION: ISRCNT.com, ID: ISRCTN13160878 . Retrospectively registered on 18 January 2016.