Instant messaging-based intervention reduces alcohol use among at-risk college students
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Key takeaways:
- Weekly alcohol consumption was 11 g lower among students exposed to the intervention.
- Consumption was even lower for those who interacted with a nurse through instant-messaging support.
An alcohol brief intervention, along with mobile-based instant messaging, reduced alcohol use and intention to drink among college students, according to a study published in JAMA Internal Medicine.
“University students consistently consume more alcohol than their non-university peers, highlighting the importance of prioritizing this group for targeted interventions,” Siu Long Chau, BNurs, a PhD candidate at the University of Hong Kong in China, and colleagues wrote. “By leveraging our prior experience in a chat-based instant messaging intervention for smoking cessation, we developed a similar intervention model for alcohol reduction.”
In the study, 772 Hong Kong students (mean age, 21 years; 51.2% women) at risk for alcohol use disorder were randomly assigned 1:1 to either an intervention group or control group, both of which received an alcohol brief intervention (ABI).
The ABI was composed of face-to-face or video conferencing with research nurses who gave personalized feedback based on the participant’s Alcohol Use Disorders Identification Test (AUDIT) risk level and a 12-page booklet that described the benefits of alcohol reduction and the harmful effects of alcohol on health and social well-being.
The intervention group also received 3 months of personalized, chat-based instant messaging, which was delivered by research nurses between 2:00 p.m. and 7:00 p.m. every Friday and on the weekends.
“The instant messages were guided by the Behavioral Change Technique taxonomy, which covers the generic information about the harms of drinking, strategies to refuse drinking invitations, and psychosocial supports,” the researchers wrote.
At the 6-month follow-up, the intervention group had:
- lower alcohol consumption in grams per week (beta = 11.42 g; 95% CI, 19.22 to 3.62)
- a lower AUDIT score (beta = 1.19; 95% CI, 1.63 to 0.34);
- reduced alcohol unit consumption per week (beta = 1.14; 95% CI, 1.92 to 0.36); and
- a lower intention to drink (OR = 0.66; 95% CI, 0.47 to 0.92) vs. the control group.
After Chau and colleagues adjusted for baseline characteristics, they found that at 6 months, intervention participants who had at least one interaction with a research nurse on the instant-messaging app had:
- lower alcohol consumption in grams per week (adjusted beta = 17.87 g; 95% CI, 32.55 to 3.2);
- lower alcohol unit consumption per week (adjusted beta = 1.79; 95% CI, 3.25 to 0.32); and
- a lower AUDIT score (adjusted beta = 0.53; 95% CI, 1.87 to 0.44) vs. intervention participants with no interactions.
The researchers noted that the clinical effects of instant messaging after an ABI “may be greater as university students rarely seek alcohol prevention and treatment services.”
“Chat-based instant messaging support might be a crucial component of the combined intervention model and could enhance the effectiveness of existing alcohol prevention and treatment services, particularly for young drinkers,” they wrote.
There were several study limitations, according to the researchers. For example, the mechanisms behind the intervention’s impact on drinking outcomes are unknown. In addition, instant messaging that is available only during office hours may limit the intervention’s effectiveness.
“Additional studies are warranted to evaluate the effectiveness of chat-based instant messaging support for alcohol reduction in drinkers with different sociodemographic characteristics,” Chau and colleagues concluded.
Perspective
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Tony Thrasher, DO, MBA, CPE, DFAPA
Given the role that alcohol use disorders play in our society's morbidity and mortality rates, this study's findings were very welcome. In particular, this project examined the role of adding technological assistance to an ABI to lower the rates of alcohol consumption and increase functionality. It was well noted that the control group was set up to have SMS messages that were focused on general health topics while the intervention group received more interactive, chat-based IM content that was moderated by a nursing professional. This control group is well chosen as there is technological based commentary being released to all patients. However, the intervention group findings noted significant self-reported reduction in the amount of drinking and AUDIT scores.
As impressive and optimistic as these findings were, I also found their transparent commentary on limitations to be refreshing and encouraging. Notably, it will be interesting to see if these results can be replicated in a Western Hemisphere university setting. This is recommended as the culture surrounding alcohol consumption/binge drinking may be even more encouraged/normalized in that milieu. Additionally, further investigations along these ends may benefit from examining an older generation with less technological investment as well as having these interventions expanded to after hours when individuals may be at higher risk of alcohol misuse.
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