Intervention reduces alcohol use for high-risk youths with chronic medical conditions

Key takeaways:

• A brief intervention reduced the frequency of alcohol use by 40% among high-risk teens with chronic medical conditions.
• The intervention is based on theories of health behavior change, researchers said.

A brief, disease-tailored intervention reduced alcohol use among vulnerable adolescents with chronic medical conditions, according to a study published in JAMA Network Open.

According to Elissa R. Weitzman, ScD, MSc, a professor of pediatrics at Harvard Medical School, and colleagues, youths with chronic medical conditions who use alcohol “face unique and potentially grave risks for medical complications and disease exacerbations.”

“Compared with youths with a chronic medical condition who do not use alcohol, those who do report nearly twice the odds of regular treatment nonadherence,” they wrote. “Yet there are few preventive interventions targeting this group’s alcohol use, despite their unique health concerns.”

According to U.S. Preventive Services Task Force, there is insufficient evidence on screening for unhealthy alcohol use among adolescents aged 12 to 17 years in primary care settings.

Weitzman and colleagues conducted a secondary analysis of a parallel randomized controlled trial in which 451 adolescents aged 14 to 18 years with a chronic medical condition — like type 1 diabetes or irritable bowel syndrome — and at high, low or no risk for alcohol use were assigned to a treatment-as-usual group or a disease-tailored, brief intervention, titled “Take Good Care (TGC).”

The intervention, conducted in clinic waiting rooms, was composed of 28 to 32 slides on alcohol-related topics “that had been identified in formative research as important to youths with a chronic medical condition and motivating for health-protecting decisions and behaviors,” the researchers wrote. “Biomedical content within the TGC intervention was tailored to each disease area and addressed the specific effects of alcohol use on disease processes, treatment safety, and efficacy.”

The current analysis’ primary outcome was self-reported frequency of alcohol use during the past 3 months and at baseline, 6 months and 12 months. The researchers also assessed two secondary outcomes: changes in the teens’ alcohol risk intolerance — meaning, their perception of how risky it was to consume certain quantities of alcohol — and their alcohol health risk knowledge.

Weitzman and colleagues found that from baseline to the 12-month follow-up, the mean frequency of alcohol use during the past 3 months among high-risk participants decreased in the intervention group from 6.3 to 4.9 days, or by 40%, and increased in the treatment-as-usual group from 5.5 to 9 days (adjusted relative rate ratio = 0.6; 95% CI, 0.38-0.94).

They added that there were no group differences among adolescents reporting no or low-risk alcohol use, as well as no group differences in changes in alcohol risk intolerance regardless of high, low or no-risk alcohol use at baseline.

However, mean alcohol health risk knowledge increased from 68.1% to 77.5% in the intervention group and from 65.2% to 82.2% in the treatment-as usual group.

According to the researchers, the intervention was effective because it was based on “theories of health behavior change.”

“These theories posit effects where interventions increase attention to a behavior, knowledge about its health effects, perceptions regarding the severity of harms that could result, perceived susceptibility to harms, and perceived benefits of avoiding the behavior,” they wrote. “The TGC design features build from these theories and emphasize personalization to a youth’s specific chronic illness, with relatable and engaging visual, narrative, and medical content to convey the social-emotional meaning of alcohol use.”

Weitzman and colleagues concluded that it will be crucial to identify and sustain TGC implementation, “for example, by testing acceptability and effects of delivery through a patient portal for home viewing.”