Abstract
The misuse of alcohol is one of New Zealand's major social and health concerns. The cost of alcohol misuse, after adjustment for the economic benefits of consumption, was estimated at $16.1 billion in 1990,4% of gross domestic product. Young people (aged 15-24 years) account for a disproportionate amount of this burden, suffering high rates of alcohol-involved road traffic injuries, drownings, falls, assaults, and suicide.
In recent time, the access of young people to alcohol in New Zealand has greatly increased, with liberalisation of the Sale of Liquor Act in 1989, removal of restrictions on the advertising of alcohol in the early 1990s, and a reduction in the minimum purchase age in 1999. Furthermore, the real price of alcohol is at its lowest in over 20 years. There is no sign in the current political climate of an impending shift to greater alcohol control. Consequently, there is a need for prevention approaches outside the legislative arena that are deliverable to many.
There is now compelling evidence that brief intervention (BI), consisting of assessment and feedback or advice given by a health professional, can reduce alcohol consumption and related harm. There is, however, little research on the application of BI to young people.
The aims of this research were to develop a BI that is acceptable to young people and to evaluate its efficacy in reducing hazardous drinking. Tertiary students, who comprise 31% of people in the 18-22 years age group, were the population. Research was conducted in 3 phases: (i) determination of the prevalence and risk factors for hazardous drinking, (ii) development of an intervention including assessments of its acceptability to the target population, and the feasibility of its implementation in a "real-world" setting, and (iii) a randomised controlled trial of the intervention.
The prevalence of hazardous drinking was found to be very high in a sample of 1,480 students, with 60% of males and 58% of females typically exceeding recommended upper limits. Alcohol-related problems were also common. For example, 37% of males and 33% of females reported alcohol-related memory loss. In a cohort of 967 students, hazardous drinking was found to be highly persistent over time.
Focus group studies conducted with students, suggested that practitioner-delivered brief intervention would be unacceptable to most hazardous drinkers. Many expressed concerns about being judged, and reservations about discussing their drinking with a health professional, unless the discussion was self-initiated. Focus groups suggested that a computerised approach to assessment and feedback might be more acceptable.
Electronic Screening and Brief Intervention (ESBI) was developed and was found to be appealing to students and implementable at the Student Health Service. ESBI consists of a series of web pages including a screening questionnaire, an assessment, and personalised, motivational feedback.
In a randomised, controlled trial, ESBI was found to produce significant reductions in hazardous drinking at 6 weeks and 6 months. The mean effect size of 0.37, falls within the range of estimates in meta-analytic reviews of practitioner-delivered BI. Given its efficacy, its acceptability, and the ease with which ESBI can be implemented, this approach has the potential to become a useful tool in the prevention of alcohol-related harm among young people.