Assessing the Costs of Excessive Alcohol Consumption in Minnesota.

INTRODUCTION: Alcohol consumption, particularly excessive drinking, incurs a high societal cost. This study aimed to apply current state-specific data from 1 state, Minnesota, to established national methods for estimating the societal cost of excessive alcohol consumption for 2 purposes: first, to update the cost estimate for the state and, second, to understand the potential benefits of using state-specific data versus a national apportionment strategy for economic burden estimates. METHODS: In 2021, established methods were used to apply alcohol-attributable fractions for health care, lost productivity, crime, and other effects (e.g., motor vehicle crashes) to 2019 Minnesota data. The main outcome measure was the annual prevalence cost (incurred and paid each year) of excessive alcohol use in Minnesota from the societal perspective. Secondary outcome measures were the cost of specific outcomes (e.g., crime), different types of consumption (e.g., drinking during pregnancy), the cost to government payers, and the cost per drink. RESULTS: The societal cost of alcohol use in Minnesota in 2019 was nearly $8 billion dollars (2019 USD) or $1,383 per resident. This estimate is substantially higher than a previous estimate on the basis of apportionment of a national estimate. CONCLUSIONS: The cost of alcohol use in Minnesota is considerable. Geographically specific and current cost estimates can inform decision making about the public health impact of excessive alcohol use and the cost effectiveness of prevention strategies. Evidence-based prevention strategies to reduce alcohol use include increased alcohol taxes, enhanced enforcement of laws prohibiting sales to minors, and electronic screening and brief intervention.

The RealU online cessation intervention for college smokers: a randomized controlled trial.

OBJECTIVES: To determine the efficacy of providing online cessation intervention for college smokers. METHODS: This is a two-group randomized controlled trial. The intervention group received $10 weekly incentives to visit an online college life magazine that provided personalized smoking cessation messages and peer email support. Evaluation assessments occurred at baseline and 8, 20, and 30 weeks after enrollment. The primary outcome is self-reported 30-day abstinence at week 30. Carbon monoxide (CO) breath testing was performed for participants reporting 30-day abstinence at week 30. RESULTS: Five-hundred and seventeen college smokers at the University of Minnesota were enrolled via internet health screening (control=260, intervention=257) in the fall of 2004. Intervention participants completed an average of 18.9 (SD 2.5) of 20 weekly website visits over the course of the study. The rate of 30-day abstinence at week 30 was higher for the intervention compared to the control group (41% vs. 23%, p<0.001). CO testing showed low rates of under-reporting. There was no difference in self-reported 6-month prolonged abstinence measured at week 30. CONCLUSION: Providing personalized smoking cessation messages as part of a general interest online college life magazine increased 30-day abstinence by the end of this two semester intervention.

Feasibility of Internet health screening to recruit college students to an online smoking cessation intervention.

Internet-based cessation programs are promising. However, little information exists on how to recruit college smokers to participate in online interventions. Two studies assessed the feasibility of Internet health screening as a recruitment strategy for college smokers. The Internet Survey Study compared Internet (n = 735), mail (n = 1,490), and phone (n = 550) surveys as means to identify college smokers. The RealU Recruitment Study described the use of an Internet-based general health screening survey (N = 25,000) to recruit for an online cessation trial. The Internet Survey Study showed that, despite large differences in response rates (Internet = 38%, mail = 47%, phone = 90%; p<.001), the rates of past-month tobacco use were similar (Internet = 35%, mail = 38%, phone = 34%; p = .35). Among past-month users, a greater proportion reported daily use on the Internet (33%) and phone (37%) surveys versus the mail survey (23%, p = .007). In the RealU Recruitment Study, 517 college smokers were recruited in 1 week. The Internet survey response rate was 26%, the prevalence of current smoking was 29%, the eligibility rate was 87%, and the enrollment rate was 32% (517/1,618). Internet health screening can be used to quickly identify and enroll large numbers of college smokers in an online smoking cessation intervention.

Strategies for increasing adherence to an online smoking cessation intervention for college students.

High rates of Internet use among young adults make online intervention with this population particularly attractive. However, low adherence rates limit the exposure to and the potential effectiveness of these programs. This study identifies strategies for increasing adherence by examining the rates of participation for a 5-week beta (pilot) version and final version of the RealU Web site, an online intervention for college smokers. Three modifications from the beta to the RealU Web site were (a) changing format from a smoking cessation Web site to an online college life magazine, (b) providing proactive peer e-mail support, and (c) adopting a more linear site structure. Participants were recruited via Internet health screening and received US$10 for completing weekly study activities. Enrollment among eligible smokers was higher for the beta compared with the RealU intervention (47/69, 68.1% vs. 517/1618, 32.0%, p<.001), but participants did not differ in terms of age, gender, or past 30-day cigarette or alcohol use. Participation fell sharply during the beta test (53% in week 1 to 26% by week 5) compared with the RealU average of 95% (range 89% to 98%). Participation during each study's final week was much higher in the RealU (93% week 20) compared with the beta (26% week 5, p<.001). After 5 weeks, self-reported 30-day abstinence was higher for RealU intervention participants (16.0%) compared with the beta participants (4.3%, p=.03). The modifications from the beta to RealU Web site described above resulted in high rates of sustained participation over 20 weeks.