A complex systems perspective on chronic aggression and self-injury: case study of a woman with mild intellectual disability and borderline personality disorder.

BACKGROUND: Challenging behaviors like aggression and self-injury are dangerous for clients and staff in residential care. These behaviors are not well understood and therefore often labeled as "complex". Yet it remains vague what this supposed complexity entails at the individual level. This case-study used a three-step mixed-methods analytical strategy, inspired by complex systems theory. First, we construed a holistic summary of relevant factors in her daily life. Second, we described her challenging behavioral trajectory by identifying stable phases. Third, instability and extraordinary events in her environment were evaluated as potential change-inducing mechanisms between different phases. CASE PRESENTATION: A woman, living at a residential facility, diagnosed with mild intellectual disability and borderline personality disorder, who shows a chronic pattern of aggressive and self-injurious incidents. She used ecological momentary assessments to self-rate challenging behaviors daily for 560 days. CONCLUSIONS: A qualitative summary of caretaker records revealed many internal and environmental factors relevant to her daily life. Her clinician narrowed these down to 11 staff hypothesized risk- and protective factors, such as reliving trauma, experiencing pain, receiving medical care or compliments. Coercive measures increased the chance of challenging behavior the day after and psychological therapy sessions decreased the chance of self-injury the day after. The majority of contemporaneous and lagged associations between these 11 factors and self-reported challenging behaviors were non-significant, indicating that challenging behaviors are not governed by mono-causal if-then relations, speaking to its complex nature. Despite this complexity there were patterns in the temporal ordering of incidents. Aggression and self-injury occurred on respectively 13% and 50% of the 560 days. On this timeline 11 distinct stable phases were identified that alternated between four unique states: high levels of aggression and self-injury, average aggression and self-injury, low aggression and self-injury, and low aggression with high self-injury. Eight out of ten transitions between phases were triggered by extraordinary events in her environment, or preceded by increased fluctuations in her self-ratings, or a combination of these two. Desirable patterns emerged more often and were less easily malleable, indicating that when she experiences bad times, keeping in mind that better times lie ahead is hopeful and realistic.

Evaluating the Effectiveness of Take it Personal!+ in People With Mild Intellectual Disability or Borderline Intellectual Functioning and Substance Use Disorder: A Multiple Baseline Single-Case Experimental Study.

Individuals with mild intellectual disabilities or borderline intellectual functioning are at increased risk to develop a substance use disorder-however, effective treatment programs adapted to this target group are scarce. This study evaluated the effectiveness of Take it Personal!+ in individuals with mild intellectual disabilities or borderline intellectual functioning and substance use disorder. Take it Personal!+ is a personalized treatment based on motivational interviewing and cognitive-behavioral therapy supported by an mHealth application. Data were collected in a nonconcurrent multiple baseline single-case experimental design across individuals with four phases (i.e., baseline, treatment, posttreatment, and follow-up). Twelve participants were randomly allocated to baseline lengths varying between 7 and 11 days. Substance use quantity was assessed during baseline, treatment, and posttreatment with a daily survey using a mobile application. Visual analysis was supported with statistical analysis of the daily surveys by calculating three effect size measures in 10 participants (two participants were excluded from this analysis due to a compliance rate below 50%). Secondary, substance use severity was assessed with standardized questionnaires at baseline, posttreatment, and follow-up and analyzed by calculating the Reliable Change Index. Based on visual analysis of the daily surveys, 10 out of 12 participants showed a decrease in mean substance use quantity from baseline to treatment and, if posttreatment data were available, to posttreatment. Statistical analysis showed an effect of Take it Personal!+ in terms of a decrease in daily substance use in 8 of 10 participants from baseline to treatment and if posttreatment data were available, also to posttreatment. In addition, data of the standardized questionnaires showed a decrease in substance use severity in 8 of 12 participants. These results support the effectiveness of Take it Personal!+ in decreasing substance use in individuals with mild intellectual disabilities or borderline intellectual functioning.

The feasibility of daily monitoring in adolescents and young adults with mild intellectual disability or borderline intellectual functioning.

BACKGROUND: It is unclear whether the limitations of young persons with a mild intellectual disability or borderline intellectual functioning preclude feasibility of the daily diary method. METHOD: For 60 consecutive days, 50 participants (Mage = 21.4, 56% male) who receive care in an ambulatory, residential, or juvenile detention setting, self-rated both standardised and personalised diary questions through an app. Diary entries were used for feedback in treatment. Interviews were used to explore acceptability. RESULTS: Average compliance was 70.4%, while 26% of participants dropped out. Compliance was good in ambulatory (88.9%) and residential care (75.6%), but not in the juvenile detention setting (19.4%). The content of self-selected diary items varied widely. Participants deemed the method acceptable. CONCLUSIONS: Daily monitoring is feasible for individuals with a mild intellectual disability or borderline intellectual functioning receiving ambulatory or residential care, and can provide scientists and practitioners with important insights into day-to-day behavioural patterns.

The mediating role of substance use motives in the relationship between personality dimensions and alcohol and drug use in adolescents and young adults with mild intellectual disabilities.

Adolescents and young adults with mild intellectual disabilities or borderline intellectual functioning (MID-BIF) are a high-risk group for developing substance use disorders. The aim of this study was to gain a better understanding of the mechanisms that underlie substance use in this particular population. We tested the mediating role of substance use motives in the relationship between personality dimensions and substance use-related outcomes. Self-reported data on substance use risk personality dimensions (i.e., sensation seeking, impulsivity, anxiety sensitivity, and negative thinking), substance use motives (i.e., social, enhancement, coping, and conformity motives), and substance use were obtained from 163 individuals with MID-BIF (mean age 18.9 years). Results show that coping motives played a main role in the associations between personality dimensions and substance use in adolescents and young adults with MID-BIF, with significant relationships between impulsivity and negative thinking and severity of alcohol use or drug use via coping motives. Moreover, findings indicated a relatively high risk for several substance use motives and associated substance use (disorder) in individuals high on impulsivity. Results show significant relationships between impulsivity and severity of alcohol use or drug use via social, enhancement, and coping motives. No mediating associations were found for conformity motives, nor did we find any mediation associations in individuals with high levels of anxiety sensitivity. These insights provide the possibility of tailoring interventions to specific motives that underlie substance use in different types of users with MID-BIF based on personality dimensions.

Exploring the role of emotional and behavioral problems in a personality-targeted prevention program for substance use in adolescents and young adults with intellectual disability.

BACKGROUND: Adolescents and young adults with a mild intellectual disability or borderline intellectual functioning (MID-BIF) are at risk for problematic substance use and are more likely to have emotional and behavioral problems than peers without MID-BIF. A personality-targeted prevention program called Take it Personal! effectively reduces substance use in adolescents and young adults with MID-BIF. AIMS: The program's effectiveness was examined on its secondary goal: reducing emotional and behavioral problems. The potentially moderating role of these problems on the program's effectiveness with substance use was also explored. METHODS AND PROCEDURES: Substance use and emotional and behavioral problems were compared between participants in Take it Personal! (n = 34) and those in the control condition (n = 32) in a quasi-experimental pre-posttest study with a three-month follow-up. Effectiveness and moderation were assessed with multilevel models. OUTCOMES AND RESULTS: Take it Personal! seems to reduce rule breaking. There were no significant effects on anxiety, withdrawal, and aggression. None of the problem domains moderated the program's effectiveness on substance use frequency. CONCLUSIONS AND IMPLICATIONS: Take it Personal! may effectively reduce rule breaking. Moreover, adolescent and young adults with different levels of emotional and behavioral problems benefit equally in terms of reduced substance use.

Take it personal! Development and modelling study of an indicated prevention programme for substance use in adolescents and young adults with mild intellectual disabilities and borderline intellectual functioning.

BACKGROUND: This paper describes the theory and development of Take it personal! an indicated prevention programme aimed at reducing substance use in individuals with mild intellectual disabilities and borderline intellectual functioning. METHOD: The process of the development of Take it personal! followed the steps of the Intervention Mapping protocol. Take it personal! is based on the theory that personality traits are an important construct to understand substance use (14-30 years old). A small modelling study was conducted with six adolescents to examine the feasibility, user-friendliness and potential effectiveness of the intervention. RESULTS: The results showed that the intervention has good feasibility and user-friendliness. Post-intervention evaluation of frequency, binge drinking and problematic use indicated that use was lower than at pre-intervention. CONCLUSIONS: Take it Personal! can be a promising preventive intervention designed to reduce substance use in individuals in this target group. A larger scale study is needed to draw further conclusions.

The effectiveness of an indicated prevention programme for substance use in individuals with mild intellectual disabilities and borderline intellectual functioning: results of a quasi-experimental study.

AIMS: To assess the effectiveness of Take it personal!, a prevention programme for individuals with mild intellectual disabilities and borderline intellectual functioning (MID-BIF) and substance use (SU). The prevention programme aims to reduce SU (alcohol, cannabis and illicit drugs) among experimental to problematic substance users. DESIGN: A quasi-experimental design with two arms and a 3-month follow-up. SETTING: Adolescents were recruited from 14 treatment centres in the Netherlands specialized in offering intra- and extramural care for people with MID-BIF and behavioural problems. PARTICIPANTS: Data were collected from 66 individuals with MID-BIF assigned either to the intervention condition (n = 34) or to the control condition (n = 32). INTERVENTIONS: Take it personal! was designed to target four personality traits: sensation-seeking, impulsive behaviour, anxiety sensitivity and negative thinking. For each of these profiles, interventions were developed that were structurally the same but contained different personality-specific materials, games and exercises. The control group received care as usual. MEASUREMENTS: Primary outcomes at 3-month follow-up were frequency of SU, severity of SU and binge drinking. RESULTS: Results showed intervention effects for SU frequency (F(1, 50.43)  = 9.27, P = 0.004) and binge drinking (F(1, 48.02)  = 8.63, P = 0.005), but not for severity of SU (F(1, 42.09)  = 2.20, P = 0.145). CONCLUSIONS: A prevention programme to reduce substance use among experimental to problematic users with mild intellectual disabilities and borderline intellectual functioning helped participants to decrease substance use frequency and binge drinking.

Individualized behavioral change of externalizing and internalizing problems and predicting factors in residential youth care.

The present study examined individualized behavioral change of externalizing and internalizing problems of adolescents in residential youth care, divided into different change groups (improvement, no change, or deterioration), by using the reliable change index. We also identified demographic and clinical factors that may predict individual behavioral change. A naturalistic dataset was used which consisted of adolescents referred to open or compulsory residential care who had outcome measures at the beginning and end of treatment. In total 742 reports of behavior problems were included: the sample consists of 265 adolescents with self-reports, 341 adolescents with group care worker reports, and 136 adolescents with parent reports. Only 42 adolescents had three sources of report, 202 adolescents had two sources of report, and 212 adolescents had one source of report. The majority of adolescents (50-73%) showed nonsignificant change in either externalizing or internalizing problems during their stay in residential care, regardless of informant. Higher problem severity at the beginning of treatment was a significant predictor of improvement in externalizing and internalizing problems throughout treatment, but the other factors (i.e., age, gender, ethnicity, and treatment duration) showed no effect. In conclusion, this study shows that with the current system of monitoring, more than half of the adolescents in residential care do not show significant change over time. This may indicate either that residential stay does not necessarily cause a significant change in problems for all adolescents, or that the system currently used for treatment monitoring is suboptimal in detecting such a change. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Post-traumatic stress disorder and substance use disorder in individuals with mild intellectual disability or borderline intellectual functioning: A review of treatment studies.

Individuals with mild intellectual disability or borderline intellectual functioning (MID-BIF; IQ 50-85) are at high risk for developing post-traumatic stress disorder (PTSD) and substance use disorders (SUD). In individuals without MID-BIF, Seeking Safety (SeSa) is found to be effective in treating PTSD and SUD simultaneously. However, little is known about integrated treatment of PTSD and SUD in individuals with MID-BIF. This review aims to provide an overview of studies about this type of triple psychopathology, as well as PTSD or SUD in individuals with MID-BIF (i.e. dual diagnosis). No studies were found on integrated treatment of PTSD and SUD in individuals with MID-BIF. Thirty-two studies were found on treatment of either PTSD (mostly Eye Movement Desensitization and Reprocessing and cognitive behavior therapy) or SUD (mostly cognitive behavior therapy and mindfulness) in individuals with MID-BIF. Only 9.4 % of these studies mentioned the co-morbidity of PTSD and SUD. Suggestions for adapting treatment to individuals with MID-BIF were provided on communication, structure, non-verbal elements, network, coping skills, therapeutic relationship and use of suitable and reliable instruments to measure treatment progress. More research is needed on the effectivity of EMDR or Imaginary Exposure (IE) combined with SUD treatment (CBT and mindfulness), and on the adaption of SeSa tot individuals with MID-BIF, as well as on this type of triple psychopathology in general.

Evaluating a personalized treatment for substance use disorder in people with mild intellectual disability or borderline intellectual functioning: A study protocol of a multiple baseline across individuals design.

BACKGROUND: The prevalence of substance use disorder (SUD) in people with Mild Intellectual Disabilities or Borderline Intellectual Functioning (MID-BIF) is high. However, an effective personalized treatment for people with MID-BIF and SUD is lacking. This paper describes the study protocol of the effectiveness study of Take it Personal!+, a personalized treatment for people with MID-BIF and SUD. METHODS: The effectiveness of Take it Personal!+ in decreasing substance use will be assessed in a non-concurrent multiple baseline across individuals design comprising ten participants with MID-BIF and SUD. The participants with MID-BIF and SUD will be randomly allocated to one of the five baseline lengths (7-11 days). Substance use, will be assessed during baseline, intervention, and post-treatment phase using a daily diary method. DISCUSSION: If this study shows that Take it Personal!+ is effective in decreasing substance use, the gap in treatment for people with MID-BIF and SUD will be filled. TRIAL REGISTRATION: The study is registered in the Netherlands Trial Register (Trial NL4935, registered July 2, 2019).

Substance use among individuals with mild intellectual disability or borderline intellectual functioning in residential care: Examining the relationship between drinking motives and substance use.

BACKGROUND: This study examined the relationship between substance use motives (i.e., social, conformity, coping and enhancement) and substance use in individuals with mild intellectual disability or borderline intellectual functioning (MID-BIF). METHOD: Data were collected among 163 clients with MID-BIF using interactive questionnaires with visual cues on a tablet with a web application. RESULTS: Results show that social motives were positively related to frequency of alcohol use, while conformity, coping and enhancement motives were positively related to severity of alcohol use. Results for drug use show that social motives were positively related to frequency of cannabis and hard drug use and that conformity motives were negatively related to frequency of cannabis use. Coping motives were positively related to severity of drug use. CONCLUSIONS: Insight in substance use motives should be used when adapting interventions, as it could contribute to the prevention and reduction of substance use disorders in individuals with MID-BIF.

Personality dimensions and substance use in individuals with mild to borderline intellectual disabilities.

AIMS: The aim of this study was to examine the role of the personality dimensions anxiety sensitivity, negative thinking, impulsivity and sensation seeking (as assessed by the revised version of the Substance Use Risk Profile Scale; SURPS) in substance use in individuals with mild to borderline intellectual disabilities (MBID). METHOD: We tested the relationship between level of ID and SURPS personality dimensions and the relationship between SURPS personality dimensions and severity of alcohol and drug use. Participants were 118 persons (mean age 20.5 years) with a mean IQ of 71.1 admitted to care facilities for persons with MBID and severe behavioral problems. RESULTS: We found no significant relationship between level of ID and the four personality dimensions. In addition, findings showed that individuals with lower levels of anxiety sensitivity, higher levels of negative thinking, impulsivity and sensation seeking showed more severe alcohol use. Individuals with higher levels of negative thinking and sensation seeking had more severe drug use. CONCLUSIONS AND IMPLICATIONS: The SURPS personality dimensions identify persons at increased risk for substance use disorders and might be useful in developing selective substance use interventions for individuals with MBID.

Evaluating a selective prevention program for substance use and comorbid behavioral problems in adolescents with mild to borderline intellectual disabilities: Study protocol of a randomized controlled trial.

BACKGROUND: Substance use and abuse is a growing problem among adolescents with mild to borderline intellectual disabilities (ID). Substance use patterns in general population are similar to patterns among non-disabled peers, but substance use has more negative consequences for adolescents with mild to borderline ID, and they are at an increased risk for developing a substance use disorder. Nevertheless, effective and evidence based prevention programs for this groups are lacking. The study described in this protocol tested the effectiveness of a selective intervention aimed at reducing substance use in adolescents with mild to borderline ID and behavioral problems. In the intervention, participants acquire competences to deal with their high-risk personality traits. METHODS: A randomized controlled trial will be conducted among 14-21-year old adolescents with mild to borderline ID and behavioral problems admitted to treatment facilities in the Netherlands. Inclusion criteria are previous substance use and personality risk for substance use. Participants will be individually randomized to the intervention (n = 70) or control (n = 70) groups. The intervention group will be exposed to six individual sessions and five group sessions carried out by two qualified trainers over six-week period. Primary outcomes will be the percentage reduction in substance use (for alcohol: percentage decrease of binge drinking, weekly use and problematic use, for cannabis: the percentage decrease of lifetime cannabis use and weekly use and for hard drug: the percentage decrease of lifetime use). Secondary outcomes will be motives for substance use, intention to use, and internalizing and externalizing behavioral problems. All outcome measures will be assessed after two, six, and twelve months after the intervention. DISCUSSION: This study protocol describes the design of an effectiveness study of a selective prevention program for substance use in adolescents with mild to borderline ID and behavioral problems. We expect a significant reduction in alcohol, cannabis and hard drug use among adolescents in the intervention group compared with the control group. TRIAL REGISTRATION: This trial is registered in the Dutch Trial Register (Cochrane Collaboration) as NTR5037 registered at 15 April 2015.

The development of a web-based brief alcohol intervention in reducing heavy drinking among college students: an Intervention Mapping approach.

In the Netherlands, young adults' drinking practices have become an issue of public concern since their drinking levels are high. Heavy drinking can place young adults at an increased risk for developing short- and long-term health-related problems. Current national alcohol prevention programmes focus mainly on adolescents and their parents and paying less systematic attention to young adults. The present study describes the theory and evidence-based development of a web-based brief alcohol intervention entitled What Do You Drink (WDYD). We applied the Intervention Mapping (IM) protocol to combine theory and evidence in the development and implementation of WDYD. The WDYD intervention aims to detect and reduce heavy drinking of young adults who are willing to decrease their alcohol consumption, preferably below the Dutch guidelines of low-risk drinking. According to the IM protocol, the development of WDYD resulted in a structured intervention. Reducing heavy drinking to low-risk drinking was proposed as the behavioural outcome. Motivational interviewing principles and parts of the I-Change Model were used as methods in the development of WDYD, whereas computer tailoring was selected as main strategy. An effect and a process evaluation of the intervention will be conducted. IM was found to be a practical instrument for developing the WDYD intervention tailored to a specific target population in the area of alcohol prevention.

Using ecological momentary assessment in testing the effectiveness of an alcohol intervention: a two-arm parallel group randomized controlled trial.

BACKGROUND: Alcohol consumption of college students has a fluctuating nature, which might impact the measurement of intervention effects. By using 25 follow-up time-points, this study tested whether intervention effects are robust or might vary over time. METHODS: Data were used from a two-arm parallel group randomized controlled trial applying ecological momentary assessment (EMA) with 30 data time-points in total. Students between 18 and 24 years old who reported heavy drinking in the past six months and who were ready to change their alcohol consumption were randomly assigned to the experimental (n = 456: web-based brief alcohol intervention) and control condition (n = 451: no intervention). Outcome measures were weekly alcohol consumption, frequency of binge drinking, and heavy drinking status. RESULTS: According to the intention-to-treat principle, regression analyses revealed that intervention effects on alcohol consumption varied when exploring multiple follow-up time-points. Intervention effects were found for a) weekly alcohol consumption at 1, 2, 3, 4, and 7 weeks follow-up, b) frequency of binge drinking at 1, 2, 7, and 12 weeks follow-up, and c) heavy drinking status at 1, 2, 7, and 16 weeks follow-up. CONCLUSIONS: This research showed that the commonly used one and six month follow-up time-points are relatively arbitrary and not using EMA might bring forth erroneous conclusions on the effectiveness of interventions. Therefore, future trials in alcohol prevention research and beyond are encouraged to apply EMA when assessing outcome measures and intervention effectiveness. TRIAL REGISTRATION: Netherlands Trial Register NTR2665.

The effectiveness of a web-based brief alcohol intervention in reducing heavy drinking among adolescents aged 15-20 years with a low educational background: a two-arm parallel group cluster randomized controlled trial.

BACKGROUND: To evaluate the slightly modified version of the web-based brief alcohol intervention "What Do You Drink" (WDYD) among heavy drinking adolescents and young adults aged 15-20 years with a low educational background at one and six months follow-up. METHODS: A two-arm parallel group cluster randomized controlled trial was conducted online in the Netherlands in 2011-2012. Participants included in the trial were recruited from preparatory and secondary vocational education institutions and had to be between 15 and 20 years of age and report heavy drinking in the past six months. In total, 73 classes representing 609 (59.9% male) participants were allocated to the experimental condition (37 classes, 318 participants: WDYD intervention) or control condition (36 classes, 291 participants: no intervention). Outcomes were heavy drinking, weekly alcohol consumption, and frequency of binge drinking. RESULTS: Regressions analyses revealed no significant main intervention effects on any of the alcohol outcomes at one and six month's follow-up according to the intention-to-treat principle. Additionally, there were no moderating effects of gender, age, educational level, and readiness to change on the relation between the WDYD intervention and the alcohol outcomes at follow-up. CONCLUSIONS: The WDYD intervention was not effective in reducing alcohol consumption among heavy drinking adolescents and young adults aged 15-20 years with a low educational background at one and six months follow-up. However, the absence of intervention effectiveness cannot be used as an argument for not conducting these types of interventions with low educated individuals, since our study was the first to target this population. TRIAL REGISTRATION: Netherlands Trial Register NTR2971.

The effectiveness of the 'what do you drink' web-based brief alcohol intervention in reducing heavy drinking among students: a two-arm parallel group randomized controlled trial.

AIMS: To evaluate the effectiveness of a web-based brief alcohol intervention 'What Do You Drink' (WDYD) among heavy drinking students at 1- and 6-month post-intervention. Additionally, it was investigated whether certain subgroups would benefit more than others from the WDYD intervention. METHODS: A two-arm parallel group randomized controlled trial was conducted online in the Netherlands in 2010-2011. Inclusion criteria were: (1) being between 18- and 24-year old, (2) reporting heavy drinking in the past 6 months, (3) being motivated to change alcohol consumption, (4) having access to the Internet and (5) giving informed consent. Participants (n = 913) were randomized to the experimental (WDYD intervention) or control condition (no intervention). Measures were heavy drinking, frequency of binge drinking and weekly alcohol consumption. RESULTS: Analyses according to the intention-to-treat principle revealed no significant main intervention effects in reducing the alcohol measures at the follow-up assessments. Secondary analyses revealed that gender, freshmen and fraternity or sorority membership did not moderate the effect of the WDYD intervention at both follow-ups. Readiness to change, problem drinking and carnival participation moderated intervention effects such that contemplators, those with severe symptoms of alcohol abuse or dependence, and those who participated in carnival benefited more than others from the WDYD intervention regarding weekly alcohol consumption at 1-month follow-up. CONCLUSIONS: The WDYD intervention was not effective in reducing the alcohol measures among heavy drinking students at 1- and 6-month post-intervention. However, there is preliminary evidence that the WDYD intervention is effective in lowering drinking levels for subgroups of heavy drinking students in the short term.

High youth access to movies that contain smoking in Europe compared with the USA.

BACKGROUND: Based on evidence that exposure to smoking in movies is associated with adolescent smoking, the WHO has called on countries to assign a rating that restricts youth access to such movies. OBJECTIVE: To evaluate youth access to movies that portray smoking in European countries and compare with that in the USA. METHODS: The authors identified the most commercially successful movies screened in six European countries (Germany, Iceland, Italy, the Netherlands, Poland and UK) and the USA between 2004 and 2009. The authors coded the 464 movies that were screened in both Europe and the USA according to whether or not they portrayed smoking. RESULTS: 87% of the movies were 'youth' rated in Europe (ratings board classification as suitable for those younger than 16 years) compared to only 67% in the USA (suitable for those younger than 17 years). Smoking was portrayed in 319 (69%) movies. 85% of the movies that portrayed smoking were 'youth' rated in Europe compared with only 59% in the USA (p<0.001). CONCLUSIONS: Tobacco imagery is still common in popular films shown in European countries and the USA. None of the seven countries examined followed the WHO recommendations on restricting youth access to movies that portray smoking. Compared to the USA, European youths have access to substantially more movies in general, and this gives them access to more movies that portray smoking in particular.

The effectiveness of a web-based brief alcohol intervention in reducing heavy drinking among adolescents aged 15 to 20 years with a low educational background: study protocol for a randomized controlled trial.

BACKGROUND: The serious negative health consequences of heavy drinking among adolescents is cause for concern, especially among adolescents aged 15 to 20 years with a low educational background. In the Netherlands, there is a lack of alcohol prevention programs directed to the drinking patterns of this specific target group. The study described in this protocol will test the effectiveness of a web-based brief alcohol intervention that aims to reduce alcohol use among heavy drinking adolescents aged 15 to 20 years with a low educational background. METHODS/DESIGN: The effectiveness of the What Do You Drink (WDYD) web-based brief alcohol intervention will be tested among 750 low-educated, heavy drinking adolescents. It will use a two-arm parallel group cluster randomized controlled trial. Classes of adolescents from educational institutions will be randomly assigned to either the experimental (n = 375: web-based brief alcohol intervention) or control condition (n = 375: no intervention). Primary outcomes measures will be: 1) the percentage of participants who drink within the normative limits of the Dutch National Health Council for low-risk drinking, 2) reductions in mean weekly alcohol consumption, and 3) frequency of binge drinking. The secondary outcome measures include the alcohol-related cognitions, attitudes, self-efficacy, and subjective norms, which will be measured at baseline and at one and six months after the intervention. DISCUSSION: This study protocol presents the study design of a two-arm parallel-group randomized controlled trial to evaluate the effectiveness of the WDYD web-based brief alcohol intervention. We hypothesized a reduction in mean weekly alcohol consumption and in the frequency of binge drinking in the experimental condition, resulting from the web-based brief alcohol intervention, compared to the control condition. TRIAL REGISTRATION: Netherlands Trial Register NTR2971.

Alcohol consumption in movies and adolescent binge drinking in 6 European countries.

OBJECTIVE: The goal of this study was to investigate whether the association between exposure to images of alcohol use in movies and binge drinking among adolescents is independent of cultural context. METHODS: A cross-sectional survey study in 6 European countries (Germany, Iceland, Italy, Netherlands, Poland, and Scotland) was conducted. A total of 16 551 pupils from 114 public schools with a mean (± SD) age of 13.4 (± 1.18) years participated. By using previously validated methods, exposure to alcohol use in movies was estimated from the 250 top-grossing movies of each country (years 2004-2009). Lifetime binge drinking was the main outcome measure. RESULTS: Overall, 27% of the sample had consumed >5 drinks on at least 1 occasion in their life. After controlling for age, gender, family affluence, school performance, television screen time, sensation seeking and rebelliousness, and frequency of drinking of peers, parents, and siblings, the adjusted ß-coefficient for lifetime binge drinking in the entire sample was 0.12 (95% confidence interval: 0.10-0.14; P < .001). The crude relationship between movie alcohol use exposure and lifetime binge drinking was significant in all countries; after covariate adjustment, the relationship was still significant in 5 of 6 countries. A sensitivity analysis revealed that the association is content specific, as there was no significant association between lifetime binge drinking and exposure to smoking in movies. CONCLUSIONS: The link between alcohol use in movies and adolescent binge drinking was robust and seems relatively unaffected by cultural contexts.