Adolescent perspectives about their participation in alcohol intervention research in emergency care: A qualitative exploration using ethical principles as an analytical framework

Aims: To explore adolescents’ experiences of consenting to, and participating in, alcohol intervention trials when attending for emergency care. Methods: In-depth semi-structured interviews with 27 adolescents (16 males; aged 14–17 years (Mage = 15.7)) who had taken part in one of two linked brief alcohol intervention trials based in 10 accident and emergency departments in England. Interviews were transcribed verbatim and subject to thematic analysis Results: Research and intervention methods were generally found to be acceptable though confidentiality was important and parental presence could hinder truthful disclosures regarding alcohol use. Participants discussed the importance of being involved in research that was relevant to them and recognised alcohol consumption as a normative part of adolescence, highlighting the importance of having access to appropriate health information. Beyond this, they recognised the benefits and risks of trial participation for themselves and others with the majority showing a degree of altruism in considering longer term implications for others as well as themselves. Conclusions: Alcohol screening and intervention in emergency care is both acceptable and relevant to adolescents but acceptability is reliant on confidentiality being assured and may be inhibited by parental presence

A comparison of the efficacy of brief interventions to reduce hazardous and harmful alcohol consumption between European and non-European countries:a systematic review and meta-analysis of randomised controlled trials

AIMS: The extent of variation attributable to regional differences for the efficacy of brief intervention (BI) to reduce hazardous and harmful alcohol consumption is unclear. The primary aim of this study was to determine overall efficacy of BI at 6 and 12 month follow-up in primary health care (PHC) and emergency department (ED) studies. The secondary aim was to examine whether variance in study outcome can be explained by the geographical region in which trials have taken place (European versus non-European). METHODS: A systematic review and meta-analysis of randomised controlled trials (RCTs) published before August 2014 was undertaken. Twenty RCTs conducted in PHC settings with a total of 8226 participants (European=4564/non-European=3662) and eight RCTs conducted in ED settings with a total of 4799 participants (European=2465/non-European=2334) were eligible. Primary outcome measure was reduction in grams of alcohol consumed per week for BI and control groups at 6 and 12 month follow-up. An inverse variance model was applied to measure the effect of treatment in mean differences for BI and control groups at 6 and 12 month follow-up. Variance between study outcomes was explored using sub-group analysis of European versus non-European countries. RESULTS: For PHC trials at 6 month follow-up, statistically significant benefits of BI were indicated (Mean Difference (MD)=-21.98 grams/week; 95% Confidence Interval (CI)=-37.40 to -6.57; p=0.005). At 12 month follow-up, statistically significant benefit of BI was evident (MD=-30.86 g/w; 95% CI=-46.49 to -15.23; p= 0.0001). For ED trials at 6 month follow-up, statistically significant benefits of BI were indicated (MD=-17.97 g/w; 95% CI=-29.69 to -6.24; p=0.003). At 12 month follow-up, statistically significant benefit in favour of BI was evident (MD=-18.21 g/w; 95% CI=-26.71 to -9.70; p<0.0001). No statistically significant differences were detected in subgroup analyses of outcomes for European versus non-European studies. CONCLUSIONS: Brief intervention (BI) to reduce alcohol consumption is associated with reducing grams of alcohol consumed per week amongst hazardous and harmful drinkers at 6 and 12 month follow-up in primary health care and emergency department trials. The geographical region in which trials are undertaken does not appear to explain variance in trial outcomes for reducing alcohol consumption

Variance in the Efficacy of Brief Interventions to Reduce Hazardous and Harmful Alcohol Consumption Between Injury and Noninjury Patients in Emergency Departments: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Study objective: We adopt a comparative framework to measure the extent to which variance in the efficacy of alcohol brief interventions to reduce hazardous and harmful drinking at less than or equal to 5-, 6-, and 12-month follow-up in emergency department settings can be determined by differences between study populations (targeted injury and noninjury specific). Methods: A systematic review and meta-analysis of randomized controlled trials published before September 2016 was undertaken. Twenty-three high-quality and methodologically similar randomized controlled trials were eligible, with a total number of 15,173 participants included. Primary outcome measure was efficacy of brief intervention compared with a control group in reducing quantity of alcohol consumed. An inverse variance model was applied to measure the effect of treatment in standard mean differences for brief intervention and control groups. Results: At 6-month follow-up, an effect in favor of brief intervention over control was identified for targeted injury studies (standardized mean difference=–0.10; 95% confidence interval [CI] –0.17 to –0.02; I2=0%). For pooled noninjury-specific studies, small benefits of brief intervention were evident at less than or equal to 5-month follow-up (standardized mean difference=–0.15; 95% CI –0.24 to –0.07; I2=0%), at 6-month follow–up (standardized mean difference=–0.08; 95% CI –0.14 to –0.01; I2=1%), and at 12-month follow-up (standardized mean difference=–0.08; 95% CI –0.15 to –0.01; I2=0%). Conclusion: Meta-analysis identified noninjury-specific studies as associated with better response to brief intervention than targeted injury studies. However, the inclusion of injured patients with noninjured ones in the experimental and control groups of noninjury-specific studies limited the interpretation of this finding