Web-based alcohol screening and brief intervention for Māori and non-Māori: the New Zealand e-SBINZ trials

BACKGROUND: Hazardous alcohol consumption is a leading modifiable cause of mortality and morbidity among young people. Screening and brief intervention (SBI) is a key strategy to reduce alcohol-related harm in the community, and web-based approaches (e-SBI) have advantages over practitioner-delivered approaches, being cheaper, more acceptable, administrable remotely and infinitely scalable. An efficacy trial in a university population showed a 10-minute intervention could reduce drinking by 11% for 6 months or more among 17-24 year-old undergraduate hazardous drinkers. The e-SBINZ study is designed to examine the effectiveness of e-SBI across a range of universities and among Māori and non-Māori students in New Zealand. METHODS/DESIGN: The e-SBINZ study comprises two parallel, double blind, multi-site, individually randomised controlled trials. This paper outlines the background and design of the trial, which is recruiting 17-24 year-old students from seven of New Zealand's eight universities. Māori and non-Māori students are being sampled separately and are invited by e-mail to complete a web questionnaire including the AUDIT-C. Those who score >4 will be randomly allocated to no further contact until follow-up (control) or to assessment and personalised feedback (intervention) via computer. Follow-up assessment will occur 5 months later in second semester. Recruitment, consent, randomisation, intervention and follow-up are all online. Primary outcomes are (i) total alcohol consumption, (ii) frequency of drinking, (iii) amount consumed per typical drinking occasion, (iv) the proportions exceeding medical guidelines for acute and chronic harm, and (v) scores on an academic problems scale. DISCUSSION: The trial will provide information on the effectiveness of e-SBI in reducing hazardous alcohol consumption across diverse university student populations with separate effect estimates for Māori and non-Māori students. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12610000279022

Non-response bias in a web-based health behaviour survey of New Zealand tertiary students

Objective: There has been little investigation of non-response bias in web-based health surveys. We hypothesised that non-respondents have a higher prevalence of risk behaviours than respondents. Method: In 2005, random samples of students aged 17–25 years from 12 New Zealand tertiary institutions (n=7130) were invited to complete a web-based health behaviour survey, with three e-mail reminders. Early respondents (before 2nd reminder) were compared with late respondents (after 2nd reminder). Late respondents served as a proxy for non-respondents. Results: 2607 students (37%) responded early, 676 (9%) responded late, and 3847 (54%) did not respond. There were differences between early and late respondents in high school binge drinking (38% vs 47%, p=0.002) and non-compliance with physical activity guidelines (12% vs 18%, p=0.004). Differences in overweight/obesity (26% vs 31%, p=0.058), smoking (18% vs 22%, p=0.091) and non-compliance with dietary guidelines (76% vs 77%, p=0.651) were non-significant but point estimates were in the expected direction. Estimated bias in prevalence of risk behaviours was an absolute difference of 1–4% and a relative difference of 0–21%. Conclusion: Respondents whose participation was hardest to elicit reported more risk behaviour. Assuming non-respondents' behaviour is similar or more extreme than that of late respondents, prevalence will have been substantially underestimated

Drinking and alcohol-related harm among New Zealand university students: findings from a national web-based survey

Background: Alcohol-related harm is pervasive among college students in the United States of America and Canada, where a third to half of undergraduates binge drink at least fortnightly. There have been no national studies outside North America. We estimated the prevalence of binge drinking, related harms, and individual risk factors among undergraduates in New Zealand. Methods: A web survey was completed by 2,548 undergraduates (63% response) at 5 of New Zealand’s 8 universities. Drinking patterns and alcohol-related problems in the preceding 4 weeks were measured. Drinking diaries for the preceding 7 days were completed. Multivariate analyses were used to identify individual risk factors. Results: A total of 81% of both women and men drank in the previous 4 weeks, 37% reported 1 or more binge episodes in the last week, 14% of women and 15% of men reported 2+ binge episodes in the last week, and 68% scored in the hazardous range (4+) on the AUDIT consumption subscale. A mean of 1.8 (95% confidence interval 1.4, 2.3) distinct alcohol-related risk behaviors or harmful consequences were reported, e.g., 33% had a blackout, 6% had unprotected sex, and 5% said they were physically aggressive toward someone, in the preceding 4 weeks. Drink-driving or being the passenger of a drink-driver in the last 4 weeks was reported by 9% of women and 11% of men. Risk factors for frequent binge drinking included: lower age, earlier age of drinking onset, monthly or more frequent binge drinking in high school, and living in a residential hall or a shared house (relative to living with parents). These correlates were similar to those identified in U.S. and Canadian studies. Conclusions: Strategies are needed to reduce the availability and promotion of alcohol on and around university campuses in New Zealand. Given the high prevalence of binge drinking in high school and its strong association with later binge drinking, strategies aimed at youth drinking are also a priority. In universities, high-risk drinkers should be identified and offered intervention early in their undergraduate careers