Disease-Tailored Preventive Intervention Reduces Alcohol Use in High-Risk Youths with Chronic Medical Conditions

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New data published in JAMA Network Open shows that a brief, self-administered, disease-tailored prevention intervention reduced alcohol use among vulnerable youths with chronic medical conditions (CMC).

In a secondary analysis of a randomized clinical trial that used data from adolescents aged 14 to 18 years with a CMC, findings showed that among those who reported high-risk alcohol use at baseline, the observed mean frequency of alcohol use from baseline to the 12-month follow-up decreased in the intervention group from 6.3 to 4.9 days, or by 40%, and increased in the treatment-as-usual group from 5.5 to 9 days (adjusted relative rate ratio 0.6, 95% CI 0.38-0.94).

Researchers also reported there were no group differences in changes in alcohol use frequency over time among participants who reported no or low-risk alcohol use.

The results suggest that a brief chronic illness-tailored preventive intervention “offers high potential for scale and merits future work to extend the intervention to address other chronic conditions and substances and to identify implementation pathways,” investigators wrote in the study published online July 10, 2024.

According to first author Elissa R. Weitzman, ScD, MSc, a professor of pediatrics at Harvard Medical School, and colleagues, 25% of youths in the US have a CMC and are particularly vulnerable to the negative effects of alcohol and other substances.

“As a group, youths with a CMC have similar rates of alcohol and other substance use as other youths in early adolescence, but they are more likely to progress to heavy and problem use by young adulthood,” Weitzman and coauthors wrote. “Like their peers, youths with a CMC who use alcohol have an increased risk of accidents, injury, school failure, and other problems, including poor mental health related to alcohol use; they also face unique and potentially grave risks for medical complications and disease exacerbations.”

Investigators added that compared to youths with a CMC who do not use alcohol, those who do have nearly twice the odds of regular treatment nonadherence. Despite these health concerns, “preventive interventions targeting these youths are scarce and lack evidence about longer-term risk-stratified effects,” Weitzman et al stated.

To fill this gap in research, investigators conducted the prespecified secondary analysis of a parallel randomized controlled trial in which 451 adolescents (mean age, 16 years; 50.8% women) with a CMC—such as type 1 diabetes, juvenile idiopathic arthritis, or inflammatory bowel disease—and at high, low, or no risk for alcohol use were assigned to a treatment-as-usual (TAU) group or a preventive intervention, titled “Take Good Care (TGC),” between May 11, 2017, and November 20, 2018.

For the purpose of the study, high-risk alcohol use was defined as heavy episodic alcohol use in the past 3 months and alcohol-related blackouts, injuries, vomiting, or emergency department visits in the previous 12 months.

The TGC intervention, conducted in clinic waiting rooms, included a deck of 28 to 32 slides on alcohol-related topics “identified in formative research as important to youths with a CMC and motivating for health-protecting decisions and behaviors,” researchers wrote. “Biomedical content within the TGC intervention was tailored to each disease area and addressed the specific effects of alcohol use on disease processes, treatment safety, and efficacy.”

For the current study, the primary outcome was self-reported frequency of alcohol use over the past 3 months, measured via a single validated question. In addition, investigators assessed 2 secondary outcomes: alcohol health risk knowledge and alcohol-risk intolerance.

Among the 451 participants, 410 went on to participate in the 12-month follow-up. At baseline, 52 participants reported high-risk alcohol use and 399 reported no or low-risk use, according to the study.

Additional findings include:

• Among participants who reported no or low-risk alcohol use at baseline, the mean observed alcohol use frequency increased from 0.3 to 1.6 days in the intervention group and from 0.2 to 0.8 days in the TAU group.

• Among participants who reported baseline high-risk alcohol use, mean alcohol health risk knowledge increased over the study period in both groups (intervention: 68.1% to 77.5%; TAU: 65.2% to 82.2%; P = .06).

• There were no group differences in changes in alcohol risk intolerance regardless of high, low, or no-risk alcohol use at baseline.

Investigators noted that the preventive intervention was effective because it was based on “theories of health behavior change.”

“These theories posit effects where interventions increase attention to a behavior, knowledge about its health effects, perceptions regarding the severity of harms that could result, perceived susceptibility to harms, and perceived benefits of avoiding the behavior,” researchers added. “The TGC design features build from these theories and emphasize personalization to a youth’s specific chronic illness, with relatable and engaging visual, narrative, and medical content to convey the social-emotional meaning of alcohol use.”

Going forward, Weitzman and colleagues emphasized the importance of identifying and evaluating pathways to identify and sustain implementation of the TGC model, “for example, by testing acceptability and effects of delivery through a patient portal for home viewing.”

Reference: Weitzman ER, Minegishi M, Dedeoglu F, et al. Disease-tailored brief intervention for alcohol use among youths with chronic medical conditions: A secondary analysis of a randomized clinical trial. JAMA Netw Open. Published online July 10, 2024. doi:10.1001/jamanetworkopen.2024.19858