Long-term effects of a nurse-led mHealth intervention on reducing alcohol consumption in university students in Hong Kong

Abstract

Alcohol consumption contributes substantially to a wide range of diseases worldwide. As a result of the reduction in alcohol taxes in Hong Kong, there has been an increase in alcohol consumption. Alcohol consumption per capita in Hong Kong increased from 2.57 liters in 2004 to 2.87 liters in 2017. Alcohol use is one of the leading causes of disability-adjusted life-year (DALY) loss among adolescents and young adults. Interventions to help teenagers reduce or stop drinking alcohol is important. This study aims to evaluate the effectiveness of current trials on reducing drinking in university students and a nurse-led real-time chat-based support to reduce alcohol consumption in university students in Hong Kong. In the first part of this thesis, a systematic review on electronic-based alcohol brief intervention (ABI) was conducted to investigate the effect on reducing alcohol consumption in youth. The second part is evaluated a randomized controlled trial of 772 university students from 11 universities in Hong Kong. All participants received a 15-minute ABI at baseline and were randomized into intervention group (N=386) or control group (N=386). Participants in the intervention group received 12-week nurseled real-time chat-based support via instant messaging application with health information related to alcohol drinking. They also received instant responses from the nurse when they had any questions about alcohol consumption. Participants in the control group received general health information for 12-week. The primary outcomes were AUDIT score and weekly alcohol consumption at 12 months post-intervention. The secondary outcomes were academic-related problems, binge drinking experience past month and heavy episodic drinking past month at 12-month. The trial was registered with ClinicalTrials.gov (NCT04025151). Ethical approval was granted by the Institutional Review Board of the HKU/Hospital Authority Hong Kong West Cluster. In the systematic review, 14 eligible studies were identified by comprehensive literature search. Electronic-based ABI is effective in reducing alcohol consumption among youth. For the second part, no significant differences in all outcomes between intervention group and control group at 12-month follow-up were observed in the RCT study by intention-to-treat analysis. Subgroup analysis showed that female students significantly reduced weekly alcohol consumption after the intervention at 12-month. (beta=1.46, 95% CI: 0.08-2.83, p=0.04) and male students in intervention group reported less binge drinking experience past month at 12-month follow-up. (OR=1.58, 95% CI:0.98-2.24, p=0.05) Lower in AUDIT at baseline (AUDIT <16) was associated with higher intervention effect on AUDIT score at 12-month. (beta=0.64, 95%CI: -0.01-1.29, p=0.05) In the systematic review, mobile phones, computers, tablets, etc., were found to be effective tools for delivering ABI to youths. The result may not be sustainable if this method is used alone. Chat-based support in the RCT study shown no significant difference between intervention group and control group. Further studies should be conducted to investigate the intervention effect in different gender and different level of risky drinkers.