Efetividade de uma intervenção via internet para redução do consumo de álcool e problemas associados entre estudantes universitários brasileiros
Arquivos
Data
2017-10-26
Autores
Souza, Andre Bedendo de 
Orientadores
Noto, Ana Regina
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivos: Avaliar a efetividade de uma intervenção por FNP via internet após 1, 3 e 6 meses na redução do consumo de álcool e problemas associados entre estudantes universitários brasileiros, bem como a efetividade isolada de dois de seus componentes (Feedback Normativo e Feedback Consequências). Métodos: Ensaio pragmático randomizado e controlado com follow-ups após 1, 3 e 6 meses. Os critérios de inclusão foram: estudante universitário, idade entre 18 e 30 anos e relato de uso de álcool nos últimos três meses. Foi utilizado um desenho de desmantelamento (dismantling design), sendo os participantes randomizados (n=46142) a um de quatro grupos: 1) Controle – avaliação somente (GC), 2) FNP completo, 3) Feedback Normativo (FN), e 4) Feedback Consequências (FC). A versão completa da intervenção apresentou dados sobre 1) perfil de consumo de álcool; 2) comparações normativas; 3) consequências do uso de álcool; 4) custos práticos do uso de álcool (gasto financeiro e consumo calórico); 5) estratégias de redução de riscos. Os desfechos avaliados foram a pontuação no AUDIT, o número de problemas, o número máximo de doses consumidas, a frequência de uso e o número de doses típicas. A motivação para receber a intervenção foi avaliada com uma escala analógica visual (intervalo de 0-10) e os universitários foram classificados como pouco motivados (pontuação < 3) ou motivados (pontuação ≥ 3). As análises estatísticas consideraram Modelos Lineares Generalizados Mistos e avaliaram os efeitos de intervenção e de seus componentes por meio de dois paradigmas: casos observados e modelos considerando taxas de adesão (Imputação Múltipla e Modelos de Padrões Mistos). Resultados: Um total de 8.211 participantes retornaram ao site em alguma das medidas de follow-up. Comparado ao GC, o FNP reduziu o número de doses típicas após um e três meses e de doses máximas após um mês (casos observados e de taxa de adesão). Estudantes motivados que receberam FNP reduziram as doses típicas após um (b = -0.51 IC95%: -0.76; -0.27, p<0.001), três (b = -0.60 IC95%: -0.91; -0,29, p<0,001) e seis meses (b = -0,58 IC95%: -0,93; -0,23, p=0,001). Os modelos considerando as taxas de adesão mostraram que os efeitos foram mais robustos após um e três meses. Por sua vez, estudantes pouco motivados no grupo FNP aumentaram a pontuação no AUDIT após 6 meses (b=1,49 IC95%: 0,74; 2,24, p<0,001). Em relação à efetividade dos componentes, comparado ao FNP, o FN reduziu a pontuação no AUDIT (b= -0,23 IC95%: -0,46; -0,002, p=0,048) e o número xviii de problemas (b= -0,16 IC95%: -0,25; -0,06, p=0,001) após um mês. Por sua vez, o FC reduziu a pontuação no AUDIT (b= -0,33 IC95%: -0,62; -0,03, p=0,029) e a frequência do uso (b= -0,37 IC95%: -0,73; -0,004, p=0,045) após 3 meses. Análises de subgrupo indicaram que entre estudantes motivados, o FN reduziu o número de problemas em T1 e aumentou número de doses típicas em T3. Já entre universitários pouco motivados, o FN reduziu o número de problemas em T1, enquanto o FC reduziu a pontuação do AUDIT em T2. Análises complementares indicaram que, comparado ao GC, o FN apresentou efeito negativo entre universitários pouco motivados e que o FC promoveu efeitos positivos em ambos os subgrupos segundo a motivação. Conclusão: O FNP via internet e seus componentes foram efetivos na redução do consumo de álcool, e somente o FN reduziu o número de problemas do uso. Os efeitos de todas as intervenções variaram segundo a motivação do participante, a qual deve ser avaliada antes da escolha do tipo de feedback disponibilizado. O FNP e FN são indicados somente a universitários motivados, enquanto o FC foi efetivo independentemente da motivação. O FNP ou seus componentes via internet constituem uma das opções dentre várias estratégias de prevenção e tratamento, sendo que sua utilização deve ser integrada às mesmas para o manejo adequado do consumo e problemas do uso de álcool entre estudantes universitários. Registro Clinical Trials: NCT02058355
Aim: To evaluate the effectiveness of an internet-based Personalized Normative Feedback (PNF) intervention after 1, 3 and 6 months in the reduction of alcohol consumption and associated problems among Brazilian university students, as well as the effectiveness isolated components (Normative Feedback and Consequences Feedback). Methods: Pragmatic randomized controlled trial with follow-up assessments after 1, 3 and 6 months. Inclusion criteria were college students, aged 18 and 30 years and reporting alcohol during the previous 3 months. We used a dismantling design and the participants were randomized (n = 46,142) into one of four groups: 1) Control - assessment only (CG), 2) PNF, 3) Normative Feedback (NF), and 4) Consequences Feedback (CF). The complete version of the intervention presented data on 1) drinking profile, 2) normative comparisons, 3) alcohol consequences, 4) practical costs (financial expenditure and caloric consumption), 5) and strategies to decrease risks. The outcomes were the AUDIT score, the number of consequences, the maximum number of drinks, the frequency of use and the number of typical drinks. The motivation to receive the intervention was assessed with a visual analogue scale (range= 0-10) and the students were the categorized either as low motivated (score <3) or motivated (score ≥ 3). Statistical analysis considered Generalized Linear Mixed Models to evaluate the effects of intervention and its components through two paradigms: observed cases and attrition models (Multiple Imputation and Patternmixture model). Results: A total of 8,211 participants accessed at least one follow-up. Compared to CG, the PNF reduced the typical drinks after one and three months and the maximum drinks after one month (observed cases and attrition models). Motivated students who received PNF reduced typical drinks after one (b = -0.51 95%CI: -0.76, - 0.27, p<0.001), three (b = -0.60 95%CI: -0.91, -0.29, p<0.001) and six months (b = - 0.58 95%CI: -0.93, -0.23, p= 0.001). The attrition models showed that the effects were more robust after one and three months. In turn, low motivated students who received the PNF increased their AUDIT scores after 6 months (b=1.49 95%CI: 0.74; 2.24, p<0.001). Regarding the effectiveness of the components, compared to the PNF, the NF reduced the AUDIT score (b = -0.23 95%CI: -0.46; -0.002, p= 0.048) and the number of consequences (b = -0.16 95%CI: -0.25; -0.06, p= 0.001), while the CF reduced the AUDIT score (b = -0.33 95%CI: -0.62; -0.03, p=0.029) and the frequency of use (b = -0.37 95%CI: -0.73; -0.004, p=0.045) after 3 months. Subgroup analyzes xx indicated that among motivated students, showed that the NF reduced the number of problems in after 1 month and increased number of typical doses after 3 months. Among the low motivated college students, NF reduced the number of consequences after 1 month, while CF reduced the AUDIT score in after 3 months. Additional analyzes indicated that compared to CG, NF showed a negative effect among low motivated students and that CF promoted positive effects in both subgroups according to motivation. Conclusion: An internet-based PNF intervention and its components were effective in reducing alcohol consumption, and only the NF reduced the alcoholrelated consequences. All interventions effects differed according to the student motivation, which should be evaluated before choosing the type of feedback provided. Both the PNF and NF are indicated only for motivated students, while the CF was effective regardless of the motivation. The provision of an internet-based PNF or its components are one alternative among several prevention, treatment and environmental strategies that should be integrated for the adequate management of alcohol use and related problems among university students. Clinical Trials Identifier: NCT02058355
Aim: To evaluate the effectiveness of an internet-based Personalized Normative Feedback (PNF) intervention after 1, 3 and 6 months in the reduction of alcohol consumption and associated problems among Brazilian university students, as well as the effectiveness isolated components (Normative Feedback and Consequences Feedback). Methods: Pragmatic randomized controlled trial with follow-up assessments after 1, 3 and 6 months. Inclusion criteria were college students, aged 18 and 30 years and reporting alcohol during the previous 3 months. We used a dismantling design and the participants were randomized (n = 46,142) into one of four groups: 1) Control - assessment only (CG), 2) PNF, 3) Normative Feedback (NF), and 4) Consequences Feedback (CF). The complete version of the intervention presented data on 1) drinking profile, 2) normative comparisons, 3) alcohol consequences, 4) practical costs (financial expenditure and caloric consumption), 5) and strategies to decrease risks. The outcomes were the AUDIT score, the number of consequences, the maximum number of drinks, the frequency of use and the number of typical drinks. The motivation to receive the intervention was assessed with a visual analogue scale (range= 0-10) and the students were the categorized either as low motivated (score <3) or motivated (score ≥ 3). Statistical analysis considered Generalized Linear Mixed Models to evaluate the effects of intervention and its components through two paradigms: observed cases and attrition models (Multiple Imputation and Patternmixture model). Results: A total of 8,211 participants accessed at least one follow-up. Compared to CG, the PNF reduced the typical drinks after one and three months and the maximum drinks after one month (observed cases and attrition models). Motivated students who received PNF reduced typical drinks after one (b = -0.51 95%CI: -0.76, - 0.27, p<0.001), three (b = -0.60 95%CI: -0.91, -0.29, p<0.001) and six months (b = - 0.58 95%CI: -0.93, -0.23, p= 0.001). The attrition models showed that the effects were more robust after one and three months. In turn, low motivated students who received the PNF increased their AUDIT scores after 6 months (b=1.49 95%CI: 0.74; 2.24, p<0.001). Regarding the effectiveness of the components, compared to the PNF, the NF reduced the AUDIT score (b = -0.23 95%CI: -0.46; -0.002, p= 0.048) and the number of consequences (b = -0.16 95%CI: -0.25; -0.06, p= 0.001), while the CF reduced the AUDIT score (b = -0.33 95%CI: -0.62; -0.03, p=0.029) and the frequency of use (b = -0.37 95%CI: -0.73; -0.004, p=0.045) after 3 months. Subgroup analyzes xx indicated that among motivated students, showed that the NF reduced the number of problems in after 1 month and increased number of typical doses after 3 months. Among the low motivated college students, NF reduced the number of consequences after 1 month, while CF reduced the AUDIT score in after 3 months. Additional analyzes indicated that compared to CG, NF showed a negative effect among low motivated students and that CF promoted positive effects in both subgroups according to motivation. Conclusion: An internet-based PNF intervention and its components were effective in reducing alcohol consumption, and only the NF reduced the alcoholrelated consequences. All interventions effects differed according to the student motivation, which should be evaluated before choosing the type of feedback provided. Both the PNF and NF are indicated only for motivated students, while the CF was effective regardless of the motivation. The provision of an internet-based PNF or its components are one alternative among several prevention, treatment and environmental strategies that should be integrated for the adequate management of alcohol use and related problems among university students. Clinical Trials Identifier: NCT02058355
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Citação
BEDENDO, André. Efetividade de uma intervenção via internet para redução do consumo de álcool e problemas associados entre estudantes universitários brasileiros. São Paulo, 2017. [191] p. Tese (Doutorado em Psicobiologia) - Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, 2017.