Full length articleMeasuring the effects on quality of life and alcohol consumption of a program to reduce binge drinking in Spanish adolescents
Introduction
According to the World Health Organization, in 2012, approximately 3.3 million deaths globally, 139 million DALYs (disability-adjusted life years), and 5% of the global burden of disease and injury were attributable to alcohol consumption (World Health Organization (WHO), 2014). Moreover, it is known that children, adolescents and elderly people are typically more vulnerable to the negative effects of excessive alcohol consumption than other age groups (Hilton, 1987; Mäkelä and Mustonen, 2000; Midanik and Clark, 1995). Among young people, this vulnerability is related to binge drinking (BD), when a great amount of alcohol is consumed during short periods of time, mainly on weekends (Anderson, 2014; Calafat Far, 2007; Cortés et al., 2007; US Surgeon General, 2007).
BD has become a concern for health policy makers. At the international level, in 2015, the European School Survey Project on Alcohol and Other Drugs (ESPAD) study investigated the drinking habits of 96,046 adolescents born in 1999 and found that every third student (35%) reported heavy episodic drinking in the past month. The term “heavy episodic drinking” is defined as drinking a minimum of five alcoholic beverages on one occasion at least once in the last 30 days and is therefore similar to BD. This study found high rates of alcohol use, particularly heavy alcohol use, although temporal trends over the past twenty years (between 1995 and 2015) indicated a positive development with an overall decrease. However, changes in heavy episodic drinking were less pronounced, with overall rates declining from 36% to 35% over the past two decades. This drinking pattern was more frequent in Austria, Cyprus and Denmark, where almost half of the students reported heavy episodic drinking (ESPAD Group, 2016). In Spain, BD among young people is one of the main public health problems, as recognized in the Spanish National Plan on Drugs, 2018). Although the 2016–2017 edition of the Survey on the Use of Drugs in Secondary Education (ESTUDES) found a 0.05% reduction from 2014, the prevalence remains high, with 31.7% of adolescents engaged in BD. Furthermore, it constitutes a serious socio-sanitary problem, with negative consequences such as disruptions in neural oscillations similar to those observed in persons with alcohol dependence (López-Caneda et al., 2014), a significantly less healthy diet (Mohamed and Ajmal, 2015) and a high probability of developing an alcohol use disorder in adulthood (Caamaño-Isorna et al., 2017; Grant et al., 2001; Spoelder et al., 2015), all of which result in a poor quality of life (QoL) (Luquiens et al., 2016). Therefore, it seems necessary to prevent or reduce this pattern of consumption to minimize the effects on health and quality of life.
In relation to the reduction or avoidance of BD, a recent study carried out by Lammers et al., 2017 Lammers et al. (2017) in The Netherlands, in 100 schools, applied a program called “Preventure”. It was particularly effective in preventing the incidence of BD in students with a sensation-seeking personality and preventing alcohol use among students with an anxiety-sensitivity personality, four and six months after an intervention. They conclude that selective or tailored prevention seems to be more effective in changing alcohol misuse behavior, specifically among high-risk young adolescents. Moreover, they added that no significant effects were revealed on personality traits due to problem drinking. This may imply that curbing the growth of drinking in early onset drinkers may delay the onset of problem drinking over the longer term (beyond 12 months post-intervention).
The QoL measure captures the physical and mental well-being of an individual: his/her cultural environment and values such as beliefs, expectations and goals (Lima-Serrano et al., 2016; Meade and Dowswell, 2015). It is a widely used measure in public health analysis and is key to decision-making in prevention and treatment strategies for the adoption of healthy lifestyles (Chai et al., 2010).
The concept of QoL in adolescence is important, as it has previously been linked to adverse childhood experiences, health conditions, and reduced life expectancy (Salinas-Miranda et al., 2015; Salum et al., 2014). It could also contribute to devising an age-appropriate policy tool for adolescents, as they differ from other age groups (Frisén, 2007). An understanding of the impact of BD on the QoL in adolescents could contribute to research and practice by providing data for economic evaluation studies and designing policies to discourage the excessive intake of alcohol.
However, to date, few studies (Lima-Serrano et al., 2016; Watson et al., 2017) have explored the relationship between alcohol drinking or BD in adolescents and HRQoL. The study carried out by Watson et al. (2017) only assessed HRQoL through the five dimensions of the EQ-5D-5 L and EQ-VAS, without calculating quality-adjusted life years (QALY´s), using a small number of participants consisting of young people with substance misuse undergoing various treatments. In addition, Lima-Serrano et al. (2016) showed a lower QoL in those who consumed alcohol using a specific QoL questionnaire (KIDSCREEN).
Sociodemographic factors associated with adolescent QoL have been investigated in numerous populations in school-based cross-sectional studies, such as the European KIDSCREEN study and the International Study on Health Behaviour of School-Aged Children (HBSC study) (Moreno et al., 2016; Ravens-Sieberer et al., 2014), which used the KIDSCREEN questionnaire. However, other generic HRQoL questionnaires are available, offering great variability in both the number and characteristics of the dimensions included (Alonso et al., 1995; Pardo-Guijarro et al., 2013; Rajmil et al., 2001). In this regard, the EQ-5D is a widely used instrument to measure perceived wellness and health status (The EuroQol Group, 1990). Its development was motivated by economic reasons, i.e., to create a way of measuring health status to allocate health care resources (Devlin and Brooks, 2017). It is considered very important for implementing health policies due to the need for both cost-effectiveness and cost-utility in the programs devised by decision-makers, as concluded by Aronsson et al. (2015). This study aimed to analyze the differences between the commonly used hypothetical UK value set and the newly introduced Swedish experience-based value set and to evaluate the health economic implications of such differences on policy decisions.
The aim of this paper is to present a comparison between the effects on health, in terms of health-related quality of life (HRQoL), and the reduction of excessive alcohol use with ALERTA ALCOHOL (Lima-Serrano et al., 2018), an intervention aimed at reducing BD in Spanish adolescents.
Section snippets
Sample and variables
The study population consisted of adolescents from Andalusia (a region in the south of Spain), aged 15 to 19 years, attending public schools. They were enrolled either in the fourth course of compulsory secondary education, higher secondary school, or the first course of vocational training (equivalent to 10th and 11th grades in the United States).
The sample is part of a two-arm cluster randomized controlled trial (CRCT) with an intervention group (IG) and a control group (CG) randomized at the
Sample characteristics
In total, 16 schools were randomized into the IG and CG. One school in the CG withdrew its participation before the initial assessment started. In total, 1247 adolescents from 15 schools participated in the baseline questionnaire, but only 612 adolescents (response rate 49.08%) participated in the 4-month follow-up questionnaire. At the follow-up assessment, some schools reported troubles with finding a date to administer the questionnaire, due to final exams. Moreover, vocational training
Discussion
The aim of this study was to compare and assess the effects on health in terms of the reduction of binge drinking and health-related quality of life in adolescents between 15 and 19 years of age enrolled in public high schools who were involved in CRCT to evaluate the ALERTA ALCOHOL program. The main findings showed that although the program was effective in reducing BD in a period of 4 months, it seems that the effects on HRQoL require a longer period to appear. Regarding the findings related
Role of funding source
Trial registration number (ClinicalTrials.gov): NCT03288896. This study was retrospectively registered on 19/09/2017.
This study has been prepared within the framework of the research project “ALCOHOL ALERT: Design, validation and evaluation of the program of selective prevention of alcohol abuse in adolescents: web-based computer-tailored intervention” (PI-0031-2014), financed by the Andalusian Public Foundation “Progress and Health” for the financing of research + innovation in biomedicine and
Contributors
Conceptualization of the study: AMVM, MLS, MTB. Analyses: AMVM, TM. Interpretation of results: AMVM, TM, MTB. Drafting the first version of the manuscript: AMVM, MTB. Revisions and approval of the manuscript: AMVM, MTB, MLS, TM, NA, SP. All authors contributed to and approved of the final manuscript.
Consent for publication
The current work has not been published previously, and it is not under consideration for publication elsewhere. The publication is approved by all authors. If accepted, it will not be published elsewhere in the same form, in English or in any other language, including electronically, without the written consent of the copyright holder.
Declaration of Competing Interest
There are no conflicts of interest for any author of this paper.
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