Sophie Baumann

Gender-specific predictors of risky alcohol use among general hospital inpatients

OBJECTIVEnTo investigate sociodemographic-, living situation- and substance-related variables as predictors of current risky alcohol use for both female and male general hospital inpatients.nnnMETHODnThe sample of 6050 female and 8282 male general hospital inpatients was recruited in 2002-2004. Using the Alcohol Use Disorder Identification Test-Consumption, they were assigned to four drinking groups: abstinent, moderate use, slightly increased use and notably increased use. Gender-specific predictors of group affiliation were determined using multivariate multinomial logistic regressions.nnnRESULTSnIn both genders, younger age, rural living environment, the occurrence of lifetime alcohol use disorders (AUDs) and current tobacco smoking were positively associated with risky alcohol use. Higher education was positively associated with slightly and notably increased use for women. Living alone, being divorced/ widowed and being unemployed (relative risk ratios=1.4-1.7) were positively associated with notably increased use for men. In both genders, older age, less education and the occurrence of lifetime AUDs were positively associated with abstinence.nnnCONCLUSIONSnHigher educated women are likely to report risky alcohol use. Marriage may have a protective effect on level of alcohol use for men only. In addition to the implementation of routine alcohol screening, the examined data may provide cost-effective information that could be used to tailor interventions.

How well do TTM measures work among a sample of individuals with unhealthy alcohol use that is characterized by low readiness to change

Little is known about the applicability of the transtheoretical model of intentional behavior change (TTM) to individuals with unhealthy alcohol use that is primarily characterized by low readiness to change. This study examined the psychometric properties of short measures by assessing three core constructs of the TTM: the 20-item Processes of Change (POC-20) scale, and short versions of the Alcohol Decisional Balance Scale (ADBS) and the Alcohol Abstinence Self-Efficacy (AASE) scale. A sample of 427 individuals with unhealthy alcohol use (Mage = 30 years, 65% men), identified at job agencies in northeastern Germany, completed all three scales. Item difficulty (d), selectivity (rit), and Cronbachs alpha were calculated. Confirmatory factory analyses were used to test for construct validity and latent mean differences across the stages. The psychometric properties of the 8-item AASE were adequate (d range: 0.59-0.78; rit range: 0.59-0.68; α range: 0.74-0.81), except for one subscale. Most items of the POC-20 and the 10-item ADBS were difficult (dPOC range: 0.08-0.40; dADBS range: 0.21-0.58); selectivity (ritPOC range: 0.26-0.62; ritADBS range: 0.34-0.68) and internal consistency (αPOC range: 0.41-0.76; αADBS range: 0.64-0.78) were low to moderate. Construct validity was acceptable (Comparative Fit Index range: 0.95-0.99). The association between stages and TTM constructs partially followed expected patterns. Suggestions for modifications of TTM measures are discussed for better applicability among proactively recruited samples of individuals with unhealthy alcohol use and with primarily low readiness to change. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

Patterns of accelerometer-based sedentary behavior and their association with cardiorespiratory fitness in adults

We aimed to identify patterns of sedentary behavior (SB) and examined whether cardiorespiratory fitness differs between classes with distinct patterns of SB. One hundred and seventy participants (57% women, mean age = 56.4 years) received accelerometry monitoring for 7 days. Prior to accelerometry assessment, cardiorespiratory fitness was assessed by peak oxygen uptake (VO2peak). VO2peak was directly measured during a symptom‐limited cardiopulmonary exercise testing on a cycle ergometer. Patterns in accelerometer data were classified based on time spent in SB per day using growth mixture modeling. Model‐implied class‐specific VO2peak means were compared using adjusted equality test of means. Growth mixture modeling revealed four patterns of SB: High, stable (n = 120, M = 724.9 min/d), Low, increase (n = 14, M = 622.2 min/d), Low, decrease (n = 11, M = 540.2 min/d), and High, decrease (n = 25, M = 694.8 min/d). Persons in class High, stable had significantly lower VO2peak values (M = 25.0 mL/kg/min, SD = 0.6) compared to persons in class Low, increase (M = 30.5 mL/kg/min, SD = 3.6; P = 0.001), in class Low, decrease (M = 30.1 mL/kg/min, SD = 5.0; P = 0.009), and in class High, decrease (M = 29.6 mL/kg/min, SD = 5.9; P = 0.032). No differences among the other classes were found. We identified four classes of individuals with distinct patterns of SB and showed that VO2peak partially differs between classes. Especially, individuals with stable high SB levels throughout the week might be addressed in public health recommendations and interventions.

Short-term stability of different drinking patterns over the course of four weeks among adults. A latent transition analysis

OBJECTIVEnThe purpose of the present study was to identify drinking patterns and determine their intraindividual stability over the course of four weeks among a sample of adults from the general population.nnnMETHODSnThe sample comprised 288 adults who reported drinking alcohol at least once per month (49% female; mean ageu2009=u200933.1 years, SD = 12.8 years). Participants were recruited in the waiting area of a local registration office in northeastern Germany. Data were collected four times over four consecutive weeks by interview (once in the registration office and thrice by telephone). To assess alcohol consumption in the past seven days, timeline follow-back questions were administered each time. For data analysis, latent profile and latent transition analyses were applied. Indicators for latent classes were total number of drinks per seven days, number of drinking days, and number of days with heavy episodic drinking.nnnRESULTSnThree classes of seven-day drinking patterns were identified at baseline: (a) light drinkers (77%), (b) moderate drinkers (18%), and (c) heavy drinkers (5%). Approximately one-fifth (21%) of baseline light drinkers and 94% of baseline moderate drinkers changed their drinking pattern at least once during the four weeks. The majority (81%) of baseline moderate drinkers also reported light drinking in at least one of the three subsequent weeks.nnnCONCLUSIONSnOur findings suggest intraindividual changes in drinking patterns even during a short period of time. Instability of drinking patterns may potentially impair the assessment of light to moderate alcohol consumption when a quantity-frequency approach is applied.

Proactive expert system intervention to prevent or quit at-risk alcohol use (PRINT): study protocol of a randomized controlled trial

BackgroundThe population impact of alcohol screening and brief intervention might be increased by approaching an entire population rather than individuals at high risk only. The aim is to present the protocol of the study “Testing a proactive expert system intervention to prevent and to quit at-risk alcohol use” (PRINT) which tests the efficacy of a computer-based brief intervention (i) to elicit drinking reductions among persons with at-risk alcohol use and (ii) to prevent at-risk alcohol use among current low-risk drinkers.Methods/designThe PRINT study is a two-arm randomized controlled trial with a 12-month follow-up. A total of 1648 participants will be proactively recruited in the waiting area of a municipal registry office. All 18- to 64-year-old persons with past year alcohol use will be randomized to either the intervention group or the control group. Participants in the intervention group will receive computer-generated individualized feedback letters at baseline, month 3, and month 6. Participants in the control group will receive assessment only. The primary outcome is the change in the number of drinks per day from baseline to month 12.DiscussionWe expect to provide a computer-based brief alcohol intervention that is appropriate for a wide range of people with alcohol use regardless of their initial alcohol-risk level. The intervention might have the potential to decrease alcohol use and alcohol-related problems on a population level at low costs.Trial registrationGerman Clinical Trials Register: DRKS00014274 (date of registration: 2018/03/12).

Long-term outcomes of a randomized controlled trial on brief alcohol interventions for job-seekers

In the past three decades, two paths of how to understand and support health behavior change have been followed: stage-tailored models and continuum models. Our aim was to investigate the comparative efficacy of a stage-tailored intervention and a non-stage-tailored intervention of the same intensity in reducing alcohol use and alcohol problem severity among job-seekers with unhealthy alcohol use. The interventions were based on the most prominent representative models, the transtheoretical model of behavior change (TTM) and the theory of planned behavior (TPB). A total of 1,243 proactively recruited job-seekers with unhealthy alcohol use (64% male, M=30 years, 76% not motivated to change) were assigned by random to three study groups: (1) individualized stage-tailored feedback letters based on the TTM, (2) individualized non-stage-tailored feedback letters based on the TPB, and (3) assessment only (controls). Both intervention groups received up to two interventions. All groups were followed-up three, six and 15 months after baseline. Piecewise latent growth models were conducted to investigate change in alcohol use and severity from baseline to month 3 and month 3 to 15. Initial motivation was tested as a moderator of intervention efficacy. All groups reduced alcohol use and severity significantly in the short term. In the long term and when including motivation as a covariate, the stage-tailored group produced a significantly greater reduction than the two other groups. Initial motivation was a significant moderator of intervention efficacy. Neither intervention was generally more or less effective than the other. The efficacy of the interventions largely depended upon the initial motivation to change alcohol use: the lower the motivation to change, the more likely the individuals were to benefit from the stage-tailored intervention; and the higher the motivation to change, the more likely the individuals were to benefit from the non-stage-tailored intervention.

Testing the efficacy of brief alcohol interventions provided through different delivery channels: study design

In the past 20 years, research has shown that brief interventions are effective in reducing health risk behaviors. Now we are in the second generation of brief intervention trials, investigating how to improve efficacy, including the investigation of cost-saving communication channels. Our aim was to investigate whether motivationally tailored interventions are more effective in reducing unhealthy alcohol use when delivered by computer or in person. Proactively recruited general hospital inpatients with unhealthy alcohol use (n=975) participated in a randomized controlled trial, and were allocated to one of three groups: 1) individualized theory-based computer generated feedback letters, 2) motivational interviewing based counselling, and 3) assessment only (controls). Both intervention groups received up to three interventions. All groups are followed up at 6, 12, 18 and 24 months. Between February 2011 and December 2012, recruitment and interventions have been completed. We have assessed 10,591 inpatients aged 18-64 years for eligibility. We have screened 6,236 inpatients regarding unhealthy alcohol use, corresponding to 91.1% of those eligible. Of all inpatients with unhealthy alcohol use, 80.6% gave informed consent to participate in the trial. So far, 71.3% to 81.5% of these have participated in the follow-ups. A large study has been successfully implemented at a general hospital. Satisfactory participation rates provide a solid basis to investigate the comparative efficacy of brief alcohol interventions delivered by computer versus in person. The follow-up period of up to 24 months provides an excellent opportunity to investigate gradually increasing effects.