Using the Internet to Screen for Risky Alcohol Use

Eric Helmuth, MA

Join Together, Boston University School of Public Health

Online Screening

A New Technique for an Old Problem

Traditional Screening AlcoholScreening.org

• Paper/Pencil• In-person Interview• Specific setting

• Online• Anonymous • At any computer at anytime

Public Health Impact

Graham, A. Disseminating Smoking Cessation Treatment via the Internet: Opportunities and Challenges, presentation.

www.AlcoholScreening.org

• Launched in April 2001

• More than 500,000 screens

• More than 100 Syndicated websites

• Viral marketing

• Links on CNN, WebMD, MSNBC.com

“Thanks for the statistics, I just thought it was ‘normal’.

I will try to cut down, I knew I was at risk because of my family tradition, yet I

thought I was still on the safe side. I have clear data to re-evaluate my habits.”

Email correspondence from AlcoholScreening.org user, (August 2006).

• 13 Questions

• Based on AUDIT

• Additional questions: Binge Drinking

• All Drinkers

• High Risk

Learn More

Get Help

Result

Normative information

Recommendation

Based on the user’s results, they receive a red, yellow,

or green light.

www.AlcoholScreening.org

People coming to AlcoholScreening.org are coming because they are worried about their drinking.

Mean AUDIT Score: 13.4 (Alcohol Dependent)

Public Heath Tests:

Efficacy?

Safe Limits

(<8)

Risky

(8-12)

Dependence (13-19)

Needs Treatment

(20>)

Learn More *

27% 16% 32% 25%

Get Help * 5% 12% 34% 49%

* p<.001

ReachCompleted screens in 43% of U.S. ZIP codes

New York

California

Cost

• $20-25K to build

• $40K per year (for 5 years)

• 500,000 screens to date

• $0.45 per screen

Plans

• Build brief intervention module– NIAAA proposals– Join Together deployment

• Develop paid syndications– Join Together

• Extend college screening– Research on change mechanisms– BU students; other colleges

Online Use Across Populations

Audience % Scores below 8

% Scores 8 and above

AlcoholScreening.org General Population

29% 71%

BU College Study College Freshman

70% 30%

Heavy Drinking Web Screen (minimal and extensive intervention)

Highest BAL Web Screen(extensive intervention only)

Consequences Web Screen

(extensive intervention only)

Costs and Calories Web Screen

(extensive intervention only)

Alcohol Screening on a College Population

The Sample (4,008 Students):

• 55% of college Freshmen completed an online screening test (AUDIT).

• 37% of men and 26% of women had unhealthy alcohol use.

Saitz, R. et al. (unpublished). Screening and brief intervention online for college students: The iHealth Study.

Method

Saitz, R. et al. (unpublished). Screening and brief intervention online for college students: The iHealth Study.

Follow-up Assessment One Month Later

No Hazardous Drinking

Unhealthy Alcohol Use

Minimal Intervention

More Extensive

Intervention

College Freshmen

Screening Invitation: Wellness or Alcohol Specific

Minimal v. More Extensive BI

More Extensive BI

Men Men were more likely to report intentions to seek help.

Women Women had greater increase in readiness to change.

Saitz, R. et al. (unpublished). Screening and brief intervention online for college students: The iHealth Study.

Unhealthy Alcohol use at 1 Month Follow-Up (all subjects)

Baseline Follow-Up

Men 36.6% 37.3%

Women 25.6% 20.3%

Total 29.6% 26.2%

85% follow-up rate

Saitz, R. et al. (unpublished). Screening and brief intervention online for college students: The iHealth Study.

Unhealthy Alcohol use at 1 Month Follow-Up (235 subjects)

• Men: Consequences decreased by 15%

• Women: Unhealthy alcohol use decreased by 33%

All 235 subjects had unhealthy alcohol use at baseline

Saitz, R. et al. (unpublished). Screening and brief intervention online for college students: The iHealth Study.

Aim

• To develop and test a strategy for universal screening for unhealthy alcohol use by college students using the web

Conclusions

• Feasibility and Reach– More than half of all freshmen completed a brief online

alcohol assessment and intervention (BI)– A substantial proportion (30%) of students completing this

assessment had unhealthy alcohol use

• An alcohol-specific invitation (as compared to a general health invitation) did not dissuade freshmen from completing online alcohol screening and BI

• Most participating students completed re-assessment 1-month later

Conclusions

• More extensive BI may have more effect on readiness and help-seeking (men) than minimal– Readiness to change drinking was low to begin

with– Some actually intended to seek help after BI

• BI appears to have reduced unhealthy use– Similarly for more extensive and minimal BI– Reductions primarily observed in women