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 ScreeningAlcoholScreening.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.

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.” 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.

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

Reach Completed 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.orgGeneral Population 29%71% BU College StudyCollege 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 (unpublished).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 MenMen were more likely to report intentions to seek help. WomenWomen 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) BaselineFollow-Up Men36.6%37.3% Women25.6%20.3% Total29.6%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