Moderators of Outcome in a Web-Based Substance Use Intervention for Adolescents
Abstract
Abstract.Aims: In this article we explore the moderators of effectiveness of WISEteens (Web-based brief Intervention for SubstancE using teens), a fully automated web-based brief motivational intervention targeting risky substance use among adolescents. Based on previous studies, we examined the differential effects on drinking of sex, readiness to change, self-efficacy, alcohol risk status, and parental monitoring as hypothesized moderators. Methods: We analyzed completers data from a two-armed RCT study with follow-up assessment after 3 months, including N = 211 self-enrolled adolescents (16 – 18 years) who screened positive for at-risk substance use in Sweden, Belgium, the Czech Republic, and Germany. The trial compared a single-session brief motivational intervention to an assessment-only control group with AUDIT-C scores for drinking frequency, quantity, and frequency of binge drinking in the past month as study outcome. Results: The analyses revealed a statistically significant moderation effect for sex on drinking in the previous month, with a stronger effect for males. In contrast, readiness to change, self-efficacy, alcohol risk status, and parental monitoring did not moderate the effects. Conclusions: Although the trial was limited by large dropout, our findings imply that web-based interventions can be particularly effective for male adolescents, although the effects of WISEteens were largely independent of other individual characteristics. Web-based brief intervention should integrate gender-specific components to raise effectiveness for females.
Zusammenfassung.Ziel: Die vorliegende Studie untersuchte differenzielle Effekte der voll-automatisierten, web-basierten motivierenden Kurzintervention WISEteens (Web-based brief Intervention for SubstancE using teens) auf den Alkoholkonsum von Jugendlichen aus vier europäischen Ländern. Ausgehend von Befunden zur Wirksamkeit web-basierter und nicht web-basierter motivierender Kurzinterventionen, untersuchten wir mögliche moderierende Einflüsse des Geschlechts, der Veränderungsbereitschaft, der Selbstwirksamkeit, des Risikostatus des Alkoholkonsums sowie der Bereitschaft der Jugendlichen, ihre Eltern über eigene Aktivitäten und Belange zu informieren (parental monitoring). Solche Analysen sind bisher vernachlässigt worden und können einen Beitrag zur heterogenen Befundlage zur Effektivität web-basierter Interventionsprogramme liefern. Methodik: Die Untersuchung wurde auf Grundlage der vollständigen Daten aus einer zweiarmigen, randomisiert-kontrollierten Studie durchgeführt und schloss N = 211 Jugendliche im Alter von 16 bis 18 Jahren aus Schweden, der Tschechischen Republik, Belgien und Deutschland ein, die vorab anhand des CRAFFT Screening Instrumentes positiv auf riskanten Substanzkonsum identifiziert wurden. In der Interventionsstudie konnte ein Haupteffekt der einmaligen motivierenden Kurzintervention im Vergleich mit einer assessment-only Kontrollgruppe über drei Monate gezeigt werden. Primäres Outcome war der selbstberichtete Alkoholkonsum im vergangenen Monat, gemessen anhand eines AUDIT-C Summenwertes mit den Indikatoren Trinkhäufigkeit, Trinkmenge und Häufigkeit des Rauschtrinkens. Ergebnisse: Für die vorliegende sekundäre Analyse wurden baseline-adjustierte Kovarianzanalysen (ANCOVA) durchgeführt, die zeigen, dass einzig das Geschlecht einen moderierenden Einfluss auf die Effektivität des Programms hatte. WISEteens war für die männlichen Teilnehmer im Vergleich zur Kontrollgruppe effektiv, nicht aber für die weiblichen. Keine signifikanten moderierenden Effekte fanden wir für die weiteren untersuchten Moderationsvariablen Veränderungsbereitschaft, Selbstwirksamkeit, Risikostatus des Alkoholkonsums und parental monitoring. Schlussfolgerungen: Obwohl die vorliegenden Studienergebnisse durch einen hohen drop-out limitiert sind, deuten sie darauf hin, dass vollautomatisierte web-basierte Interventionen günstige Effekte vor allem für männliche Jugendliche haben können, die Effektivität aber weitgehend unabhängig von motivationalen und elterlichen Faktoren sowie des Risikostatus des Alkoholkonsums vor der Intervention zu sein scheint. Die geschlechtsspezifischen Effekte könnten auf Unterschiede in den normativen alkoholbezogenen Erwartungen und eine besondere Wirksamkeit normativer Interventionselemente bei männlichen Jugendlichen zurückgehen. Um die Wirksamkeit für Mädchen weiter zu erhöhen, könnten solche Interventionsprogramme zukünftig verstärkt geschlechtsspezifische Komponenten berücksichtigen.
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