Brief motivational interventions for college student drinking may not be as powerful as we think: an individual participant-level data meta-analysis.
Brief motivational interventions for college student drinking may not be as powerful as we think: an individual participant-level data meta-analysis.
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DOI：
10.1111/acer.12714
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发表时间：
2015-05
期刊：
影响因子：
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通讯作者：
Atkins DC
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文献类型：
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作者：
Huh D;Mun EY;Larimer ME;White HR;Ray AE;Rhew IC;Kim SY;Jiao Y;Atkins DC
二十多年来，大学校园里一直在实施简短的动机干预措施（BMIs），以减少酗酒及相关负面后果。这类干预措施包括面对面的动机访谈（MIs），通常结合个性化反馈（PF），以及通过邮件、计算机或网络进行的独立的PF干预。使用已发表研究的汇总数据进行的叙述性综述和荟萃分析都表明，BMIs至少具有短期效果，尽管总体效应量较小。
本研究是对17项评估BMIs的随机临床试验进行的个体参与者层面数据（IPD）荟萃分析。与基于汇总数据的典型荟萃分析不同，IPD荟萃分析能够正确考虑抽样、样本特征以及合并数据的分布。特别是，饮酒结果通常呈现出有很多零值的高度偏态分布，但在现有研究中没有得到充分考虑。数据来自综合项目（Project INTEGRATE），这是酒精干预研究中迄今为止最大的IPD荟萃分析项目之一，代表了6713名个体，每人在基线后长达12个月内有2到5次重复测量。
我们使用贝叶斯多层过度离散泊松障碍模型来估计干预措施对每周饮酒量和饮酒峰值的影响，并使用高斯模型来估计对酒精问题的影响。对任何结果而言，总体干预效果的估计值都非常小，且在统计上不显著。我们进一步对三种干预类型（含PF的个体MI、仅PF以及团体MI）与对照组进行了事后比较。接受含PF的个体MI的参与者在酒精问题上有小幅且在统计上显著的减少。短期和长期结果相似。
本研究对BMIs在大学生饮酒预防和干预方面的效果及效应大小提出了质疑，并表明需要开发更有效的干预策略。
For over two decades, brief motivational interventions (BMIs) have been implemented on college campuses to reduce heavy drinking and related negative consequences. Such interventions include in-person motivational interviews (MIs), often incorporating personalized feedback (PF), and stand-alone PF interventions delivered via mail, computer, or the Web. Both narrative and meta-analytic reviews using aggregate data from published studies suggest at least short-term efficacy of BMIs, although overall effect sizes have been small. The present study was an individual participant-level data (IPD) meta-analysis of 17 randomized clinical trials evaluating BMIs. Unlike typical meta-analysis based on summary data, IPD meta-analysis allows for an analysis that correctly accommodates the sampling, sample characteristics, and distributions of the pooled data. In particular, highly skewed distributions with many zeroes are typical for drinking outcomes, but have not been adequately accounted for in existing studies. Data are from Project INTEGRATE, one of the largest IPD meta-analysis projects to date in alcohol intervention research, representing 6,713 individuals each with two to five repeated measures up to 12 months post-baseline. We used Bayesian multilevel over-dispersed Poisson hurdle models to estimate intervention effects on drinks per week and peak drinking, and Gaussian models for alcohol problems. Estimates of overall intervention effects were very small and not statistically significant for any of the outcomes. We further conducted post hoc comparisons of three intervention types (Individual MI with PF, PF only, and Group MI) vs. control. There was a small, statistically significant reduction in alcohol problems among participants who received an individual MI with PF. Short-term and long-term results were similar. The present study questions the efficacy and magnitude of effects of BMIs for college drinking prevention and intervention and suggests a need for the development of more effective intervention strategies.