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Electronic screening and brief intervention (eSBI) has been shown to reduce alcohol consumption, but its effectiveness over time has not been subject to meta-analysis.
The current study aims to conduct a systematic review and meta-analysis of the available literature to determine the effectiveness of eSBI over time in nontreatment-seeking hazardous/harmful drinkers.
A systematic review and meta-analysis of relevant studies identified through searching the electronic databases PsychINFO, Medline, and EMBASE in May 2013. Two members of the study team independently screened studies for inclusion criteria and extracted data. Studies reporting data that could be transformed into grams of ethanol per week were included in the meta-analysis. The mean difference in grams of ethanol per week between eSBI and control groups was weighted using the random-effects method based on the inverse-variance approach to control for differences in sample size between studies.
There was a statistically significant mean difference in grams of ethanol consumed per week between those receiving an eSBI versus controls at up to 3 months (mean difference –32.74, 95% CI –56.80 to –8.68,
A significant reduction in weekly alcohol consumption between intervention and control conditions was demonstrated between 3 months and less than 12 months follow-up indicating eSBI is an effective intervention.
The hazardous and harmful use of alcohol is a global problem, contributing 4.6% of the total global burden of disease, with the highest rates reported in the European and American regions (17.3% and 14.2%, respectively) [
The widespread use of computers, the Internet, and smartphones has led to the development of electronic systems to deliver SBI that can potentially address some of the barriers to implementation of traditional face-to-face SBI. Electronic SBI (eSBI) has the potential to offer greater flexibility and anonymity for the individual and reach a larger proportion of the in-need population. For both adults and adolescents, eSBI (computer-, Web-, and phone-based) can offer effective delivery of interventions in both educational and health care settings that may prove to be more acceptable than more traditional (face-to-face) approaches [
The current study aims to conduct a systematic review and meta-analysis of the available literature to determine the effectiveness of eSBI over time in nontreatment-seeking hazardous/harmful drinkers.
A systematic search of the literature was conducted to identify randomized controlled trials investigating the effectiveness of eSBI to reduce alcohol consumption. Relevant studies were identified through searching the electronic databases PsychINFO, Medline, and EMBASE in May 2013. The search strategy was adapted from the search terms used for the National Institute for Health and Care Excellence (NICE) guideline systematic review for the effectiveness of acamprosate/naltrexone [
Electronic database search terms.
Search term topic | Search terms |
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1. alcohol-related disorder.mp. |
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2. alcohol drinking.mp. |
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3. (alcohol and (use$ or abuse or misuse or dependen$ or drink$ or intoxication$ or disorder$ or consumption)).mp. |
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4. exp Alcoholism/ or (alcoholi$).mp. |
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5. ((hazard$ or binge or heavy or harmful or risk$) and drink$).mp. |
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6. 1 or 2 or 3 or 4 or 5 |
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7. limit 6 to abstracts |
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8. (drinker$1 or (drink$ adj2 use$1) or ((alcohol$ or drink$) adj5 (binge$ or disorder$ or harm$ or hazard$ or heavy or high risk or intoxicat$ or misus$ or problem$))). ti.ab. |
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9. 7 or 8 |
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10. exp Text Messaging/ or ((text-messag$) or (SMS) or (short message service) or (text adj messag$)).mp. |
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11. ((phone adj application$) or (phone adj app)).ti,ab,kw. |
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12. ((social-network) or ( social network) or (social-media) or (social-media)).ti,ab,kw. |
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13. skype.ti,ab,kw. |
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14. exp telemedicine/ |
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15. facebook.ti,ab,kw. |
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16. ((personal adj digital adj assistant) or pda).ti,ab,kw. |
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17. (surf$ near4 internet$).ti,ab,kw. |
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18. (surf$ near4 web$).ti,ab,kw. |
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19. (virtual adj reality).ti,ab,kw. |
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20. Second life.ti,ab,kw. |
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21. User-computer interface/ |
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22. (consumer adj health adj informatics$).ti,ab,kw. |
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23. ((e adj health) or e-health or (electronic adj health)).ti,ab,kw. |
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24. (interactive adj ((health adj communicat$) or televise$ or video$ or technolog$ or multimedia)).ti,ab,kw. |
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25. ((bulletin adj board$) or bulletinboard$ or messageboard$ or (message adj board$)).ti,ab,kw. |
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26. (blog$ or web-log$ or weblog$ ).ti,ab,kw. |
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27. ((chat adj room$) or chatroom$).ti,ab,kw. |
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28. (online or on-line).ti,ab,kw. |
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29. exp internet/ or ((internet adj based) or internet-based).ti,ab,kw. |
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30. ((web adj based) or web-based).ti,ab,kw. |
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31. ((world adj wide adj web) or (world-wide-web) or WWW or (world-wide adj web) or (worldwide adj web) or website$).ti,ab,kw. |
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32. ((electronic adj mail) or email$ or email$).ti,ab,kw. |
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33. (((mobile or cellular or cell or smart) adj (phone$ or telephone$)) or smartphone).ti,ab,kw. |
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34. ((CD adj ROM) or cd-rom or cdrom or (compact adj dis$)).ti,ab,kw. |
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35. (decision adj (tree$ or aid$)).ti,ab,kw. |
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36. (Internet or (local adj area adj network)).ti,ab,kw. |
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37. (computer$ or microcomputer$ or laptop).ti,ab,kw. |
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38. exp Software-/ |
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39. exp Computer-Graphics/ |
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40. exp Public-Health-Informatics/ |
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41. exp Audiovisual-Aids/ |
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42. exp Decision-Support-Techniques/ |
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43. exp Medical Informatics/ |
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44. exp Computer-Systems/ |
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45. (or/10-44) |
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46. alcohol reduction.mp. |
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47. brief intervention.mp. |
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48. early intervention.mp. |
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49. minimal intervention.mp. |
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50. alcohol therapy.mp. |
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51. Harm Reduction/ |
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52. screening.mp. |
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53. (counseling or counselling).mp. |
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54. controlled drinking.mp. |
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55. (brief counseling or brief counselling).mp. |
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56. physician based intervention.mp. |
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57. general practitioner intervention.mp. |
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58. Secondary Prevention/ |
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59. general practitioner’s advice.mp. |
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60. brief physician-delivered counseling.mp. |
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61. brief nurse-delivered counseling.mp. |
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62. identification.mp. |
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63. intervention.mp. |
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64. or/46-63 |
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65. exp clinical trial/ or (crossover procedure or double blind procedure or placebo$ or randomization or random sample or single blind procedure).sh. |
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66. exp clinical trial/ or cross-over studies/ or double-blind method/ or random allocation/ or randomized controlled trials as topic/ or single-blind method/ |
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67. exp clinical trial/ or (placebo or random sampling).sh. |
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68. (clinical adj2 trial$).tw. |
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69. (crossover or cross over).tw. |
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70. (((single$ or doubl$ or trebl$ or tripl$) adj5 blind$) or mask$ or dummy or singleblind$ or doubleblind$ or trebleblind$ or tripleblind$).tw. |
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71. (placebo$ or random$).mp. |
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72. (clinical trial$ or controlled clinical trial$ or random$).pt. or treatment outcome$.mp. |
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73. animals/ not human$.mp. |
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74. animal$/ not human$/ |
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75. (or/65-72) not (or/73-74) |
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76. and/9,45,64,75 |
The inclusion criteria for this review were as follows:
Randomized controlled, parallel group trial comparing eSBI with a control condition (ie, care as usual, assessment only, nonintervention);
Participants were identified, through screening, as consuming alcohol to a hazardous level;
Measured alcohol reduction by independent reports of drinking quantity (eg, average consumption of alcohol per specified time period), including self-reports or reports from others of drinking frequency (eg, number of drinking occasions per specified time period), drinking intensity (eg, number of drinks per drinking day), or drinking within recommended limits (eg, official recommendations per specified time period), or levels of laboratory markers of reduced alcohol consumption, such as serum gamma-glutamyltransferase (GGT) or mean corpuscular volume (MCV); and
Trial arms had at least 10 participants.
We defined eSBI as an electronic intervention aimed at providing information and advice designed to achieve a reduction in hazardous/harmful alcohol consumption with no substantial face-to-face therapeutic component. SBI was defined as a brief intervention comprised of a single session, ranging from 5-45 minutes in duration, and up to a maximum of 4 sessions aimed at providing information and advice designed to achieve a reduction in hazardous/harmful alcohol consumption. Studies were not deemed eligible for inclusion if participants were alcohol dependent, mandated to complete eSBI, or a preselected specific group such as pregnant women. There were no restrictions on age.
After each search, references were downloaded to the electronic bibliographic management software EndNote and duplicates were removed. Relevant titles were first identified and then abstracts were screened against inclusion criteria. If insufficient information was available in the abstract, the full text was retrieved. Eligibility was confirmed by at least one other member of the review group. The methodological quality of each study was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) validated checklist [
High quality: Majority of criteria met with little risk of bias and conclusions unlikely to change by further research.
Adequate: Most of the criteria met with some risk of bias and conclusions may change in light of further research.
Low quality: Most criteria not met or significant flaws relating to key aspects of the study design and conclusions likely to change in light of future research.
A Microsoft Word-based form was used to extract data from eligible research papers. Data extraction was conducted independently by 2 members of the research team and consensus agreement reached by discussion between the 2 members if discrepancies arose. An intention-to-treat analysis was used wherever possible. If the study was a 3-arm trial, the control group sample size was divided by 2; if it was a 4-arm trial, it was divided by 3 to avoid double counting.
For the continuous variable (grams ethanol consumed per week) the mean difference was weighted using the random-effects method based on the inverse-variance approach to control for differences in sample size between studies. Alcohol consumption data are often not normally distributed. Because of this, some studies reported the sample median and range/interquartile range (IQR) and not the mean and standard deviation (SD). If appropriate data were not available in the published research papers, to calculate an effect size (ie, the mean, SD, and sample size), authors were contacted to request the required data. If the authors were unable to provide this data, the mean and SD were imputed from the median and range using the method proposed by Hozo et al [
Alcohol consumption, reported as the number of standard drinks per week, was converted into grams of ethanol per week using the definition for a standard drink reported in the research article. If this was not reported, the established standard for the country in which the research took place was used [
To check for the consistency of effects across studies, Cochran
The length of follow-up period can vary between individual studies and there may be more than one point of follow-up per study. Therefore, subgroup analysis was performed for up to 3 months, between 3 and less than 6 months, between 6 and less than 12 months, and 12 months or greater follow-up length postintervention.
A total of 23 studies were deemed eligible for inclusion in this systematic review [
Size and nature of study population and method of recruitment.
Study IDa | Male, n (%) | Mean age (SD) | Population | Recruitment | |
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24 (100) |
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Japan, employees of a manufacturing plant with available annual health check-up data | Not reported | |
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eSBI (n=12) |
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44.3 (7.2) |
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Control (n=12) |
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43.8 (7.3) |
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Netherlands, adult general population | Visitors to the Collaborating Substance Abuse Treatment (SATC) website | |
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eSBI (n=68) | 40 (58.8) | 41.1 (9.6) |
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Control (n=69) | 35 (50.7) | 43.7 (9.3) |
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450 (100) |
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Netherlands, adults in the general population | Nationally representative online household survey | |
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eSBI (n=230) |
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40.6 (15.2) |
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Control (n=220) |
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40.3 (15.1) |
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United States, undergraduate university students | Not reported | |
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eSBI (n=30) | 11 (36.7) | 20.6 (1.48) |
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Control (n=26) | 9 (34.6) | 20.4 (1.49) |
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Canada, adults in the general population | Randomly selected from an on-going general population telephone survey | ||
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eSBI (n=92) | 53 (57.6) | 39.5 (13.5) |
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Control (n=93) | 45 (48.4) | 40.8 (13.4) |
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118 (52.5) | 22.6 (12.2) | Canada, university students | Randomly selected using student email addresses | |
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eSBI (n=211) |
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Control (n=214) |
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Sweden, third-year university students | Email invitation to all third-year students | ||
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eSBI (n=330) | 152 (46.1) | N (%):18-20=43 (13), 21-25=264 (80), ≥26=23 (7) |
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Control (n=324) | 120 (37.0) | N (%) : 18-20=49 (15), 21-25=233 (72), ≥26=29 (9) |
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Denmark, adults in the general population | Identified through the Danish Health Examination Survey, those identified as heavy drinkers were sent an email invitation to take part | |
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eSBI PFI (n=476) | 271 (56.9) | median=61 |
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eSBI PBA (n=450) | 246 (54.7) | median=59 |
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Control (n=454) | 244 (53.7) | median=60 |
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United States, university students | Identified through advertisements in the college newspaper and around the campus | |
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Exp 1: eSBI (n=65) | 41 (63.1) | 20.5 (1.80) |
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Exp 1: Control (n=79) | 49 (62.0) | 20.3 (1.63) |
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Exp 2: eSBI (n=42) | 23 (54.8) | 20.0 (1.52) |
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Exp 2: Control (n=40) | 23 (57.5) | 20.3 (2.09) |
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32 (52.5) | Males=46.1 (13.8); females=45.2 (9.4) | United States, adult general population | Identified through advertisements in the media | |
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eSBI (n=35) |
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Control (n=26) |
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Australia, random sample of undergraduate university students | Students were sent a letter by mail followed by an email containing a Web link to the study questionnaire; up to 4 email reminders were sent | |
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eSBI=1251 | 687 (54.9) | 19.7 (1.8) |
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Control=1184 | 645 (54.5) | 19.7 (1.8) |
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New Zealand, users of a university student health service | Those leaving the student health service reception desk were consecutively approached and invited to participate | |
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eSBI (n=138) | 67 (48.6) | 20.1 |
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Control (n=146) | 70 (47.9) | 20.1 |
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New Zealand, Maori university students | Invited by email with up to 3 reminder emails | |
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eSBI (n=939) | 35.7 | 20.2 (1.9) |
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Control (n=850) | 33.2 | 20.1 (2.2) |
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52 (50.0) |
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New Zealand, users of a university student health service | Those checking into the reception of the student health service were invited to take part | |
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eSBI (n=51) |
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19.9 (1.4) |
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Control (n=53) |
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20.5 (1.8) |
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18.5 (2.04) | United States, university students enrolled in first-year orientation | All students enrolled for first-year orientation were invited to take part | |
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eSBI specific (n=75) |
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eSBI neutral (n=82) |
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Control (n=88) |
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18.6 (1.2) | United States, university students | Students enrolled in introductory classes were invited to take part | |
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eSBI (n=45) |
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Control (n=42) |
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104 (41.3) | 18.5 (1.24) | United States, university students from psychology classes | Students attending psychology classes were invited to take part | |
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eSBI (n=126) |
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Control (n=126) |
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208 (42.4) |
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United States, incoming university freshmen students | Incoming university freshmen were invited to complete a Web-based survey sent via email and post | |
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eSBI GSF (n=163) |
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eSBI GNSF(n=164) |
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Control (n=163) |
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Germany, trauma center | Patients attending a trauma center were invited to take part after provision of initial care and resolution of significant pain | |
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eSBI (n=561) | 449 (80.0) | median=30 |
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Control (n=575) | 449 (78.1) | median=31 |
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18.6 (1.45) | United States, university students attending an introductory psychology class | Students attending an introductory psychology class were invited to take part | |
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eSBI (n=56) |
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Control (n=63) |
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Netherlands, volunteer members of an open access panel aged 15-20 | Registered members of an open access panel were invited to take part via email | |
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eSBI NNF (n=192) | 74 (38.5) | 18.2 (1.55) |
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eSBI NF (n=193) | 82 (42.5) | 18.1 (1.54) |
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Control=190 | 69 (36.3) | 18.1 (1.59) |
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United States, university students | Invited to participate via email using an online participant pool management system | |
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eSBI (n=39) | 18 (46.2) | 20.3 (1.67) |
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Control (n=37) | 19 (51.4) | 20.3 (1.49) |
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19.8 (SD not reported) | United States, university students | University students invited via email, presentations, and posters at the university | |
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eSBI (n=67) |
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Control (n=69) |
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a eSBI: electronic screening and brief intervention; GNSF: gender-nonspecific; GSF: gender-specific; NF: intervention with normative feedback; NNF: intervention without normative feedback; PBA=personalized brief advice intervention; PFI=brief personalized feedback intervention.
Characteristics of screening, experimental, and control interventions, and nature and timing of assessments.
Study ID | Screening cutoffa | eSBI detailsa | Control group | Dropouts at follow-up, n (%)a |
Araki et al, 2006 [ |
Abnormal levels of gamma-glutamyl transpeptidase | Personalized feedback and advice sent via 2 emails 1 month apart; encouraged to ask questions via email | Assessment only | 2 mo: (1 participant was not included in the analysis but the group that they were randomized to was not reported) |
Blankers et al, 2011 [ |
AUDIT score ≥8 and reported drinking average 14 standard drinks per week | Access to an online self-help program based on motivational interviewing and cognitive behavioral therapy principles, suggested daily use for 4 weeks | Assessment only | 3 mo: eSBI: 20 (29.4), control: 18 (26.1) |
Boon et al, 2011 [ |
Exceeding Dutch guideline for low risk drinkers (>20 alcohol units per week or > 5 alcohol units on a single occasion on at least 1 day/week) | Single, 20-min brief personalized feedback session through website with the opportunity to print the feedback | Assessment and educational leaflet, instructed to read the leaflet for 20 min and could print the material | 1 mo: eSBI: 18 (7.8), control: 19 (8.6) |
Butler et al, 2009 [ |
≥2 binge drinking occasions (≥5 drinks in 1 sitting for men and 4 or more for women) and 2 alcohol-related problems in the past 28 days Standard drink=14 g ethanol | Single, average 11-min session of computer-delivered personalized feedback and a paper copy to take home | Assessment only | 4 w: eSBI: 9 (30.0), control: 4 (15.4) |
Cunningham et al, 2009 [ |
Score ≥4 on the AUDIT-C (standard drink=13.6 g ethanol) | Single, 10-min session completing Check Your Drinking online intervention of normative and personalized feedback | Assessment and a list of possible components to include in an intervention | 3 mo: eSBI=7 (7.6), control: 3 (3.2) |
Cunningham et al, 2012 [ |
Score ≥4 on the AUDIT-C | Access to the Check Your Drinking University version online intervention of normative and personalized feedback; intervention could be accessed repeatedly | Assessment only | 6 w: eSBI: 59 (28.0), control: 75 (35.0) |
Ekman et al, 2011 [ |
(1) Weekly alcohol consumption >120 g ethanol (women) or 180 g ethanol (men) in a typical week in the past 3 months and/or (2) engaged with heavy episodic drinking defined as consuming ≥48 g of ethanol (women) or ≥60 g of ethanol (men) on ≥2 occasions in the past month | Single session intervention of personalized normative feedback delivered via email | Assessment and brief feedback consisting of 3 statements | 3 mo: eSBI: 125 (37.9), control: 113 (34.9) |
Hansen et al, 2012 [ |
Above recommended max drinking limit set by the Danish National Board of Health of 14 drinks/168 g ethanol for women or 21 drinks/252 g for men (standard drink=12 g ethanol) | PFI: fully automated, Internet-based single session of brief personalized and normative feedback; PBA: fully automated, Internet-based single session of brief personalized feedback and advice | Assessment only | 6 mo: eSBI PFI: 186 (39.0), eSBI PBA: 171 (38.0), control: 150 (33.0) |
Hester et al, 2012 [ |
Met the National Institute for Alcohol and Alcohol Abuse (2004) criteria for heavy episodic drinking of ≥4 drinks per occasion (women) or ≥5 drinks per occasion (men) at least once in past 2 weeks and an estimated peak blood alcohol concentration of 80 mg% or more (standard drink=14 g ethanol) | Self-guided College Drinkers Check-up, delivered online, single session taking up to 35 min to complete; assessment, normative feedback, and advice | Assessment only | Exp 1 (1 mo): eSBI: 2 (3.1), control: 2.5) |
Hester et al, 2005 [ |
Score ≥8 AUDIT (standard drink=14 g ethanol) | Computer-based DCU, assessment, feedback, and decision-making modules; single session can take up to 90 min to complete with the option of printing the feedback | Assessment only | 4 w: not reported |
Kypri et al, 2009 [ |
Score ≥8 on AUDIT and exceeding the Australian National Health and Medical Research Councils guideline for acute risk (defined as 4 standard drinks for women or 6 for men in a single occasion in the last 4 weeks); standard drink=10 g ethanol | Single online session of personalized feedback | Assessment only | 1 mo: eSBI: 288 (23.0), control: 237 (20.0) |
Kypri et al, 2008 [ |
AUDIT score ≥8; standard drink=10 g ethanol | Single computer-delivered session of personalized and normative feedback taking a median 9.3 min to complete | Assessment and alcohol facts leaflet | 6 mo: eSBI: 22 (15.9), control: 22 (15.1) |
Kypri et al, 2013 [ |
Score ≥4 on AUDIT; standard drink=10 g ethanol | Single online session of personalized and normative feedback taking a median 4.3 min to complete | Assessment only | 5 mo: eSBI: 207 (22.0), control: 170 (20.0) |
Kypri et al, 2004 [ |
Score ≥8 on AUDIT and consuming >4 standard drinks for men or >6 for women on ≥1 occasion in past 4 weeks (standard drink=10 g ethanol) | Computer-delivered single session of personalized feedback | Assessment and alcohol facts leaflet | 6 w: eSBI: 9 (17.6), control: 12 (22.6) |
Lewis et al, 2007 [ |
≥1 heavy episode (≥4 standard drinks in 1 sitting for women and ≥5 standard drinks in 1 sitting for men) in the previous month; standard drink=14 g ethanol | eSBI specific: gender-specific Web-based personalized normative feedback; eSBI neutral: gender-neutral Web-based personalized normative feedback; feedback was read on screen and participants were given printout to take home | Assessment only | 5 mo: eSBI specific: 11 (14.7), eSBI neutral: 15 (18.3), control: 10 (11.4) |
Murphy et al, 2010 [ |
≥2 heavy drinking episodes in the past month (described as ≥4 standard drinks on 1 occasion for women and ≥5 standard drinks for men) or ≥1 heavy drinking episodes for minority students; standard drink=14 g ethanol | Interactive, Web-based intervention, E-CHUG (Electronic Check-up and Go), assessment and personalized feedback in a single session lasting up to 45 min with a brief comprehension test on completion | Assessment only | 1 mo: eSBI: 7 (15.6), control: 3 (7.1) |
Neighbors et al, 2004 [ |
≥1 heavy drinking episode in the previous month (defined as 4 standard drinks in 1 sitting for women and 5 standard drinks for men); standard drink=14 g ethanol | Single computer-delivered session of personalized normative feedback presented on screen for 1 min plus a printout | Assessment only | 3 mo: whole sample: 53 (21.0) |
Neighbors et al, 2010 [ |
≥5 drinks for men and ≥4 drinks for women on ≥1 occasions in the past month; standard drink=14 g ethanol | eSBI GSF: single session delivered online giving personalized gender-specific feedback; eSBI GNSF: single session delivered online giving personalized gender-nonspecific feedback | Assessment and an attention test (facts about the university students were presented in the same format as the intervention) | 6 mo: eSBI GSF: 10 (6.1), eSBI GNSF: 16 (9.8), control: 13 (8.0) |
Neumann et al, 2006 [ |
AUDIT score ≥5 | Single session of computer-generated feedback and a printout to take home | Assessment only | 6 mo: eSBI:=213 (37.9), control: 207 (36.0) |
Palfai et al, 2011 [ |
Hazardous drinkers who either (1) consumed alcohol in the past month and scored ≥8 on AUDIT or (2) reported ≥2 heavy drinking episodes (defined as ≥5 drinks for men or ≥4 drinks for women in the past month; standard drink=14 g ethanol) | Single computer-delivered session of personalized, normative, and gender-specific feedback | Assessment and health guidelines for sleep and consumption of fruit and vegetables | 1 mo: whole sample: 0 (0.0) |
Spijkerman et al, 2010 [ |
Age 15-16 y: engage in binge drinking at least once a month; age 17-20 y: engaged in binge drinking ≥1/week; binge drinking defined as drinking ≥4 alcoholic drinks for women or ≥6 for men on 1 occasion; standard drink=10 g ethanol | eSBI NNF: single online session of personalized feedback tailored to age and gender, took ~15 min to complete; eSBI NF: single online session of personalized normative gender- and age-specific feedback, took ~15 min to complete | Assessment only | 1 mo: eSBI NNF: 92 (47.9), eSBI NF: 93 (48.2), control: 68 (35.8)) |
Wagener et al, 2012 [ |
≥1 heavy drinking session (≥5 drinks on 1 occasion for men or ≥4 for women), drinking ≥20 drinks/month on average and experiencing negative consequences of that use in the last month (standard drink=14 g ethanol) | Single session using of computer-delivered assessment personalized feedback using an interactive program (DRAFT-CS), took ~45 min to complete; participants were given printout of their feedback | Assessment only | 10 w: eSBI: 2 (5.1), control: 3 (8.1) |
Walters et al, 2009 [ |
Reported ≥1 heavy drinking session in the past 2 weeks defined as ≥5 standard drinks for men and ≥4 standard drinks for women (standard drink=14 g ethanol) | eSBI: single session of personalized feedback delivered through the online Check-Up to Go | Assessment only | 3 mo: eSBI: 9 (13.4), control: 6 (8.7) |
a eSBI: electronic screening and brief intervention, AUDIT: Alcohol Use Disorders Identification Test, PFI: brief personalized feedback intervention, PBA: personalized brief advice intervention, DCU: Drinkers Check Up, GSF: gender-specific, GNSF: gender-nonspecific, NNF: intervention without normative feedback, NF: intervention with normative feedback, FBO: feedback only, DRAFT-CS: Drinking Assessment and Feedback Tool for College Students.
Flow diagram of study selection and inclusion.
Nine studies included data for a follow-up period of up to 3 months (mean 1.06 months, SD 0.18), 6 studies with a follow-up period between 3 and less than 6 months (mean 3.86 months, SD 1.07), 8 studies with a follow-up period between 6 and less than 12 months (all included studies had a follow-up period of 6 months ), and 5 studies included data for a follow-up period greater than 12 months (mean 16 months, SD 6.20) (
There was statistically significant and moderate heterogeneity between studies included at less than 3 months follow-up. Heterogeneity was not statistically significant for any of the other follow-up groups. Egger’s test was not statistically significant for all follow-up periods, indicating an absence of publication bias.
Results of meta-analysis including significance test and heterogeneity statistics.
Follow-up period | Sample size, n | Mean difference |
Heterogeneity statistic | |||||
|
Experimental | Control |
|
|
|
|
|
I2 |
<3 months | 1305 | 1307 | 2.67 | .01 | 17.19 | 8 | .03 | 53.5% |
3-6 months | 1211 | 811 | 2.34 | .02 | 8.62 | 6 | .20 | 30.4% |
6-12 months | 1921 | 1751 | 2.74 | .01 | 10.91 | 8 | .21 | 26.7% |
≥12 months | 899 | 816 | 0.82 | .41 | 8.49 | 5 | .13 | 41.1% |
Forest plot for weighted mean difference (WMD) in grams of ethanol per week at follow-up between those in the eSBI group and controls.
Mean difference in grams of ethanol per week at follow-up postintervention with 95% confidence intervals.
Participants in the intervention arm of the study conducted by Blankers et al [
The length of the intervention in the study conducted by Hester et al [
The quality of the evidence reviewed was considered to be acceptable with most studies included in this review assessed as being adequate in terms of their methodological quality. Three studies were considered to be of high methodological quality [
The results of this systematic review and meta-analysis suggest that eSBI is effective in reducing alcohol consumption in the follow-up postintervention period of less than 3 months, between 3 months and less than 6 months, and between 6 months and less than 12 months, but not in the longer term follow-up period of 12 months or longer. The overall mean difference in grams of ethanol per week consumed between those in the intervention and controls groups was 16.59 (
The pattern of results found here are in-line with the results of Cunningham et al [
There was a variation in the extent of eSBI delivered between studies included in this review with some interventions taking substantially longer to complete and one study encouraged daily use of their online self-help program [
A large attrition rate (up to 55%) has been noted in some of the eSBI studies included in this review. High attrition rates are common in electronic interventions for nontreatment-seeking individuals and reasons for this are likely to be complex and varied [
Seventeen studies were included in the meta-analysis and most of these took place in the United States and with student populations. Binge drinking among young adult and student populations continues to be a concern. In the United Kingdom, 45% of males and 46% of females aged 16-24 years drink more than twice the recommended amount of alcohol (3-4 units for males and 2-3 units for females) in a single session in the previous week [
The studies included in this meta-analysis also varied in the length, content, and theoretical basis of the intervention. Although almost all the included studies incorporated an element of personalized feedback as part of the intervention, there remains variation in both the mechanism and the context of how this was delivered. Further investigation into the effective components of these interventions was not possible and this should form an area for future research.
A comprehensive search strategy was used to identify relevant published randomized controlled trials for inclusion in this review and meta-analysis. However, it is possible that some trials may have been missed because unpublished research was not sought although an Egger’s test suggested that no publication bias was present.
The results of this systematic review and meta-analysis demonstrate significant reductions in weekly alcohol consumption between intervention and control conditions at a follow-up point of less than 3 months, between 3 and 6 months, and between 6 and 12 months; as such, eSBI should be judged an effective intervention, a recent review of effective interventions targeting adolescent populations adds further support for the use of Web-/smartphone-based technology [
Alcohol Use Disorders Identification Test
electronic screening and brief intervention
mean corpuscular volume
National Institute for Health Research
screening and brief intervention
Scottish Intercollegiate Guidelines Network
This study presents independent research funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research (RP-PG-0609-10162). Colin Drummond is partly funded by the NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King’s College London and partly funded by the NIHR Collaborations for Leadership in Applied Health Research and Care South London at King’s College Hospital NHS Foundation Trust. Thomas Phillips is funded by a NIHR Clinical Doctoral Research Fellowship. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health.
None declared.