Randomized Trial of an Electronic Alcohol Screening Intervention (EASI) in a College Health Center

Introduction: College is an opportune time to intervene to reduce risky current alcohol use and prevent future problems. Many (44-65%) students binge drink, and consequences like injuries and unprotected sex are linked to drinking. Only about a third of students with alcohol use disorders receive treatment. Few (12%) student health centers use a standardized, evidence-based alcohol screening tool. This study examined 2 evidence-based tools (single-item 5/4 binge drinking and AUDIT) and brief interventions in a student health clinic. The purposes of the study are to: 1) examine provider experiences with alcohol screening/intervention; 2) investigate the influence of administration method on alcohol screening, and 3) investigate change in control over drinking, alcohol use, and alcohol consequences.

Methods: 259 students were randomized to Standard Care or Electronic Alcohol Screening Intervention (EASI). The Standard Care used the 5/4 binge drinking question; students with yes received education and/or a referral for treatment (provider discretion). EASI used the AUDIT; students with low-risk (AUDIT score 0-7) received feedback, moderate-risk (score 8-19) also received education, and high-risk (score 20+) also received counseling. Screens linked to intervention were administered via kiosk computer. Providers saw results in the EHR (e.g., AUDIT in EASI condition). Students completed an alternate screen (e.g., 5/4 question in EASI condition) on a tablet computer. Data collection of alcohol use and related problems is on-going with surveys emailed to students at 3-, 6-, and 12-months post-visit.

Results: Interview responses showed that providers were generally supportive with alcohol screening, but had concerns about time requirements. On average students rated their comfort with alcohol screening as a 7.27 on a 10 point scale (10 = extremely comfortable). Students were more likely to complete screening with the single-item screen on the kiosk (93% vs. 73%, p < .001), but completion rates were similar with the tablet (95% vs. 98%, p = .265). The AUDIT identified fewer students (14%) than the 5/4 question (49%), p < .001. Preliminary results showed a trend for students in EASI to have over twice the odds (OR = 2.26, p = .063) of taking steps to reduce alcohol use post-visit than Standard Care.

Conclusions: Universal alcohol screening in student health is acceptable to both providers and students. Using a 10-item screen on a kiosk does not reach as many students as using a single-item, but this can be mitigated by using a tablet along with a personal request. Two-stage screening may increase reach of screens. Preliminary results showed that EASI increased control over drinking, and may be linked to reduced alcohol use and associated problems over follow-up.