Epidemiology Case Study: Evaluating SMS Intervention on Binge Drinking

This case study critically appraises a randomized controlled trial (RCT) investigating the efficacy of an interactive text message (SMS) intervention in reducing binge drinking among young adults. The analysis encompasses the public health significance of binge drinking, the appropriateness of the RCT design, data collection methods, potential biases and confounding factors, and the validity of the study's findings. The study highlights the importance of addressing binge drinking due to its association with various negative consequences, and it assesses the effectiveness and cost-efficiency of using SMS interventions, particularly within college settings. The case study further explores the implications of the findings for educational institutions, government policies, and future research directions, emphasizing the potential of mobile technology in public health interventions. The Cochrane Collaboration’s Risk of Bias assessment tool is used to ensure the internal validity of the RCT.

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The Public health importance of the subject
Studies have been carried out on the prevalence of binge drinking among young adults. The
study by Tavolacci et al. (2016) reported that approximately 50% of college students were
engaged in binge drinking. Binge drinking leads to multiple injuries associated with alcohol
consumption and the development of illnesses linked to it (White and Hingson, 2013). Due to
the severe effects of binge drinking, several attempts have been made in an effort to try and
address the issue. For instance, Brief in-person interventions were proposed by Taggart et al.
(2013) tested and found to be effective, even though their impact was minimal compared to
the large population that is affected by the problem. Clark and Moss (2010) attributed the
ineffectiveness of such programs to the costs incurred in their implementations such as
offering continuous one-on-one counseling. Another approach is through the use of
automated interventions by use of mobile devices and the internet. Computerized procedures
allow standardization of support materials and low stigma with regard to individual reporting.
Carey et al. (2012) conducted a study on the effectiveness of using computerized alcohol
intervention and found out that they had short-term reductions in alcohol consumption among
college students. As a result, more other approaches such as mobile phones were later
introduced (Morgenstern, Kuerbis, and Muench, 2014). This approach is deemed useful
because the mobile phone is owned by most people and thus can reach a broad population
within a short time. Some of the effects of binge drinking include increased aggression, risky
sexual behaviour, suicidal behaviour and self-disclosure (White and Hingson, 2013). The
study aimed at assessing the efficacy of SMS intervention concerning the duration of its
effect. This study is therefore important because it aims at looking for a reliable and effective
intervention approach for binge drinking
The appropriateness of the study design

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The research used a randomized control trial (RCT). The study aimed at assessing the
stability of SMS intervention effects for six months after successful completion of the
intervention. The study reports participants to be young adults aged between 18 and 25 years
and were reimbursed for their time (US$10). Those that successfully completed the follow-
ups were also reimbursed in the following order; three months-$20, six months $30, and nine
months $40. The study randomly allocated the subjects to three groups and subjected them to
one of three treatments at a ratio of 2:1:1. One group received SMS assessment and feedback
(SA+F), the other SMS assessment, and the last one did not receive any SMS (control group).
The study used blocks of eight at all the places of recruitment assigned them to each group
electronically by using algorithms generated from the computer. Thus the sequence of
allocation was adequate leading to a low risk of bias. This also shows that the process was
truly random (Roever and Oliveira, 2015).
Methods of data collection
SMS was sent to the participants in the two experimental groups. The SA+F group received
two-way messages on Thursday and Sunday, the SA group only received SMS drinking
questions every Sunday, and the control group received none. After six to nine months of
registration, the subjects were to complete the surveys in the secured computer. Thus, data
were collected using online surveys.
Moreover, the study used blocks of eight at all the places of recruitment and assigned them to
each group electronically by using algorithms generated from the computer. The participants
were also not informed of the groups they were allocated, and the investigators were also not
made aware of the treatment allocation. These ensured adequate allocation concealment. This
also confirms sufficient blinding of the participants and researchers from the knowledge
regarding the interventions (Higgins et al., 2011).

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The study acknowledges missing outcome data, i.e., measure covariates and assert that it was
non-trivial. However, the study minimized any potential bias as a result of this missing data
by using multiple imputation procedures (McPherson et al., 2013) such as Poisson
distribution model for the frequency of drinking days, and logit distribution model for the
number of drinks per day. These measures ensured that the missing outcome data did not
have a significant impact on the outcomes. Thus, ensuring that there was no high risk of bias.
The study protocol is presented, and the findings can be pre-specified as primary and
secondary outcomes. In addition to enumerating the study procedures, the study has provided
a CONSORT diagram showing the details of the RCT and possible results. This indicates that
the study is free of selective reporting (Cheng et al., 2016).
Bias and confounding
Several attempts have been made in the study to minimize bias. The use of the self-guided
online system to collect data minimized any possibility of reporting bias (Suffoletto et al.,
2015). Furthermore, the author also ensured that only the participants were in the room
during the assessment, family and friends were requested to leave. Another step taken to
minimize reporting bias was to find out from the emergency department physicians about
their view on the association between the care counter and alcohol.
The study has described all measures to ensure that there is a low risk of performance bias.
For instance, the study has provided distinct differences between the study groups in addition
to blinding of participants and researchers about the knowledge of the intervention. The
subjects made aware of the groups they were allocated and the investigators were also
blinded of the treatment allocation. The blinding of study subjects and researchers also
minimized attrition bias.
The validity of the results

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The study can be said to be valid because of multiple reasons. The study has endeavored to
minimize and address all types of bias in the study. For instance, reporting bias, performance
bias, and attrition bias have been discussed in the research. According to Rothwell (2009), the
external validity of RCTs can be achieved by ensuring that the setting of the trial is described.
The study was web-based but still limited its participants to those found in Pittsburgh.
Participant selection has also been described in details, i.e., the inclusion and exclusion
criteria, the period for the intervention, and the random allocation ratio of the participants to
the groups. Rothwell (2009) observes that external validity in RCT is increased when there
are in-depth descriptions of the characteristics of the randomized patients. The research
provides the characteristics of the participants regarding their baseline characteristics.
Internal validity of the research has also been achieved. Savović et al. (2014) elucidate that
the Cochrane assessment tool is a most appropriate critical tool for internal validity of RCTs.
Based on the above critical analysis of the study using the Cochrane tool, it can be deduced
that the internal validity of the study was achieved. For instance, there is a ‘yes’ response to
all elements of the Cochrane tool
Implications of the study
The study found out that the use of an intervention that is computerized and with interactive
text message led to sustained reductions in the consumption of alcohol among college
students. The findings of this study have implications for different relevant institutions.
Studies have indicated that almost 50% of college students are alcoholic (Tavolacci et al.,
2016) despite the numerous interventions that have been implemented to help curb the
situation. The management of both public and private colleges can adopt this intervention to
address the issue of binge drinking among college students.

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Moreover, this approach is likely to be cost effective because it uses mobile devices that can
reach a large population. Studies have also linked high usage of mobile devices to youths.
Hence the intervention will be much appropriate for institutions of higher learning. The
ministry of education can also adopt this approach in ensuring that binge drinking among
youths is minimized. For instance, the government can implement the automated text
message- intervention in rehabilitation centers as a way of helping those addicted to alcohol
drinking. Additionally, this study acts as a basis for further research on the most appropriate
interventions for alcohol consumption among the young and old adults.

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References
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