title: Effects of a Web-Based Computer-Tailored Game to Reduce Binge Drinking Among Dutch Adolescents: A Cluster Randomized Controlled Trial.
abstract: BACKGROUND
  Binge drinking among Dutch adolescents is among the highest in Europe. Few interventions so far have focused on adolescents aged 15 to 19 years. Because binge drinking increases significantly during those years, it is important to develop binge drinking prevention programs for this group. Web-based computer-tailored interventions can be an effective tool for reducing this behavior in adolescents. Embedding the computer-tailored intervention in a serious game may make it more attractive to adolescents.
  
  
  OBJECTIVE
  The aim was to assess whether a Web-based computer-tailored intervention is effective in reducing binge drinking in Dutch adolescents aged 15 to 19 years. Secondary outcomes were reduction in excessive drinking and overall consumption during the previous week. Personal characteristics associated with program adherence were also investigated.
  
  
  METHODS
  A cluster randomized controlled trial was conducted among 34 Dutch schools. Each school was randomized into either an experimental (n=1622) or a control (n=1027) condition. Baseline assessment took place in January and February 2014. At baseline, demographic variables and alcohol use were assessed. Follow-up assessment of alcohol use took place 4 months later (May and June 2014). After the baseline assessment, participants in the experimental condition started with the intervention consisting of a game about alcohol in which computer-tailored feedback regarding motivational characteristics was embedded. Participants in the control condition only received the baseline questionnaire. Both groups received the 4-month follow-up questionnaire. Effects of the intervention were assessed using logistic regression mixed models analyses for binge and excessive drinking and linear regression mixed models analyses for weekly consumption. Factors associated with intervention adherence in the experimental condition were explored by means of a linear regression model.
  
  
  RESULTS
  In total, 2649 adolescents participated in the baseline assessment. At follow-up, 824 (31.11%) adolescents returned. The intervention was effective in reducing binge drinking among adolescents aged 15 years (P=.03) and those aged 16 years when they participated in at least 2 intervention sessions (P=.04). Interaction effects between excessive drinking and educational level (P=.08) and between weekly consumption and age (P=.09) were found; however, in-depth analyses revealed no significant subgroup effects for both interaction effects. Additional analyses revealed that prolonged use of the intervention was associated with stronger effects for binge drinking. Yet, overall adherence to the intervention was low. Analyses revealed that being Protestant, female, younger, a nonbinge drinker, and having a higher educational background were associated with adherence.
  
  
  CONCLUSIONS
  The intervention was effective for adolescents aged 15 and 16 years concerning binge drinking. Prevention messages may be more effective for those at the start of their drinking career, whereas other methods may be needed for those with a longer history of alcohol consumption. Despite using game elements, intervention completion was low.
  
  
  BACKGROUND
  Dutch Trial Register: NTR4048; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4048 (Archived by WebCite® at http://www.webcitation.org/6eSJD3FiY).
authors: School for Public Health and Primary Care CAPHRI, Department of Health Promotion, Maastricht University, Maastricht, Netherlands. astrid.jander@maastrichtuniversity.nl.
authors: Astrid
authors: http://orcid.org/0000-0003-0863-3884
authors: A
authors: Jander
authors: Rik
authors: http://orcid.org/0000-0002-3731-6610
authors: R
authors: Crutzen
authors: Liesbeth
authors: http://orcid.org/0000-0002-5719-7647
authors: L
authors: Mercken
authors: Math
authors: http://orcid.org/0000-0002-2229-1131
authors: M
authors: Candel
authors: Hein
authors: http://orcid.org/0000-0002-3640-2517
authors: H
authors: de Vries
mesh_terms: D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000517:prevention & control*; D063425:Binge Drinking / Q000517:prevention & control*; D002648:Child; D016000:Cluster Analysis; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D011795:Surveys and Questionnaires; D013548:Sweden; D018910:Video Games / Q000523:psychology*; D055815:Young Adult
keywords: adolescents; alcohol drinking; binge drinking; cluster randomized controlled trial; computer tailoring; serious games