1. Alcohol, Other Drugs, and Health: Current Evidence July-August, 2018
Journal Club
Alcohol, Other Drugs, and Health: Current Evidence
July-August, 2018

2. Gonzales NA, et al. JAMA Psychiatry. 2018;75(5):429–443.
Featured Article
Effect of middle school interventions on alcohol misuse and abuse in Mexican American high school adolescents: five-year follow-up of a randomized clinical trial
Gonzales NA, et al. JAMA Psychiatry. 2018;75(5):429–443.

3. Study Objectives
“To test whether a universal middle school prevention program can reduce the frequency of alcohol misuse and rates of alcohol use disorder 5 years after implementation” in children of Mexican Americans descent.

4. Study Design
516 Mexican-American 7th graders were randomized to a 9-session Bridges/Puentes family-focused group intervention or to a workshop control condition.
For this study, 420 of the students (81%) were followed up 5 years later, in their senior year of high school.
Follow-up assessments were for alcohol “misuse and abuse.”

5. Assessing Validity of an Article about Therapy
Are the results valid?
What are the results?
How can I apply the results to patient care?

6. Are the Results Valid? Were participants randomized?
Was randomization concealed?
Were participants analyzed in the groups to which they were randomized?
Were participants in the intervention and control groups similar?

7. Are the Results Valid? (cont‘d)
Were participants aware of group allocation?
Were outcome assessors aware of group allocation?
Was follow-up complete?

8. Were participants randomized?
Yes, a random number generator was used for randomization at the family level.
 A greater proportion of families were randomized to the intervention than control to ensure adequate intervention group size at each school

9. Was randomization concealed?
Yes.

10. Were participants analyzed in the groups to which they were randomized?
Yes.

11. Were the participants in the intervention and control groups similar?
Yes, by design there were more participants in the intervention group than control (276 versus 144).

12. Were participants aware of group allocation?
Yes.

13. Were outcome assessors aware of group allocation?
Interviews were conducted in the participants’ preferred language (English or Spanish) by linguistically matched interviewers who were blinded to condition. 

14. Was follow-up complete?
Of the 516 7th graders randomized, 420 (81%) were followed up 5 years later for this analysis.

15. How large was the treatment effect?
What Are the Results?
How large was the treatment effect?
How precise was the estimate of the treatment effect?

16. How large and precise was the treatment effect?
Compared with controls, students who were randomized to the preventive intervention were 2.5 times less likely to have had an AUD by senior year of high school, odds ration, 0.39; 95% CI,
Among students who had initiated alcohol use in middle school, students randomized to the intervention group reported less frequent alcohol use and “drunkenness”* in twelfth grade compared with those randomized to the control group.
There were no differences in frequency of alcohol use or “drunkenness” among students who initiated alcohol use after middle school.
* Based on responses to the 2001 Youth Risk Behavior Survey question: “During the past year, on how many days did you drink enough to feel pretty high/drunk?” 16

17. How Can I Apply the Results to Patient Care?
Were all clinically important outcomes considered?
Are the likely treatment benefits worth the potential harm and costs?

18. Were all clinically important outcomes considered?
The study may been underpowered to detect an impact on binge drinking.

19. Are the likely treatment benefits worth the potential harm and costs?
Costs were not discussed in this study, but the intervention was found to reduce harm among the students assessed.