The Alcohol Intervention Training Program (AITP): a response to alcohol misuse in the farming community

Background Farm men and women in Australia have higher levels of problematic alcohol use than their urban counterparts and experience elevated health risks associated with excessive alcohol consumption. The Sustainable Farm Families (SFF) program has worked successfully with farm men and women to address health, well- being and safety and has identified that further research and training is required to understand and address alcohol misuse behaviours. This project will add an innovative component to the program by training health professionals working with farm men and women to discuss and respond to alcohol-related physical and mental health problems. Methods/Design A mixed method design with multi-level evaluation will be implemented following the development and delivery of a training program (The Alcohol Intervention Training Program {AITP}) for Sustainable Farm Families health professionals. Pre-, post- and follow-up surveys will be used to assess both the impact of the training on the knowledge, confidence and skills of the health professionals to work with alcohol misuse and associated problems, and the impact of the training on the attitudes, behaviour and mental health of farm men and women who participate in the SFF project. Evaluations will take a range of forms including self-rated outcome measures and interviews. Discussion The success of this project will enhance the health and well-being of a critical population, the farm men and women of Australia, by producing an evidence-based strategy to assist them to adopt more positive alcohol-related behaviours that will lead to better physical and mental health.

The Alcohol Intervention Training Program (AITP) : a response to alcohol misuse in the farming community

Background
Farm men and women in Australia have higher levels of problematic alcohol use than their urban counterparts and experience elevated health risks associated with excessive alcohol consumption. The Sustainable Farm Families (SFF) program has worked successfully with farm men and women to address health, well- being and safety and has identified that further research and training is required to understand and address alcohol misuse behaviours. This project will add an innovative component to the program by training health professionals working with farm men and women to discuss and respond to alcohol-related physical and mental health problems.

Methods/Design
A mixed method design with multi-level evaluation will be implemented following the development and delivery of a training program (The Alcohol Intervention Training Program {AITP}) for Sustainable Farm Families health professionals. Pre-, post- and follow-up surveys will be used to assess both the impact of the training on the knowledge, confidence and skills of the health professionals to work with alcohol misuse and associated problems, and the impact of the training on the attitudes, behaviour and mental health of farm men and women who participate in the SFF project. Evaluations will take a range of forms including self-rated outcome measures and interviews.

Discussion
The success of this project will enhance the health and well-being of a critical population, the farm men and women of Australia, by producing an evidence-based strategy to assist them to adopt more positive alcohol-related behaviours that will lead to better physical and mental health.

Evaluation of an alcohol intervention training program for nurses in rural Australia

Aim: This paper reports on the development, implementation and evaluation of the Alcohol Intervention Training Program (AITP) designed to enhance nurses’ capacity to work with farming men and women who misuse alcohol.

Background: In rural and regional areas where alcohol-related behaviours and problems are relatively elevated, nurses may be the key health professionals dealing with individuals who misuse alcohol. However, they are often ill-equipped to do this, have low confidence in their ability to do so, and perceive numerous barriers. Training is required for these nurses.

Methods: We developed the AITP to enhance nurses’ capacity to work with people with alcohol-related problems. The data were collected during 2010. An intervention group of 15 rural nurses completed the AITP. Nurses’ perceived barriers, attitudes, and perceived performance in working with clients with alcohol problems, and the frequency of engaging with this client group were evaluated. Scores on these measures were compared to those of a control group of 17 nurses’ pre-treatment, post-treatment and at 3-month follow-up.

Results: Participation in the AITP resulted in initial improvements in attitudes to working with alcohol problems, but no change in perceived barriers to doing so. The level of engagement with clients having alcohol-related problems increased, as did perceptions of work performance.

Conclusion: The AITP enhances the ability of rural nurses to address the alcohol and associated health issues of clients in rural and regional areas. However, the program needs refinement and further evaluation.

Web-based alcohol intervention for Māori university students: double-blind, multi-site randomized controlled trial

AIMS: Like many indigenous peoples, New Zealand Māori bear a heavy burden of alcohol-related harm relative to their non-indigenous compatriots, and disparities are greatest among young adults. We tested the effectiveness of web-based alcohol screening and brief intervention (e-SBI) for reducing hazardous drinking among Māori university students. DESIGN: Parallel, double-blind, multi-site, randomized controlled trial. SETTING: Seven of New Zealand's eight universities. PARTICIPANTS: In April 2010, we sent e-mail invitations to all 6697 17-24-year-old Māori students to complete a brief web questionnaire including the Alcohol Use Disorders Identification Test (AUDIT)-C, a screening tool for hazardous and harmful drinking. Those screening positive were computer randomized to: <10 minutes of web-based alcohol assessment and personalized feedback (intervention) or screening alone (control). MEASUREMENTS: We conducted a fully automated 5-month follow-up assessment with observers and participants blinded to study hypotheses, design and intervention delivery. Pre-determined primary outcomes were: (i) frequency of drinking, (ii) amount consumed per typical drinking occasion, (iii) overall volume of alcohol consumed and (iv) academic problems. FINDINGS: Of the participants, 1789 were hazardous or harmful drinkers (AUDIT-C ≥ 4) and were randomized: 850 to control, 939 to intervention. Follow-up assessments were completed by 682 controls (80%) and 733 intervention group members (78%). Relative to controls, participants receiving intervention drank less often [RR = 0.89; 95% confidence interval (CI): 0.82-0.97], less per drinking occasion (RR = 0.92; 95% CI: 0.84-1.00), less overall (RR = 0.78; 95% CI: 0.69-0.89) and had fewer academic problems (RR = 0.81; 95% CI: 0.69-0.95). CONCLUSIONS: Web-based screening and brief intervention reduced hazardous and harmful drinking among non-help-seeking Māori students in a large-scale pragmatic trial. The study has wider implications for behavioural intervention in the important but neglected area of indigenous health.

Addressing alcohol related harms within maxillofacial trauma practice

Background A brief intervention, conducted in the acute setting care setting after an alcohol-related injury, has been reported to be highly beneficial in reducing the risk of re-injury and in reducing subsequent level of alcohol consumption. This project aimed to understand Australasian Oral and Maxillofacial Surgeons' attitudes, knowledge and skills in terms of alcohol screening and brief intervention within acute settings for patients admitted with facial trauma. Materials and Methods A web-based survey was made available to all members (n=200-250) of the Australian and New Zealand Association of Oral and Maxillofacial Surgeons (ANZAOMS), promoted through a number of email bulletins sent by the Association to all members. Implied consent is assumed for participants who complete the online survey. The survey explored their current level of involvement in treating patients with alcohol-relatd facial trauma, as well as their knowledge of and attitudes towards alcohol screening and brief intervention. The survey also explored their willingness for further training and involvement in implementing a SBI program. Parts of the survey were based on a hypothetical case with facial injury and drinking history which was presented to the participants and the participants were asked to give their response to this scenario. Results A total of 58 surgeons completed the on-line survey. 91% of surgeons surveyed were males and 88% were consultant surgeons. 71% would take alcohol history; 29% would deliver a brief alcohol intervention and 14% would refer the patients to an alcohol treatment service or clinician. 40% agreed to have adequate training in managing patients with alcohol-related injuries, while 17% and 19% felt they had adequate time and resources. 76% of surgeons reported the need for more information on where to refer patients for appropriate alcohol treatment. Conclusion The study findings confirm the challenges and barriers to implementing brief alcohol intervention in current practice. There are service gaps that exist, as well as opportunities for training.

An evaluation of a tiered interrelated intervention to address hazardous/ harmful drinking

In Northern Ireland, alcohol misuse impacts negatively on individual drinkers, families and communities. The ‘Alcohol and You Project’ in the South Eastern Health and Social Care Trust is a funded project providing a range of inter-related services with the Trust and alcohol/drug misuse charities. It includes a self-help interactive website, brief intervention drop in clinics and counseling services. Queen's University Belfast is evaluating the effectiveness of the project to reduce hazardous/ harmful drinking.

Training and experience of nurses in responding to alcohol misuse in rural communities

Objective Alcohol misuse by farmers continues to challenge rural nurses. This article reports on the experiences of Australian nurses participating in the Alcohol Intervention Training Program (AITP).

Design and Sample Qualitative interviews of 15 rural and remote nurses.

Measures Semi-structured phone interviews were utilized to assess the response to and implementation of the AITP—an intervention designed to build nurses' knowledge, confidence and skills when responding to alcohol misuse. It comprises practical and theoretical components and was designed for rural and remote settings where nurses encounter alcohol misuse.

Results Nurses found the training provided new—or built on existing—knowledge of alcohol misuse and offered practical hands-on “real life” skills. A range of workplace and personal situations where the content of the training was now being utilized were identified, and future use anticipated. Barriers to using the new knowledge and skills included both rural and generic issues. Constructive feedback to increasingly target the training to rural settings was recommended.

Conclusions The AITP is an effective training program. It can be further tailored to meet common needs of rural and remote nurses working with farmers who misuse alcohol, while recognizing diversity in rural practice.

Alcohol misuse interventions in the workplace: a systematic review of workplace and sports management alcohol interventions

Alcohol misuse has been linked to negative organizational outcomes, including reduced productivity and increased absenteeism. Additionally, media reports have focused on alcohol misuse within sporting organizations. Given the paucity of research evaluating alcohol misuse interventions in professional sporting organizations, two systematic literature searches were conducted. Review one examined alcohol interventions in the workplace, and Review two included sport as a search term. Resultant papers demonstrated four categories of workplace alcohol interventions; brief, web based, psychosocial, and random drug and alcohol testing. Brief interventions were prevalent, yielding largely non-significant results. Review two studies evaluated a community sporting intervention, which adopted an ecological, multi-level approach, yielding significant improvements in alcohol consumption, drink-driving, and club profitability. Brief interventions in workplaces were ineffective, and no brief interventions were found in elite sporting organizations. However, community sporting interventions showed promising results. Ongoing evaluation of alcohol interventions in professional sporting organizations are recommended.

Innovative Interventions with Alcohol Problems in Rural Areas: An Indian Experience and its Relevance to Rural America

Conventional interventions used to address the complex problems of substance abuse call for multifaceted approaches reflecting the diverse backgrounds of affected populations. In this paper the rural context is highlighted as an asset in contributing to sustainable recovery from alcohol problems. Against the background of comparing two international rural contexts and recognizing shared identities, a case is made for transfer of knowledge east to west. The success elements of a unique approach to intervention with problems associated with excessive drinking in rural areas of South India, based on the experiences of Community-Based Rehabilitation camps is described. Spanning two decades of systematic implementation, the camps utilize existing community resources for planning, execution, and follow-up of treatment while simultaneously creating greater awareness about alcohol abuse through community education. After a critical examination of prevailing treatment options for problem drinking in rural America, inter-country analysis reveals contextual similarities between rural America and rural South India based on community-orientation, cost-containment, and social capital formation with implications for rural social work intervention with alcohol problems in the United States.

Metabolic urinary profiling of alcohol hepatotoxicity and intervention effects of Yin Chen Hao Tang in rats using ultra-performance liquid chromatography/electrospray ionization quadruple time-of-flight mass spectrometry

This paper was designed to study metabonomic characters of the hepatotoxicity induced by alcohol and the intervention effects of Yin Chen Hao Tang (YCHT), a classic traditional Chinese medicine formula for treatment of jaundice and liver disorders in China. Urinary samples from control, alcohol- and YCHT-treated rats were analyzed by ultra-performance liquid chromatography/electrospray ionization quadruple time-of-flight mass spectrometry (UPLC/ESI-QTOF-MS) in positive ionization mode. The total ion chromatograms obtained from the control, alcohol- and YCHT-treated rats were easily distinguishable using a multivariate statistical analysis method such as the principal components analysis (PCA). The greatest difference in metabolic profiling was observed from alcohol-treated rats compared with the control and YCHT-treated rats. The positive ions m/z 664.3126 (9.00 min) was elevated in urine of alcohol-treated rats, whereas, ions m/z 155.3547 (10.96 min) and 708.2932 (9.01 min) were at a lower concentration compared with that in urine of control rats, however, these ions did not indicate a statistical difference between control rats and YCHT-treated rats. The ion m/z 664.3126 was found to correspond to ceramide (d18:1/25:0), providing further support for an involvement of the sphingomyelin signaling pathway in alcohol hepatotoxicity and the intervention effects of YCHT.

The next generation health intervention tool - Can smart phone applications help young people track and moderate alcohol use and potential harms?

Whilst alcohol is a common feature of many social gatherings, there are numerous immediate and long-term health and social harms associated with its abuse. Alcohol consumption is the world’s third largest risk factor for disease and disability with almost 4% of all deaths worldwide attributed to alcohol. Not surprisingly, alcohol use and binge drinking by young people is of particular concern with Australian data reporting that 39% of young people (18-19yrs) admitted drinking at least weekly and 32% drank to levels that put them at risk of alcohol-related harm. The growing market penetration and connectivity of smartphones may be an opportunities for innovation in promoting health-related self-management of substance use. However, little is known about how best to harness and optimise this technology for health-related intervention and behaviour change. This paper explores the utility and interface of smartphone technology as a health intervention tool to monitor and moderate alcohol use. A review of the psychological health applications of this technology will be presented along with the findings of a series of focus groups, surveys and behavioural field trials of several drink-monitoring applications. Qualitative and quantitative data will be presented on the perceptions, preferences and utility of the design, usability and functionality of smartphone apps to monitoring and moderate alcohol use. How these findings have shaped the development and evolution of the OnTrack app will be specifically discussed, along with future directions and applications of this technology in health intervention, prevention and promotion.