Critical appraisal

Discuss About The Alcohol Availability At Home Parental Rules.

Alcohol is the most commonly used abused drug worldwide and the highest level of alcohol is consumed by the adolescent group of people. Excessive use of alcohol has both psychology and psychological effects that increases the risk of several health condition. Consumption of alcohol not only increases the burden of health but also affects a person economically. Indiscriminate use of alcohol by the adolescents has become a major concern for the government as illness due to alcohol accounts for huge financial burden on government (Mares et al., 2015). This paper would critically analyses a qualitative paper relating family dynamics and alcohol abuse among the adolescents and the quantitative paper would describe about the effectiveness of the personality targeted intervention in the programs for the adolescents.  The critical appraisal should be conducted by using the CASP tool analysis.

Conrod, P. J., O’Leary-Barrett, M., Newton, N., Topper, L., Castellanos-Ryan, N., Mackie, C., & Girard, A. (2013). Effectiveness of a selective, personality-targeted prevention program for adolescent alcohol use and misuse: a cluster randomized controlled trial. JAMA psychiatry, 70(3), 334-342. https://doi.org/10.1001/jamapsychiatry.2013.651

According to Banducci, Hoffman, Lejuez and Koenen (2014), the risk factor which makes the young adults or the adolescent susceptible for alcohol misuse is behavioural difficulties, emotional challenges, personality factors and other family related consequences. The aim of the research article mainly encompass implementation of the personality target approach over the secondary school students who are vulnerable in getting affected in substance abuse like the students suffering from anxiety sensitivity, Business, hopelessness and sensation seeking. The authors also undertook Teacher-Delivered Personality-Target Interventions for Substance Misuse Trial over the low-risk population in order to check the effect of the projected intervention over the herd community.

The recruitment of the patients to the study was completely randomised. 149 secondary schools, which are proximal to the research centre, were invited for the study of them, the first 21 schools who signed up for study were recruited and this constitutes 14% of the schools in comparison to the overall schools which were initially approached. The sample of each school was diverse with 41% from the ethnic background. The eligibility for the projected interventions upon the target population was determined via identification of youth who suffer from anxiety, sensitivity, impulsivity, hopelessness and have a tendency of sensation seeking (Conrod et al., 2013). According to Donovan, Paramasivan, de Salis and Toerien (2014), selection of the focus group of the study via randomised recruitment of the population in the focus group helps to increase the quality of the RCT study along with the reduction in the biased outcomes. Conrod et al., 2013 also conducted the recruitment process via masking and that too in a highly confidential manner. This concealing from the participants (focus group and the target group) further increased the quality of this RCT study (Donovan, Paramasivan, de Salis and Toerien, 2014).

Randomized recruitment process

It was a 24 month follow-up study. All the high risk (HR) and low risk (LR) patients (N= 2643) were invited to participate in the follow-up assessment during their school time under a periodic interval of 6, 12, 18 and 24 months after the interventions have been provided. However, one placebo school, the follow-up rates were hampered as they failed to arrange the same at 6-month interval. Another school experienced difficulty for a 24 month follow-up. In some schools follow-up was arranged through telephonic interview as the students were unable for face-to-face interview (Conrod et al., 2013). This lack of stringent follow up session hampered the overall outcome of the study. In RCT study, loss of follow-up or increase in the dropout rates cause the generation of biased outcomes (Brannen, 2017). However, the patients were analysed in different groups based on the different students with complete blinding of the students (Conrod et al., 2013).

The students who participated in the RCT and were provided interventions were not informed about the various other types of interventions that were being offered in their schools to their friends. They were also not aware which of their friends were called on to take a part in these other types of interventions. However, the teachers who were asked to access the outcome of the interventions via a periodic follow-up were aware of the reason of the interventions (Conrod et al., 2013). Thus the study was single blind and not double-blinded trial. According to Misra (2012) randomised double blinded study are the gold standards for the RCTs. The condition where the reviewer is aware of the projected outcomes and the nature of interventions applied in the study, is suppose to suffer from the interviewer bias, response bias and reporting bias. The presence of this kind of bias leads to the generation of the erroneous results.

The groups were similar at the initiation of the study. During the initiation of the study, the main target group of the students mostly constitute pupils who suffered from certain behavioural disorders which can make them prone to victims of the alcohol abuse in bear future. The behavioural or mental traits which were selected for the study include anxiety disorder, sensitivity disorder; suffer from hopelessness, impulsivity, sensation seeking (Conrod et al., 2013). Taking the similar focus group both for the placebo and the target group, helps in the generation of the unbiased results. Moroever the age bracket of the students was not large as all the secondary school students from grade 9 were selected for the study and this might increase the quality of the overall results. According to Brannen (2017), the groups which were similar both the initiation and after the follow up of the RCT study help in the achievement of the desired outcomes.

Follow-up assessment

The students of the selected secondary schools were randomised in order to provide a short personality targeted interventions to the high risk youth or treatment as usual for the statutory education in the domain of drug intake. Apart from the education and the interventions provided at school the students were set free at while at the home thus overall treatment occurring as the chosen zone of the research was equal for all the selected group of school students (Conrod et al., 2013). However, the rate of drinking or binge drinking might vary from students to students as the drinking study not only depends on the behavioural responses but also on the family influence (Banducci, Hoffman, Lejuez & Koenen, 2014). This lack of proper monitoring while the students are in their home might lead to the generation so biased response (Brannen, 2017).

The treatment effect that was measure during the study was the rate of drinking, rate of binge drinking and the problem of drinking. These outcomes are in sync with the scope of the study. The primary outcome of the study was mainly projected over the long-term benefits of this intervention on the drinking outcomes over the high risk patients who were selected and then randomised to receive a brief section of the personality-targeted interventions.  The primary outcome mainly showed that the drinking tendency was reduced among high risk youth along with delay in the natural progression towards more risky drinking behaviour like frequent binge drinking (Conrod et al., 2013). According to Moore et al. (2015), discussing the primary outcome of the study in a succinct manner helps to increase the quality of the RCT study.

The confidence interval of the study was selected as 95% while conducting the statistical analysis. According to Moore et al. (2015) Confidence interval is the interval estimate of the computed statistical data. 95% of the confidence interval significance the 95% of interval was computed for each sample and thus there is 0.95% probability of containing population mean. It other words it can be said that the 95% of the population distribution is selected under the confidence interval (Brannen, 2017). Having high confidence interval signifies standard statistical outcome and thereby increasing the overall strength of the results (Brannen, 2017).

The results cannot be applied to the local population and as the projected focus group of the study were secondary school children who were in their 9 standards. The mindsets of the young adults like those who are in college are different from the school level children and hence the results cannot be same when the same intervention was applied to the college youth population. However, the projected interventions can surely be applied in over other population in order to ascertain outcome. Moreover, the selected group of population is composed children who are with behavioural complications like anxiety and hopelessness (Conrod et al., 2013). This has further segregated the children population making the selected focus group very specific.

Single-blinded trial

All the clinically important outcomes like the drinking rates, binge drinking, growth in the binge drinking and problem drinking. All these outcomes were considered on the basis of the statistical analysis. The drinking quality was also accessed after the procurement of the interventions that is after the 24 months. However, the author could have access the mental status of the disease like the anxiety level and depression (Conrod et al., 2013).Via doing this, the authors might have ascertained the affect of the intervention on the mental health of the school students.

Yes the benefits are worth the harm and cost. This is because, it helped to get a ascertain the benefits of the selective school-based alcohol prevention programs, Teacher-Delivered Personality-Targeted Interventions over the control of the tendency of developing alcohol abuse over the vulnerable group of school student (Conrod et al., 2013). However, further studies are required to be undertaken in order to the effectiveness of the slected program over other diverse group of population. The selected intervention helped in the achieving a statistically significant outcome, the study is worth of costs and benefits.  Moreover, none of the participants were harmed in the study and the study provided a clear view of the effectiveness of the school based interventions.

References

Banducci, A. N., Hoffman, E. M., Lejuez, C. W., & Koenen, K. C. (2014). The impact of childhood abuse on inpatient substance users: Specific links with risky sex, aggression, and emotion dysregulation. Child abuse & neglect, 38(5), 928-938. https://doi.org/10.1016/j.chiabu.2013.12.007

Brannen, J. (2017). Mixing methods: Qualitative and quantitative research. management. https://www.taylorfrancis.com/books/9781351917186

Conrod, P. J., O’Leary-Barrett, M., Newton, N., Topper, L., Castellanos-Ryan, N., Mackie, C., & Girard, A. (2013). Effectiveness of a selective, personality-targeted prevention program for adolescent alcohol use and misuse: a cluster randomized controlled trial. JAMA psychiatry, 70(3), 334-342. https://doi.org/10.1001/jamapsychiatry.2013.651

Donovan, J. L., Paramasivan, S., de Salis, I., & Toerien, M. (2014). Clear obstacles and hidden challenges: understanding recruiter perspectives in six pragmatic randomised controlled trials. Trials, 15(1), 5. https://doi.org/10.1186/1745-6215-15-5

Misra, S. (2012). Randomized double blind placebo control studies, the “Gold Standard” in intervention based studies. Indian journal of sexually transmitted diseases, 33(2), 131. doi:  10.4103/0253-7184.102130

Moher, D., Schulz, K. F., Altman, D. G., & Consort Group. (2001). The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials. https://doi.org/10.1016/S0140-6736(00)04337-3

Moore, G. F., Audrey, S., Barker, M., Bond, L., Bonell, C., Hardeman, W., … & Baird, J. (2015). Process evaluation of complex interventions: nursing Research Council guidance. bmj, 350, h1258. doi: https://doi.org/10.1136/bmj.h1258