Preventing alcohol-related harm among young women: development and feasibility testing of a community-based group intervention

Binge drinking in social groups is common among young women. This study will develop a recruitment strategy and a gender and age sensitive group intervention to tackle binge drinking among women aged 18 - 34 years. If successful, the intervention will subsequently be tested in a full scale trial. The long term aim of the full study is to reduce the frequency of binge drinking among young women, many of whom are not aware that they drink at harmful levels.

This community-based feasibility study will be conducted in two phases. Phase one involves designing and testing a community based recruitment strategy. It will recruit participants through existing community groups and networks; adverts on two local radio stations; and a poster campaign. A graphic designer will work with the team to create posters and leaflets to advertise the study. Phase one will also develop the novel group intervention. The intervention is based on current psychological theories of behaviour change. The components of the intervention will be woven into fun social activities. Lay people will be trained to deliver the intervention. Six focus groups with young women will be convened to assist in the development of the recruitment strategy and the intervention.

The intervention has several innovative features that make it attractive to the target group. It is tailored for young women and capitalises on enhancing existing social networks and support systems that exist within social groups. The intervention augments the brief alcohol intervention, which is commonly used to reduce alcohol consumption. It uses the Health Action Process Approach which is designed to lead to behaviour change through three steps: promoting motivation to change; setting goals and implementing intentions to change; and devising coping plans and relapse prevention strategies. Thus the intervention will be delivered over three sessions. Fun group activities, which reinforce the three components of the intervention, will form the basis for the sessions: making alcohol free cocktails, a makeup demonstration and a relaxation class. Employing trained lay peers to deliver the intervention, will make the study more appealing to the participants. Motivation to change will be generated using motivational interviewing techniques. The women will be encouraged to make specific plans to change their behaviour and to think about ways to overcome barriers to change.

Phase 2 uses a before and after study design to assess whether the components of the intervention are likely to reduce the frequency of binge drinking. Young women who regularly drink together will be invited to participate in the study in groups (three to eight people). In total 20 pre-existing social groups will be recruited. Groups with different characteristics will be recruited eg work colleagues; young mothers; students; and unemployed young women from areas of high deprivation.

Women will be interviewed by telephone three months after the intervention. The study will use a range of measures to assess the acceptability of the study and its potential to be an effective strategy to reduce harmful drinking. The frequency of binge drinking (6 or more units of alcohol in a single session) in the previous 30 days will be measured at baseline and three months after the intervention. The study will also assess the impact of the study on perceptions of harms, the perceived benefits of moderated drinking; and beliefs in ability to reduce binge drinking. The extent to which the women made plans to reduce the frequency of binge drinking will be measured. The impact of the group support systems in influencing both individual and group drinking behaviour will also be assessed. As recruitment to community-based interventions is typically low, a market penetration survey of 300 young women exposed to the advertising campaign will also be conducted, to assess the impact of the advertising campaign.

This feasibility study will develop and test a community based group intervention designed to reduce binge drinking among young women aged 18 - 34 years. It follows the MRC guidelines for developing complex interventions. If successful the study will lead to a full scale trial.

Binge drinking among young women is a major problem. Current interventions do not reach large numbers of people who may be unaware that they are drinking at harmful levels. This study addresses this shortcoming by offering a gender and age sensitive intervention that can be rolled out in the community at low cost. Current brief alcohol interventions are based on social cognition models which target motivation. This study uses the Health Action Process Approach which was developed to overcome a weakness of previous theories (the so-called intention-behaviour gap). Like previous theories it addresses pre-intentional motivation processes (related to behavioural intention), but also gives emphasis to post-intentional volition processes (that lead to action). Volition is fostered by encouraging goal setting, action planning and maintenance self-efficacy. This includes coping planning (prepared strategies to overcome barriers), relapse management and recovery self-efficacy.

Among young people drinking is predominantly a social activity, but current brief interventions are delivered to individuals. This study will deliver the intervention to pre-existing social groups. By taking advantage of group dynamics and support structures, the intervention could be more effective than effective than existing individual interventions. Three evening sessions of enjoyable social activities will be used to deliver the theoretically and empirically based components of the intervention. The intervention will be delivered by trained lay peers, who may be more acceptable to young people than health professionals. This increases the potential for national roll out.

The long-term aim of this study is to reduce harmful drinking among young women. A key feature of the study is that it focuses on a group who are not aware that they are susceptible to alcohol related harm. If the intervention is shown to be successful in reducing binge drinking by young women, the potential beneficial effects would be seen far beyond the target group.

The young women taking part in the study would benefit immediately by avoiding acute harms from alcohol such as the risk of violence, injuries, and unintended and unprotected sex. They would also reduce their risk of developing diseases linked to alcohol misuse in the long term eg cancer, heart disease, liver disease, reproductive problems, osteoporosis, pancreatitis and mental health problems. Other groups that would benefit include unborn children who could be affected by mothers binge drinking in early pregnancy; families by reducing alcohol related family breakdown; and whole communities by the avoidance of social disruption.

Social disruption caused by alcohol is a major concern in communities. A change in attitudes and beliefs is required to achieve a culture shift to reject the view currently held by many young people; that being drunk is acceptable and normal. This study, by tackling the problem at the community level and targeting large numbers of people, has the potential to change the current culture of regular binge drinking by young people. The study, which focuses on the importance of "looking good, feeling great", aims to promote this shift in attitudes and beliefs.

Savings to the economy, both in the short term and long term could be enormous if the intervention is successful in changing the drinking patterns by young people and reducing alcohol related harm. The burden of alcohol problems is estimated to cost NHS, in England alone, in excess of £2.7 billion. The costs to society from crime and public disorder are estimated to exceed £7 billion and loss of productivity through alcohol related absenteeism is estimated to be more than £6 billion. If these costs can be reduced by changing patterns of drinking, society as a whole will benefit.

This feasibility study has potential benefits for policy makers, both in the UK and beyond. Public health policy makers recognise the need to implement a multifaceted strategy to tackle alcohol related problems. This community based approach to prevention could form a major plank of alcohol policy. The approach, if successful, also has the potential to reach large numbers of people with a range of unhealthy behaviours eg sedentary lifestyle, smoking, unhealthy eating patterns. The findings will therefore be useful to public health policy makers, local public health and health promotion teams, community groups and the voluntary sector.

This study will employ lay people to deliver the intervention. This offers the opportunity to reach large numbers of people, including hard to reach groups, at low cost. This approach could benefit local authorities and health boards who implement health initiatives within the community. At a personal level it will provide local people with valuable skills, providing them with new opportunities for employment, but also giving them the skills to act as advocates for sensible drinking within the community.