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Cited by 136Substance Abuse Treatment and OutcomesAlcohol Consumption and Health EffectsBehavioral Health and Interventions

How effective are brief interventions in reducing alcohol consumption: do the setting, practitioner group and content matter? Findings from a systematic review and metaregression analysis

Open access
Platt, Lucy, Melendez-Torres, G J, O'Donnell, Amy, Bradley, Jennifer, Newbury-Birch, Dorothy, Kaner, Eileen, Ashton, Charlotte·2016·BMJ Open
DOI 10.1136/bmjopen-2016-011473PMC PMC4985973
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Abstract

Background: While the efficacy and effectiveness of brief interventions for alcohol (ABI) have been demonstrated in primary care, there is weaker evidence in other settings and reviews do not consider differences in content. We conducted a systematic review to measure the effect of ABIs on alcohol consumption and how it differs by the setting, practitioner group and content of intervention. Methods: We searched MEDLINE, EMBASE, PsycINFO; CINAHL, Social Science Citation Index, Cochrane Library and Global Health up to January 2015 for randomised controlled trials that measured effectiveness of ABIs on alcohol consumption. We grouped outcomes into measures of quantity and frequency indices. We used multilevel meta-analysis to estimate pooled effect sizes and tested for the effect of moderators through a multiparameter Wald test. Stratified analysis of a subset of quantity and frequency outcomes was conducted as a sensitivity check. Results: 52 trials were included contributing data on 29 891 individuals. ABIs reduced the quantity of alcohol consumed by 0.15 SDs. While neither the setting nor content appeared to significantly moderate intervention effectiveness, the provider did in some analyses. Interventions delivered by nurses had the most effect in reducing quantity (d=−0.23, 95% CI (−0.33 to −0.13)) but not frequency of alcohol consumption. All content groups had statistically significant mean effects, brief advice was the most effective in reducing quantity consumed (d=−0.20, 95% CI (−0.30 to −0.09)). Effects were maintained in the stratified sensitivity analysis at the first and last assessment time. Conclusions: ABIs play a small but significant role in reducing alcohol consumption. Findings show the positive role of nurses in delivering interventions. The lack of evidence on the impact of content of intervention reinforces advice that services should select the ABI tool that best suits their needs.

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review and metaregression found that brief alcohol interventions produced small but statistically significant reductions in alcohol consumption, with provider—especially nurses—mattering more than setting or content. Brief advice was most effective for reducing quantity consumed, while evidence in community settings remained limited.

Key findings

  • Across 52 trials and 29,891 individuals, brief alcohol interventions reduced the quantity of alcohol consumed by 0.15 SDs (95% CI −0.20 to −0.10); the time-adjusted effect was similar (d=−0.15, 95% CI −0.20 to −0.11).
  • Interventions delivered by nurses had the largest effect on quantity consumed (d=−0.23, 95% CI −0.33 to −0.13), but not on frequency of alcohol consumption.
  • Brief advice was the most effective content for reducing quantity consumed (d=−0.20, 95% CI −0.30 to −0.09); motivational interviewing (d=−0.13) and MI plus (d=−0.16) also had statistically significant effects.
  • Neither setting nor content significantly moderated intervention effectiveness in the main multilevel models; community settings showed limited effect (d=−0.03, 95% CI −0.16 to 0.10), while university and primary/ambulatory care settings had significant effects (both d=−0.20).

Methods

  • Systematic review and metaregression of randomised controlled trials published in English, searched in MEDLINE, EMBASE, PsycINFO, CINAHL, Social Science Citation Index, Cochrane Library and Global Health up to January 2015; 52 trials met inclusion criteria.
  • Eligible participants were aged 16 years or older; studies of populations with complex health problems, specialist addiction/mental health/antenatal settings, computerised interventions, group interventions, and multi-behaviour interventions were excluded.
  • Outcomes were grouped into quantity and frequency indices; multilevel meta-analysis estimated pooled effect sizes with random effects at effect-size and study levels, and multiparameter Wald tests assessed moderators (setting, provider, content), with stratified sensitivity analyses at first and last assessment times.

Limitations

  • The paper states it could not explicitly model correlation between outcomes within studies, used Cohen’s d which limits comparability with alcohol reviews using standard drinks or grams of ethanol, lacked publication-bias tests suitable for multilevel meta-analyses, and had likely underpowered frequency metaregressions; it also did not examine sex, ethnicity or age as covariates due to sample size.
  • The paper notes that community-setting evidence relied on a small number of studies across varied settings, and that risk-of-bias sensitivity analysis was not possible because many metaregression categories would have made models underpowered.
  • Evident from the text: many studies had unclear risk of bias for blinding of participants/providers, blinding of outcome assessment, and intention-to-treat analysis, limiting full risk-of-bias assessment.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1136/bmjopen-2016-011473

Cites

102 of 102 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 25 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    A total of 52 studies met our inclusion criteria.

    “A total of 52 studies met our inclusion criteria, with three studies presenting different outcomes for the same data and therefore considered as one.35–37”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [35] source

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    • cites [36] source

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    • cites [37] source

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  • Findingown data

    Interventions delivered by nurses did not have a significant effect on frequency of alcohol consumption.

    “Interventions delivered by nurses had the most effect in reducing quantity (d=−0.23, 95% CI (−0.33 to −0.13)) but not frequency of alcohol consumption.”
    Quote in the paperSubstantial claim
  • Findingown data

    ABIs reduced the quantity of alcohol consumed by 0.15 SDs.

    “ABIs reduced the quantity of alcohol consumed by 0.15 SDs.”
    Quote in the paperSubstantial claim
  • Findingown data

    In unconditional models and models controlling for time of follow-up, study-level heterogeneity as measured by I2 was in the small-to-moderate range (0-40%) as defined by the Cochrane Handbook.

    “In unconditional models and models controlling for time of follow-up, study-level heterogeneity as measured by I2 (ie, the percentage of variation between effect sizes due to heterogeneity rather than chance) was in the small-to-moderate range (0–40%) as defined by the Cochrane Handbook.30”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [30] Higgins JPT , Green S , eds. Cochrane handbook for systematic reviews of interventions. Version 5.1.0. The Cochrane Collaboration, 2011.

      Not checked in the free run.

  • Findingown data

    A large proportion of studies did not provide information on other aspects of study design including blinding of participants to the intervention, intention-to-treat analysis and blinding to outcome measurements.

    “A large proportion of studies did not provide information on other aspects of the study design including blinding of participants to the intervention, intention-to-treat analysis and blinding to outcome measurements.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 21
  • Classified as probably not a substantial claim. 35
  • The quote only partly states this claim. 1

  • May combine two claims.

    Findingown data

    Interventions produced a beneficial effect at reducing the quantity of alcohol consumed by 0.15 SDs, a small but statistically significant effect.

    “Interventions produced a beneficial effect at reducing the quantity of alcohol consumed by 0.15 SDs—a small but statistically significant effect (see table 4).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The most common providers were counsellors, who were the sole providers of interventions in 43% of trials, and physicians, who accounted for 24% of trials.

    “The most common providers included counsellors, who were the sole providers of interventions in 43% of trials, and physicians who accounted for 24% of trials.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Included studies contributed data for 29 891 individuals.

    “Included studies contributed data for 29 891 individuals.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    A total of 50 trials reported 275 eligible effect sizes on outcomes measuring quantity of alcohol consumed, with a mean follow-up of 9 months.

    “A total of 50 trials reported 275 eligible effect sizes on outcomes measuring quantity of alcohol consumed with a mean follow-up of 9 months.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    Only six studies were conducted in community settings, defined as military, research sites recruiting through a household survey, women at risk of alcohol-exposed pregnancy, and one criminal justice setting.

    “Only six studies were conducted in community settings defined as: military;55 61 62 research sites recruiting a sample through a household survey;64 and women at risk of alcohol-exposed pregnancy”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Intervention categories were well distributed, though a majority of trials (47%) included motivational interviewing alone and 39% included MI 'plus'.

    “Intervention categories were well distributed, though a majority of trials (47%) included motivational interviewing alone and 39% included MI ‘plus’.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    A minority category of different providers (8%) included a combination of psychologists, social workers or research nurses.

    “A minority category of different providers (8%) included a combination of psychologists, social workers or research nurses.”
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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    In total, 68% of trials were delivered in primary or healthcare settings (hospital or A&E).

    “In total, 68% of trials were delivered in primary or healthcare settings (hospital or A&E).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Neither the setting nor content significantly moderated intervention effectiveness.

    “While neither the setting nor content appeared to significantly moderate intervention effectiveness, the provider did in some analyses.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The provider explained some heterogeneity (residual I2=43%, Wald p=0.05) with nurses having the biggest effect (d=−30, 95% CI −0.41 to −0.20) and interventions delivered by different providers having the least effect (d=−0.07, 95% CI −0.12 to −0.03).

    “Findings also suggest that the provider explained some heterogeneity (residual I2=43%, Wald p=0.05) with nurses having the biggest effect (d=−30, 95% CI (−0.41 to −0.20)) and interventions delivered by different providers had the least effect (d=-0.07, 95% CI (−0.12 to −0.03)).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Interventions delivered at least in part by nurses appeared to have the largest effect by magnitude on quantity outcomes (d=−0.23, 95% CI −0.33 to −0.13), though this difference was not supported by a significant joint test of moderators (Wald p=0.09).

    “Interventions delivered at least in part by nurses appeared to have the largest effect by magnitude (d=−0.23, 95% CI (−0.33 to −0.13)), though this difference was not supported by a significant joint test of moderators (Wald p=0.09).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    At the first time point for amount of alcohol per unit time, interventions delivered at least in part by nurses were the most effective (d=−0.30, 95% CI −0.47 to −0.12), with a significant joint test of moderators (Wald p=0.048).

    “Examination of effects at the first time point for the amount of alcohol per unit time showed that interventions delivered at least in part by the nurses (d=−0.30, 95% CI (−0.47 to −0.12)) were the most effective, with a significant joint test of moderators (Wald p=0.048; see online web appendix table 2).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Overall effect estimates based on first and last time point were similar to the corresponding value reported in the main analysis, but estimates of heterogeneity (measured through I2) tend to be higher.

    “Overall effect estimates based on first and last time point were similar to the corresponding value reported in the main analysis, but estimates of heterogeneity (measured through I2) tend to be higher.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The content of intervention explained some heterogeneity (residual I2=43%, Wald p=0.04), brief advice was the most effective (d=−0.25, 95% CI −0.42 to −0.07) and motivational interviewing was least effective (d=−0.09, 95% CI −0.15 to −0.04).

    “The content of intervention explained some heterogeneity (residual I2=43%, Wald p=0.04), brief advice was the most effective (d=-0.25, 95% CI (−0.42 to −0.07)) and motivational interviewing was least effective (d=-0.09, 95% CI (−0.15 to −0.04); figures 3–5).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    For all quantity outcomes, the setting of intervention did not appear to fully explain heterogeneity between studies, with residual heterogeneity at 34% and a non-significant joint test of moderators (p=0.09).

    “For all quantity outcomes the setting of intervention did not appear to fully explain heterogeneity between studies, with residual heterogeneity at 34% and a statistically marginal but non-significant joint test of moderators (p=0.09).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Interventions delivered by a range of different providers were least effective and did not yield a statistically significant effect.

    “Interventions delivered by a range of different providers were least effective and did not yield a statistically significant effect.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The provider of intervention explained some heterogeneity when the analysis was limited to the amount of alcohol per unit time (residual I2=32%, Wald p=0.01) but not per drinking occasion.

    “The provider of intervention explained some heterogeneity when the analysis was limited to the amount of alcohol per unit time (residual I2=32%, Wald p=0.01) but not per drinking occasion.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    For frequency outcomes, the provider of intervention did not explain heterogeneity either combined (Wald p=0.17) or for drinking occasion per unit time (Wald p=0.73), but the effect was marginal and non-significant for bingeing occasions (Wald p=0.07).

    “For frequency outcomes, the provider of intervention did not explain heterogeneity either combined (Wald p=0.17) or for drinking occasion per unit time (Wald p=0.73) but the effect was marginal, but non-significant, for bingeing occasions (Wald p=0.07).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    There was no evidence of heterogeneity for alcohol consumed per drinking occasion or for either subset of frequency outcomes.

    “There was no evidence of heterogeneity for alcohol consumed per drinking occasion or for either subset of frequency outcomes.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    We tested for the effect of hypothesised moderators by conducting a multiparameter Wald test on provider, setting or content coefficients as appropriate.

    “We tested for the effect of our hypothesised moderators by conducting a multiparameter Wald test on provider, setting or content coefficients as appropriate.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The systematic review protocol was registered on PROSPERO at the University of York (CRD42014014799).

    “The systematic review protocol was registered on PROSPERO at the University of York (CRD42014014799).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    10% of studies were double extracted.

    “These researchers jointly reviewed the extracted data and 10% of studies were double extracted.”
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    Study design and conductreasoning

    Models included random effects on the effect size and study levels because of anticipated heterogeneity both within and across studies.

    “Models included random effects on the effect size and study levels because of anticipated heterogeneity both within and across studies.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Data were extracted independently by GJM-T, LP, AO and JB without blinding authors' names, study site, intervention or trial results.

    “Data were extracted from each publication into a database piloted on five studies, independently by GJM-T, LP, AO and JB without blinding authors' names, study site, intervention or trial results.”
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    Study design and conductnone given

    The review used a multilevel meta-analysis approach.

    “A key strength of this review is the methodologically innovative approach to the meta-analysis through the use of a multilevel meta-analysis.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Existing systematic reviews have found variability in effect by duration of intervention or number of visits, but have not taken into account differences in content or provider.

    “Existing systematic reviews have found variability in effect by duration of intervention or number of visits, but this has not taken into account differences in content or provider.6–10”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [6] Kaner EF , Beyer F , Dickinson HO , et al . Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev 2007;(2):CD004148. doi:10.1002/14651858.CD004148.pub3 source

      Not checked in the free run.

    • cites [7] source

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    • cites [8] McCambridge, 2014, Should brief interventions in primary care address alcohol problems more strongly?, Addiction source

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    • cites [9] Alvarez-Bueno, 2015, Effectiveness of brief interventions in primary health care settings to decrease alcohol consumption by adult non-dependent drinkers: a systematic review of systematic reviews, Prev Med source

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    • cites [10] source

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    Study design and conductnone given

    Eligibility assessment was conducted independently by two reviewers.

    “Eligibility assessment was conducted independently by two reviewers.”
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    Study design and conductcitation

    For the main analysis, a multilevel meta-analysis method was used to estimate pooled effect sizes.

    “For our main analysis, we used a multilevel meta-analysis method to estimate the pooled effect sizes.33”
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    • cites [33] source

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    Study design and conductcitation

    The review followed the PRISMA guidelines on reporting of systematic reviews.

    “We followed the PRISMA guidelines on reporting of systematic reviews.29”
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    • cites [29] source

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    Study design and conductnone given

    Change score models were reparametrised into a raw score metric using r=0.5, with sensitivity analysis at r=0.1 and r=0.9.

    “Change score models were reparametrised into a raw score metric using r=0.5, with sensitivity analysis at r=0.1 and r=0.9.”
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    Study design and conductown data

    As a second sensitivity analysis, the findings from the multilevel model were compared with a stratified analysis focusing on a subset of outcome variables.

    “As a second sensitivity analysis we compared the findings from the multilevel model with a stratified analysis focusing on a subset of outcome variables.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    There is some emerging evidence that motivational interviewing can be more effective than 'traditional' advice across a range of health behaviours, but this is not conclusive.

    “Although there is some emerging evidence that motivational interviewing can be more effective than ‘traditional’ advice (based on a provider-centred definition of a problem) across a range of health behaviours,11 this is not conclusive.12”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [11] Rubak, 2005, Motivational Interviewing: a systematic review and meta-analysis, Br J Gen Pract

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    • cites [12] Gaume, 2014, Mechanisms of action of brief alcohol interventions remain largely unknown—a narrative review, Front Psychiatry source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    We did not undertake meta-analysis of effect sizes from common time points because these models would have been poorly powered.

    “We did not undertake meta-analysis of effect sizes from common time points because these models would have been poorly powered.”
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    Study design and conductown data

    Loss to follow-up was assessed in the majority (80%) of studies.

    “Intention-to-treat analysis was conducted in 47% of studies and loss to follow-up assessed in the majority (80%) of studies.”
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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    In addition to sensitivity analysis on the correlation used for repeated measures conversion, we estimated a set of metaregressions for each subset of outcomes including one effect size per relevant comparison for each of first and last follow-up in the included trials.

    “In addition to sensitivity analysis on the correlation used for repeated measures conversion, we estimated a set of metaregressions for each subset of outcomes including one effect size per relevant comparison for each of first and last follow-up in the included trials.”
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    Study design and conductnone given

    Quality assessment criteria were used to assess risk of bias.

    “Quality assessment criteria were used to assess risk of bias and the majority of studies were at low risk in relation to the randomisation procedure and monitoring of loss to follow-up.”
    Quote in the paperNot a substantial claim

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    Premisecitation

    Some benefits have been observed from a small number of studies in accident and emergency (A&E) departments, as well as in general hospital settings but among mainly male patients.

    “Some benefits have been observed from a small number of studies in accident and emergency (A&E) departments,19 20 as well as in general hospital settings but among mainly male patients.21 22”
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    Study design and conductown data

    Intention-to-treat analysis was conducted in 47% of studies.

    “Intention-to-treat analysis was conducted in 47% of studies and loss to follow-up assessed in the majority (80%) of studies.”
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    Premisecitation

    The evidence base in health settings beyond primary care is weaker with moderate or no effect found in college and community settings.

    “the evidence base in health settings beyond primary care is weaker with moderate or no effect found in college16 17 and community settings.18”
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    • cites 16 17

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    • cites [18] source

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    Disagreements between reviewers were resolved by consensus.

    “Disagreements between reviewers were resolved by consensus.”
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    Study design and conductnone given

    We additionally examined the residual heterogeneity, measured as I2, between the time-adjusted model and the models including each of the three sets of covariates.

    “We additionally examined the residual heterogeneity, measured as I2, between the time-adjusted model and the models including each of the three sets of covariates.”
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    Study design and conductcitation

    Risk of bias criteria were selected from recommendations in the Cochrane Collaboration Reviewers' Handbook to assess the quality of the trials.

    “We selected a list of risk of bias criteria from recommendations in the Cochrane Collaboration Reviewers' Handbook to assess the quality of the trials.30”
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    • cites [30] Higgins JPT , Green S , eds. Cochrane handbook for systematic reviews of interventions. Version 5.1.0. The Cochrane Collaboration, 2011.

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    Study design and conductown data

    The review conducted a second sensitivity analysis comparing the findings from the multilevel model with a stratified analysis focusing on a subset of outcome variables.

    “As a second sensitivity analysis, we compared the findings from the multilevel model with a stratified analysis focusing on a subset of outcome variables.”
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    Study design and conductnone given

    There was a low risk of bias in relation to some aspects of the study design (randomisation, loss to follow-up).

    “While there was a low risk of bias in relation to some aspects of the study design (randomisation, loss to follow-up)”
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    Premisecitation

    Other evidence shows a modest effect of brief interventions delivered by non-physicians (nurses and healthcare workers) in primary care settings.

    “This finding builds on other evidence showing a modest effect of brief interventions delivered by non-physicians (nurses and healthcare workers) in primary care settings.24”
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    • cites [24] source

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    Study design and conductreasoning

    Because of the substantial number of categories for many metaregressions, the review was unable to conduct a sensitivity analysis on risk of bias as that would have resulted in underpowered models.

    “Because of the substantial number of categories for many of our metaregressions, we were unable to conduct a sensitivity analysis on risk of bias as that would have resulted in underpowered models.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    One possible reason for the low heterogeneity is that including all relevant outcomes avoided some random errors that may arise when only selecting one outcome per study.

    “One possible reason for this is that because we included all relevant outcomes, we avoided some of the ‘random errors’ that may arise when only selecting one outcome per study.”
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    Study design and conductnone given

    The review was unable to explicitly model correlation between outcomes within studies.

    “However, we were unable to explicitly model correlation between outcomes within studies”
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  • Classified as probably not a substantial claim.

    Study design and conductown data

    The review's suggestion of limited effect in community settings relied on a small number of studies across a wide variety of settings.

    “but relied on a small number of studies across a wide variety of settings.”
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    Study design and conductnone given

    The review used the broadest categories appropriate for setting and provider of interventions.

    “While we used the broadest categories appropriate for setting and provider of interventions”
    Quote in the paperNot a substantial claim

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    Interpretationown data

    There were some reductions in heterogeneity in the multilevel analysis of amount of alcohol consumed per unit time, and interventions delivered by nurses had the most effect in reducing the quantity of alcohol consumed, but not the frequency of consumption.

    “We observed some reductions in heterogeneity in the multilevel analysis of amount of alcohol consumed per unit time, and interventions delivered by nurses having the most effect in reducing the quantity of alcohol consumed, but not the frequency of consumption.”
    Quote in the paperSubstantial claim

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    Interpretationreasoning

    The use of Cohen's d to standardise outcomes may somewhat limit comparability between reviews.

    “This may somewhat limit comparability between reviews”
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    Study design and conductreasoning

    Using Cohen's d to standardise outcomes was a critical step in employing the multilevel meta-analysis model used.

    “but it was a critical step in employing the multilevel meta-analysis model we used.”
    Quote in the paperSubstantial claim
53 of 53

  • The paper relies on this without support.

    Tests for publication bias do not yet exist for multilevel meta-analyses.

    “Tests for publication bias do not yet exist for multilevel meta-analyses.”
1 of 1

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Self-check

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Each contradiction between two passages listed here was confirmed by an independent check.

  • Setting moderator p value differs from table 4

    Minor

    The text reports p=0.09 for the setting moderator on all quantity outcomes, whereas table 4 reports p=0.12. Under the paper's stated thresholds, 0.09 is marginal and 0.12 is not.

  • Nurse effect size is reported as −30

    Minor

    The reported d=−30 is inconsistent with its confidence interval and with the nearby first-time-point nurse estimate of d=−0.30. The missing decimal point changes a conclusion-bearing effect size by a factor of 100.

  • Brief-advice confidence interval differs from table 4

    Minor

    The text gives the lower confidence limit for the brief-advice quantity effect as −0.30; table 4 gives −0.31 for the same estimate.

  • Included intervention exceeds the stated session limit

    Minor

    The eligibility criteria allow no more than four sessions, but the included Aalto intervention is listed as seven sessions.

  • Time-adjusted frequency effect is reported as the unadjusted value

    Minor

    The text calls the frequency effect of −0.15 time-adjusted, but table 5 lists −0.16 for the time-adjusted model. The table lists −0.15 for the unadjusted model.

5 of 5

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Authors
Platt, L., Melendez-Torres, G. J., O'Donnell, A., Bradley, J., Newbury-Birch, D., Kaner, E., & Ashton, C.
Affiliations
  • London School of Hygiene & Tropical Medicine (GB)
  • Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
  • Newcastle University (GB)
  • Health and Social Care Institute, Teesside University, Middlesbrough, UK
  • Camden & Islington Public Health, London Boroughs of Islington and Camden, London, UK
Corresponding author
Platt, Lucy
ORCID
Venue
BMJ Open
Publisher
BMJ
Published
2016-08
Volume
6
Issue
8
Pages
e011473
ISSN
2044-6055 (ISSN-L)
DOI
10.1136/bmjopen-2016-011473
PMC
PMC4985973
OpenAlex
W2517172516
Cited by
136
References
102
Citations by year
2026: 10 · 2025: 15 · 2024: 11 · 2023: 17 · 2022: 17 · 2021: 19 · 2020: 5 · 2019: 20 · 2018: 10 · 2017: 12
FWCI
1.88
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ Open (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • HighWire Press Open Archive (submittedVersion)
Funders
  • National Institute for Health and Care Research (SPCR-092)
  • Medical Research Council (MR/K02325X/1)
Topics
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
  • Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
Keywords
brief intervention, alcohol consumption, alcohol consumption reduction, intervention settings, intervention content, brief advice, nurses, primary care, moderators of intervention effectiveness
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Alcohol Drinking, Ethanol, Counseling, Female, Humans, Male, Middle Aged, Nurses, Young Adult

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-07.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-07.

Statistics and arithmetic are recomputed, not judged.

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