Nurse-Led Approaches to Lowering Alcohol Use among Adolescents: Study Findings
, Andreia Lima 1,4, Carla Sílvia Fernandes 1, Ariana Pereira 5, Dulce Lemos 6, Lúcia Pereira 6, Raquel Delgado 7, Sandra Rodrigues 2,3 and Francisco Sampaio 1
Michaela Miertová
Round 1
Reviewer 1 Report
Comments and Suggestions for Authors
This study explores the effectiveness of nurse-based interventions in reducing alcohol consumption among adolescents contributes to an essential area of public health. However, several key aspects could enhance the study's rigor and depth:
- Novel Contribution and Clarity on Uniqueness:
The study lacks explicit identification of its novelty. Clarifying what this study offers beyond existing literature would strengthen its significance. The study already referenced several existing studies that support the role of healthcare professionals, particularly nurses, in addressing alcohol consumption among adolescents.
- Setting and Participant Selection Details:
Detailed clarification regarding the selection criteria for the participants from the private school in northern Portugal would provide insights into the representativeness of the sample.
Information on the baseline characteristics of the participants, including the number of regular alcohol consumers and their demographics, would aid in understanding the specific population under study.
- Data Reporting and Intervention Specifics:
Clarity is needed on how the data regarding alcohol consumption were collected and reported. Understanding the methods of assessment and measurement tools used would validate the findings.
Specific details about the intervention delivery, particularly whether the school nurses were involved or if it was other types of nurses, such as mental health nurses, would offer a clearer understanding of the intervention's execution.
- While the study highlights the importance of nurse-led interventions, it would be beneficial to underscore the unique findings or aspects of this particular intervention that contributed to its success.
- Emphasizing the specific implications derived from this study's findings for future interventions or policy-making would further strengthen its impact.
Author Response
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Reviewer 1 |
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This study explores the effectiveness of nurse-based interventions in reducing alcohol consumption among adolescents contributes to an essential area of public health. However, several key aspects could enhance the study's rigor and depth: |
Thank you for your thoughtful feedback and constructive suggestions. We highly value your input and have carefully considered your comments to improve the rigor and depth of our study. |
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Contribution and Clarity on Uniqueness: |
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The study lacks explicit identification of its novelty. Clarifying what this study offers beyond existing literature would strengthen its significance. The study already referenced several existing studies that support the role of healthcare professionals, particularly nurses, in addressing alcohol consumption among adolescents. |
We have introduced one paragraph (lines 149-156) to clarify your concerns. In this added section, we highlight the unique aspects of our study that contribute to the existing literature. Our study focuses on the Portuguese adolescent population, taking into account unique cultural and sociodemographic factors. We also underscore the pivotal role of the school health team, especially school nurses, in delivering motivational and brief interventions, providing a practical perspective within a school environment. These distinctive elements set our study apart and enhance its significance in addressing adolescent alcohol consumption. |
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Setting and Participant Selection Details: |
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Detailed clarification regarding the selection criteria for the participants from the private school in northern Portugal would provide insights into the representativeness of the sample. |
The section detailing participant selection (2.2 Participants) has been revised to provide a clearer explanation of the selection procedure.
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Information on the baseline characteristics of the participants, including the number of regular alcohol consumers and their demographics, would aid in understanding the specific population under study. |
Table one and Table 2. Include baseline information
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Data Reporting and Intervention Specifics |
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Clarity is needed on how the data regarding alcohol consumption were collected and reported. Understanding the methods of assessment and measurement tools used would validate the findings. |
Done
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Specific details about the intervention delivery, particularly whether the school nurses were involved or if it was other types of nurses, such as mental health nurses, would offer a clearer understanding of the intervention's execution. |
The section detailing participant selection (2.5 Participants) has been revised to explain the intervention delivery, more clearly |
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While the study highlights the importance of nurse-led interventions, it would be beneficial to underscore the unique findings or aspects of this particular intervention that contributed to its success. |
Done
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Emphasizing the specific implications derived from this study's findings for future interventions or policy-making would further strengthen its impact. |
The conclusion has been revised to provide emphasizing the specific implications |
Reviewer 2 Report
Comments and Suggestions for Authors
1. The description of brief interventions is fine, but providing an example and discussing effectiveness would be helpful here. If this lack of discussion is due to length limits, I would suggest cutting down on the discussion of problems caused by alcohol use among adolescents. The issues with adolescent alcohol use are well established and could probably be discussed in a single paragraph instead of 3-4. That suggestion of where to make cuts if length is an issue applies when making all revisions also.
2. Were T-tests used to assess differences in pre/post test scores? It is unclear which specific method was used to analyze the data.
3. Further, what is the point of collecting all of the demographic information if the study would just use a pre/post test design anyway? Additional clarity about the choice of measurement for certain constructs left unexamined in this study would be helpful.
4. Is there any good reason that a randomized control trial could not be used here? Or even a quasi-experimental design with matched treatment and control groups? While I understand that the overall N was rather small, this still seems like a bit more work could have been done and increased the validity of findings substantially and it is unclear why this was not done.
5. There doesn’t appear to be any discussion of the finding that only the AUDIT-1 scores were significantly different from pre to post test (other than the global scores). Why might this have been affected by the intervention, but not AUDIT-2 and AUDIT-3 scores?
Author Response
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Reviewer 2 |
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The description of brief interventions is fine, but providing an example and discussing effectiveness would be helpful here. If this lack of discussion is due to length limits, I would suggest cutting down on the discussion of problems caused by alcohol use among adolescents. The issues with adolescent alcohol use are well established and could probably be discussed in a single paragraph instead of 3-4. That suggestion of where to make cuts if length is an issue applies when making all revisions also. |
Some changes made |
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Were T-tests used to assess differences in pre/post test scores? It is unclear which specific method was used to analyze the data. |
The statistical analysis was re-conducted because of an error identified in the initial questionnaire |
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Further, what is the point of collecting all of the demographic information if the study would just use a pre/post test design anyway? Additional clarity about the choice of measurement for certain constructs left unexamined in this study would be helpful. |
We appreciate the reviewer's comment regarding the collection of demographic information and the choice of measurement for certain constructs in our study. Collecting demographic information, even in a pre/post-test design, serves multiple purposes. Firstly, it helps provide a comprehensive description of the study population, which can aid in better understanding the context and characteristics of the participants. Secondly, demographic data can be used for subgroup analyses, which can be valuable for exploring potential variations in intervention effects based on different demographic factors (e.g gender). While our primary analysis followed a pre/post-test design, we recognize the importance of demographic information for potential secondary or exploratory analyses. Regarding the choice of measurement for certain constructs, we agree that additional clarity in the manuscript would be beneficial. While our study focused on assessing the effectiveness of the intervention in reducing or eliminating alcohol consumption, we understand that there are other relevant constructs, such as attitudes towards alcohol, knowledge about its risks, and behavioral intentions, which were not examined comprehensively in this study. We acknowledge the importance of these constructs and their potential influence on alcohol consumption behaviors. In future research, it would be valuable to incorporate a more comprehensive set of measurements to assess these constructs and their potential mediating or moderating roles in the context of the intervention. We thank the reviewer for highlighting these points, and we will consider providing additional clarification in the manuscript to address these concerns and limitations. |
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Is there any good reason that a randomized control trial could not be used here? Or even a quasi-experimental design with matched treatment and control groups? While I understand that the overall N was rather small, this still seems like a bit more work could have been done and increased the validity of findings substantially and it is unclear why this was not done. |
We appreciate the reviewer's insightful comment regarding the use of a randomized control trial (RCT) or a quasi-experimental design with matched treatment and control groups in our study. While these designs indeed offer advantages in terms of enhancing the validity of findings, there were practical constraints that influenced our research design. Firstly, the study was conducted in a small private school with only one class per year, resulting in a limited pool of potential participants. This inherently restricted the feasibility of creating adequately sized control and treatment groups that would yield statistically meaningful results in an RCT or matched design. The small N, as the reviewer correctly pointed out, was a significant limiting factor. Additionally, the nature of our intervention, which involved a motivational group session and the distribution of questionnaires within a single class, made it challenging to implement a traditional control group. The students were from the same class, and separating them into distinct control and treatment groups within the same class would have been logistically complex and may have influenced interactions and behaviors among the students. Given these practical limitations and the small sample size, we opted for a quasi-experimental design with a single-group pre-test and post-test approach. While this design has inherent limitations in terms of internal validity compared to RCTs or matched group designs, it allowed us to assess the effects of the intervention within the constraints of our study setting. We acknowledge that a larger sample size and more robust research design would have been preferable for achieving higher validity. However, given the specific context of our study and the practical constraints, we believe that the chosen design still provides valuable insights into the potential effectiveness of the intervention. We have discussed these limitations in the manuscript to provide transparency and context for our findings. |
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There doesn’t appear to be any discussion of the finding that only the AUDIT-1 scores were significantly different from pre to post test (other than the global scores). Why might this have been affected by the intervention, but not AUDIT-2 and AUDIT-3 scores? |
The statistical analysis was re-conducted because of an error identified in the initial questionnaire. As the AUDIT questionnaire had a substantial number of missing questions, we made the decision to switch to another questionnaire, prompting the need for a statistical re-evaluation. |
Reviewer 3 Report
Comments and Suggestions for Authors
Dear Authors,
below are some suggestions for minor revision of text
Key words: to add „consumption“, „FRAMES method“
Participants: to add information regarding study data aminidstration
2.3. Inclusion criteria: proposal to modify the name, not Inclusion criteria, but Inclusion and exclusion criteria
Little mistake in Institutional Review Board Statement: “The.....
Little mistake in Funding and Conflict of interest – there is a full stop missing at the end of sentence.
References: There are small formal errors in the references (marked green color – as a example) - it needs to be adjusted according to the guidelines
As example: McCabe, E. M., Davis, C., Mandy, L., & Wong, C. (2022). The Role of School Connectedness in Supporting the Health and Well- 451 Being of Youth: Recommendations for School Nurses. NASN School Nurse, 37(1), 42-47. doi:10.1177/1942602X211048481
Author Response
Dear Revisor
We thank you for your evaluation and the positive and constructive feedback, which we have considered as much as possible. Thanks to your feedback and the additions/changes, the article is much better quality. Below are our responses to each of your comments, followed by the elements as they are now set out in the article.
Author Response File: 
Author Response.pdf
Reviewer 4 Report
Comments and Suggestions for Authors
The importance of interventions to prevent or reduce alcohol use are very important. It is also important to highlight interventions that do not have statistical significance. I wonder if this study would have been enhanced if clinical significance was evaluated.
Comments for author File: Comments.pdf
Comments on the Quality of English Language
Needs editing- see my comments in the manuscript.
Author Response
We would like to thank you for your evaluation and the positive and constructive feedback, which we have considered as much as possible. You can follow responses to your comments, followed by the elements as they are now set out in the article.
Author Response File: Author Response.pdf
Reviewer 5 Report
Comments and Suggestions for Authors
Reviewed Report on the manuscript entitled: Effectiveness of a Nurse-Based Intervention in Reducing Alcohol Consumption among Adolescents: Findings from a pre-post study
The aim of the paper was to identify the effects of motivational session programs and brief interventions in reducing or eliminating alcohol consumption in students. The study utilized a pre-post design to evaluate changes in alcohol consumption before and after the intervention.
Main Contributions
Exploration of a nurse-based intervention's effectiveness in addressing adolescent alcohol consumption, filling a gap in literature. Utilization of a pre-post study design, providing valuable insights into the potential impact of the intervention over time. Focus on a vulnerable population adolescent and addressing a significant public health concern that is alcohol consumption.
Strengths
The main strength of the paper is the fact that it focuses on a relevant and important topic within the field of adolescent health. Utilization of a pre-post study design allows for the examination of changes in alcohol consumption directly attributable to the intervention. Potential for practical implications in healthcare settings by highlighting the role of nursing staff in addressing adolescent alcohol use.
Weaknesses and Areas of Improvement
Lack of discussion on study limitations, which is crucial for interpreting the findings accurately and assessing the study's generalizability. Absence of recommendations based on the findings, limiting the practical implications of the research.
SPECIFIC COMMENTS
Abstract.
The abstract is well written and it captured all the relevant sections of the study.
Introduction
Authors made certain statements without referencing them. For instance, in page 2, line 73-74, the authors made this statement without reference “Group Motivational Intervention (GMI) is a dependent healing method that employs 73 the concepts of Motivational Interviewing within a group setting”.
Again, in line 81-86 in page 2, the authors made this long statement without reference. “In a comparative study conducted in Providence, Rhode Island - USA, a total of 215 adolescent users of alcohol and other drugs were selected to participate in two types of therapy: one group received MI sessions. The other group received a feedback report 83 based on screening questionnaires and up to five minutes with the therapist to clarify doubts about the information they received. This latter group was called "Feedback only". Both groups underwent two follow-up evaluations: one at six months and another at 12 months after the interventions”.
Methods
Inclusion Criteria
In page 4, line 187-188, the authors made this statement that need to be revised: “The exclusion criterion needed to have signed the informed consent form on the day of data collection, which was sent to the legal guardian for validation”.
Presentation of results
In page 7, the results in Table 2 are not presented clearly and too crowded. Authors should format the table.
Conclusion
In page 10-11. The authors provided the conclusion of the study. The conclusion was based on the findings of the study. However, the manuscript lacks a comprehensive discussion on the limitations of the study. Every research endeavour has its constraints, whether related to sample size, methodology, or external factors. Acknowledging these limitations is crucial for interpreting the findings accurately and providing a context for future research. Without a discussion of limitations, readers may question the validity and generalizability of the results.
Also, the authors did not provide recommendations based on their findings. The absence of recommendations undermines the practical implications of the study. Researchers typically offer recommendations to guide healthcare practitioners, policymakers, and other stakeholders on potential interventions or strategies based on the study outcomes. Without such guidance, it becomes challenging to translate research findings into actionable steps for improving adolescent health outcomes related to alcohol consumption.
In conclusion, while the study contributes to the understanding of nurse-based interventions in reducing adolescent alcohol consumption, there are areas for improvement regarding study limitations and recommendations. Addressing these weaknesses would strengthen the study's impact and applicability in addressing adolescent alcohol use in healthcare settings.
Comments on the Quality of English Language
The English language used in the report is clear, concise, and effectively communicates the study's aim, methodology, and findings. The sentence structure is varied, contributing to readability, and technical terms are appropriately used within the context of the study. Overall, the report demonstrates a high level of proficiency in English language usage, facilitating understanding for readers.
Author Response
Dear Revisor 5
We thank you for your evaluation and the positive and constructive feedback, which we have considered as much as possible. Thanks to your feedback and the additions/changes made, the article is much better quality. Below are our responses to each of your comments, followed by the elements as they are now set out in the article.
Author Response File: Author Response.pdf
