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, Marta Trapero Bertrán (dir. tes.) , José-Rafael González-López (secret.) , Juan Oliva Moreno (voc.) , Julio López Bastida (voc.) , Caroline Clarke Hayes (voc.) Background: Alcohol abuse has been recognized as a global public health concern with high prevalence among adolescents, which has numerous health, social, and economic repercussions. In light of the need for prioritization and allocation of resources for public health interventions, the aim of this thesis is to assess the efficiency of Alerta Alcohol, a webbased computer-tailored intervention for the prevention of binge drinking (BD) among adolescents. To achieve this aim, the context surrounding adolescent drinking was examined and an analysis of the impact of binge drinking was carried out. The social, economic, and family factors associated with BD were explored, and a comparison was made between the health effects produced by the Alerta Alcohol programme as measured by health-related quality of life (HRQoL) and by reduction in excessive alcohol use. Methods: The study population consisted of adolescents aged 15 to 19 years enrolled in public high schools in Andalusia, Spain. The sample was part of a two-arm cluster randomized controlled trial, with an intervention group who received the Alerta Alcohol programme and a control group who did not receive any active intervention. Longitudinal analyses were carried out to address the objectives proposed using econometric procedures (negative binomial, two-part model, finite mixture model, and generalized estimating equations approach). For the economic evaluation, a decision tree analysis was used to estimate costs and health outcomes, and incremental cost-effectiveness and cost-utility ratios were calculated from the Spanish National Health Service (NHS) and societal perspectives. Uncertainty was dealt through a multivariate deterministic sensitivity analysis of best/worst scenarios by subgroups. Results: A total of 1,247 adolescents in the pre-intervention period and 612 in the four-month follow-up period formed the sample. In relation to socioeconomic and family factors associated with BD, being 17 years old or older and having more weekly pocket money and a higher family alcohol consumption frequency were associated with greater BD among adolescents. Additionally, higher adherence to the Alerta Alcohol programme was associated with a BD reduction at the four-month follow-up and with an increase in HRQoL, although this last effect was very small. Subjects who reduced their number of BD occasions reported higher perceived HRQoL. Based on the economic evaluation, the intervention was shown to be dominant from the societal perspective using both cost per BD occasion per month averted and cost per QALY gained as outcome measures. It could also be cost-effective, depending on willingness to pay from the NHS perspective. In addition, subgroup analyses found a greater efficiency for girls and older adolescents (aged 17 years or older) of both sexes. Conclusions: The findings in relation to social, family and economic factors associated with BD in adolescence could supplement prevention policies aimed at reducing the weekly pocket money or economic means available to adolescents, given the association between this variable and increased BD, and policies aimed at involving families in these interventions, given the influence of family alcohol consumption on this pattern of alcohol consumption. This type of programme based on computer-tailored feedback could be a cost-effective way to reduce and prevent BD and to increase QALYs in young people, but long-term followup would be needed to capture the full extent of the changes and effects of the programme, after introducing some improvements in the form of the intervention and the context in which it is carried out and after ensuring greater involvement of families.
