Web-based intervention to change perceived norms of college student alcohol use and sexual behavior on spring break

A systematic review on eHealth technology personalization approaches

Despite the widespread use of personalization of eHealth technologies, there is a lack of comprehensive understanding regarding its application. This systematic review aims to bridge this gap by identifying and clustering different personalization approaches based on the type of variables used for user segmentation and the adaptations to the eHealth technology and examining the role of computational methods in the literature. From the 412 included reports, we identified 13 clusters of personalization approaches, such as behavior + channeling and environment + recommendations. Within these clusters, 10 computational methods were utilized to match segments with technology adaptations, such as classification-based methods and reinforcement learning. Several gaps were identified in the literature, such as the limited exploration of technology-related variables, the limited focus on user interaction reminders, and a frequent reliance on a single type of variable for personalization. Future research should explore leveraging technology-specific features to attain individualistic segmentation approaches.

Booster effects and mechanisms of web-based personalised normative feedback alcohol intervention for college students: A pragmatic randomised controlled trial

BACKGROUND

To evaluate the effects of booster and no booster versions of web-based alcohol Personalised Normative Feedback (PNF) and whether descriptive norms mediated and/or participant motivation moderated the effectiveness of the intervention in real world conditions (i.e. no financial incentives).

METHODS

Pragmatic randomised controlled trial with 1-, 3-, and 6-month assessments. Brazilian college students reporting alcohol use in the last 12 months (N=931) were recruited from May/2020 to December/2022 and allocated to 1) No booster/single PNF(S-PNF); 2) Booster/multiple PNF(M-PNF); or 3) Assessment-only control. We applied Helmert coding [1: Any intervention (S-PNF or M-PNF) vs. Control; and 2: S-PNF vs. M-PNF].

PRIMARY OUTCOMES

typical number of drinks/week and maximum number of drinks/week; secondary outcomes: drinking frequency and number of consequences. Three-months assessment was the primary interval. Descriptive norms were tested as mediator. Interest, importance, and readiness to change were examined as moderators.

RESULTS

Compared to control, any intervention did not influence primary outcomes at 3-months or 6-months, but did at 1-month, when reduced typical drinking (IRR:0.77, 95%CI:0.66;0.90) and maximum number of drinks (IRR:0.69, 95%CI:0.58;0.82). There was an intervention effect on the consequences at 3-months. No differences were observed between S-PNF and M-PNF. No mediation effects were found at 3-months. At 6-months, there was an indirect effect on typical drinking through norms at 3-months (b=-0.82, 95%CI:-2.03;-0.12) and effects on maximum drinks through norms at 1-month (b=-0.54, 95%CI:-1.65;-0.02). No support for moderation was found.

CONCLUSIONS

Intervention reduced alcohol drinking at 1 month only and was not effective thereafter. Mechanisms of effect remain unclear.

A Mixed-Methods Approach to Develop a Combined Model of U.S. College Student Alcohol-Associated Condomless Sex

Unhealthy alcohol use and sexually transmitted infections (STIs) are significant public health concerns for US college students. Because alcohol use and condomless sex often co-occur in this population, alcohol-associated condomless sex has been identified as a behavioral intervention target. Existing theoretical frameworks have not garnered sufficient empirical support to serve as the foundation for interventions. The primary goal of the current study was to use a mixed-methods approach to develop a model of college student alcohol-associated condomless sex that combines elements from well-established health behavior theories. In Aim 1, multilevel modeling was used to predict condomless vaginal sex in a sample of heterosexual college student drinkers (N = 53). Aim 2 consisted of in-depth interviews (n = 18) to gather perceptions about the role of alcohol in sexual activity and identify supplemental constructs omitted from theories in Aim 1. The multilevel model explained a significant proportion of variance in condomless vaginal sex at the between- and within-person level. Themes derived from the in-depth interviews identified complementary elements of condom use decision-making. Findings from both aims were synthesized to construct a combined model of alcohol-associated condomless sex. This model can be further refined and ultimately serve as the foundation of an alcohol-STI prevention-intervention.

University-based behavioral interventions to promote safer sex practices: A systematic review and meta-analysis

OBJECTIVE

This study aims to critically review the characteristics and effectiveness of university-based intervention to promote safer sex practice.

PARTICIPANTS AND METHODS

The published studies were selected from 5 databases with the publication year restricted between 1974 and 2018. The data were then pooled using a random-effect meta-analysis.

RESULTS

A total of 41 studies with 10,144 participants were included from 5,253 potentially relevant citations. Compared with minimal intervention, those people who participated in the intervention reported a statistically significant increase in the frequency of condom use (SMD 0.61; 95%CI 0.46-0.77, I2 = 9%). There was an insignificant change after the intervention (SMD 0.34; 95%CI -0.04-0.72, I2 = 72%) in communication with sexual partners and the heterogeneity existed in diversity of sessions of the intervention.

CONCLUSION

Behavioral interventions can significantly increase in the frequency of condom use but not in communication with sexual partners. A standardized measurement is a necessary consideration for future studies.

A randomized controlled trial of an online alcohol and sexual risk prevention program for college students studying abroad

INTRODUCTION

American college students who study abroad experience increases in their drinking behavior, concerning risky sexual behaviors, and high rates of sexual violence while abroad. Despite these concerns, institutions offer limited programming to students prior to departure to address these risks and no empirically supported interventions currently exist that are targeted toward preventing increased drinking, risky sexual behavior, and sexual violence abroad. To help address alcohol and sexual risk abroad, we designed a brief, single-session online predeparture intervention focused on risk and protective factors known to associate with alcohol and sexual risk abroad.

METHODS

Using a sample of 650 college students from 40 home institutions, we conducted a randomized controlled trial of the intervention and tested its effects on drinking (drinks per week, binge drinking frequency, alcohol related-consequences), risky sexual behaviors, and sexual violence victimization during the trip abroad (first month, last month abroad) and one-month and three-months after return home.

RESULTS

We observed small, but nonsignificant, intervention effects on drinks per week and binge drinking days during the first month abroad and three months after they had returned home to the United States, and small, significant effects on risky sexual behaviors during the first month abroad. The study found no observable effects at any time point for alcohol-related consequences or for sexual violence victimization abroad.

CONCLUSIONS

Though mostly nonsignificant, small initial intervention effects were promising in this first empirical test of an alcohol and sexual risk prevention program for study abroad students. However, students may need more intensive programming with booster sessions to experience lasting intervention effects during this particularly high-risk period.

CLINICALTRIALS

GOV IDENTIFIER

NCT03928067.

"On a night like this": A mixed-methods approach to understanding high-risk drinking events in college students

BACKGROUND

Previous research indicates college students report heavier drinking on certain events (e.g., 21st birthday). While past research has identified heavier drinking events, students' own reports of which events are associated with elevated drinking remains understudied. The current study utilized mixed methods to explore potential high-risk drinking events (HRDE) for college student drinkers and how these events differed from typical drinking and each other.

METHODS

College student drinkers (N = 204) reported the number of drinks they consume on nine predetermined events (e.g., Halloween). Students also responded to open-ended questions listing five events during which they had elevated drinking and indicating the amount consumed on each event. Open-ended responses were coded into similar event categories. Descriptive statistics for drinks consumed were calculated for predetermined and coded open-ended events. Chi-square analyses assessed differences in endorsement of open-ended events by birth sex, age group, and Greek membership. Two multilevel count regressions assessed within-person differences in number of drinks consumed between participants' typical drinking occasions and (1) highly endorsed open-ended events and (2) predetermined events.

RESULTS

For all open-ended event categories, average number of drinks consumed exceeded heavy episodic drinking thresholds; however, there was substantial variability. Comparing predetermined events to participants' typical drinking indicated elevated drinking on participants' birthdays, New Year's Eve, Halloween, Finals, and Spring Break; significant differences between events also emerged. Comparison of open-ended categories to participants' typical drinking indicated elevated drinking on birthdays, celebrations, parties, and holidays; however, there were no significant differences between open-ended events.

CONCLUSIONS

Students who drink alcohol report heavier drinking on specific calendar-based events (e.g., Spring Break). However, students also report non-calendar-related events (e.g., non-specific parties) as some of their highest drinking events. More research is needed to understand how intervention and prevention programs can be adapted to target both known calendar-based HRDE, and unknown, idiosyncratic HRDE.

Sex in the Context of Substance Use: A Study of Perceived Benefits and Risks, Boundaries, and Behaviors among Adolescents Participating in an Internet-Based Intervention

Little research has examined adolescents' perspectives of sex with substance use. This study examined (1) adolescents' perceived benefits and risks of sex with substance use, as well as boundaries; (2) the potential for positive and negative social influences among adolescents when they discuss these topics; and (3) whether exposure to health-promoting content is associated with trajectories of sex with substance use over a 6-month period. To address the first two objectives, 176 comments were analyzed from 71 adolescents (90% female) aged 14-18 years who participated in an Internet-based sexual health promotion intervention and posted to at least one message board addressing sex with substance use. Adolescents' perceived benefits and risks of sex with substance use primarily reflected concern for the experience of sex in the moment; perceived risks and boundaries primarily reflected concern for the ability to develop and maintain meaningful relationships. Comments of 63% and 22% of adolescents, respectively, were evaluated to have potential for health-promoting and risk-promoting social influence. To address the third objective, trajectories of self-reported sex with substance use were compared between 89 intervention and 54 control participants. No significant differences were observed. However, a dose-response effect was observed; intervention participants who completed less than one third of assigned tasks reported increases in sex with alcohol or marijuana use over time, while no marked changes or much smaller changes in sex with substance use were observed among intervention participants who completed one third or more tasks. Implications for prevention and intervention programs are discussed.

Ecological momentary assessments of night-time drinking among California adolescents: bases for informing night-time preventive interventions

BACKGROUND AND AIM

To inform the development of effective night-time preventive interventions, our goal was to assess adolescents' residence (i.e. being at) and transitions across contexts during evening hours and risks for drinking and drinking-related problems in relation to contexts and to these transitions.

DESIGN

Ecological momentary assessment and survey methods.

SETTING

Twelve mid-sized cities (50 000-500 000 population) in California, USA from December 2014 to September 2015.

ANALYTICAL SAMPLE

A total of 153 adolescents (mean age = 16.4, 46.2% female).

MEASUREMENT

Initial conditions (e.g. past-year heavy drinking, gender, best friend's approval of drinking); adolescents' residence (i.e. being at) and transitions between (a) their own homes, (b) others' homes and (c) public spaces (e.g. restaurants, parks, concert venues) at early, middle and late evening hours; drinking in these contexts at early, middle and late evening hours; and drinking-related problems across evening hours.

FINDINGS

Risks for drinking were 23.5 times greater in others' homes (P < 0.01) and somewhat less in public spaces [odds ratio (OR) = 6.01, P < 0.01], compared with own home. Risks for problems in any evening time were elevated in relation to being in others' homes (OR = 2.37, P < 0.05) and public spaces (OR = 2.71, P < 0.01) versus at own home. Drinking in others' homes was related to 5.9 times increase in odds of transitioning back to own home (OR = 5.93, P < 0.05), 11.9 times increase in odds of remaining in others' homes (OR = 11.86, P < 0.01) or 7.3 times increase in odds of transitioning from others' homes to public spaces (OR = 7.3, P < 0.05). Initial conditions were associated with being in states, drinking and problems during evening hours and transitions across states.

CONCLUSIONS

In California, adolescents who are older, female, Hispanic or have greater spending money may be more likely to be outside their own home during evening hours than adolescents who do not match those criteria. In turn, being outside one's home during evening hours appears to be related to greater risks for drinking and drinking-related problems. Finally, transitions between contexts increased differential risks for drinking such that, for example, drinking in others' homes was highly related to transitioning to public spaces and less to returning to own home.

Changes in college student alcohol use during the COVID-19 pandemic: Are perceived drinking norms still relevant?

With widespread concern for increased alcohol use during the COVID-19 pandemic, there is a pressing need to examine changes in young adults' alcohol use and to identify antecedents of increased use. We tested the hypothesis that self-reported changes in alcohol use during the pandemic (frequency, quantity, heavy episodic drinking) would relate to perceptions of peers' changes in alcohol use. In April of 2020, 507 college students self-reported changes in their alcohol use and perceived changes in use for typical students at their university (i.e., norms). Most students in our sample reported decreased alcohol use and perceived decreases in peers' alcohol use. Perceptions of peers' changes in alcohol use behavior strongly related to changes in students' own alcohol use. Findings provide strong support for norms-based strategies that can correct normative misperceptions by highlighting the fact that most college students are not in fact engaging in heavier alcohol use during the COVID-19 pandemic.

Emotional Outcomes of Casual Sexual Relationships and Experiences: A Systematic Review

Casual sexual relationships and experiences (CSREs) are common and emotionally significant occurrences. Given the uncommitted, often emotionally complicated nature of CSREs, researchers have asked whether these experiences may have positive and/or negative emotional consequences. We reviewed 71 quantitative articles examining emotional outcomes of CSREs, including subjective emotional reactions (e.g., excitement, regret) and emotional health (e.g., depression, self-esteem). Overall, people evaluated their CSREs more positively than negatively. In contrast, CSREs were associated with short-term declines in emotional health in most studies examining changes in emotional health within a year of CSRE involvement. Emotional outcomes of CSREs differed across people and situations. Women and individuals with less permissive attitudes toward CSREs experienced worse emotional outcomes of CSREs. Alcohol use prior to CSREs, not being sexually satisfied, and not knowing a partner well were also associated with worse emotional outcomes. These findings suggest directions for prevention/intervention related to CSREs. For example, skill-building related to sexual decision-making may help individuals decide whether, and under what circumstances, CSREs are likely to result in positive or negative emotional outcomes. In addition, the limitations of extant research suggest directions for future inquiry (e.g., examining whether verbal and nonverbal consent practices predict emotional outcomes of CSREs).

The association between intended drinking contexts and alcohol expectancies in college students: A daily diary study

BACKGROUND

Because of the role alcohol outcome expectancies play in subsequent drinking, it is important to understand factors that can shape alcohol expectancies to guide intervention efforts. This study examined among college students whether intended social contexts for drinking were associated with positive and negative alcohol expectancies at the daily-level.

METHODS

Participants included in analyses were 323 students, ages 18 to 24 years, enrolled at a 4-year university in the Pacific Northwest. At four 2-week measurement bursts across one year, participants were asked each afternoon to report whether they planned to drink alcohol later that day. If so, they were further asked how much they intended to drink, whether they plan to drink alone or with others, whether they plan to drink at home or bar/party, and their positive and negative expectancies of alcohol use that evening.

RESULTS

A total of 2953 person-day observations from planned drinking days were used. Results from linear mixed models, adjusted for covariates including intended number of drinks, showed that students reported greater positive alcohol expectancies on days when they intended to drink with others vs. alone and intended to drink at a bar or party vs. at home. For negative expectancies, only intended drinking with others showed a statistically significant association.

CONCLUSION

This study suggests that contextual factors may shape college students' expectancies about effects of alcohol at the daily-level. Intended drinking contexts may be important to address in event-level interventions to reduce high-risk drinking in young adults.

Sun, sea and sex: a review of the sex tourism literature

Background

Sex tourism is defined as travel planned specifically for the purpose of sex, generally to a country where prostitution is legal. While much of the literature on sex tourism relates to the commercial sex worker industry, sex tourism also finds expression in non-transactional sexual encounters. This narrative review explores current concepts related to travel and sex, with a focus on trans-national sex tourism.

Methods

The PubMed database was accessed to source relevant literature, using combinations of pertinent search terms. Only articles published in the English language were selected. Reference lists of published articles were also examined for relevant articles.

Results

With regard to preferred destinations, South/Central America and the Caribbean were more likely to receive tourists looking for casual sex. Longer duration of travel, travelling alone or with friends, alcohol or drug use, being younger and being single were factors associated with higher levels of casual sex overseas. The majority of literature retrieved on sex workers focused on risk behaviours, sexually transmitted infections (STI), mobility of sex workers and how these factors affected their lives. Sex tourists require better access to effective methods of preventing HIV, such as pre-exposure prophylaxis, and better education on HIV prevention. Drugs and alcohol play a major role as risk factors for and cofactors in casual sexual behaviour while abroad.

Conclusions

Travellers need to be informed of the increased risks of STI before travel. They should be aware of the local prevalence of STIs and the risks associated with their sexual practices when they travel, including engaging with commercial sex workers, having unprotected sexual intercourse and becoming victims of sexual violence.

The Efficacy of an Event-Specific, Text Message, Personalized Drinking Feedback Intervention

Tailgating drinking prior to a football game is a type of event-specific drinking associated with increased alcohol use and related problems. Personalized drinking feedback interventions (PFI) are efficacious in reducing alcohol use and problems. The current study aimed to advance understanding of event-specific interventions by examining: (1) the efficacy of an event-specific, text message PFI on tailgating alcohol outcomes, and (2) the extent to which intervention effects generalize to "typical" alcohol outcomes at 1-month follow-up. College students (N = 130; 71% female; 92% white) who reported tailgating within the past 30 days and binge drinking when tailgating in the past year completed assessments on tailgating and typical alcohol use. They were randomly assigned to one of two text message conditions delivered on the morning of a home football game: event-specific PFI (TXT PFI) or a control condition. Multilevel modeling examined the association of treatment condition on tailgating and 1-month alcohol outcomes. When tailgating, participants in TXT PFI reported lower estimated peak blood alcohol concentration (eBAC) and consumed less drinks than the control condition. At the 1-month "typical" drinking follow-up, participants in TXT PFI reported lower peak eBAC and fewer alcohol-related problems than the control condition. Perceived tailgating drinking norms were found to statistically mediate the relationship between condition and alcohol outcome at tailgating and 1-month follow-ups. Findings provide preliminary support for the efficacy of an event-specific, text message PFI in reducing both tailgating and typical drinking alcohol outcomes. Event-specific TXT PFI can be used for prevention/intervention of alcohol misuse.

Text message reminders as an adjunct to a substance use intervention for adolescents and young adults: Pilot feasibility and acceptability findings

OBJECTIVE

Text messaging has been proposed as a method for increasing the reach of interventions for harmful alcohol and other drug use. This paper describes the design of an automated text messaging adjunct to a substance use intervention intended to support adolescents and young adults attempting to change their alcohol and other drug use behavior. Feasibility and acceptability testing was conducted as part of this pilot study.

METHOD

Five focus groups were conducted to refine text message content and finalize pilot intervention design. Automated, daily, substance use-related reminder text messages were sent to pilot intervention participants (n = 39), who were recruited from outpatient treatment.

RESULTS

Of those who were invited, 63% enrolled in the study and 89.7% remained enrolled in the study as measured by completing at least one assessment after baseline. Participants reported a positive experience with the messages, particularly supportive/empowering messages and commitment reminder messages.

CONCLUSIONS

These findings suggest that text messaging is a feasible and acceptable method for delivery of substance use-related reminder content as an adjunct to substance use intervention.

Using Social Norms to Change Behavior and Increase Sustainability in the Real World: A Systematic Review of the Literature

Behavioral change interventions based on social norms have proven to be a popular and cost-effective way in which both researchers and practitioners attempt to transform behavior in order to increase environmental and social sustainability in real-world contexts. In this paper, we present a systematic review of over 90 empirical studies that have applied behavioral change interventions based on social norms in field settings. Building on previous research about the sources of information that people use to understand social norms and other local determinants of behavior, we propose a framework organized along two axes that describe intervention context (situated interventions applied in the same context where the target behavior happens versus remote interventions that are applied away from that context) and type of normative information leveraged (interventions that provide summary information about a group versus interventions that expose participants to the opinions and behaviors of others). We also illustrate successful applications for each dimension, as well as the social, psychological and physical determinants of behavior that were leveraged to support change. Finally, based on our results, we discuss some of the elements and practical mechanisms that can be used by both researchers and practitioners to design more integral, effective and sustainable social norm intervention in the real world.

An online alcohol and risky sex prevention program for college students studying abroad: study protocol for a randomized controlled trial

BACKGROUND

This study protocol describes a proposed randomized controlled trial that builds upon a successful pilot intervention study to address problematic and dangerous drinking among young adult college students studying abroad in foreign environments. Despite universities and colleges citing alcohol misuse as the most concerning issue for their students abroad, most institutions offer no empirically-based prevention efforts tailored to this at-risk population. The proposed intervention attempts to fill a major gap for the nearly 333,000 students completing study abroad programs each year by using empirically-based and theoretically-informed risk and protective factors to correct misperceived peer drinking norms and promote cultural engagement abroad. In addition to preventing heavy and problematic drinking, the intervention seeks to prevent risky sexual behaviors (e.g., sex without a condom) and experience of sexual violence victimization, which are strikingly common among study abroad students and have the potential for lasting physical and psychological effects upon return home.

METHODS/DESIGN

We will conduct a randomized controlled trial of an intervention with a sample of 1200 college students studying abroad from approximately 50 US universities and colleges. The brief, online intervention is text and video based and contains evidence-based components of personalized normative feedback to correct students' misperceived drinking norms, content to promote engagement with the cultural experience abroad and address difficulties adjusting to life in the foreign environment, and tips and strategies to prevent risky sexual behaviors and sexual violence victimization abroad. Participants will complete online surveys at five time points (predeparture, first month abroad, last month abroad, 1-month post-return, and 3-months post-return) to assess for intervention effects on drinking behavior, drinking consequences, risky sex, and sexual violence outcomes. We will examine whether the mechanisms targeted by the intervention (changes in perceived norms, engagement in the cultural experience abroad) serve as mediators of intervention efficacy.

DISCUSSION

The proposed study has the potential to fill an important gap in the research literature and provide empirical support for an online accessible, brief, and targeted approach that can easily be distributed to study abroad students to help prevent heavy alcohol use and sexual risk abroad. Trial registration ClinicalTrials.gov Identifier NCT03928067.

[Internet-based alcohol interventions for college students: systematic reviewIntervenciones por Internet para reducir el consumo de alcohol de los estudiantes universitarios: revisión sistemática]

Objective

To identify the main modalities of Internet-based interventions to limit alcohol use among university students, and to describe the effects of these interventions on alcohol use and related consequences.

Methods

A systematic review of PubMed, PsycINFO, and SciELO was performed using as search terms "alcohol drinking AND Internet," without date or language restrictions. Inclusion criteria were randomized controlled trial design, focus on college students and on Internet-based interventions, and evaluating the effects of the intervention on alcohol use or alcohol-related consequences.

Results

Thirty-six articles were analyzed. Two main intervention modalities were identified: personalized normative feedback (PNF, n=28) and multicomponent interventions (n=8). Twelve studies with PNF reported reductions in alcohol use 3 months after the intervention. Multicomponent interventions reduced alcohol use and related consequences; most studies focused on the website AlcoholEdu, which reduced alcohol consumption and the consequences of alcohol use 6 months after the intervention.

Conclusions

FNP and the AlcoholEdu website, the most frequently evaluated interventions among the selected studies, were effective in reducing alcohol use in university students. These strategies are an alternative to increase the access of university students to interventions aimed at limiting alcohol use.

Evaluating Personalized Feedback Intervention Framing with a Randomized Controlled Trial to Reduce Young Adult Alcohol-Related Sexual Risk Taking

The purpose of this study was to evaluate personalized feedback intervention (PFI) framing with two web-delivered PFIs aimed to reduce young adult alcohol-related risky sexual behavior (RSB). Combined PFIs typically use an additive approach whereby independent components on drinking and components on RSB are presented without the discussion of the influence of alcohol on RSB. In contrast, an integrated PFI highlights the RSB-alcohol connection by presenting integrated alcohol and RSB components that focus on the role of intoxication as a barrier to risk reduction in sexual situations. In a randomized controlled trial, 402 (53.98% female) sexually active young adults aged 18-25 were randomly assigned to a combined PFI, an integrated PFI, or attention control. All assessment and intervention procedures were web-based. At the 1-month follow-up, those randomly assigned to the integrated condition had a lower likelihood of having any casual sex partners compared to those in the control group. At the 6-month follow-up, the combined condition had a lower likelihood of having any casual sex partners compared to those in the control group. When examining alcohol-related RSB, at the 1-month follow-up, both interventions showed a lower likelihood of any drinking prior to sex compared to the control group. When examining alcohol-related sexual consequences, results showed a reduction in the non-zero count of consequences in the integrated condition compared to the control at the 1-month follow-up. For typical drinks per week, those in the combined condition showed a greater reduction in the non-zero count of drinks than those in the control condition at the 1-month follow-up. While there were no significant differences between the two interventions, the current findings highlight the utility of two efficacious web-based alcohol and RSB interventions among a national sample of at-risk young adults.

A Critical Appraisal of the Social Norms Approach as an Interventional Strategy for Health-Related Behavior and Attitude Change

The Social Norms Approach is a widely used intervention strategy for promoting positive health-related behaviors. The Approach operates on the premise that individuals misperceive their peers' behaviors and attitudes, with evidence of under- and over-estimations of behaviors and peer approval for a range of positive and negative behaviors respectively. The greater these misperceptions, the more likely an individual is to engage in negative behaviors such as consuming heavier amounts of alcohol and other substances and reduce positive behaviors such as eating healthily and using sun protection. However, there are many complexities associated with the use of social norms feedback in interventions and empirical studies. Many social norms interventions do not attempt to change misperceptions of social norms or measure changes in normative perceptions pre- and post-intervention. This has led to a conflation of generic social norms interventions with those that are explicitly testing the Approach's assumptions that it is misperceptions of peer norms which drive behavior. The aim of the present review was to provide a critical appraisal of the use of the Social Norms Approach as an intervention strategy for health-related behaviors, identify the current issues with its evidence base, highlight key opportunities and challenges facing the approach, and make recommendations for good practice when using the approach. There are three core challenges and areas for improved practice when using the Social Norms Approach. Firstly, improvements in the methodological rigor and clarity of reporting of 'social norms' research, ensuring that studies are testing the approach's assumption of the role of misperceptions on behaviors are differentiated from studies investigating other forms of 'social norms.' Secondly, the need for a more explicit, unified and testable theoretical model outlining the development of normative misperceptions which can be translated into interventional studies. Finally, a need for a more robust evaluation of social norms interventions in addition to randomized controlled trials, such as the inclusion of process evaluations, qualitative studies of participant experiences of social norms feedback, and alternative study designs better suited for real-world public health settings. Such improvements are required to ensure that the Social Norms Approach is adequately tested and evaluated.

Evaluations and Future Plans After Casual Sexual Experiences: Differences Across Partner Type

Casual sexual relationships and experiences (CSREs) are common among emerging adults, and their diversity may contribute to variability in their associations with mental health and future romantic relationship development. The present research used multiple regression analyses to examine how CSRE type (casual dating, friends with benefits [FWB], or booty call/one-night stand) is associated with short-term outcomes of these experiences, including positive and negative evaluations, plans to start a romantic relationship with a CSRE partner, and general plans for future CSREs. College students and non-college-attending emerging adults (N = 192, 80% female, mean age = 22.09 years) reported on recent sexual encounters through daily diaries collected around an alcohol consumption holiday. Individuals with casual dating partners evaluated their experiences more positively and/or less negatively than individuals with booty calls/one-night stands; these associations were moderated by gender and sexual behavior type. Individuals with casual dating partners were more oriented toward pursuing a romantic relationship with their partners than individuals with FWB or booty calls/one-night stands. However, no association was found between CSRE type and plans for future CSREs in general. Results highlight the diversity of CSREs and suggest that casual dating may be more rewarding than FWB and booty calls/one-night stands, particularly for women.

Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people

BACKGROUND

Engagement in multiple risk behaviours can have adverse consequences for health during childhood, during adolescence, and later in life, yet little is known about the impact of different types of interventions that target multiple risk behaviours in children and young people, or the differential impact of universal versus targeted approaches. Findings from systematic reviews have been mixed, and effects of these interventions have not been quantitatively estimated.

OBJECTIVES

To examine the effects of interventions implemented up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people.

SEARCH METHODS

We searched 11 databases (Australian Education Index; British Education Index; Campbell Library; Cumulative Index to Nursing and Allied Health Literature (CINAHL); Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library; Embase; Education Resource Information Center (ERIC); International Bibliography of the Social Sciences; MEDLINE; PsycINFO; and Sociological Abstracts) on three occasions (2012, 2015, and 14 November 2016)). We conducted handsearches of reference lists, contacted experts in the field, conducted citation searches, and searched websites of relevant organisations.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), including cluster RCTs, which aimed to address at least two risk behaviours. Participants were children and young people up to 18 years of age and/or parents, guardians, or carers, as long as the intervention aimed to address involvement in multiple risk behaviours among children and young people up to 18 years of age. However, studies could include outcome data on children > 18 years of age at the time of follow-up. Specifically,we included studies with outcomes collected from those eight to 25 years of age. Further, we included only studies with a combined intervention and follow-up period of six months or longer. We excluded interventions aimed at individuals with clinically diagnosed disorders along with clinical interventions. We categorised interventions according to whether they were conducted at the individual level; the family level; or the school level.

DATA COLLECTION AND ANALYSIS

We identified a total of 34,680 titles, screened 27,691 articles and assessed 424 full-text articles for eligibility. Two or more review authors independently assessed studies for inclusion in the review, extracted data, and assessed risk of bias.We pooled data in meta-analyses using a random-effects (DerSimonian and Laird) model in RevMan 5.3. For each outcome, we included subgroups related to study type (individual, family, or school level, and universal or targeted approach) and examined effectiveness at up to 12 months' follow-up and over the longer term (> 12 months). We assessed the quality and certainty of evidence using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach.

MAIN RESULTS

We included in the review a total of 70 eligible studies, of which a substantial proportion were universal school-based studies (n = 28; 40%). Most studies were conducted in the USA (n = 55; 79%). On average, studies aimed to prevent four of the primary behaviours. Behaviours that were most frequently addressed included alcohol use (n = 55), drug use (n = 53), and/or antisocial behaviour (n = 53), followed by tobacco use (n = 42). No studies aimed to prevent self-harm or gambling alongside other behaviours.Evidence suggests that for multiple risk behaviours, universal school-based interventions were beneficial in relation to tobacco use (odds ratio (OR) 0.77, 95% confidence interval (CI) 0.60 to 0.97; n = 9 studies; 15,354 participants) and alcohol use (OR 0.72, 95% CI 0.56 to 0.92; n = 8 studies; 8751 participants; both moderate-quality evidence) compared to a comparator, and that such interventions may be effective in preventing illicit drug use (OR 0.74, 95% CI 0.55 to 1.00; n = 5 studies; 11,058 participants; low-quality evidence) and engagement in any antisocial behaviour (OR 0.81, 95% CI 0.66 to 0.98; n = 13 studies; 20,756 participants; very low-quality evidence) at up to 12 months' follow-up, although there was evidence of moderate to substantial heterogeneity (I² = 49% to 69%). Moderate-quality evidence also showed that multiple risk behaviour universal school-based interventions improved the odds of physical activity (OR 1.32, 95% CI 1.16 to 1.50; I² = 0%; n = 4 studies; 6441 participants). We considered observed effects to be of public health importance when applied at the population level. Evidence was less certain for the effects of such multiple risk behaviour interventions for cannabis use (OR 0.79, 95% CI 0.62 to 1.01; P = 0.06; n = 5 studies; 4140 participants; I² = 0%; moderate-quality evidence), sexual risk behaviours (OR 0.83, 95% CI 0.61 to 1.12; P = 0.22; n = 6 studies; 12,633 participants; I² = 77%; low-quality evidence), and unhealthy diet (OR 0.82, 95% CI 0.64 to 1.06; P = 0.13; n = 3 studies; 6441 participants; I² = 49%; moderate-quality evidence). It is important to note that some evidence supported the positive effects of universal school-level interventions on three or more risk behaviours.For most outcomes of individual- and family-level targeted and universal interventions, moderate- or low-quality evidence suggests little or no effect, although caution is warranted in interpretation because few of these studies were available for comparison (n ≤ 4 studies for each outcome).Seven studies reported adverse effects, which involved evidence suggestive of increased involvement in a risk behaviour among participants receiving the intervention compared to participants given control interventions.We judged the quality of evidence to be moderate or low for most outcomes, primarily owing to concerns around selection, performance, and detection bias and heterogeneity between studies.

AUTHORS' CONCLUSIONS

Available evidence is strongest for universal school-based interventions that target multiple- risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family- or individual-level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high-quality multiple- risk behaviour intervention studies to further strengthen the evidence base in this field.

REMIT: Development of a mHealth theory-based intervention to decrease heavy episodic drinking among college students

mHealth apps are an effective means of delivering health interventions, and the college-age population is particularly proficient at using apps. Informed by current theories of Ecological Momentary Interventions (EMI), Motivational Interviewing (MI), and the Transtheoretical Model (TTM) of Change, investigators have developed a self-monitoring app-Reductions through Ecological Momentary/Motivational Intervention/Transtheoretical (REMIT)-with the aim of reducing hazardous drinking among college students. The app was developed using the Integrate, Design, Assess, and Share (IDEAS) framework. This step-by-step process for developing digital behavior change interventions was conducted in five phases to: (1) understand the users, (2) determine target behavior, (3) base the intervention in behavioral theory; (4) create delivery strategies, and (5) develop the REMIT prototype. REMIT uses assessments (informed by EMI) and components of MI and TTM to guide administration of nine modules designed to engage users in reducing alcohol use and related problems. REMIT users self-monitor their alcohol consumption and develop strategies to change drinking behaviors using a range of easy-to-use features, such as the Virtual Coach, automated text messages, interactive gaming mechanisms (gamification), drink consumption tracking, and Blood Alcohol Concentration (BAC) calculators. mHealth interventions have been shown to reduce alcohol use among college students when they are applied in real-life, real-time contexts. REMIT is a theory-based app that incorporates user-friendly features to reduce hazardous drinking among college students. The next step is to conduct a pilot trial to test the efficacy of the app and enhance the REMIT prototype.

Randomized Controlled Trials of Technology-Based HIV/STI and Drug Abuse Preventive Interventions for African American and Hispanic Youth: Systematic Review

BACKGROUND

HIV/sexually transmitted infections (STIs) and drug abuse remain significant public health concerns in the United States, and African American and Hispanic youth are disproportionately affected. Although technology-based interventions are efficacious in preventing and reducing HIV/STI and licit/illicit drug use behaviors, relatively little is known regarding the state of the science of these interventions among African American and Hispanic youth.

OBJECTIVE

The aim of this review is to identify and examine randomized controlled trials (RCTs) of technology-based HIV/STI and/or drug abuse preventive interventions for African American and Hispanic youth.

METHODS

We searched electronic databases (ie, PubMed, Proquest, PsycINFO, Ebscohost, Google Scholar) to identify studies between January 2006 and October 2016. RCTs of technology-based interventions targeting African American and Hispanic youth HIV/STI risk behaviors, including sexual risk, licit and illicit drug use, and HIV/STI testing were included.

RESULTS

Our search revealed a total of three studies that used an RCT design and included samples comprised of >50% African American and/or Hispanic youth. The follow-up assessments ranged from two weeks to six months and the number of participants in each trial ranged from 72 to 141. The three interventions were theory-driven, interactive, and tailored. The long-term effects of the interventions were mixed, and outcomes included reductions in sex partners, licit drug use, and condomless anal sex acts.

CONCLUSIONS

Although technology-based interventions seem promising in the prevention of HIV/STI and drug abuse among African American and Hispanic youth, more research is needed.

Who does not cut down? Comparing characteristics and drinking motives of drinkers and abstainers during the exam periods

OBJECTIVE

Drinking alcohol during the exams can affect academic performance and future career options, but is rarely investigated. Drinking motives, sociodemographics and personality characteristics are investigated in nonabstainers and weekly drinkers during the exams.

PARTICIPANTS

7,181 Belgian university students who anonymously responded to an email invitation to an online survey.

METHODS

Logistic regressions and mixed design analysis of variance on cross-sectional data.

RESULTS

One-third of the students continued drinking during the exams, with 40% drinking weekly. Nonabstainers were mainly men, elder, internally motivated when drinking, and housed with parents or independently. Weekly drinkers were similar, except mainly housed in student apartments or independently. Personality characteristics were nonsignificant. All drinking motives were less pronounced during the exams, with smaller differences for internal motives.

CONCLUSIONS

Mainly linked to internal drinking motives, drinking during the exams in higher education is underestimated. The characteristics and motives of students doing so can be used in future interventions.

Mobile Health Technology Using a Wearable Sensorband for Female College Students With Problem Drinking: An Acceptability and Feasibility Study

BACKGROUND

An increasing number of mobile app interventions have been developed for problem drinking among college students; however, few studies have examined the integration of a mobile app with continuous physiological monitoring and alerting of affective states related to drinking behaviors.

OBJECTIVE

The aim of this paper was to evaluate the acceptability and feasibility of Mind the Moment (MtM), a theoretically based intervention for female college students with problem drinking that combines brief, in-person counseling with ecological momentary intervention (EMI) on a mobile app integrated with a wearable sensorband.

METHODS

We recruited 10 non-treatment seeking, female undergraduates from a university health clinic who scored a 3 or higher on the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) to participate in this pilot study. Study activities involved an in-person baseline intake and 1 follow-up assessment, 2 in-person alcohol brief intervention counseling sessions, and use of MtM technology components (sensorband and EMI on a mobile app) for approximately 3-4 weeks. The intervention used motivational interviewing (MI) and cognitive behavioral therapy (CBT) strategies for reducing risks associated with drinking. We used both qualitative and quantitative assessments to measure acceptability of the intervention and feasibility of delivery. Use patterns of the sensorband and mobile app were also collected.

RESULTS

Quantitative and qualitative data indicated high levels of acceptability for the MtM intervention. Altogether, participants made reports on the app on 26.7% (78/292) the days the technology was available to them and completed a total of 325 reports with wide variation between participants. Qualitative findings indicated that sensorband-elicited alerts promoted an increase in awareness of thoughts, feelings, and behaviors related to current environmental stressors and drinking behaviors in theoretically meaningful ways. Specific challenges related to functionality and form of the sensorband were identified.

CONCLUSIONS

Delivering intervention material "just-in-time," at the moment participants need to use behavioral strategies has great potential to individualize behavioral interventions for reducing problem drinking and other health behaviors. These findings provide initial evidence for the promise of wearable sensors for increasing potency of theoretically grounded mobile health interventions and point to directions for future research and uptake of these technologies.

Individual, interpersonal, and contextual factors associated with discrepancies between intended and actual spring break drinking

The purpose of the present paper was to examine the extent to which college students underestimate the quantity of alcohol they will consume during Spring Break (SB), and whether individual, interpersonal, and contextual factors may be related to underestimation of SB drinking and drinking consequences. College students participated in web-based surveys prior to and after SB (N=603; 57% women). Overall, results indicated that individual factors (being male, being a member of a fraternity or sorority, previously experiencing more alcohol-related consequences, and intending to drink less during SB), interpersonal factors (reporting friends encourage getting drunk), and contextual factors (going on a SB trip with friends and receiving drinks from others) predicted underestimating peak drinks consumed during SB. Underestimating the peak number of drinks to be consumed on SB was associated with experiencing a greater number of alcohol-related consequences. Targeted interventions designed specifically to focus on underestimation of college student drinking and the impact of SB contextual and interpersonal factors may be an important area of study to reduce negative consequences of alcohol use during SB.

Social and Cultural Contexts of Alcohol Use: Influences in a Social-Ecological Framework

Alcohol use and misuse account for 3.3 million deaths every year, or 6 percent of all deaths worldwide. The harmful effects of alcohol misuse are far reaching and range from individual health risks, morbidity, and mortality to consequences for family, friends, and the larger society. This article reviews a few of the cultural and social influences on alcohol use and places individual alcohol use within the contexts and environments where people live and interact. It includes a discussion of macrolevel factors, such as advertising and marketing, immigration and discrimination factors, and how neighborhoods, families, and peers influence alcohol use. Specifically, the article describes how social and cultural contexts influence alcohol use/misuse and then explores future directions for alcohol research.

Social norms information for alcohol misuse in university and college students

BACKGROUND

Drinking is influenced by youth perceptions of how their peers drink. These perceptions are often incorrect, overestimating peer drinking norms. If inaccurate perceptions can be corrected, young people may drink less.

OBJECTIVES

To determine whether social norms interventions reduce alcohol-related negative consequences, alcohol misuse or alcohol consumption when compared with a control (ranging from assessment only/no intervention to other educational or psychosocial interventions) among university and college students.

SEARCH METHODS

The following electronic databases were searched up to July 2015: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, PsycINFO. The Cumulative Index to Nursing and Allied Health Literature (CINAHL) only to March 2008. Reference lists of included studies and review articles were manually searched. No restriction based on language or date was applied.

SELECTION CRITERIA

Randomised controlled trials or cluster-randomised controlled trials that compared a social normative intervention versus no intervention, alcohol education leaflet or other 'non-normative feedback' alcohol intervention and reported on alcohol consumption or alcohol-related problems in university or college students.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures as expected by Cochrane. Each outcome was analysed by mode of delivery: mailed normative feedback (MF); web/computer normative feedback (WF); individual face-to-face normative feedback (IFF); group face-to-face normative feedback (GFF); and normative marketing campaign (MC).

MAIN RESULTS

A total of 70 studies (44,958 participants) were included in the review, and 63 studies (42,784 participants) in the meta-analyses. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence.Outcomes at four or more months post-intervention were of particular interest to assess when effects were sustained beyond the immediate short term. We have reported pooled effects across delivery modes only for those analyses for which heterogeneity across delivery modes is not substantial (I(2) < 50%).Alcohol-related problems at four or more months: IFF standardised mean difference (SMD) -0.14, 95% confidence interval (CI) -0.24 to -0.04 (participants = 2327; studies = 11; moderate quality evidence), equivalent to a decrease of 1.28 points in the 69-point alcohol problems scale score. No effects were found for WF or MF.Binge drinking at four or more months: results pooled across delivery modes: SMD -0.06, 95% CI -0.11 to -0.02 (participants = 11,292; studies = 16; moderate quality evidence), equivalent to 2.7% fewer binge drinkers if 30-day prevalence is 43.9%.Drinking quantity at four or more months: results pooled across delivery modes: SMD -0.08, 95% CI -0.12 to -0.04 (participants = 21,169; studies = 32; moderate quality evidence), equivalent to a reduction of 0.9 drinks consumed each week, from a baseline of 13.7 drinks per week.Drinking frequency at four or more months: WF SMD -0.11, 95% CI -0.17 to -0.04 (participants = 9929; studies = 10; moderate quality evidence), equivalent to a decrease of 0.17 drinking days/wk, from a baseline of 2.74 days/wk; IFF SMD -0.21, 95% CI -0.31 to -0.10 (participants = 1464; studies = 8; moderate quality evidence), equivalent to a decrease of 0.32 drinking days/wk, from a baseline of 2.74 days/wk. No effects were found for GFF or MC.Estimated blood alcohol concentration (BAC) at four or more months: peak BAC results pooled across delivery modes: SMD -0.08, 95% CI -0.17 to 0.00 (participants = 7198; studies = 11; low quality evidence), equivalent to a reduction in peak BAC from an average of 0.144% to 0.135%. No effects were found for typical BAC with IFF.

AUTHORS' CONCLUSIONS

The results of this review indicate that no substantive meaningful benefits are associated with social norms interventions for prevention of alcohol misuse among college/university students. Although some significant effects were found, we interpret the effect sizes as too small, given the measurement scales used in the studies included in this review, to be of relevance for policy or practice. Moreover, the significant effects are not consistent for all misuse measures, heterogeneity was a problem in some analyses and bias cannot be discounted as a potential cause of these findings.

Changing Norms to Change Behavior

Providing people with information about the behavior and attitudes of their peers is a strategy commonly employed by those seeking to reduce behavior deemed harmful either to individuals (e.g., high alcohol consumption) or the collective (e.g., high energy consumption). We review norm-based interventions, detailing the logic behind them and the various forms they can take. We give special attention to interventions designed to decrease college students' drinking and increase environment-friendly behaviors. We identify the conditions under which norm information has the highest likelihood of changing the targeted behavior and discuss why this is the case.

Randomized controlled trial of a web-delivered personalized normative feedback intervention to reduce alcohol-related risky sexual behavior among college students

OBJECTIVE

The purpose of this study was to evaluate the efficacy of personalized normative feedback (PNF) on college student alcohol-related risky sexual behavior (RSB).

METHOD

In a randomized controlled trial, 480 (57.6% female) sexually active college students were stratified by gender and level of drinking and randomly assigned to an alcohol-only intervention, an alcohol-related RSB-only intervention, a combined alcohol and alcohol-related RSB intervention, or control. All assessment and intervention procedures were Web-based.

RESULTS

Results indicated a significant reduction in drinking outcomes for the alcohol only and the combined alcohol and alcohol-related RSB interventions relative to control. Findings further demonstrated a significant reduction in alcohol-related RSB outcomes for the alcohol-related RSB only and the combined alcohol and alcohol-related RSB interventions relative to control. There were no significant intervention effects on alcohol-related negative consequences. These findings demonstrate that the combined alcohol and alcohol-related RSB intervention was the only intervention successful at reducing both drinking and alcohol-related RSB outcomes relative to control. There were no significant differences when comparing the combined alcohol and alcohol-related RSB intervention to the alcohol-only intervention or the alcohol-related RSB-only intervention. Finally, results suggested that the intervention effects on high-risk behaviors were mediated by reductions in descriptive normative perceptions.

CONCLUSIONS

These findings demonstrate that PNF specific to drinking in sexual situations was needed to reduce alcohol-related RSB. Furthermore, this study highlights the potential utility of a brief intervention that can be delivered via the Internet to reduce high-risk drinking and alcohol-related RSB among college students.

Electronic Feedback in College Student Drinking Prevention and Intervention

Alcohol consumption is prevalent among college students and can be associated with serious negative consequences. Several efficacious programs using one-on-one brief intervention techniques have been developed to target high-risk drinking by individual students, such as the Brief Alcohol Screening and Intervention for College Students (BASICS) (Dimeff et al. 1999). To reach a larger population (e.g., the incoming freshman class), researchers have adapted these interventions so that students can access them via the Internet or in some other electronic format.The purpose of this review is to discuss specific alcohol intervention programs that were (1) designed to be delivered remotely (e.g., via the Web or on an electronic device) without interaction with a provider and (2) were tested among college students using a randomized controlled trial design. Specific studies were drawn from earlier reviews as well as a comprehensive literature search. Although many programs have limited research support, and some findings are mixed, components that were directly translated from in-person BASICS to remote-delivery mediums (i.e., personalized feedback interventions [PFIs], personalized normative feedback [PNF] interventions), and broader programs that incorporate PFI/ PNF, show promise in reducing alcohol use and/or negative consequences. However, more research is needed and suggestions for how the field can move these interventions forward are discussed.