An experimental test of assessment reactivity within a web-based brief alcohol intervention study for college students

Examining Emailed Feedback as Boosters After a College Drinking Intervention Among Fraternities and Sororities: Rationale and Protocol for a Remote Controlled Trial (Project Greek)

Background

College students involved in Greek life (ie, members of fraternities and sororities) tend to engage in more high-risk alcohol use and experience more negative consequences than those not involved in Greek life. Web-based alcohol interventions, such as Alcohol eCHECKUP TO GO, have been successful in reducing alcohol use and consequences among the general college student population, but interventions targeting alcohol reduction among those involved in Greek life have had limited success. Booster emails including personalized feedback regarding descriptive norms and protective behavioral strategies have shown potential in increasing the effectiveness of web-based interventions among college drinkers. Studies are needed to determine the efficacy of these boosters among those involved in Greek life.

Objective

The primary objective of this study is to assess the efficacy of booster emails sent to Greek life students who complete Alcohol eCHECKUP TO GO. Specifically, we expect that participants who receive the booster emails will reduce their alcohol consumption and related problems (primary aim 1), reduce perceived peer drinking, and increase the number of protective behavioral strategies they use over time (primary aim 2) relative to those who do not receive boosters. Contingent upon finding the emailed booster efficacious and sufficient enrollment of members from each organization, an exploratory aim is to examine social mechanisms of change (ie, through selection vs socialization).

Methods

This study is a remote, controlled intervention trial following participants for up to 6 months. Participants must be aged at least 18 years, undergraduate students, and members of a participating fraternity or sorority. Eligible participants complete a web-based baseline survey to assess their alcohol consumption behaviors and beliefs, including norms and protective behavioral strategies, and information about their social networks. After completing the baseline survey, they participate in the web-based intervention. Follow-up surveys are sent 1, 3, and 6 months after the intervention. Those in the booster condition also receive emails containing personalized feedback at 2 weeks and 14 weeks after the intervention. Latent growth models and R-Simulation Investigation for Empirical Network Analysis will be used to analyze the data.

Results

As of September 2022, we have enrolled 18 participants from 2 fraternities and 2 sororities, and they have completed the baseline survey. Overall, 72% (13/18) of participants have completed the 1-month follow-up. Enrollment will continue through December 2022.

Conclusions

This study aims to examine the effectiveness of personalized feedback booster emails sent after an alcohol intervention among members of college Greek life. A secondary, exploratory aim is to provide information about social mechanisms of change (if possible). The current methodology targets whole network recruitment, with chapter presidents serving as gatekeepers and facilitators. Unique challenges of recruiting whole networks and working with campus administrators are discussed.

Trial Registration

ClinicalTrials.gov NCT05107284; https://clinicaltrials.gov/ct2/show/NCT05107284

International Registered Report Identifier (IRRID)

DERR1-10.2196/42535

Repeated Assessment of Alcohol Use and Perceived Norms Among College Students Who Drink: Comparisons to a Minimal Assessment at 12-Month Follow-Up

OBJECTIVE

Clinical trials assessing efficacy of alcohol use interventions often aim to test differences between treatment and control conditions at several follow-up time points, requiring repeated assessment of outcomes (e.g., weekly number of drinks). There has been concern that repeated assessment may elicit assessment reactivity in which participants, even those who did not receive treatment, reduce their alcohol use, but findings in the literature have been mixed. The current study of assessment reactivity compared two control conditions that were part of a larger randomized controlled trial: (a) repeated assessment that completed surveys at baseline, 3-, 6-, and 12-month follow-ups, and (b) minimal assessment that only completed surveys at baseline and 12-month follow-up. Outcomes assessed at 12-month follow-up included (a) changes in alcohol use behavior and negative consequences, (b) changes in perceived descriptive and injunctive norms, and (c) participant attrition/retention.

METHOD

Participants were undergraduate students who reported at least one heavy drinking occasion (4+/5+ drinks for women/men) in the past month (N = 456; 63.3% female; mean age = 20.11 years).

RESULTS

Multiple regression models indicated no significant differences between the repeated and minimal assessment control conditions on any indices of alcohol use (p values ranged from .42 to .97), negative consequences (p = .39), or on perceived descriptive/injunctive norms (p = .60 and .23, respectively). Attrition at 12-month follow-up was low in both groups, but significantly higher (p = .006) in the repeated assessment condition (16.49%) than the minimal assessment condition (8.55%).

CONCLUSIONS

Repeated assessment did not elicit changes in alcohol use, negative consequences, or perceived norms. A minimal assessment control condition may not be necessary when assessing intervention efficacy across longitudinal follow-ups. However, when attrition at 12-month follow-up is a salient concern, a minimal assessment control may retain more participants than repeated assessment.

Alcohol Treatment Research Contributing to Changes in Substance Use Behavior and Related Negative Consequences

OBJECTIVE

The purpose of this study was to investigate the extent to which two of the more salient characteristics of a treatment research assessment protocol (i.e., the comprehensiveness of the assessment battery and the frequency of its administration) for alcohol use disorder contribute to reductions in substance use and related negative consequences.

METHOD

Study participants were recruited from two hospital-administered substance use disorder outpatient clinics. Two hundred thirty-five individuals presenting for outpatient alcohol treatment screened study eligible and provided informed consent. Study participants were randomized to one of four research assessment conditions (i.e., frequent-comprehensive, frequent-brief, infrequent-comprehensive, and infrequent-brief) based on the crossing of a 2 (i.e., assessment comprehensiveness: comprehensive vs. brief) by 2 (i.e., assessment frequency: frequent vs. infrequent) factorial design.

RESULTS

Individuals assigned to the frequent assessment conditions reported greater reductions in substance use and substance use-related negative consequences relative to their counterparts assigned to the infrequent assessment conditions. In addition, a greater proportion of individuals assigned to the frequent assessment conditions reported abstinence from both alcohol and other substances.

CONCLUSIONS

The improvements in substance use and related negative consequences associated with more frequent research assessments were statistically significant and clinically meaningful.

The use and impact of self-monitoring on substance use outcomes: A descriptive systematic review

BACKGROUND

Self-Monitoring (SM), the act of observing ones' own behavior, has been used in substance use treatment because SM may bring conscious awareness to automatized substance use behaviors. Empirical findings regarding SM's effectiveness are mixed. The aim of this study was to synthesize the literature for the efficacy of SM on substance use. Method: A literature search was conducted using MEDLINE/PubMed. Results: Out of 2,659 citations, 41 studies with 126 analyses were included. Among analyses from studies rated Moderate (n = 24) or Strong (n = 3) quality, SM was shown to have a helpful effect (e.g., reducing substance use) 29% of the time; to have no effect 63.0% of the time; and to be detrimental in 8.0% of analyses. SM's helpful effects were associated with methodological characteristics including longer monitoring and Phone/IVR and EMA/Computer methodologies compared to Paper/Pencil. SM was more helpful in non-treatment-seekers (35.0% of analyses showed SM to be helpful compared to 25.0% of analyses with treatment-seekers). Conclusions: Results of this study suggest that SM, under certain circumstances, as the potential to be a low-cost, low-risk research and early intervention strategy for substance users.

Identification of Behavior Change Techniques From Successful Web-Based Interventions Targeting Alcohol Consumption, Binge Eating, and Gambling: Systematic Review

BACKGROUND

Web-based interventions are thought to overcome barriers to treatment, such as accessibility and geographical location, which can undermine the effectiveness of traditional face-to-face interventions. Owing to these features, researchers are increasingly testing the efficacy of web-based interventions as ways to reduce alcohol misuse, binge eating, and gambling. However, many web-based interventions have poorly defined mechanisms of action; therefore, it is often uncertain how they propose to bring about behavior change.

OBJECTIVE

This systematic review aims to identify effective behavior change techniques (BCTs) present in web-based interventions aimed at reducing alcohol consumption, binge eating, or gambling.

METHODS

This systematic review covered research conducted in the last 20 years. Inclusion criteria for interventions were web-based administration; targeting alcohol use, binge eating, and/or gambling; and reporting on baseline and postintervention measures of behavior. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines were followed. We coded intervention effectiveness, study quality, and BCTs present in the interventions.

RESULTS

Following removal of 4152 ineligible articles, 45 were included in the review: 32 (71%) targeted alcohol misuse, 6 (13%) targeted binge eating, and 7 (16%) targeted gambling. In total, 5 frequency counts were performed to identify the most commonly used BCTs: all studies, effective interventions, high-quality studies at 2 thresholds, and both high quality and effective studies. The results obtained from this were integrated to identify 7 BCTs. These 7 BCTs were problem solving, feedback on behavior, self-monitoring of behavior, self-monitoring of outcomes, instruction on how to perform a behavior, information about social and health consequences, and social comparison. A total of 4 BCTs were found in all frequency counts: feedback on behavior, self-monitoring of behavior, instruction on how to perform a behavior, and social comparison. Self-monitoring of outcomes of behavior was found in 3 of the 5 frequency counts, problem solving was found in 2 frequency counts, and information about social and health consequences was found in 1 frequency count.

CONCLUSIONS

This systematic review identified 7 of the most frequently used BCTs used in web-based interventions focused on alcohol misuse, binge eating, and gambling. These results can inform the development of evidence-based eHealth interventions that have the potential to lead to effective, positive behavior changes in all 3 areas.

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.

Emotion Regulation Enhancement of Cognitive Behavior Therapy for College Student Problem Drinkers: A Pilot Randomized Controlled Trial

This pilot randomized clinical trial tested an emotion regulation enhancement to Cognitive Behavior Therapy (CBT) with 29 college student problem drinkers with histories of complex trauma and current clinically significant traumatic stress symptoms. Participants received eight face-to-face sessions of manualized internet-supported CBT for problem drinking with or without trauma-focused emotion regulation skills (Trauma Affect Regulation: Guide for Education and Therapy, TARGET). Both interventions were associated with sustained (at one-month follow-up) reductions in self-reported drinking frequency, drinking related impairment, and heavy drinking in the past week, as well as post-traumatic stress disorder (PTSD) and complex PTSD symptoms, and improvement in self-reported emotion regulation. The enhanced intervention was associated with significantly greater sustained reductions in complex PTSD symptoms and resulted in medium/large effect size reductions in days of alcohol use (versus small effects by CBT). Emotion regulation enhancement of CBT for college student problem drinkers with interpersonal trauma histories warrants further investigation.

Randomized Study of Assessment Effects on Alcohol Use by Persons With HIV in Rural Uganda

OBJECTIVE

Unhealthy alcohol use is a crucial driver of HIV in sub-Saharan Africa, and interventions are needed. The goal of this study was to assess whether assessment itself (assessment reactivity) causes declines in alcohol use in a research study in persons with HIV in Uganda.

METHOD

Study participants were adult patients of the Immune Suppression Syndrome (ISS) Clinic in Mbarara, Uganda, who were new to HIV care and reported any alcohol consumption in the prior year. Participants were randomized to (a) a study cohort, with structured interviews, breath alcohol analysis tests, and blood draws conducted quarterly, or (b) a minimally assessed arm that engaged in these procedures only once, at 6 months after baseline. The main outcome was unhealthy drinking at 6 months, defined as Alcohol Use Disorders Identification Test-Consumption [AUDIT-C] positive (≥3 for women, ≥4 for men) or phosphatidylethanol (PEth; an alcohol biomarker) level ≥ 50 ng/ml. We also examined this outcome stratified by gender.

RESULTS

We examined 175 and 139 persons in the quarterly assessed versus minimally assessed arms, respectively. Overall, 54.8% were male, the median age was 30 (interquartile range: 25-36), and 58.0% initiated anti-retroviral therapy at 6 months. Nearly equal proportions (53.7% and 51.1% in the study quarterly assessed vs. minimally assessed arm, respectively) engaged in unhealthy drinking in the 3 months before the 6-month study visit (p = .64), and we found no evidence of interaction by gender (p = .36).

CONCLUSIONS

We found no evidence of assessment reactivity in a study that included quarterly study visits. Assessment is not sufficient to act as an intervention itself in this population with high levels of unhealthy drinking. Interventions are needed to decrease alcohol consumption in this population.