Face-to-face versus computer-delivered alcohol interventions for college drinkers: a meta-analytic review, 1998 to 2010

Effectiveness of web-based personalised feedback interventions for reducing alcohol consumption among university students: A systematic review and meta-analysis

ISSUES

Meta-analysis was conducted to examine standalone web-based personalised feedback interventions (PFI) delivered in non-structured settings for reducing university students' alcohol consumption. Subgroup analyses by gender-focus, type-of-content and accessibility were conducted. Characteristics of the sample, the intervention and study quality were examined as moderators.

APPROACH

Ten databases were searched from 2000 to 2023. Eligible articles involved only randomised controlled trials. Random-effects meta-analysis was conducted to calculate the effect size on weekly alcohol consumption comparing web-PFIs and non-active controls. Meta-regressions were applied to explore effect moderators.

KEY FINDINGS

Thirty-one studies were included in the narrative synthesis, 25 of which were meta-analysed. Results found significant effect size differences on weekly alcohol consumption in favour of the intervention group in the short- (SMD = 0.11, 95% confidence interval [CI] 0.06, 0.15) and long-term period (SMD = 0.09, 95% CI 0.02, 0.15). Subgroup analyses identified that interventions which were gender-specific, multicomponent and had unlimited access had higher and significant effect sizes, although they were very similar with respect to comparative groups. Moderator analyses showed that times feedback was accessed significantly contributed to the effectiveness of the intervention. Effects diminished over time, although they remained significant.

IMPLICATIONS

The meta-analysis evidences the effectiveness of web-PFI for addressing university students' alcohol use, decreasing by 1.65 and 1.54 drinks consumed per week in the short- and long-term, respectively.

CONCLUSIONS

The results offer empirical evidence that supports the significant, although small, effect of web-PFI delivered remotely in universities. Future research should focus on increasing their impact by introducing booster sessions and content components based on students' preferences.

A blended face-to-face and eHealth lifestyle intervention on physical activity, diet, and health outcomes in Hong Kong community-dwelling older adults: a study protocol for a randomized controlled trial

Background

Aging individuals are vulnerable to various Noncommunicable Diseases (NCDs). Different behaviors are closely related to a decreased risk of suffering from NCDs: sufficient Physical Activity (PA) (e.g., at least 150 mins Moderate-to-vigorous Physical Activity (MVPA) per week) and a healthy daily diet (e.g., at least five portions of Fruit and Vegetable Intake (FVI), 5-6 taels (189.0-226.8 g) Meat, Fish, Egg and Alternatives (MFEA)). Traditional face-to-face interventions were effective in behavior change. However, it was revealed to be resource-intensive and limited transfer due to poor self-regulation skills outside of face-to-face sessions. Thus, eHealth could be a supplement for older adults outside traditional face-to-face settings. The blended approach combining these two interventions might optimize the intervention effects on lifestyle behavior initiation and maintenance, but little research can be found among Hong Kong older adults. Therefore, the study aims to test a blended intervention to promote PA, diet, and health outcomes among Hong Kong community-dwelling older adults.

Methods

This study will adopt a 10-week three-arm randomized controlled trial. The blended group will receive weekly (1) two 60-min face-to-face sessions with one for PA and one for diet, and (2) two web-based sessions with one for PA and one for diet. The face-to-face group will receive the same intervention content as the face-to-face sessions in the blended group. The control condition will receive a biweekly telephone call. The outcomes will include MVPA (minutes/week), FVI (portions/day), MFEA consumption (taels/day), social-cognitive factors (self-efficacy, planning, social support, action control), physical health outcomes (clinical indicators, senior physical fitness), mental health outcomes (depression, loneliness) and health-related quality of life. Data collection will be implemented at the pre-test, post-test, and 3-month follow-up test.

Discussion

This is the first study evaluating a blended intervention promoting multiple health behaviors among Hong Kong community-dwelling older adults. If the effect of the blended intervention is superior to the traditional face-to-face group and the control group, it will enrich lifestyle intervention approaches and can be applied to older adults, helping them obtain health benefits. Furthermore, a better understanding of mechanisms will also have implications for theory-building.

Clinical trial registration

https://www.isrctn.com/ISRCTN32329348, ISRCTN32329348.

Short-term changes in social role statuses across young adulthood and their relation to heavy drinking in a given month

Young adulthood is a developmental period during which individuals experience shifts in their social roles in various domains, which coincides with a period of time that is also high risk for lifetime peaks in alcohol use. The current study examined age-related changes in heavy episodic drinking (HED) and high-intensity drinking (HID) and associations with short-term (i.e., monthly) variation in young adults' social roles over a 2.5-year period in a community sample of young adults who reported past-year alcohol use (N = 778, baseline age range 18-23). Results showed probabilities of past-month HED and HID changed in a nonlinear fashion across ages 18-26 with greater probabilities of use at younger ages. Most participants did not report being in the same social role status every sampled month, underscoring the presence of short-term role variation. Living with parents and being in a serious romantic relationship in a given month were negatively associated with past-month HED. Living with parents in a given month was also negatively associated with past-month HID. Being a 4-year college student and being employed full-time in a given month were not significantly related to either outcome. Findings provided partial evidence that monthly statuses were associated with heavy drinking. Several avenues for future research are described in light of the findings.

Developing a Text Messaging Intervention to Prevent Binge and Heavy Drinking in a Military Population: Mixed Methods Development Study

BACKGROUND

Alcohol misuse is the fourth leading cause of death in the United States and a significant problem in the US military. Brief alcohol interventions can reduce negative alcohol outcomes in civilian and military populations, but additional scalable interventions are needed to reduce binge and heavy drinking. SMS text messaging interventions could address this need, but to date, no programs exist for military populations.

OBJECTIVE

We aimed to develop an SMS text messaging intervention to address binge and heavy drinking among Airmen in Technical Training in the US Air Force.

METHODS

We implemented a 2-phase, mixed methods study to develop the SMS text messaging intervention. In phase 1, a total of 149 respondents provided feedback about the persuasiveness of 49 expert-developed messages, preferences regarding message frequency, timing and days to receive messages, and suggested messages, which were qualitatively coded. In phase 2, a total of 283 respondents provided feedback about the persuasiveness of 77 new messages, including those developed through the refinement of messages from phase 1, which were coded and assessed based on the Behavior Change Technique Taxonomy (BCTT). For both phases, mean persuasiveness scores (range 1-5) were calculated and compared according to age (aged <21 or ≥21 years) and gender. Top-ranking messages from phase 2 were considered for inclusion in the final message library.

RESULTS

In phase 1, top-rated message themes were about warnings about adverse outcomes (eg, impaired judgment and financial costs), recommendations to reduce drinking, and invoking values and goals. Through qualitative coding of suggested messages, we identified themes related to warnings about adverse outcomes, recommendations, prioritizing long-term goals, team and belonging, and invoking values and goals. Respondents preferred to receive 1 to 3 messages per week (124/137, 90.5%) and to be sent messages on Friday, Saturday, and Sunday (65/142, 45.8%). In phase 2, mean scores for messages in the final message library ranged from 3.31 (SD 1.29) to 4.21 (SD 0.90). Of the top 5 highest-rated messages, 4 were categorized into 2 behavior change techniques (BCTs): valued self-identity and information about health consequences. The final message library includes 28 BCTT-informed messages across 13 BCTs, with messages having similar scores across genders. More than one-fourth (8/28, 29%) of the final messages were informed by the suggested messages from phase 1. As Airmen aged <21 years face harsher disciplinary action for alcohol consumption, the program is tailored based on the US legal drinking age.

CONCLUSIONS

This study involved members from the target population throughout 2 formative stages of intervention development to design a BCTT-informed SMS text messaging intervention to reduce binge and heavy drinking, which is now being tested in an efficacy trial. The results will determine the impact of the intervention on binge drinking and alcohol consumption in the US Air Force.

College Student Alcohol Use: Understanding the Role of Alcohol Expectancies, Social Anxiety, Social Connectedness, and Need to Belong

ObjectiveCollege students consume more alcohol and engage in binge drinking more frequently than their non-college attending peers, and prevalence of alcohol-related consequences (e.g., drinking and driving; taking avoidable risks) has not decreased proportionally with decreases in consumption. Social anxiety and alcohol expectancies, or beliefs about the effects of alcohol, have been found to be significantly related to alcohol use and account for significant variance in alcohol use and related consequences. Few studies, however, have examined how other social variables such as need to belong and social connectedness may fit into existing models of increased and risky alcohol use. Methods: Students at a large state university (n = 1,278) completed an online survey measuring alcohol expectancies, need to belong, social anxiety, and social connectedness. Mean age of participants was 19.65 years, and 59.5% self-identified as female, 39.8% male, and 0.7% identified as transgender. Structural equation modeling supported hypothesized relationships between need to belong, social anxiety, social connectedness, alcohol expectancies, and alcohol use, a mean centered variable that included binge drinking, drinking frequency, and amount of consumption. Results: Positive alcohol expectancies related to tension reduction, sociability, and sexuality, were positively related to drinking, such that increased alcohol expectancies were associated with increased drinking. Alcohol expectancies mediated the relationship between need to belong and increased alcohol use, as well as social connectedness and increased alcohol use. Similarly, social anxiety also mediated these relationships. No direct relationships were found between need to belong or social connectedness and alcohol use, suggesting previous research exploring these relationships may have excluded control variables (e.g., biological sex, race/ethnicity) that better explain the impact of need to belong and social connectedness on alcohol use. Conclusion: Prevention and intervention efforts might be more effective in reducing alcohol use if social factors are more broadly targeted.

Identifying factors associated with user retention and outcomes of a digital intervention for substance use disorder: a retrospective analysis of real-world data

Objectives

Successful delivery of digital health interventions is affected by multiple real-world factors. These factors may be identified in routinely collected, ecologically valid data from these interventions. We propose ideas for exploring these data, focusing on interventions targeting complex, comorbid conditions.

Materials and Methods

This study retrospectively explores pre-post data collected between 2016 and 2019 from users of digital cognitive behavioral therapy (CBT)-containing psychoeducation and practical exercises-for substance use disorder (SUD) at UK addiction services. To identify factors associated with heterogenous user responses to the technology, we employed multivariable and multivariate regressions and random forest models of user-reported questionnaire data.

Results

The dataset contained information from 14 078 individuals of which 12 529 reported complete data at baseline and 2925 did so again after engagement with the CBT. Ninety-three percent screened positive for dependence on 1 of 43 substances at baseline, and 73% screened positive for anxiety or depression. Despite pre-post improvements independent of user sociodemographics, women reported more frequent and persistent symptoms of SUD, anxiety, and depression. Retention-minimum 2 use events recorded-was associated more with deployment environment than user characteristics. Prediction accuracy of post-engagement outcomes was acceptable (Area Under Curve [AUC]: 0.74-0.79), depending non-trivially on user characteristics.

Discussion

Traditionally, performance of digital health interventions is determined in controlled trials. Our analysis showcases multivariate models with which real-world data from these interventions can be explored and sources of user heterogeneity in retention and symptom reduction uncovered.

Conclusion

Real-world data from digital health interventions contain information on natural user-technology interactions which could enrich results from controlled trials.

The effectiveness of digital health technologies for reducing substance use among young people: a systematic review & meta-analysis

BACKGROUND

Substance use amongst young people poses developmental and clinical challenges, necessitating early detection and treatment. Considering the widespread use of technology in young people, delivering interventions digitally may help to reduce and monitor their substance use.

AIMS

We conducted a systematic review and two meta-analyses to assess the effectiveness of digital interventions for reducing substance use (alcohol, smoking, and other substances) among young people aged 10 to 24 years old.

METHOD

Embase, Global Health, Medline, PsychINFO, Web of Science and reference lists of relevant papers were searched in November 2020. Studies were included if they quantitatively evaluated the effectiveness of digital health technologies for treating substance use. A narrative synthesis and meta-analysis were conducted.

RESULTS

Forty-two studies were included in the systematic review and 18 in the meta-analyses. Digital interventions showed small, but statistically significant reductions in weekly alcohol consumption compared to controls (SMD= -0.12, 95% CI= -0.17 to -0.06, I2=0%), but no overall effect was seen on 30-day smoking abstinence (OR = 1.12, 95% CI = 0.70 to 1.80, I2=81%). The effectiveness of digital interventions for reducing substance use is generally weak, however, promising results such as reducing alcohol use were seen. Large-scale studies should investigate the viability of digital interventions, collect user feedback, and determine cost-effectiveness.

PRISMA/PROSPERO

This systematic review was conducted following Cochrane methodology PRISMA guidelines. The review was registered with PROSPERO in November 2020 (CRD42020218442).

Students' Perceptions on the Effectiveness of a Computer-Delivered Alcohol Intervention

Objective: Social adjustment, including alcohol use, directly affects the success of college students. Due to an increased reliance on computer-delivered alcohol interventions (CDIs) a need has emerged to further investigate alcohol use and web-based interventions. Methods: In-depth focus group interviews were conducted with 51 undergraduate students to elicit information from students on the shared experience of participating in a CDI. Results: Participants identified the influence of gender, culture, parents, and family on alcohol use behavior. A difference in personal factors, previous exposure, and experiences can affect the attitudes, behaviors, and outcomes of a CDI. Conclusion: Multiple approaches geared towards a wide variety of students from different backgrounds and environments are needed to be truly successful in preventing alcohol misuse.

Development of a Secondary Prevention Smartphone App for Students With Unhealthy Alcohol Use: Results From a Qualitative Assessment

BACKGROUND

Despite considerable efforts devoted to the development of prevention interventions aiming at reducing unhealthy alcohol use in tertiary students, their delivery remains often challenging. Interventions including information technology are promising given their potential to reach large parts of the population.

OBJECTIVE

This study aims to develop a secondary prevention smartphone app with an iterative qualitative design involving the target population.

METHODS

The app development process included testing a first prototype and a second prototype, developed based on the results of 2 consecutive qualitative assessments. Participants (aged ≥18 years, screened positive for unhealthy alcohol use) were students from 4 tertiary education institutions in the French-speaking part of Switzerland. Participants tested prototype 1 or prototype 2 or both and provided feedback in 1-to-1 semistructured interviews after 2-3 weeks of testing.

RESULTS

The mean age of the participants was 23.3 years. A total of 9 students (4/9 female) tested prototype 1 and participated in qualitative interviews. A total of 11 students (6/11 female) tested prototype 2 (6 who tested prototype 1 and 5 new) and participated in semistructured interviews. Content analysis identified 6 main themes: "General Acceptance of the App," "Importance of the Targeted and Relevant App Content," "Importance of Credibility," "Importance of the App Usability," "Importance of a Simple and Attractive Design," "Importance of Notifications to Ensure App Use over Time." Besides a general acceptance of the app, these themes reflected participants' recommendations toward increased usability; to improve the design; to include useful and rewarding contents; to make the app look serious and credible; and to add notifications to ensure its use over time. A total of 11 students tested prototype 2 (6 who tested prototype 1 and 5 new) and participated in semistructured interviews. The 6 same themes emerged from the analysis. Participants from phase 1 generally found the design and content of the app improved.

CONCLUSIONS

Students recommend prevention smartphone apps to be easy to use, useful, rewarding, serious, and credible. These findings may be important to consider when developing prevention smartphone apps to increase the likelihood of app use over time.

TRIAL REGISTRATION

ISRCTN registry 10007691; https://www.isrctn.com/ISRCTN10007691.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s13063-020-4145-2.

Which interventions for alcohol use should be included in a universal healthcare benefit package? An umbrella review of targeted interventions to address harmful drinking and dependence

BACKGROUND

This study aimed to identify targeted interventions for the prevention and treatment of harmful alcohol use. Umbrella review methodology was used to summarise the effectiveness across a broad range of interventions, in order to identify which interventions should be considered for inclusion within universal health coverage schemes in low- and middle-income countries.

METHODS AND FINDINGS

We included systematic reviews with meta-analysis of randomised controlled trials (RCTs) on targeted interventions addressing alcohol use in harmful drinkers or individuals with alcohol use disorder. We only included outcomes related to alcohol consumption, heavy drinking, binge drinking, abstinence, or alcohol-attributable accident, injury, morbidity or mortality. PubMed, Embase, PsycINFO, Cochrane Database of Systematic Reviews, and the International HTA Database were searched from inception to 3 September 2021. Risk of bias of reviews was assessed using the AMSTAR2 tool. After reviewing the abstracts of 9,167 articles, results were summarised narratively and certainty in the body of evidence for each intervention was assessed using GRADE. In total, 86 studies met the inclusion criteria, of which the majority reported outcomes for brief intervention (30 studies) or pharmacological interventions (29 studies). Overall, methodological quality of included studies was low.

CONCLUSIONS

For harmful drinking, brief interventions, cognitive behavioural therapy, and motivational interviewing showed a small effect, whereas mentoring in adolescents and children may have a significant long-term effect. For alcohol use disorder, social network approaches and acamprosate showed evidence of a significant and durable effect. More evidence is required on the effectiveness of gamma-hydroxybutyric acid (GHB), nalmefene, and quetiapine, as well as optimal combinations of pharmacological and psychosocial interventions. As an umbrella review, we were unable to identify the extent to which variation between studies stemmed from differences in intervention delivery or variation between country contexts. Further research is required on applicability of findings across settings and best practice for implementation. Funded by the Thai Health Promotion Foundation, grant number 61-00-1812.

Effectiveness of text message interventions with different behavior change techniques on alcohol consumption among young adults: a five-arm randomized controlled trial

AIMS

This studys aim is to test the effectiveness of five interventions each utilizing a unique set of behavior change techniques on reducing alcohol consumption at 3 and 6 months among young adults with hazardous drinking.

DESIGN, SETTING AND PARTICIPANTS

This study used a five-arm parallel randomized controlled trial with 3- and 6-month follow-ups. Recruitment occurred at four emergency departments in Pittsburgh, PA, USA. Participants were non-treatment-seeking young adults (mean age = 22.1 years; 68.5% female; 37.1% black) who reported hazardous drinking.

INTERVENTIONS

Participants were randomized to one of five automated text message interventions for 12 weeks that interacted with participants on the 2 days per week that they typically drank: assisted self-monitoring (TRACK: control condition; n = 245), pre-drinking cognition feedback (PLAN; n = 226), alcohol consumption feedback (USE; n = 235), adaptive goal support (GOAL; n = 214) and a combination of interventions (COMBO; n = 221).

MEASUREMENTS

Primary outcome was number of past month binge drinking days at 3-month post-randomization calculated from a 30-day time-line follow-back. Primary intention-to-treat analysis compared PLAN, USE, GOAL and COMBO against TRACK (control condition). The four active conditions were not compared against each other. A secondary outcome, durability of effects, was measured at 6 months.

FINDINGS

From baseline to 3-month follow-up (retention = 81.1%), compared with TRACK, in which past-month mean binge drinking days increased from 2.7 to 3.4, mean binge drinking days decreased in COMBO from 3.0 to 2.3 [adjusted β = -0.52; 95% confidence interval (CI) = -0.77, -0.26], GOAL from 3.0 to 2.6 (adjusted β = -0.34; 95% CI = -0.59, -0.10) and USE from 3.3 to 2.9 (adjusted β = -0.38; 95% CI = -0.62, -0.14). At 6 months (retention = 73.8%), COMBO, GOAL, USE and PLAN had significantly lower mean binge drinking days compared with TRACK.

CONCLUSION

Text message interventions incorporating feedback on either drinking plans and/or alcohol consumption and/or drinking limit goal support produced small yet durable reductions in binge drinking days in non-treatment-seeking young adults with hazardous drinking.

Effects of Face-to-Face and eHealth Blended Interventions on Physical Activity, Diet, and Weight-Related Outcomes among Adults: A Systematic Review and Meta-Analysis

An increasing number of studies are blending face-to-face interventions and electronic health (eHealth) interventions to jointly promote physical activity (PA) and diet among people. However, a comprehensive summary of these studies is lacking. This study aimed to synthesize the characteristics of blended interventions and meta-analyze the effectiveness of blended interventions in promoting PA, diet, and weight-related outcomes among adults. Following the PRISMA guidelines, PubMed, SPORTDiscus, PsycINFO, Embase, and Web of Science were systematically searched to identify eligible articles according to a series of inclusion criteria. The search was limited to English language literature and publication dates between January 2002 and July 2022. Effect sizes were calculated as standardized mean difference (SMD) for three intervention outcomes (physical activity, healthy diet, and weight-related). Random effect models were used to calculate the effect sizes. A sensitivity analysis and publication bias tests were conducted. Of the 1561 identified studies, 17 were eligible for the systematic review. Studies varied in participants, intervention characteristics, and outcome measures. A total of 14 studies were included in the meta-analyses. There was evidence of no significant publication bias. The meta-analyses indicated that the blended intervention could lead to a significant increase in walking steps (p < 0.001), total PA level (p = 0.01), and diet quality (p = 0.044), a significant decrease in energy intake (p = 0.004), weight (p < 0.001), BMI (p < 0.001), and waist circumferences (p = 0.008), but had no influence on more moderate-to-vigorous physical activity (MVPA) or fruit and vegetable intake among adults, compared with a control group. The study findings showed that blended interventions achieve preliminary success in promoting PA, diet, and weight-related outcomes among adults. Future studies could improve the blended intervention design to achieve better intervention effectiveness.

Practitioner and digitally delivered interventions for reducing hazardous and harmful alcohol consumption in people not seeking alcohol treatment: a systematic review and network meta-analysis

AIM

To compare the effectiveness of practitioner versus digitally delivered interventions for reducing hazardous and harmful alcohol consumption.

DESIGN

Systematic review and network meta-analysis comprising comprehensive search for randomised controlled trials, robust screening and selection methods and appraisal with the Cochrane Risk of Bias tool. Network meta-analyses were conducted in Stata using random effects, frequentist models. The confidence in network meta-analysis (CINeMA) tool was used to assess confidence in effect sizes.

SETTING

Online or community or health settings where the intervention was immediately accessible without referral.

PARTICIPANTS

Non treatment-seeking hazardous or harmful drinkers.

MEASUREMENTS

Primary outcome was mean difference in alcohol consumption (g/wk); secondary outcome was number of single high intensity drinking episodes. Baseline consumption was analysed as a covariate.

FINDINGS

Of 201 included trials (94 753 participants), 152 reported a consumption outcome that could be converted to grams/week; 104 reported number of single high intensity drinking episodes. At 1 and 6 months, practitioner delivered interventions reduced consumption more than digitally delivered interventions (1 month: -23 g/wk (95% CI, -43 to -2); 6 months: -14 g/wk [95% CI, -25 to -3]). At 12 months there was no evidence of difference between practitioner and digitally delivered interventions (-6 g/wk [95% CI, -24 to 12]). There was no evidence of a difference in single high intensity drinking episodes between practitioner and digitally delivered interventions at any time point. Effect sizes were small, but could impact across a population with relatively high prevalence of hazardous and harmful drinking. Heterogeneity was a concern. Some inconsistency was indicated at 1 and 6 months, but little evidence was apparent at 12 months.

CONCLUSION

Practitioner delivered interventions for reducing hazardous and harmful alcohol consumption are more effective than digitally delivered interventions up to 6 months; at 12 months there is no evidence of a difference.

The effectiveness of a mobile intervention to reduce young adults' alcohol consumption to not exceed low-risk drinking guidelines

Background

Young adults' drinking habits often exceed low-risk drinking guidelines. As young adults show increased access, use, and interest in personalized content related to physical and mental well-being, mobile applications might be a suitable tool to reach this target group. This study investigates the effectiveness of "Boozebuster", a self-guided mobile application incorporating various therapeutic principles to reduce young adults' alcohol consumption to not exceeding low-risk drinking guideline levels, compared to an educational website condition.

Method

Young adults aged 18-30 wanting to reduce their alcohol consumption entered a two-arm, parallel-group RCT. There were no minimum drinking severity inclusion criteria. Primary outcomes included alcohol consumption quantity and frequency. Secondary outcomes included binge drinking frequency and alcohol-related problem severity. Baseline, 6-week postbaseline, and 3-month post-baseline assessments were analyzed using linear mixed model analyses. Sex, treatment adherence, experienced engagement and motivation to change alcohol use behavior were investigated as moderators. Sub-group analyses contained problem drinkers and binge drinkers.

Results

503 participants were randomized to the intervention or control condition. Results showed no intervention effects on primary or secondary outcomes compared to the control group. Both groups showed within-group reductions on all outcomes. Sub-group analyses in problem drinkers or binge drinkers showed similar results. Motivation to change drinking behavior and experienced engagement with the application significantly moderated the intervention effect regarding the quantity or frequency of alcohol consumption, respectively. Exploratory analyses showed that participants who indicated they wanted to change their drinking patterns during the initial PNF/MI module showed a significantly greater reduction in drinking quantity compared to those who indicated not wanting to change their drinking patterns.

Conclusion

The intervention group did not show a greater reduction in alcohol-related outcomes compared to the control group, but both groups showed a similar decrease. Potential explanations include similar effectiveness of both condition due to using a minimal active control in participants predominantly in the action stage of motivation to change. Future research should further explore the effectiveness of using mobile application to reduce young adults' drinking behavior to not exceed low-risk drinking guideline levels and identify factors that motivate participants to engage with such an intervention.

Intervenciones para reducir el consumo de alcohol en jóvenes universitarios

Introducción: el consumo nocivo y excesivo de alcohol en los jóvenes ha sido reconocido como un comportamiento de riesgo significativo, por tanto, reducir el consumo y los problemas asociados es una prioridad entre los investigadores, educadores y profesionales de la salud que trabajan con esta población. Objetivo: examinar la evidencia actual sobre las intervenciones para reducir el consumo de alcohol de jóvenes universitarios. Método: se utilizó la metodología propuesta por Toronto y Remington. Para la evaluación y selección de los artículos cuantitativos se empleó el Instrumento de Criterios de Elegibilidad para la Selección de los Artículos de Investigación (ICrESAI) y para la evaluación de los ensayos clínicos aleatorizados se empleó la lista de verificación Estándares Consolidados de Informes de Ensayos (Consort). Resultados: se encontraron trece artículos, diez de ellos ensayos clínicos aleatorizados, dos cuantitativos longitudinales y un ensayo factorial. Conclusión: se encontró una gran variedad de diseños y propuestas de intervención, dentro de las cuales se demostró que las intervenciones breves entregadas de manera digital, tanto en la web, como en teléfonos inteligentes, son efectivas para reducir el consumo de riesgo de alcohol entre los jóvenes.

A randomized pilot trial of a mobile phone-based brief intervention with personalized feedback and interactive text messaging to reduce driving after cannabis use and riding with a cannabis impaired driver

INTRODUCTION

Driving after cannabis use (DACU) and riding with a cannabis-impaired driver (RWCD) are national public health concerns. Though driving impairments and increased crash risk make DACU and RWCD two of the riskiest cannabis-related behaviors, many continue to drive after use and ride with others who are under the influence and do not view DACU or RWCD as dangerous. The current study examined the efficacy of an accessible, low-cost, mobile phone-based brief intervention aimed at reducing DACU and RWCD among college cannabis users in the context of a randomized three-group pilot trial.

METHOD

Participants were 97 college cannabis users (67.4 % women; average age = 21.34; 80.4 % Caucasian) who endorsed DACU at least three times in the past three months. After completing baseline measures, the study randomly assigned participants to one of three conditions: a) a substance impaired-driving personalized feedback plus MI-style interactive text messaging intervention (PF + MIT); b) a substance impaired-driving personalized feedback only intervention (PF); and c) a substance information control condition (IC). All conditions completed outcome measures three months postintervention.

RESULTS

Generalized linear mixed models (GLMM) analyses indicated that after controlling for sex, cannabis users in the PF + MIT condition significantly reduced DACU and RWCD over time compared to those in the IC condition.

CONCLUSIONS

These findings provide preliminary support for the short-term efficacy of a mobile phone-based intervention in decreasing DACU and RWCD among college cannabis users. Future research should determine whether these reductions in driving behaviors persist past three months.

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

Strengthening personalized norm feedback interventions: The ambivalent-attitude effect

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Personalized norm feedback effectively reduces heavy drinking in college students.

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Inducing ambivalence makes norms a stronger predictor of behavior.

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We predicted that ambivalence before the PNF would lower alcohol intentions.

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Ambivalent Ps intended to drink less re compared to those low in ambivalence.

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Ambivalence should be included in personalized norm feedback interventions.

This study investigated the effect of induced attitude ambivalence on the relationship between the personalized norm feedback (PNF) intervention and heavy drinking by college students. College students consume more alcohol and engage in binge drinking at greater rates than most segments of the population. Given the harmful effects of binge drinking and other risky drinking behaviors, it is important to implement effective interventions to reduce alcohol consumption. PNF is an effective intervention for reducing heavy drinking where students compare their drinking and perceptions of normative drinking with actual drinking norms. Past research suggests that inducing ambivalence makes norms a stronger predictor of behavior. We hypothesized that induced attitudinal ambivalence before the PNF intervention would lower intentions to consume alcohol. This study was a one-way design with ambivalence about drinking (high vs low) as the independent variable and intentions to drink alcohol in the future as the dependent variable (N = 338, 76 % female, M_age = 19.76, SD = 2.61). All participants received the PNF intervention after the ambivalence manipulation and before the intentions to drink alcohol measure. Results from the generalized linear model revealed a significant effect for ambivalence, p =.028. As predicted, participants in the high ambivalence condition intended to drink fewer drinks in one sitting in the future compared to those in the low ambivalence condition. These results suggest that ambivalence may play an important role in make PNF interventions more effective, though more research is necessary to untangle the relationship between ambivalence and norms.

A combined laboratory and field test of a smartphone breath alcohol device and blood alcohol concentration estimator to facilitate moderate drinking among young adults

OBJECTIVE

Innovative strategies are needed to reduce young adult drinking. Real-time feedback via mobile health (mHealth) technology (e.g., smartphone devices/apps) may facilitate moderate drinking, yet requires evidence of feasibility, acceptability, and usability.

METHOD

Young adults reporting frequent heavy drinking (N = 99, Mage = 23, 51% male) participated in a manualized, brief, motivational interview on recent typical and peak blood alcohol concentration (BAC), then were randomized to use 1 of the 3 forms of technology: (a) smartphone breathalyzer device/app; (b) app that estimates BAC based on factors including sex, weight, number/types of drinks over time; or (c) self-text messaging after each drink. Technologies were tested initially in small-group laboratory alcohol self-administration sessions. Participants then completed a 2-week field test wherein they had free access to all three technologies. Participants reported on usability and acceptability.

RESULTS

Laboratory alcohol self-administration did not differ significantly by technology condition. The smartphone breathalyzer and BAC estimator app had favorable acceptability and usability. Participants used at least one form of technology on 67% of drinking days in the field period. In exploratory analyses, alcohol use during the field period was significantly lower than the baseline including a decrease of nearly one drink per drinking day.

CONCLUSIONS

These findings support the feasibility of research combining lab and field methods to test moderate drinking technologies in young adults. Findings further support the acceptability and usability of these technologies, along with young adults' openness to using them. Exploratory results suggest potential efficacy of combined mobile technology intervention to be tested in subsequent controlled studies. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Who Opts In to Alcohol Feedback and How Does That Impact Behavior? A Pilot Trial

OBJECTIVE

Personalized feedback interventions are effective in reducing alcohol consumption and related problems. However, little is known about the role of choice in outcomes. The current study sought to (a) characterize individuals who opt in for brief alcohol-related feedback, (b) assess participants' consistency in that choice over two time points, and (c) evaluate changes in peak alcohol consumption among those who did and did not receive feedback.

METHOD

Participants reporting past-12-month alcohol consumption were recruited through Prolific. At the outset of the survey, participants were asked if they would like to receive feedback on their drinking at the end of the survey ("opt in"). Participants at Time 1 (T1; N = 732) were 41% female, 91% White, and 8% Hispanic (mean age = 36, SD = 12.25, range: 18-80). A subset was invited back for a 30-day retest (Time 2 [T2]; n = 234).

RESULTS

Those reporting higher maximum drinks and more drug use were more likely to opt in to feedback than those with lower use. Further, 85% of participants were consistent in their choice of whether to receive feedback across T1 and T2 (κ = .65). Among heavy drinking participants with T1 and T2 data (n = 163), there was an effect of feedback on intensity of consumption at T2.

CONCLUSIONS

Individuals who engage in heavy alcohol use are more likely to opt in to personalized alcohol feedback, and most do so consistently. Among heavy drinkers, feedback at T1 reduced intensity of consumption at T2, but the effect was small and requires future replication in more diverse samples.

Examining the added value of harm reduction strategies to emailed boosters to extend the effects of online interventions for college drinkers

Objective: Brief computer-delivered interventions (CDIs) reduce college student drinking and related problems but can be less efficacious and enduring than in-person interventions. The present study examined: (a) the utility of emailed personalized boosters after an evidence-based online CDI for alcohol (i.e., eCHECKUP TO GO), and (b) the added value of including protective behavioral strategies (PBS) in boosters containing personalized normative feedback (PNF) versus PNF alone. Method: 528 young adult (ages 18-24) college drinkers (71.6% female; 52.5% Black, 40.3% White) with a mean age of 19.9 years (SD = 1.65) were randomized to receive: CDI-only; CDI plus a PNF-only booster; or CDI plus a booster containing both PNF and PBS feedback. Booster emails were sent 2 weeks post-intervention. Online surveys completed pre-intervention and at 1 and 3 months assessed alcohol consumption, problems, descriptive normative perceptions, and PBS use. Results: The CDI led to significant reductions in alcohol consumption across all conditions, with no effect of boosters on drinking. Controlling for quantity, no reductions in problems were observed. Descriptive norms reduced significantly, with no condition differences. Only PBS use showed condition effects, such that the CDI-only and PNF-only booster groups reported reduced PBS use at 1 month, but the norms-plus-PBS booster group did not. Conclusions: The CDI was sufficient to change alcohol consumption and perceived norms without boosters, although the inclusion of boosters with PBS feedback may mitigate against PBS use reductions. Longer follow-ups may detect delayed booster benefits, or a larger dose through repeated exposure over time may be needed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Thirty years of BASICS: Dissemination and implementation progress and challenges

The first clinical trial of the Brief Alcohol Screening and Intervention for College Students (BASICS) was launched at the University of Washington in 1990. Since that time, multiple trials have demonstrated the efficacy of BASICS and related approaches in a variety of young adult populations and this information has been widely disseminated. However, in practice BASICS implementation varies considerably, including formats and mediums (e.g., group, telehealth, written/electronic feedback alone) not studied in the original research. Even if delivered in an individual in-person format, implementation can stray substantially from the original design. Adaptations may be necessary to address campus resource constraints or other barriers to implementation but can have unknown impacts on intervention effectiveness. Thus, despite wide-scale efforts to disseminate and implement BASICS, challenges remain, and there are several critical research gaps that need to be addressed to support campuses in implementing BASICS successfully. The current manuscript reviews several ways in which BASICS has been adapted to address these challenges, and provides recommendations for best implementation practices as well as future research needed to improve implementation and effectiveness of BASICS going forward. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Genetically influenced externalizing and internalizing risk pathways as novel prevention targets

Objective: Risky substance use among college students is widespread, and associated with numerous adverse consequences. Current interventions focus primarily on students' current substance use; we hypothesize that shifting focus from current use to underlying risk factors is a complementary approach that may improve effectiveness of prevention/intervention programming. This approach aligns with the personalized medicine movement, which aims to harness knowledge about underlying etiological factors to provide individuals with specific information about their unique risk profiles and personalized recommendations, to motivate and enable individuals to better self-regulate their health. Method: Our group is building and evaluating an online Personalized Feedback Program (PFP) for college students that provides feedback about the individual's underlying genetically influenced externalizing and internalizing risk factors for substance use, along with personalized recommendations/resources. The project capitalizes on work from a university-wide research project (Spit for Science; S4S), in which > 12,000 students (˜70% of 5 years of incoming freshmen) are being followed longitudinally to assess substance use and related factors across the college years. In this article, we describe our foundational work to develop the PFP. Results: From the S4S data, we have identified risk factors across four domains (Sensation Seeking, Impulsivity, Extraversion, and Neuroticism) that are correlated with college students' substance use. We developed an online self-guided PFP, in collaboration with professionals from student affairs, and using feedback from students, with the ultimate goal of conducting a randomized clinical trial. Conclusion: The provision of personalized risk information represents a novel approach to complement and extend existing college substance use programming. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A risk algorithm that predicts alcohol use disorders among college students

The first year of college may carry especially high risk for onset of alcohol use disorders. We assessed the one-year incidence of alcohol use disorders (AUD) among incoming first-year students, predictors of AUD-incidence, prediction accuracy and population impact. A prospective cohort study of first-year college students (baseline: N = 5843; response rate = 51.8%; 1-year follow-up: n = 1959; conditional response rate = 41.6%) at a large university in Belgium was conducted. AUD were evaluated with the AUDIT and baseline predictors with the Composite International Diagnostic Interview Screening Scales (CIDI-SC). The one-year incidence of AUD was 3.9% (SE = 0.4). The most important individual-level baseline predictors of AUD incidence were being male (OR = 1.53; 95% CI = 1.12-2.10), a break-up with a romantic partner (OR = 1.67; 95% CI = 1.08-2.59), hazardous drinking (OR = 3.36; 95% CI = 1.31-8.63), and alcohol use characteristics at baseline (ORs between 1.29 and 1.38). Multivariate cross-validated prediction (cross-validated AUC = 0.887) shows that 55.5% of incident AUD cases occurred among the 10% of students at highest predicted risk (20.1% predicted incidence in this highest-risk subgroup). Four out of five students with incident AUD would hypothetically be preventable if baseline hazardous drinking was to be eliminated along with a reduction of one standard deviation in alcohol use characteristics scores, and another 15.0% would potentially be preventable if all 12-month stressful events were eliminated. Screening at college entrance is a promising strategy to identify students at risk of transitioning to more problematic drinking and AUD, thus improving the development and deployment of targeted preventive interventions.

A mobile-based pregaming drinking prevention intervention for college students: study protocol for a randomized controlled trial

BACKGROUND

Pregaming is a high-drink context popular among college students that often leads to elevated blood alcohol levels and negative consequences. Over 15 years of research studies have demonstrated that pregaming represents one of the riskiest known behaviors among college students, yet no pregaming-specific interventions have been developed to help prevent this behavior. General brief interventions for students do not reduce pregaming behavior and may not be appropriate, as they do not help students develop skills unique to the pregaming context that could help them drink less. We developed a brief, mobile-based intervention that is proposed to prevent heavy drinking during pregaming for college students, with the ultimate goal that behavioral reductions in this risky practice will ultimately affect global drinking and prevent consequences.

METHODS/DESIGN

The intervention, Pregaming Awareness in College Environments (PACE), was developed by combining two innovations to facilitate behavior change: (1) a mobile-based application that increases accessibility, is easy and engaging to use, and broadens the reach of the intervention content and (2) personalized pregaming-specific intervention content with harm reduction and cognitive behavioral skills proven to be mechanisms preventing and reducing heavy drinking among college students. After a develop and beta-test phase, we propose to test the efficacy of PACE in a preliminary randomized controlled trial with 500 college students who pregame at least once per week. Pregaming, general drinking, and alcohol-related consequences outcomes will be examined in the immediate (2 weeks post-intervention) and short-terms (six and 14-week post-intervention). We will also evaluate moderator effects for age, sex, and heaviness of drinking to allow for more refined information for a planned larger test of the intervention to follow this initial trial of PACE.

DISCUSSION

This pregaming intervention clinical trial, if found to be efficacious, will culminate with an easily-disseminated mobile-based intervention for college student drinkers. It has the potential to reach millions of college students, perhaps as a clinical tool used by college counseling centers as an adjunct to formal care or as a preventive tool for first-year students or other high-risk groups on campus.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier NCT04016766.

Digital Health Interventions for Delivery of Mental Health Care: Systematic and Comprehensive Meta-Review

BACKGROUND

The COVID-19 pandemic has shifted mental health care delivery to digital platforms, videoconferencing, and other mobile communications. However, existing reviews of digital health interventions are narrow in scope and focus on a limited number of mental health conditions.

OBJECTIVE

To address this gap, we conducted a comprehensive systematic meta-review of the literature to assess the state of digital health interventions for the treatment of mental health conditions.

METHODS

We searched MEDLINE for secondary literature published between 2010 and 2021 on the use, efficacy, and appropriateness of digital health interventions for the delivery of mental health care.

RESULTS

Of the 3022 records identified, 466 proceeded to full-text review and 304 met the criteria for inclusion in this study. A majority (52%) of research involved the treatment of substance use disorders, 29% focused on mood, anxiety, and traumatic stress disorders, and >5% for each remaining mental health conditions. Synchronous and asynchronous communication, computerized therapy, and cognitive training appear to be effective but require further examination in understudied mental health conditions. Similarly, virtual reality, mobile apps, social media platforms, and web-based forums are novel technologies that have the potential to improve mental health but require higher quality evidence.

CONCLUSIONS

Digital health interventions offer promise in the treatment of mental health conditions. In the context of the COVID-19 pandemic, digital health interventions provide a safer alternative to face-to-face treatment. However, further research on the applications of digital interventions in understudied mental health conditions is needed. Additionally, evidence is needed on the effectiveness and appropriateness of digital health tools for patients who are marginalized and may lack access to digital health interventions.

Parental influences on marijuana use in emerging adulthood

The purpose of this study was to gain a clearer understanding of the relation between parental relationship qualities and overall emerging adulthood (EA) marijuana use processes. The present study drew from an ethnically and socioeconomially diverse sample of EAs (ages 19-22) and their parents (n = 470) from the Pacific Northwest region. This study used parent-report and child-report data to capture measures of parenting and EA marijuana use outcomes. Latent Class Growth Analysis (LCGA) was used to model trajectories of marijuana use and risk factor analyses were used to examine how marijuana group membership varied by covariates and parental relationship qualities. Results revealed that lower levels of family cohesion and quality of parent-child communication were more likely to predict membership in the high-using groups and moderate-decreasing user groups in comparison to low-to-non users. Results also indicated that lower levels of frequency of parent-child communication were more likely to predict membership in the high-users group compared to the low-to-non users. Regarding parent knowledge of marijuana use, trends toward congruence and underestimation of EA marijuana use predicted membership in the high-using and moderate-decreasing groups compared to the low-to-non users. Study results indicate EAs in their early 20s may be more likely to engage in healthy decision-making regarding marijuana use in an environment that includes warm, supportive parent-child relationships where parents are aware of their EAs use without focusing on their EA's perceptions of risk. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Social Goal Orientation Differentially Influences Exposure to Interpersonal and Noninterpersonal Trauma

Emerging adults are at an increased risk for trauma exposure, both interpersonal and non-interpersonal, which often occurs within a social context. How an individual interacts with this context may heighten or buffer against their risk for trauma. Social goal orientation represents individual differences that characterize how an individual navigates their social environment. These orientations fall along the two interacting dimensions, Agency and Communion. In a community sample (N=274; 55% female, average age = 18.9) of young adults, we sought to examine the role that these two types of social goals, both uniquely and in interaction with one another, may play in interpersonal and non-interpersonal trauma risk. Because men and women are at differential risk for trauma, we also examined the impact of gender on these associations. Findings revealed that social goal orientations are linked to trauma exposure in ways that differ depending on the type of trauma, interpersonal or non-interpersonal. Moreover, these processes differed for men and women. Whereas a high Communal Orientation was associated with decreased exposure to all trauma, for both women and men, Agentic Orientation was associated with an increased number of interpersonal and non-interpersonal trauma. For men, agency and communion interacted, suggesting that the extent to which an agentic orientation may be risky or protective for interpersonal trauma depends strongly on communal orientation. These findings provided initial evidence for the role social goal orientation may play as a risk or protective factor for trauma exposure.

The effectiveness of a web-based intervention for Japanese adults with problem drinking: An online randomized controlled trial

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We conducted an online randomized controlled trial for a web-based intervention.

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The intervention comprised normative comparison, psychoeducation, and a short quiz.

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Participants were Japanese adults aged 20 years or older and scored AUDIT ≥ 8.

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The weekly drinking quantity at the two- and six-month follow-ups decreased.

Aims

This study aimed (1) to delineate how a web-based intervention affects the problem drinking behaviors of Japanese adults and (2) to examine the moderating effects of disorder levels and alcohol outcome expectancies on intervention outcomes.

Methods

We implemented an online two-armed parallel-group randomized controlled trial with 546 Japanese adults. Adults aged 20 years or older and who scored eight or higher on the Alcohol Use Disorder Identification Test were included in this study. Participants were randomly allocated to the intervention group or the waitlist/control group. The intervention comprised assessment of drinking behavior, personalized normative feedback, psychoeducation about the consequences of problem drinking, and a short quiz. The outcomes were weekly drinking quantity and abstinent days, largest drinking quantity in one day, and alcohol-related consequences reported at baseline and at one-, two-, and six-month follow-ups. A mixed-effects model regression was conducted to compare the intervention and control groups.

Results

The attrition rates at each follow-up were 52.93%, 49.45%, and 32.60%, respectively. The time × condition interaction effect on weekly drinking quantity was significant at the two- and six-month follow-ups, d = 0.28, 95% CI [0.04, 0.51], d = 0.34, 95% CI [0.05, 0.63], respectively. Moderations related to the intervention effect were not statistically significant.

Conclusion

A web-based intervention was found to be effective for two and six months only on drinking quantity measures of Japanese adults with problem drinking. Limitations including high drop-out rates in are discussed.

Examining Cross-Country and Sex Differences on a Comprehensive Assessment of Protective Behavioral Strategies for Alcohol

OBJECTIVE

Use of protective behavioral strategies (PBS) has been associated with reduced alcohol-related harms among college students. However, most of this research has been conducted among U.S. samples. The present study examines the use of PBS in an international context.

METHOD

Participants (n = 1512) were recruited from universities in Spain (n = 298), Argentina (n = 439), and the U.S. (n = 775) to determine if there are differences in PBS use across countries and/or across sex. Further, we examined whether the association between PBS use and negative consequences differ across country and sex.

RESULTS

We found that U.S. students reported the most frequent use of Stopping/Limiting Drinking PBS (M = 3.32, SD = 1.23) compared to Argentine (M = 2.89, SD = 0.97) and Spanish (M = 2.83, SD = 0.94) students. Argentine students reported the least frequent use of Serious Harm Reduction PBS (M = 4.57, SD = 0.99) compared to U.S. (M = 5.09, SD = 0.98) and Spanish (M = 5.03, SD = 0.78) students. Elastic net regression analyses stratified by country indicated most individual PBS predicted decreased negative alcohol-related consequences, although two items consistently predicted increased consequences and we observed some variability in the most predictive specific strategies in each country. Across each subscale and for 32 of 40 individual items, females reported more frequent use of PBS than males (ps<.05).

CONCLUSIONS

From the perspective of developing and adapting interventions, we recommend the cultural context in which PBS are used is taken into account. Although future work is needed to delineate cultural factors underlying the country-level differences we found, these findings have implications for the most promising PBS to target for college students in each country.

Initial efficacy of a web-based alcohol and emotion regulation intervention for college women with sexual assault histories

OBJECTIVE

College women with sexual assault histories report greater heavy drinking relative to those without histories of assault. Moreover, individuals with sexual assault histories often have difficulty regulating emotions and tolerating distress, which can lead to a problematic pattern of drinking to cope. Thus, we evaluated the initial efficacy of a web-based alcohol intervention that included strategies to reduce drinking and improve regulatory skills for heavy drinking college women with sexual assault histories.

METHOD

The sample comprised college women (N = 200) who were 20.9 (SD = 2.8) years old and primarily White (69%). They were randomized to an assessment-only control or intervention and completed 14 daily diary assessments, pre- and posttreatment surveys, and 1- and 6-month follow-up surveys. During daily diary, the intervention group received a brief (5-10 min) alcohol reduction or regulatory skill module each day.

RESULTS

Reductions in drinking quantity and heavy episodic drinking were found for the intervention group at posttreatment and 1-month follow-up relative to controls. Improved regulatory skills and reduced posttraumatic stress disorder (PTSD) symptoms were reported at posttreatment for women who received the intervention compared to controls. Although gains were maintained, the intervention group no longer differed from controls by 6-month follow-up.

CONCLUSIONS

Results suggest this web-based intervention may result in short-term reductions in drinking and PTSD symptoms as well as improvements in regulatory abilities for college women with sexual assault histories. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Brief Alcohol Screening and Intervention for Community College Students (BASICCS): Feasibility and preliminary efficacy of web-conferencing BASICCS and supporting automated text messages

Objective: The Brief Alcohol Screening and Intervention for College Students (BASICS; Dimeff et al., 1999) is an evidence-based approach to reduce high-risk drinking and associated harms; however, implementation may present challenges for community colleges (CCs) that have limited budgets and mostly non-residential students. We examined feasibility, acceptability, and efficacy of BASICS for CC students (BASICCS) delivered remotely via web-conferencing with supporting automated text messages. Method: Participants included 142 CC students who reported exceeding National Institute on Alcohol Abuse and Alcoholism (NIAAA's) weekly low-risk drinking recommendations and/or heavy episodic drinking (HED). Participants were randomized to BASICCS or assessment-only control (AOC) and completed 1- and 3-month follow-up assessments. Results: Most students liked the personalized information in the program and found the web-conferencing platform useful, however intervention completion rate was 56%. Significant differences were found between BASICCS and AOC. At 1-month, individuals in BASICCS had 33% fewer alcohol consequences than those in AOC. At 3-month follow-up, individuals in BASICCS had lower estimated peak blood alcohol concentration, 29% fewer drinks per week, 62% fewer episodes of HED, and 24% fewer consequences than those in AOC. Conclusions: BASICCS showed evidence of being acceptable and the technology proved feasible, although the intervention completion rate in the non-treatment-seeking volunteer sample was modest. Preliminary evidence does suggest BASICCS shows promise in reducing alcohol use and consequences. Technology-based platforms could be a viable prevention solution for CC students. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

New Australian guidelines for the treatment of alcohol problems: an overview of recommendations

OF RECOMMENDATIONS AND LEVELS OF EVIDENCE

Chapter 2: Screening and assessment for unhealthy alcohol use Screening Screening for unhealthy alcohol use and appropriate interventions should be implemented in general practice (Level A), hospitals (Level B), emergency departments and community health and welfare settings (Level C). Quantity-frequency measures can detect consumption that exceeds levels in the current Australian guidelines (Level B). The Alcohol Use Disorders Identification Test (AUDIT) is the most effective screening tool and is recommended for use in primary care and hospital settings. For screening in the general community, the AUDIT-C is a suitable alternative (Level A). Indirect biological markers should be used as an adjunct to screening (Level A), and direct measures of alcohol in breath and/or blood can be useful markers of recent use (Level B). Assessment Assessment should include evaluation of alcohol use and its effects, physical examination, clinical investigations and collateral history taking (Level C). Assessment for alcohol-related physical problems, mental health problems and social support should be undertaken routinely (GPP). Where there are concerns regarding the safety of the patient or others, specialist consultation is recommended (Level C). Assessment should lead to a clear, mutually acceptable treatment plan which specifies interventions to meet the patient's needs (Level D). Sustained abstinence is the optimal outcome for most patients with alcohol dependence (Level C). Chapter 3: Caring for and managing patients with alcohol problems: interventions, treatments, relapse prevention, aftercare, and long term follow-up Brief interventions Brief motivational interviewing interventions are more effective than no treatment for people who consume alcohol at risky levels (Level A). Their effectiveness compared with standard care or alternative psychosocial interventions varies by treatment setting. They are most effective in primary care settings (Level A). Psychosocial interventions Cognitive behaviour therapy should be a first-line psychosocial intervention for alcohol dependence. Its clinical benefit is enhanced when it is combined with pharmacotherapy for alcohol dependence or an additional psychosocial intervention (eg, motivational interviewing) (Level A). Motivational interviewing is effective in the short term and in patients with less severe alcohol dependence (Level A). Residential rehabilitation may be of benefit to patients who have moderate-to-severe alcohol dependence and require a structured residential treatment setting (Level D). Alcohol withdrawal management Most cases of withdrawal can be managed in an ambulatory setting with appropriate support (Level B). Tapering diazepam regimens (Level A) with daily staged supply from a pharmacy or clinic are recommended (GPP). Pharmacotherapies for alcohol dependence Acamprosate is recommended to help maintain abstinence from alcohol (Level A). Naltrexone is recommended for prevention of relapse to heavy drinking (Level A). Disulfiram is only recommended in close supervision settings where patients are motivated for abstinence (Level A). Some evidence for off-label therapies baclofen and topiramate exists, but their side effect profiles are complex and neither should be a first-line medication (Level B). Peer support programs Peer-led support programs such as Alcoholics Anonymous and SMART Recovery are effective at maintaining abstinence or reductions in drinking (Level A). Relapse prevention, aftercare and long-term follow-up Return to problematic drinking is common and aftercare should focus on addressing factors that contribute to relapse (GPP). A harm-minimisation approach should be considered for patients who are unable to reduce their drinking (GPP). Chapter 4: Providing appropriate treatment and care to people with alcohol problems: a summary for key specific populations Gender-specific issues Screen women and men for domestic abuse (Level C). Consider child protection assessments for caregivers with alcohol use disorder (GPP). Explore contraceptive options with women of reproductive age who regularly consume alcohol (Level B). Pregnant and breastfeeding women Advise pregnant and breastfeeding women that there is no safe level of alcohol consumption (Level B). Pregnant women who are alcohol dependent should be admitted to hospital for treatment in an appropriate maternity unit that has an addiction specialist (GPP). Young people Perform a comprehensive HEEADSSS assessment for young people with alcohol problems (Level B). Treatment should focus on tangible benefits of reducing drinking through psychotherapy and engagement of family and peer networks (Level B). Aboriginal and Torres Strait Islander peoples Collaborate with Aboriginal or Torres Strait Islander health workers, organisations and communities, and seek guidance on patient engagement approaches (GPP). Use validated screening tools and consider integrated mainstream and Aboriginal or Torres Strait Islander-specific approaches to care (Level B). Culturally and linguistically diverse groups Use an appropriate method, such as the "teach-back" technique, to assess the need for language and health literacy support (Level C). Engage with culture-specific agencies as this can improve treatment access and success (Level C). Sexually diverse and gender diverse populations Be mindful that sexually diverse and gender diverse populations experience lower levels of satisfaction, connection and treatment completion (Level C). Seek to incorporate LGBTQ-specific treatment and agencies (Level C). Older people All new patients aged over 50 years should be screened for harmful alcohol use (Level D). Consider alcohol as a possible cause for older patients presenting with unexplained physical or psychological symptoms (Level D). Consider shorter acting benzodiazepines for withdrawal management (Level D). Cognitive impairment Cognitive impairment may impair engagement with treatment (Level A). Perform cognitive screening for patients who have alcohol problems and refer them for neuropsychological assessment if significant impairment is suspected (Level A).

SUMMARY OF KEY RECOMMENDATIONS AND LEVELS OF EVIDENCE

Chapter 5: Understanding and managing comorbidities for people with alcohol problems: polydrug use and dependence, co-occurring mental disorders, and physical comorbidities Polydrug use and dependence Active alcohol use disorder, including dependence, significantly increases the risk of overdose associated with the administration of opioid drugs. Specialist advice is recommended before treatment of people dependent on both alcohol and opioid drugs (GPP). Older patients requiring management of alcohol withdrawal should have their use of pharmaceutical medications reviewed, given the prevalence of polypharmacy in this age group (GPP). Smoking cessation can be undertaken in patients with alcohol dependence and/or polydrug use problems; some evidence suggests varenicline may help support reduction of both tobacco and alcohol consumption (Level C). Co-occurring mental disorders More intensive interventions are needed for people with comorbid conditions, as this population tends to have more severe problems and carries a worse prognosis than those with single pathology (GPP). The Kessler Psychological Distress Scale (K10 or K6) is recommended for screening for comorbid mental disorders in people presenting for alcohol use disorders (Level A). People with alcohol use disorder and comorbid mental disorders should be offered treatment for both disorders; care should be taken to coordinate intervention (Level C). Physical comorbidities Patients should be advised that alcohol use has no beneficial health effects. There is no clear risk-free threshold for alcohol intake. The safe dose for alcohol intake is dependent on many factors such as underlying liver disease, comorbidities, age and sex (Level A). In patients with alcohol use disorder, early recognition of the risk for liver cirrhosis is critical. Patients with cirrhosis should abstain from alcohol and should be offered referral to a hepatologist for liver disease management and to an addiction physician for management of alcohol use disorder (Level A). Alcohol abstinence reduces the risk of cancer and improves outcomes after a diagnosis of cancer (Level A).

Optimizing scalable, technology-supported behavioral interventions to prevent opioid misuse among adolescents and young adults in the emergency department: A randomized controlled trial protocol

Preventing opioid misuse and opioid use disorder is critical among at-risk adolescents and young adults (AYAs). An Emergency Department (ED) visit provides an opportunity for delivering interventions during a rapidly changing opioid landscape. This paper describes pilot data and the protocol for a 2 × 2 factorial randomized controlled trial testing efficacy of early interventions to reduce escalation of opioid (prescription or illicit) misuse among at-risk AYAs. Interventions are delivered using technology by health coaches. AYAs ages 16-30 in the ED screening positive for prescription opioid use (+ ≥ 1 risk factor) or opioid misuse will be stratified by risk severity, sex, and age group. Participants will be randomly assigned to a condition at intake, either a live video health coach-delivered single session or a control condition of an enhanced usual care (EUC) community resource brochure. They are also randomly assigned to one of two post-intake conditions: health coach-delivered portal-like messaging via web portal over 30 days or EUC delivered at 30 days post-intake. Thus, the trial has four groups: health coach-delivered session+portal, health coach-delivered session+EUC, EUC + portal, and EUC + EUC. Outcomes will be measured at 3-, 6-, and 12-months. The primary outcome is opioid misuse based on a modified Alcohol Smoking and Substance Involvement Screening Test. Secondary outcomes include other opioid outcomes (e.g., days of opioid misuse, overdose risk behaviors), other substance misuse and consequences, and impaired driving. This study is innovative by testing the efficacy of feasible and scalable technology-enabled interventions to reduce and prevent opioid misuse and opioid use disorder. Trial Registration:ClinicalTrials.gov University of Michigan HUM00177625 NCT Registration: NCT04550715.

Protective behavioral strategies underutilization mediates effect of a brief motivational intervention among socially anxious undergraduate drinkers

Social anxiety (SA) is implicated in problematic undergraduate drinking. Brief motivational interventions (BMIs) reduce problematic undergraduate drinking. However, not all students benefit. Identification of vulnerable subgroups is an important next step. The current study examined the role of SA and protective behavioral strategies (PBS) on BMI outcomes. We reanalyzed a subset of data (53.3%; N = 120; 62.5% male) from a randomized trial in which heavy drinking undergraduates were randomized to a BMI or control. SA, past-month typical drinks, peak drinks, weekly quantity, alcohol problems, and PBS were assessed at baseline and 6 weeks. Main effects and interaction among the intervention condition (BMI vs. control) and SA group (low vs. high) were tested on alcohol outcomes and PBS. High SA undergraduates reported greater baseline drinking, more alcohol problems, and lower PBS. Post-BMI, high SA drinkers continued to report greater peak drinks, typical drinks, alcohol problems, and lower PBS use, controlling for baseline use. Among the BMI condition, parallel multiple mediation analyses revealed the PBS subscale Manner of Drinking uniquely mediated the relationship between SA and heavier post-BMI drinking. The PBS Manner of Drinking and Serious Harm Reduction subscales jointly mediated the relationship between SA and greater post-BMI alcohol problems. BMIs may need to be refined to improve outcomes for socially anxious drinkers. Increasing PBS utilization post-BMI may help improve BMI efficacy in this vulnerable group. Clinical implications are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Personality or pathology? Predictors of early substance use in first-year college students

OBJECTIVE

The aim of the current study was to examine the dual role of personality and psychopathology in predicting substance use among first-year students.

PARTICIPANTS

103 first-semester undergraduate students were recruited via the university subject pool.

METHODS

Participants completed personality questionnaires, structured clinical interviews, followed by the completion of diary entries each week reporting on substance use throughout their first semester.

RESULTS

Results indicated that a past diagnosis of an affective (mood/anxiety/stress) disorder was the most significant predictor of substance use. Personality and current psychopathology had no association to substance use.

CONCLUSION

This finding is consistent with developmental models of substance use relating to emotion-related disease and suggests that greater nuance is needed in understanding substance use risk in college students.

Finding the Right Balance: A Social Norms Intervention to Reduce Heavy Drinking in University Students

Introduction: Heavy alcohol consumption constitutes a major health risk among University students. Social relationships with peers strongly affect University students' perception of the drinking behavior of others, which in turn plays a crucial role in determining their own alcohol intake. University students tend to overestimate their peers' alcohol consumption – a belief that is associated with an increase in an individual's own consumption. Therefore, we implemented a social norms intervention with personalized normative feedback at a major University in Germany to reduce and prevent excessive drinking among University students.

Methods: Our intervention was part of a regular health monitoring survey. We invited all enrolled University students to take part in this survey on two occasions. A total of 862 University students completed the questionnaire, 563 (65.3%) of which received e-mail-based feedback upon request concerning their peers' and their own alcohol consumption. For the intervention group (n = 190) as well as the control group (no feedback requested; n = 101), we included only University students in the evaluation who overestimated their peers' alcohol use and indicated above average consumption of the peers. We applied analyses of variance to assess intervention effects with regard to the correction of overestimated group norms as well as University students' drinking behavior.

Results: Within the intervention group, we observed a significantly larger reduction of the previously overestimated behavioral norms compared to the control group (p < 0.001; ηp2 = 0.06). With regard to behavioral outcomes the intervention group showed a significantly larger reduction in the AUDIT-C score (p = 0.020; ηp2 = 0.03).

Discussion: Our study confirms previous research whereupon personalized, gender-specific and selective normative feedback is effective for alcohol prevention among University students. However, University students still overestimated their peers' alcohol intake after the intervention. Furthermore, we did not reach high-risk groups (University students with the highest alcohol intake) since no feedback was requested. Future studies should address factors influencing the impact of the intervention and reachability of selective groups.

A Mobile Intervention to Promote Low-Risk Drinking Habits in Young Adults: Protocol for a Randomized Controlled Trial

BACKGROUND

Young adults' drinking habits commonly exceed recommendations for low-risk drinking, which may have a negative effect on their mental, social, and physical health. As smartphones are highly accessible to young adults, mobile apps could be used to support young adults to develop low-risk drinking habits and improve their general health.

OBJECTIVE

The objective of this study is to evaluate the effectiveness of Boozebuster, a self-guided mobile app based on healthy lifestyle-related components that aim to develop and maintain low-risk drinking habits among young adults.

METHODS

This two-arm, parallel-group randomized controlled trial will investigate whether a 6-week self-guided mobile intervention (Boozebuster) targeting drinking behavior is more effective than a minimal intervention consisting of an educational website on alcohol use and its consequences for young adults. We will recruit 506 young adults (aged 18-30 years) from the Netherlands via an open recruitment strategy by using an open access website. All outcomes will be self-assessed through questionnaires. The primary outcome is the quantity and frequency of alcohol consumption in standard drinks (10 g ethanol per standard drink) per month (timeline follow-back [TLFB]). Secondary outcomes include binge-drinking sessions per month, alcohol-related problem severity (Rutgers Alcohol Problem Index), cannabis use frequency and quantity in grams (TLFB), depressive symptoms (Center for Epidemiological Studies Depression Scale), perceived stress (Perceived Stress Scale), engagement (Twente Engagement with eHealth Technologies Scale), readiness to change (Readiness to Change Questionnaire), mental well-being (Warwick-Edinburgh Mental Wellbeing Scale), trauma and COVID-19-related trauma (Short-Form Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, 5th Edition), impulsivity (Urgency, Premeditation, Perseverance, Sensation Seeking, Positive Urgency Impulsive Behavior Scale), study or work performance (Individual Work Performance Questionnaire), and treatment adherence. Baseline (T0), 6-week postbaseline (T1), and 3-month postbaseline (T2) assessments will be conducted and analyzed on the basis of the intention-to-treat principle using multilevel mixed modeling analyses.

RESULTS

Recruitment began in September 2020. We received 933 registrations via our study information website; 506 participants have completed the T0 assessment, 336 participants have completed the T1 assessment, and 308 participants have completed the T2 assessment as of May 2021. The study is still in progress, and results will be reported in 2021 and 2022.

CONCLUSIONS

Self-guided mobile interventions based on a lifestyle approach might be an attractive approach for young adults due to their preference on self-reliance, healthy living, and increased perceived anonymity. Such interventions are yet understudied, and it is known that interventions addressing solely problem drinking are less appealing to young adults. We hypothesize that the Boozebuster mobile app will effectively reduce drinking levels compared to an alcohol educational website (control condition). If effective, our intervention could be an inexpensive and scalable public health intervention to improve drinking habits in young adults.

TRIAL REGISTRATION

Netherlands Trial Register NL8828; https://www.trialregister.nl/trial/8828.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/29750.

[Evidence-based alcohol prevention-what does effectiveness research recommend? : Results of the 2020 BZgA review of reviews on addiction prevention]

BACKGROUND

A substantial group of adolescents and young adults engage in risky alcohol use and there is a need for alcohol prevention. The 2020 BZgA review of reviews on addiction prevention provides the best available scientific knowledge on effectiveness of prevention measures for young people.

RESEARCH QUESTION

Which approaches show preventive effects on alcohol use in different prevention settings?

METHODS

A systematic literature search in June 2017 in seven international databases resulted in 28,949 hits. Inclusion criteria were a review or meta-analysis study type, a 2012-2017 publication date, a universal or selective target group, age up to 25 years, and a target behavior of alcohol consumption. Exclusion criteria were target group people with substance use disorders and target behavior risk factors. The three authors performed a systematic content analysis of 34 alcohol-related publications and assessed their methodology using AMSTAR (A MeaSurement Tool to Assess systematic Reviews). Conclusions and recommendations were framed by consensus among all authors.

RESULTS

Based on a total number of 53 conclusions on the effectiveness of alcohol prevention approaches depending on setting (family, school, college, media, health care, and community) and target group, it can be recommended - among other things - to implement family programs and parenting training, behavioral programs targeting specific personal and social skills, brief interventions with feedback, and mentoring programs. No recent reviews that investigated the effectiveness of alcohol policies at the community or national level could be identified.

CONCLUSIONS

Behavioral alcohol prevention is effective. It is recommended to address specific age and target groups in different settings by using specific interventions. Consensus is needed with regard to what kind of evidence proves effectiveness of environmental prevention measures.

Developing a brief motivational intervention for young adults admitted with alcohol intoxication in the emergency department - Results from an iterative qualitative design

BACKGROUND

Unhealthy alcohol use among young adults is a major public health concern. Brief motivational interventions for young adults in the Emergency Department (ED) have shown promising but inconsistent results.

METHODS

Based on the literature on brief intervention and motivational interviewing efficacy and active ingredients, we developed a new motivational intervention model for young adults admitted in the ED with alcohol intoxication. Using an iterative qualitative design, we first pre-tested this model by conducting 4 experimental sessions and 8 related semi-structured interviews to evaluate clinicians' and patients' perceptions of the intervention's acceptability and feasibility. We then conducted a consultation meeting with 9 international experts using a nominal group technique. The intervention model was adjusted and finally re-tested by conducting 6 new experimental sessions and 12 related semi-structured interviews. At each round, data collected were analyzed and discussed, and the intervention model updated accordingly.

RESULTS

Based on the literature, we found 6 axes for developing a new model: High level of relational factors (e.g. empathy, alliance, avoidance of confrontation); Personalized feedback; Enhance discrepancy; Evoke change talk while softening sustain talk, strengthen ability and commitment to change; Completion of a change plan; Devote more time: longer sessions and follow-up options (face-to-face, telephone, or electronic boosters; referral to treatment). A qualitative analysis of the semi-structured interviews gave important insights regarding acceptability and feasibility of the model. Adjustments were made around which information to provide and how, as well as on how to deepen discussion about change with patients having low levels of self-exploration. The experts' consultation addressed numerous points, such as information and advice giving, and booster interventions.

DISCUSSION

This iterative, multi-component design resulted in the development of an intervention model embedded in recent research findings and theory advances, as well as feasible in a complex environment. The next step is a randomized controlled trial testing the efficacy of this model.

A randomized controlled trial of a web-based personalized feedback intervention targeting frequent indoor tanning bed users: Engagement, acceptability, and preliminary behavioral outcomes

Frequent indoor tanning bed use is an established public health concern, yet research on tanning cessation interventions for frequent tanners is lacking. We describe the protocol for a brief, web-based tanning behavior change intervention and present evidence that it is acceptable and engaging to frequent indoor tanners. Lower tanning rates were not observed among participants receiving the intervention in a randomized controlled trial but participants' interest in changing tanning increased. This intervention could be a useful approach to increasing frequent tanners' interest in behavior change and openness to engaging within a more intensive, multi-component tanning cessation program.Trial Registration: NCT03448224 Clinical Trials.gov (https://clinicaltrials.gov/ct2/show/NCT03448224?cond=NCT03448224&draw=2&rank=1).

Efficacy of a complex smartphone application for reducing hazardous alcohol consumption: Study protocol for a randomized controlled trial with analysis of in-app user behavior in relation to outcome

OBJECTIVE

The efficacy of alcohol reduction applications is variable, and the underlying factors are largely unknown. The aim of this study is threefold: evaluate the relationship between user engagement and intervention efficacy, investigate the efficacy of the different functions applied, and investigate the efficacy of the intervention application compared to control groups.

METHODS

A randomized controlled trial will be conducted to determine the efficacy of a newly developed smartphone application compared to the controls in reducing alcohol consumption at a 30, 60, 90, 120, 150, and 180 days follow-up. Hazardous drinkers, aged 18 years or older, will be recruited through web articles and will be randomized (blinded to their allocation), to receive one of the two versions of the application (educational or control application) for 30 days, or will be allocated to a wait-list control group. Function usage times will be recorded on a single-user level to determine the association between application usage and efficacy.

RESULTS

Data collection will be completed by July 2020, and follow-up will be completed by January 2021.

CONCLUSIONS

The evaluation of intervention efficacy as a function of user behavior will hopefully contribute to the science of developing more efficient alcohol intervention applications in the future.

'High schools High on life': Development of an Intervention to Reduce Excessive Drinking in Danish High Schools

Background: Clear documentation of the understanding of the problem, process of development, and content of interventions is essential to enable other researchers to understand why interventions succeed or fail and to enable researcher to build on previous evidence and replicate and adapt findings in other contexts. In this paper we describe the rationale, intervention development, and final design of the 'High schools High on life' intervention; a high school-based, multi-component intervention to reduce excessive drinking among Danish high school students. Methods: The development of the intervention 'High schools High on life' was guided by the planning steps of the Intervention Mapping protocol (IM) in combination with the behavior change wheel and the behavior change techniques, theory, evidence, practice, and new empirical studies of contextual factors in the Danish high school setting. Results: The development process resulted in a multi-component intervention with the following intervention elements: a school environmental component targeting school alcohol policies and norms, a school educational component addressing students' social norms around alcohol, and a parental component encouraging parent-child communication around alcohol. Discussion: Not all steps of IM were followed rigidly. However, IM proved useful as a planning tool in combination with the behavior change wheel and the behavior change techniques, as it provided a systematic approach to the intervention development process. IM forced the research group to be explicit about decisions and choices throughout the planning process. The transparency of the developmental process and theoretical, empirical and practical/contextual foundation of the 'High schools High on life' intervention may enable future intervention studies to build on our findings and accumulate knowledge to reduce excessive drinking among young people. Trial registration: The trial was registered at clinicaltrials.gov (Trial registration number NCT03906500) prior to randomization.

Greater Engagement with Health Information Is Associated with Adoption and Maintenance of Healthy Lifestyle Behaviours in People with MS

Health communication offers an important means for patients to make informed decisions for illness self-management. We assessed how the level of engagement with selected health information at baseline is associated with the adoption and maintenance of lifestyle behaviours at a 5-year follow-up in people with multiple sclerosis (MS). Non-engagers were compared to engagers of information delivered online and print (medium), and with engagers who additionally attended a live-in workshop (high). Engagement was assessed against lifestyle behaviours by log-binomial regression. Information engagers had higher education, and were less likely to have severe disability, clinically significant fatigue, or obesity. Medium and high baseline engagement was associated with adopting healthy behaviours for omega 3 supplementation (RR = 1.70; 95%CI: 1.02–2.84), physical activity (RR = 2.16; 95%CI: 1.03–4.55), and dairy non-consumption (RR = 3.98; 95%CI: 1.85–8.56) at 5 years; associations were stronger among high engagers. Only high baseline engagement was associated with maintaining behaviours from baseline to 5 years, specifically for omega-3 (RR = 1.26; 95%CI: 1.06–1.49) and vitamin D supplementation (RR = 1.26; 95%CI: 1.04–1.54) and dairy non-consumption (RR = 1.47; 95%CI: 1.03–2.10). Health communication that includes face-to-face information delivery and practical tools for implementation in daily living may be optimal for adopting and maintaining lifestyle behaviours in people with MS.

Study protocol for a cluster randomised controlled trial testing the effectiveness of the 'High schools High on life' intervention on reducing excessive drinking in Danish high schools

INTRODUCTION

This paper describes the evaluation design of the 'High schools High on life' intervention; a school-based intervention to reduce excessive drinking among high school students in Denmark. The intervention includes a school environmental component to limit access to alcohol at school, a school-educational component to change social norms around alcohol among first year students and a parental component addressing parents' knowledge and attitudes towards alcohol.

METHODS AND DESIGN

The study will employ a cluster randomised controlled study design and will include a random sample of 16 high schools randomly allocated 1:1 to either intervention or control group. Target group: first year high school students. Timeline: baseline survey: January to March 2019, collected as part of the Danish National Youth Study 2019. Delivery of intervention: April 2019 to March 2020. Follow-up survey: April to May 2020.

PRIMARY OUTCOME MEASURE

30% reduction in mean number of binge-drinking episodes (five or more alcoholic drinks on one occasion) within the last 30 days.

SECONDARY OUTCOME MEASURES

proportion of students who drink alcohol, mean weekly alcohol consumption, alcohol intake at last school party, alcohol intake at the school during last school party, proportion of students who agree to be able to have fun at a party without drinking and the proportion of students who think alcohol plays a too dominant part at the school. Implementation will be monitored through process evaluation.

ETHICS AND DISSEMINATION

The Scientific Ethics Committees for the Capital Region of Denmark has declared that the trial is not subject to notification (jnr. 19021957). The study is registered at the Research an Innovation Office at University of Southern Denmark (ref: 10.314) allowing collection of personal data. Results will be published in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

NCT03906500.

Electronic screening and brief intervention to reduce cannabis use and consequences among graduate students presenting to a student health center: A pilot study

This pilot study sought to test the feasibility of screening and delivering a web-based intervention to reduce marijuana use and consequences among graduate student presenting to a Student Health Center (SHC). Graduate students completed a 9-item electronic health screening instrument during their visit to the SHC. Those who reported monthly or greater marijuana use were eligible for participation in the pilot trial. Forty-nine students completed baseline assessments and were randomly assigned to an electronic screening and brief intervention (eSBI) for marijuana (eCHECKUPTOGO-marijuana; [BI]) or a control condition (CTL) that consisted of minimal general health information. Participants completed measures of marijuana use frequency and negative consequences at baseline, 3- and 6-months. Latent growth modeling was used to provide effect size estimates for the influence of the intervention on 6-month outcomes. Effect size estimates showed a small-to-medium effect of BI on marijuana use frequency at 6-months; there was no evidence of the BI on consequences. Results suggest that BI may hold promise as a method to reduce marijuana use among graduate students who present to primary care settings. Future research should test the efficacy of this approach in a full-scale randomized controlled trial.