Brief online interventions targeting risk and protective factors for increased and problematic alcohol use among American college students studying abroad

Reducing Alcohol Misuse and Promoting Treatment Initiation Among Veterans Through a Brief Internet-Based Intervention: Protocol for a Randomized Controlled Trial

BACKGROUND

Young adult veterans who served after the September 11 attacks on the United States in 2001 (ie, post-9/11) are at heightened risk for experiencing behavioral health distress and disorders including hazardous drinking, posttraumatic stress disorder, and depression. These veterans often face significant barriers to behavioral health treatment, and reaching them through brief mobile phone-based interventions may help reduce drinking and promote treatment engagement.

OBJECTIVE

Following a successful pilot study, this randomized controlled trial (RCT) aims to further test the efficacy of a brief (ie, single session) mobile phone-delivered personalized normative feedback intervention enhanced with content to promote treatment engagement.

METHODS

We will conduct an RCT with 800 post-9/11 young adult veterans (aged 18 to 40 years) with potentially hazardous drinking and who have not recently received treatment for any behavioral health problems. Participants will be randomly assigned to the personalized intervention or a control condition with resources for seeking care. The personalized normative feedback module in the intervention focuses on the correction of misperceived norms of peer alcohol use and uses empirically informed approaches to increase motivation to address alcohol use and co-occurring behavioral health problems. Past 30-day drinking, alcohol-related consequences, and treatment-seeking behaviors will be assessed at baseline and 3, 6, 9, and 12 months post intervention. Sex, barriers to care, posttraumatic stress disorder, depression, and severity of alcohol use disorder symptoms will be explored as potential moderators of outcomes.

RESULTS

We expect recruitment to be completed within 6 months, with data collection taking 12 months for each enrolled participant. Analyses will begin within 3 months of the final data collection point (ie, 12 months follow-up).

CONCLUSIONS

This RCT will evaluate the efficacy of a novel intervention for non-treatment-seeking veterans who struggle with hazardous drinking and possible co-occurring behavioral health problems. This intervention has the potential to improve veteran health outcomes and overcome significant barriers to treatment.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04244461; https://clinicaltrials.gov/study/NCT04244461.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/59993.

High Spirits? Exploring "Halloweekend" Alcohol and Cannabis Use Among Heavy-Drinking College Students

OBJECTIVE

Specific events are associated with heavier and riskier substance use behaviors among college students, including holidays like Halloween, which may include several days of themed parties/events ("Halloweekend"). The current study compared drinking, pregaming (i.e., fast-paced drinking before going out for the night), cannabis use, same-day alcohol and cannabis co-use, and negative alcohol-related consequences over Halloweekend compared with two adjacent non-Halloween weekends among a sample of heavy-drinking university students.

METHOD

Participants (N = 228; 65% female) provided 28 days of daily diary data. We used a three-level generalized linear mixed model (GLMM) approach estimating zero-inflated Conway-Maxwell Poisson regressions to assess the effect of weekend and specific weekend day on number of overall drinks, number of pregaming drinks, and negative alcohol-related consequences. Proportions tests assessed for differences in any cannabis use and daily co-use between Halloweekend and non-Halloween weekends.

RESULTS

Zero-inflated portions of the GLMMs indicated that general drinking, pregaming, and negative consequences were most prevalent on Halloweekend and Fridays and Saturdays. Count portions of the models indicated that general drinking quantity was highest during these periods, and participants experienced a greater number of negative consequences on Halloweekend compared with the weekend before; no differences were observed in the quantity of pregaming drinks consumed across weekends or days. No significant differences in cannabis use or co-use were observed between weekends.

CONCLUSIONS

Given risk associated with Halloweekend compared with weekends immediately before and after, interventions targeting alcohol use and pregaming on Halloweekend may be beneficial to reduce related harm for heavy-drinking students.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

CLINICALTRIALS

GOV IDENTIFIER

NCT03928067.

Alcohol and Sexual Risk among American College Students Studying Abroad

Recent studies show that during study abroad experiences, college students greatly increase their drinking behavior, experience multiple alcohol-related consequences, engage in sexual risk behaviors, and are at-risk for sexual violence victimization. These studies, however, have been limited by small sample sizes of students from single institutions who are often studying in a particular country or region. To better understand the extent of the risks experienced by college students studying abroad, we conducted a longitudinal survey study of 2630 students from 65 different US colleges and universities studying in 12 diverse locations abroad. Total drinks per week and heavy drinking days more than doubled while students were abroad, with heavier predeparture drinkers, men, and students under age 21 experiencing the greatest increases. There were few observed overall changes in alcohol-related consequences and risky sexual behaviors; however, specific groups, such as those with heavier predeparture consequences and sexual risk behaviors, men, and those on longer abroad programs reported greater consequences and risky sex abroad. One in five students (21%) experienced sexual violence abroad, with non-consensual physical contact the most prevalent form. Women, those under age 21, and those with a history of sexual violence were most likely to experience sexual violence abroad. Findings indicate that study abroad students may warrant targeted predeparture programming to help prevent heavy drinking and sexual violence experiences abroad.

Perceived descriptive norms for alcohol use among tribal college students: Relation to self-reported alcohol use, consequences, and risk for alcohol use disorder

This research addressed gaps in the literature by testing relationships between perceived descriptive alcohol use norms and individual's own alcohol use and consequences among tribal college and university (TCU) students. Survey data were collected from 3239 tribal college students in 22 TCUs across the United States in 2015 and 2016, of whom 3174 provided usable data on the variables of interest for the current manuscript. Results indicated students misperceived the descriptive norms for alcohol use at their TCU, on average estimating students at their college drank more frequently, more per occasion, and more total drinks per week relative to the observed averages on these outcomes. Participants' own drinking was significantly related to their perceived norms, with higher perceived norms related to more drinking. In addition, higher perceived norms were associated with greater alcohol-related negative consequences and lower likelihood of being a non-drinker. These findings extend research with students at majority-serving colleges and universities, indicating normative misperceptions exist and have similar relationships to alcohol use and consequences among TCU students nationwide. These findings support adaptation of normative feedback interventions for use with TCU students to emphasize healthy alcohol norms and correct misperceptions that support the stereotype that all students drink to excess.

Changes in Cigarette, E-Cigarette, and Cannabis Use among U.S. College Students Studying Abroad

Background: Study abroad experiences among U.S. college students are risky environments for alcohol use; however little work has examined how studying abroad may affect other substance use. Purpose: This study assesses changes in frequency of cigarette, e-cigarette, and cannabis use among students studying abroad. Methods: We recruited study abroad students from 63 institutions who studied in the 12 most popular destinations; 2,086 students completed surveys before leaving the U.S. and during their last month abroad. Descriptive and multivariate mixed-effects regression analysis compared substance use by location between students and country natives using publicly available data, identified behavioral and demographic predictors of frequency of substance use abroad, and estimated average adjusted prevalence of substance use by location. Results: Students' cigarette smoking increased three-fold while abroad; patterns of use varied significantly by location and mirrored smoking behaviors of native young adults. Rates of e-cigarette use declined while abroad and rates of cannabis use were similar abroad to pre-departure rates. However, cannabis use varied substantially by location and were higher than native peer rates. For all substances, most frequent substance use abroad was reported among males and those with prior histories of single drug and polydrug use. Conclusion: Findings highlight the importance of continued research on drug use abroad among U.S. college students and pave the way for initial prevention and intervention efforts to target drug use abroad, particularly for cigarettes due to the negative health consequences of use and for cannabis given the potential legal ramification of use in non-legalized countries.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

There and Back Again … Safely: Examining Students' Reports of Substance Use and Sexual Assault Prevention Program Receipt Prior to Departure Abroad

Many universities have pre-departure programs that aim to prevent alcohol misuse and sexual assault among college students abroad, yet little is known about students' uptake of this preventative information. In this study, 2,245 study abroad students from 63 different institutions were asked about receiving pre-departure alcohol/drug and sexual assault prevention information. Only 38% of students reported receiving pre-departure information specific to alcohol/drug misuse abroad and only 22% reported receiving sexual assault prevention information prior to departure. Notably, students who were heavier drinkers prior to departure and those who intended to drink the most while abroad reported lower rates of information receipt. Overall, these findings suggest that either students are not receiving the preventative information that universities intend them to receive or the programming is not impactful enough to be recalled. Thus, there may be missed opportunities to better prepare students for risks specific to study abroad programs.

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

BACKGROUND

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

METHODS/DESIGN

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

DISCUSSION

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

Cognitive factors and addiction

The present paper provides a brief review of cognitive factors related to addiction. Five representative cognitive constructs were selected from the current literature. These include the distinction between implicit and explicit cognitions; metacognitions; expectancies; motives; and social norms. For each of these a general overview is provided along with specific findings from selected recent studies. The intention is to provide the reader with a succinct but reasonable view of how each construct is currently studied in relation to the use of alcohol and other substances and to become aware of some of the strengths and limitations corresponding to the study of these constructs.

Impact of Exchange Stay on Alcohol Consumption: Longitudinal Exploration in a Large Sample of European Students

BACKGROUND

Each year, more than 300,000 university students take part in European exchange programs. Besides their positive educational and cultural impacts, these programs are also reputed to immerse students in a high-risk festive context where excessive alcohol consumption is strongly present. There is thus a crucial need to evaluate the actual impact of those exchange stays on alcohol consumption.

METHODS

Study abroad (n = 3,950) and local (n = 3,950) European students completed a 2-part longitudinal survey and reported their alcohol consumption before (T1) and during (T2) their exchange stay (or at the beginning of the academic year and 6 months later for local students, constituting the control group).

RESULTS

During their exchange stay, individuals studying abroad showed more excessive and harmful alcohol consumption behaviors than local students, as measured by increased general alcohol consumption and binge drinking (BD) scores at T2. In particular, study abroad students under 20 years of age and performing their exchange stay in eastern Europe were the most exposed to excessive alcohol consumption and BD.

CONCLUSIONS

These results constitute the first large-scale longitudinal confirmation that exchange stays indeed constitute risky contexts in which students significantly increase their consumption and present stronger alcohol-related problems. In view of the rapid and deleterious effects of alcohol consumption in young people, it is essential to promote prevention campaigns targeting this population to limit public health consequences and possible evolution toward severe alcohol use disorders.

A Longitudinal Study of European Students' Alcohol Use and Related Behaviors as They Travel Abroad to Study

BACKGROUND

Travelling away from home can be associated with fewer limits on behavior, particularly for students who participate in exchange programs.

AIMS

To examine the effects of eight moderators on change in alcohol use and related negative outcomes, drug use and unprotected sexual behavior in European study abroad students before, during, and after their time abroad.

METHODS

A three wave (before departure, while abroad, and after their return) longitudinal design collecting data on the frequency and volume of alcohol consumed, heavy episodic drinking, alcohol-related outcomes, drug use, and unprotected casual sex.

RESULTS

The baseline survey was completed by 1145 students participating in one or two semester exchange programs (67.5% spent up to a semester abroad), of which 906 participated in two or more waves, representing 42 and 33 countries of origin and destination, respectively. Mean age was 22.2 years (SD = 2.28) and 72.7% were female. Students increased the amount of alcohol consumed by 35% (B = 0.32; 95% CI 0.287-0.349) and experienced more alcohol-related consequences (B = 0.15; 95% CI 0.089-0.219) during the study abroad experience, though levels fell below pre-departure levels when they returned home. Factors related to greater alcohol use while abroad include pre-departure expectations about alcohol use during the study abroad experience, psychological adjustment to the host country, academic involvement, and host country living costs. No statistically meaningful change in drug use and unprotected sexual behavior was observed.

CONCLUSIONS

Studying abroad exposes European students to additional time-limited alcohol-related health risks.

Italian Credit Mobility Students Significantly Increase Their Alcohol Intake, Risky Drinking and Related Consequences During the Study Abroad Experience

AIMS

To examine changes in alcohol intake and consequences in Italian students studying abroad.

METHODS

Italian exchange students planning to study abroad were invited to report on their drinking and alcohol-related negative consequences before and after their time abroad.

RESULTS

After excluding those who abstained throughout, data on 121 students were analysed and showed that they tended to consume more alcohol and experience more alcohol-related negative consequences compared to their pre-departure levels.

CONCLUSION

The added alcohol risk of study abroad for Italian students merits consideration of possible opportunities for intervention.

Interventions to reduce college student drinking: State of the evidence for mechanisms of behavior change

Interventions to reduce college student drinking, although efficacious, generally yield only small effects on behavior change. Examining mechanisms of change may help to improve the magnitude of intervention effects by identifying effective and ineffective active ingredients. Informed by guidelines for establishing mechanisms of change, we conducted a systematic review of alcohol interventions for college students to identify (a) which constructs have been examined and received support as mediators, (b) circumstances that enhance the likelihood of detecting mediation, and (c) the extent of evidence for mechanisms of change. We identified 61 trials that examined 22 potential mediators of intervention efficacy. Descriptive norms consistently mediated normative feedback interventions. Motivation to change consistently failed to mediate motivational interviewing interventions. Multiple active ingredient interventions were not substantially more likely to find evidence of mediation than single ingredient interventions. Delivering intervention content remotely reduced likelihood of finding support for mediation. With the exception of descriptive norms, there is inadequate evidence for the psychosocial constructs purported as mechanisms of change in the college drinking literature. Evidence for mechanisms will be yielded by future studies that map all active ingredients to targeted psychosocial outcomes and that assess potential mediators early, inclusively, and at appropriate intervals following interventions.

Brief alcohol interventions for adolescents and young adults: a systematic review and meta-analysis

This study reports findings from a meta-analysis summarizing the effectiveness of brief alcohol interventions for adolescents (age 11-18) and young adults (age 19-30). We identified 185 eligible study samples using a comprehensive literature search and synthesized findings using random-effects meta-analyses with robust standard errors. Overall, brief alcohol interventions led to significant reductions in alcohol consumption and alcohol-related problems among adolescents (g = 0.27 and g = 0.19) and young adults (g = 0.17 and g = 0.11). These effects persisted for up to 1 year after intervention and did not vary across participant demographics, intervention length, or intervention format. However, certain intervention modalities (e.g., motivational interviewing) and components (e.g., decisional balance, goal-setting exercises) were associated with larger effects. We conclude that brief alcohol interventions yield beneficial effects on alcohol-related outcomes for adolescents and young adults that are modest but potentially worthwhile given their brevity and low cost.

Study design to develop and pilot-test a web intervention for partners of military service members with alcohol misuse

BACKGROUND

Alcohol misuse among military service members from the recent conflicts in Iraq and Afghanistan is over two times higher compared to misuse in the civilian population. Unfortunately, in addition to experiencing personal consequences from alcohol misuse, partners and family members of alcohol-misusing service members also suffer in negative ways from their loved one's drinking. These family members represent important catalysts for helping their loved ones identify problem drinking and overcoming the barriers to seeking care. This paper describes the protocol to a pilot study evaluating a 4-session, web-based intervention (WBI) for concerned partners (CPs) of service members with alcohol misuse.

METHODS/DESIGN

The WBI will be adapted from the Community Reinforcement and Family Training (CRAFT) intervention. In the first phase, we will develop and beta-test the WBI with 15-20 CPs. In the second phase, we will randomize CPs to WBI (n = 50) or to delayed-WBI (n = 50) and evaluate the impact of the WBI on CPs' perceptions of service member help-seeking and drinking, as well as the CP's well-being and relationship satisfaction 3 months after the intervention. In the third phase, we will recruit 15-20 service members whose partners have completed the study. We will interview the service members to learn how the CP-focused WBI affected them and to assess whether they would be receptive to a follow-on WBI module to help them.

DISCUSSION

This project has the potential to benefit a large population of military service members who may be disproportionately affected by recent conflicts and whose drinking misuse would otherwise go undetected and untreated. It also develops a new prevention model that does not rely on service members or partners attending a hospital or clinical facility to access care.

TRIAL REGISTRATION

NCT02073825.

Demographic and predeparture factors associated with drinking and alcohol-related consequences for college students completing study abroad experiences

OBJECTIVE

Study abroad students are at risk for increased and problematic drinking behavior. As few efforts have been made to examine this at-risk population, the authors predicted drinking and alcohol-related consequences abroad from predeparture and site-specific factors.

PARTICIPANTS

The sample consisted of 339 students completing study abroad programs.

METHODS

Participants filled out online measures at predeparture, abroad, and at postreturn.

RESULTS

The authors found that drinking and consequences abroad were predicted by a number of factors, including demographics (eg, younger age, male sex, Greek affiliation, white ethnicity), student factors (eg, low GPA, major area of study), study abroad site factors (eg, apartment living abroad, study in Europe), predeparture levels of drinking and consequences, sensation seeking, and goals related to social gathering.

CONCLUSIONS

Findings can be used to inform campus policies for admission to study abroad programs as well as assist in the development of interventions targeted toward preventing risk for students during abroad experiences.