A Randomized Trial of a Personalized Feedback Intervention for Nonstudent Emerging Adult At-Risk Drinkers

Discovering what young adults want in electronic interventions aimed at reducing alcohol-related consequences

BACKGROUND

Despite intervention efforts, negative alcohol-related consequences continue to impact young adults. Most alcohol interventions focus on reducing alcohol consumption; however, previous research indicates that focusing solely on alcohol use may not decrease consequences. Additionally, many alcohol interventions have diminishing engagement, and few are designed with young adults involved in the development process. Drawing on user-centered design, this study sought to understand young adult perceptions, preferences, and needs for electronic interventions specifically aimed at reducing alcohol consequences.

METHODS

Using semi-structured qualitative interviews, 21 young adult drinkers (ages 18-24; 57.1% female) shared their opinions regarding the need for electronic interventions (i.e., mobile or web-delivered) to reduce alcohol consequences as well as their preferences for content, features, and ways to increase engagement. Interviews were coded and analyzed using a multi-step thematic analysis approach.

RESULTS

As part of our discovery phase of intervention development, content coding revealed four main themes. Participants perceived several benefits of interventions focused on alcohol consequences, such as promoting mindful alcohol use and reducing alcohol-related harms. Participants also discussed perceived limitations of such programs, including believing consequences from drinking are unavoidable, necessary for learning, and associated with peer pressure. Preferences for features included real-time tracking, personalized feedback, and psychoeducation along with preferences for design including non-judgmental framing, interactive content, and a user-friendly platform.

CONCLUSIONS

Engaging end users early in the development process is a valuable approach to increase intervention relevancy with the target population. This can also inform intervention content and design to maximize engagement and satisfaction (e.g., framing, features, and interactivity) while also reducing barriers identified early on (e.g., peer pressure).

Alcohol Feedback, Reflection, and Morning Evaluation (A-FRAME): Refining and testing feasibility and acceptability of a smartphone-delivered alcohol intervention for heavy-drinking young adults

BACKGROUND

Young adults drink heavily and experience negative alcohol consequences. To capitalize on mornings after drinking as an optimal time to intervene, we developed a novel, theory-based personalized feedback intervention (PFI) called Alcohol Feedback, Reflection, and Morning Evaluation (A-FRAME), to reduce heavy drinking. An initial prototype was refined via feedback from college students who drink heavily. The goal of the present study was to conduct an open trial to establish feasibility and acceptability of the refined PFI.

METHODS

The refined PFI was delivered for 4 weeks to 18 heavy-drinking young adults (Mage = 22.61, 44% women, 66.7% White, 27.8% Black, 16.7% Asian, 5.6% Native American/Alaskan Indian, 22.2% Hispanic/Latino). Participants completed a goal-setting procedure, followed by 28 daily surveys. Surveys indicating prior-day drinking were followed by the option to view personalized feedback (e.g., goal attainment, blood alcohol concentration [BAC], peer norms, protective behaviors). Aggregated feedback was also delivered at the 14- and 28-day marks. Participants completed a post-test acceptability survey and individual interviews to inform further refinement.

RESULTS

The response rate to daily surveys was 93.8% and all participants completed study procedures, demonstrating feasibility. Daily feedback was reviewed about half (45.5%) of the time it was offered (i.e., following drinking days). Biweekly feedback was viewed 50% and 56% of the time at 14- and 28-day marks, respectively. Other benchmarks for acceptability were supported by survey and interview results.

CONCLUSIONS

Open trial results support the feasibility and acceptability of this theory-based intervention for heavy-drinking young adults. A planned randomized controlled trial will evaluate efficacy.

Behavioral economic and wellness-based approaches for reducing alcohol use and consequences among diverse non-student emerging adults: study protocol for Project BLUE, a randomized controlled trial

BACKGROUND

Emerging adults (EAs) who are not 4-year college students nor graduates are at elevated risk for lifetime alcohol use disorder, comorbid drug use, and mental health symptoms, compared to college graduates. There is a need for tailored brief alcohol intervention (BAI) approaches to reduce alcohol risk and to facilitate healthy development in this high-risk population. Most BAIs include a single session focused on discussing risks associated with drinking and correcting normative beliefs about drinking rates. EAs may benefit from additional elements that enhance general wellness. The substance-free activity session (SFAS) aims to clarify life goals and values and increase goal-directed activities that provide alternatives to alcohol use, and the relaxation training (RT) session teaches relaxation and stress reduction skills.

METHODS

The present study is a randomized 3-group (BAI + SFAS vs. RT + SFAS vs. education control) trial with 525 EAs (175 per group; estimated 50% women and 50% African American) who report recent risky drinking and who are not students or graduates of 4-year colleges. Participants will have the option of completing the intervention sessions in person or via a secure video teleconference. Levels of drinking and alcohol-related problems will be evaluated at baseline and 1, 3, 6, and 12 months post-intervention. The primary hypothesis is that both BAI + SFAS and RT + SFAS participants will report significantly greater reductions in alcohol use and problems relative to education control participants, with no differences in outcomes between the two active treatment conditions.

DISCUSSION

The results of this study will inform alcohol prevention efforts for high-risk community dwelling emerging adults.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04776278.

Behavioral Economic and Wellness-based Approaches for Reducing Alcohol Use and Consequences Among Diverse Non-Student Emerging Adults: Study Protocol for Project BLUE, a Randomized Controlled Trial

Background

Emerging adults (EAs) who are not 4-year college students nor graduates are at elevated risk for lifetime alcohol use disorder, comorbid drug use, and mental health symptoms, compared to college graduates. There is a need for tailored brief alcohol intervention (BAI) approaches to reduce alcohol risk and to facilitate healthy development in this high-risk population. Most BAIs include a single session focused on discussing risks associated with drinking and correcting normative beliefs about drinking rates. EAs may benefit from additional elements that enhance general wellness. The Substance-Free Activity Session (SFAS) aims to clarify life goals and values and increase goal-directed activities that provide alternatives to alcohol use, and the Relaxation Training (RT) session teaches relaxation and stress reduction skills.

Methods

The present study is a randomized 3-group (BAI+SFAS vs. RT+SFAS vs. education control) trial with 525 EAs (175 per group; estimated 50% women & 50% African American) who report recent risky drinking and who are not students or graduates of 4-year colleges. Participants will have the option of completing the intervention sessions in person or via a secure video teleconference. Levels of drinking and alcohol-related problems will be evaluated at baseline and 1, 3, 6, and 12-months post-intervention. The primary hypothesis is that both BAI+SFAS and RT+SFAS participants will report significantly greater reductions in alcohol use and problems relative to education control participants, with no differences in outcomes between the two active treatment conditions.

Discussion

The results of this study will inform alcohol prevention efforts for high-risk community dwelling emerging adults.

ClinicalTrialsgov Identifier

NCT04776278.

Normative Perceptions of Peer Drinking Distinguish High-Intensity Drinkers from Other Drinking Groups

Background: High-intensity drinking (HID), or drinking that doubles the binge threshold (i.e., 8+/10+ drinks for women/men), is associated with more negative consequences than binge-only drinking. However, research focusing on HID and factors that may delineate HID from other drinking behaviors is lacking. The present study evaluated if perceived norms for peer drinking behavior (i.e., descriptive norms for alcohol quantity and frequency and injunctive norms) differentiated high-intensity drinkers from other drinker statuses. Further, we evaluated the role of perceived norms on odds of HID engagement and HID frequency. Finally, college status, sex, and underage drinker status were evaluated as moderators of the association between perceived norms and HID status/frequency. Methods: Participants were 623 emerging adult drinkers recruited via Craigslist (68.7% male; 69.0% White). Participants completed an online survey on their drinking behaviors and related social factors. Results: Each domain of perceived norms positively associated with drinker status. Higher perceived norms were associated with greater odds of HID and predicted HID frequency. The association between quantity and frequency descriptive norms and HID engagement was stronger for nonstudents and was only significant for males. Underage drinker status did not moderate associations between perceived norms and HID engagement. Conclusions: Findings provided evidence that perceptions of peer drinking behaviors are strong indicators of HID risk and may be especially useful for identifying high-intensity drinking males and nonstudents. The utility of perceived peer norms to differentiate this group of particularly risky drinkers suggests that social-influence-focused intervention approaches, including norms correction, may be efficacious in targeting HID among emerging adults.

Educational Attainment and Differences in Patterns of Alcohol, Cannabis, and Tobacco Use Among Young Adults

Multigroup latent profile analysis examined whether patterns of alcohol, cannabis, and tobacco use varied between college student and nonstudent young adults ( N = 745), and profiles were characterized by alcohol- and drug-related problems, psychological distress, and perceived stress. Findings supported three profiles (high use across substances, primarily high tobacco use, and low use across substances) among students. Students in the high use group, relative to other groups, experienced the highest number of problems and psychological distress. Among nonstudents, two profiles emerged (high use across substances and primarily high tobacco use), and noncollege participants in the high use group experienced the highest problems, psychological distress, and perceived stress. Students, compared to nonstudents, reported more variability in their substance use profiles, as a low substance use group was not observed among nonstudents. Prevention and intervention efforts should target nonstudents, which could aid in reducing negative health outcomes based on disparities in education.

Sensitivity analyses for data missing at random versus missing not at random using latent growth modelling: a practical guide for randomised controlled trials

BACKGROUND

Missing data are ubiquitous in randomised controlled trials. Although sensitivity analyses for different missing data mechanisms (missing at random vs. missing not at random) are widely recommended, they are rarely conducted in practice. The aim of the present study was to demonstrate sensitivity analyses for different assumptions regarding the missing data mechanism for randomised controlled trials using latent growth modelling (LGM).

METHODS

Data from a randomised controlled brief alcohol intervention trial was used. The sample included 1646 adults (56% female; mean age = 31.0 years) from the general population who had received up to three individualized alcohol feedback letters or assessment-only. Follow-up interviews were conducted after 12 and 36 months via telephone. The main outcome for the analysis was change in alcohol use over time. A three-step LGM approach was used. First, evidence about the process that generated the missing data was accumulated by analysing the extent of missing values in both study conditions, missing data patterns, and baseline variables that predicted participation in the two follow-up assessments using logistic regression. Second, growth models were calculated to analyse intervention effects over time. These models assumed that data were missing at random and applied full-information maximum likelihood estimation. Third, the findings were safeguarded by incorporating model components to account for the possibility that data were missing not at random. For that purpose, Diggle-Kenward selection, Wu-Carroll shared parameter and pattern mixture models were implemented.

RESULTS

Although the true data generating process remained unknown, the evidence was unequivocal: both the intervention and control group reduced their alcohol use over time, but no significant group differences emerged. There was no clear evidence for intervention efficacy, neither in the growth models that assumed the missing data to be at random nor those that assumed the missing data to be not at random.

CONCLUSION

The illustrated approach allows the assessment of how sensitive conclusions about the efficacy of an intervention are to different assumptions regarding the missing data mechanism. For researchers familiar with LGM, it is a valuable statistical supplement to safeguard their findings against the possibility of nonignorable missingness.

TRIAL REGISTRATION

The PRINT trial was prospectively registered at the German Clinical Trials Register (DRKS00014274, date of registration: 12th March 2018).

Social network moderators of brief alcohol intervention impact

OBJECTIVE

This investigation examined the impact of social networks on drinking reduction efforts following a brief alcohol intervention. In a reanalysis of data from an earlier randomized controlled trial with nonstudent emerging adult drinkers (Lau-Barraco et al., 2018), we aimed to test three domains of preintervention social network features as potential factors influencing intervention response: (a) general network characteristics (i.e., network size, network stability), (b) general network alcohol use (i.e., network alcohol abstainers, network heavy/problem drinkers), and (c) risky peers in network (i.e., proportion of drinking buddies, presence of drinking buddies identified as heavy/problem drinker).

METHOD

Participants were 164 emerging adult heavy drinkers recruited from the community (65.9% men; mean age = 21.98 years; 56.2% ethnic minority). Participants were randomly assigned to either a brief personalized feedback intervention (PFI) or assessment-only control and provided data at 1-month and 3-month follow-ups.

RESULTS

Greater network stability and greater representation of alcohol abstainers in one's social network were associated with improved initial postintervention response. Heavy/problem drinkers in the network did not moderate initial postintervention effects on drinking outcomes, but there was potentially a stronger intervention effect on risk reduction for those with higher proportions of drinking buddies in their network.

CONCLUSIONS

Study findings provided evidence that a PFI was efficacious in mitigating some risky social network influence. However, findings did not support a consistent impact across all the network variables examined. Future research is needed to further clarify social network influences and how they may be targeted to enhance intervention efficacy. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

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.

Perceived Substance Use Norms Among Jailed Women with Alcohol Use Disorders

BACKGROUND

Social norms regarding substance use predict substance use behaviors. In a sample of jailed women with alcohol use disorders (AUDs), we compared (i) jailed women's perceptions of the US women population's rates of substance use, with US women's actual rates of substance use; (ii) jailed women's perceived rates of substance use by US women, with their perceptions of use by their own friends; and (iii) US women's actual rates of substance use, with observed sample substance use rates.

METHODS

Participants were 205 jailed women who met criteria for an AUD. We used the 1-sample or dependent-samples t-test to make the comparisons.

RESULTS

Participants overestimated US women's rates of substance use and incarceration rates. They perceived their friends' substance use as less common than US women's. The jailed women reported higher rates of their own substance use than actual rates by US women. In addition, jailed women self-reported less cannabis use, but more alcohol and cocaine use and cigarette smoking, than they perceived their friends to have used. The more women perceived their friends as drinking, the less they had a goal to drink less or abstain from drinking postincarceration; in contrast, perceptions of US women's drinking were not related to personal goals for drinking.

CONCLUSIONS

Interventions that correct misperceptions about substance use norms may have utility for jailed women with AUDs.

Personalized feedback tempers weekend increases in alcohol use among nonstudent emerging adult drinkers

A common pattern of problematic alcohol consumption among emerging adults consists of little to no drinking during the week, with heavy drinking episodes on the weekend. However, little is known about whether brief alcohol interventions exert impact on decreasing weekend drinking escalations or simply overall consumption throughout the week. A recent randomized controlled trial of heavy drinking emerging adult nonstudents (N = 164) demonstrated the efficacy of a personalized feedback intervention (PFI). Specifically, the PFI was associated with reduced overall alcohol consumption relative to assessment-only controls. However, it is not clear if patterns of weekend drinking escalation may have been disrupted by the intervention. The current study was a follow-up analysis of the parent trial. Using retrospective daily drinking data provided at each timepoint (up to 9-months), data were coded to reflect condition, time (coded to capture initial changes post-intervention as well as long-term maintenance), and day of the week (coded to capture weekend versus weekday). A multilevel negative binomial hurdle analysis was conducted, yielding two sets of results: 1) predicting the probability of a non-drinking day, and 2) predicting number of drinks consumed. Although the three-way interaction was not significant, 2 two-way interactions indicated that weekend increases in drinking were less steep over time for both groups, and less steep for PFI participants. In addition, the higher weekend likelihood of drinking was decreased over time for both groups. Steep weekend increases in drinking were disrupted over time, particularly among PFI recipients. Personalized feedback may be effective at helping nonstudent emerging adults avoid high risk drinking situations.

The Influence of a Brief Alcohol Intervention on Alcohol Use Trajectories in Nonstudent Emerging Adult Drinkers

Background: This study sought to inform research with noncollege-attending emerging adults, an at-risk, and understudied population, by identifying patterns of response following a brief alcohol intervention. This study was a reanalysis of data from a randomized controlled intervention trial testing a brief, personalized feedback alcohol intervention targeting nonstudent emerging adult drinkers. Objectives: The study aims were to (1) model intervention response by identifying subgroups characterized by changes in heavy drinking (i.e. peak use, number of binges during a typical week, proportion of binge days, peak estimated blood alcohol concentration [eBAC]) following the alcohol intervention, and (2) distinguish subgroups on factors related to intervention response (i.e. perceived norms regarding how much peers drink, alcohol use severity, mental health symptoms, and readiness to change). Methods: Participants were 81 (64.2% men) nonstudent heavy drinkers between ages 18-25 years (average age = 22.04) recruited from the community. Results: Findings revealed two latent subgroups that exhibited differential response to the intervention (i.e. intervention "responders" and "nonresponders"). Further, responders reported higher pre-intervention descriptive normative perceptions and alcohol use severity. Conclusions/Importance: The current investigation contributed to knowledge regarding for whom brief alcohol interventions work in the short term within nonstudent emerging adults and could inform future research to facilitate behavior change in those unresponsive to intervention efforts.

A Daily Diary Study of Drinking and Nondrinking Days in Nonstudent Alcohol Users

BACKGROUND

Emerging adults with lower educational attainment are at higher long-term risk for problematic drinking and alcohol use disorders. Efforts to gain a more in-depth understanding of the drinking habits of nonstudent emerging adults are critical to reduce disparities and to shed light on targets of intervention for this vulnerable group.

OBJECTIVES

The current investigation aimed to: (1) provide a description of the daily drinking habits of nonstudent emerging adult drinkers using a 14-day diary method, and (2) examine nondrinking days by assessing their reasons for not drinking as well as strategies used to avoid drinking.

METHODS

Participants were 27 (55.5% women) emerging adult drinkers recruited from the community.

RESULTS

On drinking days, multilevel results indicated that heavier alcohol use was positively associated with level of subjective intoxication and alcohol-related problems. Men reported higher alcohol use outcomes than women across all alcohol use indicators. Regarding nonconsumptive days, the most frequently endorsed reasons for not drinking largely reflected an internal motivation, while the least endorsed reasons were related to external constraints. Pertaining to strategies used to avoid drinking, the most frequently endorsed response related to choosing alternative enjoyable activities. Diary compliance with the 14-day protocol was 90.9% for at least one daily survey. Conclusion/Importance: The present investigation represents one of the first to examine drinking behaviors using a daily diary approach with nonstudent emerging adult drinkers. Study findings filled an important gap regarding our understanding of the context of drinking of an at-risk and understudied group of drinkers.

Drinking Patterns of College- and Non-College-Attending Young Adults: Is High-Intensity Drinking Only a College Phenomenon?

BACKGROUND

Young adults report the heaviest drinking of any age group, and many are at risk for experiencing an alcohol use disorder. Most research investigating young adult drinking has focused on single indicators of use. Using multiple dimensions of consumption, such as federal guidelines for daily/weekly drinking and engagement in drinking at twice the binge threshold ("high-intensity drinking") to characterize drinking behavior could illuminate drinking patterns linked with harms.

OBJECTIVES

We used a person-centered approach to examine latent classes of drinkers from a national sample of young adults. Further, we compared classes on college status.

METHODS

We used 2012-2013 data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)-III. We included past-year drinkers aged 18-22 years (n = 2213). Latent classes were estimated based on drinking frequency, daily/weekly drinking, frequency of heavy episodic drinking (4+/5+ drinks for women/men), frequency of high-intensity drinking (8+/10+ drinks), and intoxication frequency.

RESULTS

Five latent classes were identified: Occasional, Light Drinkers (30%), Regular Drinkers (6%), Infrequent Drinkers with Occasional Binging (10%), Frequent Drinkers with Occasional Binging (22%), and High-Intensity Drinkers (32%). Although membership in the two riskiest classes were more common among college-attenders, odds of being a High-Intensity Drinker relative to the second riskiest class was not significantly different for college- and non-college-attending young adults. Conclusions/Importance: As high-intensity drinking does not appear to be a drinking pattern unique to college-attenders and non-college-attenders are less likely to mature out of heavy drinking patterns, intervention efforts are needed for this at-risk age group.

Testing Daily Associations between Impulsivity, Affect, and Alcohol Outcomes: A Pilot Study

BACKGROUND

Considerable research has examined impulsivity between individuals, but less research has focused on whether impulsivity fluctuates within a person. Although previous research supports trait levels of impulsivity as a risk factor for increased alcohol involvement, it is unclear whether daily (i.e., state) fluctuations in impulsivity coincide with same-day drinking behaviors. The present pilot study tested (1) the extent to which impulsivity fluctuates within-person; (2) the influence of daily impulsivity on alcohol use outcomes across all days (i.e., whether drinking occurred, the number of drinks consumed, and intentions to drink) and on drinking days only (i.e., whether heavy episodic drinking occurred and the number of problems experienced); and (3) daily affect as moderators of these relationships.

METHOD

Participants were 24 young adult drinkers without postsecondary education who completed a baseline plus 14 follow-up daily surveys. Each day, participants reported their impulsivity, affect, and drinking behavior.

RESULTS

Multilevel modeling revealed that 42.5% of the variability in daily impulsivity was due to within-person differences. Impulsivity was related to greater odds of heavy episodic drinking and more alcohol-related problems on drinking days. Positive affect moderated the relationship between impulsivity and alcohol-related problems, and the relationship between impulsivity and drinking intentions.

CONCLUSIONS

Findings suggest that changes in positive affect and impulsivity may be a risk factor for alcohol problems in a daily context. Future research examining within-person impulsivity and negative outcomes may benefit from considering positive affect.

Personalized Boosters After a Computerized Intervention Targeting College Drinking: A Randomized Controlled Trial

BACKGROUND

Problematic drinking among emerging adult college students is extensive. Computer-delivered interventions (CDIs) have strong appeal because they can be quickly delivered to large numbers of students. Although they are efficacious in the short term, CDIs are not as efficacious as in-person interventions longer term. This study examined the utility of emailed boosters containing personalized feedback after a CDI to enhance and extend reductions among emerging adult college drinkers. Sex and age were explored as potential moderators.

METHODS

Participants were 537 college students (67.4% female) aged 18 to 24 years (M age = 19.65, SD = 1.67) who consumed at least 1 alcoholic drink in the past 2 weeks. They were randomly assigned to CDI-only, CDI + booster email, or an assessment-only control condition, and were assessed up to 9 months postintervention. A booster email with personalized feedback was sent to the CDI + booster email group 2 weeks after completion of the CDI.

RESULTS

Moderation findings for age revealed that the booster may be an effective means to strengthen and extend intervention effects for emerging adults who are of legal drinking age. However, effects were negligible for underage drinkers. Although the booster effect for the overall sample demonstrated a trend in the expected direction, it failed to reach significance. Booster effects were not significantly moderated by sex. Intervention effects were not moderated by either age or sex.

CONCLUSIONS

The present investigation contributes to a limited body of research on boosters to augment main intervention effects in college drinkers. Our study demonstrated that a brief CDI plus a simple email booster with personalized feedback resulted in significant reductions in drinking outcomes for emerging adults of legal drinking age. Efforts to further develop and refine intervention booster strategies represent a promising future direction to minimize harmful drinking among college students.

Mediators and Moderators of a Personalized Feedback Alcohol Intervention for Nonstudent Emerging Adult Drinkers

BACKGROUND

The main objective of this study was to test proposed mediators and moderators of a personalized feedback alcohol intervention (PFI) on alcohol use. Data for the current investigation came from an earlier randomized controlled trial of a PFI targeted for nonstudent heavy drinkers between 18 and 25 years.

METHODS

Participants were 164 (65.9% men) drinkers recruited from the community. They were randomly assigned to either a single-session PFI or an assessment-only (AO) control group. Follow-up assessments at 1 and 3 months were included for analysis.

RESULTS

Perceived drinking norms mediated the intervention effect on quantity, frequency, and peak drinking; 2 dimensions of protective behavioral strategies (PBS) mediated the intervention effect on peak drinking; and drinking to cope motives did not mediate any drinking outcomes. Of the moderating factors examined (i.e., norms, PBS, drink to cope motives, age, gender), only PBS related to serious harm reduction moderated intervention impact. Specifically, for those high in serious harm reduction PBS at baseline, postintervention reductions in drinking were stronger for the PFI group compared to AO.

CONCLUSIONS

Overall, findings highlight the importance of correcting misperceived drinking norms and addressing the use of specific PBS in brief interventions. The knowledge gained from this study represents an important step toward minimizing drinking-related harms that are disproportionately experienced by those with lower educational attainment.