The effects of social and health consequence framing on heavy drinking intentions among college students

Messages focused on the effect of alcohol on the immune system boosted intention to adhere to alcohol intake guidelines during Covid-19 lockdown

Objective: Research shows that personal relevance may affect the impact of alcohol-related health information. This study explored alcohol consumption during the UK Covid-19 lockdown, and whether a message emphasising the effect of alcohol on the immune system was more effective in altering intentions to follow low-risk drinking guidelines than other messages about the effects of alcohol on health.

Methods & Measures: From April to June 2020, 953 drinkers completed an online questionnaire, and were randomly allocated to exposure to a control condition or one of three messages emphasising the impact of alcohol on: the immune system; mental health; or physical health. Outcome variables were: concern about alcohol intake, and intention to adhere to low-risk drinking guidelines.

Results: Pre-post ANCOVAs revealed that participants in the immunity message group had significantly stronger intention to adhere to low-risk guidelines than the control group (after controlling for initial intention). Concern for the effect of alcohol on health was not significantly affected.

Conclusion: During Covid-19 lockdown, a message emphasising the impact of alcohol on the immune-system had a greater effect on intention to observe low-risk drinking guidelines than other messages. Contextually relevant messages could be used for alcohol health campaigns and for improving alcohol labelling.

Investigating the impact of 'dark nudges' on drinking intentions: A between groups, randomized and online experimental study

OBJECTIVES

This study explored how 'dark nudges' (tactics used in alcohol industry-funded responsible drinking campaigns) affect drinking intentions, perceived source credibility and whether individual differences in perceptions of prototypical drinkers moderated these effects.

DESIGN

Two 2 × 2 between-groups online experimental studies.

METHODS

Study 1 (N = 164) presented three alcohol health messages per condition, comprising social norm (healthy/unhealthy ("dark nudge")) by frame (loss/gain). Study 2 (N = 229) presented one message per condition, comprising cancer causality (single cause/multiple causes (dark nudge)) by funding disclosure (disclosure/non-disclosure (dark nudge)). Outcomes were drinking intentions and perceived source credibility. Exploratory analyses considered prototype perceptions as a between-subjects moderator.

RESULTS

No significant effects of message frame, social norm, fundi or multiple cancer causality arguments on drinking intentions were found. In Study 2, in the dark nudge multiple cancer causality conditions, perceived source credibility was high when funding was undisclosed, but significantly lower when it was disclosed. Exploratory analyses suggested effects were moderated by prototype similarity. In Study 1, higher perceived similarity to a heavy drinker and lower perceived similarity to a responsible drinker were associated with higher drinking intentions in the unhealthy norm/gain frame condition, but lower drinking intentions in the other conditions.

CONCLUSIONS

Framing, social norm, funding disclosure and multiple causality manipulations as tested in this study did not exert a dark nudge effect on drinking intentions. However, the exploratory analyses suggest it could be hypothesised that the types of messages used in alcohol industry-funded responsible drinking campaigns may result in greater drinking intentions among those who identify more as heavy drinkers and less as responsible drinkers. Perceived prototype similarity may be an important moderator of the impact of alcohol health messages that warrants further research. Study 2 suggests disclosure of industry funding guides judgements of the credibility of sources of misleading messages about alcohol and cancer.

How Facebook is used to promote ENDS products near four Big 10 universities: A qualitative analysis

Objective: Electronic Nicotine Delivery System (ENDS) proprietors strategically placed near college campuses and pervasive marketing on social media platforms, such as Facebook, are critical to the tobacco industry's effort to acquire new young adult users. Understanding the themes used on Facebook to promote ENDS products to college students is necessary to develop public health messaging to combat the vaping epidemic.Methods: We identified 15 ENDS proprietors located near four Big 10 universities and qualitatively analyzed a random sample of their Facebook posts (n = 405) to identify emerging themes using a grounded theory approach.Results: ENDS proprietors in college towns use Facebook to deploy promotional messaging (n = 319), to market ENDS products as a means of celebration (n = 40), to establish a sense of community (n = 155) among ENDS users, to make marijuana references (n = 36), and to advocate (n = 27) for ENDS products.Conclusions: These themes may increase social acceptability and use of ENDS products among college students.

Factors associated with stress impacting academic success among post-secondary students: A systematic review

Objective: To synthesize peer-reviewed primary research exploring factors associated with perceived stress impacting post-secondary students' academic success. Methods: A systematic review identified research conducted in North America, Europe, and Australia in the last ten years across 12 databases. Results: Of the 6,214 references screened, 14 English articles published between 2011 and 2018 were deemed relevant. Subsequent analysis characterized articles by study design, location, population, factors with a statistically significant relationship with both perceived stress and academic success, and future research directions. Findings reveal a complex relationship among overlapping factors associated with perceived stress on academic success at both the intrapersonal (eg, academic, demographic, psychological, attitudinal, and behavioral characteristics) and interpersonal levels (eg, social capital). Conclusions: Further research should measure the association of the identified factors to inform areas where resources could be targeted within post-secondary institutions to prevent stress from unduly impacting students' educational outcomes.

"If Someone Has It, I'm Gonna Hit It": Lessons Learned From Minnesota Teens About Vaping

Youth e-cigarette use or "vaping" has increased substantially in the past few years, an escalation attributable to flavored "pod mod" e-cigarette devices that deliver higher levels of nicotine compared with free-base nicotine found in other types of e-cigarettes. Use rates, addiction, and harms are alarming as negative effects from nicotine on adolescent brain development are well documented, and e-cigarette use is predictive of cigarette smoking initiation. This qualitative study examined what drives the appeal of these products through 10 focus groups conducted in 2019 with 67 Minnesota high school students. Focus groups aimed to understand students' personal experiences and contextual factors that may contribute to current vaping trends and explore opportunities for improved prevention messaging. Study results revealed participants' divergent perceptions of tobacco products (i.e., vaping vs. e-cigarettes vs. cigarettes) and the benefits and harms of each product. Participants provided insights into why youth vape, describing vaping as an easily accessible coping method to help teens manage stress and anxiety. Peer normalization and invincibility beliefs about harms were also present. Participants generated ideas about prevention messaging, describing the ineffectiveness of prevention messages they currently receive, and expressing the need for accurate information about e-cigarette health risks presented in personalized, nonjudgmental contexts by people they know care about them. These results have clear implications for prevention initiatives and can be used to inform effective prevention strategies, messaging, programming, and policies, some of which are specific to e-cigarette prevention and others that align with the theory of positive youth development.

What's said in a subject line? Framing the email subject lines in health messages sent to university students

Objective To examine whether manipulating the frame used in email subject lines affects open or click-through rate. Participants: Students (N = 38,538) at a Midwestern university received emails from their health clinic about a stress management program (September - December 2017). Method: Three subject lines (Action Instruction only, Gain Frame plus Action Instruction, Non-loss Frame plus Action Instruction) were used. Each student randomly received one subject line in the first two months and one in the next two months. Email open and click-through rates were measured. Results: Emails with the Action Instruction only subject line were more likely to be opened; there was no difference in open rate between the two framed subject lines, and no effect on click-through rates. Conclusion: This study supports the benefits of action instructions to encourage behavior change but calls for further research on the effects of frames and action instructions in email subject lines.

Brief Underage Alcohol Use Screener Scores Predict Health Risk Behaviors

The aim of this study was to determine if adolescents' scores on a 2-item underage alcohol use screener predict risky consequences of past-year alcohol use and other health risk behaviors in a nonclinical, school-based sample of adolescents. A predominantly minority sample of 756 middle and high school students completed in-school tablet-based surveys on past-year underage alcohol use and a range of health risk behaviors. Higher scores for self alcohol risk and peer alcohol risk were associated with higher risk of past-year riding with a drunk driver and past 90-day measures of cigarette use, marijuana use, unplanned sex, and unprotected intercourse. The National Institute of Alcohol Abuse and Alcoholism Brief Alcohol Screener is a useful tool for school-based service providers, including school nurses, to identify and address the needs of adolescents at high risk of the development of alcohol use disorders, as well as a range of preventable health risk behaviors.

Targeting Physical Inactivity - Effects of Three Different Consequence Frames on Population Subgroups' Health-Related Perceptions and Behavioral Intentions

Physical inactivity constitutes a major health problem in many Western societies affecting a variety of social groups. As these groups often differ in responsivity to physical inactivity messages, the strategy of message targeting, i.e. the customization of messages toward shared characteristics of a social group provides a useful framework for designing effective communication. Whereas focusing on health consequences of physical inactivity might prove useful for some social groups, it might be more effective to emphasize its social or financial consequences for others. The current examination compares the effects of three types of consequence framing (health consequences vs. social consequences vs. financial consequences of physical inactivity) on health-related perceptions and intentions for different population subgroups. An experiment with a one-factorial between subjects design based on a quota sample was conducted. 348 respondents differing in terms of age, sex, and formal education were randomly assigned to one of the three experimental conditions and read an accordingly manipulated newspaper article. Findings show that financial and social consequence frames were more effective than health consequence frames. Both frames positively influenced behavioral intentions through perceptions of susceptibility. These effects were largely independent of sociodemographic variables, although sex and education emerged as moderators in some cases.

"Have a little less, feel a lot better": Mixed-method evaluation of an alcohol intervention

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A multimedia campaign encouraging men to drink less produced changes in alcohol use.

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Men appreciated the straightforward message and friendly tone of the campaign.

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There is also a need to develop the necessary behavioural skills for behaviour change.

The aim of the mixed-methods study reported here was to evaluate the impact of a “gain-framed”, multimedia campaign to encourage heavier drinking men aged 45–64 years to drink less. Quantitative analyses were based on pre-intervention panel surveys of 3057 men in intervention regions and 500 in the control region, and post-intervention panel surveys of 1508 men in intervention regions and 219 in the control region. Qualitative analyses entailed thematic analysis of interviews with 14 men: five who had reduced their drinking after seeing the campaign, four who had considered reducing but did not, and five who did not consider changing. Interviews focused on men’s responses to the campaign, and their ideas for how to improve it. In quantitative analyses, the campaign was associated with significant changes in alcohol consumption, and significant increases in readiness to change and likelihood of using moderate drinking strategies. In qualitative analyses, men appreciated the friendly, non-threatening tone and that the message was straightforward, meaningful, achievable, and was gain-framed - i.e., emphasised the benefits of drinking less rather than the harms of drinking too much. However, the men who did not change their behaviour also identified several barriers to responding in ways encouraged by the message. It would be important to address their views of their drinking as not problematic, as pleasurable, and as socially expected, and also their sense of not feeling empowered to initiate or maintain behaviour change.

The Development of Video Messages to Reduce Binge Drinking: Focus Group Results

AIMS

The current study examined college students' perceptions of loss framed and gain framed messages aimed at reducing binge drinking.

METHODS

Using focus groups (n = 3) consisting of undergraduates (n = 131), an iterative process was undertaken to ensure the acceptability and construct validity of loss framed and gain framed video messages. Both quantitative and qualitative data were collected.

RESULTS

Results across all focus groups demonstrated that each message condition possessed strong construct validity. Participants in focus Group 3 rated messages as moderately to highly acceptable and acceptability ratings across loss framed messages and gain framed messages were comparable.

CONCLUSIONS

These findings demonstrate the importance of focus group testing in the development of brief alcohol interventions among college students. Messages used in the currents study will be included in a video intervention aimed at reducing binge drinking among college students.

A randomised trial of the effect of appearance versus health-framed messages on engagement with an online brief screening and alcohol reduction intervention

Objectives: To compare the impact of appearance versus health-framed messages on engagement in a brief web-based risk screening and alcohol reduction intervention. Design: Randomised trial delivered via Drinkaware's website. Visitors were exposed to appearance (n = 51,588) or health-framed messages (n = 52,639) directing them towards an AUDIT-C risk screening questionnaire. Users completing this questionnaire were given feedback on their risk level and extended frame-congruent information. Outcomes: The primary outcome is completion of the AUDIT-C questionnaire. The secondary outcome is whether the participant accessed any of four further resources. Results: The appearance-framed message led to a small but significant increase in the number of users completing the AUDIT-C compared to the health-framed message (n = 3,537, 6.86% versus n = 3,355, 6.37%, p < 0.01). Conversely, following subsequent risk feedback, users exposed to extended health-framed information were more likely to access further resources (n = 1,146, 2.17% versus n = 942, 1.83%, p < 0.01). Conclusions: Physical appearance-framed messages increased the likelihood of engagement with an online alcohol screening and brief intervention tool, whereas health-framed messages increased the likelihood of accessing further resources. This highlights the potential for the use of multi-level approaches in alcohol reduction interventions.

Low-cost approaches to increasing gym attendance

We investigate the effect of two low-cost experimental interventions designed to increase physical exercise: a lottery based financial incentive and a social norming treatment. The lottery intervention provides a financial incentive to increase physical activity whereas the social norming intervention attempts to increase physical activity by providing feedback to individuals on their own and their peers' physical exercise activity. We find the larger of our two lottery treatments yields a positive and statistically significant effect on physical activity at modest cost, whereas our social norming treatment has no detectable effect.

Alcohol-related harm minimization practices among university students: Does the type of residence have an impact?

BACKGROUND

The culture of 'risk-related alcohol use' has been identified as an intrinsic part of university life for many students, especially those in residential colleges in English-speaking countries. While the prevailing approach to managing drinking in these countries is harm minimization, little is known about students' uptake of these practices or the relationship of them to students' type of residence.

OBJECTIVE

To examine the ways in which type of residence may impact alcohol-related harm minimization practices among university students.

DESIGN

A qualitative research design using focus group methodology informed all aspects of the study.

METHODS

University students (N = 70) aged 18-24 years and differentiated by their type of residence were recruited from universities in Australia. Nineteen audio-recorded focus groups were conducted. Systematic qualitative analysis was used to identify the main themes.

RESULTS

Students reported risk-related alcohol use and alcohol-related harms as either consumers or having witnessed others' consumption through three main themes: (1) The pervasiveness of alcohol use and harms; (2) Perceived safety and physical spaces; and (3) Gender-based alcohol-related harms. Harm minimization practices were talked about in terms of four themes: (1) Policy ineffectiveness; (2) Pre-drinking planning; (3) Friends look after friends; and (4) Help-seeking as a covert activity.

CONCLUSIONS

Alcohol use by university students occurs with limited knowledge of harm minimization policies or practices. Students do engage in ad hoc harm minimization practices usually developed during their first year at university through specific 'drinking cultures' that are constituted by various factors including their type of residence. Statement of contribution What is already known on this subject? Previous research has strongly indicated that university students' heavy alcohol consumption is linked with social and environmental factors such as marketing alcohol, low cost, availability, 'wet' environments, and shared accommodation. However, little is known about what, if any, alcohol-related harm minimization practices students employ and if type of residence has an impact on these practices. What does this study add? This study is one of the first to examine alcohol-related harm minimization practices among university students and type of residence demonstrating the impact of social environments on drinking and related practices. Regardless of type of residence, university students were either not aware of university and residential college alcohol policies or found them unclear. Students do engage in ad hoc harm minimization practices usually developed during their first year at university through specific 'drinking cultures' that are constituted by various factors including the type of residence. Two practical recommendations are made in this study to develop alcohol-related harm minimization related to university students.

Investigating Single- Versus Multiple-Source Approaches to Communicating Health Messages Via an Online Simulation

Purpose:

To assess whether exposing drinkers to information about the alcohol–cancer link via multiple and diverse sources in an online simulation produces larger improvements in attitudes and intentions relative to exposure to a single source of information.

Design:

Experimental; unequal randomization with respondents allocated to either the single-source (20%) or multiple-source condition (80%). Alcohol-related behavioral intentions were assessed preexposure and postexposure.

Setting:

Australia.

Participants:

A total of 2087 drinkers consuming alcohol at least twice per month.

Measures:

Scales were used to assess attitudes toward the messages (believability, convincingness, and personal relevance) and behavioral intentions (extent to which participants believed that they should and would reduce their alcohol consumption and their intention to consume 5 or more drinks in a single session).

Analysis:

Hierarchical linear regression.

Results:

Source condition was significantly associated with all 3 attitudinal variables ( P < .001). Those exposed to an alcohol warning statement from multiple sources found the message more believable, convincing, and personally relevant compared to those exposed to a warning statement via a single source. They also reported significantly greater change preexposure to postexposure on the 2 behavioral beliefs that they should (Δ M = 0.25 vs Δ M = 0.09) and would (Δ M = 0.23 vs Δ M = 0.00) reduce their current alcohol consumption ( P < .001). Further, those in the multiple-source condition reported reduced intentions to consume 5 or more standard drinks in a single sitting (Δ M = 0.21 vs Δ M = 0.14; P < .001).

Conclusion:

Findings from the online simulation provide support for the suggestion that integrated approaches involving the combination of multiple sources to deliver a message produce superior outcomes compared to relying on a single source (eg, warning labels on alcoholic beverages).

Impulsivity moderates the effects of movie alcohol portrayals on adolescents' willingness to drink

This study examined impulsivity as a moderator of adolescents' reactions to positive versus negative portrayals of drinking in American movie clips. Impulsivity, along with willingness and intentions to drink in the future, were assessed in a pretest session. In the experimental sessions, adolescents viewed a series of clips that showed drinking associated with either positive outcomes (e.g., social facilitation) or negative outcomes (fights, arguments). A third group viewed clips with similar positive or negative outcomes, but no alcohol consumption. All participants then responded to an implicit measure of attentional bias regarding alcohol (a dot probe), followed by explicit alcohol measures (self-reports of willingness and intentions to drink). Hypotheses, based on dual-processing theories, were: (a) high-impulsive adolescents would respond more favorably than low-impulsive adolescents to the positive clips, but not the negative clips; and (b) this difference in reactions to the positive clips would be larger on the willingness than the intention measures. Results supported the hypotheses: Adolescents high in impulsivity reported the highest willingness to drink in the positive-clip condition, but were slightly less willing than others in the negative-clip condition. In addition, results on the dot probe task indicated that RTs to alcohol words were negatively correlated with changes in alcohol willingness, but not intention; that is, the faster their response to the alcohol words, the more their willingness increased. The results highlight the utility of a dual-processing perspective on media influence. (PsycINFO Database Record

Developing cancer warning statements for alcoholic beverages

Background

There is growing evidence of the increased cancer risk associated with alcohol consumption, but this is not well understood by the general public. This study investigated the acceptability among drinkers of cancer warning statements for alcoholic beverages.

Methods

Six focus groups were conducted with Australian drinkers to develop a series of cancer-related warning statements for alcohol products. Eleven cancer warning statements and one general health warning statement were subsequently tested on 2,168 drinkers via an online survey. The statements varied by message frame (positive vs negative), cancer reference (general vs specific), and the way causality was communicated (‘increases risk of cancer’ vs ‘can cause cancer’).

Results

Overall, responses to the cancer statements were neutral to favorable, indicating that they are unlikely to encounter high levels of negative reaction from the community if introduced on alcoholic beverages. Females, younger respondents, and those with higher levels of education generally found the statements to be more believable, convincing, and personally relevant. Positively framed messages, those referring to specific forms of cancer, and those using ‘increases risk of cancer’ performed better than negatively framed messages, those referring to cancer in general, and those using the term ‘can cause cancer’.

Conclusion

Cancer warning statements on alcoholic beverages constitute a potential means of increasing awareness about the relationship between alcohol consumption and cancer risk.