A randomized controlled trial of a brief online intervention to reduce alcohol consumption in new university students: Combining self-affirmation, theory of planned behaviour messages, and implementation intentions

Brief online negative affect focused functional imagery training (FIT) improves four-week drinking outcomes in hazardous student drinkers: A pilot randomised controlled trial replication in South Africa

Background

Previous study has shown that functional imagery training (FIT) to utilise positive mental imagery in response to negative affect could improve alcohol-related outcomes. The current study aimed to replicate whether this negative affect focused FIT would improve alcohol-related outcomes in hazardous student drinkers in South Africa at four-week follow-up.

Methods

50 hazardous student drinkers who reported drinking to cope with negative affect were randomised into two groups. The active group (n = 25) was trained online over two weeks to respond to personalised negative drinking triggers by retrieving a personalised adaptive strategy they might use to mitigate negative affect, whereas the control group (n = 25) received standard risk information about binge drinking. Outcome measures including alcohol consumption, drinking motives, anxiety and depression, self-efficacy and use of protective behavioural strategies were obtained at baseline and four-week follow-up.

Results

FIT effects were revealed by three significant group-by-timepoint interactions in a per-protocol analysis: there was a significant decrease in depressive symptoms, drinking to cope and drinking for social reasons from baseline to follow-up in the active group, but not the control group. No effects were observed on alcohol consumption, self-efficacy, protective behaviour strategies and anxiety.

Conclusions

Preliminary evidence supports that online negative affect focused FIT can improve depression as well as coping and social drinking motives in South African hazardous student drinkers who drank to cope, at four-week follow-up, suggesting that the principles of this FIT approach might be adapted and incorporated into a clinical intervention to test for efficacy in mitigating substance use problems.

A systematic review of binge drinking interventions and bias assessment among college students and young adults in high-income countries

Alcohol is the number one substance used by young people and people of college age. Binge drinking (BD) in this age group is considered one of the most important global health issues, as much harm accrues from it and even lives are lost. This study aimed to review the interventions to curb BD or encourage responsible drinking among college students and young adults. MEDLINE (PubMed), ERIC and APA PsycINFO were searched. The selected articles were published in English and had to evaluate a BD reduction program through a randomized control trial (RCT) among college students or young adults between the ages of 17-24 years. The exclusion criteria included research not published in English, systematic review articles, qualitative studies, designs other than RCTs and discussion articles on college students drinking with no findings. The three reviewers independently screened and extracted the data using the PRISMA guidelines. The overall quality of the studies was assessed. Then, 10 of the 12 interventions studied were found to be successful in reducing BD among college students, though the effect sizes were small to medium. A minority of the studies used behavior change theories. Effective interventions for reducing BD among college students and young adults should include robust behavior change theories, longer follow-up time and the operationalization of multiple outcomes. Process evaluation is needed to be conducted in these studies.

Recruiting and retaining first-year college students in online health research: Implementation considerations

Objective: Decreasing participation in intervention research among college students has implications for the external validity of behavioral intervention research. We describe recruitment and retention strategies used to promote participation in intervention research across a series of four randomized experiments. Method: We report the recruitment and retention rates by school for each experiment and qualitative feedback from students about recommendations for improving research participation. Results: There was considerable variation among schools' recruitment (4.9% to 64.7%) and retention (12% to 67.8%) rates. Student feedback suggested study timing (e.g., early in the semester), communication strategies (e.g., social media), and incentive structure (e.g., guaranteed incentives) could improve research participation. The highest survey participation rate was observed at the university which mandated students to complete the intervention (but not the survey). Conclusions: Intervention scientists must consider the population and study context to make informed decisions related to recruitment and retention strategies.

Tracking COVID-19 vaccination expectancies and vaccination refusal in the United States

To identify factors that predict COVID-19 vaccination refusal and show how expectancies affect vaccination acceptance for non-vaccinated adults, we used a monthly repeated cross-sectional sample from June/2021 to October/2021 to collect data on vaccination behaviors and predictor variables for 2,116 US adults over 50 years of age. Selection bias modeling - which is required when data availability is a result of behavioral choice - predicts two outcomes: (1) no vaccination vs. vaccination for the entire sample and (2) the effects of expectancy indices predicting vaccination Refuser vs. vaccination Accepters for the unvaccinated group. Vaccine refusers were younger and less educated, endorsed common misconceptions about the COVID-19 epidemic, and were Black. Vaccination expectancies were related to vaccination refusal in the unvaccinated eligible group: negative expectancies increased vaccine refusal, while positive expectancies decreased it. We conclude that behavior-related expectancies (as opposed to more stable psychological traits) are important to identify because they are often modifiable and provide a point of intervention, not just for COVID-19 vaccination acceptance but also for other positive health behaviors.

The theory of planned behavior and alcohol protective behavioral strategies: a prospective study examining the role of habit and gender invariance

OBJECTIVES

Alcohol Protective Behavioral Strategies (PBS) have consistently shown to be effective in reducing alcohol use and its associated consequences. We aimed to examine the explanatory value of the Theory of Planned Behavior (TPB) for using five PBS, studying the role of habit, and its potential variation across genders.

METHODS

Targeted sampling was used to recruit 339 young adults in the community (women = 50.7%; mean age = 2.21[SD = 2.21]), who completed baseline and 2-month follow-up questionnaires.

RESULTS

The explained variance of the TPB ranged from 58-68% for intention to use PBS, and 18-50% for behavior. The inclusion of habit produced increases of 17-26% in explained variance in intention, while explained variance in behavior remained similar. Habit was the strongest predictor of intention to use PBS, followed by attitude. Except for one behavior (drinking slowly), habits did not moderate the intention-behavior relationship, and the explanatory value of the TPB did not differ across genders.

CONCLUSIONS

Our findings support the utility of the TPB as an explanatory model of alcohol PBS, along with the need to include habits within the framework of dual-process models. Interventions aimed at promoting alcohol PBS could be optimized by targeting attitudes towards PBS and habits.

Effectiveness of Self-Affirmation Interventions in Educational Settings: A Meta-Analysis

School and university can be stressful contexts that can become an important source of identity threats when social prejudices or stereotypes come into play. Self-affirmation interventions are key strategies for mitigating the negative consequences of identity threat. This meta-analysis aims to provide an overview of the effectiveness of self-affirmation interventions in educational settings. A peer-reviewed article search was conducted in January 2023. A total of 144 experimental studies that tested the effect of self-affirmation interventions in educational contexts among high school and university students from different social and cultural backgrounds were considered. The average effect of self-affirmation interventions was of low magnitude (dIG+ = 0.41, z = 16.01, p < 0.00), with a 95% confidence interval whose values tended to lie between 0.36 and 0.45 (SE = 0.0253). In addition, moderators such as identity threat, participants' age, and intervention procedure were found. Through a meta-analysis of the impact of self-affirmation interventions in educational contexts, this study suggests that interventions are effective, resulting in a small mean effect size. Thus, self-affirmation interventions can be considered useful, brief, and inexpensive strategies to improve general well-being and performance in educational settings.

Development of a Web-Based Alcohol Prevention Program Linking School-Child-Family for Intermediate Elementary Students

Family strongly influences student health behavior. However, alcohol-preventive education programs that link parents and school for intermediate-elementary school students remain scarce. Although online educational programs constitute effective interventions to intentionally improve health behaviors, traditional methods are used to implement alcohol- prevention programs for students. In this study, we aimed to (1) develop an online school-child-family alcohol-prevention program based on the theory of planned behavior and (2) examine the preliminary effects of the program on intention to consume alcohol among intermediate-elementary school students. This single-group, pre- and posttest study enrolled 46 Grade 3 students from a public elementary school in a metropolitan South Korea city and ascertained the preliminary effects of a 5-week online alcohol-prevention program by using the alcohol drinking prevention behavior scale. Attitudes, perceived behavioral control, and intention of alcohol-preventive behaviors significantly improved (p < .05) whereas subjective norms did not. The online alcohol-prevention program based on the theory of planned behavior and school-child-family linkage beneficially influenced intention, attitude, and perceived behavioral control for alcohol-prevention behavior, and the effectiveness and convenience of this program underscores its potential application as an educational intervention to improve health behaviors of intermediate-elementary school students.

Solution Focused Brief Therapy Telemental Health Suicide Intervention

One of the innumerable impacts of the coronavirus has been the change in how individuals provide services. For mental health providers, the pandemic required a sudden shift from in person to online service delivery. As therapists learn and embrace a new modality for providing therapy, crisis situations may present with some anxiety. With the pandemic increasing crisis situations for so many individuals, and teletherapy as a mode of service delivery being unlikely to go away after the pandemic, therapists require support in navigating crises situations online, in a medium that feels like the therapist has less control with their clients due to being in different physical locations. The authors believe that regardless of the primary model(s) therapists utilize in session, solution-focused brief therapy is an integrative model that uniquely captures client's resources and reasons for living and when clients are in crisis. The purpose of this paper is to present recommendations for applying solution-focused language in teletherapy practice, to provide ethical, evidenced based care for clients in crisis. A clinical vignette is used to illustrate the application of solution focused brief therapy for working with clients in crisis. Future directions and limitations are discussed.

The effect of forming implementation intentions on alcohol consumption: A systematic review and meta-analysis

ISSUES

Meta-analysis was used to estimate the effect of forming implementation intentions (i.e., if-then plans) on weekly alcohol consumption and heavy episodic drinking (HED). Sample type, mode of delivery, intervention format and timeframe were tested as moderator variables.

APPROACH

Cochrane, EThOS, Google Scholar, PsychArticles, PubMed and Web of Science were searched for relevant publications to 31 March 2021. Random-effects meta-analysis was used to estimate the effect size difference (d) between individuals forming versus not forming implementation intentions on weekly consumption and HED.

KEY FINDINGS

Sixteen studies were included in meta-analyses. The effect size difference for forming implementation intentions on weekly alcohol consumption was d₊  = -0.14 confidence interval (CI) [-0.24; -0.03]. Moderator analyses highlighted stronger effects for: (i) community (d₊  = -0.38, CI [-0.58; -0.18]) versus university (d₊  = -0.04, CI [-0.13; 0.05]) samples; (ii) paper (d₊  = -0.26, CI [-0.43; -0.09]) versus online (d₊  = -0.04, CI [-0.14; 0.06]) mode of delivery; and (iii) volitional help sheet (d₊  = -0.34, CI [-0.60; -0.07]) versus implementation intention format (d₊  = -0.07, CI [-0.16; 0.02]). In addition, effects diminished over time (B = 0.02, SE = 0.01, CI [0.03; 0.01]). Forming implementation intentions had a null effect on HED, d₊  = -0.01 CI [-0.10; 0.08].

IMPLICATIONS

Forming implementation intentions reduces weekly consumption but has no effect on HED.

CONCLUSION

This review identifies boundary conditions on the effectiveness of implementation intentions to reduce alcohol consumption. Future research should focus on increasing the effectiveness of online-delivered interventions and integrating implementation intention and motivational interventions.

Body Composition and Metabolic Status of Italian and Spanish University Students: Relationship with Fruit and Vegetable Consumption

Most university students do not follow recommendations for fruit and vegetable intake, with a consequent increase in the prevalence of cardiovascular disease (CVD) risk factors. The aim of this study was to compare obesity prevalence and biomarkers of metabolic status between Italian and Spanish university students, in relation with the consumption of fruits and vegetables. Food consumption, adherence to a Mediterranean diet (MD), level of physical activity (PA), blood glucose, total cholesterol, triglycerides and ketones, blood pressure, and body composition were evaluated. Among CVD risk factors, only glucose was significantly higher in Spaniards (SP), and only 3.1% of SP presented ketosis. SP had a higher percentage of energy from fat. Although adherence to MD and fruit and vegetable consumption did not differ between Italians and SP, students who consumed at least four servings of fruit and vegetables (FV group) showed better values for pressure and metabolic parameters than the no FV group. We observed an association between consumption of fruit and PA. Students who consumed more vegetables than fruit reported a better body composition profile and lower glucose concentrations. As previously suggested, in addition to PA, two servings of fruit and three servings of vegetables per day should be recommended.

The unappreciated relevance of auxiliary assumptions for evaluating theory-based interventions in health psychology

The use of theory in health behavior change interventions has been recently questioned with mixed results found for theory-based intervention effectiveness. But theory testing in intervention depends on not only theoretical assumptions, but on auxiliary assumptions too. Specifically, auxiliary assumptions are required to traverse the distance from nonobservational terms in theories and observational terms at the level of the empirical hypotheses in interventions. We believe intervention failures are often due to flaws in auxiliary assumptions rather than assumptions at the theoretical level. We use the theory of planned behavior to illustrate how the consideration of these auxiliary assumptions is important to appraise the effectiveness of interventions informed by theory. We hope that bringing attention to the importance of auxiliary assumptions provides a more nuanced and accurate appraisal of theory utility.

Social cognition theories and behavior change in COVID-19: A conceptual review

The COVID-19 pandemic has had unprecedented health, economic, and social consequences worldwide. Although contact reductions and wearing face coverings have reduced infection rates, and vaccines have reduced illness severity, emergence of new variants of the coronavirus that causes COVID-19, and the shift from pandemic to endemic patterns of infection, highlights the importance of ongoing preventive behavior adherence to manage future outbreaks. Research applying social cognition theories may assist in explaining variance in these behaviors and inform the development of efficacious behavior change interventions to promote adherence. In the present article, we summarize research applying these theories to identify modifiable determinants of COVID-19 preventive behaviors and the mechanisms involved, and their utility in informing interventions. We identify limitations of these applications (e.g., overreliance on correlational data, lack of long-term behavioral follow-up), and suggest how they can be addressed. We demonstrate the virtue of augmenting theories with additional constructs (e.g., moral norms, anticipated regret) and processes (e.g., multiple action phases, automatic processes) to provide comprehensive, parsimonious behavioral explanations. We also outline how the theories contribute to testing mechanisms of action of behavioral interventions. Finally, we recommend future studies applying these theories to inform and test interventions to promote COVID-19 preventive behavior adherence.

Brief Online Negative Affect Focused Functional Imagery Training Improves 2-Week Drinking Outcomes in Hazardous Student Drinkers: a Pilot Randomised Controlled Trial

BACKGROUND

Negative affect plays an important role in motivating problematic alcohol use. Consequently, training imagery-based adaptive responses to negative affect could reduce problematic alcohol use. The current study tested whether personalised online functional imagery training (FIT) to utilise positive mental imagery in response to negative affect would improve drinking outcomes in hazardous negative affect drinking students.

METHOD

Participants were 52 hazardous student drinkers who drink to cope with negative affect. Participants in the active group (n = 24) were trained online over 2 weeks to respond to personalised negative drinking triggers by retrieving a personalised adaptive strategy they might use to mitigate negative affect, whereas participants in the control group (n = 28) received standard risk information about binge drinking at university. Measures of daily drinking quantity, drinking motives, self-efficacy and use of protective behavioural strategies were obtained at baseline and 2 weeks follow-up.

RESULTS

There were three significant interactions between group and time in a per-protocol analysis: the active intervention group showed increased self-efficacy of control over negative affect drinking and control over alcohol consumption and decreased social drinking motives from baseline to 2-week follow-up, relative to the control intervention group. There were no effects on drinking frequency.

CONCLUSION

These findings provide initial evidence that online training to respond to negative affect drinking triggers by retrieving mental imagery of adaptive strategies can improve drinking-related outcomes in hazardous, student, negative affect drinkers. The findings support the utility of FIT interventions for substance use.

"… because I'm so drunk at the time, the last thing I'm going to think about is calories": Strengthening the argument for Drunkorexia as a food and alcohol disturbance, evidence from a qualitative study

Objectives

Drunkorexia are inappropriate compensatory behaviours in response to alcohol consumption (restricting food intake, excessive exercise, and purging). Past (predominantly quantitative) research shows that Drunkorexia is prevalent in 18–26‐year‐olds, and has significant negative health‐related consequences. There is a debate whether Drunkorexia constitutes an eating or substance disorder, or a Food and Alcohol Disturbance (FAD). To further explore this, and understand underlying motivators, this study utilized qualitative methods.

Design

Qualitative interviews with ten participants (aged 18–26).

Methods

Interviews were analysed with Thematic Analysis.

Results

Three themes were developed: (1) Appearance concerns as motivators, (2) Drunkorexia behaviours to get value for money, and (3) “It’s just a pattern… something I’ve always done”: Drunkorexia as a routine. Results show that Drunkorexia is driven by appearance‐related concerns, such as, wanting to look better/slimmer, engaged in, in relation to an event, such as going out drinking, and carried out despite negative health‐related consequences. However, disregard for compensatory behaviours once drunk was also described, culminating in the consumption of high‐calorie food. This suggests that Drunkorexia is not a persistent pattern of maladaptive behaviour as found in eating or substance use disorders. Wanting value for money (i.e., feeling the maximum intoxication) was described as another reason for Drunkorexia engagement; thus showing that participants consider compensatory behaviours part of their routine of going out drinking.

Conclusions

These result support the view of Drunkorexia as a FAD, rather than an eating or substance use disorder, and show that 18–26‐year‐olds are an at‐risk group for Drunkorexia and its negative health‐related consequences.

The Effectiveness of Web-Based Interventions to Promote Health Behaviour Change in Adolescents: A Systematic Review

Although web-based interventions are attractive to researchers and users, the evidence about their effectiveness in the promotion of health behaviour change is still limited. Our aim was to review the effectiveness of web-based interventions used in health behavioural change in adolescents regarding physical activity, eating habits, tobacco and alcohol use, sexual behaviour, and quality of sleep. Studies published from 2016 till the search was run (May-to-June 2021) were included if they were experimental or quasi-experimental studies, pre-post-test studies, clinical trials, or randomized controlled trials evaluating the effectiveness of web-based intervention in promoting behaviour change in adolescents regarding those health behaviours. The risk of bias assessment was performed by using the Effective Public Health Practice Project (EPHPP)-Quality Assessment Tool for Quantitative Studies. Fourteen studies were included. Most were in a school setting, non-probabilistic and relatively small samples. All had a short length of follow-up and were theory driven. Thirteen showed significant positive findings to support web-based interventions' effectiveness in promoting health behaviour change among adolescents but were classified as low evidence quality. Although this review shows that web-based interventions may contribute to health behaviour change among adolescents, these findings rely on low-quality evidence, so it is urgent to test these interventions in larger controlled trials with long-term maintenance.

Theoretical Explanation of Upper Limb Functional Exercise and Its Maintenance in Postoperative Patients With Breast Cancer

Background: Upper limb functional exercise (ULFE) has a positive effect on promoting the rehabilitation of upper limb function. However, little is known, about what drives postoperative patients to engage in and even maintain the advised exercises. This study integrated the health action process approach (HAPA) and the theory of planned behavior theory (TPB) to investigate the psychosocial determinants on the initiation and maintenance of ULFE in breast cancer patients. In addition, this study also tests key hypotheses relating to reasoned and implicit pathways to ULFE and its maintenance among postoperative patients with breast cancer. Methods: Purposive sampling was used to recruit patients from two breast cancer wards in a provincial hospital in Jiangsu, China. Patients (N = 430) completed self-reported questionnaire about constructs from integrated theories concerning ULFE at an initial time point (T1): task self-efficacy, positive outcome expectations, negative outcome expectations, risk perception, attitude behavior, subjective norm, perceived behavioral control, behavioral intention, and ULFE-in hospital (ULFE-IH). Three months later (T2), patients self-reported: maintenance self-efficacy, action planning, coping planning, recovery self-efficacy, and ULFE-maintenance (ULFE-M). Results: The model has a good fit (GoF = 0.48). For behavioral intention of ULFE, subjective norm (β = 0.35) and perceived behavioral control (β = 0.61) were positively directly related to behavioral intention. Regarding the initiation of ULFE, perceived behavioral control (β = 0.47) and behavioral intention (β = 0.42) had a direct positive relation to ULFE-IH. In the maintenance of ULFE, action planning (β = 0.30), coping planning (β = 0.21), maintenance self-efficacy (β = 0.32), and recovery self-efficacy (β = 0.09) all had significant positive relation on ULFE-M. In addition, maintenance self-efficacy had a significant positive association on action planning (β = 0.80), coping planning (β = 0.74), and recovery self-efficacy (β = 0.67). Coping planning was significantly predicted by behavioral intention (β = 0.07). Additionally, behavioral intention is a mediator of subjective norm (β = 0.14) and perceived behavioral control (β = 0.25) to ULFE-IH. Action planning, coping planning, and recovery self-efficacy are mediators of maintaining self-efficacy to ULFE-M (β = 0.46). Conclusions: This study presents the first attempt to integrate the health behavior model in ULFE in postoperative patients with breast cancer. The study has shown that the HAPA-TPB integrated model has good applicability and effectiveness to explain and predict ULFE initiation and maintenance. Future work can be considered to develop appropriate intervention strategies based on this integrated behavioral theory.

Is 'a little' too much?: An exploration of women's beliefs about alcohol use during pregnancy

OBJECTIVE

Interventions to address alcohol use during pregnancy need to target underlying determinants of the behaviour. Using the theory of planned behaviour as a theoretical framework, the aim of this study was to identify behavioural, normative and control beliefs regarding alcohol use during pregnancy among a sample of women. Design: 435 women completed a 15-minute online questionnaire designed to identify beliefs about alcohol use during pregnancy. Data were categorised according to type of belief and then summarised and described. Results: The majority of respondents saw few advantages of consuming alcohol during pregnancy and believed that most people would disapprove of alcohol use during pregnancy. Although most women endorsed alcohol abstinence during pregnancy, views on the perceived risk of different levels of alcohol use and perceptions of the 'typical' person who drinks while pregnant varied between participants. Conclusion: This work contributes to the understanding of women's beliefs about alcohol use during pregnancy. Future research should explore how women's beliefs inform their decision making about different levels of alcohol use in pregnancy. Additionally, further research or messaging about alcohol use in pregnancy must also consider the potential for contributing to stigmatising beliefs.

Psychoeducational Messaging to Reduce Alcohol Use for College Students With Type 1 Diabetes: Internet-Delivered Pilot Trial

Background

College environments promote high-volume or binge alcohol consumption among youth, which may be especially harmful to those with type 1 diabetes (T1D). Little is known about the acceptability and effectiveness of interventions targeting reduced alcohol use by college students with T1D, and it is unclear whether intervention framing (specifically, the narrator of intervention messages) matters with respect to affecting behavior change. Interventions promoted by peer educators may be highly relatable and socially persuasive, whereas those delivered by clinical providers may be highly credible and motivating.

Objective

The aim of this study is to determine the acceptability and impacts of an alcohol use psychoeducational intervention delivered asynchronously through web-based channels to college students with T1D. The secondary aim is to compare the impacts of two competing versions of the intervention that differed by narrator (peer vs clinician).

Methods

We recruited 138 college students (aged 17-25 years) with T1D through web-based channels and delivered a brief intervention to participants randomly assigned to 1 of 2 versions that differed only with respect to the audiovisually recorded narrator. We assessed the impacts of the exposure to the intervention overall and by group, comparing the levels of alcohol- and diabetes-related knowledge, perceptions, and use among baseline, immediately after the intervention, and 2 weeks after intervention delivery.

Results

Of the 138 enrolled participants, 122 (88.4%) completed all follow-up assessments; the participants were predominantly women (98/122, 80.3%), were White non-Hispanic (102/122, 83.6%), and had consumed alcohol in the past year (101/122, 82.8%). Both arms saw significant postintervention gains in the knowledge of alcohol’s impacts on diabetes-related factors, health-protecting attitudes toward drinking, and concerns about drinking. All participants reported significant decreases in binge drinking 2 weeks after the intervention (21.3%; odds ratio 0.48, 95% CI 0.31-0.75) compared with the 2 weeks before the intervention (43/122, 35.2%). Changes in binge drinking after the intervention were affected by changes in concerns about alcohol use and T1D. Those who viewed the provider narrator were significantly more likely to rate their narrator as knowledgeable and trustworthy; there were no other significant differences in intervention effects by the narrator.

Conclusions

The intervention model was highly acceptable and effective at reducing self-reported binge drinking at follow-up, offering the potential for broad dissemination and reach given the web-based format and contactless, on-demand content. Both intervention narrators increased knowledge, improved health-protecting attitudes, and increased concerns regarding alcohol use. The participants’ perceptions of expertise and credibility differed by narrator.

Trial Registration

ClinicalTrials.gov NCT02883829; https://clinicaltrials.gov/ct2/show/NCT02883829

International Registered Report Identifier (IRRID)

RR2-10.1177/1932296819839503

Testing a Self-Affirmation Intervention for Improving the Psychosocial Health of Black and White Medical Students in the US

Self-affirmation interventions have been shown to mitigate the negative psychological effects of stereotype threat on Black students in secondary and undergraduate education. However, there is currently limited research testing whether Black students in medical schools may also experience the negative influences of stereotype threat. Until now, it has been unclear whether Black (vs. White) students experience a lower sense of belonging in medical school and whether they can benefit from self-affirmation interventions during medical training. With a longitudinal field experiment, we tested (a) whether Black (vs. White) medical students in the US experience decrements in psychological well-being (i.e., fatigue, depression, anxiety), sense of belonging, perceived residency competitiveness, and residency goal stability; and (b) the extent to which a self-affirmation intervention would ameliorate any observed disparities in these outcomes for Black students. With a sample of 234 Black and 182 White medical students across 50 schools in the US, we found that Black students tended to report more fatigue and less belonging than White students; however, the self-affirmation intervention did not significantly influence students' fatigue, depression, anxiety, or belonging. Unexpectedly, Black students in the self-affirmation (vs. control) condition reported lower perceived competitiveness for residency. White students' perceived competitiveness for residency was unaffected by the intervention. Exploratory analyses revealed that Black (vs. White) students were less likely to indicate stable residency goals over time, which may be an indication of threat; however, this racial gap was eliminated with the intervention. We discuss the plausible reasons for these findings and provide recommendations for future work in this area.

Validation of persuasive audiovisual communication to reduce salt consumption by people with heart failure

OBJECTIVE

To build and validate persuasive audiovisual communication content to reduce salt consumption in the diet of people with heart failure.

METHOD

Methodological study, of a technological method, based on the Theory of Planned Behavior, in which the stages of pre-production, production and post-production were followed. Content validation was carried out with specialists in the field of health and communication.

RESULTS

Based on the survey of beliefs related to salt reduction, the video contains 42 screens with three minutes and eleven seconds in duration and has animations and motivational arguments with the aim of positively influencing behavioral intention and modeling negative beliefs in positive ones. In content validation, the judges unanimously agreed with the evaluation criteria for the target audience, language, harmony, figures, narration and persuasion strategy. The Content Validity Index was satisfactory with a 97% agreement.

CONCLUSION

Persuasive audiovisual communication was considered valid in terms of content, becoming a tool to enhance the reduction of salt consumption in the care of people with heart failure.

A systematic review of alcohol education programs for young people: do these programs change behavior?

Numerous education programs have addressed young peoples' alcohol use. To date, no peer-reviewed publication has evaluated the effectiveness of such programs delivered across a range of contexts to change alcohol-related behaviors, attitudes and/or knowledge. This systematic review aimed to identify alcohol education programs addressing young people, and determine whether they changed alcohol-related behavior, knowledge and attitudes; and, ascertain components of successful programs. Studies were identified, guided by the PRISMA review process, from the earliest records until June 2020. Included studies (N = 70) comprised an alcohol education program which focused on young people (15-24 years). Forty programs reported behavior changes, and these programs were the highest quality. Others impacted attitudes and/or knowledge only (n = 12); or reported no impacts (n = 17). Recent programs were more likely than older programs to feature online delivery and report behavior changes. To enhance alcohol education, future programs should include the identified quality criteria, alongside process and long-term outcome evaluations, to better monitor effectiveness. Findings indicated some education programs have capacity to positively change alcohol-related behavior; however, outcome consistency varied even in high-quality programs. Alcohol education programs should be designed alongside health education/promotion models and best-practice recommendations, to improve the likelihood of desirable behavior-related outcomes.

Construção e validação de recursos audiovisuais para motivar pessoas com hipertensão ao uso de anti-hipertensivos

Resumo Objetivo Construir e validar comunicação audiovisual e mensagens persuasivas para motivar o uso de anti-hipertensivos. Método Estudo metodológico baseado nas crenças de pessoas com hipertensão arterial sistêmica em relação ao tratamento medicamentoso, tendo o suporte da Teoria do Comportamento Planejado. Adotaram-se os princípios de Fleming e da Persuasão para desenvolvimento da comunicação audiovisual e mensagens. 13 juízes especialistas realizaram a validação de conteúdo, analisada pelo Índice de Validade de Conteúdo. Resultados A comunicação audiovisual apresenta 3 minutos e 58 segundos de duração e 71 telas. Foram consideradas válidas 29 mensagens persuasivas ilustradas, sendo 15 positivas e 14 negativas. Conclusão e implicações para a prática A comunicação audiovisual e as mensagens persuasivas foram consideradas válidas, adequadas e com capacidade de persuasão para motivar o uso de anti-hipertensivos orais. Pesquisa de intervenção faz-se necessária para testar o efeito dos recursos audiovisuais com intenção de realizar o comportamento.

Do preparatory behaviours predict alcohol consumption among UK university students?

OBJECTIVE

This study explored whether the frequency and habitual nature of engagement in three behaviours that may serve as preparation for alcohol consumption on a night out with friends - that is, contacting friends to arrange a night out, buying alcohol, drinking alone at home before going out - predicted consumption on such nights.

DESIGN

Prospective correlational design.

METHODS

One hundred and twenty UK university students (68 female, 50 male, two non-binary, mean age = 20.78 years, SD = 1.52) completed a survey comprising intentions, habits, and frequency and habit for the three preparatory behaviours. One week later, a second survey measured the number of nights out with friends on which alcohol was drunk (i.e., drinking frequency) and the number on which four or more alcoholic drinks were consumed (i.e, excessive drinking). Regression models were run to predict drinking frequency and excessive drinking.

RESULTS

Drinking frequency was predicted only by frequency of contacting friends (B = .28, SE = .12, p = .02), and habitually drinking alone before going out (B = .20, SE = .09, p = .03). Excessive drinking was only predicted by alcohol consumption habit (B = .67, SE = .23, p = .003).

CONCLUSIONS

Preceding actions may influence the frequency of alcohol consumption on nights out, independently of intentions and habits relating to alcohol consumption. While interventions to reduce consumption quantity in a single session might focus on disrupting the habits that sustain drinking episodes, efforts to reduce alcohol consumption frequency on nights out might focus on disrupting behaviours that precede alcohol consumption.

Effectiveness of the use of implementation intentions on reduction of substance use: A meta-analysis

OBJECTIVE

Background: Substance use, such as alcohol drinking, tobacco smoking and illicit drug use, have been associated with severe health conditions and an annual estimated 12 % of all deaths worldwide. Implementation intentions are self-regulatory processes which help achieve health-related behaviour change.

OBJECTIVES

To investigate the effectiveness of forming implementation intentions to reduce substance use.

DESIGN

Data sources: PsycINFO, MEDLINE, Psychology and Behavioural Science Collection, clinicaltrials.gov, UK Clinical Trials Gateway, Reference lists.

INCLUSION CRITERIA

RCT of substance users forming implementation intentions to reduce consumption (active or passive control condition present).

STUDY APPRAISAL AND SYNTHESIS METHODS

the SIGN checklist for RCT quality was used for quality appraisal, data was extracted by two reviewers.

RESULTS

Twenty-one studies were included in the meta-analysis. The overall effect size for alcohol use was g = 0.31 (95 % CI: 0.21, 0.42), p < .001; for tobacco smoking g = 0.31 (CI: 0.12, 0.5), p = .002; no studies were retrieved for the use of implementation intentions on illicit drug use.

CONCLUSION

This review suggests that implementation intention interventions are effective in reducing some forms of substance use (alcohol use and tobacco smoking), albeit revealing small effect sizes, among the general population and students in secondary and higher education. Review registration number: CRD42018116170.

Does the structure (tunneled vs. free-roam) and content (if-then plans vs. choosing strategies) of a brief online alcohol intervention effect engagement and effectiveness? A randomized controlled trial

Despite the potential of brief online interventions for reducing alcohol consumption, their effectiveness may be compromised by low levels of engagement and the inclusion of ineffective behavior change techniques. To test whether (i) a tunneled version of an intervention (where the content is delivered in a prespecified order) leads to greater engagement and greater reductions in alcohol consumption than a free-roam version (where the content can be viewed in any order) and (ii) forming if-then plans linking strategies to cut down with high-risk situations leads to greater reductions in alcohol consumption than only choosing strategies to cut down. Participants (N = 286 university staff and students) were randomly allocated to one of four versions of a brief online alcohol intervention in a 2 (structure: tunneled vs. free-roam) by 2 (planning: strategies vs. if-then plans) factorial design. Engagement (pages visited, time) was recorded automatically. Alcohol consumption (weekly units) was assessed at baseline and 1- and 6-month follow-up. Participants who received the tunneled version viewed significantly more pages and spent significantly more time on the website than those who received the free-roam version. Significant reductions in alcohol consumption were observed at follow-up; however, neither the structure of the intervention nor planning had a significant effect on reductions in alcohol consumption. Tunneled online interventions can increase engagement, but this may not translate into greater changes in behavior. Further experimental research using factorial designs is needed to identify the key behavior change techniques to include in brief online interventions.

Adolescent Substance Use Disorder Treatment: an Update on Evidence-Based Strategies

PURPOSE OF REVIEW

To examine the most recent published evidence (2016-2019) regarding the treatment of adolescent substance use disorders and to provide an update on evidence-based strategies, adjunctive interventions, and methods to improve currently established treatment approaches.

RECENT FINDINGS

Recent evidence suggests that psychosocial treatments such as family-based therapy, cognitive behavioral therapy, and multicomponent approaches remain the most effective methods of treatment; however, innovative ways of improving these treatment strategies may include digital and culturally based interventions. New advances in adjunctive treatments such as pharmacotherapy, exercise, mindfulness, and recovery-oriented educational centers may have some clinical utility. Well-established psychosocial interventions remain the primary modality of treatment. Promising new adjunctive treatments and improvements in our currently established treatments may yield significant improvements.

Personal agency and alcohol abstinence self-efficacy among incarcerated women

Incarcerated women with alcohol use disorders (AUDs) have unique treatment needs. Behavior change models emphasize self-efficacy in making changes to alcohol use, but have not been tested in samples of incarcerated women. Personal agency in several domains was examined as a correlate of alcohol abstinence self-efficacy in a sample of 173 incarcerated women with AUDs. Lower alcohol cravings (β = -0.19, p = .029), greater self-care (β = 0.17, p = .012), and less engagement in transactional sex (β = -0.48, p = .007) were associated with greater self-efficacy. Intrapersonal and interpersonal agency influence incarcerated women's self-efficacy.

Social modelling of health behaviours: Testing self-affirmation as a conformity-reduction strategy

OBJECTIVES

Social conformity negatively affects health. Exposure to peers who model unhealthy alcohol or food consumption increases personal consumption. Self-affirmation alters processes related to the motivations underlying conformity. We therefore tested whether self-affirmation reduces conformity to unhealthy behaviour and does so by reducing affiliation needs and/or increasing self-regulation.

DESIGN

In two studies, participants were randomized to one of four conditions in a 2 (low vs. high peer modelling) × 2 (self-affirmed vs. not) design.

METHODS

In Study 1 (N = 153), a confederate modelled low or high alcohol consumption. Participants' alcohol consumption was recorded; mimicry of confederates' sips was coded. In Study 2 (N = 122), written information indicated others' snack food intake during the study. Participants' food consumption was recorded. Affiliative interest was assessed in both studies. Inhibitory control and private self-awareness were assessed in Studies 1 and 2, respectively.

RESULTS

In Study 1, participants exposed to heavy drinking consumed significantly more alcohol and mimicked the confederate more frequently than participants exposed to the light drinking model. Self-affirmation did not reduce this tendency, nor did it affect affiliative interest or inhibitory control. Exploratory analysis supported that mimicry mediated the peer modelling-consumption relationship. In Study 2, participants ate more when they believed others had eaten a lot, as opposed to little. Self-affirmation did not reduce this tendency and did not affect affiliative interest. Self-affirmed participants had higher private self-awareness than those who were not self-affirmed, but self-awareness did not affect consumption.

CONCLUSION

Peer behaviour strongly influences personal consumption. Self-affirmation did not reduce behavioural conformity. Statement of contribution What is already known on this subject? Exposure to peers who engage in high consumption of alcohol and unhealthy foods is associated with increased personal consumption. Few studies have examined strategies to reduce conformity to consumption behaviours. What does this study add? Across two studies, self-affirmation did not reduce behavioural conformity, despite its' positive effects on private self-awareness. Conformity in face-to-face interactions is largely driven by mimicry.

Identification of health-related behavioural clusters and their association with demographic characteristics in Irish university students

Background

Students engage in risky health-related behaviours that influence their current and future health status. Health-related behaviours cluster among adults and differently based on sub-populations characteristics but research is lacking for university populations. Examining the clustering of health- related behaviours can inform our initiatives and strategies, while examining cluster members’ characteristics can help target those who can prosper most from health promotion efforts. This study examines the clustering of health-related behaviours in Irish university students, and investigates the relationship with students’ sex, age, field of study and accommodation type.

Methods

An online survey was completed by 5672 Irish university students (51.3% male; 21.60 ± 5.65 years) during 2014. Two-step cluster analysis was used to understand how health-related behaviours (physical activity, smoking, alcohol intake, drug use and dietary habits) cluster among male and female students. Binary logistic regressions were conducted to examine the likelihood of students falling into certain clusters based on their characteristics.

Results

Five cluster groups were identified in males and four in females. A quarter of males were categorised as ideal healthy with older students and those from certain fields of study having a higher likelihood of being classified in a low physical activity and poor diet (OR = 1.06–2.89), alcohol consumption (OR = 1.03–3.04), or smoking and drug use (OR = 1.06–2.73) cluster. Forty-five percent of females were categorised as ideal healthy with older females more likely to be in a low active and smoking cluster (OR = 1.03), and less likely to be in a convenience food cluster (OR = 0.96). Females from certain fields of study were also more likely to be classified in these clusters (OR = 1.59–1.76). Students living away from their family home had in increased likelihood of being in a cluster related to a higher frequency of alcohol consumption (OR = 1.72–3.05).

Conclusion

Health-related behaviours cluster among this population and need to be taken into account when designing multi-health interventions and policies. These findings can be used to target student groups at risk, leading to more efficient and successful health promotion efforts. The addition of modules providing information regarding health-related behaviours are advised in all fields of study.

Using the theory of planned behaviour and implementation intentions to reduce binge drinking in new university students

OBJECTIVE

Excessive alcohol consumption, including binge drinking, increases when students enter university. This study tests whether combining messages targeting theory of planned behaviour (TPB) constructs with if-then plans (i.e. implementation intentions) to avoid binge drinking reduces binge drinking in new university students.

DESIGN

One month after starting university, students (N = 407) were randomly assigned to condition in a 2 (TPB messages) × 2 (implementation intentions) factorial design.

MAIN OUTCOME MEASURES

Cognitions about binge drinking were assessed immediately post-intervention. Frequency of binge drinking was assessed at one-month follow-up (n = 205).

RESULTS

Participants who viewed the messages had significantly weaker intentions to engage in binge drinking and less favourable cognitions about binge drinking (affective attitude, descriptive norms, and self-efficacy) than those who did not view the messages. In addition, participants who formed an implementation intention to avoid binge drinking reported significantly fewer instances of binge drinking at follow-up.

CONCLUSION

The findings provide some support for the use of interventions based on the TPB to reduce intentions to engage in binge drinking and for forming implementation intentions to reduce the frequency of binge drinking in new university students. No evidence was found for the synergistic effect of combining the two interventions.

Wonderland and the rabbit hole: A commentary on university students' alcohol use during first year and the early transition to university

For new students, university can be a wonderland of opportunity. But the first few weeks of the university experience are also typified by change, stress and uncertainty. From a health promotion perspective, the first few weeks of the university experience present an important yet understudied opportunity for alcohol misuse prevention. In this narrative review, we distinguish students' alcohol use during their first year at university from what is known about their use in the first few weeks on campus. First, we outline the developmental context of the first year experience and the descriptive epidemiology of alcohol use and consequences. Second, we highlight how distinctly different the first few weeks of the university experience are relative to the rest of the academic year and overview the limited research on alcohol use and consequences during the first few weeks. Third, we overview the limited number of strategies that have focused on reducing alcohol use during the transition to university. Finally, we offer a number of suggestions for future research. A better understanding of the nature and determinants of alcohol use and consequences during the transition to university is critical to designing effective prevention and intervention strategies.