Stand-Alone Personalized Normative Feedback for College Student Drinkers: A Meta-Analytic Review, 2004 to 2014

Effects of experimental, network-based social circle norm feedback on studying behavior and alcohol consumption

Misrepresentation of peer behavior has often been observed in college students and may lead to over-expression of alcohol consumption and under-expression of studying. While social norm feedback approaches have had mixed success in addressing these misrepresentations and altering behavior, they may have been too unspecific to be effective and did not directly assess individual perception accuracy. We thus investigated how specific, one-time feedback on the behavioral distribution of alcohol consumption or study time of a clearly defined, individually-adjusted social circle would affect the respective norm estimations and behavior of a class of Psychology students (n = 89 in January) across their first year of study. Students overestimated alcohol consumption and partially underestimated studying norms. While social circle feedback on alcohol consumption did not clearly affect both individual estimation accuracy and alcohol consumption, feedback on peers' studying time increased studying with no clear effect on estimation accuracy. This indicates that social circle norm feedback may be suitable to evoke behavioral effects. The correction of the detected inaccuracies did not appear to be a precondition for the feedback to be effective.

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

ISSUES

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

APPROACH

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

KEY FINDINGS

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

IMPLICATIONS

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

CONCLUSIONS

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

Booster effects and mechanisms of web-based personalised normative feedback alcohol intervention for college students: A pragmatic randomised controlled trial

BACKGROUND

To evaluate the effects of booster and no booster versions of web-based alcohol Personalised Normative Feedback (PNF) and whether descriptive norms mediated and/or participant motivation moderated the effectiveness of the intervention in real world conditions (i.e. no financial incentives).

METHODS

Pragmatic randomised controlled trial with 1-, 3-, and 6-month assessments. Brazilian college students reporting alcohol use in the last 12 months (N=931) were recruited from May/2020 to December/2022 and allocated to 1) No booster/single PNF(S-PNF); 2) Booster/multiple PNF(M-PNF); or 3) Assessment-only control. We applied Helmert coding [1: Any intervention (S-PNF or M-PNF) vs. Control; and 2: S-PNF vs. M-PNF].

PRIMARY OUTCOMES

typical number of drinks/week and maximum number of drinks/week; secondary outcomes: drinking frequency and number of consequences. Three-months assessment was the primary interval. Descriptive norms were tested as mediator. Interest, importance, and readiness to change were examined as moderators.

RESULTS

Compared to control, any intervention did not influence primary outcomes at 3-months or 6-months, but did at 1-month, when reduced typical drinking (IRR:0.77, 95%CI:0.66;0.90) and maximum number of drinks (IRR:0.69, 95%CI:0.58;0.82). There was an intervention effect on the consequences at 3-months. No differences were observed between S-PNF and M-PNF. No mediation effects were found at 3-months. At 6-months, there was an indirect effect on typical drinking through norms at 3-months (b=-0.82, 95%CI:-2.03;-0.12) and effects on maximum drinks through norms at 1-month (b=-0.54, 95%CI:-1.65;-0.02). No support for moderation was found.

CONCLUSIONS

Intervention reduced alcohol drinking at 1 month only and was not effective thereafter. Mechanisms of effect remain unclear.

College men's use of protective behavioral strategies for sexual aggression, risky sexual behavior, and heavy episodic drinking

OBJECTIVE

Sexually aggressive behavior (SAB), risky sexual behavior (RSB), and heavy episodic drinking (HED) are serious behavioral health problems among college men. The present study substantially revises and validates protective behavioral strategies (PBS) measures in the SAB and RSB domains; evaluates the relations among PBS usage in the SAB, RSB, and HED domains; and determines whether college men with SAB, RSB, or HED histories report lower PBS usage.

METHOD

College students who identified as men (n = 1,121) completed measures of PBS, SAB, RSB, HED, rape-supportive attitudes, sociosexuality, and bar/party attendance.

RESULTS

Factor analyses resulted in three PBS scales (SAB, RSB-General, and RSB-Protection) that showed good fit and cross-validated well. Average scores for all four PBS measures converged moderately to strongly. Men reporting histories of SAB, RSB, or HED reported much lower domain-specific PBS use, and domain-specific PBS predicted concurrent SAB, RSB, or HED in the presence of other established predictors.

CONCLUSIONS

Four well-developed and validated PBS measures now provide an expanded set of potential harm-reduction strategies for college men who drink and engage in sexual activity. Given the strong concurrent associations between PBS use and problems, as well as the interrelatedness of PBS use across domains, future research should examine the impact of simultaneous personalized normative feedback on PBS use across alcohol and sexual domains. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Alcohol motivations associated with frequency of alcohol use, binge drinking, and alcohol problems among active duty junior enlisted soldiers and non-commissioned officers

Problematic alcohol use is a serious threat to the behavioral health of active-duty Service Members (ADSM), resulting in numerous calls from governmental agencies to better understand mechanistic factors contributing to alcohol misuse within the military. Alcohol use motives are reliable predictors of alcohol-related behaviors and are considered malleable targets for prevention and intervention efforts. However, empirical research indicates that drinking motives vary across contextually distinct populations. Although some research has been conducted among veteran and reservist populations, limited work has been specifically focused on ADSM and no research has evaluated motives and alcohol metrics among ADSM based on military rank. Participants for the current study included 682 ADSM recruited from a large military installation in the U.S. Structural equation modeling evaluated associations between four drinking motives (i.e., enhancement, social, conformity, coping) and three alcohol misuse metrics (i.e., alcohol frequency, binge frequency, alcohol problems). Three models were evaluated: one full (combined) model and two separate models based on military rank - junior enlisted (i.e., E1-E4) and non-commissioned officers (NCOs) (i.e., E5-E9). Results for junior enlisted ADSM indicated that coping and enhancement motives were most strongly associated with all alcohol misuse metrics. However, among NCOs, results indicated that alcohol problems were only associated with coping motives. Notably, results also indicated that alcohol use motives accounted for substantively more variance across all alcohol-related metrics among NCOs. Findings generally support extant military-related literature indicating use of alcohol for coping (e.g., with anxiety) as the motivation most consistently associated with increased alcohol misuse. However, novel findings highlight enhancement motives - using alcohol to attain some positive internal reward - as another, often stronger, motivation impacting alcohol use outcomes. Further, findings highlight notable distinctions between alcohol use motives (i.e., coping vs. enhancement) and the impact of alcohol use motives (i.e., effect size) on alcohol metrics between junior enlisted and NCOs.

Support for policies restricting alcohol exposure in films: Does feeding back the amount of alcohol in films increase support?

INTRODUCTION

Alcohol exposure is common in popular films, and research has demonstrated a link between alcohol exposure and use. The likelihood of implementing specific policies to reduce the amount of film exposure is dependent on the level of public support; however, evidence is currently lacking. This study investigated how supportive people are of film-related alcohol policies and whether providing information about the amount of film exposure increased support.

METHODS

Australian adults (N = 252) first provided estimates of how much alcohol they thought were in popular films and then were randomised to either see an infographic about the amount of alcohol in films or not. All participants rated how supportive they were of eight policies.

RESULTS

The items 'alcoholic beverages and consumption should not be shown in G or PG rated films' (M = 3.54) and 'alcohol should not be glorified in films' (M = 3.49) were rated significantly higher than the scale's midpoint of 3 (p < 0.001). Participants who were older, female or reported lower alcohol use were more supportive of the policies. Only one policy item, 'information about alcohol sponsorship should be provided' received higher support from those who received the infographic compared to those who did not (M = 3.53 vs. M = 3.05; t(250) = -3.09, p = 0.002).

DISCUSSION AND CONCLUSION

Participants were relatively supportive of film alcohol policies. However, providing information about the amount of alcohol in films did not make a difference on the level of support for most film alcohol policies.

The Effectiveness of Universal Educational Interventions for Prevention of Illicit Drug Use among University Students: A Systematic Review

Background

The extent of illicit drug use among university students necessitates effective preventive programs. To identify and assess the effectiveness of university-based interventions in preventing or reducing illicit drug use.

Methods

The MEDLINE (PubMed), SCOPUS, ISI (Web of Science), and other sources were searched according to the Cochrane Collaboration method. RCTs, CRTs and non- RCTs evaluating university-based interventions designed to prevent illicit drug use were reviewed. Data were extracted independently by two reviewers. The quality of the publications was assessed. Interventions were classified by type, provider, duration, and theoretical background.

Results

Of 6652 papers, 11 studies met the eligibility criteria that were conducted between 1987 and 2020. The effectiveness of interventions was different. Substantial heterogeneity among the studies prevented the integration of results for estimating summaries.

Conclusion

Despite the importance of the subject, there is a paucity of studies about specific educational programs for illicit drug use, indicating the necessity of further research in other countries.

Standalone effects of focus mode and social comparison functions on problematic smartphone use among adolescents

Problematic smartphone use (PSU) has been reported, particularly among adolescents. Digital interventions may be offered for preventing and reducing PSU. This study evaluated the effects of two smartphone-based interventions among adolescents. Grounded in nudge theory, the focus function allowed users to hide smartphone applications (apps) for a selected length of time, while the feedback function provided a social comparison of the smartphone use of the user and other users. In total, 305 adolescents with Android smartphones were randomly allocated to the focus-function group, feedback-function group or control group. Participants used their smartphones as usual during the two-week baseline period, followed by the one-week period of intervention app instillation and four-week period of intervention use. The primary outcome was self-reported PSU after the intervention period. The secondary outcomes were self-reported smartphone use time during weekdays and app-recorded smartphone use time and frequency. The Group × Time interaction effects showed reduced self-reported PSU in the focus-function and feedback-function groups, Cohen's d = -0.32, 95% CI [-0.63, -0.008], Cohen's d = -0.36, 95% CI [-0.66, -0.06], respectively. The app-recorded smartphone use frequency was also reduced in the focus-function and feedback-function groups, Cohen's d = -0.16, 95% CI [-0.07, -0.25], Cohen's d = -0.32, 95% CI [-0.23, -0.41], respectively. The findings suggest that both utilizing time-outs from nonessential apps and engaging in social comparison lower PSU and smartphone use frequency with small effect sizes. These functions may be noncoercive interventions for preventing and reducing PSU.

A pilot study of the acceptability, efficacy, and iatrogenic effects of a brief dynamic norms intervention for reducing young adult alcohol use

BACKGROUND

Alcohol use and its related consequences are a public health problem among young adults. Building upon efficacious personalized normative feedback interventions, dynamic norms can be used to highlight the decreasing prevalence of alcohol use over time among young adults' peers, thereby increasing their motivation to change drinking consistent with the trend. Because limited research has examined dynamic norms feedback interventions for alcohol use, we examined the acceptability and initial efficacy of such an intervention, and potential iatrogenic effects of showing norms feedback about drinking to light drinkers and nondrinkers.

METHODS

Participants were 546 unvaccinated young adults ages 18-24 who completed a baseline survey, intervention, and 1-month follow-up assessment. Participants were block randomized to receive a brief web-based dynamic norms intervention, with feedback content focused on either (a) alcohol-related behaviors (intervention) or (b) COVID-19 vaccine behaviors (the attention-matched control for the present study).

RESULTS

On average, participants who received the alcohol intervention rated it as generally engaging, helpful, and acceptable, with the majority (90.8%) indicating that they would recommend it to a friend. Supporting initial efficacy, in generalized linear models controlling for demographics and baseline alcohol outcomes, at 1-month follow-up the alcohol intervention was associated with statistically and clinically significant reductions in all indices of perceived drinking norms, drinking quantity, drinking frequency, and driving after drinking occasions. Lighter drinkers showed no adverse iatrogenic effects.

CONCLUSIONS

Presenting alcohol-related personalized normative feedback using dynamic trends is a promising intervention for reducing alcohol use in a community sample of young adults. Further research clarifying the optimal presentation of dynamic norms is needed.

Personalized normative feedback for hazardous drinking among college women: Differential outcomes by history of incapacitated rape

OBJECTIVE

Personalized normative feedback (PNF) interventions are effective at reducing hazardous drinking in college. However, little is known about who is most receptive to PNF. College women with a history of alcohol-related incapacitated rape (IR) are at elevated risk for hazardous drinking, but it is unclear what impact intervention messaging may have on this group and how their outcomes compare to those without past IR. To address this gap, this study involved secondary data analysis of a large web-based clinical trial.

METHOD

Heavy drinking college women (N = 1,188) were randomized into PNF (n = 895) or control conditions (n = 293). Postintervention, women reported their reactions to intervention messaging. Hazardous drinking outcomes (typical drinking, heavy episodic drinking [HED], peak estimated blood alcohol content [eBAC], blackout frequency) were assessed at baseline and 12 months.

RESULTS

Past IR was reported by 16.3% (n = 194) of women. Women with a history of IR reported more baseline hazardous drinking and greater readiness to change than women without IR. For those who received PNF, history of IR related to greater perceived impact of the intervention, but no difference in satisfaction with the message. After controlling for baseline drinking, regressions revealed the effect of PNF was moderated by IR for frequency of HED at 12 months. Simple main effects revealed PNF was associated with lower levels of hazardous drinking at follow-up among women with past IR.

CONCLUSIONS

This initial investigation suggests PNF is a low resource and easily disseminated intervention that can have a positive impact on college women with past IR. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A mobile-based pregaming drinking prevention intervention for college students: A pilot randomized controlled trial

OBJECTIVE

Pregaming is among the riskiest drinking behaviors in which college students engage, often leading to elevated blood alcohol levels and negative alcohol-related consequences. Yet, tailored interventions to reduce risk associated with pregaming are lacking. The present study was designed to develop and evaluate the efficacy of a brief, mobile-based intervention targeting heavy drinking during pregaming among college students, called Pregaming Awareness in College Environments (PACE).

METHOD

PACE was developed using two innovations to facilitate behavior change: (a) a mobile-based application to increase intervention accessibility and (b) personalized pregaming-specific intervention content delivered using a harm reduction approach with cognitive behavioral skills training. After development and β-testing, we employed a randomized clinical trial with 485 college students who reported pregaming at least once per week in the past month (Mage = 19.98; 52.2% from minoritized racial and/or ethnic groups; 65.6% female). Participants were randomly assigned to PACE (n = 242) or a control condition website (n = 243), which consisted of general information about the effects of alcohol. Analysis assessed intervention effects on pregaming drinking, global drinking, and alcohol-related consequences at 6 and 14 weeks postintervention.

RESULTS

Although participants in both conditions reduced drinking, small and significant intervention effects favoring PACE were found at 6-week follow-up for overall drinking days, pregaming days, and alcohol-related consequences.

CONCLUSIONS

Findings suggest the brief mobile PACE intervention has potential to address risky drinking, but more intensive pregaming-focused efforts may be necessary to achieve stronger and lasting effects among college students. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

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

BACKGROUND

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

AIMS

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

METHOD

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

RESULTS

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

PRISMA/PROSPERO

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

Substance-Specific Risk Factors for Cannabis and Alcohol Use Among Young Adults Following Implementation of Nonmedical Cannabis Legalization

Laws regarding cannabis are rapidly changing in the USA as more states legalize nonmedical cannabis for adults aged 21 and older. Previous research has examined whether legalization has led to an increase in cannabis use as well as the use of other substances. The current study examined changes in cannabis- and alcohol-specific risk factors following legalization of nonmedical cannabis. We used 6 years of annual cross-sectional data (2014-2019) from 12,951 young adults age 18 to 25 who resided in Washington state. Risk factors examined include perceiving that use was common among same-age peers, believing use was acceptable, having easy access, and low perceived physical and psychological harm from use. Logistic regression models estimated annual rate of increase in these risk factors. All cannabis-specific risk factors increased among those aged 21+ (range of ORs for annual rate of change: 1.07-1.31) while significant increase in cannabis-related risk factors among those under age 21 was limited to perceptions of cannabis use being common (medical use: OR=1.08, 95% CI: 1.03, 1.12; nonmedical use: OR=1.13, 95% CI: 1.08, 1.18) and low perceived physical harm of occasional use (OR=1.08, 95% CI: 1.03, 1.13). Although descriptive norms for past-year use of alcohol among those aged 21+ increased (OR = 1.09, 95% CI: 1.02, 1.17), other risk factors for alcohol did not change significantly or, in the case of low perceived physical and psychological harm, decreased among both those under age 21 and those aged 21+ (range of ORs = 0.90-0.94). Given these findings show an increase in cannabis-specific risk factors since legalization was implemented, particularly among those young adults aged 21+, preventive interventions correcting risk misperceptions and related risk factors among young adults aged 21+ may prove efficacious in reducing use and resultant negative consequences.

Awareness of peers in recovery and of a campus collegiate recovery community at a university in the southeastern United States

Objective: Little is known about the extent of student awareness about collegiate recovery communities (CRCs) and of peers in recovery. Participants: A convenience sample of 237 undergraduate students from a diverse major at a private university participated in an anonymous online survey in Fall 2019. Methods: Participants reported whether they knew about the local CRC, whether they knew a peer in recovery, sociodemographic characteristics, and other information. Multivariable modified Poisson regression models were fitted to estimate correlates of awareness of the CRC and of peers in recovery. Results: Overall, 34% were aware of the CRC and 39% knew a peer in recovery. The latter was associated with being a member of Greek life, a junior or senior, using substances regularly, and personally being in recovery. Conclusions: Future research should explore ways to increase awareness of CRCs and assess the role of connections between students in recovery and peers across campus.

A brief intervention for improving alcohol literacy and reducing harmful alcohol use by women attending a breast screening service: a randomised controlled trial

OBJECTIVES

To assess the effectiveness of a brief alcohol intervention for improving awareness of alcohol as a breast cancer risk factor, improving alcohol literacy, and reducing alcohol consumption by women attending routine breast screening.

DESIGN

Single-site, double-blinded randomised controlled trial.

SETTING

Maroondah BreastScreen (Eastern Health, Melbourne), part of the national breast cancer screening program.

PARTICIPANTS

Women aged 40 years or more, with or without a history of breast cancer and reporting any alcohol consumption, who attended the clinic for routine mammography during 5 February - 27 August 2021.

INTERVENTION

Active arm: animation including brief alcohol intervention (four minutes) and lifestyle health promotion (three minutes).

CONTROL ARM

lifestyle health promotion only.

MAJOR OUTCOME MEASURE

Change in proportion of women who identified alcohol use as a clear risk factor for breast cancer (scaled response measure).

RESULTS

The mean age of the 557 participants was 60.3 years (standard deviation, 7.7 years; range, 40-87 years); 455 had recently consumed alcohol (82%). The proportions of participants aware that alcohol use increased the risk of breast cancer were larger at four weeks than at baseline for both the active intervention (65% v 20%; odds ratio [OR], 41; 95% confidence interval [CI], 18-97) and control arms of the study (38% v 20%; OR, 4.9; 95% CI, 2.8-8.8), but the change over time was greater for the active intervention arm (arm × time: P < 0.001). Alcohol literacy also increased to a greater extent in the active than the control arm, but alcohol consumption did not significantly change in either arm.

CONCLUSION

A tailored brief alcohol intervention for women attending breast screening was effective for improving awareness of the increased breast cancer risk associated with alcohol use and alcohol literacy more broadly. Such interventions are particularly important given the rising prevalence of risky drinking among middle-aged and older women and evidence that even very light alcohol consumption increases breast cancer risk.

REGISTRATION

ClinicalTrials.gov, NCT04715516 (prospective; 20 January 2021).

Formative research to develop an app to prevent dating and sexual violence and alcohol use among high school youth

The purpose of this study was to conduct formative research to inform the development of an app, that would simultaneously engage youth and adults, to prevent dating and sexual violence (DSV) and alcohol use (AU). Participants (N = 56) were high school students, parents/guardians, and professionals (e.g., school personnel) from across the United States who participated in online focus groups. Overall, participants had positive perceptions of the utility, helpfulness, and effectiveness of an app to prevent DSV and AU among high school students. Participants provided in depth information about both the content (e.g., local rates of DSV and AU) and features (e.g., skills-based, inclusion of incentives, help button) that the app should include. These preliminary data suggest that future research to develop and pilot an app for both youth and adults to prevent DSV and AU among high school students is warranted.

A retrospective examination of changes in drinking motives during the early COVID-19 pandemic

OBJECTIVE

The COVID-19 pandemic has led to substantial changes in college student alcohol use. Changes in drinking motives may explain some of these changes in drinking patterns. The purpose of the present study is to explore how drinking motives and alcohol use have changed amongst college students considering the timeframes before and after the onset of COVID-19 pandemic (i.e., March 2020) in the United States. We hypothesized that there would be significant changes in drinking motives after March 2020, which would be significantly related to changes in alcohol use.

METHODS

Participants for the current study were undergraduate students reporting lifetime alcohol use (n = 198, M_age = 21.3, 66.7% female, 86.4% White) recruited through online advertisements in classes to complete an online survey in April 2020. Participants were asked to report on their drinking motives and alcohol use considering the timeframes before and after the onset of closures and stay-at-home orders during the COVID-19 pandemic (i.e., before and since March 2020).

RESULTS

Paired samples t-tests revealed that endorsement of social (t[171) = 12.79, p < .001, d = 1.16) and conformity motives significantly decreased (t[170] = 4.46, p < .001, d = 0.31), while endorsement of coping motives significantly increased (t[172] = -2.70, p = .008, d = .15) after the onset of COVID-19. Linear regression analyses, controlling for drinking motives before March 2020, revealed that changes in enhancement (β = -.47, p < .001) and coping motives (β = -.22, p = .04) were significantly associated with changes in alcohol use quantity.

CONCLUSIONS

Findings of the present study support the need for interventions to target coping and social drinking to reduce risk for alcohol use.

Using Alcohol and Cannabis as Sleep Aids: Associations with Descriptive Norms Among College Students

PURPOSE

Young adults may use alcohol and cannabis as sleep aids, a risky behavior that can worsen sleep health over time and lead to substance dependence. Perceived norms for such risky behaviors are often overestimated and related to one's own use. This cross-sectional study examined: (a) the extent to which college students overestimated the prevalence of alcohol and cannabis use as sleep aids (i.e., perceived descriptive norms), and (b) the extent to which perceived descriptive norms were associated with students' own use of alcohol and cannabis as sleep aids.

METHODS

2,642 undergraduate college students (Mage = 18.84 years) reported past 30-day use of alcohol and cannabis as sleep aids. Participants also estimated the percent of college students who use alcohol and cannabis as sleep aids (i.e., perceived descriptive norms).

RESULTS

One-sample t-tests revealed participants, on average, overestimated the norms for using alcohol and cannabis as sleep aids. Participants who endorsed past 30-day use of these substances as sleep aids overestimated these norms to an even greater extent. Count regression models showed perceived descriptive norms were associated with students' use of alcohol and of cannabis as sleeps aids, in respective models, even when controlling for sleep difficulties.

CONCLUSIONS

College students may overestimate the prevalence of using alcohol and cannabis as sleep aids, and students who believe these behaviors are more normative report more frequent use of these substances as sleep aids. Taken together, findings may highlight the potential for norm-correcting strategies as a prudent approach to reducing/preventing the use of alcohol and cannabis as sleep aids.

A Brief Intervention for Improving Alcohol Literacy and Addressing Harmful Alcohol use Among Women Attending an Australian Breast Screening Service (Health4Her): Protocol for a Hybrid Effectiveness-Implementation Trial (Preprint)

BACKGROUND

Alcohol consumption is a major modifiable risk factor for female breast cancer, even in small amounts. However, awareness of this risk remains low. National breast screening programs are uniquely positioned to provide timely and targeted health information and behavior change strategies to improve alcohol literacy and reduce consumption. A breast screening service is a novel health care setting for brief alcohol intervention, with the potential for extensive reach.

OBJECTIVE

This study aimed to conduct a formative evaluation with breast screening service consumers to understand the need for, and acceptability of, brief alcohol intervention in the breast screening setting and collaboratively design a brief alcohol intervention (Health4Her); to test the effectiveness of Health4Her in improving knowledge of alcohol as a breast cancer risk factor (primary outcome), improving alcohol literacy, and reducing consumption among women attending a breast screening service; and to examine the implementation strategy through process evaluation.

METHODS

This was a hybrid type II effectiveness-implementation trial comprising a randomized controlled trial (RCT) alongside a mixed methods program evaluation guided by applicable elements of the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework and Consolidated Framework for Implementation Research. Formative evaluation comprised a retrospective analysis of alcohol consumption data (n=49,240), a web-based survey (n=391), and focus groups and interviews (n=31) with breast screening service consumers. Women attending routine mammography, drinking at any level, were recruited to the single-site, double-blind RCT (n=558), and completed a baseline assessment before randomization (1:1) to receive Health4Her (alcohol brief intervention + lifestyle information) or control (lifestyle information) via animation on an iPad. Follow-up assessments were performed 4 and 12 weeks after randomization. The process evaluation included evaluation of trial administrative data, participant quantitative (n=497) and qualitative feedback (n=30), and site staff qualitative feedback (n=11).

RESULTS

This research was funded in March and May 2019. Data collection for the formative evaluation and trial recruitment occurred between January and April 2020 and February and August 2021, respectively, with finalization of follow-up data collection in December 2021. Quantitative process evaluation data were collected during trial implementation, and collection of participant and staff feedback was finalized in December 2021. Results of the retrospective analysis of alcohol consumption data from breast screening service consumers is anticipated to be published in March 2023 and the results of the RCT to be published in March 2023.

CONCLUSIONS

This study is anticipated to generate new substantial knowledge on the alcohol consumption and literacy needs of women attending breast screening and the extent to which these can be addressed using a novel, tailored brief alcohol intervention. The study design permits the evaluation of the effectiveness and implementation of Health4Her to predict and facilitate uptake in breast screening services.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04715516; https://clinicaltrials.gov/ct2/show/NCT04715516.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR1-10.2196/44867.

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

Background

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

Method

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

Results

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

Conclusion

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

Barriers to addressing alcohol use in college sexual assault prevention: Where we stand and future steps

Purpose of Review

The aims of this paper are two-fold. First, we review the current evidence on sexual assault prevention programming that also targets alcohol. Second, we identify barriers to including alcohol use in sexual assault programs and provide recommendations to overcome these barriers.

Recent Findings

We identified six sexual assault programs that also include alcohol use content, four of which have yet to be rigorously evaluated. To further refine sexual assault prevention efforts, we identified four barriers that need to be overcome including: (1) alcohol and sexual assault prevent efforts are currently siloed, (2) fear of victim blaming when integrating alcohol into programs for women, (3) a lack of evidence on how alcohol impacts bystanders, and (4) uncertainty about how to include content related to alcohol and sexual consent communicated.

Summary

Researchers and preventionists with expertise in alcohol and/or sexual assault prevention need to work together with stakeholders and students on college campuses to overcome these barriers and address a key correlate of sexual assault.

Adolescent (mis)perceptions of peer alcohol posts on social media: Prospective associations with alcohol attitudes and use

BACKGROUND

Social media is a central context in which teens interact with their peers, creating opportunities for them to view, post, and engage with alcohol content. Because adolescent peer interactions largely occur on social media, perceptions of peer alcohol content posting may act as potent risk factors for adolescent alcohol use. Accordingly, the preregistered aims of this study were to (1) compare perceived friend, typical person, and an adolescent's own posting of alcohol content to social media and (2) examine how these perceptions prospectively relate to alcohol willingness, expectancies, and use after accounting for offline perceived peer alcohol use.

METHODS

This longitudinal study included 435 adolescents (Mage  = 16.91) in 11th (48%) and 12th grade (52%). Participants completed measures of alcohol content social media posts, perceived peer alcohol use, willingness to drink alcohol, alcohol expectancies, and alcohol use at two time points, 3 months apart.

RESULTS

Consistent with preregistered hypotheses, adolescents reported that 60.3% of the typical person their age and 30.6% of their friends post alcohol content on social media. By contrast, only 7% of participants reported that they themselves posted such content to social media. After accounting for offline perceived peer drinking norms, neither perceived friend nor typical person alcohol content social media posts were prospectively associated with willingness to drink or positive or negative alcohol expectancies. Perceived friend alcohol content posts were prospectively positively associated with past 30-day alcohol consumption even after controlling for offline perceived peer drinking norms.

CONCLUSIONS

Adolescents misperceived the frequency of alcohol-related posting to social media among their peers, and perceptions of friend alcohol content posts prospectively predicted alcohol use. Given the results from the current study and the ubiquity of social media among adolescents, prevention efforts may benefit from addressing misperceptions of alcohol-related posting to social media.

Examining Emailed Feedback as Boosters After a College Drinking Intervention Among Fraternities and Sororities: Rationale and Protocol for a Remote Controlled Trial (Project Greek)

Background

College students involved in Greek life (ie, members of fraternities and sororities) tend to engage in more high-risk alcohol use and experience more negative consequences than those not involved in Greek life. Web-based alcohol interventions, such as Alcohol eCHECKUP TO GO, have been successful in reducing alcohol use and consequences among the general college student population, but interventions targeting alcohol reduction among those involved in Greek life have had limited success. Booster emails including personalized feedback regarding descriptive norms and protective behavioral strategies have shown potential in increasing the effectiveness of web-based interventions among college drinkers. Studies are needed to determine the efficacy of these boosters among those involved in Greek life.

Objective

The primary objective of this study is to assess the efficacy of booster emails sent to Greek life students who complete Alcohol eCHECKUP TO GO. Specifically, we expect that participants who receive the booster emails will reduce their alcohol consumption and related problems (primary aim 1), reduce perceived peer drinking, and increase the number of protective behavioral strategies they use over time (primary aim 2) relative to those who do not receive boosters. Contingent upon finding the emailed booster efficacious and sufficient enrollment of members from each organization, an exploratory aim is to examine social mechanisms of change (ie, through selection vs socialization).

Methods

This study is a remote, controlled intervention trial following participants for up to 6 months. Participants must be aged at least 18 years, undergraduate students, and members of a participating fraternity or sorority. Eligible participants complete a web-based baseline survey to assess their alcohol consumption behaviors and beliefs, including norms and protective behavioral strategies, and information about their social networks. After completing the baseline survey, they participate in the web-based intervention. Follow-up surveys are sent 1, 3, and 6 months after the intervention. Those in the booster condition also receive emails containing personalized feedback at 2 weeks and 14 weeks after the intervention. Latent growth models and R-Simulation Investigation for Empirical Network Analysis will be used to analyze the data.

Results

As of September 2022, we have enrolled 18 participants from 2 fraternities and 2 sororities, and they have completed the baseline survey. Overall, 72% (13/18) of participants have completed the 1-month follow-up. Enrollment will continue through December 2022.

Conclusions

This study aims to examine the effectiveness of personalized feedback booster emails sent after an alcohol intervention among members of college Greek life. A secondary, exploratory aim is to provide information about social mechanisms of change (if possible). The current methodology targets whole network recruitment, with chapter presidents serving as gatekeepers and facilitators. Unique challenges of recruiting whole networks and working with campus administrators are discussed.

Trial Registration

ClinicalTrials.gov NCT05107284; https://clinicaltrials.gov/ct2/show/NCT05107284

International Registered Report Identifier (IRRID)

DERR1-10.2196/42535

Descriptive peer drinking norms and binge drinking: Enhancement motives as a mediator and alcohol resistance self-efficacy as a moderator

The association between descriptive norms regarding peer drinking and college students’ binge drinking has been established; however, the mediating and moderating mechanisms underlying this relationship among first-and second-year college students remain minimally explored. Drawing on social norms theory, motivational model of alcohol use, and the theory of normative social behavior, the current study investigated whether enhancement drinking motives mediated the relationship between descriptive norms regarding peer drinking and college students’ binge drinking, and whether this relationship was moderated by alcohol resistance self-efficacy. Five hundred and nineteen first-and second-year college students (M_age = 19.19 years, SD = 0.98) who were from four universities and had at least one time of heavy episodic drinking during the last year completed self-report questionnaires. After controlling for sex, age, and university variable, stronger descriptive norms regarding peer drinking were positively associated with a greater frequency of binge drinking. Enhancement drinking motives partially mediated the effects of descriptive peer drinking norms on binge drinking. Furthermore, alcohol resistance self-efficacy moderated the direct effects of descriptive peer drinking norms on binge drinking. Compared with college students who reported high alcohol resistance self-efficacy, the direct effects of descriptive peer drinking norms on binge drinking were stronger among students with low alcohol resistance self-efficacy. These findings point to the potential value of alcohol intervention approaches including efforts to help first-and second-year college students change enhancement drinking motives and increase their ability of resisting drinks in the context of pervasive peer drinking.

Strengthening personalized norm feedback interventions: The ambivalent-attitude effect

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Personalized norm feedback effectively reduces heavy drinking in college students.

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Inducing ambivalence makes norms a stronger predictor of behavior.

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

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

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Ambivalence should be included in personalized norm feedback interventions.

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

Exposure to interpersonal stigma enhances the effectiveness of a culturally adapted personalized normative feedback alcohol intervention for sexual minority women

Stigma-related stress and inflated perceptions of substance use norms are positioned in the literature as theoretically distinct explanations for disproportionate substance use among sexual minorities. As research has yet to examine how these variables may interact in an intervention context, this study examined the impact of recent experiences with violence and harassment due to sexual minority status (i.e., interpersonal stigma exposure) on the effectiveness of a culturally adapted personalized normative feedback intervention for lesbian, bisexual, and queer (LBQ) women. A sub-sample of 499 moderate-to-heavy drinking LBQ women were randomized to receive personalized normative feedback (PNF) on alcohol use or control topics within a broader digital competition designed to challenge negative LBQ stereotypes. At baseline, recent interpersonal stigma exposure strengthened the relationship between perceived LBQ alcohol-related norms and participants' own alcohol-related behaviors (i.e., consumption and consequences). At follow-up, 3 months later, recent interpersonal stigma exposure moderated the effectiveness of alcohol PNF with substantially less drinking and consequences among participants in the treatment condition reporting recent violence or harassment due to sexual minority status, relative to those reporting no such experiences. Underscoring the utility of PNF for LBQ women and potentially other heavy drinking stigmatized populations, findings suggest that a greater tendency to conform to over-estimated ingroup drinking norms may be another way in which minority status-based violence and harassment contributes to alcohol consumption in stigmatized populations.

Repeated Assessment of Alcohol Use and Perceived Norms Among College Students Who Drink: Comparisons to a Minimal Assessment at 12-Month Follow-Up

OBJECTIVE

Clinical trials assessing efficacy of alcohol use interventions often aim to test differences between treatment and control conditions at several follow-up time points, requiring repeated assessment of outcomes (e.g., weekly number of drinks). There has been concern that repeated assessment may elicit assessment reactivity in which participants, even those who did not receive treatment, reduce their alcohol use, but findings in the literature have been mixed. The current study of assessment reactivity compared two control conditions that were part of a larger randomized controlled trial: (a) repeated assessment that completed surveys at baseline, 3-, 6-, and 12-month follow-ups, and (b) minimal assessment that only completed surveys at baseline and 12-month follow-up. Outcomes assessed at 12-month follow-up included (a) changes in alcohol use behavior and negative consequences, (b) changes in perceived descriptive and injunctive norms, and (c) participant attrition/retention.

METHOD

Participants were undergraduate students who reported at least one heavy drinking occasion (4+/5+ drinks for women/men) in the past month (N = 456; 63.3% female; mean age = 20.11 years).

RESULTS

Multiple regression models indicated no significant differences between the repeated and minimal assessment control conditions on any indices of alcohol use (p values ranged from .42 to .97), negative consequences (p = .39), or on perceived descriptive/injunctive norms (p = .60 and .23, respectively). Attrition at 12-month follow-up was low in both groups, but significantly higher (p = .006) in the repeated assessment condition (16.49%) than the minimal assessment condition (8.55%).

CONCLUSIONS

Repeated assessment did not elicit changes in alcohol use, negative consequences, or perceived norms. A minimal assessment control condition may not be necessary when assessing intervention efficacy across longitudinal follow-ups. However, when attrition at 12-month follow-up is a salient concern, a minimal assessment control may retain more participants than repeated assessment.

The Moderating Effect of Educational Background on the Efficacy of a Computer-Based Brief Intervention Addressing the Full Spectrum of Alcohol Use: Randomized Controlled Trial

Background

The alcohol-attributable burden of disease is high among socially disadvantaged individuals. Interventional efforts intending to have a public health impact should also address the reduction of social inequalities due to alcohol.

Objective

The aim was to test the moderating role of educational background on the efficacy of a computer-based brief intervention addressing the full spectrum of alcohol use.

Methods

We recruited 1646 adults from the general population aged 18 to 64 years (920 women, 55.9%; mean age 31 years; 574 with less than 12 years of school education, 34.9%) who reported alcohol use in the past year. The participants were randomly assigned a brief alcohol intervention or to assessment only (participation rate, 66.9%, 1646/2463 eligible persons). Recruitment took place in a municipal registry office in one German city. All participants filled out a self-administered, tablet-based survey during the recruitment process and were assessed 3, 6, and 12 months later by study assistants via computer-assisted telephone interviews. The intervention consisted of 3 computer-generated and individualized feedback letters that were sent via mail at baseline, month 3, and month 6. The intervention was based on the transtheoretical model of behavior change and expert system software that generated the feedback letters automatically according to previously defined decision rules. The outcome was self-reported change in number of alcoholic drinks per week over 12 months. The moderator was school education according to highest general educational degree (less than 12 years of education vs 12 years or more). Covariates were sex, age, employment, smoking, and alcohol-related risk level.

Results

Latent growth modeling revealed that the intervention effect after 12 months was moderated by educational background (incidence rate ratio 1.38, 95% CI 1.08-1.76). Individuals with less than 12 years of school education increased their weekly alcohol use to a lesser extent when they received the intervention compared to assessment only (incidence rate ratio 1.30, 95% CI 1.05-1.62; Bayes factor 3.82). No difference was found between groups (incidence rate ratio 0.95, 95% CI 0.84-1.07; Bayes factor 0.30) among those with 12 or more years of school education.

Conclusions

The efficacy of an individualized brief alcohol intervention was moderated by the participants’ educational background. Alcohol users with less than 12 years of school education benefited, whereas those with 12 or more years did not. People with lower levels of education might be more receptive to the behavior change mechanisms used by brief alcohol interventions. The intervention approach may support the reduction of health inequalities in the population at large if individuals with low or medium education can be reached.

Trial Registration

German Clinical Trials Register DRKS00014274; https://www.drks.de/DRKS00014274

Behavior change versus stability during the college-to-work transition: Life course and the "stickiness" of alcohol misuse at career entry

To what extent and under what conditions do college graduates disengage from employment-incompatible behaviors during the college-to-work transition? Drawing from the life course perspective, we proposed a model highlighting considerable stability of employment-incompatible behaviors during initial months of organizational socialization. Our model predicted that maturing out of such behaviors, which is expected by employers and beneficial to career adjustment, would be more likely to occur given a conducive transition context. Using a large dataset tracking graduates from their last semester in college to up to approximately 1.5 years after graduation and with alcohol use as our empirical referent, we demonstrated that a pattern of high-risk drinking behavior may remain even after the transition into full-time employment. We further showed that lower levels of perceived cohort drinking norms and higher levels of mentoring were associated with a higher probability of maturing out, manifesting in a transition from a high-risk drinking profile before graduation to a moderate drinking profile after starting full-time employment. Finally, we found that maturing out was associated with lagged outcomes including lower levels of sleep problems and depression and fewer work days lost to absenteeism, thus underscoring the consequential nature of behavior profile shifts during the college-to-work transition.

A COVID-19 disruption: The great acceleration of digitally planned and transformed behaviors in Thailand

The Coronavirus Disease 2019 (COVID-19) pandemic has reshaped human behaviors and switched communication systems from face-to-face to digital communication technologies. This study aimed to examine how digital transformation practices affect human behavioral change digitally, and how perceived COVID-19 severity affects digital transformation practices and behavioral decisions. We use the traditional theory of planned behavior (TPB) to determine new behavioral roles in the digital era, namely digitally planned and transformed behavior. The quantitative survey method was designed to collect cross-sectional data from 550 Thai citizens to provide the conceptual evidence of key proximal measures of digital attitude, digital social norms, digital behavioral control perception, and the digital behavioral decision to predict digitally planned and transformed behavior. The results show that people are more likely to digitalize than before, which predicts the decision to behave digitally at 93.9% of the variability, more than 75% of the predictive power of the total variance suggested by Hair, Ringle, and Sarstedt [1]. However, the higher the COVID-19 severity, the more likely digital transformation is impactful (β = 0.481). This study provides interesting evidence that people struggle to transform their digital behavior during the pandemic. We demonstrate that digital transformation can offer the desired consequences by cultivating digital attitudes, promoting digital social norms, increasing digital behavioral control perception, and enhancing digital behavioral decisions.

The Role of Perceived Social Norms in College Student Vaccine Hesitancy: Implications for COVID-19 Prevention Strategies

Among US adults, the highest rates of hesitancy to receive the COVID-19 vaccine are among young adults aged 18 to 25. Vaccine hesitancy is particularly concerning among young adults in college, where social interactions on densely populated campuses can lead to substantial community spread. Given that many colleges have opted not to mandate vaccines, identification of modifiable predictors of vaccine hesitancy – such as perceived social norms – is key to informing interventions to promote vaccine uptake. To address this need, we examined predictors of and explicit reasons for vaccine hesitancy among 989 students aged 18 to 25 recruited from four geographically diverse US universities in the spring of 2021. At the time of the survey, 57.3% had been vaccinated, 13.7% intended to be vaccinated as soon as possible, and 29.0% were vaccine hesitant. Common reasons for hesitancy were wanting to see how it affected others first (75.2%), not believing it was necessary (30.0%), and other reasons (17.4%), which were examined via content analysis and revealed prominent safety concerns. Despite these varied explicit reasons, logistic regressions revealed that, when controlling for demographics and pandemic-related experiences, perceived descriptive and injunctive social norms for vaccine uptake were each significant predictors of vaccine hesitancy (ORs = 0.35 and 0.78, respectively). When both norms were entered into the same model, only perceived descriptive norms uniquely predicted vaccine hesitancy (OR = 0.37; 95% CI: 0.29 – 0.46). Findings suggest perceived social norms are strongly associated with vaccine-related behavior among young adult college students. Correcting normative misperceptions may be a promising approach to increase vaccine uptake and slow the spread of COVID-19 among young adults.

Examining Social Influences on Why We Drink: Perceived Drinking Motives in the Social Network Impact Individuals' Own Drinking Motives and Alcohol Use

Introduction: A significant body of research has investigated the impacts of social influence and social selection on binge drinking and risk factors for binge drinking in emerging adults; however, one risk factor for binge drinking that has yet to be thoroughly investigated in this regard is drinking motives. Preliminary research suggests the motives of others may impact emerging adults' own alcohol use indirectly through their own motives (i.e., social influence). While these are important findings, research to date has been only conducted with adolescents or dyads and has not examined selection (i.e., selecting social network members with similar motives). We filled these gaps with a longitudinal egocentric social network design. Methods: Emerging adults (N = 177) completed measures on their alcohol use, drinking motives, and social networks at baseline (T1) and four-month follow-up (T2). Results: A cross-lagged panel model indicated T1 perceived network drinking motives predicted T2 participant drinking motives (for all motives but social), but T1 participant drinking motives did not predict T2 perceived network drinking motives. Path analysis indicated T1 perceived network drinking motives predicted T2 participant binge drinking frequency indirectly through T2 participant drinking motives for enhancement, coping-with-anxiety, and conformity, but not social or coping-with-depression, motives. Discussion: Results suggests drinking motives of those around emerging adults impact their own drinking motives, and indirectly, their own alcohol use. We found evidence of social influence, but not social selection. Conclusion: It appears that those around emerging adults have the capacity to influence their drinking behaviors and drinking motives.

An examination of the role of social comparison orientation and social norms in drunkorexia engagement

Drunkorexia is a behavior pattern marked by calorie restriction and/or compensation in relation to alcohol consumption. The aim of the present study was to examine the role of social norms (descriptive, injunctive) and social comparison orientation (SCO; global, alcohol-specific, eating disorder-related) in drunkorexia engagement. Specifically, our research aimed to examine a possible interaction between norms and SCO; we hypothesized that the relationship between social norms and drunkorexia would be moderated by SCO in that the relationship would be stronger among those elevated on SCO. Data were collected from an undergraduate sample (n = 501); participants completed the consent form and questions/questionnaires via Qualtrics. The results indicated that the predictor variables examined were correlated with overall drunkorexia engagement. In the regression models, in terms of main effects, eating disorder-related SCO emerged as the strongest predictor of the drunkorexia dimensions as well as overall drunkorexia engagement. Descriptive norms emerged as the second strongest predictor in the models. Only one interaction was identified; eating disorder-related SCO moderated the relationship between descriptive norms and the bulimia drunkorexia dimension. The simple slopes analysis indicated that descriptive norms was positively predictive of the bulimia drunkorexia dimension only among individuals with average or elevated eating disorder-related SCO. Social comparisons made regarding one's body, eating, or exercise (eating disorder-related) and social norms are potentially important targets for drunkorexia prevention and/or intervention programs. Further research is needed to better understand risk factors for drunkorexia engagement in the college population.

Understanding Perceptions of Nonsuicidal Self-Injury: Descriptive and Injunctive Norms

Nonsuicidal self-injury (NSSI) is a major public health concern. Web-based personalized feedback interventions (PFIs) may be a cost-effective and efficient way to treat NSSI. In order to develop a PFI, it is imperative to assess descriptive and injunctive norms. The current study examines descriptive and injunctive norms of NSSI within college students and adults in the community, comparing how perceived norms may differ for those who do or do not engage in NSSI. Study 1 calculated percentages of NSSI behavior within the student sample. Study 2 then examined perceived descriptive and injunctive norms between those with and without history of NSSI in both samples. Study 1 indicated that 19% of undergraduate students had histories of NSSI. Additionally, there was a general tendency to overestimate the percentage of people who engage in NSSI and the number of times a typical person engages in NSSI. Finally, those who engaged in NSSI believed that most people do not understand why individuals engage in NSSI; comparatively, the majority of people without history of NSSI still indicated that they understand why others would engage in NSSI. These research findings may be utilized in a PFI to reduce shame and NSSI behavior.

A Gamified Personalized Normative Feedback App to Reduce Drinking Among Sexual Minority Women: A Randomized Controlled Trial and Feasibility Study (Preprint)

Background

Sexual minority women disproportionately engage in heavy drinking and shoulder the burden of alcohol dependence. Although several intensive interventions are being developed to meet the needs of treatment-seeking sexual minority women, there remains a lack of preventive interventions to reduce drinking and its consequences among women not yet motivated to reduce their alcohol consumption.

Objective

We aimed to examine the feasibility and efficacy of reducing alcohol-related risks via personalized normative feedback (PNF) on alcohol use and coping delivered within LezParlay, a social media–inspired digital competition designed to challenge negative stereotypes about lesbian, bisexual, and queer (LBQ)–identified sexual minority women.

Methods

Feasibility was assessed by examining engagement with LezParlay outside the context of an incentivized research study, assessing the characteristics of the LBQ women taking part, and examining the competition’s ability to derive risk-reducing actual norms as well as levels of acceptability and perceived benefits reported by participants. Intervention efficacy was examined by randomizing a subsample of 499 LBQ alcohol consumers (ie, drinkers) already taking part in the competition to receive sexual identity–specific PNF on alcohol use and coping, alcohol use only, or control topics over only 2 rounds of play. Changes in alcohol use and negative consequences were examined 2 and 4 months after the delivery of treatment PNF.

Results

A total of 2667 diverse LBQ women played ≥1 round of LezParlay. The competition attracted large numbers of moderate and heavy drinkers; however, risk-reducing actual norms could still be derived from competition rounds and featured in PNF. Efficacy results revealed that drinkers who received PNF on alcohol use and both alcohol use and coping had similar reductions in their weekly drinks (P=.003; P<.001), peak drinks (P<.001; P<.001), and negative consequences (P<.001; P<.001) relative to those who received PNF on control topics at the 2-month follow-up. However, at the 4-month follow-up, reductions in alcohol consumption outcomes faded among those who received alcohol PNF only (weekly: P=.06; peak: P=.11), whereas they remained relatively robust among those who received PNF on both alcohol use and coping (weekly: P=.02; peak: P=.03). Finally, participants found the competition highly acceptable and psychologically beneficial as a whole.

Conclusions

The LezParlay competition was found to be a feasible and efficacious means of reducing alcohol-related risks in this population. Our findings demonstrate the utility of correcting sexual identity–specific drinking and coping norms to reduce alcohol-related risks among LBQ women and suggest that this approach may also prove fruitful in other stigmatized health disparity populations. To engage these populations in the real world and expand the psychological benefits associated with PNF, our findings also point to packaging PNF within a broader, culturally tailored competition designed to challenge negative group stereotypes.

Trial Registration

ClinicalTrials.gov NCT03884478; https://clinicaltrials.gov/ct2/show/NCT03884478

International Registered Report Identifier (IRRID)

RR2-10.2196/24647

Integrating social media inspired features into a personalized normative feedback intervention combats social media-based alcohol influence

BACKROUND

Research suggests that the social media platforms popular on college campuses may reflect, reinforce, and even exacerbate heavy drinking practices among students. The present study was designed to directly examine: (1) whether exposure to alcohol-related content on social media diminishes the efficacy of a traditional web-based personalized normative feedback (PNF) alcohol intervention among first-year drinkers; and (2) if social media inspired features and digital game mechanics can be integrated into a PNF intervention to combat social media-based alcohol influence and increase efficacy.

METHOD

Alcohol experienced first-year college students (N = 223) completed a pre-survey that assessed exposure to alcohol-related content and social media and were randomized to 1 of 3 web-based alcohol PNF conditions (traditional, gamified only, or social media inspired gamified). One month later, participants' alcohol consumption was reassessed.

RESULTS

Among participants who received traditional PNF, social media-based alcohol exposure interacted with pre-intervention drinking such that traditional PNF was less effective in reducing drinking among heavier drinkers reporting greater exposure to alcohol-related social media content. Further, when regression models compared the efficacy of all three conditions, the social media inspired gamified PNF condition was significantly more effective in reducing drinking than was traditional PNF among moderate and heavy drinkers reporting greater exposure to alcohol on social media.

CONCLUSION

Although additional research is needed, these findings suggest that representing the population of students on whom normative statistics are based with social media-like user avatars and profiles may enhance the degree to which alcohol PNF is relatable and believable among high-risk students.

Leveraging dynamic norms to reduce alcohol use among college students: A proof-of-concept experimental study

BACKGROUND

Norm-correcting interventions are an effective alcohol harm-reduction approach, but innovation is needed to increase modest effect sizes. Recent social psychology research shows that individuals may be influenced by social norms that are increasing in prevalence. Contrary to static norms that reflect the current state of normative behavior, dynamic norms reflect behavioral norms that are shifting over time. This proof-of-concept study tested the utility of dynamic norms messages within norm-correcting interventions.

METHOD

Undergraduate student drinkers (N = 461; Mage  = 19.97; 64.43% female) were randomly assigned to receive (a) dynamic norms messages highlighting a steady decrease over the past six years in heavy drinking among college students; (b) static norms messaging stating only the current norms; or (c) a control condition without normative information. Proximal outcomes assessed immediately following the experimental paradigm included intentions for total weekly drinks and heavy episodic drinking. Self-reported information on alcohol use behavior was collected at 1-month follow-up.

RESULTS

Following the experimental paradigm, participants in the dynamic norms condition estimated that future drinking norms would decrease, while those in the static norms and control groups estimated that future drinking norms would increase. Participants in the dynamic norms condition reported lower intentions for weekly drinks and heavy episodic drinking than those in the static norms and control conditions. No significant differences between conditions were found on alcohol use indices reported at the 1-month follow-up. However, dynamic norms messaging had a favorable indirect effect on heavy episodic drinking intentions mediated through lower perceived future drinking norms.

CONCLUSIONS

These findings provide proof-of-concept that dynamic norms messaging may be a prudent strategy for reducing alcohol use intentions, which can be integrated into or used alongside existing norm-correcting strategies.

Changes in college student alcohol use during the COVID-19 pandemic: Are perceived drinking norms still relevant?

With widespread concern for increased alcohol use during the COVID-19 pandemic, there is a pressing need to examine changes in young adults' alcohol use and to identify antecedents of increased use. We tested the hypothesis that self-reported changes in alcohol use during the pandemic (frequency, quantity, heavy episodic drinking) would relate to perceptions of peers' changes in alcohol use. In April of 2020, 507 college students self-reported changes in their alcohol use and perceived changes in use for typical students at their university (i.e., norms). Most students in our sample reported decreased alcohol use and perceived decreases in peers' alcohol use. Perceptions of peers' changes in alcohol use behavior strongly related to changes in students' own alcohol use. Findings provide strong support for norms-based strategies that can correct normative misperceptions by highlighting the fact that most college students are not in fact engaging in heavier alcohol use during the COVID-19 pandemic.

Frequency of Binge Drinking and Perception of Peer Alcohol Use: A Survey of University Students in a Western Canadian Province

OBJECTIVES

College and university student binge drinking is a critical health issue, and studies demonstrate students perceive high rates of drinking among their peers. High alcohol consumption and binge drinking are normalized throughout college and university, and there are gross misperceptions of perceived alcohol use among peers. The purpose of our study was to examine differences in perceptions of peer alcohol use after grouping students based on their frequency of binge drinking over a 2-week period.

METHODS

A one-way analysis of variance test was used to compare the differences in the perception of peer alcohol use after grouping students by their frequency of binge drinking.

RESULTS

Students who binge drink have significantly higher perceptions of peer alcohol use than their non-binge-drinking and abstaining peers.

CONCLUSIONS

These findings provide direction toward the feasibility of using perceptions of peer alcohol use to identify at-risk students to curtail dangerous drinking behavior.

An International Comparison of a Web-Based Personalized Feedback Intervention for Alcohol use During the Transition out of High School in the United States and Sweden

Young adult drinkers engage in a range of drinking patterns from abstaining to heavy drinking in both the United States and Sweden. Heavy drinking during young adulthood in both countries is associated with a variety of negative consequences. Personalized feedback interventions have been identified as effective prevention strategies to prevent or reduce heavy drinking in the United States. This study examined transitions in drinking profiles and compared the efficacy of a personalized feedback intervention for 3965 young adults in the United States (1,735) and Sweden (2230) during their transition out of high school. Using goodness-of-fit criteria, results indicated that three drinking profiles exist among young adults transitioning out of high school: very low drinkers/abstainers, moderate to heavy drinkers, and very heavy drinkers. Latent Markov models revealed a moderating effect of country on personalized feedback intervention such that intervention condition participants in the United States were more likely to belong to the light drinker/abstainer or moderate to heavy profile relative to the very heavy drinking profile at 6-month follow-up. There was no significant effect of personalized feedback intervention in Sweden. Future research could investigate the impact of when personalized feedback interventions are administered and could examine if personalized feedback interventions should be more intentionally culturally adapted in order to be more effective.

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

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

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

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

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

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

TRIAL REGISTRATION

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

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/29750.

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

BACKGROUND

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

RESEARCH QUESTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Young Adults Underestimate How Well Peers Adhere to COVID-19 Preventive Behavioral Guidelines

To combat the rampant spread of the SARS-CoV-2 virus that is responsible for the COVID-19 pandemic, the Centers for Disease Control and Prevention (CDC) has provided Americans with empirically supported preventive behavioral guidelines (e.g., wearing a face mask). However, there is a need to develop behavioral strategies that can effectively increase adherence to these guidelines, especially for young adults, who report particularly poor adherence. Across several domains of prevention science, norms-based interventions have successfully motivated constructive health behavior by correcting normative misperceptions, but these strategies are only relevant when these misperceptions are widespread. We examined the accuracy of young adults’ perceptions of peers’ adherence to CDC-recommended behavioral guidelines (i.e., perceived social norms) to assess the rationale for employing norm-correcting strategies. Young adult college students (N = 539; M_age = 19.5 years) self-reported their level of adherence to a list of preventive behavioral guidelines and estimated the norms regarding the extent to which other young adults adhered to these guidelines. We measured adherence and perceived norms for each guideline in terms of adherence frequency, ranging from 0 to 100% of the time. We found that young adults, on average, underestimated the extent to which other young adults adhere to each of the recommended preventive behaviors. That is, young adults tended to think that other young adults are failing to adhere to CDC guidelines, whereas our self-reported data showed adherence frequency may be quite high. Moreover, we found positive associations between self-reported adherence and perceptions of others’ adherence—that is, those who underestimated others’ adherence also self-reported lower adherence to guidelines. Findings from this study establish proof-of-concept for the development of norms-based strategies designed to improve young adults’ adherence to preventive behavioral guidelines that are both specific to the COVID-19 pandemic and that prepare for future contagious outbreaks.

A Gamified, Social Media-Inspired, Web-Based Personalized Normative Feedback Alcohol Intervention for Lesbian, Bisexual, and Queer-Identified Women: Protocol for a Hybrid Trial

BACKGROUND

Sexual minority women are more likely to drink alcohol, engage in heavy drinking, and experience alcohol-related problems than heterosexual women. However, culturally tailored interventions for this population have been slow to emerge.

OBJECTIVE

This type 1 effectiveness-implementation trial examines the feasibility and efficacy of a gamified, culturally tailored, personalized normative feedback (PNF) alcohol intervention for sexual minority women who psychologically identify as lesbian, bisexual, or queer (LBQ).

METHODS

The core components of a PNF intervention were delivered within LezParlay, a fun, social media-inspired, digital competition designed to challenge negative stereotypes about LBQ women and increase visibility. The competition was advertised on the web through social media platforms and collaboration with LBQ community organizations. After 2 rounds of play by a large cohort of LBQ women, a subsample of 500 drinkers already taking part in the competition were invited to participate in the evaluation study. Study participants were randomized to receive 1 of 3 unique sequences of PNF (ie, alcohol and stigma coping, alcohol and control, or control topics only) over 2 intervention rounds. Randomization was fully automated by the web app, and both researchers and participants were blinded.

RESULTS

Analyses will evaluate whether PNF on alcohol use reduces participants' drinking and negative consequences at 2 and 4 months postintervention; examine whether providing PNF on stigma-coping behaviors, in addition to alcohol use, further reduces alcohol use and consequences beyond PNF on alcohol alone; identify mediators and moderators of intervention efficacy; and examine broader LezParlay app engagement, acceptability, and perceived benefits.

CONCLUSIONS

This incognito intervention approach is uniquely oriented toward engaging and preventing alcohol-related risks among community populations of LBQ women who may view their heavy drinking as normative and not in need of change because of the visibility of alcohol use in sexual minority community spaces. Thus, this intervention strategy diverges from, and is intended to complement, more intensive programs being developed to meet the needs of LBQ women already motivated to reduce their consumption.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03884478; https://clinicaltrials.gov/ct2/show/NCT03884478.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/24647.

The efficacy of Personalized Normative Feedback interventions across addictions: A systematic review and meta-analysis

Personalized Normative Feedback (PNF) may help address addictive disorders. PNF highlights discrepancies between perceived and actual peer norms, juxtaposed against self-reported behavior. PNF can be self-directed and cost-efficient. Our study estimates the efficacy of PNF alone, and in combination with other self-directed interventions, to address frequency and symptom severity of hazardous alcohol use, problem gambling, illicit drug and tobacco use. We searched electronic databases, grey literature, and reference lists of included articles, for randomized controlled trials published in English (January 2000-August 2019). We assessed study quality using the Cochrane Risk of Bias tool. Thirty-four studies met inclusion criteria (k = 28 alcohol, k = 3 gambling, k = 3 cannabis, k = 0 tobacco). Thirty studies provided suitable data for meta-analyses. PNF alone, and with additional interventions, reduced short-term alcohol frequency and symptom severity. PNF with additional interventions reduced short-term gambling symptom severity. Effect sizes were small. PNF did not alter illicit drug use. Findings highlight the efficacy of PNF to address alcohol frequency and symptom severity. The limited number of studies suggest further research is needed to ascertain the efficacy of PNF for gambling and illicit drug use. Cost-effectiveness analyses are required to determine the scale of PNF needed to justify its use in various settings.