Effects of AlcoholEdu for college on alcohol-related problems among freshmen: a randomized multicampus trial

Initial Results from a New College Substance Use Prevention Program Targeting Externalizing and Internalizing Traits

Objective: College students engage in high rates of risky substance use. Standard college prevention strategies focus on providing feedback about current substance use behaviors and harm reduction strategies but do not address the underlying genetically-influenced risk factors impacting these behaviors. We created an online Personalized Feedback Program (PFP) for college students that targets genetically-influenced externalizing and internalizing risk pathways and provides personalized recommendations and campus resources. College students received personalized feedback on four risk domains (Sensation Seeking, Impulsivity, Extraversion, and Neuroticism). Methods: An open trial (n = 300) was conducted at a large public university in spring of 2021 to assess initial responses to the PFP and evaluate intentions related to future substance use and campus resource use. Results: 81% of students in the open trial reported they enjoyed the Personalized Feedback Program. Participants reported intending to use significantly more campus resources after completing the PFP. Among participants that drank, 39% reported they intended to decrease their alcohol consumption and 41% reported they intended to decrease the number of times they get drunk after completing the PFP; these intentions to reduce use after completing the PFP are higher than rates found in previous studies. Conclusion: Preliminary data indicate that the Personalized Feedback Program may be a complementary method to enhance current college substance use prevention programs.

Students' Perceptions on the Effectiveness of a Computer-Delivered Alcohol Intervention

Objective: Social adjustment, including alcohol use, directly affects the success of college students. Due to an increased reliance on computer-delivered alcohol interventions (CDIs) a need has emerged to further investigate alcohol use and web-based interventions. Methods: In-depth focus group interviews were conducted with 51 undergraduate students to elicit information from students on the shared experience of participating in a CDI. Results: Participants identified the influence of gender, culture, parents, and family on alcohol use behavior. A difference in personal factors, previous exposure, and experiences can affect the attitudes, behaviors, and outcomes of a CDI. Conclusion: Multiple approaches geared towards a wide variety of students from different backgrounds and environments are needed to be truly successful in preventing alcohol misuse.

A Systematic Review of Campus Characteristics Associated With Sexual Violence and Other Forms of Victimization

Violence researchers have highlighted a need to understand connections between campus characteristics and violent victimization among students. Responding to those calls, we systematically reviewed research examining the characteristics of secondary and post-secondary educational settings associated with sexual violence and related victimization experiences, including dating/intimate partner violence, stalking, bullying, hate crimes, and crime more broadly. We screened 1124 quantitative and qualitative records, 43 of which met the inclusion criteria for this systematic review. Evidence emerged for institution demographics, institution type, institution climate, institution financial characteristics, and educational characteristics being related to various forms of victimization; institution setting (urban vs. rural) was not associated with victimization. Additionally, evidence was observed for institution location and size/density. Some factors, including institution type and campus demographics, operated differently for different forms of victimization. We highlight limitations of existing data, including variability in the measurement of victimization outcomes, lack of power to detect differences at the campus level, and challenges of creating a database on victimization that contains campus identifiers. We also reinforce calls for more intersectional research, both in terms of the types of victimization experienced by students as well as in the disproportionate impact victimization may have on students with marginalized identities.

Effects of the Universal Prevention Curriculum for Schools on Substance Use Among Peruvian Adolescents: A Randomized Trial

This group-randomized trial assessed the effects of a universal prevention training curriculum for school administrators and teachers that focused on effective strategies to prevent adolescent substance use and related problems. Twenty-eight schools in three regions of Peru were randomly assigned to either an intervention or control condition (14 schools per condition). Repeated cross-sectional samples of 11 to 19-year-old students participated in four surveys from May 2018 to November 2019 (N = 24,529). School administrators and teachers at intervention schools participated in a universal prevention training curriculum focusing on the development of a positive school climate as well as effective policies related to school substance use. All intervention and control schools were offered Unplugged, a classroom-based substance use prevention curriculum. Outcome measures included: lifetime drug use; past-year and past-month tobacco, alcohol, marijuana, and other drug use; awareness of school tobacco and alcohol use policies; perceived enforcement of school policies; school bonding; perceived friends' use of tobacco, alcohol, marijuana and other drugs; and personal problems in general and problems related to substance use. Multi-level analyses indicated significant reductions in past-year and past-month smoking, friends' substance use, and problems related to substance use and in general at intervention relative to control schools. Significant increases were found in intervention vs. control schools related to students' awareness of school substance use policies, perceived likelihood of getting caught for smoking, and school bonding. These findings suggest that the universal prevention training curriculum and the school policy and climate changes it promoted reduced substance use and related problems in the study population of Peruvian adolescents.

The developmental unfolding of substance use disorder symptoms and academic achievement in the transition into and out of college

This study aimed to explore the prospective associations between both alcohol and cannabis use (frequency and DSM-5 substance use disorder symptom counts) as they relate to academic performance over a period of ∼ four years. The study members were students enrolled in college in the Southeastern United States (N = 209, 62 % female, 90 % white). Baseline survey data were obtained in the first year of college while participants finished the follow-up assessments ∼ 1 and ∼ 4 years from baseline (80+ % retention rates). We aimed to tease apart antecedent from consequence in the associations between substance use and academic performance using a sophisticated modeling technique that accounts for between-person influences in evaluating within-person change over time. Results showed that greater alcohol use disorder symptoms in the first year of college were associated with a within-person decline in grades in the second year of college. This was not demonstrated for alcohol or cannabis frequency, alcohol quantity, or cannabis use disorder symptoms or in relation to the later developmental transition out of college. In addition to widely implemented prevention efforts, these results indicate that screening first-year college students for alcohol use disorder symptoms and connecting them with resources and treatment may be beneficial in attempts to promote academic performance.

Alcohol Use Disorder Risk and Protective Factors and Associated Harms Among Pacific Islander Young Adults

Pacific Islander (PI) young adults (age 18 to 30 years) experience elevated rates of hazardous drinking, AUDs, and alcohol-related harms. Yet, we know little about the risk and protective factors that drive, or can prevent, PI young adult hazardous drinking behaviors and AUDs due to a lack of targeted alcohol disparities research. This large qualitative study presents data from 8 focus groups with 69 PIs (51 young adults, 18 informal providers) to explore the major risk factors, protective factors, and negative consequences associated with PI young adult hazardous drinking and AUDs. Findings revealed (1) major risk factors including the presence of significant life stressors that trigger alcohol self-medication, peer/social pressure to drink, permissive drinking norms, and frequent access to alcohol and (2) negative consequences involving physical fights, health and relationship problems, harm to personal reputation, and community harms including driving-under-the-influence and sexual violence. Protective factors against hazardous drinking and AUDs included the cultural norm of protecting the family's reputation by avoiding AUDs, church/religious faith, family responsibilities, and culturally relevant prosocial activities (e.g., sports, dance, choir). Obtaining this in-depth data revealed that an effective culturally grounded AUD prevention intervention for PI young adults-which does not currently exist-should (1) target these identified major risk factors for AUDs, while (2) integrating culturally responsive strategies that incorporate their reported protective factors.

Assessing alcohol and other drug prevention needs among Indigenous youth ages 13-17: Developing a culturally grounded Indigenous youth harm reduction intervention

Perceptions of alcohol and other drug (AOD) use, harm reduction, and culture were examined among 10 U.S. Indigenous youth 13-17 years of age. Key findings were contextualized within the four constructs of Indigenous relationality: (a) youth understand the harms of AOD use (people); (b) youth appreciate non-abstinence-based education (ideas); (c) youth need safe spaces to talk about the impacts of AOD use (place); and (d) youth desire to help prevent AOD harms for themselves and others (cosmos). Findings from this community-based participatory study serve as the theoretical foundation to support the development of an Indigenous youth harm reduction intervention to prevent AOD use and related harms among urban Indigenous youth in the Pacific Northwest.

Longitudinal latent class analysis of tobacco use and correlates among young adults over a 10-year period

INTRODUCTION

We assessed patterns and correlates, including demographic characteristics, psychological factors, and social role transitions, of young adults' tobacco use over time.

METHODS

In the fall of 2010, we recruited a cohort of 3146 students from 11 colleges in North Carolina and Virginia. Participants completed baseline and at least two survey waves between 2010 and 2019.

RESULTS

The sample was 49.8% female, 15.7% non-white, and 6.6% Hispanic. Longitudinal latent class analysis revealed a five-class model with distinct patterns and correlates of tobacco use. Limited Use (52.6% of sample) had minimal use. College-Limited Combustible Tobacco Users (18.6%) had moderate probability of cigarette, cigar, and waterpipe smoking, which decreased to no use post-college. Intermittent Sustained Polytobacco Users (10.9%) had low probability of use that continued post-college. College Polytobacco with Continued Cigarette and E-Cigarette Users (14.5%) had high probability of use of cigarette smoking and increasing probability of e-cigarette, both of which continued post-college. Sustained Polytobacco Users (5.7%) had moderate probability of use of tobacco products across all waves.

CONCLUSIONS

Patterns of tobacco use varied considerably. In most classes, tobacco use was highest during freshman year and in three classes, use continued post-college. Prevention activities should focus on first-year students and target those at risk for post-college tobacco use.

Impact of a multidisciplinary educational training program (OverdosED) on knowledge and perceptions of depressant substance use on a college campus

Objective: Pilot study to assess the efficacy of a multidisciplinary educational training program (OverdosED) designed to increase college students' knowledge of and confidence in their ability to appropriately recognize and respond to suspected overdose on depressant substances. Participants: Undergraduate students (n = 92) with Greek life affiliations at a moderately-sized private liberal arts college in the southeastern USA. Methods: Electronic surveys were administered before and after delivery of the training program. Questions assessing knowledge of depressant substance overdose were compared to determine the impact of the educational intervention. Questions assessing participants' confidence in their ability to recognize and respond to overdose and their perceptions of campus culture were also compared. Results: Mean composite scores on knowledge-based questions were significantly higher for the post-intervention survey compared to the pre-intervention survey. Confidence in knowledge also significantly increased after the intervention. Mean scores for survey responses related to campus culture were high at baseline but significantly increased after the intervention. Conclusions: OverdosED successfully increased college students' knowledge of and confidence in their ability to appropriately recognize and respond to suspected overdose on depressant substances, and positively influenced perceptions on campus culture.

C.A.R.E.S: A mobile health program for alcohol risk reduction in community college students

BACKGROUND

Compared to students at four-year residential colleges, Community College Students (CCS) are at greater risk for binge drinking and alcohol related risks, however few interventions have been developed specifically for the needs of CCS.

METHODS AND DESIGN

This study design tests the efficacy of a smartphone app (CARES) compared to an existing online alcohol education (AE) program. CCS (n = 250) will be recruited using a nationwide social media campaign and randomly assigned to either arm, stratified by sex and age (over/under 21). Eligibility screening, consent and assessments are conducted online and both interventions are accessible by smartphone. Assessments will be conducted at baseline, 4- and 8- weeks, end of treatment (12-weeks) and at 6-month follow-up. The primary outcomes are heavy episodic drinking (past 2 weeks), and alcohol related problems Confidence in refusing alcohol, use of protective behavioral strategies and expectations regarding alcohol use. Demographics including age, sex, race/ethnicity, marital and parental status and employment will be analyzed as potential covariates.

DISCUSSION

Community colleges serve approximately half of all US college students but frequently lack the resources to implement full-service alcohol prevention and education programs. The specific needs of CCS also differ from those of residential college students for whom most alcohol prevention programs have been developed. If proven efficacious, the CARES intervention may offer a scalable, easily disseminable program designed for the needs of community colleges and their students. ClinicalTrials.gov Registration: NCT03927482.

Perceptions of College Campus Alcohol and Sexual Violence Prevention Among Students with Disabilities: "It Was A Joke"

PURPOSE

The purpose of this study was to understand perceptions of campus-based alcohol and sexual violence (SV) prevention programming among college students with disabilities to inform future development of prevention programs appropriate for the needs of these students.

METHOD

The study included semi-structured, qualitative interviews with 51 college students with disabilities who reported histories of SV recruited from a larger parent study investigating a brief universal intervention to reduce alcohol related SV involving 28 campuses across Western Pennsylvania and West Virginia. Interviews focused on college-related experiences of prevention programming, and experiences of health, disability, alcohol use and violence victimization. Data were analyzed using thematic analysis.

RESULTS

Three themes emerged: (1) Students with disabilities described campus prevention programming as ineffective and irrelevant to their experiences, including referring to programs as "a joke," (2) Students wanted multi-dose, developmentally relevant content that directly addresses the complexities of their experiences with disability, alcohol, and violence, and (3) Students called for programing focused on engaging their interests.

CONCLUSIONS

Our results point to the need to augment campus-based programming, with attention to the unique needs and relevant concerns of students with disabilities, within the broader context of campus prevention programming.

Exploring the Potential Campus-Level Impact of Online Universal Sexual Assault Prevention Education

Campus sexual assault is a long-standing challenge and continues to be a severe problem for American higher education. The present study examines the short-term impact of a widely utilized sexual violence prevention course for matriculating college students as a population-level prevention approach. The course focuses on correcting misperceptions of normative behavior, increasing students' likelihood to intervene in disconcerting situations, and encouraging empathy and support for victims. Participants were 167,424 first-year college students from 80 four-year institutions who completed preintervention and postintervention surveys to assess changes in composite factor scores derived from 20 attitudinal, self-efficacy, and behavioral intention items. Employing the composite factor scores as dependent variables, individual ANOVAs were run for each of the institutions to test whether there were significant increases in mean factor scores. High percentages of institutions saw statistically significant increases (p < .05) in self-reported ability and intention to intervene to prevent sexual assault and relationship violence (98%), empathy and support for victims (84%), and corrected perceptions of social norms (75%). Fewer schools saw significant reductions in endorsement of sexual assault myths (34%). These findings suggest that when implemented as a population-level intervention for all first-year college students, the prevention course can foster accurate perceptions of positive social norms, increase empathy and support for victims, and increase students' stated ability and intention to intervene.

Changes in alcohol use as a function of psychological distress and social support following COVID-19 related University closings

Amidst the coronavirus pandemic, universities across the country abruptly closed campuses and transitioned to remote learning. The effects of these unprecedented closures are unknown. The current study examined reported alcohol consumption during the week prior to and after campus closure at a public university in Northeast Ohio. Analysis of data from 1,958 students, who endorsed using alcohol in the past 30 days, demonstrates that alcohol consumption (amount and frequency) increased as time progressed. Those with more symptoms of depression and anxiety reported greater increases in alcohol consumption (assessed via retrospective timeline follow-back) compared to students with fewer symptoms. Furthermore, students with greater perceived social support reported less alcohol consumption. Together, these findings highlight the need for universities to offer services and programs to students that will minimize risk factors and maximize protective factors in order to reduce or prevent alcohol abuse during the coronavirus pandemic.

Can Web-based preenrollment alcohol brief interventions be effective screening tools? Precollege drinking behavior predicts college retention and alcohol violations

Objective: To test if precollege drinking data gathered during an online brief intervention are associated with problems and could inform screening for campus alcohol prevention efforts. Participants: Two cohorts of incoming students (N = 5300). Method: Precollege alcohol drinking was gathered through an online preenrollment alcohol brief intervention. Drop out was obtained from university records. On-campus alcohol violations were obtained from university judicial affairs, and off-campus alcohol citations were obtained from the city police. The 2011 cohort was tracked for 4 years, the 2012 cohort for 3 years. Results: Precollege abstaining and heavy drinking were significantly associated with retention and alcohol violations, even with ethnicity, residency, and gender controlled. Association of precollege drinking with later college problems extended beyond the first year and affected retention up to four years of enrollment. Conclusions: The findings support using data from preenrollment alcohol brief interventions as screening tools to customize further campus alcohol interventions.

Comparative Effectiveness of Brief Alcohol Interventions for College Students: Results from a Network Meta-Analysis

Late adolescence is a time of increased drinking, and alcohol plays a predominant role in college social experiences. Colleges seeking to prevent students' hazardous drinking may elect to implement brief alcohol interventions (BAIs). However, numerous manualized BAIs exist, so an important question remains regarding the comparative effectiveness of these different types of BAIs for college students. This study uses network meta-analyses (NMA) to compare seven manualized BAIs for reducing problematic alcohol use among college students. We systematically searched multiple sources for literature, and we screened studies and extracted data in duplicate. For the quantitative synthesis, we employed a random-effects frequentist NMA to determine the effectiveness of different BAIs compared to controls and estimated the relative effectiveness ranking of each BAI. A systematic literature search resulted in 52 included studies: On average, 58% of participants were male, 75% were binge drinkers, and 20% were fraternity/sorority-affiliated students. Consistency models demonstrated that BASICS was consistently effective in reducing students' problematic alcohol use (ES range: g = - 0.23, 95%CI [- 0.36, - 0.16] to g = - 0.36, 95% CI [- 0.55, - 0.18]), but AlcoholEDU (g = - 0.13, 95%CI [- 0.22, - 0.04]), e-CHUG (g = - 0.35, 95%CI [- 0.45, - 0.05]), and THRIVE (g = - 0.47, 95%CI [- 0.60, - 0.33]) were also effective for some outcomes. Intervention rankings indicated that BASICS, THRIVE, and AlcoholEDU hold the most promise for future trials. Several BAIs appear effective for college students. BASICS was the most effective but is resource intensive and may be better suited for higher risk students; THRIVE and e-CHUG are less resource intensive and show promise for universal prevention efforts.

Primary versus secondary prevention messages: College students' perceptions of effectiveness by marijuana user status

Objective: With medical and recreational marijuana legislation expanding throughout the country, the need to educate high-risk populations is evident. The purpose of this study was to assess college students' perceptions of health communication messages comparing primary and secondary prevention messages concerning marijuana. Participants: Participants (n = 487) included college students, ages 18-25, enrolled in a Midwestern University. Methods: Participants assessed messages based on likeability, creativity, believability, persuasiveness, relevance, and usefulness using an online questionnaire that also included open-end comments. Results: Rasch analyses indicate that nonmarijuana users rated primary prevention messages higher than secondary prevention messages, whereas marijuana users ranked secondary prevention messages more favorably than primary prevention messages. Conclusion: Interventions designed to address marijuana use among college students may be more effective if tailored toward user status. Specifically, primary prevention materials should be designed for abstainers, while secondary prevention messages that focus on harm reduction strategies should be used with marijuana users.

[Internet-based alcohol interventions for college students: systematic reviewIntervenciones por Internet para reducir el consumo de alcohol de los estudiantes universitarios: revisión sistemática]

Objective

To identify the main modalities of Internet-based interventions to limit alcohol use among university students, and to describe the effects of these interventions on alcohol use and related consequences.

Methods

A systematic review of PubMed, PsycINFO, and SciELO was performed using as search terms "alcohol drinking AND Internet," without date or language restrictions. Inclusion criteria were randomized controlled trial design, focus on college students and on Internet-based interventions, and evaluating the effects of the intervention on alcohol use or alcohol-related consequences.

Results

Thirty-six articles were analyzed. Two main intervention modalities were identified: personalized normative feedback (PNF, n=28) and multicomponent interventions (n=8). Twelve studies with PNF reported reductions in alcohol use 3 months after the intervention. Multicomponent interventions reduced alcohol use and related consequences; most studies focused on the website AlcoholEdu, which reduced alcohol consumption and the consequences of alcohol use 6 months after the intervention.

Conclusions

FNP and the AlcoholEdu website, the most frequently evaluated interventions among the selected studies, were effective in reducing alcohol use in university students. These strategies are an alternative to increase the access of university students to interventions aimed at limiting alcohol use.

Effects of a web-based pre-enrollment alcohol brief motivational intervention on college student retention and alcohol-related violations

OBJECTIVE

To determine whether completing a pre-enrollment Web-based alcohol brief motivational intervention (BMI) increased student retention and reduced student alcohol-related violations.

PARTICIPANTS

Fall 2011 (3,364) and Fall 2012 (3,111) entering cohorts of all first-year students at a midwestern state university.

METHOD

Students completing the brief intervention (BI) were compared to students not completing the BI. Retention was tracked for four years for the 2011 cohort and three years for the 2012 cohort. Campus and community alcohol violations were tracked for two academic years following enrollment. Kaplan-Meier survival analysis and Cox regression were used to test retention survival. Logistic regression was used to test campus and community violations.

RESULTS

Students in both cohorts who completed the BI had significantly higher retention and significantly fewer alcohol-related violations than noncompleters.

CONCLUSIONS

Population-level Web-based BIs help prevent student dropout and decrease alcohol-related violations, with impacts extending multiple years. Web-based BI is an efficacious population-level prevention tool.

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

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

Alcohol and social connectedness for new residential university students: implications for alcohol harm reduction

Starting university is a significant life-event, commonly involving detachment from existing social networks and emotional stresses that increase risk of drop-out. The developmental need to form new peer relationships is prominent during this period and is correlated with successful adaptation. This study investigated the role of alcohol in the process of transition and peer group development for new students. Thematic analysis of semi-structured interviews is presented, conducted within a broader instrumental case study of campus approaches to alcohol policy and management. Twenty-three first-year students participated in interviews lasting between 45-60 minutes. Verbatim transcription was followed by within- and cross-case analysis. Drawing on social connectedness theory, we illustrate how pre-arrival concern over new peer relationships was subsequently reduced by drinking together. This reinforced participant perceptions of alcohol as beneficial for hastening development of social connections, in turn reducing anxiety and supporting successful transition. For non-/low-drinkers in the study, social connectedness without alcohol use was reported as more challenging. Alcohol was perceived as a readily-available, effective tool for hastening social connectedness, increasing student resistance to alcohol education messages provided at the start of term. Implications for addressing alcohol-related harms in students are discussed.

Contrasting staff and student views on alcohol education provision in a UK university

Alcohol education and awareness aims to teach individuals the risks of excess consumption. It is common in UK universities, despite limited evidence of success with student cohorts. This research explored the development and delivery of such alcohol activities at one UK university. In-depth, one-to-one interviews were carried out with non-academic staff and with first-year students. These aimed to understand the development of alcohol awareness messages and staff involvement in delivery, as well as exploring student responses to key alcohol educational activities. Results indicate that alcohol is a normalized aspect of UK student identity and is accepted as such by students and staff. Despite this, there is a widely held view that the university has a responsibility to provide alcohol education and awareness, which forms the basis of current practice on campus. This reflects perception of education interventions as non-coercive and acceptable within the staff-student relationship, with limited support for more interventionist approaches with a group engaging in a legal behavior with strong cultural associations. However, staff approval of education as appropriate for this audience is contradicted by students, who reject these same approaches as reminiscent of school, instead favoring self-directed learning or peer-led programs.

The Utility of a Brief Web-Based Prevention Intervention as a Universal Approach for Risky Alcohol Use in College Students: Evidence of Moderation by Family History

Background: Alcohol use on college campuses is prevalent and contributes to problems that affect the health, emotional wellbeing, and academic success of college students. Risk factors, such as family history of alcohol problems, predict future alcohol problems, but less is known about their potential impact on intervention effectiveness. The purpose of this study was to examine the effect of an intervention implemented in a non-randomized sample of drinking and non-drinking college freshmen.

Methods: Freshmen college students recruited for the intervention study (n = 153) completed a web-adaptation of the Brief Alcohol Screening and Intervention for College Students (BASICS) at the start of spring semester. We compared their 30-days post-intervention alcohol initiation, number of drinking days (DAYS), drinks per occasion (DRINKS), maximum drinks in 24 h (MAX24) and alcohol use disorder symptoms (AUDsx) to 151 comparison participants retrospectively matched on demographics and baseline alcohol use behaviors. We also tested baseline DRINKS, DAYS, AUDsx, MAX24, and parental family history (PFH) of alcohol problems as moderators of the effect of the intervention.

Results: At follow-up, intervention participants had lower rates of AUDsx than comparison participants, especially among baseline drinkers. Among participants drinking 3+ days/month at baseline, intervention participants showed fewer DAYS at follow-up than the comparison group participants. BASICS was also associated with a decreased likelihood of initiation among baseline non-drinkers. PFH significantly interacted with treatment group, with positive PFH intervention participants reporting significantly fewer AUDsx at follow-up compared to positive PFH comparison participants. We found no evidence for an effect of the intervention on DRINKS or MAX24 in our analyses.

Conclusions: Results suggest some indication that novel groups, such as non-drinkers, regular drinkers, and PFH positive students may experience benefits from BASICS. Although conclusions were limited by lack of randomization and short follow-up period, PFH positive and low to moderate drinking groups represent viable targets for future randomized studies.

Alcohol-related blackouts across 55 weeks of college: Effects of European-American ethnicity, female sex, and low level of response to alcohol

BACKGROUND

While high blood alcohol concentrations (BACs) are required for alcohol-related blackouts (ARBs), additional characteristics also contribute to the risk, including a person's ethnicity, sex, and phenotypes relating to heavier drinking. Few prospective studies of ARBs have evaluated how these additional characteristics interact.

METHOD

Data regarding 398 European American (EA), Asian and Hispanic students were extracted from a 55-week prospective study of different approaches to decrease heavy drinking among college freshmen. Information on past month ARB frequency was determined at 8 assessments. While controlling for the prior month maximum BAC and active education vs. control group assignment, the patterns and intensities of ARBs over time across ethnic groups were evaluated with ANOVA at each follow-up for the full sample, and then separately by sex and then by low vs. high levels of response to alcohol status (LR). The overall pattern of ARBs over time was evaluated with a 3 ethnic groups by 2 sexes by 2 LR status by 8 time points mixed-design ANOVA.

RESULTS

Higher rates of ARBs over time were associated with EA ethnicity, female sex and a low LR to alcohol, with the ethnic differences in ARBs most robust in females and drinkers with high LRs. Participation in education programs aimed at heavy drinking was associated with decreases in ARBs.

CONCLUSIONS

The data indicate that in addition to BACs achieved, propensities toward ARBs relate to complex interactions between additional risk factors, including ethnicity, sex, and LR status.

Online personalized normative alcohol feedback for parents of first-year college students

This study examined the efficacy of a personalized normative feedback (PNF) alcohol intervention for parents of students transitioning into college. A sample of 399 parent-student dyads were recruited to take part in the intervention during the summer prior to matriculation. Parents were randomly assigned to receive either normative feedback regarding student drinking and other college parents' alcohol-related communication or general college health norm information. Students completed measures of alcohol use, alcohol consequences, and parent-child alcohol-specific communication both 1 and 6 months after matriculation. The results indicated that in comparison with the control condition parents who received PNF reported immediate changes in their perceptions of other parents' behaviors; however, these changes in parent perceived norms did not translate into long-term changes in student drinking behaviors or parent-child communication. Findings highlight the need to consider content beyond normative feedback for parent based alcohol intervention. (PsycINFO Database Record

Use of theory in computer-based interventions to reduce alcohol use among adolescents and young adults: a systematic review

BACKGROUND

Alcohol use and binge drinking among adolescents and young adults remain frequent causes of preventable injuries, disease, and death, and there has been growing attention to computer-based modes of intervention delivery to prevent/reduce alcohol use. Research suggests that health interventions grounded in established theory are more effective than those with no theoretical basis. The goal of this study was to conduct a literature review of computer-based interventions (CBIs) designed to address alcohol use among adolescents and young adults (aged 12-21 years) and examine the extent to which CBIs use theories of behavior change in their development and evaluations. This study also provides an update on extant CBIs addressing alcohol use among youth and their effectiveness.

METHODS

Between November and December of 2014, a literature review of CBIs aimed at preventing or reducing alcohol in PsychINFO, PubMed, and Google Scholar was conducted. The use of theory in each CBI was examined using a modified version of the classification system developed by Painter et al. (Ann Behav Med 35:358-362, 2008).

RESULTS

The search yielded 600 unique articles, 500 were excluded because they did not meet the inclusion criteria. The 100 remaining articles were retained for analyses. Many articles were written about a single intervention; thus, the search revealed a total of 42 unique CBIs. In examining the use of theory, 22 CBIs (52 %) explicitly named one or more theoretical frameworks. Primary theories mentioned were social cognitive theory, transtheoretical model, theory of planned behavior and reasoned action, and health belief model. Less than half (48 %), did not use theory, but mentioned either use of a theoretical construct (such as self-efficacy) or an intervention technique (e.g., manipulating social norms). Only a few articles provided detailed information about how the theory was applied to the CBI; the vast majority included little to no information.

CONCLUSIONS

Given the importance of theory in guiding interventions, greater emphasis on the selection and application of theory is needed. The classification system used in this review offers a guiding framework for reporting how theory based principles can be applied to computer based interventions.

Randomised controlled trial using smartphone website vs leaflet to support antenatal perineal massage practice for pregnant women

BACKGROUND

In Japan, the rate of pregnant women who practice antenatal perineal massage was only 15.1%.

AIM

The aim of this study was to develop and evaluate a smartphone website and a leaflet to support antenatal perineal massage practice for primiparous women.

METHODS

In a randomised control trial, 161 primiparous women were randomly assigned to a smartphone website group (n=81) or a leaflet group (n=80). Data analysis were by per protocol analysis and intention to treat analysis.

FINDINGS

Of the 161 women participants, 47 in the smartphone website group and 49 in the leaflet group completed all questionnaires. Primary outcome was continuance rate (three times a week over a three week period) of antenatal perineal massage practice. The rates by a per protocol analysis were 51.1% in the smartphone website group and 51.0% in the leaflet group, respectively. There was no significant difference between the groups. Moreover, the rates by an intention to treat analysis were 29.6% in the smartphone website group and 31.3% in the leaflet group, respectively. There was also no significant difference between the groups. There were no significant differences in the evaluation of perineal massage, childbirth self-efficacy, satisfaction with efforts towards childbirth, and perineal outcomes following childbirth which were measured as secondary outcomes between the groups.

CONCLUSION

There was no significant difference in continuance rate of antenatal perineal massage practice between those using a smartphone website and those with a leaflet, however, the rate was better than no instructions.

An experimental test of assessment reactivity within a web-based brief alcohol intervention study for college students

OBJECTIVE

Web-based brief alcohol intervention (WBI) programs have efficacy in a wide range of college students and have been widely disseminated to universities to address heavy alcohol use. In the majority of efficacy studies, web-based research assessments were conducted before the intervention. Web-based research assessments may elicit reactivity, which could inflate estimates of WBI efficacy. The current study tested whether web-based research assessments conducted in combination with a WBI had additive effects on alcohol use outcomes, compared to a WBI only.

METHODS

Undergraduate students (n=856) from universities in the United States and Canada participated in this online study. Eligible individuals were randomized to complete 1) research assessments+WBI or 2) WBI-only. Alcohol consumption, alcohol-related problems, and protective behaviors were assessed at one-month follow up.

RESULTS

Multiple regression using 20 multiply imputed datasets indicated that there were no significant differences at follow up in alcohol use, alcohol-related problems, or protective behaviors used when controlling for variables with theoretical and statistical relevance. A repeated measures analysis of covariance revealed a significant decrease in peak estimated blood alcohol concentration in both groups, but no differential effects by randomized group. There were no significant moderating effects from gender, hazardous alcohol use, or motivation to change drinking.

CONCLUSIONS

Web-based research assessments combined with a web-based alcohol intervention did not inflate estimates of intervention efficacy when measured within-subjects. Our findings suggest universities may be observing intervention effects similar to those cited in efficacy studies, although effectiveness trials are needed.

Effects of Brief Alcohol Interventions on Drinking and Driving among Youth: A Systematic Review and Meta-analysis

OBJECTIVE

Alcohol-impaired driving persists as a major cause of traffic fatalities and injuries among young drivers. This meta-analysis examined whether brief alcohol interventions were effective in reducing driving after drinking among adolescents and young adults.

METHOD

Our systematic search identified 12 experimental/quasi-experimental evaluations (16 intervention groups) that measured driving while intoxicated and related consequences and provided data for effect size calculation (N = 5,664; M age =17 years; 57% male). The studies were published between 1991 and 2011. Three-level random-effects meta-analyses using a structural equation modeling approach were used to summarize the effects of the interventions.

RESULTS

Compared with controls, participants in brief alcohol interventions reported reduced drinking and driving and related consequences (ḡ = 0.15, 95% CI [0.08, 0.21]). Supplemental analyses indicated that reductions in driving while intoxicated were positively associated with the reduced post-intervention heavy use of alcohol. These findings were not attenuated by study design or implementation factors.

CONCLUSIONS

Brief alcohol interventions under 5 hours of contact may constitute a promising preventive approach targeting drinking and driving among adolescents and young adults. Reducing heavy episodic alcohol consumption appeared to be a major factor in reducing drunk-driving instances. Interpretation of the findings must be made with caution, however, given the possibility of publication bias and the small observed effect size. Future research should focus on the exact mechanisms of behavior change leading to beneficial outcomes of brief alcohol interventions and the potential effectiveness of combined brief interventions and other preventive approaches.

Qualitatively Assessing the Experiences of College Students Completing AlcoholEdu: Do Participants Report Altering Behavior After Intervention?

To reduce college student drinking and associated alcohol-related consequences, many universities are turning to e-interventions, such as AlcoholEdu. To date, however, results of evaluations examining the impact of AlcoholEdu are mixed. Among these evaluations, few qualitative assessments have examined the experiences and perceptions of students who complete AlcoholEdu. This investigation aimed to assess whether students (a) find the program educational and engaging, (b) implemented specific strategies learned from participation, and (c) self-report altering their behavior as a result of participation. Even though respondents universally reported an increase in alcohol-related knowledge, there was an evident disconnect between this knowledge and their actual behavior. In other words, respondents reported that they did not implement what was taught in AlcoholEdu. Moreover, students highlighted several limitations associated with the program that would have influenced its overall impact, such as ignoring video segments of the program and clicking through assessments simply to complete the task. If used, college administrators and health professionals should implement e-interventions such as AlcoholEdu as one component of a multifaceted approach rather than a panacea for the current high-risk drinking practices of college students.

The glass is half full: evidence for efficacy of alcohol-wise at one university but not the other

This research extends the growing literature about online alcohol prevention programs for first-year college students. Two independent randomized control studies, conducted at separate universities, evaluated the short-term effectiveness of Alcohol-Wise, an online alcohol prevention program not previously studied. It was hypothesized the prevention program would increase alcohol knowledge and reduce alcohol consumption, including high-risk alcohol-related behaviors, among first-year college students. At both universities, the intervention significantly increased alcohol-related knowledge. At one university, the prevention program also significantly reduced alcohol consumption and high-risk drinking behaviors, such as playing drinking games, heavy drinking, and extreme ritualistic alcohol consumption. Implications for the use of online alcohol prevention programs and student affairs are discussed.

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

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

Personalized feedback as a universal prevention approach for college drinking: a randomized trial of an e-mail linked universal web-based alcohol intervention

Alcohol use among first-year university students continues to be a central health concern. Efforts to address drinking in this population have increasingly relied on web-based interventions, which have the capacity to reach large numbers of students through a convenient and highly utilized medium. Despite evidence for the utility of this approach for reducing hazardous drinking, recent studies that have examined the effectiveness of this approach as a universal prevention strategy in campus-wide studies have produced mixed results. We sought to test the effectiveness of a web-based alcohol intervention as a universal prevention strategy for first-year students. An e-mail invitation linked to a brief, web-based survey on health behaviors was sent to all first-year students during the fall semester. Those who completed the baseline assessment were randomized to receive either a feedback-based alcohol intervention (intervention condition) or feedback about other health-related behaviors such as sleep and nutrition (control condition). A second web-based survey was used to collect follow-up drinking data 5 months later. The number of heavy drinking episodes in the previous month and alcohol-related consequences in the previous 3 months served as the primary dependent variables. Negative binomial regression analyses did not indicate a significant effect of the intervention at follow-up on either heavy drinking episodes or alcohol-related consequences. Analyses of additional drinking outcomes among the subsample of students who reported that they did not drink at baseline showed that those who received the alcohol intervention were subsequently less likely to drink alcohol. These results suggest that web-based alcohol interventions may be a potentially useful method of maintaining abstinence among underage, non-drinking students. Overall, however, results indicate that an e-mail-linked, campus-wide, web-intervention approach to address alcohol use among first-year students may have limited effectiveness as an approach to minimize hazardous drinking over the course of the year.

Effects of an online alcohol education course among college freshmen: an investigation of potential mediators

The authors investigated possible mediating effects of psychosocial variables (perceived drinking norms, positive and negative alcohol expectancies, personal approval of alcohol use, protective behavioral strategies) targeted by an online alcohol education course (AlcoholEdu for College) as part of a 30-campus randomized trial with 2,400 first-year students. Previous multilevel analyses have found significant effects of the AlcoholEdu course on the frequency of past-30-day alcohol use and binge drinking during the fall semester, and the most common types of alcohol-related problems. Exposure to the online AlcoholEdu course was inversely related to perceived drinking norms but was not related to any of the other psychosocial variables. Multilevel analyses indicated at least partial mediating effects of perceived drinking norms on behavioral outcomes. Findings of this study suggest that AlcoholEdu for College affects alcohol use and related consequences indirectly through its effect on student perceptions of drinking norms. Further research is needed to better understand why this online course did not appear to affect other targeted psychosocial variables.

New research findings since the 2007 Surgeon General's Call to Action to Prevent and Reduce Underage Drinking: a review

OBJECTIVE

In 2007, the U.S. Department of Health and Human Services issued The Surgeon General's Call to Action to Prevent and Reduce Underage Drinking, a publication documenting a problem linked to nearly 5,000 injury deaths annually and poor academic performance, potential cognitive deficits, risky sexual behavior, physical and sexual assaults, and other substance use. This report reviews subsequent underage drinking and related traffic fatality trends and research on determinants, consequences, and prevention interventions.

METHOD

New research reports, meta-analyses, and systematic literature reviews were examined.

RESULTS

Since the Call to Action, reductions in underage frequency of drinking, heavy drinking occasions, and alcohol-related traffic deaths that began in the 1980s when the drinking age nationally became 21 have continued. Knowledge regarding determinants and consequences, particularly the effects of early-onset drinking, parental alcohol provision, and cognitive effects, has expanded. Additional studies support associations between the legal drinking age of 21, zero tolerance laws, higher alcohol prices, and reduced drinking and related problems. New research suggests that use/lose laws, social host liability, internal possession laws, graduated licensing, and night driving restrictions reduce traffic deaths involving underage drinking drivers. Additional studies support the positive effects of individually oriented interventions, especially screening and brief motivational interventions, web and face-to-face social norms interventions, college web-based interventions, parental interventions, and multicomponent community interventions.

CONCLUSIONS

Despite reductions in underage alcohol consumption and related traffic deaths, underage drinking remains an enduring problem. Continued research is warranted in minimally studied areas, such as prospective studies of alcohol and brain development, policy studies of use/lose laws, internal possession laws, social host liability, and parent-family interventions.

Electronic Feedback in College Student Drinking Prevention and Intervention

Alcohol consumption is prevalent among college students and can be associated with serious negative consequences. Several efficacious programs using one-on-one brief intervention techniques have been developed to target high-risk drinking by individual students, such as the Brief Alcohol Screening and Intervention for College Students (BASICS) (Dimeff et al. 1999). To reach a larger population (e.g., the incoming freshman class), researchers have adapted these interventions so that students can access them via the Internet or in some other electronic format.The purpose of this review is to discuss specific alcohol intervention programs that were (1) designed to be delivered remotely (e.g., via the Web or on an electronic device) without interaction with a provider and (2) were tested among college students using a randomized controlled trial design. Specific studies were drawn from earlier reviews as well as a comprehensive literature search. Although many programs have limited research support, and some findings are mixed, components that were directly translated from in-person BASICS to remote-delivery mediums (i.e., personalized feedback interventions [PFIs], personalized normative feedback [PNF] interventions), and broader programs that incorporate PFI/ PNF, show promise in reducing alcohol use and/or negative consequences. However, more research is needed and suggestions for how the field can move these interventions forward are discussed.

Substance use, aggression perpetration, and victimization: temporal co-occurrence in college males and females

Many studies have documented associations of substance use with aggression perpetration and aggression victimization; however, little is known about the co-occurrence of these problem behaviors within the same day in college students. The present study investigated whether substance use and aggression increase the likelihood of each other and whether attitudes justifying aggression strengthen those associations. College student participants (N = 378, 32% males) self-selected into an online study in which they reported on 2 days of alcohol/drug use and on aggression perpetration and victimization (including physical, psychological and electronic aggression, and sexual coercion) with friends and dating partners. Using regression to test for nonequivalence of predictor and outcome variables, we found bidirectional effects for males only. Males' substance use was associated with an increased likelihood on the same day of aggression perpetration and of aggression victimization; males' aggression perpetration and aggression victimization were associated with an increased likelihood of substance use on the same day. Females did not show significant contingencies between substance use and aggression in either direction. Males' attitudes justifying male-to-female aggression were associated with their aggression perpetration and victimization and their justification of female-to-male aggression strengthened the link between substance use and aggression perpetration. With interpersonal aggression and substance use being significant problems on college campuses, many colleges offer separate preventive intervention programs aimed at these public health challenges; this study suggests possible benefits of an integrated approach that addresses connections between alcohol/drug use and aggression.

Population-level administration of AlcoholEdu for college: an ARIMA time-series analysis

Autoregressive integrated moving averages (ARIMA) is a powerful analytic tool for conducting interrupted time-series analysis, yet it is rarely used in studies of public health campaigns or programs. This study demonstrated the use of ARIMA to assess AlcoholEdu for College, an online alcohol education course for first-year students, and other health and safety programs introduced at a moderate-size public university in the South. From 1992 to 2009, the university administered annual Core Alcohol and Drug Surveys to samples of undergraduates (Ns = 498 to 1032). AlcoholEdu and other health and safety programs that began during the study period were assessed through a series of quasi-experimental ARIMA analyses. Implementation of AlcoholEdu in 2004 was significantly associated with substantial decreases in alcohol consumption and alcohol- or drug-related negative consequences. These improvements were sustained over time as succeeding first-year classes took the course. Previous studies have shown that AlcoholEdu has an initial positive effect on students' alcohol use and associated negative consequences. This investigation suggests that these positive changes may be sustainable over time through yearly implementation of the course with first-year students. ARIMA time-series analysis holds great promise for investigating the effect of program and policy interventions to address alcohol- and drug-related problems on campus.

The burden of alcohol use: excessive alcohol consumption and related consequences among college students

Research shows that multiple factors influence college drinking, from an individual's genetic susceptibility to the positive and negative effects of alcohol, alcohol use during high school, campus norms related to drinking, expectations regarding the benefits and detrimental effects of drinking, penalties for underage drinking, parental attitudes about drinking while at college, whether one is member of a Greek organization or involved in athletics, and conditions within the larger community that determine how accessible and affordable alcohol is. Consequences of college drinking include missed classes and lower grades, injuries, sexual assaults, overdoses, memory blackouts, changes in brain function, lingering cognitive deficits, and death. This article examines recent findings about the causes and consequences of excessive drinking among college students relative to their non-college peers and many of the strategies used to collect and analyze relevant data, as well as the inherent hurdles and limitations of such strategies.

Students' experiences with web-based alcohol prevention: a qualitative evaluation of AlcoholEdu

AIM

To provide more in-depth information about students' experiences with AlcoholEdu and in particular to assess if students perceive that the course gives them tools to better control their drinking-related behavior.

METHODS

Focus group interviews with freshmen at three California universities.

FINDINGS

1) The course provides so much information that everyone can find some of it relevant; 2) participants prefer information presented in ways they can identify with; 3) participants report problems with surveys in the program pointing to redundancy and length; and 4) participants did not expect the course to impact their behavior relating to alcohol.

CONCLUSION

AlcoholEdu provides valuable information for freshmen in college about how to avoid problems with alcohol. However, the course could have much more impact if closer to college reality.