Sunny Young

Loyola Marymount University | LMU · Department of Psychology

Despite concerted efforts, high-risk drinking remains a significant problem on college campuses. Further, the transition into college is an identified critical period in which risky drinking patterns are often established and serious negative consequences occur. Colleges commonly employ Normative Re-Education (NR), a promising intervention approach focused on correcting over-estimated peer drinking norms, to reduce alcohol risk in first-year students. However, the most cost-effective and scalable NR strategies, including web-based personalized normative feedback (PNF) interventions, have yielded only modest reductions in drinking. Several issues have been identified that may explain these relatively small effects. For example, students often question the credibility of the normative data, the content fails to capture students’ attention, and heavy drinkers often react to feedback defensively. These issues are not surprising as, unlike social media and digital gaming applications that capture and sustain young adults’ attention, web-based PNF formats lack the sophisticated digital graphics, social interactivity, and other dynamic features to which students have become accustomed. Further, colleges often make participation mandatory or offer incentives to enroll students in current interventions, likely a detriment to student motivation and thus intervention effectiveness. Our new gamified, social media-inspired, incognito approach to PNF addresses these issues by delivering alcohol PNF within a fun smartphone app that tests first-year students’ perceptions of college life and classmates’ attitudes and behaviors on a weekly basis across the first semester of college. Integrating features from popular social media platforms and evidence-based digital game mechanics (e.g., co-presence, a wager-based system of points, and chance-based uncertainty), the app also features enhanced PNF and includes several novel features informed by longstanding cognitive and social psychological theories. Five pilot studies support the ability of this gamified, app-based, incognito alcohol intervention strategy to engage first-year college students and reduce drinking more effectively than existing NR approaches. The proposed research will evaluate the gamified app as a low cost, self-sustaining, alcohol intervention approach in a large multi-site (LMU and UH) randomized controlled trial with three cohorts of N=400 first-year students per site (N=2,400 total). Student participants will play the app weekly over the 12 weeks of their first semester in college. Additionally, students not enrolled in the RCT study will also play throughout the 12-week period (≈300 per site per cohort; ≈1800 total), testing their knowledge and understanding of peer behavior, receiving feedback, and competing for prizes with the RCT participants. Each week, all players will answer questions of interest on three topics about first-year students’ attitudes and behaviors (alcohol and partying, health, drinking-related consequences, sex, studying, etc.) generated by the student players. They will also guess how “typical” students answered the same questions and wager points on how close to the correct answer (group norm) their guess is. Further, they will rate the behaviors of others and, then, submit and vote on questions for subsequent rounds. At the end of each week, players will receive enhanced PNF feedback on two of the topics, as well as receive feedback on how other preferred-sex students rated their individual behavior (preferred-sex injunctive norms). Innovatively, the study’s design, which randomizes RCT participants to one of four levels of alcohol feedback (0%, 25%, 50%, & 75%), will evaluate the effectiveness of alcohol feedback delivered in the app relative to feedback on control topics and identify the optimal doses of on-going alcohol feedback to be delivered to different types of student drinkers (nondrinker, light drinker, moderate to heavy drinker). Among the non-RCT additional players on each campus, confidential user data will evaluate the sustainability of app play in an ecologically valid setting consistent with how colleges might cost-effectively offer this game in the future, in the absence of individual incentives. As a naturalistic intervention able to organically attract student participation at minimal cost, this smartphone application represents a potentially powerful new paradigm for college alcohol prevention by integrating social media and gamified elements to deliver credible, engaging and impactful content.

This project will refine and extend our successful parent-based social norms intervention for reducing risky college drinking (Feedback Intervention Targeting Student Transitions and Risk Trajectories; NIAAA grant R21 AA021870). We aim to adapt the parent-based intervention (PBI) for online rather than in-person delivery, significantly enhance the content, and conduct a feasibility trial. Pilot work by the HeadsUP Team has revealed that, like students, parents display predictable normative misperceptions. Specifically, parents overestimate how approving other parents are of drinking and underestimate how often other parents engage with their students about drinking. As predicted by social norms theory, these false beliefs are associated with parents displaying more approving attitudes themselves and communicating less frequently. Correcting these norms should motivate parents to proactively engage their child in risk-reducing directions. Thus, our original PBI delivered to parents in person at a single summer orientation session combined a social norms feedback component with informational material (“tips”). While the effects on weekly drinking, HED, and non-drinker alcohol use initiation were robust 1-month into college (3-months post intervention), they were no longer present near the end of the second semester. Additionally, the original PBI’s usefulness as a universal approach was limited because it was delivered to parent groups on-campus during pre-college orientation sessions and many colleges do not hold summer orientations and/or lack the resources to administer the session. The current project seeks to refine and adapt this intervention using a new cutting-edge modality developed by our team in extensive pilot work conducted during the past two years. Drawing from the computer science literature on virtual co-presence, we have been able to create an online environment that mimics the effects of a live group social norms session. Applied to the PBI, this technology will make the program much easier to disseminate. Further, it will allow us to easily extend the PBI, delivering additional content to parents in additional modules across students’ first year of college. This proposal has two main Aims accomplished in two distinct phases. Phase I will employ a mixed-method participatory design approach to digital product development with several sets of parent focus groups first querying parents’ normative attitudes and behaviors related to parent-student alcohol communication, as well as their preferences for web-based platform features, graphics, layouts, and notifications. Then, a longitudinal survey study will follow 500 parents of incoming first-year students through their students’ first-semester to document norms and identify additional parent-child communication concerns that emerge during the transition to college. A final set of parent focus groups will examine the completed web-based parent platform for feedback and ease-of-use. Importantly, parent focus group and survey data will together inform the development of intervention content and features. Phase 1 will result in a fully-functional, user-friendly, web-based FITSTART+ platform carefully tailored to the needs and desires of parents’ of first-year college students (AIM 1). In Phase II, the project will assess the feasibility and efficacy of the completed FITSTART+ intervention through a pilot trial (AIM 2).