Article

Enhancing the Efficacy of Computerized Feedback Interventions for College Alcohol Misuse: An Exploratory Randomized Trial

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Abstract

Objective: Personalized feedback interventions (PFIs) have been associated with decreased alcohol consumption and related problems among college students; however, the necessary and sufficient components responsible for efficacy remain unclear. The present study investigated the relative efficacy of 3 computerized PFIs with differing content, the content-specific mechanisms of change within PFIs, and the moderating roles of comparison orientation and baseline risk in intervention outcomes. Method: College students (N = 212) reporting alcohol use in a typical week completed an assessment prior to randomization (norms PFI, enhanced PFI, choice PFI, assessment only) and 1 month postintervention. Results: Participants who received a PFI reported greater decreases in alcohol use, peak blood alcohol concentration (BAC), related problems, and perceptions of typical students' drinking than those in the control group. Neither tendency to compare oneself with others nor baseline risk moderated outcomes. PFIs influenced weekly alcohol use indirectly through changes in descriptive normative perceptions and alcohol-related consequences indirectly through changes in peak BAC. Conclusions: Computerized PFIs are more effective than assessment alone in decreasing alcohol use and related problems among college students. Normative comparisons may be sufficient to elicit behavior change, and inclusion of select additional components may not yield significant improvements in outcomes. However, the consistent benefit of including feedback on physical and monetary costs of drinking and moderation strategies, although nonsignificant, may warrant the negligible increase in time and money required to provide such information electronically. Computerized PFIs seem to be an ideal first step to the prevention and treatment of college alcohol misuse. (PsycINFO Database Record

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... College students were recruited from a large, four-year, land grant university as part of a randomized controlled trial examining the efficacy of three computerized personalized feedback interventions (PFIs) for heavy alcohol use. Details regarding study design and intervention content have been published elsewhere (Miller, Leavens, Meier, Lombardi, & Leffingwell, 2016). Briefly, students reporting alcohol use in a typical week were recruited primarily from a research participant pool to complete an online assessment of health behaviors. ...
... Participants who were included versus excluded from analyses did not differ significantly at baseline in age, gender, drinks per week, experience of alcohol-induced amnesia, peak BAC, use of protective behavioral strategies, or experience of alcohol-related consequences. Because the three interventions piloted in the parent trial did not demonstrate differential efficacy in reducing alcohol use or consequences (Miller et al., 2016), intervention participants were collapsed into a single personalized feedback intervention group (PFI n = 140) and compared to the assessment only control group (AO n = 58). ...
... First, participants in the intervention group received one of three different feedback profiles (normative feedback, normative feedback in addition to feedback on practical costs and protective behavioral strategies, or normative feedback in addition to feedback of their choice), but were collapsed into one group for the present study. It is possible that there were differential mediation or moderation effects as a result of the type of feedback received; however, outcomes at onemonth follow-up did not differ as a function of feedback content (Miller et al., 2016). Second, mediator and outcome variables were assessed at the same time point, which prevents us from stating with certainty that decreases in peak BAC preceded change in alcohol-related consequences. ...
Article
Alcohol-induced amnesia (“blackout”) is a reliable predictor of alcohol-related harm. Given its association with other negative consequences, experience of alcohol-induced amnesia may serve as a teachable moment, after which individuals are more likely to respond to intervention. To test this hypothesis, alcohol-induced amnesia was evaluated as a moderator of brief intervention effect on (a) alcohol-related consequences and (b) the proposed intervention mediators, protective behavioral strategies and peak blood alcohol concentration (BAC). Baseline alcohol risk measured using the Alcohol Use Disorders Identification Test (AUDIT) was also evaluated as a moderator to rule out the possibility that amnesia is simply an indicator of more general alcohol risk. College students (N = 198) reporting alcohol use in a typical week completed assessments at baseline and one-month follow-up as part of a larger intervention trial. Participants were randomized to assessment only (AO; n = 58) or personalized feedback intervention (PFI; n = 140). Hierarchical regression was used to examine direct and indirect intervention effects. A significant group by amnesia interaction revealed that only PFI participants who had experienced alcohol-induced amnesia in the past month reported decreases in alcohol consequences at one-month follow-up. The PFI reduced alcohol-related consequences indirectly through changes in peak BAC, but only among those who had experienced amnesia at baseline. In contrast, baseline alcohol risk (AUDIT) did not moderate intervention effects, and use of protective behavioral strategies did not statistically mediate intervention effects. Findings suggest that loss of memory for drinking events is a unique determinant of young adult response to brief alcohol intervention. Normative feedback interventions may be particularly effective for individuals who have experienced alcohol-induced amnesia in the past 30 days.
... Although simple incentives such as participant payments may suffice for short-term studies, these do not scale to long-term interventions. Alternative approaches to improve engagement have used individualized feedback and visualization [14], badges [15], self-tracking [16], or self-experimentation [17]. Participant burden can be reduced, for example, via passive sensing tools [18]. ...
... Individualized visualization and feedback have been shown to be effective both as a means of engagement [15] and treatment [14]. Although these visualizations must be tailored to the specific study or treatment, a variety of tools are available to display different types of data, such as those displayed in Figure 3. ...
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Background: Mobile health (mHealth) methods often rely on active input from participants, for example, in the form of self-report questionnaires delivered via web or smartphone, to measure health and behavioral indicators and deliver interventions in everyday life settings. For short-term studies or interventions, these techniques are deployed intensively, causing nontrivial participant burden. For cases where the goal is long-term maintenance, limited infrastructure exists to balance information needs with participant constraints. Yet, the increasing precision of passive sensors such as wearable physiology monitors, smartphone-based location history, and internet-of-things devices, in combination with statistical feature selection and adaptive interventions, have begun to make such things possible. Objective: In this paper, we introduced Wear-IT, a smartphone app and cloud framework intended to begin addressing current limitations by allowing researchers to leverage commodity electronics and real-time decision making to optimize the amount of useful data collected while minimizing participant burden. Methods: The Wear-IT framework uses real-time decision making to find more optimal tradeoffs between the utility of data collected and the burden placed on participants. Wear-IT integrates a variety of consumer-grade sensors and provides adaptive, personalized, and low-burden monitoring and intervention. Proof of concept examples are illustrated using artificial data. The results of qualitative interviews with users are provided. Results: Participants provided positive feedback about the ease of use of studies conducted using the Wear-IT framework. Users expressed positivity about their overall experience with the framework and its utility for balancing burden and excitement about future studies that real-time processing will enable. Conclusions: The Wear-IT framework uses a combination of passive monitoring, real-time processing, and adaptive assessment and intervention to provide a balance between high-quality data collection and low participant burden. The framework presents an opportunity to deploy adaptive assessment and intervention designs that use real-time processing and provides a platform to study and overcome the challenges of long-term mHealth intervention.
... The content of PFIs may also impact efficacy. In one dismantling study, Cunningham et al. (2012) found that including normative comparisons in addition to descriptive information about an individual's gambling patterns reduced the intervention's efficacy, which is particularly interesting given the importance of normative feedback within interventions for other health risk behaviors (Miller et al. 2016;Lewis et al. 2014). Given these counterintuitive findings, the investigators proposed that future studies examine the salience of information contained within the PFI to the recipient. ...
... The present findings suggest that the specific information delivered to individuals may impact intervention efficacy. Qualitative investigations into the type of information individuals with gambling problems find most meaningful may aid in optimizing the content of these interventions (Miller et al. 2016). Finally, longer-term effects of these interventions are unknown. ...
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Personal Feedback Interventions (PFIs) have been widely used to reduce the amount of time and money individuals spend on gambling. A central component of these interventions is personalized information about an individual’s gambling behavior, often in comparison to others’ gambling. The purpose of the present review and meta-analysis was to evaluate these interventions in terms of content, mode of delivery, target sample, and efficacy. Sixteen interventions from 11 studies were reviewed. We found a small, statistically significant effect in favor of PFIs versus control (d = 0.20, 95% CI 0.12, 0.27). Six moderators of intervention efficacy were explored. These interventions appeared to be most efficacious when used in populations of greater gambling severity, when individuals were provided with gambling-related educational information, and when used in conjunction with motivational interviewing. Factors associated with reduced efficacy include in-person delivery of feedback without motivational-interviewing and informing participants of their score on a psychological measure of gambling severity. Efficacy did not vary as a function of college or community samples. PFIs are a low cost, easily disseminated intervention that can be used as a harm-reduction strategy. However, more substantial effects may be attained if used as part of a larger course of therapy.
... Of the remaining 903, 38 were deemed unreliable because they reported over 100 drinks per sitting, gave the same response for every expectancy item, or responded "I don't know" to more than 50% of items. The rates of unreliable responses were comparable to similar prevention/intervention strategies (Brown-Rice et al., 2017;Miller et al., 2016). The final sample consisted of 865 participants. ...
Article
Prevention programs may have contributed to modest declines in alcohol use among college students in recent years, but negative consequences continue to be pervasive. First year college students (FYCS) are particularly vulnerable, and there is clearly a need for more effective methods to reduce risk. Meta-analyses focused on expectancy challenge (EC) have found this approach to be effective, but “experiential” EC that includes a drinking exercise is not suitable for most FYCS, many of whom are underage. A non-experiential alternative, the Expectancy Challenge Alcohol Literacy Curriculum (ECALC), is practical for widespread implementation. ECALC has been effective with mandated students and members of fraternities, and in the present study, we focused on evaluating effects with FYCS. In a group randomized trial, 48 class sections of a course designed for FYCS received either ECALC or an attention-matched control presentation. ECALC was associated with significant changes on six expectancy subscales of the Comprehensive Effects of Alcohol Scale (CEOA). Structural equation modeling was used to examine the mediated effects of the intervention on alcohol-related harms via alcohol expectancies. There were significant indirect effects from condition to alcohol use (IND = -0.04, p < .001) and alcohol harms (IND = -0.07, p < .001). This model accounted for 54% of the variance in alcohol use and 46% of the variance in alcohol-related harms. These findings suggest ECALC is an effective, single session group-delivered program that can be incorporated into classroom curricula.
... Studie Miller et al.84 ...
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This is an update of our systematic review which we have done in 2011. The new data cover the time frame from 2010 - 2016. 74 studies with youth until the age of 25 years have been included. The programs which have been analyzed were School, college, university and community prevention, family- based , multi-component and emergency room interventions
... Of the remaining 903, 38 were deemed unreliable because they reported over 100 drinks per sitting, gave the same response for every expectancy item, or responded "I don't know" to more than 50% of items. The rates of unreliable responses were comparable to similar prevention/intervention strategies (Brown-Rice et al., 2017;Miller et al., 2016). The final sample consisted of 865 participants. ...
Article
The primary aim of the current study is to determine the incremental efficacy of adding a novel values component to a personalized feedback intervention for young adult drinking. Undergraduate students (N = 254) were randomized to receive either traditional, traditional with values assessment, or values enhanced feedback. Results showed significant decreases in drinks per week (p < .01) and alcohol-related consequences (p < .05) across all feedback conditions. Further research is needed to determine whether using values-based feedback could enhance intervention effects and how best to incorporate feedback in a way that is feasible and acceptable to recipients.
Article
Background Personalized normative alcohol feedback (PNF) is associated with decreased alcohol use among young adults. However, limited research has examined the influence of depressive symptoms on PNF efficacy. This study examined symptoms of depression as a moderator of college student response to a computerized PNF intervention for alcohol use. Methods College students (N = 212, 59% female) who reported drinking in a typical week completed baseline and one-month assessments as part of a previously published intervention trial. We randomized participants to alcohol PNF (n = 153) or assessment only (n = 59). We used regression models to examine the interaction between PNF and symptoms of depression on alcohol outcomes at one-month follow-up. Results One in four participants screened positive for clinically significant symptoms of depression. Depressive symptoms did not moderate intervention effects on drinking quantity. However, PNF was only associated with reduced frequency of heavy episodic drinking and lower probability of any alcohol-related consequence in the context of mild to moderate (not minimal) symptoms of depression. Conclusions PNF is more effective than assessment alone in reducing drinking quantity, regardless of symptoms of depression. However, it may only be more effective in decreasing frequency of heavy episodic drinking and the probability of alcohol-related consequences among those experiencing mild to moderate (as opposed to minimal) symptoms of depression. Alcohol intervention trials should assess symptoms of depression and consider them in data analysis.
Article
Objective: To evaluate the effectiveness and moderators of E-Interventions versus assessment only (AO) controls in the reduction of alcoholic drinks per week (DWP) in university students. Study design and methods: Cochrane library, CINAEL, ERIC, MEDLINE, PsycINFO, PubMed, and Web of Science were searched up to June 2017. Studies were included if they were: an RCT, assessed the effectiveness of E-Interventions at reducing DWP, and employed university/college students. 23 studies (N = 7,614) were included and quality was assessed using the JADAD scale. Results: Weighted mean effect sizes were calculated using random-effects models. These showed a small, significant effect of E-Interventions at reducing the number of alcoholic DWP. Moderator analysis found a significant advantage for web-based personalised feedback interventions compared to other E-Interventions. Conclusions: E-Interventions show a small, significant effect at reducing mean alcoholic DPW. Personalised feedback E-Interventions showed the strongest effect.
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Background Young people’s risky use of alcohol or recreational drugs, such as cannabis, remains a significant public health issue. Many countries have made substantial efforts to minimize the long-term consequences of alcohol and/or cannabis use at multiple levels, ranging from government policy initiatives to primary health care services. In this review, we focused on the effects of brief interventions, provided by electronic devices (computerized brief interventions). A brief intervention is defined as any preventive or therapeutic activity delivered by a health worker, psychologist, social worker, or volunteer worker, and given within a maximum of four structured therapy sessions each lasting between five and ten minutes with a maximum total time of one hour. Brief interventions may work by making the clients think differently about their alcohol/cannabis use, and by providing them with skills to change their behavior if they are motivated to change. A computerized brief intervention, in contrast, is not directly delivered by a human being, but may be delivered through online and offline electronic devices. Such interventions can reach large audiences at a low cost and can simultaneously simulate an ‘interpersonal therapeutic component’ by targeting recipients’ feedback. Objectives To assess the effectiveness of early, computerized brief interventions on alcohol and cannabis use by young people aged 15 to 25 years who are high or risky consumers of either one or both of these substances by synthesizing data from randomized controlled trials. Search methods We searched 11 electronic databases including MEDLINE, PsycINFO, EMBASE, Cinahl and The Cochrane Library in April 2016 for published, unpublished and ongoing studies using adapted subject headings and a comprehensive list of free-text terms. Additionally, we searched the reference lists of the included studies. We also have set up an EBSCO host alert notification (EPAlerts@EPNET.COM) that continuously surveys the Cochrane Library (including CENTRAL), Medline and Embase. We receive updated searches via email. This search is up to date as of May 2016. Selection criteria We included all randomized or quasi-randomized controlled trials of any computerized brief intervention used as a stand-alone treatment aimed at reducing alcohol and/or cannabis consumption. Eligible comparators included no intervention, waiting list control or an alternative brief intervention (computerized or non-computerized). Participants were young people between 15 and 25 years of age who were defined as risky consumers of alcohol or cannabis, or both. Data collection and analysis Two researchers independently screened titles and abstracts against the inclusion criteria. Two researchers independently assessed the full texts of all included articles. We used standard methodological procedures expected by the Campbell Collaboration. Results We included 60 studies that had randomized 33,316 participants in this review. Study characteristics: The studies were mostly from the United States and targeted high and risky alcohol use among university students. Bias/quality assessment: Some of the studies lacked clear descriptions of how the randomization sequence was generated and concealed. Many of the studies did not blind the participants. Some of the studies suffered from high loss to follow-up, and few studies had a pre-registered protocol. Findings: For alcohol, we found moderate quality evidence that multi-dose assessment and feedback was more effective than a single-dose assessment. We found low quality evidence that assessment and feedback might be more effective than no intervention. Assessment and feedback might also be more effective than assessment alone (low quality evidence). Short-term effects (< 6 months) were mostly larger than long-term (≥6 months) effects. For cannabis, we found that assessment and feedback might slightly reduce short-term consumption compared to no intervention. Adding feedback to assessment may have little or no effect on short-term cannabis consumption. Moreover, there may be little or no difference between assessment plus feedback and education on short-term and long-term cannabis consumption. Adverse effects: We did not find evidence of any adverse effects of the interventions. Implications for policy, practice and research Computerized brief interventions are easy to administer, and the evidence from this review indicates that such brief interventions might reduce drinking for several months after the intervention. Additionally, there is no evidence for adverse effects. This means that brief, computerized interventions could be feasible ways of dealing with risky alcohol use among young people. The evidence on cannabis consumption is scarcer, suggesting the need for more research.
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Brief motivational interventions (BMIs) that aim to reduce alcohol use and related problems have been widely implemented in college settings. BMIs share common principles, but vary in specific content. Thus far, the variation in content has not been thoroughly understood in relation to intervention outcomes. The present study addressed this gap by examining variation in breadth of BMI content (i.e., total number of components covered), the extent to which content was personalized to participants, and the interaction between breadth and personalization in relation to treatment outcomes. Data (N = 6,047 participants across 31 separate BMI conditions) came from an integrative data analysis (IDA) study featuring individual-level data from a broad sample of 24 BMI studies of college students. Participants were assessed at baseline and at least 1 follow-up point, conducted up to 12 months postbaseline. Structural equation modeling revealed a significant interaction effect between breadth and personalization of BMI content on alcohol use and related problems at the long-term follow-up (6-12 months) but not at the short-term follow-up (1-3 months). Results indicated that "more is better" for reducing both alcohol use and related problems when BMIs were highly personalized to participants. For less personalized BMIs, coverage of more components was associated with increases in both alcohol use and problems. Findings point to the importance of strategically designing BMIs to maximize their impact on drinking outcomes in college students.
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Previous studies of different methods of testing mediation models have consistently found two anomalous results. The first result is elevated Type I error rates for the bias-corrected and accelerated bias-corrected bootstrap tests not found in nonresampling tests or in resampling tests that did not include a bias correction. This is of special concern as the bias-corrected bootstrap is often recommended and used due to its higher statistical power compared with other tests. The second result is statistical power reaching an asymptote far below 1.0 and in some conditions even declining slightly as the size of the relationship between X and M, a, increased. Two computer simulations were conducted to examine these findings in greater detail. Results from the first simulation found that the increased Type I error rates for the bias-corrected and accelerated bias-corrected bootstrap are a function of an interaction between the size of the individual paths making up the mediated effect and the sample size, such that elevated Type I error rates occur when the sample size is small and the effect size of the nonzero path is medium or larger. Results from the second simulation found that stagnation and decreases in statistical power as a function of the effect size of the a path occurred primarily when the path between M and Y, b, was small. Two empirical mediation examples are provided using data from a steroid prevention and health promotion program aimed at high school football players (Athletes Training and Learning to Avoid Steroids; Goldberg et al., 1996), one to illustrate a possible Type I error for the bias-corrected bootstrap test and a second to illustrate a loss in power related to the size of a. Implications of these findings are discussed.
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Despite major advances and success in finding effective interventions for problematic drinking among college students, personalized feedback interventions (PFIs) continue to include a range of components that vary widely across intervention trials. To facilitate research regarding which feedback components may be most effective, the present research provides preliminary evidence regarding student perceptions of and preferences for different types of feedback components. Undergraduate student drinkers (n = 397, 41% male) rated their affinity for and skepticism of 14 feedback components and identified the feedback components that they most preferred. The majority of students preferred information regarding descriptive normative comparisons and the practical costs of drinking, whereas few reported a desire to learn behavioral strategies to limit risk or didactic information. High-risk drinkers (n = 228) reported lower ratings for all feedback components than did low-risk drinkers, and men (n = 162, 41%) provided significantly lower ratings for all feedback components than did women. This is the first study to document student preferences for the different feedback components included in PFIs. The current study generates hypotheses regarding components that may increase the efficacy of current feedback interventions for high-risk drinking. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
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Aims: To evaluate the effectiveness of a web-based brief alcohol intervention 'What Do You Drink' (WDYD) among heavy drinking students at 1- and 6-month post-intervention. Additionally, it was investigated whether certain subgroups would benefit more than others from the WDYD intervention. Methods: A two-arm parallel group randomized controlled trial was conducted online in the Netherlands in 2010-2011. Inclusion criteria were: (1) being between 18- and 24-year old, (2) reporting heavy drinking in the past 6 months, (3) being motivated to change alcohol consumption, (4) having access to the Internet and (5) giving informed consent. Participants (n = 913) were randomized to the experimental (WDYD intervention) or control condition (no intervention). Measures were heavy drinking, frequency of binge drinking and weekly alcohol consumption. Results: Analyses according to the intention-to-treat principle revealed no significant main intervention effects in reducing the alcohol measures at the follow-up assessments. Secondary analyses revealed that gender, freshmen and fraternity or sorority membership did not moderate the effect of the WDYD intervention at both follow-ups. Readiness to change, problem drinking and carnival participation moderated intervention effects such that contemplators, those with severe symptoms of alcohol abuse or dependence, and those who participated in carnival benefited more than others from the WDYD intervention regarding weekly alcohol consumption at 1-month follow-up. Conclusions: The WDYD intervention was not effective in reducing the alcohol measures among heavy drinking students at 1- and 6-month post-intervention. However, there is preliminary evidence that the WDYD intervention is effective in lowering drinking levels for subgroups of heavy drinking students in the short term.
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Personalized drinking feedback is an evidence-based and increasingly common way of intervening with high-risk college drinking. This article extends an earlier review by Walters and Neighbors (S. T. Walters & C. Neighbors, 2005, Feedback interventions for college alcohol misuse: What, why, and for whom? Addictive Behaviors, 30, 1168-1182) by reviewing the literature of published studies using personalized feedback as an intervention for heavy drinking among college students. This article updates and extends the original review with a more comprehensive and recent set of 41 studies, most of which were not included in the original article. This article also examines within-subject effect sizes for personalized feedback interventions (PFIs) for high-risk alcohol use and examines the content of PFIs more closely to provide insight on the most essential components that will guide the future development of feedback-based interventions. In general, PFIs appear to be reliably effective at reducing harmful alcohol misuse among college students. Some components are almost universally included (i.e., drinking profile and normative comparison), precluding inferences regarding their unique contribution. Significantly larger effect sizes were observed for interventions that included decisional balance, practical costs, and strategies to limit risks. The present research provides an important empirical foundation for determining the relative contribution of individual components and facets in the efficacy of PFIs. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
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This randomized controlled trial evaluated the efficacy of a brief intervention designed to reduce the harmful consequences of heavy drinking among high-risk college students. Students screened for risk while in their senior year of high school (188 women and 160 men) were randomly assigned to receive an individualized motivational brief intervention in their freshman year of college or to a no-treatment control condition. A normative group selected from the entire screening pool provided a natural history comparison. Follow-up assessments over a 2-year period showed significant reductions in both drinking rates and harmful consequences, favoring students receiving the intervention. Although high-risk students continued to experience more alcohol problems than the natural history comparison group over the 2-year period, most showed a decline in problems over time, suggesting a developmental maturational effect. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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This study tested the hypothesis that client choice influences intervention outcomes. We recruited 288 student drinkers (60% men, 67% freshmen) required to participate in an intervention due to a violation of campus alcohol policy. Participants were randomized either to self-chosen or researcher-assigned interventions. In the choice condition they selected either a brief motivational intervention (BMI) or a computer-delivered educational program. In the assigned condition they received 1 of the 2 interventions, assigned randomly. Follow-up assessments at 1 and 2 months revealed that choice was associated with higher intervention satisfaction. However, the assigned and choice conditions did not differentially change on consumption or consequences across intervention type. Overall, change scores favored the BMI over the computer-delivered intervention on consumption and consequences. Exploratory analyses revealed that given the choice of intervention, heavier-drinking students self-selected into the face-to-face BMI. Furthermore, among the students who received a BMI, the students who chose it (despite their heavier drinking) reduced drinks per drinking day more than did the assigned students. In summary, offering a choice of intervention to students mandated for campus alcohol violations increased the chance that at-risk students will select a more intensive and effective intervention. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
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Alcohol consumption is prevalent among college students and can become problematic for some. Numerous randomized controlled trials have evaluated the efficacy of individual preventive interventions in reducing alcohol use and alcohol-related problems in college student populations. Consistent with earlier reviews, the balance of the evidence from studies conducted during the past 3 years strongly supports the efficacy of brief motivational interventions combined with personalized feedback interventions (PFIs) and personalized normative feedback (PNF), as well as of stand-alone PFI/PNF interventions. Recent analyses also continue to support the efficacy of alcohol expectancy challenge interventions, although the findings are less consistent. In addition, recent analyses offer mixed support for feedback-based interventions focused solely on blood alcohol concentration and for multicomponent, alcohol education-focused interventions that include elements of PFI/PNF. No evidence of efficacy was found for programs that only included alcohol education.
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The authors evaluated the efficacy of Brief Alcohol Screening and Intervention for College Students (BASICS: L. A. Dimeff, J. S. Baer, D. R. Kivlahan, & G. A. Marlatt, 1999), a single session of drinking-related feedback intended to reduce heavy drinking and related harm. College student drinkers (N = 99) were assigned to BASICS, an educational intervention, or an assessment-only control group. At 3 months postintervention. there were no overall significant group differences, but heavier drinking BASICS participants showed greater reductions in weekly alcohol consumption and binge drinking than did heavier drinking control and education participants. At 9 months, heavier drinking BASICS participants again showed the largest effect sizes. BASICS participants evaluated the intervention more favorably than did education participants. This study suggests that BASICS may be more efficacious than educational interventions for heavier drinking college students.
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The authors evaluated the efficacy of a computer-delivered personalized normative feedback intervention in reducing alcohol consumption among heavy-drinking college students. Participants included 252 students who were randomly assigned to an intervention or control group following a baseline assessment. Immediately after completing measures of reasons for drinking, perceived norms, and drinking behavior, participants in the intervention condition were provided with computerized information detailing their own drinking behavior, their perceptions of typical student drinking, and actual typical student drinking. Results indicated that normative feedback was effective in changing perceived norms and alcohol consumption at 3- and 6-month follow-up assessments. In addition, the intervention was somewhat more effective at 3-month follow-up among participants who drank more for social reasons.
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In this randomized controlled trial, the authors evaluated brief motivational interventions (BMIs) for at-risk college drinkers. Heavy drinking students (N = 509; 65% women, 35% men) were randomized into 1 of 6 intervention conditions formed by crossing the baseline Timeline Followback (TLFB) interview (present versus absent) and intervention type (basic BMI, BMI enhanced with a decisional balance module, or none). Assessments completed at baseline, 1, 6, and 12 months measured typical and risky drinking as well as drinking-related problems. Relative to controls, the TLFB interview reduced consumption but not problems at 1 month. The basic BMI improved all drinking outcomes beyond the effects of the TLFB interview at 1 month, whereas the enhanced BMI did not. Risk reduction achieved by brief interventions maintained throughout the follow-up year.
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This study evaluated the effectiveness of a web-based personalized normative feedback program, electronic Check-Up to Go (e-CHUG), in decreasing heavy drinking among 1st-year university students. Results indicated high-risk students receiving the e-CHUG program during 1st-year orientation activities reported significantly greater reductions in heavy drinking and alcohol-related consequences than did students in an assessment-only control group at a 3-month follow-up. Recommendations for integrating e-CHUG into orientation activities are discussed.
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Analyzes and clarifies the differences between eta-squared and partial eta-squared in fixed factor analysis of variance (ANOVA) designs. The formulas are presented and discussed, and an example is presented along with the appropriate use and meaning of the 2 coefficients. Finally, a general discussion of the use of eta-squared and partial eta-squared is provided. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Alcohol misuse occurs commonly on college campuses, necessitating prevention programs to help college drinkers reduce consumption and minimize harmful consequences. Computer-delivered interventions (CDIs) have been widely used due to their low cost and ease of dissemination but whether CDIs are efficacious and whether they produce benefits equivalent to face-to-face interventions (FTFIs) remain unclear. Therefore, we identified controlled trials of both CDIs and FTFIs and used meta-analysis (a) to determine the relative efficacy of these two approaches and (b) to test predictors of intervention efficacy. We included studies examining FTFIs (N=5237; 56% female; 87% White) and CDIs (N=32,243; 51% female; 81% White). Independent raters coded participant characteristics, design and methodological features, intervention content, and calculated weighted mean effect sizes using fixed and random-effects models. Analyses indicated that, compared to controls, FTFI participants drank less, drank less frequently, and reported fewer problems at short-term follow-up (d(+)s=0.15-0.19); they continued to consume lower quantities at intermediate (d(+)=0.23) and long-term (d(+)=0.14) follow-ups. Compared to controls, CDI participants reported lower quantities, frequency, and peak intoxication at short-term follow-up (d(+)s=0.13-0.29), but these effects were not maintained. Direct comparisons between FTFI and CDIs were infrequent, but these trials favored the FTFIs on both quantity and problem measures (d(+)s=0.12-0.20). Moderator analyses identified participant and intervention characteristics that influence intervention efficacy. Overall, we conclude that FTFIs provide the most effective and enduring effects.
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Transdermal alcohol sensors continuously collect reliable and valid data on alcohol consumption in vivo over the course of hours to weeks. Transdermal alcohol readings are highly correlated with breath alcohol measurements, but transdermal alcohol levels lag behind breath alcohol levels by one or more hours owing to the longer time required for alcohol to be expelled through perspiration. By providing objective information about alcohol consumption, transdermal alcohol sensors can validate self-report and provide important information not previously available. In this article, we describe the development and evaluation of currently available transdermal alcohol sensors, present the strengths and limitations of the technology, and give examples of recent research using the sensors.
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This study evaluated the efficacy of a web-based personalized normative feedback program targeting heavy drinking in first-year intercollegiate athletes. The program was offered through the Athletic Department first-year seminar at a National Collegiate Athletic Association (NCAA) Division I university. Athletes were randomly assigned to either a web-based feedback group or a comparison condition. Results indicated high-risk athletes receiving the intervention reported significantly greater reductions in heavy drinking than those in the comparison group. Additionally, intervention effects were mediated by changes in perceptions of peer drinking. Findings support the use of web-based normative feedback for reducing heavy drinking in first-year intercollegiate athletes.
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Objective: Behavioral economic theory suggests that a reduction in substance use is most likely when there is an increase in rewarding substance-free activities. The goal of this randomized controlled clinical trial was to evaluate the incremental efficacy of a novel behavioral economic supplement (Substance-Free Activity Session [SFAS]) to a standard alcohol brief motivational interviewing (BMI) session for heavy-drinking college students. Method: Participants were 82 first-year college students (50% female; 81.7% White/European American; M age = 18.5 years, SD = 0.71) who reported 2 or more past-month heavy drinking episodes. After completing a baseline assessment and an individual alcohol-focused BMI, participants were randomized to either the SFAS or to a Relaxation Training (RT) control session. The SFAS was delivered in an MI style and attempted to increase the salience of delayed academic and career rewards and the patterns of behavior leading to those rewards. Results: The combination of an alcohol BMI plus the SFAS was associated with significantly greater reductions in alcohol problems compared with an alcohol BMI plus RT at the 1-month and 6-month follow-up assessments (p = .015, ηp² = .07), an effect that was partially mediated by increases in protective behavioral strategies. BMI + SFAS was also associated with greater reductions in heavy drinking among participants who at baseline reported low levels of substance-free reinforcement or symptoms of depression. Conclusion: These results are consistent with behavioral economic theory and suggest that a single session focused on increasing engagement in alternatives to drinking can enhance the effects of brief alcohol interventions.
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Web-based screening and brief interventions that include personalized feedback about their alcohol use have proven to be particularly promising for reducing hazardous drinking among university students. Despite the increasing use of these approaches, there is still relatively little known about how the content of these interventions may influence outcomes and who may benefit most from these approaches. The current study sought to address these issues by examining how individual differences in alcohol consequences influence outcomes of a laboratory-based computerized intervention. One-hundred and nineteen introductory psychology students who either had two episodes of heavy episodic drinking in the past month or scored ≥8 on the AUDIT participated in this randomized controlled trial for course credit. Participants were assigned to 1 of 4 conditions in this 2 Intervention (Alcohol Feedback vs. Control)×2 Assessment (Motivational Assessment vs. No Motivational Assessment) between-subjects design. Quantity of alcohol consumed per week and heavy episodic drinking one month later were the primary dependent variables. Controlling for corresponding baseline alcohol measures, hierarchical linear regression analyses showed a significant interaction between intervention condition and baseline alcohol-related consequences. For those who reported more alcohol consequences at baseline, the alcohol intervention resulted in significantly less alcohol use and fewer heavy drinking episodes at follow-up, while no difference was observed between intervention conditions for those with few baseline consequences. Assessment did not moderate intervention effects. These findings suggest that a feedback-based computerized intervention that includes normative information about alcohol use and consequences may be more effective for hazardous drinking students who are experiencing higher levels of alcohol-related consequences.
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Objective: Web-based brief alcohol interventions have the potential to reach a large number of individuals at low cost; however, few controlled evaluations have been conducted to date. The present study was designed to evaluate the efficacy of gender-specific versus gender-nonspecific personalized normative feedback (PNF) with single versus biannual administration in a 2-year randomized controlled trial targeting a large sample of heavy-drinking college students. Participants included 818 freshmen (57.6% women; 42% non-Caucasian) who reported 1 or more heavy-drinking episodes in the previous month at baseline. Participants were randomly assigned in a 2 (gender-specific vs. gender-nonspecific PNF) × 2 (single vs. biannual administration of PNF) + 1 (attention control) design. Assessments occurred every 6 months for a 2-year period. Results from hierarchical generalized linear models provided modest effects on weekly drinking and alcohol-related problems but not on heavy episodic drinking. Relative to control, gender-specific biannual PNF was associated with reductions over time in weekly drinking (d = -0.16, 95% CI [-0.02, -0.31]), and this effect was partially mediated by changes in perceived norms. For women, but not men, gender-specific biannual PNF was associated with reductions over time in alcohol-related problems relative to control (d = -0.29, 95% CI [-0.15, -0.58]). Few other effects were evident. The present research provides modest support for the use of biannually administered web-based gender-specific PNF as an alternative to more costly indicated prevention strategies.
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Although heavy episodic drinkers are at risk to experience alcohol-related consequences, studies show that a large percentage of student drinkers do not experience problems as a result of their drinking. The present study was a more in-depth examination of factors beyond just drinking quantity and frequency to explain why students experience consequences. The current research examined the relationship between the use of protective behaviors, alcohol use, and alcohol related consequences, as well as the relationship between attitudinal and cognitive predictors of engaging in protective behaviors when drinking. We hypothesized there would be a significant direct effect of protective behaviors on consequences after taking into account the effect of alcohol use and that cognitive predictors, including perceived self-efficacy, perceived effectiveness, and subjective norm, would be associated with the attitude and frequency of engaging in protective behaviors. Results supported both hypotheses, indicating good model fit for all models and significant paths between constructs (p's<.05). These findings extend the literature on protective behaviors by providing insight as to their utility in preventing harm and why students choose to engage in these behaviors. Implications for interventions are also discussed.
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Motivational interviewing (MI) is a counseling style that has been shown to reduce heavy drinking among college students. To date, all studies of MI among college students have used a format that includes a feedback profile delivered in an MI style. This study was a dismantling trial of MI and feedback among heavy-drinking college students. After an initial screen, 279 heavy-drinking students were randomized to (a) Web feedback only, (b) a single MI session without feedback, (c) a single MI session with feedback, or (d) assessment only. At 6 months, MI with feedback significantly reduced drinking, as compared with assessment only (effect size = .54), MI without feedback (effect size = .63), and feedback alone (effect size = .48). Neither MI alone nor feedback alone differed from assessment only. Neither sex, race or ethnicity, nor baseline severity of drinking moderated the effect of the intervention. Norm perceptions mediated the effect of the intervention on drinking. MI with feedback appears to be a robust intervention for reducing drinking and may be mediated by changes in normative perceptions.
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Individual drinking patterns and the perceived typical drinking patterns of close friends and reference groups were assessed in two different studies with college students. In both studies virtually all students reported that their friends drank more than they did. These effects were found across different levels of individual drinking, within different types of samples, across gender of subjects and with different types of questionnaire assessment. In addition, students' estimates of typical or average drinking within their own social living groups were significantly higher than average drinking within the group estimated from self-reports. Because of the consistent, asymmetrical pattern of reports of self and other drinking, it was interpreted that reports of others' drinking were exaggerated. These biases were particularly evident within organized social groups (i.e., fraternities and sororities) but were minimal in reference to "students in general" or "people in general." Results are discussed in terms of cognitive and motivational factors that potentially could promote or excuse excessive drinking practices among college students.
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Development and validation of a measure of individual differences in social comparison orientation (the Iowa-Netherlands Comparison Orientation Measure [INCOM]) are described. Assuming that the tendency toward social comparison is universal, the scale was constructed so as to be appropriate to and comparable in 2 cultures: American and Dutch. It was then administered to several thousand people in each country. Analyses of these data are presented indicating that the scale has good psychometric properties. In addition, a laboratory study and several field studies are described that demonstrated the INCOM's ability to predict comparison behavior effectively. Possible uses of the scale in basic and applied settings are discussed.
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A self-regulation model for predicting alcohol problem recognition among heavy drinking college students (N = 72) was tested. The effects of both self-focusing and normative information concerning alcohol use were assessed in a 2 (self-focusing information: present, absent) x 2 (normative information: present, absent) factorial design. A significant two-way interaction on both a Decisional Balance Measure (DBM) and the Contemplation subscale of the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) revealed that relative to a control condition, either type of information presented alone increased negative evaluations of drinking and problem recognition, whereas presenting both types of information together had less effect on negative evaluations and even decreased problem recognition. The interaction obtained with DBM scores was further qualified by a three-way interaction that limited this pattern to participants scoring higher on self-deception. The same interactive pattern of self-focusing by normative information on problem recognition approached statistical significance on the Precontemplation subscale. Finally, a thinking-aloud procedure employed to obtain immediate reactions to the presentation of experimental information offered corroborative results, with the joint presentation of self-focusing and normative information triggering the most defensive reactions. Results and their clinical implications are discussed in terms of a self-regulation model for problem recognition.
Article
This study consisted of a randomized controlled trial of a 1-session motivational intervention for college student binge drinkers. Sixty students who reported binge drinking 2 or more times in the past 30 days were randomly assigned to either a no-treatment control or a brief intervention group. The intervention provided students with feedback regarding personal consumption, perceived drinking norms, alcohol-related problems, situations associated with heavy drinking, and alcohol expectancies. At 6-week follow-up, the brief intervention group exhibited significant reductions on number of drinks consumed per week, number of times drinking alcohol in the past month, and frequency of binge drinking in the past month. Estimates of typical student drinking mediated these reductions. This study replicates earlier research on the efficacy of brief interventions with college students and extends previous work regarding potential mechanisms of change.
Article
When a meta-analysis on results from experimental studies is conducted, differences in the study design must be taken into consideration. A method for combining results across independent-groups and repeated measures designs is described, and the conditions under which such an analysis is appropriate are discussed. Combining results across designs requires that (a) all effect sizes be transformed into a common metric, (b) effect sizes from each design estimate the same treatment effect, and (c) meta-analysis procedures use design-specific estimates of sampling variance to reflect the precision of the effect size estimates.
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This study evaluated the relative efficacy of personalized drinking feedback (PDF) delivered with and without a motivational interview (MI) for college student drinkers. Heavy-drinking college students (N = 54; 691% female) were identified from a large screening sample and randomly assigned either to receive PDF during a single MI session or to receive PDF without an MI. Of these participants, 51 (94%) completed a 6-month follow-up assessment that included measures of alcohol consumption and alcohol-related problems. At 6-months postintervention, participants in both groups showed significant, small to moderate reductions in alcohol consumption, but the groups did not differ. Women showed larger reductions than men. Rates of alcohol-related problems remained relatively unchanged. The hypothesis that an MI would enhance the efficacy of PDF was not supported.
Article
Background: College students tend to pour single servings of beer and liquor that are larger than commonly used standards. The reasons for this are unknown. Students might overpour because they lack knowledge of standard serving sizes. Alternatively, they might know how much alcohol to pour but simply have difficulty pouring the correct amounts. Misperceptions of standard serving sizes could lead to inaccuracies in self-reported consumption. If this is the case, then the validity of students' responses on alcohol surveys and the definitions of risky drinking that are based on them would be called into question. This study examined how college students define standard drinks, whether their definitions are similar to the definitions commonly used by alcohol researchers and government agencies, and whether their definitions of standard drinks are related to the sizes of the drinks that they pour. The study also examined whether feedback regarding the accuracy of their definitions of standard drinks leads students to alter their self-reported levels of consumption. Methods: Students (N = 133) completed an alcohol survey and performed tasks that required them to free-pour a single beer, glass of wine, shot of liquor, or the amount of liquor in a mixed drink. Roughly half of the students received feedback regarding their definitions of standard drinks. All students then were resurveyed about their recent levels of consumption. Results: With the exception of beer, students incorrectly defined the volumes of standard servings of alcohol, overestimating the appropriate volumes. They also overestimated appropriate volumes when asked to free-pour drinks. Positive relationships existed between students' definitions of standard drinks and the sizes of the drinks that they free-poured. Feedback regarding misperceptions of standard drink volumes led to an increase in levels of self-reported consumption, suggesting that students' original estimates of their alcohol consumption were too low. Conclusions: Despite the recent focus on alcohol education and prevention at the college level, college students have not been taught how to define standard drinks accurately. They tend to overstate the appropriate volumes, leading them to overpour drinks and underreport levels of consumption. Self-reported consumption levels are altered by feedback regarding the accuracy of students' definitions of standard drinks. The findings raise important questions about the validity of students' responses on alcohol surveys and the definitions of risky drinking that are based them.
Article
Alcohol use by college students is commonly measured through the use of surveys. The validity of such data hinge on the assumption that students are aware of how much alcohol they actually consume. Recent studies call this assumption into question. Students tend to overestimate the appropriate sizes of standard drinks, suggesting that they might underestimate how much alcohol they consume. If this is true, then students' actual blood alcohol concentrations (BACs) should be higher than BACs estimated based on self-report data. The present study examined this issue Breathalyzer readings and self-reported drinking data were collected from 152 college students during the fall of 2004. Estimated BACs were calculated by means of a standard formula, and the relation between actual and estimated BACs was examined. Factors contributing to discrepancies between the two values were identified Estimated BAC levels were significantly higher, not lower, than breath BAC measures. The accuracy of estimated BACs decreased as the number of drinks and amount of time spent drinking increased. Being male and drinking only beer predicted greater accuracy of estimated BACs Although laboratory data suggest that students underestimate how much they drink, the hypothesis was not supported by data collected in the field. It appears that students might actually overestimate rather than underestimate their levels of consumption when surveyed in the midst of a night of drinking. The findings corroborate observations made by other researchers and suggest that the findings of laboratory studies on college drinking do not necessarily extend to real-world settings.
Article
Heavy alcohol use among college students represents a public health problem on American college campuses. A promising area for combating this problem is identifying protective behavioral strategies that may reduce consumption and its resulting negative consequences among students who do choose to use alcohol. The purpose of this study was to develop and conduct initial psychometric analyses on a new scale, which we named the Protective Behavioral Strategies Survey. Data were collected on 437 undergraduate students, who volunteered to participate in the study, at a large, public university in the northeast region of the United States. Results from an exploratory factor analysis yielded three theoretically meaningful factors that we labeled Limiting/Stopping Drinking, Manner of Drinking and Serious Harm Reduction. The three factors were, as a group, significantly associated with both alcohol consumption and alcohol-related problems, but the strongest unique relationship existed between Manner of Drinking and the outcome variables. Protective behavioral strategies seem to be a measurable construct that are related to alcohol consumption and alcohol-related problems, and thus may be a useful component of intervention and prevention programs with college students.
Article
In light of increasing numbers of controlled studies evaluating alcohol abuse prevention interventions for college drinkers, we conducted a meta-analysis to summarize the current status of the literature. The meta-analysis includes 62 studies, published between 1985 to early 2007, with 13750 participants and 98 intervention conditions. All studies were content coded for study descriptors, participant characteristics, and intervention components. We derived weighted mean effect sizes for alcohol interventions versus comparison conditions for consumption variables and alcohol-related problems, over four measurement intervals. Over follow-up intervals lasting up to 6 months, participants in risk reduction interventions drank significantly less relative to controls. Students receiving interventions also reported fewer alcohol-related problems over longer intervals. Moderator analyses suggest that individual, face-to-face interventions using motivational interviewing and personalized normative feedback predict greater reductions in alcohol-related problems. Implications for future research include attention to maintenance of effects, and developing more efficacious interventions for at-risk college drinkers.
Article
This research evaluated the efficacy of a computerized, freshmen-specific personalized normative feedback (PNF) intervention on reducing alcohol consumption among high-risk drinking freshmen. Students (N=316; 53.8% female) completed measures of perceived drinking norms and drinking behavior. After completing the baseline assessment, students were randomly assigned to receive either freshmen-specific PNF that was gender-specific or gender-neutral, or to assessment only control. Findings demonstrated that students exhibited normative misperceptions for typical freshmen drinking behavior and that perceptions of typical same-sex freshmen drinking were positively associated with riskier drinking behavior. At follow-up, students randomly assigned to receive PNF reduced perceptions of typical freshmen drinking behavior and personal drinking behavior relative to those who did not receive PNF. Findings extend previous evaluations of computer-based PNF and suggest that computer-based PNF for incoming freshmen utilizing freshmen-specific norms that are gender-specific may constitute a promising prevention strategy.