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Text Messages Conveying Parent Drinking Limits: A Potential Avenue for Preventing and Reducing Alcohol Use in College Students
Abstract
Objective:
Although previous research has established that students who perceive that their parents have lower drinking limits consume less alcohol, optimal approaches for effectively communicating these limits are less understood. To address this gap in the literature, the present study examined the effects of hypothetical limit-focused text messages on estimated drinking behavior.
Method:
Undergraduate college students (N=253) completed an online survey in which they were instructed to imagine a scenario where they were planning to go out at night to an event involving drinking. Participants were randomly assigned to a condition where they would receive one of four hypothetical text messages from their mother and/or father containing a range of drinking limits. They were then asked to report how much alcohol they would realistically consume on this night if they were and were not obligated to check in with their parent at the end of the night.
Results:
Hypothetical text messages from mothers and fathers containing lower drinking limits resulted in lower estimated alcohol consumption. A drinking limit of zero resulted in the least amount of expected alcohol consumption but specifying 1-2 drinks as a limit might produce a similar effect if parents also required their student to check-in at the end of the night.
Conclusion:
Findings from this study provide initial support for future studies to investigate the effects of limit setting text messages sent from parents on college student drinking, as well as the effects of text messages sent from parents requiring that students check-in.
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The prevalence of non-communicable diseases, such as diabetes and cardiovascular disease, is rising in low- and middle-income countries (LMICs). Health behavior change (HBC) interventions such as the widely used Diabetes Prevention Program (DPP) are effective at reducing chronic disease risk, but have not been adapted for LMICs. Leveraging mobile health (mHealth) technology such as text messaging (SMS) to enhance reach and participant engagement with these interventions has great promise, yet we lack evidence-informed approaches to guide the integration of SMS specifically to support HBC interventions in LMIC contexts. To address this gap, we integrated guidance from the mHealth literature with expertise and first-hand experience to establish specific development steps for building and implementing SMS systems to support HBC programming in LMICs. Specifically, we provide real-world examples of each development step by describing our experience in designing and delivering an SMS system to support a culturally-adapted DPP designed for delivery in South Africa. We outline eight key SMS development steps, including: 1) determining if SMS is appropriate; 2) developing system architecture and programming; 3) developing theory-based messages; 4) developing SMS technology; 5) addressing international SMS delivery; 6) testing; 7) system training and technical support; and 8) cost considerations. We discuss lessons learned and extractable principles that may be of use to other mHealth and HBC researchers working in similar LMIC contexts.
Trial registration Clinicaltrials.gov, NCT03342274. Registered 10 November 2017.
In emerging adulthood, when many young people are away from their families for the first time, mobile phones become an important conduit for maintaining relationships with parents. Yet, objective assessment of the content and frequency of text messaging between emerging adults and their parents is lacking in much of the research to date. We collected two weeks of text messages exchanged between U.S. college students (N = 238) and their parents, which yielded nearly 30,000 parent-emerging adult text messages. We coded these text message exchanges for traditional features of parent-emerging adult communication indexing positive connection, monitoring and disclosures. Emerging adults texted more with mothers than with fathers and many messages constitute parental check-ins and emerging adult sharing regarding youth behavior and well-being. Findings highlight that both the frequency and content of parent-emerging adult text messages can be linked with positive (perceived text message support) and negative (perceived digital pressure) aspects of the parent-emerging adult relationship. The content of parent-emerging adult text messages offers a valuable, objective window into the nature of the parent-emerging adult relationships in the digital age of the 21st century.
Background
With the growing interest in mobile health (mHealth), behavioral medicine researchers are increasingly conducting intervention studies that use mobile technology (eg, to support healthy behavior change). Such studies’ scientific premises are often sound, yet there is a dearth of implementational data on which to base mHealth research methodologies. Notably, mHealth approaches must be designed to be acceptable to research participants to support meaningful engagement, but little empirical data about design factors influencing acceptability in such studies exist.
Objective
This study aims to evaluate the impact of two common design factors in mHealth intervention research—requiring multiple devices (eg, a study smartphone and wrist sensor) relative to requiring a single device and providing individually tailored feedback as opposed to generic content—on reported participant acceptability.
Methods
A diverse US adult convenience sample (female: 104/255, 40.8%; White: 208/255, 81.6%; aged 18-74 years) was recruited to complete a web-based experiment. A 2×2 factorial design (number of devices×nature of feedback) was used. A learning module explaining the necessary concepts (eg, behavior change interventions, acceptability, and tailored content) was presented, followed by four vignettes (representing each factorial cell) that were presented to participants in a random order. The vignettes each described a hypothetical mHealth intervention study featuring different combinations of the two design factors (requiring a single device vs multiple devices and providing tailored vs generic content). Participants rated acceptability dimensions (interest, benefit, enjoyment, utility, confidence, difficulty, and overall likelihood of participating) for each study presented.
Results
Reported interest, benefit, enjoyment, confidence in completing study requirements, and perceived utility were each significantly higher for studies featuring tailored (vs generic) content, and the overall estimate of the likelihood of participation was significantly higher. Ratings of interest, benefit, and perceived utility were significantly higher for studies requiring multiple devices (vs a single device); however, multiple device studies also had significantly lower ratings of confidence in completing study requirements, and participation was seen as more difficult and was associated with a lower estimated likelihood of participation. The two factors did not exhibit any evidence of statistical interactions in any of the outcomes tested.
Conclusions
The results suggest that potential research participants are sensitive to mHealth design factors. These mHealth intervention design factors may be important for initial perceptions of acceptability (in research or clinical settings). This, in turn, may be associated with participant (eg, self) selection processes, differential compliance with study or treatment processes, or retention over time.
With widespread concern for increased alcohol use during the COVID-19 pandemic, there is a pressing need to examine changes in young adults’ alcohol use and to identify antecedents of increased use. We tested the hypothesis that self-reported changes in alcohol use during the pandemic (frequency, quantity, heavy episodic drinking) would relate to perceptions of peers’ changes in alcohol use. In April of 2020, 507 college students self-reported changes in their alcohol use and perceived changes in use for typical students at their university (i.e., norms). Most students in our sample reported decreased alcohol use and perceived decreases in peers’ alcohol use. Perceptions of peers’ changes in alcohol use behavior strongly related to changes in students’ own alcohol use. Findings provide strong support for norms-based strategies that can correct normative misperceptions by highlighting the fact that most college students are not in fact engaging in heavier alcohol use during the COVID-19 pandemic.
Background
Studies have shown that parents have a significant influence on emerging adult college students’ drinking during the first year of college. Limited research has been conducted to address the question of whether parenting later in college continues to matter in a similar manner. The current study utilized a prospective design to identify associations between parental permissiveness toward alcohol use and monitoring behaviors and student drinking outcomes during the first and fourth years of college.
Methods
Participants (N = 1,429) at 3 large public universities completed surveys during the fall semesters of their first (T1) and fourth years (T2) (84.3% retention). The study employed a saturated autoregressive cross‐lag model to examine associations between parental permissiveness of college student alcohol use, parental monitoring, student drinking, and consequences at T1 and T2, controlling for peer norms, sex, and campus.
Results
Examination of the association between parenting and student drinking outcomes revealed: (i) parental permissiveness was positively associated with drinking at T1 and again at T2; (ii) parental permissiveness had indirect effects on consequences via the effects on drinking at both times. Specifically, a 1‐unit increase in parental permissiveness at T1 resulted in students experiencing 4 to 5 more consequences as a result of their drinking; (iii) parental permissiveness was not directly associated with monitoring at T1 or T2; and (iv) parental monitoring was significantly associated with drinking at T1 but not T2.
Conclusions
The findings provide evidence for the continued importance of parenting in the fourth year of college and parents expressing low permissiveness toward student drinking may be beneficial to reducing risky drinking even as students turn 21.
Recruiting pregnant smokers into clinical trials is challenging since this population tends to be disadvantaged, the behavior is stigmatized, and the intervention window is limited. The purpose of this study is to test the feasibility and effectiveness of recruiting pregnant smokers into a smoking cessation trial by sending recruitment text messages to an existing subscriber list. Recruitment messages were sent to subscribers flagged as pregnant in Text4baby, a national text messaging program for pregnant women and mothers. Four recruitment messages were rotated to test the effectiveness of different emotional frames and a financial incentive. Study staff called subscribers who expressed interest to screen for eligibility and enroll eligible women. Between October 6, 2015 and February 2, 2016, 10,194 recruitment messages were sent to Text4baby subscribers flagged as pregnant, and 10.18% (1038) responded indicating interest. No significant increase in cancellation was observed compared to subscribers who received other ad hoc messages. Of respondents, 54.05% (561) were reached by phone for follow-up, and 21.97% (228) were found to be eligible. Among the eligible, 87% (199) pregnant smokers enrolled. The recruitment message with a pride emotional appeal had a significantly higher response (p = 0.02) compared to the recruitment message with no emotional appeal, but enrollment did not significantly differ between recruitment messages with different emotional appeals. The recruitment messages with a reference to financial incentive yielded higher response (p < 0.01) and enrollment (p = 0.03) compared to a recruitment message without. This study demonstrates success recruiting pregnant smokers using text message. Future studies should consider building on this approach for recruiting high-risk populations.
Objectives
We compared the effectiveness of diabetes-focused messaging strategies at increasing enrolment in a healthy food programme among adults with diabetes.
Methods
Vitality is a multifaceted wellness benefit available to members of Discovery Health, a South Africa-based health insurer. One of the largest Vitality programmes is HealthyFood (HF), an incentive-based programme designed to encourage healthier diets by providing up to 25% cashback on healthy food purchases. We randomised adults with type 2 diabetes to 1 of 5 arms: (1) control, (2) a diabetes-specific message, (3) a message with a recommendation of HF written from the perspective of a HF member with diabetes, (4) a message containing a physician's recommendation of HF, or (5) the diabetes-specific message from arm 2 paired with an ‘enhanced active choice’(EAC). In an EAC, readers are asked to make an immediate choice (in this case, to enrol or not enrol); the pros and cons associated with the preferred and non-preferred options are highlighted. HF enrolment was assessed 1 month following the first emailed message.
Results
We randomised 3906 members. After excluding those who enrolled in HF or departed from the Vitality programme before the first intervention email, 3665 (94%) were included in a modified intent-to-treat analysis. All 4 experimental arms had significantly higher HF enrolment rates compared with control (p<0.0001 for all comparisons). When comparing experimental arms, the diabetes-specific message with the EAC had a significantly higher enrolment rate (12.6%) than the diabetes-specific message alone (7.6%, p=0.0016).
Conclusions
Messages focused on diabetes were effective at increasing enrolment in a healthy food programme. The addition of a framed active choice to a message significantly raised enrolment rates in this population. These findings suggest that simple, low-cost interventions can enhance enrolment in health promoting programmes and also be pragmatically tested within those programmes.
Trial registration number
NCT02462057.
A randomized controlled trial tested an interactive normative feedback-based intervention—codenamed“FITSTART”—delivered to groups of 50–100 parents of matriculating college students. The 60-minsession motivated parents to alter their alcohol-related communication by correcting normative misperceptions
(e.g., about how approving other parents are of student drinking) with live-generated data. Then,tips were provided on discussing drinking effectively. Incoming students (N � 331; 62.2% female)completed baseline measures prior to new-student orientation. Next, at parent orientation in June, thesestudents’ parents were assigned to either FITSTART or a control session. Finally, 4 months later, students
completed a follow-up survey. Results revealed that students whose parents received FITSTART duringthe summer consumed less alcohol and were less likely to engage in heavy episodic drinking (HED)
during the first month of college. These effects were mediated by FITSTART students’ lower perceptionsof their parents’ approval of alcohol consumption. Further, FITSTART students who were not drinkersin high school were less likely to initiate drinking and to start experiencing negative consequences duringthe first month of college, where FITSTART students who had been drinkers in high school experiencedfewer consequences overall and were significantly more likely to report that they did not experience anyconsequences whatsoever during the first month of college. Importantly, FITSTART is the first parentbasedintervention to impact HED, one of the most well-studied indicators of risky drinking. Thus, interactive group normative feedback with parents is a promising approach for reducing college alcohol risk.
Keywords: parent-based intervention, alcohol, college, normative feedback
Drinking identity-how much individuals view themselves as drinkers-is a promising cognitive factor that predicts problem drinking. Implicit and explicit measures of drinking identity have been developed (the former assesses more reflexive/automatic cognitive processes; the latter more reflective/controlled cognitive processes): each predicts unique variance in alcohol consumption and problems. However, implicit and explicit identity's utility and uniqueness as predictors relative to cognitive factors important for problem drinking screening and intervention has not been evaluated. Thus, the current study evaluated implicit and explicit drinking identity as predictors of consumption and problems over time. Baseline measures of drinking identity, social norms, alcohol expectancies, and drinking motives were evaluated as predictors of consumption and problems (evaluated every 3 months over 2 academic years) in a sample of 506 students (57% female) in their first or second year of college. Results found that baseline identity measures predicted unique variance in consumption and problems over time. Further, when compared to each set of cognitive factors, the identity measures predicted unique variance in consumption and problems over time. Findings were more robust for explicit versus implicit identity and in models that did not control for baseline drinking. Drinking identity appears to be a unique predictor of problem drinking relative to social norms, alcohol expectancies, and drinking motives. Intervention and theory could benefit from including and considering drinking identity. (PsycINFO Database Record
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.
To enhance prevention efforts to reduce college drinking, parents have been identified as an important source of influence that can be modified with brief interventions. Research suggests parental permissiveness toward drinking in adolescence is positively related to college student drinking, though existing studies have not comprehensively accounted for potential confounders (e.g., parental drinking). The present study used propensity modeling to estimate the effects of pre-college parental permissiveness on college student drinking and consequences while accounting for an inclusive range of confounders. A random sample of 1,518 incoming students at a large university completed baseline measures of parental permissiveness and a list of confounders (e.g., parental drinking, family history). At follow-up 15 months later, participants reported on their drinking and alcohol-related consequences. To control for potential confounders, individuals were weighted based on their propensity scores to obtain less biased estimates of the effects of parental permissiveness on drinking and consequences. Analyses revealed parental permissiveness was consistently and positively associated with college drinking and consequences when the confounders were not accounted for, but these effects were attenuated after weighting. Parents' allowance of drinking was not related to college drinking or consequences after weighting. Students' perceived parental limits for consumption were related to drinking and consequences in the weighted models. Prevention efforts may benefit from targeting parents' communication of acceptable limits for alcohol consumption.
This study examined the extent to which profiles of perceived parenting are associated with trajectories of alcohol-related behaviors across the first year of college. Participants were surveyed five times from the summer before college to the fall of the second year. A total 285 college students were enrolled from the incoming classes of consecutive cohorts of students at a large, public university in the Northeastern United States. At baseline, participants provided information on their parents' alcohol-related behaviors (e.g., parental modeling of use; perceived approval of underage use) and parenting characteristics (e.g., parental monitoring; parent-child relationship quality). Students also reported on their personal alcohol-related behaviors at each time point. Latent profile analysis was used to identify four subgroups based on the set of parenting characteristics: High Quality (14%) - highest parent-teen relationship quality; High Monitoring (31%) - highest parental monitoring and knowledge; Low Involvement (30%) - poor relationship quality, little monitoring and communication; and Pro-Alcohol (21%) - highest parental modeling and approval. Students were then assigned to profiles, and their alcohol-related behaviors were examined longitudinally using latent growth curve modeling. In general, students in the Pro-Alcohol profile displayed the highest baseline levels of typical weekend drinking, heavy episodic drinking, and peak blood alcohol content, in addition to showing steeper increases in typical weekend drinking across the first year of college. Results support the notion that parental behaviors remain relevant across the first year of college. Differential alcohol-related behaviors across parenting profiles highlight the potential for tailored college intervention. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
Recent efforts to reduce college student heavy episodic drinking have examined parental influences, with the goal of continually refining parent-based interventions (PBIs). This research has primarily relied on student-reported data, which is often cited as a methodological limitation although the degree to which parent- and student-reported data on parenting behaviors correspond is unknown. The goals of the present study were to assess the level of consistency between parent- and student-reported data for commonly examined parenting constructs and compare their associations with college student drinking. Data were collected from a sample of 145 parent-student dyads using a longitudinal design. At baseline, parents and students reported on parental monitoring, approval of light and moderate/heavy drinking, and permissiveness. At a 10-month follow up, students reported on their typical weekly drinking and consequences. Parents' and students' reports of parenting behavior at baseline were compared and their associations with student drinking and consequences at follow up were assessed. Agreement between parents' and students' reports of parenting was fair to moderate, with intraclass correlation coefficients ranging from .34 to .61. Student-reported data were more reliably associated with student drinking at follow up. Studies examining parent influences on college student drinking, including research on PBIs, do not appear to be limited by using student-reported data. Implications for future research are discussed.
There is an imperative to predict hazardous drinking among college students. Implicit measures have been useful in predicting unique variance in drinking and alcohol-related problems. However, they have been developed to test different theories of drinking and have rarely been directly compared with one another. Thus, their comparative utility is unclear. The current study examined five alcohol-related variants of the Implicit Association Test (IAT) in a sample of 300 undergraduates and sought to establish their predictive validity. Results indicated that the Drinking Identity IAT, which measured associations of "drinker" with "me," was the most consistent predictor of alcohol consumption, alcohol problems, and alcohol cravings. It also had the highest internal consistency and test-retest reliability scores. The results for the Alcohol Excitement and Alcohol Approach IATs were also promising, but their psychometric properties were less consistent. Although the two IATs were positively correlated with all of the drinking outcome variables, they did not consistently predict unique variance in those variables after controlling for explicit measures. They also had relatively lower internal consistencies and test-retest reliabilities. Ultimately, results suggested that implicit drinking identity may be a useful tool for predicting alcohol consumption, problems, and cravings and a potential target for prevention and intervention efforts. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
This prospective study used a conceptually based risk and protective framework to investigate whether parental influences exert a protective effect on the robust association between peer influences and college alcohol involvement. Participants were incoming freshmen in the control condition of a randomized clinical trial, N = 256, 57.0% female, baseline age: M = 18.36 years (SD = 0.41). Participants completed telephone surveys in the summer before matriculation (baseline) and in the spring of the freshman (10-month) and sophomore years (22-month) with 85.6% retention at 22-months. Latent growth models were estimated for heavy episodic drinking and alcohol-related consequences. Descriptive norms and social modeling among peers were positively associated with initial heavy drinking and consequences; parental drinking permissiveness was positively associated with initial heavy drinking. Greater social modeling among peers was associated with less growth in consequences. Parental monitoring was not significantly associated with alcohol involvement. Prematriculation social modeling exhibited a weaker positive association with initial heavy drinking and consequences at low prematriculation parental drinking permissiveness compared to high. Similarly, prematriculation descriptive norms exhibited a weaker positive association with initial heavy drinking at low prematriculation parental drinking permissiveness compared to high. Prematriculation descriptive norms were not significantly associated with growth in heavy drinking at low parental drinking permissiveness; in contrast, higher prematriculation descriptive norms were associated with less growth in heavy drinking at high parental drinking permissiveness. Findings provide support for a protective parental influence on peer-alcohol relations extending into college. Parental drinking permissiveness may be an important target for parent-based interventions.
We hypothesized that etiologically relevant parental, peer, and demographic variables would predict both the transition into alcohol use and consequences and the increase in intensity of these outcomes from prematriculation to the sophomore year of college.
College students (N = 388) at a midsized northeastern public university were assessed during the summer before matriculation and during the spring semesters of their freshman and sophomore years. A recently developed mixed model for analyzing longitudinal response patterns with predominating zeros was employed to examine categorical transitions (binary portion) and growth (intensity portion).
As expected, there were strong effects of time reflected in both the binary and intensity portions of the models across the three outcomes (weekly alcohol use, heavy episodic drinking, and alcohol-related problems). Parental permissiveness of drinking and student intention to affiliate with fraternity/sorority organizations predicted the transition to use and consequence status for all three outcomes and for increases in alcohol use and consequences. Peer disapproval of drinking strongly predicted all alcohol use and consequence outcomes. Parental disapproval of heavy drinking, parental monitoring, and male gender were variably influential across the outcomes at low to moderate levels.
Our findings indicate the importance of the parental context (e.g., parental permissiveness of drinking) as well as peer influences (e.g., intended fraternity/sorority involvement) in drinking behavior among college students. These findings underscore the need to examine both onset and growth of drinking outcomes. Intervention and prevention implications are explored.
Parental monitoring has been conceptualized as tracking and surveillance but operationalized as knowledge of daily activities. This study tested the tracking and surveillance explanation of why parental knowledge is linked to better adolescent adjustment. Participants were 1,186 14-year-olds in central Sweden and their parents. The results supported and extended a reinterpretation of parental monitoring (H. Stattin & M. Kerr, in press). Across sex and informant, high parental knowledge was linked to multiple measures of good adjustment. But children's spontaneous disclosure of information explained more of these relations than parents' tracking and surveillance efforts did. Parents' control efforts were related to good adjustment only after the child's feelings of being controlled, which were linked to poor adjustment, were partialed out. The findings suggest that parents' tracking and surveillance efforts are not as effective as previously thought.
Peer pressure is consistently implicated in the excessive drinking of college students. However, both theory and empirical findings suggest that peer pressure is a combination of three distinct influences: overt offers of alcohol, modeling, and social norms. Overt offers of alcohol can range from polite gestures to intense goading or commands to drink. Modeling occurs when the student's behavior corresponds to another student's concurrent drinking behavior. Perceived social norms can serve to make excessive alcohol use appear common and acceptable to the student. This review critically examines the literature on each form of peer influence and provides suggestions for future research.
This study investigated the influences of peer and parent variables on alcohol use and problems in a sample of late adolescents in the summer immediately prior to entry into college. Participants (N = 556) completed a mail survey assessing peer influences (alcohol offers, social modeling, perceived norms), parental behaviors (nurturance, monitoring), and attitudes and values (disapproval for heavy drinking, permissiveness for drinking), and alcohol use and alcohol-related consequences. Hierarchical regression analyses indicated significant associations between both peer and parental influences and alcohol involvement, and showed that parental influences moderated peer-influence-drinking behavior, such that higher levels of perceived parental involvement were associated with weaker relations between peer influences and alcohol use and problems. These findings suggest that parents continue to exert an influential role in late adolescent drinking behavior.
The authors explored the predictive influence of both parental attachment and parental control on early onset of alcohol consumption in adolescence by use of a longitudinal sample of 1,012 young adolescents. Whether the relationship between parental control and adolescents' drinking is moderated by parental attachment was also examined. Consistent with other studies, attachment and strict control were cross-sectionally related to adolescents' alcohol use at all 3 measurements. However, the longitudinal results of structural equation modeling analyses suggest that a good attachment relationship between parent and child does not prevent adolescents from drinking. In addition, strict control was related to lower engagement in alcohol use. Furthermore, with regard to the moderating effect, parental attachment did not moderate longitudinally the association between parental control and an early development of alcohol use. Implications for further research are discussed.
Objective: This study evaluated FITSTART+, a parent-based intervention (PBI), for preventing risky drinking among first-year college students. Participants: Participants were traditional first-year students aged between 17 and 20. Method: In total, 391 eligible students completed a baseline survey and their parents were then invited to use the FITSTART+ PBI or Control web-applications. 266 students had a parent who created a profile in the app (FITSTART+ PBI, n = 134; FITSTART+ Control, n = 132). Additionally, 58 parents randomized to the FITSTART+ PBI did not complete the personalized normative feedback (PNF) component of the intervention. Results: No significant effect on drinking or related consequences was detected between Intervention and Control groups. However, exploratory analyses revealed that completing PNF in the FITSTART+ PBI condition was associated with a greater likelihood of remaining zero on consequences at follow-ups. Conclusion: The PNF component of the FITSTART+ PBI showed potential in preventing risky drinking, warranting further research.
Objective:
We examined (a) whether changes in parent-student phone call and text messaging communication during the transition into college are associated with alcohol use and related consequences, and (b) whether pre-matriculation drinking patterns predicted these changes in parent-student communication.
Method:
First-year students (N=246; Mage=17.91, SDage=0.39; 61.8% female) participated in a longitudinal survey study as a part of a larger study. Prior to matriculation (T0), participants reported their drinking and whether they experienced alcohol consequences in the past 30 days. Approximately one month into their first semester (T1), participants reported if the frequency of their calling and texting their parents had decreased, remained the same, or increased since the start of college. Drinking and consequences were then reassessed four months later (T2). Analytic models evaluated (a) whether a decrease in calling and texting parents, as reported by students (compared to an increase or no change), predicted drinking outcomes, and (b) whether pre-college drinking (compared to non-drinking) predicted changes in communication.
Results:
Changes in phone calls and texting with mothers and fathers during the first month of college predicted alcohol use and consequences into the second semester. Additionally, heavy drinking predicted lower odds of texting frequency with mothers staying the same or increasing.
Conclusion:
This study underscores that consistent call or text communication with students upon their transition into college could serve as a protective factor against alcohol risk. By closely monitoring such communication, parents may be better equipped to identify potential signs of risky drinking behavior in their first-year students.
Objective:
Whether college students' reports of their parents' behaviors are as reliable a predictor of student drinking as their parents' own reports remains an open question and a point of contention in the literature. To address this, the current study examined concordance between college student and mother/father reports of the same parenting behaviors relevant to parent-based college drinking interventions (relationship quality, monitoring, and permissiveness), and the extent to which student and parent reports differed in their relation to college drinking and consequences.
Method:
The sample consisted of 1,429 students and 1,761 parents recruited from three large public universities in the United States (814 mother-daughter, 563 mother-son, 233 father-daughter, and 151 father-son dyads). Students and their parents were each invited to complete four surveys over the course of the students' first four years of college (one survey per year).
Results:
Paired samples t-tests revealed that parent reports of parenting constructs were typically more conservative than student reports. Intraclass correlations revealed moderate associations between parent and student reports on quality of parenting, general monitoring, and permissiveness. The associations between parenting constructs and drinking and consequences were also consistent when using parent and student reports of permissiveness. Results were generally consistent for all four types of dyads, and at each of the four time points.
Conclusions:
Taken together, these findings provide additional support for the use of student reports of parental behaviors as a valid proxy of parents' actual reports and as a reliable predictor of college student drinking and consequences.
The present study tracked adolescents via mobile phones to describe how parents and their adolescent children are using digital technologies in daily life (i.e. facilitating warmth and behavioral control), and whether these uses are associated with the quality of offline parent-adolescent interactions and with adolescents’ mental health. A sample of young adolescents (N = 388; mean age 13.37) completed a 14-day ecological momentary assessment in 2016- 2017, reporting on their daily digital contact and offline interactions with their parents and their mental health. Adolescents reported using texting and calling to communicate somewhat infrequently with their parents (i.e., on 29% of days), but days with more digital contacts (for both warmth and behavioral control) were also more likely to be characterized by more positive offline interactions with parents. Furthermore, adolescents struggling with mental health symptoms across the study period reported using texts/calls more frequently to seek out parent support, and parents were more likely to do text/call “check ins” on young people who were experiencing more behavioral problems. Results highlight the potential for digital communication devices to be used as tools in fostering parent-adolescent connection, support provision, and behavioral control in the digital era.
Objective
A real-world, randomized study assessing the impact of a new, personalized, pharmacist-led text messaging service for managing type 2 diabetes (T2D).
Methods
Messages were tailored to patient’s needs based on their disease management habits, propensity for reactance, and physical activity levels at baseline. Treatment adherence (assed using the Morisky Medication Adherence Scale, MMAS-8, questionnaire), clinical factors (body mass index and physical activity) and biological markers for T2D were compared between patients who received a text message daily for 3 months in addition to standard care (SMS group) and those who received standard care alone (control group).
Results
114 pharmacies recruited 499 patients. Greater increases in global MMAS-8 scores were observed after 3 months for the SMS group than for the control group, however, this improvement was not sustained after the text messages stopped. Body mass index was found to improve with the text messaging service.
Conclusion
This study indicated that personalized text messages provided by community pharmacists can have an impact on adherence levels among T2D patients.
Practice Implications
Pharmacy-led innovations, such as text messaging services, could be used to accompany patients in their treatment and to improve patient understanding of their illness between healthcare appointments.
Mobile technology has created the opportunity for health systems to provide low cost tobacco cessation assistance to patients. The goal of the present study was to examine the feasibility and effectiveness of an intervention (Text2Connect) that uses text messages to offer proactive connection to the New York State Smokers' Quitline. The electronic health record at two urban health systems was queried for patients who were current smokers and who had an outpatient visit between March 2015 and February 2016. Smokers (N = 4000) were sent an informational letter. Those who did not opt out (N = 3719) were randomized to one of 6 message sequences in order to examine the effect of theoretically informed message frames on response rates. Participants were sent a series of text messages at baseline and at 1 month and were asked to reply in order to be contacted by the state quitline (QL). After removing 1403 nonworking numbers, texts were sent to 2316 patients, and 10.0% (205/2060) responded with a QL request. Almost one quarter (23.6%, 486/2060) replied STOP and 66.4% (1369/2060) never responded. QL request rates were significantly higher when response efficacy messages were not used (p < .001). There were no differences by message framing on STOP requests (p > .05). The Text2Connect intervention was well accepted with a minority opting out. A 10% QL response rate is noteworthy given that only 5-7 brief outreach text messages were used. Results indicate that simple self-efficacy-focused messaging is most effective at supporting response rates.
Past cross-sectional research suggests that zero-tolerance messaging by parents of college students may be more effective than harm-reduction communication at reducing student alcohol risk. The current study employs longitudinal data to examine whether communication type interacts with student alcohol use to predict subsequent drinking outcomes. U.S. college students reported on their own exposure to zero-tolerance and harm-reduction maternal communication. Approximately seven months later, students completed measures of maternal alcohol approval and their own alcohol behaviors. The relationship between communication and subsequent alcohol behaviors depended on students’ baseline drinking. For heavy drinkers, harm-reduction communication was associated with less alcohol use and consequences. For those who drank less than two drinks a week, zero-tolerance communication was associated with fewer negative consequences. Zero-tolerance communication was associated with perceiving mothers as less approving, while harm reduction communication was associated with perceiving mothers as more approving. There were indirect effects of communication on drinking through perceived maternal approval. While overall harm-reduction communication may lead students to perceive mothers as more approving of alcohol use, there may be contexts in which this type of communication is beneficial.
College students who perceive their parents to hold permissive views about their alcohol use engage in heavier drinking. However, few studies have assessed perceived parental permissibility of alcohol use (PPP) longitudinally across the later college years, and few have assessed variation in changes in PPP and whether or not these changes differentially predict drinking. This study assessed whether PPP changed across college and used two approaches to determine whether PPP predicted binge drinking frequency and peak drinking. Data on college students' daily lives and risk behaviors were collected from 687 students (51% female) in a large university in the Northeast United States over four years. Perceived parental permissibility of alcohol use increased from the last year of high school through the third year of college with males reporting significantly higher PPP by the third year of college. From 12th grade through the third year of college, between-person differences in mean PPP were positively associated with binge drinking frequency and peak drinking, and patterns of PPP change differentially predicted both drinking outcomes through fourth year. These findings suggest that PPP is a dynamic construct that may evidence important developmental changes across college and the transition to adulthood. More broadly, the results indicate that aspects of the parent-child relationship continue to change after high school and may be important as they are linked with college student risk behaviors.
This meta-analysis investigated the efficacy of text messaging-based health promotion interventions. Nineteen randomized controlled trials conducted in 13 countries met inclusion criteria and were coded on a variety of participant, intervention, and methodological moderators. Meta-analytic procedures were used to compute and aggregate effect sizes. The overall weighted mean effect size representing the impact of these interventions on health outcomes was d = .329 (95% CI = .274, .385; p < .001). This effect size was statistically heterogeneous (Q18 = 55.60, p < .001, I(2) = 67.62), and several variables significantly moderated the effects of interventions. Smoking cessation and physical activity interventions were more successful than interventions targeting other health outcomes. Message tailoring and personalization were significantly associated with greater intervention efficacy. No significant differences were found between text-only interventions and interventions that included texting plus other components. Interventions that used an individualized or decreasing frequency of messages over the course of the intervention were more successful than interventions that used a fixed message frequency. We discuss implications of these results for health promotion interventions that use text messaging.
This study evaluated the effectiveness of a parent based intervention (PBI) in reducing drinking among first year college students (N=443). Students were assigned to one of three conditions: PBI, PBI plus booster brochures (PBI-B), and an assessment only control group (CNT). At a 4-month post-intervention follow-up, results indicated students in the PBI-B group reported significantly less drinking to intoxication and peak drinking relative to the PBI group and CNT group. No significant differences were found between the PBI group and CNT group. Results provide further support for PBIs to reduce college student drinking and suggest that a booster brochure increases the effectiveness of PBIs.
Mobile phone text messaging is a potentially powerful tool for behavior change because it is widely available, inexpensive,
and instant. This systematic review provides an overview of behavior change interventions for disease management and prevention
delivered through text messaging. Evidence on behavior change and clinical outcomes was compiled from randomized or quasi-experimental
controlled trials of text message interventions published in peer-reviewed journals by June 2009. Only those interventions
using text message as the primary mode of communication were included. Study quality was assessed by using a standardized
measure. Seventeen articles representing 12 studies (5 disease prevention and 7 disease management) were included. Intervention
length ranged from 3 months to 12 months, none had long-term follow-up, and message frequency varied. Of 9 sufficiently powered
studies, 8 found evidence to support text messaging as a tool for behavior change. Effects exist across age, minority status,
and nationality. Nine countries are represented in this review, but it is problematic that only one is a developing country,
given potential benefits of such a widely accessible, relatively inexpensive tool for health behavior change. Methodological
issues and gaps in the literature are highlighted, and recommendations for future studies are provided.
The purpose of this study was to investigate gender-specific variations in the associations between communication with father and mother, cigarette smoking, alcohol drinking and marijuana use in male and female adolescents. Cross-sectional data were collected from a national sample of 1308 tenth graders who participated in the 2005/06 U.S. HBSC. Outcome variables were self-reported substances used in the past 30 days. Logistic regression analyses controlling for race/ethnicity, family structure and socioeconomic status showed that the association of mother and father communication with adolescent substance use varied by substance and gender. Among sons, father communication was protective against marijuana use and mother communication was protective against smoking. Neither father nor mother communication was protective against substance use by daughters. Research is needed to understand gender-specific differences in correlates of adolescent substance use and the implications for prevention and intervention.
This study examined the impact of parental modeled behavior and permissibility of alcohol use in late high school on the alcohol use and experienced negative drinking consequences of college students. Two-hundred ninety college freshmen at a large university were assessed for perceptions of their parents' permissibility of alcohol use, parents' alcohol-related behavior, and own experienced negative consequences associated with alcohol use. Results indicate that parental permissibility of alcohol use is a consistent predictor of teen drinking behaviors, which was strongly associated with experienced negative consequences. Parental modeled use of alcohol was also found to be a risk factor, with significant differences being seen across the gender of the parents and teens. Discussion focuses on risk factors and avenues for prevention research.
Monitoring (tracking and surveillance) of children's behavior is considered an essential parenting skill. Numerous studies show that well-monitored youths are less involved in delinquency and other normbreaking behaviors, and scholars conclude that parents should track their children more carefully. This study questions that conclusion. We point out that monitoring measures typically assess parents' knowledge but not its source, and parents could get knowledge from their children's free disclosure of information as well as their own active surveillance efforts. In our study of 703 14-year-olds in central Sweden and their parents, parental knowledge came mainly from child disclosure, and child disclosure was the source of knowledge that was most closely linked to broad and narrow measures of delinquency (normbreaking and police contact). These results held for both children's and parents' reports, for both sexes, and were independent of whether the children were exhibiting problem behavior or not. We conclude that tracking and surveillance is not the best prescription for parental behavior and that a new prescription must rest on an understanding of the factors that determine child disclosure.
The precautionary principle (PP) is an extension of the public health presage that prevention is better than cure. The PP has recently achieved new relevance in regard to serious but uncertain threats to human health and the environment and has now entered national and international legislation. However, frameworks for its unambiguous application in practice are yet to be designed. They will depend on legal and cultural circumstances and are likely to involve pluralities of perspectives and stakeholder participation. The rules for causal reasoning and dose dependence need to be addressed and may be conveniently expressed in accordance with probability theory. Although the PP will allow action before convincing evidence is secured, it is not science averse. However, it provides an occasion to review environmental health research strategies, methodologies, and research-reporting traditions. From this perspective, current research is afflicted by important biases and insufficient focus on major environmental health problems.