On Doing Research in a Clinical Setting

Abstract

Objective: To evaluate the efficacy of a stand-alone personalized normative feedback (PNF) intervention targeting misperceptions of gambling among college students. Participants: Undergraduates (N = 136; 55% male) who reported gambling in the past 30 days were recruited between September 2011 and March 2012. Methods: Using a randomized clinical trial design, participants were assigned to receive either PNF or an attention control task. In addition to self-report, this study used 2 computer-based risk tasks framed as “gambling opportunities” to assess cognitive and behavioral change at 1 week post intervention. Results: After 1 week, participants receiving PNF showed a marked decrease in perception of other students’ gambling, and evinced lower risk-taking performance on 2 analog measures of gambling. Conclusions: Changes in both self-reported perceived norms and analog gambling behavior suggest that a single, stand-alone PNF intervention may modify gambling among college students. Whether it can impact gambling outside of the laboratory remains untested.     

Efficacy of a web-based, tailored, alcohol prevention/intervention program for college students: 3-month follow-up

This study presents the results of an efficacy evaluation of a web-based brief motivational alcohol prevention/intervention program called Michigan Prevention and Alcohol Safety for Students (M-PASS). Four on-line sessions providing individually-tailored feedback were delivered to first-year college students over 9 weeks. Non- and low-risk drinking participants received risk prevention, while high-risk drinking participants received a risk-reduction intervention. Both intervention and control groups were surveyed at baseline and at a 3-month follow-up. Analysis showed positive effects for both men and women on stage of change, drinking behavior, drinking motivation and attitudes, and use of risk-reduction strategies. These results provided evidence of efficacy and found that M-PASS had both intervention and prevention effects, making it unique among currently developed brief alcohol interventions for college students.     

Integrating mailed personalized feedback and alcohol screening events: a feasibility study

This study characterized a sample of college students attending National Alcohol Screening Day (NASD), and tested the feasibility of using NASD as a platform for initiating the delivery of mailed personalized feedback forms. Participants (N = 153, 65% female) attended NASD and completed the Alcohol Use Disorders Identification Test (AUDIT [1]). A subset of at-risk drinkers completed additional questionnaires about their alcohol use and received personalized feedback through the mail. Thirty-four percent of the participants scored above the recommended clinical cutoff on the AUDIT. Men reported higher levels of alcohol consumption and alcohol-related negative consequences. The subset of at-risk drinkers reported frequent occasions of binge drinking and relatively high blood alcohol concentrations (BAC). NASD is an effective way of identifying college students with clinically significant levels of alcohol use, and provides an efficient mechanism for initiating the delivery of personalized feedback. More research on the combined effects of NASD and personalized feedback is warranted.     

Social norms approaches using descriptive drinking norms education: a review of the research on personalized normative feedback

College students have been shown to consistently overestimate the drinking of their peers. As a result, social norms approaches are effective in correcting these misperceived norms to reduce alcohol consumption and alcohol-related problems. In this review of literature, the authors critically evaluated the effectiveness of personalized normative feedback. In addition, the authors reviewed personalized normative feedback interventions and provided suggestions for increasing the efficacy of these interventions by making better use of salient referent group data.     

The Effect of Graduate School on Identity Issues

Abstract

Objectives: To provide a critical review of the efficacy of brief interventions for alcohol use in college health centers. Methods: Studies were included if (a) they examined brief intervention trials that were conducted in college- or university-based student health centers or emergency departments, and (b) they provided pre–post data to estimate change. Results: Twelve studies suggested that screening and brief interventions in these settings are acceptable, feasible, and promote risk reduction. Conclusions: Findings support continued use of time-limited, single-session interventions with motivational interviewing and feedback components.     

Effects of a social norm feedback campaign on the drinking norms and behavior of Division I student-athletes

Social norm feedback is a promising strategy for reducing alcohol misuse on college campuses. However, little is known about the impact of these interventions on at-risk populations, such as student-athletes. This study examined the effects of a campus-wide media campaign on Division I student-athletes at three universities. A discriminant function analysis revealed that a composite measure of perceived campus drinking norms distinguished between two campaign exposure groups. With the exception of one perceived norm measure (closest friends), the campaign-exposed group reported more conservative estimates of alcohol use in peers. However, there was no evidence that the campaign had reduced alcohol use. The inability of the campaign to reduce perceptions of alcohol use among one's closest friends may have accounted for the lack of change in drinking behavior. Discussion is directed to the potential limitations of using social norm feedback campaigns to reduce alcohol misuse in high-risk groups, such as student-athletes.     

Do lesbians overestimate alcohol use norms? Exploring the potential utility of personalized normative feedback interventions to reduce high-risk drinking in Southern California lesbian communities

This study examines the potential utility of social norms-based approaches to reduce heavy alcohol use in lesbian community settings. In a sample of 278 Southern Californian lesbians recruited from social media networks to complete an online survey, the majority of participants overestimated the quantity of alcohol consumed by their lesbian peers and more frequent lesbian bar attendance was associated with elevated perceptions of how much other lesbians drink. Greater than 90% of participants expressed interest in receiving personalized normative feedback, suggesting that culturally tailored personalized normative feedback interventions focused on correcting perceptions of heavy drinking may be successful in mitigating the alcohol-related risks of lesbians in Southern California, and potentially beyond.     

A Comparison of an Assessment/Information-Based Group versus an Assessment-Only Group

Abstract

The use/abuse of alcohol leading to impaired driving, accidents and even fatalities is a major social concern. National data sets demonstrate that college students abuse alcohol. This research paper outlines a program designed to reduce levels of drinking and presents a format for evaluating its effectiveness. An experimental study (n = 55) was conducted to examine drinking patterns among full-time college students at four-year institutions to observe whether exposure to a personalized feedback pamphlet would reduce the amount of alcohol consumption between a treatment and nontreatment control group. The posttreatment drinking, as defined by the number of times a week participants consumed five or more drinks per setting, between groups was not statistically significant. However, posttreatment drinking, as defined by the average number of drinks consumed in a sitting, between groups was significant. While the treatment group demonstrated a greater decrease in the number of subscales, this difference was not statistically significant.     

Efficacy of interventions targeting alcohol,drug and smoking behaviors in university and college students: A review of randomized controlled trials

Objective: To evaluate the effectiveness of interventions targeting alcohol consumption, drug use and smoking for college/university students.Participants: College/University students.Methods: Studies were eligible if: (1)included students attending universities/colleges; (2)implemented in a university/college setting; (3)aimed to improve at least one of the following behaviors: alcohol and/or drug use and/or smoking; (4)were RCTs. The effect of the interventions on behaviors was determined by the percentage of studies that reported an effect. Due to the heterogeneity of outcomes meta-analysis was not conducted.Results: 88 studies met criteria. University-based interventions were effective for reducing alcohol-related outcomes (drinking patterns, BAC, consequences, problem drinking). Inconsistent findings for drug and smoking were observed.Conclusions: University-based interventions have the potential to improve health for students. While there is a breadth of research examining the efficacy of interventions to reduce alcohol consumption, further research is needed to determine the best approach for addressing smoking and drug use among students.     

Reducing High-Risk Drinking Among Student-Athletes: The Effects of a Targeted Athlete-Specific Brief Intervention

Abstract

Objective: This study examined the effects of a single-session motivational interviewing–based in-person brief alcohol intervention that contained student-athlete–specific personalized drinking feedback. Participants: Participants were 170 National Collegiate Athletic Association Division I student-athletes meeting screening criteria for heavy episodic drinking. Methods: Baseline assessments of alcohol use frequency and quantity, norm perceptions of peers' alcohol use, experiences of negative consequences, and use of protective behaviors were administered to student-athletes prior to a 1-session brief intervention containing personalized feedback highlighting the relationship between alcohol use and athletic performance. Follow-up assessment was conducted 3 months post intervention. Results: Student-athletes participating in the athlete-specific brief intervention showed significant reductions in their alcohol use and alcohol-related negative consequences, increases in use of protective behavioral strategies, and corrections in norm misperceptions at 3 months post intervention relative to a no-treatment comparison group. Conclusions: Student-athlete–specific brief alcohol interventions show promise in addressing high-risk drinking, reducing associated harms, and supporting health.     

Using national alcohol screening day to deliver personalized feedback: a pilot study

The current study tested the effectiveness of using National Alcohol Screening Day (NASD) to deliver personalized feedback via mail. At-risk NASD participants were assigned to either personalized or generic feedback conditions and attended a 4-week follow-up. Results failed to find any group differences on alcohol-related variables. However, participants in the personalized group reported a reduction in the maximum number of drinks consumed on one occasion. The personalized group also had a more accurate view of the amount of alcohol their peers consumed. NASD is a vehicle to efficiently deliver feedback to individuals about their alcohol use; however, more research is needed to determine the types of feedback that would be most effective.     

A randomized test of a small-group interactive social norms intervention

Social norms interventions are a common approach to addressing the problem of college student drinking. An increasingly popular but not yet well-validated social-norms-based intervention consists of providing normative feedback to students in small groups. OBJECTIVE, PARTICIPANTS, AND METHODS: In this study, the authors used a randomized design to test an interactive form of small-group social norms correction with 502 first-year students during September and October 2001. Because the unit of random assignment was at the level of the classroom, the authors used hierarchical linear modeling to estimate variability. They investigated whether small-group interactive social norms correction could influence alcohol perceptions and behaviors above and beyond a noninteractive social norms education approach. RESULTS: Results indicate that the approach has a fairly substantial influence on student perceptions; however, the findings do not support an influence of interactive small-group social norms correction on measures of alcohol use behaviors. CONCLUSIONS: Given these findings, the use of interactive small-group social norms approach to influence student misperceptions may be considered as a primer for population-level preventive interventions.     

Personalized boosters for a computerized intervention targeting college drinking: The influence of protective behavioral strategies

ABSTRACT

Objective: Computerized interventions are cost-effective and can quickly deliver individual feedback to many students. However, in-person interventions are more efficacious. The current study sought to improve the efficacy of a popular online intervention via e-mailed boosters with personalized feedback. Participants: Participants were 213 student drinkers at a southeastern public university, ages 18–24. Methods: Students were randomized into (1) intervention only, or (2) intervention plus booster. Alcohol consumption and related problems were assessed at baseline, 2 weeks post, and 4 weeks post. Results: Boosters yielded reductions in drinking, but not alcohol-related problems. Boosters were associated with significant reductions for drinking frequency, heavy drinking days, peak drinks, and associated blood alcohol concentration (BAC). Protective behavioral strategies (PBS) moderated this effect, with significant reductions for students low in PBS, but not students already highly engaged in PBS use. Conclusions: Easy dissemination and low cost make e-mailed boosters a very efficient way to promote student health.     

Web-based treatment for problem drinking

Interest in Web-based interventions to curtail hazardous drinking has increased in recent years. Emerging research findings suggest that Web-based interventions may help reduce alcohol abuse, especially among college students and women. At the same time, it may be difficult for marginalized individuals and those in rural areas to access the Internet. Nurses are encouraged to help clients evaluate alcohol intervention Web sites to identify the best treatment options. Additional research is recommended to determine the efficacy of online alcohol treatment services.     

In praise of feedback: an effective intervention for college students who are heavy drinkers

The efficacy of brief motivational feedback to reduce drinking among college students has been reported by several researchers. As an extension of this theoretical and applied framework, the author tested the use of mailed feedback to influence the drinking behavior of students self-identified as moderate-to-heavy drinkers in two randomized trials. A 6-week follow-up of the efforts suggested the efficacy of the feedback intervention at reducing alcohol consumption. The feedback mechanism used in the studies is described in detail and possible reasons for its efficacy are explored. In light of the cost-effective nature of this intervention, it may warrant a place in larger campus prevention programs.     

Environmental Approaches to Prevention in College Settings

Because of concerns regarding drinking among college students and its harmful consequences, numerous prevention efforts have been targeted to this population. These include individual-level and community-level interventions, as well as other measures (e.g., online approaches). Community-level interventions whose effects have been evaluated in college populations include programs that were developed for the community at large as well as programs aimed specifically at college students, such as A Matter of Degree, the Southwest DUI Enforcement Project, Neighborhoods Engaging With Students, the Study to Prevent Alcohol-Related Consequences, and Safer California Universities. Evaluations of these programs have found evidence of their effectiveness in reducing college drinking and related consequences. The most effective approaches to reducing alcohol consumption among college students likely will blend individual-, group-, campus-, and community-level prevention components.     

In Praise of Feedback: An Effective Intervention for College Students Who Are Heavy Drinkers

Abstract

The efficacy of brief motivational feedback to reduce drinking among college students has been reported by several researchers. As an extension of this theoretical and applied framework, the author tested the use of mailed feedback to influence the drinking behavior of students self-identified as moderate-to-heavy drinkers in two randomized trials. A 6-week follow-up of the efforts suggested the efficacy of the feedback intervention at reducing alcohol consumption. The feedback mechanism used in the studies is described in detail and possible reasons for its efficacy are explored. In light of the cost-effective nature of this intervention, it may warrant a place in larger campus prevention programs.     

Predictors of Student and Career Decision‐Making Self‐Efficacy Among Nontraditional College Women

A study of 354 nontraditional college women found robust levels of confidence in their ability to manage the student role and pursue career‐related tasks. Findings indicated that perceived career barriers and social support accounted for variance in student and career decision‐making self‐efficacy for nontraditional college women with and without children. Social support added to the prediction of self‐efficacy over and above the contribution of perceived barriers. The discussion focuses on recommendations for career counseling interventions to facilitate educational and vocational success among nontraditional college women.     

Heavy drinking on college campuses: no reason to change minimum legal drinking age of 21

The recent Amethyst Initiative argues that a minimum legal drinking age (MLDA) of 21 has created a culture of heavy alcohol use on college campuses by making drinking clandestine and extreme. This group and others argue that lowering the MLDA will reduce the problem of "binge drinking" on college campuses. However, such a policy change would remove one of the most researched and supported policies in the nation's alcohol control arsenal. There is little evidence that other interventions or policies are capable of working on the same broad level as MLDA 21, and there could also be a deleterious ripple effect in related legislation because MLDA 21 works in conjunction with other drinking laws. In addition, historic and international experiences with a lowered MLDA indicate there are serious social and public health consequences. Instead of removing efficacious interventions, we must remain committed to implementing and enforcing evidence-based practices and legislation.