Alcohol Intervention for First Year College Students
Condition: Underage Alcohol Use
MeSH terms: Alcohol Drinking; Underage Drinking
Study type: Interventional

Summary: 
      While a large focus of research on U.S. college drinking has focused on the prevalence of and
      problems related to heavy-episodic drinking, less has focused on college students who are
      either abstainers or lighter drinkers (i.e., for men, drinking 4 or fewer drinks in two hours
      and 14 or fewer drinks per week; and for women drinking 3 or fewer in two hours and 7 or
      fewer drinks per week). Over 40% percent of college students ages 18-22 do not report
      drinking in the past month with only half of those engaging in regular heavy-episodic
      drinking. Research suggests that a significant proportion of students who were abstinent or
      light drinkers prior to and upon entering college initiate drinking and progress to becoming
      heavy-episodic drinkers. This provides evidence that the first few months of college is a
      high-risk time for initiating both drinking and heavy-episodic drinking and that delaying the
      onset of heavy-episodic drinking among light drinkers and abstainers should lead to reduced
      harms throughout the college years and young adulthood. Mobile phone-based interventions are
      an innovative method for reaching young people and have been established as an empirical
      approach towards addressing health issues, including alcohol use. The ultimate goal of this
      proposal is to develop, refine and pilot a text message (TM) intervention for abstainer and
      lighter drinking first year college students with the ultimate goal of delaying alcohol
      initiation and/or reducing alcohol use escalation. An iterative process of focus groups,
      intervention content development, and user feedback focused on the unique experiences of
      abstainers and lighter drinkers will inform the TM Intervention to be delivered in a pilot
      study with 6 weeks of TMs. The pilot study will include a 6 week post-intervention
      assessment, and 3, 6, and 9 month follow-ups among 100 incoming first year abstainer and
      lighter drinker college students. Given that reducing young adults' and college students'
      engagement in excessive alcohol use has been listed as a major objective of Healthy People
      2020 and a key priority of NIAAA, an intervention that focuses on delaying alcohol initiation
      and escalation into higher-risk alcohol use among abstainer and lighter drinkers could make
      important strides to achieving this goal.
    

Detailed description: 
      The first year at college, and specifically the first 6 weeks of college, has been identified
      as a critical period particularly influential to college students' alcohol use trajectories.
      The prevalence of heavy drinking increases rapidly upon college entry relative to pre-college
      use and patterns of high-risk alcohol use established during the transition to college can
      result in a range of adverse consequences that persist throughout the academic year. While a
      large focus of research on U.S. college drinking has been on the prevalence of and problems
      related to heavy-episodic drinking (4+/5+ drinks in two hours for women/men), less research
      has focused on college students who are either abstainers (i.e., do not drink any alcohol) or
      lighter drinkers (i.e., men: 4 or fewer drinks in two hours and 14 or fewer drinks per week;
      women: 3 or fewer in two hours and 7 or fewer drinks per week). Research indicates that
      between 21% and 26% of first-year colleges students who were abstinent or light drinkers
      before college escalated to heavy episodic drinking during their freshman year. Further, over
      40% percent of college students ages 18-22 do not report drinking in the past month, with
      only half of those engaging in regular heavy-episodic drinking. Research indicates that risk
      cognitions (i.e., prototypes, norms) are associated with initiation and escalation of alcohol
      use and also tend to peak around the time that individuals transition out of high school and
      into a riskier college environment. Delaying the onset of heavy-episodic drinking among
      abstainers and lighter drinkers during the first-year of college, a particularly high-risk
      period, should lead to reduced related harms throughout both the college years and young
      adulthood.

      Tailoring intervention approaches to students at various levels of risk, including abstainers
      or lighter drinkers, may greatly increase efficacy and reduce costs associated with universal
      interventions (King et al., 2008). No single intervention is likely to sufficiently reduce
      college drinking or consequences; therefore a "mix of strategies is best". An underexplored
      strategy is delivering intervention content that reinforces existing reasons for not drinking
      among abstainers and lighter drinkers, with the goal of delaying the initiation of heavy
      drinking and/or the escalation to heavy drinking during the first year of college. Given that
      longitudinal findings indicate that stronger endorsement of reasons for drinking lightly or
      not drinking, such as academic responsibilities, normative influence, and concern for social
      images are associated with delayed alcohol initiation, lower levels of alcohol use and higher
      rates of abstention among young adults, including college students, interventions for
      abstainers and lighter drinkers that focus on reinforcing proximal reasons not to drink or to
      drink lightly have promise to dissuade students from initiation of drinking or to delay more
      hazardous drinking patterns later on.

      Additionally, mobile phone-based interventions are an innovative method for reaching young
      people and have been established as an evidence-based, recommended approach towards
      addressing health issues including alcohol use. Mobile phone text-messaging (TM) offers an
      innovative technological approach to brief intervention for college students in a mode in
      which they are familiar and they already use frequently. Presenting preventative intervention
      content via TM, especially for abstainer and lighter drinking college students, may be one
      way to delay alcohol use initiation and prevent the escalation of alcohol use during the
      first year of college. Therefore, the present project has the following primary aims:

      Aim 1: Recruit first year college students who are abstainers and lighter drinkers to examine
      students' reactions to TM intervention content through an iterative process of focus groups,
      intervention content development, and user feedback, which will inform a new intervention to
      be delivered in a pilot study (Aim 3).

      Aim 2: Through focus groups, elicit responses to timing of the TM intervention, specifically
      what days and times per week and how many times per day (set within research-established
      ranges) abstainer and lighter drinkers think receiving TMs will the most useful and impactful
      to inform TM delivery for the pilot study (Aim 3).

      Aim 3: Conduct a pilot study with 6 weeks of TM intervention content, a 6 week
      post-intervention assessment and 3, 6, and 9 month follow-ups among 100 abstainer or lighter
      drinking first-year college students to determine feasibility, acceptability, and preliminary
      effect sizes (to estimate power and sample sizes for a future R01). Newly enrolled first-year
      college students will be randomized to the TM intervention or assessment only control. The
      investigators hypothesize the TM Intervention will be feasible and acceptable to abstainer
      and lighter drinking students, including being accessible, usable, convenient, relevant and
      helpful. The investigators further hypothesize that receiving the TM intervention will be
      associated with less initiation and escalation of drinking, fewer negative consequences, more
      favorable prototypes of abstainers and lighter drinkers, greater perceived abstaining and
      light drinking norms, greater engagement and enjoyment of alternative activities, and greater
      endorsement of personal goals that do not involve alcohol at the 6 week post-intervention
      assessment and 3, 6, and 9 month follow-ups relative to assessment only control.
    

Intervention name(s): Text Messaging Intervention
Intervention type(s): Behavioral
Intervention description(s): The content for the text messaging Intervention will be designed to be non-confrontational in tone, seek to increase motivation to drink lightly or not at all, and based both on general information about light and non-drinking as well as information provided during the baseline assessment.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention