Alcohol Abuse, Alcohol Drinking
Conditions
Keywords
brief intervention, college students
Brief summary
High volume drinking by young adults has proven resistant to change, so new approaches are needed. We adapt a theory-based attitude change strategy for use in alcohol prevention. This research tests the impact of brief writing and advocacy activities on subsequent drinking and negative consequences.
Detailed description
The persistence of risky drinking among young adults in college calls for continued efforts to prevent harms related to alcohol. Many prevention interventions rely on a primary mechanism of change: correcting exaggerated drinking norms. We propose to test a novel prevention strategy targeting another mechanism of change: creating attitude-behavior dissonance. To date, attitude change activities have not been harnessed as a behavior change strategy for alcohol abuse prevention, so this study adapts counter-attitudinal advocacy (CAA) to the alcohol prevention context. The goals of the proposed research are to demonstrate (a) the utility of CAA to change high volume drinking and related consequences, (b) that attitude change and attitude-behavior dissonance mediates the CAA manipulation effect, and (c) that CAA-induced risk reduction is not inferior to an established intervention based on Personalized Normative Feedback (PNF). A pair of studies will be implemented across two sites. First surveys to document peer behaviors and normative perceptions (N = 500 at each site) will be conducted, in order to deliver accurate, campus-specific PNF. The next study consists of a randomized controlled trial (RCT) with 2 experimental conditions (CAA and PNF) and a 3rd assessment only control condition to determine the impact of CAA on alcohol outcomes. For the RCT, a total of 600 heavy drinking students who have endorsed alcohol-related negative consequences will be recruited. Alcohol outcomes will be assessed at 1-, 3-, and 6-month follow-ups to test hypotheses that, relative to assessment only control, the CAA manipulation will decrease alcohol consumption and consequences. We will also test the hypothesis that CAA condition will be no less efficacious than (i.e., not inferior to) the PNF condition. The RCT also allows tests of hypotheses about effect moderators and mediators. This study will demonstrate the generalizability of CAA activities to the alcohol prevention context, as well as their generalizability across demographically different settings. Implications for the public health include establishing the efficacy of a new approach for reducing high volume drinking and related consequences among young adults.
Interventions
BEHAVIORALCounter Attitudinal Advocacy
same as Counter Attitudinal Advocacy arm
BEHAVIORALPersonalized Normative Feedback
same as Personalized Normative Feedback arm
Sponsors
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
University of Houston
Brown University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 26 Years
Healthy volunteers
Yes
Inclusion criteria
* Age 18-26 * Male or female student at Brown University or University of Houston * Past month heavy episodic drinking (for men, \>5 drinks in one day, for women \>4 drinks in one day) * At least two self-reported negative consequences from drinking in the past month
Exclusion criteria
* status as a second semester Senior
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Drinks Per Week as Assessed by the Daily Drinking Questionnaire | 6-month follow up | Number of standard drinks consumed in a typical week over the past 30 days; scores can range from zero but have no upper limit as they are counts of drinks |
| Alcohol-related Consequences as Assessed by the Young Adult Alcohol Consequences Questionnaire | 6-month follow up | The Young Adult Alcohol Consequences Questionnaire is a checklist of 48 different consequences that could be experienced over the past 30 days; the total score ranges from 0-48; higher scores indicate more problems experienced in the past 30 days |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Counter Attitudinal Advocacy Participants in this arm will articulate ways to avoid alcohol-related consequences using self-generated protective strategies and publicly state those strategies.
Counter Attitudinal Advocacy: same as Counter Attitudinal Advocacy arm | 191 |
| Personalized Normative Feedback Participants in this arm will view personalized normative feedback regarding their 1) own drinking quantity and frequency of drinking, 2) perceptions of typical drinking by same-sex students' on campus (i.e., perceived descriptive norms), and 3) actual drinking rates by same-sex students' on campus (i.e., actual descriptive norms).
Personalized Normative Feedback: same as Personalized Normative Feedback arm | 196 |
| Assessment-only Control Participants in this arm will not receive any intervention. | 200 |
| Total | 587 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Overall Study | duplicate cases | 2 | 0 | 0 |
| Overall Study | technical problem | 0 | 1 | 0 |
| Overall Study | Withdrawal by Subject | 1 | 0 | 0 |
Baseline characteristics
| Characteristic | Counter Attitudinal Advocacy | Personalized Normative Feedback | Assessment-only Control | Total |
|---|---|---|---|---|
| Age, Continuous | 19.7 years STANDARD_DEVIATION 1.4 | 19.9 years STANDARD_DEVIATION 1.7 | 20.0 years STANDARD_DEVIATION 1.7 | 19.9 years STANDARD_DEVIATION 1.6 |
| Alcohol problems | 11.1 problems STANDARD_DEVIATION 7 | 12.0 problems STANDARD_DEVIATION 7.6 | 11.5 problems STANDARD_DEVIATION 7.2 | 11.5 problems STANDARD_DEVIATION 7.3 |
| Drinks per week | 9.9 drinks per week STANDARD_DEVIATION 6.2 | 9.8 drinks per week STANDARD_DEVIATION 5.9 | 10.0 drinks per week STANDARD_DEVIATION 7.8 | 9.9 drinks per week STANDARD_DEVIATION 6.7 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 46 Participants | 43 Participants | 47 Participants | 136 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 145 Participants | 153 Participants | 153 Participants | 451 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 3 Participants | 1 Participants | 3 Participants | 7 Participants |
| Race (NIH/OMB) Asian | 46 Participants | 47 Participants | 44 Participants | 137 Participants |
| Race (NIH/OMB) Black or African American | 16 Participants | 20 Participants | 13 Participants | 49 Participants |
| Race (NIH/OMB) More than one race | 24 Participants | 16 Participants | 27 Participants | 67 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 22 Participants | 17 Participants | 20 Participants | 59 Participants |
| Race (NIH/OMB) White | 80 Participants | 95 Participants | 93 Participants | 268 Participants |
| Region of Enrollment United States | 191 participants | 196 participants | 200 participants | 587 participants |
| Sex: Female, Male Female | 119 Participants | 124 Participants | 126 Participants | 369 Participants |
| Sex: Female, Male Male | 72 Participants | 72 Participants | 74 Participants | 218 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 191 | 0 / 196 | 0 / 200 |
| other Total, other adverse events | 0 / 191 | 0 / 196 | 0 / 200 |
| serious Total, serious adverse events | 0 / 191 | 0 / 196 | 0 / 200 |
Outcome results
Primary
Alcohol-related Consequences as Assessed by the Young Adult Alcohol Consequences Questionnaire
The Young Adult Alcohol Consequences Questionnaire is a checklist of 48 different consequences that could be experienced over the past 30 days; the total score ranges from 0-48; higher scores indicate more problems experienced in the past 30 days
Time frame: 6-month follow up
Population: Participants were included if they provided data at the 6 month follow-up
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Counter Attitudinal Advocacy | Alcohol-related Consequences as Assessed by the Young Adult Alcohol Consequences Questionnaire | 6.4 problems | Standard Deviation 7 |
| Personalized Normative Feedback | Alcohol-related Consequences as Assessed by the Young Adult Alcohol Consequences Questionnaire | 7.2 problems | Standard Deviation 7.4 |
| Assessment-only Control | Alcohol-related Consequences as Assessed by the Young Adult Alcohol Consequences Questionnaire | 8.3 problems | Standard Deviation 8.6 |
Comparison: Our main hypothesis is that, relative to Assessment-Only control, the Counter Attitudinal Advocacy intervention will decrease alcohol problems from baseline to 6-months.p-value: 0.01495% CI: [-3.41, -0.39]Regression, Linear
Primary
Drinks Per Week as Assessed by the Daily Drinking Questionnaire
Number of standard drinks consumed in a typical week over the past 30 days; scores can range from zero but have no upper limit as they are counts of drinks
Time frame: 6-month follow up
Population: Participants were included in this analysis if they provided drinks per week data at the 6-month follow-up
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Counter Attitudinal Advocacy | Drinks Per Week as Assessed by the Daily Drinking Questionnaire | 6.8 drinks per week | Standard Deviation 7.6 |
| Personalized Normative Feedback | Drinks Per Week as Assessed by the Daily Drinking Questionnaire | 6.0 drinks per week | Standard Deviation 5.2 |
| Assessment-only Control | Drinks Per Week as Assessed by the Daily Drinking Questionnaire | 7.1 drinks per week | Standard Deviation 6.8 |
Comparison: Our main hypothesis is that, relative to Assessment-Only control, the Counter Attitudinal Advocacy intervention will decrease alcohol consumption (drinks per week) from baseline to 6-months.p-value: 0.64695% CI: [-1.632, 1.013]Regression, Linear