Finding the Right Balance: A Social Norms Intervention to Reduce Heavy Drinking in University Students

Introduction: Heavy alcohol consumption constitutes a major health risk among University students. Social relationships with peers strongly affect University students' perception of the drinking behavior of others, which in turn plays a crucial role in determining their own alcohol intake. University students tend to overestimate their peers' alcohol consumption – a belief that is associated with an increase in an individual's own consumption. Therefore, we implemented a social norms intervention with personalized normative feedback at a major University in Germany to reduce and prevent excessive drinking among University students.Methods: Our intervention was part of a regular health monitoring survey. We invited all enrolled University students to take part in this survey on two occasions. A total of 862 University students completed the questionnaire, 563 (65.3%) of which received e-mail-based feedback upon request concerning their peers' and their own alcohol consumption. For the intervention group (n = 190) as well as the control group (no feedback requested; n = 101), we included only University students in the evaluation who overestimated their peers' alcohol use and indicated above average consumption of the peers. We applied analyses of variance to assess intervention effects with regard to the correction of overestimated group norms as well as University students' drinking behavior.Results: Within the intervention group, we observed a significantly larger reduction of the previously overestimated behavioral norms compared to the control group (p < 0.001; ηp2 = 0.06). With regard to behavioral outcomes the intervention group showed a significantly larger reduction in the AUDIT-C score (p = 0.020; ηp2 = 0.03).Discussion: Our study confirms previous research whereupon personalized, gender-specific and selective normative feedback is effective for alcohol prevention among University students. However, University students still overestimated their peers' alcohol intake after the intervention. Furthermore, we did not reach high-risk groups (University students with the highest alcohol intake) since no feedback was requested. Future studies should address factors influencing the impact of the intervention and reachability of selective groups.

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Changing University Students’ Alcohol Culture with a web-based intervention: Clustered Randomized Controlled Trial (Preprint)

10.2196/preprints.25189 ◽

2020 ◽

Author(s):

Jane Greve ◽

Rune Vammen Lesner ◽

Stefan Bastholm Andrade

Keyword(s):

Alcohol Consumption ◽

University Students ◽

Alcohol Intake ◽

Intervention Group ◽

Control Group ◽

First Year Students ◽

Personal Benefit ◽

Drinking Culture ◽

The University ◽

The Impact

BACKGROUND In most Western countries, excessive alcohol intake among university students is a cause of concern. The majority of students view drinking as a cornerstone of university life, and many find it difficult to go against the dominant drinking culture. While digital health interventions have been shown to reduce drinking among university students, no intervention has been aimed at changing the overall university drinking culture. This intervention provided the students with tools that helped them make pre-commitment strategies and change their views on the social norms that prevent excessive alcohol intake. OBJECTIVE Our objective is to evaluate the impact of an intervention aimed at reducing the excessive drinking culture among Danish university students. As a secondary outcome, we measured the impact of the intervention on two individual motivational factors for participating in the drinking culture at the university: alcohol consumption as both a personal benefit and a facilitator of socialization. METHODS To evaluate the impact of the intervention, we conducted a cluster randomized controlled experiment among university students at Aarhus University. The students were stratified by gender and self-reported binge drinking. Each student was assigned to either a control or an intervention group. A baseline questionnaire was sent to the participants when school started in September 2019, and a follow-up questionnaire was sent out two months later. The primary outcomes were measured with the Alcohol Use Disorder Identification Test (questions 1-3). To examine the mechanisms underlying the effect, we analyzed two motivational factors for participating in the drinking culture at the university: alcohol consumption as both and a personal benefit and a facilitator of socialization. RESULTS In total 961 students signed up, and 509 of them completed the follow-up questionnaire. Compared to the students in the control group, the students in the intervention group had a 15.8% (P<.001) reduction on their monthly level of alcohol intake two months after the intervention. The result is driven by a large effect on male and first-year students. The intervention had no effect on binge drinking, alcohol addiction, or severely harmful alcohol consumption. Our results also showed that while the students in the intervention group found it less difficult to say “no” to drinking there were no difference in the assessment of being part of the student environment between the students in the intervention and control Group. CONCLUSIONS The intervention had a significant and reducing impact on the students’ monthly alcohol intake. That the effect of the intervention was largest among the young and first-year students, who will be the responsible for the drinking culture at the University in the coming years, suggest that small nudging-based interventions can potentially have significant long-term beneficial effects. CLINICALTRIAL American Economic Association’s registry for randomized trials with RCT ID: AEARCTR-0004703. https://www.socialscienceregistry.org/trials/4703.

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Controlled Study of the Impact of a Virtual Program to Reduce Stigma Among University Students Toward People With Mental Disorders

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.632252 ◽

2021 ◽

Vol 12 ◽

Author(s):

Matías E. Rodríguez-Rivas ◽

Adolfo J. Cangas ◽

Daniela Fuentes-Olavarría

Keyword(s):

Mental Disorders ◽

University Students ◽

Intervention Group ◽

Project Based Learning ◽

Controlled Study ◽

Control Group ◽

Global Score ◽

Stigma Reduction ◽

Before And After ◽

The Impact

Stigma toward mental disorders is one of today's most pressing global issues. The Covid-19 pandemic has exacerbated the barriers to social inclusion faced by individuals with mental disorders. Concurrently, stigma reduction interventions, especially those aimed at university students, have been more difficult to implement given social distancing and campus closures. As a result, alternative delivery for programs contributing to stigma reduction is required, such as online implementation. This paper reports the results of a controlled study focused on an online multi-component program on reducing stigma toward mental illness that included project-based learning, clinical simulations with standardized patients and E-Contact with real patients. A total of 40 undergraduate students from the Universidad del Desarrollo in Santiago, Chile, participated in the study. They were randomly divided between an intervention and control group. The intervention group participated in the online multi-component program, while the control group participated in an online educational program on cardiovascular health. We assessed the impact of the program by using the validated Spanish-language versions of the Attribution Questionnaire AQ-27 and the Questionnaire on Student Attitudes toward Schizophrenia with both groups, before and after the intervention. In addition, an ad hoc Likert scale ranging from 0 to 5 was used with the intervention group in order to assess the learning strategies implemented. Following the intervention, the participants belonging to the intervention group displayed significantly lower levels of stereotypes, perception of dangerousness, and global score toward people with schizophrenia (p < 0.001). In addition, participants presented lower levels of dangerousness-fear, avoidance, coercion, lack of solidarity, and global score (p < 0.001). The control group displayed no statistically significant differences in the level of stigma before and after the evaluation, for all of the items assessed. Finally, the overall assessment of each of the components of the program was highly positive. In conclusion, the study shows that online programs can contribute to reducing stigma toward mental disorders. The program assessed in this study had a positive impact on all the dimensions of stigma and all of the components of the program itself were positively evaluated by the participants.

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The Impact of a Web-Based Mindfulness, Nutrition and Fitness Platform on the Health Status of First-Year University Students: Protocol for a Randomized Controlled Trial (Preprint)

10.2196/preprints.24534 ◽

2020 ◽

Author(s):

Claire F Trottier ◽

Jessica RL Lieffers ◽

Steven T Johnson ◽

João F Mota ◽

Roshni K Gill ◽

...

Keyword(s):

Physical Activity ◽

University Students ◽

Intervention Group ◽

Mental Wellbeing ◽

Control Group ◽

First Year ◽

Web Based ◽

Related Quality ◽

First Year University ◽

The Impact

BACKGROUND First-year university students are at increased risk for presenting with anxiety, depression, suicidal thoughts and poor nutritional status. Self-care plays an essential role in optimizing mental health and can prevent/treat stress, anxiety and depression. Web-based self-monitoring of diet and physical activity can lead to similar or improved health outcomes compared to conventional methods. Such tools are also popular among university students. OBJECTIVE The primary objective of this 12-week randomized control trial was to assess the impact of a web-based wellness platform on perceived stress among first-year university students. The study’s secondary outcome was to assess the effects of the platform on diet quality and exploratory outcomes were body composition, health related quality of life, mindfulness, mental wellbeing and physical activity. METHODS Ninety-seven first-year undergraduate students were randomized to either the intervention (n=48) or control (n=49) group. The intervention consisted of access to a web-based platform called My Viva Plan® (MVP) which aims to support healthy living on the topics of mindfulness, nutrition, and fitness. The platform is fully automated and is guided by principals of cognitive behavior theory. Participants in the intervention group were instructed to use MVP as frequently as possible over 12 weeks. The control group did not receive access to MVP. Perceived stress was assessed using the Stress Indicators Questionnaire at baseline, week 6 and week 12. Three day food records were used to analyze dietary intake at baseline and week 12. Health related quality of life, mindfulness, mental wellbeing and physical activity questionnaires were completed at baseline, week 6 and week 12 and body composition was assessed at baseline and week 12. Study assessments were completed in-person at baseline and week 12 and electronically at week 6. RESULTS Study recruitment started in August 2018 with batch enrollment for students registered in the fall (September 2018 to December 2018) and winter (January 2019 to April 2019) academic terms at the University of Alberta, Edmonton, Alberta. Eighty participants completed the 12-week trial (n=35 in the intervention group; n=45 in the control group). All data collection ended in May 2019. CONCLUSIONS This project is the first to explore the impact of an online platform designed to promote health and wellness; it will also shed light into its applicability in first-year university students. If successful, this may become an important health care tool for preventative care in first year university students. CLINICALTRIAL ClinicalTrials.gov NCT03579264

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Impact of Perceived Second-Hand Consequences Related to Alcohol Use on College Students' Drinking Behavior Intent: A Test of Feasibility

Journal of Drug Education ◽

10.2190/wckv-2jlh-80c7-k9cr ◽

2002 ◽

Vol 32 (3) ◽

pp. 179-193 ◽

Cited By ~ 5

Author(s):

Mickey Trockel ◽

Andrew Wall ◽

Janet Reis

Keyword(s):

College Students ◽

Alcohol Use ◽

Structural Equation ◽

Drinking Behavior ◽

Intervention Group ◽

Equation Modeling ◽

Class Discussion ◽

Control Group ◽

Negative Consequences ◽

The Impact

This article presents the results of an experiment designed to determine the impact of a group discussion about second-hand consequences of alcohol use on college students' intentions to consume alcohol. Participants were students enrolled in two large Community Health courses at a large Midwestern university ( n = 184). After randomization of class sections into an intervention or a control group, intervention group students participated in a class discussion on the negative consequences college students experience as a result of other students' drinking behavior, prior to answering survey questions regarding their drinking behavior intent. Compared to controls who completed the questionnaire only, intervention group participants reported intent to limit themselves to fewer drinks per drinking occasion ( p = .003) and fewer drinks per week ( p = .004). The effects of the brief educational intervention were analyzed using structural equation modeling, to test the feasibility of a hypothesized intervention mechanism.

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A Text Message�Based Intervention Targeting Alcohol Consumption Among University Students: User Satisfaction and Acceptability Study (Preprint)

10.2196/preprints.9641 ◽

2017 ◽

Author(s):

Ulrika Müssener ◽

Kristin Thomas ◽

Catharina Linderoth ◽

Matti Leijon ◽

Marcus Bendtsen

Keyword(s):

Randomized Controlled Trial ◽

Alcohol Consumption ◽

University Students ◽

User Satisfaction ◽

Text Messaging ◽

Controlled Trial ◽

Intervention Group ◽

Control Group ◽

Drinking Habits ◽

Randomized Controlled

BACKGROUND Heavy consumption of alcohol among university students is a global problem, with excessive drinking being the social norm. Students can be a difficult target group to reach, and only a minority seek alcohol-related support. It is important to develop interventions that can reach university students in a way that does not further stretch the resources of the health services. Text messaging (short message service, SMS)–based interventions can enable continuous, real-time, cost-effective, brief support in a real-world setting, but there is a limited amount of evidence for effective interventions on alcohol consumption among young people based on text messaging. To address this, a text messaging–based alcohol consumption intervention, the Amadeus 3 intervention, was developed. OBJECTIVE This study explored self-reported changes in drinking habits in an intervention group and a control group. Additionally, user satisfaction among the intervention group and the experience of being allocated to a control group were explored. METHODS Students allocated to the intervention group (n=460) were asked about their drinking habits and offered the opportunity to give their opinion on the structure and content of the intervention. Students in the control group (n=436) were asked about their drinking habits and their experience in being allocated to the control group. Participants received an email containing an electronic link to a short questionnaire. Descriptive analyses of the distribution of the responses to the 12 questions for the intervention group and 5 questions for the control group were performed. RESULTS The response rate for the user feedback questionnaire of the intervention group was 38% (176/460) and of the control group was 30% (129/436). The variation in the content of the text messages from facts to motivational and practical advice was appreciated by 77% (135/176) participants, and 55% (97/176) found the number of messages per week to be adequate. Overall, 81% (142/176) participants stated that they had read all or nearly all the messages, and 52% (91/176) participants stated that they were drinking less, and increased awareness regarding negative consequences was expressed as the main reason for reduced alcohol consumption. Among the participants in the control group, 40% (52/129) stated that it did not matter that they had to wait for access to the intervention. Regarding actions taken while waiting for access, 48% (62/129) participants claimed that they continued to drink as before, whereas 35% (45/129) tried to reduce their consumption without any support. CONCLUSIONS Although the main randomized controlled trial was not able to detect a statistically significant effect of the intervention, most participants in this qualitative follow-up study stated that participation in the study helped them reflect upon their consumption, leading to altered drinking habits and reduced alcohol consumption. CLINICALTRIAL International Standard Randomized Controlled Trial Number ISRCTN95054707; http://www.isrctn.com/ISRCTN95054707 (Archived by WebCite at http://www.webcitation.org/705putNZT)

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How effective is a social norms programme in changing perceived injunctive norms about drug use?

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.243 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

C Stock ◽

l Vallentin-Holbech

Keyword(s):

Drug Use ◽

Social Norms ◽

Good Life ◽

Intervention Group ◽

Control Group ◽

Marginal Effect ◽

The Good Life ◽

Normative Feedback ◽

Injunctive Norms ◽

Response Options

Abstract Social norm theory suggests that students often overestimate the frequency and quantity of drug use among their peers (descriptive norms) as well as how acceptable their peers feel these risky behaviours to be (injunctive norms) and tend to match their own behaviour to this incorrect perception. This study aims to investigate whether a Danish social norms based intervention (The GOOD Life) using both descriptive and injunctive normative information may change students perception of peers' attitudes towards smoking, drinking and using cannabis. In total 38 schools were included in a cluster-randomised controlled trial and allocated to either intervention (n = 641) or control group (n = 714) during 2015/2016. Students (aged 13-17 years) from both groups completed an online survey before the intervention and 3 months after baseline. The GOOD Life intervention provided normative feedback tailored for each school-grade using three communication channels: classroom sessions, posters and web application. Outcome measures were perception of peers' attitude towards: smoking, drinking alcohol, getting drunk and using cannabis. All with five response options from 'never okay' (1) to 'okay' (5). Intervention effects at follow-up were examined using ordinal logistic regression models and marginal effect-estimates. Students in the intervention group were less likely to perceive peers to approve of smoking (Coef: -0.22, p = 0.04, 95%CI [-0.43; -0.01]). The marginal effect estimates showed that compared to the control group, students in the intervention group were 5% more likely to perceive that peers think it is never okay to smoke, 3% less likely to perceive that peers think it is okay to smoke occasionally and 1% less likely to perceive that peers think it is okay to smoke frequently. No significant effects were found for injunctive norms regarding alcohol consumption and cannabis use. Key messages The intervention The GOOD life has potential to produce change in perceived injunctive norms among Danish adolescents. Prevention programmes should thoroughly consider how to incorporate injunctive normative feedback.

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Effectiveness of a Text Messaging�Based Intervention Targeting Alcohol Consumption Among University Students: Randomized Controlled Trial (Preprint)

10.2196/preprints.9642 ◽

2017 ◽

Author(s):

Kristin Thomas ◽

Ulrika Müssener ◽

Catharina Linderoth ◽

Nadine Karlsson ◽

Preben Bendtsen ◽

...

Keyword(s):

Alcohol Consumption ◽

University Students ◽

Controlled Trial ◽

Intervention Group ◽

Heavy Drinking ◽

Text Message ◽

Control Group ◽

Excessive Drinking ◽

Secondary Outcomes ◽

Text Message Intervention

BACKGROUND Excessive drinking among university students is a global challenge, leading to significant health risks. However, heavy drinking among students is widely accepted and socially normalized. Mobile phone interventions have attempted to reach students who engage in excessive drinking. A growing number of studies suggest that text message–based interventions could potentially reach many students and, if effective, such an intervention might help reduce heavy drinking in the student community. OBJECTIVE The objective of this study was to test the effectiveness of a behavior change theory–based 6-week text message intervention among university students. METHODS This study was a two-arm, randomized controlled trial with an intervention group receiving a 6-week text message intervention and a control group that was referred to treatment as usual at the local student health care center. Outcome measures were collected at baseline and at 3 months after the initial invitation to participate in the intervention. The primary outcome was total weekly alcohol consumption. Secondary outcomes were frequency of heavy episodic drinking, highest estimated blood alcohol concentration, and number of negative consequences attributable to excessive drinking. RESULTS A total of 896 students were randomized to either the intervention or control group. The primary outcome analysis included 92.0% of the participants in the intervention group and 90.1% of the control group. At follow-up, total weekly alcohol consumption decreased in both groups, but no significant between-group difference was seen. Data on the secondary outcomes included 49.1% of the participants in the intervention group and 41.3% of the control group. No significant between-group difference was seen for any of the secondary outcomes. CONCLUSIONS The present study was under-powered, which could partly explain the lack of significance. However, the intervention, although theory-based, needs to be re-assessed and refined to better support the target group. Apart from establishing which content forms an effective intervention, the optimal length of an alcohol intervention targeting students also needs to be addressed in future studies. CLINICALTRIAL International Standard Randomised Controlled Trial Number ISRCTN95054707; http://www.isrctn.com/ISRCTN95054707 (Archived by WebCite at http://www.webcitation.org/70Ax4vXhd)

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The effect of the implementation of a good medical practice booklet on nursing home residents’ drug prescriptions: a difference-in-differences analysis based on data from electronic pill dispensers (Preprint)

10.2196/preprints.13507 ◽

2019 ◽

Author(s):

Stéphane Sanchez ◽

Cécile Payet ◽

Marie Herr ◽

Anne Dazinieras ◽

Caroline Blochet ◽

...

Keyword(s):

Nursing Homes ◽

Medical Practice ◽

Intervention Group ◽

Medication Use ◽

Nursing Home Residents ◽

Control Group ◽

Multilevel Regression ◽

Difference In Differences ◽

Good Medical Practice ◽

The Impact

BACKGROUND The elderly are particularly exposed to adverse events from medication. Among the various strategies to reduce polypharmacy, educational approaches have shown promising results. OBJECTIVE We aimed to evaluate the impact of the implementation of a good medical practice booklet on polypharmacy in nursing homes. METHODS We identified nursing homes belonging to a geriatric care provider that had launched a policy of proper medication use using a good medical practice booklet delivered to prescribers and pharmacists. Data were derived from electronic pill dispensers. The effect of the intervention on polypharmacy was assessed with multilevel regression models, with a control group to account for natural trends over time. The main outcomes were the average daily number of times when medication was administered and the number of drugs with different presentation identifier codes per resident per month. RESULTS 96,216 residents from 519 nursing homes were included between 1 January 2011 and 31 December 2014. The intervention group and the control group both decreased their average daily use of medication (-0.05 and -0.06). The good medical practice booklet did not have a statistically significant effect (exponentiated difference-in-differences coefficient 1.00, 95% confidence interval 0.99-1.02, P=.45). CONCLUSIONS Although the good medical practice booklet itself did not seem effective in decreasing medication use, our data show the effectiveness of a higher-level policy to decrease polypharmacy.

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A Social Norms Approach to Reducing Alcohol Consumption Among College Freshmen

NASPA Journal ◽

10.2202/0027-6014.1278 ◽

2003 ◽

Vol 40 (4) ◽

Cited By ~ 2

Author(s):

Jannette Y. Berkley-Patton ◽

Ellie C. Prosser ◽

Kathleen A. McCluskey-Fawcett ◽

Carrie Towns

Keyword(s):

College Students ◽

Social Norms ◽

Drinking Behavior ◽

School Level ◽

Drinking Patterns ◽

Normative Feedback ◽

High School Level ◽

University Life ◽

Incoming Freshmen

The social norms media approach is an intervention designed to change college students drinking behavior by correcting false perceptions through normative feedback. The present study is a preliminary assessment of a social norms interventions attempt to decrease drinking amounts in students making the transition to university life. Data were collected on three groups of first-year students: (a) spring 1999 for baseline freshmen drinking norms, (b) summer 1999 to assess incoming freshmen drinking patterns, and (c) spring 2000 as a follow-up to assess effectiveness of the intervention for freshmen who entered fall 1999. Results indicated that the majority of freshmen students consistently drank in a moderate range (05 drinks), yet consistently overestimated their peers drinking levels. Incoming freshmen had significantly higher levels of drinking and greater misperceptions than baseline university freshmen. Results suggest the drinking rates significantly decreased for incoming freshmen from summer 1999 compared to spring 2000 follow-up norms. Also, the results suggest that normative feedback on college students drinking may be needed at the high school level to correct faulty perceptions prior to entering a university environment.

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The Effect of Javanese Language Videos with a Community Based Interactive Approach Method as an Educational Instrument for Knowledge, Perception, and Adherence amongst Tuberculosis Patients

Pharmacy ◽

10.3390/pharmacy9020086 ◽

2021 ◽

Vol 9 (2) ◽

pp. 86

Author(s):

Fauna Herawati ◽

Yuni Megawati ◽

Aslichah ◽

Retnosari Andrajati ◽

Rika Yulia

Keyword(s):

Intervention Group ◽

Personal Control ◽

Control Group ◽

P Value ◽

Interactive Approach ◽

Community Based ◽

Tuberculosis Patients ◽

Level Of Knowledge ◽

The Impact

The long period of tuberculosis treatment causes patients to have a high risk of forgetting or stopping the medication altogether, which increases the risk of oral anti-tuberculosis drug resistance. The patient’s knowledge and perception of the disease affect the patient’s adherence to treatment. This research objective was to determine the impact of educational videos in the local language on the level of knowledge, perception, and adherence of tuberculosis patients in the Regional General Hospital (RSUD) Bangil. This quasi-experimental study design with a one-month follow-up allocated 62 respondents in the intervention group and 60 in the control group. The pre- and post-experiment levels of knowledge and perception were measured with a validated set of questions. Adherence was measured by pill counts. The results showed that the intervention increases the level of knowledge of the intervention group higher than that of the control group (p-value < 0.05) and remained high after one month of follow-up. The perceptions domains that changed after education using Javanese (Ngoko) language videos with the Community Based Interactive Approach (CBIA) method were the timeline, personal control, illness coherence, and emotional representations (p-value < 0.05). More than 95% of respondents in the intervention group take 95% of their pill compared to 58% of respondents in the control group (p-value < 0.05). Utilization of the local languages for design a community-based interactive approach to educate and communicate is important and effective.

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