Abstract
Alcohol consumption is prevalent among college students and can become problematic for some. Numerous randomized controlled trials have evaluated the efficacy of individual preventive interventions in reducing alcohol use and alcohol-related problems in college student populations. Consistent with earlier reviews, the balance of the evidence from studies conducted during the past 3 years strongly supports the efficacy of brief motivational interventions combined with personalized feedback interventions (PFIs) and personalized normative feedback (PNF), as well as of stand-alone PFI/PNF interventions. Recent analyses also continue to support the efficacy of alcohol expectancy challenge interventions, although the findings are less consistent. In addition, recent analyses offer mixed support for feedback-based interventions focused solely on blood alcohol concentration and for multicomponent, alcohol education–focused interventions that include elements of PFI/PNF. No evidence of efficacy was found for programs that only included alcohol education.
As detailed by Johnston and colleagues (2009), the majority of young adults, in particular college students, consume alcohol. Moreover, a substantial proportion of those who consume alcohol misuse it, engaging in heavy episodic drinking,1 which directly and indirectly contributes to a host of harmful consequences (O’Malley and Johnston 2002; Perkins 2002). The rates of heavy drinking peak at ages 21 or 22 (Johnston et al. 2009), suggesting that most college students mature out of heavy drinking. Nevertheless, the harm they experience as a result of heavy drinking, such as poor academic and work performance or serious physical injury, may irrevocably alter students’ natural developmental trajectories. In an effort to prevent or mitigate such long-term harm, myriad prevention programs have been developed to reduce college student drinking by targeting individual factors associated with alcohol use and misuse, including alcohol expectancies, drinking motives, perceived norms, and natural ambivalence regarding behavior (Baer 2002; Presley et al. 2002). A wealth of research has been devoted to evaluating the efficacy of these preventive interventions. The purpose of this article is to provide a comprehensive summary of the current state of the science with regard to individual-focused preventive interventions whose efficacy in reducing alcohol use and alcohol-related problems has been evaluated in the college student population using randomized controlled trials. Conclusions from earlier reviews in this area are described briefly, with greater focus given to summarizing evidence accumulated in the past three years (2007-2010).
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Individual-Focused Preventive Interventions: Specific Components and Evidence of Efficacy
Previous Reviews
Larimer and Cronce (2002, 2007) conducted qualitative reviews of research published between 1984 and early 2007 that evaluated the efficacy of individual preventive interventions aimed at college students. Both reviews noted a dearth of support for educational or awareness models, including information-based and values clarification approaches, whereas there was evidence of efficacy for skills-based interventions, including self-monitoring/assessment, alcohol expectancy challenge (AEC), and multicomponent skills training. Moreover, both reviews documented strong empirical support for brief motivational interventions (BMIs) delivered via mail, online, or in person. As the name implies, in-person BMIs are brief (i.e., typically delivered over one or two sessions) and focus on enhancing motivation and commitment to change problematic behavior. To this end, BMIs often provide personalized feedback regarding the client’s drinking and related consequences, alcohol expectancies, and drinking motives; when delivered alone in the absence of a trained facilitator, this personalized feedback component is referred to as a personalized feedback intervention (PFI). BMIs and PFIs often additionally include general alcohol information (i.e., alcohol education) and alcohol-specific coping and harm-reduction skills. PFIs typically include personalized normative feedback (PNF), which compares the client’s self-reported drinking behavior to the average drinking behavior of a specific reference group (e.g., typical student, typical female). This PNF encourages clients to explore and enhance discrepancies between their perception of their own drinking as “typical” and the actual drinking behaviors of their peers—that is, that the majority of students drink moderately, often significantly less than the individual receiving the intervention. Like PFIs, PNF can be delivered as a stand-alone intervention in the absence of in-person contact. Larimer and Cronce (2007) independently detailed empirical evidence supporting normative re-education interventions, in particular computer-administered or in-person PNF interventions, that produced reductions in drinking and/or consequences mediated through changes in normative perceptions.
Complementing the qualitative reviews by Larimer and Cronce (2002, 2007), Carey and colleagues (2007) conducted a quantitative review evaluating 62 randomized clinical trials of 98 alcohol interventions for college students published during roughly the same time period (i.e., 1985 to early 2007). This meta-analysis similarly supported the efficacy of individual-focused alcohol interventions in reducing the quantity and frequency of alcohol use and alcohol-related negative consequences. The investigators further noted that significant intervention effects on indices of alcohol consumption peaked before the 6-month follow-up and that subsequently emerging effects on alcohol-related negative consequences lasted through long-term follow-up (ranging from 1 to 3.75 years). Specifically, Carey and colleagues (2007) concluded that individual interventions that utilized motivational interviewing techniques, included personalized feedback on alcohol expectancies and drinking motives with normative re-education components, and included decisional balance exercises demonstrated greater efficacy in reducing alcohol-related consequences than did various comparison groups. This combination of intervention components is common to intervention approaches patterned after the Brief Alcohol Screening and Intervention for College Students (BASICS) program (Dimeff et al. 1999).
Review of Recent Individual-Focused Preventive Intervention Studies
In the years since the publication of the reviews by Carey and colleagues (2007) and Larimer and Cronce (2002, 2007), numerous studies of individual-focused preventive interventions for college student drinking have been published. Of these, 36 studies, evaluating 56 unique interventions, met criteria for inclusion in this review (see the tables for details). Studies were identified via a comprehensive search of electronic databases, including PsycInfo and Medline (for a list of search terms used, see Larimer and Cronce 2007), covering the period from late 2007 to early 2010. Additional studies were identified indirectly (e.g., they were referenced in the introduction section of one of the identified studies), and as-yet-unpublished studies were provided directly by authors. Studies were included if they utilized a randomized controlled trial approach—that is, if they randomly assigned individual participants (or intact groups) to one of two or more experimental conditions, including at least one active intervention and an ostensibly inert control (e.g., assessment only) or active intervention comparison group. Although the number of studies meeting inclusion criteria suggests that a meta-analysis may be warranted, a qualitative approach was selected for this review to facilitate more rapid communication with key stakeholders concerning the current state of alcohol prevention.2 However, intervention effect sizes are reported for relevant outcomes in all studies that included effect size estimates in the original report or provided sufficient postintervention data to calculate between-group estimates (see tables). Within-group effect size estimates are also provided for studies wherein significant within-person reductions in alcohol use or consequences were evident.
Many of the studies included in this review evaluate the efficacy of multicomponent BMIs, many of which were adapted from the BASICS program. Most of these BMIs incorporated a PFI with PNF. Some studies evaluated one or more PFI/PNF intervention delivered alone, without the benefit of a trained intervention facilitator. Interventions were delivered via various modalities, including in-person group and individual sessions, mailed printed material, and Web-based content. In addition, some interventions were conducted in special settings (i.e., primary care, in the student’s home before entering college) or targeted high-risk student subpopulations (i.e., mandated/sanctioned students, freshmen, or athletes).
Stand-Alone PFI/PNF Interventions
A total of 17 studies evaluated the impact of 14 unique PFIs/PNF and 4 PNF-only interventions implemented via written material, mail, computer, Web, or electronic diary on college student drinking (see table 1). Of the 14 PFI/PNF interventions evaluated, six were associated with reductions in drinking but not drinking-related consequences relative to the comparison condition at follow-up. One PFI/PNF intervention (Doumas and Andersen, 2009) was associated with reduced drinking-related consequences as well as alcohol use. Four additional PFI/PNF interventions were associated with significant within-person reductions in alcohol use and/or consequences across assessment periods, but between-groups differences were not evident. Of the four PNF-only interventions evaluated, three resulted in reductions in drinking outcomes at follow-up. The remaining PNF-only intervention had no effects on t
บทคัดย่อแอลกอฮอล์เป็นแพร่หลายในหมู่นักศึกษา และสามารถเป็นปัญหาสำหรับบางคน ทดลองควบคุม randomized จำนวนมากมีประเมินประสิทธิภาพของมาตรการป้องกันแต่ละในการลดสุราและปัญหาที่เกี่ยวข้องกับแอลกอฮอล์ในประชากรนักเรียนวิทยาลัย สอดคล้องกับก่อนหน้านี้รีวิว ยอดดุลของหลักฐานจากการศึกษาดำเนินการในช่วง 3 ปีที่ผ่านมาขอสนับสนุนประสิทธิภาพของมาตรการหัดย่อรวมกับส่วนบุคคลงานวิจัยความคิดเห็น (PFIs) และส่วนบุคคล normative ติชม (PNF), เช่น ณงาน PFI/PNF แบบสแตนด์อโลน วิเคราะห์ล่าสุดยังคงสนับสนุนประสิทธิภาพของแอลกอฮอล์เสถียรภาพความท้าทายงานวิจัย แม้ว่าการพบกันน้อยลง นอกจากนี้ วิเคราะห์ล่าสุดให้การสนับสนุนผสม สำหรับผลป้อนกลับตามมาตรการเน้นเลือดแอลกอฮอล์ความเข้มข้นเท่านั้น และ สำหรับ multicomponent แอลกอฮอล์ – เน้นการศึกษางานวิจัยที่มีองค์ประกอบของ PFI/PNF พบของประสิทธิภาพสำหรับโปรแกรมที่รวมการศึกษาแอลกอฮอล์เท่านั้นAs detailed by Johnston and colleagues (2009), the majority of young adults, in particular college students, consume alcohol. Moreover, a substantial proportion of those who consume alcohol misuse it, engaging in heavy episodic drinking,1 which directly and indirectly contributes to a host of harmful consequences (O’Malley and Johnston 2002; Perkins 2002). The rates of heavy drinking peak at ages 21 or 22 (Johnston et al. 2009), suggesting that most college students mature out of heavy drinking. Nevertheless, the harm they experience as a result of heavy drinking, such as poor academic and work performance or serious physical injury, may irrevocably alter students’ natural developmental trajectories. In an effort to prevent or mitigate such long-term harm, myriad prevention programs have been developed to reduce college student drinking by targeting individual factors associated with alcohol use and misuse, including alcohol expectancies, drinking motives, perceived norms, and natural ambivalence regarding behavior (Baer 2002; Presley et al. 2002). A wealth of research has been devoted to evaluating the efficacy of these preventive interventions. The purpose of this article is to provide a comprehensive summary of the current state of the science with regard to individual-focused preventive interventions whose efficacy in reducing alcohol use and alcohol-related problems has been evaluated in the college student population using randomized controlled trials. Conclusions from earlier reviews in this area are described briefly, with greater focus given to summarizing evidence accumulated in the past three years (2007-2010).Go to:Individual-Focused Preventive Interventions: Specific Components and Evidence of EfficacyPrevious ReviewsLarimer and Cronce (2002, 2007) conducted qualitative reviews of research published between 1984 and early 2007 that evaluated the efficacy of individual preventive interventions aimed at college students. Both reviews noted a dearth of support for educational or awareness models, including information-based and values clarification approaches, whereas there was evidence of efficacy for skills-based interventions, including self-monitoring/assessment, alcohol expectancy challenge (AEC), and multicomponent skills training. Moreover, both reviews documented strong empirical support for brief motivational interventions (BMIs) delivered via mail, online, or in person. As the name implies, in-person BMIs are brief (i.e., typically delivered over one or two sessions) and focus on enhancing motivation and commitment to change problematic behavior. To this end, BMIs often provide personalized feedback regarding the client’s drinking and related consequences, alcohol expectancies, and drinking motives; when delivered alone in the absence of a trained facilitator, this personalized feedback component is referred to as a personalized feedback intervention (PFI). BMIs and PFIs often additionally include general alcohol information (i.e., alcohol education) and alcohol-specific coping and harm-reduction skills. PFIs typically include personalized normative feedback (PNF), which compares the client’s self-reported drinking behavior to the average drinking behavior of a specific reference group (e.g., typical student, typical female). This PNF encourages clients to explore and enhance discrepancies between their perception of their own drinking as “typical” and the actual drinking behaviors of their peers—that is, that the majority of students drink moderately, often significantly less than the individual receiving the intervention. Like PFIs, PNF can be delivered as a stand-alone intervention in the absence of in-person contact. Larimer and Cronce (2007) independently detailed empirical evidence supporting normative re-education interventions, in particular computer-administered or in-person PNF interventions, that produced reductions in drinking and/or consequences mediated through changes in normative perceptions.Complementing the qualitative reviews by Larimer and Cronce (2002, 2007), Carey and colleagues (2007) conducted a quantitative review evaluating 62 randomized clinical trials of 98 alcohol interventions for college students published during roughly the same time period (i.e., 1985 to early 2007). This meta-analysis similarly supported the efficacy of individual-focused alcohol interventions in reducing the quantity and frequency of alcohol use and alcohol-related negative consequences. The investigators further noted that significant intervention effects on indices of alcohol consumption peaked before the 6-month follow-up and that subsequently emerging effects on alcohol-related negative consequences lasted through long-term follow-up (ranging from 1 to 3.75 years). Specifically, Carey and colleagues (2007) concluded that individual interventions that utilized motivational interviewing techniques, included personalized feedback on alcohol expectancies and drinking motives with normative re-education components, and included decisional balance exercises demonstrated greater efficacy in reducing alcohol-related consequences than did various comparison groups. This combination of intervention components is common to intervention approaches patterned after the Brief Alcohol Screening and Intervention for College Students (BASICS) program (Dimeff et al. 1999).Review of Recent Individual-Focused Preventive Intervention StudiesIn the years since the publication of the reviews by Carey and colleagues (2007) and Larimer and Cronce (2002, 2007), numerous studies of individual-focused preventive interventions for college student drinking have been published. Of these, 36 studies, evaluating 56 unique interventions, met criteria for inclusion in this review (see the tables for details). Studies were identified via a comprehensive search of electronic databases, including PsycInfo and Medline (for a list of search terms used, see Larimer and Cronce 2007), covering the period from late 2007 to early 2010. Additional studies were identified indirectly (e.g., they were referenced in the introduction section of one of the identified studies), and as-yet-unpublished studies were provided directly by authors. Studies were included if they utilized a randomized controlled trial approach—that is, if they randomly assigned individual participants (or intact groups) to one of two or more experimental conditions, including at least one active intervention and an ostensibly inert control (e.g., assessment only) or active intervention comparison group. Although the number of studies meeting inclusion criteria suggests that a meta-analysis may be warranted, a qualitative approach was selected for this review to facilitate more rapid communication with key stakeholders concerning the current state of alcohol prevention.2 However, intervention effect sizes are reported for relevant outcomes in all studies that included effect size estimates in the original report or provided sufficient postintervention data to calculate between-group estimates (see tables). Within-group effect size estimates are also provided for studies wherein significant within-person reductions in alcohol use or consequences were evident.Many of the studies included in this review evaluate the efficacy of multicomponent BMIs, many of which were adapted from the BASICS program. Most of these BMIs incorporated a PFI with PNF. Some studies evaluated one or more PFI/PNF intervention delivered alone, without the benefit of a trained intervention facilitator. Interventions were delivered via various modalities, including in-person group and individual sessions, mailed printed material, and Web-based content. In addition, some interventions were conducted in special settings (i.e., primary care, in the student’s home before entering college) or targeted high-risk student subpopulations (i.e., mandated/sanctioned students, freshmen, or athletes).Stand-Alone PFI/PNF Interventions A total of 17 studies evaluated the impact of 14 unique PFIs/PNF and 4 PNF-only interventions implemented via written material, mail, computer, Web, or electronic diary on college student drinking (see table 1). Of the 14 PFI/PNF interventions evaluated, six were associated with reductions in drinking but not drinking-related consequences relative to the comparison condition at follow-up. One PFI/PNF intervention (Doumas and Andersen, 2009) was associated with reduced drinking-related consequences as well as alcohol use. Four additional PFI/PNF interventions were associated with significant within-person reductions in alcohol use and/or consequences across assessment periods, but between-groups differences were not evident. Of the four PNF-only interventions evaluated, three resulted in reductions in drinking outcomes at follow-up. The remaining PNF-only intervention had no effects on t
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