Kimberly A. Mallett

Personalized mailed feedback for college drinking prevention: a randomized clinical trial

The current study was designed to evaluate the efficacy of a mailed feedback and tips intervention as a universal prevention strategy for college drinking. Participants (N = 1,488) were randomly assigned to feedback or assessment-only control conditions. Results indicated that the mailed feedback intervention had a preventive effect on drinking rates overall, with participants in the feedback condition consuming less alcohol at follow-up in comparison with controls. In addition, abstainers in the feedback condition were twice as likely to remain abstinent from alcohol at follow-up in comparison with control participants (odds ratio = 2.02), and feedback participants were significantly more likely to refrain from heavy episodic drinking (odds ratio = 1.43). Neither gender nor severity of baseline drinking moderated the efficacy of the intervention in these analyses, but more conservative analyses utilizing last-observation carryforward suggested women and abstainers benefited more from this prevention approach. Protective behaviors mediated intervention efficacy, with participants who received the intervention being more likely to use strategies such as setting limits and alternating alcohol with nonalcoholic beverages. Implications of these findings for universal prevention of college drinking are discussed.

Heavy drinking in college students: who is at risk and what is being done about it?

Problem drinking and related consequences are a major social issue plaguing college campuses across the United States. Each year, alcohol is responsible for fatalities, assaults, serious injuries, and arrests that occur among college students. The authors review and discuss the risk factors, drinking patterns, and consequences that are relevant to the general student population. In addition, the authors highlight individuals at an increased risk of experiencing alcohol-related problems, such as Greek-letter social organization members and student athletes. The authors also discuss the interventions that attempt to reduce risky drinking and related problems in these subgroups as well as the future directions for research.

Examination of the Mediational Influences of Peer Norms, Environmental Influences, and Parent Communications on Heavy Drinking in Athletes and Nonathletes

The present study used perspectives from the general literature on college alcohol consumption to examine mediational influences of peer, environmental, and parental variables on heavy drinking for student athlete and nonathlete samples. Eight hundred thirty-five freshmen who differed in organized sports involvement were compared on heavy drinking outcomes, peer norms, environmental influences, and parental communication. College athletes reported significantly more heavy drinking experiences than nonathletes. Peer norms, environmental influences, and parental communication were all significant mediators of the athlete-heavy drinking relationship. Athletes reported a higher perception of peer drinking, peer approval of drinking, higher alcohol availability, and direct drink offers, which, in turn, were related to higher rates of heavy drinking. Parental communication mediated the athlete-heavy drinking relationship differently, depending on the specific topic of conversation. Discussion surrounding the importance of incorporating a variety of interventions aimed at reducing collegiate athlete drinking on the basis of the peer, environmental, and parental influences observed in the present analyses are presented. Limitations and directions for future research are also noted.

Transitions in first-year college student drinking behaviors: does pre-college drinking moderate the effects of parent- and peer-based intervention components?

This study used Latent Transition Analysis (LTA) to examine a stage-sequential model of alcohol use among a sample of high-risk matriculating college students (N=1,275). Measures of alcohol use were collected via web-administered surveys during the summer before entering college and followed-up during the fall semester of college. Seven indicators of alcohol use were used in the LTA models, including temporal measures of typical drinking throughout the week. The results indicated that four latent statuses characterized patterns of drinking at both times, though the proportion of students in each status changed during the transition to college: (a) nondrinkers; (b) weekend nonbingers; (c) weekend bingers; and (d) heavy drinkers. Heavy drinkers were distinguished by heavy episodic drinking (HED), and increased likelihood of drinking throughout the week, especially on Thursdays. Covariates were added to the LTA model to examine the main and interaction effects of parent- and peer-based intervention components. Results indicated that participants in the parent and peer conditions were least likely to transition to the heavy drinkers status. Results also indicated that the parent condition was most effective at preventing baseline nondrinkers from transitioning to heavy drinkers whereas the peer condition was most effective at preventing escalation of use among weekend nonbingers. The results underscore the value of considering multiple dimensions of alcohol use within a person-centered approach. Differential treatment effects were found across baseline drinking class, suggesting the benefit for tailored intervention programs to reduce high-risk drinking among college students.

An examination of depressive symptoms and drinking patterns in first year college students

Depression and alcohol use are often found in college students, particularly during their first year. The current study assessed the interrelationship of alcohol use and specific depression symptoms. A large sample (n = 869) of first year students were invited to participate via the Internet. Results indicated that specific depression symptoms correlated with alcohol consumption. Self-reported heavy, problem drinkers experienced significantly higher Beck Depression Inventory scores than all other groups. Our findings highlight the importance of screening for both alcohol use and depressed mood in college students.

Are all alcohol and energy drink users the same? Examining individual variation in relation to alcohol mixed with energy drink use, risky drinking, and consequences.

Individuals who consume alcohol mixed with energy drinks (AmEDs) have been identified as higher-risk drinkers, as they are more prone to drink increased amounts of alcohol and experience more consequences compared with non-AmED users. The present study examined differential AmED use and alcohol consumption simultaneously as multidimensional risk behaviors among AmED users. Students who identified as drinkers and current AmED users (n = 195) completed a Web-based survey related to their AmED consumption and typical drinking patterns. Latent profile analysis was used to classify participants into distinct AmED user profiles. Profiles were then compared on AmED-based cognitive factors (e.g., expectancies, norms) and alcohol-related consequences. Four AmED user profiles emerged: moderate drinker, low proportion AmED users (ML); heavy drinker, low proportion AmED users (HL); moderate drinker, high proportion AmED users (MH); and heavy drinker, high proportion AmED users (HH). Membership in higher-proportion AmED groups was associated with more positive AmED expectancies and perceived norms. No significant differences were observed in the amount of consequences endorsed by HL and HHs; however, MHs experienced significantly more alcohol-related physical consequences than MLs. This suggests that increased use of AmEDs is associated with increased risk of experiencing alcohol-related consequences for moderate drinkers. Screening students for AmED use could be used as a novel, inexpensive tool to identify high-risk drinkers for targeted interventions aimed at reducing alcohol consumption and related problems.

Age of drinking onset as a moderator of the efficacy of parent-based, brief motivational, and combined intervention approaches to reduce drinking and consequences among college students.

BACKGROUND The current study tested age of onset as a moderator of intervention efficacy on drinking and consequence outcomes among a high-risk population of college students (i.e., former high school athletes). METHODS Students were randomized to one of four conditions: assessment only control, combined parent-based intervention (PBI) and brief motivational intervention (BMI), PBI alone, and BMI alone. Participants (n = 1,275) completed web-administered measures at baseline (summer before starting college) and 10-month follow-up. RESULTS Overall, the combined intervention demonstrated the strongest and most consistent reductions across all outcomes, particularly with the youngest initiators. Participants who initiated drinking at the youngest ages had significantly lower peak drinking, typical weekly drinking, and reported consequences at follow-up when they received the combined intervention when compared to the control group. The BMI and PBI groups, when examined independently, demonstrated significant effects across outcomes but were inconsistent across the different age groups. CONCLUSION Results suggest the combination of a PBI and a peer-delivered BMI is an appropriate and efficacious way to reduce drinking and related consequences among individuals who initiated drinking earlier in adolescence and are at an increased risk of experiencing alcohol problems.

One-time or repeat offenders? An examination of the patterns of alcohol-related consequences experienced by college students across the freshman year

Recent studies have examined alcohol-related consequences in college students as an independent outcome variable, rather than as a result of heavy drinking. The present study examined the patterns of consequences experienced by first-year college students (n=169). Specifically, the number of distinct consequences and the frequency of repeated consequences were evaluated as well as the combination of the two. Results revealed that 80% of participants reported experiencing multiple consequences, with over 34% of students reporting 6 or more unique consequences over the course of their freshmen year. In addition, nearly 50% of the sample reported experiencing 3 or more consequences repeatedly. Further, 23% of the sample reported experiencing 5 or more repeated consequences and 6 or more multiple consequences. These individuals experienced 38% of the multiple consequences and 54% of the repeated consequences reported by the entire sample, suggesting individuals who endorsed experiencing multiple consequences repeatedly also experienced a disproportionate number of the total consequences reported by the sample. The findings suggest there are specific high-risk patterns of alcohol-related consequences and demonstrate a need for further examination of additional variables that predict consequences.

Comparing the Efficacy of an In-Person Intervention With a Skin Self-examination Workbook

From 1992 to 2004, melanoma incidence for all categories of tumor thickness increased 3.1% annually, and there was a 3.8% annual increase in the thickest cancers (Breslow depth, >4 mm), which have the least favorable prognosis.1–3 Since most melanomas are discovered by the patient or a partner, skin self-examination (SSE) with the assistance of a partner has the potential to improve long-term survival.4–6 Given the challenge of examining difficult-to-see body areas (eg, the back), partner assistance is important.7 By creating a workbook from our experience with 130 in-person interventions that increased SSE and partner-assisted skin examination (PASE),7–9 we extend our groups previous research. The workbook codifies the dialog of the in-person intervention with exercises that amplify skills and provide a framework for the patient and partner to understand the significance of melanoma by “story telling” about other people with melanoma in a way that is a call to action. Herein, we compare the efficacy of the workbook with that of in-person training.

Skin Self-Examination Education for Early Detection of Melanoma: A Randomized Controlled Trial of Internet, Workbook, and In-Person Interventions

Background Early detection of melanoma improves survival. Since many melanoma patients and their spouses seek the care of a physician after discovering their melanoma, an ongoing study will determine the efficacy of teaching at-risk melanoma patients and their skin check partner how to conduct skin self-examinations (SSEs). Internet-based health behavior interventions have proven efficacious in creating behavior change in patients to better prevent, detect, or cope with their health issues. The efficacy of electronic interactive SSE educational intervention provided on a tablet device has not previously been determined. Objective The electronic interactive educational intervention was created to develop a scalable, effective intervention to enhance performance and accuracy of SSE among those at-risk to develop melanoma. The intervention in the office was conducted using one of the following three methods: (1) in-person through a facilitator, (2) with a paper workbook, or (3) with a tablet device used in the clinical office. Differences related to method of delivery were elucidated by having the melanoma patient and their skin check partner provide a self-report of their confidence in performing SSE and take a knowledge-based test immediately after receiving the intervention. Methods The three interventions used 9 of the 26 behavioral change techniques defined by Abraham and Michie to promote planning of monthly SSE, encourage performing SSE, and reinforce self-efficacy by praising correct responses to knowledge-based decision making and offering helpful suggestions to improve performance. In creating the electronic interactive SSE educational intervention, the educational content was taken directly from both the scripted in-person presentation delivered with Microsoft PowerPoint by a trained facilitator and the paper workbook training arms of the study. Enrollment totaled 500 pairs (melanoma patient and their SSE partner) with randomization of 165 pairs to the in-person, 165 pairs to the workbook, and 70 pairs to electronic interactive SSE educational intervention. Results The demographic survey data showed no significant mean differences between groups in age, education, or income. The tablet usability survey given to the first 30 tablet pairs found that, overall, participants found the electronic interactive intervention easy to use and that the video of the doctor-patient-partner dialogue accompanying the dermatologist’s examination was particularly helpful in understanding what they were asked to do for the study. The interactive group proved to be just as good as the workbook group in self-confidence of scoring moles, and just as good as both the workbook and the in-person intervention groups in self-confidence of monitoring their moles. While the in-person intervention performed significantly better on a skill-based quiz, the electronic interactive group performed significantly better than the workbook group. The electronic interactive and in-person interventions were more efficient (30 minutes), while the workbook took longer (45 minutes). Conclusions This study suggests that an electronic interactive intervention can deliver skills training comparable to other training methods, and the experience can be accommodated during the customary outpatient office visit with the physician. Further testing of the electronic interactive intervention’s role in the anxiety of the pair and pair-discovered melanomas upon self-screening will elucidate the impact of these tools on outcomes in at-risk patient populations. Trial Registration ClinicalTrials.gov NCT01013844; http://clinicaltrials.gov/show/NCT01013844 (Archived by WebCite at http://www.webcitation.org/6LvGGSTKK).