Elsevier

Addictive Behaviors

Volume 35, Issue 3, March 2010, Pages 183-189
Addictive Behaviors

Web-based alcohol prevention for incoming college students: A randomized controlled trial

https://doi.org/10.1016/j.addbeh.2009.10.012Get rights and content

Abstract

College students are an at-risk population based on their heavy alcohol consumption and associated consequences. First-year students are at particular risk due to greater freedom and access to alcohol on campus. Web-based (electronic) interventions (e-interventions) are being rapidly adopted as a universal approach to prevent high-risk drinking, but have not been well evaluated. The objective of this study was to investigate the effectiveness of the two most widely adopted EIs, AlcoholEdu and The Alcohol eCHECKUP TO GO (e-Chug), in reducing both alcohol use and alcohol-related consequences in incoming college students. To do so, we conducted a 3-group randomized trial (N = 82) comparing AlcoholEdu and e-Chug to an assessment-only control group. Compared to the assessment-only control group, participants in the AlcoholEdu and e-Chug groups reported lower levels of alcohol use across multiple measures at 1-month follow-up. Participants who received AlcoholEdu showed significantly fewer lower alcohol-related consequences than assessment-only controls, while there was a trend for reduced consequences in participants who received e-Chug versus assessment-only. Findings indicate that e-intervention is a promising prevention approach to address the problem of college student alcohol consumption, especially for campuses that have limited resources.

Introduction

College student alcohol use is a major public health concern (U.S. Department of Health and Human Services, 2000). Large-scale surveys indicate that approximately 68% of all college students drank alcohol in the past month (Johnston, O'Malley, Bachman, & Schulenberg, 2006), and approximately 40% of all college students engage in heavy episodic drinking, defined as consumption of 5 or more drinks for men (4+ for women) in one drinking episode during the past 2 weeks (Wechsler, Dowdall, Davenport, & Rimm, 1995). Heavy episodic alcohol consumption in college students is related to numerous consequences, including academic difficulties, property damage, risky sexual activity, blackouts, alcohol poisoning, and death (Hingson et al., 2002, Jackson et al., 2005, Wechsler and Isaac, 1992). Recent reports indicate that college drinking has not decreased over the past decade (Johnston et al., 2006), and cross-sectional data evidenced a 16% increase in the proportion of students who engage in frequent heavy episodic alcohol use (≥ 3 in the past two weeks) between 1993 and 2001 (CASA, 2007). The first year of school is a particularly risky period, and many first-year college students develop a pattern of heavy drinking that puts them at risk for adverse consequences (see Borsari, Murphy, & Barnett, 2007).

Campus administrators have increased efforts to devise and implement prevention programs that minimize high-risk drinking (Wechsler et al., 2002), but individual and group prevention sessions are costly and require considerable staff effort to deliver. Because of their broad reach and low administrator burden, web-based (electronic) interventions (EIs) have been adopted as a promising universal approach to prevent high-risk drinking. Recent technological advances, including increased access to the internet and faster internet connections, have resulted in greater incorporation of electronic methods of communication (email, streaming video, interactive programs) into interventions (see Walters, Wright, & Shegog, 2006 for review). EIs for behavior change show promising results for alcohol use and dependence (Hester et al., 2005, Neighbors et al., 2009), smoking cessation (Saitz et al., 2007), mental health conditions (Christensen et al., 2006, Griffiths and Christensen, 2006), and physical activity (Napolitano et al., 2003).

We are aware of six commercial web-based EIs targeting college student alcohol use: (1) Under the Influence, (2) Alcohol Response-Ability, (3) myStudentBody, (4) College Alc, (5) AlcoholEdu (Outside the Classroom) and (6) The Alcohol eCHECKUP TO GO (e-Chug). Programs vary in scope and length, but all of these e-interventions provide normative drinking information, protective strategies (e.g., tips for safer drinking), and alcohol education. Although educational strategies do not appear to be an effective prevention strategy when used alone (Goodstadt & Caleekal-John, 1984), other components used by these interventions have evidence of effectiveness with heavier drinking college students, including cognitive-behavioral skills, normative drinking information, and motivational information (Larimer and Cronce, 2002, Larimer and Cronce, 2007).

In the first controlled evaluation of an e-intervention for college student alcohol use, myStudentBody, a multimedia health educational website incorporating motivational enhancement strategies, was evaluated in a sample of 265 students from five campuses in the northeast (Chiauzzi, Green, Lord, Thum, & Goldstein, 2005). In the study, participants were randomly assigned to receive access to myStudentBody or educational literature. Students who received myStudentBody demonstrated a steeper reduction in alcohol use and consequences 1 month after receiving access to the website than students in the comparison group, but no differences in consumption or alcohol-related consequences were found at 3-month follow-up.

College Alc is a 75-minute EI that uses multimedia video clips, illustrations, and static text to present educational information about the physiological effects of alcohol, descriptive alcohol norms, high-risk behaviors (e.g., drinking and driving), and safer-drinking strategies. College Alc was evaluated in a sample of college freshman (N = 370) who were randomized to College Alc or an assessment-only control group (Paschal, Bersamin, Fearnow-Kenney, Wyrick, & Currey, 2006). Results indicated that students assigned to College Alc showed increased knowledge about alcohol, fewer positive attitudes about alcohol use, and higher intentions to use safer-drinking strategies relative to the control group at the end of the first semester in college. However, no differences in alcohol use, alcohol expectancies, normative beliefs, or negative alcohol-related consequences were observed.

In a supplemental analysis of College Alc using the same sample, students in the College Alc group who reported drinking within 30 days of the baseline survey showed decreases in heavy episodic drinking, drinking to the point of intoxication, and alcohol-related consequences, while drinkers in the control group reported increases for each of these outcomes (Bersamin, Paschall, Fearnow-Kenney, & Wyrick, 2007). However, the generalizability of these findings is unknown, given the low initial response rate (16%), low treatment adherence (only 48% of the participants completed the entire College Alc curriculum), and follow-up rate (59%).

AlcoholEdu and e-Chug have received more systematic evaluation. AlcoholEdu is a 3-hour educational program that utilizes multimedia presentations and static text within three content areas. The first content area (“Shaping our Decisions”) focuses on social pressures, injunctive alcohol norms, alcohol advertising, and biopsychosocial consequences of heavy episodic drinking. The second content area (“Knowing the Facts”) provides information about the physiological effects of alcohol and alcohol expectancies. The final section (“When it Matters”) provides tips and suggestions about how to be safer when drinking. The program blends text-based information, streaming video, and interactive web pages.

In a non-experimental and retrospective evaluation of the 2003 version of AlcoholEdu, college students from 225 campuses who completed AlcoholEdu between 2003 and 2004 were randomly assigned to an intervention or comparison group within 4-week blocks (Wall, 2007). Baseline alcohol use and alcohol-related consequences for the comparison group were compared to the intervention group's post-test alcohol use and alcohol-related consequences (N = 24,877; 7.3% incoming freshman, 92.7% matriculated). Results indicated that the intervention group reported fewer heavy episodic drinking episodes and alcohol-related consequences than the comparison group. Interpretation of the findings of this study is limited because only students who completed the post-test assessment were included in the analyses (49.5% of the sample).

More recently, a randomized controlled trial (RCT) was conducted to evaluate the efficacy of AlcoholEdu (Croom et al., 2009). In this study, incoming students (N = 3216) were randomized to the 2006 version of AlcoholEdu or a waitlist control group. Participants were 1891 students (a 57% response rate) who completed the baseline and 1-month follow-up assessment. Results indicated that students who received AlcoholEdu reported playing drinking games less frequently than the control group at follow-up, and endorsed more correct answers on the AlcoholEdu knowledge exam than the control group at follow-up. However, groups did not differ according to the amount of alcohol consumed during a typical week. No differences were found at follow-up for other risky behaviors (e.g., drinking shots, engaging in heavy episodic drinking, pregaming), safer-drinking behaviors (e.g., eating before drinking, alternating alcoholic beverages with non-alcoholic drinks), or high-risk outcomes (e.g., hangovers, alcohol induced memory loss, one-night stands). Limitations of this study include high levels of attrition (40%) and a randomization procedure that failed to produce equivalent groups at baseline for past alcohol-education exposure, alcohol knowledge, readiness to change, and parental discussions about drinking. However, because AlcoholEdu is regularly revised, these results may not generalize to newer versions of AlcoholEdu.

In a second RCT of AlcoholEdu, freshman students (N = 1620) were assigned to the 2007 version of AlcoholEdu (n = 810) or an assessment-only control group (n = 810) at the start of the Fall semester (Lovecchio, Wyatt, & DeJong, in press). One follow-up was conducted 30 days after baseline, and this survey was completed by 92% of the AlcoholEdu group and 68% of the control group. Results indicated that the AlcoholEdu group consumed less alcohol than the control group at the 1-month follow-up. In addition, the AlcoholEdu group reported experiencing fewer negative alcohol-related consequences at follow-up than the control group. A limitation of this study is that participants who failed to complete the follow-up were lighter drinkers at baseline than completers. Although baseline alcohol use was used as a covariate in the data analysis, it is possible that the differential rate of attrition may have affected the findings.

e-Chug is the briefest alcohol EI currently available for college students (approximately 20 min to complete). This EI provides students personalized normative feedback (PNF) using text and illustrations to present the amount of alcohol consumed, caloric intake from alcohol use, gender-specific alcohol normative information, estimated annual monetary cost of the alcohol consumed, estimated BAC, tolerance, and negative alcohol-related consequences. e-Chug also presents three short videos (approximately 3 min) about standardized drink definitions, BAC, and the biphasic response curve. The last section of e-Chug contains a list of safer-drinking strategies and a referral list of local and national resources.

e-Chug has been evaluated in two separate RCTs as an indicated intervention for heavier drinking college students (Walters, Vader, & Harris, 2007) and as primary prevention for first-year students (Doumas & Andersen, 2009). In Walters et al., freshmen (N = 106) from a large public university who reported at least one heavy episodic drinking episode in the past month were randomly assigned to e-Chug or an assessment-only condition. Assessments were completed at baseline, 2, and 4 months. Results indicated that students who received e-Chug demonstrated a steeper reduction in alcohol use at the 2-month follow-up compared to the control group, but the groups did not differ in alcohol consequences, and no significant differences were found at the 4-month follow-up. These results from the heavy drinking students are consistent with a growing body of research that indicates that the mechanism of PNF delivery (e.g., stand-alone, mailed, or internet-delivered) is not related to superior treatment outcomes (see White, 2006 for review). Although this study primarily targeted heavy drinking college students, lower-risk drinkers (abstainers and light drinkers, N = 245) were also randomized to conditions, but no significant differences in alcohol consumption were observed between groups for these lighter drinkers.

Doumas and Andersen (2009) evaluated the efficacy of e-Chug in a sample of freshman students who were recruited from six first-year college seminar sections. Participants (N = 80, response rate 92%) were randomized to e-Chug or assessment-only by section and they completed a baseline assessment. These participants were classified as high-risk or low-risk based according to whether they reported engaging in at least one heavy episodic drinking episode in the past two weeks. Participants were recontacted after 3 months and 65% (n = 52) completed the follow-up assessment. Results indicated that high-risk drinkers who received e-Chug reported drinking less alcohol and fewer alcohol-related consequences than the comparison group at follow-up. Low-risk drinkers in both groups were not significantly different for alcohol use and related consequences at follow-up. One limitation of this study is that participants who completed the follow-up assessments reported experiencing significantly fewer alcohol-related consequences at baseline than those who did not complete the follow-up. Although there is strong evidence for PNF as an indicated intervention and primary prevention for already enrolled first-year students, PNF, and specifically e-Chug, has not been evaluated as a universal prevention program for incoming students.

The purpose of the present study was to conduct an evaluation of the two most highly adopted EIs used as universal prevention for incoming college students. We decided to evaluate these programs with incoming students because EIs are commonly administered during this high-risk transition from high school to college, before students have increased access to alcohol and decreased parental monitoring. As even minimal PNF has been found to reduce alcohol use, we expected that students who received AlcoholEdu or e-Chug would report lower levels of alcohol use and alcohol-related consequences at follow-up than assessment-only controls. In addition, we expected that the more comprehensive information presented in AlcoholEdu would be more effective with incoming students than PNF, so we expected that students who received AlcoholEdu would report lower levels of alcohol use and alcohol-related consequences at follow-up than students who completed e-Chug.

Section snippets

Setting

The project was conducted at a four-year, private liberal arts university located in the Northeast. The school has approximately 4000 undergraduates (15% minority, 51% female). First-year students primarily live on campus, and there are no fraternities or sororities. All procedures were approved by the University Institutional Review Board.

Sample characteristics

Of the 150 students invited to participate, 39 students did not respond to our survey, 12 of which were not eligible to participate (6 did not matriculate and 6 were younger than 18 years old). A total of 111 students opened the email invitation to the survey. Of these 111 students, 15 students were not eligible because they were minors, and 13 did not consent to participate. Out of the 83 eligible students who consented, 82 completed the baseline assessment. Consequently, 82 (67%) of the

Discussion

This is the first controlled study to simultaneously evaluate the effectiveness of AlcoholEdu and e-Chug when used as prevention for incoming students. Consistent with our expectation, the AlcoholEdu and e-Chug groups reported less alcohol use at follow-up than the control group. On average, students in both EI groups reported decreased or stable alcohol use involvement post-baseline for several outcomes, while the control group reported increased alcohol use for all outcomes. For example,

Role of funding sources

Funding for this study was provided by a Research Excellence Award from the Center for Alcohol and Addiction Studies (CAAS) at Brown University to Dr. Hustad. CAAS had no role in the study procedures, data collection, data analysis or interpretation of the results, manuscript preparation, or the decision to submit this manuscript for publication. This work was also supported by the National Institute on Alcohol Abuse and Alcoholism Grants T32-AA07459 to Dr. Hustad and AA015518 to Dr. Borsari.

Contributors

Drs. Hustad, Barnett, Borsari, and Jackson designed the study and wrote the procedures. Drs. Hustad, Barnett, and Borsari conducted the literature searches. Drs. Hustad and Jackson conducted the statistical analysis. Dr. Hustad wrote the first draft of the manuscript and all authors contributed to and approved the final manuscript that is submitted to Addictive Behaviors.

Conflict of Interest

All authors declare that they have no conflicts of interest.

Acknowledgements

The authors would like to thank Donna Darmody for her assistance with recruitment. This work was supported by the National Institute on Alcohol Abuse and Alcoholism Grants T32-AA07459 and a Research Excellence Award from the Center for Alcohol and Addiction Studies at Brown University to Dr. Hustad and AA015518 to Dr. Borsari. The contents of this manuscript do not represent the views of the Department of Veterans Affairs or the United States Government.

References (36)

  • CASA (Center on Addiction and Substance Abuse)

    Wasting the best and brightest: Substance abuse at America's colleges and universities

    (2007)
  • E. Chiauzzi et al.

    My student body: A high-risk drinking prevention web site for college students

    Journal of American College Health

    (2005)
  • H. Christensen et al.

    Online randomized controlled trial of brief and full cognitive behaviour therapy for depression

    Psychological Medicine

    (2006)
  • J. Cohen

    Statistical power analysis for the behavioral sciences

    (1988)
  • K. Croom et al.

    Impact of an online alcohol education course on behavior and harm for incoming first-year college students: Short-term evaluation of a randomized trial

    Journal of American College Health

    (2009)
  • D.M. Doumas et al.

    Reducing alcohol use in first-year university students: Evaluation of a web-based personalized feedback program

    Journal of College Counseling

    (2009)
  • M.S. Goodstadt et al.

    Alcohol education programs for university students: A review of their effectiveness

    International Journal of Addictions

    (1984)
  • K.M. Griffiths et al.

    Review of randomised controlled trials of internet interventions for mental disorders and related conditions

    Clinical Psychologist

    (2006)
  • Cited by (135)

    • First wave of scalable digital therapeutics: Internet-based programs for direct-to-consumer standalone care for mental health and addiction

      2022, Digital Therapeutics for Mental Health and Addiction: The State of the Science and Vision for the Future
    • Transitional Age Youth and College Mental Health

      2019, Child and Adolescent Psychiatric Clinics of North America
    View all citing articles on Scopus
    View full text