College student alcohol use and associated negative consequences are identified public health problems. In particular, first year students transitioning to college are at increased risk. Scarce intervention resources must be used as wisely as possible to address these concerns. One way to address heavy drinking while conserving resources is to first utilize universal interventions, identify students at high risk who do not respond well, and then motivate them to engage in indicated intervention. This approach to prevention is `adaptive? because information about the student in the course of the intervention (e.g., response status) is used to determine whether more resources should be invested to transition (i.e., coach) him/her to indicated services. The purpose of the proposed project is to answer critical questions concerning implementing an adaptive preventive intervention (API). Specifically, an API that employs cost-effective, technology-based brief interventions can do the following: First, provide a universal personalized normative feedback (PNF) intervention followed by student self-monitoring (SM). Second, motivate students who continue to drink heavily (i.e., 2+ reports of 4/5+ drinks for women/men, or 1 report of 8/10+ drinks for women/men) to transition to additional intervention resources. To optimize the efficacy of this intervention, we will investigate the best timing for delivering the initial universal (PNF+SM) intervention, either providing information as an inoculation before moving to college or providing particularly salient information once they are experiencing the college context at the beginning of their first semester. Additionally, we will examine how best to motivate heavy-drinking students to pursue indicated intervention, either via automated emails or online interaction with a personal health coach (mBridge). A sequential multiple assignment randomized trial (SMART) design (N=700 college students) will be employed to address these questions. College students will be randomized to receive PNF either before college begins (2 weeks before classes start) or during the beginning of the first semester (about 3 weeks after they arrive on campus). Following the PNF, participants will be asked to self-monitor their drinking behaviors bi-weekly during the first semester; these assessments will be used to identify heavy-drinking students in need of indicated intervention. As soon as heavy drinking is identified, the student will be re-randomized to either an automated email or mBridge coach to offer additional intervention resources. Students who do not screen in will continue with the bi-weekly assessments. The specific aims are to examine: (1) the efficacy of an API compared to an assessment-only control, (2) whether the API can be optimized by altering the timing of the universal intervention and/or the type of message to transition to indicated intervention, and (3) moderators of these effects (e.g., pre-college drinking intentions, high-intensity (compared to binge) drinking during the start of college). Frequency of heavy drinking, alcohol-related consequences, and health services utilization will be assessed prior to the start of classes, at the end of the first semester, and at the end of the academic year. The API to be constructed through this project will offer a novel strategy for mitigating both the acute negative health consequences (e.g., injury, alcohol poisoning) and the long-term health consequences (e.g., alcohol use disorders) of young adult alcohol use.
University of Minnesota
09/26/2018 to 08/31/2020