Efficacy and Mechanisms of Technology-based Behavioral Interventions
| Status: | Recruiting |
|---|---|
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 4/29/2018 |
| Start Date: | November 15, 2017 |
| End Date: | May 2020 |
| Contact: | James M Henson, Ph.D. |
| Email: | jhenson@odu.edu |
| Phone: | 757-683-5761 |
Large scale surveys indicate that approximately 68% of college students drink alcohol every
month and 40% of college students engage in heavy episodic drinking. Despite
prevention/intervention efforts, problematic alcohol consumption among college students
continues to result in an estimated 1,800 deaths and 600,000 injuries annually, and
epidemiological studies demonstrate no appreciable decrease in risk among college students.
The purpose of the proposed research is to improve extant college-drinking interventions by
advancing the dissemination methodology and the intervention content (Specific Aim 1). As a
methodological improvement, rapid advances in mobile computing makes ecological momentary
interventions (EMIs) increasingly feasible. EMIs refer to interventions that can be delivered
multiple times and "in the moment". EMIs can optimize the timing and location of the
intervention while also increasing the dose of the intervention. To improve the intervention
content, the researchers will examine protective behavioral strategies (PBS) to reduce
alcohol problems, not just alcohol use. PBS are behaviors that one can engage in immediately
prior to, during, and immediately following alcohol use that limit alcohol use and/or
alcohol-related harm. Research suggests that PBS use can protect individuals from alcohol
problems above and beyond its effect on reducing alcohol use. The primary purpose of this
research is to provide a more powerful test of a PBS intervention's effects on
alcohol-related consequences by using a technology-based intervention methodology (i.e.,
EMI). Participants will be randomized into to a fully crossed, 3 (Standard BMI, BMI with a
PBS component, control) X 2 (PBS-based EMI, Ecological Assessment Only) design. These 6
conditions will answer several critically important research questions (Specific Aim 2): a)
does the addition of a PBS component improve the efficacy of a standard BMI, b) does a
PBS-based EMI improve efficacy over the standard, single session BMI, c) does the combination
of motivation-based intervention (BMI) with a skills-based intervention (EMI) yield even
greater decreases in consequences (i.e., moderation). A final purpose of this research is to
examine PBS norms, PBS perceived effectiveness, and motivation to change PBS use as novel
mediators of the improved interventions. Results can be used to disseminate more effective
college drinking interventions that are cheaper and more efficacious.
month and 40% of college students engage in heavy episodic drinking. Despite
prevention/intervention efforts, problematic alcohol consumption among college students
continues to result in an estimated 1,800 deaths and 600,000 injuries annually, and
epidemiological studies demonstrate no appreciable decrease in risk among college students.
The purpose of the proposed research is to improve extant college-drinking interventions by
advancing the dissemination methodology and the intervention content (Specific Aim 1). As a
methodological improvement, rapid advances in mobile computing makes ecological momentary
interventions (EMIs) increasingly feasible. EMIs refer to interventions that can be delivered
multiple times and "in the moment". EMIs can optimize the timing and location of the
intervention while also increasing the dose of the intervention. To improve the intervention
content, the researchers will examine protective behavioral strategies (PBS) to reduce
alcohol problems, not just alcohol use. PBS are behaviors that one can engage in immediately
prior to, during, and immediately following alcohol use that limit alcohol use and/or
alcohol-related harm. Research suggests that PBS use can protect individuals from alcohol
problems above and beyond its effect on reducing alcohol use. The primary purpose of this
research is to provide a more powerful test of a PBS intervention's effects on
alcohol-related consequences by using a technology-based intervention methodology (i.e.,
EMI). Participants will be randomized into to a fully crossed, 3 (Standard BMI, BMI with a
PBS component, control) X 2 (PBS-based EMI, Ecological Assessment Only) design. These 6
conditions will answer several critically important research questions (Specific Aim 2): a)
does the addition of a PBS component improve the efficacy of a standard BMI, b) does a
PBS-based EMI improve efficacy over the standard, single session BMI, c) does the combination
of motivation-based intervention (BMI) with a skills-based intervention (EMI) yield even
greater decreases in consequences (i.e., moderation). A final purpose of this research is to
examine PBS norms, PBS perceived effectiveness, and motivation to change PBS use as novel
mediators of the improved interventions. Results can be used to disseminate more effective
college drinking interventions that are cheaper and more efficacious.
Hazardous alcohol use among college students is a significant public health concern that has
resulted in the development of numerous interventions. Although motivational interviewing
components are effective at reducing problematic alcohol consumption among college students
via reductions in descriptive norms (i.e., the perceived drinking by peers), the effects of
single-session brief motivational interventions (BMIs) on alcohol use and consequences are
relatively short-lived (i.e., 3 months). Guided by a harm-reduction perspective, researchers
have become increasingly interested in how protective behavioral strategies (PBS) can impact
alcohol consequences beyond the effects of reduced alcohol consumption. PBS have been found
to be a robust predictor of alcohol-related problems controlling for consumption, and
multiple intervention studies have found that PBS mediates intervention effects. Few studies,
however, have examined the efficacy of PBS-related intervention components.
Specific Aim 1a: The researchers will augment and improve extant college alcohol
interventions by developing and rigorously evaluating an added PBS component to an existing
BMI with demonstrated efficacy to further reduce alcohol-related consequences beyond what is
explained by reduced consumption.
An additional goal of this research is to deliver PBS in a way that capitalizes on newer
technologies that allow for the repeated in vivo delivery of alcohol interventions. Given the
widespread use of handheld devices among the college population, ecological momentary
intervention (EMI) shows great promise in producing lasting behavior for a modest cost.
Specific Aim 1b: The researchers will develop a technology-based, college-drinking ecological
momentary intervention (EMI; a newer, less explored methodology) that is disseminated using
mobile, hand-held devices, which can be used in vivo with every drinking episode.
Characterizing Intervention Efficacy. The researchers intend to demonstrate that adding a
PBS-focused component can increase efficacy beyond standard single-session BMIs while keeping
costs minimal. Although the researchers predict that the PBS-based EMI will effect greater
and more lasting decreases in alcohol consequences beyond standard intervention, it is
important to verify that cheaper, single-session alternatives are not as effective (i.e.,
PBS-based BMI). Therefore, the researchers intend to implement a 2 (EMI, Ecological Momentary
Assessment only [EMA]) by 3 (no single-session intervention control, standard BMI, BMI plus
PBS component) factorial design. The researchers will characterize the efficacy of the
BMI+PBS and EMI over traditional, single-session BMIs in several ways:
Specific Aim 2a: The researchers will examine whether the EMI methodology effects greater and
more lasting behavior change as compared to the EMA assessment conditions.
To accomplish Specific Aim 2a, the researchers will examine the main effect of assessment
(EMI vs. EMA) to demonstrate that the EMI conditions yield better longitudinal outcomes
regardless of the single-session intervention.
Specific Aim 2b: The researchers will examine whether the PBS intervention component leads to
reduced alcohol related consequences as compared to a standard BMI, even with a
single-session intervention.
To accomplish Specific Aim 2b, the researchers will examine the main effect of the
single-session intervention to demonstrate that a single-session BMI that has been enhanced
by the PBS component will yield superior longitudinal effects relative to a BMI without the
PBS component regardless of assessment style (EMA or EMI); the researchers further expect
both BMI groups to be superior to the no-intervention control.
Specific Aim 2c: The researchers expect the EMI to moderate the single-session intervention,
such that the PBS-BMI coupled with EMI will yield superior longitudinal outcomes on drinking
consequences.
The researchers expect the PBS intervention component to be most efficacious when delivered
in vivo during high-risk, alcohol use situations (i.e., EMI), where student motivation and
perceived norms about drinking are most challenged. By using a 2X3 design, the researchers
will be able to verify the synergistic interaction and characterize the effect size of the
relative superiority of the PBS single-session component coupled with the PBS-based EMI.
Mechanisms of Behavior Change. Unlike the BMI, which relies upon motivation and descriptive
norm changes, the researchers expect the PBS intervention component to have different
mechanisms of behavior change. Specifically, the PBS component is an intervention that
emphasizes skill use rather than motivation. Further, when coupled with EMI, which is a
direct behavioral intervention, the PBS component will effect change by targeting specific
behaviors as opposed to drinking motivation.
Specific Aim 3: To characterize the differential mechanisms of behavior change across the
single-session and EMI interventions.
The researchers expect key differences in the mediating variables across interventions
conditions. The researchers will examine PBS norms, PBS perceived effectiveness, and
motivation to change PBS to ascertain how the researchers can best effect increases in PBS
use in college populations.
resulted in the development of numerous interventions. Although motivational interviewing
components are effective at reducing problematic alcohol consumption among college students
via reductions in descriptive norms (i.e., the perceived drinking by peers), the effects of
single-session brief motivational interventions (BMIs) on alcohol use and consequences are
relatively short-lived (i.e., 3 months). Guided by a harm-reduction perspective, researchers
have become increasingly interested in how protective behavioral strategies (PBS) can impact
alcohol consequences beyond the effects of reduced alcohol consumption. PBS have been found
to be a robust predictor of alcohol-related problems controlling for consumption, and
multiple intervention studies have found that PBS mediates intervention effects. Few studies,
however, have examined the efficacy of PBS-related intervention components.
Specific Aim 1a: The researchers will augment and improve extant college alcohol
interventions by developing and rigorously evaluating an added PBS component to an existing
BMI with demonstrated efficacy to further reduce alcohol-related consequences beyond what is
explained by reduced consumption.
An additional goal of this research is to deliver PBS in a way that capitalizes on newer
technologies that allow for the repeated in vivo delivery of alcohol interventions. Given the
widespread use of handheld devices among the college population, ecological momentary
intervention (EMI) shows great promise in producing lasting behavior for a modest cost.
Specific Aim 1b: The researchers will develop a technology-based, college-drinking ecological
momentary intervention (EMI; a newer, less explored methodology) that is disseminated using
mobile, hand-held devices, which can be used in vivo with every drinking episode.
Characterizing Intervention Efficacy. The researchers intend to demonstrate that adding a
PBS-focused component can increase efficacy beyond standard single-session BMIs while keeping
costs minimal. Although the researchers predict that the PBS-based EMI will effect greater
and more lasting decreases in alcohol consequences beyond standard intervention, it is
important to verify that cheaper, single-session alternatives are not as effective (i.e.,
PBS-based BMI). Therefore, the researchers intend to implement a 2 (EMI, Ecological Momentary
Assessment only [EMA]) by 3 (no single-session intervention control, standard BMI, BMI plus
PBS component) factorial design. The researchers will characterize the efficacy of the
BMI+PBS and EMI over traditional, single-session BMIs in several ways:
Specific Aim 2a: The researchers will examine whether the EMI methodology effects greater and
more lasting behavior change as compared to the EMA assessment conditions.
To accomplish Specific Aim 2a, the researchers will examine the main effect of assessment
(EMI vs. EMA) to demonstrate that the EMI conditions yield better longitudinal outcomes
regardless of the single-session intervention.
Specific Aim 2b: The researchers will examine whether the PBS intervention component leads to
reduced alcohol related consequences as compared to a standard BMI, even with a
single-session intervention.
To accomplish Specific Aim 2b, the researchers will examine the main effect of the
single-session intervention to demonstrate that a single-session BMI that has been enhanced
by the PBS component will yield superior longitudinal effects relative to a BMI without the
PBS component regardless of assessment style (EMA or EMI); the researchers further expect
both BMI groups to be superior to the no-intervention control.
Specific Aim 2c: The researchers expect the EMI to moderate the single-session intervention,
such that the PBS-BMI coupled with EMI will yield superior longitudinal outcomes on drinking
consequences.
The researchers expect the PBS intervention component to be most efficacious when delivered
in vivo during high-risk, alcohol use situations (i.e., EMI), where student motivation and
perceived norms about drinking are most challenged. By using a 2X3 design, the researchers
will be able to verify the synergistic interaction and characterize the effect size of the
relative superiority of the PBS single-session component coupled with the PBS-based EMI.
Mechanisms of Behavior Change. Unlike the BMI, which relies upon motivation and descriptive
norm changes, the researchers expect the PBS intervention component to have different
mechanisms of behavior change. Specifically, the PBS component is an intervention that
emphasizes skill use rather than motivation. Further, when coupled with EMI, which is a
direct behavioral intervention, the PBS component will effect change by targeting specific
behaviors as opposed to drinking motivation.
Specific Aim 3: To characterize the differential mechanisms of behavior change across the
single-session and EMI interventions.
The researchers expect key differences in the mediating variables across interventions
conditions. The researchers will examine PBS norms, PBS perceived effectiveness, and
motivation to change PBS to ascertain how the researchers can best effect increases in PBS
use in college populations.
Inclusion Criteria:
- Current college students at the sponsor institution at the time of enrollment
- Above the age of 18
- Consumed at least standard drink of alcohol in the past 4 weeks
Exclusion Criteria:
- Under age of 18
- Not a college student
- Did not drink alcohol in the past 4 weeks
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