Individual-level interventions to reduce college student drinking: A meta-analytic review
Introduction
Young adults between the ages of 18–25 report high rates of alcohol consumption, including heavy episodic (binge) drinking, defined as consuming five or more drinks at a time (Substance Abuse and Mental Health Services Administration [SAMHSA], 2006). Compared to their peers not attending college, college students consume larger quantities of alcohol on drinking occasions (SAMHSA, 2006), and as many as 43% of undergraduates report heavy episodic drinking at least once in the last two weeks (Wechsler et al., 2002). Heavy episodic drinking increases risks for social and academic problems as well as risks for unintended injuries, assault, and death (Hingson et al., 2005, Wechsler et al., 2002). Healthy People 2010, a report outlining national priorities in health promotion and disease prevention, characterized heavy episodic drinking by young adults as a major national health problem (U.S. Department of Health and Human Services, 2000). This report set an objective of reducing binge drinking among college students to 20% by 2010.
More than 4000 colleges and universities in the United States enroll more than 14 million undergraduate students (National Center for Education Statistics, 2005), many of whom are younger than the minimum legal drinking age of 21. Institutions of higher education are charged with upholding state and local laws, as well as promoting safe living and learning environments. A recent survey of college administrators from 747 institutions revealed that all campuses engaged in some form of alcohol abuse prevention programming; 90% provided counseling and treatment services for students, and nearly as many provided prevention services (e.g., alcohol education) for freshmen or other at-risk groups (Wechsler, Seibring, Liu, & Ahl, 2004). Given the universal nature of these prevention efforts and the numbers of students affected, it is important that college and university administrators have access to information regarding empirically-supported interventions to prevent alcohol abuse.
Several qualitative reviews have summarized the results of studies evaluating interventions to reduce heavy drinking among college students. For example, Larimer and Cronce (2002) reviewed 32 studies and found evidence of efficacy for some individual-level interventions (e.g., brief motivational interventions, cognitive-behavioral skills training) but not for others (e.g., alcohol education). More recent qualitative reviews support the efficacy of feedback-based interventions (Walters & Neighbors, 2005) and interventions for mandated students (Barnett & Read, 2005) in producing within-groups reduction on consumption and problems. A review of the literature on computer-administered alcohol prevention programs for college students found only two controlled studies with behavioral outcomes (Walters, Miller, & Chiauzzi, 2005). However, the numbers of publications in peer-reviewed journals has burgeoned in the last decade, and the numbers of controlled studies that allow strong inference are now sufficient to support a meta-analysis of this literature. A meta-analysis can clarify the current status of the efficacy literature, and help to guide future research.
This meta-analysis includes published studies that evaluated individual-level interventions designed to reduce alcohol use by college students. We recognize that limiting a review to published studies potentially excludes information (i.e., the file–drawer effect; Rosenthal, 1979); however, publication in a peer-reviewed journal serves as a proxy indicator of minimum methodological quality. To be included, studies needed to (a) be designed to reduce alcohol use and/or consequences in college drinkers; (b) use random assignment to intervention conditions, including a control condition; and (c) report behavioral outcomes related to alcohol consumption and/or alcohol-related problems. Excluded are studies evaluating interventions not -administered to individuals, where the dose received could not be determined (i.e., campus-wide media or social norms campaigns).
Three decisions guided this meta-analysis. First, we report between-groups effects rather than within-groups effects; this decision recognizes that college drinking fluctuates over the course of an academic semester (Del Boca, Darkes, Greenbaum, & Goldman, 2004) as well as across years in college (e.g., Baer, Kivlahan, Blume, McKnight, & Marlatt, 2001). Focusing on between-groups effects controls for maturation and historical variables; thus, we use a stringent test of efficacy to establish whether interventions influence college drinking beyond what would be expected from naturally-occurring change (Campbell & Stanley, 1963). Second, we present effect sizes for multiple consumption variables and for alcohol-related problems; we aim to clarify the extent to which interventions produce changes on measures of consumption quantity, drinking frequency, indices of intoxication, and/or negative consequences resulting from drinking. Third, we evaluate effect sizes separately for follow-ups of different durations. This decision allows conclusions regarding the maintenance or duration of intervention effects. We predict that alcohol risk reduction interventions for college drinkers will produce significant between-groups effects, that risk reduction will be observed both on alcohol consumption and alcohol-related consequences, and that effects will be apparent relatively soon after intervention exposure.
When significant and heterogeneous effect sizes emerge from our meta-analysis, we plan to conduct exploratory analyses to evaluate what intervention and student characteristics predict alcohol risk reduction. The interventions obtained for this review vary with respect to theoretical underpinnings, intervention content, mode of administration (e.g., computer vs. in-person), length (one vs. multiple sessions), format (group vs. individual), and degree of tailoring. In addition, study participants vary by year in school, gender and racial/ethnic composition, and volunteer or mandated status. A meta-analysis can address whether these potential moderators influence the magnitude of effect sizes. Results from moderator analyses will allow us to draw empirically-informed conclusions regarding types of interventions and student characteristics associated with intervention efficacy.
Section snippets
Search strategy and study selection
Several strategies were used to search for relevant published (or in press) manuscripts: (a) electronic reference databases (PsycINFO, PubMED, ERIC, CRISP, and the Cochrane Library) using a Boolean search strategy with the following abbreviated and full keywords: (alcohol OR drink⁎ OR binge) AND (college OR university) and (intervention OR prevention) and (random⁎ OR control⁎); (b) reference sections of relevant review or published studies; (c) examining online contents of relevant journals
Description of studies
Table 1 provides sample characteristics, target group, and intervention details for the 62 included studies. Studies appeared between 1985 and early 2007; the median publication year was 2004. All were written in English and were published (or in press) in journals. Studies were conducted predominately in the United States (85%). Most studies were conducted at public universities (72%) of large size (> 10,000; 89%). Participants typically volunteered (71%; e.g., experimental credit or
Discussion
To our knowledge, this study provides the first meta-analytic integration of the results of randomized clinical trials designed to evaluate alcohol abuse prevention programs for college drinkers. A compelling benefit of meta-analysis is that it can provide a powerful method to test effects across many studies, each of which may not be adequately powered to detect intervention effects at standard conventions of significance. Meta-analysis also affords the opportunity to identify moderators when
Acknowledgements
This work was supported by the National Institute on Alcohol Abuse and Alcoholism Grants K02-AA15574 and R01-AA12518 to Kate B. Carey. The authors thank Jennifer Elliott for her assistance with this project. We thank the following study authors for providing additional intervention or statistical information: Arthur W. Blume, PhD., William R. Corbin, PhD, Lisa Curtin, PhD, John Darkes, PhD, Kim Fromme, PhD, Helena Hansson, PhD, Kyp Kypri, PhD, James G. Murphy, PhD, Dara R. Musher-Eizenman, PhD,
References marked with an asterisk indicate studies included in the meta-analysis. Supplement papers (e.g., intervention details, additional measurement occasions) are also asterisked and the reference paper is indicated in brackets. (103)
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Addictive Behaviors
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Evaluation of a treatment-appropriate cognitive intervention for challenging alcohol outcome expectancies
Addictive Behaviors
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Computer-enhanced primary care practitioner advice for high-risk college drinkers in a student primary health-care setting
Cognitive and Behavioral Practice
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Reducing excessive alcohol consumption at university fraternity parties: A cost-effective incentive/reward intervention
Addictive Behaviors
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A pilot test of an alcohol skills training programme for Mexican–American college students
International Journal of Drug Policy
(2006) - et al.
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Lifestyle modification with heavy alcohol drinkers: Effects of aerobic exercise and meditation
Addictive Behaviors
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Developing discrepancy within self-regulation theory: Use of personalized normative feedback and personal strivings with heavy-drinking college students
Addictive Behaviors
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Addictive Behaviors
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Psychological Bulletin
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Journal of Substance Abuse Treatment
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Addictive Behaviors
Effects of normative feedback on consumption among heavy drinking college students
Journal of Drug Education
American College Health Association National College Health Assessment Spring 2006 Reference Group data report (abridged)
Journal of American College Health
Brief intervention for heavy-drinking college students: 4-year follow-up and natural history
American Journal of Public Health
An experimental test of three methods of alcohol risk reduction with young adults
Journal of Consulting and Clinical Psychology
Changing perceptions of peer norms as a drinking reduction program for college students
Journal of Alcohol and Drug Education
Effects of a brief motivational intervention with college student drinkers
Journal of Consulting and Clinical Psychology
Two brief alcohol interventions for mandated college students
Psychology of Addictive Behaviors
How the quality of peer relationships influences college alcohol use
Drug and Alcohol Review
Stepped care for mandated college students: A pilot study
American Journal on Addictions
The efficacy of motivational interviewing: A meta-analysis of controlled clinical trials
Journal of Consulting and Clinical Psychology
Experimental and quasi-experimental designs for research
Brief motivational interventions for heavy college drinkers: A randomized controlled trial
Journal of Consulting and Clinical Psychology
My student body: A high-risk drinking prevention web site for college students
Journal of American College Health
Statistical power analysis of the behavioral sciences
Mailed personalized normative feedback as a brief intervention for at-risk college drinkers
Journal of Studies on Alcohol
Harm reduction for alcohol-use-related problems among college students
Substance Use and Misuse
Goal setting and feedback in the reduction of heavy drinking in female college students
Journal of College Student Psychotherapy
Expectancy challenge and drinking reduction: Experimental evidence for a mediational process
Journal of Consulting and Clinical Psychology
Expectancy challenge and drinking reduction: Process and structure in the alcohol expectancy network
Experimental and Clinical Psychopharmacology
Up close and personal: Temporal variability in the drinking of individual college students during their first year
Journal of Consulting and Clinical Psychology
Brief alcohol screening and intervention for college students
A controlled evaluation of two prevention programs in reducing alcohol use among college students at low and high risk for alcohol related problems
Journal of Alcohol and Drug Education
Prevention of heavy drinking and associated negative consequences among mandated and voluntary college students
Journal of Consulting and Clinical Psychology
Behavioral strategies for alcohol abuse prevention with high-risk college males
Journal of Alcohol and Drug Education
An intervention program for university students who have parents with alcohol problems: A randomized controlled trial
Alcohol and Alcoholism
Distribution theory for Glass's estimator of effect size and related estimators
Journal of Educational Statistics
Statistical methods for meta-analysis
Quantifying heterogeneity in a meta-analysis
Statistics in Medicine
Measuring inconsistency in meta-analysis
British Medical Journal
Magnitude of alcohol-related mortality and morbidity among U.S. college students ages 18–24: Changes from 1998 to 2001
Annual Review of Public Health
Meta-analysis of psychological interventions for chronic low back pain
Health Psychology
Educational biofeedback driving simulator as a drink-driving prevention strategy
Journal of Alcohol and Drug Education
Assessing heterogeneity in meta-analysis: Q statistic or I2 index?
Psychological Methods
Quantitative synthesis of social psychological research
DSTAT 2.00: Software for meta-analysis
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