Background Illicit substance misuse is a growing public health problem, with misuse peaking among 18–25 year-olds, and attendance at third-level education identified as a risk factor. Illicit substance misuse has the potential to harm mental and physical health, social relationships, and impact on academic achievements and future career prospects. Digital interventions have been identified as a vehicle for reaching large student populations and circumventing the limited capacity of student health services for delivering face-to-face interventions. Digital interventions have been developed in the area of alcohol and tobacco harm reduction, reporting some effectiveness, but the evidence for the effectiveness of digital interventions targeting illicit substance misuse is lacking. This review aims to systematically identify and critically appraise studies examining the effectiveness of digital interventions for illicit substance misuse harm reduction in third-level students. Methods We systematically searched ten databases in April 2018 using keywords and database specific terms under the pillars of “mHealth,” “substance misuse,” and “student.” To be eligible for inclusion, papers had to present a measure of illicit substance misuse harm reduction. Included articles were critically appraised and included in the qualitative synthesis regardless of quality. Results A total of eight studies were included in the qualitative synthesis. Studies reported harm reduction in terms of substance misuse or initiation, as consequences or problems associated with substance misuse, or as correction of perceived social norms. Overall, five out of the eight studies reported at least one positive outcome for harm reduction. The critical appraisal indicated that the study quality was generally weak, predominantly due to a lack of blinding of study participants, and the use of self-reported substance misuse measures. However, results suggest that digital interventions may produce a modest reduction in harm from illicit substance misuse. Conclusions The results of this review are positive, and support the need for further high-quality research in this area, particularly given the success of digital interventions for alcohol and tobacco harm reduction. However, very few studies focused solely on illicit substances, and those that did targeted only marijuana. This suggests the need for further research on the effectiveness of this type of intervention for other illicit substances. Trial registration This review is registered on PROSPERO, ID number: CRD42018097203.

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Background: Illicit substance use by third-level students is associated with depressive symptoms, health risk, relationship strain, and legal ramifications. Prevention and intervention programmes have often been grounded in information exchange, aimed at education of students about the associated risks. However, these interventions produce only small to moderate effect sizes in promoting reduction or cessation of substance use in third-level students. Understanding what motivates third-level students to change their substance use behaviour is essential in the planning of effective behaviour change programmes. The aim of this scoping review was to determine factors that relate to student motivations to reduce or stop their illicit use of substances, and to increase understanding of the factors that may be pertinent in behaviour change interventions for substance use in this population. Method: We searched 8 databases in August 2018 using search terms based on ‘students’, ‘illicit substance use’, and ‘motivations’. We identified 86 research articles that reported on third-level students’ illicit substance use, and included reasons or motives for their usage. Results: After full-text screening, only three studies were eligible for inclusion in the qualitative synthesis. The majority of studies were excluded as they described motives for abstention, but did not describe motivation for reducing or stopping current patterns of use of illicit substances. Conclusion: Few efforts have been made to identify motivations of third-level students to decrease or cease substance use. Promising avenues for future research on motivations to change in relation to substance use include the social contextual factors, perceptions of effects on social relationships, and actions of friends and family members to prompt contemplations of change.

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Daily stress experiences trigger biological and psychological responses that help to manage the stress experience. However, if repeated or chronic, these stress responses are harmful to biological and psychological health.  Stress during adolescence is especially important to consider because it can entirely reshape the persons’ lifelong health and disease risk.  This reshaping of health occurs partly as a result of stress-induced biological changes, conceptualised as ‘allostatic load’.   Allostatic load is the cumulative cost of chronic stress experiences and is measured using biomarkers of risk in the body’s cardiovascular and metabolic systems.  There is strong evidence of the relationship of stress and allostatic load in adults, but this relationship is rarely considered in adolescents, despite evidence that adolescents experience transition-stress via the biopsychosocial changes during this developmental stage.  As this transition-stress is experienced when adolescents are still developing stress-regulation skills, the effects of stress may be exacerbated, and manifest as allostatic load.  Preventing the onset and progression of allostatic load requires adaptive patterns of stress regulation in combination with positive health behaviours. The aim of this research is to understand the interaction of these factors and identify effective ways for adolescents to reduce allostatic load risk and develop positive health behaviours.