Interventions to reduce college student drinking: State of the evidence for mechanisms of behavior change

Abstract

Interventions to reduce college student drinking, although efficacious, generally yield only small effects on behavior change. Examining mechanisms of change may help to improve the magnitude of intervention effects by identifying effective and ineffective active ingredients. Informed by guidelines for establishing mechanisms of change, we conducted a systematic review of alcohol interventions for college students to identify (a) which constructs have been examined and received support as mediators, (b) circumstances that enhance the likelihood of detecting mediation, and (c) the extent of evidence for mechanisms of change. We identified 61 trials that examined 22 potential mediators of intervention efficacy. Descriptive norms consistently mediated normative feedback interventions. Motivation to change consistently failed to mediate motivational interviewing interventions. Multiple active ingredient interventions were not substantially more likely to find evidence of mediation than single ingredient interventions. Delivering intervention content remotely reduced likelihood of finding support for mediation. With the exception of descriptive norms, there is inadequate evidence for the psychosocial constructs purported as mechanisms of change in the college drinking literature. Evidence for mechanisms will be yielded by future studies that map all active ingredients to targeted psychosocial outcomes and that assess potential mediators early, inclusively, and at appropriate intervals following interventions.

The relative strength of attitudes versus perceived drinking norms as predictors of alcohol use

“…Based on cognitive dissonance theory (Festinger, 1957), Miller (1983) noted “… if a person perceives his or her behavior to be seriously discrepant with his or her beliefs, attitudes, or feelings, a motivational condition is created to bring about change in one or another of these elements so that consistency is restored” (p. 157). Despite the use of some attitude change techniques in MI, few studies have provided strong tests of attitude change as a mechanism of behavior change (Reid & Carey, 2015). Furthermore, the results of this study suggest that a brief motivational intervention that was designed to change norms was effective and those changes in norms are associated with changes in drinking.…”

Do my peers approve? Interest in injunctive norms feedback delivered online to college student drinkers

“…A number of college student drinking interventions elicit changes in alcohol use outcomes by correcting overestimated descriptive norms (Carey, Scott-Sheldon, Carey, & DeMartini, 2007; Cronce & Larimer, 2011; Reid & Carey, 2015). The perception that one’s peers approve of heavy drinking behaviors (“injunctive norms”) has received less attention in the prevention and intervention literature, but shows promise as an intervention strategy for college student drinking.…”

“…Notably, injunctive norms are amenable to change following even a brief statement describing the attitudes of peers (Prince & Carey, 2010). A recent review of college student drinking interventions identified six studies that measured injunctive norms as a potential mechanism of effect (Reid & Carey, 2015), but only one specifically targeted injunctive norms (Schroeder & Prentice, 1998). While this study did not show change in injunctive norms, Reid and Carey (2015) note that this may be due to the long follow-up (4–6 months) and single-item measure of injunctive norms that may have been insensitive to change.…”

“…A recent review of college student drinking interventions identified six studies that measured injunctive norms as a potential mechanism of effect (Reid & Carey, 2015), but only one specifically targeted injunctive norms (Schroeder & Prentice, 1998). While this study did not show change in injunctive norms, Reid and Carey (2015) note that this may be due to the long follow-up (4–6 months) and single-item measure of injunctive norms that may have been insensitive to change. Although they did not target injunctive norms directly, the authors of one other study (Turrisi et al, 2009) did find support for mediation effects through both descriptive and injunctive norms (Prince & Carey, 2010).…”

“…Although they did not target injunctive norms directly, the authors of one other study (Turrisi et al, 2009) did find support for mediation effects through both descriptive and injunctive norms (Prince & Carey, 2010). Since the Reid and Carey (2015) review, Prince, Maisto, Rice, and Carey (2015) conducted the first randomized clinical trial comparing an injunctive norms feedback intervention to descriptive norms feedback, combined feedback, and assessment only. They found that injunctive norms feedback reflecting peer disapproval of consequences resulted in decreased estimates of typical blood alcohol levels and fewer alcohol-related consequences among college students; moreover, the injunctive norms intervention was more effective than the descriptive norms intervention in reducing typical blood alcohol concentrations.…”