A further consideration is whether PNF would be more effective when used with all students, rather than just those identified as being at higher risk, because of the prevention paradox [24]. CAS 4. 2000, 48: 235-238. Data from the ESPAD Project. No, PLOS is a nonprofit 501(c)(3) corporation, #C2354500, based in San Francisco, California, US, https://doi.org/10.1371/journal.pone.0044120, http://www.cabinetoffice.gov.uk/sites/default/files/resources/Behaviour-Change-Insight-Team-Annual-Update_acc.pdf, http://www.camh.net/About_Addiction_Mental_Health/Drug_and_Addiction_Information/evaluate_your_drinking.html, https://docs.google.com/folder/d/0B6qFfRezLfa4SlYyWVB6MHZwTEU/edit, http://wwwaddiction-ssaorg/2011/McCambridgeJ%20Presentationppt. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Kypri K, Langley J, Saunders J, Cashell-Smith M: Assessment may conceal therapeutic benefit: findings from a randomized controlled trial for hazardous drinking. Abstract. In the completed case analyses (i.e. Baseline alcohol use and misuse will be measured in two of the groups, but not the third group. In another study we have shown that a small change in AUDIT score may have an important impact on population levels of alcohol disorders [32]. Been in a fight; 4. Correspondence to Currently there is no published Cochrane systematic review on the effectiveness of social norms approaches, though a Cochrane protocol on this topic has been published [5]. During university or college years, students can escalate their alcohol use to dangerous levels [1], and student alcohol consumption levels are typically higher than their non-university peers [2]–[6]. The Harvard College Alcohol study of more than 49,000 U.S. students [25] found that most alcohol-related harms arise from those who are not higher risk drinkers, and this finding is supported by evidence from other countries [26]. Personalized normative feedback (PNF) is a brief intervention designed to correct misperceptions regarding the prevalence of problematic behavior by showing individuals engaging in such behaviors that their own behavior is atypical with respect to actual norms. David R Foxcroft. Analyses focused on high-risk drinkers, as well as all students, because of research evidence for the prevention paradox in student drinkers. International Standard Randomised Controlled Trial Number: ISRCTN30784467. 1751 students, from 22 British Universities, allocated to a PNF group, a normal control group, or a delayed measurement control group to allow assessment of any measurement effects. Recruitment, follow-up and attrition are described in Figure 1. Wrote the paper: DRF MTM RO. The aim of the trial is to determine the effectiveness of an on-line personalized feedback intervention for reducing alcohol consumption amongst undergraduate University students when compared with a control group, in both the UK and Portugal. However, Kypri has not been able to establish whether the normative feedback intervention, or simply measuring drinking behaviour using the alcohol use disorders identification test (AUDIT) screening tool, was the active ingredient accounting for this effect. By . Other parts of this study were supported by Alcohol Research UK and the European Foundation for Alcohol Research. Kypri also suggested that a social desirability response bias may have influenced the results. Multivariate analyses will be conducted with gender, nationality, University year (one and two), social desirability and study country as covariates. 2001, Geneva: World Health Organisation, Jernigan D: Global Status Report: Alcohol and Young People. personalized normative feedback (PNF), which provides individuals with accurate information to reduce mispercep-tions regarding the frequency and acceptability of risky peer behavior. = 6) for females [38], and power = .9 and α = .05 (2-tailed tests). We fitted two different random effect models to assess an intention-to-treat hypothesis. Making students aware of this misperception may help change behaviour and reduce problem drinking. A7. Analyzed the data: RO DRF MTM. Only one outcome measure, weekly drinking, showed a significant effect at 6-months with an odds ratio (OR) of 0.417 (95% CI 0.223, 0.781), but this had disappeared by 12-months (OR = 0.710, 95% CI 0.435, 1.160). https://doi.org/10.1371/journal.pone.0044120, Editor: James Coyne, The main objective of this study was to examine the effectiveness of computer-based PNF, compared with (i) screening/assessment only, for reducing alcohol-related problems in first and second year UK university undergraduate students. The difference between “yourself” and “students in your year” ranged between −7 and +5, with a negative score indicating that respondents thought that other students were drinking more. : The Swedish Council for Information on Alcohol and Other Drugs (CAN) and the Pompidou Group at the Council of Europe, 156-, CAMH: Centre for Addiction and Mental Health. Yes The intervention and main control group were followed up at 6- and 12-months, and the delayed control group at 12-months only. In conclusion, our results show no evidence for the effectiveness of personalised normative feedback for the prevention of alcohol misuse and alcohol-related problems in a UK student population. The normative feedback approach relies largely on raising awareness amongst students about how much their peers actually drink (and do not drink) and to correct existing misperceptions [3]. And last, evidence about whether universal or targeted approaches are better with this population group. Responses were summed to provide an alcohol-related problems score (range 10 to 20 with a higher score indicating more problems). Google Scholar, Perkins HW: Social Norms and the Prevention of Alcohol Misuses in Collegiate Contexts. Another possibility is that the UK offers a more challenging context for effectiveness because of local contextual factors that are not present in other countries, for example it may be that the prevalence of excessive drinking behaviours in the UK, and the cultural acceptance of heavier drinking, provides a more hostile environment for success of normative feedback interventions. 10.1111/j.1360-0443.2005.01294.x. No, Is the Subject Area "Medical risk factors" applicable to this article? Studies have shown that university/college students tend to have an exaggerated view of the quantities of alcohol being consumed by their peers. We performed sensitivity analyses to explore the effect of departures from the assumption made in the main analysis. PubMed Define the components of personalized normative feedback 6. https://doi.org/10.1371/journal.pone.0044120.g001. This randomized controlled trial evaluated a computer-delivered, norms-based personalized feedback intervention which systematically varied the focus on whether specific drinking behaviors were described as common or uncommon (a descriptive norm), whether the drinking behaviors were healthy versus unhealthy, and whether the drinking behaviors were positively or negatively framed (an injunctive norm). Free Online Library: Personalized normative feedback to reduce drinking among college students: a social norms intervention examining gender-based versus standard feedback. follow-up respondents only) for high risk drinkers 104/116 universities and 550/1187 individuals were followed up and analysed at 6-months, and 97/116 universities and 444/1187 individuals at 12-months. Randomisation occurs after students have read the consent form, with affirmative consent given proceeding to the on-line questionnaire. We have not been able to assess impact on acute harms, violence and crime because of insufficient information for modelling. Ethics approval for this study was provided by Oxford Brookes University Research Ethics Committee (UREC No. Blackout or memory lapse; 2. Annual Symposium of the Society for the Study of Addiction 2007; York. Article The effectiveness of brief personalized normative feedback in reducing alcohol-related problems amongst University students: protocol for a randomized controlled trial. Addiction. The interaction between these different components, and how they are presented to participants, may be important in determining effectiveness. Heavy drinking among college students continues to be an epidemic problem and has inspired a considerable amount of intervention research. Springer Nature. 14, Moreira T, Foxcroft D: Social norms interventions to reduce alcohol misuse in University or College students (Protocol). Alcohol Use Disorders Identification Test, European School Survey Project on Alcohol and Other Drugs, Diagnostic and Statistical Manual of Mental Disorders, WHO: Global Burden of Disease study. On the other hand, this study was a large pragmatic randomised trial with design, sampling, recruitment and follow-up characteristics that are similar to other large European trials [44]–[46]. There is one intervention group and two control groups, controlling separately for measurement and for intervention effects. All models included a random intercept to account for clustering within participant (same university) as well as fixed effects for group, follow-up assessment and their interaction. Aims To evaluate the effects of the two main components of a Personalised Normative Feedback (PNF) (Normative feedback only –NFO; and Consequences feedback only ‐ … Yes A recent Cochrane review [20] found some limited evidence for the effectiveness of computer-based PNF in University students though questions remain about the generalizability of these findings to other countries, including the U.K. [21], [22]. Perceived norms were measured using an adaptation of the two versions of the Drinking Norms Rating Form [35]. Addiction. At the end of the trial a computer science specialist de-encrypted the data and all personal identifying details were removed from the dataset. Respondents completed the Alcohol Use Disorders Identification Test (AUDIT) which is a 10-item scale with good validity that is designed to assess hazardous and harmful drinking [31]. Missed a lecture/class; 6. To assess the relative effectiveness of whole population (universal) versus screening and brief intervention (SBI; targeted) normative feedback in reducing alcohol related problems. Although Kypri [9] and others have targeted high risk drinkers, the prevention paradox states that more harm comes from those at lower levels of risk, and Rossow [10] has recently demonstrated that this paradox holds, albeit to a lesser extent, for heavy episodic drinking and acute harms. Both authors have contributed to the analytical strategy, on developing the intervention and overall methodological development. Data are collected at baseline, six months and 12 months. DRF declares that his Department has received funding from the alcohol industry for prevention projects, and that he is a Trustee of the alcohol-industry funded Drinkaware Trust. One of the best trials we have identified so far has been by Kypri [6]in New Zealand, where an electronic Screening and Brief Intervention (SBI) approach identified students at high risk and then provided normative feedback to this group. Personalized Normative Feedback (PNF) One promising strategy in reducing college student drinking involves reducing overestimated descriptive drinking normative perceptions. PubMed There is a potential risk to internal validity from the low follow-up rates achieved in our study, although students unavailable for follow-up were similar across groups with regard to sex, age and baseline drinking status, and the multiple imputation sensitivity analysis did not produce any marked or systematic changes in treatment effect sizes or significance. here. All these other European trials have had low follow-up rates from those randomised and assessed at baseline, and with similar non-significant effects to our study. Similarly, the postgraduate researcher who emailed the standardised PNF to the intervention group participants was not blind to group allocation. A specimen feedback is available to download [30]. Tom Arnett, Research Fellow at the ... old PD — what PD has been or used to be — I think a positive development is we see more and more PD becoming more personalized to teachers’ needs. Sample characteristics are described in Table 1. The computer-based randomisation ensured that researchers and participants were not aware of allocated group. Journal of American College Health. We intend to assess intervention efficacy in the student population as a whole and in particular a subgroup of hazardous drinkers (AUDIT ≥ 8), for both males and females. Both authors have contributed to the development of this protocol. Department of Psychology, Social Work and Public Health, Oxford Brookes University, Oxford, Oxfordshire, United Kingdom. Scores ranged between 0 and 21, with a higher score indicating more positive expectancies. Yes Our results fail to replicate the findings of the New Zealand, Australian and U.S. trials of brief, web-based, social normative feedback [40]–[42]. Participants gave their informed consent to participate by completing the web-based questionnaire. Personalized normative feedback (PNF) has shown promise as a stand-alone intervention for reducing alcohol use among college students. Personalised normative feedback (PNF) aims to correct this misperception by providing information about personal drinking levels and patterns compared with norms in similar aged peer groups. Demographic questions will be answered by all three groups before randomization. All data collection is done online, through the trial website, accessed via a web-link promoted in all forms of advertisement. Cite this article. On the other hand, a study in Canada [51] found that the social norm materials that were designed to be the least comparable had the greatest impact, and that Canadian students were more familiar with American drinking norms because of media influence, with television being the most significant medium for the spread of youth culture. At randomisation participants were not aware of the nature of the intervention, but full participant blinding was not possible. Trouble with local or campus authorities; 9. Moreira, T., Foxcroft, D.R. Eligible participants were undergraduate university students (first and second year students; academic year 2008/9) from U.K. universities, recruited through university information systems (posters, email messages, bulletin boards) and through online social networking sites. PubMed Follow-up rates were low, with only 50% responding at 6-months and only 40% responding at 12-months. Data will be analysed by a researcher blinded to experimental group. 1963, Boston: Houghton Mifflin, Barbro A, Björn H, François B, Marie C, Anna K, Anastasios F, Sabrina M, Alojz N, Januzs S, Marcis T: Alcohol and Drug Use Among European 17–18 Year Old Students. No, Is the Subject Area "Traumatic injury risk factors" applicable to this article? Yes Analyses were performed on the full sample (all students) and also with a higher risk sub-sample to test the prevention paradox prediction. Information was also provided on the money that they might be spending annually on alcohol and also the calories they might be consuming at their current drinking levels. Higher risk drinkers were those who, at baseline, scored 8 or more on the AUDIT scale (the cut-off for hazardous drinking) and also drank more than the recommended weekly consumption limits. Terms and Conditions, Brief and cost-effective, PNF consists of an individualized report in which national or campus-wide drinking statistics are Follow-up rates were low, with only 50% and 40% responding at 6- and 12-months, respectively, though comparable to similar European studies. Recruitment, consent, randomisation and data collection are all on-line. A further methodological challenge is the expected high rate of attrition from follow-up. The brief personalised normative feedback given to each intervention group participant will comprise the results of their drinking behaviour assessment alongside information about alcohol and how it might affect them at their current drinking levels. Feedback, personalised & normative" by Youth AOD Toolbox on Vimeo, the home for high quality videos and the people who love them. We needed an achieved sample size of 900 hazardous drinkers (150 per gender per group), based on effect size estimates of a mean difference in AUDIT score of 1.9 (s.d. Again, only weekly drinking had a significant effect at six-months (OR = 0.440, 95% CI 0.245, 0.788), but not at 12-months (OR = 0.770, 95% CI 0.495, 1.197). Kypri K, Saunders J, Williams S, McGee R, Langley J, Cashell-Smith M, Gallagher S: Web-based screening and brief intervention for hazardous drinking: a double-blind randomized controlled trial. Feedback, personalised & normative on Vimeo So, one possible explanation for our null results in this study is that we obtained results on a different group of students than other studies that have found significant effects. At the same time, binge drinking rates amongst young people are high in the UK and Holland, and are increasing in the UK where alcohol related violence and crime is a major cause for concern. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials. Intended for healthcare professionals. No, Is the Subject Area "Randomized controlled trials" applicable to this article? The interactions were removed from the analysis due to insignificant effects. In the full sample analysis there was a similar pattern of no effect of the intervention (Tables 5 and 6) at either time-point and in both the completed case analysis and the multiple imputation analysis. Been embarrassed by your actions; 3. Click through the PLOS taxonomy to find articles in your field. Students were recruited into the study at the beginning of the academic year 2007/8, and followed up for 6- and 12-months. they withdrew from the allocated treatment); 2. In reaction to the national health objective of reducing the proportion of college students engaging in heavy at-risk drinking, the addition of a stress and coping component to a Personalized Normative Feedback (PNF) intervention was examined. School of Health and Social Care, Oxford Brookes University, Oxford, OX3 0FL, UK, You can also search for this author in 2007, CD006748-006710.001002/14651858.CD14006748. Ethics approval for this study is provided by Oxford Brookes University Research Ethics Committee (REC No-2006/28). TM is a research student supervised by DF. Is the Subject Area "Alcohol consumption" applicable to this article? Manage cookies/Do not sell my data we use in the preference centre. Once consent was given, participants were randomized by computer. Randomisation is achieved by concealed centrally-allocated computer generated random numbers. Respondents were then categorised according to whether they were drinking more than 14 units a week for women and more than 21 units a week for men [33]. For more information about PLOS Subject Areas, click Medical Statistics Programme, Oxford Brookes University, Oxford, Oxfordshire, United Kingdom, Affiliation The brief personalised normative feedback given to each intervention group participant will comprise the results of their drinking behaviour assessment alongside information about alcohol and how it might affect them at their current drinking levels. In the UK alcohol-related mortality is increasing compared with many other European countries where rates are declining or unchanged. 2002, 164-172. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Respondents also completed a drinking diary about a “typical week”, where they indicated the number of drinks/units they usually drink on each day of the week, and this was used to calculate the number of units consumed each week. A chained equation imputation model was fittedsimultaneously for all outcomes as well as baseline AUDIT score, age, and sex, to create imputed complete data sets. Citation: Moreira MT, Oskrochi R, Foxcroft DR (2012) Personalised Normative Feedback for Preventing Alcohol Misuse in University Students: Solomon Three-Group Randomised Controlled Trial. Social desirability responsiveness was also assessed using the short form of the Marlowe Crown scale 2 [37]. We also provided financial feedback, health information and advice on where help can be obtained. Article Social Marketing Feedback is a technique that is commonly used when providing education around a wide range of health topics, with the aim of stimulating motivation for change. Approximately 501 college students at the University of Texas at El Paso were recruited to participate during the spring, summer, and fall 2011 semesters. A copy of the online questionnaire is available for download [30]. Article Google Scholar. Social normative feedback is a prevention intervention based on the fact that young people tend to overestimate alcohol consumption amongst their peer group resulting in motivation, or “peer pressure” to drink more to catch up with their peers and be normal. 2007, 102 (1): 62-70. Sustained an injury; 8. We performed a main analysis of all observed data that are valid under a plausible assumption about the missing data; and 3. Therefore it is possible that this relatively cheap intervention may be relatively more effective if delivered at a whole population level rather than just to those at higher levels of risk. Providing feedback is not an essential element of MI but it can be useful for raising topics and beginning a conversation with clients in a pre-contemplative stage (Miller & Rollnick, 2009; p134). The 12-month significant effect remained in the multiple imputation analysis, but this should be regarded with caution given the very high attrition rates. Participants are undergraduate university students (first and second year) enrolled in UK and Portuguese universities. No funder has had any role in the preparation of the manuscript or the decision to submit. https://doi.org/10.1371/journal.pone.0044120.t003, https://doi.org/10.1371/journal.pone.0044120.t004. Information about how much students actually consume, accurate statistics about the frequency of negative consequences among them and basic information relating to alcohol are part of the approach [4]. Intention to treat was applied in all analyses. PLoS ONE 7(9): Solomon three-group randomised controlled trial. The feedback also provided general information about alcohol and how it might affect them at their current drinking levels, including how long it could take to return to a zero blood alcohol level after a typical drinking occasion. statement and Yes This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Six- and twelve-month follow-up analysis in the high risk sub-sample showed no effects of the intervention, at either time-point (Tables 3 and 4) and in both the completed case analysis and the multiple imputation analysis, for most outcomes.
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