Responses were summed to provide an alcohol-related problems score (range 10 to 20 with a higher score indicating more problems). Missed a lecture/class; 6. Previous reviews have examined PNF in combination with other components but not as a stand-alone intervention. Baseline alcohol use and misuse will be measured in two of the groups, but not the third group. https://doi.org/10.1371/journal.pone.0044120.t003, https://doi.org/10.1371/journal.pone.0044120.t004. https://doi.org/10.1371/journal.pone.0044120.s001, https://doi.org/10.1371/journal.pone.0044120.s002. The intervention group will receive the brief personalized normative feedback via email within a few weeks of completing the assessment and will be followed up at 6 months, along with the first control group. It is hard to see how the sub-set of students that were retained in the study are generally representative of the whole student population, so inferences from sample to the pre-specified study population are problematic. Perceived norms were measured using an adaptation of the two versions of the Drinking Norms Rating Form [35]. statement and There was no direct human involvement in the randomization process. 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. In the completed case analyses (i.e. Yes e44120. This self-report questionnaire assesses positive expectancies related to alcohol consumption (social changes, cognitive improvement, sexual enhancement and relaxation) with 21 statements and a true/false answer format. Once consent was given, participants were randomized by computer. Both authors have contributed to the analytical strategy, on developing the intervention and overall methodological development. 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. Making students aware of this misperception may help change behaviour and reduce problem drinking. The computer-based randomisation ensured that researchers and participants were not aware of allocated group. 10.1111/j.1360-0443.2005.01294.x. For more information about PLOS Subject Areas, click 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. 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. Both authors have read and approved the final manuscript. 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]. Received unwanted sexual advances. 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]. The trial is jointly funded by Fellowship and project grants from the Foundation for Science and Technology (Fundação para a Ciência e a Tecnologia [FCT]) (Portugal), the Alcohol Education and Research Council (AERC) (UK) and the European Research Advisory Board (ERAB) (Belgium). Analyses focused on high-risk drinkers, as well as all students, because of research evidence for the prevention paradox in student drinkers. Individual-level strategies aim to produce changes in attitudes or behaviors related to alcohol use rather than the environments in which alcohol use occurs. https://doi.org/10.1371/journal.pone.0044120.g001. Copyright: © Moreira et al. Yes At randomisation participants were not aware of the nature of the intervention, but full participant blinding was not possible. Affiliation No, Is the Subject Area "Control theory" applicable to this article? 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. Working with Kypri, we have used his dataset to model the potential of normative feedback to reduce alcohol related problems. Attrition in this study was lower than in other European research on email- or web-based social normative feedback interventions with university students [44]–[46] though higher than in some Australian or U.S. studies [40], [42]. Alongside demographic questions (including: age, gender, weight, nationality, university year) we have carefully selected validated measurement instruments: Alcohol Use Disorders Inventory Test (AUDIT) and brief version (AUDIT-C), Alcohol Expectancies Questionnaire (AEQ, brief version), Social Desirability Scale (SDS, brief version), Self-report measures on alcohol consumption (from ESPAD and Centre for Addiction and Mental Health (CAMH), Toronto) [12, 13], Perceived norms (validated adaptation of the two versions of the Drinking Norms Rating Form). Analyses were performed on the full sample (all students) and also with a higher risk sub-sample to test the prevention paradox prediction. No, Is the Subject Area "Traumatic injury risk factors" applicable to this article? Yes No, Is the Subject Area "Undergraduates" applicable to this article? Follow-up rates were low, with only 50% and 40% responding at 6- and 12-months, respectively, though comparable to similar European studies. Addiction. There is one intervention group and two control groups, controlling separately for measurement and for intervention effects. 2007, Stockholm: Sweden. The intervention group received brief personalised normative feedback (PNF) within a few weeks of completing the baseline assessment, which comprised an online questionnaire with demographic questions and an assessment of drinking behaviour. with self-guided personalized normative feedback (SWF) or web-based assessment with counselor-guided personalized normative feedback (CWF). Is the Subject Area "Alcohol consumption" applicable to this article? A second objective was to assess the relative effectiveness of whole population (universal) versus screening and brief intervention (SBI; targeted) normative feedback in reducing alcohol related problems. Results indicated students in the CWF condition reported significantly greater reductions in weekly drinking quantity and binge drinking frequency than those in the SWF group at follow-up (M = 8 months). In the analysis, respondents were scored 1 if they were over these levels, otherwise 0. Define the components of personalized normative feedback 6. We have incorporated a number of features designed to improve this, including: Three e-mail reminders at seven day intervals to non-responders; A figure of 150 students per group is specified for analysis for both male and female hazardous drinkers resulting in an overall sample size requirement of 4000 students in each country. 10.1111/j.1360-0443.2004.00847.x. Normative feedback as an approach to alcohol misuse prevention is based on Social Norming Theory. The internal consistency for this scale was alpha = 0.71. Feedback, personalised & normative" by Youth AOD Toolbox on Vimeo, the home for high quality videos and the people who love them. In fact, the low-follow-up rates add to the problem with understanding how generalizable these study results are given the recruitment methods used: only those students who saw the study adverts (via email, student information systems or Facebook) were able to participate and, as the most effective recruitment strategy was Facebook with 78% of all participants, it is unclear how representative these participants are of the general student body. In the second random effects model we carried out a sensitivity analysis using multiple imputation. The brief personalised normative feedback (PNF) emailed to each participant in the intervention group one to two weeks post-baseline comprised the results of their drinking behaviour assessment compared with, in an easy to read graphical format, average levels of drinking amongst their student peer group. 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. We fitted two different random effect models to assess an intention-to-treat hypothesis. Personalized normative feedback (PNF) has shown promise as a stand-alone intervention for reducing alcohol use among college students. 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]. Values were imputed for all participants, even for those with no post-baseline data. 2006/28). Ethics approval for this study was provided by Oxford Brookes University Research Ethics Committee (UREC No. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials. An important conclusion to draw out from our study, alongside these other European studies, is that the acceptability and viability of recruiting students into a brief personalised feedback intervention, outside of a university medical centre screening programme [40] or a mandated student alcohol education programme [42], seems to be low. At the end of the trial a computer science specialist de-encrypted the data and all personal identifying details were removed from the dataset. Multivariate analyses will be conducted with gender, nationality, University year (one and two), social desirability and study country as covariates. 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. Springer Nature. All other scores (Audit, Alcohol-related Problems, Drinking Norms and Positive Expectancies) were analyzed with linear/log-linear regression using xtmixed (StataCorp). All three groups will be followed up at 12 months. Yes CAS Scores ranged between 0 and 21, with a higher score indicating more positive expectancies. PNF uses norms clarification to correct drinking norms misperceptions by highlighting discrepancies between personal alcohol use, perceived peer alcohol use, and actual peer alcohol use. A more serious issue is in relation to external validity, specifically generalizability [22]. Personalized PD, Formative Feedback, and Deliberate Practice. Ethics approval for this study is provided by Oxford Brookes University Research Ethics Committee (REC No-2006/28). To assess the relative effectiveness of whole population (universal) versus screening and brief intervention (SBI; targeted) normative feedback in reducing alcohol related problems. Usual quantity of alcohol consumption was assessed with one question asking how many drinks/units a respondent usually consumed on a drinking occasion, with responses 0, 1, 2, 3, 4, 5, 6, or 7 or more. Therefore, other problems were measured in a newly-developed self-reported scale with nine possible problems, listed on a yes/no scale: 1. This analysis indicates that there was no effect on drinking behaviour of the baseline measures and questions about alcohol use and problems. It is conceivable that this could have influenced retention rates, but we regard this as unlikely given more immediate feedback was provided in similar studies that had similar or poorer retention rates [44]–[46] and similar findings of limited/no effectiveness. The reason(s) for the inconsistent findings between our study and some other studies is not clear. We have not included the delayed control group in attrition assessment or statistical analysis of effects because there were no statistical differences between the main control and the delayed control groups at 12-month follow-up for any drinking behaviour measures (frequency of drinking, χ2 = 6.29, df = 6, p = 0.39; usual quantity of alcohol, t = 0.075, df = 699, p = 0.94; AUDIT, t = 0.63, df = 699, p = 0.53; alcohol-related problems, t = −0.181, df = 699, p = 0.86; perceived drinking norms, t = −0.609, df = 699, p = 0.54). Journal of Studies on Alcohol. All participants were sent a follow-up assessment the day after their birthday celebration (92.9% retention rate). Been embarrassed by your actions; 3. PubMed 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. Annual Symposium of the Society for the Study of Addiction 2007; York. 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. 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. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Details of recommended sensible drinking levels were also provided. Data from the remotely completed online questionnaires were automatically entered and stored in a web based server. Been in a fight; 4. We were not able to collect information about reasons for non-completion of follow-up questionnaires. 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. A Solomon Three Group Design will be used. By . Norms clarification has been identified as an effective component of college student drinking interventions, prompting research on norms clarification as a single-component intervention known as Personalized Normative Feedback (PNF). Analyzed the data: RO DRF MTM. broad scope, and wide readership – a perfect fit for your research every time. 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). Michael Bernstein, University of Rhode Island. Canada. The AUDIT score was specified as the primary outcome variable. Cookies policy. A Solomon Three Group Design [11] will be used in each country (UK and Portugal) where participants will be randomly assigned, with concealed allocation, to one of three groups (see Figure 1). 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. Yes But our results are generally in agreement with other work from the UK and Sweden, where randomised trials aimed at assessing the effectiveness of an electronic web-based personalised feedback intervention have found little or no effect for most outcome measures [43]–[46]. Drinking behaviour measures were (i) alcohol disorders; (ii) frequency; (iii) typical quantity, (iv) weekly consumption; (v) alcohol-related problems; (vi) perceived drinking norms; and (vii) positive alcohol expectancies. 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. 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. Trouble with local or campus authorities; 9. Details of sensible drinking levels will also be provided and contact details of health services and helplines they can contact if they feel they need further help. At this point, participants are randomised to intervention or control groups. 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]. Identify at least two web-based brief interventions that provide brief MET 7. A more conventional Solomon four group design was not possible given that the intervention required baseline information in order to personalise feedback to each participant. 2006, 101 (1): 84-90. All analyses were intention-to-treat (ITT) and all participants were followed up regardless of their compliance with the intervention. 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. A specimen feedback is available to download [30]. This article is published under license to BioMed Central Ltd. Aims To evaluate the effects of the two main components of a Personalised Normative Feedback (PNF) (Normative feedback only –NFO; and Consequences feedback only ‐ … This study, conducted by lead author Dr. Mary Beth Miller, Brown University adjunct assistant professor of behavioral and social sciences, examined blackouts as a moderator of young adult veteran response to a brief, online personalized normative feedback (PNF) … Click through the PLOS taxonomy to find articles in your field. Cochrane Database of Systematic Reviews. Information will also be provided on the money that they might be spending on alcohol and also the calories they might be consuming at their current drinking levels. PLoS ONE 7(9): The author(s) declare that they have no competing interests. personalized normative feedback (PNF), which provides individuals with accurate information to reduce mispercep-tions regarding the frequency and acceptability of risky peer behavior. California Privacy Statement, Randomisation occurs after students have read the consent form, with affirmative consent given proceeding to the on-line questionnaire. The study utilised a Solomon three group randomised controlled trial design [27], with one intervention and two control groups to control separately for intervention and for measurement effects. PNF has established efficacy as included within multicomponent interventions targeting military populations or as a stand-alone intervention with young adult We found no evidence for any systematic attrition bias. PNF is intended to raise motivation for behaviour change and has been highlighted for alcohol misuse prevention by the British Government Behavioural Insight Team. Personalized Normative Feedback (PNF) One promising strategy in reducing college student drinking involves reducing overestimated descriptive drinking normative perceptions. No, Is the Subject Area "Motivation" applicable to this article? Frequency of alcohol consumption was assessed with one question asking how often the respondent drank, with responses ‘Never’, ‘1–2 per year’, ‘Once a Month’, ‘Twice a Month’, ‘Once a Week’, ‘Twice a Week’, or ‘Daily’. Journal of American College Health. Google Scholar, Perkins HW: Social Norms and the Prevention of Alcohol Misuses in Collegiate Contexts. Clues as to the differences in effect across different studies might lie in the differences in intervention content and delivery. There is one intervention group and two control groups, controlling separately for measurement and for intervention effects. Despite the modest effect sizes observed in increasingly popular web-based personalized normative feedback (PNF) alcohol interventions for college students, previous research has yet to consider how gamification might be used to enhance efficacy. Personalized Normative Feedback and the Moderating Role of Personal Norms: A Field Experiment to Reduce Residential Water Consumption - P. Wesley Schultz, Alyssa Messina, Giuseppe Tronu, Eleuterio F. Limas, Rupanwita Gupta, Mica Estrada, 2016. Second, evidence regarding the differential effectiveness of social norms interventions in countries with different drinking cultures and patterns. Responses were calculated as number of drinking days per month; for example ‘Never’ scored 0, ‘Once a Week’ scored 4.5, and ‘Daily’ scored 30. Overall, there is a consistent pattern of no effect across most outcome measures and time points. 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]. Participants completed online questionnaires at baseline, 6- and 12-months (only 12-months for the delayed measurement controls). Free Online Library: Personalized normative feedback to reduce drinking among college students: a social norms intervention examining gender-based versus standard feedback. Addiction. 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. No additional external funding was received for this study. Article Feedback, personalised & normative on Vimeo The AUDIT scale is scored between 0 and 40, with a higher score indicating higher levels of drinking. David R Foxcroft. School of Health and Social Care, Oxford Brookes University, Oxford, OX3 0FL, UK, You can also search for this author in 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]. Personalized normative feedback (PNF) is one-time individually delivered information designed to correct normative misperceptions. Manage cookies/Do not sell my data we use in the preference centre. 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]. personalized normative feedback, such as information about personal drinking patterns and drinking risk status relative topeerdrinkingnormativedata(Larimeretal.,2001;Marlatt et al., 1998). Brief personalised normative feedback (PNF) interventions focus on an individual's own drinking behaviour, providing factual details about personal drinking levels and patterns in comparison with norms for drinking in similar aged peer groups, alongside more general information about alcohol risk and harms [12]–[15]. Studies have shown that university/college students tend to have an exaggerated view of the quantities of alcohol being consumed by their peers. Correspondence to Recruitment, follow-up and attrition are described in Figure 1. The interactions were removed from the analysis due to insignificant effects. Furthermore, students will also be recruited via Facebook, a social networking website. Yes Firstly, evidence of the potential to reduce hazardous and harmful drinking amongst University students might lead to better prevention programmes across Europe. 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. No, Is the Subject Area "Medical risk factors" applicable to this article? 2007, 102 (1): 62-70. Over the past few years, innovative approaches to implementing brief motivational interventions have been developed, with a growing number of controlled studies There is also a question about whether PNF is effective over and above the simple alcohol screening/assessment test that itself raises awareness about alcohol consumption [23]. The primary outcomes are AUDIT Score, weekly consumption, perceived social norms, and alcohol related problems; secondary outcomes include alcohol expectancies and other health behaviours. 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. Moreover, this one effect should not be over-interpreted given the consistent pattern of no effect across most outcome measures and time points. Other parts of this study were supported by Alcohol Research UK and the European Foundation for Alcohol Research. Approximately 501 college students at the University of Texas at El Paso were recruited to participate during the spring, summer, and fall 2011 semesters. This on-line randomised controlled trial has the potential to address three key issues. The main objective of the trial was to assess the effectiveness of PNF with risky drinking college students for the prevention of alcohol misuse. 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. Randomisation is achieved by concealed centrally-allocated computer generated random numbers. 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 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). All questionnaires were completed remotely via web-based forms, and so outcome assessment was blinded. 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. In the full population analyses 111/122 universities and 876/1751 individuals were followed up and analysed at 6-months, and 107/122 universities and 718/1751 individuals at 12-months. Grateful thanks to Dr Gil Lopes for developing the web-based technology for this study. Solomon three-group randomised controlled trial. 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. We have not been able to assess impact on acute harms, violence and crime because of insufficient information for modelling. PubMed 2008, [http://www.camh.net/About_Addiction_Mental_Health/Drug_and_Addiction_Information/evaluate_your_drinking.html], The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2458/8/113/prepub. 2001, Geneva: World Health Organization, 57-. Rossow I, Romelsjo A: The extent of the 'prevention paradox' in alcohol problems as a function of population drinking patterns. Many brief interventions include personalized normative feedback (PNF) using gender-specific or gender-neutral referents. Research has demonstrated that when compared with more distal referents, proximal referents are more effective for preventing student alcohol misuse and related problems [35], [49], [50]. 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. Personalized Normative Feedback (PNF) is one norms-based intervention strategy that has become a dominant approach for reducing problematic alcohol use on college campuses. 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. 2007. Part of https://doi.org/10.1371/journal.pone.0044120.t005, https://doi.org/10.1371/journal.pone.0044120.t006. One particular intervention that has recently gained widespread attention is the social-norms approach (Perkins, 2002; Wechsler et al., 2004).The social-norms approach, social marketing, and personalized normative feedback (PNF; Lewis and … We are also interested in how the prevention paradox should inform the choice of intervention population. The collected scores about the “Frequency of drinking” and the “Quantity of drinking” were analysed with a mixing distribution of the Poisson regression with a Gamma mixture for panel data using the Stata 10.1 (StataCorp, College Station, Texas). Undergraduate students in year one and two of their course will be invited to participate via poster, flyer, email or via university student information systems at the beginning of the academic year 2007/8. Competing interests: MTM and RO declare no competing interests. Social desirability responsiveness was also assessed using the short form of the Marlowe Crown scale 2 [37]. 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). Young people who engage in one problem behaviour (e.g. https://doi.org/10.1371/journal.pone.0044120, Editor: James Coyne, 4. AIMS: To evaluate the effects of the two main components of a personalized normative feedback (PNF) [normative feedback only (NFO); and consequences feedback only (CFO)] compared with the full intervention (PNF) in reducing alcohol use and consequences. Data from the ESPAD Project. BMC Public Health 8, 113 (2008). PNF is intended to raise motivation for behaviour change [16], [17] and has been highlighted as a promising intervention by the British Government Behavioural Insight Team [18], [19].
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