Individual-focused approaches to the prevention of college student drinking.
Article Type: Report
Subject: Drinking of alcoholic beverages (Research)
College students (Alcohol use)
College students (Research)
Authors: Cronce, Jessica M.
Larimer, Mary E.
Pub Date: 09/22/2011
Publication: Name: Alcohol Research & Health Publisher: U.S. Government Printing Office Audience: Academic; Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2011 U.S. Government Printing Office ISSN: 1535-7414
Issue: Date: Fall, 2011 Source Volume: 34 Source Issue: 2
Topic: Event Code: 310 Science & research
Product: Product Code: E197500 Students, College
Accession Number: 275974730
Full Text: As detailed by Johnston and colleagues (2009), the majority of young adults, in particular college students, consume alcohol. Moreover, a substantial proportion of those who consume alcohol misuse it, engaging in heavy episodic drinking, (1) which directly and indirectly contributes to a host of harmful consequences (O'Malley and Johnston 2002; Perkins 2002). The rates of heavy drinking peak at ages 21 or 22 (Johnston et al. 2009), suggesting that most college students mature out of heavy drinking. Nevertheless, the harm they experience as a result of heavy drinking, such as poor academic and work performance or serious physical injury, may irrevocably alter students' natural developmental trajectories. In an effort to prevent or mitigate such long-term harm, myriad prevention programs have been developed to reduce college student drinking by targeting individual factors associated with alcohol use and misuse, including alcohol expectancies, drinking motives, perceived norms, and natural ambivalence regarding behavior (Baer 2002; Presley et al. 2002). A wealth of research has been devoted to evaluating the efficacy of these preventive interventions. The purpose of this article is to provide a comprehensive summary of the current state of the science with regard to individual-focused preventive interventions whose efficacy in reducing alcohol use and alcohol-related problems has been evaluated in the college student population using randomized controlled trials. Conclusions from earlier reviews in this area are described briefly, with greater focus given to summarizing evidence accumulated in the past 3 years (2007-2010).

INDIVIDUAL-FOCUSED PREVENTIVE INTERVENTIONS: SPECIFIC COMPONENTS AND EVIDENCE OF EFFICACY

Previous Reviews

Larimer and Cronce (2002, 2007) conducted qualitative reviews of research published between 1984 and early 2007 that evaluated the efficacy of individual preventive interventions aimed at college students. Both reviews noted a dearth of support for educational or awareness models, including information-based and values-clarification approaches, whereas there was evidence of efficacy for skills-based interventions, including self-monitoring/assessment, alcohol expectancy challenge (AEC), and multicomponent skills training. Moreover, both reviews documented strong empirical support for brief motivational interventions (BMIs) delivered via mail, online, or in person. As the name implies, in-person BMIs are brief (i.e., typically delivered over one or two sessions) and focus on enhancing motivation and commitment to change problematic behavior. To this end, BMIs often provide personalized feedback regarding the client's drinking and related consequences, alcohol expectancies, and drinking motives; when delivered alone in the absence of a trained facilitator, this personalized feedback component is referred to as a personalized feedback intervention (PFI). BMIs and PFIs often additionally include general alcohol information (i.e., alcohol education) and alcohol-specific coping and harm-reduction skills. PFIs typically include personalized normative feedback (PNF), which compares the client's self-reported drinking behavior to the average drinking behavior of a specific reference group (e.g., typical student, typical female). PNF encourages clients to explore and enhance discrepancies between their perception of their own drinking as "typical" and the actual drinking behaviors of their peers--that is, that the majority of students drink moderately, often significantly less than the individual receiving the intervention. Like PFIs, PNF can be delivered as a stand-alone intervention in the absence of in-person contact. Larimer and Cronce (2007) independently detailed empirical evidence supporting normative reeducation interventions, in particular computer-administered or in-person PNF interventions, that produced reductions in drinking and/or consequences mediated through changes in normative perceptions.

Complementing the qualitative reviews by Larimer and Cronce (2002, 2007), Carey and colleagues (2007) conducted a quantitative review evaluating 62 randomized clinical trials of 98 alcohol interventions for college students published during roughly the same time period (i.e., 1985 to early 2007). This meta-analysis similarly supported the efficacy of individual-focused alcohol interventions in reducing the quantity and frequency of alcohol use and alcohol-related negative consequences. The investigators further noted that significant intervention effects on indices of alcohol consumption peaked before the 6-month followup and that subsequently emerging effects on alcohol-related negative consequences lasted through long-term followup (ranging from 1 to 3.75 years). Specifically, Carey and colleagues (2007) concluded that individual interventions that used motivational interviewing techniques, included personalized feedback on alcohol expectancies and drinking motives with normative reeducation components, and included decisional balance exercises demonstrated greater efficacy in reducing alcohol-related consequences than did various comparison groups. This combination of intervention components is common to intervention approaches patterned after the Brief Alcohol Screening and Intervention for College Students (BASICS) program (Dimeff et al. 1999).

Review of Recent Individual-Focused Preventive Intervention Studies

In the years since the publication of the reviews by Carey and colleagues (2007) and Larimer and Cronce (2002, 2007), numerous studies of individual-focused preventive interventions for college student drinking have been published. Of these, 36 studies evaluating 56 unique interventions, met criteria for inclusion in this review (see the tables for details). Studies were identified via a comprehensive search of electronic databases, including PsycINFO and MEDLINE (for a list of search terms used, see Larimer and Cronce 2007), covering the period from late 2007 to early 2010. Additional studies were identified indirectly (e.g., they were referenced in the introduction section of one of the identified studies), and as-yet-unpublished studies were provided directly by authors. Studies were included if they used a randomized controlled trial approach--that is, if they randomly assigned individual participants (or intact groups) to one of two or more experimental conditions, including at least one active intervention and an ostensibly inert control (e.g., assessment only) group. Although the number of studies meeting inclusion criteria suggests that a meta-analysis may be warranted, a qualitative approach was selected for this review to facilitate more rapid communication with key stakeholders concerning the current state of alcohol prevention. (2) However, intervention effect sizes are reported for relevant outcomes in all studies that included effect size estimates in the original report or provided sufficient postintervention data to calculate between-group estimates (see tables). Within-group effect size estimates also are provided for studies wherein significant within-person reductions in alcohol use or consequences were evident.

Many of the studies included in this review evaluate the efficacy of multicomponent BMIs, many of which were adapted from the BASICS program. Most of these BMIs incorporated a PFI with PNF. Some studies evaluated one or more PFI/PNF interventions delivered alone, without the benefit of a trained intervention facilitator. Interventions were delivered via various modalities, including in-person group and individual sessions, mailed printed material, and Web-based content. In addition, some interventions were conducted in special settings (i.e., primary care, in the student's home before entering college) or targeted high-risk student subpopulations (i.e., mandated/sanctioned students, freshmen, or athletes).

Stand-Alone PFI/PNF Interventions. A total of 17 studies evaluated the impact of 14 unique PFIs/PNF and 4 PNF-only interventions implemented via written material, mail, computer, Web, or electronic diary on college student drinking (see table 1). Of 14 PFI/PNF interventions evaluated, 6 were associated with reductions in drinking but not drinking-related consequences relative to the comparison condition at followup. One PFI/PNF intervention (Doumas and Andersen 2009) was associated with reduced drinking-related consequences as well as alcohol use. Four additional PFI/PNF interventions were associated with significant within-person reductions in alcohol use and/or consequences across assessment periods, but between-group differences were not evident. Of four PNF-only interventions evaluated, three resulted in reductions in drinking outcomes at followup. The remaining PNF-only intervention had no effects on these outcomes but was associated with reductions in perceived drinking norms and increased readiness/preparation for behavior change.

In-Person BMIs. The literature review also identified 17 studies evaluating 20 unique in-person BMIs (individual and group), most of which incorporated PFI and/or PNF (see table 2). Of these interventions, 13 were associated with reductions in drinking, alcohol-related negative consequences, and/or associated psychopathology, and three interventions exhibited a protective effect against the onset of or increase in alcohol use and/or related consequences. One of these studies (Schaus et al. 2009) demonstrated a sleeper effect of the intervention, with short-term reductions in drinking and subsequently emerging reductions in consequences. Also note that another of these studies (Doumas and Hannah 2008) was not specifically aimed at college students but targeted young adults (ages 18 to 24) who were employed; however, 75 percent of the sample concurrently was enrolled in school. This study found that BMI combined with PFI was equivalent to PFI alone in reducing drinking-related variables. Finally, one of these studies (Hansson et al. 2007) specifically evaluated intervention gains between the 12-month and 24-month followup and found an advantage for a BMI combined with coping skills over either component alone. A quantitative comparison of changes from baseline to the 12-month followup was not presented. However, figures displaying group means suggest a potential short- term effect of the BMI-only condition in reducing estimated blood alcohol concentrations (BACs), which, if counted, would bring the above total support for BMI conditions from 13 to 14.

Other conclusions that can be drawn from the analysis of these studies include the following:

* Findings of studies evaluating BMI in specialized settings and high-risk subpopulations suggest that primary care is an effective venue for delivery of this type of intervention (Schaus et al. 2009).

* Group BMI or BMI enhanced with parental coaching is effective in reducing drinking among college freshmen (Turrisi et al. 2009; Wood et al. 2010).

* BMI is effective for nonmandated high-risk drinkers (Doumas and Hannah 2008; Stahlbrandt et al. 2007).

* Studies involving students who had been mandated to participate in the interventions documented benefits of BMIs (Carey et al. 2009; White et al. 2007), in particular for females (Carey et al. 2009) and those who received additional services, including coping skills, problem solving, and stress management training, in the context of a student assistance program (Amaro et al. 2009). Another study (Carey et al. 2010) additionally found greater benefit of BMI participation in reducing alcohol consumption among female mandated students compared with two separate multicomponent educational programs; however, reductions in the BMI were similar to assessment only. Participation in any of the three interventions was associated with short-term reductions in alcohol consumption among male mandated students.

Other Preventive Approaches. Additional studies evaluated other specific alcohol interventions, in most cases comparing these approaches to other active interventions (e.g., BMI or PFI/PNF) (see table 3). Two studies published in the time period evaluated included alcohol expectancy challenge (AEC) protocols, which generally are considered to be more skills based than motivational in nature. Lau-Barraco and Dunn (2008) evaluated a single-session, gender-specific in vivo (experiential) AEC. In contrast, Wood and colleagues (2007) assessed a two-session mixed-gender in vivo AEC, both alone and in combination with a BMI involving a PFI/PNF component. Both AEC interventions resulted in reductions in alcohol use but not alcohol consequences.

Two other studies (Glindemann et al. 2007; Thombs et al. 2007) investigated the efficacy of BAC feedback, another cognitive--behavioral skills-based approach used to intervene with college students. One of these studies (Glindemann et al. 2007) demonstrated a positive effect of the intervention (i.e., reductions in BACs), whereas the other (Thombs et al. 2007) reported a potential inadvertent opposite (i.e., iatrogenic) effect--that is, an increase in BACs. These mixed findings may be related to differences between the two studies in terms of the timing of the feedback (i.e., immediate versus delayed) and use of incentives to promote lower BACs (i.e., a $100 cash raffle for participants with BACs lower than 0.05 percent in the study by Glindemann and colleagues [2007]).

Four studies evaluated alcohol education either as a stand-alone intervention (see Thadani et al. 2009) or as a comparison intervention for PFI/PNF interventions with or without BMI. These studies generally found increases in alcohol knowledge among the students receiving the intervention. However, the interventions generated equivocal or negative effects on alcohol use and related consequences because they detected no group differences and/or lacked an assessment-only control group.

Finally, eight studies tested nine unique multicomponent, education-focused programs, which included general alcohol information as well as elements typically associated with efficacious BMI and PFI/PNF interventions, such as personalized feedback, normative reeducation, challenge of positive drinking expectancies, and tips for harm reduction. Just over one-half of these programs were associated with reductions in drinking and/or alcohol consequences, whereas the remainder (i.e., Alcohol 101 Plus [Carey et al. 2009]; an in-person, facilitator-led program [Cimini et al. 2009]; AlcoholEdu for College, 2006 version [Croom et al. 2008]; and Alcohol 101 [Lau-Barraco and Dunn 2008]) produced equivocal results. Of note, because the effective multicomponent education programs (e.g., AlcoholEdu, 2007 version; AlcoholEdu for College; AlcoholEdu for Sanctions; and College Alc) included BMI and PFI/PNF elements, it is impossible to disentangle the effect of education alone from the effects of these efficacious components.

INDIVIDUAL-FOCUSED PREVENTIVE INTERVENTIONS: CONCLUSIONS AND FUTURE RESEARCH

In summary, studies published between 2007 and early 2010 provide consistent support for the efficacy of brief, personalized, individual motivational feedback (i.e., BMI with PFI/PNF) interventions and stand-alone PFI/PNF interventions. These studies also provide support for the efficacy of AEC interventions, although less consistent, and offer mixed support for BAC feedback. These conclusions are in line with previous reviews (Carey et al. 2007; Larimer and Cronce 2002, 2007). Also consistent with previous reviews, there was an absence of support for programs solely including alcohol education, although multicomponent alcohol education--focused programs, which combine educational elements with BMI, PFI, and PNF components, had greater, albeit mixed, support.

Although the balance of the evidence supports the efficacy of PFI/PNF-only interventions, additional research on these interventions is necessary to identify the elements and/or modalities that are associated with behavior change and to determine for whom in-person BMI is more (or less) efficacious compared with PFI/PNF-only interventions. The lack of intervention effects in a few of the BMI and PFI/PNF studies may reflect the potential absence (or ineffective delivery) of necessary intervention components or the presence of potential moderators of intervention effects (e.g., mandated student status). Additional research also needs to establish the efficacy of these brief interventions in reducing long-term risk. Thus, it may be necessary to modify and evaluate existing interventions and/or evaluate the effects of supplemental interventions in order to extend their short-term effects and enhance or prolong their impact on negative drinking consequences. Recent findings (Carey et al. 2007; Schaus et al. 2009) suggesting longer-term emergent effects on alcohol-related consequences, particularly in response to in-person BMIs (Carey et al. 2007), indicate that the addition of longer-term follow-up assessments will be necessary to achieve this. Finally, additional research is needed to evaluate the efficacy of BMIs in combination with other interventions, including interventions targeting environmental change, parenting practices, or psychiatric comorbidity. Ultimately, multiple intervention strategies may be necessary to produce lasting effects on college student drinking and related harm.

Unfortunately, key stakeholders (e.g., college administrators, campus health professionals) face numerous barriers when trying to implement efficacious individual-focused alcohol interventions. For example, with the exception of commercially available programs, such as e-Chug or AlcoholEdu, the measures and feedback programs used in most intervention protocols are not easily accessible or not immediately useable. For those seeking to implement the BASICS approach (Dimeff et al. 1999), a published manual and measures are available. However, campus personnel may not have adequate resources (e.g., the expertise to train and supervise therapists, access to programs that can generate personalized feedback, or access to campus specific normative drinking data) to implement the program with sufficient fidelity.

Many of these barriers can be overcome by pairing health and counseling personnel with faculty in academic departments who may have experience with program evaluation and implementation. Word processing and spreadsheet/database programs generally available to campus personnel can be used to generate basic personalized feedback. Distance-learning methods currently used to disseminate some evidence-based public health interventions (e.g., video- or Web-based conferencing of initial training and ongoing clinical supervision) could be adapted to support implementation of BMI protocols. Implementation of routine alcohol screening in campus health centers could be used to gather normative data for use in PFI/PNF and to identify students appropriate for intervention.

Barriers to intervention implementation also necessitate additional research into increasing the reach of evidence-based approaches. This includes research related to training of providers and assessment of fidelity for in-person interventions, methods to improve impact and portability of Web-based or mailed/written interventions, and research on adaptation of efficacious interventions so they are appropriate for young adults from different cultural backgrounds and in contexts outside the traditional, mainstream college setting. To date, young adults in the workplace, community-college settings, tribal colleges and universities, historically Black colleges and universities, and other minority-serving institutions have been substantially underrepresented in efficacy trials of BMIs and related interventions. Careful consideration and the development of meaningful community partnerships to support the bidirectional learning necessary to adapt and implement efficacious brief prevention approaches in these settings are needed.

ACKNOWLEDGEMENTS

This research was supported through funding from the National Institute on Alcohol Abuse and Alcoholism (T32--AA--007455, Psychology Training in Alcohol Research).

FINANCIAL DISCLOSURE

The authors declare that they have no competing financial interests.

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(1) The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines binge or heavy episodic drinking as the consumption of an amount of alcohol leading to a blood alcohol concentration (BAC) of 0.08 percent, which, for most adults, would be reached by consuming five drinks for men or four for women over a 2-hour period (NIAAA 2004). Wechsler and colleagues (1995) similarly denote a binge episode as consumption of five or more drinks for men and four or more drinks for women but do not stipulate a bounded time frame during which consumption must occur or link the episode to a particular BAC. The latter definition by Wechsler and colleagues (1995) was used most frequently across the studies reviewed here.

(2) Both meta-analytic (quantitative) and qualitative reviews seek to combine findings from multiple studies addressing a shared research hypothesis (e.g., that a particular type of intervention will reduce alcohol use and/or consequences). In a meta-analysis, findings are combined via a common measure of effect size (e.g., Cohen's d), and conclusions are based on a weighted average of all of the effect sizes. By comparison, a qualitative approach is more inductive, and conclusions summarize the balance of the evidence based on an additive evaluation of the separate studies.

Jessica M. Cronce, Ph.D., and Mary E. Larimer, Ph.D.

Jessica M. Cronce, Ph.D., is a senior postdoctoral fellow, and Mary E. Larimer, Ph.D., is a professor in the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington.
Table 1 Studies Assessing the Efficacy of Stand/Alone PFI/PNF
Interventions Compared With Assessment Only or Other Interventions

                                    Intervention
Study                                Conditions

PFI/PNF vs. assessment only

Bewick et     1. Web-based PFI/PNF *
al. (2008)    2. Assessment only

Doumas &      1. Web-based PFI/PNF (e-Chug) *
Andersen      2. Assessment only
(2009)

Geisner,      1. Mailed PFI/PNF with general tips
et al.        2. Assessment only
(2007)

Hustad et     1. Web-based PFI/PNF (e-Chug) *
al. (2010)    2. Multicomponent alcohol education-focused
                 program (AlcoholEdu)
              3. Assessment only

Weitzel et    1. PFI/PNF only
al. (2007)    2. Assessment only

PFI/PNF vs. waitlist control

White et      1. PFI/PNF (within person *)
al. (2008)    2. Waitlist control (received PFI with PNF based on
                 baseline assessment at first followup) (within
                 person *)

PFI/PNF vs. alcohol education

Doumas &      1. Web-based PFI/PNF *
Haustveit     2. Alcohol education
(2008)

Doumas et     1. Web-based PFI/PNF *
al. (2009)    2. Web-based alcohol education (Judicial Educator)

Minimal PFI/PNF vs. enhanced PFI/PNF

Saitz et      1. Minimal Web-based PFI/PNF (within person *)
al. (2007)    2. Enhanced Web-based PFI/PNF (within person *)

PFI/PNF vs. BMI

Butler et     1. In-person BMI with PFI
al. (2009)    2. Computerized PFI alone *
              3. Assessment only

Doumas &      1. BMI with Web-based PFI/PNF
Hannah        2. Web-based PFI/PNF only *
(2008)        3. Assessment only

Mun et al.    1. BMI with PFI/PNF
(2009)        2. Written PFI/PNF only

Walters et    1. BMI with PFI/PNF
al. (2009)    2. BMI without PFI/PNF
              3. Web-based PFI/PNF only
              4. Assessment only

White et      1. BMI with PFI/PNF
al. (2007)    2. Written PFI/PNF only (within person *)

PNF-only vs. assessment only

Lewis et      1. Gender-specific computerized PNF *
al. (2007     2. Gender-neutral computerized PNF *
              3. Assessment only

Lewis et      1. 21st birthday card with PNF
al. (2008)    2. Assessment only

Neighbors     1. 21st birthday card with PNF *
et al.        2. Assessment only
(2009)

                Student Population
              Outcome (Intervention          Effect          Follow-up
Study               Condition)                Sizes           Period

PFI/PNF vs. assessment only

Bewick et     Reduced drinks per       d = 0.29              12 weeks
al. (2008)      drinking occasion
                (1)

Doumas &      Among high-risk                                3 months
Andersen      drinkers:
(2009)        Reduced frequency of     d = 0.85
                intoxication (1)
              Reduced alcohol          d = 0.80
                consequences (1)

Geisner,      Reduced perceived        d = 0.60              1 month
et al.          drinking norms (1)
(2007)        No group difference
              with respect to
              alcohol use or
              consequences (1, 2)

Hustad et     Reduced typical and      ds = 0.54 to 0.85     1 month
al. (2010)      peak drinking (1)
              Reduced typical and      ds = 0.59 to 0.75
                peak drinking (2)
              Reduced alcohol          d = 0.56
                consequences (2)

Weitzel et    Reduced drinks per       N/A                   2 weeks
al. (2007)    drinking day during
              the intervention
              period, but not at
              followup (1)

PFI/PNF vs. waitlist control

White et      Mandated/sanctioned                            2 months
al. (2008)    students:                                      and 7
              No group differences                           months
              (1, 2)
              Within-person            Within-person ds:
              comparisons:
              Reduced drinking         ds = 0.23, 0.28       2 months
                frequency (1, 2)
              Reduced heavy            d = 0.29
                drinking episodes
                (1)
              Reduced peak BAC         ds = 0.24, 0.28
                (1, 2)
              Reduced alcohol          d = 0.23
                consequences (2)
              Reduced drinking         ds = 0.24, 0.28       7 months
                frequency (1, 2)
              Reduced peak BAC (2)     d = 0.22
              Reduced alcohol          ds = 0.20, 0.19
                consequences (1, 2)

PFI/PNF vs. alcohol education
  L
Doumas &      Among high-risk                                6 weeks
Haustveit     drinkers:                                      and 3
(2008)        Reduced weekly           [[eta.sub.p.sup.2]    months
                drinking quantity        = 0.14
                (1)
              Reduced peak drinking    [[eta.sub.p.sup.2]
                quantity (1)             = 0.15
              Reduced frequency of     [[eta.sub.p.sup.2]
                intoxication (1)         = 0.20
              * Drinking reductions
                were positively
                associated with
                reductions in
                perceived norms for
                typical student
                drinking

Doumas et     Mandated/sanctioned                            30 days
al. (2009)    students:
              Reduced weekly           [[eta.sub.p.sup.2]
                drinking quantity        = 0.07
                (1)
              Reduced peak drinking    [[eta.sub.p.sup.2]
                quantity (1)             = 0.08
              Reduced frequency of     [[eta.sub.p.sup.2]
                intoxication (1)         = 0.07
              * Changes in drinking
                were mediated via
                reductions in
                 perceived norms
                for alcohol
                consumption

Minimal PFI/PNF vs. enhanced PFI/PNF

Saitz et      High-risk drinking
al. (2007)    freshmen:
              No group differences                           1 month
                (1, 2)
              Within-person
              comparisons:
              Reduced AUDIT scores
                (1, 2)
              Reduced quantity
                drinks per week
                (women; 1, 2)
              Reduced heavy
                drinking episodes
                (women; 1, 2)

PFI/PNF vs. BMI

Butler et     Reduced frequency of     [[eta.sub.p.sup.2]    4 weeks
al. (2009)      typical drinking         = 0.13
                (1, 2)
              Reduced quantity of      [[eta.sub.p.sup.2]
                typical drinking         = 0.17
                (1, 2)
              Reduced frequency of     [[eta.sub.p.sup.2]
                binge drinking           = 0.15
                (1, 2)

Doumas &      Among high-risk                                30 days
Hannah        drinkers:
(2008)        Reduced weekend          [[eta.sub.p.sup.2]
                alcohol use (1, 2)       = 0.07
              Reduced peak drinking    [[eta.sub.p.sup.2]
                quantity (1, 2)          = 0.05
              Reduced frequency of     [[eta.sub.p.sup.2]
                intoxication (1, 2)      = 0.04

Mun et al.    No group differences                           15 months
(2009)          (1, 2)

Walters et    Reduced alcohol use      d = 0.54              6 months
al. (2009)      and problems (1)
              No group differences
              on alcohol use or
              consequences (2, 3, 4)

White et      Mandated/sanctioned      N/A                   4 months
al. (2007)    students:                d = 0.27              15 months
              No group differences
              (1, 2)
              Protective effect
              against increases in
              alcohol consequences
              (1)
              Within-person            Within-person ds:     15 months
              comparisons:
              Reduced quantity         d = 0.28
                drinks per week (1)
              Reduced peak BAC         d = 0.36, 0.19
                (1, 2)
              Reduced alcohol          d = 0.39
                consequences (1)

PNF-only vs. assessment only

Lewis et      Reduced quantity         N/A                   5 months
al. (2007       drinks per week (1)
              Reduced drinking
                frequency (1)
              Reduced drinking
                frequency (2)

Lewis et      Reduced normative        [[eta.sub.p.sup.2]    1 -week
al. (2008)      misperceptions (1)       = 0.07
              No group differences
              with respect to
              alcohol use or
              consequences (1,2)

Neighbors     Reduced BAC on 21st      d = 0.33              4 days
et al.          birthday (1)                                 post-
(2009)        * Intervention was                             birthday
                more effective
                among those with
                baseline intentions
                to reach higher
                BACs

NOTE: Mun et al. (2009) reported the outcome of subsequent analyses
related to the efficacy of Interventions originally reported In White
et al. (2007); as such, these Interventions are not Included In the
total count of unique interventions provided in the text.
Intervention conditions followed by an "*" indicates the specific
intervention was associated with reductions, or exhibited a
protective effect against, relevant behavioral outcomes (e.g.,
quantity or frequency of alcohol consumption; alcohol/related
negative consequences). Effect sizes reported Include Cohen's d
(Cohen, 1988), which denotes the standardized difference between the
mean of the Intervention and comparisons groups and eta squared
([eta]2), which denotes the proportion of total variability In the
dependent variable attributable to the effect of the Independent
variable, or partial eta squared ([eta] p2). According to Cohen's
(1988, 1992) definitions of effect size, small, medium, and large
effects for dare considered to be In the 0.20, 0.50, and 0.80 ranges,
respectively, and for [eta]2 and [eta] p2 are 0.01, 0.06, and 0.14,
respectively. N/A = effect size estimate not available.

Table 2 Studies Assessing the Efficacy of In-Person BMIs

                       Intervention
Study                   Conditions

BMI vs. assessment only

Amaro et      1. In-person BMI with PFI
al. (2009)       plus indicated
                 cognitive--behavioral
                 interventions *
              2. Counseling services as
                 usual

LaBrie et     1. Group BMI *
al. (2008)    2. Assessment only

LaBrie et     1. Group BMI
al. (2009)    2. Assessment only

BMI vs. PFI/PNF only

Butler et     1. In-person BMI with
al. (2009)       PFI *
              2. Computerized PFI alone
              3. Assessment only

Doumas &      1. BMI with Web-based
Hannah           PFI/PNF *
(2008)        2. Web-based PFI/PNF
                 only
              3. Assessment only

Mun et al.    1. BMI with PFI/PNF
(2009)        2. Written PFI/PNF only

Walters et    1. BMI with PFI/PNF *
al. (2009)    2. BMI without PFI/PNF
              3. Web-based PFI/PNF
                 only
              4. Assessment only

White et      1. BMI with PFI/PNF *
al. (2007)    2. Written PFI/PNF only

BMI vs. other interventions

Carey et      1. In-person BMI with PNF *
al. (2009)    2. Multicomponent alcohol
                 education-focused
                 program (Alcohol 101 Plus)

Carey et      1. In-person BMI with
al. (2010)       PFI/PNF *
              2. Multicomponent alcohol
                 education--focused
                 program (Alcohol 101 Plus)
              3. Multicomponent alcohol
                 education--focused
                 program (AlcoholEdu
                 for Sanctions)
              4. Waitlist control

Cimini et     1. Group BMI
al. (2009)    2. Interactive peer theatrical
                 presentation
              3. In-person alcohol
                 education

Hansson et    1. BMI(possible *; refer to
al. (2007)       article)
              2. Coping skills training
              3. BMI + coping skills
                 training *

Schaus et     1. BMI with PNF *
al. (2009)    2. Alcohol education

Stahlbrandt   1. Modified group
et al.           BASICS-based BMI *
(2007)        2. 12-step focused group
              3. Assessment only

Turrisi et    1. Parent-based intervention
al. (2009)       (PMI)
              2. BMI with PFI/PNF *
              3. PMI + BMI *
              4. Assessment only

Wood et       1. BMI with PFI/PNF *
al. (2007)    2. Alcohol expectancy
                 challenge (AEC)
              3. BMI with PFI/PNF + AEC
              4. Assessment only

Wood et       1. BMI with PFI/PNF *
al. (2010)    2. Parent-based intervention
                 (PMI)
              3. BMI + PMI *
              4. Assessment only

                Student Population
              Outcome (Intervention          Effect          Follow-up
Study               Condition)                Sizes           Period

BMI vs. assessment only

Amaro et      Mandated/sanctioned
al. (2009)      students:
              Reduced weekday          d = 1.06              6 months
                alcohol use (1)
              Reduced alcohol          d = 0.65
                consequences (1)
              Increased use of         d = 1.98              10 weeks
                protective
                behavioral
                strategies (1)

LaBrie et     Freshmen women:
al. (2008)    Reduced typical          d = 0.34
                drinking (1)
              Reduced                  d = 0.42
                heavy-episodic
                drinking (1)
              * Intervention was
                more effective for
                those with higher
                social and
                enhancement
                drinking motives

LaBrie et     Freshmen women:                                6 months
al. (2009)    No group differences
                (1, 2)

BMI vs. PFI/PNF only

Butler et     Reduced frequency of     [[eta].sub.p.sup.2]   4 weeks
al. (2009)      typical drinking         = 0.13
                (1, 2)
              Reduced quantity of      [[eta].sub.p.sup.2]
                typical drinking         = 0.17
                (1, 2)
              Reduced frequency of     [[eta].sub.p.sup.2]
                binge drinking           = 0.15
                (1, 2)

Doumas &      Among high-risk
Hannah        drinkers:
(2008)        Reduced weekend          [[eta].sub.p.sup.2]   30 days
                alcohol use (1, 2)       = 0.07
              Reduced peak drinking    [[eta].sub.p.sup.2]
                quantity (1, 2)          = 0.05
              Reduced frequency of     [[eta].sub.p.sup.2]
                intoxication (1, 2)      = 0.04

Mun et al.    No group differences                           15 months
(2009)          (1, 2)

Walters et    Reduced alcohol use      d = 0.54              6 months
al. (2009)      and problems (1)
              No group differences
                on alcohol use or
                consequences
                (2, 3, 4)

White et      Mandated/sanctioned                            4 months
al. (2007)    students:                N/A                   15 months
              No group differences
                (1, 2)
              Protective effect        d = 0.27
                against increases
                in alcohol
                consequences (1)
              Within-person            Within-person ds:
              comparisons:
              Reduced quantity         d = 0.28              15 months
                drinks per week (1)
              Reduced peak BAC         d = 0.36, 0.19
                (1, 2)
              Reduced alcohol          d = 0.39
                consequences (1)

BMI vs. other interventions

Carey et      Mandated/sanctioned
al. (2009)    students:
              Reduced alcohol use      ds = 0.21 to 0.38     1 month
                (various indices)
                among women only (1)

Carey et      Mandated/sanctioned      N/A                   1 month
al. (2010)      students:
              Reduced alcohol use
                (various indices)
                among men (1, 2, 3)
              No group differences
                on problems among
                men (1, 2, 3, 4)
              Reduced alcohol use
                without group
                differences among
                women (1, 2, 3, 4)
              Reduced problems
                without group
                differences among
                women (1, 3, 4)
              Women in (1)
                experienced greater
                reductions in
                alcohol use
                relative to (2, 3)

Cimini et     Mandated/sanctioned                            6 months
al. (2009)    students:
              No group differences
                (1, 2, 3)

Hansson et    Reduced alcohol          ds = 0.52 to 0.60     12-24
al. (2007)      psychopathology (3)                          months
              Reduced drinking         ds = 0.42 to 0.72
                consequence
                scores (3)
              Reduced estimated        d = 0.49
                BACs (3)

Schaus et     Reduced typical          ds = 0.27-0.41        3 and 6
al. (2009)      drinking (1)                                 months
              Reduced peak             ds = 0.25-0.36
                drinking (1)
              Reduced typical          ds = 0.28-0.35
                BAC (1)
              Reduced peak BAC (1)     ds = 0.37-0.49
              Reduced frequency of     ds = 0.42-0.50
                intoxication (1)
              Reduced alcohol          ds = 0.23-0.29        6 and 9
                problems (1)                                 months

Stahlbrandt   Among high-risk          d = 0.27              2 years
et al.          drinkers:
(2007)        Reduced AUDIT
                scores (1)

Turrisi et    Reduced typical          ds = 0.14-0.20        10 months
al. (2009)      drinking (3)
              Reduced peak             ds = 0.17-0.26
                drinking (3)
              Reduced alcohol          ds = 0.13-0.20
                consequences (3)
              * Changes in drinking
                were mediated via
                reductions in
                perceived
                descriptive and
                injunctive norms
                for alcohol
              Reduced peak BAC (2)     d = 0.16
              Reduced number of        ds = 0.16-0.18
                drinks/weekend (2)

Wood et       Reduced total alcohol    ds = 0.16-0.25        1 month,
al. (2007)      use (1)                                      3 months,
              Reduced total alcohol    ds = 0.01-0.20        and 6
                use (2)                                      months
              Reduced heavy            ds = 0.18-0.26
                episodic
                consumption (1)
              Reduced heavy            ds = 0.00-0.22
                episodic
                consumption (2)
              Reduced alcohol          ds = 0.29-0.33
                consequences (1)

Wood et       Protective effect
al. (2010)    against:
              Initiating heavy         hs = 0.02-0.22        10 months
                episodic                                     and
                consumption (1)                              22 months
              Experiencing onset       hs = 0.07-0.15
                alcohol
                consequences (1)
              Experiencing onset       N/A
                alcohol
                consequences (3)

NOTE: conditions followed by an "*" indicates the specific
intervention was associated with reductions, or exhibited a
protective effect against, relevant behavioral outcomes (e.g.,
quantity or frequency of alcohol consumption; alcohol/related
negative consequences). Mun et al. (2009) and LaBrie et al. (2009)
both reported the outcome of subsequent analyses related to the
efficacy of interventions originally reported in White et al. (2007)
and LaBrie et al. (2008), respectively; as such, these interventions
are not included in the total count provided in the text. Effect
sizes reported include Cohen's d(Cohen, 1988), which denotes the
standardized difference between the mean of the intervention and
comparisons groups, Cohen's h(Cohen, 1988), which denotes the
difference between two proportions, and eta squared ([eta]p2), which
denotes the proportion of total variability in the dependent variable
attributable to the effect of the independent variable, or partial
eta squared ([eta]p2). According to Cohen's (1988, 1992) definitions
of effect size, small, medium, and large effects for d and h are
considered to be in the 0.20, 0.50, and 0.80 ranges, respectively,
and for [eta]2 and [eta]p2 are 0.01, 0.06, and 0.14, respectively.
N/A = effect size estimate not available.

Table 3 Studies Assessing the Efficacy of Other Preventive
Interventions

                          Intervention
Study                      Conditions

Alcohol expectancy challenge

Lau-Barraco   1. Alcohol expectancy
and Dunn         challenge (AEC) *
(2008)        2. Multicomponent alcohol
                 education-focused
                 program (Alcohol 101)
              3. Assessment only

Wood et       1. BMI with PFI/PNF
al. (2007)    2. Alcohol expectancy
                 challenge (AEC) *
              3. BMI with PFI/PNF + AEC
              4. Assessment only

Blood alcohol concentration (BAC) feedback

Glindemann    1. BAC feedback *
et al.        2. Assessment only
(2007)

Thombs et     1. BAC feedback
al. (2007)    2. BAC feedback +
                 normative re-education

Alcohol education

Doumas &      1. Web-based PFI with PNF
Haustveit     2. Alcohol education
(2008)

Doumas et     1. Web-based PFI with PNF
al. (2009)    2. Internet-based alcohol
                 education (Judicial
                 Educator)

Schaus et     1. BMI with PNF
al. (2009)    2. Alcohol education

Thadani et    1. Alcohol education
al. (2009)    2. Assessment only

Multicomponent, education-focused interventions

Bersamin      1. Multicomponent alcohol
et al.           education-focused program
(2007)           (College Alc) *
              2. Assessment only

Carey et      1. In-person BMI with PNF
al. (2009)    2. Multicomponent alcohol
                 education-focused program
                 (Alcohol 101 Plus)

Carey et      1. In-person BMI with
al. (2010)       PFI/PNF
              2. Multicomponent alcohol
                 education-focused program
                 (Alcohol 101 Plus) *
              3. Multicomponent alcohol
                 education-focused program
                 (AlcoholEdu for
                 Sanctions) *
              4. Waitlist control

Cimini et     1. Group BMI
al. (2009)    2. Interactive peer theatrical
                 presentation
              3. In-person multicomponent
                 alcohol education-focused program

Croom et      1. Multicomponent alcohol
al. (2008)       education-focused program
                 (AlcoholEdu for
                 College)
              2. Assessment only

Hustad et     1. Web-based PFI with PNF
al. (2010)       (e-Chug)
              2. Multicomponent alcohol
                 education-focused program
                 (AlcoholEdu for College) *
              3. Assessment only

Lau-Barraco   1. Alcohol expectancy
and Dunn         challenge (AEC)
(2008)        2. Multicomponent alcohol
                 education-focused program
                 (Alcohol 101)
              3. Assessment only

Lovecchio     1. Multicomponent alcohol
et al.           education-focused program
(2010)           (AlcoholEdu) *
              2. Assessment only

              Student Population
                    Outcome
                 (Intervention            Effect            Follow-up
Study             Condition)               Sizes             Period

Alcohol expectancy challenge

Lau-Barraco   Reduced quantity of   ds = 0.30 to 0.35     1 month
and Dunn        drinks per
(2008)          week (1)
              Reduced frequency     ds = 0.34 to 0.36
                of binge
                drinking (1)

Wood et       Reduced total         ds = 0.16-0.25        1 month,
al. (2007)      alcohol use (1)                           3 months,
              Reduced total         ds = 0.01-0.20        and 6
                alcohol use (2)                           months
              Reduced heavy         ds = 0.18-0.26
                episodic
                consumption (1)
              Reduced heavy         ds = 0.00-0.22
                episodic
                consumption (2)
              Reduced alcohol       ds = 0.29-0.33
                consequences (1)

Blood alcohol concentration (BAC) feedback

Glindemann    Lower BACs (1)        d = 0.31              Unspecified
et al.        Increased             d = 0.20
(2007)        percentage of
              individuals with a
              BAC <.08 g % (1)

Thombs et     Increased observed    d = 0.30              Next day
al. (2007)    mean BAC (2)                                follow-up,
                                                          aggregated
                                                          across
                                                          participants
                                                          over 2-year
                                                          project
                                                          period

Alcohol education

Doumas &      Among high-risk
Haustveit     drinkers:
(2008)        Reduced weekly        [[eta].sub.p.sup.2]   6 weeks and
                drinking              = 0.14              3 months
                quantity (1)
              Reduced peak          [[eta].sub.p.sup.2]
                drinking              = 0.15
                quantity (1)
              Reduced frequency     [[eta].sub.p.sup.2]
                of intoxication       = 0.20
                (1)
              * Drinking
               reductions were
                positively
                associated with
                reductions in
                perceived norms
                for typical
                student drinking

Doumas et     Mandated/sanctioned
al. (2009)    students:
              Reduced weekly        [[eta].sub.p.sup.2]   30 days
                drinking quantity     = 0.07
                (1)
              Reduced peak          [[eta].sub.p.sup.2]
                drinking quantity     = 0.08
                (1)
              Reduced frequency     [[eta].sub.p.sup.2]
                of intoxication       = 0.07
                (1)
              * Changes in
                drinking were
                mediated via
                reductions in
                perceived norms
                for alcohol
                consumption

Schaus et     Reduced typical       ds = 0.27-0.41        3 months and
al. (2009)      drinking (1)                              6 months
              Reduced peak          ds = 0.25-0.36
                drinking (1)
              Reduced typical       ds = 0.28-0.35
                BAC (1)
              Reduced peak          ds = 0.37-0.49
                BAC (1)
              Reduced frequency     ds = 0.42-0.50
                of intoxication
                (1)
              Reduced alcohol       ds = 0.28-0.29        6 months and
                problems (1)                              9 months

Thadani et    Freshmen women:       d = 0.73              6 months
al. (2009)    Increased alcohol
              knowledge (1)
              No group
              differences on
              alcohol use or
              consequences
              (1, 2)

Multicomponent, education-focused interventions

Bersamin      Freshmen:                                   3 months
et al.        Reduced heavy         d = 0.15
(2007)          episodic
                consumption (1)

Carey et      Mandated/sanctioned
al. (2009)    students:
              Reduced alcohol use   ds = 0.21 to 0.38     1 month
                (various indices)
                among women
                only (1)

Carey et      Mandated/sanctioned
al. (2010)    students:
              Reduced alcohol use   NA                    1 month
                (various indices)
                among men
                (1, 2, 3)
              No group
                differences on
                problems among
                men (1, 2, 3, 4)
              Reduced alcohol use
                without group
                differences among
                women
                (1, 2, 3, 4)
              Reduced problems
                without group
                differences among
                women (1, 3, 4)
              Women in (1)
                experienced
                greater
                reductions in
                alcohol use
                relative to
                (2, 3)

Cimini et     Mandated/sanctioned                         6 months
al. (2009)    students:
              No group
                differences
                (1, 2, 3)

Croom et      Increased alcohol     d = 0.52              6 weeks'
al. (2008)      knowledge (1)                             post-
              Lower participation   d = 0.12              matriculation
                in drinking
                games (1)
              Less likely to use    N/A
                safer sex
                strategies (1)
              No group
                differences with
                respect to
                alcohol use or
                consequences
                (1, 2)

Hustad et     Reduced typical       ds = 0.54 to 0.85     1 month
al. (2010)      and peak
                drinking (1)
              Reduced typical       ds = 0.59 to 0.75
                and peak
                drinking (2)
              Reduced alcohol       d = 0.56
                consequences (2)

Lau-Barraco   Reduced quantity      ds = 0.30 to 0.35     1 month
and Dunn        of drinks per
(2008)          week (1)
              Reduced frequency     ds = 0.34 to 0.36
                of binge
                drinking (1)

Lovecchio     Increased alcohol     d = 0.11              1 month
et al.          knowledge (1)
(2010)        Decreased             d = 0.28
                responsible
               drinking
                behavior (1)
              Protective effect
              against:
              Increased alcohol     d = 0.59
                consequences (1)
              Increased             d = 0.65
                accepting
                others'
                drinks (1)
              Increased positive    d = 0.07
                alcohol
                expectancies (1)

NOTE: conditions followed by an "*" indicates the specific
intervention was associated with reductions, or exhibited a
protective effect against, relevant behavioral outcomes (e.g.,
quantity or frequency of alcohol consumption; alcohol-related
negative consequences). Effect sizes reported include Cohen's d
(Cohen, 1988), which denotes the standardized difference between the
mean of the intervention and comparisons groups, Cohen's h (Cohen
1988), which denotes the difference between two proportions, and eta
squared ([eta]2), which denotes the proportion of total variability
in the dependent variable attributable to the effect of the
independent variable, or partial eta squared ([eta]p2). According to
Cohen's (1988, 1992) definitions of effect size, small, medium, and
large effects for d and h are considered to be in the 0.20, 0.50, and
0.80 ranges, respectively, and for [eta]2 and [eta]p2 are 0.01, 0.06,
and 0.14, respectively. NA = effect size estimate not available.
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