An International Comparison of a Web-Based Personalized Feedback Intervention for Alcohol use During the Transition out of High School in the United States and Sweden.

Young adult drinkers engage in a range of drinking patterns from abstaining to heavy drinking in both the United States and Sweden. Heavy drinking during young adulthood in both countries is associated with a variety of negative consequences. Personalized feedback interventions have been identified as effective prevention strategies to prevent or reduce heavy drinking in the United States. This study examined transitions in drinking profiles and compared the efficacy of a personalized feedback intervention for 3965 young adults in the United States (1,735) and Sweden (2230) during their transition out of high school. Using goodness-of-fit criteria, results indicated that three drinking profiles exist among young adults transitioning out of high school: very low drinkers/abstainers, moderate to heavy drinkers, and very heavy drinkers. Latent Markov models revealed a moderating effect of country on personalized feedback intervention such that intervention condition participants in the United States were more likely to belong to the light drinker/abstainer or moderate to heavy profile relative to the very heavy drinking profile at 6-month follow-up. There was no significant effect of personalized feedback intervention in Sweden. Future research could investigate the impact of when personalized feedback interventions are administered and could examine if personalized feedback interventions should be more intentionally culturally adapted in order to be more effective.

Alcohol trajectories over three years in a Swedish residence hall student population.

Although it is known that college students have a high alcohol consumption, less is known about the long-term drinking trajectories amongst college students and, in particular, students living in residence halls, known to be high-risk drinkers. Over four consecutive years, the drinking habits of 556 Swedish residence hall students were analyzed. The main instruments for measuring outcome were AUDIT (Alcohol Use Identification Disorders Test), SIP (Short Index of Problems) and eBAC (estimated Blood Alcohol Concentration). The drinking trajectories among Swedish residence hall students showed stable and decreasing drinking patterns, with age and gender being predictors of group membership.

Do responsible beverage service programs reduce breath alcohol concentration among patrons: a five-month follow-up of a randomized controlled trial.

AIMS: To examine whether the decrease in the mean breath alcohol concentration (BrAC) and the rowdy social atmosphere reported after one month remained stable in the five-month assessment. DESIGN: Randomized controlled trial. SETTING: University bars. PARTICIPANTS: The five-month assessment was based on 596 students visiting student bars during ordinary pub evenings. INTERVENTION: Bartenders (n = 40) in 6 of 12 bars on a university campus underwent training programs in a randomized pattern. Bartenders in control bars did not participate in the program. MEASUREMENTS: The BrAC and reported social atmosphere in a five-month follow-up assessment. FINDINGS: All measurements (BrAC, rowdy, cozy, and high social atmosphere) showed that time had a significant decreasing effect. The positive effects on BrAC and rowdy atmosphere shown in the one-month follow-up were no longer evident after five months. CONCLUSION: The positive results after one month were not stable after five months. The study's limitations are noted.

Intervention for hazardous alcohol use and high level of stress in university freshmen: a comparison between an intervention and a control university.

BACKGROUND: The first year of university studies is associated with increased levels of alcohol drinking and stress. This study examines the one-year outcome of both primary and secondary interventions of one alcohol programme and one stress intervention programme at an intervention university in comparison with a control university. METHODS: At the intervention university all freshmen were offered a primary prevention programme for hazardous alcohol use and stress management and, in addition, those who had high ratings for stress and/or hazardous alcohol use were offered a secondary intervention programme for alcohol consumption and/or stress management. Freshmen still attending the two universities one year later responded to follow-up questionnaires. RESULTS: The primary alcohol and stress interventions were associated with lower alcohol expectancies and mental symptoms, but no differences in AUDIT scores (-0.2, CI 95% -0.5 to 0.1), estimated blood alcohol concentrations or stress in comparison to freshmen at the control university. The secondary alcohol interventions were associated with decreased AUDIT (-1.1, CI 95% -2.0 to -0.2) as well as alcohol expectancies, blood alcohol concentrations, stress and mental symptoms in comparison to high-risk freshmen at the control university. The secondary stress interventions were associated with decreased mental symptoms and alcohol expectancies, but not stress, AUDIT scores (-0.6, CI 95% -1.4 to 0.2) and blood alcohol concentrations in comparison to high-risk freshmen at the control university. CONCLUSION: This study suggests that both primary and secondary alcohol and stress interventions have 1-year effects in university freshmen and could be implemented in university settings.

Stress and hazardous alcohol use: associations with early dropout from university.

BACKGROUND: The transition to studying at university is associated with increased levels of both stress and hazardous alcohol use. The aim of this study is to investigate the influence of these factors on first-year dropout from university studies. METHODS: Two complete cohorts of university freshmen at two homogeneous universities, one in the north and one in the south of Sweden, were asked to participate in an intervention study. Participants responded to a baseline questionnaire including measures of stress and alcohol use. Official university records showing dropout over 12 months were collected. RESULTS: A multivariate analysis established that high stress and admission to the northern university were associated with dropout from university studies, while symptoms of depression and anxiety as well as hazardous drinking were not. CONCLUSIONS: There is a need to address the issue of stress associated with the start of university studies. It seems important to offer stress-reducing interventions, specifically aimed at reducing transitional stress, as soon as students start university.

Measurement properties of the Arnetz and Hasson stress questionnaire in Swedish university freshmen.

BACKGROUND: The aim of this study was to evaluate the measurement properties of the Arnetz and Hasson seven-item stress questionnaire in order to select high-risk freshmen for a stress and alcohol intervention research project. METHODS: Two complete cohorts of university freshmen at two universities were asked to participate in an intervention study. All subjects responded to seven Visual Analogue Scales (VAS) measuring common areas associated with stress. Measurement properties were evaluated by analysing internal consistency and construct validity. RESULTS: A total of 2,032 (72%) freshmen agreed to participate. In total 14,184 out of 14,224 (99.7%) of the Visual Analogue Scales were answered. The Chronbach's alpha coefficient for the complete scale was 0.787. The Varimax rotation factor analysis, using an eigen value of 1, resulted in one factor that covered all items with factor scores of 0.50 and over. This factor explained 46% of the variance. A logistic regression analysis established that mental symptoms, living outside a serious relationship, and female gender were associated with a high stress level. CONCLUSIONS: The Arnetz and Hasson stress questionnaire is easy to use and offers sufficient internal consistency and construct validity.

Cross-cultural patterns in college student drinking and its consequences--a comparison between the USA and Sweden.

AIMS: The aim of the study was to compare alcohol use, consequences and common risk factors between American and Swedish college students. METHODS: A secondary comparative analysis from one American and two Swedish studies in college settings. RESULTS: Swedish freshmen report higher alcohol use than US freshmen students. Swedish residence hall students report higher alcohol use than US residence hall students, but lower than American fraternity/sorority members. US students were less likely to be drinkers. Controlling for age, country moderated the relationship between family history and harmful drinking scores for women (stronger in the USA), and between expectancies and harmful drinking scores for men (stronger in Sweden), though in both cases this represented a small effect and patterns were similar overall. CONCLUSIONS: Swedish students are at higher risk for alcohol use than US students, but similar patterns between aetiological predictors and outcomes in both countries suggest that research from the USA is generalizable to Swedish students and vice versa. More research is needed to better understand unique relationships associated with age and family history.

College students' drinking patterns: trajectories of AUDIT scores during the first four years at university.

AIMS: Changes in AUDIT score trajectories were examined in a student population during their first 4 years at a university, including high-risk consumers and a subsample of low-risk consumers. METHOD: 359 students were selected for the present study, comprising all high-risk consumers (the 27% with highest scores, i.e. 11 for males and 7 for females) and a randomized sample of low-risk consumers (n = 177 and 182, respectively). The Alcohol Use Disorder Identification Test (AUDIT) was used as screening instrument. Trajectory analyses were made using a semiparametric group-based model. RESULTS: In the low-AUDIT group, five distinct trajectories were identified: three stable non-risky consumption groups (83%) and two increasing groups (17%; from non-risky to risky). In the high-AUDIT group, three groups were identified: two stable high groups (58%) and one decreasing group (from risky to non-risky consumption; 41%). In the integrated model, stable risky consumption comprised 16% of the total sample, decreasing consumption 11%, increasing consumption comprised 13% and stable non-risky consumption 60% of the sample. Gender influenced the trajectories. CONCLUSION: The pattern of changes in risk consumption is similar to that found in corresponding US studies.

Two-year outcome of an intervention program for university students who have parents with alcohol problems: a randomized controlled trial.

BACKGROUND: Only a few intervention studies aiming to change high-risk drinking behavior have involved university students with heredity for alcohol problems. This study evaluated the effects after 2 years on drinking patterns and coping behavior of intervention programs for students with parents with alcohol problems. METHOD: In total, 82 university students (57 women and 25 men, average age 25 years) with at least 1 parent with alcohol problems were included in the study. The students were randomly assigned to 1 of the 3 programs: (i) alcohol intervention program, (ii) coping intervention program, or (iii) combination program. All the 3 intervention programs were manual based and individually implemented during 2 2-hour sessions, 4 weeks apart. Before the participants were randomly assigned, all were subjected to an individual baseline assessment. This assessment contained both a face-to-face interview and 6 self-completion questionnaires: the Alcohol Use Disorders Identification Test, estimated Blood Alcohol Concentration, Short Index of Problems, the Symptom Checklist-90, Coping with Parents' Abuse Questionnaire, and The Interview Schedule for Social Interaction (ISSI). Follow-up interviews were conducted after 1 and 2 years, respectively. The results after 1 year have previously been reported. RESULTS: All participants finished the baseline assessment, accepted and completed the intervention. Ninety-five percent of the students completed the 24-month follow-up assessment. Only the group receiving the combination program continued to improve their drinking pattern significantly (p < 0.05) from the 12-month follow-up to the 24-month follow-up. The improvements in this group were significantly better than in the other 2 groups. The group receiving only alcohol intervention remained at the level of improvement achieved at the 12-month follow-up. The improvements in coping behavior achieved at the 12-month follow-up remained at the 24-month follow-up for all the 3 groups, i.e., regardless of intervention program. CONCLUSION: Positive effects of alcohol intervention between 1 and 2 years were found only in the combined intervention group, contrary to the 1-year results with effects of alcohol intervention with or without a combination with coping intervention.

Alcohol involvement in Swedish University freshmen related to gender, age, serious relationship and family history of alcohol problems.

AIM: The primary aim of this study was to describe alcohol involvement in relation to gender and different age cohorts among freshmen at two Swedish universities. The secondary aim was to investigate whether the results were related to a likelihood of students being in serious relationships and/or had a first-degree relative with alcohol problems. METHODS: Two complete cohorts of university freshmen at two homogeneous universities were asked to participate in an intervention study, and the results of the basic assessments are presented in this article. The following instruments were used: the Alcohol Use Disorders Identification Test (AUDIT), the Estimated Blood Alcohol Concentration (eBAC) and a shortened version of the Alcohol Expectancy Questionnaire (AEQ). RESULTS: A total of 2032 (72%) freshmen agreed to participate. The mean AUDIT score was 8.8 (+/-4.9) for men and 6.0 (+4.0) for women, and there were high correlations between the AUDIT and other instruments. There were significant differences between different age groups for both men and women. Both genders were more likely to have AUDIT scores higher than the usual cut-off levels for high-risk interventions among those with first-degree heredity of alcohol problems, while those students in serious relationships were less likely to have AUDIT scores above the usual cut-off levels for high-risk interventions. CONCLUSIONS: This study reveals a high level of alcohol involvement among Swedish university freshmen. This is affected by age, gender, heredity of alcohol problems and serious relationships.

Two-year outcome of alcohol interventions in Swedish university halls of residence: a cluster randomized trial of a brief skills training program, twelve-step-influenced intervention, and controls.

BACKGROUND: High-risk alcohol consumption among university students is well documented. Several types of intervention have proved to be effective in reducing alcohol consumption. This study examines the 2-year outcome of 2 different alcohol intervention programs at university halls of residence. METHODS: Ninety-eight university halls of residence (with 556 students) were cluster randomized to 2 different intervention groups: a brief skills training program (BSTP) with interactive lectures and discussions, a twelve-step-influenced (TSI) program with didactic lectures by therapists trained in the 12-step approach, and a control group. All students completing the baseline assessment received personalized feedback by mail. Students responded to mailed follow-up questionnaires after 1, 2, and 3 years, including alcohol use disorders identification test (AUDIT; years 2 and 3), short index of problems (SIP), and estimated blood alcohol concentration (eBAC). RESULTS: All groups significantly reduced their AUDIT scores from baseline to the second year follow-up, with no significant differences between the groups. Seventy-seven percent of the students belonged to a population with high-risk consumption, using the AUDIT cut-off scores of 8 and 4 for men and women, respectively. Students with high-risk alcohol consumption showed significant differences in AUDIT score reduction in favor of the BSTP compared with controls, and had a tendency to show better results than the TSI intervention (p=0.06). Similar trends could be seen using SIP and eBAC. The TSI did not differ significantly from the control group within the group of students with high-risk alcohol consumption. CONCLUSIONS: This study suggests that a BSTP is effective as an intervention in students with high-risk alcohol consumption.

Comparison between a cognitive behavioural alcohol programme and post-mailed minimal intervention in high-risk drinking university freshmen: results from a randomized controlled trial.

AIM: Examine the effect of a 10 h intervention programme compared with post-mailed minimal intervention (PMMI) given to high-risk alcohol-drinking university freshmen in a random design. METHOD: In total 693 freshmen at the Lund Institute of Technology, Lund University, Sweden were included in the study. A cognitive behavioural alcohol program (CBAP) or PMMI was given to high-risk drinking freshmen (n = 177) in a randomized design. A 10-item screening instrument, Alcohol Use Disorder Identification Test (AUDIT), was used before and 1 year after the intervention programmes were given. RESULTS: There were no significant differences between the CBAP and the PMMI groups. Both groups declined their AUDIT scores with -1.7 [CI 95% -2.6, -0.7] and -2.7 [CI 95% -3.6, -1.7], respectively which could be explained by effects of regression to the mean. CONCLUSION: No significant differences between the groups were found.

Education of key personnel in student pubs leads to a decrease in alcohol consumption among the patrons: a randomized controlled trial.

AIMS: To decrease alcohol consumption among patrons in student pubs by server-training programmes. DESIGN: Randomized controlled trial. SETTING: University campus. PARTICIPANTS: A total of 1322 students visiting local student pubs during ordinary pub evenings. INTERVENTION: Educational programmes were given to bartenders (n = 40) in a randomized design in six of 12 pubs on a university campus. Bartenders in control pubs were not given the programme. MEASUREMENTS: Breath alcohol concentration (BAC), expressed in percentage, among the patrons and the reported social atmosphere in the pub ('high', 'cosy' and 'rowdy') measured on a visual analogue scale in the pub before and after the intervention programme was given. FINDINGS: BACs of patrons in the intervention pubs were reduced by more than those of the patrons in the control pubs at a 1-month follow-up. The mean difference in BAC between intervention and control groups was -0.011% (95% confidence interval, 0.022-0.000). The intervention group also decreased more in reported level of 'rowdy' social atmosphere than did the control group. The mean difference was -6 points (95% confidence interval -11 to -1). No differences were found in reported 'cosy' and 'high' atmosphere. CONCLUSION: Alcohol levels among the patrons were decreased and the 'rowdy' social atmosphere reduced in the intervention group. Server-training programmes for personnel in student pubs could be a component in the prevention of alcohol problems in university student populations.