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The brief personalised normative feedback given to each intervention group participant will comprise the results of their drinking behaviour assessment alongside information about alcohol and how it might affect them at their current drinking levels. here. Random effects models [29], [30] allow the incorporation of all participants with at least 1 follow-up observation. Heavy alcohol consumption amongst students impacts on individuals, educational institutions, and society [7], [8]: excessive drinking behaviour amongst students is linked with a range of alcohol related problems, including injuries, unprotected sex, violence, car accidents, and health problems [9], resulting in a significant economic burden for health systems [10]. The innovative design and sampling aspects of this study: the Solomon three-group design to test for measurement effects, and the whole sample and higher risk sub-sample analyses to test the prevention paradox prediction, were illuminating. Define the components of personalized normative feedback 6. Brief and cost-effective, PNF consists of an individualized report in which national or campus-wide drinking statistics are 2004, 99 (11): 1410-1417. Working with Kypri, we have used his dataset to model the potential of normative feedback to reduce alcohol related problems. Identify the Checkup models and the research results that support their effectiveness 8. 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. PFIs aim to reduce drinking by providing feedback to recipients that is personalized and often includes multiple components, including feedback comparing the recipients own drinking and perceived norms to actual norms (i.e, personalized normative feedback). PNF was provided by email. The primary outcomes are AUDIT Score, weekly consumption, perceived social norms, and alcohol related problems; secondary outcomes include alcohol expectancies and other health behaviours. Personalized Normative Feedback (PNF) is a popular social norms-based intervention strategy which presents individuals with a personalized, individual report designed to correct misperceived peer norms using a graphical display. The effectiveness of brief personalized normative feedback in reducing alcohol-related problems amongst University students: protocol for a randomized controlled trial. 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]. 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. Yes 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]. 2006/28). 1999, 319: 508-512. Free Online Library: Personalized normative feedback to reduce drinking among college students: a social norms intervention examining gender-based versus standard feedback. Responses were summed to provide an alcohol-related problems score (range 10 to 20 with a higher score indicating more problems). Personalised normative feedback (PNF) aims to correct this misperception by providing information about personal drinking levels and patterns compared with norms in similar aged peer groups. Scores ranged between 0 and 21, with a higher score indicating more positive expectancies. Article  In reaction to the national health objective of reducing the proportion of college students engaging in heavy at-risk drinking, the addition of a stress and coping component to a Personalized Normative Feedback (PNF) intervention was examined. Young people who engage in one problem behaviour (e.g. In conclusion, our results show no evidence for the effectiveness of personalised normative feedback for the prevention of alcohol misuse and alcohol-related problems in a UK student population. 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). Feedback is a technique that is commonly used when providing education around a wide range of health topics, with the aim of stimulating motivation for change. Data are collected at baseline, six months and 12 months. 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. PubMed Google Scholar. 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]. Annual Symposium of the Society for the Study of Addiction 2007; York. PNF is intended to raise motivation for behaviour change and has been highlighted for alcohol misuse prevention by the British Government Behavioural Insight Team. Studies have shown that university/college students tend to have an exaggerated view of the quantities of alcohol being consumed by their peers. There is one intervention group and two control groups, controlling separately for measurement and for intervention effects. 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. 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). The 12-month significant effect remained in the multiple imputation analysis, but this should be regarded with caution given the very high attrition rates. PubMed  In the first random effects model we treated all missing values as missing at random (MAR). Only one outcome measure, weekly drinking, showed a significant effect at 6-months with an odds ratio (OR) of 0.417 (95% CI 0.223, 0.781), but this had disappeared by 12-months (OR = 0.710, 95% CI 0.435, 1.160). DF has contributed to the drafting process. 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]. Intended for healthcare professionals. 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. they withdrew from the allocated treatment); 2. The reason(s) for the inconsistent findings between our study and some other studies is not clear. https://doi.org/10.1371/journal.pone.0044120.g001. PLoS ONE 7(9): Furthermore, students will also be recruited via Facebook, a social networking website. One line of thought is that the accumulating evidence on social normative feedback is an example of initially positive research findings ultimately being found to be false [47]. Department of Psychology, Social Work and Public Health, Oxford Brookes University, Oxford, Oxfordshire, United Kingdom. We performed sensitivity analyses to explore the effect of departures from the assumption made in the main analysis. https://doi.org/10.1371/journal.pone.0044120.t003, https://doi.org/10.1371/journal.pone.0044120.t004. The applicability of personalised normative feedback to populations and settings that are different from those in the trials whether positive effects have been found is uncertain [22]; moreover an overall conclusion of no effect for this sort of intervention [47] cannot be discounted. Similarly, we found no evidence that a population wide intervention was more effective than a targeted intervention with a higher risk sub-sample of students but, given that we found no effects of the PNF intervention across a range of alcohol outcomes, this is not surprising. 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. A personalized normative feedback text-message intervention to reduce 21st birthday alcohol use and problems. No, Is the Subject Area "Questionnaires" applicable to this article? Discover a faster, simpler path to publishing in a high-quality journal. Clues as to the differences in effect across different studies might lie in the differences in intervention content and delivery. 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]. Springer Nature. PubMed  The normative feedback approach relies largely on raising awareness amongst students about how much their peers actually drink (and do not drink) and to correct existing misperceptions [3]. Google Scholar, Perkins HW: Social Norms and the Prevention of Alcohol Misuses in Collegiate Contexts. Analyses focused on high-risk drinkers, as well as all students, because of research evidence for the prevention paradox in student drinkers. : The Swedish Council for Information on Alcohol and Other Drugs (CAN) and the Pompidou Group at the Council of Europe, 156-, CAMH: Centre for Addiction and Mental Health. 2000, 48: 235-238. = 6) for females [38], and power = .9 and α = .05 (2-tailed tests). Follow-up rates were low, with only 50% and 40% responding at 6- and 12-months, respectively, though comparable to similar European studies. Analyzed the data: RO DRF MTM. Sample characteristics are described in Table 1. Wrote the paper: DRF MTM RO. Currently there is no published Cochrane systematic review on the effectiveness of social norms approaches, though a Cochrane protocol on this topic has been published [5]. Is the Subject Area "Alcohol consumption" applicable to this article? e44120. The main objective of the trial was to assess the effectiveness of PNF with risky drinking college students for the prevention of alcohol misuse. The objective of the trial was to assess the effectiveness of PNF with college students for the prevention of alcohol misuse. We should also point out that, like many other studies that have reported the effects of brief personalised normative feedback, the intervention contained more than just the normative feedback. Normative feedback as an approach to alcohol misuse prevention is based on Social Norming Theory. Young people tend to over-estimate peer group drinking levels. Part of All questionnaires were completed remotely via web-based forms, and so outcome assessment was blinded. 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. We have found that a UK web-based personalised normative feedback (PNF) intervention did not motivate students to reduce their alcohol intake: students who received the brief personalised PNF intervention did not have lower AUDIT scores, drink less alcohol or have fewer alcohol related problems than control group students at 6- or 12-month follow-ups. We fitted two different random effect models to assess an intention-to-treat hypothesis. Oxford, Oxford Brookes, Nottingham and Plymouth Universities in the UK and Portucalense, Lusiada, Fernando Pessoa, Autonoma and ISMAI Universities from Portugal have agreed to collaborate. Randomisation is achieved by concealed centrally-allocated computer generated random numbers. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. 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. Personalized normative feedback (PNF) has shown promise as a stand-alone intervention for reducing alcohol use among college students. But, due to the low follow-up rates, we cannot absolutely rule out the possibility that differential attrition in relation to unmeasured and uncontrolled confounders could have affected the results. Therefore, other problems were measured in a newly-developed self-reported scale with nine possible problems, listed on a yes/no scale: 1. In the analysis, respondents were scored 1 if they were over these levels, otherwise 0. 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. 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. Taking account of known prevalence rates for hazardous drinkers in this population, and with cautious estimates for participation and attrition rates, we aimed to recruit 4000 students. Once consent was given, participants were randomized by computer. Participants gave their informed consent to participate by completing the web-based questionnaire. Values were imputed for all participants, even for those with no post-baseline data. We also provided financial feedback, health information and advice on where help can be obtained. Randomisation occurs after students have read the consent form, with affirmative consent given proceeding to the on-line questionnaire. Been in a fight; 4. Ethics approval for this study is provided by Oxford Brookes University Research Ethics Committee (REC No-2006/28). This article is published under license to BioMed Central Ltd. PubMed  Personalized Normative Feedback (PNF) One promising strategy in reducing college student drinking involves reducing overestimated descriptive drinking normative perceptions. Information was also provided on the money that they might be spending annually on alcohol and also the calories they might be consuming at their current drinking levels. 14, Moreira T, Foxcroft D: Social norms interventions to reduce alcohol misuse in University or College students (Protocol). Making students aware of this misperception may help change behaviour and reduce problem drinking. Personalised normative feedback (PNF) aims to correct this misperception by providing information about personal drinking levels and patterns compared with norms in similar aged peer groups. Affiliation In the UK alcohol-related mortality is increasing compared with many other European countries where rates are declining or unchanged. Objective: Twenty-first birthdays are associated with extreme levels of heavy drinking and alcohol-related harm. 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]. 2006, 101 (1): 84-90. 10.1111/j.1360-0443.2004.00847.x. Kypri K, Saunders J, Williams S, McGee R, Langley J, Cashell-Smith M, Gallagher S: Web-based screening and brief intervention for hazardous drinking: a double-blind randomized controlled trial. This analysis indicates that there was no effect on drinking behaviour of the baseline measures and questions about alcohol use and problems. Competing interests: MTM and RO declare no competing interests. In the second random effects model we carried out a sensitivity analysis using multiple imputation. Analyses were performed on the full sample (all students) and also with a higher risk sub-sample to test the prevention paradox prediction. 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’. Yes Copyright: © Moreira et al. Yes Around 55,000 young people in Europe died from causes related to alcohol use in 1999 [1, 2]. Campbell D, Stanley J: Experimental and quasi-experimental designs for research. Intention to treat was applied in all analyses. http://www.camh.net/About_Addiction_Mental_Health/Drug_and_Addiction_Information/evaluate_your_drinking.html, http://www.biomedcentral.com/1471-2458/8/113/prepub, http://creativecommons.org/licenses/by/2.0. 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. Eligible participants were undergraduate university students (first and second year students; academic year 2008/9) from U.K. universities, recruited through university information systems (posters, email messages, bulletin boards) and through online social networking sites. 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. This group is likely to be a minority so the sample size has to be increased to ensure sufficient numbers of this high risk group to enable robust statistical analysis with power =.9 and α = .05 (2-tailed tests) and taking account of expected participation and attrition rates. 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]. Individual-level strategies aim to produce changes in attitudes or behaviors related to alcohol use rather than the environments in which alcohol use occurs. Data from the remotely completed online questionnaires were automatically entered and stored in a web based server. Moreover, this one effect should not be over-interpreted given the consistent pattern of no effect across most outcome measures and time points. Medical Statistics Programme, Oxford Brookes University, Oxford, Oxfordshire, United Kingdom, Affiliation Overall, statistical analyses with the high risk sub-sample, and for all students, showed no significant effects of the intervention, at either time-point, in a completed case analysis and a multiple imputation analysis. For more information about PLOS Subject Areas, click 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). A Solomon Three Group Design will be used. Michael Bernstein, University of Rhode Island. No, Is the Subject Area "Undergraduates" applicable to this article? Sliwinski (2002) suggested that personalized normative feedback develops discrepancy by making student’s drinking behaviors sa-lient, by providing them a context in which to evaluate their drinking, and by highlighting the inconsistency between current behavior and both normative and personal standards. The brief personalised normative feedback given to each intervention group participant will comprise the results of their drinking behaviour assessment alongside information about alcohol and how it might affect them at their current drinking levels. Participants were recruited via a web site that provided trial information and enabled informed consent. Yes And last, evidence about whether universal or targeted approaches are better with this population group. One of the best trials we have identified so far has been by Kypri [6]in New Zealand, where an electronic Screening and Brief Intervention (SBI) approach identified students at high risk and then provided normative feedback to this group. 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.

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