Binge drinking among US college students represents a significant public health concern, linked to adverse outcomes including academic impairment, sexual assault, drunk driving, and premature death. Traditional interventions have shown limited effectiveness over the past decade, prompting researchers to explore smartphone-based alcohol interventions. While reviews support the feasibility of app-based interventions for college students, results have been inconsistent across studies, potentially due to insufficient personalization and tailoring. The present study addresses these limitations by developing bhoos, a novel smartphone app that incorporates real-time drink tracking and just-in-time feedback based on estimated blood alcohol content, designed to enhance protective drinking behaviors through personalized intervention delivery.
This study was conducted in three phases. Phase 1 evaluated the bhoos app using a simple pre-post design, Phase 2 randomized participants into groups with or without additional monetary incentives, and Phase 3 used focus groups to explore user experiences. Eligible participants were 18–35 years old enrolled students. Eighty-three students participated in Phase 1 and 172 in Phase 2; the incentive group could earn up to $30 for engagement milestones. Key measures included the Alcohol Use Disorders Identification Test (AUDIT), a modified Daily Drinking Questionnaire, a Protective Behavioral Strategies Scale, and the System Usability Scale (SUS). Data were analyzed with ANOVAs and paired t tests, while focus groups provided qualitative insights into app strengths, weaknesses, and usefulness.
In Study 1 (N=234), most students were classified as low-risk (59%) or hazardous (40%) drinkers. No significant effects of study phase or incentives were found on alcohol consumption or app usability. However, confidence in using protective behavioral strategies (PBS) increased significantly, with gains observed only in the Phase 2 no-incentive group. Students demonstrated moderate engagement, averaging 12.67 days of app use over 28 days. Focus groups highlighted the app’s usefulness for tracking drinking patterns, while suggesting improvements such as incorporating videos and expanding tracking to include mood and stress. Based on Study 1 feedback, the app was revised for Study 2 (N=43), though recruitment was limited due to COVID-19 and a campus tragedy. Results demonstrated significant increases in PBS confidence and a reduction in drinking frequency, though drinking quantities remained unchanged. Usability ratings improved substantially compared to Study 1.
Takeaway: Smartphone-based interventions featuring personalized delivery and real-time feedback effectively enhanced college students’ protective drinking behaviors, indicating that tailored mobile approaches may provide scalable solutions for campus alcohol misuse prevention.