College students frequently engage in heavy drinking, which leads to significant negative consequences including blackouts and academic problems for drinkers, while even non-drinking students experience secondhand effects. While personalized normative feedback (PNF) interventions have shown effectiveness in reducing consumption, they require substantial resources and are less effective for reducing alcohol-related consequences. Counter-attitudinal advocacy (CAA) is a novel alternative approach that targets supportive alcohol attitudes by having heavy drinkers publicly advocate for moderate drinking, creating cognitive dissonance. A small pilot study of CAA showed promising results in reducing drinking intentions and consumption compared to controls, suggesting that this approach could expand the toolbox of brief alcohol prevention interventions for college students who drink heavily. Building on this, the current study aims to compare the efficacy of both PNF and CAA interventions over a 6-month period to determine their relative effectiveness in reducing hazardous drinking and alcohol-related consequences.
The study was conducted with 585 undergraduate students aged 18-26 from two research-intensive universities in the United States. Participants were selected based on reporting at least one episode of high-risk drinking and two or more alcohol-related problems within the past month. Participants were randomly assigned to one of three conditions: a control group without intervention, a Personalized Normative Feedback (PNF) group, or a Counter-Attitudinal Advocacy (CAA) group. Following their respective intervention activities, participants completed online follow-up assessments at 1, 3, and 6 months. Primary measurement instruments included the Daily Drinking Questionnaire, estimated peak Blood Alcohol Concentration (BAC), and the Young Adult Alcohol Consequences Questionnaire. Data analysis was performed using generalized linear mixed models (GLMM) to evaluate changes in alcohol consumption, drinking frequency, BAC, and alcohol-related problems across four time points. The analysis examined differences between conditions hierarchically, with drinks per week included as a time-varying covariate when analyzing alcohol-related consequences.
According to the study findings, the Personalized Normative Feedback (PNF) group reported 16.9% fewer drinks per week compared to the control group and 13.1% fewer drinks than the Counter-Attitudinal Advocacy (CAA) group. No significant differences were observed between PNF and control groups regarding typical quantity consumed or peak Blood Alcohol Concentration (BAC), and CAA did not differ from control on any consumption outcomes. However, with respect to alcohol-related problems, the CAA group reported significantly fewer problems relative to the control group, whereas no differences were found between PNF and control. Temporal analysis indicated that both alcohol consumption and alcohol-related problems decreased overall during the follow-up period, with a significant condition-by-time interaction observed only for typical drinking quantity, where CAA demonstrated greater reductions compared to PNF. No significant differences in alcohol-related problems were observed between the PNF and CAA groups during the follow-up period.
Takeaway: Personalized Normative Feedback (PNF) and Counter-Attitudinal Advocacy (CAA) showed differing patterns of effectiveness, with PNF associated with reduced alcohol consumption and CAA associated with reduced alcohol-related problems over time.