Lee Christine M, Cadigan Jennifer M, Calhoun Brian H, Cronce Jessica M, Fairlie Anne M, Rhew Isaac C, Patrick Megan E, Walter Theresa, Graupensperger Scott, Yan Alice N, Duckworth Jennifer C, Larimer Mary E
Department of Psychiatry and Behavioral Sciences, Center for the Study of Health and Risk Behaviors, School of Medicine, University of Washington, Seattle, Washington, USA.
Department of Counseling Psychology and Human Services, University of Oregon, Eugene, Oregon, USA.
Alcohol Clin Exp Res (Hoboken). 2025 Jun;49(6):1321-1336. doi: 10.1111/acer.70056. Epub 2025 Apr 25.
High-risk drinking among college students is common, and alcohol expectancies and experienced consequences are proximal predictors of use. This study tested short- and long-term efficacy of a personalized just-in-time adaptive intervention with daily messages about alcohol use, alcohol expectancies, and consequences delivered via mobile app.
Participants were 408 students enrolled at a 2- or 4-year college (75% 4-year; 64% female) who completed twice-daily assessments for 21 days and follow-up surveys at 1-, 6-, and 12-months. Data collection spanned January 2020 through April 2022. Participants were randomized to either an intervention condition receiving daily intervention messages and other related alcohol and expectancy-focused content via the app or an assessment-only control condition. Both conditions were administered daily surveys through the app.
Poisson multilevel models were conducted to examine intervention effects on alcohol outcomes (i.e., drinks per week, heavy episodic drinking frequency, peak estimated blood alcohol concentration, and alcohol-related consequences, as well as positive and negative alcohol expectancies) at each follow-up assessment. On average, participants in both conditions reported decreased alcohol use outcomes, consequences, and expectancies at 1-, 6-, and 12-month follow-up compared to baseline. A single statistically significant difference between participants in the intervention and control conditions was observed at 1-month follow-up. Specifically, participants in the intervention condition reported a 17% greater decrease in heavy episodic drinking frequency than participants in the control condition, on average.
Findings highlight the complexities of developing, implementing, and testing adaptive interventions, particularly within the context of the COVID-19 pandemic.
大学生中的高风险饮酒行为很常见，饮酒预期和经历的后果是饮酒行为的近端预测因素。本研究测试了一种个性化的即时自适应干预措施的短期和长期效果，该干预措施通过移动应用程序每天发送有关饮酒、饮酒预期和后果的信息。
参与者为408名就读于两年制或四年制大学的学生（75%为四年制；64%为女性），他们在21天内每天完成两次评估，并在1个月、6个月和12个月时进行随访调查。数据收集时间跨度为2020年1月至2022年4月。参与者被随机分为干预组和仅进行评估的对照组，干预组通过应用程序接收每日干预信息以及其他与酒精和预期相关的内容，两组均通过应用程序进行每日调查。
采用泊松多水平模型来检验每次随访评估时干预对酒精相关结果（即每周饮酒量、重度饮酒发作频率、估计的血液酒精浓度峰值、与酒精相关的后果以及积极和消极的饮酒预期）的影响。平均而言，与基线相比，两组参与者在1个月、6个月和12个月随访时报告的酒精使用结果、后果和预期均有所下降。在1个月随访时，干预组和对照组参与者之间观察到一个统计学上的显著差异。具体而言，干预组参与者报告的重度饮酒发作频率下降幅度平均比对照组参与者高17%。
研究结果凸显了开发、实施和测试自适应干预措施的复杂性，尤其是在新冠疫情背景下。
