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Running head: RIORDAN ET AL.
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Copy editor: mcarpenter4/2/2015
A Brief Orientation Week Ecological Momentary Intervention to Reduce University
Student Alcohol Consumption
BENJAMIN C. RIORDAN, M.SC.,a TAMLIN S. CONNER, PH.D.,a JAYDE A. M. FLETT, B.SC.
a
HONS.,
a
& DAMIAN SCARF, PH.D.a,*
Department of Psychology, University of Otago, Dunedin, New Zealand
Received: December 10, 2014. Revision: March 3, 2015.
The authors acknowledge the University of Otago Department of Psychology for funding
assistance and the Master and Associated Masters of the dormitory.
*Correspondence may be sent to Damian Scarf at the Department of Psychology,
University of Otago, P.O. Box 56, Dunedin, 9054, New Zealand, or via email at:
[email protected].
Riordan, B. C., Conner, T. S., Flett, J. A. M., & Scarf, D. (2015). A brief Orientation Week
ecological momentary intervention to reduce university student alcohol consumption.
Journal of Studies on Alcohol and Drugs, 76, 525-529.
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ABSTRACT. Objective: Orientation Week is a series of events at the beginning of the
university year that introduces incoming students to university life. It is also the period of the
academic year when students consume more alcohol than at any other time. Recently, we
demonstrated that alcohol consumption during Orientation Week was related to alcohol
consumption during the academic year. The aim of the present study was to determine whether a
brief ecological momentary intervention (EMI) implemented during Orientation Week could
reduce alcohol consumption during Orientation Week and throughout the academic year.
Method: Participants were 130 freshman-year university students (72 women; 58 men)
randomly assigned to either an ecological momentary assessment (EMA) condition or an EMAEMI condition. In both conditions, participants reported pre-university, Orientation Week, and
academic year weekend alcohol consumption. Those in the EMA-EMI condition also received
EMI text messages promoting moderation every night during Orientation Week. Results:
Although the EMI did not affect men’s drinking, women in the EMA-EMI condition, compared
with women in the EMA condition, consumed significantly fewer drinks during Orientation
Week, M = 17.1, SD = 13.3 vs. M = 26.4, SD = 22.5, respectively, t(70) = -1.927, p < .05,
Cohen’s d = 0.473, and reported consuming fewer weekend drinks during the academic semester,
M = 5.0, SD = 3.3 vs. M = 7.5, SD = 6.3, respectively, t(70) = -2.263, p < .05, d = 0.451.
Conclusions: This study represents the first important steps in reducing drinking among
university students by developing and using EMIs during Orientation Week. (J. Stud. Alcohol
Drugs, 76, 000–000, 2015)
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EARLY UNIVERSITY LIFE is a period associated with heavy alcohol consumption and a
higher incidence of alcohol-related harm (Del Boca et al., 2004; Kypri et al., 2005; O’Malley &
Johnston, 2002; Slutske, 2005). One factor underlying this heavy alcohol consumption is eventspecific drinking (Neighbors et al., 2006, 2007, 2011, 2012; Riordan et al., 2015). For example,
Orientation Week, a period that aims to help new students acclimate to university life, is
characterized by excessive alcohol consumption, with students consuming an average of 26
standard drinks across the week (Riordan et al., 2015). Furthermore, beyond the event itself, the
pattern of alcohol use developed during Orientation Week persists throughout the academic year
(Riordan et al., 2015). Given these findings, there is a clear need to develop interventions that
take into account event-specific drinking and its potential flow-on effect.
Ecological momentary interventions (EMIs), which use mobile devices as a medium to
deliver interventions, are a promising method with which to tackle student drinking. EMIs
provide individuals with “real-time” advice, prompting them to apply that advice in a real-world
setting (Heron & Smyth, 2010). By providing reminders close in time to the actual behavior
(e.g., during a night out drinking), EMIs place greater control of drinking on the individual.
Although EMIs have demonstrated efficacy in smoking cessation (Rodgers et al., 2005),
reducing risky sexual behavior (Ybarra & Bull, 2007), and a range of other health behaviors
(Cohn et al., 2011; Heron & Smyth, 2010), their potential efficacy in changing drinking behavior
is only beginning to be explored (Suffoletto et al., 2012, 2014; Weitzel et al., 2007).
In the present study, we implemented an alcohol-reduction EMI during Orientation
Week. Students were randomly assigned to either an ecological momentary assessment (EMA;
i.e., assessment only) condition or an EMA-EMI (i.e., assessment and intervention) condition.
Participants assigned to the EMA condition received assessment text messages during
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Orientation Week and once a week during the first semester of the academic year. The messages
asked participants to report their alcohol consumption (i.e., number of drinks consumed the day
before). In contrast, participants in the EMA-EMI condition received EMA messages while also
receiving one EMI message, with a health or social consequence of alcohol use, every night
during Orientation Week. We hypothesized that students in the EMA-EMI condition would
consume less alcohol during Orientation Week and during the first semester of the academic year
compared with students in the EMA condition.
Method
Sample and procedure
Freshman-year students living in a university dormitory at the University of Otago, New
Zealand, were recruited the Sunday before Orientation Week during their first dormitory meeting
of the year. During this meeting, students were told the definition of a standard drink (e.g., 1
standard drink = 330 ml [11 oz] can or bottle of normal strength beer/cider; 1 small shot of
distilled spirits (30 ml; 1 oz); ready to drink beverages = 1.3 standard drinks; 440 ml [15 oz] can
of beer = 1.5; and 1 bottle of wine = 8 standard drinks), before filling out a paper-and-pencil
survey containing measures of pre-university alcohol use. Of the 480 students residing in the
dormitory, 445 students attended the first meeting and filled out the initial survey. Following the
survey, participants were invited to sign up for a voluntary intervention study, which would
require them to report their drinking throughout the year and potentially receive text messages
during Orientation Week detailing certain consequences of drinking. Those who agreed provided
a mobile phone number and completed a consent form (n = 295, 66% of the initial sample, 162
women and 133 men). Participation was incentivized by a chance to win one of three Samsung
Galaxy Tablets.
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Participants were randomly assigned to either the EMA or EMA-EMI condition. All
participants were sent EMA messages during Orientation Week, as well as EMA messages every
week during the first semester asking them to report their alcohol use. Those in the EMA-EMI
condition also received a text message every night during Orientation Week at 7:30 P.M. with a
health or social consequence of alcohol use.
Of the 295 students who signed up for the study, 130 (44%) completed the study with
sufficient data to be included in the analysis. This represented 29% of those who completed the
initial survey and consisted of 72 women and 58 men of predominantly European descent
(81.4%; 7.8% Asian, 3.1% Māori/Pacific Islander, 7.8% another ethnicity or mixed ancestry,
0.8% did not identify their ethnicity). The gender and ethnicity of those retained was
representative of the dormitory population, ethnicity χ2(3, n = 436) = 2.049, p = .562, nine did
not identify their ethnicity; gender χ2(1, n = 445) = 0.078, p = .780. Additional attrition analysis
for pre-university alcohol use is presented below. Approval for this study was granted by the
University of Otago Human Ethics Committee.
Intervention messages and timing
Intervention messages were based on pilot data from a separate sample of 168 college
students (99 women and 69 men). Pilot participants were ages 18–27 years (M = 21.8, SD = 2.3)
and predominantly undergraduate students (79%) of European descent (84.5%; Asian 4.8%,
Māori/Pacific Islander 1.8%, other 8.9%). In the pilot study, participants rated from 0 (not
effective) to 10 (very effective) how effective a number of drinking messages would be at
reducing their alcohol use. Participants rated 16 messages created from eight alcohol-related
consequence categories (long-term health, short-term health, weight, behavior, aesthetic, social,
sex, and academic). A mean score was calculated for each of the eight message categories. Both
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men and women rated long-term health and social messages as the two most effective messages,
and variations of each message type were created for the EMA-EMI condition.
The intervention messages were sent at 7:30 P.M. each night during Orientation Week.
The social messages were sent on nights with Orientation events that had more of an active
social focus (e.g., toga party), Tuesday and Saturday (“Think about your mates when you drink,
you can ruin their nights too”) and Thursday (“Drinking too much can turn you into a burden for
your mates”). The health messages were sent on the remaining nights, Monday (“Long-term
heavy drinking can cause serious health risks later in life”), Wednesday (“Long-term drinking
can increase the risk of a stroke. Start good drinking habits now.”), and Friday (“Heavy drinking
can cause alcohol poisoning”).
Alcohol consumption measures
Pre-university alcohol consumption was measured using a modified timeline followback
(Sobell & Sobell, 1992). Students were asked, “Think of a typical week in the last 30 days for
you. Think of what you did, where you lived, what your weekly activities were. Try to accurately
remember how much alcohol you typically drank.” For each day, participants provided an
estimate of the number of drinks they had consumed and a sum of these provided a measure of
pre-university alcohol use.
Orientation Week alcohol consumption was measured using four EMA text messages.
The first EMA message was sent on the Thursday of Orientation Week and asked students to
report their drinking from the first 3 days of Orientation Week (e.g., “How many alcoholic
standard drinks did you have Mon, Tues, Wed? Send reply like this: 1,5,0”). Given that students
consume more alcohol during the Thursday–Saturday period during Orientation Week, the next
three EMA messages (sent on Friday, Saturday, and Sunday) only asked participants to report
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their drinking from the previous day (e.g., “How many alcoholic standard drinks did you have
yesterday? Send reply like this: 5”).
During the academic semester, EMA messages were sent every week alternating between
Friday and Sunday to reduce the burden on participants. These messages asked participants to
report the number of drinks consumed the day before (Thursday or Saturday). We used this
method of surveying alcohol use because students consume around 75% of their weekly alcohol
during the Thursday–Saturday period (O’Connor & Colder, 2005), with Thursdays and
Saturdays being peak drinking nights at the University of Otago.
Data preparation
All statistical analysis was performed using SPSS version 21.0. Participants who
completed the initial survey, completed at least three Orientation Week reports, and replied to at
least one Friday and one Sunday text message throughout the semester were included in the
analysis.
Orientation Week drinking was determined by adding the number of drinks students had
consumed over the week. For participants with missing data, Orientation Week drinking was
calculated by determining a daily drinking mean and multiplying that by 6. Because participants
had complete reports from the majority of Orientation Week days (M = 5.2, out of 6) and the
report response rates were similar across the days of the week (Monday–Wednesday 84.6%,
Thursday 86.9%, Friday 86.9%, and Saturday 90.8%), χ2(5, n = 130) = 3.232, p = .664, this
approach was the most appropriate way to deal with missing reports.
To estimate semester weekend drinks, a mean of both Thursday and Saturday drinks was
calculated and then added together. This method was appropriate because participants responded
to the majority of Thursday (M = 4.8, out of 6) and Saturday (M = 4.8, out of 6) EMA messages.
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Attrition analysis
To ensure the representativeness of the 130 participants who met retention criteria, each
condition’s pre-university alcohol consumption was compared with that of the larger dormitory
population. Men retained in both the EMA and EMA-EMI conditions did not differ from men in
the rest of the dormitory in terms of pre-university drinking, retained EMA M = 13.8, SD = 13.5,
vs. wider dormitory M = 18.5, SD = 16.0, t(192) = -1.512, p = .132; retained EMA-EMI M =
15.2, SD = 13.9, vs. wider dormitory M = 18.5, SD = 16.0, t(192) = -0.946, p = .346. Women
retained in the EMA-EMI condition did not differ significantly on pre-university drinking
measures from the rest of the dormitory, M = 8.5, SD = 8.4 vs. M = 11.2, SD = 9.3, t(249) = 1.401, p = .162. However, women retained in the EMA condition consumed significantly less
alcohol pre-university than the rest of the dormitory, M = 7.8, SD = 7.7 vs. M = 11.6, SD = 9.4,
t(249) = -2.560, p < .05.
Results
There was no overall difference between EMA and EMA-EMI conditions for preuniversity drinking [M = 10.3, SD = 10.7, vs. M = 12.0, SD = 12.0, t(128) = 0.839, p = .403];
Orientation Week drinking [M = 31.5, SD = 25.4, vs. M = 29.2, SD = 27.3, t(128) = -0.479, p =
.633]; or semester weekend drinking [M = 9.6, SD = 8.4, vs. M = 8.6, SD = 7.9, t(128) = -0.665,
p = .507]. As shown in Figure 1, however, women in the EMA-EMI condition, compared with
women in the EMA-only condition, consumed significantly fewer drinks during Orientation
Week [M = 17.1, SD = 13.3, vs. M = 26.4, SD = 22.5, t(70) = -1.927, p < .05; unequal variances,
Cohen’s d = 0.473; a medium effect size], and weekend drinks during the first semester [M = 5.0,
SD = 3.3, vs. M = 7.5, SD = 6.3, t(70) = -2.163, p < .05; unequal variances, d = 0.451; a medium
effect size]. There was no difference between men in the EMA versus EMA-EMI conditions (d =
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0.042 for Orientation Week drinking, d = 0.089 for weekend drinking). [COMP: Figure 1 about
here]
Discussion
Women who received text messages noting the health or social consequences of their
drinking during Orientation Week consumed significantly less alcohol during Orientation Week
and throughout the first semester than those who received only EMA messages. In contrast, there
was no difference between men’s drinking in either condition at any time. For women, social
messages may have been effective in reminding them about the impact their drinking might have
on others during a period in which they are trying to form a new friend group, and/or the health
messages may have been effective in reminding them to consider the potential long-term impact
of heavy alcohol consumption. The decrease in drinking during the semester for women in the
EMA-EMI condition may be attributable to a flow-on effect (i.e., Orientation Week drinking
establishes a pattern of drinking that persists through the year; Riordan et al., 2015) or the lasting
effect of the EMI messages (i.e., participants remembered the warnings, and this modulated their
drinking behavior).
Previous drinking interventions using EMIs (Suffoletto et al., 2012, 2014; Weitzel et al.,
2007) or brief motivational interventions (Carey et al., 2009, 2011; Marlatt et al., 1998) have
reported equally effective results for both men and women. However, the gender difference we
observed may be attributable to gender differences in event-specific drinking. For example, one
possibility for why the EMI was not effective for men is that peer influences during Orientation
Week may be more intense for men than for women (Riordan et al., 2015). Indeed, men tend to
receive more social reinforcement for getting drunk (Balsa et al., 2011), and, to combat this, men
may require a more intensive intervention than the brief EMI implemented in the current study.
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However, researchers must be cautious with simply increasing the frequency of messages (Heron
& Smyth, 2010). Weitzel et al. (2007) noted that participants thought daily EMIs, the same
frequency used in the current study, for 2 weeks was too frequent. An alternative approach is to
combine EMIs with other interventions, for example combining a brief normative feedback
intervention (Kypri et al., 2013, 2014) with EMI reminders of the feedback.
Strengths and weaknesses
A major strength of this study was the use of text messaging to reduce alcohol
consumption during a known window of risk. Previous successful event-specific interventions
have used approaches that require participants to remember the intervention content (Hembroff
et al., 2007) and thus may be ineffective in the context of large social events. EMIs offer an
exciting new medium for event-specific prevention by providing participants with real-time
advice.
The main weakness of this study was that it suffered from similar attrition rates as other
studies using freshman-year students offering similar incentives (Doumas et al., 2011). Although
participants were representative of the dormitory population as a whole, they may have differed
on an unmeasured variable. For example, participants higher in agreeableness tend to have
higher completion rates (Conner & Lehman, 2012) and may have been more likely to be
influenced by the EMI messages.
Another limitation was the choice of control group. Participants in the EMA-EMI
condition received more messages than those in the EMA condition, and reductions in drinking
may have been due to an increase in contact, rather than the EMI messages. Furthermore, both
conditions may have reduced their drinking because they were constantly being alerted to how
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much alcohol they had consumed. Future research should consider a contact-matched control as
well as a no-assessment control to evaluate the effectiveness of this intervention.
Conclusion
This study represents a crucial first step in using EMIs during Orientation Week to
decrease alcohol use. Although EMIs have been used to treat a variety of health behaviors
(Heron & Smyth, 2010), this is one of the first aimed at a sensitive period to affect student
alcohol use.
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FIGURE 1.
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Plot of standard drink1 consumption (with standard errors) during pre-university,
Orientation Week, and first semester alcohol use for both men and women in the EMA
(assessment only) and EMA-EMI (assessment and intervention) conditions. EMA = Ecological
Momentary Assessment; EMI = Ecological Momentary Intervention.
*p < .05.
1
New Zealand definition of a standard drink = 10 grams of ethanol
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Figure 1
*
*
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