Social norms interventions to reduce alcohol misuse in University or College students

Moreira MT, Smith LA, Foxcroft D

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Summary

Social norms interventions to reduce alcohol misuse in university and college students

Misuse of alcohol can result in disabilities and death. Alcohol also leads to accidents, fights and unprotected sex. Young people aged 15 to 24 years contribute a high proportion to this burden. University students may not drink as frequently as their non-university peers but they have a tendency to drink excessively when they do. Social norms refer to our perceptions and beliefs about what is 'normal' behaviour. People may believe that their peers drink heavily, which influences their drinking, yet much of peer influence is the result of incorrect perceptions. Normative feedback relies on the presentation of information on these misperceptions, about personal drinking profiles, risk factors, and normative comparisons. Feedback can be given alone or in addition to individual or group counselling.
This systematic review was based on 22 controlled trials involving 7275 college or university students randomly assigned to the social norms intervention or a control group. Interventions delivered using the web or computer, or in individual face-to-face sessions, appeared to reduce alcohol misuse. The evidence was less convincing for group face-to-face sessions. Mailed and group feedback were on the whole no different than with the control intervention. Two large studies showed contradictory results for a social marketing campaign. Only a small number of good quality studies were available for many of the outcomes and analyses, and most of the studies were from the USA. The intensity of the intervention differed between trials as did the control intervention, which was no intervention, educational leaflets or an alcohol educational session. Individual face-to-face feedback typically involved social norms feedback as just one aspect of a broader motivational interviewing intervention. Locations where alcohol outlet density is higher may promote higher consumption through more frequent alcohol promotions and easier access to alcohol, so the effectiveness of an intervention designed to reduce drinking could be expected to be lower in these areas.

This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 1, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This record should be cited as: Moreira MT, Smith LA, Foxcroft D. Social norms interventions to reduce alcohol misuse in University or College students. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD006748. DOI: 10.1002/14651858.CD006748.pub2.

This version first published online: July 08. 2009

Abstract

Background

Drinking is influenced by youth (mis)perceptions of how their peers drink. If misperceptions can be corrected, young people may drink less.

Objectives

To determine whether social norms feedback reduces alcohol misuse in university or college students.

Search strategy

Cochrane Drugs and Alcohol Group Register of Trials; Central; MEDLINE; EMBASE; PsyInfo; CINAHL (up to March 2008).

Selection criteria

RCT or cluster RCT that evaluate social normative intervention with no intervention, alcohol education leaflet or other non-normative feedback intervention

Data collection and analysis

2/3 authors extracted data. Included studies were assessed against criteria indicated in the Cochrane Reviewers Handbook version 5.0.0.

Main results

Twenty-two studies were included (7,275 participants).

Alcohol related problems: Significant reduction with Web/computer feedback (WF) (SMD -0.31 95% Cl -0.59 to -0.02), three studies, 278 participants. No significant effect of mailed feedback (MF), individual face-to-face feedback (IFF) or group face-to-face feedback (GFF).

Peak Blood Alcohol Content (BAC) : Significant reduction with WF (SMD -0.77 95% Cl -1.25 to -0.28), two studies, 198 participants. No significant effect of MF or IFF.

Drinking Frequency: Significant reduction with WF (SMD -0.38 95% Cl -0.63 to -0.13), two studies, 243 participants and IFF (SMD -0.39 95% Cl -0.66 to -0.12), two studies, 217 participants. No significant effect of MF.

Drinking Quantity: Significant reduction with WF (SMD -0.35 95% Cl -0.51 to -0.18), five studies, 556 participants and GFF (SMD -0.32 95% Cl -0.63 to -0.02) three studies, 173 participants. No significant effect of MF or IF.

Binge drinking: Significant reduction with WF (SMD -0.47 95% Cl -0.92 to -0.03) one study, 80 participants, IFF (SMD -0.25 95% Cl -0.49 to -0.02) three studies, 278 participants and and GFF (SMD -0.38 95% Cl -0.62 to -0.14) four studies, 264 participants. No significant effect for MF.

BAC: No significant effect of MF and IFF

Drinking norms: Significant reduction with WF (SMD -0.75 95% Cl -0.98 to -0.52 ) three studies, 312 participants.

Authors' conclusions

WF and IFF are probably effective in reducing alcohol misuse. No direct comparisons of WF against IFF were found, but WF impacted across a broader set of outcomes and is less costly so therefore might be preferred. Significant effects were more apparent for short-term outcomes (up to three months). For mailed and group feedback, and social norms marketing campaigns, the results are on the whole not significant and therefore cannot be recommended.

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