Research article
Evaluation of an Internet-Based Alcohol Misuse Prevention Course for College Freshmen: Findings of a Randomized Multi-Campus Trial

https://doi.org/10.1016/j.amepre.2011.03.021Get rights and content

Background

Internet-based alcohol misuse prevention programs are now used by many universities. One popular 2- to 3-hour online course known as AlcoholEdu for College is typically required for all incoming freshmen and thus constitutes a campus-level strategy to reduce student alcohol misuse.

Purpose

Multi-campus study to evaluate the effectiveness of an Internet-based alcohol misuse prevention course.

Design

RCT with 30 universities: 21 entered the study in Fall 2007, nine in Fall 2008. Fifteen were randomly assigned to receive the online course and the other 15 were assigned to the control condition. The course was implemented by intervention schools during the late summer and/or fall semester. Cross-sectional surveys of freshmen were conducted at each university, beginning prior to the intervention in Spring 2008–2009; post-intervention surveys were administered in Fall 2008–2009 and Spring 2009–2010.

Setting/participants

Public and private universities of varying sizes across the U.S. Random samples of 200 freshmen per campus were invited to participate in online surveys for the evaluation. Overall survey response rates ranged from 44% to 48% (M ≈ 90 participants per campus).

Intervention

The online course includes five modules; the first four (Part I) are typically offered in the late summer before matriculation, and the fifth (Part II) in early fall. Course content includes defining a standard drink, physiologic effects of alcohol, the need to monitor blood alcohol level, social influences on alcohol use, alcohol laws, personalized normative feedback, and alcohol harm-reduction strategies. Students must pass an exam after Part I to advance to Part II.

Main outcome measures

Past-30-day alcohol use, average number of drinks per occasion, and binge drinking.

Results

Multilevel intent-to-treat analyses indicated significant reductions in the frequency of past-30-day alcohol use (beta = –0.64, p<0.05) and binge drinking (beta = –0.26, p<0.05) during the fall semester immediately after completion of the course. However, these effects did not persist when assessed in the spring semester. Post hoc comparisons suggested stronger course effects on these outcomes at colleges with higher rates of student course completion. No course effects were observed for average number of drinks per occasion or prevalence of binge drinking, regardless of the campus course completion rate.

Conclusions

This study provides initial evidence that the Internet-based alcohol misuse prevention course has beneficial short-term effects on hazardous drinking behavior among first-year college students, which should be reinforced through effective environmental prevention strategies.

Trial registration number

This trial is registered in Clinicaltrials.gov (NCT 01382979).

Introduction

Heavy alcohol use and related problems such as drinking and driving continue to be prevalent among college students. A recent national study indicates that estimates for alcohol-related deaths among college students aged 18–24 years increased from 1440 in 1998 to 1825 in 2005, and that the majority of deaths could be attributed to driving after drinking.1 From 1999 to 2005, the prevalence of past-30-day heavy or “binge” drinking increased from 42% to 45%, and the prevalence of driving after drinking in the past year increased from 26.5% to 28.9%.1 Levels of heavy drinking and driving after drinking remained significantly higher among college students than among same-age peers who were not attending college.1

Many universities across the U.S. are now using web-based programs or courses to address this persistent problem.2 Popular web-based programs such as AlcoholEdu for College are modeled on efficacious multicomponent interventions led by trained clinicians (e.g., Brief Alcohol Screening and Intervention for College Students, or BASICs).3 Such interventions typically include personalized feedback to change normative beliefs about alcohol use, education about alcohol's effects on the brain and on behavior, risk awareness, challenges to expectations regarding the effects of alcohol use, and suggestions for alcohol-free activities and strategies to minimize alcohol-related harm.3, 4 Although brief interventions such as BASICs with trained clinicians are now fairly well established, web-based interventions are still being developed and tested. Thus, questions remain about their potential for reducing student alcohol misuse and related consequences.

A number of RCTs have been conducted at the individual level to evaluate web-based programs such as e-CHUG5 and MyStudentBody6 with college students who have recently engaged in heavy drinking, and College Alc7, 8 and AlcoholEdu for College,9, 10, 11 which target all incoming freshmen. Findings of these studies are mixed and suggest that online alcohol prevention programs may be most effective for students with a recent history of heavy alcohol use, although one recent experimental study at a single institution did find beneficial effects of AlcoholEdu for College on drinking behavior with a large sample of first-year students.11 Very few studies have examined the effectiveness of web-based alcohol prevention programs that attempt to reach an entire population of students who may be at risk for alcohol misuse and related problems, and almost all studies to date have limited their assessments to the short-term effects (e.g., 30 days post-intervention) of such programs.

The present study was conducted to evaluate the popular Internet-based course known as AlcoholEdu for College, which was designed as a campus-level prevention strategy for incoming freshmen,11, 12 and is now being used by more than 200 universities. The online course was developed by Outside The Classroom and is typically required of all incoming freshmen, which differentiates it from other web-based interventions (e.g., e-CHUG, MyStudentBody) that are typically used only for students with a recent history of heavy drinking. The course extends traditional educational approaches to prevent alcohol misuse by including normative feedback to correct student misperceptions about the acceptability and level of heavy drinking on campus, interactive exercises to challenge alcohol expectancies, and recommendations for strategies to reduce the likelihood of heavy drinking and related consequences (e.g., avoiding drinking games).

As the intervention is intended to be administered across an entire campus, the appropriate evaluation design is a randomized multi-campus design. Even if the developers' intent were different, the current common practice mitigates against research designs that employ within-campus RCTs, because of the potential for contamination across students. A randomized multi-campus design was used to determine whether the Internet-based course affects targeted behavioral outcomes, particularly binge drinking, among incoming freshmen during their first fall semester, and whether any observed effects would persist into the spring semester. It was hypothesized that students in colleges implementing the course would report lower levels of alcohol use and binge drinking than those in control schools, but that any course effects observed would be stronger in the fall than the spring semester. It was also hypothesized that at the institutional level, a higher level of student participation in the course (i.e., percentage of incoming freshmen who complete the course) would yield larger intervention effects on targeted behavioral outcomes.

Section snippets

Design

The Internet-based course was evaluated as a campus-level prevention strategy using an RCT. Colleges eligible to participate in the study had never implemented the online course or any other type of online alcohol prevention program designed for all incoming freshmen and expressed willingness to be randomly assigned to an intervention or control condition in the first year of the study. Participating schools also agreed to work with Outside The Classroom to implement the course if assigned to

Survey Response Rate

The overall survey response rate ranged from 44% to 48% (∼90 respondents per school each semester). Because response rates were less than optimal, nonresponse weights were created to reduce the possibility of sample bias due to over- or under-representation of several demographic subgroups. Nonresponse weights were computed as ratios based on gender/ethnic breakdowns for the entire freshman classes at the universities, relative to analogous breakdowns from the survey respondent samples.

Discussion

This study was the first to use a randomized multi-campus design to evaluate one of the more popular Internet-based courses for incoming freshmen. Consistent with expectations, analysis results suggest that the course reduced the frequency of past-30-day alcohol use and binge drinking among first-year students at intervention schools relative to those at control schools during the fall semester immediately following course implementation. Post hoc comparisons also suggest that the effects noted

Conclusion

The current study represents the first multi-campus evaluation of an Internet-based course as a campus-level strategy to reduce hazardous drinking among incoming freshmen. Prior studies have shown higher rates of hazardous drinking among college students in general, and among freshmen in particular, during the fall semester,14 indicating the need for effective prevention strategies that are timed to address this problem. Based on the findings, the online course appears to constitute a strategy

References (15)

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