Sex differences in young children's perceptions of situational drinking norms over time.

OBJECTIVES: To date, there have been no previous studies examining sex differences in the development of alcohol-related perceptions over time, a potential avenue for targeted prevention and early intervention efforts. This article examines any potential sex differences in young children's development of situational drinking norms over time. METHOD: Two hundred ninety-eight children (aged 4-6 years at baseline) completed the Dutch electronic Appropriate Beverage Task-which involves attributing alcoholic beverages to adults in varying situational contexts-annually over 3 years (2015, 2016, 2017). Three-level regression models were estimated examining whether perceptions of situational drinking norms varied as a function of the sex of the participant and whether there were any changes over time. RESULTS: Over time children did not attribute more alcoholic beverages to adults in various situations, instead both boys and girls became more accurate at correctly identifying situations in which drinking is more common. Over time, both boys and girls attributed more alcoholic beverages in common situations and less in uncommon situations, with no significant sex differences in attributions of alcohol found. CONCLUSIONS: We identified no significant sex differences in the development of situational drinking norms over time, suggesting that education and prevention campaigns can be unified/nontargeted by sex. However, given our findings differ from previous studies that identify significant sex differences between children on the development of other alcohol-related cognitions beyond situational drinking norms, there is a need for more international research in this space to understand the importance and nature of the development of alcohol-related perceptions over time. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Effects of exposure to mother's and father's alcohol use on young children's normative perceptions of alcohol.

BACKGROUND: While consumption of alcohol does not often begin until early adolescence, young children are highly capable of internalizing normative information through observational learning. We used a longitudinal multiple-informant family study to examine the impact of exposure to mothers' and fathers' drinking on young children's normative perceptions of who drinks alcohol. METHODS: Three hundred twenty-nine children (4 to 6 years old at baseline [Mage 4.78 (SD = 0.725)], 51% girls) completed the Dutch electronic appropriate beverage task [eABT] where they attributed alcoholic beverages to a variety of persons depicted in an illustrated scenario. Their parents completed an online survey that included information on alcohol use and exposure. RESULTS: Children more frequently exposed to their mothers' drinking provided females shown in the eABT illustrations with alcohol significantly more often than children less frequently exposed to mothers' drinking. There was no effect of mother's exposure on providing males in the eABT with alcoholic beverages. Similarly, children more frequently exposed to their fathers' drinking provided fathers with alcoholic beverages significantly more often than children less frequently exposed to their fathers' drinking. There was no effect of father's exposure on providing the females with alcoholic beverages, nor was there an effect of father's exposure on providing "other males" with alcohol. These patterns held after adjusting for age and sex. CONCLUSIONS: This study demonstrates that there are gender-specific effects of exposure to parents' (particularly mothers') drinking on young children's perceptions of person-specific drinking norms. The findings provide unique evidence in a young population group of effects on an understudied dimension of alcohol-related perceptions with implications for future drinking behavior.

Men and Women's Alcohol Consumption by 4- to 8-Year-Olds: A Longitudinal Investigation of Gendered Drinking Norms.

INTRODUCTION: Evidence suggests an association between perceived alcohol-related norms and personal consumption. These perceptions develop over years of observation and exposure to alcohol, likely beginning in early childhood, and likely differing by sex. Understanding the early development of perceptions of drinking may provide insight into the development of gendered drinking practices. The aim of this study was to explore boys' and girls' perceptions about men and women's alcohol consumption and whether and how these change over time as children age. METHODS: 329 children (aged 4-6 years at baseline) completed the Dutch electronic Appropriate Beverage Task annually for three consecutive years (2015 [baseline], 2016, 2017). Regression models were used to examine whether perceptions of consumption varied as a function of the gender of the adult, the participants' sex, and any changes over time. RESULTS: In illustrated pictures, children perceived that men (39%) drank alcoholic beverages more often than women (24%). Men were perceived to drink alcohol more frequently than women at baseline and this difference increased with age. Girls were more likely to perceive men drinking at baseline (aged 4-6), but there were few sex differences by time point three (aged 6-8). DISCUSSION/CONCLUSION: From a young age, children perceive that men drink more than women. These perceptions strengthen as children grow older, with young girls perceiving these gender differences at earlier ages than boys. Understanding children's perceptions of gendered drinking norms and their development over time can enable targeted prevention efforts.

Development of a Dynamically Tailored mHealth Intervention (What Do You Drink) to Reduce Excessive Drinking Among Dutch Lower-Educated Students: User-Centered Design Approach.

BACKGROUND: The high prevalence and adverse consequences of excessive drinking among lower-educated adolescents and young adults are public concerns in the Netherlands. Evidence-based alcohol prevention programs targeting adolescents and young adults with a low educational background are sparse. OBJECTIVE: This study aimed to describe the planned process for the theory- and evidence-based development, implementation, and evaluation of a dynamically tailored mobile alcohol intervention, entitled What Do You Drink (WDYD), aimed at lower-educated students from secondary vocational education and training (Middelbaar Beroepsonderwijs in Dutch). METHODS: We used intervention mapping as the framework for the systematic development of WDYD. It consists of the following six steps: assessing needs (step 1), formulating intervention objectives (step 2), translating theoretical methods into practical applications (step 3), integrating these into a coherent program (step 4), anticipating future implementation and adoption (step 5), and developing an evaluation plan (step 6). RESULTS: Reducing excessive drinking among Dutch lower-educated students aged 16 to 24 years was defined as the desired behavioral outcome and subdivided into the following five program objectives: make the decision to reduce drinking, set realistic drinking goals, use effective strategies to achieve drinking goals, monitor own drinking behavior, and evaluate own drinking behavior and adjust goals. Risk awareness, motivation, social norms, and self-efficacy were identified as the most important and changeable individual determinants related to excessive drinking and, therefore, were incorporated into WDYD. Dynamic tailoring was selected as the basic intervention method for changing these determinants. A user-centered design strategy was used to enhance the fit of the intervention to the needs of students. The intervention was developed in 4 iterations, and the prototypes were subsequently tested with the students and refined. This resulted in a completely automated, standalone native app in which students received dynamically tailored feedback regarding their alcohol use and goal achievement via multiple sessions within 17 weeks based on diary data assessing their alcohol consumption, motivation, confidence, and mood. A randomized controlled trial with ecological momentary assessments will be used to examine the effects, use, and acceptability of the intervention. CONCLUSIONS: The use of intervention mapping led to the development of an innovative, evidence-based intervention to reduce excessive alcohol consumption among lower-educated Dutch adolescents and young adults. Developing an intervention based on theory and empirical evidence enables researchers and program planners to identify and retain effective intervention elements and to translate the intervention to new populations and settings. This is important, as black boxes, or poorly described interventions, have long been a criticism of the eHealth field, and effective intervention elements across mobile health alcohol interventions are still largely unknown. TRIAL REGISTRATION: Netherlands Trial Registry NTR6619; https://trialsearch.who.int/Trial2.aspx?TrialID=NTR6619.

Why adolescents engage in early alcohol use: A study of drinking motives.

Shortly after young adolescents initiate alcohol use, we investigated whether (1) drinking motives are associated with current alcohol use and binge drinking, (2) motives predict these alcohol outcomes 6 months later, and (3) alcohol outcomes predict motives 6 months later. Data on adolescents' drinking motives and alcohol use were drawn from a Dutch longitudinal 7-wave family study at the timepoint of alcohol use initiation (t0, N = 210, 51.4% male, Mage = 14.01 SD = 1.02) and 6 months later (t1, n = 88). Logistic and linear regressions were conducted. Results indicated that young adolescents mainly drink for social and enhancement motives rather than coping and conformity motives. Shortly after alcohol initiation, social motives were associated with alcohol use at t0 (OR = 1.52), enhancement motives with binge drinking at t0 (OR = 2.35), and coping motives with binge drinking at t0 (OR = 2.62) and at t1 (OR = 3.00). Conformity motives were inversely associated with binge drinking at t0 (OR = 0.42). Binge drinking predicted coping motives at t1 (B = 0.71, SE = -0.35), but no other associations among alcohol use, binge drinking, and drinking motives at t1 were found. Conclusively, this study shows that young adolescents drink to enjoy parties and to get drunk (social and enhancement motives) rather than to fit in (conformity motives). The study also indicates that shortly after alcohol initiation, alcohol to cope represents a reciprocal risk factor for binge drinking that may persist in the future, thus pointing to the importance of drinking motives for drinking behaviors among young adolescents. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Beverage-specific situational norms: Evidence from the Dutch electronic appropriate beverage task.

INTRODUCTION AND AIMS: By the time young adolescents initiate alcohol consumption they have firmly established attitudes, expectations and beliefs about alcohol and its effects. To further unravel the origins of this knowledge in childhood, we aim to address Dutch children's knowledge of the types of alcoholic beverages adults typically consume in certain situational contexts (i.e. their knowledge of beverage-specific situational norms). DESIGN AND METHODS: A total of 329 children (4-8 years old) completed the Dutch electronic Appropriate Beverage Task at three-time points (2015, 2016, 2017). Three-level regression models were estimated examining whether children's beverage-specific situational norms depend on the gender of the person displayed in the task, sex of the participant and whether there were any beverage-specific changes over time. RESULTS: Beverage-specific findings seem to be robust across the appropriateness of the situation. Beer was the most frequently attributed alcoholic beverage overall and across the common drinking situations. White wine was attributed significantly more to females in the task. Beer, red wine and champagne were attributed significantly more to males. Attributions of individual alcoholic beverages did not change significantly over time. There were no significant differences between the participating boys and girls. DISCUSSION AND CONCLUSIONS: Results suggest that 4-8-year olds are yet to form knowledge of beverage-specific situational norms. Independent of the situation, time and participants' sex, the gender of the person displayed in the task seemed to be more salient to children than situational or environmental indicators in determining consumption.

Alcohol expectancies change in early to middle adolescence as a function of the exposure to parental alcohol use.

INTRODUCTION: The subjective effects of alcohol, i.e., alcohol expectancies (AE), are important predictors of alcohol use. This three-year longitudinal study examined: 1) the development of enhancement, social, coping, and conformity AE from age 10-16; 2) the association between parental alcohol use exposure and positive AE among adolescents and between exposure and changes in AE over the six month period and 3) the moderating effect of gender on the association between exposure and change in AE. METHODS: A longitudinal study followed adolescents between 10-13-years old at baseline (N = 755; 45.6 % boys) in six months intervals for three years, resulting in seven measurements. RESULTS: Adolescents most strongly endorsed enhancement AE. Social and coping AE dimensions positively increased over time. The estimated Multilevel Model of Change revealed that exposure to either fathers 'or mothers' alcohol use predicted an increase in social AE six months later (B = .129, SE = .032). Exposure to fathers' drinking predicted an increase in enhancement AE for boys (B = .075, SE = .031) but not for girls (B=-0.045, SE = .030). No associations between parental exposure and other AE dimensions were found. CONCLUSION: The results add to previous studies in showing that the association between parental drinking behavior and offspring AE develops within short periods. Prevention should, therefore, include explicit guidelines for parents with respect to how their drinking behavior affect their offspring.

From Age 4 to 8, Children Become Increasingly Aware About Normative Situations for Adults to Consume Alcohol.

AIMS: Limited cross-sectional studies have indicated that young children have some knowledge of the type of situations in which adults usually consume alcohol. However, it is unclear when and how this knowledge develops over time. This study tests the hypothesis that between the ages of 4 and 8, children become more knowledgeable about common drinking situations (e.g. 'partying') and uncommon situations (e.g. 'driving'). METHODS: Data of two independent samples were used: a cross-sectional study (parents) and a three-wave longitudinal study (children). Parents and children were recruited via a convenience and random sampling strategy, respectively. To identify common, ambivalent, and uncommon drinking situations, parents (N = 158; 47% men) completed an online survey in which they indicated how common it is that any adult would drink alcohol in the 18 situations of the Dutch electronic appropriate beverage (eABT). Children (N = 329; 48.9% boys) completed the Dutch eABT to assess their knowledge of situations in which adults usually consume alcohol. RESULTS: General linear model repeated measures with post-hoc pairwise comparisons showed that parents' perceptions of common, ambivalent, and uncommon situations in which adults consume alcohol predicted the initial level and the change over time in children's knowledge of adults' alcohol use in these situations. CONCLUSIONS: Children aged 4-8 become increasingly knowledgeable about drinking norms in specific situations which implies that they know in what kind of situation alcohol consumption is a common human behavior. This knowledge may put them at risk for early alcohol initiation and frequent drinking later in life.

Exposure to Parental Alcohol Use Rather Than Parental Drinking Shapes Offspring's Alcohol Expectancies.

BACKGROUND: Alcohol expectancies (AE), that is, the anticipated effects of alcohol, start developing early in childhood and are important predictors of alcohol use years later. Whereas previous research has demonstrated that parental drinking relates to children's AE, this study aims to test whether exposure to parental alcohol use mediates the link between parental alcohol use and positive and negative AE among children (6 to 8 years) and early adolescents (12 to 15 years). METHODS: Longitudinal multi-informant family studies were conducted in the Netherlands among children (Study 1 (2015 to 2017): N = 329; 48.9% boys; Mage  = 4.6) and adolescents (Study 2 [2015 to 2018]: N = 755; 45.6% boys; Mage  = 11.3). Fathers' and mothers' alcohol use in terms of quantity and exposure (i.e., the frequency of alcohol use in 9 family-specific situations), and offspring's AE were collected using online questionnaires. RESULTS: Structural equation modeling conducted in the full sample and separately by gender revealed the following: For children, no associations were found in the full sample. However, gender-specific results indicated that fathers' exposure was associated with (and mediated) favorable AE. Among adolescents, fathers' exposure was associated with (and mediated) social and coping AE (both boys and girls) and enhancement AE (only boys). Contrastingly, neither mothers' alcohol use nor its exposure was associated with any AE. Although different associations were found by offspring's gender, strong evidence for gender differences was lacking. CONCLUSIONS: This study indicates that, for specific expectancies, exposure to fathers' alcohol use shapes offspring's cognitions about the effects of alcohol, rather than fathers' alcohol use in general. Prevention efforts could focus on lowering the degree to which fathers expose their drinking, which might be more easily changeable than drinking in general.

Exposure to drinking mediates the association between parental alcohol use and preteen alcohol use.

OBJECTIVE: The aim of the present study was to test the link between exposure to parental alcohol use (i.e., preteens seeing their parents drinking) and preteen's alcohol use. Specifically, this study aimed to (a) replicate the association between parental alcohol use and preteen alcohol use and (b) test whether alcohol use exposure mediated this association. METHOD: Families were recruited from five regions in the Netherlands from 104 schools that agreed to participate. Preteens (N = 755, Mage = 11.27, SD = 0.56, 45.8% boys) and their mothers (N = 755) participated in the study. Preteens reported lifetime alcohol use and parental alcohol use exposure. Mothers reported on alcohol use for both parents. Structural Equation Modelling was used to assess direct and mediated paths between parental alcohol use, preteen's exposure to alcohol use and preteen alcohol use in one model. RESULTS: Unexpectedly, father's alcohol use was negatively associated (ß = -0.121, p = .012) and mother's alcohol use was not associated (ß = 0.056, p = .215) with preteen's alcohol use. A positive indirect effect emerged through alcohol use exposure, showing that exposure to father's alcohol use mediated the association between parent's and preteen's alcohol use (ß = 0.064, p = .001). This effect was absent for mother's alcohol use (ß = 0.026, p = .264). Gender differences were non-significant. CONCLUSIONS: Parental alcohol exposure positively mediated the association of parental alcohol use with preteen's alcohol use. These effects were found for both boys and girls and were most robust for father's drinking. The findings might provide clues for preventive action, for example, by emphasizing that exposure should be restricted to prevent preteen's alcohol use.

Development of alcohol expectancies and early alcohol use in children and adolescents: A systematic review.

PURPOSE: Developmental changes in alcohol expectancies (AE) have been proposed to lead to alcohol use initiation and later alcohol use in adolescence. This systematic review aims to provide longitudinal evidence of the development of AE and the relation of AE to alcohol outcomes from childhood to late adolescence (4-18 years old). METHODS: A computer-assisted search of relevant articles identified 1602 studies, of which 43 studies (conducted between 1996 and 2016) were selected. RESULTS: First, negative AE decline and positive AE increase in early adolescence. Moreover, alcohol use (initiation) seems to strongly influence changes in AE. Second, AE predict alcohol use initiation and drinking patterns over time. Third, longitudinal predictors of AE could be divided into individual predictors (i.e., alcohol-related cognitions, psychopathology, and genetics) and environmental predictors (i.e., family, peer, and media influences). Lastly, the results indicated that AE function as mediators of the relations between the various individual and environmental predictors and adolescent's alcohol use. CONCLUSIONS: Alcohol expectancies form an important framework through which drinking behavior can be explained over time. Due to the diverse findings on the predictors of AE, future longitudinal studies should further clarify the factors that are essential in the development of AE and adolescent's later alcohol use.

Alcohol-Related Knowledge and Alcohol-Related Norms in 4- to 6-Year-Olds-Evidence from the Dutch Electronic Appropriate Beverage Task.

BACKGROUND: Limited research is available on children's alcohol-related knowledge and alcohol-related norms, yet a better comprehension of these factors may be crucial in explaining alcohol use later in life. This study provides insights into alcohol-related knowledge and alcohol-related norms in 4- to 6-year-olds. METHODS: Participating children (N = 329; 48.9% boys) were shown, on a tablet, 18 drawings depicting 72 male and female adults and/or children in various situations, and were asked to indicate what the depicted persons drank by touching 1 of 12 depicted beverages (4 alcoholic; 8 nonalcoholic). Subsequently, the children were asked to name the beverages and indicate whether they contained alcohol. RESULTS: Children identified 30.7% of the alcoholic beverages (i.e., beer, champagne, red wine, and white wine) correctly by name, and they identified 41.6% of the alcoholic beverages correctly as alcohol containing. Children more often correctly identified the name and nonalcoholic content of nonalcoholic beverages compared to the name and alcoholic content of alcoholic beverages. No sex differences emerged in the correct identification of the name and the content of both alcoholic beverages and nonalcoholic beverages. However, alcohol-related knowledge was age graded. Alcoholic beverages were more often assigned to male adults (39.2%) than to female adults (24.8%) or to children (13.2%). Additionally, alcoholic beverages were more often assigned to adults depicted in the presumably more appropriate situations (e.g., "when having an indoor party": 37.0%) than to those depicted in the presumably more inappropriate situations (e.g., "when driving a car": 28.6%). CONCLUSIONS: Four- to 6-year-olds already have knowledge about alcohol and its norms in adult culture. Insight into the development of children's alcohol-related knowledge and alcohol-related norms over time is required to investigate the transitions to alcohol expectancies, drinking motives, and alcohol initiation often occurring in adolescence.

Alcohol-related cognitions in children (aged 2-10) and how they are shaped by parental alcohol use: A systematic review.

BACKGROUND: This systematic review aims to summarize the evidence of the impact of parental alcohol use on the acquisition of children's alcohol-related cognitions (alcohol-related knowledge, alcohol-related norms, alcohol expectancies) in the developmental period from age two to ten. METHODS: A computer-assisted systematic literature search was performed in PubMed, PsychINFO, ERIC, and EMBASE. Overall, 20 out of the 3406 unique articles identified in the first screening were included. RESULTS: The results revealed that children acquire knowledge about alcohol already at age two and from age four on, they understand its use in adult culture. By the age of four, children have certain alcohol expectancies. The evidence of the impact of parental alcohol use on the acquisition of children's alcohol-related cognitions is inconsistent so far with studies showing positive and no effects. Unfortunately, the existing evidence is limited because most studies a) were conducted exclusively in the United States and more than two decades ago, b) used cross-sectional study designs, and c) used non-representative samples recruited using convenience sampling strategies. CONCLUSIONS: Research on children's alcohol-related cognitions is underdeveloped. To elucidate the conclusions about alcohol involvement in early life, studies with longitudinal study designs need to be conducted among representative samples of children and early adolescents by using age-appropriate measurement tools in a broader cultural context.

The effect of the 'What Do You Drink' web-based brief alcohol intervention on self-efficacy to better understand changes in alcohol use over time: randomized controlled trial using ecological momentary assessment.

BACKGROUND: To examine whether (1) the 'What Do You Drink' (WDYD) intervention resulted in drinking refusal self-efficacy (DRSE) changes directly after the intervention, and if so, whether these changes sustained at six-months follow-up and (2) DRSE was related to alcohol use over time, and if so, whether the strength of these relationships differed across conditions. Insight herein can help explain the sustained preventive effects of the WDYD intervention on alcohol use, as reported previously. METHODS: Alcohol use and DRSE data were collected from 907 participants (60.3% male; M=20.8 (SD=1.7) in a two-arm parallel group randomized controlled trial applying ecological momentary assessment with 30 time-points. Participants were randomized to the experimental (n=456: WDYD intervention) or control condition (n=451: no intervention). RESULTS: Latent Growth Curve (LGC) analyses that modeled individual change in DRSE over time by condition revealed that participants in the experimental condition experienced a higher social pressure DRSE compared to participants in the control condition at six-months follow-up. Moreover, LGC analyses with time-varying covariates revealed that DRSE was negatively related to weekly alcohol consumption and social pressure DRSE to frequency of binge drinking. The WDYD intervention did not affect the strength of these relationships. CONCLUSIONS: The WDYD intervention increased the level of social pressure DRSE directly after the intervention that sustained at six-months follow-up. This change is likely to be responsible for the sustained preventive effects of the WDYD intervention on alcohol use, as reported previously.

Using ecological momentary assessment to test the effectiveness of a web-based brief alcohol intervention over time among heavy-drinking students: randomized controlled trial.

BACKGROUND: Web-based brief alcohol interventions are effective in reducing alcohol use among students when measured at limited follow-up time points. To date, no studies have tested Web-based brief alcohol intervention effectiveness over time by using a large number of measurements. OBJECTIVE: Testing whether the What Do You Drink (WDYD) Web-based brief alcohol intervention can sustain a reduction in alcohol use among heavy-drinking students aged 18-24 years at 1-, 3-, and 6-month follow-up intervals. METHODS: A purely Web-based, 2-arm, parallel-group randomized controlled trial applying an ecological momentary assessment approach with 30 weekly measurements was conducted in the Netherlands (2010-2011). Participants were recruited offline and online. A total of 907 participants were randomized into the experimental condition (n=456) including the single-session and fully automated WDYD intervention, or into the control condition (n=451) including assessment only. Weekly alcohol consumption and frequency of binge drinking were the self-assessed outcome measures. RESULTS: Attrition rates of the 907 participants were 110 (12.1%), 130 (14.3%), and 162 (17.9%) at 1-, 3-, and 6-month follow-up intervals, respectively. Latent growth curve analyses according to the intention-to-treat principle revealed that participants in the experimental condition had significantly lower weekly alcohol consumption compared to participants in the control condition that was sustained at 3-month follow-up (intercept=-2.60, P<.001; slope=0.16, P=.08). Additional linear regression analyses indicated that this intercept difference resulted from significantly higher levels of alcohol units per week for participants in the control condition compared to those in the experimental condition at 1-month (beta=-2.56, SE 0.74, Cohen's d=0.20, P=.001), 3-month (beta=-1.76, SE 0.60, Cohen's d=0.13, P=.003), and 6-month (beta=-1.21, SE 0.58, Cohen's d=0.09, P=.04) follow-up intervals. Latent growth curve analyses further indicated that participants in the experimental condition had a significantly lower frequency of binge drinking compared to participants in the control condition that was sustained at 6-month follow-up (intercept=-0.14, P=.01; slope=0.004, P=.19). This intercept difference resulted from higher levels in this outcome for participants in the control condition relative to participants in the experimental condition at 1-month (beta=-1.15, SE 0.06, Cohen's d=0.16, P=.01), 3-month (beta=-0.12, SE 0.05, Cohen's d=0.09, P=.01), and 6-month (beta=-0.09, SE 0.05, Cohen's d=0.03, P=.045) follow-up intervals. CONCLUSIONS: The WDYD intervention was shown to be effective in preventing an increase in weekly alcohol consumption and frequency of binge drinking directly after the intervention. This effect was sustained 3 and 6 months after the intervention. TRIAL REGISTRATION: Netherlands Trial Register NTR2665; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2665 (Archived by WebCite at http://webcitation.org/6LuQVn12M).

The development of a web-based brief alcohol intervention in reducing heavy drinking among college students: an Intervention Mapping approach.

In the Netherlands, young adults' drinking practices have become an issue of public concern since their drinking levels are high. Heavy drinking can place young adults at an increased risk for developing short- and long-term health-related problems. Current national alcohol prevention programmes focus mainly on adolescents and their parents and paying less systematic attention to young adults. The present study describes the theory and evidence-based development of a web-based brief alcohol intervention entitled What Do You Drink (WDYD). We applied the Intervention Mapping (IM) protocol to combine theory and evidence in the development and implementation of WDYD. The WDYD intervention aims to detect and reduce heavy drinking of young adults who are willing to decrease their alcohol consumption, preferably below the Dutch guidelines of low-risk drinking. According to the IM protocol, the development of WDYD resulted in a structured intervention. Reducing heavy drinking to low-risk drinking was proposed as the behavioural outcome. Motivational interviewing principles and parts of the I-Change Model were used as methods in the development of WDYD, whereas computer tailoring was selected as main strategy. An effect and a process evaluation of the intervention will be conducted. IM was found to be a practical instrument for developing the WDYD intervention tailored to a specific target population in the area of alcohol prevention.

Using ecological momentary assessment in testing the effectiveness of an alcohol intervention: a two-arm parallel group randomized controlled trial.

BACKGROUND: Alcohol consumption of college students has a fluctuating nature, which might impact the measurement of intervention effects. By using 25 follow-up time-points, this study tested whether intervention effects are robust or might vary over time. METHODS: Data were used from a two-arm parallel group randomized controlled trial applying ecological momentary assessment (EMA) with 30 data time-points in total. Students between 18 and 24 years old who reported heavy drinking in the past six months and who were ready to change their alcohol consumption were randomly assigned to the experimental (n = 456: web-based brief alcohol intervention) and control condition (n = 451: no intervention). Outcome measures were weekly alcohol consumption, frequency of binge drinking, and heavy drinking status. RESULTS: According to the intention-to-treat principle, regression analyses revealed that intervention effects on alcohol consumption varied when exploring multiple follow-up time-points. Intervention effects were found for a) weekly alcohol consumption at 1, 2, 3, 4, and 7 weeks follow-up, b) frequency of binge drinking at 1, 2, 7, and 12 weeks follow-up, and c) heavy drinking status at 1, 2, 7, and 16 weeks follow-up. CONCLUSIONS: This research showed that the commonly used one and six month follow-up time-points are relatively arbitrary and not using EMA might bring forth erroneous conclusions on the effectiveness of interventions. Therefore, future trials in alcohol prevention research and beyond are encouraged to apply EMA when assessing outcome measures and intervention effectiveness. TRIAL REGISTRATION: Netherlands Trial Register NTR2665.

The effectiveness of a web-based brief alcohol intervention in reducing heavy drinking among adolescents aged 15-20 years with a low educational background: a two-arm parallel group cluster randomized controlled trial.

BACKGROUND: To evaluate the slightly modified version of the web-based brief alcohol intervention "What Do You Drink" (WDYD) among heavy drinking adolescents and young adults aged 15-20 years with a low educational background at one and six months follow-up. METHODS: A two-arm parallel group cluster randomized controlled trial was conducted online in the Netherlands in 2011-2012. Participants included in the trial were recruited from preparatory and secondary vocational education institutions and had to be between 15 and 20 years of age and report heavy drinking in the past six months. In total, 73 classes representing 609 (59.9% male) participants were allocated to the experimental condition (37 classes, 318 participants: WDYD intervention) or control condition (36 classes, 291 participants: no intervention). Outcomes were heavy drinking, weekly alcohol consumption, and frequency of binge drinking. RESULTS: Regressions analyses revealed no significant main intervention effects on any of the alcohol outcomes at one and six month's follow-up according to the intention-to-treat principle. Additionally, there were no moderating effects of gender, age, educational level, and readiness to change on the relation between the WDYD intervention and the alcohol outcomes at follow-up. CONCLUSIONS: The WDYD intervention was not effective in reducing alcohol consumption among heavy drinking adolescents and young adults aged 15-20 years with a low educational background at one and six months follow-up. However, the absence of intervention effectiveness cannot be used as an argument for not conducting these types of interventions with low educated individuals, since our study was the first to target this population. TRIAL REGISTRATION: Netherlands Trial Register NTR2971.

The effectiveness of the 'what do you drink' web-based brief alcohol intervention in reducing heavy drinking among students: a two-arm parallel group randomized controlled trial.

AIMS: To evaluate the effectiveness of a web-based brief alcohol intervention 'What Do You Drink' (WDYD) among heavy drinking students at 1- and 6-month post-intervention. Additionally, it was investigated whether certain subgroups would benefit more than others from the WDYD intervention. METHODS: A two-arm parallel group randomized controlled trial was conducted online in the Netherlands in 2010-2011. Inclusion criteria were: (1) being between 18- and 24-year old, (2) reporting heavy drinking in the past 6 months, (3) being motivated to change alcohol consumption, (4) having access to the Internet and (5) giving informed consent. Participants (n = 913) were randomized to the experimental (WDYD intervention) or control condition (no intervention). Measures were heavy drinking, frequency of binge drinking and weekly alcohol consumption. RESULTS: Analyses according to the intention-to-treat principle revealed no significant main intervention effects in reducing the alcohol measures at the follow-up assessments. Secondary analyses revealed that gender, freshmen and fraternity or sorority membership did not moderate the effect of the WDYD intervention at both follow-ups. Readiness to change, problem drinking and carnival participation moderated intervention effects such that contemplators, those with severe symptoms of alcohol abuse or dependence, and those who participated in carnival benefited more than others from the WDYD intervention regarding weekly alcohol consumption at 1-month follow-up. CONCLUSIONS: The WDYD intervention was not effective in reducing the alcohol measures among heavy drinking students at 1- and 6-month post-intervention. However, there is preliminary evidence that the WDYD intervention is effective in lowering drinking levels for subgroups of heavy drinking students in the short term.

The effectiveness of a web-based brief alcohol intervention in reducing heavy drinking among adolescents aged 15 to 20 years with a low educational background: study protocol for a randomized controlled trial.

BACKGROUND: The serious negative health consequences of heavy drinking among adolescents is cause for concern, especially among adolescents aged 15 to 20 years with a low educational background. In the Netherlands, there is a lack of alcohol prevention programs directed to the drinking patterns of this specific target group. The study described in this protocol will test the effectiveness of a web-based brief alcohol intervention that aims to reduce alcohol use among heavy drinking adolescents aged 15 to 20 years with a low educational background. METHODS/DESIGN: The effectiveness of the What Do You Drink (WDYD) web-based brief alcohol intervention will be tested among 750 low-educated, heavy drinking adolescents. It will use a two-arm parallel group cluster randomized controlled trial. Classes of adolescents from educational institutions will be randomly assigned to either the experimental (n = 375: web-based brief alcohol intervention) or control condition (n = 375: no intervention). Primary outcomes measures will be: 1) the percentage of participants who drink within the normative limits of the Dutch National Health Council for low-risk drinking, 2) reductions in mean weekly alcohol consumption, and 3) frequency of binge drinking. The secondary outcome measures include the alcohol-related cognitions, attitudes, self-efficacy, and subjective norms, which will be measured at baseline and at one and six months after the intervention. DISCUSSION: This study protocol presents the study design of a two-arm parallel-group randomized controlled trial to evaluate the effectiveness of the WDYD web-based brief alcohol intervention. We hypothesized a reduction in mean weekly alcohol consumption and in the frequency of binge drinking in the experimental condition, resulting from the web-based brief alcohol intervention, compared to the control condition. TRIAL REGISTRATION: Netherlands Trial Register NTR2971.