Browsing by Author "Lewis, Melissa A."
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Item A multisite randomized trial of normative feedback for heavy drinking: Social comparison versus social comparison plus correction of normative misperceptions(Journal of Consulting and Clinical Psychology, 2016-03) Neighbors, Clayton; Lewis, Melissa A.; LaBrie, Joseph W.; DiBello, Angelo M.; Young, Chelsie M.; Rinker, Dipali; Litt, Dana M.; Rodriguez, Lindsey M.; Knee, C. Raymond; Hamor, Ezekiel; Jerabeck, Jessica M.; Larimer, Mary E.Objective: Given widespread alcohol misuse among college students, numerous intervention programs have been developed, including personalized normative feedback (PNF). Most research evaluating PNF assumes that presenting one's own perceived norms is necessary to correct normative misperceptions and thereby reduce drinking. Alternatively, simply providing social comparison information showing that one drinks more than others may be sufficient. The present study evaluated the efficacy of full PNF (one's own drinking, campus drinking rates, and perceived norms) and a partial personalized social comparison feedback (PSCF; one's own drinking and campus drinking rates) in a randomized trial among heavy-drinking college students. Method: Participants included 623 heavy-drinking students from three universities. Assessments occurred at baseline and three- and six-months post-baseline. Results: Primary analyses examined differences across four drinking outcomes (drinks per week, total drinks past month, frequency of past month drinking, and negative alcohol-related consequences) at three- and six-month follow-ups controlling for the baseline variable. Results revealed significant reductions across all alcohol consumption outcomes at three months in both intervention conditions compared to attention-control. Mediation analyses demonstrated significant indirect effects of the intervention on six-month drinking through changes in perceived norms at three months. Moreover, evidence emerged for changes in drinking at three months as a mediator of the association between PSCF and six-month perceived norms. Conclusions: The present research suggests PNF may not require explicit consideration of one's perceived norms in order to be effective and that direct social comparison provides an alternative theoretical mechanism for PNF efficacy.Item A Randomized Controlled Trial of Event Specific Prevention Strategies for Reducing Problematic Drinking Associated with 21st Birthday Celebrations(Journal of Consulting and Clinical Psychology, 2012) Neighbors, Clayton; Lee, Christine M.; Atkins, David C.; Lewis, Melissa A.; Kaysen, Debra; Mittmann, Angela; Fossos, Nicole; Geisner, Irene M.; Zheng, Cheng; Larimer, Mary E.Objective: While research has documented heavy drinking practices and associated negative consequences of college students turning 21, few studies have examined prevention efforts aimed to reduce high-risk drinking during 21st birthday celebrations. The present study evaluated the comparative efficacy of a general prevention effort (i.e., BASICS) and event specific prevention in reducing 21st birthday drinking and related negative consequences. Furthermore, this study evaluated inclusion of peers in interventions and mode of intervention delivery (i.e., in-person vs. web). Method: Participants included 599 college students (46% male) who intended to consume at least five/four drinks (men/women respectively) on their 21st birthday. After completing a screening/baseline assessment approximately one week before turning 21, participants were randomly assigned to one of six conditions: 21st birthday in-person BASICS, 21st birthday web BASICS, 21st birthday in-person BASICS plus friend intervention, 21st birthday web BASICS plus friend intervention, BASICS, or an attention control. A follow-up assessment was completed approximately one week after students’ birthdays. Results: Results indicated a significant intervention effect for BASICS in reducing blood alcohol content reached and number of negative consequences experienced. All three in-person interventions reduced negative consequences experienced. Results for the web-based interventions varied by drinking outcome and whether or not a friend was included. Conclusions: Overall, results provide support for both general intervention and ESP approaches across modalities for reducing extreme drinking and negative consequences associated with turning 21. These results suggest there are several promising options for campuses seeking to reduce both use and consequences associated with 21st birthday celebrations.Item An examination of college student activities and attentiveness during a web-delivered personalized normative feedback intervention(Psychology of Addictive Behaviors, 2015-03) Lewis, Melissa A.; Neighbors, ClaytonBoth heavy drinking and related risky sexual behavior among college students are common and are often associated with a number of negative consequences. A previously reported randomized controlled trial showed that a brief personalized normative feedback (PNF) intervention reduced the alcohol consumption and alcohol-related risky sexual behavior of heavy drinking, sexually active college students (Lewis et al., in press). For the present study, we examined what activities students were engaged in when viewing the feedback as well as who they were with and where they were when receiving the intervention. Furthermore, we conducted supplemental analyses with perceived attentiveness as a hypothesized predictor of change using the same sample (N = 480). Findings indicated that most students were engaged in activities when viewing the feedback and that most students viewed the feedback alone and at home. Furthermore, results revealed PNF to be most effective in reducing drinks per week among participants who reported greater attention. Clinical implications and suggestions for additional research examining how attentiveness can be increased during web-based interventions are discussed.Item Efficacy of web-based personalized normative feedback: A two-year randomized controlled trial(Journal of Consulting and Clinical Psychology, 2010-12) Neighbors, Clayton; Lewis, Melissa A.; Atkins, David C.; Jensen, Megan M.; Walter, Theresa; Fossos, Nicole; Lee, Christine M.; Larimer, Mary E.Objective: Web-based brief alcohol interventions have the potential to reach a large number of individuals at low cost; however, few controlled evaluations have been conducted to date. The present study was designed to evaluate the efficacy of gender-specific versus gender-nonspecific personalized normative feedback (PNF) with single versus biannual administration in a 2-year randomized controlled trial targeting a large sample of heavy-drinking college students. Method: Participants included 818 freshmen (57.6% women; 42% non-Caucasian) who reported 1 or more heavy-drinking episodes in the previous month at baseline. Participants were randomly assigned in a 2 (gender-specific vs. gender-nonspecific PNF) × 2 (single vs. biannual administration of PNF) + 1 (attention control) design. Assessments occurred every 6 months for a 2-year period. Results: Results from hierarchical generalized linear models provided modest effects on weekly drinking and alcohol-related problems but not on heavy episodic drinking. Relative to control, gender-specific biannual PNF was associated with reductions over time in weekly drinking (d = −0.16, 95% CI [−0.02, −0.31]), and this effect was partially mediated by changes in perceived norms. For women, but not men, gender-specific biannual PNF was associated with reductions over time in alcohol-related problems relative to control (d =−0.29, 95% CI [−0.15,−0.58]). Few other effects were evident. Conclusions: The present research provides modest support for the use of biannually administered web-based gender-specific PNF as an alternative to more costly indicated prevention strategies.Item Event specific drinking among college students(Psychology of Addictive Behaviors, 2011-12) Neighbors, Clayton; Atkins, David C.; Lewis, Melissa A.; Lee, Christine M.; Kaysen, Debra; Mittmann, Angela; Fossos, Nicole; Rodriguez, Lindsey M.College represents a period of risk for heavy drinking and experiencing unwanted consequences associated with drinking. Previous research has identified specific events including holidays (e.g., New Years), school breaks (e.g., Spring Break) and personally relevant events (e.g., 21st birthdays) that are associated with elevated risk of heavy drinking and negative alcohol-related consequences. The systematic evaluation of relative risk offers insights into event specific drinking and an empirical basis upon which to consider allocation of limited prevention resources. Thus, the purpose of the present study was to provide a comparative index of drinking across a wide range of holidays and compare holiday drinking to 21st birthday drinking. Participants were 1,124 students (55% female) who had turned 21 within the previous three weeks in 2008 and provided 90-day retrospective reports of their drinking using the Timeline Follow-back. Results based on a hurdle mixed model for blood alcohol content (BAC) revealed several holidays that stand out for elevated drinking, including New Year’s Eve and July 4th, whereas other holidays appear more similar to weekend drinking, such as Spring Break (approximately last week of March) and graduation (mid-June). Drinking on holidays or special days was substantially lower than drinking on 21st birthdays. Results are discussed in terms of practical applications for targeted intervention efforts on college campuses toward specific events where elevated drinking is known to occur.Item Injunctive norms and alcohol consumption: A revised conceptualization(Alcoholism: Clinical and Experimental Research, 2016-05) Krieger, Heather; Neighbors, Clayton; Lewis, Melissa A.; LaBrie, Joseph W.; Foster, Dawn W.; Larimer, Mary E.Background: Injunctive norms have been found to be important predictors of behaviors in many disciplines with the exception of alcohol research. This exception is likely due to a misconceptualization of injunctive norms for alcohol consumption. To address this, we outline and test a new conceptualization of injunctive norms and personal approval for alcohol consumption. Traditionally, injunctive norms have been assessed using Likert scale ratings of approval perceptions, whereas descriptive norms and individual behaviors are typically measured with behavioral estimates (i.e., number of drinks consumed per week, frequency of drinking, etc.). This makes comparisons between these constructs difficult because they are not similar conceptualizations of drinking behaviors. The present research evaluated a new representation of injunctive norms with anchors comparable to descriptive norms measures. Methods: A study and a replication were conducted including 2,559 and 1,189 undergraduate students from three different universities. Participants reported on their alcohol-related consumption behaviors, personal approval of drinking, and descriptive and injunctive norms. Personal approval and injunctive norms were measured using both traditional measures and a new drink-based measure. Results: Results from both studies indicated that drink-based injunctive norms were uniquely and positively associated with drinking whereas traditionally assessed injunctive norms were negatively associated with drinking. Analyses also revealed significant unique associations between drink-based injunctive norms and personal approval when controlling for descriptive norms. Conclusions: These findings provide support for a modified conceptualization of personal approval and injunctive norms related to alcohol consumption and, importantly, offers an explanation and practical solution for the small and inconsistent findings related to injunctive norms and drinking in past studies.Item Normative misperceptions of peer seatbelt use among high school students and their relationship to personal seatbelt use(Traffic Injury Prevention, 2014) Litt, Dana M.; Lewis, Melissa A.; Linkenbach, Jeffrey W.; Lande, Gary; Neighbors, ClaytonObjectives: This research examined gender-specific perceptions of peer seat belt use norms among high school students and their relationship with one’s own seat belt use. We expected that students would underestimate the seat belt use of their peers and that these perceptions would be positively associated with their own seat belt use. Methods: High school students from 4 schools (N = 3348; 52% male) completed measures assessing perceived seat belt use and personal seat belt use. Results: Findings demonstrated that students perceived that others engaged in less seat belt use than they do and that perceived norms were positively associated with one’s own seat belt use. Conclusions: Peer influences are a strong predictor of behavior, especially among adolescents. Ironically, adolescents’ behaviors are often influenced by inaccurate perceptions of their peers. This research establishes the presence of a misperception related to seat belt use and suggests that misperception is associated with own behaviors. This research provides a foundation for social norms–based interventions designed to increase seat belt use by correcting normative misperceptions among adolescents.Item Prototype Willingness Model cognitions mediate personalized normative feedback efficacy(Prevention Science, 12/19/17) Lewis, Melissa A.; Litt, Dana M.; Tomkins, Mary; Neighbors, ClaytonPersonalized normative feedback (PNF) interventions have been shown to be efficacious at reducing college student drinking. Because descriptive norms have been shown to mediate PNF efficacy, the current study focused on examining additional prototype willingness model social reaction cognitions, namely, prototypes and willingness, as mediators of intervention efficacy. We expected the PNF interventions to be associated with increased prototype favorability of students who do not drink, which would in turn be associated with decreased willingness to drink and subsequently, less drinking. The current study included 622 college students (53.2% women; 62% Caucasian) who reported one or more heavy drinking episodes in the past month and completed baseline and three-month follow-up assessments. As posited by the framework of the prototype willingness model, sequential mediation analyses were conducted to evaluate increases in abstainer prototype favorability on willingness on drinking, and subsequently willingness to drink on drinking behavior. Mediation results revealed significant indirect effects of PNF on three-month drinking through three-month prototypes and willingness, indicating that the social reaction pathway of the prototype willingness model was supported. Findings have important implications for PNF interventions aiming to reduce high-risk drinking among college students. Study findings suggest that we should consider looking at additional socially-based mediators of PNF efficacy in addition to perceived descriptive norms.Item Randomized controlled trial of a spring break intervention to reduce high-risk drinking(Journal of Consulting and Clinical Psychology, 2014-04) Lee, Christine M.; Neighbors, Clayton; Lewis, Melissa A.; Kaysen, Debra; Mittmann, Angela; Geisner, Irene M.; Atkins, David C.; Zheng, Cheng; Garberson, Lisa A.; Kilmer, Jason R.; Larimer, Mary E.Objective: While recent studies have documented high-risk drinking occurring during Spring Break (SB), particularly on SB trips with friends, published intervention studies are few. The present study evaluated the efficacy of Event Specific Prevention (ESP) strategies for reducing SB drinking among college students, compared to general prevention strategies and an assessment-only control group, as well as evaluated inclusion of peers in interventions and mode of intervention delivery (in-person vs. web). Method: Participants included 783 undergraduates (56.1% women, average age 20.5) intending to go on a SB trip with friends as well as to drink heavily on at least one day of SB. Participants completed assessments prior to SB and were randomized to one of five intervention conditions: SB in-person BASICS, SB web BASICS, SB in-person BASICS with friend, SB web BASICS with friend, general BASICS, or an attention control condition. Follow-up assessment was completed one week after SB. Results: While the SB web BASICS (with and without friends) and general BASICS interventions were not effective at reducing SB drinking, results indicated significant intervention effects for SB in-person BASICS in reducing SB drinking, particularly on trip days. Follow-up analyses indicated change in descriptive norms mediated treatment effect and reductions in drinking, while SB drinking intentions and positive expectancies did not. Conclusions: Overall, results suggest an in-person SB-specific intervention is effective at reducing SB drinking, especially during trips. In contrast, interventions that contain non-SB related content, are web-based, or seek to involve friends may be less effective at reducing SB drinking.Item RCT of web-based personalized normative feedback for college drinking prevention: Are typical student norms good enough?(Journal of Consulting and Clinical Psychology, 2013-12) LaBrie, Joseph W.; Lewis, Melissa A.; Atkins, David C.; Neighbors, Clayton; Zheng, Cheng; Kenney, Shannon R.; Napper, Lucy E.; Walter, Theresa; Kilmer, Jason R.; Hummer, Justin F.; Grossbard, Joel; Ghaidarov, Tehniat M.; Desai, Sruti; Lee, Christine M.; Larimer, Mary E.Objectives: Personalized normative feedback (PNF) interventions are generally effective at correcting normative misperceptions and reducing risky alcohol consumption among college students. However, research has yet to establish what level of reference group specificity is most efficacious in delivering PNF. This study compared the efficacy of a web-based PNF intervention employing eight increasingly-specific reference groups against a Web-BASICS intervention and a repeated-assessment control in reducing risky drinking and associated consequences. Method: Participants were 1663 heavy drinking Caucasian and Asian undergraduates at two universities. The referent for web-based PNF was either the typical same-campus student, or a same-campus student at one (either gender, race, or Greek-affiliation), or a combination of two (e.g., gender and race), or all three levels of specificity (i.e., gender, race, and Greek-affiliation). Hypotheses were tested using quasi-Poisson generalized linear models fit by generalized estimating equations. Results: The PNF intervention participants showed modest reductions in all four outcomes (average total drinks, peak drinking, drinking days, and drinking consequences) compared to control participants. No significant differences in drinking outcomes were found between the PNF group as a whole and the Web-BASICS group. Among the eight PNF conditions, participants receiving typical student PNF demonstrated greater reductions in all four outcomes compared to those receiving PNF for more specific reference groups. Perceived drinking norms and discrepancies between individual behavior and actual norms mediated the efficacy of the intervention. Conclusions: Findings suggest a web-based PNF intervention using the typical student referent offers a parsimonious approach to reducing problematic alcohol use outcomes among college students.Item Remote vs. in-lab computer-delivered personalized normative feedback interventions for college student drinking(Journal of Consulting and Clinical Psychology, 2015-06) Rodriguez, Lindsey M.; Neighbors, Clayton; Rinker, Dipali; Lewis, Melissa A.; Lazorwitz, Brenda; Gonzales, Rubi G.; Larimer, Mary E.Objective: Computer-based interventions aimed at reducing college student drinking have shown positive effects. This paper compares differences in effects of computer-based personalized normative feedback (PNF) interventions based on delivery modality (in-person vs. remotely) across six previously evaluated studies with similar content. Method: Three studies included evaluations of a computer-based PNF intervention where baseline and intervention procedures took place inside a laboratory setting; three separate studies included evaluations of the same intervention where participants completed the procedures remotely over the web. Thus, we tested for differences in intervention efficacy by delivery modality. Outcomes included drinks per week, drinking-related consequences, and the putative intervention mechanism, perceived drinking norms. Results: Evidence from hierarchical linear models indicated that computer-based interventions are less effective at reducing drinking and related consequences when delivered remotely than when delivered in-person. Conclusion: The advantages of interventions delivered remotely are not without cost. Suggestions for why remote computer-based interventions may be less effective are discussed.Item Social-norms interventions for light and nondrinking students(Group Processes and Intergroup Relations, 2011-09) Neighbors, Clayton; Jensen, Megan M.; Tidwell, Judy; Walter, Theresa; Fossos, Nicole; Lewis, Melissa A.Social-norms approaches to alcohol prevention are based on consistent findings that most students overestimate the prevalence of drinking among their peers. Most interventions have been developed for heavy-drinking students, and the applicability of social-norms approaches among abstaining or light-drinking students has yet to be evaluated. The present research aimed to evaluate the impact of two types of online social-norms interventions developed for abstaining or light-drinking students. Identification with other students was evaluated as a moderator. Participants included 423 freshmen and sophomore college students who reported never or rarely drinking at screening. Students were randomly assigned to one of three conditions: (a) personalized-norms feedback, (b) social-norms marketing ads, or (c) attention control. Data were analyzed using generalized linear mixed models. Results provided some support for both interventions but were stronger for social-norms marketing ads, particularly among participants who identified more closely with other students.Item Spring Break versus Spring Broken: Predictive utility of Spring Break alcohol intentions and willingness at varying levels of extremity(Prevention Science, 2014-02) Litt, Dana M.; Lewis, Melissa A.; Patrick, Megan E.; Rodriguez, Lindsey M.; Neighbors, Clayton; Kaysen, DebraObjective: Within the domain of risk-related behavior, many times the decision to engage is not a product of premeditation or intention. The Prototype Willingness model was created to capture and explain the unintended element of risk behavior. The present study aimed to evaluate the importance of willingness versus intention, two important constructs within the Prototype Willingness model, in relation to Spring Break drinking behavior when assessed at both high and low extremities. Method: College undergraduates (N = 275) completed questionnaires prior to Spring Break regarding their anticipated Spring Break activities. Willingness and intention were assessed for different levels of risk. Specifically, participants indicated the extent to which they intended to (a) get drunk and (b) drink enough to black out or pass out; and the extent to which they were willing to (a) get drunk and (b) drink enough to black out or pass out. When classes resumed following Spring Break, the students indicated the extent to which they actually (a) got drunk and (b) drank enough to black out or pass out. Results: Results demonstrated that when the health-related risk was lower (i.e., getting drunk), intention was a stronger predictor of behavior than was willingness. However, as the level of risk increased (i.e., getting drunk enough to black out or pass out), willingness more strongly predicted behavior. Conclusion: The present study suggests that willingness and intentions differentially predict Spring Break alcohol-related behavior depending on the extremity of behavior in question. Implications regarding alcohol interventions are discussed.Item The use of protective behaviors in relation to gambling among college students(Journal of Gambling Studies, 2014-03) Lostutter, Ty W.; Lewis, Melissa A.; Cronce, Jessica M.; Neighbors, Clayton; Larimer, Mary E.The purpose of the current study was to evaluate a measure of gambling protective behaviors and examine the relationship between indices of gambling behavior, including frequency, quantity and problem severity, and the use of gambling protective behaviors. Undergraduates from a large public university (N = 4,014) completed a web-based screening survey comprising measures of gambling and health behaviors, from which those who gambled within the past 6-months (n = 1,922, 48% of the entire sample) were invited to complete the baseline assessment, including the Gambling Protective Behavior Scale (GPBS). The GPBS was determined to have two subscales, primarily consisting of harm reduction strategies that reduce the money or time spent on gambling, or avoidance strategies that help to minimize engagement in gambling activities. Hierarchical multiple regressions found participants’ sex moderated the relationship between use of protective behavioral strategies and gambling outcomes. However, effects were in the opposite direction to those hypothesized. Specifically, because women gambled less, had lower gambling problem severity, and reported more frequent use of gambling avoidance protective behaviors, the relationship between use of gambling protective behaviors and gambling outcomes was stronger for men than women. Men who used more avoidance strategies gambled less frequently compared to men who used fewer avoidance strategies. Similarly, men who used more harm reduction strategies spent fewer dollars on gambling and had lower scores on gambling problem severity compared to men using fewer harm reduction strategies for women these relationships were less pronounced. Implications of incorporating specific gambling protective behavioral strategies into prevention and treatment programs are discussed.