The persistence of risky drinking among young adults in college calls for continued efforts to prevent harms related to alcohol. Current prevention interventions have achieved some success, but the majority of those interventions rely on a single mechanism of change: correcting exaggerated drinking norms. We propose to test a novel prevention strategy targeting another mechanism of change: creating attitude-behavior dissonance. To date, changing alcohol-related attitudes and the resulting attitude-behavior discrepancy have not been harnessed as a behavior change strategy for alcohol abuse prevention. Informed by an extensive literature showing strong and consistent associations between alcohol attitudes and drinking behavior, we adapted a brief counter-attitudinal advocacy (CAA) manipulation to the alcohol prevention context. The goals of the proposed research are to demonstrate (a) the utility of CAA to change high volume drinking and related consequences, (b) that attitude change and attitude-behavior dissonance mediates the CAA manipulation effect, and (c) that CAA-induced risk reduction is not inferior to an established intervention based on Personalized Normative Feedback (PNF). To achieve these goals, we propose a pair of studies implemented across two sites. First we conduct an initial survey to document peer behaviors and normative perceptions (N = 500 at each site), required to deliver accurate, campus-specific PNF. Next we conduct an RCT with 2 experimental conditions (CAA and PNF) and a 3rd assessment only control condition to determine the impact of CAA on alcohol outcomes. For the RCT, we will recruit a total of 600 heavy drinking students who endorse >2 alcohol-related negative consequence. Based on pilot work, we designed a prompt to elicit counter-attitudinal statements in favor of moderate drinking. Drawing from the college intervention literature, we will also use a standard PNF condition as a comparison. We will collect alcohol outcomes at 1-, 3-, and 6-month follow-ups. We will test hypotheses that, relative to assessment only control, the CAA manipulation will (a) increase positive moderate drinking attitudes, (b) decrease positive heavy drinking attitudes, (c) increase attitude- behavior dissonance, and (d) decrease drinks per drinking day, binge frequency, peak BAC, and alcohol consequences, and increase PBS. We will also test the hypothesis that CAA condition will be no less efficacious than (i.e., not inferior to) the PNF condition in reducing drinks per drinking day, binge frequency, peak BAC, and alcohol consequences. In addition, we will test hypotheses about participant characteristics (drinker identity, preference for consistency) that might moderate the influence of the CAA manipulations on drinking behaviors. This study will demonstrate the generalizability of attitude change theory and CAA methods to the alcohol prevention context, as well as their generalizability across demographically different settings. Implications for the public health include establishing the efficacy of a new approach for reducing high volume drinking and related consequences among young adults engaging in at-risk drinking.

Public Health Relevance

High volume drinking by young adults has proven resistant to change, so new approaches are needed. Given strong associations between alcohol-related attitudes and drinking behavior, we adapt a theory- based attitude change strategy for use in alcohol prevention. This research tests the impact of brief counter attitudinal advocacy activities on subsequent drinking and negative consequences.

National Institute of Health (NIH)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Research Project (R01)
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National Institute on Alcohol Abuse and Alcoholism Initial Review Group (AA)
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Shirley, Mariela
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Brown University
Public Health & Prev Medicine
Schools of Public Health
United States
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