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Using Facebook to deliver alcohol interventions using social norms approach. Brad Ridout, Faculty of Health Sciences.

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  • 1. USING FACEBOOK TO DELIVER A SOCIAL NORM INTERVENTION TO REDUCE PROBLEM DRINKING AT UNIVERSITY BRAD RIDOUT, PhD CANDIDATE Dr ANDREW CAMPBELL, SENIOR LECTURER ABSTRACT INTRODUCTION. University students usually overestimate peer alcohol use, resulting in them ‘drinking up’ to perceived norms. Social norms theory suggests that correcting these inflated perceptions can reduce alcohol consumption. Recent findings by the current authors show portraying oneself as ‘a drinker’ is considered by many students to be a socially desirable component of their Facebook identity, perpetuating an online culture that normalises binge-drinking (Ridout et al., 2012). However, social networking sites have yet to be utilised in social norms interventions. METHOD. Actual and perceived drinking norms were collected from 244 university students. Ninety-five students who screened positive for hazardous drinking were randomly allocated to a control or intervention group that received social norms feedback via personalised Facebook messages over three sessions. RESULTS. At one month post-intervention, the quantity and frequency of alcohol consumed by the intervention group during the previous month had significantly reduced compared to baseline and controls. Reductions were maintained three months post-intervention. Perceived drinking norms of the intervention group were significantly more accurate post-intervention. DISCUSSION. This is the first study to show Facebook can successfully correct misperceptions of peer drinking norms, resulting in clinically significant reductions in alcohol use. Facebook has many advantages over traditional social norms delivery and provides an innovative method for tackling university drinking. These results have implications for the use of positive messages about safe alcohol use in Facebook newsfeeds, which may counter the negative messages regarding alcohol normally seen on Facebook. INTRODUCTION An increasing body of research has shown that the social norms approach can be effective in reducing problematic alcohol use in university populations (Moriera et al., 2009). University students tend to overestimate how much the average student drinks, increasing the likelihood they will ‘drink up’ to these misperceived norms. As normative beliefs are one of the strongest determinants of alcohol consumption among university students (Lewis & Clemens, 2008), social norms theory suggests correcting inflated perceptions of drinking norms can lead to reductions in alcohol consumption. Previous research has found that media exposure has an impact on normative beliefs regarding alcohol use among adolescents (Anderson et al., 2009). In addition to exaggerated portrayals of alcohol use in marketing and traditional media, today’s youth are confronted with an abundance of alcohol-related content on social media, such as photos and comments from friends, as well as advertisements and alcohol-related games. Recent findings by the current authors show portraying oneself as ‘a drinker’ is considered by many students to be a socially desirable component of their Facebook identity, perpetuating an online culture that over-represents and normalises binge-drinking (Ridout et al., 2012). Social norms interventions focus on gauging perceived quantity or frequency of alcohol use by others, accurately measuring the actual normative quantity or frequency of alcohol consumed, then dispersing this normative data back to the sampled group. Social norms theory proposes that if true normative feedback is delivered effectively and is well received by the targeted sample, they will be less likely to conform to the false norm, mediating decreases in actual alcohol use. Despite a Cochrane review finding that delivering social norms feedback online is as effective as face-to-face (Moriera et al., 2009), social networking sites have yet to be utilised in social norms interventions. The current study aims to address this gap in the literature by conducting a social norms intervention using Facebook. It is proposed that utilising a social networking site, such as Facebook, to deliver social norms information has a number of advantages over using an external website or regular email. Firstly, it allows feedback to be provided to participants in the form of an ‘inbox’ message that is identical to a message that would be received from a ‘Facebook friend’, and in the environment most often used to digest textual information regarding their peers’ drinking behaviour. It also has the additional benefit of remaining visible whenever the participant uses their Facebook inbox, so that they may refer back to it. Finally, the exponential uptake of smartphone technology means that many students now have access to Facebook on their mobile phones. Given that many young people use Facebook while out socialising, there may be potential for students to be reminded of their personalised social norms feedback while actually in a situation where they are drinking. Main Hypothesis: Participants who receive personalised social norms feedback will report less monthly alcohol consumption (quantity and frequency) at followup, compared to baseline and a control group. METHOD A randomised controlled trial was conducted at an Australian university in 2012. Social norms data regarding perceived alcohol use of their classmates’ and own actual alcohol consumption, as measured by the Graduated-Frequency Measure (GF; Midanik, 1994), was collected via an online survey of a class of 244 undergraduate students (M = 19.05 years, range 17–36, 78% female), 98 of whom were identified by the Alcohol Use Disorders Identification Test (AUDIT, Babor et al., 2001) as reporting potentially hazardous alcohol use and randomly allocated to either the intervention or control group. Participants in the intervention group received social norms feedback one week after completing the initial screening questionnaire, in the form of a Facebook ‘inbox’ message, including statements comparing the participants’ perceptions of classmates’ alcohol use with actual descriptive and injunctive social norms calculated from their classmates’ responses. Figures comparing the participant’s average episodic and weekly alcohol consumption with the median consumption of their classmates who drink were also included. As per World Health Organization recommendations (Babor et al., 2001), the message stated the participant’s AUDIT score, an explanation of associated health risks and information on reducing these risks (see Figure 1). To confirm feedback was read and understood, the message concluded with a hyperlink to a brief online form asking participants to type in the figures regarding their own and their classmates’ alcohol use and approval of heavy drinking. Follow-up assessments were conducted at one and three months, with all participants completing the GF on each occasion. The intervention group received an updated Facebook social norms feedback message one week after completing the one month follow-up and were again asked to confirm they had read and understood via a brief online form. The social norms questions and AUDIT were completed again by all participants at the three month follow-up. RESULTS Prior to any social norms feedback being sent out, checks were carried out to ensure that the intervention and control groups did not differ on any reported demographic or alcohol variables of interest. Three participants failed to complete all surveys and were therefore excluded from analysis. The 95 remaining participants were 80% female and ranged in age from 17-24 years (M = 18.93, SD = 1.223). Data collected on the key outcome variable (GF) was heavily skewed in the positive direction. In order to allow for parametric analysis, a log10 transformation was carried out. Descriptive statistics are based on original values. A repeated measures ANOVA revealed a significant interaction between intervention group and follow-up time on alcohol consumption quantity, F(2,186) = 5.818, p < .01. A Helmert contrast comparing baseline quantity to an average of follow-ups confirmed that, as predicted, the intervention group reduced their monthly drinking quantity at the follow-ups significantly more in comparison to the control group, F(1,93) = 10.446, p < .01 (see Figure 2). A second repeated measures ANOVA revealed there was also a significant interaction between the intervention group and follow-up time on alcohol consumption frequency, F(2,186) = 6.281, p < .01. A Helmert contrast comparing baseline frequency to an average of follow-ups confirmed that, as predicted, the intervention group reduced their monthly drinking frequency at the follow-ups significantly more when compared to the control group, F(1,93) = 10.569, p < .01 (see Figure 3). Figure 4 shows significant changes in accuracy of perceived drinking norms by the intervention group post-intervention, compared to the control group whose perceptions remained largely unchanged.
  • 2. USING FACEBOOK TO DELIVER A SOCIAL NORM INTERVENTION TO REDUCE PROBLEM DRINKING AT UNIVERSITY BRAD RIDOUT, PhD CANDIDATE; Dr ANDREW CAMPBELL, SENIOR LECTURER; THE UNIVERSITY OF SYDNEY Hi Student Thank you for completing the alcohol survey for HSBH1005 recently. Some of the questions you answered come from the Alcohol Use Disorders Identification Test (AUDIT), a questionnaire developed by the World Health Organisation to determine whether a person’s drinking might be becoming problematic. Your AUDIT score was 14. This puts you in the HAZARDOUS range. A person scoring in this range has a high risk of experiencing short-term harm such as blackouts, personal injury, trouble with the law, social embarrassment, and poor academic performance. A person scoring in this range is also at risk of experiencing long-term harms such as road trauma, unplanned pregnancy and sexually transmitted infections, liver disease, certain cancers, and damage to the prefrontal area of the brain responsible for cognitive reasoning and emotional and behavioural regulation. THE BEST WAY TO REDUCE YOUR RISK LEVEL IS TO REDUCE THE NUMBER OF DRINKS YOU CONSUME PER OCCASION. You said that you drink alcohol 2-3 times a week and that you think a typical student in this unit of study drinks 4 or more times a week. Actually, of the students in this unit who drink alcohol, most (84%) do so only 2-4 TIMES A MONTH OR LESS. You said that you have 7 to 9 standard drinks when drinking and that you think a typical student in this unit of study has 7 to 9 standard drinks when drinking. Actually, of the students in this unit who drink alcohol, just over half (51%) have NO MORE THAN 4 standard drinks on a typical day when drinking. You said that you have six or more standard drinks weekly and that you think a typical student in this unit of study has six or more standard drinks weekly. Actually, of the students in this unit who drink alcohol, most (84%) have 6 or more standard drinks ONCE A MONTH OR LESS. Only 2% of students drank as much as you did in the past month. You said that you are neutral regarding other students drinking heavily in public, and that you think most students in your unit of study are neutral regarding other students drinking heavily. Results revealed that only 3% of students in your unit of study approve of other students drinking heavily in public, while more than half (52%) DISAPPROVE. Please confirm that you have read and understood these results by taking a minute to complete the form at the following link: https://www.surveymonkey.com/s/XXXXXXX. You must complete this brief form in order to continue your participation in this study. Many thanks, The Research Team Figure 1. Sample social norms feedback via Facebook message Brad Ridout PhD Candidate Faculty of Health Sciences The University of Sydney PO Box 170, Lidcombe NSW 1825 AUSTRALIA T: +61 2 9036 7129 F: +61 2 9351 4331 brad.ridout@sydney.edu.au Dr Andrew Campbell Senior Lecturer Faculty of Health Sciences The University of Sydney PO Box 170, Lidcombe NSW 1825 AUSTRALIA T: +61 2 9351 9762 F: +61 2 9351 9540 andrew.campbell@sydney.edu.au
  • 3. Perceived norms (1-5 Likert scale) Mean difference from actual norm USING FACEBOOK TO DELIVER A SOCIAL NORM INTERVENTION TO REDUCE PROBLEM DRINKING AT UNIVERSITY BRAD RIDOUT, PhD CANDIDATE; Dr ANDREW CAMPBELL, SENIOR LECTURER; THE UNIVERSITY OF SYDNEY     2 2 2 2 1.8 1.8 1.8 1.8 1.6 1.6 1.6 1.6 1.4 1.4 1.4 1.4 1.2 1.2 1.2 1.2 1 1 1 1 0.8 0.8 0.8 0.8   0.6 0.6 0.6 0.6 0.4 0.4 0.4 0.4   0.2 0.2 0.2 0.2 0 0 0         Baseline 3 month follow-up Baseline 3 month follow-up How often do you think a typical student drinks? How many standard drinks when drinking? Non-significant Interaction: F(1,93) = .45, p > .05 F(1,93) = 9.34, p < .01 Significant Interaction: Intervention Control 0 Baseline 3 month follow-up How often has 6 or more drinks on one occasion? Significant Interaction: F(1,93) = 21.19, p < .001 Baseline 3 month follow-up How do students feel about others drinking in public? Significant Interaction: F(1,93) = 12.03, p < .01 Figure 4. Changes in perceived drinking norms compared to actual drinking norms before and after intervention. and has successfully addressed the limitations of many previous social norms interventions by: - Including a control group - Confirming participants read and understood feedback (first study to do so) - Not conflating the social norms effect by including other intervention strategies (such as alcohol education and further resources). While previous studies have focused on how online social networking content can perpetuate a binge drinking culture (Ridout et al., 2012), these results have implications for the use of Facebook to promote positive messages about safe alcohol use, which may counter the negative messages regarding alcohol normally seen on Facebook. Given the power of peer influence among adolescents, and that heavy drinking at university can escalate into a long-term struggle with alcohol, correcting misperceptions regarding the prevalence and social approval of binge drinking behaviour is an inexpensive and effective strategy that could potentially bring widespread benefit to university populations. Future studies are now needed to validate the current findings with larger and more diverse samples. CONCLUSIONS This is the first study to show Facebook can successfully correct misperceptions of peer drinking norms, resulting in clinically significant reductions in alcohol use. These findings suggest that informing above average drinkers of the actual drinking norms among their proximal peers (those in the same unit of study) and how their perceived norms and own drinking behaviour and compares to these norms, influences a change in drinking behaviour, both in terms of how often they drink alcohol and how many standard drinks they consume on each occasion. This lends support to the increasing body of literature that has found brief online social norms interventions effective in reducing problematic drinking behaviour. Results also suggest that corrections to misperceived norms are lasting, as evidenced by the significant increase in accuracy of norm perceptions at the three month follow-up. Facebook has many advantages over traditional social norms delivery, as discussed above, and given its ubiquitous nature, provides an engaging and innovative method for tackling the challenge of university drinking. Furthermore, this study provides support for the effectiveness of online social norms interventions REFERENCES Anderson, P., de Bruijn, A., Angus, K., Gordon, R., & Hastings, G. (2009). Impact of alcohol advertising and media exposure on adolescent alcohol use: A systematic review of longitudinal studies. Alcohol and Alcoholism, 44, 229–243. Babor, T. F., Higgins-Biddle, J. C., Saunders, J. B., & Monteiro, M. G. (2001). The Alcohol Use Disorders Identification Test, Guidelines for use in primary care (2nd ed.). Geneva, Switzerland: World Health Organization. Lewis, T. F. & Clemens, E. (2008). The influence of social norms on college student alcohol and marijuana use. Journal of College Counselling, 11, 19–31. Midanik, L. T. (1994). Comparing usual quantity/frequency and graduated frequency scales to assess yearly alcohol consumption: Results from the 1990 United States National Alcohol Survey. Addiction, 89, 407–412. Moreira, M. T., Smith, L. A., & Foxcroft, D. (2009). Social norms interventions to reduce alcohol misuse in university or college students (Review). Cochrane Database of Systematic Reviews, 3, CD006748. Ridout, B., Campbell, A., & Ellis, L. (2012). ‘Off your Face(book)’: Alcohol in online social identity construction and its relation to problem drinking in university students. Drug and Alcohol Review, 31, 20–26. Brad Ridout PhD Candidate Faculty of Health Sciences The University of Sydney PO Box 170, Lidcombe NSW 1825 AUSTRALIA T: +61 2 9036 7129 F: +61 2 9351 4331 brad.ridout@sydney.edu.au Dr Andrew Campbell Senior Lecturer Faculty of Health Sciences The University of Sydney PO Box 170, Lidcombe NSW 1825 AUSTRALIA T: +61 2 9351 9762 F: +61 2 9351 9540 andrew.campbell@sydney.edu.au