Put Down That Beer and Pick Up Your Phone
Nudging offers a promising way to talk to college students about alcohol.
Posted Oct 10, 2017
Watch any movie about college students, from Animal House to Neighbors, and you get the sense that they drink a lot. But unlike many of the ways that Hollywood exaggerates for effect, in this respect, they’re not that far from the truth. National studies of undergraduates at four-year colleges and universities consistently find that about half of these students binge drink, with up to a quarter doing so on a regular basis. Binge drinking poses a litany of risks both short-term (e.g., alcohol poisoning, aggression, drunk driving) and long-term (e.g., academic challenges, withdrawal from college, health impairment). It’s no wonder there are hundreds of studies trying to reduce college students’ drinking, most with little long-term success.
I’ve written here previously about how behavioral science and text messaging can help students navigate challenges they face in college, from seeking help with studying to battling food insecurity. But having published extensively on college students’ drinking motives and behavior, I’ve recently been thinking about whether behavioral science could have a similar impact on preventing alcohol abuse. Go to any college party, and you’re more likely to see students with their hands all over their phones rather than each other. And, in fact, studies are emerging that using ecological momentary intervention, a method that leverages young adults’ infatuation with their phones, to get through to them about alcohol use and make positive changes in their drinking behavior.
An early example comes from the University of Pittsburgh Medical Center (UPMC). Researchers there recruited 765 young adults, ages 18 to 25, who visited the UPMC emergency room for reasons unrelated to alcohol but who did report past hazardous drinking. Participants in the intervention were paid up to $100 to receive a text message every Thursday for 12 weeks asking them about their drinking plans for the weekend. If they indicated a desire to drink and committed to a plan to limit their drinking, they received tailored feedback to help them achieve that goal. On average, people receiving these text messages were 25 percent less likely to binge drink over those three months than people in the control group.
Inspired by this work, a group at the University of Otago in New Zealand designed a text message intervention targeting Orientation Week, the time when new students live on campus before classes begin and have copious opportunity to consume alcohol. One-hundred-and-thirty freshmen participated for the chance to win a new tablet. Students received one text message at 7:30 p.m. on each night of Orientation Week with a warning about either social (e.g., “Drinking too much can turn you into a burden for your mates”) or health consequences (e.g., “Long-term drinking can increase the risk of a stroke”) of drinking. Men were not swayed by this intervention, but women who received these messages consumed an average of 9 fewer drinks during Orientation Week. Further inquiry suggested that the social consequences of drinking, which are immediate and easy to imagine, were more effective in changing women’s habits than the long-term health risks.
Now one of the great challenges of any intervention, be it to reduce drinking, increase recycling, or anything else, is for it to continue to have an impact after the intervention has ceased. This kind of long-term change is a core component of “wise interventions,” which seek to influence the psychology underlying people’s actions so that shifts in their behavior stick. The evidence suggests that these texting interventions are, indeed, wise. Young adults who received text messages from UPMC about alcohol use were still 25 percent less likely to binge drink than control participants six months after the intervention ended. And female college students who received texts during Orientation Week at the University of Otago drank an average of two-and-a-half fewer drinks per weekend throughout their first semester. It’s been suggested that interventions such as these continue to influence drinking patterns by altering how students think about alcohol, increasing both their readiness and intention to reduce how much they drink.
When using text messaging to intervene with college students, whether to reduce binge drinking, encourage studying, or completion of the FAFSA, what can be learned here? One important lesson is to think about timing. Researchers targeted Orientation Week at the University of Otago, a high-risk period that likely sets the stage for students’ drinking throughout their first year. Nudges were also timely in that they were sent each night at 7:30 pm, typically right when drinking is about to begin. These decisions likely had a strong impact on the effectiveness of this intervention. What these nudges say is also important, with an advantage toward content that addresses the here and now. Most college students (like most people) are present-oriented, and a focus on short-term gains and costs can be much more persuasive than anything far off in the future. These studies demonstrate the utility of a focus on the present: At UPMC, messages attempted to restrain alcohol use this coming weekend, with no mention of long-term changes; and at the University of Otago, female students appeared to be more sensitive to the immediate risks of binge drinking, such as embarrassing yourself in front of your “mates,” rather than any long-term consequences.
These studies also hint at some of the challenges inherent in text-based interventions. Without the ability to offer incentives for participation, the reach of a text-messaging campaign may be limited. One effective strategy is to employ an opt-out system in which all students receive texts automatically; in my own work, this can keep upwards of 80 percent of students receiving texts for at least one semester. Second, any intervention will not be homogeneously successful across student groups, such as the University of Otago program that failed to change men’s alcohol use. Focus groups, interviews, and pilot testing are all ways to refine an intervention for the students you serve at your institution. Finally, the best interventions turn brief contact with students into long-term changes, but that is easier said than done. Nudges that alter how students see themselves or interpret their environment, rather than just compel a behavioral response that they may not repeat, are key to achieving this goal, but crafting effective messages requires thoughtful consideration of the relevant behavioral science.
Text-messaging interventions offer a promising avenue to connect with a wide swath of college students and change how they think about alcohol. Is this an approach you’re seeing or considering at your institution? What kinds of student behaviors would you want to address using behavioral nudging?
Mason, M., Benotsch, E. G., Way, T., Kim, H., & Snipes, D. (2014). Text messaging to increase readiness to change alcohol use in college students. The Journal of Primary Prevention, 35, 47-52.
Riordan, B. C., Conner, T. S., Flett, J. A. M., & Scarf, D. (2015). A brief Orientation Week ecological momentary intervention to reduce university alcohol consumption. Journal of Studies on Alcohol and Drugs, 76, 525-529.
Suffoletto, B., Kristan, J., Chung, T., Jeong, K., Fabio, A., Monti, P., & Clark, D. B. (2015). An interactive text message intervention to reduce binge drinking in young adults: A randomized controlled trial with 9-month outcomes. PLoS One, 10, e0142877. Available from http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0142877
Wechsler, H., Lee, J. E., Kuo, M., Seibring, M., Nelson, T. F., & Lee, H. (2002). Trends in college binge drinking during a period of increased prevention efforts: Findings from 4 Harvard School of Public Health college alcohol survey studies: 1993-2001. Journal of American College Health, 50(5), 203-217.