Cross-Tailoring Integrative Alcohol and Risky Sex Feedback for College Students: A Hybrid Type 1 Effectiveness-Implementation Trial

PROJECT SUMMARY/ABSTRACT Alcohol misuse and related risky sexual behavior (RSB) are significant public health concerns among college students. Two-thirds of students are current drinkers, at least 1 in 3 report past month binge drinking (5+ drinks in a row), and 1 in 10 report high intensity drinking (10+ drinks in a row). Greater student alcohol consumption and heavy drinking on a given day is linked to increased sexual activity and RSB (e.g., unprotected sex, sex with casual partners). This puts students at risk for negative health outcomes (e.g., STIs) and is a pathway to sexual victimization and escalated drinking. The first few weeks of college, or the ‘red zone,’ present a critical window of opportunity to intervene for escalated alcohol use and associated risks, which can result in a potentially high public health and clinical impact. However, individual-level prevention strategies for college students tend to focus on students’ alcohol use patterns and consequences more broadly, with little to no integration of content on the relationship between alcohol use and RSB, an important gap in the literature and a priority area for NIAAA. Our team previously established the short-term efficacy of a personalized feedback intervention (PFI), a gold standard intervention approach, with integrated content on alcohol and RSB. We propose to extend our integrated PFI to include a cross-tailored dynamic feedback (CDF) component, which leverages technology to incorporate daily assessments of student behavior and provide users with dynamic weekly feedback over 12 weeks to amplify the effectiveness of the integrated PFI and to be easily implemented on college campuses. The project utilizes a multisite, hybrid type 1 effectiveness-implementation study design to (1) evaluate the impact of CDF for at-risk first-year college students and (2) identify implementation factors critical to its success to facilitate future scale-up in campus settings. The first aim is to conduct a multi-level stakeholder-engaged adaptation of the integrated alcohol and risky sex PFI through the development and inclusion of CDF. The second aim is to conduct a randomized controlled trial (RCT) of the enhanced intervention (PFI+CDF) in a sample of 600 first- year college students who report recent binge drinking and are sexually active. Our primary hypothesis is that participants who receive the PFI+CDF intervention will report less alcohol use, fewer risky sexual behaviors, and fewer consequences relative to those who receive a PFI supplemented with generic health information at follow- up (1, 2, 3, 6, and 13 months). Our third aim seeks to identify factors critical to PFI+CDF implementation in campus settings through conducting focus groups with a subset of students from the RCT and with local and national systems-level stakeholders. The intervention has strong potential for widespread dissemination and targets a group at high risk for alcohol misuse and RSB.