Examining Emailed Feedback as Boosters After a College Drinking Intervention Among Fraternities and Sororities: Rationale and Protocol for a Remote Controlled Trial (Project Greek)

Background College students involved in Greek life (ie, members of fraternities and sororities) tend to engage in more high-risk alcohol use and experience more negative consequences than those not involved in Greek life. Web-based alcohol interventions, such as Alcohol eCHECKUP TO GO, have been successful in reducing alcohol use and consequences among the general college student population, but interventions targeting alcohol reduction among those involved in Greek life have had limited success. Booster emails including personalized feedback regarding descriptive norms and protective behavioral strategies have shown potential in increasing the effectiveness of web-based interventions among college drinkers. Studies are needed to determine the efficacy of these boosters among those involved in Greek life. Objective The primary objective of this study is to assess the efficacy of booster emails sent to Greek life students who complete Alcohol eCHECKUP TO GO. Specifically, we expect that participants who receive the booster emails will reduce their alcohol consumption and related problems (primary aim 1), reduce perceived peer drinking, and increase the number of protective behavioral strategies they use over time (primary aim 2) relative to those who do not receive boosters. Contingent upon finding the emailed booster efficacious and sufficient enrollment of members from each organization, an exploratory aim is to examine social mechanisms of change (ie, through selection vs socialization). Methods This study is a remote, controlled intervention trial following participants for up to 6 months. Participants must be aged at least 18 years, undergraduate students, and members of a participating fraternity or sorority. Eligible participants complete a web-based baseline survey to assess their alcohol consumption behaviors and beliefs, including norms and protective behavioral strategies, and information about their social networks. After completing the baseline survey, they participate in the web-based intervention. Follow-up surveys are sent 1, 3, and 6 months after the intervention. Those in the booster condition also receive emails containing personalized feedback at 2 weeks and 14 weeks after the intervention. Latent growth models and R-Simulation Investigation for Empirical Network Analysis will be used to analyze the data. Results As of September 2022, we have enrolled 18 participants from 2 fraternities and 2 sororities, and they have completed the baseline survey. Overall, 72% (13/18) of participants have completed the 1-month follow-up. Enrollment will continue through December 2022. Conclusions This study aims to examine the effectiveness of personalized feedback booster emails sent after an alcohol intervention among members of college Greek life. A secondary, exploratory aim is to provide information about social mechanisms of change (if possible). The current methodology targets whole network recruitment, with chapter presidents serving as gatekeepers and facilitators. Unique challenges of recruiting whole networks and working with campus administrators are discussed. Trial Registration ClinicalTrials.gov NCT05107284; https://clinicaltrials.gov/ct2/show/NCT05107284 International Registered Report Identifier (IRRID) DERR1-10.2196/42535

AA-2 BRAITMAN, A The booster is low-cost and easy to disseminate, thus implementable on a large scale. Consequently, the public health impact may be far-reaching. This K01 application proposes to refine a recently-developed (by the applicant) email booster program for a brief online alcohol use prevention intervention for young adult college students. Training goals include furthering expertise in emerging adult alcohol use and evaluation of booster sessions and to train in social network analysis. The applicant is promising with a clear program of research and the mentoring team is very good.
The applicant was responsive to most of the critiques. Most notably, the mentoring team now includes an expert on social network analyses, and the social network analysis section of the training plan and the research study is now more well-developed.
There are a few lingering concerns regarding further development of SNA analysis and greater explanation given to the *new* benefits of this training plan, but otherwise this is a very good application and much improved.

Strengths
Solid publication record with 13 pubs, several first authored and in her line of research.
Applicant has an F32 postdoctoral award from NIAAA.

Strengths
The applicant's training plan is detailed and feasible.
The training (including new training opportunities added in this revision) in social network analysis is a strength.

Weaknesses
The applicant somewhat clarified what new skills would be learned from the first goal of training in young adult alcohol use (by stating that she would learn about mobile technology and tracking of alcohol use), but that new skill is not well-integrated into the research plan and into her future career trajectory.

Strengths
Booster sessions as supplements to online interventions have the promise of bridging the gap in effect sizes from online and in-person interventions.
Social network analyses of *how* online interventions and boosters work (through socialization and selection effects within networks) is novel and is now better developed.
The two adjustments to the booster sessions (personalized booster contact and timing of boosters) that will be tested are now clearly justified based on the literature.
Research plan follows clearly from applicant's program of research.

Weaknesses
It is stated that study 3 will examine the impact of delivery of the intervention and booster sessions to a social network (fraternities and sororities) on intervention efficacy. BUT, Study 3 examines an intervention (with or without booster) delivered to students recruited through fraternities and sororities. All subjects get the intervention. Thus, it is unclear how this study can test whether the intervention is more effective being delivered within social networks vs. to individuals since there was not random assignment of delivery of the intervention.
The section on SNA analyses is much improved, but it still is a bit underdeveloped. For example, the analysis section did not detail how it would treat socialization effects for participants who had many friends who did the intervention vs. those who only had a few friends (or, for example, sorority members) who consented to participate in the intervention.

Strengths
Primary sponsor is now Carey, who has expertise in booster sessions.
Second sponsor Kelly has expertise in youth drinking and harm reduction and in interventions and is PI on one R01 through NIDA.
Added a mentor in SNA analyses.

Weaknesses
Given that Dr. Kelly was the mentor for the applicant's F32 fellowship, the applicant changed the primary sponsor to be Carey. That makes sense, but it would be good to outline the novel training opportunities that Carey would provide in a bit more detail.

Weaknesses
None noted.

Protections for Human Subjects:
Acceptable Risks and Adequate Protections Data and Safety Monitoring Plan (Applicable for Clinical Trials Only): AA-2 BRAITMAN, A

Inclusion of Women, Minorities and Children:
G1A -Both Genders, Acceptable M1A -Minority and Non-minority, Acceptable

Training in the Responsible Conduct of Research:
Acceptable Comments on Format (Required): Good-a mix of workshops at ODU and at conferences and meetings with sponsors.

Comments on Subject Matter (Required):
Subject matter stated-a wide range.
Comments on Faculty Participation (Required; not applicable for mid-and senior-career awards):

Comments on Duration (Required):
Throughout the award.

Comments on Frequency (Required):
Frequency of workshops is now stated.

Resource Sharing Plans:
Acceptable Budget and Period of Support: This K01 application proposes to expand the applicant's ability to become an independent researcher through examining various aspects of harm reduction for college student drinking. The proposed project is of value given the deteriorating effects of alcohol prevention/intervention initiatives for college students and the increased emphasis on computer based interventions even though in person interventions tend to outperform computer interventions. Thus, the research proposed attempts to bridge the gap that exists between these two interventions bu studying booster sessions and eventually the involvement of social networks. The training plan is solid and the mentoring team is strong 1 K01 AA023849-01A1 6 AA-2 BRAITMAN, A especially given the addition of a social network expert. The applicant has demonstrated strong promise to develop into an independent researcher. The only main concern that still exists is the limited exposure the applicant has had outside to research training outside of her doctoral training program and postdoc (all at ODU). Thus, her training has appears to be vary narrowed with this limited exposure.

Strengths
The applicant has an impressive publication history which shows promise of further development as an independent researcher.
The applicant has received a NIAAA F 32.

Strengths
The applicant's plan is feasible and details the development of scientific ability.
The coursework and interactions with mentors are strong.

Weaknesses
It remains unclear how new skills will be developed through the first 2 goals and how this differentiates from the F 32. A great

Strengths
The research plan is consistent with the applicant's research focus.
It is important to better appreciate the value or lack of for booster sessions.
Helping to understand the role of personal contact is very important.

Strengths
The mentoring team is strong with varied expertise and mentoring experience.
The mentoring team was reorganized and additional expertise was added. This revised application by a highly qualified and promising applicant is very responsive to feedback from reviewers. The applicant has modified her mentoring team to include an expert on social network analysis and has redistributed the role of mentors to allow for novel mentoring experiences with an offsite mentor. She has strengthened her research plan and provided greater details on key training components. Overall, this is a strong application.

Strengths
As before, an excellent candidate with a strong background in alcohol research.
Prior recipient of a NIAAA F32.
A couple of new pubs since last submission.

Weaknesses
The prior submission listed 3 first authored papers under review but it is not indicated whether these are in press/under revision etc.

Research Plan:
Strengths 3 aims: to bridge gap between online and in-person interventions; timing of booster delivery (2-14 wks.); role of social networks in booster efficacy. Aims are much tighter in this revised version and more compelling.
Major concern #1 on last submission was that evidence for effectiveness of booster was limited, except in applicant's work. This is partially addressed by detailing differences in the applicant's work relative to other research.
Major concern #2 was lack of research on delivery of intervention via social networks which is problematic in the absence of random assignment of participants. Cluster-randomization is proposed.
Major concern #3 was lack of details on the SNA. This has been carefully addressed (e.g. use of SAOMs).

Weaknesses
A minor concern is the proposal to develop a competitive R01 in year 5. Given the current likelihoods of success with R01 submissions, relegating R01 submission to year 5 appears shortsighted.