Remotely Educating Young Women About Alcohol: A Randomized Trial of the PartyWise Intervention

Abstract

Background:

Alcohol and binge drinking pose significant health risks, especially for underage women; nonetheless, binge drinking is common.

Materials and Methods:

To evaluate the effectiveness of the PartyWise intervention in increasing awareness of sex differences in the risks of binge drinking, we used social media to enroll 520 female adolescents aged 15–19 years in a randomized controlled trial. Intervention participants received telephone screening, a brief counseling intervention with web-based resources (http://www.partywise.org), and up to 8 weekly text messages.

Results:

At baseline, most (71%) participants reported alcohol consumption in the prior month and 44% reported binge drinking (four or more drinks on one occasion), without differences between study groups; 79% of participants were aware of sex-based differences in alcohol risks. At follow-up, intervention recipients were more knowledgeable about sex-based differences in alcohol risks (adjusted odds ratio [adj OR] 8.87, 95% confidence interval [CI] 3.35–23.49 at 3 months; adj OR 2.44, 95% CI 1.21–4.90 at 9 months) and more likely to accurately define binge drinking (adj OR 1.63, 95% CI 1.02–2.60 at 3 months; OR 1.37, 95% CI 0.89–2.06 at 9 months). Although rates of any binge drinking in the past month remained similar between groups, intervention recipients were less likely to report binge drinking more than once in the past 30 days (22% vs. 32%, adj OR 0.58, 95% CI 0.35–0.99 at 3 months; 27% vs. 30%, adj OR 0.97, 95% CI 0.60–1.55 at 9 months).

Conclusions:

The PartyWise intervention is a promising approach to increasing awareness of the risks of binge drinking for underage women in a remotely delivered platform. Clinical Trials Registration: The Share Health Study: Teen Social Connections and Health (Phase 2), NCT03842540, https://clinicaltrials.gov/ct2/show/NCT03842540?id=NCT03842540&draw=2&rank=1

Introduction

Underage alcohol consumption is reported by 19% of those younger than 20 years in the United States.¹ Among U.S. high school students, 14% report current binge drinking.² Underage drinking is associated with multiple adverse outcomes, including both short- and long-term health risks.³ In particular, alcohol use during adolescence and young adulthood can compromise brain development and impair decision-making, learning, and impulse control, and increase risky behaviors.⁴

Young women who consume alcohol face additional risks compared with their male counterparts. There are biologic differences in the way male and female bodies process alcohol, which make women more susceptible to liver disease and other injuries with lower levels of drinking.⁵ Women have more frequent alcohol-related backouts (defined as being unable to remember what happened while drinking) compared with men. Notably, blackouts have been associated with later development of alcohol use disorder.⁶ Furthermore, women's use of alcohol has been described as “telescoping,” meaning that young women's drinking intensifies more quickly than that of young men's drinking.^7
–9

Women's alcohol consumption can adversely impact sexual and reproductive health. Intoxication increases risk of unprotected sexual activity,¹⁰ sexually transmitted infections, and undesired pregnancy. Alcohol consumption during pregnancy adversely impacts fetal development.¹¹ Of particular concern for young women, alcohol consumption has been associated with risk for sexual assault,¹² which can pose long-term physical and psychological consequences.

Prior studies of ways to reduce adolescent alcohol consumption have shown that accurate knowledge of alcohol's effects reduces alcohol use.^13,14 Furthermore, multiple studies have found Screening, Brief Intervention, with Referral to Treatment (SBIRT) to be an evidence-based approach to using a single conversation to reduce alcohol consumption.¹⁵ The SBIRT model has been used in a variety of settings including emergency departments, primary care clinics, and health professional education programs and has been found to be effective in changing short-term behavior related to risky alcohol use.^16,17 The American Academy of Pediatrics endorses the use of SBIRT to screen youth for substance abuse.¹⁸ However, best practices for SBIRT with adolescent populations have not been well established.¹⁹

We piloted the feasibility of delivering the PartyWise intervention in eight busy family planning clinics in California and found that the intervention was acceptable to both patients and clinic staff (NCT02791971). Recognizing that adolescents may prefer electronic to clinic-based screening for substance use,²⁰ and that in a previous study a web-based intervention was useful for college students,²¹ in this study, we evaluated the effectiveness of remote delivery of the PartyWise intervention. Specifically, we hypothesized that this intervention would increase young women's awareness of sex-based differences in the effects of alcohol and ability to define binge drinking, and reduce alcohol consumption and binge drinking.

Materials and Methods

We conducted a randomized controlled trial to evaluate the effects of the PartyWise intervention compared with an attention control at 3 and 9 months post-intervention. This study was approved by the University of California, San Francisco Committee for Human Research and registered on ClinicalTrials.gov (NCT03842540) before enrollment of any participants.

Participant recruitment and inclusion

Participants were recruited via social media advertising on Facebook and Instagram. After clicking on the ad, participants were directed to an online study information page where they could read about the survey and click to consent to participate in the study. After consenting, participants were directed to an online eligibility screening survey.

Participants were eligible if they were aged 15–19 years, female, able to speak and read English, using highly effective birth control (i.e., a subdermal implant or intrauterine contraceptive), and living in the District of Columbia or in 1 of the 21 states (Alaska, Arizona, Arkansas, California, Colorado, Georgia, Idaho, Iowa, Kentucky, Maryland, Massachusetts, Minnesota, Montana, New Mexico, New York, North Carolina, Oregon, Tennessee, Virginia, Washington State, and Wyoming) where minors do not require parental consent for sensitive health services.

Eligible individuals provided their contact information and completed an initial health behavior survey. Parental consent was waived for this study. Research assistants attempted to contact consenting individuals who completed this initial survey for up to 4 weeks from the date of initial survey completion. Participants who were reached by phone were randomized using a web-based tool that concealed allocation (1:1) while creating groups of approximately equal size to receive either a single telephone-based SBIRT conversation as part of the PartyWise intervention or an attention control counseling intervention focused on contraception; participants in the attention control group were blinded to the purpose of the PartyWise intervention.

Intervention

Informed by the I-Change model which posits that change occurs in three stages (pre-motivational, motivation, and post-motivational, with the pre-motivational stage dependent on awareness derived from cognizance, knowledge, risk perceptions, and perceived cues),^22,23 the PartyWise intervention included a single telephone conversation during which scripted alcohol screening was performed with a brief counseling intervention that used motivational interviewing with web-based graphics designed to increase adolescent women's awareness of sex differences in the risks of alcohol consumption and reduce the adolescent's alcohol consumption (Supplementary Data S1); when referral to treatment was indicated, participants were directed via http://www.partywise.org to the national helpline operated by the Substance Abuse and Mental Health Services Administration (SAMHSA).

Participants were offered 8 weekly text messages, which included facts about the risks of alcohol consumption with encouragement to revisit the PartyWise website for more information (see page 6 of Supplementary Data S1). The website and handouts used as part of this intervention were developed in partnership with a graphic design and web development team experienced in developing youth friendly resources after review of existing materials available from other sources including those developed by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute on Drug Abuse (NIDA), and the American Academy of Pediatrics.¹⁸

The attention control group included scripted counseling of similar duration, designed to encourage adolescents to discuss their contraceptive experiences with their peers and web-based educational resources, produced by the same graphic design team.²⁴ Field testing of attention control materials informed the look and feel of the PartyWise intervention, which was then piloted in eight busy family planning clinics in California. The script used during the phone-based counseling was equivalent to that field tested but included probes to confirm that participants were able to navigate to the website at the time of the phone call and review the resources available online.

Study procedures

On enrollment, we invited all participants to complete identical online surveys using the Qualtrics platform. Surveys included 60–70 questions (depending on skip patterns) regarding demographic characteristics (11 items), reproductive history (12 items), contraceptive knowledge (17 items), communication with peers and parents (7 items), school-based health curricula (8 items), and personal history of substance use (7 items) using validated items from the Youth Risk Behavior Surveillance System.²⁵ In addition, participants were asked two items developed for the current study “Does alcohol typically affect men and women differently?” (correct answer, “yes”) and “How many drinks can women have on one occasion before a clinician calls it ‘binge drinking?’” (correct answer, “3,” per the NIAAA definition of binge drinking).²⁶

At 3 and 9 months post-intervention, a follow-up survey link was sent to all participants via text and/or email by research assistants who were blinded to participant group allocation. Participants had 4 weeks to complete each survey. Reminders were sent out weekly to participants who had not yet completed a survey. Participants were compensated $25 for each survey they completed. Outcome assessment was conducted in a blinded manner. Sample size was constrained by funding and time available to complete this project. Participants in the control group were blinded to the outcomes of interest, but those receiving the PartyWise intervention were aware of the intervention's goals. Analysis data sets were assembled by linking baseline and follow-up data, using study identifiers, which blinded the analyst to intervention allocation.

We examined the baseline equivalence of the randomly generated study groups with regard to primary language, age, schooling, parental education, race/ethnicity, participation in a class on alcohol, tobacco, or other drugs, and history of substance use, using Pearson chi square tests and Fisher exact tests as appropriate to test the statistical significance of any baseline differences identified between the groups (Supplementary Data S2). After confirming that there were no significant differences (defined as a p < 0.05) in the demographic characteristics of participants who did and did not complete follow-up, we examined the effectiveness of this intervention among participants completing follow-up using chi square tests.

We then fit univariate models separately for each covariate and also fit two multivariable models, including (1) all covariates and (2) a parsimonious model created by stepwise elimination of covariates with a p > 0.10 for each outcome of interest; as these two approaches to multivariable modeling produced similar results, here, we present the fully adjusted models. Covariates included in the models were participants' demographic characteristics (age younger than 18 years vs. older), race/ethnicity (white/non-white), parental education (college/less), currently in school (or not), and baseline knowledge (aware alcohol impacts women and men differently, accurately defines binge drinking for a young woman, ever had a class on alcohol, tobacco, or other drugs) and consumption of alcohol in past 30 days, binge drinking in past 30 days, tobacco use in past 30 days, and ever use of tobacco, marijuana, or other drugs at baseline.

We constructed 10 separate fully adjusted multivariable logistic regression models with the covariates listed above to examine the effects of the PartyWise intervention on 5 outcomes of interest (awareness of sex differences in alcohol's effects, accurate definition of binge drinking for a young woman, alcohol consumption in past 30 days, binge drinking in past 30 days, and binge drinking on more than one occasion in the past 30 days) at 2 time points (3- and 9-month follow-up). In addition, we examined whether outcomes differed for participants who accepted or declined text messages, using multivariable logistic regression to control for differences in the baseline characteristics of those who accepted or declined text messages. All statistical analyses were performed with SAS enterprise guide, Version 7.1 (SAS Institute, Inc., Cary, NC, USA).

Results

Between February 2019 and July 2019, we enrolled 520 participants from 21 states and the District of Columbia (Fig. 1). Half (n = 262) were allocated to receive the PartyWise intervention, whereas the other half (n = 258) formed the control group. At baseline, study groups were similar. The mean and median age of participants was 18 years (standard deviation: 1.0); 89% were students. Most (70%) were white; 13% were Hispanic (Table 1). There were no significant differences between the study groups in age, schooling, parental education, race/ethnicity, or prior participation in a class on alcohol, tobacco, or other drugs.

FIG. 1.

Flow of participants in this randomized trial evaluating the PartyWise intervention.

Table 1.

Sociodemographic Characteristics of Study Participants on Enrollment

	PartyWise (n = 262)		Control (n = 258)		p
	n	%	n	%	p
Age (years)					0.93
15	6	2.3	4	1.5
16	11	4.2	12	4.7
17	40	15.3	38	14.7
18	86	32.8	91	35.3
19	119	45.4	113	43.8
Race/ethnicity					0.30
Hispanic (any race)	36	13.7	29	11.2
White, non-Hispanic	181	69.1	184	71.3
Black or African American, non-Hispanic	2	0.8	8	3.1
Multiracial,^a non-Hispanic	29	11.1	26	10.1
Other,^b non-Hispanic	14	5.3	11	4.3
Parental education					0.17
College education	226	86.3	212	82.2
Less than college educated	35	13.4	46	17.8
Education
Currently in school	235	89.7	227	88.0	0.53
Attending college	153	58.4	145	56.2	0.61
Substance use
Tobacco, ever smoked^c	113	43.3	131	51.0	0.12
Tobacco, in past 30 days^d	41	36.3	37	29.8	0.20
Marijuana, ever	209	79.8	209	81.0	0.88
Other drugs,^e ever	67	25.6	81	31.5	0.30

Participants who selected more than one racial/ethnic category.

Includes Asian, American Indian or Alaska Native, Native Hawaiian or other Pacific Islander.

Have you ever tried cigarette smoking, even one or two puffs?

Of those who had ever smoked (n = 113 and n = 131).

Have you ever used any other drug or substance to “get high”?

Although 90% had participated in a class about alcohol, and 78% were aware of sex differences in alcohol's effects, few (20%) could accurately define binge drinking for a young woman (Table 2). While all participants were under the legal drinking age, most (71%) participants reported alcohol consumption in the prior 30 days, with 43% of participants reporting having had four or more alcoholic drinks on at least one occasion in the past month. Alcohol consumption on more than 15 of the past 30 days was reported by 2.5% of participants, without differences between the groups. Of those who reported any alcohol consumption, 35% reported that when they consumed alcohol, they had an average of four or more alcoholic drinks. Study groups were similar at baseline with regard to the median number of days on which binge drinking occurred: 2 (range 1–16).

Table 2.

Education About, Knowledge, and Use of Alcohol by Underage Women on Enrollment, Before Intervention Delivery

	PartyWise (n = 262)		Control (n = 258)		p
	n	%	n	%	p
Class on alcohol, tobacco, or other drugs	240	91.6	230	89.1	0.28
Aware alcohol impacts women and men differently	214	81.7	193	74.8	0.14
Accurately defines binge drinking^a	52	19.8	53	20.5	0.84
No alcohol on any of the past 30 days^b	80	30.5	71	27.5	0.68
Average number of drinks per day when alcohol was consumed
1	35	19.2	35	18.7	0.25
2	40	22.0	44	23.5
3	50	27.5	36	19.3
4+	57	31.3	72	38.5
Binge drinking^a in past 30 days
0 day	150	57.3	144	55.8	0.44
1 day	43	16.4	37	14.3
2+ days	64	24.4	75	29.1
Missing data	5	1.9	2	0.8

Defined for a young woman as four or more alcoholic drinks on one occasion.

How many days have you had more than a few sips of beer, wine, or any drink containing alcohol?

More than 99% of participants in each study arm received their allocated intervention (Fig. 1). Intervention phone calls averaged 6 (median 5, range 4–14) minutes; duration of contact with participants receiving the attention control intervention was similar. During the PartyWise screening, risky drinking was identified for 37% of participants by combining information on whether in the past year the individual had consumed alcohol on 6 or more days and/or had three or more alcoholic drinks in a single day (screening limited to those reporting having had three or more alcoholic drinks in a single day in the past year identified 34% of participants as at risk).

Of those reporting risky drinking, 93% accepted referral information and 60% opted to receive weekly text messages for the following 8 weeks (detailed on page 6 of Supplementary Data S1). Participants were more likely to agree to receive text messages if they were at least 18 years of age (72% vs. 57% of younger participants, p = 0.05) and their parents had no college education (86% vs. 65%, p = 0.05). At baseline, those who accepted texts had significantly greater awareness that alcohol impacts women and men differently (86% vs. 77%, p = 0.02) and were more likely to be able to accurately define binge drinking for a young woman (25% vs. 12%, p = 0.0005) but were no less likely to have consumed alcohol or had an episode of binge drinking in the prior 30 days.

Follow-up data were collected from 77% of participants at 3 months and 87% of participants at 9 months, without differential follow-up between the study groups (Fig. 1). Between enrollment and follow-up, similar proportions of participants in both study groups reported attending a class on alcohol, tobacco, or other drug use (19% vs. 14%, p = 0.27 at 3-month follow-up; 22% vs. 19%, p = 0.14 at 9-month follow-up). Of participants who completed 9-month follow-up, most (79%) reported that they liked the PartyWise intervention materials. Most (86%) agreed with the statement “I found the information in the handouts helpful,” whereas 75% of participants agreed with the statement that the intervention “handouts helped me think about making healthy choices related to alcohol in my life.”

Both 3 and 9 months after intervention delivery, participants who received the PartyWise intervention were more likely to know that there are sex-based differences in alcohol's effects (Table 3). In addition, participants who received the PartyWise intervention were more likely to accurately define binge drinking for a young woman as four or more alcohol drinks on one occasion (Table 3). Although rates of any binge drinking in the past month remained similar between the groups (Table 3), intervention recipients were less likely to report binge drinking on more than one occasion in the past month (22% vs. 32%, adjusted odds ratio [adj OR] 0.58, 95% confidence interval [CI] 0.35–0.99) at 3-month follow-up; at 9-month follow-up, this trend was no longer statistically significant (27% vs. 30%, adj OR 0.97, 95% CI 0.60–1.55).

Table 3.

Effects of the PartyWise Intervention on Underage Women's Knowledge and Use of Alcohol

	3 Months after intervention					9 Months after intervention
	PartyWise (n = 197), %	Control (n = 202), %	Unadj OR (95% CI)	Adj OR^a (95% CI)	Adj OR^b (95% CI)	PartyWise (n = 222), %	Control (n = 227), %	Unadj OR (95% CI)	Adj OR^a (95% CI)	Adj OR^b (95% CI)
Aware alcohol impacts women and men differently	97.0	81.2	7.38 (3.04–17.89)	8.87 (3.35–23.49)	8.59 (3.31–22.27)	93.7	85.5	2.53 (1.31–4.87)	2.44 (1.21–4.90)	2.30 (1.17–4.51)
Accurately defines binge drinking for a young woman^c	32.5	23.3	1.59 (1.02–2.47)	1.59 (1.01–2.48)	1.59 (1.01–2.48)	34.7	27.8	1.38 (0.93–2.06)	1.37 (0.89–2.06)	1.42 (0.94–2.15)
No alcohol in past 30 days	31.0	25.2	1.29 (0.84–1.98)	1.15 (0.71–1.87)	1.25 (0.81–1.94)	21.2	22.0	1.05 (0.68–1.63)	0.92 (0.57–1.48)	1.37 (0.71–2.66)
No binge drinking in past 30 days^c	57.9	52.0	1.28 (0.86–1.90)	1.26 (0.78–2.02)	1.48 (0.90–2.44)	56.3	55.5	1.10 (0.75–1.60)	0.92 (0.58–1.45)	0.94 (0.58–1.51)
Binge drinking^c more than once in past 30 days	21.8	31.7	0.60 (0.38–0.94)	0.58 (0.35–0.99)	0.64 (0.40–1.00)	26.6	30.0	0.85 (0.56–1.28)	0.97 (0.60–1.55)	0.91 (0.55–1.51)

Multivariable model of effect of PartyWise intervention on row's outcome, adjusted for age, race/ethnicity (dichotomized as white/non-white), parental education, current student, baseline class on alcohol, tobacco, or other drugs, baseline awareness that alcohol impacts women and men differently, and ability to accurately define binge drinking for a young woman, baseline alcohol in past 30 days, baseline binge drinking in past 30 days, tobacco in past 30 days, and ever use of tobacco, marijuana, or other drugs.

Parsimonious models for 3 months: awareness of sex differences adjusted for race/ethnicity and baseline measure; for accurate definition of binge drinking, adjusted for baseline measure; for any drinking, adjusted only for age; for binge drinking, adjusted for baseline measure, age, and being in school; for multiple episodes of binging, adjusted only for ever use of tobacco. Parsimonious models of outcomes at 9 months: awareness of sex differences adjusted only for baseline awareness of sex differences; for binge drinking, adjusted only for baseline accurate definition of binge drinking; for any drinking, adjusted for baseline binge drinking and age; for binge drinking, adjusted only for baseline binge drinking; for multiple episodes of binge drinking, adjusted only for baseline binge drinking.

Defined as four or more alcoholic drinks on one occasion for young women.

Adj OR, adjusted odds ratio; CI, confidence interval; Unadj OR, unadjusted odds ratio.

Among participants who reported any alcohol consumption, we found no significant differences in the number of days on which alcohol was consumed or the average number of drinks per day of drinking (Table 4). However, at 3 months of follow-up, participants who received the PartyWise intervention were more likely to report an average of less than three alcoholic drinks at a time (54% vs. 42%, p = 0.05). At all study time points, alcohol consumption and binge drinking were most frequently reported by participants who reported having used tobacco, alcohol, or marijuana on enrollment (data not shown). We did not find significant differences in the knowledge or alcohol-related behaviors of those who accepted or declined text messaging at 3-month follow-up, after adjusting for differences in baseline characteristics and knowledge.

Table 4.

Frequency and Volume of Alcohol Consumption Among Underage Women Reporting any Alcohol Consumption on Follow-Up After Enrolling in a Randomized Evaluation of the PartyWise Intervention

	3 Months after enrollment					9 Month after enrollment
	PartyWise (n = 136)		Control (n = 151)		p	PartyWise (n = 175)		Control (n = 177)		p
	n	%	n	%		n	%	n	%
Number of days on which alcohol was consumed^a
1	21	15	25	17	0.63	27	15	31	18	0.24
2	29	21	21	14		28	16	25	14
3	14	10	22	15		35	20	23	13
4	19	14	22	15		20	11	20	11
5+	50	37	57	38		58	33	75	42
Missing	3	2	4	3		7	4	3	2
Average number of drinks per day
1	33	24	32	21	0.29	48	27	36	20	0.27
2	41	30	32	21		45	26	51	29
3	30	22	38	25		39	22	40	23
4+	30	22	45	30		36	21	47	27
Missing	2	1	4	3		7	4	3	2
Binge drinking^b in prior 30 days
Any days	79	58	92	61	0.62	88	50	95	54	0.52
0	57	42	59	39		87	50	82	46
1	36	26	28	19		29	13	27	15
2+	43	32	64	42	0.06^c	59	27	68	38	0.36^c

In prior 3 months.

Binge drinking is defined for young women as having four or more alcoholic drinks on one occasion.

p Value comparing those reporting binge drinking on 2+ days in past 30 days versus no more than once, limited to those who reported any drinking. As reported in text, when those reporting no drinking at all are included with those reporting no more than one episode of binge drinking in past 30 days, 78% PartyWise versus 68% control, p = 0.03 at 3-month follow-up.

However, at 9-month follow-up, after adjusting for baseline differences in knowledge, those who accepted the follow-up texts were significantly more likely to be aware that alcohol impacts women and men differently (98% vs. 83%, adj OR 13.32, 95% CI: 2.79–63.49) and to accurately define binge drinking (40% vs. 23%, adj OR 2.07, 95% CI 1.04–4.10). Although rates of any alcohol use in the prior 30 days were similar (76% vs. 77%), those who accepted text messages were less likely to report any binge drinking (adj OR 0.52, 95% CI 0.27–0.99) and binge drinking more than once in the past 30 days (adj OR 0.48, 95% CI 0.23–0.999) after controlling for differences in baseline knowledge, age, and parental education of those who accepted or declined text messages.

Discussion

This randomized trial found that remote delivery of the PartyWise intervention was feasible, acceptable and effectively increased awareness of sex-based differences in the risks of alcohol consumption among underage women. In addition, the 5-minute PartyWise intervention increased participants' ability to accurately define binge drinking for young women and reduced the proportion of participants who reported at 3-month follow-up having engaged in binge drinking on multiple occasions in the past month.

Given the prevalence of binge drinking among adolescents in the United States, the reproductive health risks of binge drinking, and concern that rates of binge drinking among women of reproductive age have been increasing,²⁷ there is a critical need to identify innovative and efficient ways to limit the adverse effects of alcohol. This study builds on a large body of literature supporting the SBIRT model,²⁸ by demonstrating the feasibility of using telephone counseling and web-based educational resources to deliver SBIRT to adolescent women outside clinical settings. Most participants reported that they liked the PartyWise intervention materials and found that the intervention helped them to make healthy choices related to alcohol in their life.

Importantly, this remotely delivered scripted counseling intervention required less than 10 minutes of staff time per participant, and when studied in busy family planning clinics, was found to be acceptable to both clinicians and patients, which may make it a useful adjunct to other busy clinical settings and a cost-effective way to reach adolescents. Previously, a text messaging campaign designed to change perceptions of binge drinking²⁹ among university students in the United Kingdom, that utilized the theory of planned behavior was also found to be effective in changing both attitudes toward binge drinking and rates of binge behaviors. A recent study of young adults found that a mobile app designed to limit escalation of substance use was an acceptable delivery platform³⁰ and further supports the feasibility of delivering interventions to prevent substance use remotely.

Furthermore, the use of SBIRT with adolescents has been found to produce long-term decreases in utilization of emergency department and psychiatric services.³¹ As adolescent drinking has been associated with alcohol dependence and continued alcohol consumption in adulthood,³² and binge drinking before pregnancy has been associated with greater risk for continued alcohol consumption and binge drinking during pregnancy,³³ effective early interventions have considerable potential for impacting population health.

This study has a number of limitations, which require consideration. First, online recruitment using social media resulted in study participants who were largely Caucasian, had college educated parents, and internet access allowing use of social media; results may therefore not be generalizable to all U.S. communities. However, when the PartyWise intervention was piloted with clients recruited from eight family planning clinics, 71% of whom were Latina, it was found to be feasible and acceptable to both clients and staff. Although the current study population included adolescent women from more than 20 different states across the United States, rates of heavy binge drinking were relatively low, which may have reduced our ability to identify significant effects.

In addition, the Trump administrations' decision to eliminate the Office of Adolescent Health which funded this study adversely impacting recruitment for this study and limited the final sample available for analysis, reducing power to examine outcomes at follow-up. As we made multiple comparisons without corrections to prevent type 1 error, we recognize that this remains a possibility. Thus, further evaluations of the durability of the effects of the PartyWise intervention are needed to clarify whether “booster” interventions may extend the impact of this intervention. While offering a promising demonstration of the PartyWise intervention's effects on underage women's knowledge of sex-based differences in the risks of binge drinking, this study relied on participants' self-reported alcohol consumption, which may be subject to both recall and social desirability biases. Nonetheless, this intervention shows promise in improving alcohol-related knowledge and reducing health risks for underage women.

Conclusions

In summary, the findings of this study indicate that using the PartyWise website to support phone delivery of SBIRT to underage women has the potential to improve young women's understanding of the risks of binge drinking. Remote delivery of the PartyWise intervention may be particularly relevant given recent Covid-related requirements for social distancing, which have disrupted school-based curriculum and appear to have increased alcohol consumption in some communities.³⁴ Further evaluations of the effectiveness of this intervention are warranted.

Footnotes

Acknowledgements

We gratefully acknowledge Russell Cole, PhD, for advising us on this project and U.S. District Judge John C. Coughenour whose May 2018 ruling that the Trump administration “failed to articulate a satisfactory explanation for its decision to shorten [our] project period, [saying it exemplified] arbitrary and capricious agency action meriting reversal” allowed completion of this project.

Authors' Contributions

E.B.S. conceptualized and designed the study, designed the data collection instruments, assisted in drafting the initial article, and reviewed and revised the article. B.C. assisted in drafting the initial article, design of the analysis, and reviewed and revised the final article. M.F. conducted data analyses, and reviewed and revised the final article. F.R. and K.T. coordinated and supervised data collection and data cleaning and reviewed and revised the article. D.J.T. advised on the design of data analysis and critically reviewed the article for important intellectual content. M.M. assisted with data analysis and reviewed the article. J.S. assisted with study design, design of data analysis, and critically reviewed the article for important intellectual content.

Disclaimer

The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the Office of Population Affairs or the U.S. Department of Health and Human Services.

Author Disclosure Statement

No competing financial interests exist.

Funding Information

All phases of this study were funded by the U.S. Department of Health and Human Services Award No. TP2AH000045 from the Office of Population Affairs (OPA, formerly the Office of Adolescent Health [OAH]). The U.S. Department of Health and Human Services, Office of Population Affairs had no role in the design and conduct of this study. Dr. Chatterton's effort was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) T32HP30037.

Supplementary Material

Supplementary Data S1

Supplementary Data S2

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