Folkhälsomyndigheten har på regeringens uppdrag utlyst medel till tre projekt med syfte att förebygga ANDT-bruk, främja psykisk hälsa och social inkludering hos unga vuxna i migration som är 18-29 år. Till projekten kopplades ett uppdrag som följeforskare. Denna slutrapport har sammanställts av följeforskaren. Inledningsvis beskrivs projektens mål och organisation. Därefter presenteras resultat från följeforskarens arbete, en avgränsad litteraturöversyn, en processutvärdering, en mål-resultatutvärdering, och en enkätundersökning, som tillsammans syftar till att belysa projektens innehåll, utveckling och resultat. Rapporten avslutas med en sammanfattning som behandlar projektens tillgångar respektive begränsningar och en diskussion som fokuserar på formen för utvecklingsmedel.

Samtliga av de tre projekten har genomfört vad man förutsatt i ansökan om projektmedel. Projektet Hälsofrämjarna har genomförts av Vuxenutbildningen i Kramfors kommun. Här har fyra hälsomoduler utvecklats och sedan implementerats i undervisningen i svenska för invandrare (SFI). Projektet Främja Hälsa Ung har genomförts av Rädda Barnen och Region Jämtland Härjedalen. I projektet har individer med språklig och kulturell kompetens rekryterats och utbildats för att genom gruppmöten främja målgruppens hälsokompetens. Projektet TB for YOU har genomförts av föreningen Tegelbruket i Örebro. I projektet har verksamhetens ungdomscoacher identifierat och erbjudit målgruppen den egna verksamhetens program inom kultur, bildning och idrott.

Samtliga program uppvisar såväl positiva som negativa tendenser. Resultat från följeforskarens enkätundersökning visar att de unga vuxna i migration som medverkat i projekten har betydande behov av förebyggande insatser. I jämförelse med nationella referensdata visade det sig att studiedeltagarna var särskilt utsatta vad avser sociala relationer. Allvarlig psykisk ohälsa i form av depression och suicidförsök var också vanligt förekommande. Alkohol och droganvändande var dock inte särskilt omfattande. Projekten har utvecklats i olika utsträckning under projekttiden, vilket sannolikt kan härledas till såväl interna som externa faktorer. Enkätundersökningen och effektutvärderingen har metodologiska tillkortakommanden som framförallt avser begränsade populationer och låga uppföljningsfrekvenser. Effektutvärderingen har till följd av den begränsade populationen inte kunnat identifiera några statistiskt säkerställda resultat. De tendenser som presenteras ska tolkas med försiktighet.

Unga vuxna i migration är inte en homogen grupp. Rapportens innehåll understryker behovet av att utveckla förebyggande program som kan nå målgruppen på så många tillgängliga sätt som möjligt. Förhoppningen är att många låter sig inspireras av de projekt som beskrivs i denna rapport. 

New technologies have previously been used to deliver alcohol interventions to university students. In this study automated interventions delivered by Interactive Voice Response (IVR) are compared to automated interventions delivered over the Internet (WEB). A total of 2 825 Swedish university students responded to a web-survey assessing risky alcohol consumption using the Alcohol Use Disorders Identification Test (AUDIT). A total of 1 423 (50%) had a risky alcohol consumption and were randomized to one out of four different intervention conditions: a single IVR or WEB intervention given one week after baseline, a repeated IVR or WEB intervention given one and two weeks after intervention, or to an untreated control group. Each intervention was really short including less than 500 words, giving a brief feedback on the baseline assessment and instructions on how obtain a Blood Alcohol Concentration (BAC) below 0,06 percentage. Follow-up of intervention results were assessed six weeks after the baseline assessment. At follow- up all intervention groups had significantly reduced their AUDIT scores in comparison to the control group. The reduction in AUDIT scores did not differ between IVR and WEB interventions, and there was no difference between single and repeated interventions. This study indicates that IVR and WEB interventions are equally effective in delivering brief alcohol interventions to university students, and that there is no additional effect by repeating the intervention.

New technologies have previously been used to deliver alcohol interventions to university students. In this study automated interventions delivered by Interactive Voice Response (IVR) are compared to automated interventions delivered over the Internet (WEB). A total of 2 825 Swedish university students responded to a web-survey assessing risky alcohol consumption using the Alcohol Use Disorders Identification Test (AUDIT). A total of 1 423 (50%) had a risky alcohol consumption and were randomized to one out of four different intervention conditions: a single IVR or WEB intervention given one week after baseline; a repeated IVR or WEB intervention given one and two weeks after intervention, or to an untreated control group. Each intervention was really short including less than 500 words, giving a brief feedback on the baseline assessment and instructions on how obtain a Blood Alcohol Concentration (BAC) below 0,06 percentage. Follow-up of intervention results were assessed six weeks after the baseline assessment. At follow-up all intervention groups had significantly reduced their AUDIT scores in comparison to the control group. The reduction in AUDIT scores did not differ between IVR and WEB interventions, and there was no difference between single and repeated interventions. This study indicates that IVR and WEB interventions are equally effective in delivering brief alcohol interventions to university students, and that there is no additional effect by repeating the intervention.

This study evaluated automated techniques including personalized normative feedback and protective behavioral strategies, for brief interventions intended to reduce peak alcohol concentrations in university students. After completing baseline assessment, a total of 1,678 hazardous-drinking consumers were randomized to a single or a repeated Internet (WEB) or Interactive Voice Response (IVR) intervention, or to a control group (Single WEB: 323; Single IVR: 329; Repeated WEB: 318; Repeated IVR: 334; Control group: 374). At follow-up, six weeks after baseline, questionnaires were returned by 1,422 participants (Single WEB: 277; Single IVR: 286; Repeated WEB: 259; Repeated IVR: 279; Control group: 321). It was found that peak estimated BAC was reduced in the total group (b -0.14, 95% confidence interval (CI) -0.023; -0.005), in the total (b -0.17, 95% CI -0.027; -0.007) and single (b -0.021, 95% CI -0.032; -0.011) WEB group, and in the total (b -0.011, 95% CI -0.021; -0.015) and repeated (b -0.012, 95% CI -0.023; -0.000) IVR groups, compared to controls. The reduction in peak estimated BAC was greater in the single WEB group compared to the single IVR group (b -0.011, 95% CI -0.022; -0.000). This study concluded that both WEB and IVR interventions have a small but significant effect in reducing heavy episodic drinking, which may be due to the relatively large sample size. Repeated intervention may be needed if delivered by IVR.

Introduction: This study replicates two US intervention studies using personalized normative feedback (PNF) on alcohol-related risky sexual behavior (RSB).

Methods: In a randomized controlled trial, 654 Swedish university students were assigned to an alcohol only intervention, an alcohol-related RSB only intervention, a combined alcohol and alcohol-related RSB intervention, an integrated alcohol and alcohol-related RSB intervention, or control. Follow-up assessments were made at 3 and 6 months post-intervention.

Results: In comparison to controls, drinks per week were reduced at 3 months in the Alcohol Only, Combined, and Integrated intervention groups. Frequency and quantity of drinking before sex were reduced at 3- and 6-month follow-up for the Sex Only, Combined, and Integrated intervention groups. The Alcohol Only intervention showed significant results on frequency of drinking before sex at 3 months, and on quantity of drinking before sex at 6 months. The Combined intervention had reduced outcomes on alcohol-related consequences and on alcohol-related sexual consequences at both follow-ups. Alcohol Only and Integrated interventions showed effects on both outcomes regarding consequences at 6 months, and the Sex Only group showed effects on sexual consequences at 6 months.

Conclusions: It is concluded that PNF interventions offer considerable positive effects, and could be used to reduce alcohol-related RSB in Swedish university students.

Background: Problematic alcohol use in Sweden occurs among 16 % of the adult population. Digital interventions of varying intensity have shown positive effects in contributing to reductions in problematic use, and the TeleCoach app has shown positive effects in non-treatment-seeking university students with excessive drinking (Gajecki et al., 2017). This pilot study evaluates the app among adult internet help-seekers. This pilot study evaluated the app among adult internet help-seekers, and motivated continued data collection in the current target group Methods: Adult internet-help seekers, recruited via advertisement, were included if they scored ³6 (women) or ³8 (men) on the Alcohol Use Disorders Identification Test (AUDIT). Those with depression scores of ³31 on the Montgomery Åsberg Depression Rating Scale (MADRS-S) or problematic drug use scores of ³8 on the Drug Use Disorders Identification Test (DUDIT) were contacted for a telephone interview and included following clinical assessment; if not reached they were excluded. Participants randomized at a 1:1 ratio to the TeleCoach™ web-based app or to a web-based app with information texts from primary care-based self-help material for changing problematic alcohol use. At six-week follow-up, the primary outcome was the number of standard drinks per past week (Timeline-Followback). Results: Of 147 persons assessed for eligibility, 89 were assigned to the intervention group (n=42) or control group (n=47). Average AUDIT levels at baseline were ³18.The baseline number of standard drinks per week was 32.73 (SD 21.16) for the intervention group, and 26 (4.08) for the control group; at 6-week follow-up it was 12.73 (10.52) and 13.48 (11.13) for the intervention and control groups, respectively. No significant between-groups effects occurred, but withingroup changes over time were significant (F(1, 55)=43.98; p< 0.000), with an effect size of 1.37 for the intervention group and 0.92 for the control group. Conclusions: The results suggest that web-based apps can be of help to internet help-seekers motivated to reduce problematic alcohol use. We have proceeded with the planned larger randomized, controlled study and will present 6-week follow-up data for the entire study sample (n=∼1000) in this presentation.

Konsultationsteamet är en verksamhet i Malmö vars syfte är att ge stöd till personer som vill lämna ett kriminellt liv och/eller gängtillhörighet och/eller som lever under allvarliga hot. De individer vars ärenden aktualiseras har antingen inte polisanmälts eller avser ärenden där en tidigare polisanmälan är nedlagd. I aktuell utvärdering ges en beskrivning av verksamhetens uppkomst, utveckling och innehåll. Utifrån tillgänglig dokumentation analyseras verksamhetens resultat och som sedan relateras till verksamhetens mål. Som del av utvärderingen har en Workshop genomförts för att formulera syfte och mål för Konsultationsteamet, identifiera kritiska faktorer för resultat samt att skapa en åtgärdslista för att komma vidare i konkret målarbete. Avslutningsvis föreslås en modell för hur verksamheten ska utvärderas i framtiden. Utvärderingens resultat visar att av de individer som Konsultationsteamet har haft kontakt med sedan verksamhetens start och fram till och med 2014 har drygt 60 % inte erhållit en ny påföljd samt att 56 % varken förekommer i polisens påföljds- eller misstankeregister. Viktiga resultat är även att Konsultationsteamet har skapat en åtgärdslista för att komma vidare i konkret målarbete samt att ett konkret förslag för systematisk och kontinuerlig uppföljning har utvecklats. Utvärderingens slutsats är att Konsultationsteamet bedriver och kontinuerligt utvecklar en viktig verksamhet och som genererar ett relativt bra resultat, samt att föreliggande dokumentation sannolikt har betydelse för såväl Konsultationsteamet eget utvecklingsarbete som för det nationella utvecklingsarbete som genomförs på området.

Background: Alcohol-related sexual consequences are common in college students. A newly developed 41-item Alcohol-Related Sexual Consequences Scale has recently been evaluated in at-risk young adults in the U.S. The current study aims to validate the Scale in Swedish college students. Methods: The occurrence of alcohol-related sexual consequences was assessed by birth gender, relationship status, gender identity/sexual orientation, and age. Negative binomial regression was used to assess convergent and divergent validity. Results: On average, 5.4 (SD 5.1) alcohol-related sexual consequences were experienced past three months. Greater scores were reported in singles, LGBTQ (Lesbian, Gay, Bisexual, Transgender, Queer/Questioning), and younger students. All sex-related covariates showed robust associations with alcohol-related sexual consequences while most alcohol-related covariates were not associated (e.g., convergent validity). All alcohol-related covariates showed robust associations with alcohol consequences while most sex-related covariates were not associated (e.g., divergent validity). In the full model predicting alcohol-related sexual consequences, being a woman, single, and younger were identified as independent predictors. Conclusions: This newly developed scale assessing alcohol-related sexual consequences could be used in both epidemiological studies and intervention studies targeting at-risk students.

Objectives This study evaluates whether initiation rates, completion rates, response patterns and prevalence of psychiatric conditions differ by level of personal integrity information given to prospective participants in an online mental health self-report survey. Methods A three-arm, parallel-group, single-blind experiment was conducted among students from two Swedish universities. Consenting participants following e-mail invitation answered the World Health Organization (WHO) World Mental Health-International College Student (WMH-ICS) mental health self-report survey, screening for eight psychiatric conditions. Random allocation meant consenting to respond (1) anonymously; (2) confidentially, or (3) confidentially, where the respondent also gave consent for collection of register data. Results No evidence was found for overall between-group differences with respect to (1) pressing a hyperlink to the survey in the invitation email; and (2) abandoning the questionnaire before completion. However, participation consent and self-reported depression were in the direction of higher levels for the anonymous group compared to the two confidential groups. Conclusions Consent to participate is marginally affected by different levels of personal integrity information. Current standard participant information procedures may not engage participants to read the information thoroughly, and online self-report mental health surveys may reduce stigma and thus be less subject to social desirability bias.

Objective: During the COVID pandemic, government authorities worldwide have tried to limit the spread of the virus. Sweden's distinctive feature was the use of voluntary public health recommendations. Few studies have evaluated the effectiveness of this strategy. Based on data collected in the spring of 2020, this study explored associations between compliance with recommendations and observed symptoms of contagion in others, using self-report data from university students.

Results: Compliance with recommendations ranged between 69.7 and 95.7 percent. Observations of moderate symptoms of contagion in "Someone else I have had contact with" and "Another person" were markedly associated with reported self-quarantine, which is the most restrictive recommendation, complied with by 81.2% of participants. Uncertainty regarding the incidence and severity of contagion in cohabitants was markedly associated with the recommendation to avoid public transportation, a recommendation being followed by 69.7%. It is concluded that students largely followed the voluntary recommendations implemented in Sweden, suggesting that coercive measures were not necessary. Compliance with recommendations were associated with the symptoms students saw in others, and with the perceived risk of contagion in the student's immediate vicinity. It is recommended that voluntary recommendations should stress personal relevance, and that close relatives are at risk.

OBJECTIVE: The present study investigates if symptoms of COVID-19 contagion in different social contexts (cohabitants, family, acquaintances, and others) are associated with university students' own self-reported symptoms of COVID-19 contagion, mental health, and study capacity. This was investigated by a cross-sectional survey administrated in Sweden during the first wave of the COVID-19 pandemic, at the time when universities were locked down to limit viral spread and contagion.

RESULTS: Mild to moderate symptoms of COVID-19 in cohabitants and family members were associated with student's self-reported symptoms of contagion, while no associations could be seen in relation to mental health and study capacity. Symptoms of COVID-19 contagion in acquaintances and others were not associated with students' self-reported symptoms, nor with their mental health and study capacity. To conclude, during the initial lockdown of universities students' self-reported symptoms of contagion were mainly associated with cohabitants and family members, while symptoms of contagion in different social contexts were not associated with mental health and study capacity. Findings suggest that lockdown of universities may have contributed to limiting infection pathways, while still allowing students to focus on their studies despite significant contagion among others known to the student.

Objective: To investigate perceived changes in academic self-efficacy associated with self-reported symptoms of COVID-19, changes in mental health, and trust in universities’ management of the pandemic and transition to remote education during lockdown of Swedish universities in the spring of 2020. Methods: 4495 participated and 3638 responded to self-efficacy questions. Associations were investigated using multinomial regression. Results: Most students reported self-experienced effects on self-efficacy. Lowered self-efficacy was associated with symptoms of contagion, perceived worsening of mental health and low trust in universities’ capacity to successfully manage the lockdown and transition to emergency remote education. Increased self-efficacy was associated with better perceived mental health and high trust in universities. Conclusion: The initial phase of the pandemic was associated with a larger proportion of students reporting self-experienced negative effects on academic self-efficacy. Since self-efficacy is a predictor of academic performance, it is likely that students’ academic performance will be adversely affected. 

Trots att vi vet att problematiskt spelbeteende ofta utvecklas ofta i yngre vuxenålder, saknas kunskap om faktorer som i åldersgruppen predicerar spelproblem och spelberoende.

This observational study sought to improve our understanding of factors that contribute to risky sexual behavior among women seeking treatment for alcohol and other substance use disorders. Women were recruited at the start of outpatient (n=236) or inpatient (n=166) treatment. At intake, a Timeline Follow-back interview was used to obtain retrospective reports of daily drinking, drug use, and sexual behavior for a 90-day pre-treatment baseline period. Additional interview and questionnaire measures also were obtained. Measures were re- administered at four 90-day follow-up interviews. Among women who reported sex with a primary partner during baseline (n=261), 15% reported consistent condom use for all events with this partner, whereas 80% reported no condom use with this partner. Among women who reported sex with a non-primary partner (n=159; doesn’t include commercial sex trading), 26% reported consistent condom use and 45% reported no condom use with such partners. Significant correlates of non-use of condoms included negative beliefs and attitudes and low self-efficacy regarding condom use and AIDS prevention, as well as psychological distress, sexual impulsiveness and sensation seeking, history of severe assault by a male partner, and (with primary partners) negative partner attitudes toward condom use. Some of these correlates also predicted unprotected sex with a primary partner during the first 90 days after treatment entry, after controlling for baseline. However, unsafe sex with a non-primary partner during follow-up was most notably associated with follow-up levels of substance use, i.e., more drinks per drinking day and greater frequency of alcohol, marijuana, and cocaine use. In sum, preliminary analyses of baseline and follow-up data indicate a high prevalence of unprotected sex in this population. Identification of factors related to baseline and follow-up levels of risky behavior may suggest targets for future intervention development.

OBJECTIVE: This study used causal inference to estimate the longitudinal effects of contagion in cohabitants and family members on university students' mental health and academic self-efficacy during the COVID-19 pandemic.

DESIGN: A prospective longitudinal study including a baseline online measurement in May 2020, and online follow-ups after 5 months and 10 months. Participants were recruited through open-access online advertising.

SETTING: Public universities and university colleges in Sweden.

PARTICIPANTS: The analytical sample included 2796 students.

OUTCOME MEASURES: Contagion in cohabitants and in family members was assessed at baseline and at the 5-month follow-up. Mental health and academic self-efficacy were assessed at the 5-month and 10-month follow-ups.

RESULTS: Mild symptoms reported in cohabitants at baseline resulted in negative mental health effects at follow-up 5 months later, and mild baseline symptoms in family members resulted in negative effects on academic self-efficacy at follow-ups both 5 and 10 months later.

CONCLUSIONS: Notwithstanding the lack of precision in estimated effects, the findings emphasise the importance of social relationships and the challenges of providing students with sufficient support in times of crisis.

BACKGROUND: Addressing the effects of non-compliance with health-related recommendations in pandemics is needed for informed decision-making. This longitudinal study investigated the effects of non-compliance on mental health and academic self-efficacy among university students in Sweden.

METHODS: Baseline assessments were conducted in May 2020, with follow-ups after 5 and 10 months. Students (n = 3123) from 19 universities completed online questionnaires covering compliance, mental health, and academic self-efficacy. Effects of non-compliance were estimated using causal inference and multilevel multinomial regression.

RESULTS: Non-compliant students constituted a minority, but their proportion increased over time. Regarding mental health and academic self-efficacy, few differences were observed between compliant and non-compliant students. When differences were identified, non-compliant students experienced fewer negative effects on mental health and academic self-efficacy than compliant students.

CONCLUSION: The findings may suggest that non-compliance may have involved a trade-off between increased individual freedom and mitigating negative outcomes. Addressing the research gap on non-compliance effects is crucial for informed decision-making and promoting the common good. This may guide strategies balancing individual autonomy and collective well-being during future pandemics.

PRE-REGISTRATION: Center for Open Science (OSF), https://accounts.osf.io/login?service=https://osf.io/37dhm/ .

In higher education, students' trust in the university management may affect both mental health and academic self-efficacy. This longitudinal study, conducted during the most challenging course of the COVID-19 pandemic, uses multinomial regression and causal inference to estimate the effects of students' trust in their universities' strategies for managing the pandemic, on students' self-reported changes in mental health and academic self-efficacy. The analyzed sample (N = 2796) was recruited through online advertising and responded to a baseline online survey in the late spring of 2020, with two follow-up surveys five and ten months later. Results show that positive trust in university management of the pandemic protected against experiencing one's mental health and academic self-efficacy as worse rather than unchanged, both five and ten months after the baseline assessment. The findings emphasize the importance of developing and maintaining trust-building measures between academia and students to support students' mental health and academic self-efficacy in times of uncertainty.

Systematic evaluation of child and adolescent psychiatric outpatient treatment is important but time-consuming. The aim of this paper was to study whether Interactive Voice Response (IVR) is a more effective method than a questionnaire sent by post when following up outpatient treatment in child and adolescent psychiatry. Eighty patients were recruited from a child and adolescent psychiatric outpatient unit in Sweden. One parent of each of the patients was randomized to complete the BCFPI follow-up form, using either IVR (n = 40) or postal survey (n = 40) one month after discharge. The response rate for complete answers was 65% in the IVR group and 38% in the postal survey group (p = 0.014). There was less need for reminders in the IVR group (p = 0.000). IVR is a promising and cost-effective method for evaluating evidence-based treatment in child and adolescent psychiatric care.

Objective The primary objective was to evaluate 6-month outcomes for brief and extensive automated telephony interventions targeting problematic alcohol use, in comparison to an assessment-only control group. The secondary objective was to compare levels of problematic alcohol use (hazardous, harmful or probable dependence), gender and age among study participants from clinical psychiatric and addiction outpatient settings and from population-based telephone helpline users and Internet help-seeker samples. Results The Alcohol Use Disorders Identification Test (AUDIT) was used for screening of problematic alcohol use and 6-month follow-up assessment. A total of 248 of help-seekers with at least hazardous use (AUDIT scores of ≥ 6/≥ 8 for women/men) were recruited from clinical and general population settings. Minor recruitment group differences were identified with respect to AUDIT scores and age at baseline. One hundred and sixty persons (64.5%) did not complete the follow-up assessment. The attrition group had a higher proportion of probable dependence (71% vs. 56%; p = 0.025), and higher scores on the total AUDIT, and its subscales for alcohol consumption and alcohol problems. At follow up, within-group problem levels had declined across all three groups, but there were no significant between-group differences. Trial registration ClinicalTrials.gov NCT01958359, Registered October 9, 2013. Retrospectively registered

Introduction: Risk factors of traditional substance use related problems in young adults are more well-known than for behavioral addictions such as gambling and gaming problems. The present study aims to provide knowledge about the longitudinal patters of substance use related and behavioral addictions in early adulthood. Methods: Using self-report surveys, substance-related, psychiatric, and demographic predictors were assessed in Swedish high school seniors and re-assessed six years later along with gambling and gaming problems, n = 800. Associations (Risk Ratios) between risk factors in late adolescence and problem behaviors in young adulthood were analyzed. Results: Tobacco use, illicit drug use, and hazardous drinking in young adulthood were associated with tobacco use, illicit drug use, alcohol use, conduct problems, and impaired impulse control in late adolescence. Gambling problems in young adulthood were only associated with heredity of alcohol problems, while gaming was not associated to any problem behavior in late adolescence. Conclusion: It is concluded that predictors for traditional substance-related addictions differ from predictors for behavioral addictions, and that this difference is more pronounced for gaming problems than for gambling problems.

The objective of this research was to study whether automated telephony could be used in paroled offenders to perform daily assessment of variables associated with recidivismin crime, and whether there are grounds for studying the effects of a brief intervention based on these assessments during 30 days following probation. The design included a randomized controlled trial using automated daily assessments and feedback interventions based on Interactive Voice Response (IVR). Participants included paroled offenders (N = 108) during their first 30 days after leaving prison. All subjects were called daily and answered assessment questions. Based on the content of their daily assessments, the subjects in the intervention group received immediate feedback and a recommendation by IVR, and their probation officers also received a daily report by email. Main outcomemeasures (assessed daily) included Stress (Arnetz and Hasson Stress Questionnaire and a revised version of Daily Assessment of Daily Experience), Mood (SCL-8D measuring depression and anxiety), and Use and Urge to Use Alcohol and Drugs (revised version of the Alcohol Urge Questionnaire). Participants were also asked to rate the severity of their most stressful event that day. The outcome variables were analyzed using linear mixed models, presented as group differences between means, 95%CI. Results indicated that the intervention group showed greater improvement than the control group in stress (9.6, 0.5; 18.7, p = 0.038), depression/anxiety (4.6, 0.2; 9.0, p = 0.042), alcohol use (0.8, 0.1; 1.4, p = 0.031), drug use (1.0, 0.5; 1.6, p = 0.000), and in the severity of themost stressful daily event (1.9, 1.1; 2.7, p = 0.000). There were no differences between the groups in the Stress scale and in craving for alcohol and drugs. Overall, the research suggests that in paroled offenders, automated telephony is an effective technology thatmay be used to follow up and to give interventions, resulting in reduced stress and drug use.

This randomized trial evaluates whether automated telephony could be used to perform daily assessments in paroled offenders (N = 108) during their first 30 days after leaving prison. All subjects were called daily and answered assessment questions. Based on the content of their daily assessments, subjects in the intervention group received immediate feedback and a recommendation by automated telephony, and their probation officers also received a daily report by email. The outcome variables were analyzed using linear mixed models. The intervention group showed greater improvement than the control group in the summary scores (M = 9.6, 95% confidence interval [CI] = [0.5, 18.7], p = .038), in mental symptoms (M = 4.6, CI = [0.2, 9.0], p = .042), in alcohol drinking (M = 0.8, CI = [0.1, 1.4], p = .031), in drug use (M = 1.0, CI = [0.5, 1.6], p = .000), and in most stressful daily event (M = 1.9, CI = [1.1, 2.7], p = .000). In conclusion, automated telephony may be used to follow up and to give interventions, resulting in reduced stress and drug use, in paroled offenders.

Substance use disorders and problematic substance use are common problems in adolescence and young adulthood. Brief personalized feedback has been suggested for treatment of alcohol and drug problems and poor mental health. This repeated measurement randomized controlled trial examines the effect of an Interactive Voice Response (IVR) system for assessing stress, depression, anxiety and substance use. The IVR system was used twice weekly over three months after treatment initiation, with or without addition of a personalized feedback intervention on stress and mental health symptoms. Both IVR assessment only (control group) and IVR assessment including feedback (intervention group) were provided as an add-on to treatment-as-usual procedures (TAU) in outpatient treatment of substance use problems in adolescents and young adults (N=73). By using a mixed models approach, differences in change scores were analyzed over the three-month assessment period. Compared to the control group, the intervention group demonstrated significantly greater improvement in the Arnetz and Hasson stress score (AHSS, p=0.019), the total Symptoms Checklist 8 score (SCL-8D, p=0.037), the SCL-8D anxiety sub-score (p=0.017), and on a summarized feedback score (p=0.026), but not on the depression subscale. There were no differences in global substance use scores between the intervention group (feedback on mental health symptoms) and the control group. In conclusion, IVR may be useful for follow-up and repeated interventions as an add-on to regular treatment, and personalized feedback could potentially improve mental health in adolescents and young adults with problematic substance use.

Background and objectives: Internet gaming disorder (IGD) is associated with health, social, and academic problems but whether these are consequences of the disorder rather than precursors or correlates is unclear. We aimed to evaluate whether IGD in the 1st year of university predicts health, academic and social problems 1 year later, controlling for baseline health, academic and social problems, demographics, and mental health symptoms.

Methods: In a prospective cohort study, 1741 university students completed both a baseline online survey in their 1st year and a follow-up survey 1 year later. Log-binomial models examined the strength of prospective associations between baseline predictor variables (IGD, baseline health, academic and social problems, sex, age, and mental health symptoms) and occurrence of health, academic and social problems at follow-up.

Results: When extensively adjusted by the corresponding outcome at baseline, any mental disorder symptoms, sex, and age, baseline IGD was associated only with severe school impairment and poor social life (risk ratio [RR] = 1.77; 95% confidence interval [CI] = 1.14-2.75, p = .011; RR = 1.22; 95% CI = 1.07-1.38, p = .002, respectively).

Conclusions and scientific significance: University authorities and counselors should consider that incoming 1st-year students that meet criteria for IGD are likely to have increased academic and social impairments during their 1st year for which they may want to intervene. This study adds to the existing literature by longitudinally examining a greater array of negative outcomes of IGD than previously documented.

Med hänvisning till CANs skolundersökningar kan det konstateras att användande av narkotika och cannabis generellt har ökat från 1989 till 2013. Denna ökning gäller alla regioner i Sverige och oavsett var i landet man bor så följs upp- och nedgångar i drogvanorna i stor del åt. Under åren 2012–2014 användes mest cannabis i Stockholm och Malmö och minst i Glesbygden. Det förelåg inte skillnader mellan cannabisanvändande och betyg eller föräldrarnas utbildningsnivå. Resultat från den europeiska ESPAD-skolstudien visade en ökning av cannabisanvändande fram till 2003 med något lägre nivåer 2007 och 2011. Cannabisanvändandet i Sverige var lägre eller mycket lägre än i de flesta andra länder. När det gäller primärprevention av cannabisanvändande har en nyligen publicerad systematisk litteraturgenomgång av tillgänglig forskning dragit slutsatsen att många men inte alla studier har signifikant positiva effekter, men att effektstorlekarna är i regel små eller triviala. Högst effektstorlek återfinns i generella multimodala program riktade till gruppen 10–13 år, som inte leds av ungdomarnas ordinarie lärare, och som innehåller högst 10 sessioner samt en s k boostersession för att förstärka effekten. För behandling av missbruk eller beroende av cannabis rekommenderar Socialstyrelsen att hälso- och sjukvården samt socialtjänsten ska erbjuda kognitiv beteendeterapi (KBT) eller återfallsprevention med tillägg av motiverande samtal eller Motivational Enhancement Therapy (MET) som är en särskild kombination av bedömning, återkoppling och motivationshöjande samtal. När det gäller den legalisering av cannabis som genomförts i USA sammanfattas dels ett kritiskt ställningstagande inklusive därpå nödvändiga rekommendationer som har publicerats av American Academy of Pediatrics (AAP) och som är den ledande vetenskapliga organisationen för barnläkare i USA. Avslutningsvis presenteras en nyligen presenterad analys från en svensk-amerikansk studie som studerat effekter av legalisering av cannabis i delstaten Washington och som visar att tillgängligheten inte har förändrats men att det finns en tendens (p=0,08) till ökad konsumtion av cannabis till följd av legaliseringen samt att pojkar anser att kontinuerligt användande av cannabis till följd av legaliseringen innebär mindre risk.

Med hänvisning till CANs skolundersökningar kan det konstateras att användande av narkotika och cannabis generellt har ökat från 1989 till 2013. Denna ökning gäller alla regioner i Sverige och oavsett var i landet man bor så följs upp- och nedgångar i drogvanorna i stor del åt. Under åren 2012–2014 användes mest cannabis i Stockholm och Malmö och minst i Glesbygden. Det förelåg inte skillnader mellan cannabisanvändande och betyg eller föräldrarnas utbildningsnivå. Resultat från den europeiska ESPAD-skolstudien visade en ökning av cannabisanvändande fram till 2003 med något lägre nivåer 2007 och 2011. Cannabisanvändandet i Sverige var lägre eller mycket lägre än i de flesta andra länder. När det gäller primärprevention av cannabisanvändande har en nyligen publicerad systematisk litteraturgenomgång av tillgänglig forskning dragit slutsatsen att många men inte alla studier har signifikant positiva effekter, men att effektstorlekarna är i regel små eller triviala. Högst effektstorlek återfinns i generella multimodala program riktade till gruppen 10–13 år, som inte leds av ungdomarnas ordinarie lärare, och som innehåller högst 10 sessioner samt en s k boostersession för att förstärka effekten. För behandling av missbruk eller beroende av cannabis rekommenderar Socialstyrelsen att hälso- och sjukvården samt socialtjänsten ska erbjuda kognitiv beteendeterapi (KBT) eller återfallsprevention med tillägg av motiverande samtal eller Motivational Enhancement Therapy (MET) som är en särskild kombination av bedömning, återkoppling och motivationshöjande samtal. När det gäller den legalisering av cannabis som genomförts i USA sammanfattas dels ett kritiskt ställningstagande inklusive därpå nödvändiga rekommendationer som har publicerats av American Academy of Pediatrics (AAP) och som är den ledande vetenskapliga organisationen för barnläkare i USA. Avslutningsvis presenteras en nyligen presenterad analys från en svensk-amerikansk studie som studerat effekter av legalisering av cannabis i delstaten Washington och som visar att tillgängligheten inte har förändrats men att det finns en tendens (p=0,08) till ökad konsumtion av cannabis till följd av legaliseringen samt att pojkar anser att kontinuerligt användande av cannabis till följd av legaliseringen innebär mindre risk.

The present study includes baseline data from 2867 students (77.8% from Sweden, 22.2% from US) and evaluates the relationships among self-reported disabilities, alcohol use, other substance use, and psychosocial adjustment. There were 114 (4.6%) ‘‘hard-of-hearing’’ (HH) students, 129 (5.2%) reported visual disabilities, 33 (1.3%) reported motor disabilities, 223 (9.0%) reported a reading/writing disability, and 97 (3.6%) reported they had ‘‘other’’ disabilities. Of these, 70 (14.1%) reported more than one disability. Presence of a disability was significantly higher among Sweden students (2 (1)=19.93, p< 0.001), with 19.1% of Sweden students and 11.5% of US students reporting at least one disability. Reporting any type of disability was associated with significantly greater alcohol use frequency, intensity, and related problems (all p < 0.02), significantly more mental health symptoms and conduct problems (p < 0.005), and significantly greater likelihood of illicit and prescription drug use (all p < 0.001). With respect to specific disabilities, individuals with motor disabilities reported the highest levels of alcohol use and mental health symptoms, whereas individuals who reported ‘‘other’’ disabilities had higher rates of illicit drug use and conduct problems. Further, there was a significantly positive correlation between the number of disabilities and intensity of alcohol use, mental health symptoms, conduct problems, illicit and prescription drug use, and alcohol related problems (all p < 0.001). The association between conduct problems and disability (any disability and number of disabilities) was moderated by country of origin, gender, and drinking for coping reasons on the Drinking Motives Questionnaire. Participants in Sweden, males, and those who drank for coping reasons were more likely to report a relationship between disability and conduct problems (p < 0.001). Participants who drank for coping reasons were also more likely to report a relationship between disability and alcohol related problems (p=0.001). These findings indicate students with disabilities are an important risk group for preventive interventions for alcohol, substance, and mental health problems, and may benefit from interventions which target healthy coping skills. This research was supported by NIAAA # 5R01AA018276 awarded to Drs. Larimer & Berglund

Aims: Perceived risk is related to use of cannabis, alcohol, and tobacco among youth. Sweden and US have different policies and customs related to these substances thatmay influence both risk perception and behavior regarding use of these substances. Differences in perceived risk of cannabis, cigarettes, chewing tobacco and alcohol in Sweden and the US have been reported but no direct systematic comparison has been performed. Design and setting: The ATLAS Project is a long-term longitudinal study comparing the development of substance use from high school to the young adult life period (18–23 years) in the US and Sweden. Participants: Baseline data for 3352 17–19 year-old high school students (65%from Sweden, 56% women, mean age 17.8, 35%from US 58%women,mean age 17.6). Measurements: Surveys of perceived risk items, ever use of cannabis, cigarettes and alcohol, as well as conduct problems, mental health symptoms, and impulsivity. Findings: The largest differences between the countries were found for the risk of cannabis use. Swedish participants reported much higher perceived risk both for continuous and occasional use than US students. For cigarettes, chewing tobacco and alcohol students from the US reported higher risk perception than the Swedish students did. Females reported higher perceived risk for all substances than male students.Conduct problems were associated with less perceived risk in all examples and impulsivity in cannabis and alcohol issues. Increasedmental health symptoms were associated with increased perceived risk for alcohol. Those who have used the specific drug reported lower levels of risk for that drug butmostly not for other drugs. Conclusions: Perceived risk for cannabis was higher in Swedish students than in US students while cigarette smoking, chewing tobacco and alcohol use were perceived as more risky in the US. One possibility could be that Sweden has much tougher drug laws than the US while less stringent alcohol and tobacco laws.

Overconsumption of alcohol, from hazardous to excessive, heavy, and harmful levels, is common among university students. Consenting Swedish students were assigned to one of two smartphone apps offering feedback on estimated blood alcohol concentration (eBAC; Promillekoll/PartyPlanner) or assessment only (n = 2166; 1:1:1 ratio). App participants with excessive drinking according to public health criteria (>9/>14 drinks/week for women/men, respectively) at a 7 week follow-up were additionally assigned to the skills-based TeleCoach app or waitlist (n = 186; 1:1 ratio). All participants were followed at 14 and 20 weeks. At 7 weeks, Promillekoll users showed higher risk of excessive drinking (odds ratio (OR) = 1.83; p

AIMS: The COVID-19 containment strategy in Sweden uses public health recommendations relying on personal responsibility for compliance. Universities were one of few public institutions subject to strict closure, meaning that students had to adapt overnight to online teaching. This study investigates the prevalence of self-reported recommendation compliance and associations with self-reported symptoms of contagion, self-experienced effects on mental health and academic self-efficacy among university students in Sweden in May-June 2020.

METHODS: This was a cross-sectional 23 question online survey in which data were analysed by multinomial regression, taking a Bayesian analysis approach complemented by null hypothesis testing.

RESULTS: A total of 4495 students consented to respond. Recommendation compliance ranged between 70% and 96%. Women and older students reported higher compliance than did men and younger students. Mild to moderate COVID-19 symptoms were reported by 30%, severe symptoms by fewer than 2%; 15% reported being uncertain and half of the participants reported no symptoms. Mental health effects were reported by over 80%, and changes in academic self-efficacy were reported by over 85%; in both these areas negative effects predominated. Self-reported symptoms and uncertainty about contagion were associated with non-compliance, negative mental health effects, and impaired academic self-efficacy.

CONCLUSIONS: Students generally followed public health recommendations during strict closure of universities, but many reported considerable negative consequences related to mental health and academic self-efficacy. Digital interventions should be developed and evaluated to boost coping skills, build resilience and alleviate student suffering during the pandemic and future similar crises.

Two years ago, a Special Issue on E-health Interventions for Addictive Behaviors was published in the International Journal of Behavioral Medicine. The issue included 16 articles, addressing topics like methodologies for developing e-health interventions, how to engage intervention users and establish a working alliance, and empirical findings from randomized controlled trials and a naturalistic study. The issue began with two articles offering a wide perspective on the field, with a systematic review of reviews on digital interventions for problematic alcohol use, as well as a too for describing e-health interventions as a step towards standardized reporting in order to facilitate communication about the interventions and comparisons between them. This symposium will follow up on the Special Issue by bringing together some of the contributors for presentations of their current work and a discussion on the current state-of-the-art in digital interventions for addictive behaviors. This symposium is sponsored by SBM’s Scientific and Professional Liaison Council (SPLC), in partnership with the International Society of Behavioral Medicine (ISBM).

Mobile interventions based on text messages, automated telephone programs (interactive voice response (IVR)), and smartphone apps offer a new approach targeting hazardous alcohol use in university students. This review covers seven recent studies involving college or university students that evaluated intervention efficacy in comparison to controls: four using text messages, one using IVR, and two smartphone apps. Only the study evaluating IVR reported positive results for the primary outcome. Two of the text message studies reported positive results on secondary outcomes, while the other two reported no differences in comparison to control groups. For smartphone apps, one study reported positive results on secondary outcomes, while the other showed no differences in comparison to controls for a web-based app and negative results for a native app. Further development of mobile interventions is needed for this at-risk population, both in terms of intervention content and use of robust research designs.

Background: About 50% of university students overconsume alcohol, and drinking habits in later adulthood are to some extent established during higher educational studies. Several studies have demonstrated that Internet-based interventions have positive effects on drinking habits among university students. Our recent study evaluated two mobile phone apps targeting drinking choices at party occasions via personalized feedback on estimated blood alcohol concentration (eBAC) for students with hazardous drinking. No changes in drinking parameters were found over a seven-week period apart from an increase in number of drinking occasions among men for one of the apps tested. Up to 30% of the study participants drank at potentially harmful levels: higher than the national recommended number of standard drinks per week (a maximum of 9 for women and 14 for men) in Sweden. Objective: (1) To evaluate improved versions of the two mobile phone apps tested in our prior trial, in a new, 3-armed randomized controlled trial among university students with at least hazardous drinking habits according to the Alcohol Use Disorders Identifications Test (AUDIT; Study 1). (2) After 6 weeks, to target study participants showing alcohol consumption higher than the national recommended levels for standard drinks per week by offering them participation in a second, 2-armed randomized trial evaluating an additional mobile phone app with skill enhancement tasks (Study 2). (3) To follow participants at 6, 12 and 18 weeks after recruitment to Study 1 and at 6 and 12 weeks after recruitment to Study 2. Methods: Two randomized controlled trials are conducted. Study 1: Students are recruited at four Swedish universities, via direct e-mail and advertisements on Facebook and student union web sites. Those who provide informed consent, have a mobile phone, and show at least hazardous alcohol consumption according to the AUDIT (≥6 for women; ≥8 points for men) are randomized into three groups. Group 1 has access to the Swedish government alcohol monopoly’s app, Promillekoll, offering real-time estimated eBAC calculation; Group 2 has access to a Web-based app, PartyPlanner, developed by the research group, offering real-time eBAC calculation with planning and follow-up functions; and Group 3 participants are controls. Follow-up is conducted at 6, 12 and 18 weeks. Study 2. Participants who at the first 6-week follow-up show drinking levels higher than 9 (W) or 14 (M) standard drinks (12 g alcohol) per week, are offered participation in Study 2. Those who consent are randomized to either access to a skills training app, TeleCoach or to a wait-list control group. Results: Latent Markov models for Study 1 and mixed models analyses for Study 2 will be performed. Study 2 data will be analyzed for publication during the spring of 2016; Study 1 data will be analyzed for publication during the fall of 2016. Conclusions: If mobile phone interventions for reducing hazardous alcohol use are found to be effective, the prospects for positively influencing substance use-related health among university students can considerably improve.

Introduction: Most university students overconsume alcohol and have smartphones. Brief online interventions reduce students’ alcohol intake. Delivering brief interventions to students via smartphone apps should be investigated. Method: Students at several Swedish universities were invited to the 3 studies described via e-mails and online ads. Students with a smartphone and risky alcohol consumption according to the Alcohol Use Disorders Identification Test (AUDIT) were included, following informed consent. Three apps were tested, two targeting individual drinking choices on party occasions (Promillekoll and PartyPlanner), and one targeting high-risk users (TeleCoach™). Study 1 offered randomization into 3 groups: Promillekoll (1), offering real-time estimated blood alcohol concentration (eBAC) calculation; PartyPlanner (2), a web-based app with real-time eBAC calculation and additional planning/follow-up functions; a control group (3). Follow-up occurred at 7 weeks. Study 2 replicated Study 1; changes included improved apps based on Study 1 results, and follow-up times extended from 7 to 14 and 21 weeks (T1, T2 & T3). Study 3 offered participants at T1 from Study 2, who drank over 9 (women) and 14 (men) standard drinks/week, randomization into an intervention group (TeleCoach™) and a wait-list control group (intervention offered at T2). Results: For Study 1, 1932 fulfilled eligibility criteria for randomization. Attrition was 22.7–39.3 percent, higher among heavier drinkers and highest in Group 2. Per-protocol analyses revealed one significant timeby- group interaction, where Group 1 participants increased the frequency of their drinking occasions compared to controls (p = 0.001). Among all participants, 29 percent showed high-risk drinking, over the recommended weekly drinking levels of 9 (women) and 14 (men) standard glasses. Preliminary results will be reported for Studies 2 and 3. Discussion: Mobile phone apps offer a huge potential for making brief interventions available to more university students than ever before. Research is needed to identify effective app content.

Background: Improving relationship dynamics positively impacts both partners’ health among couples. However, few studies have investigated sexual and gender minority (SGM) couples’ relationship goals and their experiences toward achieving them.

Purpose: The present study investigated SGM couples’ experiences that centered on them working toward or maintaining their relationship goals over time.

Method: From a cohort study with SGM couples, a purposive sample of 40 couples was selected and interviewed over Zoom. Interviews were individual-level, semi-structured, and recorded. Thematic analysis was used to analyze the transcripts.

Results: Approximately half of the 40 couples identified as gay male couples, a third as lesbian couples, and about one-fifth as queer or gender minority couples. Top three reported relationship goals were 1) improving communication, 2) working on finances, and 3) enhancing intimacy. Feeling emotionally connected, career-related decisions, and improving sexual satisfaction were other commonly reported goals. Overall, most partners felt they made progress toward at least 1 of their 3 relationship goals within the prior 6 months. However, perceived relationship goal progress varied extensively between partners across couple groups. Facilitator-related themes about relationship goal progress included dyadic efforts, having a support system including professional help, and planning. Barrier-related themes included nonexistent or minimal effort, different communication styles, employment and economical struggles, and competing life and health priorities.

Conclusion(s): Dyadic efforts and support systems were key toward someone working toward or maintaining their relationships goals. Findings suggest key relationship functioning areas to target in a future multiple health behavior change intervention for SGM couples.

Alcohol is one of the leading risk factors for global disease burden and overconsumption leads to a wide variety of negative consequences in everyday life. Digital interventions have shown small positive effects in contributing to reductions in problematic use. Specific research on smartphone apps is sparse and the few studies published indicate effects ranging from negative or null to small or moderate. TeleCoach™, a web-based skills training smartphone app, has shown positive effects in non-treatment-seeking university students with excessive drinking. This pilot trial aimed to evaluate app effects in a sample of internet help-seekers from the general population in Sweden. A total of 89 participants were recruited via online advertisement. Following baseline assessment for hazardous use, they were randomized to TeleCoach or a web-based control app offering brief information and advice regarding problematic alcohol use. The primary outcome was number of standard drinks per week; secondary outcomes included drinking quantity and frequency, binge drinking and blood alcohol count measures as well as app user data and comorbidity related to depression, anxiety, and drug use. Analysis of baseline and 6-week follow-up outcomes showed significant within-group effects on alcohol consumption but no significant between-group differences. Effect sizes for the within-group changes in the primary outcome over time were significant [F(1, 55)=43.98; p < 0.001], with a Cohen's d of 1.37 for the intervention group and 0.92 for the control group. This difference in effect sizes indicated that continuation of the study as a large randomized, controlled trial with up to 1,000 participants could be worthwhile.

Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT03696888.

Background: Problematic alcohol use in Sweden occurs among 16 % of the adult population. Digital interventions of varying intensity have shown positive effects in contributing to reductions in problematic use, and the TeleCoach app has shown positive effects in non-treatment-seeking university students with excessive drinking (Gajecki et al., 2017). This pilot study evaluated the app among adult internet help-seekers, and motivated continued data collection in the current target group. Methods: Adult internet-help seekers, recruited via advertisement, were included if they scored ³6 (women) or ³8 (men) on the Alcohol Use Disorders Identification Test (AUDIT). Those with depression scores of ³31 on the Montgomery Åsberg Depression Rating Scale (MADRS-S) or problematic drug use scores of ³8 on the Drug Use Disorders Identification Test (DUDIT) were contacted for a telephone interview and included following clinical assessment; if not reached they were excluded. Participants randomized at a 1:1 ratio to the TeleCoach™ web-based app or to a web-based app with information texts from primary care-based self-help material for changing problematic alcohol use. At six-week follow-up, the primary outcome was the number of standard drinks per past week (Timeline-Followback). Results: Of 147 persons assessed for eligibility, 89 were assigned to the intervention group (n=42) or control group (n=47). Average AUDIT levels at baseline were ³18.The baseline number of standard drinks per week was 32.73 (SD 21.16) for the intervention group, and 26 (4.08) for the control group; at 6-week follow-up it was 12.73 (10.52) and 13.48 (11.13) for the intervention and control groups, respectively. No significant between-groups effects occurred, but withingroup changes over time were significant (F(1, 55)=43.98; p< 0.000), with an effect size of 1.37 for the intervention group and 0.92 for the control group. Conclusions: The results suggest that web-based apps can be of help to internet help-seekers motivated to reduce problematic alcohol use. We have proceeded with the planned larger randomized, controlled study and will present 6-week follow-up data for the entire study sample (n=∼1000) in this presentation.

Objective: Mental wellbeing is a fundamental aspect of the broader notion of quality of life. Little is known about the mental wellbeing of university students in general and Swedish university students in particular. As emerging adults, university students typically experience substantial changes to their living conditions, relationships, and academic stress, and depression and anxiety are prospectively associated with lower academic achievement at the end of the first year.

Methods: Data from five cross-sectional cohorts (n = 7423), collected between spring 2020 and spring 2022, were compared descriptively, regarding sociodemographic factors, lifetime and past 30-day symptoms of mental health problems, experiences of bullying, feeling loved and measures of well-being. Linear regression identified protective factors for wellbeing according to the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS), and risk factors for lower wellbeing.

Results: Participants were > 70% women, 24–27 years old, 75–83% born in Sweden. About one-third had experienced physical bullying at school and about 70% felt loved and cared for. About two-thirds had medium levels of wellbeing, with one-third having low levels and about 5% having high levels. Protective factors for wellbeing included older age, male gender, feeling loved most of the time, and the grit construct. Risk factors included being an international student, non-heterosexual sexual orientation, having symptoms of depression or anxiety most of the time, and experiencing effort/reward imbalance.

Conclusions: A large proportion of students experience less than optimal wellbeing. Interventions to enhance positive, nurturing relationships and reinforce grit-related factors could support students in this challenging period of life.

Background and Aims: University students with risky drinking are a clear target group for intervention via smartphone apps. This study compared three different apps over a 20-week period, for university students with hazardous and excessive drinking patterns. Materials and Methods: Students from six campuses were invited to a three-armed trial (A). Those with hazardous alcohol use (n = 2166) were randomly assigned to one of two smartphone apps offer- ing feedback on real-time estimated blood alcohol concentration (eBAC) levels, or to a control group, with three follow-ups at 6, 12 and 20  weeks. At 6  weeks, participants in the app groups with excessive weekly alcohol consumption of >9 (women) or >14 (men) drinks per week (n  =  257), were offered participation in a second trial (B); con-senters (n  =  186) were randomly assigned to a skills-based app or a waitlist group, and compared with an assessment-only control group. Results: Six-week analyses (n = 2166) replicated our earlier trial from 2014, re-confirming earlier results: the Promillekoll app was associated with higher quantity and frequency of drinking compared to controls, and a higher risk for excessive drinking; the PartyPlanner group did not differ from controls. Lower-risk drinkers from trial A (n = 1177) up to 20 weeks did not differ from controls on main outcomes. However, sub-analyses showed that individuals with higher consumption had higher motivation to reduce intake. In both intervention groups, con-sumption was lower for more highly motivated participants compared to controls at 6- and 20-week follow-ups. Latent class analysis of par- ticipants in both trials (n = 2166) revealed a class (n = 146) that drank several days a week and that differed significantly from the remain- ing cohort in gender, age, and alcohol consumption. For this class, access to the Promillekoll app appeared marginally associated with lower quantity over time; access to the skills-based TeleCoach app was clearly associated with fewer drinking days up to 20 weeks. Conclusions: Smartphone apps targeting eBAC can influence drink-ing levels up to 20 weeks for university students with hazardous use and higher motivation to reduce their drinking. A skills-based app that reduces intake among students with excessive weekly consumption can be particularly effective for students with daily drinking habits.

Introduction & Purpose: Digital interventions for changing problematic alcohol use have shown small effect sizes in relation to control groups. A meta-analysis (Riper et al., 2014) found an overall effect size of 0.20, with slightly higher effect sizes of 0.23 for interventions with a human guide, compared to 0.20 for unguided interventions. This presentation describes five different interventions, from unguided low-intensity to high-intensity guided interventions, evaluated in separate randomized controlled trials (RCT). Methods: Target groups included internet help-seekers and university students, with hazardous drinking according to the Alcohol Use Disorders Identification Test (AUDIT), excessive drinking based on national public health guidelines, or diagnosed alcohol use disorder (AUD). Study 1 evaluated eScreen.se, offering minimal screening and personal feedback, and alkoholhjalpen.se, a self-help program, with 633 internetbased participants reporting hazardous drinking. Study 2 evaluated the PartyPlanner and Promillekoll smartphone apps with 1932 university students reporting hazardous drinking. Study 3 evaluated the TeleCoach skills-based app with 186 university students who drank excessively. For studies 1-3 assessment-only controls were comparison groups. Study 4 compared the unguided eChange 10-week program to a guided version with 80 internet-based participants having at least hazardous use. Study 5 with 166 participants compared the high-intensity ePlus 13-week program to the unguided eChange program in a 13-week version, and a small wait-list control group. Results: Studies 1-5 are compared with one another in terms of baseline characteristics and results. Although inclusion criteria varied, baseline AUDIT levels out of a maximum of 40 points for studies 1-5 respectively were 20.82 (SD 6.93), 10.55 (3.90); 13.46 (4.69); 21.00 (4.90) and 23.70 (1.40). Within-group and between-group results are compared, showing greater effects for more intensive interventions. Conclusions: Effects vary by target groups, severity levels and interventions, but it is clear that digital interventions contribute to reduced problematic alcohol use.

BACKGROUND: Emerging adulthood is often associated with mental health problems. About one in three university students report symptoms of depression and anxiety that can negatively affect their developmental trajectory concerning work, intimate relationships, and health. This can interfere with academic performance, as mood and anxiety disorders are key predictors of dropout from higher education. A treatment gap exists, where a considerable proportion of students do not seek help for mood and anxiety symptoms. Offering internet interventions to students with mental health problems could reduce the treatment gap, increase mental health, and improve academic performance. A meta-analysis on internet interventions for university students showed small effects for depression and none for anxiety. Larger trials are recommended to further explore effects of guidance, transdiagnostic approaches, and individual treatment components.

METHODS: This study will offer 1200 university students in Sweden participation in a three-armed randomized controlled trial (RCT) evaluating a guided or unguided transdiagnostic internet intervention for mild to moderate depression and anxiety, where the waitlist control group accesses the intervention at 6-month follow-up. Students reporting suicidal ideation/behaviors will be excluded and referred to treatment within the existing healthcare system. An embedded study within the trial (SWAT) will assess at week 3 of 8 whether participants in the guided and unguided groups are at higher risk of failing to benefit from treatment. Those at risk will be randomized to an adaptive treatment strategy, or to continue the treatment as originally randomized. Primary outcomes are symptoms of depression and anxiety. Follow-ups will occur at post-treatment and at 6-, 12-, and 24-month post-randomization. Between-group outcome analyses will be reported, and qualitative interviews about treatment experiences are planned.

DISCUSSION: This study investigates the effects of a transdiagnostic internet intervention among university students in Sweden, with an adaptive treatment strategy employed during the course of treatment to minimize the risk of treatment failure. The study will contribute knowledge about longitudinal trajectories of mental health and well-being following treatment, taking into account possible gender differences in responsiveness to treatment. With time, effective internet interventions could make treatment for mental health issues more widely accessible to the student group.

Objective Adolescent alcohol use predicts a myriad of negative mental and physical health outcomes including fatality (Midanik, 2004). Research in parental influence on alcohol consumption finds parental monitoring (PM), or knowing where/whom your child is with, is associated with lower levels of alcohol use in adolescents (e.g., Arria et al., 2008). As PM interventions have had only limited success (Koutakis, Stattin, & Kerr, 2008), investigating moderating factors of PM is of importance. Country may serve as one such moderator (Calafat, Garcia, Juan, Becoña, & Fernández-Hermida, 2014). Thus, the purpose of the present report is to assess the relationship between PM and alcohol use in the US and Sweden. Method High school seniors from the US (n = 1181, 42.3% Male) and Sweden (n = 2171, 44.1% Male) completed assessments of total drinks consumed in a typical week, problematic alcohol use, and perceived PM. Results Generalized linear mixed modeling (GLM, Cohen, Cohen, West, & Aiken, 2013; Hilbe, 2011) was used to examine whether country moderated the relationship between PM and alcohol use. Results revealed main effects of country and PM and a significant interaction between country and PM in predicting total drinks per week and PM in predicting problematic alcohol use (p < 0.001). Conclusions While PM is related to lower quantity of alcohol consumed and problematic alcohol use, greater PM appears to be more strongly related to fewer drinks per week and less problematic alcohol use in the US, as compared to Sweden.

The transition fromadolescence to emerging adulthood is a period of increased risk for heavy drinking behavior. Prior research has found that college students drink more and experience more consequences than their non-college counterparts. However, sparse research has examined whether students who are college- versus work-bound show differences in drinking and related consequences in high school (HS) as well. In addition, little research has explored whether alcohol expectancies also change over time as a function of selection into college versus non-college environments. The current study examined whether alcohol-related expectancies, consequences, and drinking changed over the course of a year as a function of whether participants transitioned into a four-year university (UNI), community college/trade school (CC), or workforce setting (WF). Participants (N=848) were HS seniors (mean age=17.5 years; 37%male, 73%Caucasian) taking part in a larger study examining alcohol use trajectories.Measures included alcohol expectancies (CEOA), drinking (DDQ), and alcohol-related problems (RAPI) assessed during their senior year and one year later. Repeatedmeasures ANOVAs revealed significant main effects for time, indicating increases in drinks per week F(1, 807)=19.18, p>0.001 and alcohol-related problems F(1, 808)=8.78, p>0.01 and a decrease in alcohol expectancies F(1, 808)=14.35, p>0.001 from baseline to 12 month follow-up. Results also found a main effect for group, indicating UNI students held higher expectancies F(2, 808)=8.15, p>0.001 and drank more F(2, 807)=6.26, p>0.01 than other participants. A significant time9group interaction showed that whereas UNI-bound students drank less thanWF-bound students in HS, the roles reversed one year later with UNI students drinking more thanWF students F (2, 807)=27.56, p>0.001. Similarly, WF-bound students had more alcohol-related problems in HS followed by CC-bound students and UNI-bound students, but one year later the order reversed with UNI students exhibiting the most alcohol-related problems F(2, 807)=5.21, p>0.01. Results indicate that whereas UNI-bound seniors exhibit the highest expectancies, drink less, and experience fewer problems during HS, upon entry into UNI, they experience more problems and out-drink their CC andWF counterparts. These results highlight the importance of prevention strategies, including an expectancy challenge component, especially for UNI-bound HS seniors.

PURPOSE: University students in a study on estimated blood alcohol concentration (eBAC) feedback apps were offered participation in a second study, if reporting continued excessive consumption at 6-week follow-up. This study evaluated the effects on excessive alcohol consumption of offering access to an additional skills training app. METHOD: A total of 186 students with excessive alcohol consumption were randomized to an intervention group or a wait list group. Both groups completed online follow-ups regarding alcohol consumption after 6 and 12 weeks. Wait list participants were given access to the intervention at 6-week follow-up. Assessment-only controls (n = 144) with excessive alcohol consumption from the ongoing study were used for comparison. RESULTS: The proportion of participants with excessive alcohol consumption declined in both intervention and wait list groups compared to controls at first (p < 0.001) and second follow-ups (p = 0.054). Secondary analyses showed reductions for the intervention group in quantity of drinking at first follow-up (-4.76, 95% CI [-6.67, -2.85], Z = -2.09, p = 0.037) and in frequency of drinking at both follow-ups (-0.83, 95% CI [-1.14, -0.52], Z = -2.04, p = 0.041; -0.89, 95% CI [-1.16, -0.62], Z = -2.12, p = 0.034). The odds ratio for not having excessive alcohol consumption among men in the intervention group compared to male controls was 2.68, 95% CI [1.37, 5.25] (Z = 2.88, p = 0.004); the figure for women was 1.71, 95% CI [1.11, 2.64] (Z = 2.41, p = 0.016). CONCLUSION: Skills training apps have potential for reducing excessive alcohol use among university students. Future research is still needed to disentangle effects of app use from emailed feedback on excessive alcohol consumption and study participation. TRIAL REGISTRATION:NCT02064998.

PURPOSE: Patients' problematic substance use prevalence and effects were explored in relation to internet-based cognitive behavioral therapy (ICBT) outcomes for depression, panic disorder and social anxiety disorder. METHODS: At baseline and treatment conclusion, 1601 ICBT patients were assessed with self-rated measures for alcohol and drug use (AUDIT/DUDIT), depressive symptoms (MADRS-S), panic disorder symptoms (PDSS-SR) and social anxiety symptoms (LSAS-SR). RESULTS: Problematic substance use (AUDIT ≥ 8 for men, ≥ 6 for women; DUDIT ≥ 1) occurred among 32.4% of the patients; 24.1% only alcohol, 4.6% only drugs, and 3.7% combined alcohol and drug use. Hazardous alcohol use and probable alcohol dependence negatively affected panic disorder outcomes, and hazardous drug use led to worse social anxiety outcomes. Depression outcomes were not affected by substance use. Treatment adherence was negatively affected by problematic drug use among men and 25-34 year olds; combined substance use negatively affected adherence for women and 35-64 year olds. CONCLUSION: Problematic substance use does not preclude ICBT treatment but can worsen outcomes, particularly problematic alcohol use for panic disorder patients and hazardous drug use for social anxiety patients. ICBT clinicians should exercise particular caution when treating men and younger patients with problematic drug use, and women or older patients with combined substance use.