Are online norms-based alcohol interventions efficacious for college students with higher social anxiety?

Are online norms-based alcohol interventions efficacious for college students with higher social anxiety? - PMC Skip to main content An official website of the United States government Here's how you know Here's how you know Search Log in Primary site navigation Search Log in Search PMC Full-Text Archive Search in PMC Journal List User Guide As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health. Learn more: PMC Disclaimer | PMC Copyright Notice Alcohol Clin Exp Res (Hoboken) . Author manuscript; available in PMC: 2026 Jun 2. Published in final edited form as: Alcohol Clin Exp Res (Hoboken). 2025 Jun 2;49(7):1564–1575. doi: 10.1111/acer.70077 Are online norms-based alcohol interventions efficacious for college students with higher social anxiety? Katherine Walukevich-Dienst 1 , Scott Graupensperger 1 , Marilyn L Piccirillo 2, 3 , Kirstyn N Smith-LeCavalier 3 , Jessica Acolin 1 , Mary E Larimer 1, 3 Author information Article notes Copyright and License information 1 Department of Psychiatry and Behavioral Sciences, Center for the Study of Health and Risk Behaviors, University of Washington, Seattle, Washington, USA 2 Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA 3 Department of Psychology, University of Washington, Seattle, Washington, USA ✉ Correspondence Mary E. Larimer, Department of Psychiatry and Behavioral Sciences, Center for the Study of Health and Risk Behaviors, University of Washington, Box 357238, Seattle, WA 98195, USA. larimer@uw.edu Issue date 2025 Jul. PMC Copyright notice PMCID: PMC12244436  NIHMSID: NIHMS2087628  PMID: 40457580 The publisher's version of this article is available at Alcohol Clin Exp Res (Hoboken) Abstract Background: Undergraduates with higher social anxiety symptoms are at risk for co-occurring substance misuse, heavier drinking in certain contexts, and experiencing more negative alcohol-related consequences. Among undergraduates broadly, online norms-based interventions provide consistent and cost-effective reductions in alcohol use and related risks. However, research on norms-based interventions for undergraduates with higher social anxiety symptoms is limited, and less is known about the longitudinal impacts of social anxiety symptoms on the efficacy of online, norms-based alcohol interventions. Methods: Secondary analyses were conducted on data from a large randomized controlled trial (RCT) with undergraduates who reported past-month heavy episodic drinking and were randomized to an attention control or a norms-based intervention. Generalized linear models tested whether baseline social anxiety symptoms moderated the efficacy of receiving a norms-based intervention versus a nonalcohol-focused attention control condition at 3-, 6-, and 12-month follow-up. Results: Social anxiety symptoms moderated intervention efficacy on the number of typical drinks consumed and descriptive norms at 3 months, as well as injunctive norms at 3 and 12 months. However, these effects appeared to be primarily driven by the individuals with higher social anxiety symptoms in the attention control group. Overall, norms-based interventions demonstrated efficacy in reducing the number of typical drinks consumed, descriptive and injunctive norms, and negative consequences up to 12 months later, regardless of social anxiety symptoms. Conclusions: Results demonstrated that online norms-based interventions were similarly efficacious for reducing drinking, negative consequences, and normative beliefs for undergraduates, regardless of social anxiety symptoms. Further, effects were maintained up to 12 months. Thus, existing alcohol-focused brief interventions are efficacious for those with higher social anxiety symptoms, even without adaptation for social anxiety-specific concerns. Individuals with higher social anxiety symptoms who did not receive an active intervention reduced drinking beliefs and behaviors, although reductions were not maintained over time. Keywords: alcohol, normative beliefs, personalized feedback intervention, social anxiety, undergraduates INTRODUCTION Social anxiety, or the fear of being negatively judged or evaluated by others in social situations, is a frequently reported concern among young adults. Estimated prevalence rates of social anxiety disorder among young adults range from 9.1% to 36% ( Harvard Medical School, 2007 ; Jefferies & Ungar, 2020 ; Kessler et al., 2005 ), and problems with social anxiety typically onset during late adolescence as youth undergo critical social transitions that define early adulthood (e.g., forming new peer groups, entering new academic or work settings, initiating romantic or sexual relationships; Kessler et al., 2005 ). Both clinical and subclinical levels of social anxiety symptoms are associated with significant functional impairment, including high rates of co-occurring substance misuse ( Fehm et al., 2008 ). Meta-analytic research finds that trait levels of social anxiety symptoms are typically negatively associated with overall patterns of drinking among young adults, including drinking frequency and quantity ( Schry & White, 2013 ). However, more recent research points to heterogeneity. For instance, higher levels of trait social anxiety symptoms are positively associated with heavier drinking in certain contexts (e.g., pregaming, intimate, or date contexts), particularly among young adults who endorse certain motives, such as drinking to cope or drinking to facilitate socialization ( Buckner, Lewis, et al., 2020 ; Hurd et al., 2020 ; Terlecki & Buckner, 2015 ; Walukevich-Dienst et al., 2022 ). Importantly, even subclinical symptoms of social anxiety are associated with more negative alcohol-related consequences, including impairments in academic and emotional functioning among college students ( Villarosa-Hurlocker & Madson, 2020 ) and alcohol use disorder ( Crum & Pratt, 2001 ). Taken together, social anxiety symptoms may put college students at risk for heavy drinking in certain contexts or when specific psychosocial factors are present, supporting a need for efficacious interventions to reduce hazardous drinking among college students with higher social anxiety symptoms. Brief alcohol-focused interventions are evidence-based, short (i.e., ≤5 h of contact time; Tanner-Smith & Lipsey, 2015 ), and demonstrate consistent and cost-effective prevention of alcohol-related risks among young adults and undergraduates (e.g., Dotson et al., 2015 ; Larimer et al., 2004 , 2023 ; Lewis et al., 2007 ; Neighbors et al., 2004 ; Tanner-Smith & Lipsey, 2015 ). As Internet usage is nearly universal among young adults (99% of young adults; Pew Research Center, 2024 ), a particular strength of these types of interventions is that they are highly accessible, easy to personalize to different campuses/groups, and can be easily disseminated to the vast majority of college students. Social norms are often a key component of such brief interventions ( Tanner-Smith & Lipsey, 2015 ). Social norms, including both descriptive (i.e., perceptions of peer drinking behavior) and injunctive (i.e., perceptions of peer approval of drinking behavior), are consistently strong predictors of drinking behaviors ( Dotson et al., 2015 ; Graupensperger et al., 2020 ; Neighbors, Fossos, et al., 2007 ; Neighbors, Lee, et al., 2007 ). Furthermore, young adults commonly overestimate their peers’ approval and use of alcohol (e.g., Borsari & Carey, 2003 ; LaBrie et al., 2010 ). Consequently, brief alcohol-focused interventions typically provide psychoeducation to correct baseline misperceptions of drinking norms, or personalized normative feedback (PNF; Tanner-Smith & Lipsey, 2015 ). Modifying normative misperceptions via PNF effectively decreases unhealthy alcohol use and related negative consequences and is posited to be a primary mechanism of behavior change ( Dotson et al., 2015 ; Saxton et al., 2021 ). Yet, the associations between social anxiety symptoms, perceived norms, and drinking outcomes are not well understood and are mixed in regard to whether and how social anxiety symptoms are associated with normative beliefs ( Buckner et al., 2011 ; Ham & Hope, 2005 , 2006 ; LaBrie et al., 2008 ; Linden et al., 2012 ; Neighbors, Fossos, et al., 2007 ; Neighbors, Lee, et al., 2007 ). Accordingly, it is unclear whether existing norms-based interventions effectively address the needs of individuals with higher levels of social anxiety, given conflicting evidence regarding social anxiety’s associations with patterns of drinking. For instance, college students with higher social anxiety may be more responsive to norm-correcting feedback given fears of being negatively evaluated or judged for drinking more heavily than their peers (e.g., LaBrie et al., 2008 ; Neighbors, Fossos, et al., 2007 ; Neighbors, Lee, et al., 2007 ). Alternatively, the briefest versions of norms-based interventions do not include information on addressing negative alcohol consequences that appear to better characterize the drinking patterns of some young adults with higher levels of social anxiety (i.e., standalone PNF-only feedback; Dotson et al., 2015 ). Indeed, there is mixed evidence as to whether online norms-based interventions are similarly efficacious in reducing risky drinking among undergraduates with higher levels of social anxiety ( Terlecki et al., 2011 , 2012 ). Specifically, in one study ( Terlecki et al., 2011 ), undergraduates were randomized to control or a face-to-face Brief Alcohol Screening and Intervention for College Students session (BASICS; Dimeff et al., 1999 ), a widely used, brief, motivational feedback intervention designed to reduce high-risk drinking and associated consequences, which incorporates descriptive norms feedback as a key component. Undergraduates with higher levels of social anxiety (versus lower levels of social anxiety) reported increased alcohol consumption 1-month post-BASICS ( Terlecki et al., 2011 ), in part due to smaller changes in descriptive norms from baseline to follow-up among individuals who received BASICS versus assessment-only control ( Terlecki et al., 2012 ). In fact, changes in descriptive norms moderated the association between baseline social anxiety symptoms and follow-up alcohol consumption, such that higher social anxiety symptoms were positively associated with alcohol consumption at 1-month follow-up among those with smaller (versus larger) changes in descriptive norms ( Terlecki et al., 2012 ). Therefore, further longitudinal investigation into drinking outcomes for young adults with higher social anxiety is warranted to better clarify conflicting evidence from cross-sectional literature and initial investigations of norms-based intervention efficacy with short-term follow-up ( Terlecki et al., 2011 , 2012 ). Present study The present study sought to build upon prior work by examining the longitudinal impacts of baseline social anxiety symptoms on the efficacy of online, norms-based alcohol intervention up to 12 months postintervention. We conducted a secondary analysis among a large, multisite sample of undergraduates ( N = 1137) who were randomized to one of four online, norms-based interventions or an attention control condition (for main outcomes see Larimer et al., 2023 ). We tested whether baseline levels of social anxiety symptoms moderated the association between intervention and control conditions (i.e., receipt of a norms-based intervention vs. attention control) and changes in typical weekly drinking, alcohol-related negative consequences, descriptive norms, and injunctive norms at 3-, 6-, and 12-month follow-ups. MATERIAL S AND METHODS Participants and procedures We conducted a secondary analysis to examine the moderating effect of social anxiety symptoms on the efficacy of norms-based interventions compared with an attention control condition that provided nonalcohol-specific feedback; social anxiety symptoms were not a primary focus of the original work. Data collection for the parent study occurred from 2010 to 2011. The primary outcomes publication ( Larimer et al., 2023 ) compared the efficacy of four web-based personalized normative feedback interventions (descriptive norms alone, injunctive norms alone, or combined descriptive and injunctive norms) to a web-based multicomponent personalized feedback intervention and nonalcohol-related normative feedback attention control. Results indicated that all four active interventions were efficacious for reducing norms and alcohol consumption, with most conditions demonstrating long-term effects up to 12 months. Detailed procedures are reported in Larimer et al. (2023) ; below, we briefly describe procedures relevant to the present study. A random sample of 5998 undergraduate students from two West Coast universities were mailed and emailed invitations to participate in a study on alcohol use and college drinking perceptions. Invitations included a link to an online screening survey. Approximately 46.1% of those invited (Campus 1 n = 1521, Campus 2 n = 1246) completed the screening survey and 54.0% ( n = 1494) met inclusion criteria for the larger study (i.e., at least one occasion of heavy episodic drinking in the past month; 4+/5+ drinks on a single occasion for females/males). Eligible participants were invited to enroll in the study after completing an online baseline questionnaire that assessed substance use behaviors and related psychosocial factors. Participants were randomized to a minimal assessment control group, a nonalcohol-related attention control group, or one of the four norms-based intervention conditions, which were delivered online via a webpage immediately after completion of the baseline assessment; the intervention could be completed on any device with access to the Internet. Participants completed follow-up surveys 3, 6, and 12 months after baseline. Invitations and follow-up surveys were sent at the beginning of each quarter (fall, winter, spring, summer) but were timed to avoid overlap with high-risk drinking events (i.e., New Year’s Eve, Spring Break, 4th of July, Halloween, participant’s birthday). The minimal assessment control condition did not complete a 3-month follow-up, so this condition was not included in the present analyses; however, previous research demonstrated that the attention control did not display treatment reactivity when contrasted with the minimal assessment condition ( Graupensperger et al., 2022 ). The analytic sample ( N = 1137) comprised 226 participants in the attention control group and 911 participants in the active intervention group (see Table 1 ). TABLE 1. Generalized linear models estimating associations between social anxiety symptoms (SIAS) and alcohol use outcomes at baseline, among all participants. Drinks per week (DDQ) Negative consequences (RAPI) Perceived descriptive norms Perceived injunctive norms RR 95% CI p RR 95% CI p RR 95% CI p RR 95% CI p (Intercept) 28.58 13.49, 60.41 <0.001 10.08 3.31, 30.58 <0.001 21.49 13.26, 34.79 <0.001 20.98 12.56, 35 <0.001 Age at baseline 0.97 0.94, 1.01 0.111 0.98 0.93, 1.03 0.386 0.99 0.97, 1.01 0.448 1.01 0.99, 1.04 0.320 Birth sex (M = 0, F= 1) 0.58 0.53, 0.64 <0.001 0.80 0.69, 0.92 0.002 0.93 0.88, 0.99 0.029 0.87 0.81, 0.92 <0.001 Campus (public = 0, private = l) 1.06 0.96, 1.17 0.242 1.08 0.94, 1.25 0.290 1.09 1.02, 1.16 0.008 0.99 0.93, 1.06 0.770 SIAS score 0.94 0.88, 1.00 0.044 1.10 1.01, 1.2 0.026 0.99 0.95, 1.03 0.597 1.00 0.96, 1.05 0.823 Open in a new tab Abbreviation: SIAS, Social Interaction Anxiety Scale. On average, participants were 20.13 years old (SD = 1.36; range, 18–24) and 62.2% identified as female. Regarding race and ethnicity, 12.5% identified as Hispanic/Latinx across all racial groups, 62.6% identified as non-Hispanic White, 12.1% non-Hispanic Asian, 7.5% non-Hispanic multiracial, 2.2% non-Hispanic Black/African American, 1.6% non-Hispanic Hawaiian/Pacific Islander, and 0.3% non-Hispanic American Indian/Alaskan Native; 1.2% provided their own response. A range of class years was represented (14.6% 1st year, 20.2% 2nd year, 25.6% 3rd year, and 39.6% 4th year+). Average retention across the three follow-up assessments was high (91.2%). All study procedures were approved by the university institutional review boards at both campuses. Intervention conditions Attention control Participants in the attention control condition viewed generic feed-back on nondrinking behaviors (i.e., hours spent texting, down-loading music, and playing video games in a typical week) online. Participants viewed a bar graph displaying (a) participants’ own behavior and (b) actual behavior for a typical student on their campus and text describing their percentile rank compared with other students on their campus. Intervention conditions Participants in the intervention conditions received one of four norms-based online interventions: (1) descriptive norms only (i.e., text and bar graphs of one’s own drinking behavior, perceived drinking behavior of typical same-gender students, and actual campus-specific drinking norms of typical students + percentile rank), (2) injunctive norms only (i.e., text and bar graphs displaying perceived and actual acceptability of drinking behaviors), (3) both descriptive and injunctive norms, or (4) a multicomponent PFI (i.e., descriptive and injunctive norms, alcohol-related psychoeducation, and additional personalized feedback). In the multicomponent PFI, psychoeducational components included standard drink size, effects of alcohol at different blood alcohol content levels, protective behavioral strategies; additional personalized feedback components included negative consequences, financial costs of drinking, alcohol tolerance. For the present study, we combined the four intervention conditions as they displayed minimal differences in efficacy between conditions ( Larimer et al., 2023 ) and all provided corrective feedback on perceived norms; the combined active intervention conditions will be collectively referred to as “norms-based intervention” hereafter. For a detailed description of each intervention condition, see Larimer et al. (2023) . Measures Social Interaction Anxiety Scale (SIAS; Mattick & Clarke, 1998 ) was used to assess baseline levels of social anxiety symptoms. The SIAS is a 20-item measure that asks participants to rate the extent to which they experience anxiety related to different social situations measured (from 0 = Not at all to 4 = Extremely ). The current study removed the three reverse-scored items, given concerns they detract from validity ( Rodebaugh et al., 2011 ), and summed the scores from the remaining items to produce a total score. Total SIAS scores greater than 28 are indicative of clinically elevated social anxiety symptoms ( Rodebaugh et al., 2011 ). For the analytic models, the SIAS total score was computed as a total score ranging from 0 to 4 as this better handles item-level missingness, enhances interpretability, and is otherwise mathematically equivalent to sum scoring within regression models ( Widaman & Revelle, 2023 ). Descriptive statistics (including clinical cutoffs) present the SIAS total score (i.e., 0–68). Internal consistency was excellent in the current sample ( α = 0.94). An adapted version of the Drinking Norms Rating Form (DNRF; Baer et al., 1991 ) was used to assess descriptive and injunctive drinking norms at baseline and all follow-ups. Participants reported their perceptions of the number of drinks consumed on each day of the week by a typical student on their campus (descriptive norms) as well as the number of drinks a typical student on their campus would view as acceptable to consume on each day of the week ( Krieger et al., 2016 ). Responses for each day were summed to create composite scores for descriptive and injunctive norms, respectively. At baseline and all follow-ups, typical alcohol quantity was assessed using the Daily Drinking Questionnaire (DDQ; Collins et al., 1985 ), which asked participants to consider a typical week in the past month, and for each day of the week, report the number of standard drinks they typically consumed. Responses were summed to create a composite score of the total number of standard drinks per week. A modified version of the Rutgers Alcohol Problem Index (RAPI) was used to assess the frequency of 25 alcohol-related negative consequences in the past 3 months (0 = Never to 4 =10 or more times ) at baseline and all follow-ups. Two items were added to the original RAPI, as done in prior work ( Geisner et al., 2018 ): “Drove shortly after having two or more drinks” and “drove shortly after having four or more drinks.” Responses were summed, with higher scores indicating a greater number of negative consequences experienced. For all time points, internal consistency was strong ( α = 0.90–0.94). Data analytic strategy Primary analyses examined the extent to which baseline social anxiety symptoms (measured continuously using the SIAS) moderated the efficacy of norms-based interventions, relative to the attention control using a generalized linear mixed-effects models (GLMM). As we sought to examine the potential moderation at each of the 3-, 6-, and 12-month follow-ups, we specified time as a categorical covariate (i.e., Time 0 = Baseline). The main effect of condition was estimated by a Condition × Time product term that reflects the difference between conditions at a given follow-up, relative to the difference between conditions at baseline, and thereby factors in participants’ starting scores on a given outcome prior to the intervention (i.e., between conditions at a given follow-up among those with SIAS scores of 0). These main effects are already reported ( Larimer et al., 2023 ), but must be included when adding the three-way interactions testing the extent to which social anxiety moderated intervention efficacy (i.e., significant reductions in alcohol outcomes). These are estimated by the addition of a SIAS × Condition × Time product term, with separate estimates at each follow-up. These three-way interactions reflect the extent to which differences between conditions at a given follow-up relative to differences at baseline vary as a function of social anxiety symptoms. Marginal effects from the three-way interactions were then plotted to aid interpretation ( McCabe et al., 2022 ). GLMMs account for repeated assessments nested within participants and account for the overdispersed count outcomes (i.e., Poisson model with additional observation-level random effect to account for overdispersion; Harrison, 2014 ). The main outcomes paper ( Larimer etal., 2023 ) used a zero-inflated modeling approach for these outcomes, but this adds numerous complexities to interpreting the interactions estimated herein; thus, we did not use a zero-inflated approach for these secondary analyses. In these models, covariates are connected to outcomes through a natural logarithm link function, and coefficients are exponentiated to yield rate ratios (RR), whereby RRs of 1 indicate no effect and RRs smaller or larger than 1 indicate percentage reductions or increases in the outcome, respectively. GLMMs controlled for age, birth sex, and campus, and were fit using the “glmmTMB” package in R ( Brooks et al., 2017 ), and the marginal effects were estimated and plotted using the “sjPlot” package ( Lüdecke et al., 2023 ). RESULTS Descriptive statistics for outcome variables, stratified by condition, are shown in Table S1 . In an initial step, we fit regression models estimating associations between SIAS scores and baseline drinks per week, baseline negative consequences, and baseline perceived norms ( Table 1 ). Social anxiety symptoms were inversely associated with baseline drinks per week, indicating those with higher social anxiety reported lower levels of drinking at baseline. Social anxiety symptoms were positively associated with negative consequences (even when controlling for weekly number of drinks), indicating those with higher social anxiety symptoms reported more negative consequences despite drinking less, on average. Social anxiety symptoms were not significantly associated with perceived norms. Social anxiety moderating intervention effects The GLMMs shown in Tables 2 and 3 estimated moderation effects of social anxiety symptoms on intervention efficacy. Specifically, the focal estimates in these models are the three-way interactions at each follow-up point. We did not interpret the main effects of the intervention (see Larimer et al., 2023 for main outcomes). TABLE 2. Generalized linear mixed-effects models estimating the extent to which social anxiety symptoms (SIAS) moderate intervention effects of brief norms-based interventions on 3-, 6-, and 12-month alcohol-related follow-up outcomes. Drinks per week (DDQ) Negative consequences (RAPI) RR 95% CI p RR 95% CI p (Intercept) 33.46 15.96, 70.17 <0.001 14.57 4.71, 45.09 <0.001 Age at baseline 0.95 0.92, 0.98 0.003 0.93 0.88, 0.98 0.004 Birth sex (M = 0, F = 1) 0.64 0.58, 0.70 <0.001 0.88 0.77, 1.02 0.088 Campus (public = 0, private = 1) 1.09 0.99, 1.20 0.066 1.15 1.00, 1.33 0.053 SIAS score at baseline 0.96 0.83, 1.10 0.532 1.19 0.96, 1.47 0.115 Time: 3 months 1.28 1.16, 1.42 <0.001 1.12 0.96, 1.30 0.161 Time: 6 months 1.09 0.98, 1.21 0.115 1.07 0.92, 1.25 0.369 Time: 12 months 0.97 0.87, 1.08 0.552 1.00 0.85, 1.18 0.968 Condition (assessment-only control = 0, active intervention = 1) 1.02 0.80, 1.29 0.897 1.11 0.78, 1.60 0.560 Two-way interactions Condition × Time: 3 months 0.69 0.61, 0.77 <0.001 0.87 0.73, 1.03 0.103 Condition × Time: 6 months 0.79 0.70, 0.89 <0.001 0.78 0.65, 0.93 0.005 Condition × Time: 1 months 0.80 0.71, 0.91 <0.001 0.80 0.67, 0.96 0.016 SIAS × Time: 3 months 0.80 0.74, 0.86 <0.001 0.92 0.84, 1.01 0.099 SIAS × Time: 6 months 0.94 0.88, 1.01 0.098 1.03 0.94, 1.13 0.518 SIAS × Time: 12 months 1.01 0.94, 1.08 0.882 0.96 0.87, 1.06 0.426 Condition × SIAS 0.95 0.81, 1.11 0.490 0.89 0.70, 1.12 0.315 Three-way interactions SIAS × Condition × Time: 3 months 1.23 1.14, 1.34 <0.001 1.10 0.99, 1.22 0.080 SIAS × Condition × Time: 6 months 1.07 0.99, 1.16 0.084 1.05 0.95, 1.16 0.337 SIAS × Condition × Time: 12 months 1.04 0.96, 1.13 0.311 1.07 0.96, 1.19 0.249 Open in a new tab Note : In these models, the main effect is operationalized as a Condition × Time product term; thus, the three-way interactions show the moderation effect of SIAS on intervention efficacy at a given follow-up, relative to baseline. Refer to Figure 1 for plots of interaction marginal effects. Abbreviation: SIAS, Social Interaction Anxiety Scale. TABLE 3. Generalized linear mixed-effects models estimating the extent to which social anxiety symptoms (SIAS) moderate intervention effects of brief norms-based interventions on 3-, 6-, and 12-month norms-related follow-up outcomes. Perceived descriptive norms Perceived injunctive norms RR 95% CI p RR 95% CI p (Intercept) 22.95 14.95, 35.23 <0.001 22.77 14.82, 34.97 <0.001 Age at baseline 0.98 0.96, 1.00 0.031 1.00 0.98, 1.02 0.875 Birth sex (M=0, F = 1) 0.98 0.93, 1.04 0.491 0.87 0.82, 0.92 <0.001 Campus (public = 0, private = 1) 1.14 1.08, 1.21 <0.001 0.97 0.92, 1.03 0.352 SIAS score at baseline 1.06 0.97, 1.15 0.193 1.05 0.96, 1.14 0.262 Time: 3 months 1.05 0.96, 1.15 0.307 1.14 1.06, 1.23 <0.001 Time: 6 months 1.02 0.92, 1.12 0.742 1.11 1.02, 1.20 0.010 Time: 12 months 0.99 0.90, 1.09 0.861 1.16 1.07, 1.25 <0.001 Condition (AOC = 0, active intervention = 1) 1.05 0.91, 1.21 0.530 1.14 0.99, 1.31 0.065 Two-way interactions Condition × Time: 3 months 0.75 0.68,0.84 <0.001 0.65 0.60, 0.71 <0.001 Condition × Time: 6 months 0.78 0.70, 0.87 <0.001 0.72 0.66, 0.79 <0.001 Condition × Time: 12 months 0.83 0.75, 0.93 <0.001 0.69 0.63, 0.75 <0.001 SIAS × Time: 3 months 0.89 0.84, 0.95 <0.001 0.92 0.88, 0.97 0.001 SIAS × Time: 6 months 0.95 0.89, 1.01 0.103 0.98 0.93, 1.03 0.406 SIAS × Time: 12 months 0.93 0.87, 0.99 0.023 0.92 0.87, 0.97 0.002 Condition × SIAS 0.93 0.85, 1.02 0.123 0.95 0.87, 1.04 0.283 Three-way interactions SIAS × Condition × Time: 3 months 1.11 1.04, 1.19 0.003 1.10 1.04, 1.16 <0.001 SIAS × Condition × Time: 6 months 1.04 0.97, 1.12 0.239 1.01 0.95, 1.07 0.709 SIAS × Condition × Time: 12 months 1.07 0.99, 1.14 0.070 1.11 1.04, 1.17 <0.001 Open in a new tab Note : In these models, the main effect is operationalized as a Condition × Time product term; thus, the three-way interactions show the moderation effect of SIAS on intervention efficacy at a given follow-up, relative to baseline. Refer to Figure 2 for plots of interaction marginal effects. Abbreviation: SIAS, Social Interaction Anxiety Scale. Typical drinks per week Social anxiety symptoms significantly moderated the effect of condition (i.e., norms-based intervention vs. attention control) on drinks per week, but only significantly so at the 3-month follow-up ( Table 2 ). As demonstrated in the upper half of Figure 1 , the plotted marginal effects show that those who received a norms-based intervention reported decreases in drinking at 3 months regardless of social anxiety symptoms. However, participants with lower social anxiety symptoms who received attention control saw an initial increase in drinking at 3 months. In contrast, participants with higher social anxiety symptoms in the attention control group exhibited a decrease in drinks per week at 3 months. Thus, the moderation effect of social anxiety symptoms on intervention efficacy appears to be driven by the decrease in drinking at the 3-month follow-up among participants who received the attention control. Taken together, it appears that norms-based intervention was efficacious at reducing typical drinks per week, regardless of social anxiety. FIGURE 1. Open in a new tab Marginal effects plots of the three-way interactions shown in Table 2 . Negative consequences Social anxiety symptoms did not significantly moderate the effect of intervention on negative consequences at 3-, 6-, or 12-month follow-up ( Table 2 ), as shown in the lower half of Figure 1 . Descriptive norms Social anxiety symptoms significantly moderated the effect of intervention on descriptive norms at 3 months ( Table 3 ). The plotted marginal effects show that participants who received a norms-based intervention exhibited a decrease in descriptive norms, regardless of the level of social anxiety. Interestingly, participants with higher social anxiety symptoms who received the attention control also reported a decrease in descriptive norms at the 3-month follow-up ( Figure 2 ). FIGURE 2. Open in a new tab Marginal effects plots of the three-way interactions shown in Table 3 . Injunctive norms Social anxiety symptoms significantly moderated the effect of condition on injunctive norms at 3- and 12-month follow-up ( Table 3 ). Again, the plotted marginal effects show that participants who received a norms-based intervention exhibited similar decreases in injunctive norms, regardless of social anxiety ( Figure 2 ). Yet, participants who received the attention control demonstrated relative consistency in ratings of injunctive norms, although those with higher social anxiety symptoms reported a slight decrease in injunctive norms at 3- and 12-month follow-ups. DISCUSSION The purpose of the present study was to test the moderating effect of baseline social anxiety symptoms on the efficacy of online, norms-based interventions for reducing college student drinking. In contrast to prior work focused on an in-person norms-based intervention ( Terlecki et al., 2011 , 2012 ), results suggest that online norms-based interventions were similarly efficacious for reducing drinking, negative consequences, and normative beliefs for college students, regardless of baseline social anxiety symptoms. The significant moderation effects of social anxiety symptoms observed at the 3-month follow-up appeared to be driven largely by decreases in drinking and descriptive norms among those who did not receive the norms-based intervention. Specifically, students with lower levels of social anxiety at baseline who received the attention control demonstrated stability or modest increases in drinking/descriptive norms from baseline to the 3-month follow-up. In contrast, students with higher levels of social anxiety who received the attention control demonstrated decreases in drinking and descriptive norms; however, as displayed in Figures 1 and 2 , these initial decreases do not appear to be maintained without intervention. Overall, online norms-based interventions demonstrated utility in decreasing drinking, normative beliefs, and drinking-related negative consequences among students with higher social anxiety symptoms, suggesting that existing brief alcohol-focused interventions deliver an efficacious impact even without adaptation for social anxiety-specific concerns. Data from participants with higher social anxiety symptoms who did not receive a norms-based intervention provide much-needed insight into the longitudinal relationships between social anxiety symptoms and drinking norms/behaviors. The naturally occurring variability in drinking outcomes suggests that these individuals may be more amenable to changing their drinking behaviors and normative beliefs over time, perhaps as a function of experience and context. In line with the theories of self-presentation of social anxiety ( Schlenker & Leary, 1982 ) and social learning ( Bandura & Walters, 1977 ), undergraduates with social anxiety who believe that other students drink more than they do may occasionally drink more in an attempt to make a good impression with peers ( Buckner & Matthews, 2012 ; Sharp & Getz, 1996 ). If these attempts to manage impressions through drinking backfire (i.e., result in negative consequences; Buckner & Matthews, 2012 ; Martin & Leary, 2001 ), those higher in social anxiety may seek to change their drinking behaviors and beliefs to avoid negative consequences and perceived negative judgments from others. In partial support of this contention, college students with higher social anxiety symptoms who reported greater fears of negative evaluation were more likely to report using more serious harm reduction protective behavioral strategies (e.g., use a designated driver) and endorsed fewer alcohol-related consequences ( Villarosa-Hurlocker et al., 2018 ). However, changes in drinking may depend on additional contextual factors. For instance, individuals with higher social anxiety symptoms may be more susceptible to drinking more when they are feeling socially anxious, spending time in unfamiliar social settings or personal/intimate contexts, or struggling to make strong social connections within a group ( Caumiant et al., 2023 ; Goodman et al., 2018 ; Graupensperger et al., 2021 ; Terlecki & Buckner, 2015 ). Additionally, on average, norms-based interventions demonstrated efficacy for reducing injunctive norms, regardless of one’s level of social anxiety symptoms at baseline. Among undergraduates with higher social anxiety symptoms, injunctive norms (i.e., higher perceived acceptability) are associated with greater drinking ( LaBrie et al., 2008 ) and more alcohol-related negative consequences ( Buckner et al., 2011 ), though results are inconsistent across studies (e.g., Linden et al., 2012 ). However, higher injunctive norms appear to be a particularly strong predictor of heavy episodic drinking among students with higher social anxiety ( Linden et al., 2012 ). The vast majority of brief interventions for alcohol tend to include descriptive norms, but not injunctive norms ( Miller et al., 2013 ), even though previous work suggests that incorporating injunctive norms into brief alcohol interventions may improve intervention outcomes ( Prince et al., 2015 ) beyond descriptive-norms-only feedback ( Larimer et al., 2023 ). Despite these mixed cross-sectional findings, results from the present study suggest brief norms-based interventions hold value for reducing the perceived acceptability of drinking for some individuals with co-occurring mental health concerns. Clinical implications The present study found existing brief online norms-based interventions demonstrated utility for reducing drinking among undergraduates with higher social anxiety. This finding is particularly important for several reasons. First, prior work demonstrated that person-delivered norms-based interventions were not efficacious for reducing drinking for students with higher social anxiety symptoms; thus, it may be useful to explore whether online-delivered norms intervention produces better outcomes compared with person-delivered interventions and identify mechanisms underlying these differences (e.g., perceived judgment and social interaction). Second, given similar effects on drinking-related outcomes regardless of social anxiety symptoms, it may be unnecessary to include additional integrated treatment components that focus specifically on social anxiety and drinking for online norms-based interventions. Third, existing online norms-based interventions may play an important role in preventing progression to alcohol use disorder among this high-risk group, as some research indicates that people with social anxiety disorder are at particularly high risk for developing an alcohol use disorder (e.g., Buckner et al., 2008 ; Crum & Pratt, 2001 ; Rosenström & Torvik, 2023 ; Torvik et al., 2019 ). It will be important for future work to test this explicitly. The large sample size and focus on clinical significance (i.e., effect sizes versus statistical significance) increase our confidence in the interpretation of our findings. Although findings from the present study suggest that existing online, alcohol-focused, norms-based interventions may be a reasonable and effective starting point to reduce alcohol-related risk, existing online norms-based interventions for alcohol are easily and widely disseminated and may therefore be a possible “point of entry” to additional interventions or resources for co-occurring mental health concerns that impact drinking. Rates of treatment seeking are relatively low among people who are diagnosed with comorbid social anxiety disorder and alcohol use disorder (e.g., Schneier et al., 2010 ), and students with higher social anxiety/mood symptoms and hazardous drinking tend to be more interested in seeking treatment for social anxiety/mood symptoms than their drinking ( Capron et al., 2018 ; Tran et al., 2004 ). It is possible that providing tailored resources (e.g., contact information for on-campus mental health services) or optional intervention components (e.g., integrated PFI that concurrently targets drinking and co-occurring mental health problems; Buckner, Zvolensky, et al., 2020 ; Lebeaut et al., 2023 ; Paulus et al., 2021 ) to individuals with higher social anxiety may provide additional benefits to both social anxiety symptoms and drinking behaviors. Limitations and future directions As the current sample was comprised of people who engaged in past-month heavy episodic drinking, results may not generalize to socially anxious students who drink less heavily; thus, researchers should test whether findings extend to preventative or earlier intervention. Furthermore, social anxiety symptoms were assessed at baseline only; it would be prudent for future work to consider whether the variability in social anxiety severity over time also influences drinking outcomes. Additionally, results from previous research provide conflicting evidence depending on the type of social anxiety endorsed (i.e., interaction fears specifically or social anxiety broadly) and its association with drinking norms ( Buckner et al., 2011 ; Ham & Hope, 2005 , 2006 ; LaBrie et al., 2008 ; Linden et al., 2012 ; Neighbors, Fossos, et al., 2007 ; Neighbors, Lee, et al., 2007 ). Thus, additional research is needed to test whether findings are consistent when using other measures or types of social anxiety symptoms. Finally, the interventions in the present study used typical same-campus students as the referent group for the normative feedback. Some research suggests that additional tailoring of personalized normative feedback (i.e., beyond what the “typical” student does, for instance, by gender) may have additional benefit above “typical” student norms ( Larimer et al., 2009 ); thus, future research should aim to replicate findings among interventions that use higher-specificity normative feedback (e.g., gender, age, or grade-based norms). CONCLUSIONS In sum, online, norms-based alcohol-focused interventions demonstrated utility for reducing drinking, negative consequences, and norms among college students with higher social anxiety symptoms at baseline. Individuals with higher social anxiety who did not receive an active intervention reduced drinking behaviors without intervention, although these reductions were not maintained over time. Future work should consider identifying psychosocial factors contributing to the variability in drinking behaviors/beliefs among undergraduates with higher social anxiety. Supplementary Material S1 Supplementary Tables NIHMS2087628-supplement-S1_Supplementary_Tables.docx (20.3KB, docx) SUPPORTING INFORMATION Additional supporting information can be found online in the Supporting Information section at the end of this article. ACKNOWLEDGMENTS Data collection and analysis was supported by grants from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) to Mary E. Larimer: grants R37AA012547 and T32AA07455. Manuscript preparation was supported by the following grants from the NIAAA: K23AA031034 (PI: Walukevich-Dienst), K99029459, and R00AA029459 (PI: Piccirillo), and T32AA07455 (PI: Larimer), as well as from the National Institute on Drug Abuse (NIDA): F31DA057796 (Smith-LeCavalier). The content of this manuscript is solely the responsibility of the author(s) and does not necessarily represent the official views of NIAAA, NIDA, or the National Institutes of Health. Portions of these findings in a preliminary form were submitted for presentation at the Annual Meeting of the Research Society on Alcohol in June 2024. Footnotes CONFLICT OF INTEREST STATEMENT The authors have no conflicts of interest to declare. DATA AVAILABILITY STATEMENT Research data are not shared. REFERENCES Baer JS, Stacy A & Larimer M (1991) Biases in the perception of drinking norms among college students. Journal of Studies on Alcohol, 52(6), 580–586. Available from: 10.15288/jsa.1991.52.580 [ DOI ] [ PubMed ] [ Google Scholar ] Bandura A & Walters RH (1977) Social learning theory, vol. 1. Englewood Cliffs, NJ: Prentice Hall. [ Google Scholar ] Borsari B & Carey KB (2003) Descriptive and injunctive norms in college drinking: a meta-analytic integration. Journal of Studies on Alcohol, 64(3), 331–341. Available from: 10.15288/jsa.2003.64.331 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Brooks ME, Kristensen K, Van Benthem KJ, Magnusson A, Berg CW, Nielsen A et al. (2017) Modeling zero-inflated count data with glmmTMB [Preprint]. Ecology, 1–13. Available from: 10.1101/13275328068963 [ DOI ] [ Google Scholar ] Buckner JD & Matthews RA (2012) Social impressions while drinking account for the relationship between alcohol-related problems and social anxiety. Addictive Behaviors, 37(4), 533–536. Available from: 10.1016/j.addbeh.2011.11.026 [ DOI ] [ PubMed ] [ Google Scholar ] Buckner JD, Ecker AH & Proctor SL (2011) Social anxiety and alcohol problems: the roles of perceived descriptive and injunctive peer norms. Journal of Anxiety Disorders, 25(5), 631–638. Available from: 10.1016/j.janxdis.2011.02.003 [ DOI ] [ PubMed ] [ Google Scholar ] Buckner JD, Lewis EM, Terlecki MA, Albery IP & Moss AC (2020) Context-specific drinking and social anxiety: the roles of anticipatory anxiety and post-event processing. Addictive Behaviors, 102, 106184. Available from: 10.1016/j.addbeh.2019.106184 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Buckner JD, Timpano KR, Zvolensky MJ, Sachs-Ericsson N & Schmidt NB (2008) Implications of comorbid alcohol dependence among individuals with social anxiety disorder. Depression and Anxiety, 25(12), 1028–1037. Available from: 10.1002/da.20442 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Buckner JD, Zvolensky MJ & Lewis EM (2020) On-line personalized feedback intervention for negative affect and cannabis: a pilot randomized controlled trial. Experimental and Clinical Psychopharmacology, 28(2), 143–149. Available from: 10.1037/pha0000304 [ DOI ] [ PubMed ] [ Google Scholar ] Capron DW, Bauer BW, Madson MB & Schmidt NB (2018) Treatment seeking among college students with comorbid hazardous drinking and elevated mood/anxiety symptoms. Substance Use & Misuse, 53(6), 1041–1050. Available from: 10.1080/10826084.2017.1392982 [ DOI ] [ PubMed ] [ Google Scholar ] Caumiant EP, Fairbairn CE, Bresin K, Gary Rosen I, Luczak SE & Kang D (2023) Social anxiety and alcohol consumption: the role of social context. Addictive Behaviors, 143, 107672. Available from: 10.1016/j.addbeh.2023.107672 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Collins RL, Parks GA & Marlatt GA (1985) Social determinants of alcohol consumption: the effects of social interaction and model status on the self-administration of alcohol. Journal of Consulting and Clinical Psychology, 53(2), 189–200. Available from: 10.1037/0022-006X.53.2.189 [ DOI ] [ PubMed ] [ Google Scholar ] Crum RM & Pratt LA (2001) Risk of heavy drinking and alcohol use disorders in social phobia: a prospective analysis. The American Journal of Psychiatry, 158(10), 1693–1700. Available from: 10.1176/appi.ajp.158.10.1693 [ DOI ] [ PubMed ] [ Google Scholar ] Dimeff LA, Baer JS, Kivlahan DR & Marlatt GA (1999) Brief alcohol screening and intervention for college students (BASICS): a harm reduction approach. New York, NY: Guilford Press. [ Google Scholar ] Dotson KB, Dunn ME & Bowers CA (2015) Stand-alone personalized normative feedback for college student drinkers: a meta-analytic review, 2004 to 2014. PLoS One, 10(10), e0139518. Available from: 10.1371/journal.pone.0139518 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Fehm L, Beesdo K, Jacobi F & Fiedler A (2008) Social anxiety disorder above and below the diagnostic threshold: prevalence, comorbidity and impairment in the general population. Social Psychiatry and Psychiatric Epidemiology, 43(4), 257–265. Available from: 10.1007/s00127-007-0299-4 [ DOI ] [ PubMed ] [ Google Scholar ] Geisner IM, Mallett K, Varvil-Weld L, Ackerman S, Trager BM & Turrisi R (2018) An examination of heavy drinking, depressed mood, drinking related constructs, and consequences among high-risk college students using a person-centered approach. Addictive Behaviors, 78, 22–29. Available from: 10.1016/j.addbeh.2017.10.022 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Goodman FR, Stiksma MC & Kashdan TB (2018) Social anxiety and the quality of everyday social interactions: the moderating influence of alcohol consumption. Behavior Therapy, 49(3), 373–387. Available from: 10.1016/j.beth.2017.10.002 [ DOI ] [ PubMed ] [ Google Scholar ] Graupensperger S, Schultz NR, Lewis M, Kilmer J & Larimer M (2022) Repeated assessment of alcohol use and perceived norms among college students who drink: comparisons to a minimal assessment at 12-month follow-up. Journal of Studies on Alcohol and Drugs, 83(4), 588–595. Available from: 10.15288/jsad.2022.83.588 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Graupensperger S, Turrisi R, Jones D & Evans MB (2020) Longitudinal associations between perceptions of peer group drinking norms and students’ alcohol use frequency within college sport teams. Alcoholism, Clinical and Experimental Research, 44(2), 541–552. Available from: 10.1111/acer.14270 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Graupensperger S, Turrisi R, Jones D & Evans MB (2021) Dynamic characteristics of groups and individuals that amplify adherence to perceived drinking norms in college club sport teams: a longitudinal multilevel investigation. Psychology of Addictive Behaviors, 35(3), 351–365. Available from: 10.1037/adb0000654 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Ham LS & Hope DA (2005) Incorporating social anxiety into a model of college student problematic drinking. Addictive Behaviors, 30(1), 127–150. Available from: 10.1016/j.addbeh.2004.04.018 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Ham LS & Hope DA (2006) Incorporating social anxiety into a model of college problem drinking: replication and extension. Psychology of Addictive Behaviors, 20(3), 348–355. Available from: 10.1037/0893-164X.20.3.348 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Harrison XA (2014) Using observation-level random effects to model overdispersion in count data in ecology and evolution. PeerJ, 2, e616. Available from: 10.7717/peerj.616 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Harvard Medical School. (2007). National Comorbidity Survey (NCS). Available from: https://www.hcp.med.harvard.edu/ncs/index.php . [Accessed 21st August 2017]. Hurd LE, Ham LS, Melkonian AJ, Zamboanga BL & Jackson KK (2020) Context matters for the socially anxious: moderating role of drinking context on alcohol outcome expectancies. Substance Use & Misuse, 55(8), 1257–1268. Available from: 10.1080/10826084.2020.1735435 [ DOI ] [ PubMed ] [ Google Scholar ] Jefferies P & Ungar M (2020) Social anxiety in young people: a prevalence study in seven countries. PLoS One, 15(9), e0239133. Available from: 10.1371/journal.pone.0239133 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR & Walters EE (2005) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593–602. Available from: 10.1001/archpsyc.62.6.593 [ DOI ] [ PubMed ] [ Google Scholar ] Krieger H, Neighbors C, Lewis MA, LaBrie JW, Foster DW & Larimer ME (2016) Injunctive norms and alcohol consumption: a revised conceptualization. Alcoholism, Clinical and Experimental Research, 40(5), 1083–1092. Available from: 10.1111/acer.13037 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] LaBrie JW, Hummer JF & Neighbors C (2008) Self-consciousness moderates the relationship between perceived norms and drinking in college students. Addictive Behaviors, 33(12), 1529–1539. Available from: 10.1016/j.addbeh.2008.07.008 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] LaBrie JW, Hummer JF, Neighbors C & Larimer ME (2010) Whose opinion matters? The relationship between injunctive norms and alcohol consequences in college students. Addictive Behaviors, 35(4), 343–349. Available from: 10.1016/j.addbeh.2009.12.003 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Larimer ME, Cronce JM, Lee CM & Kilmer JR (2004) Brief intervention in college settings. Alcohol Research & Health, 28(2), 94–104. [ PMC free article ] [ PubMed ] [ Google Scholar ] Larimer ME, Graupensperger S, Lewis MA, Cronce JM, Kilmer JR, Atkins DC et al. (2023) Injunctive and descriptive normative feedback for college drinking prevention: is the whole greater than the sum of its parts? Psychology of Addictive Behaviors, 37(3), 447–461. Available from: 10.1037/adb0000893 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Larimer ME, Kaysen DL, Lee CM, Kilmer JR, Lewis MA, Dillworth T et al. (2009) Evaluating level of specificity of normative referents in relation to personal drinking behavior. Journal of Studies on Alcohol and Drugs, Supplement, 16, 115–121. Available from: 10.15288/jsads.2009.s16.115 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Lebeaut A, Pedersen ER, Francis DJ, Zvolensky MJ & Vujanovic AA (2023) Evaluation of an integrated personalized feedback intervention for hazardous drinkers with elevated anxiety sensitivity and PTSD symptoms: protocol for a randomized controlled trial. Contemporary Clinical Trials Communications, 32, 101088. Available from: 10.1016/j.conctc.2023.101088 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Lewis MA, Neighbors C, Oster-Aaland L, Kirkeby BS & Larimer ME (2007) Indicated prevention for incoming freshmen: personalized normative feedback and high-risk drinking. Addictive Behaviors, 32(11), 2495–2508. Available from: 10.1016/j.addbeh.2007.06.019 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Linden AN, Lau-Barraco C & Braitman AL (2012) Social anxiety among young adult drinkers: the role of perceived norms and drinking motives. Journal of Drug Education, 42(3), 293–313. Available from: 10.2190/DE.42.3.c [ DOI ] [ PubMed ] [ Google Scholar ] Lüdecke D, Bartel A, Schwemmer C, Powell C, Djalovski A & Titz J (2023) sjPlot: data visualization for statistics in social science (version 2.8.15) [Computer software]. Available from: https://cran.r-project.org/web/packages/sjPlot/index.html [Accessed 13th March 2024]. Martin KA & Leary MR (2001) Self-presentational determinants of health risk behavior among college freshmen. Psychology & Health, 16(1), 17–27. Available from: 10.1080/08870440108405487 [ DOI ] [ Google Scholar ] Mattick RP & Clarke JC (1998) Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36(4), 455–470. Available from: 10.1016/s0005-7967(97)10031-6 [ DOI ] [ PubMed ] [ Google Scholar ] McCabe CJ, Halvorson MA, King KM, Cao X & Kim DS (2022) Interpreting interaction effects in generalized linear models of nonlinear probabilities and counts. Multivariate Behavioral Research, 57(2–3), 243–263. Available from: 10.1080/00273171.2020.1868966 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Miller MB, Leffingwell T, Claborn K, Meier E, Walters S & Neighbors C (2013) Personalized feedback interventions for college alcohol misuse: an update of Walters & Neighbors (2005). Psychology of Addictive Behaviors, 27(4), 909–920. Available from: 10.1037/a0031174 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Neighbors C, Fossos N, Woods BA, Fabiano P, Sledge M & Frost D (2007) Social anxiety as a moderator of the relationship between perceived norms and drinking. Journal of Studies on Alcohol and Drugs, 68(1), 91–96. Available from: 10.15288/jsad.2007.68.91 [ DOI ] [ PubMed ] [ Google Scholar ] Neighbors C, Larimer ME & Lewis MA (2004) Targeting misperceptions of descriptive drinking norms: efficacy of a computer-delivered personalized normative feedback intervention. Journal of Consulting and Clinical Psychology, 72(3), 434–447. Available from: 10.1037/0022-006X.72.3.434 [ DOI ] [ PubMed ] [ Google Scholar ] Neighbors C, Lee CM, Lewis MA, Fossos N & Larimer ME (2007) Are social norms the best predictor of outcomes among heavy-drinking college students? Journal of Studies on Alcohol and Drugs, 68(4), 556–565. Available from: 10.15288/jsad.2007.68.556 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Paulus DJ, Gallagher MW, Neighbors C & Zvolensky MJ (2021) Computer-delivered personalized feedback intervention for hazardous drinkers with elevated anxiety sensitivity: a pilot randomized controlled trial. Behaviour Research and Therapy, 141, 103847. Available from: 10.1016/j.brat.2021.103847 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Pew Research Center. (2024) Internet, broadband fact sheet. Pew Research Center. Available from: https://www.pewresearch.org/internet/fact-sheet/internet-broadband/#smartphone-dependency-over-time [Accessed 12th February 2025]. [ Google Scholar ] Prince MA, Maisto SA, Rice SL & Carey KB (2015) Development of a face-to-face injunctive norms brief motivational intervention for college drinkers and preliminary outcomes. Psychology of Addictive Behaviors, 29(4), 825–835. Available from: 10.1037/adb0000118 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Rodebaugh TL, Heimberg RG, Brown PJ, Fernandez KC, Blanco C, Schneier FR et al. (2011) More reasons to be straightforward: findings and norms for two scales relevant to social anxiety. Journal of Anxiety Disorders, 25(5), 623–630. Available from: 10.1016/j.janxdis.2011.02.002 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Rosenström TH & Torvik FA (2023) Social anxiety disorder is a risk factor for alcohol use problems in the National Comorbidity Surveys. Drug and Alcohol Dependence, 249, 109945. Available from: 10.1016/j.drugalcdep.2023.109945 [ DOI ] [ PubMed ] [ Google Scholar ] Saxton J, Rodda SN, Booth N, Merkouris SS & Dowling NA (2021) The efficacy of personalized normative feedback interventions across addictions: a systematic review and meta-analysis. PLoS One, 16(4), e0248262. Available from: 10.1371/journal.pone.0248262 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Schlenker BR & Leary MR (1982) Social anxiety and self-presentation: a conceptualization model. Psychological Bulletin, 92(3), 641–669. Available from: 10.1037/0033-2909.92.3.641 [ DOI ] [ PubMed ] [ Google Scholar ] Schneier FR, Foose TE, Hasin DS, Heimberg RG, Liu S-M, Grant BF et al. (2010) Social anxiety disorder and alcohol use disorder comorbidity in the National Epidemiologic Survey on alcohol and related conditions. Psychological Medicine, 40(6), 977–988. Available from: 10.1017/S0033291709991231 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Schry AR & White SW (2013) Understanding the relationship between social anxiety and alcohol use in college students: a meta-analysis. Addictive Behaviors, 38(11), 2690–2706. Available from: 10.1016/j.addbeh.2013.06.014 [ DOI ] [ PubMed ] [ Google Scholar ] Sharp MJ & Getz JG (1996) Substance use as impression management. Personality and Social Psychology Bulletin, 22(1), 60–67. Available from: 10.1177/0146167296221006 [ DOI ] [ Google Scholar ] Tanner-Smith EE & Lipsey MW (2015) Brief alcohol interventions for adolescents and young adults: a systematic review and meta-analysis. Journal of Substance Abuse Treatment, 51, 1–18. Available from: 10.1016/j.jsat.2014.09.001 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Terlecki MA & Buckner JD (2015) Social anxiety and heavy situational drinking: coping and conformity motives as multiple mediators. Addictive Behaviors, 40, 77–83. Available from: 10.1016/j.addbeh.2014.09.008 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Terlecki MA, Buckner JD, Larimer ME & Copeland AL (2011) The role of social anxiety in a brief alcohol intervention for heavy-drinking college students. Journal of Cognitive Psychotherapy, 25(1), 7–21. Available from: 10.1891/0889-8391.25.1.7 [ DOI ] [ Google Scholar ] Terlecki MA, Buckner JD, Larimer ME & Copeland AL (2012) Brief motivational intervention for college drinking: the synergistic impact of social anxiety and perceived drinking norms. Psychology of Addictive Behaviors, 26(4), 917–923. Available from: 10.1037/a0027982 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Torvik FA, Rosenström TH, Gustavson K, Ystrom E, Kendler KS, Bramness JG et al. (2019) Explaining the association between anxiety disorders and alcohol use disorder: a twin study. Depression and Anxiety, 36(6), 522–532. Available from: 10.1002/da.22886 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Tran GQ, Anthenelli RM, Smith JP, Corcoran KJ & Rofey DL (2004) Alcohol use, cognitive correlates of drinking and change readiness in hazardous drinkers with high versus low social anxiety. Journal of Studies on Alcohol, 65(6), 715–724. Available from: 10.15288/jsa.2004.65.715 [ DOI ] [ PubMed ] [ Google Scholar ] Villarosa-Hurlocker MC & Madson MB (2020) A latent profile analysis of social anxiety and alcohol use among college students. Addictive Behaviors, 104, 106284. Available from: 10.1016/j.addbeh.2019.106284 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Villarosa-Hurlocker MC, Whitley RB, Capron DW & Madson MB (2018) Thinking while drinking: fear of negative evaluation predicts drinking behaviors of students with social anxiety. Addictive Behaviors, 78, 160–165. Available from: 10.1016/j.addbeh.2017.10.021 [ DOI ] [ PubMed ] [ Google Scholar ] Walukevich-Dienst K, Blayney JA, Fairlie AM, Jaffe AE & Larimer ME (2022) Social anxiety and pre-party motives are associated with alcohol-related negative consequences during college students’ most recent pre-party occasion. Journal of Studies on Alcohol and Drugs, 83(6), 820–828. Available from: 10.15288/jsad.21-00434 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Widaman KF & Revelle W (2023) Thinking thrice about sum scores, and then some more about measurement and analysis. Behavior Research Methods, 55(2), 788–806. Available from: 10.3758/s13428-022-01849-w [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Associated Data This section collects any data citations, data availability statements, or supplementary materials included in this article. Supplementary Materials S1 Supplementary Tables NIHMS2087628-supplement-S1_Supplementary_Tables.docx (20.3KB, docx) Data Availability Statement Research data are not shared. ACTIONS View on publisher site PDF (1.0 MB) Cite Collections Permalink RESOURCES Similar articles Cited by other articles Links to NCBI Databases Follow NCBI NCBI on X (formerly known as Twitter) NCBI on Facebook NCBI on LinkedIn NCBI on GitHub NCBI RSS feed Connect with NLM NLM on X (formerly known as Twitter) NLM on Facebook NLM on YouTube National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894 Web Policies FOIA HHS Vulnerability Disclosure Help Accessibility Careers NLM NIH HHS USA.gov Back to Top

Related documents

• Feasibility and acceptability of CoMUni: A social media- based intervention to increase mental health help seeking in UK undergraduate students#372615
• Implementing what works in alcohol policy: progress report on the SAFER initiative#317111
• Awareness and perceptions of social prescribing among university students in the UK#448666
• Feasibility and Acceptability of Mindfulness-based Resilience Training for Rural Law Enforcement Officers#889112
• “It’s Okay Not to Be Okay”? Awareness Fatigue and the Critique of Mental Health Campaigns in Lived-Experience Communities on Reddit#376434