To the best of our knowledge, this is the first study to demonstrate an association between specific content of displayed alcohol references on Facebook evaluated using clinical screening criteria, and self-reported problem drinking behaviors and consequences. Our data illustrates that participants who chose to display references to intoxication or problem drinking on publicly available Facebook profiles were more likely to meet problem drinking criteria using the AUDIT score compared to participants who displayed either no alcohol references, or alcohol references, on their Facebook profiles.
Our findings further illustrate that mean AUDIT scores increase as categories of displayed alcohol references on Facebook profile escalate. The lowest mean AUDIT scores were amongst Non-Displayers, higher mean AUDIT scores were found among Alcohol Displayers, and highest mean AUDIT scores were among I/PD Displayers. The I/PD Displayers group was the only group with mean AUDIT score in the problem drinking category. Additionally, I/PD Displayers were more likely to report experiencing an alcohol-related injury in the last year. Facebook displays of intoxication and problem drinking may be indicators of both overall problem drinking concerns, as well as short-term morbidity related to alcohol use in the college population. Thus, it can be concluded that there is likely a difference in clinical relevance between displayed alcohol references and I/PD references as representations of college alcohol use.
Our findings related to gender suggest that the association between I/PD Displayer and AUDIT score may be stronger for males than females. Compared to female college students, male college students are more likely to drink alcohol as well as engage in binge drinking.30, 31
Further, males are less likely to be seen in clinic; approximately 38% of males report having a preventive health check in the past year compared to 69% of females.11, 32
Thus, if Facebook presents a valid complementary method of identifying males at high risk for problem drinking, then this method would likely capture a population with high rates of problem drinking and low likelihood of seeking care in a clinic.
Our study findings are limited in that we only examined publicly available profiles on one SNS. Therefore we cannot generalize our findings to profiles that have security set to private, or to profiles on other SNSs. It is important to note that SNS profile privacy settings are not permanent; profile owners may change their privacy settings at any time or to reflect what security upgrades are offered by Facebook. It is unclear whether profile owners who maintained a private profile at the time of this study would be more likely, or less likely, to display alcohol references. For this study, the finding that our prevalence of problem drinking was consistent with other national estimates suggests our sample was representative.29
Study findings are also limited in that our study sample included very few minority and no African American participants, which is consistent with the demographic of our universities.
Despite these potential limitations, our findings have important implications. Although approximately half of the screened profiles were excluded due to privacy settings, at present only 12% of college students report undergoing alcohol screening using a standardized instrument.12
Facebook is used by up to 98% of the college population, and about half of college students’ profiles in our study were public; thus, use of Facebook as a complementary and innovative screening tool still represents a substantial improvement over the norm.12
Our goal in evaluating publicly available profiles was to assess information that could be viewed by any Facebook user’s peers, parents, professors or any other university affiliates. By assessing public profiles, our goal was to identify a subset of the Facebook population that may be accessible for future intervention efforts.
There are several ways in which these findings could contribute towards enhancing alcohol screening or intervention efforts among college students. Attention to both privacy concerns and ethics are paramount to the success of any future research or clinical efforts involving SNSs.33, 34
A first option is to use displayed information on SNS profiles as a way to identify students at risk and recommend that these students be seen in clinic for further screening or counseling. Findings in our paper suggest that approximately half of profiles were excluded due to privacy settings. Since the time of our data collection, Facebook profile security settings have again changed and more options exist to set sections of the profile to private while leaving the profile itself publicly available. It is possible that more profiles may now be publicly available. As Facebook security is ever-changing, it is likely that an ideal target to undertake initial screening is someone known to the college student who would have full access to profile content. This approach may also lead to better acceptance by the profile owner if he or she is approached with concerns and a request to undergo further clinical screening. It is possible that trusted peer leaders such as dormitory resident advisors could receive training in identification of at-risk students from Facebook I/PD references. These peer leaders could then provide resources to a student who displayed repeated concerning references on Facebook. Our findings suggest that training in CRAFFT criteria could allow such peer leaders to distinguish a student who displays references to problem drinking from students who may display references to alcohol on Facebook.
Another consideration is the role of the clinician in these screening efforts. It is unlikely that a clinician would have time or training to undertake evaluation of Facebook profiles in the college health setting. However, clinicians may be approached by parents, professors or administrators regarding the content of a student’s Facebook profile. These study findings can be used towards offering evidence-based guidance that students who display references to intoxication or problem drinking on Facebook should undergo clinical screening for problem alcohol use.
A final consideration is the use of targeted messaging based on the displayed content on a SNS profile. This approach would provide messages to Facebook profile owners regardless of privacy settings. Advertisements on Facebook are triggered by keywords displayed on the profile. For example, displayed text references to terms such as “diet” will trigger advertisements for weight loss services displayed next to the profile. It is possible that universities could choose to place messages, or educational materials such as an online alcohol screening program, targeted to keywords representing problem drinking behaviors. Our findings suggest that targeting keywords that relate to intoxication or problem drinking, rather than to general keywords regarding alcohol, may provide an innovative method to deliver a tailored message to a target population. Before such efforts can move forward, a better understanding of what type of messages would be acceptable to the college population as “pop up” advertisements needs to be undertaken.