This three-paper dissertation presents the theory-based design and empirical testing of social media messages aimed at increasing college women's abilities to refuse unwanted alcohol. Health professionals often use the integrative model of behavior prediction to guide intervention message design. However, there is limited research on how this model can be used to promote assertive behaviors, such as refusing alcohol.

To address this gap in the literature, the first paper expands our knowledge of how the integrative model of behavior prediction operates in multiple refusal contexts. Regarding alcohol refusal, survey data from 204 college women reveal that perceived norms and self-efficacy are determinants of refusal intentions. The survey also indicated that compared to their non-Greek peers, sorority women had lower intentions to refuse unwanted alcohol, and this audience may benefit from an intervention aimed at enhancing refusal skills.

The second paper analyzes the underlying alcohol refusal beliefs of sorority women and their perceptions of mass media portrayals of refusal in alcohol-related situations. Thematic analysis of data from four focus groups with a total of 37 women revealed that intervention messages should highlight the importance of pre-planning refusal and recognizing and adhering to one's limits. These findings were then incorporated into the design of theory-based electronic health messages.

The third paper presents the findings from a message testing experiment. A total of 822 sorority women participated in a randomized controlled trial pre-posttest experiment with four conditions. Individuals viewed social media messages that featured (1) norm corrective messages, (2) role model messages, (3) a combination of these two approaches, or (4) a control condition with no health information. Results provide support for the use of norm corrective messages in an electronic health context.

Overall, the findings provide an original contribution to message design research by identifying strategies that may be successful in the promotion of alcohol refusal. Additionally, results reveal the efficacy of applying the integrative model of behavior prediction to the creation of refusal intervention messages. These findings enhance message design research and can be applied in future interventions to empower women to have greater agency over their bodies and their health.