Background
A major global public health concern, alcohol leads to over 200 diseases and injury-related conditions. Advise on alcohol has been strengthened in last version of the European Code Against Cancer (ECAC). Total intake and drinking patterns play a significant role in shaping health and social consequences. One particularly concerning behaviour is binge drinking aka heavy episodic drinking. In Romania, alcohol consumption is deeply ingrained in cultural and social practices, often viewed as a normative behaviour during social gatherings and celebrations. 83.6% of Romanian students consume alcohol at least once per week and 13.8% engaged in frequent binge drinking. This high prevalence underscores the need for targeted interventions in this demographic.
Objectives
The aim of this implementation research study is to adapt an effective intervention to reduce alcohol consumption to the contextual needs of binge drinking in Romanian youth. This paper presents the intervention adaptation process, implementation outcomes and preliminary findings from the formative research.
Methods
Using the Behaviour Change Wheel as the overarching framework for intervention adaptation, the following steps are being conducted. A desk review informed priority cancer risk factors in Romania and alcohol was selected for intervention. This was further vetted at a stakeholder consultation comprising national and local level public health authorities, academics/researchers, and chronic disease patient coalition representative. The idea on peer-led screening and brief counselling in a university setting was selected. Currently, formative research with qualitative exploration and co-design workshop with university students are being conducted. The output from these steps will be an adapted intervention package. The intervention will be a pilot implementation research with a cluster randomised trial design. The main implementation outcomes of interest are Acceptability, Appropriateness, Feasibility, Fidelity, Adoption, Sustainability.
Results
Three focus group discussions with 15 participants from a renowned university were held in the city of Cluj, Romania. They represented students aged 20-25 years, from different levels of studies from undergraduate to PhD and from varied disciplines. Students indicated that binge drinking was primarily facilitated by social norms, easy access to low-cost alcohol, and the use of alcohol to manage social anxiety and stress. Drinking was commonly normalised within student social life, with implicit peer pressure making refusal difficult, particularly in group settings. Key barriers to excessive drinking included negative physical consequences, next-day academic or work responsibilities, driving, and increasing self-regulation over time. Participants emphasised the importance of practical skills to resist pressure, such as advance planning, assertive refusal, and mutual peer support. Peer-led support was viewed positively when delivered by credible peers with lived experience and framed as supportive rather than moralising. Formal or authority-driven approaches were perceived as less acceptable. 
Conclusions
Implementation research for primary prevention is a necessary step to translate the ECAC recommendations into interventions to reach people and have make a real-world impact. The implementation outcome from this study will help guide the decisions for further scale-up of the intervention to a fully powered trial and inform the pathways for a programmatic uptake throughout universities in Romania.