Change IS Possible: Reducing High-Risk Drinking Using a Collaborative Improvement Model

Abstract

Objective: To describe the adoption of public health and improvement methodologies to address college students’ high-risk drinking behaviors and to aid in prevention efforts. Participants: Members of 32 colleges and universities, content experts, and staff members of the National College Health Improvement Program (NCHIP). Methods: A 2-year learning collaborative developed by NCHIP trained individuals from 32 different college and universities in using the Plan–Do–Study–Act cycle as a method to create and implement initiatives aimed at reducing students’ high-risk drinking behaviors and related harms. Results: Participants experienced success ranging from noteworthy increases in type and amount of interventions directed at reducing high-risk drinking, to creating collaboratives across campus, the local community, and stakeholders. Challenges related to data collection and creating lasting cultural change remain. Conclusions: The use of quality improvement methodologies and creation of a national collaborative successfully effected meaningful change in high-risk drinking behaviors on college campuses.     

Social norms theory-based interventions: testing the feasibility of a purported mechanism of action

Social norms-based interventions targeting college student drinking behaviors have become increasingly popular. Such interventions purportedly modify student misperceptions of fellow student drinking behaviors, which leads to changes in individual drinking behavior. Despite claims of successful interventions, research demonstrating that social norms-based interventions modify student perceptions is lacking. OBJECTIVE: The authors conducted a laboratory experiment examining the feasibility of this mechanism of action and aimed to determine the validity of the campus-specific drinking norms hypothesis. PARTICIPANTS AND METHODS: The authors randomly assigned 60 students to 1 of 3 research conditions: Alcohol 101 (national drinking norms), a didactic presentation of campus specific drinking norms, or a control condition. RESULTS: Both intervention groups modified student misperceptions regarding peer alcohol use, and these changes were sustained 1 week later. CONCLUSIONS: Social norms-based interventions can contribute to more accurate drinking perceptions among college students.     

Social Norms Theory-Based Interventions: Testing the Feasibility of a Purported Mechanism of Action

Social norms-based interventions targeting college student drinking behaviors have become increasingly popular. Such interventions purportedly modify student misperceptions of fellow student drinking behaviors, which leads to changes in individual drinking behavior. Despite claims of successful interventions, research demonstrating that social norms-based interventions modify student perceptions is lacking. Objective: The authors conducted a laboratory experiment examining the feasibility of this mechanism of action and aimed to determine the validity of the campus-specific drinking norms hypothesis. Participants and Methods: The authors randomly assigned 60 students to 1 of 3 research conditions: Alcohol 101 (national drinking norms), a didactic presentation of campus specific drinking norms, or a control condition. Results: Both intervention groups modified student misperceptions regarding peer alcohol use, and these changes were sustained 1 week later. Conclusions: Social norms-based interventions can contribute to more accurate drinking perceptions among college students.     

Validation of a measure of college students' intoxicated behaviors: associations with alcohol outcome expectancies, drinking motives, and personality

OBJECTIVE: The authors aimed to develop a measure of college students' intoxicated behaviors and to validate the measure using scales assessing alcohol outcome expectancies, motives for drinking, and personality traits. PARTICIPANTS AND METHOD SUMMARY: The authors administered these measures and an inventory describing 50 intoxicated behaviors to 198 college students and conducted factor analysis on intoxicated behaviors. Logistic regression models examined relationships between intoxicated behavior dimensions and expectances, motives, and personality traits. RESULTS: Self-reported behaviors during intoxication episodes were reducible to 3 basic dimensions that formed reliable and valid scales: social, antisocial, and emotionally labile intoxication. CONCLUSIONS: Researchers can use the Intoxicated Behaviors Inventory to evaluate the effectiveness of interventions targeting drinking or to identify college students at risk for problematic consequences of alcohol use. In addition, results point to the need for community efforts to encourage more moderate drinking among college students.     

Evaluation of the energize your life! Social marketing campaign pilot study to increase fruit intake among community college students

In this study, the authors evaluated the effectiveness of the Energize Your Life! social-marketing campaign pilot study to improve knowledge, attitudes, and fruit intake among community college students. The authors used a cross-sectional, quasi-experimental, pre- and posttest design. They randomly selected community college students (N = 1,367) and exposed the intervention campus to fruit fairs to distribute fresh fruit, 100% fruit juice, and fruit smoothie samples and information about fruit to students. The authors also addressed policy change to increase the accessibility of fruit on campus. There was a significant increase in fruit intake between pre- and posttest at the intervention campus. Although students had positive attitudes toward intake, most did not achieve the minimum recommended daily 2 servings of fruit. Approximately 25% of the students had insufficient funds, which affected their food intake. Longer-term social marketing interventions may be an effective means of improving the dietary quality of community college students.     

Environmental Approaches to Prevention in College Settings

Because of concerns regarding drinking among college students and its harmful consequences, numerous prevention efforts have been targeted to this population. These include individual-level and community-level interventions, as well as other measures (e.g., online approaches). Community-level interventions whose effects have been evaluated in college populations include programs that were developed for the community at large as well as programs aimed specifically at college students, such as A Matter of Degree, the Southwest DUI Enforcement Project, Neighborhoods Engaging With Students, the Study to Prevent Alcohol-Related Consequences, and Safer California Universities. Evaluations of these programs have found evidence of their effectiveness in reducing college drinking and related consequences. The most effective approaches to reducing alcohol consumption among college students likely will blend individual-, group-, campus-, and community-level prevention components.     

Academic demands are associated with reduced alcohol consumption by college students: evidence from a daily analysis

There is little empirical evidence linking academic demands or rigor to alcohol consumption by college students. In a 3-week daily study of full-time college students at a public, residential campus in the United States, both current day and next day's academic demands were negatively related to alcohol consumption, and these relationships were mediated by daily academic effort. Academic demands on the previous day were not related to alcohol consumption, indicating that students do not engage in compensatory or celebratory drinking when demands end. The results suggest that enhancing academic expectations and rigor may be an appropriate intervention target to reduce student drinking.     

High-risk health and credit behavior among 18- to 25-year-old college students

The number of students accumulating credit card debt--and the amount of debt itself--on college campuses is increasing. If high-risk credit and health behavior are associated, health behavior interventions might apply to high-risk credit behavior. OBJECTIVE: The authors' purpose was to examine these possible associations. PARTICIPANTS AND METHODS: They used a retrospective design with existing data from a sample of 45,213 US college students and several ordinal regression models, which corresponded with high priority college health issues. RESULTS: Students with high-risk credit behavior were more likely to have driven after drinking, used amphetamines in the previous 30 days, felt functionally impaired by depression in the previous 12 months, had a higher body mass index (BMI), or had a lower grade-point average (GPA). They were less likely to have participated in vigorous physical activity, used condoms for oral or vaginal sex in the prior 30 days, or used marijuana. The findings support the notion that high-risk health and credit behaviors are associated. CONCLUSIONS: Further research could clarify the nature of this relation.     

Efficacy of a web-based, tailored, alcohol prevention/intervention program for college students: 3-month follow-up

This study presents the results of an efficacy evaluation of a web-based brief motivational alcohol prevention/intervention program called Michigan Prevention and Alcohol Safety for Students (M-PASS). Four on-line sessions providing individually-tailored feedback were delivered to first-year college students over 9 weeks. Non- and low-risk drinking participants received risk prevention, while high-risk drinking participants received a risk-reduction intervention. Both intervention and control groups were surveyed at baseline and at a 3-month follow-up. Analysis showed positive effects for both men and women on stage of change, drinking behavior, drinking motivation and attitudes, and use of risk-reduction strategies. These results provided evidence of efficacy and found that M-PASS had both intervention and prevention effects, making it unique among currently developed brief alcohol interventions for college students.     

Heavy episodic drinking and college entrance

The college environment appears to encourage heavy drinking. Consequently, correlates of student drinking were assessed at college entrance. First-semester freshmen (N = 520, 54 percent women) completed self-report measures of social affiliation and self/peer drinking for high school and college. Analyses indicated that: 1) increased drinking at college entrance mirrored perceived increases by peers, 2) perceptions of peer drinking were robustly overestimated with women displaying the larger overestimation bias; and 3) social affiliation was associated with men's drinking and moderated its relation to perceived peer drinking at college entrance. These results advance understanding of the manner in which heavy drinking patterns emerge as men and women enter college, and campus programs that consider these factors may better promote health and reduce the harms associated with heavy drinking among college students.     

Effects of a social norm feedback campaign on the drinking norms and behavior of Division I student-athletes

Social norm feedback is a promising strategy for reducing alcohol misuse on college campuses. However, little is known about the impact of these interventions on at-risk populations, such as student-athletes. This study examined the effects of a campus-wide media campaign on Division I student-athletes at three universities. A discriminant function analysis revealed that a composite measure of perceived campus drinking norms distinguished between two campaign exposure groups. With the exception of one perceived norm measure (closest friends), the campaign-exposed group reported more conservative estimates of alcohol use in peers. However, there was no evidence that the campaign had reduced alcohol use. The inability of the campaign to reduce perceptions of alcohol use among one's closest friends may have accounted for the lack of change in drinking behavior. Discussion is directed to the potential limitations of using social norm feedback campaigns to reduce alcohol misuse in high-risk groups, such as student-athletes.     

Building,Engaging, and Sustaining a Continuum of Care From Harm Reduction to Recovery Support: The Rutgers Alcohol and Other Drug Assistance Program

Since 1983, the focus of the Rutgers Alcohol and Other Drug Assistance Program (ADAP) has been developing policies, training staff to identify students at risk, developing and implementing evidence-based screening and brief interventions, providing short-term counseling by professionals trained in alcohol and other drug abuse to assist students beyond brief interventions, identifying effective treatment for college students, developing a campus recovery program, on-campus recovery housing, and other supports for students in recovery. This article presents a case study of the Rutgers ADAP program, of building and sustaining a program committed to engaging students in both evidence-based risk reduction interventions and an on-campus recovery community given their stage of change and motivation to make changes. Historical milestones are described as part of a creative model for intervention. We identify the challenges of integrating substance abuse recovery into campus mental health programs, and of integrating recovery into other university communities.     

Fat on Campus: Fat College Students and Hyper(in)visible Stigma

This article examines fat college students’ experiences of stigma. Fourteen college students and recent graduates describe their experiences of discrimination and stigma during their college careers. From these interviews, themes of hyper(in)visibility, anticipated stigma, spaces where stigma is more salient, and stigma management emerged. Fat students experience hyper(in)visibility: They are simultaneously hypervisible and invisible, on campus. This experience is impacted by gender and age. This hyper(in)visibility—combined with past experienced stigma—created a sense of anticipated stigma in students. Experiences of hyper(in)visiblity and anticipated stigma are made more salient by the size and shape of various campus spaces: classrooms, dining halls, student recreation centers, and recreational drinking spaces. Fat students often managed this stigma by avoiding these spaces and withdrawing from campus life. Students also embraced other stigma-resistance strategies and found peer groups and campuses spaces to facilitate this resistance.     

The Problem of Alcohol Advertisements in College Newspapers

Abstract

In a sample of college newspapers, alcohol advertisements made up approximately one-half of all national advertising. Most of these were for beer. In addition, most of the papers also carried local “on sale” alcohol ads. Ads for soft drinks and for books were far less prominent in the sample. Numerous beer ads contained a philosophy inimical to the aims of college education. Study, learning, science, campus organizations, graduation, and even education itself were ridiculed, and beer drinking was substituted for them. These appeals were considered in relation to studies of drinking problems on campus and peer pressures on students to join in the drinking. Campus efforts toward alcohol education were reviewed and outstanding programs singled out. It was suggested that students, faculty, and staff discuss the problem and seek some resolution.     

How much is enough? Willingness to participate in alcohol interventions

This study examined the willingness of drinkers to participate in alcohol interventions designed to cut down or stop alcohol use by degree of service-provider contact. One hundred fifty-six university students and staff who attended a campus health fair participated in an alcohol survey. Of the college drinkers, 73.7% reported they were willing to participate in one or more alcohol interventions with minimal provider contact, compared with 48.5% who said they would participate in programs with high provider contact. Respondents preferred minimal-contact strategies (use of nonalcoholic or low-alcohol beverages, information pamphlets, cash awards, television programs, and mailed instructions) to high-contact approaches. Men were significantly more willing (ps less than .05) than women to participate in nearly half (11 to 21) of the alcohol interventions. Three measures indicative of motivation to control drinking were significantly associated with greater willingness to participate in nearly all strategies. This study also suggested that drinkers who were highly motivated to control their drinking did not prefer minimal-contact interventions over high-contact interventions.     

Gender differences in predicting high-risk drinking among undergraduate students

The purpose of this study was to examine gender differences in college students' high-risk drinking as measured by an estimated blood alcohol concentration (eBAC) based on gender, height, weight, self-reported number of drinks, and hours spent drinking. Using a developmental/contextual framework, high-risk drinking is conceptualized as a function of relevant individual characteristics, interpersonal factors, and contextual factors regularly mentioned in the college drinking literature. Individual characteristics include race, gender, and age; interpersonal characteristics include number of sexual partners and having experienced forced sexual contact. Finally, contextual factors include Greek membership, living off-campus, and perception of peer drinking behavior. This study is a secondary data analysis of 1,422 students at a large university in the Southeast. Data were gathered from a probability sample of students through a mail survey. A three-step hierarchical logistic regression analysis showed gender differences in the pathway for high-risk drinking. For men, high-risk drinking was predicted by a combination of individual characteristics and contextual factors. For women, interpersonal factors, along with individual characteristics and contextual factors, predicted high-risk drinking, highlighting the importance of understanding female sexual relationships and raising questions about women's risk-taking behavior. Implications for prevention and assessment are discussed.     

Alcohol Education Project: Preliminary Answers

Abstract

The goal of the five year University of Massachusetts (UMass) Demonstration Alcohol Education Project has been to promote responsible decision making about alcohol use. The UMass/Amherst campus has 25,000 students, of which there is an approximate one third turnover every academic year. Educational methods used to achieve the goal have included community development, mass media, and such intensive approaches as workshops, courses, and guest lectures. Mass media reaches up to 70% of the student body, while intensive interventions reach about 5%.

Data has been gathered from a large number of sources in order to evaluate the following objectives: 1) University students will demonstrate decreased inappropriate alcohol consumption patterns. 2) University students will demonstrate an increased level of planning, conducting, and participation in responsible social activities. 3) University students will demonstrate an increased number of interventions with peers around alcohol issues. 4) University students will demonstrate a decrease in peer pressures which contribute to inappropriate alcohol use among their peers. 5) Key people within the university community will demonstrate an increase in behavior which encourages responsible decisions about alcohol.

Analysis of the program model indicates the initial assumptions were generally valid. For example, predisposing factors such as attitudes toward drinking, and certain demographics are in fact predictors of contexts and quantity and frequency of drinking, which are in turn predictors of negative consequences. Preliminary results from the data collected indicate significant changes in knowledge, but no significant change in individual behavior for the parameters measured. There are indications of trends toward changes in party giving behaviors and heightened alcohol awareness in certain dormitories. Additionally, the university community designed and adopted a set of guidelines for interpretation of the trustees' policy on consumption of alcoholic beverages on campus. The guidelines were designed to be social and educational in nature; their impact was confounded when the minimum drinking age for the state was raised to 20.     

"The responsibility to inform, the power to act": a conference for New England college newspaper editors on the role of the campus press in addressing substance use issues.

College newspapers are a powerful but underutilized medium for educating students on health issues, including those related to drug and alcohol use on campus. Editors of these publications are in a position to wield significant influence among their readers. In addition to communicating factual information about the prevalence and impact of substance use among college students, editors can use the press to advocate changes in students' attitudes and behaviors and in college or community policies that affect substance use. A pilot conference was held to help New England college newspaper editors perceive the importance of their role in educating their peers about substance use and other health-related issues, and to offer concrete suggestions as to how they can incorporate these topics into an "activist" campus press.     

Correction of normative misperceptions: an alcohol abuse prevention program.

Normative misperception refers to the tendency of college students to misperceive campus drinking norms to be more liberal than they actually are. Initial investigations have demonstrated the effectiveness of normative education on reduction of alcohol use in primary and secondary education settings. This study examined the utility of a group program designed to challenge seventy-one male college students' misperceptions of college drinking norms. Participants were enrolled into either a normative education group or a control group representing traditional alcohol education efforts. Participants in the normative education groups demonstrated more accurate perceptions of campus drinking norms and a significant reduction in consequences of alcohol use while those in the control group did not. Changes in normative perceptions were among the strongest contributors to a function discriminating between those who decreased their drinking and those who did not. Results suggest that normative education may be an effective approach to modifying drinking behaviors.