The Efficacy of the Social Norms Approach to Substance Abuse Prevention Applied to Fraternity Men

Abstract

Students tend to overestimate the amount of alcohol consumed among their peers and often drink to that imaginary level. The social norms strategy, designed to correct norm misperceptions, has been correlated with a decrease in reported consumption in the general college population. However, it has had little or no impact among Greek students, the group that consumes the most alcohol. The authors investigated and subsequently found three possible flaws in the application of the social norms strategy that may account for the failure to decrease binge drinking among fraternity men: there is no predominant, healthy drinking norm in this population; students are influenced more by people within their network(s) than by others; and binge drinking is the norm in this group and may serve to perpetuate the problem. The findings, though preliminary, provide the first step in developing interventions beyond the social norms approach to address binge drinking among fraternity men.     

Asian Americans and Mental Health Services

Abstract

Research in the 1970s and 1980s revealed that Asian Americans, compared with other ethnic groups, tended to under-utilize mental health services. This article is aimed at adding new information to the literature by examining data from the 1990s. The raw data comprised 97,212 total admissions representing 45,774 total individuals utilizing mental health services during a four-year period in San Diego County, California. By comparing our findings with previous research cases on utilization patterns of mental health services, new evidence is found about Asian Americans in terms of their (1) underrepresentation in mental health services, (2) presentation of more severe symptoms than those of other racial/ethnic groups when first seen at clinics, (3) lower dropout rates and higher average lengths of stay than other racial/ethnic groups, and (4) higher percentages of using day treatment and outpatient programs but lower percentage of using inpatient programs.     

Adolescents Seeking Mental Health Services

Summary

Inner-city adolescents receiving mental health services often get inadequate medical care. However, when those who seek counseling are asked about their health concerns, they say they want to discuss them with their therapists. Based on responses to a clinical self-assessment questionnaire (Adquest), adolescent mental health clients reported sleep difficulties, weight and eating concerns, and frequent headaches and stomachaches. Age and gender differences in patterns of vulnerability and willingness to talk were explored.     

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.     

Declining Negative Consequences Related to Alcohol Misuse Among Students Exposed to a Social Norms Marketing Intervention on a College Campus

Objective: The authors examined whether alcohol-related negative consequences decreased among students exposed to an intervention. Participants: Beginning in 1999, approximately 2,500 randomly selected undergraduates from a 4-year US university annually participated in a Web-based survey over 6 years. Methods: The educational intervention used social norms initiatives. Main outcome measures included recall of intervention, estimated blood alcohol content (eBAC) when drinking, and 10 negative consequences from alcohol within the past year. Results: First-year students recalling exposure had lower odds of negative consequences (odds ratio [OR] = 0.78, 95% confidence interval [CI] = 0.64-0.95) and of having an eBAC higher than .08 (OR = 0.76, 95% CI = 0.62-0.92). Over the 6 study years, the odds among all participants of experiencing (a) none of 10 alcohol consequences nearly doubled (OR = 2.13, 95% CI = 1.82-2.49) and (b) multiple consequences decreased by more than half (OR = 0.43, 95% CI = 0.36-0.50). Conclusions: These findings have important implications for US colleges and universities engaged in the reduction of harm associated with alcohol misuse.     

Evidence-based Medicine and Child Mental Health Services

There is increased focus on using research evidence to guide clinical practice in the provision of child mental health services, to allocate resources and to make policy decisions. Emphasis has been placed on randomised controlled trials, which are clearly vital. However, given the complexity of children's lives and the multiple systems relevant to their care, it is important to consider alternative research designs and to think creatively about outcomes. In the context of difficulties with random allocation a number of quasi-experimental designs are described that may more closely reflect actual clinical work. In the context of ecological theory, the importance of taking a systems level approach to evaluation is highlighted, with examples from the US. Finally, the ways in which qualitative outcomes measures can be used to sensitively describe the effects of treatment are outlined, and their potential for giving voice to children and families as consumers of mental health services. These suggestions aim to lessen the tension between the requirements of the scientific investigations of treatment effectiveness and the realities of clinicians' daily experiences.     

Alcohol-Related Problems Seen at the Student Health Services

Abstract

The number and types of alcohol-related problems seen by medical, nursing, and mental health professionals at the University of Massachusetts Health Services has been assessed since 1975 as part of a Demonstration Alcohol Education Project.

Medical outpatient clinic alcohol-related contacts using encounter forms completed on every outpatient visit during 1975 and 1976 revealed that 0.08% of approximately 92,500 visits annually were alcohol related, including 0.03% for chronic problems and 0.05% for acute problems (mainly contusions, lacerations, and fractures). Week-long contact surveys conducted in November 1976, and April 1977 recorded a much higher proportion of alcohol-related problems for over 60% of about 2,200 contacts each week. In November 1976, 1.4% of 1,346 reported visits were alcohol related, including 8.0% of contacts which occurred on weekends. In April 1977 2.7% of 1,582 reported visits were alcohol related, including 17.0% of weekend visits. No chronic alcohol problems were reported either week, and most of the acute problems involved traumatic injuries, such as contusions, lacerations, and sprains.

Mental health outpatient clinic alcohol-related contacts self-reported by students at the initial visit revealed that 5.8% of 1,179 initial visits between January 1976, and June 1977 were alcohol related, most involving their own alcohol use. Week-long contact surveys involving all 256 contacts during November 1976 and 192 contacts during April 1977 showed that 13.7% of contacts were for alcohol-related problems, over half due to alcohol abuse by someone else, such as a parent or boy/girlfriend.

The findings suggest that a significant proportion of students seen by student health services have acute rather than chronic alcohol-related problems, especially acute traumatic injuries and relationship problems.     

Referent Group Proximity,Social Norms,and Context: Alcohol Use in a Low-Use Environment

Abstract

Objective: The purpose of this study was to investigate the relationship between perceived normative use of alcohol and reported consumption in an environment where relatively little alcohol use occurs. Participants: A total of 585 undergraduate students completed an online survey on alcohol use in March 2006. Methods: Participants reported personal alcohol use and perceptions of use by “friends,” “the average student,” and “the average student who drinks.” Results: Due to the large number of students reporting zero alcohol use, zero-inflated negative binomial regression was used to analyze the data. Results showed that perceptions of use and beliefs about the acceptability of use by proximal groups were strongly and positively correlated with personal alcohol use. Perceptions of distal groups were either not correlated or were correlated negatively with personal use. Conclusion: These findings suggest that the use of distal referent groups for a social norms campaign in a low-use environment may have paradoxical effects.     

Do lesbians overestimate alcohol use norms? Exploring the potential utility of personalized normative feedback interventions to reduce high-risk drinking in Southern California lesbian communities

This study examines the potential utility of social norms-based approaches to reduce heavy alcohol use in lesbian community settings. In a sample of 278 Southern Californian lesbians recruited from social media networks to complete an online survey, the majority of participants overestimated the quantity of alcohol consumed by their lesbian peers and more frequent lesbian bar attendance was associated with elevated perceptions of how much other lesbians drink. Greater than 90% of participants expressed interest in receiving personalized normative feedback, suggesting that culturally tailored personalized normative feedback interventions focused on correcting perceptions of heavy drinking may be successful in mitigating the alcohol-related risks of lesbians in Southern California, and potentially beyond.     

Perceived Norms and Alcohol Consumption: Differences Between College Students From Rural and Urban High Schools

Objective: The authors examined perceived norms and drinking among college students who attended high schools in rural and urban communities. Participants and Methods: Undergraduates (99 men and 85 women) who attended high schools in communities with populations ranging from less than 100 to more than 400,000 completed surveys assessing perceived norms and alcohol consumption. Results: Analyses revealed that students from smaller towns and in smaller high school graduating classes reported heavier drinking and that perceived norms were positively associated with drinking. Perceived norms were unrelated to population variables, and the relationship between perceived norms and drinking did not vary as a function of population variables. Results suggest that differences in drinking as a function of coming from more rural areas contribute to drinking behavior in college independently of perceived norms. Conclusions: College students may adjust to campus drinking norms relatively quickly, and longitudinal research would be useful in understanding this transition.     

Utilization of Mental Health and Chemical Dependency Services:

No abstract available for this article.     

An Evaluation of Mental Health Services for the Culturally Diverse

ABSTRACT

The purpose of this project was to examine the needs of multicultural populations in the mental health system, and see how these needs get addressed in current policies. As a social worker in the mental health system, I wanted to investigate the strengths and weaknesses of service providers in their ability to meet the needs of diverse populations. In doing this research, I hoped to make a space for people whose families have had to deal with mental health services, and explore the experiences of those who have not had the opportunity to discuss them. In addition, the purpose of this paper is to contribute to a body of increased knowledge on how the mental health system treats people who belong to a cultural minority.     

Chapter 4. Older Latinos and Mental Health Services

SUMMARY

This article discusses the biopsychosocial and spiritual aspects related to older Latinos' use of mental health care. It also addresses the environment that older Latinos have to navigate to access mental health services. Structural barriers to mental health services are emphasized as critical to a holistic assessment of the client's situation.     

Current and Future Trends in Internet-Supported Mental Health Interventions

Despite growing research in the past two decades involving Internet-supported or online mental health interventions, there has been only a few attempts to provide a synthesis of the research findings and future trends. The Internet has grown exponentially during this time, providing greater access to a wider population than ever before. Consequently, online mental health interventions have the potential to be cost-effective, convenient, and reach a more diverse population than traditional, face-to-face interventions. This paper reviews and summarizes the current research for online mental health interventions and discusses future trends. These interventions range from psychoeducational static webpages and complex, personalized, interactive cognitive-behavioral-based self-help programs, to videoconferencing, self-help support groups, blogging, and professional-led online therapy. Future trends in online interventions include the greater prevalence of online therapy and the use of video chat and videoconferencing technologies to enhance and extend the therapeutic relationship. The use of texting or short message service (SMS), mobile communications, smart phone applications, gaming, and virtual worlds extends the intervention paradigm into new environments not always previously considered as intervention opportunities. We find that there is strong evidence to support the effective use and future development of a variety of online mental health applications.     

Results of a Social Norm Intervention to Prevent Binge Drinking Among First-year Residential College Students

Abstract

The effects of a primary prevention social norm intervention on binge drinking among 1st-year residential college students were examined. Six hundred thirty-four students attending a medium-sized public university in the South were randomly assigned to receive a two-phase social norm intervention or the standard campus psychoeducational prevention program. At posttest, no differences were found between intervention and control group students on any of the alcohol use and alcohol-use risk factor measures. Significant subgroup differences were found by stage of initiating binge drinking behaviors, for frequency of alcohol use, F(3, 507) = 3.69, p = .01; quantity of alcohol use, F(3, 507) = 2.51, p = .05; and social norms, F(3, 505) = 2.53, p = .05. These findings suggest the need for tailoring social norm binge drinking interventions to students' stage of initiating heavy drinking and carefully monitoring for potential negative, as well as positive, effects of norm-based prevention messages.     

Factors Affecting the Usage Rate for Mental Health Sections of College and University Health Services

Abstract

The history of the Mental Health Annual Program Survey (MHAPS) is briefly reviewed. Characteristics of the institutions participating in MHAPS during the 1975–76 program year are reported. Usage rate data for the sample are reviewed, and the procedures employed in determining the predictors of sample variability in mental health section usage rate are described. Variability in usage rate was regressed against six categories of variables: institutional characteristics, alternative available resources, mental health section staffing levels and staffing patterns, allocations of staff time, and programming options. When the significant predictors included in these six categories were pooled, five variables were sufficient to account for 95% of usage rate variance. The number of weekly interview hours per 1000 full-time students and the proportion of full-time staff each accounted for 29% of usage rate variance. Visits per patient accounted for 18%, time allocated to consultative services for 10%, and the availability of off-campus resources for 8%. The effects that changes in the values of the predictors can be expected to have on usage rate are illustrated, and the implications of these results for the use of comparative data are discussed.     

Peer Support Among Consumers of Professional Mental Health Services

ABSTRACT

Peer-support services have become increasingly prevalent in mental health; consumers now deliver many services once provided by professional mental health providers. Recognizing this key asset in mental health consumers' service environment is critical for social workers. This exploratory study examines differences among 311 consumers of professional mental health services, half of whom also used peer-support services. The two groups (peer support compared with non-peer-support) were compared on a number of dimensions related to their utilization of and satisfaction with professional mental health services. Users of peer-support services perceived greater availability of professional services and used more professional services, but found professional services to be less useful than those not participating in peer support. No differences between the two groups were found for overall satisfaction with professional services. Findings related to policy, practice, and research are discussed.     

Engaging with Parents in Child and Adolescent Mental Health Services

This paper asks the question: How can child and adolescent mental health clinicians constructively engage parents as a resource in the young person's treatment? It draws from qualitative research data that explore parents' experience of their involvement in their adolescent's mental health treatment program. The paper especially focuses on challenges for clinicians in engaging with parents as part of the treatment program for young people. Clinicians' input about their perceptions of interacting with parents is utilised alongside parents' experiences of their involvement in clinical processes. The clinician data revealed key challenges were managing their reactions to parent defensiveness; broadening the focus from just alleviating symptoms in the young person; not taking sides with the young person; and resisting becoming an expert instructor. The paper discusses Murray Bowen's original family research about engaging parents in treatment with the symptom bearer and addresses how clinicians can build a positive alliance with parents that avoids blame while constructively opening exploration of the family relationship process as part of a collaborative approach.