Among colleges large and small
across the United States, few activities are as ubiquitous to the common
experience as binge drinking. This rapid
intake of alcohol not only affects those who choose to partake, but also those
individuals who choose not to imbibe so aggressively or at all, as they must
endure the degeneracy, violence, and general destruction that their binge
drinking classmates tend to visit upon the campus.
In a national study conducted between
1999-2005, the prevalence of past-30-day binge drinking among college students
increased from 42% to 45% (1). These
figures indicate a significant frequency of this dangerous behavior. For the purposes of this discussion, we will
use the National Institute on Alcohol Abuse and Alcoholism definition of binge
drinking that states, “For the
typical adult, [binge drinking] corresponds to consuming five or more drinks
for men, or four or more drinks for women, in about 2 hours” (2). For the individual who chooses to engage in
binge drinking, the effects on health, personal relationships, and academic
performance can be substantial. Binge
drinking can have a detrimental effect on heart, liver, and neurological
function, as well as putting the individual at an increased risk for dangerous behavior,
injuries, and death (3). In a study
completed in 2009, researchers found that for college students age 18-24,
alcohol annually caused: 1,825 deaths, 599,000 unintentional injuries, 696,000
incidents of assault, and 97,000 cases of rape or sexual abuse (4). For college administrators, parents, and
students, these are not trivial statistics.
It is for these enumerated reasons, and a bevy of others that binge
drinking is considered a significant public health concern on college campuses.
Many
public health interventions have been attempted in the past to combat this
unhealthy and dangerous behavior, with varying levels of success and
efficacy. This critique will consider
one in particular, AlcoholEdu, on the basis of its failure to consider a number
of social and behavioral principles and theories. Following a brief introduction to AlcoholEdu,
these failures will be made apparent in the subsequent three sections. Following these sections, an alternative
approach to combating rampant binge drinking will be proposed.
AlcoholEdu
AlcoholEdu is a web-based intervention intended for
all members of an incoming freshmen class just prior to enrollment at a college
or university. The course “extends traditional
educational approaches to prevent alcohol misuse by including normative
feedback to correct student misperceptions about the acceptability and level of
heavy drinking on campus, interactive exercises to challenge alcohol
expectancies, and recommendations for strategies to reduce the likelihood of
heavy drinking and related consequences (e.g., avoiding drinking games)” (1). An increasing number of academic institutions
are utilizing this web-based program because it represents a broad-reach
approach and is relatively cost effective (5).
This course consists of Part I, which contains four distinct learning
modules, and Part II, which includes the fifth and final learning module. Part I typically takes 2-3 hours and must be
completed prior to moving on to campus.
Part II occurs approximately 30-45 days later and primarily consists of
a content review and brief survey to gauge student experience during the first
few weeks on campus (1). After
completing Part I and Part II, students have no further interaction with the
AlcoholEdu program.
On
a positive note for AlcoholEdu, some studies revealed a reduced frequency of
past-30-day alcohol use and binge drinking among first year students (in
intervention schools as opposed to control schools) immediately following the
intervention. Unfortunately, however, “these
effects did not persist in the subsequent spring semester, regardless of the
level of student participation. Additionally, no significant effects were
observed, in either of the two follow-up periods, for either the average number
of drinks students consumed per occasion or the prevalence of binge drinking”
(1). These results indicate that while
AlcoholEdu might be on the correct path towards positively influencing rates of
binge drinking on college campuses, this intervention carries with it too many
flaws and does not sufficiently address issues caused by environment or social
interactions.
Critique of Intervention 1 – Reliance
on the Health Belief Model and Failure to Acknowledge Environmental Pressure
The first thing that a student
realizes when they sit down to complete AlcoholEdu is brazenly expressed to
them in the title of this intervention: “you are about to be educated about
alcohol”. This didactic approach is
indicative of a longstanding effort in public health to educate individuals in
the hopes of impelling a healthful behavior, and is often expressed using the
Health Belief Model. The Health Belief
model instructs us that an individual will choose to prevent or avoid an
unhealthy behavior if the six constructs provided are satisfied. First, the
individual must (1*) perceive their susceptibility to the bad outcome, (2*) perceive
the severity of the behavior, (3*) believe taking action would reduce their
susceptibility, and (4*) believe the benefits outweigh the costs of taking the
action. Furthermore, the individual (5*)
must be exposed to cues or factors that prompt action, and (6*) they must be
confident in their ability to successfully perform an action (7).
Unfortunately, this approach is
often ineffective in the effort to influence behavior change, but especially so
in this particular case, because it does not account for social or
environmental factors. To the point of the second construct (2*), students who
engage in aggressive drinking might perceive the severity of the behavior, or
the detrimental health outcomes, but this is often lost when caught up in
social situations and especially when alcohol has been ingested. Furthermore, when a student sees friends,
teammates, or other college students engaging in aggressive drinking, in
essence normalizing that behavior, then the perceived severity of that action
is often lessened. Additionally, and
most importantly in the issue of college drinking, is the failure of construct
(4*). Many college students believe that
drinking and peer acceptance, or social prowess, are inexorably linked. In fact, “some groups such as fraternities and sororities may actually have a
stake in maintaining a normative perception among students of high alcohol use,
as it may also connect to other perceived norms and beliefs about social group
popularity” (8). So, in this case, the
cost of limiting alcohol consumption, and thus potentially reducing popularity
amongst peer groups, is a cost that often
outweighs the health benefits of that
same action. This shortsighted attitude
of invincibility and adherence to perceived group norms is especially prevalent
among male student-athletes and members of the Greek (fraternities and
sororities) community (7).
Critique of Intervention 2 –
Inspiring Reactance
Psychological
Reactance Theory instructs us that when a social influence seeks to repeal,
infringe, or threaten an individual’s freedom, that person will often
experience reactance, or “a motivational state aimed at restoring the
threatened freedom” (5). For American
adolescents, few life events conjure the same level of perceived freedom as the
move away from home and on to a college campus.
It is in the state of a nearly frenzied excitement about this impending
freedom that AlcoholEdu requires the incoming freshman to sit diligently at a
computer for upwards of three hours and receive a lecture on healthy behavior
regarding alcohol consumption. As
outlined in the above section, this is often not the best way to attempt a public
health intervention, but this approach seems especially ineffective within the
context of nearly unprecedented freedom for many incoming freshmen.
AlcoholEdu
further incites resistance to its important message by ignoring the substantial
role that similarity can play in deflecting reactance. As noted in the study by Paul J. Silvia,
“When the communicator was highly similar to the participant, people agreed strongly,
regardless of threat. Similarity
increased the force toward persuasion by increasing liking, and it decreased
the force toward resistance by making the message seem less threatening” (9). AlcoholEdu does little to deflect this
reactance on two primary fronts, which will be outlined in the following
paragraphs.
First, the
length of the required course inspires feelings of being lectured, an
interaction rarely enjoyed or practiced by members of a similar group. While there are some interactive aspects of
AlcoholEdu that allow students to become engaged in the learning process (such
as interactive activities to enter body mass and number of drinks to determine
potential Blood Alcohol Content), the majority of the course requires the
student to absorb oft-repeated or common sense facts about alcohol (1). For example, one section of AlcoholEdu
instructs the accepted measurement of one drink: 12 oz. of beer, 5 oz. of wine,
or 1.5 oz. of hard liquor. Now while this
may be informative to some members of the population, I would argue that most
18-19 year old adolescents would be insulted that they are required to rehear
the same commonly accepted facts that have been instilled in them throughout
lower level and secondary education.
Although there may exist useful facts and information within the
program, the presence of these obvious facts may cause some members of the
community to mentally disengage from the learning process. The benefits of educating a small portion of
the population are outweighed by the cost of losing the attentiveness of the
majority. Not properly engaging students
can inspire dislike and thus exacerbate negative reactance.
Secondly, an inherent flaw in a
broad based approach like AlcoholEdu is the inability to target subjects with a
similar instructor. The presence of a
similar instructor in public health interventions has the very positive effect
of increasing “liking” and as a result decreasing reactance. Silvia continues, “As expected, people in the
high-similarity group expressed more liking for the communicator and did people
in the low similarity group”.
Furthermore, “When similarity was low, threatening attitudinal freedom
led to less agreement. When the
similarity was high, however, threatening the freedom had no effect: People
strongly agreed with the communicator regardless of the level of threat”
(8). While there is obviously some effort
in AlcoholEdu to use college age actors and instructors in their program, it is
simply impossible to connect with every distinct group of students using such a
broad approach.
Critique of Intervention 3 –
Limited Interaction with Students and the Failure to Counter Negative Modeling
The third and
final critique of AlcoholEdu rests on the assertion that the amount of time
spent trying to influence behavior regarding student alcohol use is plainly
insufficient. As noted in the
description of AlcoholEdu earlier in this critique, this intervention simply
did not have a negligible effect after the first semester. It is generally accepted that the first six
weeks of a student’s college career are an important time to intervene, as that
is the time when social pressures and student expectations are at their zenith
(10), but to only intervene at that time is welcoming the short-lived success
of that intervention. Once the student
has settled into college life, expectations from peers, modeling behavior, and
the acceptance of perceived social norms can have a far greater formative effect
than a one-time intervention could ever hope to counter.
Modeling
and social learning can have a dramatic effect on how a student chooses to
engage in alcohol use and to interact socially, regardless of their prior
knowledge or perceptions of alcohol.
Defleur and Ball-Rokeach explain in their Theories of Mass
Communication, “if a particular pattern of behavior is performed by a
model, and if that pattern is identified as problem-solving, rewarding, or in
some other way desirable in its consequences, the probability that it will be
adopted by an observer is increased” (11).
As an example, if a young male student sees an older male student, a
sports team or fraternity leader for instance, engage in excessive drinking and
then enjoy the reward of popularity or social success, then the eventual
success (popularity) will be attributed to the perceived impetus (aggressive
drinking). If the young student engages
in said behavior and enjoys a similar result of increased popularity, it is
then likely that the particular pattern will become a more permanent fixture of
that individual’s behavior (11).
While
AlcoholEdu is noble in purpose and earnest in effort, it will simply not be
effective among the cohorts of heaviest drinkers because it does not sufficiently
counter for the social development of behavior.
As a result of a national collegiate survey completed in 1995,
researchers noted, “measures
reflecting intensive peer exposure—having five or more close student friends,
socializing with friends more than 2 hours per day and living in a fraternity
or sorority—predicted significantly higher levels of heavy drinking…”
(12). If these factors are indicators of
the heaviest drinkers on campus, then any effort to influence behavior with
alcohol related knowledge, applied only during the first weeks of college, will
be virtually ineffective. Once an
individual is established in those social groups, his or her previous
perceptions of alcohol and appropriate behavior might be swept away (8).
New Intervention Proposal – Increase
face-to-face Interactions and Branding Positive Behavior
For an intervention to achieve a measurable amount of success in
altering the incidence of collegiate binge drinking, it must present a more
comprehensive approach to altering perceptions and influencing behavior. This intervention will be conducted, not by a
web-based, impersonal survey or instructional video, but by targeted
instructors who will be best suited to deflect reactance for that particular
group. For example, targeting high-risk
drinkers like male student-athletes, with an older and noticeably “successful”
(academically, socially, or athletically) male student-athlete could yield
positive results. Furthermore, this intervention will not only take place
during the first weeks of freshman year, but throughout the year, thus
increasing the likelihood that the formation of social groups will not
altogether negate the effects of the intervention.
In fact, by
encouraging those who imbibe responsibly to maintain a positive and noticeable
presence in social situations, others might be inspired to emulate that
behavior. This might impel the formation
of a distinct identity along the lines of safe and healthful drinking behavior. “Branding” of responsible individuals can
help to inspire other people to adopt that behavior as well. Although this intervention is not as
economical or as easily applied as a program like AlcoholEdu, the positive, long-term
effects of reducing the incidence of destructive binge drinking on a college
campus will return the investment many times over.
Defense of Intervention 1 – Deflecting
Reactance
Psychological
reactance represents possibly the greatest impediment to the success of an
intervention regarding collegiate binge drinking. The newfound and unprecedented freedom
experienced by college freshmen is likely to produce an exceptionally strong
feeling of reactance when that freedom is threatened by an intervention. The key to deflecting that reactance, I
believe, can be found in increasing the feelings of similarity, and by that
measure, increasing the compliance through “liking”. As Hovland, Janis, and Kelley stated:
An individual is likely to feel that
persons with status, values, interests, and needs similar to his own see things
as he does and judge them from the same point of view. Because of this, their assertions about
matters of which the individual is ignorant but where he feels the viewpoint
makes a difference… will tend to carry special credibility (9).
Individuals are likely to absorb
the anecdotes, heed the warnings, and acknowledge or adopt the alternative
behavior if an individual who is similarly situated expresses it to them.
Although
this may seem like an intervention that will be difficult to implement, it can
be easily achieved by recruiting positive models on a small scale. For example,
the college or university might charge an athletics coach with recruiting an
older team member with a record of responsible behavior to speak with freshmen
teammates once every few weeks after practice.
The individuals recruited to speak with their teammates do not need any
formal training, just a willingness to have a frank and open discussion about
social interactions and behavior regarding alcohol. These informal meetings will give an
opportunity to discuss good and bad interactions with alcohol without inciting
the negative reactance response.
Defense of Intervention 2 –
Face-to-Face Interactions
While computer-based interventions, like AlcoholEdu, have gained
popularity due to their broad reach and low cost, one must question whether
these efforts produce long-term benefits that can begin to compare to more
personal interactions. The results of a
study completed in 2011 would indicate that the answer is unequivocally
negative. Researchers from Brown University
and others concluded:
FTFI (face-to-face intervention)
participants drank less, drank less frequently, and reported fewer problems at
short-term follow-up; they continued to consume lower quantities at
intermediate and long-term follow-ups {as compared to the control group}”. Meanwhile, “Compared to controls, CDI
(computer delivered intervention) participants reported lower quantities,
frequency, and peak intoxication at short-term follow-up, but these effects
were not maintained. Direct comparisons between FTFI and CDIs were infrequent,
but these trials favored the FTFIs on both quantity and problem measures
(13).
Even though computer delivered
interventions are certainly easier to present to a greater number of people, is
it really worthwhile if results do not last beyond the first few months of
school? Furthermore, if less than 50% of
students engage in binge drinking (as noted in the statistics above), it would seem
to make more sense to choose an intervention that more specifically targets
those individuals and is more
effective. While the results of
face-to-face interactions are not as easily achieved, the eventual benefits of
such interventions seem to far outweigh the costs.
Defense of Intervention 3 – Branding
Positive Behavior
One of the more successful public health interventions in recent
memory was achieved by the “truth” campaign, an anti-smoking initiative that
adopted a novel approach to combating teenage tobacco use. The “truth” campaign was novel, not only in
its success against a rather imposing foe (the tobacco industry), but also in
its adoption of marketing theory and branding to achieve that goal (14). Although this campaign was directed at middle
and high school age adolescents, I believe that the same principles can also be
successfully applied to a slightly older cohort.
An
important facet of the “truth” campaign was to replace one identity with
another. As Hicks notes in his essay,
“If we were to turn the tables on tobacco we surmised that we could not take
away their tool of rebellion without giving them an alternative” (14). Although college drinking is not directly
analogous to the “rebellious” tone of adolescent tobacco use, one might replace
the perceived “popularity” associated with college binge drinking by
highlighting those individuals who choose not to drink so aggressively; “branding”
more responsible individuals and encouraging them to engage fully in the social
drinking events could achieve this. A
way to “brand” these individuals would be to give them brightly colored shirts
and instruct them to attend parties in a highly visible fashion; that is, interact
with others frequently and positively. By
providing conspicuous examples of people who can have fun while maintaining
sobriety, this might inspire others, especially those with initial, bad
experiences with college drinking, to adopt that brand. As Hicks describes, the more people who adopt
this brand, the greater the level of “accumulated awareness” (14). Success will hopefully breed more success
with this intervention.
Conclusion –
The health and safety concerns associated with rampant binge drinking
on college campuses are not trivial or insignificant; these concerns deserve
the full and focused attention of parents, administrators, and students
alike. Unfortunately, interventions like
AlcoholEdu are simply an insufficient approach to what amounts to a very
serious public health concern. By
engaging students on a more personal and comprehensive level, taking steps to
avoid reactance, and providing positive alternatives to that behavior, I fully
believe that great strides can be made in reducing the very detrimental health,
social, and academic effects associated with binge drinking.
References:
(1) Paschall M., et al. Evaluation of
Internet-Based Alcohol Misuse Prevention Course for College Freshmen. American Journal of Preventative Medicine
2011;41(3):300 –308.
(2) National
Institute on Alcohol Abuse and Alcoholism. Moderate
& Binge Drinking. Washington DC: National Institute on Alcohol Abuse
and Alcoholism. http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking
(3) Centers for Disease Control and
Prevention. Fact Sheets – Binge Drinking. Atlanta, Georgia: CDC. http://www.cdc.gov/alcohol/fact-sheets/binge-drinking.htm
(4) Hingson
RW., et al. Magnitude of and trends in alcohol-related mortality and morbidity
among U.S. college students ages 18-24, 1998-2005.
Journal of Studies on Alcohol and Drugs, July (Suppl 16): 12-20, 2009.
(5) Hustad J., et al. Web-based alcohol
prevention for incoming college students: A randomized controlled trial. Addictive Behaviors 2010; 35: 183-189.
(6) Silvia P. Deflecting Reactance: The Role
of Similarity in Increasing Compliance and Reducing Resistance. Basic and Applied Social Psychology
2005; 27(3) 277-284.
(7) Smedley BD. Promoting Health: Strategies
from Social and Behavioral Research.
Institute of Medicine 2000; (In coursepack: 215-226)
(8) Perkins HW. Social Norms and the Prevention of Alcohol Misuse in
Collegiate Contexts. Department of
Anthropology and Sociology, Hobart and William Smith Colleges, Geneva, New York
14456. http://www.collegedrinkingprevention.gov/supportingresearch/journal/perkins2.aspx
(9)
(see (6))
(10) National Institute on Alcohol Abuse and
Alcoholism. College Fact Sheet. Washington DC: http://pubs.niaaa.nih.gov/publications/CollegeFactSheet/CollegeFactSheet.pdf
(11) Defleur &
Ball-Rokeach, Socialization and Theories of Indirect Influence (307-319). In:
Defleur & Ball-Rokeach, (5)ed. Theories of Mass Communication. White
Plains, NY: Longman Inc. 1989
(12) Wechsler, H., Dowdall, G.W., Davenport, A. and
Castillo, S. Correlates of college student binge drinking. American Journal of Public Health 85: 921- 926, 1995.
(13) Carey K., et al., Face-to-face
versus computer-delivered alcohol interventions for college drinkers: A
meta-analytic review, 1998 to 2010. Clinical
Psychology Review 2012; 32, 8: 690-703
(14) Hicks
J. The strategy behind Florida’s “truth” campaign. Tobacco Control 2001; 10:3-5
No comments:
Post a Comment