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Journal of Studies on Alcohol and Drugs
Supplement Number 16, July 2009
College Drinking: New Research From the National Institute on Alcohol Abuse and Alcoholism's Rapid Response to College Drinking Problems Initiative
Special Editors: William DeJong, Ph.D., Mary E. Larimer, Ph.D., Mark D. Wood, Ph.D.
NIAAA's Rapid Response to College Drinking Problems Initiative: Reinforcing the Use of Evidence-Based Approaches in College Alcohol Prevention
Dejong, W., Larimer, M.E., Wood, M.D., and Hartman, R.
Objective: The National Institute on Alcohol Abuse and Alcoholism (NIAAA) created the Rapid Response to College Drinking Problems initiative so that senior college administrators facing an alcohol-related crisis could get assistance from well-established alcohol researchers and NIAAA staff. Method: Based on a competitive grant process, NIAAA selected five teams of research scientists with expertise in college drinking research. NIAAA then invited college administrators to propose interventions to address a recently experienced alcohol-related problem. Between September 2004 and September 2005, NIAAA selected 15 sites and paired each recipient college with a scientific team. Together, each program development/evaluation team, working closely with NIAAA scientific staff, jointly designed, implemented, and evaluated a Rapid Response project. Results: This supplement reports the results of several Rapid Response projects, plus other findings of interest that emerged from that research. Eight articles present evaluation findings for prevention and treatment interventions, which can be grouped by the individual, group/interpersonal, institutional, and community levels of the social ecological framework. Additional studies provide further insights that can inform prevention and treatment programs designed to reduce alcohol-related problems among college students. This article provides an overview of these findings, placing them in the context of the college drinking intervention literature. Conclusions: College drinking remains a daunting problem on many campuses, but evidence-based strategies—such as those described in this supplement—provide hope that more effective solutions can be found. The Rapid Response initiative has helped solidify the necessary link between research and practice in college alcohol prevention and treatment. (J Stud Alcohol Drugs Suppl. 2009 Jul; (16): 5–11.)
Magnitude of and Trends in Alcohol-Related Mortality and Morbidity Among U.S. College Students Ages 18-24, 1998-2005
Hingson, R.W., Zha, W., and Weitzman, E.R.
Objective: The aim of this study was to estimate, among college students ages 18-24, the numbers of alcohol-related unintentional injury deaths and other problems over the period from 1998 through 2005. Method: The analysis integrated data on 18- to 24-year-olds and college students from each of the following data sources: the National Highway Traffic Safety Administration Fatality Analysis Reporting System, Centers for Disease Control and Prevention Injury Mortality Data, National Coroner Studies, census and college enrollment data, the National Household Survey on Drug Use and Health, and the College Alcohol Study. Results: Among college students ages 18-24, alcohol-related unintentional injury deaths increased 3% per 100,000 from 1,440 in 1998 to 1,825 in 2005. From 1999 to 2005, the proportions of college students ages 18-24 who reported consuming five or more drinks on at least one occasion in the past month increased from 41.7% to 44.7%, and the proportions who drove under the influence of alcohol in the past year increased from 26.5% to 28.9%—7% and 9% proportional increases, respectively. The increases occurred among college students ages 21-24, not 18-20. In 2001, 599,000 (10.5%) full-time 4-year college students were injured because of drinking, 696,000 (12%) were hit or assaulted by another drinking college student, and 97,000 (2%) were victims of alcohol-related sexual assault or date rape. A 2005 follow-up of students in schools with the highest proportions of heavy drinkers found no significant changes in the proportions experiencing these events. Conclusions: The persistence of college drinking problems underscores an urgent need to implement prevention and counseling approaches identified through research to reduce alcohol-related harms among college students and other young adults. (J Stud Alcohol Drugs Suppl. 2009 Jul; (16): 12–20.)
Evaluating a Comprehensive Campus-Community Prevention Intervention to Reduce Alcohol-Related Problems in a College Population
Saltz, R.F., Welker, L.R., Paschall, M.J., Feeney, M.A., and Fabiano, P.M.
Objective: This article evaluates Western Washington University's Neighborhoods Engaging with Students project—a comprehensive strategy to decrease disruptive off-campus parties by increasing student integration into and accountability to the neighborhoods in which they live. The intervention includes increasing the number of and publicity regarding “party emphasis patrols” and collaboration with the city to develop a regulatory mechanism to reduce repeat problematic party calls to the same address. The enforcement components are complemented by campus-based, late-night expansion programming, as well as neighborhood engagement strategies including an educational Web site designed to increase students' knowledge of and skills in living safely and legally in the community, service-learning projects in the campus-contiguous neighborhoods, and a neighborhood-based conflict-resolution program. Method: The evaluation comprised data from three public universities in Washington. In addition to the Western Washington University site, a second campus created an opportunity for a “natural experiment” because it adopted a very similar intervention in the same time frame, creating two intervention sites and one comparison site. Annual, Web-based student surveys in 2005 and 2006 included measures of alcohol consumption, alcohol-related problems, and student perception of alcohol control and prevention activities. Results: Although statistical power with three campuses was limited, results using hierarchical linear modeling showed that the prevalence of heavy episodic drinking was significantly lower at the intervention schools (odds ratio = 0.73; N = 6, 150 students). Conclusions: The results suggest that alcohol control measures can be effective in reducing problematic drinking in college settings. These findings strongly support conducting a replication with greater power and a more rigorous design. (J Stud Alcohol Drugs Suppl. 2009 Jul; (16): 21–27.)
An Evaluation of College Online Alcohol-Policy Information: 2007 Compared With 2002
Faden, V.B., Corey, K., and Baskin, M.L.
Objective: To receive federal funds, colleges and universities are required to provide information to students about their alcohol policies as part of their alcohol-abuse prevention efforts. This study investigated whether and how the availability and completeness of alcohol-policy information on college Web sites changed between 2002 and 2007. Method: The Web sites of the top 52 national universities listed in the 2002 rankings of U.S. News and World Report, which were reviewed for alcohol-policy information in 2002, were reviewed again in 2007 using the same Web search methodology. Results: Much more information regarding college alcohol policies was available on the Web sites of the 52 universities in 2007 than in 2002. Substantial increases were seen in the areas of (1) rules, restrictions, requirements; and (2) consequences for infractions, especially for student groups. In addition, information on university Web sites regarding their alcohol policies was easier to access in 2007 than in 2002. Conclusions: These findings indicate that colleges have made online alcohol-policy information more available and accessible to their students and other interested parties, including parents. This may reflect a greater engagement of colleges and universities in the issue of drinking on campus in general. (J Stud Alcohol Drugs Suppl. 2009 Jul; (16): 28–33.)
Screening for High-Risk Drinking in a College Student Health Center: Characterizing Students Based on Quantity, Frequency, and Harms
Schaus, J.F., Sole, M.L., McCoy, T.P., Mullett, N., Bolden, J., Sivasithamparam, J., and O'Brien, M.C.
Objective: This study examined characteristics of students who presented to a college health center and screened positive for the 5/4 definition of high-risk drinking (five or more drinks in a row for men, or four or more drinks in a row for women, on at least one occasion in the past 2 weeks) and analyzed the students' data according to their reporting of alcohol-related harms. Method: Secondary analysis of data obtained for an intervention study to reduce high-risk drinking in college students was used. Data on alcohol use and alcohol-related harms were obtained from Web-based Healthy Lifestyle Questionnaires and 30-day alcohol recall diaries (Timeline Followback calendar). Students (N = 363; 52% female) were classified as nonheavy, heavy, and heavy and frequent drinkers, based on their self-reported alcohol use. Alcohol-related harms were measured using the Rutgers Alcohol Problem Index and eight additional items derived from the Drinker Inventory of Consequences-2L. Results: Students in the nonheavy, heavy, and heavy and frequent groups had mean Rutgers Alcohol Problem Index scores of 10, 14, and 23, respectively. The heavy-and- frequent drinking group comprised 20% of the sample but experienced 31% of the total harms. Conclusions: The 5/4 screening question accurately identified college students presenting to a college health center who were already experiencing significant alcohol-related harms. The addition of a frequency question (drinking 3 or more days per week) to the 5/4 screening question provided a simple method for identifying those students at highest risk and in greatest need of intervention. (J Stud Alcohol Drugs Suppl. 2009 Jul; (16): 34–44.)
Trial of the University Assistance Program for Alcohol Use Among Mandated Students
Amaro, H., Ahl, M., Matsumoto, A., Prado, G., Mulé, C., Kemmemer, A., Larimer, M.E., Masi, D., and Mantella, P.
Objective: The aim of this study was to investigate the effectiveness of a brief intervention for mandated students in the context of the University Assistance Program, a Student Assistance Program developed and modeled after workplace Employee Assistance Programs. Method: Participants were 265 (196 males and 69 females) judicially mandated college students enrolled in a large, urban university in the northeast United States. All participants were sanctioned by the university's judicial office for an alcohol- or drug-related violation. Participants were randomized to one of two intervention conditions (the University Assistance Program or services as usual) and were assessed at baseline and 3 and 6 months after intervention. Results: Growth curve analyses showed that, relative to services as usual, the University Assistance Program was more efficacious in reducing past-90- day weekday alcohol consumption and the number of alcohol-related consequences while increasing past-90- day use of protective behaviors and coping skills. No significant differences in growth trajectories were found between the two intervention conditions on past-90-day blood alcohol concentration, total alcohol consumption, or weekend consumption. Conclusions: The University Assistance Program may have a possible advantage over services as usual for mandated students. (J Stud Alcohol Drugs Suppl. 2009 Jul; (16): 45–56.)
Assessing the Effectiveness of Peer-Facilitated Interventions Addressing High-Risk Drinking Among Judicially Mandated College Students Continued
Cimini, M.D., Martens, M.P., Larimer, M.E., Kilmer, J.R., Neighbors, C., and Monserrat, J.M.
Objective: This study examined the effectiveness of three peer-facilitated brief alcohol interventions—small group motivational interviewing, motivationally enhanced peer theater, and an interactive alcohol-education program—with students engaging in high-risk drinking who were referred for alcohol policy violations. Method: Undergraduate students referred for alcohol policy violations (N = 695) at a large northeastern public university were randomized to one of the three conditions. Six-month follow-up data were collected on drinking frequency and quantity, negative consequences, use of protective behaviors, and perceptions of peers’ drinking norms. Results: There were no statistically significant overall pre-post effects or treatment effects. However, exploratory analyses indicated that decreases in perceived norms and increases in use of protective behavioral strategies were associated with reductions in alcohol use and alcohol-related problems at follow-up (p < .01). Conclusions: The presence of nonsignificant pre-post or main effects is, in part, consistent with recent research indicating that sanctioned college students may immediately reduce drinking in response to citation and that brief interventions may not contribute to additional behavioral change. The presence of statistically significant correlations between alcohol use and related problems with corrections in norms misperceptions and increased use of protective behaviors at the individual level holds promise for both research and practice. The integration of elements addressing social norms and use of protective behaviors within brief cognitive-behavioral intervention protocols delivered by trained peer facilitators warrants further study using randomized clinical trials. (J Stud Alcohol Drugs Suppl. 2009 Jul; (16): 57–66.)
A Randomized Trial of a Parent-Based Intervention on Drinking Behavior Among Incoming College Freshmen
Ichiyama, M.A., Fairlie, A.M., Wood, M.D., Turrisi, R., Francis, D.P., Ray, A.E., and Stanger, L.A.
Objective: Despite research suggesting that parental involvement can affect alcohol involvement among adolescents, few studies have focused on parent-based alcohol prevention strategies among college undergraduates. We report the results of a randomized trial of a parent-based intervention (PBI) in a sample of college freshmen. Method: Across two cohorts, 724 incoming freshman—parent dyads completed baseline assessments and were randomly assigned to PBI or intervention as usual (an alcohol fact sheet for parents). Student follow-up assessments were completed at 4 and 8 months. Results: Two-part latent growth curve modeling was used to test hypothesized intervention effects. Outcome variables were drinks per week (past month), heavy episodic drinking (past 2 weeks), and alcohol-related problems (past 3 months). Over the 8-month follow-up period, PBI had a significant effect on drinks per week but not heavy episodic drinking or alcohol-related problems. Specifically, compared with students in the intervention-as- usual condition, students receiving the PBI were significantly less likely to transition from nondrinker to drinker status and showed less growth in drinking over the freshman year. However, the direct PBI effect on growth was qualified by a PBI x Gender interaction, with probes indicating that the effect applied to women but not men in the PBI condition. Conclusions: This study extends previous research by demonstrating the potential utility for PBIs to decrease the likelihood of transitioning into drinker status and, at least for women, for slowing growth in drinking over the freshman year. (J Stud Alcohol Drugs Suppl. 2009 Jul; (16): 67–76.)
Preventing Risky Drinking in First-Year College Women: Further Validation of a Female-Specific Motivational-Enhancement Group Intervention
Labrie, J.W., Huchting, K.K., Lac, A., Tawalbeh, S., Thompson, A.D., and Larimer, M.E.
Objective: Female college students have increased their alcohol consumption rates. The current study sought to replicate the effectiveness of a female-specific motivational-enhancement group intervention and extended previous work by adding a 6-month follow-up. The intervention included several motivational-enhancement components delivered in a group setting and included a group discussion of female-specific reasons for drinking. Method: Participants were 285 first-year college women. Data collection consisted of an online pre-intervention questionnaire, 10 weeks of online follow-up assessment, and a 6-month online follow-up. Using a randomized design, participants chose a group session, blind to treatment status. Held during the first weeks of the first semester, 159 participants received the intervention and 126 participants received an assessment-only control. Results: Using a repeated-measures analysis of covariance, intervention participants consumed significantly less than control participants on drinks per week (F = 11.86, 1/252 df, p < .001), maximum drinks (F = 11.90, 1/252 df, p < .001), and heavy episodic drinking events (F = 20.14, 1/252 df, p < .001) across 10 weeks of follow-up. However, these effects did not persist at the 6-month follow-up. Moderation effects were found for social motives on all drinking variables, such that the intervention was most effective for those women with higher social motives for drinking. Conclusions: Efficacy was found for a female-specific motivational group intervention in creating less risky drinking patterns among first-year women, especially women with social motives for drinking. The effect dissipated by the second semester, suggesting the need for maintenance or booster sessions. (J Stud Alcohol Drugs Suppl. 2009 Jul; (16): 77–85.)
Effects of Residential Learning Communities on Drinking Trajectories During the First Two Years of College
Cranford, J.A., McCabe, S.E., Boyd, C.J., Lange, J.E., Reed, M.B., and Scott, M.S.
Objective: Participation in residential learning communities (RLCs) is associated with lower rates of alcohol consumption among college students. This study used variable- and pattern-centered analytic approaches to examine the influence of RLCs on the drinking behavior of students during their first 2 years in college. Method: A Web-based survey was administered to a stratified random sample of 1,196 first-year students (51.8% women) attending a large university. The sample included 456 students (38.1%) who lived in and participated in RLCs and 740 students (61.9%) who did not participate in RLCs (non-RLCs). During their first semester, students reported on their precollege and current drinking. Students also completed measures of alcohol involvement 6 months later during their second semester and 18 months later during their fourth semester. Results: Mixed factorial analyses of variance showed that RLC students reported fewer drinks per occasion than non-RLC students before college. RLC and non-RLC students showed increases in maximum drinks per occasion from precollege to first and second semesters, but only non-RLC students continued to increase their drinking from second to fourth semester. Latent class growth analyses indicated four trajectory classes: (1) low stable (25.1%), (2) light increasing (19.2%), (3) moderate increasing (36.8%), and (4) heavy increasing (18.9%). Non-RLC students had higher odds of being in the heavy-increasing drinking trajectory class. Conclusions: Compared with their non-RLC peers, RLC students not only drink less before college and show smaller increases in drinking over time but also are less likely to be in a high-risk drinking trajectory group. Identification of selection, socialization, and reciprocal influence processes that underlie RLC effects can better inform prevention efforts for sustained lower risk drinking among college students. (J Stud Alcohol Drugs Suppl. 2009 Jul; (16): 86–95.)
Common Ground: An Investigation of Environmental Management Alcohol Prevention Initiatives in a College Community
Wood, M.D., Dejong, W., Fairlie, A.M., Lawson, D., Lavigne, A.M., and Cohen, F.
Objective: This article presents an evaluation of Common Ground, a media campaign-supported prevention program featuring increased enforcement, decreased alcohol access, and other environmental management initiatives targeting college student drinking. Method: Phase 1 of the media campaign addressed student resistance to environmentally focused prevention by reporting majority student support for alcohol policy and enforcement initiatives. Phase 2 informed students about state laws, university policies, and environmental initiatives. We conducted student telephone surveys, with samples stratified by gender and year in school, for 4 consecutive years at the intervention campus and 3 years at a comparison campus. We did a series of one-way between-subjects analyses of variance and analyses of covariance, followed by tests of linear trend and planned comparisons. Targeted outcomes included perceptions of enforcement and alcohol availability, alcohol use, and alcohol-impaired driving. We examined archived police reports for student incidents, primarily those resulting from loud parties. Results: There were increases at the intervention campus in students' awareness of formal alcohol-control efforts and perceptions of the alcohol environment, likelihood of apprehension for underage drinking, consequences for alcohol-impaired driving, and responsible alcohol service practices. There were decreases in the perceived likelihood of other students' negative behavior at off-campus parties. Police-reported incidents decreased over time; however, perceived consequences for off-campus parties decreased. No changes were observed for difficulty finding an off-campus party, self-reported alcohol use, or alcohol-impaired driving. Conclusions: The intervention successfully altered perceptions of alcohol enforcement, alcohol access, and the local alcohol environment. This study provides important preliminary information to researchers and practitioners engaged in collaborative prevention efforts in campus communities. (J Stud Alcohol Drugs Suppl. 2009 Jul; (16): 96–105.)
Readiness to Change Drinking Behavior in Female College Students
Kaysen, D.L., Lee, C.M., Labrie, J.W., and Tollison, S.J.
Objective: Motivational interviewing (MI) therapies are effective in reducing high-risk drinking in college populations. Although research supports efficacy of MI prevention strategies in reducing alcohol use, there are little data examining readiness to change (RTC), the underlying theoretical model of MI interventions. The purpose of the present study was to explore RTC variability and drinking behavior and whether MI increases RTC in an intervention group compared with controls. Method: Two-hundred eighty-five first-year female college students participated in the study. Present analyses focused on those students who consumed alcohol in the month before the study (n = 182). RTC was measured using the Readiness to Change Ruler. Results: Analyses were conducted using hierarchical linear modeling. There was significant variability in RTC: 71.86% of variance in RTC was between- person differences, and 28.14% was within-person differences. Higher RTC was associated with lower intentions to drink and future drinking behavior. However, in weeks in which students drank more, they experienced a decrease in RTC. Based on the significant cross-level interaction, the intervention group had significantly higher RTC than controls. Conclusions: These results provided partial support for our hypotheses. The overall theoretical construct of RTC varies both across and within individuals. These results also offer support for the utility of MI-based prevention strategies in increasing RTC within individuals. However, we did not consistently find that these changes related to drinking changes. Findings provide support for both the construct of RTC and utility of MI interventions in changing these beliefs in female college students. (J Stud Alcohol Drugs Suppl. 2009 Jul; (16): 106–114.)
Evaluating Level of Specificity of Normative Referents in Relation to Personal Drinking Behavior
Larimer, M.E., Kaysen, D.L., Lee, C.M., Kilmer, J.R., Lewis, M.A., Dillworth, T., Montoya, H.D., and Neighbors, C.
Objective: Research has found perceived descriptive norms to be one of the strongest predictors of college student drinking, and several intervention approaches have incorporated normative feedback to correct misperceptions of peer drinking behavior. Little research has focused on the role of the reference group in normative perceptions. The current study sought to examine whether normative perceptions vary based on specificity of the reference group and whether perceived norms for more specific reference-group norms are related to individual drinking behavior. Method: Participants were first-year undergraduates (n = 1,276, 58% female) randomly selected from a university list of incoming students. Participants reported personal drinking behavior and perceived descriptive norms for eight reference groups, including typical student; same gender, ethnicity, or residence; and combinations of those reference groups (e.g., same gender and residence). Results: Findings indicated that participants distinguished among different reference groups in estimating descriptive drinking norms. Moreover, results indicated misperceptions in drinking norms were evident at all levels of specificity of the reference group. Additionally, findings showed perceived norms for more specific groups were uniquely related to participants' own drinking. Conclusions: These results suggest that providing normative feedback targeting at least one level of specificity to the participant (i.e., beyond what the “typical” student does) may be an important tool in normative feedback interventions. (J Stud Alcohol Drugs Suppl. 2009 Jul; (16): 115–121.)
Alcohol Poisoning Among College Students Turning 21: Do They Recognize the Symptoms and How Do They Help?
Oster-Aaland, L., Lewis, M.A., Neighbors, C., Vangsness, J., and Larimer, M.E.
Objective: The aims of this study were to (1) determine recognition of and self-reported concern regarding alcohol poisoning symptoms versus other alcohol-related behaviors among students turning 21 years old, (2) assess the frequency of helping behavior among students in situations where peers display alcohol poisoning symptoms, (3) assess sources from which students seek help, and (4) consider reasons why students report reluctance to seek help. Method: Students (N = 306; 50% male) completed a Web-based self-report assessment during the week before their 21st birthday focusing on drinking behavior, alcohol-related consequences, concern for symptoms of alcohol poisoning, and observations of and experience with helping behavior. Results: Results indicated most students report having helped another student with symptoms of alcohol poisoning and show concern about the symptoms. Students most often seek help from other students and parents. When students do not help their peers, it is most often because of the perception that help is not needed. Heavier drinkers report a greater likelihood to help a peer showing symptoms of alcohol poisoning. Conclusions: Prevention professionals should incorporate students, friends, and parents in interventions that provide knowledge and helping strategies for alcohol poisoning symptoms. In addition, prevention efforts regarding alcohol poisoning should focus on heavy drinkers, as they are most likely to be in situations requiring help. Finally, administrators implementing medical amnesty policies should couple those policies with educational strategies aimed at recognition of alcohol poisoning symptoms. (J Stud Alcohol Drugs Suppl. 2009 Jul; (16): 122–130.)
Alcohol Screening and Brief Intervention in a College Student Health Center: A Randomized Controlled Trial
Schaus, J.F., Sole, M.L., McCoy, T.P., Mullett, N., and O'Brien, M.C.
Objective: This study tested the effectiveness of brief primary care provider interventions delivered in a college student health center to a sample of college students who screened positive for high-risk drinking. Method: Between November 2005 and August 2006, 8,753 students who presented as new patients to the health service at a large public university were screened for high-risk drinking, and 2,484 students (28%) screened positive on the 5/4 gender-specific high-risk drinking question (i.e., five or more drinks per occasion for men and four or more for women). Students who screened positive for high-risk drinking and consented to participate (N = 363; 52% female) were randomly assigned either to a control group (n = 182) or to an experimental group (n = 181). Participants in the experimental group received two brief intervention sessions that were founded in motivational interviewing techniques and delivered by four specially trained providers within the student health center. Data on alcohol use and related harms were obtained from a Web-based Healthy Lifestyle Questionnaire, 30-day Timeline Followback alcohol-use diaries, the Rutgers Alcohol Problem Index (RAPI), and eight items from the Drinker Inventory of Consequences-2L. Results: Repeated measures analysis showed that, compared with the control group (C), the intervention group (I) had significant reductions in typical estimated blood alcohol concentration (BAC) (C = .071 vs I = .057 at 3 months; C = .073 vs I = .057 at 6 months), peak BAC (C = .142 vs I = .112 at 3 months; C = .145 vs I = .108 at 6 months), peak number of drinks per sitting (C = 8.03 vs I = 6.87 at 3 months; C = 7.98 vs I = 6.52 at 6 months), average number of drinks per week (C = 9.47 vs I = 7.33 at 3 months; C = 8.90 vs I = 6.16 at 6 months), number of drunk episodes in a typical week (C = 1.24 vs I = 0.85 at 3 months; C = 1.10 vs I = 0.71 at 6 months), number of times taken foolish risks (C = 2.24 vs I = 1.12 at 3 months), and RAPI sum scores (C = 6.55 vs I = 4.96 at 6 months; C = 6.17 vs I = 4.58 at 9 months). Conclusions: Brief interventions delivered by primary care providers in a student health center to high-risk- drinking students may result in significantly decreased alcohol consumption, high-risk drinking, and alcohol-related harms. (J Stud Alcohol Drugs Suppl. 2009 Jul; (16): 131–141.)