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Alcoholism & Other Chemical Substance Dependency
Students who were randomly assigned to receive the intervention were provided with a two-phase program targeting social norms. During the fall semester, intervention participants received a series of three greeting cards providing prevention messages based on social norms and a definition of binge drinking. During the spring semester, intervention participants received a brief peer follow-up telephone survey to reinforce prevention messages on the greeting cards and to encourage the participants to continue to model healthy, nonbinge drinking behavior on and off campus. Each of the greeting cards addressed social environment risk factors for heavy episodic drinking, including (a) observational learning (modeling) of healthy nondrinking behavior through real-life campus photographs; and (b) prevention messages targeting social norms related to binge drinking, perceived peer prevalence of binge drinking, and the stages of initiation of binge drinking, based on preintervention data. The cards targeted holiday events that are often associated with increased alcohol consumption--Halloween, Thanksgiving Day, and winter holiday season.
The three norm messages in all cards were followed by "Have a Great Time! From the Healthy Student Coalition." The following two definitions were printed on the bottom of each of the greeting cards: (a) "'Heavy drinking' or 'high-risk drinking' is defined as five or more drinks for men on one occasion, and four or more drinks for women on one occasion," and (b) "'One drink' is equal to a bottle of beer, a glass of wine, a wine cooler, a shot of liquor, or a mixed drink." Of those students who responded to the follow-up telephone survey, 84% recalled receiving at least two of three greeting cards; 71% said that they liked the cards some or a lot; and 70% said that the information in the greeting cards would help students avoid drinking heavily at least a little in the next 6 months. Student peers made brief telephone calls to the intervention group to reinforce the greeting-card prevention messages, to prompt students to read the greeting cards, and to encourage recipients to continue to model healthy, nonbinge drinking behavior on and off campus. The peers also collected information about the students' perceived satisfaction with this prevention strategy and sought to learn how effective the strategy was in preventing heavy drinking.
We provided training on how to conduct the telephone contacts in a pleasant and nonjudgmental manner. The 2-day, 21 1/2-hour training consisted of reviewing the telephone follow-up protocol, role playing, and group feedback. We used the telephone protocol to ensure continuity in implementing student contacts. The student staff members introduced themselves as members of the Healthy Student Coalition with the college health program. After thanking the students for their participation in creating the baseline data collection, we informed them about the purpose of the phone survey and assured them that all responses were confidential.
Telephone questions included process measures such as the number of greeting cards the student received and whether the respondents liked the cards. The questions and answers paralleled the norm messages on the greeting cards and measured respondents' willingness to avoid future heavy drinking. For example, "In a recent survey of undergraduate campus residents, how many reported they have NOT recently engaged in heavy drinking? (a) 64%, (b) 49%, (c) 30%, (d) 22%." The answer was: "64% reported they have NOT recently engaged in heavy drinking. It may seem like all students drink heavily, but research shows that more campus students drink moderately, if at all."
Seventy-one percent of the intervention students participated in the telephone survey. Phone contacts lasted an average of 5 minutes each (SD = 1.16). Reports from the student research staff immediately after they made individual telephone calls indicated that 80% of the survey participants said that they considered the telephone conversations either effective or very effective. Eighty-eight percent said that students were responsive or very responsive to the contacts, and 95% reported that the flow of the phone contact was smooth or very smooth (all items measured on a 4-point scale of not at all to very). Intervention students who could not be reached by telephone after three follow-up calls (29%) were mailed a brochure with prevention messages similar to those in the telephone contact protocol.
Our findings in this study indicate that a brief, primary prevention, social norm intervention targeting 1st-year residential college students had no apparent impact on overall reduction of alcohol consumption or reducing alcohol-use risk factors. This finding is somewhat surprising, given that previous studies of norm-based college programs have suggested successful modifications in perceptions of peer drinking or reduced alcohol use.
Methodological limitations aside, previous studies of binge drinking interventions for college students have not reported unequivocally positive results. In particular, such programs have been shown to have some hypothesized outcomes in altering perceived peer drinking prevalence, but they do not always perform better than traditional educational programs in altering drinking behavior. Our findings in the present study support the notion that normative information may have limited effects on modifying the drinking behaviors of college students.
These results raise questions about the efficacy of primary prevention binge drinking interventions that target entire segments of college students, regardless of their stage of readiness to engage in heavy drinking. These data may also suggest why previous studies of secondary prevention social-norm programs targeting students who regularly engage in heavy drinking may be most effective. Another reason for the negative outcomes from the intervention is that prevention messages may have elicited defensive reactions among students who were in a preparation stage of developing binge drinking. A recent study by Nye and associates found that combining self-focusing (self-monitoring) and normative (self-evaluation) self-regulation information resulted in less recognition of problems than either type of information alone. Although both intervention components in the present study emphasized normative information, depicting student models in the greeting card strategy and asking students about their willingness to avoid heavy drinking in the follow-up phone contacts may have served to focus students on their drinking, thereby setting up defensive denial. This may be the case for students who are highly vested in continuing heavy consumption, such as those planning to engage in regular binge drinking. For students at earlier and later stages of acquiring heavy drinking behaviors, however, self-deception regarding their alcohol consumption may have been less critical, thereby permitting those students to be positively influenced by the normative messages. Future longitudinal intervention studies should examine the roles of various strategies for providing self-focusing versus normative prevention messages. In addition, providing more subtle, credible prevention messages should be tested for the ability to change entrenched beliefs among 1st-year dormitory students in an experimental stage of binge drinking behavior.
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