Common ground: an investigation of environmental management alcohol prevention initiatives in a college community

A Group Randomized Trial of the Stop Service to Obviously-Impaired Patrons (S-STOP) Program to Prevent Overservice in Bars and Restaurants in College Communities

BACKGROUND

College student drinking in on-premises establishments has been associated with heavy alcohol consumption and a range of problems including assault, fighting, risky sex, and drinking and driving. Although more strictly enforcing overservice laws might reduce heavy drinking in on-premises establishments, law enforcement agencies have few resource-efficient tools for doing so, resulting in these laws seldom being enforced.

OBJECTIVES

In this paper, we report the results of an evaluation of the Stop Service to Obviously-impaired Patrons (S-STOP) program that was implemented in 303 bars and restaurants in 18 university communities in California using a randomized cross-over design (early vs. delayed implementation). The S-STOP program: (a) deployed pseudo-intoxicated patrons who attempted to purchase a drink when showing obvious signs of intoxication; (b) provided feedback to owners and managers on staff performance; and (c) offered free online refresher training for staff.

RESULTS

Overall, alcohol servers in bars and restaurants in these college communities were willing to serve a pseudo-intoxicated mystery shopper 90% of the time. The study found no evidence that S-STOP reduced the prevalence of alcohol sales to apparently impaired patrons during the two intervention stages of the study.

CONCLUSIONS

The findings highlight the need for developing effective interventions to prevent overservice and should prompt college and university leaders to take the lead in addressing the problem of alcohol overservice at on-premises establishments by working with community leaders, law enforcement, and retailers.

A systematic review of alcohol education programs for young people: do these programs change behavior?

Numerous education programs have addressed young peoples' alcohol use. To date, no peer-reviewed publication has evaluated the effectiveness of such programs delivered across a range of contexts to change alcohol-related behaviors, attitudes and/or knowledge. This systematic review aimed to identify alcohol education programs addressing young people, and determine whether they changed alcohol-related behavior, knowledge and attitudes; and, ascertain components of successful programs. Studies were identified, guided by the PRISMA review process, from the earliest records until June 2020. Included studies (N = 70) comprised an alcohol education program which focused on young people (15-24 years). Forty programs reported behavior changes, and these programs were the highest quality. Others impacted attitudes and/or knowledge only (n = 12); or reported no impacts (n = 17). Recent programs were more likely than older programs to feature online delivery and report behavior changes. To enhance alcohol education, future programs should include the identified quality criteria, alongside process and long-term outcome evaluations, to better monitor effectiveness. Findings indicated some education programs have capacity to positively change alcohol-related behavior; however, outcome consistency varied even in high-quality programs. Alcohol education programs should be designed alongside health education/promotion models and best-practice recommendations, to improve the likelihood of desirable behavior-related outcomes.

Boards of trustees must assume responsibility for making alcohol prevention on campus a top priority

Few colleges have made the prevention of alcohol-related injuries and deaths an institutional priority, and even fewer have implemented prevention strategies with a solid evidentiary base. We look to presidents to provide leadership on this issue, but those who do are atypical. Boards of trustees should step in by asserting that student wellness be a primary focus in the institution's strategic plan, with specific, measurable goals; holding the president accountable for progress in reducing high-risk drinking and its consequences; and mandating a line item in the annual budget, with adequate staffing and revenues to put evidence-based practices in place. Boards will be more likely to respond when led to focus on the cost implications of the campus alcohol problem; the link between high-risk drinking and mission-critical institutional objectives such as academic performance, student engagement, and retention; and the institution's potential liability if evidence-based prevention strategies are not in place.

Response of colleges to risky drinking college students

Heavy drinking and related consequences continue to affect college campuses due to fatalities, assaults, serious injuries, and arrests that occur among students. Several approaches aimed at reducing the harm incurred by students and the college communities as a result of heavy drinking are being used with varying success. A review of interventions including educational, individual, and environmental approaches are described, as well as new, promising, strategies. Despite some success, elevated and risky drinking patterns continue. As such, concerns over implementation of evidence-based treatments and areas in need of further study are discussed. [Full text available at http://rimed.org/rimedicaljournal-2014-10.asp, free with no login].

Local Support for Alcohol Control Policies and Perceptions of Neighborhood Issues in Two College Communities

BACKGROUND

Although valuable, national opinion surveys on alcohol policy may be less informative for policy development at the local level. Using samples of adult residents in 2 college communities, the present study: (1) measured public support for local alcohol control policies to stem underage drinking and alcohol overservice in on-premise outlets, (2) assessed residents' opinions regarding neighborhood problems, and (3) identified factors associated with strong policy support.

METHODS

We administered random-sample telephone surveys to residents aged 21 years and older in college communities located in Community 1 (N = 501; mean age = 57.4 years, SD = 14.7) and Community 2 (N = 505; mean age = 56.0 years, SD = 15.2). The response rates were typical of telephone surveys (Community 1: 33.5%; Community 2: 29.9%). We assessed support for 16 alcohol control policies and the occurrence of specific types of neighborhood incidents (e.g., witnessing intoxicated people). We used multiple regression analyses to determine factors associated with policy support.

RESULTS

Residents in Community 1 reported significantly higher weekly alcohol use, a greater number of witnessed neighborhood incidents, and a higher level of perceived neighborhood problems than did residents in Community 2. Residents in Community 1 perceived local alcohol control policies and their enforcement to be significantly stricter. Overall, policy support was high and did not differ between the communities. In both communities, higher policy support was significantly associated with being female, being older, less weekly alcohol use, and lower perceived strictness of alcohol control policies and enforcement.

CONCLUSIONS

It is important for campus officials and community leaders to be aware of and publicize favorable public opinion when advocating for policy change, especially at the local level. Information on residents' perceptions of the neighborhood issues they face can also inform local policy and enforcement efforts.

New research findings since the 2007 Surgeon General's Call to Action to Prevent and Reduce Underage Drinking: a review

OBJECTIVE

In 2007, the U.S. Department of Health and Human Services issued The Surgeon General's Call to Action to Prevent and Reduce Underage Drinking, a publication documenting a problem linked to nearly 5,000 injury deaths annually and poor academic performance, potential cognitive deficits, risky sexual behavior, physical and sexual assaults, and other substance use. This report reviews subsequent underage drinking and related traffic fatality trends and research on determinants, consequences, and prevention interventions.

METHOD

New research reports, meta-analyses, and systematic literature reviews were examined.

RESULTS

Since the Call to Action, reductions in underage frequency of drinking, heavy drinking occasions, and alcohol-related traffic deaths that began in the 1980s when the drinking age nationally became 21 have continued. Knowledge regarding determinants and consequences, particularly the effects of early-onset drinking, parental alcohol provision, and cognitive effects, has expanded. Additional studies support associations between the legal drinking age of 21, zero tolerance laws, higher alcohol prices, and reduced drinking and related problems. New research suggests that use/lose laws, social host liability, internal possession laws, graduated licensing, and night driving restrictions reduce traffic deaths involving underage drinking drivers. Additional studies support the positive effects of individually oriented interventions, especially screening and brief motivational interventions, web and face-to-face social norms interventions, college web-based interventions, parental interventions, and multicomponent community interventions.

CONCLUSIONS

Despite reductions in underage alcohol consumption and related traffic deaths, underage drinking remains an enduring problem. Continued research is warranted in minimally studied areas, such as prospective studies of alcohol and brain development, policy studies of use/lose laws, internal possession laws, social host liability, and parent-family interventions.

College student drinking research from the 1940s to the future: where we have been and where we are going

OBJECTIVE

College student drinking is not a new phenomenon, yet the field of research studying college student drinking is relatively young. In recognition of the 75th anniversary of what is now the Journal of Studies on Alcohol and Drugs, this article reviews the path from the first article to focus exclusively on college student drinking as the topic (published in 1945) to the current state of the science and attempts to look forward to the next steps in the field's research agenda.

METHOD

Articles were selected by consensus of the authors from incarnations of the journal and other academic journals based on their relevance to the genesis of current best practices regarding college student drinking prevention.

RESULTS

Major eras and themes include (a) early efforts to describe and understand college student drinking; (b) building foundations for prevention and intervention efforts in response to growing concerns about high-risk drinking; (c) the emergence of harm-reduction efforts, normative interventions, and efforts to document campus strategies; (d) efficacious prevention efforts and high-risk drinking; (e) the "Call to Action" Task Force Report from the National Institute on Alcohol Abuse and Alcoholism; and (f) updates to the science (including emerging technology).

CONCLUSIONS

Understanding the rich history of science related to college drinking prevention should prepare and guide our field for the next 75 years of scientific advances, leading to even greater understanding of the etiology and topology of college student drinking as well as more effective methods to reduce alcohol-related harms.

Impact of a randomized campus/community trial to prevent high-risk drinking among college students

BACKGROUND

High-risk drinking by college students continues to pose a significant threat to public health. Despite increasing evidence of the contribution of community-level and campus-level environmental factors to high-risk drinking, there have been few rigorous tests of interventions that focus on changing these interlinked environments. The Study to Prevent Alcohol Related Consequences (SPARC) assessed the efficacy of a comprehensive intervention using a community organizing approach to implement environmental strategies in and around college campuses. The goal of SPARC was to reduce high-risk drinking and alcohol-related consequences among college students.

METHODS

Ten universities in North Carolina were randomized to an Intervention or Comparison condition. Each Intervention school was assigned a campus/community organizer. The organizer worked to form a campus-community coalition, which developed and implemented a strategic plan to use environmental strategies to reduce high-risk drinking and its consequences. The intervention was implemented over a period of 3 years. Primary outcome measures were assessed using a web-based survey of students. Measures of high-risk drinking included number of days alcohol was consumed, number of days of binge drinking, and greatest number of drinks consumed (all in the past 30 days); and number of days one gets drunk in a typical week. Measures of alcohol-related consequences included indices of moderate consequences due to one's own drinking, severe consequences due to one's own drinking, interpersonal consequences due to others' drinking, and community consequences due to others' drinking (all using a past 30-day time frame). Measure of alcohol-related injuries included (i) experiencing alcohol-related injuries and (ii) alcohol-related injuries caused to others.

RESULTS

We found significant decreases in the Intervention group compared with the Comparison group in severe consequences due to students' own drinking and alcohol-related injuries caused to others. In secondary analyses, higher levels of implementation of the intervention were associated with reductions in interpersonal consequences due to others' drinking and alcohol-related injuries caused to others.

CONCLUSIONS

A community organizing approach promoting implementation of environmental interventions can significantly affect high-risk drinking and its consequences among college students.

Effects of depressed mood on drinking refusal self-efficacy: examining the specificity of drinking contexts

College students with elevated depressive symptoms are more likely to engage in risky drinking and experience alcohol-related negative consequences. Efforts to understand the association between depressed mood and alcohol use have begun to identify the role of cognitive-motivational processes. Drinking refusal self-efficacy is one such process that influences the decision to drink, but its relationship with depressed mood remains unclear. The current study sought to clarify the role of these processes using a depressed mood induction procedure in a sample of college student drinkers. Eighty-six students were randomized to a depressed or neutral mood induction and completed assessments of drinking refusal self-efficacy. Depressed mood significantly decreased self-efficacy in high-risk drinking contexts related to depression, whereas ratings of other high-risk contexts were unaffected. These findings suggest that the association between hazardous drinking and depressed mood may be due in part to the direct influence of mood state on one's self-efficacy to resist drinking in relevant contexts.

Alcohol risk management in college settings: the safer California universities randomized trial

CONTEXT

Potentially effective environmental strategies have been recommended to reduce heavy alcohol use among college students. However, studies to date on environmental prevention strategies are few in number and have been limited by their nonexperimental designs, inadequate sample sizes, and lack of attention to settings where the majority of heavy drinking events occur.

PURPOSE

To determine whether environmental prevention strategies targeting off-campus settings would reduce the likelihood and incidence of student intoxication at those settings.

DESIGN

The Safer California Universities study involved 14 large public universities, half of which were assigned randomly to the Safer intervention condition after baseline data collection in 2003. Environmental interventions took place in 2005 and 2006 after 1 year of planning with seven Safer intervention universities. Random cross-sectional samples of undergraduates completed online surveys in four consecutive fall semesters (2003-2006).

SETTING/PARTICIPANTS

Campuses and communities surrounding eight campuses of the University of California and six in the California State University system were utilized. The study used random samples of undergraduates (∼500-1000 per campus per year) attending the 14 public California universities.

INTERVENTION

Safer environmental interventions included nuisance party enforcement operations, minor decoy operations, driving-under-the-influence checkpoints, social host ordinances, and use of campus and local media to increase the visibility of environmental strategies.

MAIN OUTCOME MEASURES

Proportion of drinking occasions in which students drank to intoxication at six different settings during the fall semester (residence hall party, campus event, fraternity or sorority party, party at off-campus apartment or house, bar/restaurant, outdoor setting), any intoxication at each setting during the semester, and whether students drank to intoxication the last time they went to each setting.

RESULTS

Significant reductions in the incidence and likelihood of intoxication at off-campus parties and bars/restaurants were observed for Safer intervention universities compared to controls. A lower likelihood of intoxication was observed also for Safer intervention universities the last time students drank at an off-campus party (OR=0.81, 95% CI=0.68, 0.97); a bar or restaurant (OR=0.76, 95% CI=0.62, 0.94); or any setting (OR=0.80, 95% CI=0.65, 0.97). No increase in intoxication (e.g., displacement) appeared in other settings. Further, stronger intervention effects were achieved at Safer universities with the highest level of implementation.

CONCLUSIONS

Environmental prevention strategies targeting settings where the majority of heavy drinking events occur appear to be effective in reducing the incidence and likelihood of intoxication among college students.

Fraternity and sorority leaders and members: a comparison of alcohol use, attitudes, and policy awareness

BACKGROUND

Studies have documented that members of college fraternities and sororities (i.e., Greeks) drink more heavily and experience more alcohol-related consequences than other students. Few studies have examined the role of Greek leaders in the socialization of Greek members.

OBJECTIVES

The present study investigated how alcohol-related attitudes and behaviors among Greek leaders differ from the attitudes and behaviors of members.

METHODS

At a single university, two anonymous surveys were conducted in 2006 and 2007 (N = 726 and 757, respectively) at fraternity and sorority chapter meetings. All individuals present at the meetings were invited to participate. One-way analyses of covariance (ANCOVAs), controlling for age and sex, were conducted to examine the effect of leadership status on alcohol-related attitudes and behaviors. Zero-inflated negative binomial regression was used to analyze the effect of leadership status on alcohol-impaired driving.

RESULTS

Few differences were found between Greek leaders and members. In both years, leaders perceived alcohol control policies as stricter than did members. Notably, leaders and members did not significantly differ in reports of alcohol use or consequences.

CONCLUSION

With this additional study, the literature suggests that alcohol-related attitude and behavioral differences between Greek leaders and members may be highly variable across college and university campuses.

SCIENTIFIC SIGNIFICANCE

The socialization process among Greek leaders and members warrants further investigation. The current findings suggest that future research should examine the roles that campus climate and on-campus initiatives may play in the Greek socialization process.

Preventing alcohol use among late adolescent urban youth: 6-year results from a computer-based intervention

OBJECTIVE

This study was undertaken to evaluate the efficacy of a skills-based CD-ROM intervention, with and without a parent component, to reduce alcohol use among urban youth at 6-year follow-up.

METHOD

At recruitment, 513 youths with a mean age of 10.8 years were randomly assigned to one of three study arms: youth CD-ROM intervention plus parent component, youth CD-ROM intervention only, or control. All youths completed pretest, posttest, and annual follow-up measures. Youths and parents in their respective arms received the initial intervention program between pretest and posttest measures and received booster interventions between each follow-up measure.

RESULTS

With 80% sample retention at 6-year follow-up, youths in both intervention arms reported less past-month alcohol and cigarette use and fewer instances of heavy drinking and negative alcohol-related consequences. Despite having similar numbers of drinking peers as youths in the control arm, youths in both intervention arms reported greater alcohol-refusal skills. Only past-month cigarette use differed between the two intervention arms, with youths in the intervention-plus-parent-component arm smoking less than youths in the CD-ROM intervention-only arm.

CONCLUSIONS

Six years after initial intervention, youths who received a culturally tailored, skills-based prevention program had reduced alcohol use and lower rates of related risky behaviors than youths in the control arm.

Prevention and early intervention to improve mental health in higher education students: a review

BACKGROUND

The age at which most young people are in higher education is also the age of peak onset for mental and substance use disorders, with these having their first onset before age 24 in 75% of cases. In most developed countries, over 50% of young people are in higher education.

AIMS

To review the evidence for prevention and early intervention in mental health problems in higher education students. The review was limited to interventions targeted to anxiety, depression and alcohol misuse.

METHODS

Interventions to review were identified by searching PubMed, PsycINFO and the Cochrane Database of Systematic Reviews. Interventions were included if they were designed to specifically prevent or intervene early in the general (non-health professional) higher education student population, in one or more of the following areas: anxiety, depression or alcohol misuse symptoms, mental health literacy, stigma and one or more behavioural outcomes.

RESULTS

For interventions to prevent or intervene early for alcohol misuse, evidence of effectiveness is strongest for brief motivational interventions and for personalized normative interventions delivered using computers or in individual face-to-face sessions. Few interventions to prevent or intervene early with depression or anxiety were identified. These were mostly face-to-face, cognitive-behavioural/skill-based interventions. One social marketing intervention to raise awareness of depression and treatments showed some evidence of effectiveness.

CONCLUSIONS

There is very limited evidence that interventions are effective in preventing or intervening early with depression and anxiety disorders in higher education students. Further studies, possibly involving interventions that have shown promise in other populations, are needed.

NIAAA's rapid response to college drinking problems initiative: reinforcing the use of evidence-based approaches in college alcohol prevention

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.