Environmental Approaches to Prevention in College Settings

By Saltz, Robert F. | Alcohol Research, Fall 2011 | Go to article overview

Environmental Approaches to Prevention in College Settings


Saltz, Robert F., Alcohol Research


Because of the concerns regarding drinking among college students and its harmful consequences to the students, their families, communities, and society as a whole, the identification of prevention strategies shown to be effective in college populations was a fundamental objective of the National Institute on Alcohol Abuse and Alcoholism's (NIAAA) Task Force on College Student Drinking (NIAAA 2002). In its conclusions and recommendations, the Task Force categorized available interventions into four tiers, based on the level of empirical support found in the research literature. Tier 1 strategies have the strongest evidence of efficacy; they include such approaches as brief interventions, cognitive-behavioral interventions, and expectancy challenge, all of which are aimed at individual students. By identifying these strategies, the Task Force provided a valuable service to both the college and research communities, and with enhanced funding from NIAAA, additional research on these programs and strategies has continued in the years since (for more information, see the article by Cronce and Larimer, pp. 204-221).

The Task Force also drew attention to other prevention strategies reported in the research literature that had been shown to be effective in general populations but for which essentially no evidence of efficacy for colleges and universities existed. These Tier 2 strategies included such universal alcohol control measures as enforcing laws related to the minimum drinking age and reducing alcohol-impaired driving, raising the price of alcoholic beverages, reducing the density of alcohol outlets, and promoting responsible beverage service among retailers. Because these interventions typically require action at the community level, the Task Force stated that "[the] formation of a campus and community coalition involving all major stakeholders may be critical to implement these strategies effectively" (NIAAA 2002, p. 20). In calling for research on these Tier 2 strategies in college communities, the Task Force report prompts the reasonable question of why additional interventions should be studied. Community-based prevention interventions would seem difficult to design and implement and even more difficult to evaluate. For example, when an entire campus or community is the unit of intervention, a rigorous research design would require multiple intervention or control conditions as well comparison campuses, preferably with random assignment to intervention condition. With this level of effort required, it is little wonder that such studies are rare. Why, then, would it not be sufficient to just further develop and improve the existing individual-level Tier 1 interventions?

Several reasons support additional attention to community-level Tier 2 interventions as well as to the Tier 1 interventions. First, in their current form, many of the Tier 1 interventions are labor intensive and require skilled people to conduct them, even if there are promising efforts to overcome these potential barriers. If these interventions were to be adopted for all students, they would require time for screening each student, plus the time needed to deliver brief interventions for those who screen positive. Thus, adopting these strategies as campus-wide efforts would result in many research, cost, recruitment, and logistical challenges.

Second, the Tier 1 interventions are most appropriate for students whose drinking already is problematic or who at least are members of subgroups who drink more heavily than the general population (see Larimer and Cronce 2002, 2007). However, alcohol-related harm is not limited to those whose drinking can be characterized as consistently heavy or risky (Gruenewald et al. 2003; Weitzman and Nelson 2004). At the population level, light and moderate drinkers outnumber the heaviest drinkers to such an extent that, even though they have a lower level of individual risk, they are responsible for the majority of alcohol-related problems (see Kreitman 1986). …

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