Development and Evaluation of Theory-Based Alcohol Education Programs (2006)

Dear Editor: Excessive alcohol consumption leads to more than 1,400 unintentional deaths and 500,000 unintentional injuries every year on college campuses. It also contributes to myriad other high-risk behaviors such as drunk driving, unprotected sex, and physical fighting (Hingson, Heeren, Zakocs, Kopstein, & Weschler, 2002). The primary behavioral risk factor for alcohol-related problems is heavy episodic alcohol use or binge drinking, defined as consuming more than five drinks in one sitting for men or more than four drinks for women (Wechsler et al., 2002). According to recent national data, approximately 2 in 5 college students engage in binge drinking (Wechsler et al., 2002). In an effort to curb what many describe as an epidemic of binge drinking among students, the Centers for Disease Controls (CDC) has established goals under the auspices of Healthy People 2010 for reducing binge drinking among high school and college students to 11% and 20%, respectively (U.S. Department of Health and Human Services, 2000). In their review of college drinking prevention programs, Ziemelis, Bucknam, and Elfessi (2002) point out the paucity of research on theory-based interventions. This is surprising given the growing body of literature that collectively applies change theories to health behaviors. For example, the Theory of Planned Behavior (TPB) has been used to predict several health behaviors, including alcohol consumption. The TPB suggests that behavior is a function of behavioral intentions (the perceived likelihood of performing a given behavior). Three constructs directly influence behavioral intentions including: 1) attitude (positive or negative evaluations of performing a behavior), 2) subjective norms (perception of social expectations regarding adoption of a given behavior), and 3) perceived behavioral control (personal beliefs regarding the ease of performing the target behavior) (Godin & Kok, 1996). Attitudes toward a particular behavior are based on beliefs about the benefits or drawbacks that will result from engaging in such a behavior. For example, one's attitude toward drinking may be formed out of beliefs that drinking will facilitate social assimilation. On the other hand, one may also believe that a negative consequence of drinking will involve suffering a hangover the next day. Subjective norms also play a role in forming a set of beliefs and subsequent intention to act. The degree to which a student feels drinking is accepted or even expected among peers also influences decisions associated with drinking. Finally, the individual must see the behavior as something that can be controlled. If drinking is perceived as somehow beyond ones ability to refuse, social norms and attitudinal beliefs will not come into play. In research using the TPB, Marcoux and Shope (1997) successfully predicted use, rates of use, and abuse of alcohol among a large sample of middle school students accounting for high amounts of variance in intention to use alcohol. Schlegel, D'avernas, Zanna, Decourville, and Manske (1992) later examined the TPB constructs as predictors of problem drinking among high school students in a 12-year longitudinal study. Results showed that the TPB was effective in predicting both frequency of drinking behavior and quantity of alcohol consumed during each episode. The authors conclude that primary prevention of problem drinking should be aimed at changing beliefs and attitudes to prevent excessive drinking, as well as improving perceived behavioral control (Schlegel et al., 1992). The development and delivery of TPB based curriculum for college students is described below. Prior to developing the curriculum, a series of six focus groups were conducted by a trained doctoral student. Focus group sessions were recorded, discussions were transcribed, and responses were coded. The first group was asked to discuss general campus issues that impacted quality of life. …