Evaluation of a computer administered alcohol education program for college students.

Abstract

The computer administered alcohol education program, Alcohol 101, is a popular tool for colleges attempting to foster more responsible drinking in college students. The effectiveness of this program in changing attitudes was assessed by measuring the attitudes of students who completed the program as one of the consequences of disciplinary action for alcohol abuse on campus. Students completed a questionnaire before and immediately after spending an hour with the simulation program. A subsample of 16 participants completed the same questionnaire one week later. Immediately after completing the simulation, responses to the attitude questionnaire were no different than before completing the program. Furthermore, those who complete the questionnaire one week later express less realistic attitudes than at the time of exposure to Alcohol 101.

INTRODUCTION

The abuse of alcohol by college students is a long-standing problem that seems quite resistant to change. Wechsler and his colleagues (Wechsler, Lee, Kuo, Seibring, Nelson, & Lee, 2002; Wechsler, Lee, Nelson, & Kuo, 2002) summarized the results of four Harvard School of Public Health College Alcohol Studies, dating from 1993 through 2001. They reported that the level of binge drinking has remained relatively stable across the four surveys. They also reported that students do not feel that their behavior has been affected by educational efforts at their institutions. The good news is that, over the years, there has been a decrease in the proportion of underage students who drink. Alcohol-control policies at the local and state level do seem to be somewhat effective as a deterrent in this regard.

Alcohol abuse, however, does constitute a serious problem on campuses. Of the 14,115 students completing a survey for Knight, Wechsler, Kuo, Seigring, Weitzman and Schuckit (2002), 31.6% reported symptoms consistent with a diagnosis of alcohol abuse according to DSM-IV classification standards and an additional 6.3% met the criteria for alcohol dependence. Alcohol abuse leads to problems such as risky sexual behavior, (Cooper, 2002), alcohol-related sexual assault (Abbey, 2002), an increase in aggressive behavior and a greater risk of being the victim of violence (Giancola, 2002).

Several studies have suggested that students who expect positive outcomes from drinking are most likely to abuse alcohol. For example, Neighbors, Walker, and Larimer (2003) reported that college students linked the expectation of positive consequences from the consumption of alcohol to higher consumption of alcohol. One such positive outcome some students expect from drinking is the ability to cope with problems (Park, & Levenson, 2002). While a sample of male students identified alcohol and drug use as major problems for their health, their feelings about alcohol tended to be ambivalent. While they recognized potential dangers, they also saw alcohol as having positive benefits, such as a way to cope with problems and a way to increase social confidence (Davies, et al., 2000). Reise and Riley (2002b) found that expectations about positive effects of alcohol, a history of drinking in high school, and membership in Greek organizations, as well as campus rules on alcohol use, and knowledge of skills for safe alcohol use all contributed to predicting how much alcohol students consumed on a weekly basis. In a study investigating how positive and negative expectancies about drinking affect consumption of alcohol, Lee, Greely, and Oei (1999) found that both kinds of expectancies were significantly related to drinking behavior. Those with positive expectancies seemed to drink more per session, while those with negative expectancies drank less per session. This suggests that programs affecting students' expectancies about alcohol (alcohol expectancies) might have some success in dealing with this serious problem.

In a review of the empirical literature, Walters and Bennett (2000) concluded that the type of program that is likely to have the greatest impact on student drinking is one that gives skills training, personalized feedback, and attitudinal-based interventions.

In a review of published studies reporting individually-focused intervention strategies, Larimer and Cronce (2002) concluded that the evidence suggests that educational, awareness, information based, and values clarification approaches to the treatment of alcohol misuse are not effective. They recommend that high-risk students be targeted by intervention program that emphasize skill-based and motivational treatment. Individual treatment may not be possible in many cases. While a program of intervention described by McNally, Palfai, and, Kahler (2005) appeared to be somewhat successful, it required individual sessions with participants lasting an hour and a half. An alternative method of providing individualized attention is through a multi-media CD-ROM based education program called Alcohol 101 created by The Century Council; American School Counselor Association (1997). The Century Council, funded by the nation's distillers, is a national not-for-profit organization whose purpose is to discourage underage drinking, drinking and driving, and also to encourage responsible decision-making about the use of alcohol. This interactive program presents various scenarios in which the participant must make decisions related to drinking. After seeing the consequences of that choice, participants may make other choices. Reis, Riley and Baer (2000) present a comprehensive overview of the program and how it was developed.

In one study evaluating this program (Reis and Riley, 2002a), the changes in alcohol expectations and intentions to change drinking behaviors of 360 students who experienced the Alcohol 101 program were compared to a control group of 350 students who wrote an essay on how to become a more responsible drinker. A higher proportion of participants assigned to the computer program shifted from unrealistic expectations to realistic expectations on the consequences of drinking alcohol compared to those in the essay control condition. Even though this research has reported positive effects of the alcohol education program, it is still unclear how effective the program is at sustaining changed beliefs in students' views of the affects of alcohol.

The aim of current research study was to evaluate the Alcohol 101 education program by measuring changes in expectations and intentions not only from pre-intervention to immediate post intervention, but also after a delay of one week.

METHOD

Participants

Participants were recruited through the Alcohol 101 Education Program administered by the John Carroll University Counseling Center. University Housing refers undergraduate students to the program because of alcohol violations. A total of 82 such students volunteered to participate in the study. The data of one student were omitted from the analysis because some items on the questionnaire were not completed. Of the 81 students who completed the evaluations, 25 were enrolled in an Introductory Psychology course and were given credit toward a psychology course requirement. All participants were at least 18 or older and were treated in accordance with the Ethical Principles of Psychologists and Code of Conduct (American Psychological Association, 2002).

Materials

The intervention used in this study was the Alcohol 101 CD-ROM program (The Century Council, the American School Counselor Association, 1997). This is an interactive multimedia computer program that addresses students' expectations about the consequences of drinking alcohol. The program depicts real life settings in which many college students may find themselves, like a college party or hanging out at a bar. Students are presented with common scenarios associated with college drinking and are allowed to select decisions to be made by the characters. Depending on the decisions that the student chooses, the characters play out consequences ranging from having a good and safe time by abstaining from drinking, to getting involved in serious trouble. For example, being charged with driving under the influence of alcohol, allegations of rape, or even dying in an auto accident are all potential consequences due to drinking. The program is similar to other alcohol education programs in that it addresses the effects of alcohol on behavior and the consequences of decision making while under the influence of alcohol.

The alcohol worksheet created by Reis and Riley (2002a) was revised to assess expectations of alcohol use and intentions to change. This Alcohol Expectations and Intentions to Change Worksheet (AEICW), included in the appendix, has a four point Likert Scale that replaced the original yes/no response so interval data could be collected. Higher scores on the questionnaire indicate more realistic expectations about the affects of alcohol and a stronger willingness to change current drinking behaviors. An internal consistency estimate of reliability was computed for the AEICW yielding a coefficient a of .58 for pre-intervention, .68 for the first post-intervention, and .53 for the second post-intervention.

Procedure

For two semesters students who were referred to the Alcohol 101 education program and agreed to participate in the study completed the AEICW questionnaires. During the first semester, students were given the AEICW questionnaire to complete immediately before the Alcohol 101 intervention and again immediately after. A total of 47 students participated during the first semester. During the second semester, students were offered a five dollar payment if they agreed to complete a third AEICW questionnaire in one week. They were given a stamped envelope containing the third questionnaire to be completed and mailed back to counseling services after one week had passed. Thirty-five students accepted the reward but only 16 returned the questionnaire.

RESULTS

A one-way repeated measures ANOVA was conducted on the pre-intervention and the first post-intervention scores on the AEICW. The results indicated no difference in scores before the Alcohol 101 program (M = 36.10, SD = 3.56) and the first post-intervention test (M = 36.47, SD = 4.06), F(1, 80) = 1.43, p = .236, partial [[eta].sup.2] = .018, indicating that students' expectations and intentions on the use of alcohol were not immediately changed by the Alcohol 101 intervention.

A second one-way repeated measures ANOVA was conducted on the pre-intervention and the first and second post-intervention scores for the 16 students who completed the delayed posttest. Results indicated a significant difference in the AEICW scores, F (2, 30) = 10.76, p < .005, [[eta].sup.2] = .418. Pairwise comparisons indicated that, for these 16 students, there was a significant drop in AEICW scores for the delayed post intervention compared to both the first post-intervention (p < .001) and the pre-intervention (p = .021). At delayed post-test, participants had less realistic expectations regarding the effects of alcohol. As with the full sample, there was no significant difference between the pre-intervention and the first post-intervention scores. Means and standard deviations for the three scores are presented in Table 1.

In order to compare the results of the current study with the results of Reis and Reilly (2002a), responses to individual items on the AEICW were grouped together so that strongly disagree/disagree became NO, and strongly agree/agree became YES. The proportion of participants changing responses from pre to post intervention tests found by Reis and Reilly and by the current study is presented in Table 2. For most items, the proportion of students who shifted from unrealistic to realistic expectations regarding the affects of alcohol were much lower in our study than the changes reported by Reis and Reilly. Also, we report the proportion of students who changed from realistic to unrealistic expectations on each item. Reis and Reilly did not report the proportion of students in this category.

DISCUSSION

There was no significant difference between scores on the AEICW from pre-intervention to the immediate post-intervention test. This may indicate that participants were answering the questionnaires in a way that they thought they were expected to on both the pre and post intervention tests. This is not surprising given that the students were taking Alcohol 101 as a consequence of being caught drinking alcohol in their dormitories. However, AEICW scores obtained one week after the intervention were significantly lower (less realistic) than both the pre-intervention and immediate post-intervention scores. These delayed responses may more reliably reflect students' true attitudes about the effects of alcohol.

Unfortunately, conclusions based on this study must be made with caution due to the relatively low reliability of the AEICW questionnaire in this sample. An item analysis was performed to see if removing any items would increase the coefficient alpha, but none of the individual items seriously lowered the reliability. Future research should incorporate a new scale with higher reliability.

When we calculated the proportion of students reporting a change from unrealistic to realistic expectations following the Alcohol 101 intervention, as done by Reis and Reilly (2002a), our findings did not replicate theirs. Although some post-intervention items showed some increase in realistic attitudes from pre-intervention, the degree of change was not nearly as great as that reported by Reis and Reilly. The two items on which our sample had a higher percent of change than reported by Reis and Reilly, as well as not having any students change from realistic to unrealistic views, were items six (Alcohol makes me do things I later regret), which had a 61.5% change from unrealistic to realistic views, and item eight (Alcohol is easy to abuse), which had a 86% change. Table 2 shows the results of the present study contrasted with the results from Reis and Reilly.

Why our study failed to replicate Reis and Reilly (2002a) is unclear, but it may have to do with the setting or environment in which the two studies were performed. For both studies, the student sample used was that of students currently facing an alcohol violation while enrolled at a Midwestern university. However, Reis and Reilly used students from a large public Midwestern university, while the current study was performed at a small private Midwestern university. Also, the sample in the current study is much smaller than the Reis and Reilly study, which may contribute to the low internal consistency in our measure. It is clear that much more research must be performed before adequate conclusions can be reached regarding the effectiveness of the Alcohol 101 program.

The current study found that scores on the delayed post-intervention questionnaire were significantly lower than scores on both the pre and first post-intervention questionnaires. It is possible that these scores more adequately reflect the students' true expectations about the consequences of drinking alcohol due to the fact that this delayed AEICW questionnaire was completed outside the pressures of the counseling services office and mailed back one week later by the students, thus reducing the potential for the social desirability phenomenon to occur. Though there were only 16 delayed post-intervention questionnaires mailed back to counseling services, which is a relatively small sample, it is likely that the students who mailed back the questionnaire are more responsible, took the study more seriously, and in turn, were more honest than the other students who took the five dollar incentive and didn't bother to return the final questionnaire. Thus, even though concrete conclusions can not be reached because of the small sample, there is some evidence that students' expectations may become less realistic a week after the Alcohol 101 program. This demonstrates the need for future research to incorporate more and longer delayed post-measurements so that effects of the intervention program can be measured over time. It is the goal for all interventions to have a lasting effect on their participants, and this study demonstrated the importance of determining if that occurs. Finally, future research should attempt to use a greater incentive to motivate students to return a greater number of post-intervention questionnaires.

In the current study, the computer-administered Alcohol 101 program, used widely by universities across the United States for educating students about the potential dangers of drinking alcohol, failed to create more realistic expectations and intentions to change drinking behaviors. This finding must be interpreted with caution due to the low reliability of the AEICW measure. The results of this study suggest that a delayed measurement of attitudes toward alcohol may differ from measures taken immediately before and after an intervention. Furthermore, researchers may need to take into account the environment from which their sample is drawn when looking at how programs may affect attitudes toward drinking.

References

Abbey, A. (2002) Alcohol-related sexual assault: A common problem among college students. Journal of Studies on Alcohol, 63 (Suppl. 14), 118-128.

American Psychological Association (2002). Ethical Principles of Psychologists and Code of Conduct. American Psychologist, 57, 1060-1073.

The Century Council; American School Counselor Association. (1997). Alcohol 10l [Computer Software]. Urbana-Champaign, IL: University of Illinois.

Cooper, M. L. (2002). Alcohol use and risky sexual behavior among college students and youth: Evaluating the evidence. Journal of Studies on Alcohol, 63 (Suppl. 14), 101-117

Davies, J., McCrae, B. P., Frank. J., Dochnahl, A., Pickering, T., Harrison, B., Zakrzewski, M. & Wilson, K. (2000) Identifying male college students' perceived health needs, barriers to seeking help, and recommendations to help men adopt healthier lifestyles. Journal of American College Health, 48, 259-267.

Giancola, P. R. (2002) Alcohol-related aggression during college years: Theories, risk factors, and policy implications. Journal of Studies on Alcohol, 63 (Suppl. 14), 129-139.

Knight, J. R., Wechsler, H., Kuo, M., Seibring, M., Weitzman, E. R., & Schuckit, M. A. (2002). Alcohol abuse and dependence among U.S. college students. Journal of Studies on Alcohol, 63, 263.

Latimer, M. E., & Cronce, J. M. (2002) Identification, prevention and treatment: A review of individual focused strategies to reduce problematic alcohol consumption by college students. Journal of Studies on Alcohol, 63 (Suppl. 14), 148-163.

Lee, N. K., Greely, J., & Oei, T. P. (1999). The relationship of positive and negative alcohol expectancies to patterns of consumption of alcohol in social drinkers. Addictive Behaviors, 24, 359-369.

McNally, A. M, Palfia, T. P., & Kahler, C. W. (2005). Motivational intervention for heavy drinking college students: Examining the role of discrepancy-related psychological processes. Psychology of Addictive Behaviors, 19, 79-87.

Neighbors, C., Walker, D. D., & Larimer, M. E. (2003). Expectancies and evaluations of alcohol effects among college students: Self-determination as a moderator. Journal of Studies on Alcohol, 64, 292-300.

Park, C. L., & Levenson, M. R. (2002). Drinking to cope among college students: Prevalence, problems, and coping processes. Journal of Studies on Alcohol, 63, 486-497.

Reis, J., & Riley, W. (2002a). Assessment of a computer-supported alcohol education intervention program, Health Education, 102, 124-132.

Reis, J., & Riley, W. (2002b). Predictors of college students' alcohol consumption: Implications for student education. The Journal of Genetic Psychology, 16, 282-290.

Reis, J., Riley, W., & Baer, J. (2000) Interactive multimedia preventive alcohol education: An evaluation of effectiveness with college students. Journal of Computing Research, 23, 41-65.

Walters, S. T., & Bennett, M. E. (2000). Addressing drinking among college students: A review of the empirical literature. Alcoholism Treatment Quarterly, 18, 61-77

Wechsler, H., Lee, J. E., Nelson, T. F., & Kuo, M. (2002). Underage college students' drinking behavior, access to alcohol, and the influence of deterrence policies: Findings from the Harvard School of Public Health College Alcohol Study. Journal of American College Health, 50, 223-236.

Wechsler, H., Lee, J. E., Kuo, M., Seibring, M., Nelson, T. F., & Lee, H. (2002). Trends in college binge drinking during a period of increased prevention efforts: Findings from the Harvard School of Public Health College Alcohol Study surveys: 1993-2001. Journal of American College Health, 50, 203-217.

Author Note

Janet D. Larsen and Brandon Kozar, Department of Psychology, John Carroll University.

We would like to thank Dr. John Ropar and Tiffany Plute at the Counseling Services office for their help and support in making this research study possible, Dr. John H. Yost of the psychology department for his suggestions and advice, and The Graduate School of John Carroll University for funding.

Correspondence concerning this article should be addressed to Janet Larsen, Department of Psychology, John Carroll University, University Heights, Ohio 44118. Phone: [phone]; Fax: [phone]; E-mail: [e-mail]

Janet D. Larsen and Brandon Kozar

John Carroll University

Appendix

Alcohol Expectations and Intentions Worksheet

(Please check the answer box that best represents your opinion)

Alcohol:                                         Strongly    Disagree
                                                 Disagree

* 1. Enhances social interaction.
* 2. Decreases stress.
  3. Interferes with safe decision making.
* 4. Promotes male bonding.
* 5. Promotes female bonding.
  6. Makes me do things I later regret.
* 7. Gives me something to do.
  8. Is easy to abuse.
* 9. Is easy to use safely.
 10. Takes time and experience to know how to
       use.
 11. Interferes with really getting to know
       people.

As of this moment:
  1. I plan on changing my drinking behavior
       to be more safe and responsible.
  2. I plan on eating a full meal before
       drinking.

Alcohol:                                         Agree       Strongly
                                                             Agree

* 1. Enhances social interaction.
* 2. Decreases stress.
  3. Interferes with safe decision making.
* 4. Promotes male bonding.
* 5. Promotes female bonding.
  6. Makes me do things I later regret.
* 7. Gives me something to do.
  8. Is easy to abuse.
* 9. Is easy to use safely.
 10. Takes time and experience to know how to
       use.
 11. Interferes with really getting to know
       people.

As of this moment:
  1. I plan on changing my drinking behavior
       to be more safe and responsible.
  2. I plan on eating a full meal before
       drinking.

* Indicates reverse scoring

Table 1

Pre, First, and Second Post Alcohol Intervention Scores on the AEICW

Questionnaire Scores

                       First            Delayed
     Pre-              Post-             Post-
 intervention      intervention      intervention

  M       SD        M       SD        M       SD

36.06    3.75     34.69    3.55     32.62    3.46

Note: N = 16, higher scores indicate more realistic expectations about
the effects of alcohol and a stronger willingness to change current
drinking behaviors.

Table 2

Comparison of Percent of Change in Reis and Reilly (2002a)
and present study

           Reis and Reilly
          (2002a) (moderate
           drinking group)               Present study

            % unrealistic      % unrealistic     % realistic to
            to realistic        to realistic      unrealistic

Item1            50%            12.5% (8/64)      23.5% (4/17)
Item2            59%            27% (13/48)       9.1% (3/33)
Item3            64%             75% (6/8)        6.8% (5/73)
Item4            62%            15.5% (9/58)      30.4% (7/23)
Item5            57%            20% (10/50)       25.8% (8/31)
Item6            53%           61.5% (24/39)       0% (0/42)
Item7            69%            30% (14/47)       17.6% (6/34)
Item8            70%            86% (12/14)        0% (0/67)
Item9            68%            29% (17/58)       17.4% (4/23)
Item10           43%             44% (7/16)        0% (0/65)
Item11           53%            46% (24/52)       13.8% (4/29)
Item12           --             37% (10/27)       3.7% (2/54)
Item13           --              80% (8/10)       1.4% (1/71)

Note: Percentages are based on students who initially agreed to
either unrealistic or realistic expectations about the affects of
alcohol at pretest and then switched to realistic or unrealistic
expectations at post-test.