Impacts of a university course on students' reported alcohol consumption and consequential sexual activity.

Abstract: This study investigated the impacts made by five 50-minute targeted educational sessions that incorporated both supply and demand reduction strategies aimed at alcohol. One hundred thirteen University of Toledo students participated in the study that involved both a control and experimental group. On measured items related to personal alcohol use, students in the control group reported 9 significant increases and 1 significant decrease. On measured items related to drinking and sexual activity, students in the experimental group reported only 3 significant increases and 11 significant decreases.

**********

Current research has shown that approximately 80% of college students drink alcohol and that between 40% and 50% engage in heavy episodic (HE) drinking (Boyd & Faden, 2002). According to The Harvard School of Public Health College Alcohol Study, the rates for HE drinking have remained almost identical from 1993 to 2001 (Wechsler, Lee, Kuo, Seibring, Nelson, & Lee, 2002). In addition, the majority of college students are sexually active and a substantial minority has expreienced a number of negative consequences related to sexual risk taking (Cooper, 2002). The concerns for public health that arise from these numbers are many. In addition to the effects of alcohol, a number of studies have demonstrated a strong correlational link between HE drinking and risky sexual behaviors among college students has been shown in a number of studies. Risky sexual behaviors has been defined to include such things as having multiple, casual, or unknown partners; failing to discuss risk topics such as sexual history and STD history prior to intercourse; failing to take protective actions such as the use of condoms orother birth control; and engaging in anal intercourse. The consequences of such behaviors present real and serious threats to both the mental and physical health of college students, including unwanted pregnancy and contraction of HIV/AIDS or other STD.

Studies exploring the link between HE drinking and risky sexual behavior have found correlational, but not causal, relationships between alcohol use and certain types of sexual behavior (Cooper, 2002; Halpern-Felsher, Millstein, & Ellen, 1996). Third variables have been considered in a number of studies exploring the link between HE drinking and risky sexual behaviors. Religious convictions (Poulson, Eppler, Satterwhite, Wuensch, & Bass, 1998), alcohol myopia (Cooper, 2002; MacDonald, MacDonald, Zanna, & Fong, 2000.), and the length and type of relationship between the sexual partners (Halpern-Felsher et al., 1996) have been explored. The effect of personality types, especially those who have a need for risk and sensation seeking (Justus, Finn, & Steinmetz, 2000); how students' expectations of the effects of alcohol impacts their behaviors, and students' perceptions of social norms as they relate to alcohol use and sexual behavior (Bon & Hittner, 2001; Cooper, 2002) have also been studied. Each of the these studies showed a statistically significant correlation between the variable examined and risky sexual behavior linked to HE drinking. The link between HE drinking and risky sexual behaviors is varied and complex.

Efforts to intervene on HE drinking on college campuses across the United States have employed a variety of supply and demand-oriented approaches (Wechsler, Seibring, I-Chao, & Ahl, 2004). These strategies included various forms of targeted alcohol educational programs, social norms campaigns, and institutional restrictions placed upon alcohol use on campus. Wechsler et al. investigated the implementation rates of various approaches and questioned the reliance that many schools are taking in either carrying out social norm campaigns or by implementing institutional restrictions on alcohol consumption. The researchers in this study cite a recent study that documented the lack of success of alcohol focused social norms and educational campaigns and various other studies that document the success of institutional policies that restrict access to alcohol (Wechsler et al., 2004; Wechsler, Nelson, Lee, Seibring, Lewis, & Keeling; 2003).

The aim of this small study was to see if a targeted educational intervention that incorporates both supply and demand reduction strategies could be successful in effecting behavior change. The intervention included a demand-reduction social norm component that reviewed alcohol consumption and sexual behavior statistics on U.S. college campuses; a demand-reduction oriented educational component that examined alcohol's effects on perception and decision-making, participation in sexual activity and binge drinking; and a supply-reduction oriented educational component aimed at informing students about University of Toledo alcohol-related statistics and its alcohol-free policy (e.g., rules against alcohol consumption) on campus.

METHOD

DESIGN

In this study, a pre-test and post-test control group design was implemented. The control and experimental groups consisted of students attending the University of Toledo in Toledo, Ohio. Students enrolled in the two concurrent class sections of Human Sexuality during the spring semester of 2001 formed the experimental group, while the control group included only those students who had never previously taken the course. The experimental group received five 50-minute sessions of class time devoted to alcohol consumption and risky sexual behaviors. The control group did not receive an intervention.

SAMPLE

A sample of University of Toledo undergraduate students was selected based upon their current enrollment in the Human Sexuality course, as well as those who had never enrolled in the course. Of the 125 students selected, 113 participated in the study, 59 in the experimental group and 54 in the control group. Due to general absence and attrition, only 98 students took both the pre-test and the post-test; 56 from the experimental group and 42 from the control group.

COURSE CONTENT

The five 50-minute sessions of class were devoted to the following items:

1. Alcohol consumption on U.S. college campuses,

2. Sexual behavior, Spring Break phenomenon, and the impact of alcohol on perception,

3. Binge drinking, including its definition, practice and consequences,

4. Sexually transmitted diseases and sexual victimization, as it applies to alcohol consumption,

5. Campus alcohol-related statistics for the University of Toledo, and

6. University of Toledo's alcohol-free policy.

DATA COLLECTION

Data were collected through a pre-test and post-test design. Pre-tests were given to both the experimental and the control groups during the first week of the 2001 spring semester. Inclusion criteria for the control and experimental group were as follows 1) experimental group participants must be current University of Toledo students enrolled in the HEAL 3700 Human Sexuality course, and 2) control group participants must be students who have never taken the HEAL 3700 Human Sexuality course at the University of Toledo. Students who met the experimental group criterion received five 50-minute sessions on binge drinking and risky sexual behavior over the course of sixteen weeks. At the conclusion of the semester, the same surveys were administered to those students in the control and experimental groups. The post-test took place during the first week of May 2001. When both surveys had been collected, the pre-tests and post-tests were paired using the last four digits of each of students' identification numbers.

MEASURES

The impact the course had upon student drinking and their participation in unplanned and risky sexual behavior was measured using The Harvard School of Public Health College Alcohol Survey (CAS; Wechsler et al., 2002). This instrument measures drinking and risky sexual behavior using Likert scales. The survey also measured students' Perception of Campus Drinking Norms, Perception of Campus Policies, Access to Alcohol, and Consequences of Alcohol Consumption. These subscales included questions related to unplanned sexual activity and failure to use protection while having sex. The instrument has an extensive history of use on college campuses throughout the United States

DATA ANALYSIS

Investigators used the SPSS statistical software package (version 11.5) to complete quantitative data analysis. Descriptive statistics were used to describe participants' demographic characteristics and their scores on each of the subscales of the SF-36 survey. Paired samples t-tests were employed to detect any statistically significant differences in selected item responses from the CAS between the pre-test and post-test (Wechsler et al., 2002). The level of significance for all tests was set at the .05 level.

RESULTS

A total of 113 college students were involved at the beginning of the study. Only 98 college students completed both the pre-test and post-test; 56 from the experimental group and 42 from the control group. College students involved in this study were primarily female (58%), in their 2nd year of university study (42%), and an average of 21 years of age. In addition, a majority of the college students lived in an off-campus house or apartment (84%).

PERSONAL ALCOHOL USE

Paired samples t-tests revealed various statistically significant changes in personal alcohol use scores between the pre-test and the post-test (see Table 1). Experimental group college students experienced a statistically significant increase on 3 items: the number of drinks consumed at a college sporting event in the past 30 days (t = -4.968, p = .000), the number of drinks consumed at an off-campus party in the past 30 days (t = -5.828, p = .000), and the number of drinks consumed at an off-campus bar or pub in the past 30 days (t = -5.177, p = .000). However, this group also experienced a statistically significant decrease on 11 personal alcohol use items: the number of times five or more drinks were consumed in a row in the past two weeks (t = 3.161, p = .002); when the last drink was consumed (t = 4.351, p = .000); the number of occasions where an alcoholic drink was consumed in the past 30 days (t = 2.812, p = .007); the number of drinks consumed per occasion in the past 30 days (t = 7.146, p = .000); the number of times drunk in the past 30 days (t = 3.214, p = .002); the number of drinks consumed at a student gathering in a dorm room in the past 30 days (t = 2.673, p = .010); the number of drinks consumed at a gathering of faculty and students in the past 30 days (t = 4.841, p = .000); the number of drinks consumed at a dormitory social event or party (t = 21.633, p = .000); the number of drinks consumed at a fraternity or sorority event in the past 30 days (t = 3.594, p = .001); the number of drinks consumed at a campus dance or concert in the past 30 days (t = 6.390, p = .000); and the number of drinks consumed at a campus pub in the past 30 days (t = 2.310, p = 0.025).

Control group college students experienced more increases on personal alcohol use items than the experimental group did. They experienced a statistically significant increase on 9 items: the number of occasions where an alcoholic drink was consumed in the past 30 days (t = -5.700, p = .000); the number of drinks consumed per occasion in the past 30 days (t = -2.364, p = .023); the number of times drunk in the past 30 days (t = -4.545, p = .000); the number of drinks consumed at a faculty and student gathering in the past 30 days (t = -3.240, p = .002); the number of drinks consumed at a dormitory social event or party(t = -2.593, p = .013); the number of drinks consumed at a fraternity or sorority event in the past 30 days (t = -2.417, p = .020); the number of drinks consumed at a campus dance or concert in the past 30 days (t = -3.467, p = .001); the number of drinks consumed at a keg party on campus in the past 30 days (t = -2.993, p = .005); and the number of drinks consumed at another campus party or event in the past 30 days (t = -2.077, p = .044). The control group also experienced a significant decrease on only 1 personal alcohol use item: when the last drink was consumed (t = 3.525, p = .001).

DRINKING AND SEXUAL ACTIVITY

Paired samples t-tests revealed statistically significant changes in the sexual activity-related consequences of alcohol consumption experienced by students (see Table 2). Experimental group students experienced a statistically significant increase on 1 of 2 items: Since the beginning of the school year, how often has your drinking caused you to engage in unplanned sexual activity? (t = -3.762, p = .000) Control group students experienced a statistically significant increase on both items: since the beginning of the school year, how often has your drinking caused you to engage in unplanned sexual activity? (t = -3.99, p = .000), and since the beginning of the school year, how often has your drinking caused you to not use protection when you had sex? (t = -3.79, p = .000).

DISCUSSION

As indicated in the results outlined above, experimental group students experienced a statistically significant increase on the three items involving alcohol consumption relating to college sporting events and off-campus drinking at parties, bars and pubs. While these results are disappointing in light of the components incorporated into the Human Sexuality course, it should be noted that during the spring 2001 semester, The University of Toledo experienced a particularly successful men's basketball season and the university community evidently had much to celebrate. In addition, the end of the semester was imminent, and end-of-the-year parties and increased alcohol consumption are not uncommon at this time of the year at The University of Toledo and university campuses throughout the nation. Five, 50-minute sessions of class time devoted to alcohol consumption and risky sexual behaviors is likely not enough to counter the strong traditions and social norms related to major sporting accomplishments and end-of-semester celebrations.

In contrast, the control group results showed an increase in nine personal alcohol use items. These increases included the number of occasions where an alcoholic drink was consumed in the past 30 days; the number of drinks consumed per occasion in the past 30 days; the number of times drunk in the past 30 days; the number of drinks consumed at a faculty and student gathering in the past 30 days; the number of drinks consumed at a dormitory social event or party; the number of drinks consumed at a fraternity or sorority event in the past 30 days; the number of drinks consumed at a campus dance or concert in the past 30 days; the number of drinks consumed at a keg party on campus in the past 30 days; and the number of drinks consumed at another campus party or event in the past 30 days.

Differences in the results between the experimental and control groups are noteworthy. While control group scores for nine personal alcohol use items increased, this trend did not occur in the experimental group. In fact, experimental group scores decreased on seven of these items. Specifically these items included the number of occasions where an alcoholic drink was consumed in the past 30 days; the number of drinks consumed per occasion in the past 30 days; the number of times drunk in the past 30 days; the number of drinks consumed at a faculty and student gathering in the past 30 days; the number of drinks consumed at a dormitory social event or party; the number of drinks consumed at a fraternity or sorority event in the past 30 days and; the number of drinks consumed at a campus dance or concert in the past 30 days. Two of these items (5 and 7) assessed on-campus drinking. A portion of the intervention focused on the university's policy for alcohol consumption which largely addresses on-campus drinking. Results suggest that this component of the course had a positive impact on the experimental group's behaviors regarding on-campus drinking. In addition, the interventions content did result in reduced alcohol consumption by students in the experimental group over a variety of situations (e.g., changes in eleven personal alcohol use items).

In reference to the results relating to drinking and sexual activity there was an increase in risky sexual behaviors in both the experimental and control groups as reported by 1 item. This item stated: since the beginning of the school year, how often has your drinking caused you to engage in unplanned sexual activity? The control group also experienced an increase in the item: since the beginning of the school year, how often has your drinking caused you to not use protection when you had sex?

IMPLICATIONS

Alcohol consumption and its many associated negative consequences are a large problem on university campuses across the United States and beyond. This current research study suggests that a multidimensional intervention in a university human sexuality course can have a positive impact on student behaviors. Similar course content could be made available to a wider student population. More needs to be done to effectively reduce the number of students who are consuming alcohol, and the number of students who are engaging in heavy episodic drinking and associated risky sexual behaviors. More rigorous and larger studies need to be carried out to determine the optimal balance between the content of the intervention and the optimal length and timing of such an intervention.

STRENGTHS

There are several strengths to this study. First, this study is novel in that it is the first research study to investigate the effects of this type of intervention with University of Toledo college students. Second, investigators used a control group to more fully assess the true impact of the curriculum. Many studies utilizing this instrument have not utilized a control group (Wechsler et al., 2003). Finally, the investigators tested the results of the curriculum by using a respected, valid and reliable survey instrument.

LIMITATIONS

There are a number of limitations to this project. First, the participants were not randomly selected nor randomly assigned. Second, the intervention was brief(i.e. five one hour sessions). Third, the sample was relatively small and cannot be generalized outside of the University of Toledo. Finally, the design used in this study makes it difficult to rule out the Hawthorne effect.

CONCLUSION

The results of this study are promising. However, additional research needs to be conducted implementing similar interventions over longer periods of time. This research should include a larger and more diverse sample of college student participants that employs more than one comparison or control group.

REFERENCES

Bon, S. R., & Hittner, J. B. (2001). Normative perceptions in relation to substance use and HIV-risky sexual behaviors of college students. Journal of Psychology, 135(2), 165-178.

Boyd, G. M., & Faden, V. (2002). College drinking, what it is, and what to do about it: A review of the state of the science. Journal of Studies on Alcohol, 14, 6-13.

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

Halpern-Felsher, B. L., Millstein, S.G., & Ellen, J.M. (1996). Relationship of alcohol use and risky sexual behavior: A review and analysis of findings. Journal of Adolescent Health, 19, 331-336.

Justus, A. N., Finn, P. R., & Steinmetz, J.E. (2000). The influence of traits of disinhibition on the association between alcohol use and risky sexual behavior. Alcoholism-Clinical and Experimental Research, 24(7), 1028-1035.

MacDonald, T. K., MacDonald, G., Zanna, M. P., & Fong, G.T. (2000). Alcohol, sexual arousal, and intentions to use condoms in young men: Applying alcohol myopia theory to risky sexual behavior. Health Psychology, 19(3), 290-298.

Perkins, H.W. (2002). Surveying the damage: A review of research on consequences of alcohol misuse in college populations. Journal of Studies on Alcohol, 14, 91-100.

Poulson, R. L., Eppler, M.A., Satterwhite, T. N., Wuensch, K. L., & Bass, L.A. (1998). Alcohol consumption, strength of religious beliefs, and risky sexual behavior in college students. Journal of American College Health, 46(5), 227-232.

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. Journal of American College Health, 50(5), 203-217.

Weschler, H., Nelson, T. F, Lee, J. E., Seibring, M., Lewis, C., & Keeling, R. P. (2003). Perception and reality: A national evaluation of social norms marketing interventions to reduce college students' heavy alcohol use. Journal of Studies on Alcohol, 64(4), 484-494.

Wechsler H., Seibring M., Liu I.C., & Ahl M. (2004). Colleges respond to student binge drinking: Reducing student demand or limiting access. Journal of American College Health, 52(4), 159-168.

CHES AREA

Responsibility III--Implementing Health Education Programs

Thomas Tatchell, PhD is an Assistant Professor of Public Health for the Department of Public Health and Rehabilitation Services at The University of Toledo. Phillip J. Waite, PhD is an Assistant Professor of Health Education for the Department of Health, Physical Education & Recreation at Utah State University. Renny H. Tatchell, PhD is a Professor and Chair in the Department of Communication Disorders at Central Michigan University. Address all correspondence to Thomas Tatchell, PhD, Department of Public Health and Rehabilitative Services, The University of Toledo, Toledo, OH, Mail Stop #201; PHONE: [phone]; FAX: [phone]; E-MAIL: [e-mail].

Table 1. Alcohol Item Means and Standard Deviations

                                              Data Collection

                                 N (Valid
       Groups                     Cases)    Pre-test      Post-test

5+ drinks in 2 weeks
Exp. Group                          59
  Mean                                        2.75     1.97 ([dagger])
  Standard Deviation                          1.43     1.11
Control Group                       54
  Mean                                        2.63     2.54
  Standard Deviation                          1.58     1.46
4 drinks in 2 weeks
Exp. Group                          59
  Mean                                        2.10     2.17
  Standard Deviation                          1.43     1.21
Control Group                       54
  Mean                                        1.81     1.85
  Standard Deviation                          1.35     1.23
Last Drink
Exp. Group                          59
  Mean                                        4.71     4.24 ([dagger])
  Standard Deviation                          0.77     1.06
Control Group                       54
  Mean                                        4.33     3.94 ([dagger])
  Standard Deviation                          1.26     1.28
# Drinks last 30 days
Exp. Group                          56
  Mean                                        2.71     2.27 ([dagger])
  Standard Deviation                          1.36     1.11
Control Group                       42
  Mean                                        3.05     4.79 *
  Standard Deviation                          1.61     1.28
# Drinks per occasion in           days
  past 30
Exp. Group                          56
  Mean                                        5.22     2.62 ([dagger])
  Standard Deviation                          2.48     1.67
Control Group                       42
  Mean                                        4.62     5.17 *
  Standard Deviation                          2.82     2.19
Times drunk in past 30 days
Exp. Group                          53
  Mean                                        1.94     1.43 ([dagger])
  Standard Deviation                          1.05     0.95
Control Group                       42
  Mean                                        2.05     3.36 *
  Standard Deviation                          1.41     1.76
# Drinks at student gathering
  in past 30 days
Exp. Group                          56
  Mean                                        2.18     1.64 ([dagger])
  Standard Deviation                          1.16     0.95
Control Group                       42
  Mean                                        2.52     2.69
  Standard Deviation                          3.09     2.38
# Drinks at faculty gathering
  in past 30 days
Exp. Group                          56
  Mean                                        2.02     1.27 ([dagger])
  Standard Deviation                          1.13     0.45
Control Group                       42
  Mean                                        1.86     2.45 *
  Standard Deviation                          1.37     1.61
# Drinks at dorm event in past
  30 days
Exp. Group                          56
  Mean                                        4.44     1.33 ([dagger])
  Standard Deviation                          0.76     0.64
Control Group                       42
  Mean                                        1.81     2.26 *
  Standard Deviation                          1.19     1.47
# Drinks at frat/soror event
  in past 30 days
Exp. Group                          56
  Mean                                        2.27     1.58 ([dagger])
  Standard Deviation                          1.11     0.92
Control Group                       42
  Mean                                        2.29     2.86 *
  Standard Deviation                          1.50     1.77
# Drinks at campus dance
  /concert in past 30 days
Exp. Group                          56
  Mean                                        2.62     1.15 ([dagger])
  Standard Deviation                          1.67     0.36
Control Group                       42
  Mean                                        1.62     2.10 *
  Standard Deviation                          1.06     1.19
# Drinks at keg party on
  campus in past 30 days
Exp. Group                          56
  Mean                                        1.42     1.78
  Standard Deviation                          0.94     0.99
Control Group                       42
  Mean                                        2.19     2.57 *
  Standard Deviation                          1.55     1.36
# Drinks at college sport
  event in past 30 days
Exp. Group                          56
  Mean                                        1.27     1.91 *
  Standard Deviation                          0.45     0.82
Control Group                       42
  Mean                                        1.86     1.79
  Standard Deviation                          1.41     1.20
# Drinks at campus pub in
  past 30 days
Exp. Group                          56
  Mean                                        1.64     1.29 ([dagger])
  Standard Deviation                          0.95     0.46
Control Group                       42
  Mean                                        1.76     1.88
  Standard Deviation                          1.32     1.17
# Drinks at off-campus party
  in past 30 days
Exp. Group                          56
  Mean                                        1.33     2.36 *
  Standard Deviation                          0.64     1.14
Control Group                       42
  Mean                                        3.62     3.50
  Standard Deviation                          1.51     1.35
# Drinks at another campus
  party/event in past 30 days
Exp. Group                          56
  Mean                                        1.58     1.73
  Standard Deviation                          0.92     1.18
Control Group                       42
  Mean                                        2.57     2.76 *
  Standard Deviation                          1.78     1.56
# Drinks at off-campus bar/pub
  in past 30 days
Exp. Group                          56
  Mean                                        1.15     1.98 *
  Standard Deviation                          0.36     1.19
Control Group                       42
  Mean                                        3.38     3.38
  Standard Deviation                          1.45     1.29

Notes: * indicates a significant increase from the pretest to the
post-test, p < .05.

([dagger]) indicates a significant decrease from the pretest to
the post-test, p < .05.

Table 2. Sexual Activity-Related Consequences Item Means and Standard
Deviations
                                                   Data Collection

                                            N
                                          (Valid   Pre-
Groups                                    Cases)   test   Post-test

Since the beginning of the school year,
how often has your drinking caused
you to engage in unplanned
sexual activity?

Exp. Group                                  56
  Mean                                             1.44      1.76 *
  Standard Deviation                               0.73      0.82

Control Group                               42
  Mean                                             1.56      2.03 *
  Standard Deviation                               0.79      0.89

Since the beginning of the school year,
how often has your drinking caused
you to engage in unplanned
sexual activity?

Exp. Group                                  56
  Mean                                             1.44      1.75
  Standard Deviation                               0.73      0.82

Control Group                               42
  Mean                                             1.48      1.89 *
  Standard Deviation                               0.79      0.90

Notes: * indicates a significant increase from the pretest to the
posttest, p < .05.