Challenging Dogma - Spring 2008

...Using social sciences to improve the practice of public health

Friday, April 18, 2008

But What About The Binge Drinkers? How The Social Norms Campaigns Fail To Change Binge Drinking Behaviors On College Campuses. –Jackie Harvey

Binge drinking on college campuses is a matter of national concern (1). Despite many traditional public health attempts to change college student binge drinking behavior (2-3), the problem persists (4-5). Colleges began to adopt social norms campaigns to curb binge drinking en mass after research by Perkins and Berkowitz showed that students’ perceptions of alcohol consumption on campus presumed a higher level of consumption and higher rates of permissive attitudes towards substance abuse (6). The researchers suggested that correcting these misperceptions might reduce heavy drinking. The social norms campaign incorporates the social sciences and mass media to ensure that students have an accurate perception of the presence of alcohol consumption on campus. The theory behind the campaign is “the revelation of accurate information about the environmental context—in the form of group or population norms—to reduce individual problem behavior and enhance protective behavior (7).”
Colleges that adopt the social norms campaign are attracted to the very low cost-to-results ratio (8). In most programs, on-campus advertising is by far the largest expense (6). Research demonstrates the high efficacy of a mass-marketing campaign in changing students’ misconceptions of the rate of alcohol consumption on campus (9). In fact, there is little opposition to the findings that show a change in the students’ perception of alcohol consumption. Rather, the oversight with this intervention lies in the reduction of actual binge drinking on campus.
Changing Perception Does Not Change Behavior
The campaign incorrectly assumes that a change in binge drinking behavior is directly related to a corrected perception of the level of binge-drinking on campus. Additionally, research has indicated that students, specifically those in large universities (where the social norms campaign is touted as most effective), are not influenced by the behavior of the entire campus, but rather, their own smaller peer group (10). Furthermore, a campaign that seeks to reeducate students by showing that the rate of alcohol consumption on campus is actually lower than initially perceived runs the risk of normalizing underage alcohol consumption within the target population. Proponents of the social norms campaign are excited by the low-cost, high-results promise of correcting student perceptions, but colleges fail to realize that the campaign must be part of a larger, comprehensive program—not simply used to pacify parents worried about increasing binge drinking statistics on campus. While the social norms campaign succeeds in providing the truth about alcohol consumption on campus, it fails to significantly change the behavior of the target population- binge drinkers-on campus.
The goal of the social norms campaign is to use mass media efforts to correct the misperceptions of the level of alcohol consumption on campus. In theory, by correcting the perceived level of consumption, the students then would be less likely to feel supported in their binge drinking habits and/or would refrain from using their peers as a justification for increased alcohol consumption. However, an analysis of this behavioral model quickly shows that the correction of perceptions does not always directly link directly to a correction of behavior. The theory of reason action (11) shows perceived social norms and attitudes towards behavior directly affecting one’s intentions which, in turn, directly affect behavior. However, a main criticism of the very traditional theory of reasoned action is that intentions do not directly lead to behaviors (12-13).
Applied to a college setting, a student may be fully aware that the average number of drinks consumed per weekend night is actually only four drinks thanks to the social norms campaign advertising. She may therefore decide that she will not consume more than four drinks herself while getting ready to go out with friends on a Friday night. That is, of course, until there is a cute boy at a party who offers her a fourth…and then a fifth drink, which she gladly accepts. In this student’s case, behavior was not entirely reasonable- she did not need to consume the drink in order to gain the boy’s attention, but decisions are not always well reasoned! Another example of the disconnect between intention and behavior is the social cultures on college campuses. Despite an intention to remain sober on a weekend night, it is very likely that much of the social scene revolves around parties that have a lot of alcohol and other students drinking. Rather than stay in on the weekend, a student may find his or herself out with friends that insist on going out to parties on the weekend. Again, the student intended to remain sober, but the behavior was the result of a poorly reasoned belief that s/he must drink to maintain certain friendships, resulting in a weekend of binge drinking. There is significant research to support the lack of a connection between intent and behavior in young adults (13)
Not All Students Misperceive Consumption Levels
On many campuses, there is no misperception of the level of alcohol consumption on campus (14). In fact, campuses with more accurate perceptions of alcohol consumption had more drinking than campuses with less accurate perceptions (15). In these cases, according to the Social Norms institute, “if the needs assessment indicates that a campus has very few binge drinkers and/or those students do not misperceive the campus norm,” then the social norms approach would not be effective. Despite these statistics, the social norms marketing campaign is by far the most popular anti-drinking campaign on college campuses. Even in schools where the students are fully aware of the drinking habits of their peers, administrators fall back on the campaign.
Few Schools Succeed with Social Norms Alone
The National Social Norms Institute cites only six institutes of higher education in which there has been a change in alcohol consumption after the implementation of the social norms campaign. In several of these schools, the behavior change may be attributed to other programs used in conjunction with the mass media approach implemented by the social norms campaigns. Many schools that tout the social norms marketing on campus do not have any data to support its efficacy on campus. After investigating their elaborate social norms website, I contacted Southern Methodist University (SMU) in the hopes that they would have some insight into the success of their extensive campaign (16). The administration commented that there was no data available at the time, and, that there was no evidence that the levels of drinking have decreased on campus during the time of the program.
The failure rate of the social norms campaign in schools is unknown, since many schools, such as SMU do not perform follow-up evaluations of the program. Many articles have explored reasons for failures at particular schools, citing poor implementation of the program (17). A major study in 2003 sought to perform a national evaluation of the social norms marketing programs but did not detect a decrease in alcohol consumption (10).
Individual Peer Groups Are Most Valued
I challenge that the program is not suitable for the vast majority of schools in reducing the level of binge drinking. Young adults are not affected by what their peer group as a whole does in college. Why would one student out of 15,000 care what the average student consumes during one weekend? The first response would be “surely those numbers don’t refer to me and my friends.” Students are influenced by their own, smaller peer group (sports teams, sororities, organizations) far more than statistics about the school as a larger entity. Peer group influence over behavior is evidenced in the social networking theory, which explains that the most important predictor of behavior is what is happening in your own social network.
Research into the effect of the social norms campaign on specific campus groups shows that the reductions of the level of drinking in Greek members is very slight (18). Not only do Greeks have a reputation for high levels of alcohol consumption, but on many college campuses, Greek organizations have a huge impact on the social lives of the students.
By targeting the Greek organizations themselves, college campuses could be much more successful in changing student attitudes about drinking. Not only are Greek organizations powerful campus figures, they are also upperclassmen. Targeting older peer leaders to serve as role models would be significantly more effective. A 2003 study by Campo et. al found that drinking behavior was related to perception of friends drinking, but not to the campus norms. The research indicates that drinking behavior is “positively related to perceptions of friends' drinking as suggested by the theory of planned behavior, which emphasizes subjective as opposed to social norms” (19). The social network theory provides an explanation for the usefulness of targeting Greek upperclassmen in order to reduce the level of drinking. The social network theory also predicts behavior, not intention— a model that can predict a behavior of sobriety is far more effective than a model that can predict intention but not behaviors.
Reliable Sources are Key
In addition to believing that statistics refer to those outside of their own peer group, communication theory explains that the target population (college students) must be able to trust and have confidence in the source of the information. The social norms campaigns survey students in class in order to ensure participant in the study (6). However, what are the odds that students that have been drinking heavily are up in time for class the next day, much less willing to fill out a survey? Are students able to trust information that comes from the school administration? If the students do not believe that the information is reliable, their perceptions will not change.
Unintended Concequences
Similar to peers, students are affected by marketing. The social norms campaign is founded on the theory that mass media can change students’ perceptions of drinking on campus. However, what other perceptions are the media blitz changing? Social marketing can normalize underage drinking by advertising what most students are doing, not what they should do. Messages posted around campus advertise that having a ‘few’ drinks is normal, but five drinks is not. This type of advertising would be like putting up posters in a middle school saying that “most of your friends smoke three cigarettes per day, not twelve, like you think!”
In “A Social Norms Approach to Preventing Binge Drinking at Colleges and Universities,” a major limitation listed is that the social influence methods “may be ineffective or have minimal impact” (18). In fact, the guide shows that promoting a non-normative behavior such as drinking alcohol on a college campus, regardless of the legal status, may be “counterproductive and unintentionally reinforce the actual drinking norm.”
Even more telling is that the alcohol industry, including Anheuser-Busch, is a large financial backer of the social norms campaign on college campuses. The social norms campaign provides an easy venue for the alcohol industry to downplay the seriousness of the campus alcohol problems while continuing to provide an image of concern towards underage drinking. The campaign is not implying that students should stop drinking—simply that their peers may not drink quite as heavily as once thought.
Another aspect of the oversights of the social norms campaign involving the link between intention and behavior is the accessibility of alcohol on college campuses. An awareness that fewer of their peers binge drink than one originally perceived does not change the students’ access to the alcohol. One suggestion to preventing binge drinking is to implement a physical barrier between the students and the alcohol, such as an increase in monitoring liquor store sales, or preventing marketing campaigns from targeting college students.
More rigorous research is needed to put social norms marketing to the test, but the evidence to date has been encouraging. The social norms campaign should be commended for its new approach to solving public health problems. The campaign went beyond simply restating problem behaviors or positing what are believed to be good prevention practices, to documenting effective prevention results. Finally, social marketing campaigns need to be viewed in context, as part of a comprehensive approach to prevention (20). Campus and community officials have other means of clarifying for students that underage drinking is against the law. One approach would be stricter enforcement: undercover operations to catch retailers who sell to minors; parental notification when students break the rules; prosecution for using fake IDs or purchasing alcohol for minors. In essence, a social norms campaign, by making clear that students don’t have to drink heavily to fit in, can serve to decrease normative pressure to break the law against underage drinking.
REFERENCES
Wechsler H, Davenport A, Dowdall G, Moeykens B, Castillo S. Health and behavioral consequences of binge drinking in college: A national survey of students at 140 campuses. Journal of the American Medical Association 1994; 272:1672–1677.
A matter of degree: The national effort to reduce high-risk drinking among college students. Robert Wood Johnson Foundation; 1996. Available at: http://www.rwjf.org/app/rw_about_our_grantees/rw_gra_main_set.html. Accessed March 24th 2008.
Hansen, W. B. School-Based Alcohol Prevention Programs. Alcohol Health and Research World 1993; 17: 54–60.
Wechsler H, Lee J, Kuo M, Lee H. College binge drinking in the 1990s: A continuing problem. Results of the Harvard School of Public Health 1999 College Alcohol Study. Journal of American College Health 2000; 48:199–210.
Wechsler H, Dowdall GW, Maenner G, Gledhill-Hoyt J, Lee H. Changes in binge drinking and related problems among American college students between 1993 and 1997. Journal of American College Health 1998;47:57–68.
Perkins, H. W., & Berkowitz, A. D.. Perceiving the community norms of alcohol use among students: Some research implications for campus alcohol education programming. International Journal of the Addictions 1986; 21, 961–976.
Perkins, H. W. The Social Norms Approach to Preventing School and College Age Substance Abuse. Josey-Bass, New York, NY: 2003.
Langford, L. and Gomberg, L. Frequently Asked Questions Topic: Social Norms and Social Marketing. Available at http://www.higheredcenter.org/ta/faq/social.html#q7. Accessed April 2nd 2008.
Perkins, H. W., & Wechsler, H. Variation in perceived college drinking norms and its impact on alcohol abuse: A nationwide survey. Journal of Drug Issues 1996: 26, 961–974.
Wechsler H, Nelson TF, Lee JE, Seibring M, Lewis C, Keeling RP. Perception and Reality: A National Evaluation of Social Norms Marketing Interventions to Reduce College Students' Heavy Alcohol Use. Journal of Studies on Alcohol 2003; 64: 484-494.
Salazar MK. Comparison of four behavioral theories. AAOHN Journal 1991; 39:128-135
Ogden J. Some problems with social cognition models: a pragmatic and conceptual analysis. Health Psychology 2003; 22:424-428.
Sheeran, P. Intention. Behavior Relations: A Conceptual and Empirical ReviewEuropean Review of Social Psychology, 2002.
Richard P. Bagozzi. The Self-Regulation of Attitudes, Intentions, and Behavior. Social Psychology Quarterly 2002; 55: 178-204
Licciardone, JC. Perceptions of Drinking and Related Findings from the Nationwide Campuses Study. Journal of American College Health, 2003; 51: 238-245.
http://www.smu.edu/healthcenter/alcoholeducation/adp_socialnorms.asp)
Thombs,D. Dotterer,S. Olds, R.S., Sharp, K., Raub, C. A Close Look at Why One Social Norms Campaign Did Not Reduce Student Drinking. Journal of American College Health 2004; 53: 61-68.
Haines, M. “A Social Norms Approach to Preventing Binge Drinking at Colleges and Universities.” The Higher Education Center for Alcohol and Other Drug Prevention. Newton, MA. 1996.
Campo, S. Brossanrd, D., Frazer, MS, Marchess, T, Lewis D & Talbor J et al. Are Social Norms Campaigns Really Magic Bullets? Assessing the Effects of Student misperceptions on Drinking Behavior. Health Communication 2003; 15: 481-497.
The Social Norms Approach: Theory, Research and Annotated Bibliography http://www.higheredcenter.org/socialnorms/theory/correction.html. Accessed April 1st 2008.

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2 Comments:

  • At April 18, 2008 at 2:47 PM , Blogger Matthew said...

    Interesting paper. I was not aware of this campaign proir to reading this. In response to your section about reliable sources - I would not be suprised if Universities tended to bias their data in an effort to improve their public image and increase their reputation. Also, in response to addressing social norms by targeting the leaders of Greek houses - in theory this would work well, but in practice, it could be very challenging to institute change among organizations centered around drinking.

     
  • At April 25, 2008 at 3:15 PM , Blogger Elizabeth Victoria said...

    Great topic! When I was out at the University of Colorado-Boulder a few years ago, they were instituting this huge anti-binge drinking campaign in response to some deaths related to fraternity hazing. Basically they made it much, much harder for underage students to get alcohol. Interestingly, this worked (at least while I was there) but during the same time that alcohol usage went down, marijuana and other drug usage went up! This doesn't mean much with regard to causation or chain-of effects, etc. since it's just a correlation. Still, it was striking, and people made jokes about it all the time, criticizing the ineffectiveness of the new rules. Great paper!

     

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