College Student Drinking & The Campus Environment: A Community Prevention Intervention
Principal Investigator: Robert F. Saltz, Ph.D.

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Figure 1 presents an expanded set of alcohol-related consequences ordered from least to most prevalent across the sample of drinkers.

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In this figure (Figure 1), the vertical bars represent the total count of each type of problem (e.g., there were approximately 1550 hangovers reported by the drinkers in the sample).

Some students would have reported a number of hangovers while others might have reported no hangovers. Thus, the aggregate count of problems might best be seen as the cumulative total of problems that the campus might "see" as a whole, regardless of who was subjected to them.

The line running through the bars represents a 50% reference, rising as the problems become more prevalent. Finally, the lighter-shaded portion at the bottom of each bar represents the "share" of problems reported by the group identified as "frequent binge drinkers." What the figure shows is that this latter high-risk group represents just a minority of problems of each type (i.e., their share accounts for less than half of all problems reported).

The objective of this illustration is not to take issue with the point that there are some students at high risk of sustaining alcohol-related problems, or even that a campus would not be well-advised to identify such students and provide some kind of intervention. Rather, we wish to draw attention to the phenomenon that some have called the "prevention paradox" (Kreitman, 1986).

The phrase refers to the common observation that, by virtue of their much larger numbers, light and moderate drinkers can often produce a larger proportion of problems than a high-risk sub-population. The situation in this case is similar. Even if the frequent binge drinkers were to abstain from alcohol altogether, the campus would still have to contend with a large portion of the problems it had been experiencing before.

Yet targeting high-risk drinkers seems a reasonable thing to do and, indeed, Wechsler and his colleagues strongly advise doing just that in the conclusion to their paper (Wechsler, et al., 1994). As prevention resources are often quite limited, however, campus administrators and prevention specialists need to be very strategic in their choice of interventions.

What about the population of binge drinkers per se (ignoring the category of frequent binge drinkers)? Wechsler and his colleagues show that this group constitutes about 42-45% of the student population in their national sample (Wechsler, et al., 1998). It seems clear that such a large group no longer provides an efficient "target" for whatever specific intervention might be chosen for them, in which case we would begin to think of universal prevention approaches anyway.

Is there an alternative to targeting high-risk students? In a word, "yes." If we consider the case of traffic safety, we may take note of the fact that, in addition to driver education and sanctions tied to driving laws, we also have interventions that target specific places (and times) that have been identified as producing problems. Thus, we have stop signs or traffic signals to reduce collisions at intersections, warning signs, pedestrian crosswalks, and even the use of crossing guards at times when children are arriving or leaving their schools.

Perhaps more important, we have developed a variety of ways to monitor traffic crashes, injuries, and deaths in ways that help us identify these times and places in need of attention.

We are not arguing for one approach over another. As campuses grow more sophisticated about monitoring their own prevention initiatives and evaluating their impact, we will begin to see thoughtful blending of individual and environmental strategies. In the meantime, we must remember that light and moderate drinkers often comprise many, if not the majority, of the problems we need to address


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