Last August, before starting classes, before even really getting to explore campus, the 4,000-some members of the freshman class were required to take an hour-long clinic designed to improve their behaviors.
The Booze, Sex, and Reality Checks program came during the Week of Welcome. Amidst the moving in, concerts, picnics, and open houses, WSU’s new students ducked into cool classrooms for versions of a seminar on drinking and sex.
“We don’t normally have firsthand interaction with students,” says Leah Hyman, a human development graduate student who broke form to assist a WSU drug and alcohol counselor in the workshops. In a field rife with papers and surveys, Hyman was intrigued to work with the subjects directly. At the same time, it was frustrating, says Hyman. Some students made it clear that they didn’t drink at all, and didn’t plan to. Others announced they were already experienced and educated about alcohol. Many said the mandatory meeting was a waste of time.
Freshman Ashley Guarino had learned about alcohol and its effects at high school. The grounding was reinforced by her dad, who works for a beer distributor. He gave her a detailed lesson about the difference between shots and beer. “I knew pretty much everything they were saying,” she says of the workshop.
“They were trying to treat us like freshmen,” she says, then pauses. “But I guess that’s exactly what we are.”
A few students said they found it useful. “Especially women,” says Hyman. Judging by their responses, “We shocked them.” She showed them that all drinks are not created equal, that there are different sizes of shot glass and how minute a single shot looked in a plastic party cup. “Where they were thinking they were only having one drink, they were actually drinking two,” she says.
National statistics show that academic failure, sexual assault, and risky sexual behavior are linked to excessive drinking. According to the National Institutes of Health, about four out of five college students drink alcohol and about half of those who drink also binge drink. Each year, more than 1,800 college students between 18 and 24 die from alcohol-related unintentional injuries.
“You want to say to these students, don’t do it. Don’t drink. You want to scare them,” says Hyman. “But we know that’s not going to work.”
Instead the trainers followed an intervention designed by Patricia Maarhuis, coordinator for WSU’s Alcohol and Drug Counseling, Assessment, and Prevention Services. Using proven science-based practices, she created a clinic to help students limit their drinking and to stay safe when they do drink.
The Booze, Sex, and Reality Checks program prompts the freshmen to think about why they drink and how it makes them feel. While first reminding them that underage drinking is illegal, the counselors urge the students to drink responsibly, to opt for beer in bottles, and to avoid mixed drinks.
“If it’s fruity, you have no sense of how much alcohol you’re getting,” says Hyman. “That was a knockout statement. That’s when I saw their eyes light up.”
It may have been useful to some, says Guarino. She liked the wallet-sized BAC (Blood Alcohol Concentration) chart that shows how a number of drinks over a certain amount of time affect people at different weights. “They approached it in an adult manner, saying there are ways to make sure you don’t get harmed and keep things in moderation,” she says.
In spite of this mandatory class, last fall a number of WSU students suffered dangerous consequences from binge drinking. Several had to be taken to Pullman’s emergency room. In October freshman Kenneth Hummel died from acute alcohol poisoning, a heartbreaking event for his friends and classmates.
“It was so disheartening,” says Gitanjali Shrestha, another graduate student who helped with the workshops. “We talked about how we could have prevented it. We wondered what else we could have done.”
It also left many connected with WSU—faculty, families, and alumni—wondering: Why does alcohol consumption seem to be such a problem now? And it triggered a campus-wide review of student drinking and other behaviors.
But maybe there’s evidence that the workshop did in some ways work. Shrestha, Hyman, and WSU’s behavioral scientists are evaluating whether it caused the majority of the freshmen to think about consequences to over-indulging, to be more aware of what they’re drinking, and to consider how they feel when they have had too much. They’re hoping through their research, application, and assessment to enhance this intervention, and take other steps to alter the drinking culture that affects not only WSU, but college campuses around the country.
“Our objective is not to eliminate drinking,” says Laura Griner Hill, professor in the Department of Human Development and associate director of health promotion and research for WSU. “It’s to minimize the harm that comes from it.”
Preventing bad things before they happen
Using tools like BAC cards, plastic cups, motivational questions, and health care surveys, the University is addressing the problems with student drinking.
The theory behind it is “prevention science,” a new field involving many disciplines and devoted to the scientific study of theory, research, and practice related to the prevention of problems. In short—it’s the science of preventing bad things before they happen. Antisocial behavior, drug and alcohol abuse, marital discord, and academic failure are just a few of the issues prevention science has addressed so far.
Last fall WSU introduced a doctoral degree in prevention science with the support of faculty from nursing, human development, kinesiology, health and wellness, education, and communication. “We are the first prevention science PhD in the world,” says Hill. In other schools it is often tied into another discipline like public health or education. The first WSU graduates, among them Hill’s students, are expected to complete their degrees in 2015.
Hill herself started graduate school with a plan to become a clinical psychologist, but she found herself drawn to this new field. “My heart was not in trying to fix a problem that existed, but in trying to prevent a problem before it occurs,” she says.
A hundred and fifty years ago our biggest health concerns were cholera and typhus, says Hill. “Now most of what kills us is tied to behaviors we can change.” Smoking, hygiene, diet, and physical activity are some of the most basic concerns. With prevention science, you can focus on the factors that lead to the development of unwanted behaviors and then by changing those factors, change the outcomes.
For example, in colleges where alcohol is not allowed to be sold on campus, drinking goes down, says Hill. Where there are higher taxes on alcohol, drinking goes down. Where there are more classes on Friday mornings, drinking goes down.
Then there are protective factors which, when introduced, can prepare someone to make a better choice when a challenge arises. Individual students often perceive that their peers are drinking more than they actually are and then drink more themselves, says Hill. By revealing the true numbers (which are almost always lower), the student may want to conform to the actual majority and as a result have healthier behaviors. They may decide to avoid drinking games, and might pace their consumption to one or fewer drinks per hour, she says.
The WSU prevention science program involves generating research-based understanding of an issue and putting that knowledge into practice in real programs for families, children, communities, and, lately, WSU undergraduates. “We’re using evidence-based approaches,” implemented by a number of different units on campus, says Hill.
With students the research focuses include drugs and alcohol, risky sexual behavior, health, and academics. “So my role on campus, in part, is to apply a public health approach using risk and protective factors,” says Hill.
In most universities the areas connected to students’ health and well-being are fragmented into separate services. “Here we have buy-in from all different units on campus to pool our data and pool our resources to improve health and well-being,” says Hill. The Booze, Sex, and Reality Checks program is administered by the drug and alcohol counselors, but it is augmented with other resources by University Recreation, student life, athletics, Health and Wellness Services, the Dean of Students, and the prevention science program itself.
Often the instinct is to lecture the students about alcohol and its impact and offer cautionary tales. But that doesn’t work, says Hill. Instead, the key is to motivate the students to think more about their behaviors and make their own decisions. Beneath it all is “self-determination theory,” the idea that humans are motivated by three basic psychological needs: competence, relatedness, and autonomy. Consider the freshmen who are experiencing their first independence from their parents. They feel in control of their own decisions (competence), free from their parents’ influence (autonomy), and they connect with a group of friends (relatedness).
While it’s probably not kosher to say it, an example of relatedness is that partying with peers can enhance a student’s feelings of affiliation and strengthen his or her connection to campus, says Hill. That in turn can help make the student more likely to stay and graduate.
In many of their projects, Hill’s students make the Pullman campus their scientific locus. The population they’re working with are the very people they walk past on Glenn Terrell Mall, stand in line with at the Todd Hall Atrium café, and even sometimes teach in their human development classes.
A few of the graduate students are exploring ways to improve the student experience, to enhance the undergraduates’ feelings of connectedness beyond partying. One is looking at how students may enrich their ties to WSU through Multicultural Student Services. Another is addressing student retention by helping freshmen make friends and connect with faculty and staff through supper clubs. Paula Adams, one of the first students to pursue a doctorate in prevention science, has a $300,000 Department of Justice grant to implement programming to reduce violence against women on campus. Gitanjali Shrestha, who is also working on a prevention science doctorate, is evaluating substance abuse prevention programs. And for her master’s degree, Leah Hyman is working on student retention.
“Now we have this academic and scholarly link where we can apply practices and study the results,” says Hill.
The age of reason
After the alcohol-related incidents last fall, WSU President Elson S. Floyd formed a task force to look at what the University was doing to address student use of drugs and alcohol and see what new strategies could be pursued. He put Bruce Wright, psychologist and executive director of Health and Wellness Services, in charge of the group, which had representatives from around Pullman. They looked at student conduct, hospital data, and a National College Health Assessment survey where students reported on their own behaviors.
“We don’t really seem to be having more students in terms of gross numbers drinking,” says Wright, noting that WSU’s numbers aren’t markedly different than other campuses’ around the country. Those who binge drink seem to be the same percentage as in past years and as on other campuses. But what seems to be different is the behaviors of that small segment of higher risk drinkers. Though their number was about the same as in past years, their risky behavior seems to be growing riskier. “We were seeing extreme blood alcohol levels of 0.3, 0.4, and in one case 0.5,” says Wright.
These students may come to WSU with an underlying level of alcohol tolerance, which then allows them to consume more than their classmates, drinking to the point of poisoning, coma, or even death, he says. “We’re trying to sort out why this is happening.”
Contributing factors include prefunctioning before events and online drinking games, he says. And there’s a shift away from beer and wine to hard liquor and to drinking more in a shorter period of time.
Then there are energy drinks, which can mask some of the symptoms of alcohol intoxication, says Wright. Where normally a drinker would pass out, the energy drink allows him or her to stay awake and drink more. This too, seems to be a problem for high-risk drinkers. “There has been plenty of focus on documenting the problems,” he says. “But not enough on best practices” for addressing or even avoiding the problems. “We can’t just focus on risk factors, we also need to increase protective factors.”
Understanding how to help young people develop healthy behaviors has evolved in the past 10 to 15 years. It’s not just one factor, but a variety, including age, that should be considered. “One thing we know about the brain is that it doesn’t mature completely until about the age of 25,” says Wright. The prefrontal regions of the brain, the parts that anticipate consequences for behaviors, planning ahead, and controlling impulses, are the last to fully develop.
“They’re not wired well to control their impulses,” says Hill of the students. In some instances, particularly under the influence of alcohol, “they don’t have the inhibitions that help us not make that bad choice.” But there are ways to prompt the young person to pursue more healthy behaviors.
The route to Wright’s office runs through the front lobby of the Health and Wellness clinic where, one day last spring, five or six students wait to see a doctor or nurse. As each student steps to the counter to check in, he or she is asked a few questions including “Do you use alcohol?” If the answer is yes, then the student is asked “In an evening, do you exceed a certain number of drinks?” If a woman says four drinks or a man says five, an audit is triggered. In the examination room, that student is briefly left alone with a computer questionnaire with ten questions. “By leaving them alone to fill it out, we feel we get a more honest response,” says Wright.
Next the health care provider comes in and asks some brief, open-ended questions. Prevention scientists call this the brief motivational interview. When Wright is seeing a student, he’ll review the questionnaire and note the answers. “Then I say, ‘Can we talk about that?’” If the student responded that he has drunk to the point of passing out, says Wright, “I ask, ‘OK, what do you think about that?’ Sometimes I open with ‘OK, what do you like about drinking?’ And then I follow up with ‘Do you see any downsides to that?’ Then ‘Do other people in your environment see any?’”
“It’s mainly a pause and reflect,” he says of the interview. It doesn’t seem like much. But for students who may have been ambivalent about their drinking behavior, just those questions can trigger healthier behaviors, he says.
The way the questions are phrased reinforces the student’s autonomy, allowing them to decide for themselves what to do.
Best of all, based on the results from other practices and studies, “We know it works,” says Hill of the brief interview. “If every student is getting that when they come in for their flu shot, then we’ve changed the culture. We’ve managed to stimulate the intrinsic motivation to more beneficial behavior.”
In place of parents
All these efforts should happen early in a student’s college career. For many freshmen that fall semester is the first time they’ve ever gone 48 hours without parental supervision. “A huge amount of what we ask students to do is to suddenly become responsible,” says Melynda Huskey, dean of students. Many come from highly structured, highly supportive home environments and they aren’t offered much autonomy to make decisions for themselves. “They get here and we flip a switch,” she says. “They are suddenly independent.”
Sure, maybe they had alcohol when they were in high school, but they still had to go home, and still had to face mom and dad the next day. And this generation of parents is much more hands-on, says Huskey. “That can work against us. When you’ve had people make decisions for you, [when you’re away from them] you’re apt to experiment with just how far you can go.”
Yes, college is where you should experiment and explore. “But our goal is helping students stay focused on ‘What do I really want out of life?’” she says. “College is a place where that can happen.”
There’s another side to her office. When students develop problems, when they’re failing classes, have issues of conduct, are arrested, or injured, they go see the dean. “And sadly, when a student dies, our office handles that, too,” says Huskey.
Those in the prevention science program are investigating and actively trying to reduce those negative experiences. Hill and associate professor Matt Bumpus, who co-direct the Project Healthy Campus research lab, are seeking ways to a healthier campus by looking at factors such as the relationship of physical activity to student retention, the roles of peers and mentors in the freshman experience, and the importance of communication between young adult children and parents.
There’s a beauty to how things are fitting together, says Huskey. With their help, research and science are being put to practical use in student affairs right here on campus. “We’re doing what research-based institutions are doing in all the other fields,” says Huskey. “We’re working on evidence-based protocols and evaluating their success.”
Last spring, while evaluating Booze, Sex, and Reality Checks, Hill’s students reviewed a National College Health Assessment survey of students’ health, safety, drug use, alcohol use, sexual health, and issues with academic performance. The survey asked the students whether they had five or more drinks at a sitting in the last two weeks, and how many drinks they had in how many hours the last time they socialized. After the unfortunate events of fall semester, Hill and her team were expecting to see that the drinking reported was the same or higher than the previous year.
Instead, the results surprised them all. They thought they’d failed to alter behaviors, but “the data told us different,” says Shrestha. The students reported drinking less than those in previous years and the amount they thought their peers were drinking was down too. Thirty- four percent (up from 28 percent the previous year) reported that they do not drink at all. And significantly fewer reported having suffered harm or danger related to their use of alcohol: fewer blackouts, fewer injuries, and fewer occasions of unprotected sex.
Even more remarkable was the differences between this year’s Greek system residents and those in previous years, says Hill. This year’s freshmen in fraternities and sororities were significantly less likely to binge drink or experience harm from drinking, they drank less frequently, and they were more likely to avoid drinking games.
Hill re-ran the data, then changed the variables and ran it again. Still it came out showing a significant change in behaviors from the freshmen surveyed a year earlier. Finally, here were data that the Booze, Sex, and Reality Checks program worked.
As this issue of the magazine reaches mailboxes around Washington, a new group of freshmen are about to step into their own mandatory Booze, Sex, and Reality Checks. Hill and her team are also working on parent interventions. With researchers at the University of Washington, they’re developing a program to start this fall to guide parents to talk with their students about drugs and alcohol before they even get to Pullman, encouraging the parents to explore scenarios and talk about how the student plans to respond. So far, it all seems to be working.
“We’ve had multiple years of data for comparison,” says Hill. Over the past few years, “It has been very, very consistent with regards to drinking and harm. Then this year’s data was completely different.” For now, Hill and her team are cautiously optimistic. “We’ll be much more confident about that after we do it again this summer and measure it again next year.”