I recently met with a school district administrator about conducting a research project in one of the district’s high schools around alcohol use during high school prom, since this can be a high-risk event related to drinking, driving, and other behaviors for students. I knew that there was interest in this as this particular high school conducted a “mock crash” program shortly before senior prom every year.
A “mock crash” program is a simulated car crash that takes place at a school. It involves a driver who is “intoxicated” and police and fire departments participate, heightening the realism for the students. The dangers and consequences of drinking while driving and riding are both shown and explained to the assembled students.
The school administrator interrupted our free-flowing conversation with a blunt question – she asked whether I thought the mock crash that they do is effective in reducing harm among their students.
The truth is, there is little evidence that these programs are effective in decreasing risky behaviors.
While I considered my response the administrator stated, “I don’t think they work.”
Taken aback, I asked her why the high school continues to do this program every year. She responded with a sigh, stating that they had sought to discontinue the program but parents objected and the district felt that they didn’t have any alternatives available.
As a researcher who studies substance use and risk behaviors, I would like to think that school districts are implementing evidence-based prevention efforts. As a pragmatist, I recognize that limited resources and a lack of readily available programs can make this difficult and that doing “something” can be viewed as preferable to doing nothing.
The good news is that high school alcohol prevention efforts stand ready to benefit from a promising body of research on reducing college drinking. This line of research focuses on addressing drinking during high-risk events, like high school prom, by providing students with personalized normative feedback.
High School Alcohol Use is Common and Risky
Even though it is illegal, alcohol use is pervasive among high school students. Most teens initiate alcohol use before age 18, with over 60% of adolescents reporting that they have drank alcohol prior to leaving high school. Further, heavy drinking occurs with some frequency among 12th graders with over 1 in 5 reporting 5+ drinks, 1 in 10 reporting 10+ drinks and more than 1 in 20 reporting 15+ drinks in a row on at least one occasion during the past two weeks.
This early use contributes to unintentional injury, suicide, fatal crashes, addiction, academic struggles, and social/interpersonal impacts.
Clearly, drinking in high school has real and profound consequences for students.
Identification of High-Risk Events Holds Promise for Decreasing Harms Associated with High School Alcohol Use
Prevention efforts to address high school drinking commonly take a general approach that seeks to decrease alcohol use and associated harms by influencing attitudes and educating students. However, a compelling complementary approach is to target alcohol use associated with specific, high-risk, events. A key assumption to this approach is that heavy alcohol use does not occur with equal probability on each day during high school but is more often associated with certain events and times. Identification of drinking tied to specific events, because they can be anticipated and are time-limited, creates the opportunity for targeted interventions.
These targeted efforts have great potential to reduce a disproportionate share of harms. An effective targeted alcohol prevention effort, then, requires accurate identification of high-risk events.
While little research has been conducted to identify high-risk drinking events in high school, anecdotal evidence abounds. News stories during high school prom and graduation season frequently warn of the dangers of underage drinking. In addition, popular high school films often depict these as times of rampant alcohol use and accompanying risky behaviors. Preliminary data supports alcohol use at specific events.
I recently collected pilot data from over four hundred college students and asked about alcohol use during their senior year in high school. Roughly 1 in 4 of these participants reported drinking alcohol during senior prom and during a graduation party.
Relationship of Social Norms to Drinking Behaviors
Effective alcohol intervention programs frequently rely upon social learning theory that suggests, in part, that perceptions of peer behaviors such as perceived descriptive (e.g., the perceived use of alcohol by others) and injunctive norms (e.g., the perceived approval of drinking behavior by others) exert powerful influences on personal alcohol use. Research has consistently shown that perceived social norms are among the strongest predictors of alcohol use among college students and teens.
Further, research has reliably demonstrated that perceptions of both descriptive and injunctive norms around alcohol use are often inaccurate – individuals consistently overestimate the quantity and frequency of drinking among peers as well as overestimating approval of drinking behavior by their peers with the greatest misperceptions occurring for typically heavier drinkers.
Lessons from Research on College Drinking
Researchers studying alcohol use in college students identified a number of high-risk events – notable among them are 21st birthday celebrations and Spring Break – where college students drank at higher rates. These researchers found that college students consistently overestimated the number of other students who drank during these events and overestimated the amount that others drank.
Intervention messages focused on correcting this bias and reducing perceived norms for general drinking and event-specific drinking (e.g., 21st birthdays) have proven effective in reducing drinking during high-risk events among college students. The logic behind these normative interventions is straightforward – college students may drink to “match” the perceived drinking norm. Since alcohol norms tend to be inflated, an intervention that corrects normative misperceptions can reduce drinking behaviors.
Towards a Norms Based Alcohol Intervention of High-Risk High School Events
While norms-based interventions have proven effective in addressing high-risk drinking events in college, similar efforts have not been used to target high-risk drinking events in high school. This effort is overdue, and adapting event-specific interventions to a high school population is an area of research that I am currently pursuing.
Revisiting the pilot data that I previously mentioned around alcohol use during prom and graduation, we see a stark example of the same inflated perception of alcohol use among other high school students when compared to reported drinking behavior.
For both the senior prom and a graduation party, study participants reported a belief that nearly everyone drank alcohol. However, actual drinking behavior was much lower with 3 out of 4 not drinking during these events. This was indicative of an inflation bias in normative perceptions around how widespread drinking was during these events.
In addition, participants believed that others drank significantly more than actual drinking behavior, indicating an inflation bias in quantity of alcohol consumed at these events. These findings were consistent with research on college students and this presents an opportunity to intervene and reduce drinking behaviors by correcting these normative misperceptions.
Steps a High School Can Take to Intervene in High-Risk Events
These preliminary data suggest that alcohol use during high school can be reduced and student populations made safer by targeting high-risk events. Steps for this intervention are relatively straightforward. The first requirement is to accurately identify a high-risk drinking event. In this article, I have suggested prom and graduation as candidates but these events could vary by institution.
The second requirement is to accurately assess risk behaviors of interest during this event. I have suggested the quantity of alcohol consumed around the event as well as the number of students who consume alcohol. Other high-risk variables could be of interest such as driving or riding in a car with someone who has been drinking alcohol.
With these two pieces of information, high-school prevention specialists could then implement a brief, personalized intervention that contrasts alcohol-related behaviors with an individual’s normative beliefs.
Addressing Social Norms Can be Effective
Graduating from high school can be an exciting transition for students, one that should be celebrated. Prom and graduation parties serve important functions. Parents, educators and administrators alike want this to be a safe time for their students. There is a need for effective, evidence-based interventions that can help students safely navigate this time and these events.
Circling back to my conversation with the school administrator: I applaud that the district recognized the need to address risky behaviors around a high-risk event and I encourage them and other school districts to consider implementing a norms-based intervention on its own or to complement ongoing efforts.
