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A Peer-Facilitated Intervention toReduce Risky Drinking Among Fraternityand Sorority MembersDina J. Wilke PhD a , Annelise Mennicke MSW a , Richard L. HowellMS b & Amy B. Magnuson PhD RD/N ca College of Social Work , Florida State University , Tallahassee ,Florida , USAb Center for Prevention Research , Florida State University ,Tallahassee , Florida , USAc Health Services , Florida State University , Tallahassee , Florida ,USAPublished online: 28 Feb 2014.

To cite this article: Dina J. Wilke PhD , Annelise Mennicke MSW , Richard L. Howell MS & AmyB. Magnuson PhD RD/N (2014) A Peer-Facilitated Intervention to Reduce Risky Drinking AmongFraternity and Sorority Members, Journal of Social Work Practice in the Addictions, 14:1, 42-63, DOI:10.1080/1533256X.2014.873323

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Journal of Social Work Practice in the Addictions, 14:42–63, 2014Copyright © Taylor & Francis Group, LLCISSN: 1533-256X print/1533-2578 onlineDOI: 10.1080/1533256X.2014.873323

A Peer-Facilitated Intervention to ReduceRisky Drinking Among Fraternity and

Sorority Members

DINA J. WILKE, PHDAssociate Professor, College of Social Work, Florida State University,

Tallahassee, Florida, USA

ANNELISE MENNICKE, MSWDoctoral Student, College of Social Work, Florida State University,

Tallahassee, Florida, USA

RICHARD L. HOWELL, MSAssociate Director, Center for Prevention Research, Florida State University,

Tallahassee, Florida, USA

AMY B. MAGNUSON, PHD, RD/NHealth Promotion Director, Health Services, Florida State University,

Tallahassee, Florida, USA

Results from a pilot study of a peer-facilitated brief motivationalinterview using personalized normative feedback with membersof fraternities and sororities are presented. Eight fraternity andsorority houses were randomly selected and then randomized intotreatment or control conditions. Quantitative data testing inter-vention efficacy indicated no differences between treatment andcontrol group 30 days postintervention on measures of alcoholconsumption and alcohol-related consequences. Qualitative infor-mation from follow-up focus groups of intervention participantsidentified themes related to intervention dosage, and credibilityof the normative data and peer educator. Recommendations aremade for future research and intervention strategies with thispopulation.

Received August 14, 2013; revised November 12, 2013; accepted November 30, 2013.The authors would like to thank the FSU Greek Life administrative leadership for their

support and involvement in the study as well as the Student Counseling Center for providingBMI training to the peer educators.

Address correspondence to Dina J. Wilke, College of Social Work, Florida State University,296 Champions Way, Tallahassee, FL 32306-2570, USA. E-mail: dwilke@fsu.edu

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Peer-Facilitated Intervention to Reduce Risky Drinking 43

KEYWORDS brief motivational interviews, college students, fra-ternities and sororities, high-risk drinking, peer education

High-risk drinking behaviors are common for many college students andare typically seen as part of the normal college experience (Kington, 2002).Although high-risk drinking might be perceived as a normative experienceby many, there are real and serious consequences for some people. High-risk drinking can lead to academic problems, physical deterioration, or evendeath (Wechsler et al., 2002). A study comparing national data over a 6-yearperiod found unintentional death due to alcohol, driving under the influenceof alcohol, and consumption of five or more drinks at least one time in thepast month all increased among college students from 1998 to 2005 (Hingson,Zha, & Weitzman, 2009). Other national data have estimated that about 10.5%of students report injuries as a result of their drinking, 12% have experiencedbeing assaulted by someone else who was drinking, and 2% acknowledgesexual assault (Hingson, Heeren, Winter, & Wechsler, 2005).

The National Institute on Alcohol Abuse and Alcoholism (NIAAA)defines high-risk drinking as a pattern of drinking that raises a person’sblood alcohol concentration (BAC) above .08, typically five or more drinksin a 2-hour sitting for men, or four or more drinks in a 2-hour sitting forwomen (NIAAA, 2004). In large national samples of college students, theaverage rate of high-risk drinking has hovered around 40% since the 1990s(O’Malley & Johnston, 2002). Indeed the most recent data from the CoreInstitute, a national database of drug and alcohol use in colleges and uni-versities collected via the usage of a common instrument, indicates that theaverage rate of high-risk drinking in the past 2 weeks among college studentsduring the period from 2009 to 2011 was about 44% (Core Institute, 2013).It is worth noting that the definition of high-risk drinking in this instrument isfive or more drinks in one sitting, which underestimates the rate of high-riskdrinking for women. Further, national data reported by the American CollegeHealth Association (ACHA) from Fall 2012 (ACHA, 2012) finds that of thosestudents consuming alcohol, about 35% drank in a way that raised their esti-mated BAC to .08 or higher the “last time they partied.” Although there arelimitations in both of these survey instruments, it remains clear that high-riskdrinking is a common, if not normative, experience for college students.

GREEK DRINKING

Researchers have been investigating the drinking behaviors of studentsinvolved in the Greek system (i.e., members of college fraternities and soror-ities) since the early 1990s. They have consistently found that Greeks drink

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alcohol more frequently (Lo & Globetti, 1995), drink more per drinking occa-sion (Alva, 1998), and have more negative alcohol-related consequences thannon-Greek college students (Bosari, Hustad, & Capone, 2009; Larimer et al.,2001; Wechsler, Kuh, & Davenport, 1996).

In a national study of fraternity members, Caudill et al. (2006) found that86% of respondents consumed five or more drinks in one sitting in the past2 weeks, and 64% indicated drinking that much at least three times in theprevious 2 weeks. Although quantity, frequency, and alcohol-related conse-quences were all lower for older students compared to younger students, alldrinking behavior was within the definition of high risk. Cashin, Meilman,and Presley (1998) found that Greek-affiliated males drank 12 drinks perweek on average compared to 6 drinks per week for nonaffiliated males.Greek-affiliated females drank six drinks per week on average compared totwo drinks per week for nonaffiliated females. McCabe et al. (2005) reportedthat 70% of fraternity members and 50% of sorority members engaged inheavy episodic drinking in the past 2 weeks versus 42% and 29% of non-affiliated members, respectively. Members of fraternities and sororities alsoexperience alcohol-related consequences at higher rates than nonmembers.For example, Greeks suffer more academic problems, blackouts, and sex-ual consequences associated with drinking than non-Greeks (Cashin et al.,1998).

ALCOHOL INTERVENTIONS

Several different strategies for interventions with college students have beendesigned to reduce high-risk drinking. According to Larimer and Cronce(2007) these interventions can be separated into three categories: educationand awareness programs, cognitive and behavioral skills-based programs,and motivational and feedback-based approaches. They found good evi-dence in support of brief motivational interventions (BMIs), including BMIsdelivered with personalized feedback, individually, in groups, or as stand-alone feedback with no in-person contact. Further, other interventionstargeted to reduce college drinking have little to no evidence of their effec-tiveness. These included information and knowledge approaches and briefvalues clarification interventions. There is also mixed support for normativereeducation programs (Larimer & Cronce, 2007).

Motivational Interviewing

Motivational interviewing (MI) is a strategy that seeks to engage clients ina collaborative process of change. It is client-centered and directive, with agoal to help explore and resolve client ambivalence toward behavior change(Miller & Rollnick, 2002). MI seeks to find reasons for a person to change

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Peer-Facilitated Intervention to Reduce Risky Drinking 45

and garner commitment to that change in a setting that is supportive andnonconfrontational. Those using MI strategies respect individual autonomy,are nonaggressive, and work to identify reasons for drinking and reasons forchange (Juarez, Walters, Daugherty, & Radi, 2006).

There are four general principles of MI (Miller & Rollnick, 2002). The firstinvolves the expression of empathy whereby client ambivalence is acknowl-edged as a normal part of the change process. Reflective listening is used toestablish a nonconfrontational partnership with the client. The second princi-ple involves developing a discrepancy between the client’s stated goals andcurrent behavior. Importantly, the client provides the rationale for change.Third, resistance is also seen as a normal part of a change process andshould not be directly opposed. This is in contrast to a confrontationalapproach, which attempts to convince clients that their beliefs are misguided,and evidence is provided that demonstrates that. In MI, clients are seen asbeing experts in their own lives, and resistance and defensiveness are indi-cators that different responses are needed. Finally, supporting self-efficacyis a key principle of MI and rests on core principles of autonomy andself-determination. There is significant evidence of the effectiveness of MIapproaches, and several studies have demonstrated its effectiveness withcollege students (Amaro et al., 2009; Baer et al., 1992; Schaus, Sole, McCoy,Mullett, & O’Brien, 2009).

MI techniques have been adapted to brief intervention strategies, whichmight be ideal for the Greek college population. Although many studiesmention using “brief” MI to elicit behavior change, very little research hasinvestigated what length of time is effective. One study (Kulesza, Apperson,Larimer, & Copeland, 2010) found that participants in a 10-minute interven-tion group, but not a 50-minute intervention group, consumed significantlyfewer drinks per week at follow-up compared to a no-treatment con-trol group. These findings suggest that brief interventions are a promisingapproach for alcohol interventions, and might even be more effective thanlonger interventions.

Personalized Normative Feedback

Personalized normative feedback is one method commonly used in con-junction with BMI to raise awareness of the nature and consequences ofan individual’s drinking (Carey, Carey, Maisto, & Henson, 2006). To elicitchange, interviewers might reveal a discrepancy between an individual’salcohol use compared to normative data of their peers. Providing this feed-back might elicit motivation for behavior change (Bosari & Carey, 2000).Feedback can be delivered in multiple formats including giving summariesof information about an individual’s personal drinking patterns, comparingdrinking patterns to those of other adults or college-aged peers, highlight-ing specific risk factors, and exploring the negative consequences associated

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with drinking (Walters, Vader, Harris, Field, & Jouriles, 2009). Some studentsoverestimate both the acceptability of heavy drinking and the amount thatother students drink, thus using these inaccurate norms as the basis for theirown behavior choices (White, 2006). Individualized feedback can be used tocorrect these misperceptions in an attempt to change behavior.

Personalized feedback in combination with BMI has been shown tobe beneficial. For example, Juarez et al. (2006) found that participants whoreceived feedback showed larger decreases in alcohol dependence symp-toms than participants who received only MI without feedback. Additionally,Walters et al. (2009) sought to test the effectiveness of BMI with personalizedfeedback by comparing four intervention strategies: Web-based personalizedfeedback only, a single MI session without feedback, a single MI session withfeedback, or assessment only. At 6-month follow-up, those receiving MI withpersonalized feedback showed greater reductions in drinking compared toall the other groups. Marlatt et al. (1998) found those who received a BMIwith personalized feedback reported less frequent drinking, lower overallquantity, and lower peak quantities of alcohol consumption compared to thecontrol group at a 6-month follow-up. Several other studies have found BMIwith personalized feedback to be effective (Bosari & Carey, 2000; Murphyet al., 2001).

Use of Peers

Much research has been conducted on the usefulness of BMI with person-alized feedback to reduce drinking among college students, and researchershave begun to explore different methods of delivering the feedback.Different studies have looked into the effects of personalized feedbackdelivered in person, by mail, or through a computer-generated assessment(see White, 2006, for a review). Results seem to suggest that all methodsof personalized feedback are effective in reducing drinking. However, littleresearch has been conducted on who is best suited to deliver in-person feed-back. Most studies that use in-person feedback use the services of a trainedclinical professional to conduct the motivational interview and personalizedfeedback. Few studies have explored the efficacy of BMI interventions whendelivered by a peer.

The theoretical basis for using a peer to deliver the intervention stemsfrom the large influence that peers have on behavior for college-aged individ-uals. Several studies have investigated the use of peer-delivered personalizedfeedback, with positive results. O’Leary, Bosari, Colby, and Monti (2007)found some support for the hypothesis that peer support can increase theeffects of BMI, as participants who were part of a treatment group thatused supportive peers reported better alcohol-related outcomes than par-ticipants in the condition that did not use a peer. However, it should benoted that these results were not statistically significant, possibly due to small

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Peer-Facilitated Intervention to Reduce Risky Drinking 47

sample sizes. Cimini et al. (2009) investigated the use of peer facilitators todeliver BMI interventions. They reported no statistically significant pre–postdifferences. However, this study did not include a comparison or controlgroup, so the effectiveness of the three particular treatments delivered bypeers as compared to the same treatments delivered by professionals is notknown.

Finally, in a study testing a brief alcohol intervention among fraternitymembers, Larimer et al. (2001) found that students who received the inter-vention from a trained peer had significantly greater reductions in typicalpeak estimated blood alcohol concentrations (eBACs) than students whoreceived the intervention from professionals. However, both interventiongroups had lower levels of drinking posttreatment than the assessment-onlygroup.

The purpose of this project was to test a peer-facilitated, brief motiva-tional interview using personalized normative feedback specifically targetedfor Greek life. This intervention was intended to enhance an existingsocial norms campaign across campus. This article describes the results ofthe intervention and the subsequent feedback gathered from interventionparticipants.

METHOD

This pilot study was conducted at a large, public university in the Southeastand was approved by the university’s Human Subject Committee. A certificateof confidentiality was also obtained from the NIAAA.

Participants

Greek houses with a traditional residential status and greater than 100 resi-dents were included in the sampling frame. Houses were stratified by genderand four fraternities and four sororities were randomly selected from the eli-gible houses. In an effort to control for the threat to internal validity fromthe diffusion of treatments, entire houses were then randomly assigned totreatment or control conditions. Control houses received existing alcoholawareness programming on campus, which includes a social norms mar-keting campaign and required risk management educational programs onhigh-risk drinking and related consequences. Treatment houses received thepeer-facilitated BMI in addition to existing programming.

Overall, based on house rosters, the control condition consisted of219 eligible fraternity members and 330 eligible sorority members, and in thetreatment condition there were 272 eligible fraternity and eligible 354 soror-ity members. However, technical problems prevented timely administrationof the posttest survey for one of the sororities in the treatment condition.

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48 D. J. Wilke et al.

Although the posttest data were ultimately collected, the timing of datacollection was beyond the 30 days posttreatment established for this follow-up. That house was eliminated in the analysis, thereby reducing the eligiblerespondents in the treatment condition for sororities to 170. Although thepretest and posttest instruments were delivered to the entire house, onlyrespondents who completed the intervention were included in the analysis.This reduced the sample size even further to 44 respondents in the treatmentgroup and 96 in the control group. Nonresponse at posttest accounts for themajority of this reduction in sample size.

Treatment

Peer educators were recruited through existing peer educator groups in thecampus health service and counseling center. Announcements were also sentto listservs for campus student leaders. Peer educators were paid $350 andreceived 6 hours of training on BMI that included lecture and role-plays andan additional 2 hours of alcohol education training.

Six peer educators went as a group to the selected fraternity or sororityhouse on multiple occasions. They first went to a scheduled house meetingin an effort to maximize the number of residents available for the interven-tion, and then followed with two additional times to meet with remaininghouse members. The intervention was delivered during a 4-month period oftime for all treatment houses. Formal fidelity checking was not completed.Project team members debriefed peer educators on a regular basis and usedthose meetings to reinforce the intervention strategies.

Intervention participants completed a six-question paper-and-pencilscreening provided by the peer educator that asked general alcohol con-sumption questions (quantity and frequency) along with questions onalcohol-related consequences. These items replicated data gathered inannual campus surveys for the existing social norms campaigns. Followingcompletion of the screening instrument, the peer educator conducted a 10-to 15-minute BMI with the student, comparing his or her drinking behaviorwith the campus-based drinking norms and attempting to elicit discussionof the participant’s responses. The peer educator then led the student toexamine his or her alcohol use and, when appropriate, encouraged the stu-dent to decrease or eliminate the quantity or frequency of drinking, decreasehigh-risk behaviors, or increase protective behaviors.

Following completion of the interview, each student received a self-monitoring card designed to help track consumption of alcohol, and anestimated eBAC card with an explanation of how to use it as a protectivestrategy. Peer educators were also able to explain the effects of alcohol, clar-ify the signs of alcohol poisoning, and assist with the identification of addi-tional protective behaviors as needed. On completion of the intervention,participants received a $10 gift card to a local retail establishment.

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Peer-Facilitated Intervention to Reduce Risky Drinking 49

Evaluation

A standard pretest–posttest design was used to assess the efficacy of theintervention. All data were gathered using Internet-based survey methods.One treatment and one control house was engaged in the study at a time.A link to the pretest was e-mailed to all members of the selected treatmentand control houses 2 weeks prior to the start of the intervention. A remindere-mail was sent to nonresponders after 1 week. Posttest data were gath-ered 30 days after the intervention and this procedure was repeated until allhouses completed the data collection and intervention cycles. Participantswho completed both a pretest and posttest were entered into a drawing forone of several different gift cards and an iPad.

Three outcome variables were selected to assess interventioneffectiveness—typical eBAC, maximum eBAC, and alcohol-related conse-quences. Estimated BAC was calculated using a modified version of the DailyDrinking Questionnaire–Revised (DDQ–R; Collins, Parks, & Marlatt, 1985)based on self-reported typical and maximum alcohol consumption patterns.Respondents were also asked about their weight and the number of hoursspent drinking in the typical and maximum conditions. Estimated BAC wascalculated using the National Highway Traffic Safety Administration (1994)formula.

The Rutgers Alcohol Problem Inventory (RAPI; White & Labouvie, 1989)was used to measure alcohol-related consequences. The RAPI is a 25-itemscale that asks respondents about the frequency of consequences associ-ated with alcohol consumption. Examples of items include not being ableto do homework or study for a test, going to school high or drunk, drivingshortly after having more than four drinks, and so on. Five response optionsare available (never, 1 to 2 times, 3 to 5 times, 6 to 10 times, and morethan 10 times). Individual consequences were unweighted, and scores weresummed so that higher scores indicated more alcohol-related consequences.

Both the DDQ–R and the RAPI were modified such that students wereasked to identify behaviors in the past 30 days. Pre- and posttest scores werecalculated for all variables and difference scores were used as the dependentvariable in the final analyses.

ANALYSIS

The low number of participants in each group necessitated nonparametricprocedures. Independent samples Kruskal–Wallis, a nonparametric analogto one-way analysis of variance, was used. Four groups were created inan effort to test for the combined impact of organizational type (fraternityor sorority) and intervention condition (treatment or control) on the out-come variables of interest. Overall we expected that treatment participantswould report greater improvement in alcohol consequences and typical

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50 D. J. Wilke et al.

and maximum eBAC levels compared to the control group participants.We further expected this effect would be stronger for females than males.

Focus Groups

Follow-up focus groups were conducted to learn more about implementa-tion of the intervention. The specified purpose was twofold: (a) to learnhow to improve data collection methods and (b) to obtain reactions toand suggestions for improvement of the actual intervention. As such, eli-gible participants were individuals from treatment houses who took part inthe intervention. Three focus groups were conducted to cover the range ofpotential ideas and achieve saturation.

Focus groups were led by the second author, a doctoral student,who was supported by a MSW student research assistant. They wererecorded using an electronic recorder and were hand-transcribed by aresearch assistant. Transcriptions were then electronically coded using NVivosoftware.

QUESTIONS

A list of questions was generated as prompts for discussions. The questionswere disseminated and revised based on feedback from experts in the field.Question utility and wording were considered after each focus group, butno questions were amended during the process. Example questions pertain-ing to data collection methods include, “If you were designing a study andtrying to maximize the number of responses to a survey within your peergroup, what would you do to make sure you got the best response rate?” and“Do you think your peers were completely honest about their own drinkingbehaviors?” Examples of questions pertaining to intervention improvementinclude: “Did the discussion with the peer educator cause you to think dif-ferently about your drinking habits? If yes, how so?” and “Would it be betterto have a peer educator who was recruited and trained from your house?”Although these questions were used as a semistructured interview guide,the interviewer was flexible with this structure and allowed participants todiscuss these topics in the natural order in which they came up. The inter-viewer also took care to limit the focus groups to 1.5 hours while getting toall the identified topics, so some redirection and focusing was done duringthe groups.

RECRUITMENT

Participants were recruited from three of the houses that participated in theintervention. The intervention was delivered to four Greek houses, two fra-ternity and two sorority. However, one of the houses lost its charter in the

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Peer-Facilitated Intervention to Reduce Risky Drinking 51

time between intervention delivery and focus group data collection, and wastherefore unavailable for recruitment. Chapter presidents were contacted andinformed of the goal of this phase of the study. Presidents were asked todisseminate recruitment material, which included a brief description of thestudy and information about incentives. Members of the Greek chapters wereinvited to participate if they engaged in the peer-facilitated brief interventionand were undergraduate students age 18 and above.

Focus groups were conducted in the chapter houses for convenienceon the participants’ part and to increase participation. On arrival, researchersensured potential participants met eligibility criteria. Informed consent wasgathered by having participants sign a form. After submission of the informedconsent, participants could choose a $25 gift card from several local estab-lishments. Incentives were given prior to the focus group to ensure thatparticipation was voluntary and participants knew they could leave atany time without penalty. No demographic information was collected, andconfidentiality was ensured by deidentifying the data on transcription.

ANALYSIS

Focus group transcripts were analyzed using a thematic strategy. Each tran-script was initially read and reread by the coder to get a general sense ofthe data. Major themes were reflected on and noted using memos. Then thetranscripts were coded using open coding. Using the constant comparativemethod, codes were constantly rearranged, collapsed, or expanded through-out the process to accurately reflect the nature of the data, known as axialcoding. After completion of primary coding, manifest themes were identified.Additionally, to speak to the higher level of the data, latent themes were alsoidentified. Manifest themes are those that are transparent and directly statedby participants, whereas latent themes are more discrete and not as directlystated by participants. The final coding scheme was inspected with regard tothe study aims, and codes were organized accordingly, with care to preservetheir meaning.

RESULTS

Intervention Results

SAMPLE DESCRIPTIVE

During the data cleaning process, respondents whose calculated eBACs weregreater than .40 (the level typically associated with death) were removed(n = 19 in the treatment group and n = 11 in the control group). Overall,matched pretest and posttest data were received from 43 of the eligiblerespondents from the fraternity treatment group (15.8% response rate) and38 from the fraternity control group (17.4% response rate). There were

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matched data available for 57 of the eligible respondents from the soror-ity treatment group (33.5% response rate) and 58 of the eligible respondentsfrom the sorority control group (17.6% response rate). The overall responserate among those with matched pre- and posttest data across all groups was19.7%.

Given the loss of respondents from pretest to posttest, independent sam-ples t tests were run to assess for baseline differences between respondersand nonresponders on all three outcome variables. There were no signifi-cant differences at baseline between posttest responders and nonrespondersfor alcohol consequences, t(367) = –.425, p = .671; typical eBAC, t(355) =–.193, p = .847; or maximum eBAC, t(355) = –.632, p = .528.

A significant oversight was discovered during posttest data collection.Although pre- and posttest data were collected electronically from the masterlist of house residents, we neglected to account for the status of studentsin the treatment houses who might have completed the surveys withoutparticipating in the intervention. This was corrected by (a) adding an itemon subsequent posttests that asked if the student met with a peer educatorand (b) sending a brief survey to those who already completed the posttestto retrospectively identify if they participated. As a result, completed datawere lost when participants did not respond to this data request or whenthey indicated that they did not participate in the intervention (n = 26 forfraternities and n = 19 for sororities). Overall, there were matched pretestand posttest data available for 44 participants in the treatment group and96 participants in the control condition for a total sample size of 140 students(see Table 1).

TABLE 1 Sample Descriptives

% M SD Range

Organization typeFraternity 39.3Sorority 60.7

Intervention statusTreatment group 31.4Control group 68.6

Alcohol-related consequencesPretest 6.06 7.0 0–37Posttest 4.13 5.8 0–40Difference −1.94 6.5 −37–29

eBAC, typical consumption in past 30 daysPretest .088 .081 .00–.33Posttest .074 .072 .00–.34Difference −.015 .071 −.29–.15

eBAC, maximum consumption in past 30 daysPretest .131 .094 .00–.34Posttest .113 .092 .00–.32Difference −.017 .082 −.31–.32

Note. n = 140. eBAC = estimated blood alcohol concentration.

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Peer-Facilitated Intervention to Reduce Risky Drinking 53

TABLE 2 Pretest Differences Between Treatment and Control Conditions

Treatmenta Controlb

M SD M SD t p Value

Alcohol-related consequences 5.52 7.72 6.31 6.67 −.618 (df = 138) .537eBAC, typical consumption .079 .091 .092 .077 −.868 (df = 133) .387eBAC, maximum consumption .113 .092 .140 .094 −1.545 (df = 124) .125

Note. eBAC = estimated blood alcohol concentration.an = 44. bn = 96.

PRETEST DIFFERENCES

Independent samples t tests were used to assess for pretest differencesbetween the treatment and control groups on all dependent variables.Overall, there were no pretest differences between treatment and controlgroup that needed to be accounted for in the posttest analyses (see Table 2).

KRUSKAL–WALLIS RESULTS

To test the impact of the intervention on the dependent variables, aKruskal–Wallis test was used. There were no significant differences betweenpretest and posttest scores, thus providing no support for the mainresearch hypotheses. The distribution of scores was equivalent acrossthe four groups (fraternity/treatment, fraternity/control, sorority/treatment,and sorority/control) for alcohol consequences (p = .113), typical eBAC(p = .133), and maximum eBAC (p = .179).

Focus Group Results

PARTICIPANTS AND ANALYTIC STRATEGY

As a result of the lack of empirical support for the effectiveness of theintervention, a qualitative follow-up study was completed with interventionparticipants. A total of 43 individuals participated in three different focusgroups; 18 in the first group, 14 in the second, and 11 in the third. Thefirst two groups were conducted in sorority houses, and the third was in afraternity house, so over half (74.4%) of the sample was female. Individualswere eligible for the focus group if they participated in the intervention andinterviews were conducted within the houses. This resulted in homogenousgroups in that participants all belonged to the same fraternity or sorority.

Manifest Themes

Two manifest themes were identified through coding: suggestions on howto improve data collection and reactions to the interventions.

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HOW TO IMPROVE DATA COLLECTION

Two important subthemes emerged from the prompts regarding data collec-tion: (a) concerns about legitimacy and convenience and (b) suggestions forincentives.

Legitimate and convenient. This theme included suggestions for datacollection that focused on making the survey legitimate and convenient.Suggestions to enhance legitimacy included having invitations for participa-tion come directly from chapter leadership as opposed to being sent by theresearch team or coming from the Office of Greek Life.

A second aspect of this theme was the need for the survey and recruit-ment to be convenient. Respondents remarked that e-mail invitations wereeasy to ignore or forget about so they frequently suggested using other formsof Internet recruitment such as Facebook or Twitter. Although there wassome debate about what form of the survey was best, for the most part,participants agreed that an electronic survey completed online at one’s con-venience was the best method of delivery. Respondents believed the returnrate for paper surveys would be low due to the ease of forgetting or ignoringthem. They believed that bringing laptops to the houses to complete surveyselectronically would be too cumbersome and require a long waiting periodthat would discourage participation.

Incentives. The second major theme regarding data collection was theimportance of incentives, which were considered essential for participationin this type of study. The majority of participants reported that the incentiveswere the main reason they completed the survey. Students generally agreedthat the most effective incentives were those that were immediately available.Delayed or raffle-type incentives were not viewed as positively as small,immediately redeemable incentives. Participants appreciated gift certificatesand suggested a wide variety of desirable retailers.

INTERVENTION REACTIONS

The second manifest theme focused on reactions to the intervention.Distrust of information. A pattern that emerged from the data was that

participants distrusted the normative information being presented. This dis-trust emerged for several reasons. First, some participants felt that even theirsafe drinking behaviors were criticized. This led them to be skeptical of theinformation presented and made the intervention lose credibility. For exam-ple, one female participant recounted, “The weekend we did the survey Ididn’t even drink that much at all, I think I had, like, two or somethinglike that, which isn’t bad. He [the peer educator] was still telling me whatI did was wrong, and I was just like, someone just told you they drank for15 hours.” She went on to describe how this made her discredit the infor-mation and feel like the intervention was not context appropriate. Others

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were skeptical of the information they received because it did not matchtheir experiences. Several participants lamented that according to the eBACchart, they should have been blacked out or even dead. One male partic-ipant stated, “The chart said I should be pretty much blacked out after acertain number of drinks, and I know for a fact that after that many I can stillremember stuff.” Similarly, a female participant stated, “I was just like, havefun with your little statistics, I’m still alive.”

Participants were also distrustful of the assumption that excessive drink-ing among Greeks was especially problematic as compared to the generalcollege population. When asked if they believed it was possible to changethe excessive drinking habits of the Greek population, many participantsbecame defensive and responded that they resented the implication thatGreeks had a drinking problem. One male participant stated, “Just to focussolely on like Greek life, when we only represent like 18% of most of thecampus and we have like 40,000 plus students, I mean, we probably have,like, less of a problem compared to, like, independents. So I know, like,we’re a group of people so it’s easier to focus on us, but I—we all, Greeks,independents, we all came to college to get an education and have fun, soto pick on one group is not going to be successful to the whole university.”Many participants did not accept the notion that Greeks drank at higher lev-els, and several participants went as far as to ask the researchers to presentdata supporting this assertion.

Need for follow-up. Many respondents remarked that the interventionmade them think about their drinking behaviors very briefly, but that it wasnot enough to influence their drinking patterns. For example, one womanremarked, “Like, to be completely honest, like, I felt bad for like—I was like,hmm, maybe I shouldn’t have drank so much, for like, 30 minutes. And then,I mean, cuz I’ve read and heard all those statistics before, like, I know howmany drinks is too many for me. I know all that. So, like, it made me thinkabout it a little bit, but it really didn’t change anything.”

One suggestion to improve the intervention was to do a follow-upbooster session with the participants. Several students identified that con-sistency and follow-up would help keep the information fresh, otherwise itis easily forgotten. Participants seemed to think that one dose of the inter-vention was not enough to change behavior, but multiple, consistent dosesmight make an impact.

Uniqueness of intervention. Many participants indicated that the inter-vention was not effective because they had reached information saturationon the topic. They repeatedly stated that the information presented by thepeer educator was nothing they had not heard before. As members of Greeklife, they are exposed to many types of alcohol-use interventions, some ona semester basis, so they are often very knowledgeable about the effectsof alcohol use. For example, one female participant stated, “Greek Life givespresentations all the time. We have to go to risk management every semester,

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and they say the exact same thing, so we all pretty much know that already,and it doesn’t really change when you have someone else telling you it,especially someone you don’t know.”

Peer educator feedback. Participants identified issues related to the peereducator that prevented them from feeling completely comfortable while dis-cussing their drinking habits. The pattern that emerged was that participantswanted a peer who would be knowledgeable about their lifestyle and wouldnot judge them when they discussed their drinking habits. Respondents sug-gested a peer educator who was in their age range and fluent in Greekculture who would not display judgment if they revealed excessive drinking.For example, one female participant stated, “He didn’t have to say it butit was just his body language, and you can just tell sometimes, like, yeah,stereotype, sorry about it, but you could just tell. Like I knew that he wasn’tin Greek life, and I could also tell that he was a little older, but I knew thathe wasn’t in Greek life and he was kind of taken aback by some of myanswers.”

There was considerable debate among participants about whether thepeer educator should be from within the Greek Life system. Some respon-dents endorsed this idea because they believed the familiarity with theirculture would make them feel at ease when discussing their own drinkinghabits. However, other participants felt as though they would face more judg-ment if they revealed excessive drinking to certain Greeks. For example, onefemale participant stated in reaction to the suggestion that the peer educatorcome from Greek Life:

I think that that’s not a good idea, because honestly, like, you can get intoa lot of trouble for drinking in Greek Life, so even if it was like, a GreekLife advisor or something like that, if anything came back to the houseor reflected poorly on your chapter, you wouldn’t wanna say anything,cuz that’s a person who is in a position of authority, and if it was like,another sorority sister, if it was somebody from a house down the streetor something like that, I would feel really awkward, cuz I’d be like, okay,I’m going to see you out at the bar, like, that’s really awkward.

Meanwhile, the men stated that they would be inclined to inflate theirexcessive drinking if it were another male Greek from their own house. Onemale respondent stated, “I feel like some people would want to exaggeratemore in front of a peer or like a brother just to be, like, yeah, I drank somuch and all that—maybe trying to impress somebody.” Although there wasconsiderable debate about whether the participant should come from GreekLife, the general pattern that emerged was that it was important for the peereducator to be knowledgeable about Greek Life culture so they could makethe participants feel more comfortable.

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Peer-Facilitated Intervention to Reduce Risky Drinking 57

Latent Themes

Two major latent themes were identified during coding—the importance ofappearance and the impact of norms.

APPEARANCE ISSUES

Much of the discussion by participants centered on how they felt uncomfort-able being completely honest during the intervention because of the impactit would have on their image as fraternity or sorority members. Respondentsseemed less concerned about how their self-reported behavior would impacttheir personal reputation, and more concerned about how it would impactthe reputation of their house or Greek life as a whole. For example, onefemale participant stated,

I realized, too, like, halfway through when we were answering that wewere, like, representing Greek life as a whole and we already have thatstereotype of, like, we party too much and, like, we don’t get stuff doneand whatever it is . . . so realizing that I was representing all of it kind oflike skewed my answers, cuz I didn’t want my answers to reflect like allGreek life in a negative way.

A male participant stated something similar:

When someone is like, interviewing me about how much I drink, like, Idon’t want to be completely truthful cuz I don’t like people judging meand I feel like people are doing it. They’re looking like, “Oh this kid isGreek, he just gets drunk all the time and parties and doesn’t give a shitabout school.”

Many participants also had a negative reaction to the intervention’sexclusive focus on Greek life. Respondents felt it was unfair for Greek lifeto be targeted when they believed that all college students or other targetgroups like athletics also need alcohol-related intervention. They expresseddisdain over the constant focus on Greeks and drinking, and the perceivedinattention to positive activities in which Greeks are involved. Participantswere tired of the association between Greek life and drinking. This asso-ciation impacted their level of honesty in the intervention, as they wereconcerned about how the peer educator would view Greek life or how theresults would look to researchers.

NORMS ISSUES

Individual norms. A major pattern that emerged when discussing thepotential to change the excessive drinking habits of Greek life was the idea

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that there are individual factors that affect drinking. First, participants reit-erated the message that not all Greeks are the same, and there are someindividuals who drink more than others and give all of Greek life a badreputation. For example, one female participant stated,

First of all, I honestly don’t think Greek life has excessive drinkingproblem—I think it’s specific people, and then that’s like—you see thosepeople and you think it’s Greek life, but those specific people havingno—like hearing some of the facts, maybe it would change their opin-ions, but I also think it also depends on the person. Like for me, if I wereto go out and drink a lot, if I personally were to hear these facts, theywould make me think twice the next time I went out, but I know somepeople just don’t care.

Another female respondent added:

I feel it’s just a personal choice, because again, grouping all of Greek lifeis saying that every single one of us is exactly the same, and in this room,that’s not even true about the 16 of us, let alone the thousands of peoplethat are part of Greek life. So I think that no matter what you do, it’s notgoing to change the entire Greek life as a whole.

The idea here was that individuals needed to be targeted, and that Greek lifeas a whole was not the problem.

A second pattern that emerged at the individual level was that people’sdrinking behaviors naturally change as they age and mature. For example,one female participant stated,

I really like, as a freshman, I was like the crazy girl or whatever, and nowI’m basically a grandma, and I don’t think that, like, no matter how manypresentations you give it’s really going to change someone’s point of viewif they want to go out. I think only maturity and more responsibilitiesare the only things that’s gonna make someone calm down and realizethey’re damaging their body.

One male respondent, in reaction to the prompt about changingexcessive drinking habits among Greeks, stated,

I would go after freshman more cuz they seem to be the ones who getreally, really drunk, compared like to the older people, cuz they’re likenew to being free from their parents, so they just abuse their—I mean,I did too—they abuse their freedom. So they’re usually the ones gettingcarried out of bars and stuff. You can tell they’re freshman.

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Greek-specific norms. Group members discussed how norms centeredon Greek life impacted the drinking levels of individuals, suggesting thatthose who join Greek life are inclined to be more social. They associatedbeing more social with higher alcohol consumption, and therefore, higherrates of drinking among those in Greek life. Also, many participants speci-fied how fraternities and sororities in Greek life host more social events thatallow for more opportunities for drinking than the general college student.Related to this idea of social drinking events, participants gave many exam-ples of drinking-related events that were affiliated with Greek life culture.Many of these involved of excessive drinking behavior (i.e., drinking for15 hours straight), and were also related to football games. When discussingthe best time to deliver an intervention, respondents suggested during a“normal week” that did not involve a social drinking event, although therewas no agreement about when that would occur. Instead the norm seemedto be hosting social drinking activities on a regular basis that would “skew”the reported drinking behaviors of the participants. For example, one maleparticipant gave his thoughts on when the researchers should deliver theintervention:

I would say do it like end of January or beginning of February kindof, then you’re eliminating the freshmen—like they’ve had a semester ofcollege. They know what they’re getting into. They start to know theirlimits. It’s not football season. I feel like spring is just more of a normaltone, not a lot going on, and not a lot to skew the results. It’s more realresults.

DISCUSSION

Overall, although the quantitative results for the pilot study were disappoint-ing, the focus group data provided useful insight for replication efforts orother alcohol intervention studies with college students. However, theseresults should be considered within the context of the study’s strengthsand limitations. First, there were implementation challenges that we believecould have influenced the findings and thus limited the internal validity ofthe results. Although the effort to randomly select houses, along with ran-dom assignment to treatment or control conditions should be considereda strength of this study, data collection difficulties coupled with the gen-eral nonresponse issues of electronic surveys resulted in a loss of data, andthereby power to detect any differences. Certainly, the complete loss of datafrom one of the treatment sororities resulted in the treatment by genderinteractions analyses being limited to only one house.

Second, focus group data seemed to suggest that the intervention wasnot always carried out in the manner in which it was intended. Participantsindicated experiences where positive drinking choices were criticized simply

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because drinking was involved. However, given the general defensive toneof many of the participant responses, it is unclear if the criticisms wereactual or perceived. Regardless, this might indicate a need for more trainingin advance of the intervention, better fidelity checks, or ongoing, formal“check-ins” with the peer educators about how they were responding to theintervention participants.

Finally, nothing is known about those in the treatment houses whochose not to participate in the intervention. We might speculate that thosefor whom drinking was not a regular choice declined to participate, as theirdrinking behavior was not an issue. Alternatively, we might suggest thatthose at highest risk avoided participating. Regardless, we are unable toassess if, or how, self-selection issues affected the outcome and limit ourexternal validity.

However, several important themes emerged from the focus groupsthat might help to understand our findings and inform future research onthese types of interventions. Overall, there was significant frustration anddefensiveness in response to suggestions that Greeks engaged in exces-sive drinking, and dismissal or skepticism of data that suggested otherwise.Campus-based normative data were generally not perceived as being cred-ible, as participants believed there was nothing unique about the drinkingof Greek life members compared to a non-Greek college student. Thesefindings seem to suggest that care must be taken in developing the credi-bility of normative data, particularly in the face of general defensiveness ofthe intervention participants. Although norms-based interventions frequentlyneed to establish the credibility of data, group interventions can engage inexperiential activities like using clicker questions to help demonstrate differ-ences between perceived versus actual behaviors. More research is neededto identify ways to establish data credibility within a 1:1 context such as BMI,particularly when skepticism is high.

Second, credibility issues were also raised about the peer educators,who, although students themselves, were perceived to lack an understandingor acceptance of Greek life. Focus group participants presented strong rea-sons for and against using peer educators who were members of fraternitiesor sororities. In the end, the only consensus was that careful attention mustbe paid to the selection of peer facilitators who adequately understand andaccept Greek life culture as a way to help develop credibility. Further, thereceptivity of the audience to the general message (or in this case, the lack ofreceptivity to the general message) must be taken into account when trainingpeer educators and developing the intervention. Collaborative partnershipsare essential as Greek life administrators, chapter presidents, and volunteersfrom Greek life membership can all be engaged to help craft the interventionand pave the way for its implementation. In this project, a successful collab-orative team was established between the research team and campus Greeklife administrators who fully endorsed the project and took responsibility for

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recruitment of houses. However, more time was likely needed to nurture therelationships the research team developed with chapter leaders.

Finally, how brief is too brief of an intervention? There is no clear answerin the empirical literature, but the focus group responses seem to suggest thatthe intervention might have been too brief to make a meaningful difference.Longer interventions could assist with establishing the credibility of data, butthey then become more cumbersome to implement. There was also somesuggestion that a booster session would help reinforce the general content,but it would also add to the complexity of the programming. It might be thata 1:1 peer-facilitated BMI using normative feedback is better used as an earlyintervention strategy (for judicial referrals, as an example) rather than as abroad-based prevention strategy.

On balance, there is enough credible research to suggest that briefmotivational interventions providing personalized normative feedback are aneffective way to address high-risk drinking by college students. However, ourstudy added two additional factors: peer facilitators and a Greek life focus.We found no differences between the treatment and control group at 1-month follow-up in alcohol consumption or related consequences, althoughwe cannot dismiss the implementation challenges that might have influencedour results. However, important feedback addressing incentives, messagecredibility, and peer educators was derived from focus groups of interven-tion participants that should help with future research and program planningfor members of fraternities and sororities.

FUNDING

This study was funded through the Social Sciences Program EnhancementGrant from the Florida State University (FSU) Council on Research andCreativity.

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