Alcohol Education Programs Research Articles

Prior Sexual Aggression as a Moderator of an Integrated Alcohol and Sexual Assault Prevention Program for Heavy Drinking College Men: A Brief Report.

Sexual aggression and heavy drinking are interrelated concerns among college men. As a result, integrated prevention interventions now exist to address co-occurring risk for sexual aggression and heavy drinking. The Sexual Assault and Alcohol Feedback and Education (SAFE) program is a multi-session integrated alcohol and sexual assault prevention program for college men that addresses alcohol use, sexual activity, social norms, alcohol-related sexual consequences, understanding of consent, and engagement in bystander intervention. Given that prior sexual aggression is a risk factor for subsequent perpetration of sexual aggression, the present study examined whether the effect of SAFE on a range of outcomes (rape myth acceptance, hypergender ideology, labeling of consent, and bystander intervention intentions) depended on men's baseline history of perpetration. Participants in the study were heavy drinking college men (N = 115) randomly assigned to SAFE or a mindfulness-based control condition, and who completed follow-ups at two and six months. Data were analyzed using multilevel modeling. Degree of prior sexual aggression significantly moderated effects of SAFE on change in intentions to intervene, as well as rape myth acceptance, between baseline and six months. As baseline perpetration decreased, those receiving SAFE significantly increased bystander intervention intentions more so than the control group. As baseline perpetration increased, those receiving SAFE significantly increased rape myth acceptance more so than the control group. Findings emphasize the importance of continued examination of who benefits from integrated alcohol and sexual assault prevention programs.

Process evaluation of a UK school-based alcohol intervention using the Behaviour Change Wheel Framework

ABSTRACTThere are few process evaluations of school-based alcohol education programmes, especially examining teacher’s role in implementation. Using a Behaviour Change Wheel (BCW) framework, this qualitative study identifies the barriers and enablers to teacher delivery of the Talk About Alcohol (TAA) programme in UK secondary schools and provides strategies for improvement in this context. Ten teachers were interviewed about influences on their delivery of the TAA programme. Interview transcripts were analysed thematically using the Theoretical Domains Framework (TDF) and then Behaviour Change Techniques (BCTs) were identified for optimisation. Key enablers included increased knowledge from training and resources, increased confidence and effective resource design. Barriers included social pressure on students and further training on complex issues related to alcohol use such as consent. Delivery was influenced by a range of positive enablers which can inform other school-based alcohol interventions. Strategies for optimisation include follow-up training sessions, notifications of new updates to the programme resources, training highlighting past successes for teachers and further action planning for students. This evaluation highlights how the BCW approach can be used to improve teacher implementation in educational research.

Peer-led interventions to reduce alcohol consumption in college students: A scoping review.

Risky alcohol consumption among college students is a significant public health issue. In the college setting, students can collaborate in the implementation of peer-led interventions. To date, evidence of peer-led programmes in reducing harmful alcohol consumption in this population is inconclusive. The aim of the current scoping review is to provide a broad overview by systematically examining and mapping the literature on peer-led interventions for preventing risky alcohol consumption by college students. The specific aims were to (1) identify the underlying focus of the interventions and assess their (2) effectiveness and (3) feasibility. A comprehensive search was conducted in PubMed, PsycINFO, CINAHL, Cochrane Library, Web of Science, DART-Europe, RCAAP, Trove and ProQuest. The inclusion criteria were peer-led interventions that exclusively addressed alcohol consumption, college students as the target population and interventional studies (randomised controlled trials, quasi-experimental studies, systematic reviews and meta-analyses of interventions). The methodological quality of the articles was evaluated. From 6654potential studies, 13 were included. Nine interventions were described within these studies: Voice of Reason programme, Brief Advice sessions, Peer Theatre, Alcohol Education programme, Perceptions of Alcohol Norms intervention, Motivational Intervention, Alcohol Skills Training programme, Lifestyle Management Class and the Brief Alcohol Screening and Intervention for College Students. Only the last showed significant reductions in three of the four outcome measures: quantity and frequency of drinking, estimated peak blood alcohol concentration and alcohol-related consequences. It did not significantly decrease the number of heavy-drinking episodes. Peer interventions may be effective in preventing alcohol use among college students, although the evidence is weak and scarce. Further research is needed to strengthen the findings about peer-led interventions.

#BingeDrinking—Using Social Media to Understand College Binge Drinking: Qualitative Study

BackgroundHazardous drinking among college students persists, despite ongoing university alcohol education and alcohol intervention programs. College students often post comments or pictures of drinking episodes on social media platforms.ObjectiveThis study aimed to understand one university’s student attitudes toward alcohol use by examining student posts about drinking on social media platforms and to identify opportunities to reduce alcohol-related harm and inform novel alcohol interventions.MethodsWe analyzed social media posts from 7 social media platforms using qualitative inductive coding based on grounded theory to identify the contexts of student drinking and the attitudes and behaviors of students and peers during drinking episodes. We reviewed publicly available social media posts that referenced alcohol, collaborating with undergraduate students to select their most used platforms and develop locally relevant search terms; all posts in our data set were generated by students associated with a specific university. From the codes, we derived themes about student culture regarding alcohol use.ResultsIn total, 1151 social media posts were included in this study. These included 809 Twitter tweets, 113 Instagram posts, 100 Greekrank posts, 64 Reddit posts, 34 College Confidential posts, 23 Facebook posts, and 8 YouTube posts. Posts included both implicit and explicit portrayals of alcohol use. Across all types of posts reviewed, positive drinking attitudes were most common, followed by negative and then neutral attitudes, but valence varied by platform. Posts that portrayed drinking positively received positive peer feedback and indicate that drinking is viewed by students as an essential and positive part of university student culture.ConclusionsSocial media provide a real-time picture of students’ behavior during their own and others’ heavy drinking. Posts portray heavy drinking as a normal part of student culture, reinforced by peers’ positive feedback on posts. Interventions for college drinking should help students manage alcohol intake in real time, provide safety information during alcohol use episodes, and raise student awareness of web-based privacy concerns and reputation management. Additional interventions for students, alumni, and parents are needed to address positive attitudes about and traditions of drinking.

Alcohol use and alcohol-related consequences based on gender and sexual orientation among college students.

Research has not yet investigated how the association between alcohol and alcohol-related consequences differs across cisgender heterosexual women (CHW), cisgender heterosexual men (CHM), and sexual and gender minority (SGM) college students. Participants were N = 754 college students (34.5% CHW [n = 260]; 34.5% CHM [n = 260]; 31.0% SGM [n = 234]) between the ages 18 and 25 who completed a survey on sexual orientation, gender identity, alcohol use (i.e., average drinks per week), and alcohol-related consequences. Among individuals who reported alcohol use, CHM reported significantly more drinks per week compared to CHW and SGM. The logistic model of a zero-inflated negative binomial regression indicated that excess zeros in the alcohol-related consequences were more likely among (1) nondrinkers and (2) SGM compared to CHM. The count portion of the model indicated that, among drinkers, there was a positive association between drinks per week and alcohol-related consequences. Estimated alcohol-related consequences per drink were 1.90% higher among CHW than CHM and 2.76% higher among SGM than CHM. Exploratory analyses did not find significant differences in outcomes between cisgender female and male sexual minority students. Findings suggest that although CHW and SGM students consume less alcohol than CHM, these students experience more alcohol-related consequences per drink. This study advances the field's knowledge of alcohol use patterns and consequences among SGM college students. There is a need for alcohol education programming that is tailored to the unique experiences, identities, and minority stressors of SGM college students.

Distilling the curriculum: An analysis of alcohol industry-funded school-based youth education programmes.

Background and aimFor decades, corporations such as the tobacco and fossil fuel industries have used youth education programmes and schools to disseminate discourses, ideas and values favourable to their positions, and to pre-empt regulation that threatens profits. However, there is no systematic research into alcohol industry-funded youth education programmes. This article serves to address this important gap in the literature.MethodsUsing a discourse theoretical approach informed by poststructural discourse theory and critical discourse analysis, we analysed teaching materials from three school-based youth education initiatives which focus on alcohol consumption and health harms: Drinkaware for Education, The Smashed Project (funded by Diageo), and Talk About Alcohol (Alcohol Education Trust). These materials, some of which are disseminated internationally, are provided to schools through intermediary bodies in receipt of alcohol industry funding.FindingsThe analysis found that these materials drew from and presented discourses of personal responsibility, moderate alcohol consumption, and involved a narrowing of the problem definition and causes. The locus of the problem is located by the discourses within individuals including youth, with causes of youth alcohol consumption repeatedly presented as peer pressure and ‘poor choices’, with little or no mention of alcohol industry marketing or other practices. All programmes promoted familiarisation and normalisation of alcohol as a ‘normal’ adult consumer product which children must learn about and master how to use responsibly when older. The discourses constructed in these materials closely align with those of other alcohol industry corporate social responsibility discourses which employ selective presentation of harms, including misinformation about cancer, and ambiguous terms such as “responsible drinking”. Furthermore, the role of alcohol price, availability and access, and the impacts of alcohol and the industry on inequities were not articulated within the discourses. The research was limited to an analysis of teaching materials and further research is needed to explore their impact on youth, teachers and wider discourses and social norms.ConclusionAlcohol industry-sponsored youth education programmes serve industry interests and promote moderate consumption while purportedly educating children about harms and influences of alcohol use. There are considerable conflicts of interest in the delivery of alcohol education programmes funded by the alcohol industry and intermediary bodies in receipt of such funding. Alcohol education materials should be developed independent from industry, including funding, and should empower children and young people to understand and think critically about alcohol, including harms and drivers of consumption, and effective interventions needed to protect them and others from alcohol-related harms. Independent organisations can use this analysis to critique their materials to strengthen alignment with meeting student and public health interests. The ongoing exposure of children and young people to such conflicted and misleading materials needs urgent attention from policymakers, practitioners, teachers and parents, and resources dependent on industry support should cease being used in schools.

Integrating student and teacher insights to a school-based alcohol program through co-design.

School-based programs may be more effective when an array of stakeholders, including users, are involved during the relevant stages of program co-creation-specifically during key development stages such as design, implementation and evaluation. How such programs can be operationally co-created and tested is less known and is therefore the purpose of this article. Two sequential co-design phases underpin this study. First, a co-design session with 20 health and physical education (HPE) teachers focussed on reviewing, testing and critically discussing initial prototype online modules for an alcohol education program. Teacher insights were assessed and incorporated, and the updated online modules were tested with secondary school students (n = 120) capturing their experience in a classroom setting. Insights from each group were analysed using thematic analysis. Teachers and students serve important roles in program co-creation. Teachers remain an underutilized stakeholder group whom are however critical in delivering important insights to enhance educational program design. Teachers demanded more relevance to the national curriculum, further alignment with curriculum assessment standards, and age appropriate content. Student feedback focussed largely on realistic content, personalization and gamification elements. This study represents an application of the seven-step co-design process and advances understanding of the 'fuzzy back-end' of the process, namely reflecting on feasibility of integrating teacher and student feedback and ideas. More specifically, how these key-yet distinct-stakeholder groups can be involved, and the merits of their involvement are discussed.

C.A.R.E.S: A mobile health program for alcohol risk reduction in community college students

BackgroundCompared to students at four-year residential colleges, Community College Students (CCS) are at greater risk for binge drinking and alcohol related risks, however few interventions have been developed specifically for the needs of CCS. Methods and designThis study design tests the efficacy of a smartphone app (CARES) compared to an existing online alcohol education (AE) program. CCS (n = 250) will be recruited using a nationwide social media campaign and randomly assigned to either arm, stratified by sex and age (over/under 21). Eligibility screening, consent and assessments are conducted online and both interventions are accessible by smartphone. Assessments will be conducted at baseline, 4- and 8- weeks, end of treatment (12-weeks) and at 6-month follow-up. The primary outcomes are heavy episodic drinking (past 2 weeks), and alcohol related problems Confidence in refusing alcohol, use of protective behavioral strategies and expectations regarding alcohol use. Demographics including age, sex, race/ethnicity, marital and parental status and employment will be analyzed as potential covariates. DiscussionCommunity colleges serve approximately half of all US college students but frequently lack the resources to implement full-service alcohol prevention and education programs. The specific needs of CCS also differ from those of residential college students for whom most alcohol prevention programs have been developed. If proven efficacious, the CARES intervention may offer a scalable, easily disseminable program designed for the needs of community colleges and their students.ClinicalTrials.gov Registration: NCT03927482.

Academic health services and health needs of college students around the era of the Covid-19 pandemic

Objective: The university medical services vary around the world (even within each university), but there are only a few publications on the utilization of these services by the students. The available on-campus services of public health care might include general health care, women’s centers, mental health care, disability services, wellness resource centers, career counseling, and alcohol and other drug education programs.
 Evidence Acquisition: This paper reviews the current literature on the overtime and current (due to Covid-19 pandemic) public health needs of college students based on studies that report the commonest specific diagnostic reasons for using the on-campus health care services.
 Results: Special reference is done on mental health problems among students generally and the students of health professions fields (a specific category themselves). Besides, other issues of interest are the substance-related problems among students and their perceptions about mental health problems and on- campus help- seeking services.
 Conclusions: It is unanimous that we need further educational and promotional campaigns to enhance the students; help-seeking behaviors, reduce stigmatizing behaviors and create more preventive public health services on campus, but also out-campus due to the Covid-19 pandemic.

A systematic review of alcohol education programs for young people: do these programs change behavior?

Numerous education programs have addressed young peoples' alcohol use. To date, no peer-reviewed publication has evaluated the effectiveness of such programs delivered across a range of contexts to change alcohol-related behaviors, attitudes and/or knowledge. This systematic review aimed to identify alcohol education programs addressing young people, and determine whether they changed alcohol-related behavior, knowledge and attitudes; and, ascertain components of successful programs. Studies were identified, guided by the PRISMA review process, from the earliest records until June 2020. Included studies (N = 70) comprised an alcohol education program which focused on young people (15-24 years). Forty programs reported behavior changes, and these programs were the highest quality. Others impacted attitudes and/or knowledge only (n = 12); or reported no impacts (n = 17). Recent programs were more likely than older programs to feature online delivery and report behavior changes. To enhance alcohol education, future programs should include the identified quality criteria, alongside process and long-term outcome evaluations, to better monitor effectiveness. Findings indicated some education programs have capacity to positively change alcohol-related behavior; however, outcome consistency varied even in high-quality programs. Alcohol education programs should be designed alongside health education/promotion models and best-practice recommendations, to improve the likelihood of desirable behavior-related outcomes.

The use of immersive stories to influence college students’ attitudes and intentions related to drinking and driving

Objective College students are at risk of drinking and driving. The current study examines the use of immersive stories to prevent college students from drinking and driving. Participants 107 college students participated in the study. Methods Participants were randomly assigned to watch an immersive 360° video, which featured a story of a young female driver who caused a fatal car crash due to impaired driving, either in head-mounted displays (HMDs) or in tablets. Results The story viewed through HMDs (vs. tablets) led to lower intentions to drink and drive only among female participants. Moreover, female participants’ perceived similarity to the protagonist mediated the effect of modality on their intentions to drink and drive. Conclusions 360° video stories experienced through high immersion (via HMDs) have the potential to prevent risky behavior. It is important to consider the protagonist’s gender when adopting immersive stories in alcohol education programs on college campuses.

한국 임산부의 음주행동에 미치는 요인 분석

Objectives: Drinking alcohol during pregnancy can adversely affect the health of the pregnant woman and the fetus. Although the drinking alcohol rate of Korean women is gradually increasing, studies on the drinking alcohol rate of pregnant women during pregnancy are insufficient. In particular, few studies have been conducted on the variables that can predict drinking alcohol behavior during pregnancy. Methods: In 2017, we administered a self-report questionnaire for pregnant women less than 30 days before the due date of visiting a university hospital and a specialized hospital. We investigated the demographic and obstetric characteristics, as well as the drinking alcohol history of pregnant women. Results: The average age of 306 subjects was 33.4±4.2, and the average years of education was 15.3±1.8. In the CAGE, 17.0% responded ‘yes’ to more than two questions, and 37.6% responded if they had ever experienced a blackout or blackouts. The rate of drinking alcohol during pregnancy was 27.1%, including the period when respondents were unaware of being pregnant. And after respondents became aware of being pregnant, 7.2% experienced drinking alcohol. Significant variables explaining pregnant women who continue to drink alcohol even after knowing that they are pregnant were: the education of pregnant women (p<.001), family history of drinking alcohol (p<.05), and experiences of drinking alcohol before becoming pregnant (p<.05). Conclusion: The results of this study showed that a large number of pregnant women continued to drink alcohol during pregnancy. Thus, these results suggest that more non-drinking alcohol pregnant women should devise appropriate anti-drinking alcohol education programs for pregnant women who drink alcohol during pregnancy.

Practice-Based Teaching Model for Undergraduate Public Health Students: Partnership for Exercise Is Medicine on Campus Initiative

The practice-based teaching (PBT) pedagogical approach is vital to prepare students to learn collaboratively how to solve real-world complex public health problems. Despite evidence of the new PBT approach in graduate public health courses, little is known about the development of PBT in undergraduate public health courses. The purpose of this article is to describe an undergraduate course design using PBT, offer suggestions for using the effective PBT STEPS (Securing Partnerships, Technology and Training, Engagement and Implementation, Presenting Deliverables, Sizing Up Results) framework, and explain lessons learned. The experiences are based on 4 years of successful implementation of the PBT course project, Exercise Is Medicine on Campus (EIM-OC) initiative. The college campus is a promising setting to promote EIM-OC and physical activity awareness. Undergraduate public health students in the Health Administration of Programs course partnered with the campus Wellness, Alcohol and Violence Education Program for the fall initiative. We used the comprehensive PBT STEPS framework in planning the EIM-OC. The evaluation included the number of participants at the Chancellor Walk and activity stations and student reflective writing papers. The findings suggest the effectiveness of PBT pedagogy for faculty to redesign an existing course. Students gain a deeper understanding of campus health and health topics. Faculty can guide students and empower them for working with partners to think, act, and practice like professionals during academic preparation.

Evaluating Undergraduate Alcohol Health Literacy and Education Efficacy

This study examined the U.S. undergraduate students’ knowledge of the long-term health effects of alcohol consumption. It also examined the efficacy of alcohol education programs at informing students of health effects and influencing drinking behavior. A national online questionnaire was distributed to collect self-reported data from students. Findings indicate that student knowledge of the health risks of alcohol consumption is poor. Around half of undergraduate students are aware that alcohol is associated with some negative health effects, but far fewer are aware of alcohol’s specific health risks. Additionally, findings reaffirm that alcohol consumption and binge drinking remain common behaviors among students, and suggest that, despite widespread adoption, alcohol education programs are not very effective at reducing alcohol consumption. Most research participants reported that knowledge of negative long-term health effects of alcohol consumption was unlikely to influence their drinking behavior.

A systematic review of parent based programs to prevent or reduce alcohol consumption in adolescents

BackgroundAdolescent alcohol consumption is an issue of ongoing concern and programs targeting parents have been identified as an important component in minimizing and preventing alcohol related harm in adolescents. This paper aims to evaluate existing parent based alcohol education programs with a focus on understanding parent specific outcomes including parental attitudes, parent-child communication, alcohol specific rule setting and parental monitoring; study quality, the extent of stakeholder engagement in program design and the level of theory application.MethodA systematic review of electronic databases EBSCO, Emerald, ProQuest, PubMed, Ovid, ScienceDirect, Taylor and Francis and Web of Science was conducted from database inception to August 2019. A total of 4288 unique records were retrieved from the eight databases. Studies were included if they evaluated school based alcohol education programs that included a parent component and detailed outcome measures associated with parent data. The methodological quality of the included studies was assessed using the Effective Public Health Practice Project (EPHPP) quality assessment tool.ResultsIn total 17 studies qualified for assessment, detailing 13 individual parent programs. Of these, ten programs demonstrated positive effects in at least one parent reported outcome measure. Stakeholder engagement during the design of programs was lacking with the majority of programs. One third of the programs did not report theory use and when theory was used reporting was weak with three programs applying theory, five testing theory and none building theory. According to the EPHPP tool, overall ten programs were rated as weak, three as moderate and none as strong.ConclusionFuture studies are recommended to further enhance the effectiveness of parental programs by improving study quality, increasing stakeholder engagement and increasing the level of theory application and reporting.

The relationship between self-efficacy, readiness to change, and AUDIT risk levels in a sample of active duty emergency department patients

ABSTRACTThe purpose of this study was to test the relationship between self-efficacy, readiness to change, and Alcohol Use Disorders Identification Test (AUDIT) risk levels in a sample of active duty drinkers who were seeking care in a military emergency department. Civilian health educators screened participants for alcohol use with the AUDIT and collected sociodemographic, service, and drinking-related cognitions data from active duty patients admitted to an emergency department. A total of 787 active duty military personnel participated in the study. Almost half (48%) drank at least once a week and 32% reported consuming five or more alcoholic drinks during a typical drinking episode. One in five participants reported heavy episodic drinking weekly to almost daily. Results of a multinomial logistic regression model showed that active duty service members with a self-reported diagnosis of posttraumatic stress disorder since joining the military were more likely to be an at-risk or high/severe risk drinker relative to a low risk drinker. Higher controlled drinking self-efficacy was associated with a decrease in the odds of being either an at-risk or high/severe risk drinker. Increased readiness to reduce drinking was associated with an increase in the odds of being either an at risk or high/severe risk drinker. The results of this research suggest self-efficacy to control one’s heavy drinking as well as readiness to change may be important factors to consider when designing alcohol education programs within the military.

Examining the Role of Race and Gender as Moderators of the Relationship Between Depressive Symptoms and Hazardous Alcohol Consumption among DUI Offenders

Research consistently documents a positive association between depressive symptoms and hazardous drinking. Fewer studies have examined this relationship among high-risk populations such as Driving Under the Influence (DUI) offenders and rarely evaluate whether the association between depression and hazardous drinking varies by race and gender. We examined the relationship between depressive symptoms and hazardous drinking in a diverse sample of DUI offenders, extending previous research by examining the moderating effects of race and gender. We analyzed survey data collected from DUI offenders (N = 10,082) enrolled in the 2012 Mississippi Alcohol and Safety Education Program. We estimated a series of nested regression models to assess the relationship between depressive symptoms and hazardous drinking. The analyses also assessed the extent to which the hypothesized association between depression symptomology and hazardous drinking varied by race and gender. We documented a positive association between depressive symptoms and hazardous drinking among DUI offenders. The association between depressive symptoms and hazardous drinking was stronger for black offenders relative to white. We found no significant differences by gender. The incorporation of culturally specific needs of DUI offenders may help intervention efforts more efficiently reduce negative consequences associated with impaired driving.

Sexual Assault Prevention for Heavy Drinking College Men: Development and Feasibility of an Integrated Approach.

Despite the prevalence of sexual assault on college campuses, few interventions aimed at decreasing college men's proclivity to perpetrate sexual aggression have been developed and tested. This article details the theoretical framework, content, and piloting of a sexual assault prevention program for college men who engage in heavy drinking, a high-risk group who may be particularly well positioned to intervene as proactive bystanders in drinking environments. In an open trial, male facilitators delivered the three-session Sexual Assault and Alcohol Feedback and Education (SAFE) program to 25 heavy drinking college men. Session 1 was a 90-min review of personalized normative feedback regarding alcohol use, sexual activity, alcohol-related sexual consequences, understanding of consent, and engagement in bystander intervention, delivered individually in a motivational interviewing style. Session 2 was a 2½-hr group-based sexual assault prevention workshop focusing on social norms, empathy, masculinity, consent, and bystander intervention. Session 3 was a 90-min booster group session that reviewed previous topics and included the active practice of bystander intervention skills. Analyses of postsession assessments of utility, therapeutic alliance, and satisfaction and examination of alcohol use and sexual assault-related outcomes from baseline to the 2-month assessment support the preliminary feasibility and acceptability of the SAFE program.

The Impact of Serious Educational Gameplay on Adolescent Binge Drinking Intentions: A Theoretically Grounded Empirical Examination.

Game On: Know Alcohol, a school-based alcohol education program, aimed to educate adolescents on the harmful effects of (excessive) alcohol consumption. The program included two user-centered serious educational games, Perfect Pour and Dumb Driver. To evaluate the objective effect of playing Perfect Pour and Dumb Driver on the key psychosocial determinants of adolescent binge drinking intentions in the context of the theory of reasoned action (TRA). Data were drawn from four Game On: Know Alcohol program schools ( N = 303 adolescents aged 14-16 years), and two TRA models incorporating four game metrics were analyzed using structural equation modeling. The theoretically guided TRA models linked to gameplay data explained 66% of variance in adolescents' binge drinking intentions. Average game duration and average score of Perfect Pour were significantly associated with adolescents' attitudes toward binge drinking, whereas no objective effect on the key psychosocial determinants was observed for Dumb Driver. Inconclusive findings suggest that further research is needed to fully understand how serious educational games may be designed to effectively influence adolescents' binge drinking intentions. Opportunities to extend theory application beyond evaluation are noted in addition to other opportunities for future research.

University Students' Willingness to Assist Fellow Students Who Experience Alcohol-Related Facial Flushing to Reduce Their Drinking.

This study explored bystanders’ willingness to help a friend who flushes when drinking to reduce his/her drinking. Alcohol-related facial flushing is an indicator of an inherited variant enzyme, aldehyde dehydrogenase (ALDH), that impairs alcohol metabolism and increases drinkers’ lifetime risk of certain aerodigestive cancers. Individuals who flush should reduce their alcohol exposure, but they may continue to drink if social pressures and rules of etiquette make not drinking socially risky. The analysis used data from 2912 undergraduate students from 13 universities in southwestern, central and northeastern China from a survey asking how they respond to someone’s flushing in various scenarios. Latent class analysis grouped students by similar responses to flushing. A multinomial logistic regression explored how class membership was associated with knowledge, drinking status, and reactions to one’s own flushing. Five classes were derived from the latent class analysis, ranging from always intervene to mostly hesitate to help; in between were classes of students who were willing to help in some scenarios and hesitant in other scenarios. Only 11.6% students knew the connection between facial flushing and impaired alcohol metabolism, and knowledgeable students were somewhat more likely to assist when they saw someone flushing. In the absence of knowledge, other factors—such as drinking status, the gender of the bystander, the gender of the person who flushed, and degree of friendship with the person who flushed—determined how willing a person was to help someone reduce or stop drinking. Class membership was predicted by knowledge, gender, drinking status, and reactions to one’s own flushing. Of these 4 factors, knowledge and reactions to one’s own flushing could be influenced through alcohol education programs. It will take some time for alcohol education to catch up to and change social and cultural patterns of drinking. Meanwhile, motivational strategies should be developed to increase the willingness of bystanders to assist friends and to create a social expectation that flushers should stop or reduce their drinking.