Responses to the Four Articles
Surveys of student alcohol and other drug use allow researchers to assess usage patterns over time and thus serve an important role within college drug prevention programs. The number of institutions conducting such surveys has increased recently. Nevertheless, major problems exist regarding survey conceptualization, development, implementation, and data interpretation. Most reviews of the literature examining collegiate substance use have called attention to these problems, which include difficulties in defining abuse, lack of standardized instruments, and problems related to sample selection and data collection (Anker, Milman, Kahan & Valenti 1971; Berkowitz & Perkins 1986; Brennan, Walfish & AuBuchon 1986; Saltz & Elandt 1986).
This section reviews surveys that assess alcohol and other drug use for counseling, educational, and evaluational purposes and recommends that they be based on relevant theoretical frameworks. Recent attempts to standardize survey instruments and procedures to administer them are presented. Such instruments include the Core Alcohol and Drug Survey developed and used by Drug Prevention Programs in Higher Education's Grantees and the Centers for Disease Control's (CDC) Youth Risk Behavior Survey. A review is given of the literature on alcohol and other drug use among college populations. In addition, an appendix is included that contains sample questionnaire items that are based on theory. These provide information that can be used in prevention programs. Although the section emphasizes alcohol use (as does the literature), relevant studies are presented regarding other drug use. The administration of survey questionnaires and the analysis of survey data are not discussed.
Overview of Existing Research
Although much is known about college students' alcohol and other drug abuse patterns, a brief overview of the available literature suggests that there are several gaps where new information is needed. In addition, substantial variation exists in sampling procedures, instrumentation, problem definition, methodology, and data analysis. These issues are discussed to establish the need for more comprehensive, standardized instrumentation that could be used to develop a national data base assessing collegiate use and abuse patterns.
Alcohol
Student use and abuse of alcohol has been studied extensively, and a number of important literature reviews summarize what is known about this topic (Berkowitz & Perkins 1986; Berkowitz & Perkins 1987a; Brennan et al. 1986; Saltz & Elandt 1986). Alcohol is clearly the drug of choice on college campuses. Over 90 percent of college students report regular consumption, averaging two to four drinks per occasion a few times weekly, and most studies suggest that approximately 20-25 percent of students have drinking problems (Berkowitz & Perkins 1986). Use patterns and problem incidence vary considerably with respect to gender, family history of alcoholism and other patterns, religious orientation, and racial and ethnic background.
The literature reflects a variety of sampling approaches for assessing alcohol use and abuse, including single or multiple campus studies at one point in time; multiple studies of a single campus over time (Meilman, Stone, Gaylor & Turco 1990; Perkins 1992; Temple 1986); or national studies using large, representative samples at multiple points in time (Engs 1977; Engs & Hanson, 1985; Johnston, O'Malley & Bachman 1989; Presley & Meilman 1991). Wechsler and McFadden's study (1979) of students at 34 New England colleges provides one of the most comprehensive discussions of alcohol use problems and patterns at one point in time, and the Institute for Social Science Research's Monitoring the Future project provides excellent data tracking a representative national sample over an extended time period (Johnston et al. 1989). Although most studies cited here use random selection techniques to ensure a representative sample of students, the literature is replete with surveys using extremely unrepresentative convenience samples (such as students in introductory courses or alcohol education workshops), from which it is almost impossible to generalize. Another approach has been to conduct repeated surveys of college administrators assessing their perceptions of student use patterns and problems as well as surveys of available campus resources (Anderson & Gadaleto 1984; Gadaleto & Anderson 1986).
In addition to this variability in sampling approaches, substantial differences exist across studies in instrumentation, problem definition, methodology, and data analysis that prevent detailed comparisons from being made across studies. As a result, many researchers have called for the development of standardized instrumentation that can be used with all sampling approaches. Standardized instrumentation would also allow data from different studies to be aggregated and for meta-analyses to be conducted.
Other Drug Use
Although illicit drug use has been studied extensively among pre-college adolescents and among college students in the early 1960s and early 1970s, few recent studies exist on college populations. (In contrast, hundreds of studies have been published on alcohol use and abuse.) Available research has focused on overall prevalence rates without attempting to define abuse or examine motivations, negative consequences, and other correlates. These studies suggest that illicit drug use increased dramatically from the mid-1960s through the mid-1970s, eventually decreasing in the 1980s (Meilman, Gaylor, Turco & Stone 1990). The Monitoring the Future project (Johnston, O'Malley & Bachman 1989) provides the most comprehensive dataset available on illicit drug abuse. In 1988, 37 percent of college students reported using an illicit drug within the past year, with dramatic decreases in all illicit drug categories since 1980, when 57 percent of students reported such use within the past year. These decreasing use patterns were documented for both men and women. Meilman, Gaylor, Turco & Stone (1990) reported similar decreases in illicit drug use in their study of a single campus over a 10-year period.
In general, the available studies on illicit (i.e., illegal) drug use among college students focus on prevalence statistics and provide a much less detailed picture of student use patterns and problems than is available for alcohol. The research literature on such drug use among college students is also extremely dated. The few recent studies are difficult to compare and suffer from many of the methodological problems noted above with respect to research on alcohol. The fact that students may be less willing to report their illegal drug use than their alcohol use may explain the lack of information on this topic. Studies of illicit drug use thus require particular attention to the development of methods of administering surveys that ensure anonymity and confidentiality.
Gaps in the Literature
Despite the overwhelming amount of information available on college students' alcohol use and on some aspects of other drug use, there are substantial gaps and problems with the available literature. These include a lack of information on ethnic minorities, nontraditional students, and high-risk groups; divergent definitions of abuse; and a lack of theoretical sophistication in models of abuse and in the development of appropriate questionnaires and methods of data analysis to test them.
Special Populations
Very little is known about the use and abuse patterns of nontraditional students and ethnic minorities in college. Surveys and data analyses are often conducted in such a way as to overlook or obscure gender differences as well, although men and women continue to demonstrate different patterns of alcohol (Berkowitz & Perkins 1987a; Perkins 1992) and other drug use (Johnston, O'Malley & Bachman 1989). Except for adult children of alcoholics, little is known about other high-risk groups. Because such populations may differ in their substance use and related problems, it is not appropriate to apply globally derived prevention strategies and outcome goals to them.
Our knowledge base on other drug use among college students is even more deficient in these areas. More basic knowledge is needed about the predisposing motivations and negative consequences of illicit drug use and about the prevalence of polydrug use/abuse. Although substantial and theoretically sophisticated literature exists on the correlates and developmental pathways leading to illicit drug abuse among teenagers, it is not clear to what extent this literature is generallly applied to college students. Finally, very little research has been conducted on the effects of polydrug use, although such use has become increasingly common.
Nonusers
Information on the correlates of abstinence or reduced use has been overlooked in most studies, despite the increasing numbers of students who are currently choosing to reduce or eliminate drug use and despite the importance of understanding how such decisions are made. One way to obtain such information is to incorporate into surveys items that assess the extent to which students have reduced or discontinued use. The percentage of students who have reduced or discontinued use can be determined by including survey questions assessing whether or not students have ever used alcohol and other drugs. Answers to such questions provide a baseline from which the number of students who are current users can be subtracted, yielding the number of students who have discontinued use. Similarly, questions asking individuals to compare their current use with last year's use can provide estimates of individuals who have increased or decreased consumption. The relationship of abstinence, discontinuance, or changes-in- use patterns could then be assessed in relation to relevant demographic factors and other variables-such as motivation for and consequences of use. Obviously, a better understanding of the factors associated with abstinence and decreased use would have extremely important applications to the design and implementation of more effective drug prevention programs.
Definitional Problems
Researchers and practitioners often fail to agree on what constitutes abuse. In a recent comprehensive review of the literature on this topic, we noted that alcohol abuse has been variously defined in terms of the following: excessive consumption, frequent intoxication, self-identification as a problem drinker, frequent expressions of concern from others, negative or escapist motivations for drinking, and negative consequences resulting from use (Berkowitz & Perkins 1986). In a study incorporating these measures into a single survey instrument, 71 percent of the students surveyed met the criteria for one of the six problem drinking measures, although only 3 percent met the criteria for all six (Perkins & Berkowitz 1985). We concluded that problem drinking may take a variety of forms and is not a unidimensional phenomenon that can be assessed with a single measure or composite scale. We also noted that some definitions developed for adult populations may be too broad or inclusive for young adults in college. In general, most studies have used idiosyncratic or simplistic definitions of abuse or have failed to define it at all.
The literature on illicit drug use is much less confusing because most researchers have equated any use of these drugs with abuse. However, a number of well-conducted longitudinal studies suggest that many teenagers who experiment with illicit drugs do not necessarily abuse them (Newcomb & Bentler 1988) and that those who do experiment do not necessarily have more problems than peers who abstain or develop patterns of abuse (Shedler & Block 1990). A variety of definitions taking into account quantity and frequency of use, motivations for use, and negative consequences of use should be developed for other drugs to parallel information available in the research literature on alcohol.
Because there is little consensus within the research and scholarly literature on how to define abuse, those designing surveys need to exercise judgment in selecting a definition that meets the needs of their program and that is broad enough to capture the majority of abusers. It is advisable to incorporate more than a single definition into drug surveys and to consider the usefulness of this information for outreach and informational purposes.
Theoretically Based Surveys
In general, most surveys are developed outside of any theoretical framework for understanding collegiate substance abuse, and data have been analyzed using simplistic comparisons between variables. This stands in marked contrast to the literature on illicit drug use among pre-college adolescents, where a number of researchers have developed theoretically sophisticated models examining the initiation and development of use and abuse patterns (Jessor & Jessor 1977; Kandel, 1980; Newcomb & Bentler, 1988). Such research can be studied to provide models that can guide the development of surveys and programmatic strategies within college and university settings.
The importance of theory to the design of survey questionnaires and the development of effective program strategies should not be overlooked. Rather, the relationship of theory, assessment, and practice should be seen as mutually interdependent. Any approach to assessment and practice should incorporate relevant theory, and what is learned from surveys and effective prevention programs should, in turn, be applied to these theories to modify and adapt them. The literature examining peer influences on substance use provides an excellent example of how theory can be applied to the process of survey design for college populations.
A number of well-developed theoretical frameworks have attempted to articulate the mechanisms by which these peer influences and peer perceptions operate (Gonzalez 1989; Jessor & Jessor 1977; Oetting & Beauvais 1986). The perceived or actual use patterns of peers, especially close friends, has been repeatedly demonstrated to have more impact on young adults than personality and environmental influences and other demographic and background factors such as ethnicity, religious background, parental use patterns, and gender. Examples from this literature can be used to demonstrate how theoretical issues can be translated into survey items and then used to develop effective intervention strategies.
Gonzalez (1989) noted the importance of students' perceptions of the environment on drug use, as articulated within the health belief model. On our own campus, we have documented the role of students' misperceptions of their peers' attitudes and use patterns (Perkins & Berkowitz 1986b) and suggested ways for such information to be incorporated into prevention programming (Berkowitz & Perkins 1987b). The existence of such misperceptions has now been documented on a variety of campuses nationwide and has provided the basis for a number of innovative prevention strategies (Berkowitz, Haines & Perkins 1991; Hansen & Graham 1991) and research studies (Baer, Stacy & Larimer 1991; Prentice & Miller 1993). Questions that assess the extent of peer misperceptions, the amount and nature of "peer pressure" experienced by students, and the extent to which students are bothered by others' use can be readily incorporated into survey instruments.
Finally, developmental approaches to substance use stress the importance of critical transition periods when use may increase dramatically (Zucker & Noll 1982). In the college environment, a number of studies have documented dramatic increases in alcohol and other drug use during the first year of college (Perkins & Berkowitz 1986a; Newcomb & Bentler 1987). Questions designed to assess such changes can provide valuable information that may be incorporated into outreach activities.
Information collected from surveys documenting student misperceptions, misinformation, and responsible attitudes about use can serve as effective prevention tools when presented in the campus media or in outreach programs. Such information can help students with more responsible attitudes about drug use realize that they are actually the majority on campus. Strategies that provide such information can be used to empower the "silent majority" of responsible users to be more assertive about confronting the use and abuse patterns of peers.
Summary
To address these gaps, surveys need to incorporate questions assessing use patterns, motivations, negative consequences, and other correlates of both alcohol and other drug use, as well as obtaining demographic information on ethnicity and risk factors such as familial abuse. Questionnaire items should be included that represent a variety of different definitions of abuse and assess the factors associated with a decision to abstain or reduce use. Finally, more attention should be given to the relationship of theory to assessment and programming by developing questionnaires incorporating theoretically derived items that provide information relevant to specific prevention activities.
Alternate Applications of Alcohol and Other Drug Surveys
Alcohol and other drug surveys are most frequently conducted to provide descriptive information regarding patterns of student use and to evaluate changes and trends over time. Other uses of surveys, such as to support clinical and educational programs, are frequently overlooked. Yet surveys designed with these purposes in mind can provide valuable data for use in counseling settings and in the design and delivery of outreach programs (Perkins & Berkowitz 1986a; Berkowitz & Perkins 1987b). Such surveys incorporate questions derived from a particular theoretical perspective on substance use, such as peer influence theories, and utilize this information to affect the attitudes, perceptions, and behaviors that contribute to substance use and abuse. Well-designed surveys can also serve the evaluation process by providing more fine-grained analyses of the relative impact of program interventions on a variety of constituencies.
Counseling Applications
Survey results can be helpful to clinicians who provide individual and group counseling for students with personal, family, or friend-related problems. Counselors working with students from these groups can refer to campus statistics regarding the numbers of students affected. Such information can help a student normalize her or his experience, breaking down denial and the sense that no one else has the same problem. Similar information can be used to advertise support groups or broaden the discussions in such groups. Students who feel they are the only responsible users on a campus that they perceive as promoting irresponsible use are often relieved to find that such perceptions are often inaccurate and exaggerated. Thus, information generated from surveys can be used in counseling settings to provide students with a basis for reality testing in their experiences of peer pressures and in comparing their own or family drinking problems with those of student peers.
Educational Program Uses
The integration of research on student attitudes, behaviors, and perceptions about drug use into educational programs provides direct, ongoing feedback to students about their own behavior. Such information can be integrated into symposia, classes, and media presentations and can be used to create outreach programs tailored to the specific needs and use patterns of different campus groups. A review of the prevention literature suggests that such specifically targeted programs are more effective than generic programs directed toward the larger student body (Berkowitz 1990).
Information derived from carefully designed surveys can be used to correct misperceptions students have about campus use and abuse patterns. Such misperceptions have been shown to impact on students' own substance use (Perkins & Berkowitz 1986b; Prentice & Miller 1993; Baer, Stacy & Larimer 1991) and have been documented nationally in a variety of campus settings. Aggregate responses to questions that assess students' attitudes toward drug use and their perceptions of the attitudes of others (friends, living unit members, or the campus as a whole) can reveal the existence of these misperceptions and can be integrated into outreach programs to correct them (Berkowitz & Perkins 1986; Berkowitz & Perkins 1987b).
The extent to which students are knowledgeable about the risks associated with different substances has been correlated with use patterns in many of studies (Bachman, Johnston, O'Malley & Humphreys 1988; Gonzalez & Haney 1990). Information on these risks and the extent to which students on campus perceive drug use to be problematic is another way in which survey results can be incorporated into outreach and prevention activities potentially to change drug use patterns.
Using Surveys for Evaluation Purposes
The process of evaluating alcohol and other drug programs has been thoroughly discussed and reviewed elsewhere (French, Fisher & Costa 1983; Greenfield, 1989; Hawkins & Nederhood, 1987). Most evaluation efforts focus on changes within the student body, such as overall, campuswide reductions in the frequency and quantity of drug use and the negative consequences of such use. This approach provides little information about the relative effectiveness of different program interventions and the extent to which these interventions may impact different program activities in the course of the academic year (Berkowitz & Perkins 1987b). This lack of comprehensiveness in program evaluation methodologies may partly explain why most efforts to summarize the conclusions of outcome studies report little or no change in high school and/or college student behavior as a result of drug prevention programs (Braucht & Braucht 1984; Goodstadt & Caleekal-John 1984; Moskowitz 1989; Oblander 1984). This problem can be addressed by including survey questions assessing the extent to which respondents are aware of or have participated in program activities. Data analysis can then examine the relationship between program participation and changes in drug use behaviors within the campus as a whole and for specific subpopulations.
Trends Toward Standardization
Currently, efforts are being made at the national level to work toward standardization of survey instruments. As a result, practitioners now have access to a few carefully developed questionnaires and uniform methods of administration and data analysis that address some of the problems reviewed. These resources are briefly summarized below.
FIPSE Grantee Developed Core Instrument and Users Manual
In 1986 Congress passed the Drug-Free Schools and Communities Act, providing federal funding for drug prevention programs in primary, secondary, and postsecondary settings. Since then, hundreds of institutions of higher education have received funding for drug prevention activities through the Fund for the Improvement of Postsecondary Education (FIPSE). Under the auspices of FIPSE, a standardized instrument assessing alcohol and other drug use has been developed that is available to all FIPSE grantees as well as to other institutions of higher education. An Instrument Selection Committee with membership from seven representative institutions developed this questionnaire, which was designed to be compatible with other national data bases, such as the Monitoring the Future project and the Centers for Disease Control's Youth Risk Behavior Survey. For a small fee, users can purchase machine-scoreable questionnaires that are completed and sent to a central data processing center for analysis and comparison with the data from similar institutions. This project has tremendous potential for providing a national data base on substance use among college students at institutions of higher education. Such a data base could have aggregate samples large enough to assess the use patterns of understudied groups as well as to follow long-term trends and developments. To date, approximately 500,000 questionnaires have been scored and analyzed for over 800 funded institutions. The data are being aggregated on a number of variables to establish national and regional norms for alcohol and other drug use measures by class year, school type, and school size (Presley, Meilman 1991; Presley, Meilman & Lyerla 1993).
The Core Alcohol and Drug Survey User's Manual that accompanies the questionnaire reviews sampling procedures, methods of survey administration, and techniques for ensuring a high response rate (Presley, Harrold, Scouten, Lyerla & Meilman 1993). It provides a good introduction to survey administration procedures that can be used with or without the FIPSE questionnaire itself.
The usefulness of the Core Instrument is constrained by its brief length (it has only 23 questions, of which 11 are demographic) and by its complicated item ranges. The Core Instrument Committee is currently developing an optional second page supplement which will give users the option of an expanded instrument. On smaller campuses, for example, there may be insufficient numbers of nontraditional and ethnic minority students to justify asking all of the 11 questions assessing student demographics. Given their small numbers within certain campus environments, students from these groups may feel that their anonymity is compromised by being asked for so much detail about themselves. These limitations can be overcome on campuses where this is a concern by using a fewer number of the Core Instrument's demographic items and by incorporating questions from the instrument into longer surveys designed to assess a wider range of drug-related variables.
Overall, the Core Instrument provides an excellent resource for individuals who need a short questionnaire, but who do not have the support services or expertise required to score questionnaires and analyze their own data. An additional advantage is that the Core Instrument can be used to compare individual campuses with national and regional norms for similar types of schools. The most recent revision of the Core Instrument allows individual campuses to include additional questions of their own choice in addition to the standardized Core Instrument questions, thus creating some degree of flexibility for individual campus programs. (Information on the availability of the Core Instrument can be obtained from the Core Institute, Student Health Programs, Kesnar Hall, Southern Illinois University, Wellness Center, Southern Illinois University, Carbondale, Illinois 62901; phone (618) 453-4366.)
Youth Risk Behavior Survey
The CDC has recently released a survey designed to monitor youth and young adult health behaviors and practices. However, as of November 1993 they have not collected any data. The Youth Risk Behavior Survey (YRBS) was developed by a panel of experts in conjunction with 19 federal agencies and 16 local departments of education. It includes a set of core questions for a number of health risk behaviors including alcohol and other drug use, as well as tobacco use, sexual behaviors, diet, intentional and unintentional injuries, and physical activity. (The entire instrument is available directly from the Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Division of Adolescent and School Health, Bldg-3, Room B-15, A-14, Atlanta, GA 30333.)
Data collected with this instrument will help provide national profiles of comprehensive health risk behaviors. The questionnaire was initially developed for use with high school students but has been adapted for college students by a consortium of college and universities. The college form of the YRBS is called the YRBS-C. A limitation on this instrument is that it only assesses actual drug use behavior and not motivations, consequences, or other related variables. The core alcohol and drug questions from the Youth Risk Behavior Survey can be incorporated into a larger instrument assessing a broader range of variables. Information on the YRBS-C can be obtained from the Centers for Disease Control.
The YRBS will be used to help monitor progress toward Healthy People 2000 and toward the National Health Objectives for the Year 2000. Healthy People 2000 is a broad-based federal initiative to improve the health of all Americans over the next decade. The National Health Objectives for the Year 2000, which were released in September 1990, set measurable goals for the nation to achieve by 2000 in a variety of health-related areas-including use of alcohol and other drugs and related health behaviors (DHHS 1991). These objectives include specific goals for minority and underserved populations that reflect the needs and current health status of these groups when they are different from the majority population. A task force of the American College Health Association has participated extensively in the planning process to ensure that the final Health Objectives reflect the health needs and issues of college students (Guyton et al. 1989) and will be undertaking pilot studies using the YRBS-C on representative campuses. The objectives will be used as criteria in the awarding of many federal grants and may influence the direction of health promotion and disease prevention efforts in this country during the 1990s. Because of the importance of the Health Objectives, surveys of collegiate alcohol and other drug use would benefit from incorporating questions compatible with the Youth Risk Behavior Survey items.
Summary and Recommendations
The college drug prevention field is currently in a position to make major advances in the areas of assessment, research, and evaluation. Following a decade of research conducted with highly idiosyncratic survey instruments and methodologies, significant advances have been made toward developing standardized assessment instruments and methods of administration. The FIPSE Core Instrument and the Youth Risk Behavior Survey provide standardized formats for asking questions about alcohol and other drugs. Methods of survey administration can now be standardized, as well, by using the FIPSE Users Manual. When information collected through these surveys is centralized, it will be possible to analyze and evaluate prevalence and incidence rates, trends, and use patterns of special populations and high-risk groups on a national scale. In addition, data generated through standardized instruments will provide a basis for comparison with pre-college youth and peers of the same age who are not in college.
The design and administration of surveys for assessment purposes is best seen as an ongoing process involving awareness of program goals and strategies, current theories and knowledge, and methods for evaluating and providing feedback about current use patterns and eventual program results. The process begins with the identification of program goals and intervention strategies that incorporate or apply current knowledge and theories about drug use. This is followed by step-by- step descriptions of program goals and by the development of questionnaire items that can provide relevant information. In this way, the value of surveys in providing needs assessments, program evaluations, and information that can be used in outreach and counseling efforts is maximized.
The following summary highlights points to be considered in developing survey instruments:
In summary, the lack of standardization among survey instruments used to assess drug use and abuse among college students has created numerous problems for both practitioners and researchers. The lack of standardization has made it extremely difficult to compare data across studies. Two recent efforts toward the development of standardized instrumentation may help to solve this problem and provide access to large datasets tracking use patterns over time. As the Youth Risk Behavior Survey and the FIPSE Core Instrument differ, researchers and practitioners now have the opportunity to choose from two carefully developed instruments.
Checklist on Assessment
A. FIPSE Pre/Post Core Instrument
B. Example survey items assessing peer influence variables
C. Example evaluation questionnaire
D. Healthy People 2000 Fact Sheet
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The Influence of College Environments on Student Drinking
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