PREVENTION OF ALCOHOL-RELATED PROBLEMS AMONG COLLEGE STUDENTS Release Date: November 25, 1998 RFA: AA-99-001 P.T. National Institute on Alcohol Abuse and Alcoholism SAMHSA Center for Substance Abuse Prevention Department of Education Letter of Intent Receipt Date: February 23, 1999 Application Receipt Date: March 23, 1999 PURPOSE The National Institute on Alcohol Abuse and Alcoholism (NIAAA), in conjunction with the Department of Education (DOE) and the Center for Substance Abuse Prevention (CSAP), seeks grant applications to conduct intervention-oriented research that will ultimately lead to the reduction of alcohol-related problems among college students. Alcohol abuse among college students, many of whom are under the minimum legal drinking age, is a major health problem on college campuses with serious negative consequences for individual drinkers, those around them, and the college environment. National surveys have consistently found that the prevalence of periodic heavy or high-risk drinking, as indicated by self-reports of consuming five or more drinks on a single occasion (so called "binge" drinking), is greatest among young adults compared to all other age groups, and among young adults, college students have the highest prevalence of high-risk drinking. (Gfroerer et al., 1997, Johnston et al., 1997) The purpose of this Request for Applications (RFA) is to encourage research that develops and/or tests interventions that have the potential of preventing or reducing alcohol abuse and associated problems among college students. These prevention strategies may focus on the larger normative or cultural environment in which drinking occurs or on drinkers as individuals or groups of persons engaged in hazardous drinking behavior. The interventions may include campus or community policies that are initiated and implemented by persons or systems that are completely independent of the research endeavor ("natural experiments"), or they may be initiated by the research team in cooperation with a college or university. HEALTHY PEOPLE 2000 The Public Health Service (PHS) is committed to achieving the health promotion and disease prevention objectives of "Healthy People 2000," a PHS-led activity for setting priority areas. This RFA, Prevention of Alcohol-Related Problems Among College Students, is related to the priority area of alcohol abuse reduction and alcoholism prevention. Potential applicants may obtain a copy of "Healthy People 2000" (Full Report: Stock No. 170-011-00474-0 or Summary Report: Stock No. 017-001-00473-1) through the Superintendent of Documents, Government Printing Office, Washington, DC 20402-9325 (telephone 202-512-1800). ELIGIBILITY REQUIREMENTS Applications may be submitted by domestic and foreign, for-profit and non-profit organizations, public and private, such as universities, colleges, hospitals, laboratories, units of State and local governments, and eligible agencies of the Federal Government. Racial/ethnic minority individuals, women, and persons with disabilities are encouraged to apply as Principal Investigators. MECHANISM OF SUPPORT Research support may be obtained through applications for a research project grant (R01). Investigators who wish to submit a new application that requests $500,000 or more for direct costs in any year must obtain written approval from the NIAAA prior to submitting the application. Applicants also may submit Investigator-Initiated Interactive Research Project Grants (IRPG) under this RFA. Interactive Research Project Grants require the coordinated submission of related regular research project grant applications (R01s) from investigators who wish to collaborate on research but do not require extensive shared physical resources. These applications must share a common theme and describe the objectives and scientific importance of the interchange of, for example, ideas, data, and materials among the collaborating investigators. A minimum of two independent investigators with related research objectives may submit concurrent, collaborative, cross-referenced individual R01 applications. Applications may be from one or several institutions. Further information on the IRPG mechanism is available in program announcement PA-96-001, NIH Guide for Grants and Contracts, Vol. 24, No. 35, October 6, 1995, and from the NIAAA program staff listed under INQUIRIES. FUNDS AVAILABLE Up to $3 million in total costs will be available for the first year of awards under this RFA. It is anticipated that four to eight awards will be made under this RFA in FY 1999. This level of support is dependent on receipt of applications of high scientific merit. The usual policies governing grants administration and management, including facilities and administrative costs, will apply. Funding beyond the first and subsequent years of the grant will be contingent upon satisfactory progress during the preceding years and availability of funds. The earliest possible award date is September 30, 1999. RESEARCH OBJECTIVES Background A 1993 national survey of students at 140 colleges (Wechsler et al., 1994) found that almost half (44 percent) of the respondents had engaged in "binge" drinking over the last two weeks (defined for men as consuming five or more drinks in a single setting and for women as consuming four or more drinks) and that 19 percent of the respondents frequently engaged in such behavior. Moreover, the study showed a strong, positive relationship between the frequency of "binge" drinking and a variety of other alcohol-related problems: failing to use protection when having sexual intercourse, engaging in unplanned sexual intercourse, getting into trouble with campus police, damaging property, drinking and driving, and getting hurt or injured. These data also indicated that the majority of students who do not engage in "binge" drinking still experience adverse consequences or "secondary binge effects" from the drunken behavior of others. These ranged in seriousness from nuisances, such as having studying interrupted or having to "baby sit" a drunk student, to assault and rape. On campuses where "binge" drinking is more prevalent, non-"binge" drinkers are more likely to experience such secondary effects. (Wechsler et al., 1995) In response to increased public and private concern about campus alcohol problems, administrators and education, health, and public safety officials are seeking guidance in developing policies and programs that will prevent and reduce student "binge" drinking. Unfortunately, there is relatively little research specifically focused on preventive interventions in college settings, and existing campus efforts to reduce abusive drinking have not had benefit of a body of rigorously tested interventions from which to draw. In response to this need for guidance in developing college alcohol policies, the Department of Education has taken leadership in disseminating information on "model" programs through its support of the Higher Education Center for Alcohol and Other Drug Prevention. These programs are based on theory, consensus of experts, and practical experience. However, resources have not been available to rigorously assess their effectiveness, and scientifically grounded research in this area is urgently needed. Environmental factors underlying high-risk drinking by college students. There is strong evidence that environmental factors play a major role in promoting and supporting excessive drinking. Campuses differ in the amount of "binge" drinking that takes place, and although there may be some self-selection at work students already intent on heavy drinking deliberately selecting "party schools" - it is clear that campus norms shape the drinking practices of individual students. Lower levels of "binge" drinking are found among students attending "commuter" colleges where the majority of students live off-campus. (Chaloupka and Wechsler, 1996) Students who live at home drink less than those who live in dorms or apartments, and students who live alone drink less than those with roommates (Gfroerer et al., 1997). Identification of environmental factors that predict campus-wide differences in alcohol use and "binge" drinking could provide strong direction for intervention development, but there have been few scientific studies of this nature. In one exception, data from the 1993 campus drinking survey by Wechsler and colleagues were analyzed in conjunction with other campus and State-level information (Chaloupka and Wechsler, 1996). The investigators found that alcohol availability, as indicated by the number of outlets within one mile of campus and the presence of a bar on campus, correlated positively with levels of drinking and "binge" drinking on campus. Analogously, an index of the restrictiveness of State drunk driving laws targeting youth and young adults was inversely related to measures of drinking, especially among males. It has been argued that the demonstrated effectiveness of some environmental interventions in the general population (e.g., reduced alcohol availability, increased enforcement of drunk driving laws, lowered blood alcohol limits (zero tolerance) for minors is an indication of their potential to reduce college alcohol problems (Hingson et al., 1997), and the findings from this study support that view. Many studies find that fraternity and sorority members drink more frequently and consume more alcohol than do their non-Greek peers, and that members of the Greek system accept as normal high levels of alcohol consumption and associated problems (Baer, 1994). The effects on student drinking from high-risk alcohol use norms within the Greek system appear to extend well beyond membership, and the mere presence of at least one fraternity or sorority is associated with higher campus-wide levels of drinking and "binge" drinking (Chaloupka and Wechsler, 1996). Individual factors underlying high-risk drinking. Although research on interventions to reduce college alcohol problems is limited, there have been studies that describe student alcohol use practices, and a number of correlates and predictors of episodic heavy or "binge" drinking by college students have been identified. Many of these, such as individual characteristic variables that students "bring with them" when they arrive on campus, are not subject to manipulation, or they are not causal. Nevertheless, they can serve as markers of risk to identify individuals or groups for whom more intensive intervention may be appropriate, and those with strong predictive ability should be controlled in the evaluation of intervention outcomes. Demographic variables and previous drinking experience are prime examples. High-risk drinking is more prevalent among white students than African American or Asian students, but race and ethnicity do not "cause" drinking problems. Interventions Research is encouraged on the development and testing of interventions that will lead to significant reductions in the incidence and prevalence of alcohol problems on college campuses by preventing and reducing high-risk and abusive drinking among college students. The ultimate goal of all alcohol-problem preventive interventions is to prevent underage drinking and influence individual and group behavior regarding alcohol use in ways that reduce risks to drinkers and those around them. Environmental interventions seek to achieve this goal by changing external contingencies that promote or inhibit drinking, or the cost- risk-benefit matrix within which drinking decisions are made. For example, reductions in the availability of alcohol increase the amount of effort (i.e., cost) necessary to obtain alcohol, enforcement of drunk driving laws increases the risk associated with drinking and driving, and alcohol-free activities provide alternative ways to achieve the benefit of socializing with peers. In contrast, individual-focused interventions affect drinking behavior by influencing the knowledge, attitudes, and skills of the individual. These approaches often focus on increasing awareness and understanding of risks associated with heavy or "binge" drinking, developing refusal skills, or providing more realistic perceptions of attitudes toward drinking held by peers (reducing perceived drinking benefit). While individuals" understanding of costs and potential consequences associated with high risk drinking, as well as their behavioral skills, may be increased, the "real world" external contingencies associated with drinking are not directly changed by these interventions. Under this RFA, environmental interventions will be emphasized. These may involve changes in campus or community policies and practices to directly address factors contributing to abusive drinking, such as reductions in alcohol availability and increased sanctions against alcohol misuse, or they may involve changes in campus systems or structures to promote non-drinking norms. Examples of environmental interventions include: o Community-level policies that reduce alcohol availability to students, such as restricting hours of operation of alcohol beverage outlets, providing server training, and enforcing laws against sales to underage individuals, o Community-level policies related to sanctions against alcohol misuse, such as changes in the enforcement of laws against DUI, and in the disposition of alcohol-related misdemeanors, e.g., vandalism, fighting, noise, and public drunkenness, o Campus disciplinary responses to alcohol-related rule infraction offenses, including parental notification regarding alcohol-related infractions, Provision of alcohol-free environments, such as "dry" dorms which students may self-select or "dry" campuses, o Restrictions on alcohol availability on campus and at college sponsored events, including responsible beverage service at campus-sponsored events, and Restrictions on alcohol promotion, such as ads in student newspapers and event sponsorship. Although interventions should address the overall incidence and prevalence of college alcohol problems, applicants are not restricted to testing interventions that are directed toward the entire campus population (i.e., universal prevention approaches). Selective interventions, which are delivered to specific populations known to be at higher than average risk, and indicated interventions, delivered to individuals or groups who have exhibited signs of abusive and risky drinking, may also be tested. However, selective and indicated interventions must be justified on the basis of their potential effects on campus-wide alcohol- related problems. That is, can it be reasonably argued that a reduction in alcohol misuse, including "binge" drinking, within the target group will affect overall campus norms or the incidence of serious alcohol-related problems? Examples of selective and indicated preventive interventions include: Interventions directed to campus groups with known high-rates of alcohol misuse, such as fraternities and sororities or athletes, Interventions directed to specific environments where alcohol misuse often takes place, such as dorms, stadium parking lots, or parties, and Interventions for students screened for risk and found to be in need of more intensive preventive intervention than that provided for the general student population. Individual-focused interventions are not excluded, but their rationale should address cost of delivery, feasibility for large scale delivery, and their expected effects on recipients and overall campus drinking norms. Resource- intensive intervention approaches are expected to yield larger effects on direct recipients than less intense interventions, and applications should include a plan for maximizing campus-wide benefit through delivery to selected or indicated populations. The per capita cost for implementation of universal intervention approaches should be much lower. Examples of individual-focused interventions include: o Promoting parental involvement in communicating non-drinking and non-"binge" drinking policies and standards to incoming students, o Motivational interviewing or brief counseling for problem drinkers, Normative feedback to promote realistic perception of drinking by other students, and o Other information-based approaches. College settings provide unique opportunities to reach at-risk populations, and applicants are encouraged to make use of campus or community organizations and systems to increase the efficiency of their intervention efforts. Both environmental and individual-focused interventions may effectively incorporate features of college systems in their intervention strategies. Examples include: o Integration of alcohol prevention material into academic curricula, Use of student health services for screening and intervention delivery to problem drinkers, o Collaborative agreements with campus and community police departments through which alcohol-related infractions are reported to an appropriate administrative office for disciplinary action and/or intervention referral, and o Social marketing approaches utilizing campus media (e.g., student newspapers, campus radio stations, e-mail, etc.). Multi-component interventions that combine several environmental and/or individual-focused interventions may be tested. For example, social marketing and media campaigns might be combined with the institution of new policies or changes in enforcement of existing policies. Individual-focused interventions might combine universal, selective, and indicated components. Study Designs and Methods Tests of interventions must employ sound experimental designs or, when justified, quasi-experimental designs. Both within-campus and multi-campus designs will be considered. Although random assignment to condition is preferred, it is recognized that this is not always possible, especially when comparisons are being made across campuses or among naturally occurring groups within campuses (e.g., dorms, fraternities). Some groups may self-select for intervention by initiating alcohol problem reduction activities independently of the investigator (natural experiments) or groups recruited by an investigator may be unwilling to agree to randomization. In these cases, comparison groups must be selected. Careful attention should be paid to ensure equivalency between intervention and comparison groups, which may require matching. Outcome measures must include alcohol-related behaviors or events. Examples include incidence or prevalence of drinking, high-risk drinking, alcohol-related public disturbances, vandalism, accidents, violence, date rape, emergency room admissions, arrests, and car crashes. Cognitive or attitudinal changes may be of interest as indicators of mediation processes, but are not sufficient indicators of outcome. Careful attention must be paid to the identification of outcome measures that are valid, reliable, and sensitive to change. This may be problematic for campus-wide or community indicators of alcohol problems that have a low baseline frequency and/or may not be reported consistently (e.g., assaults, car crashes, accidents). Measurement of outcome variables may be especially challenging for evaluations of policy effects or campus-wide initiatives, especially in the case of "natural experiments" when investigators may not have sufficient lead time to collect their own baseline data. Archival data may be used, but unless their scientific quality can be assured, additional outcome measures will be needed. The use of pre-existing survey databases is another possibility, provided appropriate sampling techniques have been used. Measurement of the independent variables (interventions) can be problematic when naturally occurring or program-driven interventions are being evaluated (e.g., policy changes, multi-component campus-wide activities, coalitions). In these cases the program actually delivered what really takes place on the campus may differ considerably from the formal program plan. Similarly, program implementation may follow a very different time line than that represented in the program plan and formal status reports. The collection of retrospective data and the use of key informants are possible approaches to this problem. Feasibility And Methods Development Studies. Research focused solely on describing college drinking practices, identifying risk and protective factors, and developing models of the etiology of drinking problems will not be supported under this RFA. However, it is recognized that in some cases the existing knowledge base may not support implementation and evaluation of full scale prevention trials. In these cases feasibility and methods development studies will be considered, but they must be specifically linked to potential intervention approaches and should be presented within the context of planned intervention efforts. Such studies may appear as an initial development phase in a larger intervention study, or they may be submitted as small separate studies. In the latter case, no more than two years of funding should be requested, and the applicants should indicate plans and capacity for conducting subsequent intervention research. Collaborations. The proliferation of campus efforts to reduce abusive drinking is an indicator of the pressing need for research-based programs with demonstrated effectiveness. Often program planners do not have technical or material resources needed for state-of-the-art scientific evaluations, and social and behavioral scientists may not have access to administrative channels needed for university-wide cooperation or to resource networks important for program development, implementation, evaluation, and dissemination. Thus, collaborations among program planners, educators, and researchers are encouraged. Where appropriate, collaborations between or among campuses are also encouraged. INCLUSION OF WOMEN AND MINORITIES IN RESEARCH INVOLVING HUMAN SUBJECTS It is the policy of the NIH that women and members of minority groups and their subpopulations must be included in all NIH supported biomedical and behavioral research projects involving human subjects, unless a clear and compelling rationale and justification is provided that inclusion is inappropriate with respect to the health of the subjects or the purpose of the research. This policy results from the NIH Revitalization Act of 1993 (Section 492B of Public Law 103-43). All investigators proposing research involving human subjects should read the "NIH Guidelines For Inclusion of Women and Minorities as Subjects in Clinical Research," which have been published in the Federal Register of March 28, 1994 (FR 59 14508-14513) and in the NIH Guide for Grants and Contracts, Volume 23, Number 11, March 18, 1994. Investigators also may obtain copies of the policy from the program staff listed under INQUIRIES. Program staff may also provide additional relevant information concerning the policy. INCLUSION OF CHILDREN AS PARTICIPANTS IN RESEARCH INVOLVING HUMAN SUBJECTS It is the policy of NIH that children (i.e., individuals under the age of 21) must be included in all human subjects research, conducted or supported by the NIH, unless there are scientific and ethical reasons not to include them. This policy applies to all initial (Type 1) applications submitted for receipt dates after October 1, 1998. All investigators proposing research involving human subjects should read the "NIH Policy and Guidelines on the Inclusion of Children as Participants in Research Involving Human Subjects" that was published in the NIH Guide for Grants and Contracts, March 6, 1998, and is available at the following URL address: http://grants.nih.gov/grants/guide/notice-files/not98-024.html LETTER OF INTENT Prospective applicants are asked to submit, by February 23, 1999, a letter of intent that includes a descriptive title of the proposed research, the name, address, and telephone number of the Principal Investigator, the identities of other key personnel and participating institutions, and the number and title of the RFA in response to which the application may be submitted. Although a letter of intent is not required, is not binding, and does not enter into the review of a subsequent application, the information that it contains allows NIAAA staff to estimate the potential review workload and to avoid conflict of interest in the review. The letter of intent is to be sent to: Office of Scientific Affairs National Institute on Alcohol Abuse and Alcoholism 6000 Executive Boulevard, Room 409, MSC 7003 Bethesda, MD 20892-7003 Telephone: (301) 443-4375 FAX: (301) 443-6077 APPLICATION PROCEDURES The research grant application form PHS 398 (rev. 4/98) is to be used in applying for these grants. These forms are available at most institutional offices of sponsored research and from the Division of Extramural Outreach and Information, National Institutes of Health, 6701 Rockledge Drive, MSC 7910, Bethesda, MD 20892-7910, telephone 301/710-0267, Email: grantinfo@nih.gov. The RFA label available in the PHS 398 (rev. 4/98) application form must be affixed to the bottom of the face page of the application. Failure to use this label could result in delayed processing of the application such that it may not reach the review committee in time for review. In addition, the RFA title and number must be typed on line 2 of the face page of the application form and the YES box must be marked. Page limits and limits on size of type are strictly enforced. Non-conforming applications will be returned without being reviewed. Submit a signed, typewritten original of the application, including the checklist and three signed photo copies in one package to: CENTER FOR SCIENTIFIC REVIEW NATIONAL INSTITUTES OF HEALTH 6701 ROCKLEDGE DRIVE, ROOM 1040 - MSC 7710 BETHESDA, MD 20892-7710 BETHESDA, MD 20817 (for express/courier service) At the time of submission, two additional copies of the application must also be sent to: Office of Scientific Affairs National Institute on Alcohol Abuse and Alcoholism 6000 Executive Boulevard, Room 409, MSC 7003 Bethesda, MD 20892-7003 Rockville, MD 20852 (for express/courier service) Applications must be received by March 23, 1999. If an application is received after that date, it will be returned to the applicant without review. REVIEW CONSIDERATIONS Upon receipt, applications will be reviewed for completeness by the Center for Scientific Review (CSR) and for responsiveness by the NIAAA. Incomplete applications will be returned to the applicant without further consideration. If the application is not responsive to the RFA, CSR staff may contact the applicant to determine whether to return the application to the applicant or submit it for review in competition with unsolicited applications at the next review cycle. Applications that are complete and responsive to the RFA will be evaluated for scientific and technical merit by an appropriate peer review group convened by the NIAAA in accordance with the review criteria stated below. As part of the initial merit review, a process will be used by the initial review group in which applications receive a written critique and undergo a process in which only those applications deemed to a have the highest scientific merit, generally the top half of the applications under review, will be discussed, assigned a priority score, and receive a second level review by the National Advisory Council on Alcohol Abuse and Alcoholism. Review Criteria The goals of NIH-supported research are to advance our understanding of biological systems, improve the control of disease, and enhance health. In the written comments, reviewers will be asked to discuss the following aspects of the application in order to judge the likelihood that the proposed research will have a substantial impact on the pursuit of these goals. Each of these criteria will be addressed and considered in assigning the overall score, weighting them as appropriate for each application. Note that the application does not need to be strong in all categories to be judged likely to have major scientific impact and thus deserve a high priority score. For example, an investigator may propose to carry out important work that by its nature is not innovative but is essential to move a field forward. Significance: Does the study address the goals of the RFA? If the aims of the study are achieved, how will scientific knowledge be advanced? Will the study advance the concepts or methods that drive this field? Approach: Are the conceptual framework, design, methods, and analyses adequately developed, well-integrated, and appropriate to the aims of the project? Does the applicant acknowledge potential problem areas and consider alternative designs? Feasibility: Can the design be implemented (including recruitment of subjects, cooperation of relevant organizations, and/or collection of necessary data)? Innovation: Does the project employ novel concepts, approaches, theories, or methods? Investigator: Are the principal investigator and key research personnel appropriately trained and well suited to carry out this work? Environment: Does the scientific environment in which the work will be done contribute to the probability of success? Does the proposed research take advantage of the unique features of the scientific environment or employ useful collaborative arrangements? Is there evidence of institutional support? Budget: Is the requested budget and estimation of time to completion of the study appropriate for the proposed research? In addition, plans for the recruitment and retention of subjects will be evaluated as well as the adequacy of plans to include both genders and minorities and their subgroups and children as appropriate for the scientific goals of the research. The initial review group will also examine the provisions for the protection of human subjects and the safety of the research environment. AWARD CRITERIA Applications recommended for approval by the National Advisory Council on Alcohol Abuse and Alcoholism will be considered for funding on the basis of the overall scientific and technical merit of the proposal as determined by peer review, NIAAA programmatic needs and balance, and the availability of funds. INQUIRIES Inquiries concerning this RFA are encouraged. The opportunity to clarify any issues or questions from potential applicants is welcome. Direct inquiries regarding applications under this RFA to: Gayle M. Boyd, Ph.D. Division of Clinical and Prevention Research National Institute on Alcohol Abuse and Alcoholism 6000 Executive Boulevard MSC 7003 Bethesda, MD 20892-7003 Telephone: (301) 443-8766 FAX: (301) 443-8774 Email: gboyd@willco.niaaa.nih.gov Lavona Grow Safe and Drug-Free Schools Program Office of Elementary and Secondary Education 1250 Maryland Avenue, S.W., Suite 604 Washington, DC 20202-6123 Telephone: (202) 708-4850 FAX: (202) 260-7767 Email: Lavona_Grow@ed.gov Barbara D. Wagner Office of Policy and Planning Center for Substance Abuse Prevention 5600 Fishers Lane, Rockwall II, Room 920 Rockville, MD 20857 Telephone: (301) 443-2325 FAX: (301) 443-9140 Email: bwagner@samhsa.gov Direct inquiries regarding fiscal matters to: Linda Hilley Grants Management Branch National Institute on Alcohol Abuse and Alcoholism 6000 Executive Boulevard MSC 7003 Bethesda, MD 20892-7003 Telephone: (301) 443-0915 FAX: (301) 443-3891 Email: lhilley@willco.niaaa.nih.gov AUTHORITY AND REGULATIONS This program is described in the Catalog of Federal Domestic Assistance, No. 93.273. Awards are made under the authorization of the Public Health Service Act, Sections 301 and 464H, and administered under the PHS policies and Federal Regulations at Title 42 CFR Part 52 and 45 CFR Part 74. This program is not subject to the intergovernmental review requirements of Executive Order 12372 or Health Systems Agency Review. The PHS strongly encourages all grant recipients to provide a smoke-free workplace and promote the non-use of all tobacco products. In addition, Public Law 103-227, the Pro-Children Act of 1994, prohibits smoking in certain facilities (or in some cases, any portion of a facility) in which regular or routine education, library, day care, health care or early childhood development services are provided to children. This is consistent with the PHS mission to protect and advance the physical and mental health of the American people. References Baer, J.S. (1994) Effects of college residence on perceived norms for alcohol consumption: An examination of the first year in college. Psych Addict. Behav., 8 (1), 43-50. Chaloupka, F.J. and Wechsler, H. (1996) Binge drinking in college: The impact of price, availability, and alcohol control policies. Contemporary Economic Policy, 14 (4), 112-124. Geller, E.S., Kalsher, M. & Clarke, S.W. (1991) Beer versus mixed-drink consumption at fraternity parties: A time and place for low-alcohol alternatives. JSA, 52 (3), 197-204. Gfroerer, J.C., Greenblatt, J.C. & Wright, D.A. (1997) Substance use in the US college-age population: Differences according to educational status and living arrangement. AJPH, 87, 62-65. Hingson, R., Berson, J. and Dowley, K. (1997) Interventions to reduce college student drinking and related health and social problems. In Plant, M., Single, E., and Stockwell, T. (eds.) Alcohol: Minimising the Harm, What Works? New York: Free Association Books. Johnston, L.D., O"Malley, P.M., & Bachman, J.G. (1997) National survey results on drug use from the Monitoring the Future Study, 1975-1995, Vol.2, College students and young adults. USDHHS, NIDA, NIH Pub. No. 98-4140. Wechsler, H., Davenport, A., Dowdall, G. Moeykens, B., & Castillo, S. (1994) Health and behavioral consequences of binge drinking in college. JAMA, 272 (21), 1672-1677. Wechsler, H., Moeykens, B., Davenport, A., Castillo, S., & Hansen, J. (1995) The adverse impact of heavy episodic drinking on other college students. JSA, 56 (6), 628-634.

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