Prevention of Alcohol Consumption Among Youth

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Table of Contents

Introduction and Rationale
Literature Review
Methodology
Theory Constructs and Intervention Components
Intervention
Measurement Tools
Measurement Plan
Operational Plan
Study Strengths and Limitations
Works Cited

Introduction and Rationale

Globally, alcohol consumption is a big health risk. According to Birech et al. (137), it is the third biggest health risk and among the leading causes of high morbidity and mortality rates in developing countries. Indeed, the chronic intake, or long-term intake of alcohol, leads to serious health complications such as liver disease, mental health problems, and permanent head damage (National Institute on Alcohol Abuse and Alcoholism 5). To affirm this finding, studies done in the United Kingdom (UK) have shown that liver complication is the fifth largest cause of death in the country (Birech et al. 137). In fact, researchers estimate that it accounts for more than 15,000 deaths in the country, annually (National Institute on Alcohol Abuse and Alcoholism 5).

Associated socioeconomic effects of excessive, or irresponsible, alcohol consumption have also led to the increase of socioeconomic ills such as crime, sexual abuse, road accidents, and the likes (Grønbæk 407; Birech et al. 137). The British Crimes Survey reinforces the association between crime, injury, and alcohol by reporting that more than 76,000 incidences of facial injuries were associated with alcohol consumption (Birech et al. 137). Studies that have investigated the relationship between excessive alcohol consumption and mortality rates have also established that 26% of deaths among 16-24 year olds are because of irresponsible drinking (Grønbæk 407).

According to Birech et al. (137), the per capita consumption of alcohol in the US is more than 1.9 gallons. This statistic is equivalent to about two-thirds of an ounce of alcohol every day. Demographic differences explain how people consume this much alcohol. For example, studies conducted in Europe (the United Kingdom and Scandinavia in particular) have shown that there is a higher percentage of males who consume alcohol (75%) compared to their female counterparts (56%) (Birech et al. 137). Relative to these findings, health researchers have highlighted a growing problem of poor lifestyle choices among young people (Collins and Carey 498). In detail, there has been a lot of concern among different health groups regarding the increased incidences of smoking, irresponsible sexual practices, and alcoholism among the youth (Grønbæk 407).

Often, many public health campaigns have focused on addressing smoking and irresponsible sexual behaviors among the youth. Comparatively, there have been limited attempts to address alcoholism, which is a serious, and growing problem among this demographic. The seriousness of the health problem stems from the fact that alcoholism among the youth has become part of a young and growing culture among many American students who see it as a “part-time activity” (Collins, Witkiewitz, and Larimer 322). For example, in many colleges around the country, undergraduate students engage in binge drinking, not because it is beneficial to them, but because it is what they do to “pass time” and have fun.

To support the above observation, O’malley and Johnston (23) conducted a study to evaluate drinking practices in Michigan by reviewing 68 surveys, which showed that the rate of alcohol consumption among college students has significantly increased since the Second World War (and continues to do so today). The same phenomenon is highlighted in the book Drinking in College by Straus and Bacon (cited in O’malley and Johnston 23). Therefore, we could say that most students now see binge drinking in college as a “social norm.” Despite the existence of no health benefits associated with the practice and its multiple health problems, few health stakeholders have treated alcoholism among the youth with the seriousness it deserves.

Since most alcoholics and adults started drinking around their high school days or during their college years, this proposal intends to target undergraduate students as the main audience for a public health campaign to prevent alcohol abuse among the population called “Stop the Madness.” The goal is to prevent students from inculcating excessive alcohol consumption as part of their lifestyle during their younger years. The justification for doing so stems from the realization that many people start taking alcohol during their youth and continue the same habit throughout their entire lives. Therefore, addressing alcoholism among the population during their undergraduate years could amount to a concerted effort to addressing the larger health issue of alcoholism in America.

Using the theory of planned behavior would help to realize this goal because it focuses on changing people’s lifestyle habits – which is at the core of our analysis. More importantly, this theory would help us to communicate the message that young people do not need to partake in alcohol consumption to feel accepted. We presume that this strategy would be effective in solving alcoholism among the general population because it is easier to change the mindset of young people compared to older persons because the latter is hard-wired not to change their lifestyle. Therefore, changing the communication/message surrounding alcohol consumption among young people during their undergraduate years could have a significant impact on their future behavior change.

Literature Review

Different researchers have used different models to explain human behaviors associated with alcohol consumption (O’malley and Johnston 23). However, the theory of planned behavior emerges as the most commonly used model to explain this relationship. Proposed by Icek Ajzen, the theory of planned behavior explains human behavior by presupposing that the most important attribute to consider in understanding human behavior is the intention to partake in the behavior in the first place (Bilic 243). Using this analogy, the theory of planned behavior identifies three main factors to consider when understanding human behavior – attitude, subjective norms, and perceived behavioral controls (Javadi et al. 52-53).

Proponents of the theory see perceived behavioral controls as a combination of the limits that people experience when wanting to do something and the belief that they would be able to do it (O’malley and Johnston 23). When using the ideas of Ajzen, this relationship is represented by the combination of the perceptions of external barriers and self-efficacy (Javadi et al. 52-53). Proponents of the theory also point out that perceived behavioral control can accurately predict behavior if it correctly represents the actual control over behavioral performance (Collins and Carey 498).

In a study to investigate how the theory of planned behavior explains patterns of alcohol consumption, O’malley and Johnston (23) conducted a meta-analysis of 40 studies that analyzed alcohol consumption by investigating gender differences in alcohol consumption and age of participants. From the study, they found that people’s attitudes had the greatest effect on their alcohol consumption patterns (O’malley and Johnston 23). The researchers also highlighted the importance of understanding the importance of self-efficacy and intention in evaluating the patterns of alcohol consumption among the youth. Self-efficacy was found to have a strong relationship with intention, while intention was found to have a strong relationship with alcohol consumption as opposed to self-efficacy (O’malley and Johnston 23).

All these moderating effects were found to have a strong relationship with different components of the theory of planned behavior. More importantly, patterns of consumption that were more elaborate and clearly defined had the strongest relationships with the theory of planned behavior (O’malley and Johnston 23). The researchers also found that females reported a stronger effect of attitudes and relations when it came to understanding their effects of alcohol consumption (O’malley and Johnston 23). Comparatively, adults had a stronger attitude-intention relations and self efficacy-intention relations compared to adolescents (O’malley and Johnston 23). Nonetheless, these studies showed how well the theory of planned behavior could explain the different patterns of alcohol consumption among different demographics and identify the specific aspects of people’s intuition, thoughts, and beliefs affected their consumption of alcohol (Collins, Witkiewitz and Larimer 322).

Meta-analytic reviews that have investigated different applications of the theory of planned behavior in health sciences affirm that it is useful and reliable in predicting people’s intentions and behaviors for many health-related conditions (Collins and Carey 498). For example, Cooke et al. (149) reviewed more than 200 studies that used the theory to predict health-related behaviors and found that the model was reliable to use in predicting alcohol consumption patterns. The researchers also found that the theory used intention and perceived behavioral control to explain 19% of health-related problems (Cooke et al. 149). They also found that subjective norms and perceived behavioral controls could explain 44% of variance in intention (Cooke et al. 149).

Some observers have also documented different instances where health experts have used the model to analyze individual health-related behaviors (Collins and Carey 498). For example, numerous studies have highlighted different instances where health stakeholders have applied the theory to explain people’s physical activities (Collins, Witkiewitz and Larimer 322). Similar studies have used the theory of planned behavior to explain people’s smoking habits (Birech et al. 137). Here, studies that have investigated the relationship between the theory and smoking have established weak relationships between the theory’s variables and the habit (Birech et al. 137). For example, Cooke et al. (149) say there have been weak, or negative, relationships between smoking and PBC–intention and PBC–behavior relationships. Based on this observation, experts acknowledge that the outcome of investigations that have used the theory of planned behavior to explain behaviors that are beneficial to health and those that are not beneficial to health may be different (Collins, Witkiewitz and Larimer 322). The difference is mostly attributed to PBC.

The main point to note in understanding this relationship is the need to emphasize a lack of control that is often associated with certain health risks. This emphasis is particularly useful in evaluating human behavior that is sustained by some demographics, but that may be deemed socially undesirable (Grønbæk 407). For example, peer pressure may explain why some young people continue to engage in harmful lifestyle habits despite having knowledge that doing so would be harmful to their health (Grønbæk 407). Based on this understanding, some observers emphasize the need to explain some human behaviors by referring to external causes that may affect them in the first place (Cooke et al. 149).

By linking beliefs and behavior, the theory of planned behavior proposes that subjective norms, beliefs, and perceived behavioral control all contribute towards explaining why people do the things they do (Collins and Carey 498). Broadly, these underlying factors demonstrate that people do the things they do because of their beliefs. Although we intend to use this theory in a health context, other researchers have used it in different fields, including marketing, public relations, and advertising (among others) (Collins and Carey 498).

Although different reviews have used the theory of planned behavior to explain patterns of alcohol consumption among different demographics, most of their findings have had unique limitations. For example, some studies have failed to disassociate alcohol consumption from the use of other drugs and substances. Illustratively, a study by Collins, Witkiewitz and Larimer (322) used the theory of planned behavior to explain alcohol consumption patterns but failed to disassociate the behavior with substance abuse and smoking. A second limitation is the limited number of studies that have uniquely used the theory of planned behavior to explain alcohol consumption. For example, O’malley and Johnston (23) found only five studies that applied the theory of planned behavior to alcohol consumption. Lastly, another limitation that characterizes these studies is the presence of reviews that have obscured different episodes of alcohol consumption, such as episodic drinking, binge drinking, and abstinence. The failure to recognize the differences in alcohol consumption patterns has obscured differences in the prediction of the different patterns of alcohol consumption.

Based on the above limitations, the proposed health campaign intends to fill the research gaps for three reasons. The first one is to identify the unique constructs of the theory of planned behavior which best explain alcohol consumption patterns among the youth (some constructs of the theory of planned behavior, such as PBC, have been found to have a weak predictor of alcohol consumption patterns) (Javadi et al. 52-53). The second reason is to establish the true impact of PBC in predicting alcohol consumption patterns, especially because different research studies have shown a weak ability of PBC to estimate alcohol consumption patterns (Javadi et al. 52-53). This debate has been further compounded by the fact that researchers have used different measures to identify PBC. The last reason for undertaking this study is to establish the main moderators of alcohol consumption, such as the frequency of drinking and gender, which may explain alcohol consumption patterns among the youth.

Methodology

For purposes of developing our public health campaign, we will engage a qualitative design of the health issue because the structure of the public health campaign is to appeal to people’s subjective beliefs and attitudes towards alcohol consumption. The initiative would borrow from the principles of Östlund et al. (369), which strive to seek a subjective meaning of a study phenomenon. This health promotion strategy would be useful in appealing to the underlying motivation, opinions, and reasons for why young people engage in alcohol consumption and why they should stop it (McKibbon and Gadd 1-3). To develop an effective marketing campaign, we intend to use different tenets of the theory of planned behavior to design the public health campaign. The following section of this proposal outlines the plan of doing so.

Theory Constructs and Intervention Components

As highlighted in the literature review section of this proposal, the theory of planned behavior has unique tenets that underlie its application. We will use these unique tenets to develop a robust public health campaign that would use the following aspects of the theory of planned behavior to guide its design.

Normative beliefs and Subjective Norms

Understanding people’s normative beliefs and subjective norms is a key component of the theory of planned behavior. We will use this attribute of the theory to explain patterns of alcohol consumption among the target population. To understand how we would apply these specific tenets to the research problem, it is pertinent to understand the distinction between normative beliefs and subjective norms. Normative beliefs are those that influence an individual’s perception of social, or normative, pressures (Javadi et al. 52-53). Stated differently, these beliefs would dictate how people’s opinions about alcohol consumption would affect the behavior of the target group towards the same. Subjective norms would define how people consume alcohol, based on the beliefs and practices of people who are close to them, such as their spouses, friends, or family members (Collins and Carey 498). Generally, we will appeal to how these two sets of beliefs influence alcohol consumption patterns among the target group.

Control Beliefs and PBC

This section of our design would mostly focus on investigating how different factors would either support or hinder, the consumption of alcohol among the target population. This aspect of our analysis is mostly related to understanding the influence of self-efficacy in explaining alcohol consumption patterns. The concept of perceived behavioral control would help us understand an individual’s perceived ease, or difficulty, of consuming alcohol. Most researchers have related this attribute of the theory of planned behavior with the need to assess a total set of accessible control beliefs (Collins and Carey 498).

Behavioral intention and Behavior

Intention is a key concept of the theory of planned behavior, which we have consistently mentioned in the literature review section of this proposal. Broadly, it refers to a person’s readiness to undertake a specific action. Some people term it as an antecedent of behavior, but most researchers deem it as a basis for appealing to a person’s attitude towards a behavior (Collins and Carey 499). In this regard, it constitutes people’s subjective norms and perceived behavioral controls. Each of these factors is a predictor of human behavior and holds different weights. The concept of behavior (in isolation) refers to the observation of an individual’s response regarding a particular behavior intended to achieve a specific target. Proponents of the theory of planned behavior who contend that behavior is a function of compatible intentions propagate this view (Collins, Witkiewitz and Larimer 322). They also contend that perceived behavioral controls are bound to moderate the effect of intention on behavior. Using this analogy, we will use the effects of behavioral intention and behavior on the patterns of alcohol consumption among young people to design the campaign. This would be a key tenet of our design.

Intervention

There are different types of interventions to use in public health campaigns. For purposes of this paper, these interventions refer to the mechanisms for delivering the program content. There would be two types of interventions used – posters and radio messaging. The goal is to reach as many people as possible. The campaign would be aired on-campus radio to sensitize people about the negative effects of alcohol because this form of media reaches a wide audience of students as most of them listen to the radio. Print media would be available to double down on the same message. It is preferable because it has a reinforcing effect on the messaging in the sense that many students would be seeing it all the time.

Measurement Tools

This section of the proposal outlines the plans for operationalizing the health program and measuring its efficacy. The measurement plan appears below.

Measurement Plan

To evaluate the performance of the health program, we would conduct an interview with a random sample of the student population. In such interactions, we would look for terms such as “I am sure I can,” I am confident I will” and such like terms to explain the students’ commitment towards stopping alcohol abuse. The point of doing so is to measure the confidence towards the probability of executing the behavior under investigation. To measure social influence on the behavior of the respondents, we would look at unique statements that show the respondents transferring the reason for engaging in alcohol consumption to other people. For example, we would look for statements, such as “most of my friends drink,” “I am uncomfortable drinking in front of people who do not drink,” “In my family, we all drink” and such like statements. Again, these statements would show the respondents’ vulnerability to social influence and they would indicate the failure of the health program. Therefore, the students’ response would play a big role in reviewing the efficacy of the public health campaign.

Operational Plan

The operational plan would hinge on investigating the alcohol consumption patterns among the student population by comparing it against different measures of the theory of planned behavior. The different measures would be perceived behavior control vs. self-efficacy, attitude towards behavior vs. outcome expectancy, and social influence. We discuss these measures below.

Perceived Behavior Control vs. Self-Efficacy

In this section of our analysis, we would investigate the perceptions of the students regarding their views of behavior control and self-efficacy towards alcohol consumption. Some of the issues we would seek to understand in this section of analysis would be how well the respondents think they could stop drinking, whether they crave for it and whether it would be easy, or difficult, to stop the habit.

Attitude towards behavior vs. Outcome Expectancy

In this part of the conceptual framework, we will investigate how people’s beliefs translate to the subjective reality of their actions. In other words, we will explore how people’s expectations translate to value, in terms of the actions they pursue.

Social Influence

In this section of the conceptual framework, we would explore how much of young people’s decisions to drink stems from the expectations of their friends, family members, or their colleagues.

Study Strengths and Limitations

Strengths

The main strength of this paper is the reliance on a proven theoretical underpinning of evaluating human behavior – theory of planned behavior. This theoretical framework has unique merits that would help in the comprehension of the research issue and in the holistic review of a common social and health issue among young people – alcohol abuse.

Limitations

The main limitation of this study is the limited demographic profile of the study group. The target group would mostly be undergraduate students aged between 16 – 25 years. This means that the findings of this study would mostly relate to young people within this age group. Lastly, because of resource constraints, the findings of this study would be limited to only one campus. Therefore, it may be difficult to extrapolate the findings of this paper to other campuses that do not share the same socio-political dynamics as the target group.

Works Cited

Bilic, Bojan. “The Theory of Planned Behavior and Health behaviors: Critical Analysis of Methodological and Theoretical Issues.” Hellenic Journal of Psychology 2.1 (2005): 243-259. Print.

Birech, Jeniffer, Kabiru Joseph, Misaro Josphine & Kariuki David. “Alcohol Abuse and the Family: A Case Study of the Nandi Community of Kenya.” International Journal of Humanities and Social Science 3.15 (2013): 137-144. Print.

Collins, Susan and Carey Kate. “The Theory of Planned Behavior as a Model of Heavy Episodic Drinking Among College Students.” Psychol Addict Behav. 21.4 (2007): 498–507. Print.

Collins, Susan, Witkiewitz Katie and Larimer Mary. “The Theory of Planned Behavior as a Predictor of Growth in Risky College Drinking.” J Stud Alcohol Drugs 72.2 (2011): 322–332. Print.

Cooke, Richard, Dahdah Mary, Norman Paul and French David. “How well does the Theory of Planned Behavior Predict Alcohol Consumption? A Systematic Review and Meta-Analysis.” Health Psychology Review 10.2 (2016): 148-167. Print.

Grønbæk, Morten. “The Positive and Negative Health Effects of Alcohol- and The Public Health Implications.” Journal of Internal Medicine 265 (2009): 407–420. Print.

Javadi, Marzieh, Kadkhodaee Maryam, Yaghoubi Maryam, Maroufi Maryam and Shams Asadollah. “Applying Theory of Planned Behavior in Predicting of Patient Safety.” Behaviors of Nurses Mater Sociomed 25.1 (2013): 52–55. Print.

McKibbon, Kathleen and Gadd Cynthia. “A Quantitative Analysis of Qualitative Studies In Clinical Journals For The 2000 Publishing Year.” Bmc Med Inform Decis Mak 4.11(2004): 1-8. Print.

National Institute on Alcohol Abuse and Alcoholism. “Health Risks and Benefits of Alcohol Consumption.” Alcohol Research & Health 24.1 (2000): 5-11. Print.

O’malley, Patrick and Johnston Lloyd. “Epidemiology of Alcohol and Other Drug Use among American College Students.” Journal of Studies on Alcohol / Supplement 14.1 (2002): 23-39. Print.

Östlund, Ulrika, Kidd Lisa, Wengström Yvonne and Rowa-Dewar Neneh. “Combining qualitative and quantitative research within mixed method research designs: A methodological review.” International Journal of Nursing Studies 48.3 (2011): 369-383. Print.

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