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College Alcohol Risk Assessment Guide Environmental Approaches to Prevention Barbara E. Ryan / Tom Colthurst / Lance Stars, PhD The Higher Education Center for Alcohol and Other Drug Prevention Education Development Center, Inc. 55 Chapel Street Newton, MA 02158 - 1060 Tel: 800 676 - 1730 In cooperation with Alcohol, Tobacco, and Other Drug Studies UCSD Extension, University of California, San Diego This publication was supported by a grant from the U. S. Department of Education, Fund for the Improvement of Post-Secondary Education (FIPSE).

Acknowledgments We wish to thank the individuals listed below for reviewing draft manuscripts for this publication. We appreciate the comments they provided to help the authors assure that this Guide has a solid scientific foundation and contains clear messages. To the extent that we achieved that goal, the credit is theirs. To the extent that we didnt, the fault is ours. William DeJong, PhD, lecturer, Harvard School of Public Health. James H.

Evans, MS, assistant professor of behavioral sciences and chair, Chemical Dependency Program, San Diego City College. Louis Gliksman, PhD, scientist and acting director, Social Evaluation and Research Department, Addiction Foundation, London, Ontario, Canada. Thomas Griffin, MSW, division director, Health Promotion Resources, St. Paul, MN. Latina M.

Grow, director of dissemination competition, FIPSE, Drug Prevention Programs in Higher Education, U. S. Department of Education, Washington, DC. Harold D. Holder, PhD, director, Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley.

Karen Hughes, MPH, associate director, the Trauma Foundation at San Francisco General Hospital. Michelle Johnston, MPH, campus organizer, University of California, San Diego. Chris Locate, PhD, project director, California College Health 2000, San Diego State University. Special thanks go to members of the San Diego Area Intercollegiate Consortium for the Prevention of Alcohol and Other Drug Problems and to participants in project focus groups who provided valuable insight and direction for the development of this Guide. U.

S. Department of Education This guide is a publication of the Higher Education Center for Alcohol and Other Drug Prevention funded by the U. S. Department of Education, under contract No.

SS 95013001. Views expressed are those of the contractor. No official support or endorsement by the U. S. Department of Education is intended or should be inferred. The University of California, San Diego, first published the CARA in 1994, with support from the U.

S. Department of Education Fund for the Improvement of Postsecondary Education. The Higher Education Center for Alcohol and Other Drug Prevention subsequently engaged the same authorship team to update the publication, hence this Second Edition, 1997. Layout Design: J. Lane Designs Production: The Higher Education Center College Alcohol Risk Assessment Guide Environmental Approaches to Prevention 4 Introduction 11 Problem-Oriented Prevention 13 Scanning 19 Analysis 25 Response 43 Assessment 49 Let Students Have a Say in Prevention Appendices A: Scanning Exercises B: Analysis Exercises C: Selected Publications and Resources D: About the Authors Introduction The College Alcohol Risk Assessment Guide will help you identify and modify risks that contribute to alcohol-related problems within college and university communities. The Guide describes methods and exercises you can follow to gather and organize information about alcohol use and associated adverse consequences at institutions of higher education and within surrounding communities.

Despite general agreement among campus officials and students alike that alcohol use contributes to a range of problems confronting colleges and universities, prevention often does not command a high priority for students, faculty, and staff. Making the case for prevention can be frustrating work, posing the challenge of getting people to understand why problems occur and how they can make a difference. The Guide can help you meet that challenge. Its four goals are to: help you gather information on the extent of problems related to alcohol use at your college or university; help you understand and describe environmental factors within your campus community that promote or discourage high-risk alcohol use; assist you in organizing information on alcohol-related problems in an intelligible way, so that you can articulate concerns and generate a prevention support network at your college; prepare you for work in reducing alcohol-related problems by identifying possible issues that can stimulate prevention efforts.

What Is Prevention? This Guide focuses on alcohol problem prevention, defined as the avoidance of problems (the 5 Ds) related to alcohol use, such as social Disruption including lost academic opportunities injury, property Damage, Disability and physical Disorder, and premature Death. Although problems related to the use of illicit drugs continue to challenge colleges and universities, alcohol has long been the drug of choice among college students, who drink at higher rates than their non college counterparts. (1) Over 40 percent of college students-and half of the males report binge drinking (consuming five or more drinks on a single occasion) within the prior two weeks. (2, 3) Surveys of campus officials, students, and faculty find that alcohol problems rank high among campus- life issues of greatest concern. (4) However, this focus on alcohol problems is not meant to diminish or discount problems related to other drug use. And while the Guide specifically addresses risks for alcohol problems, some of the approaches and exercises presented are also applicable to the prevention of other drug problems. But fundamental differences in public policies governing the sale and use of alcoholic beverages-in contrast with illicit drugs-allow for a wider range of prevention strategies) Lloyd D. Johnston et al. , Drug Use, Drinking, and Smoking: National Survey Results from High School, College, and Young Adult Populations, 1975 - 1990 (Washington, DC: National Institute on Drug Abuse, 1991), p. 9. (2) Cheryl A.

Presley, Philip W. Meilman, and Rob Lyerla, Alcohol and Drugs on American College Campuses: Use, Consequences, and Perceptions of the Campus Environment, Vol. 1: 1989 - 91 (Carbondale, IL: The Core Institute, 1993), p. 45. (3) Henry W. Webster et al. , Health and Behavioral Consequences of Binge Drinking in College: A National Survey of Students at 140 Colleges, Journal of the American Medical Association, p. 272 (1994). (4) The Carnegie Foundation for the Advancement of Teaching, Campus Life: In Search of Community (Princeton, NJ: Princeton University Press, 1990), p. 3 Public Health Approach The strategies to prevent or reduce alcohol problems described in the Guide reflect a public health perspective. A distinctive feature of public health is that it focuses on communities, not individuals.

A public health perspective stresses that problems arise through reciprocal relationships among an individual, a direct cause, and an environment. In the case of alcohol problems, the direct cause is alcohol, and the environment is the social and physical context in which drinking occurs. Public health prevention strategies place particular emphasis on ways to shape the environment to reduce alcohol-related problems. Environmental factors influencing individual drinking decisions include how, where, and when alcohol is made available in a given community or setting.

These factors are often governed by formal and informal policies, such as customs, traditions, and norms. For example, federal and state tax policies influence the price of alcoholic beverages and help determine its economic availability (see The Price of Alcoholic Beverages). A public health approach acknowledges that alcohol problems are ultimately linked to the larger social and economic system. Beginning in the 1970 s, new information on the nature, magnitude, and incidence of alcohol problems showed that alcohol can be problematic when used by any drinker, depending on the situation or context of drinking. (5) There was renewed emphasis on the diverse consequences of alcohol use-particularly trauma associated with drinking and driving, fires, and water sports-as well as long-term health consequences. Research Basis What do we know about preventing alcohol-related problems?

Because alcohol- related problems are complex, there are no easy answers. However, findings from a body of research studies suggest that certain actions can reduce certain problems. The key to successful prevention initiatives is matching up a specific problem with actions that have been found to be successful in reducing that problem. (6) The approaches described in the Guide are based on research demonstrating that increases in alcohol availability lead to increases in alcohol consumption, which in turn lead to increases in alcohol problems (7) (see Alcohol in the Environment). A complex set of cultural, social, economic, and political interactions contribute to the level of alcohol availability in a given society, community, or even neighborhood. (8) Patterns of consumption and problems in the general population similarly vary in relation to the physical, psychosocial, and normative environment in which individual drinking decisions occur, as influenced by the retail, public, and social availability of alcohol. In general, alcohol availability refers to the manner in which alcohol is served and sold in a given community or society. For example, if beer is priced lower than sodas during happy hour at a campus pub, the result is an increase in the economic availability of alcohol (see The Price of Alcoholic Beverages).

Problem Identification and Analysis Traditional prevention efforts on college campuses have, for the most part, focused on providing individuals with information and skills to help them avoid problems. A pamphlet on alcohol use and problems distributed in student orientation packets is one example of individual-centered prevention activities. These activities focus on the who of alcohol problems. This Guide will help you collect information to understand and respond to the what, where, when, why, and how surrounding alcohol use and related problems. What are the problems at our college? Where and when do they occur?

Responses to those questions help you gain a better understanding of why problems occur. Then you can determine how to make environmental changes to reduce problems. Once you collect information, the findings can serve several purposes. Most important, information informs prevention strategies and decisions by helping you identify opportunities for intervention and environmental change. By sharing information with the larger campus community, you not only raise awareness but also spark discussion and debate and generate interest and involvement of community members) Dan E. Beauchamp, Beyond Alcoholism: Alcohol and Public Health Policy (Philadelphia: Temple University Press, 1981), pp. 152 - 182. (6) U.

S. Department of Health and Human Services, Seventh Special Report to the U. S. Congress on Alcohol and Health (Rockville, MD, 1990), pp. 210 - 211. 7 (7) Mark H. Moore and Dean R.

Gerstein, eds. , Alcohol and Public Policy: Beyond the Shadow of Prohibition (Washington, DC: National Academy Press, 1981), p. 47 (8) Harold D. Holder and Lawrence Wallace, Contemporary Perspectives in Preventing Alcohol Problems: An Empirically Derived Model, Journal of Public Health Policy, 7, No. 3 (Autumn 1986): pp. 324 - 33 After the drinking age was raised to 21, underage students at a large western university started holding large, off-campus parties on a main street near campus with a lot of rental houses. Neighborhood residents began to find more and more beer cans littering their lawns, noted an increase in neighborhood vandalism, and were often awakened by party noises. Hundreds of students roamed the streets going from party to party, causing traffic problems and other disturbances.

In response to complaints, city and campus police embarked on a joint effort to enforce underage drinking laws by standing on street corners and handing out citations to offenders. Things started to change. Fewer beer cans littered the neighborhood, vandalism dropped, and police reported that calls for noise disturbances, incidents of vandalism, and drunk and disorderly conduct declined almost 30 percent. A new city ordinance requires offenders to appear in court and pay larger fines. They must also attend and pay for a university alcohol education class, which helps support the campus prevention program.

PREVENTION STRATEGIES (9) Individual Behavior and behavior change Relationship between individuals and their alcohol-related problems Short-term program development People remain isolated and focused on self Individual as audience Professionals make the decisions Environmental Policy and policy change Social, political, and economic context of alcohol-related problems Long-term policy development People gain power by acting collectively Individual as advocate Professionals help create avenues for citizens to develop and express their voice Prevention on Campus: A Broader View Colleges and universities have developed a wide range of creative and innovative approaches for imparting information and raising awareness about alcohol use and problems. For example, students at many campuses use theater to get alcohol prevention messages across to their classmates. Many campuses have developed cadres of peer educators who make presentations about alcohol awareness and problem avoidance in classrooms and at residence halls and fraternities. Alcohol education activities are a necessary part of alcohol problem prevention efforts.

However, they are insufficient by themselves to achieve substantial reductions in alcohol problem. (10) Alcohol problems are matters of public policy and not just individual habits and lifestyles. Its not just a matter of the right people making the right decisions-whether to drink and when to drink and where to drink-its more than that. Its the rules and regulations-formal as well as informal-and the environment that surround those decisions) Adapted from James F. Mosher, speech at the FIPSE New Grantee Training Institute, February 1993. (10) Adapted from James F. Mosher, speech at the FIPSE New Grantee Training Institute, February 199 Prevention is more likely to be successful when efforts directed at altering individual behavior operate in tandem with those directed at altering the environment.

By moving away from a singular focus that tends to blame individual drinkers, we can look to broader influences in our environments that contribute both to individual and community alcohol problems. (11) Students making the transition to adulthood often live in a learning environment that supports experimentation and limits adult responsibility. Not surprisingly, many experiment with alcohol, drink heavily, and are at high risk for alcohol-related problems. (12) But there are new ways for colleges and universities to both examine risk levels and make changes to mitigate those risks. How to Use This Guide Changes in institutional environments surrounding alcohol use require the broadest involvement of those affiliated with the institution, including students, parents, staff, faculty, alumni, and members of surrounding communities. The challenge for environmental prevention is generating and sustaining coalitions committed to making changes. A staff person cannot do it sitting in an office. The key to sustaining an interest in prevention is energizing new or existing campus organizations, especially students, to take an interest in prevention.

Sometimes linking campus efforts with prevention activities in surrounding communities helps stimulate interest. Coordination with state and national organizations or activities can generate local interest. At most colleges and universities, alcohol problem prevention issues are not a very high priority. Often the limited resources available are bounded by time constraints of a specific government grant. To imbue prevention values within an institution, those concerned with prevention must become brokers-that is, they become agents for issues that are important and market them to campus resources. You and your group can be agents for prevention by building and sustaining relationships with others who may have an interest in the numerous social, cultural, and economic issues surrounding alcohol use in our society.

You can help them refocus those interests to support prevention efforts. This Guide helps you develop relationships through an information-driven process that draws the attention of campus members to those factors in your environment that contribute to alcohol-related problems. Use the exercises in the Guide to expand the circle of people interested in and committed to reducing specific alcohol-related problems at your school. The exercises give people a better understanding of what problems are occurring on campus.

By examining campus and community environments, they learn where and when problems occur, which in turn helps them understand why problems occur. If they understand the environmental factors influencing problems at their school, they then feel they know how to make changes to reduce those problems. Everyone is in charge of prevention. And prevention is not a program. Rather, it is an informed commitment. The process described in the Guide gives you the information you need to generate that commitment on your campus 11) James F.

Mosher and David H. Jernigan, New Directions in Alcohol Policy, Annual Review of Public Health, 10 (1989): 245 - 79. (12) Henry Wechsler and Nancy Isaac, Alcohol and the College Freshman: Binge Drinking and Associated Problems (Washington, DC: AAA Foundation for Traffic Safety, 1991), pp. 21 - 2 Problem-Oriented Prevention Some problems related to alcohol use reported by U. S. college students: (13) Missed classes Performed poorly on a test Had hangover Been hurt or injured Fights or arguments Trouble with authorities Damaged property Taking sexual advantage Drinking and driving Problem-oriented prevention targets attention and action on specific consequences of alcohol use. College administrators and students report a range of alcohol-related problems at colleges and universities. National surveys recount aggregate problem levels (see sidebar).

But individual campuses may differ based on factors such as the mean age of the student body, employment status, ethnicity, religious beliefs, and extent of fraternity / sorority involvement. The Guide includes a series of information collection exercises that will help you define specific problems at your institution and understand your own culture of alcohol use and adverse consequences. Problem-oriented prevention borrows the SARA method (scanning, analysis, response, assessment), a law enforcement community policing technique growing in popularity. This method helps cops move from merely responding to incidents in an isolated manner to analyzing underlying problems and response options in collaboration with community groups. SARA readily transfers to prevention efforts in a range of communities. For colleges and universities, it uses campus collaboration and information as a way to develop and monitor problem reduction strategies in an understandable process.

In scanning you look beyond immediate incidents or issues to determine if they are part of a broader problem. If so, you then engage in problem analysis, through the gathering of information from a wide variety of sources, to determine not only the nature and scope of the problems but also the resources to help solve the problem. You are then ready to implement a response intended to provide long-range solutions to underlying problems. Then you assess whether your strategy has been successful and make any necessary changes following the same approach 13) Presley, Meilman, and Lyerla, op. Cit. , pp. 20 - 2 SARA Scanning Develop a campus profile Look around Have conversations Recruit allies Analysis Identify information needs Collect information Define problems Response Decide what to do Implement actions to reduce problems Assessment Collect information on problem indicators Measure impact of responses Reassess priorities Scanning Scanning is both the first step in understanding the nature of alcohol use and adverse consequences and a way to identify potential areas of support for prevention efforts. Scanning helps you think about your institutions environment from a risk indicator perspective.

Most problems related to alcohol use are not identified as such until they attain community visibility. Indicators of alcohol problems often go unnoticed until the problems become so severe that they can no longer be ignored. But campuses dont have to wait for a riot-like the one during Rancho Chico Days, involving students from Chico State University in California, or a tragedy like the alcohol poisoning death of a University of Florida student-to take a look at the environment to see what kinds of problems exist. Scanning is something most of us do everyday. We walk around to get a sense of what a community is like.

What are the issues for community members surrounding alcohol use and adverse consequences? We talk to people, maybe take some photographs or use a video camera to record information. What kinds of problems are we seeing out there? Where do we start? Enlisting Allies While one person could scan a campus, these exercises are a good way to get others involved. Scanning is easy, interesting, and even entertaining.

Group members can compare impressions and information gained through scanning to gauge preliminary agreement on problems and contributing factors. Scanning exercises can help you develop a core group of interested individuals and generate discussion on your campus by highlighting alcohol issues in the environment. Forms for the following exercises are included in Appendix A. Scanning Exercise A- 1 A Quick Profile, helps you develop a quick profile of your campus to highlight environmental factors that may be contributing to alcohol use and adverse consequences. You and members of your group note your impressions and opinions at your institution. This exercise helps initiate discussion and generate interest in prevention.

A- 2 Looking Around, gets your group out and about on your campus and in surrounding communities to look for problem indicators. You record what you see when looking at your campus and community and compare your impressions with others in your group. Once you and your group have developed some impressions of problems related to alcohol use at your school, a simple way to find out what other people think is to talk with them. Not only will conversations help you confirm or negate your impressions, they will also help you identify potential allies and opponents, as well as resources for prevention efforts. A- 3 Having Conversations, lists those on campus who are both potential allies and sources of information. Talk to some or all of these people.

For some conversations you might want to make an appointment. Other conversations might be more informal, such as at receptions, around a cafeteria table, or in student lounges. Though you want to get opinions about issues that you and your group think are important, be attentive for other issues raised. You dont always need to talk to the person in charge. Those in the so-called trenches of campus life can often provide valuable insights into alcohol use and adverse consequences. Scanning Yields Preliminary Information Its important to talk to a variety of people on campus.

You want to get a representative picture of widely held values on your campus regarding alcohol use and measures to reduce problems. Go where students congregate and talk to them at random. Scanning doesnt have to be overly formal. Use conversations to identify existing campus information resources on alcohol- related problems and to encourage others to get involved with your group. For example, residence life advisors at one college kept routine records of incidents, such as rowdy behavior and curfew violations. While many problems were alcohol- related, it wasnt mentioned unless the incident was directly related to drinking.

Minor changes in the way incidents were recorded resulted in a clearer understanding of the role of alcohol in residence hall problems, suggesting points for intervention. You may find that others who collect campus information-such as campus security and health services-can make small changes in the way they record information that will help your efforts. Information gained from scanning exercises serves multiple purposes. You and your group can: identify specific problems on your campus; discover high-risk drinking environments on your campus and in your community; enlist new allies by using information to establish relationships with a cadre of students, faculty, and campus officials; and stimulate informed consideration of problems and contributing environmental factors on campus.

However scanning usually doesnt provide you with enough information to understand fully the nature of the problems. Further analysis is often necessary for your campus to agree on problem definition. Scanning helps narrow the field of interest by directing your attention to important issues on your campus. A picture is worth a thousand words.

Recruit student photographers and cinematographers to document the environment. Pictures or videos of on- and off- campus alcohol outlets, social events, billboards, and other activities can describe eloquently the alcohol environment on your campus. Use photos and videos to raise environmental issues and generate campus dialogue about environmental messages. Look around and talk to people.

Students complain that there is nothing to do when they are not studying or in class, and cite boredom and stress as reasons for drinking. One way to determine opportunities for socializing is through a quick scan of the campus newspaper and bulletin boards to see what types of activities are advertised and promoted. Things to look for are extracurricular activities that are alcohol-related, such as student night drink specials at local taverns, and those that are not, such as lectures, concerts, film festivals, or sports activities. Are students perceptions of the campus environment correct?

Is more information needed before changes can occur? Make it easy: Ask residence hall advisors to place one check mark for an incident report if the perpetrator had been drinking, two check marks if the victim had been drinking. Three check marks signify that both had been drinking. Analysis Does your school do yearly quality-of-life surveys? Check to see if responses include problem indicators.

Does your school conduct exit surveys or interviews with graduates or with those who leave before graduation? Garbology is like archeology. Trash and litter are physical evidence of human activities. Garbage and litter indicate what people are drinking, and where and when drinking occurs. The goal of analysis is to collect accurate information on indicators of problems related to alcohol use. Indicators are measures of the nature, magnitude, or incidence of problems.

Analysis provides you with information you need to understand environmental influences on alcohol use and adverse consequences on your campus. Use this information to formulate prevention strategies aimed at altering environments to reduce risks associated with drinking on your campus. Surveys of campus populations are a common way to collect problem information. Other methods are less traditional. For example, counting the number of reported incidents of underage drinking in residence halls is one way to measure the magnitude of underage drinking on your campus. Another indicator of underage drinking is the number of beer cans discarded in trash bins at a residence hall for first-year students.

Counting beer cans on different days can tell you when d

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