The college population is replete with high-risk drinkers. The 2001 survey of 10,904 students at 119 colleges and universities conducted by the Harvard School of Public Health found that 40% of female students drank four or more drinks in a row in the past 2 weeks, meeting the criteria for binge drinking (Wechsler et al., 2002
). Four of five sorority and fraternity members surveyed met the standard for binge drinking. One in five students was a frequent binge drinker, defined as having three binges in the past 2 weeks, a rate that has not changed since 1993. Women’s drinking, in particular, appears to be increasing with more than a doubling of frequent binge drinking among women enrolled in all-women’s colleges (from 5.3% in 1993 to 11.9% in 2001) and a lesser, but still significant, increase for women in coeducational schools. Reifman and Watson (2003)
found that women had a higher probability of adopting binge drinking during their first year of college than men. College risky drinking, and especially engaging in binging, is an entrenched behavior with numerous problematic outcomes such as higher total volume of alcohol consumed, higher consumption of illicit drugs and cigarettes, unplanned sex, rape, accidents, driving while intoxicated, and deaths (Howard & Wang, 2004
; Jones, Oeltmann, Wilson, Brener, & Hill, 2001
; Wechsler & Isaac, 1992
; Wechsler, Davenport, Dowdall, Moeykens, & Castillo, 1994
). A cross-sectional and prospective study by O’Neill, Parra, and Sher (2001)
concluded that heavy drinking during the college years strongly predicts alcohol use disorders up to 10 years later.
Another health risk to college women is inadequate use of contraception. Sawyer, Pinciaro, and Anderson-Sawyer (1998)
investigated the reasons for pregnancy testing at a student health clinic by college women. They found that 37% of the women failed to use any contraception method at the time of possible pregnancy. Pregnancy testing data were examined over a 5-year period and revealed that nearly 60% of women had a method of birth control but did not use it on the occasion of sexual intercourse. Their findings suggest that unintended pregnancy in college students is an ongoing problem. Their results also indicated that even when students adopt a contraceptive method, they fail to use it consistently. Similarly, Kusseling, Wenger, and Shapiro (1995)
found that female college students failed to use contraception effectively over time, typically using them reliably at baseline but demonstrating subsequent failure to use them effectively at follow-up. Their study confirmed that college women are at high risk for unintended pregnancy and suggested that interventions should address the consistency of contraceptive use. Ni-Riain (1998)
found that knowledge and access to contraceptives are not sufficient to ensure correct, consistent use of contraceptives. All of the participants in the study were students who presented for emergency contraception in a 3.5-year period at a large student health center. These women became more effective contraceptive users after an interactive counseling session following the pregnancy scare. These results could indicate that women’s motivation to use contraception changed following feedback that they could become pregnant if they did not improve their contraception use.
Combining binge drinking or regular drinking with using contraception ineffectively results in the risk of alcohol-exposed pregnancy (AEP). The consequences of unintended pregnancy affected by alcohol may include increased abortion rates or a range of neurobehavioral effects if the fetus is carried to term, which are considered to be fetal alcohol spectrum disorders, including the most severe form, fetal alcohol syndrome (American Academy of Pediatrics, 2000
; Eustace, Kang, & Coombs, 2003
; NOFAS, 2004
; Sihvo, Bajos, Ducot, & Kaminski, 2003
). Among 2,672 community women surveyed in six settings across three communities, rates of risk for AEP were high—between 10% and 26% depending on setting (Project CHOICES Research Group, 2002
). Given that high rates of risky-level drinking are consistently reported in college women (Wechsler et al., 2002
), these women may also be at risk for AEP if they are sexually active and fail to use effective contraception. A recent survey of 2,012 university women found that most sexually active women (74%) were risky drinkers and that a significant minority (21%) were ineffective contraceptive users, with a combined risk for AEP evidenced in 17% of those who were sexually active (Ceperich, Ingersoll, Nettleman, & Johnson, 2004
). College women were at risk primarily because of binge drinking paired with using contraceptives ineffectively.
To address the risk of AEP among college women, interventions could target drinking, contraception, or both. There have been many efforts to reduce problematic drinking among college students, with no published reports of interventions to improve contraception among college women. Heavy-drinking high school seniors who received a motivational intervention showed decreased drinking and lower levels of negative consequences of drinking 2 years later (Marlatt et al., 1998
). Baer et al. (1992)
found that a single session of individualized feedback and professional advice using a motivational counseling style produced 40% reductions in drinking for 2 years among young adults. These results were equivalent to those achieved by a 6-week skills building intervention.
Several studies have attempted to reduce risky drinking in college samples using assessment and personalized feedback either delivered in a motivational interviewing (MI) counseling style or through mailed feedback without interpersonal interaction. Nye, Agostinelli, and Smith (1999)
found that providing either self-focusing information or norms-based feedback information increased problem recognition and discrepancy about current drinking and other goals. Murphy et al. (2001)
randomized heavier-drinking college students to BASICS, which is an individual treatment including cognitive–behavioral skills training, motivational enhancement, and feedback about drinking patterns, to an education condition in which participants watched two alcohol-related videos and talked individually with a counselor afterward, or to a no-treatment control. Heaviest-drinking students who were in the BASICS condition showed the most reduction at 3- and 9-month follow-up. Agostinelli, Brown, and Miller (1995)
found that mailed personalized feedback resulted in reductions in drinking and peak intoxication levels among heavy-drinking college students. Similarly, Walters (2000)
found that mailed feedback designed to influence drinking among drinking college students was superior to group or classroom education plus feedback and to controls at a 6-week follow-up in two studies conducted at different college campuses. In a similar study, Walters, Bennett, and Miller (2000)
found that mailed feedback produced a 53% decrease in drinking quantity at 6-week follow-up. Mailed feedback was again superior to participation in a psychoeducational group that included feedback and to control. Taken together, these studies suggest that intervention models using personalized risk feedback or a single session focusing on an individual at risk can be effective to reduce drinking among the college-age population. Additional sessions have shown no enhanced benefit despite their increased cost.
To date, there are no published reports on preventing the combined risk of AEP owing to risky drinking and inadequate contraception among sexually active college women. One model of an individual-focused intervention used a platform of MI (Miller & Rollnick, 2002
) to deliver a five-session personalized feedback and counseling plus contraceptive consultation intervention to community women at risk for AEP (Project CHOICES Intervention Research Group, 2003
). This intervention was found to be feasible and promising with community women; 68.5% of participants were no longer at risk for AEP at the 6-month follow-up. More women achieved this by changing both drinking and contraception (32.9%) than by improving contraception only (23.1%) or by reducing drinking only (12.6%). Therefore, interventions to reduce AEP risk among college women should include an emphasis on improving contraception and/or reducing risky drinking. In this article, we describe a novel one-session intervention to reduce AEP risk among college women and present 1-month outcomes of a randomized trial designed to test the efficacy of this intervention.