A programme to reduce excessive alcohol consumption among college students in Ireland: analysis of context, implementation and impact

Aim: Hazardous and harmful alcohol consumption among college students remains a significant issue, and is associated with a range potentially deleterious effects on students’ physical and mental health, social relationships and academic performance – in addition to the harms caused to others and to the wider community. To address this ongoing issue, a new pilot alcohol programme – Responding to Excessive Alcohol Consumption in Third-level (REACT) – was launched in Ireland in 2016. The aim of this research is to examine the context, implementation and impact regarding this programme and to add to the evidence base in this area more broadly. Methods: A mixed methods approach was adopted. The wider alcohol policy context in Ireland was first analysed using critical discourse analysis and with a particular emphasis on the much-debated Public Health (Alcohol) Bill, whose publication coincided with the introduction of the REACT programme. Protocol information on the REACT programme’s design and implementation was then outlined. To determine the prevalence of hazardous and harmful alcohol consumption (HHAC) among college students in Ireland, along with other related behaviours, consequences and attitudes, a baseline study was conducted among a cross-section of college students prior to the implementation of REACT. Following commencement of programme implementation, qualitative research was conducted among both participating and non-participating colleges to determine perceived factors influencing the implementation and adoption of REACT. A qualitative study was also undertaken to explore college students’ perspectives on alcohol control measures and alcohol more generally in the context of the REACT programme. Finally, a follow-up study was conducted two years’ postimplementation to determine if the programme had an impact on the prevalence of HHAC among college students, in addition to other secondary outcomes including the proportion of non-drinkers, alcohol-related harms and alcohol-related awareness. Data were analysed using QSR International NVIVO and IBM SPSS software. Results: Analysis of the wider alcohol policy context in Ireland points to a markedly neoliberal policy climate in recent decades, marked by deregulation and liberalisation of the drinks industry, with the debate on alcohol regulation largely dominated by two main positions at present – the public health perspective and that of industry. The REACT programme has been introduced at a significant juncture in Ireland’s alcohol policy landscape – reflected by the growing recognition of the need for more effective policy responses both in the college sector and nationally. The programme provides a structure to translate policy into practice for those seeking to reduce HHAC and related harms among college students. Analysis of the prevalence of HHAC among college students in Ireland confirms that there is still a critical need for interventions in this area, with over two thirds of the students surveyed in this research showing signs of HHAC. Significant challenges may be faced in implementing such programmes, however, as demonstrated by the particular challenges cited by both participating and non-participating colleges regarding the REACT programme’s implementation and adoption. In particular, the limitations posed by the wider college sector in Ireland at present, characterised by rising student numbers and reduced resources, may hinder implementation and adoption of programmes of this kind. Students also appear to remain sceptical or ambivalent about the potential efficacy of such programmes, in the face of what they perceive as the pervasiveness of alcohol in both student life and Irish culture. However, such beliefs belie more heterogeneous drinking practices among the students as well as an inherent awareness of the multiple layers of influence on student drinking, notwithstanding the emphasis on personal responsibility by some of the younger students. Finally, the follow-up study on student alcohol consumption confirms the continued high prevalence of HHAC among the college students surveyed. At the same time, it raises questions about the efficacy of the REACT programme in its current form, given the lack of impact found at the two-year follow-up on prevalence of HHAC, adverse consequences and awareness of own drinking, although it is important to remain cautious of these results given the survey limitations. Conclusion: The REACT programme represents a novel approach to reducing HHAC among college students in Ireland. The research for this thesis, however, points to barriers to implementation and adoption of this programme and raises questions about the impact of REACT at the two-year follow-up. Moreover, students continue to remain sceptical or ambivalent about the potential efficacy of such programmes. These findings, along with proper dissemination of the results, should constitute important considerations in any future decisions on or development of the REACT programme. Further recommendations are provided in relation to future programme implementation and development and to add to the evidence base in this area