Sociological/Cultural Influences of Drinking n 127
workplace as well as impairing mental and physical health and adding costs to health care and workforce productivity. Given these concerns, what can be done from a legal, policy, or program perspective to control, prevent, or treat alcohol-related problems? Cer- tain social control strategies have been used with varying levels of success, including sale/use restrictions, blood alcohol tests, drivers license withdrawal, and modifications of the drinking age. These will be briefly discussed together with certain preventive policies such as pricing/taxing policies, warnings, advertising limits, and convenience or access restrictions. Here the gap between those who needed and received alcohol-related treat- ment is considered. Finally, social norms and the prevention of alcohol abuse are exam- ined with specific attention to university settings.
explain why they differ from adults in their reaction to alcohol pricing. Chaloupka and Wechsler (1996) focused on college students’ reactions to alcohol pricing and drunk-driving laws as deterrents to drinking and binge drinking. They found that, compared with other groups, college students were less responsive to the price of alcohol, but that the severity of penalties for drunk driving reduced drinking and binge drinking. Research by Grossman et al. (1995) and by Chaloupka and associ- ates (1993) conclude that increased tax on alcohol would reduce adolescent alcohol consumption as well as drinking-related injuries and death. Other research on the influence of pricing finds that increasing beer tax can lead to a reduction of domes- tic violence against children (Markowitz and Grossman 1998).
Warnings
Alcohol warning labels are a potential deterrent to alcohol use and abuse. However, there is little evidence demonstrating that alcohol-related attitudes or behaviors have changed after the addition of container warnings (Andrews 1995; MacKin- non 1995). There is a body of research suggesting that gender, socioeconomic status, religion, and race/ethnicity may influence the receptivity and efficacy of warnings.
In general, there is some evidence that women are more likely than men to seek out, read, and heed product warnings and to view alcohol as harmful (Godfrey et al., 1983; LaRue and Cohen 1987; Laughery and Brelsford 1991; Nohre et al., 1999), whereas men are more conscious that alcohol warnings exist and more accurate in recalling the warning than women (Graves 1983; Kaskutas and Greenfield 1992, 1997). Lower socioeconomic status (SES) adults are found to more frequently think alcohol is harmful and to believe warnings that are on alcohol containers than higher SES adults, but they are less frequently correct in recalling specific risks associated with alcohol abuse (Mazis et al., 1991). Practicing Mormons, conscious of their church’s admonishment against alcohol use and Utah’s restrictive alcohol control laws, less frequently view the alcohol warning label than non-Mormons (Mayer et al., 1991). Some researchers detect no differences among African Ameri- cans, Hispanics, and whites (Mazis et al., 1996; Kaskutas and Greenfield 1997), whereas MacKinnon (1995) find nonwhites have greater awareness of the warn- ing label law but no greater exposure. The latter study of high school seniors also finds other “receiver characteristics” to be associated with warning label measures in addition to those already mentioned, including student grades, heavy drinking experience, student friendship with alcohol users, drinking from the alcohol con- tainer, attendance at religious services, and television watching, among others.
Advertising Limits
Targeted marketing of alcohol to underage drinkers has been a recurring issue.
Research by Grube and Wallack (1994) showed that exposure to beer advertisements
Sociological/Cultural Influences of Drinking n 129
among fifth- and sixth-grade students was significantly linked to their intentions to drink in adulthood. Three additional examples developed by Beauchamp and his colleagues (2004) highlight the marketing aspect of the problem: Cisco wine, Hooper’s Hooch, and Absolut vodka. In the Cisco wine case, a drink classified as a fortified desert wine, but with a 20 percent alcohol level, was packaged in a “cooler style” appearance, sold in single bottles at convenience stores, priced affordably, and marketed with a slogan “Cisco takes you by surprise.” When the U.S. Surgeon General referred to the drink as “dangerous” and a “wine fooler” and other public interest groups complained, some stores discontinued sales. Despite modification of the label and discontinuation of the marketing slogan, underage drinkers con- tinued to use it as a cheap way to get high. Eventually, the bottle and the label were further modified to the satisfaction of the Surgeon General, the Bureau of Alco- hol, Tobacco, and Firearms (BATF), and the Federal Trade Commission (FTC).
Hooper’s Hooch and other drinks known as “alcopops” are fruit drinks with alco- hol content between 5 and 7 percent. Some firms were accursed of target market- ing these drinks to youths. Objections by the Center for Science in the Public Interest, the BATF and FTC alleged a connection between underage drinking and advertising. Finally, Absolut vodka advertisements and Web site (despite restricted access) gained popularity with adolescents, which some journalists thought might influence youthful drinkers. These examples illustrate the controversy surrounding niche marketing of alcohol products to underage drinkers.
Convenience/Access
There is a positive association between the increased availability of alcohol and its use and abuse. This has prompted some to advocate tight restrictions on the sale of alcohol, but others believe such restrictions are ineffective (Morgan 1992). There is some evidence to suggest that making alcohol less accessible may lead to a reduction in severe violence (Markowitz and Grossman 1998).
When regulation and prevention fail, or inadequately address the problem, the focus shifts to treatment alternatives. These might include support groups, medica- tion, family interventions, and cognitive-behavior therapy. Each of these holds some promise for ameliorating the problems facing specific alcohol abusers. However, the proportion of people needing treatment for an alcohol problem vastly exceeds the number receiving treatment. It is estimated that 18.6 million people (7.9 percent of the total population) need treatment, whereas only 1.5 million (8.3 percent of the needy) receive it. Among those needing but not receiving treatment, most failed to acknowledge the need for treatment of an alcohol problem. Of the group acknowl- edging the need, 35 percent tried but were unsuccessful in obtaining treatment and 65 percent failed to seek treatment. For those receiving treatment, the highest pro- portion (46.3 percent) used their own savings to pay for it, a smaller proportion used
private insurance (31.7 percent), and about equal proportions relied on Medicaid (21.4 percent) or another form of public assistance (21.5 percent) (HHS 2002a).
Social Norms
A large and growing body of research focuses on social norms and drinking, espe- cially among college students. Social norms research examines the actual or per- ceived behavior of those in one’s social network and whether those in the network approve the behavior (Simon 2003). Using this approach, alcohol-related research finds that young adults and college students often overestimate the number of their peers who consume alcohol, the amount consumed, and the number who drink excessively (Perkins and Berkowitz 1991; Agostinelli and Miller 1994; Perkins 1994, 2002; Perkins et al., 1999). Furthermore, peer norms are deemed more sig- nificant than other reference groups or factors in explaining alcohol consumption, including parents, faculty, and resident advisors as well as other sociodemographic and contextual variables. Peer norms are important because if there is a large gap between actual and perceived student drinking norms, the exaggerated beliefs of peer drinking norms may facilitate alcohol misuse as students seek to conform to perceived norms. The premise of many prevention programs is that correcting students’ misperceptions regarding classmates’ alcohol consumption would alter their perception of the social norm and thus lead to reduced campus drinking.
This section reviews selected studies of social norms, some related programmatic alternatives to reduce campus drinking, and a few of the lessons learned from such efforts.
Rimal and Real (2003) make the distinction between two types of perceived norms: descriptive and normative. Descriptive norms refer to peoples’ beliefs about how prevalent a particular behavior (drinking) is among their cohort group. Such perceptions may be accurate or inaccurate. Injunctive norms refer to the degree to which people perceive pressure to conform to particular behaviors (consuming alcohol). These pressures may take various forms, including exclusion from the group. The authors assume that congruence between these two types of norms (beliefs that most students drink and pressures exist to comply) strongly influences behavior. Based on a survey of college students, Rimal and Real found that the two types of norms had differential effects on behavior: descriptive norms failed to achieve significance when other factors were included in the model, but perceived benefits to oneself were significantly linked to consumption. Their findings suggest that health campaigns designed to reduce consumption should not only correct misperceptions about the extent of drinking, but also alter students’ perceptions regarding the benefits from consumption. This could be done through antialcohol campaigns challenging the perceived benefits associated with alcohol consumption or, alternatively, conveying the benefits of moderate or no drinking while stressing the costs associated with heavy drinking.
Sociological/Cultural Influences of Drinking n 131
Sociocultural explanations for alcohol use are especially apt for heavy drink- ers. Research by Wild (2002) found that heavy consumers of alcohol (five or more drinks at least once per week or more) were more likely than those who use less alcohol to believe their drinking habits were more typical of consumption pat- terns among friends, coworkers, and the general public and that others consumed more alcohol in various social settings than they did. They were also more likely to attribute alcohol problems to others and to have fewer qualms about the drinking habits of friends, coworkers, and the general public. This leads heavy drinkers to view their own drinking patterns as “normative, rather than unusual or deviant”
(Prentice and Miller 1993; Wild 2002, p. 474).
How can student misperceptions of peer norms be reduced? One way is to com- municate the actual student norms regarding drinking, thereby dispelling myths.
This approach is deemed to be simple, efficient, and effective. Advertisements and articles in student newspapers, lectures, posters, radio spots, and so forth can be included in such an information campaign (Berkowitz and Perkins 1991; Stef- fian 1997; Barnett et al., 1996). Certain groups can be targeted for programming (e.g., fraternities and sororities, residence halls, heavy drinkers). Media campaigns focusing on the adverse consequences of heavy drinking have been launched in Boston (“Party Smart”), Ohio (“Dirk” campaign), and elsewhere; however, such information campaigns have had negligible impact on student drinking (DeJong 2002). Advocacy campaigns take a more aggressive stance by urging students to get involved to do something to reduce behaviors such as binge drinking. Web sites such as HadEnough.org stress the adverse consequences of heavy drinking. DeJong identifies several guidelines and lessons based on the successes and failures of past mass communication campaigns:
Launch a strategic planning process Select a strategic objective
Select the target audience Develop a staged approach Define the key promise Avoid fear appeals
Select the right message source Select a mix of media channels Maximize media exposure Conduct formative research
Conduct process and outcome evaluations (p. 186–189)
Within the public health community, there is a recognition that it may be counter- productive to pursue preventive approaches which depend on calling attention to the severity of alcohol use (e.g., binge drinking) and that a more useful strategy is to base campaigns on perceptual norms. This is predicated on the belief that if the
“perceived prevalence of drinking can be reduced, then actual consumption will n
n n n n n n n n n n
decline as well” (Haines 1996; Perkins et al., 1999; Steffian 1997; Rimal and Real 2003, p. 196).
Conclusion
There is a rich literature on alcohol—its use, abuse, and the consequences of consumption. This chapter provides an overview of some of the sociocultural dimensions of this issue, but barely scratches the surface of this complex topic. It highlights the alcohol consumption patterns of diverse special populations, selected consequences of excessive consumption, and some social control strategies to deal with the resulting social problems. Much of the literature has focused on the under- age drinker and the heavy drinker, emphasizing the social context for drinking and the social consequences of consumption. Legal strategies have had some impact on ameliorating the adverse consequences of underage and heavy drinking, but other preventive and treatment strategies are needed together with public education, con- trolled access, appropriate advertising, and pricing policies to adequately address the problem. This is especially important given the gap between treatment needed and treatment received. Public policy initiatives such as increased public funding of treatment programs and additional publication of resource guides for commu- nity leaders are needed as well. Prevention programs centered on social norms offer another strategy for addressing issues surrounding alcohol consumption. Public health initiatives focused on information dissemination, marketing, and advocacy campaigns have shown promising results in selected settings. Regardless of the stra- tegic approach employed, sensitivity to cultural differences and contextual factors will aid in tailoring interventions and policies to properly address the needs of diverse demographic and cultural groups.
References
Agostinelli, G., and W. Miller. “Drinking and Thinking: How Does Personal Drinking Affect Judgments of Prevalence and Risk?” Journal of Drug Education 55 (1994):
327–37.
Alaniz, M., R. Parker, A. Gallegos, and R. Cartmill. “Immigrants and Violence: The Importance of Context.” Hispanic Journal of Behavioral Science 20:2 (1998): 81–6.
Alaniz, M., R. Parker, A. Gallegos, and R. Cartmill. “Ethnic Targeting and the Objecti- fication of Women: Alcohol Advertising and Violence Against Young Latinos.” In Currents in Criminology, edited by Parker, R. 1999.
Alaniz, M., and C. Wilkes. “Reinterpreting Latino Culture in the Commodity Form: The Case of Alcohol Advertising in the Mexican American Community.” Hispanic Jour- nal of Behavioral Science 17:4 (1995): 430–51.
Andrews, J. “The Effectiveness of Alcohol Warning Labels: A Review and Extension.”
American Behavioral Scientist 83 (1995): 622–33.
Sociological/Cultural Influences of Drinking n 133
Archer, L., B. Grant, and D. Dawson. “What If Americans Drank Less? The Potential Effect on the Prevalence of Alcohol Abuse and Dependence.” American Journal of Public Health 85:1 (1995): 61–6.
Barnett, L., J. Far, A. Mauss, and J. Miller. “Changing Perceptions of Peer Norms as a Drinking Reduction Program for College Students.” Journal of Alcohol and Drug Education 41:2 (1996): 39–62.
Beauchamp, T., J. Cuddihy, J. Greene, M. Hammer, and D. Spring. “Marketing Alcoholic Beverages and its Impact on Underage Drinkers.” In Case Studies in Business, Society and Ethics, edited by T. Beauchamp. Upper Saddle River, NJ: Prentice Hall, 2004:
169–76.
Behling, D. “Alcohol Abuse Encountered in 51 Instances of Reported Child Abuse.” Clini- cal Pediatrics 18 (1979): 87–91.
Bobo, J., and C. Husten. “Sociocultural Influences on Smoking and Drinking.” Alcohol Research & Health 24:4 (2000): 225–40.
Botvin, G., R. Malgady, K. Griffin, L. Scheier, and J. Epstein. “Alcohol and Marijuana Use Among Rural Youth: Interaction of Social and Intrapersonal Influences.” Addictive Behaviors 23:3 (1998): 379–87.
Brook, J., M. Whiteman, A. Gordon, C. Nomura, and D. Brook. “Onset of Adolescent Drinking: A Longitudinal Study of Intrapersonal and Interpersonal Antecedents.”
Advances in Alcohol and Substance Abuse 5:3 (1986): 91–110.
Burns, W., S. Hampson, H. Severson, and P. Slovik. “Alcohol-Related Risk Taking Among Teenagers: An Investigation of Contributing Factors and a Discussion of How Mar- keting Principles Can Help.” Advances in Consumer Research 20 (1993): 183–7.
Cahalan, D., and R. Room. Problem Drinking Among American Men. New Brunswick, NJ:
Rutgers Center of Alcohol Studies, 1974.
Chaloupka, F., H. Saffer, and M. Grossman. “Alcohol-Control Policies and Motor Vehicle Fatalities.” Journal of Legal Studies 22:1 (1993): 161–86.
Chaloupka, F., and H. Wechsler. “Binge Drinking in College: The Impact of Price, Avail- ability, and Alcohol Control Policies.” Contemporary Economic Policy 14:4 (1996):
112–25.
Children of Alcoholics Foundation. Helping Children Affected by Parental Addiction and Family Violence: Collaboration, Coordination, and Cooperation. New York: CAF, 1996.
Collins, J. Drinking and Crime: Perspectives on the Relationships Between Alcohol Consump- tion and Criminal Behavior. New York: The Guilford Press, 1981.
Dawson, D., B. Grant, and P. Chou. “Gender Differences in Alcohol Intake.” In Stress, Gen- der, and Alcohol-Seeking Behavior, edited by Hunt, W., and S. Zakhari, S. NIAAA Research Monograph No. 29. NIH Pub. No. 95-3893. Bethesda, MD: NIAAA:
1995: 1–21.
DeJong, W. “The Role of Mass Media Campaigns in Reducing High-Risk Drinking Among College Students.” Journal of Studies on Alcohol 14 (2002): 182–92.
Dufour, M. “What is Moderate Drinking?” Alcohol Research & Health 23:1 (1999): 5–20.
Engs, R., D. Hanson, L. Gliksman, and C. Smythe. “Influence of Religion and Culture on Drinking Behaviours: A Test of Hypotheses Between Canada and the USA.” British Journal of Addiction 85 (1990): 1475–82.
Famularo, R., K. Stone, R. Barnum, and R. Wharton. “Alcoholism and Severe Child Mal- treatment.” American Journal of Orthopsychiatry 56 (1986): 481–5.
Foster, S., R. Vaughan, W. Foster, and J. Califano. “Alcohol Consumption and Expendi- tures for Underage Drinking and Adult Excessive Drinking.” Journal of the American Medical Association 289:8 (2003): 989–95.
Friedrich, M., M. Mackesy-Amiti, P. Goldstein, B. Spunt, and H. Brownstein. “Substance Involvement Among Juvenile Murderers: Comparison with Older Offenders Based on Interviews with Prison Inmates.” International Journal of Addictions 30:22 (1995):
1363–82.
Gelles, R., and C. Cornell. Intimate Violence in Families. Newbury Park, CA: Sage Publica- tions, 1990.
Gil, D. Violence Against Children: Physical Child Abuse in the United States. Cambridge, MA: Harvard University Press, 1973.
Godfrey, S., L. Allender, K. Laughery, and V. Smith. “Warning Messages: Will the Con- sumer Bother to Look?” Proceedings of the Human Factors Society. 27th annual meeting. Santa Monica, CA: HFS: 1983: 950–4.
Graves, K. “An Evaluation of the Alcohol Warning Label: A Comparison of the United States and Ontario, Canada in 1990 and 1991.” Journal of Pubic Policy and Marketing 12 (1993): 19–29.
Greenfield, T., and J. Rogers. “Who Drinks Most of the Alcohol in the U.S.? The Policy Implications.” Journal of Student Alcohol 60 (1999): 78–89.
Grossman, M., J. Sindelar, M. Mullahy, and R. Anderson. “Policy Watch: Alcohol and Cigarette Taxes.” Journal of Economic Perspectives 7:4 (1993): 211–22.
Grossman, M., F. Chaloupka, H. Saffer, and A. Laixuthai. “Effects of Alcohol Price Policy on Youth: A Summary of Economic Research.” In Alcohol Problems Among Adoles- cents: Current Directions in Prevention Research, edited by Boyd, G., J. Howard, and R. Zucker, R. Hillsdale, NJ: Lawrence Erlbaum Associates, 1995: 225–42.
Grube, J., and L. Wallack. “Television Beer Advertising and Drinking Knowledge, Beliefs, and Intentions Among Schoolchildren.” American Journal of Public Health 84:2 (1994): 254–9.
Gruenwald, P., W. Ponicki, and P. Mitchell. “Suicide Rates and Alcohol Consumption and Problems in Ontario, 1975–1983. Addiction 90 (1995): 1063–75.
Haines, M. P. “Social Norms Approach to Preventing Binge Drinking at Colleges and Universities.” Newton, MA: Higher Education Center for Alcohol and Other Drug Prevention, Department of Education, 1996.
Kaskutas, L., and T. Greenfield. “First Effects of Warning Labels on Alcoholic Beverage Containers.” Drug and Alcohol Dependence 31 (1992): 1–14.
Kaskutas, L., and T. Greenfield. “The Role of Health Consciousness in Predicting Atten- tion to Health Warning Messages.” American Journal of Public Health Promotion 11 (1997): 186–193.
Kendall, R. “Alcohol and Suicide.” Substance and Alcohol Actions/Misuse 4 (1983): 121–7.
LaRue, C., and H. Cohen. “Factors Affecting Consumers’ Perceptions of Product Warn- ings: An Examination of the Differences Between Male and Female Consumers.”
Proceedings of the Human Factors Society. 31st annual meeting. Santa Monica, CA:
HFS, 1987: 610–4.
Sociological/Cultural Influences of Drinking n 135
Laughery, K., and J. Brelsford. “Receiver Characteristics in Safety Communications.” Pro- ceedings of the Human Factors Society. 35th annual meeting. Santa Monica, DA:
HFS, 1991: 1068–72.
Lester, D. “Alcoholism and Drug Abuse.” In Assessment and Prediction of Suicide, edited by Maris, R., A. Berman, J. Maltsberger, and R. Yufit. New York: Guilford, 1992a:
321–6.
Lester, D. Why People Kill Themselves. 3rd edition. Springfield, IL: Charles C. Thomas, 1992b.
MacKinnon, D. “Review of the Effects of the Alcohol Warning Label.” In Drug and Alcohol Abuse Reviews. Alcohol, Cocaine, and Accidents, Vol. 7, pp. 131–161. Ed. Watson, R.
Totowa, NJ: Humana Press, 1995.
Mann, R., H. Suurvali, and R. Smart. “The Relationship Between Alcohol Use and Mor- tality Rates from Injuries: A Comparison of Measures.” American Journal of Drug and Alcohol Abuse 27:4 (2001): 737–48.
Margolis, R., and J. Zweben Treating Patients with Alcohol and Other Drug Problems: An Integrated Approach. Washington, D.C.: American Psychological Association, 1998.
Markowitz, S., and M. Grossman. “Alcohol Regulation and Domestic Violence Towards Children.” Contemporary Economic Policy 16:3 (1998): 309–21.
Mayer, R., K. Smith, and D. Scammon. “Evaluating the Impact of Alcohol Warning Labels.” Advances in Consumer Research 18 (1991): 706–14.
Mazis, M., L. Morris, and J. Swasy. “An Evaluation of the Alcohol Warning Label: Initial Survey Results.” Journal of Public Policy and Marketing 10 (1991): 229–41.
Mazis, M., L. Morris, and J. Swasy. “Longitudinal Study of Awareness, Recall, and Accep- tance of Alcohol Warning Labels.” Applied Behavioral Science Review 4 (1996):
111–20.
Midanik, L., T. Tam, T. Greenfield, and R. Caetano. “Risk Functions for Alcohol-Related Problems in a 1988 National Sample.” Addiction 91 (1996): 1427–37.
Mizruchi, E., and R. Perrucci. “Prescription, Proscription and Permissiveness: Aspects of Norms and Deviant Drinking Behavior.” In The Domesticated Drug: Drinking Among Collegians, edited by Maddox, G. New Haven, CT: College & University Press, 1970:
234–53.
Morgan, J. “Prohibition Was and Is Bad for the Nation’s Health.” In Substance Abuse: A Comprehensive Textbook, edited by Lowinson, J., P. Ruiz, R. Millman, and J. Lan- grod, J. 2nd edition. Baltimore: Williams & Wilkins, 1992: 1012–8.
Morris, B. R. “Help for Older People with Alcohol Problems.” New York Times D5. May 18, 2004a.
Morris, B. R. “When Retirement Leaves an Emptiness, Some Fill it with Alcohol.” New York Times D5. May 18, 2004b.
Muller, A. “Business Recession, Alcohol Consumption, Drinking and Driving Laws:
Impact on Oklahoma Motor Vehicle Fatalities and Fatal Crashes.” American Journal of Public Health 79:10 (1989): 1366–70.
Mumenthaler, M., J. Taylor, R. O’Hara, and J. Yesavage. “Gender Differences in Moderate Drinking Effects.” Alcohol Research & Health 23:1 (1999): 55–67.
National Institute on Alcohol Abuse and Alcoholism. Physician’s Guide to Helping Patients with Alcohol Problems. Rockville, MD: NIAAA. NIH Pub. No. 95-3769, 1995.