An Applied Theatre Prevention Program to Reduce Alcohol-Related Risky Behaviours During Schoolies

Author postprint of Quek, L. H., White, A., Low, C., Brown, J., Dalton, N., Dow, D., & Connor, J. P. (2012). Please refer to published article at doi 10.1111/j.1465-3362.2012.00453.x

Good choices, great future: An applied theatre prevention program to reduce alcohol-related risky behaviours during Schoolies

Authors

Lake-Hui Quek PhD, Senior Research Officer, Angela White PhD, Manager of Research, Christine Low BPsy, Coordinator (Prevention), Judith Brown EdD, Senior Lecturer, Nigel Dalton Sgt, Mackay District Crime Prevention Coordinator, Debbie Dow BSocWk, Community Support Officer, Jason P. Connor PhD, Associate Professor and Director. Dr Lake-Hui Quek, Centre for Youth Substance Abuse Research, The University of Queensland, K Floor Mental Health Centre, Royal Brisbane and Women's Hospital, Herston, Qld 4029, Australia. Tel: +61 7 3365 5247; Fax: +61 7 3365 5488; E- mail: [email protected]

Abstract

Introduction and Aims. The contextual and temporal factors of post-school celebratory events (‘Schoolies’) place young people at elevated risk of excessive drinking compared with other social occasions. This study investigates the impact of an applied theatre prevention program ‘Choices’ in reducing the risk of drinking and other risk behaviours during Schoolies celebrations.

Design and Methods. Choices was delivered in the last term of Year 12 across 28 North Queensland schools. A total of 352 school leavers (43.1% male, mean age = 17.14 years) completed a questionnaire at Whitsunday Schoolies, Queensland, Australia on 23–24 November 2010. Nearly 49% of respondents had attended Choices. The survey included measures of alcohol use, illicit drug use and associated problems during Schoolies and a month prior to Schoolies.

Results. After controlling for gender and pre-Schoolies drinking, school leavers who attended Choices were significantly less likely to report illicit drug use (OR = 0.51, P < 0.05) and problem behaviours (OR = 0.40, P < 0.01) than those who did not attend Choices. There was, however, no intervention effect in risky drinking (i.e. drank on 5 or more days, typical amount five or more standard drink and binge drank on 3 or more days) at Schoolies (OR = 0.92, P = 0.80).

Discussion and Conclusions. Delivery of a youth-specific applied theatre prevention program employing a harm minimisation framework may be effective in reducing high-risk behaviours associated with alcohol consumption at celebratory events, even if young people expect to engage in excessive alcohol consumption.

Introduction

Author postprint of Quek, L. H., White, A., Low, C., Brown, J., Dalton, N., Dow, D., & Connor, J. P. (2012). Please refer to published article at doi 10.1111/j.1465-3362.2012.00453.x

Celebrating ‘Schoolies’ is a major social phenomenon in Australia, where masses of young people converge on well-known holiday destinations to celebrate the end of high school. Traditionally, Schoolies is a week-long party held in late November and early December at various beachside holiday locations. From its beginnings on the Gold Coast, Queensland in the 1970s, Schoolies has grown to encompass over a dozen destinations across Australia and several regional overseas venues such as Bali and Fiji. In 2010, it was estimated that over 30 000 young people attended Schoolies on the Gold Coast alone [1]. Each year Schoolies attracts considerable media scrutiny and public concern regarding its impact upon both young people and the local communities in and around Schoolies venues. For many, Schoolies is considered a rite of passage and a celebration of the transition from adolescence to young adulthood and greater independence [2]. For others in the community, it is perceived as a ‘boozy party’ marked by binge drinking, risk behaviours and associated health and social harms [3,4].

Being in an environment surrounded by peer drinking and a desire to fit in, it is not surprising that a majority of young people engage in binge drinking during this event [4–7]. Binge drinking puts young people at greater risk of accidents, injuries and other negative social and health outcomes [8–11], especially for those who have little or no experience with alcohol [12]. With reduced inhibition, motor coordination and decision-making abilities, young current drinkers who binge were more likely to ride with a driver who had been drinking, be a victim of dating violence or sexual harassments, be involved in fights, attempt suicide and use illicit drugs compared with those who do not binge [7,11]. A recent study found that students maintained their increased maximum number of drinks consumed after returning from Spring Break (a comparable celebratory event in the USA) [13] in a short-term follow up. These risks highlight the importance of tackling binge drinking and its associated negative outcomes at Schoolies.

Focusing on creating a safer environment for school leavers, local governments and community organisations have stepped up harm prevention efforts by registering school leavers, engaging them in diversionary activities and providing water and help stations [1,3,5]. These safety response strategies are generally well received by school leavers, and they reduce vandalism and nuisance behaviours within the surrounding community precincts [3]. Despite the potential benefit of education programs in addressing young people's explicit expectations and intention to party and drink [6,7,14], interventions addressing individual and peer risk factors (e.g. drug education programs) remained relatively underutilised. Implementations of education programs require coordinated efforts from schools, community organisations and Schoolies organisers, and thus, are often difficult to implement. Whitsunday Schoolies is in a unique position to deliver a prevention program given most of the attendees are from surrounding local areas [15].

The applied theatre prevention program, ‘Choices’, was developed and performed by Central Queensland Conservatorium of Music (CQCM) in partnership with government and non-government services (e.g. alcohol and drug, sexual health, police, ambulance, transport). The aim of Choices is to reduce risk-taking behaviours during Schoolies using a harm minimisation framework [16]. Applied

Author postprint of Quek, L. H., White, A., Low, C., Brown, J., Dalton, N., Dow, D., & Connor, J. P. (2012). Please refer to published article at doi 10.1111/j.1465-3362.2012.00453.x

theatre programs (broadly defined as using theatre to address social issues) are not only an excellent medium for engaging young people [17,18], but also effective for raising awareness of drug issues, increasing knowledge and changing attitudes and behaviours [19,20]. Unlike the traditional drug education programs (e.g. Drug Abuse Resistance Education (DARE)) [21], applied theatre programs such as Choices are designed to be evocative and stimulating learning experiences by eliciting emotional responses and act as a springboard for further discussion [22–24].

The primary aim of this study was to investigate the effectiveness of Choices in reducing risky drinking, illicit drug use and problem behaviours (e.g. driving under the influence, arguments) during Schoolies. This study also examined the predictors of risky drinking, illicit drug use and problem behaviours at Schoolies. Given the gender differences in alcohol and drug consumption, it was expected that risky drinking, illicit drug use and problem behaviours during Schoolies would be different for male and female school leavers [4,7]. Furthermore, drinking behaviours leading up to Schoolies were also expected to influence the level of alcohol consumption during Schoolies [12]. Finally, this study also considered the effect of drinking and illicit drug use at Schoolies on problem behaviours.

Methods

Intervention

Choices is a 50 min applied theatre prevention program performed by CQCM students (voluntarily) to encourage Year 12 students to make better choices about how they party and behave during Schoolies. A series of safety messages addressing a range of issues, including alcohol and illicit drug use, seeking help, safe sex, drink driving, liquor licensing, policing, services at Schoolies and looking after mates, were selected by the Choices Committee. These safety messages are embedded within skits, contemporary pop culture and music (e.g. Glee, Home and Away and Dr Phil). The performance is followed by a 20 min interactive forum to provide students with an opportunity to clarify information and safety messages, as well as ask specific questions of the Choices panel (which includes alcohol and drug worker, sexual health worker, transport and main roads worker and police officer).

All high schools with Year 12 students in the Mackay and Townsville Health Service Districts were invited to participate in Choices. Fourteen schools in the Mackay Health Service District and 14 in the Townsville Health Service District participated in the program. The schools were selected on a first- come-first-serve basis. The Choices presentation was delivered to Year 12 students at the participating schools from 18 to 29 October 2010. The majority of students (687/746) reported being satisfied with the program on an eight-item measure (e.g. useful, enjoyment, relevance), and also showed improvement in a safer celebration knowledge (12 true or false statements, e.g. the only way to reduce blood alcohol concentration is time) (Mpre = 8.63, Mpost = 10.50, t (745) = −21.97, P < 0.001). Both measures were specifically developed for this study.

Participants

Author postprint of Quek, L. H., White, A., Low, C., Brown, J., Dalton, N., Dow, D., & Connor, J. P. (2012). Please refer to published article at doi 10.1111/j.1465-3362.2012.00453.x

A cross-sectional behavioural survey of young people was conducted on 23–24 November 2010 (officially the last day) at Whitsunday Schoolies, Queensland, Australia. A total of 352 registered school leavers (43.1% male, mean age = 17.14, SD = 0.41) were recruited by Choices team members via convenience sampling strategies. They were approached at Schoolies Central, around the Airlie Beach Lagoon and in parts of the main street in Airlie Beach and asked to complete a survey. All registered school leavers, regardless of their previous participation in Choices, were eligible to complete the survey. Nearly half (49%) of the survey respondents reported attending the Choices prevention program in the month prior to attending Schoolies.

Measures

The survey consisted of questions on participant demographics, Schoolies (e.g. accommodation, services accessed, activities participated in) and the Choices prevention program (e.g. key message remembered). The survey also included alcohol consumption, illicit drug use and problem behaviours.

Alcohol consumption. The Alcohol Use Disorder Identification Test—Consumption (AUDIT-C) is an abbreviated version of AUDIT consisting of three items measuring consumption of alcohol [25,26]. The AUDIT-C has good psychometric properties, with the 3 week test–retest reliability = 0.98, and acceptable levels of internal consistencies (rα = 0.69 to 0.91) [25]. School leavers were invited to complete the AUDIT-C for the month prior to Schoolies (rα = 0.80). To capture consumption during the week of Schoolies, the response for the AUDIT-C items 1 and 3 were modified to ‘none/never’, ‘1–2 days’, ‘3–4 days’, ‘5–6 days’ and ‘everyday’. The internal consistency for this modified scale was high (rα = 0.89).

The Substance and Choices Scale Clinical Questionnaire (SACS) [27]. SACS includes 12 items in Part A assessing frequency of illicit drug use and 10 items in Part B assessing problems associated with substance use (e.g. driven under the influence, unsafe sex/unwanted sexual experience, arguments, got into serious trouble, consuming alone). The measure has excellent internal consistency of 0.91 and good test–retest reliability of 0.88 [27]. School leavers rated their illicit drug use in the month prior to Schoolies as 0 ‘never’, 1 ‘once a week’, 2 ‘more than once a week’ and 3 ‘most days’ (rα = 0.92). The SACS was also modified to assess drug use and problems associated with substance use during the week of Schoolies (rα = 0.91).

Analyses

The data were analysed using spss version 18. The three outcome variables were risky drinking, drug use and problem behaviours. To capture different aspects of risky drinking, risky drinking during Schoolies was coded as present if the young person: (i) drank everyday during the official Schoolies (i.e. 5 or more days); (ii) typical amount consumed was more than the National Health and Medical Research Council (NHMRC)-recommended guidelines for a single occasion (five or more standard

Author postprint of Quek, L. H., White, A., Low, C., Brown, J., Dalton, N., Dow, D., & Connor, J. P. (2012). Please refer to published article at doi 10.1111/j.1465-3362.2012.00453.x

drinks); or (iii) consumed more than five standard drinks (binge amount) on more than half the time during Schoolies (i.e. 3 or more days) based on AUDIT-C responses. Due to the relative infrequent illicit drug use (drug other than alcohol), illicit drug use was coded as present if the young person reported using any illicit drugs at least once during Schoolies. Problem behaviours were coded as present if the young person reported any problem on Part B of the measure (score of at least 1) as very few young people reported more than one problem. Participants with missing data on the outcome measures of alcohol use (n = 6), illicit drug use (n = 33) and problem behaviours (n = 33) were excluded for analysis.

A multivariable modelling approach using binary logistic regression was chosen to permit consideration of a range of risk factors related to risky drinking, illicit drug use and problem behaviour. Gender was entered at Step 1 and pre-Schoolies drinking was entered at Step 2 for all models. At Step 3, risky drinking at Schoolies was entered for the illicit drug use model, while risky drinking and illicit drug use at Schoolies was entered for the problem behaviour model. Choices prevention program was entered at the final step for all the models. Sensitivity analyses found no significant differences in models when excluding young people living outside of the Choices prevention program delivery catchment area.

Results

Of the young people who participated in the Whitsunday Schoolies survey, the majority (90%) reported drinking during Schoolies. Overall, 76% reported that they drank in a risky manner during Schoolies, with 64% drinking on 5 or more days, 67% typically consuming five or more drinks and 59% binge drinking (consume six or more drinks) on 3 or more days. Approximately 15% of participants reported consuming illicit drugs and 35% engaged in problem behaviours at least once during Schoolies. In the month prior to Schoolies, only 26% of young people stated that they had consumed little or no alcohol, 57% indicated that they had drunk 2–4 times that month and 17% stated that they had been drinking more than once a week.

Risky drinking

Three binary logistic regression models were conducted to determine the influence of the Choices prevention program on: (i) risky drinking; (ii) illicit drug use; and (iii) problem behaviours (see Table 1). In the model for risky drinking, only the pre-Schoolies drinking was significant. In the month prior to Schoolies, if the young person was drinking 2–4 times or drinking more than weekly, they were at greater risk of risky drinking during Schoolies. The Choices prevention program did not influence young people's risky drinking during Schoolies. Sensitivity analyses performed on different sub- definitions of risky drinking, including: (i) drinking on 5 or more days; (ii) typical amount consumed more than five standard drinks; and (iii) consuming more than five standard drinks on 3 or more days, revealed a consistent finding.

Author postprint of Quek, L. H., White, A., Low, C., Brown, J., Dalton, N., Dow, D., & Connor, J. P. (2012). Please refer to published article at doi 10.1111/j.1465-3362.2012.00453.x

Table 1. Binary logistic regression models for the influence of Choices and other risk factors on risky drinking, illicit drug use and problem behaviours during Schoolies

Illicit drug use

For the illicit drug use model, all predictors were significant except for gender. Drinking in the month prior to Schoolies was a significant predictor for illicit drug use during Schoolies, but only for those who drank on a weekly basis (OR = 4.65). Young people who drank 2–4 times per month were at no greater risk than those who drank less than monthly or who were abstinent. Drinking at a risky level during Schoolies also predicted greater illicit drug use over and above young people's general consumption (OR = 3.87). After controlling for these effects, the Choices prevention program significantly reduced the risk of illicit drug use during Schoolies by 50%.

Problem behaviours

In relation to the problem behaviour model, all predictors for problem behaviour were significant except for gender. Drinking in the month prior to Schoolies was a significant predictor of problem behaviours during Schoolies only for those who drank on a weekly basis. Those who drank 2–4 times a month were not at greater risk than those who drank monthly or who were abstinent. Both risky drinking and illicit drug use during Schoolies predicted greater risk for problem behaviour. The Choices prevention program reduced the risk of engaging in risky behaviour by 59% even after controlling for the effect of gender, pre-Schoolies drinking, binge drinking and illicit drug use at Schoolies.

Author postprint of Quek, L. H., White, A., Low, C., Brown, J., Dalton, N., Dow, D., & Connor, J. P. (2012). Please refer to published article at doi 10.1111/j.1465-3362.2012.00453.x

Discussion

This study provides data on the potential utility of an applied theatre prevention program on reducing alcohol-related risk behaviours during Schoolies. Choices reduced the risk of illicit drug use and engagement in problem behaviours during Schoolies. The intervention effects were strong even after adjusting for other predictors of illicit drug use and problem behaviours, such as gender, pre- Schoolies drinking, risky drinking and/or illicit drug use during Schoolies. The lack of intervention effect for risky drinking in Schoolies may be due to restricted variability in the outcome measurement when the majority of school leavers are drinking at risky levels. These results may also reflect the nature of Schoolies as a celebratory event associated with alcohol consumption. Combined with the fact that many Schoolies attendees have only recently become legally able to drink alcohol, the potency of the Choices prevention program upon alcohol consumption may have been reduced. Nonetheless, a reduction in problem behaviours, such as arguments, drink driving or riding with a drunk driver, highlights the importance of implementing prevention programs aimed at keeping young people safe at celebratory events, even if they expect to engage in risky drinking. This is an important finding and suggests that targeted youth-specific prevention programs employing a harm minimisation framework can be effective in reducing high-risk behaviours associated with alcohol consumption.

A number of factors may have played a role in the Choices prevention program mediating risk behaviours. The program focused on a harm minimisation approach in that it did not tell young people to abstain but emphasised ways to celebrate more safely. The youth-oriented nature of pop culture used within the applied theatre program also helps to engage young people. It is developed and presented by young people for young people employing youth music, television shows and other readily identifiable themes. Finally, the recency effect of delivering the program in the last 2 weeks of school may have increased the salience and relevance of the harm minimisation message.

In relation to risky drinking at Schoolies, school leavers who drank more frequently in the month leading up to Schoolies were more likely to engage in risky drinking, use illicit drugs and engage in problem behaviours during Schoolies than those who drank rarely or were abstinent. This is inconsistent with previous research that found emergency department patients who usually drank little but on occasion drank heavily were at greater risk of injury [9]. This suggests that young people who have just reached or on the cusp of legal drinking age may have different risk profiles. Drinking in the month leading up to Schoolies is the only significant predictor for risky drinking, with those drinking more frequently than once a month being 8 to 13 times more likely to engage in risky drinking at Schoolies than those who only drank once a month or who abstained. The implication for parents is that ‘inoculation’ of young people to the effects of alcohol does not work and may increase the risky drinking and the associated risk behaviours during Schoolies. It also raises the question of how best to address a young person's current drinking pattern to minimise risky drinking and related behaviours at events such as Schoolies or other similar large-scale entertainment events. Future studies need to consider the timing for delivering prevention programs and incorporate reminders via apps or website prior to or during the event.

Author postprint of Quek, L. H., White, A., Low, C., Brown, J., Dalton, N., Dow, D., & Connor, J. P. (2012). Please refer to published article at doi 10.1111/j.1465-3362.2012.00453.x

The findings from this study should be interpreted in light of several limitations. The cross-sectional survey of those who did and did not attend Choices used a convenient sampling methodology. We have no data on the level of Schoolies information or intervention received by the non-Choices respondents. Second, the study recruited young people regardless of where they were from. While young people living in the local areas (Mackay and Townsville) may be different from other young people who had travelled from elsewhere in Australia to attend Whitsunday Schoolies, sensitivity analyses found that the young person's residence did not influence any of the models. Third, the study only assessed for drinking in the month leading up to Schoolies retrospectively which may be less accurate [28]. Nevertheless, it is important to account for this period as young people may have escalated their drinking after exams period. Fourth, the study did not specifically examine the occurrence of problem behaviours in association with alcohol consumed. Future studies would benefit from a longitudinal study design that included surveying students prior to Schoolies. However, the key strength of this research is that it allows examination of prevention effects on behaviours during Schoolies.

Conclusions

School and community preventative actions are critical in reducing alcohol-related harms for young people embarking on Schoolies. The delivery of a youth-specific applied theatre prevention program employing a harm minimisation framework may be effective. School leavers attending Choices were able to translate knowledge acquired during the presentation into behaviours resulting in safer celebration. Further research is required to examine peer influence on drinking at Schoolies and the long-term outcomes of binge drinking at Schoolies.

Acknowledgements

The authors wish to acknowledge the Central Queensland Conservatorium of Music student volunteers who directed and performed Choices. The delivery of the program was funded and supported by Mackay and Townsville Alcohol, Tobacco and Other Drugs (ATODS), Department of Communities, Choices Committee, Whitsunday Schoolies Committee, Central Queensland University, Conservatorium of Friends Mackay Inc., Department of Transport and Main Roads, Queensland Police Service, the Whitsunday Regional Council and donations from local business.

References

[1] National School Leavers Conference. 2011 National School Leavers Conference Program. Gold Coast, Queensland: Department of Communities, Queensland Goverment, 2011.

[2] Winchester H, McGuirk P, Everett K. Schoolies week as a rite of passage: a study of celebration and control. In: Teather EK, ed. Embodied geographies: space, bodies and rites of passage. London: Routledge, 1999:59–77.

Author postprint of Quek, L. H., White, A., Low, C., Brown, J., Dalton, N., Dow, D., & Connor, J. P. (2012). Please refer to published article at doi 10.1111/j.1465-3362.2012.00453.x

[3] Midford R, Midford S, Farringdon F. School leaver (graduate) celebrations in Margaret River, Western Australia: a community approach to management. Subst Use Misuse 2007;42:1915–32.

[4] Salom C, Watts M, Kinner S, Young D. Schoolies week in perspective: studies of alcohol, drug and risk-taking behaviour. Of Substance 2005;3:26–8.

[5] Midford R, Young N, Farringdon F, Bogaards T. School leaver celebrations in Western Australia: a three-year intervention study. Int J Health Promot Educ 2004;42:100–8.

[6] Smith AM, Rosenthal D. Sex, alcohol and drugs? Young people's experience of Schoolies Week. Aust N Z J Public Health 1997;21:175–80.

[7] Zinkiewicz L, Davey J, Curd D. Sin beyond surfers? Young people's risky behaviour during Schoolies Week in three Queensland regions. Drug Alcohol Rev 1999;18:279–85.

[8] Astudillo M, Kuntsche S, Graham K, Gmel G. The influence of drinking pattern, at individual and aggregate levels, on alcohol-related negative consequences. Eur Addict Res 2010;16:115–23.

[9] Gmel G, Bissery A, Gammeter R, et al. Alcohol-attributable injuries in admissions to a Swiss emergency room – an analysis of the link between volume of drinking, drinking patterns, and preattendance drinking. Alcohol Clin Exp Res 2006;30:501–9.

[10] Begg SJ, Vos T, Barker B, Stanley L, Lopez AD. Burden of disease and injury in Australia in the new millennium: measuring health loss from diseases, injuries and risk factors. Med J Aust 2008;188:36–40.

[11] Miller JW, Naimi TS, Brewer RD, Jones SE. Binge drinking and associated health risk behaviors among high school students. Pediatrics 2007;119:76–85.

[12] Lee CM, Lewis MA, Neighbors C. Preliminary examination of spring break alcohol use and related consequences. Psychol Addict Behav 2009;23:689–94.

[13] Lee CM, Maggs JL, Rankin LA. Spring break trips as a risk factor for heavy alcohol use among first-year college students. J Stud Alcohol 2006;67:911–16.

[14] Neighbors C, Walters ST, Lee CM, et al. Event-specific prevention: addressing college student drinking during known windows of risk. Addict Behav 2007;32:2667–80.

[15] Choices Committee. Choices 2009 Report. Mackay: Alcohol, Tobacco and Other Drugs Services, 2009.

[16] Brown J, Gunning C, Turner R, Novisel J, eds. Vomit on the dance floor: unlocking the key messages for a safe ‘Schoolies’ week using performing arts and peer education strategies. Safe Living on the Edge: 7th Australian Injury Prevention Conference, 2004 15–17 September; Mackay, Queensland, Australia.

[17] Guttman N, Gesser-Edelsburg A, Israelashvili M. The paradox of realism and ‘authencity’ in entertainment-education: a study of adolescents' views about anti-drug abuse dramas. Health Commun 2008;23:128–41.

Author postprint of Quek, L. H., White, A., Low, C., Brown, J., Dalton, N., Dow, D., & Connor, J. P. (2012). Please refer to published article at doi 10.1111/j.1465-3362.2012.00453.x

[18] Joronen K, Rankin SH, Astedt-Kurki P. School-based drama interventions in health promotions for children and adolescents: systematic review. J Adv Nurs 2008;63:116–31.

[19] Stephens-Hernandez AB, Livingston JN, Dacons-Brock K, et al. Drama-based education to motivate participation in substance abuse prevention. Subst Abuse Treat Prev Policy 2007;2:11.

[20] Starkey F, Orme J. Evaluation of a primary school drug drama project: methodological issues and key findings. Health Educ Res 2001;16:609–22.

[21] Pan W, Bai HY. A multivariate approach to a meta-analytic review of the effectiveness of the DARE Program. Int J Environ Res Pub Health 2009;6:267–77.

[22] Harding CG, Safer LA, Kavanagh J, et al. Using live theatre combined with role playing and discussion to examine what at-risk adolescents think about substance abuse, its consequences, and prevention. Adolescence 1996;31:783–96.

[23] Safer LA, Harding CG. Under pressure program: using live theatre to investigate adolescents' attitudes and behavior related to drug and aclohol abuse education and prevention. Adolescence 1993;28:135–48.

[24] Stephenson SD, Iannone R. A drug evaluation curriculum with drama as its base: the target project. Coll Stud J 2006;40:631–40.

[25] Reinert DF, Allen JP. The alcohol use disorders identification test: an update of research findings. Alcohol Clin Exp Res 2007;31:185–99.

[26] Kriston L, Holzel L, Weiser AK, Berner MM, Harter M. Meta-analysis: are 3 questions enough to detect unhealthy alcohol use? Ann Intern Med 2008;149:879–88.

[27] Christie G, Marsh R, Sheridan J, et al. The Substances and Choices Scale (SACS) – the development and testing of a new alcohol and other drug screening and outcome measurement instrument for young people. Addiction 2007;102:1390–8.

[28] Kraus CL, Salazar NC, Mitchell JR, et al. Inconsistencies between actual and estimated blood alcohol concentrations in a field study of college students: do students really know how much they drink? Alcohol Clin Exp Res 2005;29:1672–6.