Reported changes in students' alcohol consumption following a brief education of what constitutes a standard drink.

Reported changes in students' alcohol consumption following a brief education of what constitutes a standard drink. ABSTRACT Intercept surveys were conducted with 149 college students eachasked to record their alcohol consumption for the previous two weeksusing the Timeline Follow-back (TLFB TLFB Timeline Followback Method (alcoholism)method). Immediately followingcompletion of the pretest pre��test?n.1. a. A preliminary test administered to determine a student's baseline knowledge or preparedness for an educational experience or course of study.b. A test taken for practice.2. TLFB alcohol survey the students werepresented with brief educational information defining what constitutesone standard drink. Students then completed a new posttest post��test?n.A test given after a lesson or a period of instruction to determine what the students have learned. TLFB surveyand re-recorded the number of drinks they had in the previous two weeks.Among drinkers the majority, 55%, reported an increased number of drinksin response to the standard drink education information they received.Posteducation TLFB survey records were significantly higher thanbaseline presurvey records conducted within a five minute timeframe ofone another. Validating the accuracy of baseline self-reported alcoholconsumption is important to both prevention and intervention fieldspotentially enabling practitioners to more accurately: a) assess alcoholeducation and counseling needs; b) assess baseline alcohol use rates;and c) measure outcomes. ********** Quantity of alcohol consumption, typically obtained throughself-report measures, is frequently utilized as an outcome measure instudies evaluating the efficacy of alcohol prevention, education, andintervention (Larimer & Cronce, 2007). In clinical settings, aclient's reported number of drinks per drinking occasion is oftenan important component of alcohol assessment and screening. In the fieldof public health, alcohol prevention programs typically use preprogram pre��pro��gram?tr.v. pre��pro��grammed or pre��pro��gramed, pre��pro��gram��ming or pre��pro��gram��ing, pre��pro��gramsTo program in advance; preset. alcohol intake as baseline data against which programmatic pro��gram��mat��ic?adj.1. Of, relating to, or having a program.2. Following an overall plan or schedule: a step-by-step, programmatic approach to problem solving.3. outcomes aremeasured. Baseline alcohol assessment and outcome measures by and largeutilize: a) frequency (number of drinking days per/occasion), b)quantity (number of alcoholic drinks consumed per occasion), and c)alcohol related consequences (Larimer, et al. 2007; Blow et al., 2007;Babor et al., 1992). While there are methodological steps that minimizeresponse bias (Babor, Stephens, & Marlatt, 1987), there has beendebate about relying solely on measures of alcohol intake quantity as aprimary determinant determinant,a polynomial expression that is inherent in the entries of a square matrix. The size n of the square matrix, as determined from the number of entries in any row or column, is called the order of the determinant. of alcohol related risks and prevention programoutcomes in college or university settings (DeJong, 1998; White, Kraus,& Swartzwelder, 2006; Wechsler & Austin 1998; Wechsler, Dowdall,Davenport Davenport,city (1990 pop. 95,333), seat of Scott co., E central Iowa, on the Mississippi River; inc. 1836. Bridges connect it with the Illinois cities of Rock Island and Moline; the three communities and neighboring Bettendorf, Iowa, are known as the Quad Cities. , & Castillo 1995). Inaccurate baseline reports of alcoholconsumption may result in errors in outcome assessment; and may eclipsepositive outcomes by producing false negative or false positiveoutcomes. Several studies have documented inaccuracies in direct assessmentof the quantity of alcohol consumed per occasion among college students.College students' misperceptions of standard alcohol serving sizeshave lead to underreporting inaccuracies in self-reported alcoholconsumption (Presley & Pimental, 2006; Wansink & Van Ittersum,2005; White, et al., 2005). Inaccurate reporting is often based onvariations in the size and shape of alcohol containers as well asvarying alcohol content of beverages (e.g. Wine, beer, liquor liquor/li��quor/ (lik��er) (li��kwor) pl. liquors, liquo��res ? [L.]1. a liquid, especially an aqueous solution containing a medicinal substance.2. ) and thelack of understanding about what constitutes a standard drink (Wansink& Van Ittersum, 2005; Lemmens, 1994; Turner, 1990). Given this, thevalidity of responses to alcohol surveys and the classification ofdrinking (e.g., moderate or heavy drinker) based on quantity of drinksreported are called into question. Studies conducted using objectiveobservation measures of drinks that were 'free-poured' (i.e.,pouring a drink without measuring an amount to be added) by bartendersand college students found they underestimated the amount of alcoholpoured by nearly 20%. Participants tended to over-pour their drinksparticularly in wider tumbler style glasses which resulted inunderreported levels of consumption based on inaccurate estimates(Wansink & Van Ittersum, 2005; White, et al., 2005). Underagedrinking among adolescents and college students is most likely to occurin nonregulated environments where alcohol is free-poured in nonstandard non��stan��dard?adj.1. Varying from or not adhering to the standard: nonstandard lengths of board.2. containers or serving sizes and with inconsistent strength across mixeddrinks. The layperson's ability to accurately document/record his orher alcohol consumption is similar to the accuracies and inaccuracies ofdietary recall and dietary records. Researchers have found thatindividuals generally underreport un��der��re��port?tr.v. un��der��re��port��ed, un��der��re��port��ing, un��der��re��portsTo report (income or crime statistics, for example) as being less than actually is the case. their baseline, preprogram orprecounseling dietary intake due to a lack of knowledge about whatconstitutes a standard serving of food and drink (Macdiarmid &Blundell, 1998; Mela & Aaron, 1997; Schoeller, 1990). Followingeducation as to what constitutes a standard serving for various foodsand beverages, the difference in dietary records and recall changesignificantly reflecting a more accurate understanding and measurementof a standard serving size. Similarly, nutritionists have found thatinformation about what constitutes a standard alcoholic drink alsochanges significantly following education on how to assess and measurealcohol consumption, particularly for drinks served in nonstandardserving size containers or mixed drinks (Strecher, Becker, Clark, &Prasada-Rao, 1989; Wansink & Van Ittersum, 2005; White, et al.,2005). Both the specificity of the survey measure, as well as the type ofsurvey administration, result in significant differences for variablesthat describe the quantity of alcohol consumed (Fishburne & Brown,2006). This study aimed to assess the consistency with which collegestudents' self-report alcohol consumption (defined as standarddrinks consumed per drinking day) before and immediately following briefeducation about what constitutes one standard drink. We hypothesizedthat there would be a significant increase in the quantity of drinksrecorded in the posteducation survey for each drinking day in responseto the participants' increased understanding of what constitutes astandard alcoholic drink. METHODS This study received approval from the Institutional Review BoardCommittee for Human Subjects Research. Participants were 149undergraduate college students randomly selected for interceptinterviews with students from four college campuses, three private andone public institution. The institutional demographics The attributes of people in a particular geographic area. Used for marketing purposes, population, ethnic origins, religion, spoken language, income and age range are examples of demographic data. from which thesamples were drawn included one large urban based Ivy League Ivy LeagueGroup of eight universities in the northeastern U.S., high in academic and social prestige, that are members of an athletic conference for intercollegiate gridiron football dating to the 1870s. institution, two medium sized private religiously affiliated suburbanbased institutions, and one urban based medium sized public institution.All institutions were residential campuses with undergraduatepopulations that were primarily of traditional age (18-23). Studentsamples from these institutions were selected in part because thecampuses did not have in place universal or population level alcoholeducation and prevention programs for their undergraduate students atthe time of our study and were therefore likely to represent a studentpopulation that may not have received systematic education about whatconstitutes a standard drink. Researchers were stationed outside of thecampus student unions and campus dining halls to facilitate access to adiverse sample of undergraduate college students. Three researchers conducted the survey administration, educationalpresentation and postsurvey administration. The researchers receivedthorough training in the protocol for conducting the intercept surveysincluding the preeducation survey, the presentation of the educationalnarrative, and procedures for the posteducation survey. Interceptinterviews are a reliable and valid method of data collection for publichealth research. The face-to-face intercept interview method, as used inthis study, has enabled researchers to better access hard to reachpopulations; has produced more representative distributions of race,age, and sex; and yields better completion rates than the well-acceptedmethods of random-digit-telephone survey, or mail surveys, particularlyfor collecting health information (Hox & De Leeuw, 1994; Miller,Wilder, Stillman, & Becket beck��et?n. NauticalA device, such as a looped rope, hook and eye, strap, or grommet, used to hold or fasten loose ropes, spars, or oars in position.[Origin unknown.]Noun 1. , 1997). This study used a two-weekTimeline Follow-back (TLFB) calendar grid for students to recordretrospective estimates of their daily drinking for the two weeks priorto the date of their intercept survey. The TLFB instrument has beenevaluated with clinical and non-clinical populations to obtain validestimates of daily alcohol consumption for a specified time period(Sobell & Sobell, 1992). The TLFB method is recommended for use whenrelatively precise estimates of drinking are necessary to provide awhole picture of drinking days (i.e., high- and low-risk days) and forthe measurement of drinking pre and posttreatment (Sobell& Sobell,2003). Intercept survey subjects were approached in person by oneresearcher; participants were asked if they would be willing toparticipate in a brief survey of college student alcohol use. Theresearchers informed each participant of the voluntary nature of theirengagement with this survey study and were assured anonymity andconfidentiality of their responses. The subjects' agreement toparticipate in the study served as verbal consent. Participants wereasked to record their daily alcohol consumption for the previous twoweeks using the TLFB calendar grid. Immediately following completion oftheir two week TLFB drink record, the researchers read each participantthe standard narrative and presented supporting visual imageillustrating for participants what constitutes one standard drink ofalcohol. The standard narrative and visual aids visual aidsNoun, plobjects to be looked at that help the viewer to understand or remember something defined one standarddrink as one 12-ounce beer, one 8.5-ounce malt beverage Malt beverage is an American term for both alcoholic and non-alcoholic fermented beverages, in which the primary ingredient is barley, which has been allowed to sprout ("malt") slightly before it is processed. , one 5-ounceglass of wine, one mixed drink containing one (1.5-ounce) shot ofalcohol, or one single (1.5-ounce) shot of liquor. Immediately following the brief educational explanation of whatconstitutes a standard drink, the survey participants were asked tore-record their alcohol consumption for the previous two weeks using ablank copy of the same TLFB calendar grid. The posteducation TLFBalcohol grid was used to compare participant responses to theirpreeducation reports for assessment of possible changes in theirunderstanding of what constitutes a standard drink. Participants werepermitted to ask the researchers for clarification and additionalinformation about their alcohol consumption, if they were not sure ofthe number of drinks to record. Common points of clarification asked byparticipants included questions about whether a single shot of alcoholcounts as a drink, how to measure and record mixed drinks with multipleshots of alcohol such as "long island iced tea," and how torecord drinks served in the ubiquitous "red plastic" 16 ounceparty cups. When survey administrators were asked how to record a"long island iced tea," participants were provided withinformation on the recipe/formula for a standard "long island icedtea," which is comprised of four standard (1.5 ounce) shots ofalcohol and may then need to be recorded as four drinks rather than onedrink. If the survey researcher were asked how to measure wine, mixeddrinks and beer served at "house parties" in non-standard sizecups (e.g., commonly used red plastic 16-ounce party cups), participantswere again provided information on what constitutes a standard drink anda visual aid to enable them to self-assess and calculate the estimatednumber of ounces in containers or cups they drank from. The number of drinking days for each participant was calculated asa sum of the days in the two week TLFB in which the number of drinksrecorded was greater than zero. For each participant the number ofdrinks recorded per drinking day was added to establish a singlenumerical total for each participant, representing the total number ofdrinks recorded for the two week TLFB in the preeducation survey and thetotal for the two week TLFB posteducation survey. Weekly sums werecomputed because of the frequency of zeroes reported for nondrinkingdays from the daily data recorded for the two-week period. The data forthe weekly sum of alcohol quantity were nonnormal in their distribution.Standard-paired sample t tests were conducted with the data using SPSS A statistical package from SPSS, Inc., Chicago (www.spss.com) that runs on PCs, most mainframes and minis and is used extensively in marketing research. It provides over 50 statistical processes, including regression analysis, correlation and analysis of variance. 14.0, comparing each subject's two-week sum for their presurvey andpostsurvey two-week timeline follow-back (TLFB) drinking records. RESULTS In total, 245 potential subjects were approached and asked if theywould take part in the survey of which 149 (60.8%) agreed toparticipate. One hundred forty-nine undergraduate students participatedin the intercept interviews, completed the presurvey, listened to theeducational narrative, and completed the postsurvey TLFB grid. Of the149 subjects who agreed to participate, 81% (n--121) reported consumingat least one drink of alcohol and had at least one drinking day for thetwo week recall. Data for the 28 non-drinkers were removed from thefinal data set producing a final matched participant dataset of 57female and 64 male subjects. The majority of participants, 55.4% (n =67), underreported their alcohol consumption for the baselinepreeducation survey. Of the 121 drinkers only 44.6% (n = 54) recordedthe same number of drinks for both the presurvey and postsurvey TLFBcalendar grid. One subject reported a decrease in alcohol consumptionfor one of the drinking days following the educational clarification ofwhat constitutes a drink, however the subject's two-week sum forthe TLFB remained constant in the postsurvey. A summary of all paired sample t tests appears in Table One. Apaired sample t test was conducted between the variables for the sum ofparticipants' two-week Timeline Follow-back baseline presurvey (M =22.05, SD = 22.38) and the sum of their posteducation survey (M = 27.79,SD = 27.31). The participants' recording of the number of drinksthey consumed over the previous two weeks increased significantlyfollowing the educational presentation of what constitutes one standarddrink (t 120 = -6.623, p< .001). Because of concern about the largestandard deviations suggesting a great deal of variability in the dataset and the possibility that statistical outliers could dramaticallyimpact the means and contribute to observed variability, the SPSSexplore command was used and identified 8 scores labeled as"extremes" at each time point (cases for which the TLFB sumwas equal to or exceeded 69 drinks or higher at presurvey, and cases forwhich the TLFB sum was equal to or exceeded 84 drinks or higher atpostsurvey). In all, ten participants accounted for the 16 extremevalues, with six participants having extreme values at both the pre andpostsurvey assessments (with highest estimates for drinking reaching 136drinks), two having extreme presurvey summary scores (both of which were83 drinks), and two having extreme postsurvey summary scores (both ofwhich were over 84 drinks). Data were reanalyzed with these tenparticipants withheld from the sample. Findings were similar, with asignificant increase (t 110 = -7.473, p< .001) in estimated sums frompresurvey (M = 16.97, SD = 13.83) to postsurvey (M = 21.45, SD = 17.05).Separate, subsequent analyses omitted participants for whom theirpre/post difference was labeled "extreme" through the SPSSexplore command (i.e., differences of 18 or greater between pre andpostsurveys), and findings again demonstrated a significant increase inpostsurvey estimates (M = 23.50, SD = 22.60) from presurvey estimates (M= 20.11, SD = 21.35) for these participants (t 109 = -7.358, p<.001). Finally, participants were omitted from analyses if they had avalue considered extreme on either their prepost difference, theirpresurvey sum, or their postsurvey sum was an extreme score (n = 17). Inthe remaining sample (n = 104), findings were again similar, withpostsurvey sums (M=19.60, SD = 15.96) significantly greater thanpresurvey sums (M = 16.22, SD = 13.93) (t 103 = -7.19, p< .001). Allfindings described above were replicated when analyses were runseparately by gender. DISCUSSION Underreporting alcohol consumption during baseline assessment dueto lack of accurate understanding of what constitutes a standard drinkmay skew (1) The misalignment of a document or punch card in the feed tray or hopper that prohibits it from being scanned or read properly.(2) In facsimile, the difference in rectangularity between the received and transmitted page. outcome measures. The current study highlights the importanceof clear standard drink definition at all assessment points. If baselinemeasures of alcohol consumption are completed without accurateinformation, subsequent education could lead to adjustments inparticipants' alcohol records at follow-up, thereby not accuratelymeasuring the effectiveness (or ineffectiveness) of alcohol education,prevention and intervention programs. Educational information providedto students during counseling and through alcohol education/preventionprograms may change how students report alcohol use. Findings from thisstudy indicate that baseline assessment estimates are likely to beunderreported in the absence of explicit supporting information todefine and/or illustrate what constitutes a standard drink as part ofthe survey or measure. If baseline assessment is underreported,postprogram or follow-up assessment measuring the number of drinksconsumed in a given occasion may appear to increase, remain unchanged,and be difficult to interpret if a participant uses a different frame ofreference to report consumption. We recommend using valid, reliablemeasures of alcohol consumption wherever possible in program evaluation Program evaluation is a formalized approach to studying and assessing projects, policies and program and determining if they 'work'. Program evaluation is used in government and the private sector and it's taught in numerous universities. and note the importance of providing participants with clear, concise,written information of what constitutes one standard drink at eachassessment point (pre, post, and follow-up) in addition to keepinginstructions and guidelines guidelines,n.pl a set of standards, criteria, or specifications to be used or followed in the performance of certain tasks. consistent. There are several limitations to the current study. The interceptinterview method of data collection has some weaknesses; notably thetime intensive nature of each interview between researcher and interviewsubject interrupts interrupts - interrupt consistency in the research design established tointerview every fifth subject. However, to minimize the potential ofbias in subject selection, data collection procedures were repeated onmultiple campuses following identical protocol of approaching everyfifth subject by a count that began following completion of eachinterview subject. Although there were students randomly interviewedfrom multiple campuses, the overall sample was small. Ethnicity ethnicityVox populi Racial status–ie, African American, Asian, Caucasian, Hispanic ofparticipants was not collected, and, therefore, considerations aboutgeneralizability could not be made. Future studies could examine anydiscrepancies after education about drink composition has occurred withlarger samples and with more attention paid to demographic variables.Additionally, a drink definition was provided in person as was theopportunity to consult when a student was unsure about how to compute To perform mathematical operations or general computer processing. For an explanation of "The 3 C's," or how the computer processes data, see computer. anestimate. It is unclear how these findings would extend when thisinformation is delivered in written format or on-line. Future studiescould examine the impact of providing this information in verbal ornarrative form compared to visual or pictorial information. Program evaluation does not always occur with reliable, valid,standardized measures. If information obtained between assessmentperiods somehow impacts a participant's approach to a survey, thisis a significant threat to validity. The current study demonstrated theimportance of clearly defining a standard drink prior to surveycompletion. Providing individuals with education about what constitutesa standard drink prior to completing baseline assessment and duringfollow-up assessment could increase the likelihood that subjects arereporting their alcohol intake with a consistent frame of reference. Any correspondence concerning this article should be addressed to:Dessa Bergen-Cico, Ph.D, Assistant Professor, Department of Health andWellness, College of Human Services and Health Professions, SyracuseUniversity Syracuse University,main campus at Syracuse, N.Y.; coeducational; chartered 1870, opened 1871. Syracuse is noted for its research programs in government and industry; facilities include the Center for Science and Technology, the Newhouse Communications Center, and , Room 306, 406 Ostrom Ave., Syracuse, NY 13244, Phone: (315)247-1747; Email: dkbergen@syr.edu. REFERENCES Babor, T. F., Stephens, R.S., & Marlatt, G.A. (1987). Verbalreport methods in clinical research on alcoholism alcoholism,disease characterized by impaired control over the consumption of alcoholic beverages. Alcoholism is a serious problem worldwide; in the United States the wide availability of alcoholic beverages makes alcohol the most accessible drug, and alcoholism is : response bias and itsminimization. Journal of Studies on Alcohol, 48, 410-424. Babor, T. F., Hodgson, B., Ritson, B., McRee, G., Ernberg, K.,Connor, K., & Grant, M. (1992). Experimental design and projectadministration. In T. F. Babor, & M. Grant (Eds.) , Program onsubstance abuse. Project on identification and management ofalcohol-related problems. Report on phase II: A randomized clinicaltrial randomized clinical trial,n a clinical study where volunteer participants with comparable characteristics are randomly assigned to different test groups to compare the efficacy of therapies. of brief interventions in primary health care (15-56). Geneva Geneva, canton and city, SwitzerlandGeneva(jənē`və), Fr. Genève, canton (1990 pop. 373,019), 109 sq mi (282 sq km), SW Switzerland, surrounding the southwest tip of the Lake of Geneva. :World Health Organization. Blow, EC., Barry, K.L., Walton, M.A., Maio, R.F., Chermack, S.T.,Bingham, C.R., Ignacio R.V., & Strecher, V.J. (2006). The efficacyof two brief intervention A Brief intervention is a technique, similar to an intervention, to help reduce alcohol misuse. It work in two ways: by getting people to think differently about their alcohol use so that they begin to think about or make changes in their alcohol consumption. strategies among injured in��jure?tr.v. in��jured, in��jur��ing, in��jures1. To cause physical harm to; hurt.2. To cause damage to; impair.3. at-risk drinkers inthe emergency department: impact of tailored messaging and brief advice.Journal of Studies on Alcohol, 67(4), 568-578. DeJong, W. (1998). Language matters. Catalyst, 4(1), 5. Gruenewald,P. J., & Johnson, F. W. (2006). The stability and reliability ofself-reported drinking measures. Journal of Studies on Alcohol, 67(5),738-745. Hox, J.J. & De Leeuw, E.D. (1994). A comparison of nonresponsein mail, telephone, and face-to-face surveys. Quality and Quantity, 28,329-344. Kuther, T. L. & Timoshin, A. (2003). A Comparison of socialcognitive and psychosocial psychosocial/psy��cho��so��cial/ (si?ko-so��shul) pertaining to or involving both psychic and social aspects. psy��cho��so��cialadj.Involving aspects of both social and psychological behavior. predictors of alcohol use by collegestudents. Journal of College Student Development Journal of College Student Development is an academic journal founded in 1959 and is the official publication of the American College Personnel Association. The journal publishes scholarly articles and reviews from a wide variety of academic fields related to college , 44(2), 143-154. Larimer, M.E., Lee, C.M., Fabiano, P.M., Stark, C.B. Feeney, M.,Kilmer, J.R., Geisner, I.M., Marlett, A. K., Lostutter, T.W. Cronce,J.M., & Neighbors., C., et al. (2007). Personalized per��son��al��ize?tr.v. per��son��al��ized, per��son��al��iz��ing, per��son��al��iz��es1. To take (a general remark or characterization) in a personal manner.2. To attribute human or personal qualities to; personify. mailed feedbackfor college drinking prevention: a randomized clinical trial. Journal ofConsulting and Clinical Psychology The Journal of Consulting and Clinical Psychology (JCCP) is a bimonthly psychology journal of the American Psychological Association. Its focus is on treatment and prevention in all areas of clinical and clinical-health psychology and especially on topics that appeal to a broad , 75(2), 285-294. Larimer, M.E. & Cronce, J.M. (2007). Identification,prevention, and treatment revisited: individual-focused college drinkingprevention strategies 1999-2006. Journal of Addictive Behavior Addictive behavior is any activity, substance, object, or behavior that has become the major focus of a person's life to the exclusion of other activities, or that has begun to harm the individual or others physically, mentally, or socially. , 32(11),2439-2469. Lemmens, P.H. (1994). The alcohol content of self-report andstandard drinks. Addiction, 89, 593-601. Macdiarmid, J. & Blundell, J. (1998). Assessing dietary intake:who, what and why of under-reporting. Nutrition Research Reviews, 11(2),231-253. Mela, D. J. & Aaron, J. I. (1997). Honest but invalid: whatsubjects say about recording their food intake. Journal AmericanDietetic dietetic/di��e��tet��ic/ (di?ah-tet��ik) pertaining to diet or proper food. di��e��tet��icadj.1. Of or relating to diet.2. Association, 97, 791-793. Miller, K.W., Wilder, L.B., Stillman, F.A., & Becker, D.M.(1997). The feasibility of a street-intercept survey method in anAfrican-American community. American Journal of Public Health, 87(4),655-658. Presley, C. A., & Pimentel, E.R. (2006). The introduction ofthe heavy and frequent drinker: a proposed classification to increaseaccuracy of alcohol assessments in postsecondary educational settings.Journal of Studies on Alcohol, 67(2), 324-331. Sobell, L.C. & Sobell, M.B. (2003) Alcohol consumptionmeasures. In J.P. Allen & V.B. Wilson (Eds.) Assessing alcoholproblems: A guide for clinicians and researchers (75-99). Second Edition(NIH "Not invented here." See digispeak. NIH - The United States National Institutes of Health. Publication No. 03-3745) National Institute on Alcohol Abuse andAlcoholism. Sobell, L.C. & Sobell, M.B. (1993). Timeline Follow-back: Atechnique for assessing self-reported ethanol ethanol(ĕth`ənōl')or ethyl alcohol,CH3CH2OH, a colorless liquid with characteristic odor and taste; commonly called grain alcohol or simply alcohol. consumption. In J. Allen& R. Z. Litten (Eds.), Measuring alcohol consumption: Psychosocialand biological methods. (41-72). Totowa, N J: Humana Press. Schoeller, D. A. (1990). How accurate is self-reported dietaryenergy intake? Nutrition Reviews, 48, 373-379. Strecher, V.S., Becker, M.H., Clark, N.M., & Prasada-Rao, P.(1989). Using patients' descriptions of alcohol consumption, diet,medication compliance, and cigarette smoking: the validity ofself-reports in research and practice. Journal General InternalMedicine, 4(2), 160-166. Turner, C. (1990). How much alcohol is in a standard drink? BritishJournal of Addiction, 85, 1171-1175. Wansink, B. & Van Ittersum, K. (2005). Shape of glass andamount of alcohol poured: comparative study of effect of practice andconcentration. British Medical Journal The British Medical Journal, or BMJ, is one of the most popular and widely-read peer-reviewed general medical journals in the world.[2] It is published by the BMJ Publishing Group Ltd (owned by the British Medical Association), whose other , 331, 24-31. White, A.M., Kraus, C.L., Flom, J.D., Kestenbaum, L.A., Mitchell,J.R., Shah, K., & Swartzwelder, H.S. (2005). College students lackknowledge of standard drink volumes: implications for definitions ofrisky drinking based on survey data. Alcoholism, Clinical andExperimental Research, 29(4), 631-638. White, A.M., Kraus, C.L., & Swartzwelder, H.S. (2006). Manycollege freshmen drink at levels far beyond the binge threshold.Alcoholism: Clinical and Experimental Research, 30(6), 1006-1010. Wechsler, H,. Dowdall, G.W., Davenport, A., & Castillo, S.(1995). Correlates of college student binge drinking binge drinkingAn early phase of chronic alcoholism, characterized by episodic 'flirtation' with the bottle by binges of drinking to the point of stupor, followed by periods of abstinence; BD is accompanied by alcoholic ketoacidosis–accelerated lipolysis and . American Journalof Public Health, 85, 921-926. Wechsler H., & Austin S.B. (1998). Binge drinking: Thefive/four measure. Journal of Studies on Alcohol, 59, 122-123. Dessa Bergen-Cico, Ph.D. Syracuse Unvierstiy and Jason Kilmer, Ph. D University of WashingtonTABLE 1Summary of Consumption Estimates Prior to and Following EducationAbout Standard Drink Composition.Participants Included in Analyses Two-Week TLFB Presurvey EstimateAll (n=121) 22.05 [+ or -] 22.38Extreme values for presurvey andpostsurvey excluded (n=111) 16.97 [+ or -] 13.83Extreme values for pre/postsurveydifference excluded (n=110) 20.11 [+ or -] 21.35Extreme values for any of theabove variables (n= 104) 16.22 [+ or -] 13.93Participants Included in Analyses Two-Week TLFB Postsurvey EstimateAll (n=121) 27.79 [+ or -] 27.31Extreme values for presurvey andpostsurvey excluded (n=111) 21.45 [+ or -] 17.05Extreme values for pre/postsurveydifference excluded (n=110) 23.50 [+ or -] 22.60Extreme values for any of theabove variables (n= 104) 19.60 [+ or -] 15.96Participants Included in Analyses t, df, and p-valueAll (n=121) t 120 = -6.623, p<.001Extreme values for presurvey andpostsurvey excluded (n=111) t 110 = -7.473, p<.001Extreme values for pre/postsurveydifference excluded (n=110) t 109 = -7.358, p<.001Extreme values for any of theabove variables (n= 104) t 103 = -7.19, p<.001