View in EDS HTML Full Text PDF Full Text

The Bystander Intervention for Problematic Alcohol Use Model (BIPAUM)

Saved in:
Bibliographic Details
Title: The Bystander Intervention for Problematic Alcohol Use Model (BIPAUM)
Language: English
Authors: Annelise Mennicke (ORCID 0000-0003-4259-4356), Jessamyn Bowling (ORCID 0000-0001-7410-4433), Erika Montanaro (ORCID 0000-0001-8936-6372), Madi Williams, Hannah Carlson, Victoria McClare, Erin A. Meehan, Jasmine Temple (ORCID 0000-0001-5356-713X), Bridget N. Jules (ORCID 0000-0003-4862-3613), Anvi Tirunagari, Neha Kissler, Phoebe Pruneda, Keshawn S. Mathews (ORCID 0000-0002-2931-2695), Gabrielle Haley, Michael J. Brienzo, Iris F. McMillan (ORCID 0000-0003-3694-5391), Anna Yoder, Casey Mesaeh, Christopher Correia (ORCID 0000-0003-2458-4066), Sarah McMahon (ORCID 0000-0002-7227-951X)
Source: Journal of American College Health. 2025 73(2):792-802.
Availability: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 11
Publication Date: 2025
Sponsoring Agency: National Institute on Alcohol Abuse and Alcoholism (NIAAA) (DHHS/NIH)
Contract Number: 1R15AA02891001
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Postsecondary Education
Descriptors: Intervention, Audiences, Alcohol Abuse, College Students, Barriers, Affordances, Planning, Attention, Decision Making, Evaluation, Student Behavior
Geographic Terms: North Carolina
DOI: 10.1080/07448481.2023.2245497
ISSN: 0744-8481
1940-3208
Abstract: Objective: The study aimed to identify phases of bystander intervention (BI) for problematic alcohol use (PAU) among college students. Participants: Twenty focus groups and nine interviews were conducted. Methods: Transcripts were thematically analyzed. Results: The phases of the Bystander Intervention for Problematic Alcohol Use Model (BIPAUM) include: (1) plan in advance, (2) notice and interpret a sign, (3) decide (i.e., assume responsibility, assess support/feasibility to intervene, and identify intervention strategy), (4) intervene, and (5) assess outcomes. Assessing outcomes loops to influence future behavior and each phase is influenced by barriers and facilitators. Conclusions: These unique phases should be considered when designing and evaluating intervention programs for PAU to meet students' needs and better reduce PAU. Future research should empirically test the BIPAUM. The results of the current study demonstrate a promising opportunity for applying BI to PAU, with the goal of reducing risky drinking among college students.
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1473132
Database: ERIC
Full text is not displayed to guests.
FullText Links:
  – Type: pdflink
    Url: https://content.ebscohost.com/cds/retrieve?content=AQICAHj0k_4E0hTGH8RJwT4gCJyBsGNe_WN95AvKlDbXJGqwxwHulQ5hpL0b3NxnLyAlVA6PAAAA4zCB4AYJKoZIhvcNAQcGoIHSMIHPAgEAMIHJBgkqhkiG9w0BBwEwHgYJYIZIAWUDBAEuMBEEDBxUKvfrxw5huFhNlAIBEICBmzo2AMj2JdU1qZuYO12_N7Eqs-Hv8iRkHbx9eAe-lbfG2z1kq9TEcsoP_T7RECSrhVyCXfjUQDAZH7iqkRe1g607CPsZ_AapnRsXRR5JW4YGScWzi1sndNQYIrX0W0u6NBfkZTKK7sG3BS5wmLoTIZsUvVwLmFewIxzbG4At4hDm1NewrlKzbgJU9vxq7LRVDYKg8v_zjiW3nUPR
Text:
  Availability: 1
  Value: <anid>AN0182848232;acl01feb.25;2025Feb10.04:08;v2.2.500</anid> <title id="AN0182848232-1">The bystander intervention for problematic alcohol use model (BIPAUM) </title> <p>Objective: The study aimed to identify phases of bystander intervention (BI) for problematic alcohol use (PAU) among college students. Participants: Twenty focus groups and nine interviews were conducted. Methods: Transcripts were thematically analyzed. Results: The phases of the Bystander Intervention for Problematic Alcohol Use Model (BIPAUM) include: (<reflink idref="bib1" id="ref1">1</reflink>) plan in advance, (<reflink idref="bib2" id="ref2">2</reflink>) notice and interpret a sign, (<reflink idref="bib3" id="ref3">3</reflink>) decide (i.e., assume responsibility, assess support/feasibility to intervene, and identify intervention strategy), (<reflink idref="bib4" id="ref4">4</reflink>) intervene, and (<reflink idref="bib5" id="ref5">5</reflink>) assess outcomes. Assessing outcomes loops to influence future behavior and each phase is influenced by barriers and facilitators. Conclusions: These unique phases should be considered when designing and evaluating intervention programs for PAU to meet students' needs and better reduce PAU. Future research should empirically test the BIPAUM. The results of the current study demonstrate a promising opportunity for applying BI to PAU, with the goal of reducing risky drinking among college students.</p> <p>Keywords: Bystander intervention; college; model development; problematic alcohol use</p> <p>Problematic alcohol use (PAU) among college students is a significant concern.[<reflink idref="bib1" id="ref6">1</reflink>] Bystander intervention (BI) may be a promising strategy to address PAU, as BI has demonstrated effectiveness in increasing prosocial behavior in other domains.[<reflink idref="bib2" id="ref7">2</reflink>] BI is a harm reduction strategy that leverages peers and community members to protect individuals from potential harm.[<reflink idref="bib3" id="ref8">3</reflink>] Theories of BI (e.g., Situational Model;[<reflink idref="bib4" id="ref9">4</reflink>] Theory of Action Coils[<reflink idref="bib5" id="ref10">5</reflink>]) have primarily been applied to domains of interpersonal violence and might not be relevant to the unique dynamics of PAU. This investigation aims to examine the phases of BI for PAU among college students.</p> <hd id="AN0182848232-2">PAU among college students</hd> <p>PAU among college students is common. For example, 31% of college students report binge drinking and 66% report excessive drinking during the past six months.[<reflink idref="bib1" id="ref11">1</reflink>]<sups>,</sups>[<reflink idref="bib6" id="ref12">6</reflink>] Over 1,800 college students die annually from alcohol-related injuries.[<reflink idref="bib7" id="ref13">7</reflink>]<sups>,</sups>[<reflink idref="bib8" id="ref14">8</reflink>] Some consequences of PAU include decreased academic effort[<reflink idref="bib9" id="ref15">9</reflink>] and experiences of sexual violence.[<reflink idref="bib10" id="ref16">10</reflink>]<sups>,</sups>[<reflink idref="bib11" id="ref17">11</reflink>] Drinking during college is often social,[[<reflink idref="bib12" id="ref18">12</reflink>], [<reflink idref="bib14" id="ref19">14</reflink>], [<reflink idref="bib16" id="ref20">16</reflink>]] with common drinking events including parties, tailgates, and ritualistic hazing that is often part of fraternity/sorority life.[[<reflink idref="bib18" id="ref21">18</reflink>], [<reflink idref="bib20" id="ref22">20</reflink>]]</p> <p>Despite being commonplace, PAU is not a monolithic phenomenon. Drinking behavior varies based on the settings in which people drink,[<reflink idref="bib22" id="ref23">22</reflink>] people's social networks and group affiliations, and their demographic characteristics. For example, male college athletes are more likely than female athletes to engage in binge drinking.[<reflink idref="bib23" id="ref24">23</reflink>] Another example suggests that relative to white college students, Asian American and African American college students drink less frequently and have lower rates of binge drinking.[<reflink idref="bib24" id="ref25">24</reflink>]<sups>,</sups>[<reflink idref="bib25" id="ref26">25</reflink>] As such, to effectively reduce the negative consequences associated with PAU, it is important to tailor PAU intervention strategies to drinking settings and friend groups. We sought to examine phases of BI for PAU among friends, as the threshold of opportunities for intervention is typically higher, and bystanders are more likely to intervene in situations with their friends than strangers.[<reflink idref="bib26" id="ref27">26</reflink>]</p> <hd id="AN0182848232-3">PAU intervention strategies</hd> <p>Alcohol prevention programs are common and primarily delivered to individuals to address personal drinking behaviors at universities.[<reflink idref="bib27" id="ref28">27</reflink>]<sups>,</sups>[<reflink idref="bib28" id="ref29">28</reflink>] Examples such as time-intensive individualized normative comparisons of drinking behavior show small to moderate reductions in drinking but are less impactful at reducing the long-term frequency of PAU.[<reflink idref="bib29" id="ref30">29</reflink>]<sups>,</sups>[<reflink idref="bib30" id="ref31">30</reflink>] Interventions aimed at altering the environment to reduce drinking (e.g., reducing the availability of alcohol on or near college campuses) are less studied. However, they may show evidence of effectiveness in reducing PAU when combined with other intervention strategies.[<reflink idref="bib31" id="ref32">31</reflink>] Interventions may be most effective when combining individual, environmental, and community strategies to prevent PAU.[<reflink idref="bib31" id="ref33">31</reflink>] Given the social contexts in which drinking occurs,[<reflink idref="bib22" id="ref34">22</reflink>]<sups>,</sups>[<reflink idref="bib32" id="ref35">32</reflink>] PAU interventions would benefit from a greater focus on increasing prosocial behavior to minimize alcohol-related harm.</p> <hd id="AN0182848232-4">Bystander intervention programs</hd> <p>One potential solution that capitalizes on the social nature of young adults is BI, which empowers individuals who observe a concerning situation (bystanders) to take action to prevent or stop harm from occurring. In other domains of harm (e.g., mental health;[<reflink idref="bib33" id="ref36">33</reflink>]<sups>,</sups>[<reflink idref="bib34" id="ref37">34</reflink>] sexual violence;[<reflink idref="bib2" id="ref38">2</reflink>]<sups>,</sups>[<reflink idref="bib35" id="ref39">35</reflink>] bullying[<reflink idref="bib36" id="ref40">36</reflink>]<sups>,</sups>[<reflink idref="bib37" id="ref41">37</reflink>]), BI training has been shown to increase the prosocial behaviors of bystanders. Because alcohol use among college students is largely a social endeavor that occurs among friends,[<reflink idref="bib32" id="ref42">32</reflink>]<sups>,</sups>[<reflink idref="bib38" id="ref43">38</reflink>] BI may be an effective strategy to reduce PAU.</p> <p>The application of BI to PAU is in its infancy. Given the association between sexual violence (SV) and PAU,[<reflink idref="bib39" id="ref44">39</reflink>] some BI programs aimed at reducing the prevalence of SV also include PAU-related content. These programs show increased SV bystander-related behaviors,[<reflink idref="bib40" id="ref45">40</reflink>]<sups>,</sups>[<reflink idref="bib41" id="ref46">41</reflink>] and some improvements in alcohol outcomes.[<reflink idref="bib40" id="ref47">40</reflink>] Few alcohol-specific BI initiatives have been tested, and among those that have, mixed results have been found. One study evaluating a mass media campaign aimed at increasing prosocial bystander behaviors to reduce PAU among non-college-aged adults found no significant increase in alcohol-related bystander outcomes.[<reflink idref="bib42" id="ref48">42</reflink>] In contrast, an in-person BI training program was shown to increase alcohol-related bystander behaviors.[<reflink idref="bib43" id="ref49">43</reflink>] The National Institute on Alcohol Abuse and Alcoholism has identified BI as an environmental approach with low implementation barriers; however, more robust evaluations need to be conducted in this area.[<reflink idref="bib44" id="ref50">44</reflink>] The mixed effectiveness of alcohol-specific BI programs underscores that there may be unique elements to PAU that should be examined to refine intervention development further.</p> <hd id="AN0182848232-5">The process of BI</hd> <p>The Situational Model is the foundational BI theory, providing linear steps a bystander goes through before engaging in bystander action in situations of emergency and sexual violence.[<reflink idref="bib4" id="ref51">4</reflink>] Within this model, a bystander must notice a concerning event, interpret it as dangerous, assume responsibility to intervene, know how to intervene, and take action.[<reflink idref="bib45" id="ref52">45</reflink>] The Theory of Action Coils[<reflink idref="bib5" id="ref53">5</reflink>] has extended the Situational Model to account for important contextual considerations influencing the decision-making process. This theory asserts that a decision to intervene is cyclical, looping between internal decision-making processes, contextual factors, and potential outcomes of bystander action.</p> <p>One important contextual factor that has gained recognition in the BI field is the influence of alcohol intoxication. Because many sexual assaults involve alcohol use by the victim and/or perpetrator,[<reflink idref="bib46" id="ref54">46</reflink>] and bystanders to the situation are often consuming alcohol,[<reflink idref="bib47" id="ref55">47</reflink>] researchers have investigated the influence of alcohol intoxication on the proposed steps of the Situational Model and found that alcohol intoxication does impact bystander behavior at every step. For instance, intoxication has been shown to decrease the accuracy of situational assessments of risk and the perceived need to intervene,[<reflink idref="bib48" id="ref56">48</reflink>]<sups>,</sups>[<reflink idref="bib49" id="ref57">49</reflink>] highlighting the need to investigate the adequacy of existing BI models within the domain of PAU. The Situational Model and Action Coils models may not fully account for the experiences of PAU among college students. Furthermore, these factors were developed primarily within the context of sexual assault and interpersonal violence, and additional factors may influence intervention in the context of PAU.[<reflink idref="bib5" id="ref58">5</reflink>]<sups>,</sups>[<reflink idref="bib50" id="ref59">50</reflink>]</p> <p>Additionally, most BI research in interpersonal violence has centered around the experiences of white, cisgender women[<reflink idref="bib51" id="ref60">51</reflink>] despite known variations in BI opportunities, decision-making processes, and actions taken among marginalized/minoritized communities. For example, studies show that women, Black, Indigenous, People of Color (BIPOC), and gay men are more likely to help when witnessing a potentially violent event compared to men, white individuals, and heterosexual men, respectively.[[<reflink idref="bib52" id="ref61">52</reflink>], [<reflink idref="bib54" id="ref62">54</reflink>]] Thus, it is important to interrogate whether the traditional models used to understand BI in the context of interpersonal violence are relevant and applicable to BI for PAU in more diverse populations.</p> <hd id="AN0182848232-6">Purpose</hd> <p>Given the social nature of drinking among college students, a social approach like BI may effectively reduce PAU. However, unique components of alcohol use may need to be accounted for when applying BI to PAU. Previous models of BI have not been extensively tested with diverse populations. This study uses a diverse sample to explore the following research question: What are the phases of BI for PAU among college friends?</p> <hd id="AN0182848232-7">Methods</hd> <p>Focus group/interview data were utilized to better understand students' perspectives on BI for PAU. Data were collected between November 2021 and April 2022. Protocols were approved by the sponsoring university's Office of Research Protections and Integrity (#21-0222).</p> <hd id="AN0182848232-8">Sample and Recruitment Procedures</hd> <p>The study's sampling frame included all students enrolled at the University of North Carolina at Charlotte during the 2021–2022 academic year. Recruitment strategies included email solicitation, campus flyering, and social media posts. Emails were sent to leaders of campus-based organizations (e.g., Black Student Union, Office of Fraternity and Sorority Life) and faculty. A $10 Amazon e-gift card was offered to participants, which was increased to $20, and an entry for a random drawing for an iPad after experiencing recruitment challenges.</p> <p>All recruitment materials contained a link to an electronic screener survey to ascertain participants' eligibility, which included: a) enrolled as a full-time undergraduate student, b) between 18–25 years old, and c) friends with individuals who drink alcohol. Eligible respondents were then routed to a consent form. Homogenous groups were scheduled (see Table 2) with a target size of 3 to 10 participants. To ensure representation from diverse students, purposive sampling was utilized to recruit individuals from hard-to-schedule populations (e.g., fraternity/sorority members, student-athletes) to participate in individual interviews. Data collection was closed upon reaching approximately 50% overall participation of those identifying as white versus BIPOC individuals and sexual and gender minority versus cisgender heterosexual. Recruitment for student-athletes and fraternity/sorority members was slow, and we stopped after five months due to budget constraints.</p> <p>Table 2. Focus group/interview characteristics.</p> <p> <ephtml> <table><thead><tr><td>Focus Group/Interview Identity</td><td>Type</td><td><bold># Participants</bold> (<italic>N</italic> = 79)</td></tr></thead><tbody valign="top"><tr><td>Asian</td><td>Focus group</td><td char=".">3</td></tr><tr><td>Bisexual/Pansexual</td><td>Focus group</td><td char=".">7</td></tr><tr><td>Black/African American</td><td>Focus group</td><td char=".">3</td></tr><tr><td>Black/African American</td><td>Focus group</td><td char=".">3</td></tr><tr><td>Black/African American Women</td><td>Focus group</td><td char=".">3</td></tr><tr><td>First-Year</td><td>Focus group</td><td char=".">10</td></tr><tr><td>First-Year</td><td>Focus group</td><td char=".">2</td></tr><tr><td>Interfraternity Council</td><td>Interview</td><td char=".">1</td></tr><tr><td>Interfraternity Council</td><td>Focus group</td><td char=".">3</td></tr><tr><td>Latinx</td><td>Focus group</td><td char=".">4</td></tr><tr><td>Latinx/Asian</td><td>Focus group</td><td char=".">2</td></tr><tr><td>Lesbian</td><td>Focus group</td><td char=".">2</td></tr><tr><td>Men</td><td>Focus group</td><td char=".">6</td></tr><tr><td>Middle Eastern/Arab</td><td>Focus group</td><td char=".">2</td></tr><tr><td>More than one race</td><td>Interview</td><td char=".">1</td></tr><tr><td>National Pan-Hellenic Council</td><td>Interview</td><td char=".">1</td></tr><tr><td>Panhellenic Association</td><td>Focus group</td><td char=".">2</td></tr><tr><td>Panhellenic Association</td><td>Focus group</td><td char=".">3</td></tr><tr><td>Queer Sexual Identity</td><td>Focus group</td><td char=".">6</td></tr><tr><td>Non-straight sexually diverse</td><td>Focus group</td><td char=".">3</td></tr><tr><td>Student Athlete</td><td>Focus group</td><td char=".">2</td></tr><tr><td>Student Athlete</td><td>Interview</td><td char=".">1</td></tr><tr><td>Student Athlete</td><td>Interview</td><td char=".">1</td></tr><tr><td>Student Athlete</td><td>Interview</td><td char=".">1</td></tr><tr><td>Student Athlete</td><td>Interview</td><td char=".">1</td></tr><tr><td>Student Athlete</td><td>Interview</td><td char=".">1</td></tr><tr><td>Transgender</td><td>Focus group</td><td char=".">2</td></tr><tr><td>White Women</td><td>Focus group</td><td char=".">2</td></tr><tr><td>White Male</td><td>Interview</td><td char=".">1</td></tr></tbody></table> </ephtml> </p> <hd id="AN0182848232-9">Focus group and interview Procedures</hd> <p>Focus groups and interviews were conducted electronically via Zoom by two research assistants: a discussion facilitator and a co-facilitator responsible for logistics. Although participants were encouraged to keep their cameras on for the discussion, several measures were taken to protect participant confidentiality. The facilitator reviewed informed consent and the importance of confidentiality. Participants changed their names to a pseudonym before the group started. The Zoom chat function was limited to messaging between the participant and the facilitator/co-facilitator. Focus groups and interviews were audio recorded and transcribed using Zoom and Microsoft Word transcription features. Transcripts were reviewed and revised for accuracy by research team members.</p> <p>To ensure participation and address issues of positionality, the research team discussed their positionality as it relates to comfortability in conducting focus groups and interviews. Each team member was able to conduct focus groups/interviews with student groups that matched their identities. The research team members were diverse in racial/ethnic identity, sexual and gender identity, grade level, research experience level, and affiliation with student organizations. Additionally, team members noted their emerging concerns, insights, reflections, and questions during each focus group/interview. After each focus group/interview, the two team members discussed these concerns, insights, questions, and biases with each other to establish reflexivity and trustworthiness throughout the data collection process.[<reflink idref="bib55" id="ref63">55</reflink>]<sups>,</sups>[<reflink idref="bib56" id="ref64">56</reflink>] Discussions were also had weekly with the larger team.</p> <hd id="AN0182848232-10">Data collection instruments</hd> <p></p> <hd id="AN0182848232-11">Screener survey</hd> <p>A screener survey was administered via Qualtrics to determine study eligibility and gather demographic and scheduling information. As part of this screener, participants indicated their age, degree level, enrollment status, and whether or not they were friends with anyone who drank alcohol. They provided additional demographic information, including their year in school, international or domestic student status, gender, race/ethnicity, sexual identity, affiliations with fraternities/sororities and or intercollegiate athletics, and whether they were first-generation or transfer students. Participants were asked to indicate their availability and provide information about how they heard about the study. Participants also indicated their preferred pseudonyms.</p> <hd id="AN0182848232-12">Focus group discussion guide</hd> <p>A focus group discussion guide was developed based on a systematic review of bystander measures and the Situational Model[<reflink idref="bib4" id="ref65">4</reflink>] and Theory of Action Coils[<reflink idref="bib5" id="ref66">5</reflink>] frameworks. A multidisciplinary group of research assistants and faculty reviewed the discussion guide, provided feedback, and piloted the tool in a mock focus group. The finalized guide covered six topics: 1) defining concerning alcohol use (e.g., "What are some risky things that happen when your friends are drinking?"), 2) noticing a concerning situation (e.g., "When you are wondering if someone has crossed the tipping point, what makes you confident that they are in danger?"), 3) taking action (e.g., "When you notice that a friend in your group is drinking in a concerning way, have you ever stepped in to do something about it?"), 4) barriers and facilitators (e.g., "What factors influenced your decision not to help out a friend who might be in trouble because of their drinking?"), 5) identifying intervention strategies (e.g., "Thinking back on times where you thought a friend might be in a bad situation because of their drinking, what are some things you COULD have done that you didn't do?"), and 6) identity related-issues (e.g., "Thinking back over these topics we covered, do you think any of the answers for you and your friends are different because of your identity as [focus group identity]?").</p> <hd id="AN0182848232-13">Data analysis</hd> <p>Transcripts were analyzed using deductive and inductive thematic analyses, in which common concepts are grouped together to form themes.[<reflink idref="bib57" id="ref67">57</reflink>] The researchers' codebook was developed based on the Situational Model,[<reflink idref="bib4" id="ref68">4</reflink>] the Theory of Action Coils,[<reflink idref="bib5" id="ref69">5</reflink>] and initial readings of the transcripts. The researchers used Dedoose software for coding. The research team of nine trained coders coded an initial two focus groups. The researchers used the Dedoose "test" function to confirm reliability and discussed any codes with a kappa of less than 0.70. The researchers' preliminary codebook was then refined and augmented. The researchers then re-confirmed reliability with the updated codebook using the "test" function to ensure that all codes were good to strong agreement. Using the finalized codebook, each transcript was first coded by two coders in which meaningful chunks of text were coded into categories.[<reflink idref="bib58" id="ref70">58</reflink>] Then, in second cycle coding, the researchers used focused coding to search for frequent and significant ideas to develop themes and subthemes.[<reflink idref="bib58" id="ref71">58</reflink>] For instance, first cycle coding developed categories of codes such as "notice" and "plan in advance." In second cycle coding, the team discussed the significant themes under each of these categories and identified additional factors that impeded or facilitated intervention in PAU situations (e.g., "decide phase appears to involve several steps, such as assuming responsibility and assessing the feasibility and acceptance of an identified intervention strategy"). Second cycle coding also involved visually mapping each theme onto the larger intervention process to identify a model for PAU.</p> <hd id="AN0182848232-14">Results</hd> <p></p> <hd id="AN0182848232-15">Participant characteristics</hd> <p>A total of 20 focus groups (<emph>n</emph> = 70 participants) and 9 interviews were conducted with 79 full-time undergraduate college students. Study participants were 18 to 24 years old (<emph>M<subs>age</subs></emph> = 20.1 years; <emph>SD</emph> = 1.2). University grade-level representation was relatively evenly dispersed (Table 1). A majority of participants were women and identified as heterosexual. Across BIPOC participants, those who identified as Black/African American were represented the most. Finally, 22.8% were affiliated with fraternities or sororities, and 12.7% were intercollegiate student-athletes. Focus groups ranged in size from 2 to 10 participants, with an average size of 3.5 participants (<emph>SD</emph> = 2.1). Focus groups lasted an average of 67 min (range 30-106 min, <emph>SD</emph> = 19.5), while interviews lasted an average of 45 min (range 33-75 min, <emph>SD</emph> = 14.3).</p> <p>Table 1. Sample characteristics (<emph>N</emph> = 79).</p> <p> <ephtml> <table><thead><tr><td>Characteristics</td><td><bold>Total</bold> % (<italic>n</italic>) or Mean (<italic>SD)</italic></td></tr></thead><tbody valign="top"><tr><td><bold>Age</bold></td><td char=".">20.11 (1.22)</td></tr><tr><td><bold>University Class-level</bold></td><td /></tr><tr><td> Freshman/First-year</td><td char=".">19 (15)</td></tr><tr><td> Sophomore</td><td char=".">24.1 (19)</td></tr><tr><td> Junior</td><td char=".">29.1 (23)</td></tr><tr><td> Senior</td><td char=".">27.8 (22)</td></tr><tr><td><bold>Gender</bold></td><td /></tr><tr><td> Cisgender woman</td><td char=".">60.8 (48)</td></tr><tr><td> Cisgender man</td><td char=".">35.4 (28)</td></tr><tr><td> Transgender/nonbinary/genderfluid</td><td char=".">3.8 (3)</td></tr><tr><td><bold>Race/Ethnicity</bold></td><td /></tr><tr><td> Caucasian/white</td><td char=".">49.4 (39)</td></tr><tr><td> African American/Black</td><td char=".">24.1 (19)</td></tr><tr><td> Two or more races/Other</td><td char=".">11.3 (9)</td></tr><tr><td> Asian</td><td char=".">7.6 (6)</td></tr><tr><td> Latinx/Hispanic</td><td char=".">7.6 (6)</td></tr><tr><td><bold>Sexual Identity</bold></td><td /></tr><tr><td> Heterosexual/straight</td><td char=".">59.5 (47)</td></tr><tr><td> Bisexual</td><td char=".">17.7 (14)</td></tr><tr><td> Two or more sexual identities</td><td char=".">12.8 (10)</td></tr><tr><td> Gay or Lesbian</td><td char=".">5 (4)</td></tr><tr><td> Pansexual/Otherwise identified</td><td char=".">5 (4)</td></tr><tr><td><bold>Affiliations</bold></td><td /></tr><tr><td> Fraternity/sorority</td><td char=".">22.8 (18)</td></tr><tr><td> Intercollegiate student athlete</td><td char=".">12.7 (10)</td></tr></tbody></table> </ephtml> </p> <hd id="AN0182848232-16">Bystander intervention for Problematic alcohol use model</hd> <p>Researchers assessed focus group and interview data and identified phases of BI for PAU that were similar but distinct from steps identified by the Situational Model. As a result, we propose the BI for PAU model (BIPAUM), which is comprised of the following phases: 1) plan in advance, 2) notice and interpret a sign, 3) decide (including identify an intervention strategy, assess feasibility/support, and assume responsibility), 4) intervene, and 5) assess outcomes (Figure 1). Participant quotes are attributed to their pseudonym and include their gender, race, sexual identity, and affiliation with a fraternity/sorority or student-athlete if applicable.</p> <p>PHOTO (COLOR): Figure 1. Bystander Intervention for Problematic Alcohol Use Model (BIPAUM).</p> <hd id="AN0182848232-17">Plan in advance</hd> <p>The first phase for some participants was plan in advance. Many participants discussed creating a strategy before consuming alcohol with their friends to decrease the likelihood of adverse consequences. Notably, this preventative phase did not occur among all participants. Among those who did, plans in advance often included logistics related to drinking, such as bringing their own alcohol, food, and water, and designated a caretaker among the friend group.</p> <p> <emph>Have one person in the friend group not drink anything for the night...one dedicated person. You can switch it up at every party, but just have one person there who doesn't drink anything to make sure that nobody is doing anything stupid in the friend group. (Jack B., cisgender man, white, heterosexual</emph>)</p> <p>For others, plan in advance included agreements to leave drinking environments together. "<emph>...we made a promise that if we showed up together, we're gonna leave together. So, making sure...your plans from the beginning of the night stay the same so that nothing happens (Perri O., cisgender woman, white, bisexual, student athlete)</emph>." Participants also discussed holding each other accountable while drinking for intentions set before drinking.</p> <p> <emph>I know that me and my friends have talked about, '...I plan on going out and making out with this person.'...and then we'll get to a party and if somebody is drunk and they're like, 'I think me and this guy are going to do something." I'm like, 'Are you still Ok with this?'...but if it's like, 'You said something before and you were very adamant, don't let me do this.' And even if I am intoxicated and you are intoxicated, I'm still going to hold you to that. Sober you said no. (Rebecca M., cisgender woman, white, heterosexual, fraternity/sorority</emph>)</p> <hd id="AN0182848232-18">Notice and interpret a sign</hd> <p>Notice and interpret a sign of a friend's concerning drinking is the second phase of BIPAUM, or the first phase for those who do not engage in the planning phase. Participants discussed noticing several types of signs as problematic, including physiological symptoms, quantity and frequency of drinking, reasons for drinking, as well as general and SV-related concerning behaviors. Noticing was described as synonymous with interpreting signs as problematic—they were not discussed as separate processes, but as simultaneous processes.</p> <p>Physiological signs of PAU were observable by others, including stumbling, drinking a large quantity quickly (such as a handle of vodka), or friends showing up to events intoxicated. <emph>"I was concerned about my friend [when]... he was always talking about how he was drinking on a daily basis to the point where he was throwing up...(Sarah J., cisgender woman, Latinx/Asian, bisexual)."</emph> Participants' friends' concerning reasons for drinking varied greatly from needing alcohol to socialize to masking stress and difficulties in one's life. <emph>"I had a female friend who [asked me] for alcohol to deter like the stress of an exam... to use alcohol as a substance to remove that just leads to bad habits and addictions in a way... (Junior, cisgender man, African American/Asian, heterosexual)</emph>." Risky behaviors included aggression, stunts (such as breaking tables), driving while intoxicated, among others. SV-related behaviors also caused concern. This may be risky actions one may partake in involving sex, altered behavior in regards to sex, or concerning practices one may engage in involving sex. <emph>"I've been to parties where I've seen people isolate themselves to a corner and then they start doing touchy feely things. ...That's when it starts crossing over... because then it's making sure that things are continuing to be consensual (Junior, cisgender man, African American/Asian, heterosexual)."</emph></p> <hd id="AN0182848232-19">Decide</hd> <p>After participants noticed a sign of PAU, they described moving to a decision-making phase that involves iteratively considering whether to assume responsibility to act, what strategy to use to intervene, and whether the strategy selected will be feasible and supported.</p> <hd id="AN0182848232-20">Assume responsibility to act</hd> <p>Participant's assessment of the situation and surroundings shape their decision to assume responsibility, including participants' relationship with the drinking friend, the number of people witnessing the problematic drinking, and the potential risk of intervention. A closer relationship with the drinking friend increased the likelihood of assuming responsibility. "<emph>I will help a friend because I care about them, so I don't want to see them hurt (Genevieve N., cisgender woman, Black, heterosexual)."</emph> The diffusion of responsibility to others was facilitated by weak connections with the drinking friend. "<emph>I don't know this person very well, and we're around other people who do know them... 'wouldn't they notice something before I did?' (Sadie Gemme, cisgender woman, Latinx/Hispanic, heterosexual)."</emph> Participants with situational power (e.g., being the host) were also more likely to assume responsibility. "<emph>I will definitely cut people off... especially if they're at my apartment...I feel more responsible if I'm hosting, so I take care of them (Melissa B., cisgender woman, Latinx/Hispanic, heterosexual)."</emph> Factors related to own intoxication were also considered, including whether a more sober friend could act instead, or a "not my problem" attitude.</p> <p> <emph>I can have that 'it's not my problem' mentality sometimes, but I feel like...you're in your own group. If I know someone is being taken care of properly by some other people, I'm like 'all right. I'll just stay out of it.' (Maggie M., cisgender woman, Asian, heterosexual).</emph> </p> <hd id="AN0182848232-21">Identify an intervention strategy</hd> <p>Participants identified many intervention options. Types of intervention strategies were often considered in tangent with a drinking friend's level of intoxication and extremeness of behaviors. Severity of the drinking friend's problematic behavior increased participants' choice of more drastic (i.e., effortful) and safety-oriented interventions. For example, one participant described a low-effort intervention, <emph>"Stepping outside makes a world of difference...breath of fresh air. It gives you a good gauge... if you need to chill out for the night...it could make or break you (Sech C., cisgender man, Asian, heterosexual)."</emph> On the other end of the spectrum, a more extreme type of intervention was identified as calling 911 or emergency services, "<emph>"If someone is genuinely suffering, I wouldn't hesitate to call 911. I'd probably call parents beforehand to make sure there's nothing else that I could do (Sarah M., cisgender woman, white, heterosexual)."</emph></p> <p>Participants mentioned how their identification of intervention strategies was related to the desired goal of the intervention. Some strategies focused on reducing their drinking friend's alcohol intake. <emph>"The only small thing I could think of is putting more juice in alcoholic drinks for my friends when they ask me to make them something to slow things down." (August S., cisgender woman, white, heterosexual).</emph> Moreover, participants shared strategies they utilized to reduce the likelihood of a drinking friend becoming a perpetrator or victim of SV.</p> <p> <emph>Sometimes if some guy tries to come towards my friend at a party, and I don't know him and my friend is intoxicated, I try to stand right next to [her]. Just in case he tries to put his hands on her, or tries to be like, 'oh you should go upstairs so we can talk'. I'm very much like 'no, she's staying with me'. (August S., cisgender woman, white, heterosexual).</emph> </p> <p>Participants described other strategies that focused on the drinking friend's well-being (i.e., good friend behavior) and were not done with strangers.</p> <p> <emph>If we do go out, we'll get an Uber or a Lyft, or one of us will stay sober and drive and watch out for everyone. If someone's getting too drunk then you stop the night and take care of them... make sure that no one gets hurt or gets in trouble. (Mark W., cisgender man, white, heterosexual, fraternity/sorority)</emph> </p> <hd id="AN0182848232-22">Assess support for/feasibility of intervening</hd> <p>In this phase, participants described considering situational dynamics to determine the feasibility of helping. One consideration was the availability of peer support and social norms for helping. Others' opinion on the need for intervention and subsequent involvement facilitated intervention.</p> <p> <emph>For me, it's easier if I know I'm not the only person that has noticed something. ...my girlfriend and I are usually drinking with the same group of friends and so usually, if I feel like one person is over doing it, I can kind of sneakily ask her if she thinks it's too much...to just double check that I'm interpreting things correctly. (Anna B., cisgender woman, white, bisexual, student-athlete)</emph> </p> <p>The degree to which helping would impact the relationship with the drinking friend was also considered by some participants. For example, one participant described,</p> <p> <emph>It's kind of hard because I want to be your friend... I don't wanna make you mad 'cause I keep asking you, but then it's hard for me to know. We just wanna do a check up like 'are we all good? If not, speak up or forever hold your peace'... I don't want to badger. (Brittany, cisgender woman, African American/Black, heterosexual, fraternity/sorority)</emph> </p> <p>The environment or place was a factor of intervention feasibility. For example, one participant stated, <emph>"In situations where my friends know where we're going, or I know who's driving, or I know where things are. If you're in an unfamiliar situation, you might not even know where the bathroom is or you can get water (Alex G., cisgender woman, white, bisexual and demisexual)."</emph> Knowledge of policies or resources further facilitated intervening.</p> <p> <emph>I think it's easier to intervene when you know how to do it, and where to go. If you're looking for help knowing there's this bystander intervention thing where if you go to somebody on campus, you're not going to get in trouble for reporting that. (Nathan Private, cisgender man, African American/Black, heterosexual, fraternity/sorority)</emph> </p> <p>Participants select their type of intervention depending on their assessment of the support for and feasibility of intervention, as well as the specific time period prior to the intervention.</p> <hd id="AN0182848232-23">Intervene</hd> <p>After deciding to intervene, participants described the act of intervening. Intervention types fell into different categories, including getting someone home or putting them to bed safely, taking someone away from the drinking environment, delegating to others, attempting to get the person to stop drinking or to drink less, engaging in behaviors to address or prevent SV, and general actions that were classified as good friend behavior. For instance, participants stated getting someone home or putting them to bed safely was a useful strategy. <emph>"Sometimes, I mean, I've put my cousin to bed...we put them on their side ...just making sure they're not throwing up. And if they are... throwing up, I try to hold their hair, stand by them to watch them, clean them up and stuff (Saya, cisgender woman, Middle Eastern/Arab, pansexual)."</emph> Delegating to others includes strategies to elicit help from others to remedy the concerning situation. Participants reported delegating to the drinking friend's friends, a bartender, a host, among others. A more formal and last-resort type of delegating included calling 911. Other strategies included monitoring their friends, tricking or bribing them, being forceful, distracting the friend, acting like the parent of the group, using the buddy system, or delegating/conferring with other people.</p> <hd id="AN0182848232-24">Assess outcomes</hd> <p>Participants who intervened often evaluate the impact of their intervention on their drinking friend's behavior, their relationship with their drinking friend, and their own feelings about their intervention. This information is often used to guide intervention decisions in future instances of PAU with friends. Outcomes of intervention could be positive or negative.</p> <p>Positive outcomes of intervention could include reducing their friend's drinking behavior, getting or keeping their friend safe, feeling proud of their intervention techniques, or setting an example for others about intervention. The outcomes of intervention could influence each phase of the model in future situations of PAU. For example, if individuals intervened and deemed the outcomes of their intervention to be helpful toward their desired goal (e.g., getting their friend to drink less), they may be more likely to perform that intervention strategy in the future. <emph>"Yeah. I'll say that my friends will in the morning... will be like 'thanks, for giving me all that water. I don't have a hangover now because of it... (Chelsea S., cisgender woman, African American/Black, bisexual and questioning)."</emph> Assessing outcomes was considered a feedback process to inform future intervention. <emph>"It's like once you learn something, like after an experience you kind of learned it, and so you keep that in mind for the next time, so that you're more prepared (Melissa B., cisgender woman, Latinx/Hispanic, heterosexual)."</emph></p> <p>Negative outcomes of intervention could include failing to keep others safe, losing relationships with the drinking friend, or personal feelings of embarrassment. Similarly, if participants experienced the outcomes of their intervention to be negative or ineffective, future avoidance of the strategy is possible. <emph>"It definitely helps in the short term... but in my experience a lot of people... return back to their same drinking habits regardless of the shame that comes with being stopped or being told to be less rowdy (John S., cisgender man, Latinx/Hispanic, heterosexual)."</emph> For some, BI can have embarrassing social implications.</p> <p> <emph>I feel like it's mostly negative because they might feel embarrassed when you're helping that person... And the next morning, like, 'I wish you weren't there or like that didn't happen. And now I have to go to the same class with you.' (Sasha, cisgender woman, Asian, bisexual, fraternity/sorority)</emph> </p> <p>Social relationships were shown to influence the outcome assessment of BI for PAU and related back to prior phases of the model.</p> <hd id="AN0182848232-25">Barriers and facilitators</hd> <p>Barriers and facilitators were identified across all phases of the BIPAUM, including personal, interpersonal, and contextual factors. While a detailed qualitative account of participant's perception of barriers and facilitators is beyond the scope of the current paper, a general description is provided.</p> <hd id="AN0182848232-26">Personal factors</hd> <p>Personal factors influencing how/if participants intervene with others discussed in focus groups and interviews include knowledge and beliefs, family and personal histories, and self-intoxication. For example, beliefs about personal responsibility influenced whether or how participants chose to intervene. An important personal component impacting most phases of the model was participant's self-intoxication. While some participants indicated that self-intoxication presents barriers to BIs, a subset of participants experienced self-intoxication as a facilitator, as it emboldened them to take action. <emph>"If I'm not drinking then it's a lot easier for me to intervene and help everyone out, but if I am drinking, I tend to over intervene almost 'cause I'm usually sort of shy or passive, but when I start drinking those sort of limiters just go away. So if I see something, instead of thinking it through... I would just walk up and be upfront and just directly intervene."</emph> (<emph>Mani, cisgender man, Asian, heterosexual</emph>).</p> <hd id="AN0182848232-27">Interpersonal factors</hd> <p>Interpersonal factors, such as relational distance with a friend, shared identity, or relationship concerns, were identified as barriers and facilitators to BI for PAU. For example, participants indicated that intervening was easier when they knew the drinking friend well. Group norms existing among shared identities influence different phases.</p> <hd id="AN0182848232-28">Contextual factors</hd> <p>Several contextual factors were identified as barriers or facilitators to BI for PAU, including resources, environment, and policies. Resources entailed access to support and education. Being in a familiar or known environment was often perceived as a facilitator, whereas being in an unknown environment felt like a barrier to many. Finally, policies such as legal consequences, police conduct, and healthcare costs were noted as barriers.</p> <hd id="AN0182848232-29">Discussion</hd> <p>This research developed the BIPAUM, a model describing the process of BI for PAU among friends, based on data from focus groups and interviews conducted with diverse college students. The BIPAUM consists of the following phases: 1) plan in advance, 2) notice and interpret a sign, 3) decide (including assume responsibility, identify an intervention strategy, assess support/feasibility for intervening, 4) intervene, and 5) assess outcomes. Notably, the final phase of the model can affect future BI for PAU and barriers and facilitators (i.e., personal, interpersonal, and contextual factors) impact decision-making throughout each phase.</p> <hd id="AN0182848232-30">Comparisons to existing literature</hd> <p>The current model follows the general flow of the Situational Model of BI for SV.[<reflink idref="bib4" id="ref72">4</reflink>] However, the BIPAUM integrates noticing a sign and interpreting it as problematic into a single phase. Further, the decide phase incorporates additional elements which are considered iteratively aligning with the Theory of Action Coils[<reflink idref="bib5" id="ref73">5</reflink>], whereas the Situational Model[<reflink idref="bib4" id="ref74">4</reflink>] proposes these elements occur linearly. The BIPAUM also shares characteristics with the Theory of Action Coils[<reflink idref="bib5" id="ref75">5</reflink>], where reactions from others are considered and inform current and future BI decisions. These characteristics are similar to the BIPAUM's assess outcomes phase, which affects decision-making across each phase of the model. Previous models have acknowledged barriers and facilitators to BI[<reflink idref="bib4" id="ref76">4</reflink>]<sups>,</sups>[<reflink idref="bib59" id="ref77">59</reflink>] and the BIPAUM proposes specific barriers and facilitators that are unique to PAU and affect all phases. One contribution of the current model is making explicit the optional and preventative plan in advance phase. Strategies used to plan in advance align with current literature on Protective Behavioral Strategies (PBS) for reducing or limiting alcohol intake. These strategies include assigning a designated driver and eating and drinking before and while drinking.[<reflink idref="bib60" id="ref78">60</reflink>] As Plan in Advance was not a phase all participants engaged in, future work to enhance these PBS may be helpful.</p> <p>Another unique contribution of the BIPAUM is the inclusion of self-intoxication as a barrier/facilitator. Although research on BI for SV has acknowledged the impact of bystander intoxication on behavior,[<reflink idref="bib47" id="ref79">47</reflink>]<sups>,</sups>[<reflink idref="bib48" id="ref80">48</reflink>]<sups>,</sups>[<reflink idref="bib61" id="ref81">61</reflink>] the BIPAUM is the first model, to our knowledge, to account for self-intoxication. In the context of BI for PAU, it is more likely that potential bystanders will be drinking (or intoxicated) due to the social nature of drinking.[<reflink idref="bib21" id="ref82">21</reflink>] Participants in the current study discussed how self-intoxication interacts with the phases of BIPAUM to facilitate or deter bystander action. This finding extends research on BI for SV that has theorized[<reflink idref="bib61" id="ref83">61</reflink>] and demonstrated[<reflink idref="bib62" id="ref84">62</reflink>] the impacts of self-intoxication and draws attention to its impact on BI broadly.</p> <hd id="AN0182848232-31">Implications for research</hd> <p>Future research should test the pathways theorized in this model. While care was taken to include students with diverse identities and experiences, the BIPAUM may not operate the same way for individuals from particular student groups, especially those with unique cultures related to drinking (e.g., bisexual women[<reflink idref="bib63" id="ref85">63</reflink>]) and norms related to BI.[<reflink idref="bib64" id="ref86">64</reflink>] Additionally, longitudinal research is warranted to fully capture the nuances of BI for PAU.[<reflink idref="bib48" id="ref87">48</reflink>] The BIPAUM was explicitly developed to address BI for PAU among friends. Helping acquaintances and strangers likely present different barriers to action that would need specialized training to counteract. Further, as "Plan in Advance" was a common step, additional research on effective PBS that students engage in for situations of PAU is warranted. Lastly, the BIPAUM can guide the development of measures of BI for PAU that can be used to effectively evaluate future intervention programs.</p> <hd id="AN0182848232-32">Implications for practice</hd> <p>The results of the current study hold important practice implications for addressing PAU with college students. Whereas previous approaches for addressing PAU on college campuses utilize an individual-level focus[<reflink idref="bib27" id="ref88">27</reflink>]<sups>,</sups>[<reflink idref="bib28" id="ref89">28</reflink>] and often imply an abstinence orientation,[<reflink idref="bib65" id="ref90">65</reflink>] BI for PAU has the benefit of capitalizing on the social nature of drinking by providing a social harm-reduction approach[<reflink idref="bib66" id="ref91">66</reflink>] that acknowledges that many students will drink and empowers friends to help keep each other safe. Interventions can include didactic and experiential training that focuses on improving skills related to noticing and interpreting signs of PAU among friends, increasing knowledge of intervention options, creating conditions supportive of BI through social norms campaigns, and increasing self-efficacy to intervene through practice-based experiences.</p> <p>There are several unique factors to account for when considering BI program development for PAU. First, drinking is a more ubiquitous experience.[<reflink idref="bib6" id="ref92">6</reflink>] The commonplace nature of alcohol use could positively or negatively impact BI for PAU. PAU is likely a less taboo topic than SV, making intervention programs more appealing and acceptable to students. Additionally, students might be more able to see themselves in these situations, allowing them to role-play, visualize, and embody the messaging. Second, as with BI for SV,[<reflink idref="bib67" id="ref93">67</reflink>] ambiguity is a potent barrier to BI for PAU. For example, students may find it difficult to discern whether a friend has had too much to drink, especially when just starting to experiment with alcohol. Such ambiguity makes it difficult to decide whether intervention is necessary. Ambiguous situations may lead students to believe that help is unnecessary and may not help at all.[<reflink idref="bib68" id="ref94">68</reflink>] Further complicating this issue is self-intoxication, which potentially interacts to decrease the prevalence of bystander action further. This phenomenon is a challenge for this field and should be further studied.</p> <hd id="AN0182848232-33">Limitations</hd> <p>The results of the current study need to be considered in light of several limitations. First, this study was conducted at a large southeastern university with many commuter and transfer students, creating diversity in prior college experiences and PAU risk factors. The university's urban setting and absence of on-campus fraternity housing may have contributed to a unique off-campus drinking environment that does not necessarily reflect those of other university-affiliated fraternities. Second, only one participant identified as a historically Black fraternity/sorority member, highlighting the need for future research with other historically underrepresented fraternities/sororities. Third, while we intentionally recruited participants from diverse backgrounds, results are presented holistically. Additional research examining nuances both within and across diverse student groups is necessary. Fourth, while most of the data were obtained <emph>via</emph> focus groups, individual interviews were also conducted, which may have altered the types of experiences conveyed. An additional limitation is that participant recruitment and data collection occurred during the COVID-19 pandemic (November 2021 - April 2022), which greatly impacted the well-being and experiences of college students.[<reflink idref="bib69" id="ref95">69</reflink>]<sups>,</sups>[<reflink idref="bib70" id="ref96">70</reflink>] First- and second-year students, in particular, likely had fewer first-hand opportunities to engage in BI for PAU, as fewer social engagements and reduced heavy drinking were reported during this time.[<reflink idref="bib71" id="ref97">71</reflink>]<sups>,</sups>[<reflink idref="bib72" id="ref98">72</reflink>] Finally, participants in the study described variations of PAU experiences, but additional research examining BI for PAU among heavy drinkers is necessary.[<reflink idref="bib68" id="ref99">68</reflink>]</p> <hd id="AN0182848232-34">Conclusion</hd> <p>The BIPAUM can guide intervention development and evaluation tools for reducing alcohol consumption on college campuses, as it is a social solution to a social problem. Including diverse student voices and a collaborative research team enhances the validity of this model and underscores its potential for harm reduction among college students.</p> <hd id="AN0182848232-35">Conflict of interest disclosure</hd> <p>The authors have no conflicts of interest to report. The authors confirm that the research presented in this article met the ethical guidelines, including adherence to the legal requirements, of the USA and received approval from the Institutional Review Board of the University of Charlotte at North Carolina.</p> <p>Correction Statement</p> <p>This article has been corrected with minor changes. These changes do not impact the academic content of the article.</p> <ref id="AN0182848232-36"> <title> Footnotes </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> *Victoria McClare changed affiliations to Yale University upon completion of the study.</bibtext> </blist> </ref> <ref id="AN0182848232-37"> <title> References </title> <blist> <bibtext> Substance Abuse and Mental Health Services Administration. Key Substance Use and Mental Health Indicators in the United States: Results from the 2020 National Survey on Drug Use and Health. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration; 2022.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref2" type="bt">2</bibl> <bibtext> Coker AL, Cook-Craig PG, Williams CM, et al. Evaluation of Green Dot: An active bystander intervention to reduce sexual violence on college campuses. Violence against Women. 2011; 17 (6): 777 – 796. doi: 10.1177/1077801211410264.</bibtext> </blist> <blist> <bibl id="bib3" idref="ref3" type="bt">3</bibl> <bibtext> McMahon S, Banyard VL. When can I help? A conceptual framework for the prevention of sexual violence through bystander intervention. Trauma Violence Abuse. 2012; 13 (1): 3 – 14. doi: 10.1177/1524838011426015.</bibtext> </blist> <blist> <bibl id="bib4" idref="ref4" type="bt">4</bibl> <bibtext> Burn SM. A situational model of sexual assault prevention through bystander intervention. Sex Roles. 2009; 60 (11-12): 779 – 792. doi: 10.1007/s11199-008-9581-5.</bibtext> </blist> <blist> <bibl id="bib5" idref="ref5" type="bt">5</bibl> <bibtext> Banyard VL. Bystander action coils: Moving beyond the situational model. In: Toward the Next Generation of Bystander Prevention of Sexual and Relationship Violence. New York, NY: Springer Briefs in Criminology. Springer International Publishing; 2015 : 53 – 75. doi: 10.1007/978-3-319-23171-6_4.</bibtext> </blist> <blist> <bibl id="bib6" idref="ref12" type="bt">6</bibl> <bibtext> Wechsler H, Lee JE, Kuo M, Lee H. College binge drinking in the 1990s: A continuing problem results of the Harvard School of Public Health 1999 College Alcohol Study. J Am Coll Health. 2000; 48 (5): 199 – 210. doi: 10.1080/07448480009599305.</bibtext> </blist> <blist> <bibl id="bib7" idref="ref13" type="bt">7</bibl> <bibtext> Hingson R, Heeren T, Winter M, Wechsler H. Magnitude of alcohol-related mortality and morbidity among U.S. college students ages 18–24: Changes from 1998 to 2001. Annu Rev Public Health. 2005; 26 (1): 259 – 279. doi: 10.1146/annurev.publhealth.26.021304.144652.</bibtext> </blist> <blist> <bibl id="bib8" idref="ref14" type="bt">8</bibl> <bibtext> Hingson RW, Zha W, Weitzman ER. Magnitude of and trends in alcohol-related mortality and morbidity among U.S. college students ages 18-24, 1998-2005. J Stud Alcohol Drugs Suppl. 2009;(16): 12 – 20. doi: 10.15288/jsads.2009.s16.12.</bibtext> </blist> <blist> <bibl id="bib9" idref="ref15" type="bt">9</bibl> <bibtext> Allen HK, Calhoun BH, Maggs JL. High-risk alcohol use behavior and daily academic effort among college students. J Am Coll Health. 2022; 70 (2): 335 – 339. doi: 10.1080/07448481.2020.1752697.</bibtext> </blist> <blist> <bibtext> Miranda RJ, Meyerson LA, Long PJ, Marx BP, Simpson SM. Sexual assault and alcohol use: Exploring the self-medication -hypothesis. Violence Vict. 2002; 17 (2): 205 – 217. doi: 10.1891/vivi.17.2.205.33650.</bibtext> </blist> <blist> <bibtext> Reed E, Amaro H, Matsumoto A, Kaysen D. The relation between interpersonal violence and substance use among a sample of university students: Examination of the role of victim and perpetrator substance use. Addict Behav. 2009; 34 (3): 316 – 318. doi: 10.1016/j.addbeh.2008.10.015.</bibtext> </blist> <blist> <bibtext> Cashin JR, Presley CA, Meilman PW. Alcohol use in the Greek system: Follow the leader? J Stud Alcohol. 1998; 59 (1): 63 – 70. doi: 10.15288/jsa.1998.59.63.</bibtext> </blist> <blist> <bibtext> Christiansen M, Vik PW, Jarchow A. College student heavy drinking in social contexts versus alone. Addict Behav. 2002; 27 (3): 393 – 404. doi: 10.1016/S0306-4603(01)00180-0.</bibtext> </blist> <blist> <bibtext> O'Hare TM. Drinking in college: consumption patterns, problems, sex differences and legal drinking age. J Stud Alcohol. 1990; 51 (6): 536 – 541. doi: 10.15288/jsa.1990.51.536.</bibtext> </blist> <blist> <bibtext> Rosenquist JN, Murabito J, Fowler JH, Christakis NA. The spread of alcohol consumption behavior in a large social network. Ann Intern Med. 2010; 152 (7): 426 – 433, W141. doi: 10.7326/0003-4819-152-7-201004060-00007.</bibtext> </blist> <blist> <bibtext> Supski S, Lindsay J, Tanner C. University students' drinking as a social practice and the challenge for public health. Critical Public Health. 2017; 27 (2): 228 – 237. doi: 10.1080/09581596.2016.1190001.</bibtext> </blist> <blist> <bibtext> Wechsler H, Dowdall GW, Davenport A, Castillo S. Correlates of college student binge drinking. Am J Public Health. 1995; 85 (7): 921 – 926. doi: 10.2105/AJPH.85.7.921.</bibtext> </blist> <blist> <bibtext> Borsari B, Hustad JTP, Capone C. Alcohol use in the Greek System, 1999–2009: A decade of progress. Curr Drug Abuse Rev. 2009; 2 (3): 216 – 255. doi: 10.2174/1874473710902030216.</bibtext> </blist> <blist> <bibtext> Gardner M, Steinberg L. Peer Influence on risk taking, risk preference, and risky decision making in adolescence and adulthood: An experimental study. Dev Psychol. 2005; 41 (4): 625 – 635. doi: 10.1037/0012-1649.41.4.625.</bibtext> </blist> <blist> <bibtext> Leonard KE, Mudar PJ. Alcohol use in the year before marriage: Alcohol expectancies and peer drinking as proximal influences on husband and wife alcohol involvement. Alcoholism Clin Exp Res. 2000; 24 (11): 1666 – 1679. doi: 10.1111/j.1530-0277.2000.tb01968.x.</bibtext> </blist> <blist> <bibtext> Reid AE, Carey KB. Why is social network drinking associated with college students' alcohol use? Focus on psychological mediators. Psychol Addict Behav. 2018; 32 (4): 456 – 465. doi: 10.1037/adb0000374.</bibtext> </blist> <blist> <bibtext> LaBrie JW, Hummer J, Kenney S, Lac A, Pedersen E. Identifying factors that increase the likelihood for alcohol-induced blackouts in the prepartying context. Subst Use Misuse. 2011; 46 (8): 992 – 1002. doi: 10.3109/10826084.2010.542229.</bibtext> </blist> <blist> <bibtext> Tewksbury R, Higgins GE, Mustaine EE. Binge drinking among college athletes and non-athletes. Deviant Behavior. 2008; 29 (3): 275 – 293. doi: 10.1080/01639620701588040.</bibtext> </blist> <blist> <bibtext> Iwamoto DK, Kaya A, Grivel M, Clinton L. Under-researched demographics: Heavy episodic drinking and alcohol-related problems among Asian Americans. Alcohol Research: Current Reviews. 2016; 38 : 17 – 25.</bibtext> </blist> <blist> <bibtext> Thorpe S, Tanner AE, Ware S, Guastaferro K, Milroy JJ, Wyrick DL. Black first-year college students' alcohol outcome expectancies. Am J Health Educ. 2020; 51 (2): 78 – 86. doi: 10.1080/19325037.2020.1713259.</bibtext> </blist> <blist> <bibtext> Seo S, Witte TH, Casper DM, Owen S. Helping friends and strangers in risky situations: Outcomes of bystander interventions for sexual assault and dating violence. Journal of Aggression, Maltreatment & Trauma. 2022; 31 (4): 540 – 561. doi: 10.1080/10926771.2021.1984350.</bibtext> </blist> <blist> <bibtext> Carey KB, Scott-Sheldon LAJ, Carey MP, DeMartini KS. Individual-level interventions to reduce college student drinking: A meta-analytic review. Addict Behav. 2007; 32 (11): 2469 – 2494. doi: 10.1016/j.addbeh.2007.05.004.</bibtext> </blist> <blist> <bibtext> Scott-Sheldon LAJ, Carey KB, Elliott JC, Garey L, Carey MP. Efficacy of alcohol interventions for first-year college students: A meta-analytic review of randomized controlled trials. J Consult Clin Psychol. 2014; 82 (2): 177 – 188. doi: 10.1037/a0035192.</bibtext> </blist> <blist> <bibtext> Saxton J, Rodda SN, Booth N, Merkouris SS, Dowling NA. The efficacy of Personalized Normative Feedback interventions across addictions: A systematic review and meta-analysis. PLoS One. 2021; 16 (4): e0248262. doi: 10.1371/journal.pone.0248262.</bibtext> </blist> <blist> <bibtext> Foxcroft DR, Coombes L, Wood S, Allen D, Santimano NMA, Moreira MT. Motivational interviewing for the prevention of alcohol misuse in young adults. Cochrane Database Syst Rev. 2016; 7 (7): CD007025. doi: 10.1002/14651858.CD007025.pub4.</bibtext> </blist> <blist> <bibtext> Saltz RF. Environmental approaches to prevention in college settings. Alcohol Res Health. 2011; 34 (2): 204 – 209.</bibtext> </blist> <blist> <bibtext> Lawrence SA, Hall T, Lancey P. The relationship among alcohol consumption, tailgating, and negative consequences. Journal of Child & Adolescent Substance Abuse. 2012; 21 (3): 222 – 237. doi: 10.1080/1067828X.2012.689805.</bibtext> </blist> <blist> <bibtext> Aldrich RS, Wilde J, Miller E. The effectiveness of QPR suicide prevention training. Health Education Journal. 2018; 77 (8): 964 – 977. doi: 10.1177/0017896918786009.</bibtext> </blist> <blist> <bibtext> Mitchell SL, Kader M, Darrow SA, Haggerty MZ, Keating NL. Evaluating Question, Persuade, Refer (QPR) Suicide prevention training in a college setting. Journal of College Student Psychotherapy. 2013; 27 (2): 138 – 148. doi: 10.1080/87568225.2013.766109.</bibtext> </blist> <blist> <bibtext> Powers RA, Leili J. Bar training for active bystanders: Evaluation of a community-based bystander intervention program. Violence against Women. 2018; 24 (13): 1614 – 1634. doi: 10.1177/1077801217741219.</bibtext> </blist> <blist> <bibtext> Polanin JR, Espelage DL, Pigott TD. A meta-analysis of school-based bullying prevention programs' effects on bystander intervention behavior. Betts J, ed. School Psychology Review. 2012; 41 (1): 47 – 65. doi: 10.1080/02796015.2012.12087375.</bibtext> </blist> <blist> <bibtext> Ttofi MM, Farrington DP. Effectiveness of school-based programs to reduce bullying: A systematic and meta-analytic review. J Exp Criminol. 2011; 7 (1): 27 – 56. doi: 10.1007/s11292-010-9109-1.</bibtext> </blist> <blist> <bibtext> McCabe SE, Knight JR, Teter CJ, Wechsler H. Non-medical use of prescription stimulants among US college students: prevalence and correlates from a national survey. Addiction. 2005; 100 (1): 96 – 106. doi: 10.1111/j.1360-0443.2005.00944.x.</bibtext> </blist> <blist> <bibtext> Abbey A, Wegner R, Woerner J, Pegram SE, Pierce J. Review of survey and experimental research that examines the relationship between alcohol consumption and men's sexual aggression perpetration. Trauma Violence Abuse. 2014; 15 (4): 265 – 282. doi: 10.1177/1524838014521031.</bibtext> </blist> <blist> <bibtext> Morean ME, Darling N, Smit J, et al. Preventing and responding to sexual misconduct: Preliminary efficacy of a peer-led bystander training program for preventing sexual misconduct and reducing heavy drinking among collegiate athletes. J Interpers Violence. 2021; 36 (7-8): NP3453 – NP3479. doi: 10.1177/0886260518777555.</bibtext> </blist> <blist> <bibtext> Zinzow HM, Thompson MP, Goree J, Fulmer CB, Greene C, Watts HA. Evaluation of a college sexual violence prevention program focused on education, bystander intervention, and alcohol risk reduction. College Student Affairs Journal. 2018; 36 (2): 110 – 125. doi: 10.1353/csj.2018.0019.</bibtext> </blist> <blist> <bibtext> Guerette RT, Flexon JL, Marquez C. Instigating bystander intervention in the prevention of alcohol-impaired driving: Analysis of data regarding mass media campaigns. J Stud Alcohol Drugs. 2013; 74 (2): 205 – 211. doi: 10.15288/jsad.2013.74.205.</bibtext> </blist> <blist> <bibtext> Anthenien AM, Neighbors C, Rosa J. Training first-year college students to intervene in alcohol-related emergencies: Addressing bystander beliefs and perceived consequences of intervening. Journal of Alcohol and Drug Education. 2017; 61 (3): 17 – 36.</bibtext> </blist> <blist> <bibtext> National Institute on Alcohol Abuse and Alcoholism. Planning Alcohol Interventions Using NIAAA's College AIM. Published 2019.</bibtext> </blist> <blist> <bibtext> Ajzen I. The theory of planned behavior. Organizational Behavior and Human Decision Processes. 1991; 50 (2): 179 – 211. doi: 10.1016/0749-5978(91)90020-T.</bibtext> </blist> <blist> <bibtext> Cantor D, Fisher B, Chibnall S, et al. Report on the AAU Campus Climate Survey on Sexual Assault and Sexual Misconduct. Published online 2020.</bibtext> </blist> <blist> <bibtext> Haikalis M, Leone RM, Parrott DJ, DiLillo D. Sexual assault survivor reports of missed bystander opportunities: The role of alcohol, sexual objectification, and relational factors. Violence against Women. 2018; 24 (10): 1232 – 1254. doi: 10.1177/1077801218781941.</bibtext> </blist> <blist> <bibtext> Melkonian AJ, Ham LS, Wiersma-Mosley JD, et al. Alcohol -intoxication impairs the bystander intervention process in a -hypothetical sexual assault: A field investigation. Psychol Violence. 2020; 10 (6): 657 – 666. doi: 10.1037/vio0000283.</bibtext> </blist> <blist> <bibtext> Orchowski LM, Berkowitz A, Boggis J, Oesterle D. Bystander intervention among college men: The role of alcohol and correlates of sexual aggression. J Interpers Violence. 2016; 31 (17): 2824 – 2846. doi: 10.1177/0886260515581904.</bibtext> </blist> <blist> <bibtext> Banyard V, Moschella E, Jouriles E, Grych J. Exploring action coils for bystander intervention: Modeling bystander consequences. J Am Coll Health. 2021; 69 (3): 283 – 289. doi: 10.1080/07448481.2019.1665052.</bibtext> </blist> <blist> <bibtext> Harris JC, Linder C, eds. Intersections of Identity and Sexual Violence on Campus: Centering Minoritized Students' Experiences. 1st ed. Sterling, VA: Stylus Publishing, LLC; 2017.</bibtext> </blist> <blist> <bibtext> Brown AL, Banyard VL, Moynihan MM. College students as helpful bystanders against sexual violence: Gender, race, and year in college moderate the impact of perceived peer norms. 2014. https://journals.sagepub.com/doi/10.1177/0361684314526855</bibtext> </blist> <blist> <bibtext> Diamond-Welch BK, Hetzel-Riggin MD, Hemingway JA. The willingness of college students to intervene in sexual assault situations: Attitude and behavior differences by gender, race, age, and community of origin. Viol Gender. 2016; 3 (1): 49 – 54. doi: 10.1089/vio.2015.0023.</bibtext> </blist> <blist> <bibtext> Hoxmeier JC, Acock AC, Flay BR. Students as prosocial bystanders to sexual assault: Demographic correlates of intervention norms, intentions, and missed opportunities. J Interpers Violence. 2020; 35 (3-4): 731 – 754. doi: 10.1177/0886260517689888.</bibtext> </blist> <blist> <bibtext> Forero R, Nahidi S, De Costa J, et al. Application of four-dimension criteria to assess rigour of qualitative research in emergency medicine. BMC Health Serv Res. 2018; 18 (1): 120. doi: 10.1186/s12913-018-2915-2.</bibtext> </blist> <blist> <bibtext> Lincoln YS, Guba EG. Naturalistic Inquiry. Newbury Park, CA: Sage Publications, Inc; 1985.</bibtext> </blist> <blist> <bibtext> Boyatzis RE. Transforming Qualitative Information: Thematic Analysis and Code Development. Newbury Park, CA: Sage Publications, Inc; 1998 :xvi, 184.</bibtext> </blist> <blist> <bibtext> Saldaña J. The Coding Manual for Qualitative Researchers. 3rd ed. Newbury Park, CA: Sage Publications, Ltd; 2015.</bibtext> </blist> <blist> <bibtext> Banyard VL. Toward the Next Generation of Bystander Prevention of Sexual and Relationship Violence: Action Coils to Engage Communities. New York, NY: Springer International Publishing; 2015. doi: 10.1007/978-3-319-23171-6.</bibtext> </blist> <blist> <bibtext> Pearson MR. Use of alcohol protective behavioral strategies among college students: A critical review. Clin Psychol Rev. 2013; 33 (8): 1025 – 1040. doi: 10.1016/j.cpr.2013.08.006.</bibtext> </blist> <blist> <bibtext> Leone RM, Haikalis M, Parrott DJ, DiLillo D. Bystander intervention to prevent sexual violence: The overlooked role of bystander alcohol intoxication. Psychol Violence. 2018; 8 (5): 639 – 647. doi: 10.1037/vio0000155.</bibtext> </blist> <blist> <bibtext> Ham LS, Wiersma-Mosley JD, Wolkowicz NR, Jozkowski KN, Bridges AJ, Melkonian AJ. Effect of alcohol intoxication on bystander intervention in a vignette depiction of sexual assault. J Stud Alcohol Drugs. 2019; 80 (2): 252 – 260. doi: 10.15288/jsad.2019.80.252.</bibtext> </blist> <blist> <bibtext> Green KE, Feinstein BA. Substance use in lesbian, gay, and bisexual populations: An update on empirical research and implications for treatment. Psychol Addict Behav. 2012; 26 (2): 265 – 278. doi: 10.1037/a0025424.</bibtext> </blist> <blist> <bibtext> Burns VL, Eaton AA, Long H, Zapp D. Exploring the role of race and gender on perceived bystander ability and intent: Findings before and after exposure to an online training program to prevent sexual assault on campus. Violence against Women. 2019; 25 (8): 999 – 1017. doi: 10.1177/1077801218807089.</bibtext> </blist> <blist> <bibtext> Baer JS, Kivlahan DR, Fromme K, Marlatt GA. Secondary prevention of alcohol abuse with college student populations: A skills-training approach. In: Alcohol Use and Misuse by Young Adults. Notre Dame, IN: University of Notre Dame Press; 1994 : 83 – 108.</bibtext> </blist> <blist> <bibtext> Walters ST, Bennett ME, Noto JV. Drinking on campus: What do we know about reducing alcohol use among college students? J Subst Abuse Treat. 2000; 19 (3): 223 – 228. doi: 10.1016/S0740-5472(00)00101-X.</bibtext> </blist> <blist> <bibtext> Pugh B, Ningard H, Ven TV, Butler L. Victim ambiguity: Bystander intervention and sexual assault in the college drinking scene. Deviant Behavior. 2016; 37 (4): 401 – 418. doi: 10.1080/01639625.2015.1026777.</bibtext> </blist> <blist> <bibtext> Oster-Aaland L, Lewis MA, Neighbors C, Vangsness J, Larimer ME. Alcohol poisoning among college students turning 21: Do they recognize the symptoms and how do they help? J Stud Alcohol Drugs Suppl. 2009;(16): 122 – 130. doi: 10.15288/jsads.2009.s16.122.</bibtext> </blist> <blist> <bibtext> Sauer N, Sałek A, Szlasa W, et al. The impact of COVID-19 on the mental well-being of college students. Int J Environ Res Public Health. 2022; 19 (9): 5089. doi: 10.3390/ijerph19095089.</bibtext> </blist> <blist> <bibtext> Vargas-Ramos JC, Lerma C, Guzmán-Saldaña RME, Lerma A, Bosques-Brugada LE, González-Fragoso CM. Academic performance during the COVID-19 pandemic and its relationship with demographic factors and alcohol consumption in college students. Int J Environ Res Public Health. 2022; 19 (1): 365. doi: 10.3390/ijerph19010365.</bibtext> </blist> <blist> <bibtext> Jackson KM, Merrill JE, Stevens AK, Hayes KL, White HR. Changes in alcohol use and drinking context due to the COVID-19 pandemic: A multimethod study of college student drinkers. Alcohol Clin Exp Res. 2021; 45 (4): 752 – 764. doi: 10.1111/acer.14574.</bibtext> </blist> <blist> <bibtext> Ryerson NC, Wilson OWA, Pena A, Duffy M, Bopp M. What happens when the party moves home? The effect of the COVID-19 pandemic on U.S. college student alcohol consumption as a function of legal drinking status using longitudinal data. Transl Behav Med. 2021; 11 (3): 772 – 774. doi: 10.1093/tbm/ibab006.</bibtext> </blist> </ref> <aug> <p>By Annelise Mennicke; Jessamyn Bowling; Erika Montanaro; Madi Williams; Hannah Carlson; Victoria McClare; Erin A. Meehan; Jasmine Temple; Bridget N. Jules; Anvi Tirunagari; Neha Kissler; Phoebe Pruneda; Keshawn S. Mathews; Gabrielle Haley; Michael J. Brienzo; Iris F. McMillan; Anna Yoder; Casey Mesaeh; Christopher Correia and Sarah McMahon</p> <p>Reported by Author; Author; Author; Author; Author; Author; Author; Author; Author; Author; Author; Author; Author; Author; Author; Author; Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib10" firstref="ref16"></nolink> <nolink nlid="nl2" bibid="bib11" firstref="ref17"></nolink> <nolink nlid="nl3" bibid="bib12" firstref="ref18"></nolink> <nolink nlid="nl4" bibid="bib14" firstref="ref19"></nolink> <nolink nlid="nl5" bibid="bib16" firstref="ref20"></nolink> <nolink nlid="nl6" bibid="bib18" firstref="ref21"></nolink> <nolink nlid="nl7" bibid="bib20" firstref="ref22"></nolink> <nolink nlid="nl8" bibid="bib22" firstref="ref23"></nolink> <nolink nlid="nl9" bibid="bib23" firstref="ref24"></nolink> <nolink nlid="nl10" bibid="bib24" firstref="ref25"></nolink> <nolink nlid="nl11" bibid="bib25" firstref="ref26"></nolink> <nolink nlid="nl12" bibid="bib26" firstref="ref27"></nolink> <nolink nlid="nl13" bibid="bib27" firstref="ref28"></nolink> <nolink nlid="nl14" bibid="bib28" firstref="ref29"></nolink> <nolink nlid="nl15" bibid="bib29" firstref="ref30"></nolink> <nolink nlid="nl16" bibid="bib30" firstref="ref31"></nolink> <nolink nlid="nl17" bibid="bib31" firstref="ref32"></nolink> <nolink nlid="nl18" bibid="bib32" firstref="ref35"></nolink> <nolink nlid="nl19" bibid="bib33" firstref="ref36"></nolink> <nolink nlid="nl20" bibid="bib34" firstref="ref37"></nolink> <nolink nlid="nl21" bibid="bib35" firstref="ref39"></nolink> <nolink nlid="nl22" bibid="bib36" firstref="ref40"></nolink> <nolink nlid="nl23" bibid="bib37" firstref="ref41"></nolink> <nolink nlid="nl24" bibid="bib38" firstref="ref43"></nolink> <nolink nlid="nl25" bibid="bib39" firstref="ref44"></nolink> <nolink nlid="nl26" bibid="bib40" firstref="ref45"></nolink> <nolink nlid="nl27" bibid="bib41" firstref="ref46"></nolink> <nolink nlid="nl28" bibid="bib42" firstref="ref48"></nolink> <nolink nlid="nl29" bibid="bib43" firstref="ref49"></nolink> <nolink nlid="nl30" bibid="bib44" firstref="ref50"></nolink> <nolink nlid="nl31" bibid="bib45" firstref="ref52"></nolink> <nolink nlid="nl32" bibid="bib46" firstref="ref54"></nolink> <nolink nlid="nl33" bibid="bib47" firstref="ref55"></nolink> <nolink nlid="nl34" bibid="bib48" firstref="ref56"></nolink> <nolink nlid="nl35" bibid="bib49" firstref="ref57"></nolink> <nolink nlid="nl36" bibid="bib50" firstref="ref59"></nolink> <nolink nlid="nl37" bibid="bib51" firstref="ref60"></nolink> <nolink nlid="nl38" bibid="bib52" firstref="ref61"></nolink> <nolink nlid="nl39" bibid="bib54" firstref="ref62"></nolink> <nolink nlid="nl40" bibid="bib55" firstref="ref63"></nolink> <nolink nlid="nl41" bibid="bib56" firstref="ref64"></nolink> <nolink nlid="nl42" bibid="bib57" firstref="ref67"></nolink> <nolink nlid="nl43" bibid="bib58" firstref="ref70"></nolink> <nolink nlid="nl44" bibid="bib59" firstref="ref77"></nolink> <nolink nlid="nl45" bibid="bib60" firstref="ref78"></nolink> <nolink nlid="nl46" bibid="bib61" firstref="ref81"></nolink> <nolink nlid="nl47" bibid="bib21" firstref="ref82"></nolink> <nolink nlid="nl48" bibid="bib62" firstref="ref84"></nolink> <nolink nlid="nl49" bibid="bib63" firstref="ref85"></nolink> <nolink nlid="nl50" bibid="bib64" firstref="ref86"></nolink> <nolink nlid="nl51" bibid="bib65" firstref="ref90"></nolink> <nolink nlid="nl52" bibid="bib66" firstref="ref91"></nolink> <nolink nlid="nl53" bibid="bib67" firstref="ref93"></nolink> <nolink nlid="nl54" bibid="bib68" firstref="ref94"></nolink> <nolink nlid="nl55" bibid="bib69" firstref="ref95"></nolink> <nolink nlid="nl56" bibid="bib70" firstref="ref96"></nolink> <nolink nlid="nl57" bibid="bib71" firstref="ref97"></nolink> <nolink nlid="nl58" bibid="bib72" firstref="ref98"></nolink>
Header DbId: eric
DbLabel: ERIC
An: EJ1473132
AccessLevel: 3
PubType: Academic Journal
PubTypeId: academicJournal
PreciseRelevancyScore: 0
IllustrationInfo
Items – Name: Title
  Label: Title
  Group: Ti
  Data: The Bystander Intervention for Problematic Alcohol Use Model (BIPAUM)
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Annelise+Mennicke%22">Annelise Mennicke</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-4259-4356">0000-0003-4259-4356</externalLink>)<br /><searchLink fieldCode="AR" term="%22Jessamyn+Bowling%22">Jessamyn Bowling</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-7410-4433">0000-0001-7410-4433</externalLink>)<br /><searchLink fieldCode="AR" term="%22Erika+Montanaro%22">Erika Montanaro</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-8936-6372">0000-0001-8936-6372</externalLink>)<br /><searchLink fieldCode="AR" term="%22Madi+Williams%22">Madi Williams</searchLink><br /><searchLink fieldCode="AR" term="%22Hannah+Carlson%22">Hannah Carlson</searchLink><br /><searchLink fieldCode="AR" term="%22Victoria+McClare%22">Victoria McClare</searchLink><br /><searchLink fieldCode="AR" term="%22Erin+A%2E+Meehan%22">Erin A. Meehan</searchLink><br /><searchLink fieldCode="AR" term="%22Jasmine+Temple%22">Jasmine Temple</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-5356-713X">0000-0001-5356-713X</externalLink>)<br /><searchLink fieldCode="AR" term="%22Bridget+N%2E+Jules%22">Bridget N. Jules</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-4862-3613">0000-0003-4862-3613</externalLink>)<br /><searchLink fieldCode="AR" term="%22Anvi+Tirunagari%22">Anvi Tirunagari</searchLink><br /><searchLink fieldCode="AR" term="%22Neha+Kissler%22">Neha Kissler</searchLink><br /><searchLink fieldCode="AR" term="%22Phoebe+Pruneda%22">Phoebe Pruneda</searchLink><br /><searchLink fieldCode="AR" term="%22Keshawn+S%2E+Mathews%22">Keshawn S. Mathews</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-2931-2695">0000-0002-2931-2695</externalLink>)<br /><searchLink fieldCode="AR" term="%22Gabrielle+Haley%22">Gabrielle Haley</searchLink><br /><searchLink fieldCode="AR" term="%22Michael+J%2E+Brienzo%22">Michael J. Brienzo</searchLink><br /><searchLink fieldCode="AR" term="%22Iris+F%2E+McMillan%22">Iris F. McMillan</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-3694-5391">0000-0003-3694-5391</externalLink>)<br /><searchLink fieldCode="AR" term="%22Anna+Yoder%22">Anna Yoder</searchLink><br /><searchLink fieldCode="AR" term="%22Casey+Mesaeh%22">Casey Mesaeh</searchLink><br /><searchLink fieldCode="AR" term="%22Christopher+Correia%22">Christopher Correia</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-2458-4066">0000-0003-2458-4066</externalLink>)<br /><searchLink fieldCode="AR" term="%22Sarah+McMahon%22">Sarah McMahon</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-7227-951X">0000-0002-7227-951X</externalLink>)
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+American+College+Health%22"><i>Journal of American College Health</i></searchLink>. 2025 73(2):792-802.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 11
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2025
– Name: SourceSuprt
  Label: Sponsoring Agency
  Group: SrcSuprt
  Data: National Institute on Alcohol Abuse and Alcoholism (NIAAA) (DHHS/NIH)
– Name: NumberContract
  Label: Contract Number
  Group: NumCntrct
  Data: 1R15AA02891001
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Intervention%22">Intervention</searchLink><br /><searchLink fieldCode="DE" term="%22Audiences%22">Audiences</searchLink><br /><searchLink fieldCode="DE" term="%22Alcohol+Abuse%22">Alcohol Abuse</searchLink><br /><searchLink fieldCode="DE" term="%22College+Students%22">College Students</searchLink><br /><searchLink fieldCode="DE" term="%22Barriers%22">Barriers</searchLink><br /><searchLink fieldCode="DE" term="%22Affordances%22">Affordances</searchLink><br /><searchLink fieldCode="DE" term="%22Planning%22">Planning</searchLink><br /><searchLink fieldCode="DE" term="%22Attention%22">Attention</searchLink><br /><searchLink fieldCode="DE" term="%22Decision+Making%22">Decision Making</searchLink><br /><searchLink fieldCode="DE" term="%22Evaluation%22">Evaluation</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Behavior%22">Student Behavior</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22North+Carolina%22">North Carolina</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1080/07448481.2023.2245497
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0744-8481<br />1940-3208
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objective: The study aimed to identify phases of bystander intervention (BI) for problematic alcohol use (PAU) among college students. Participants: Twenty focus groups and nine interviews were conducted. Methods: Transcripts were thematically analyzed. Results: The phases of the Bystander Intervention for Problematic Alcohol Use Model (BIPAUM) include: (1) plan in advance, (2) notice and interpret a sign, (3) decide (i.e., assume responsibility, assess support/feasibility to intervene, and identify intervention strategy), (4) intervene, and (5) assess outcomes. Assessing outcomes loops to influence future behavior and each phase is influenced by barriers and facilitators. Conclusions: These unique phases should be considered when designing and evaluating intervention programs for PAU to meet students' needs and better reduce PAU. Future research should empirically test the BIPAUM. The results of the current study demonstrate a promising opportunity for applying BI to PAU, with the goal of reducing risky drinking among college students.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2025
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1473132
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1473132
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1080/07448481.2023.2245497
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 11
        StartPage: 792
    Subjects:
      – SubjectFull: Intervention
        Type: general
      – SubjectFull: Audiences
        Type: general
      – SubjectFull: Alcohol Abuse
        Type: general
      – SubjectFull: College Students
        Type: general
      – SubjectFull: Barriers
        Type: general
      – SubjectFull: Affordances
        Type: general
      – SubjectFull: Planning
        Type: general
      – SubjectFull: Attention
        Type: general
      – SubjectFull: Decision Making
        Type: general
      – SubjectFull: Evaluation
        Type: general
      – SubjectFull: Student Behavior
        Type: general
      – SubjectFull: North Carolina
        Type: general
    Titles:
      – TitleFull: The Bystander Intervention for Problematic Alcohol Use Model (BIPAUM)
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Annelise Mennicke
      – PersonEntity:
          Name:
            NameFull: Jessamyn Bowling
      – PersonEntity:
          Name:
            NameFull: Erika Montanaro
      – PersonEntity:
          Name:
            NameFull: Madi Williams
      – PersonEntity:
          Name:
            NameFull: Hannah Carlson
      – PersonEntity:
          Name:
            NameFull: Victoria McClare
      – PersonEntity:
          Name:
            NameFull: Erin A. Meehan
      – PersonEntity:
          Name:
            NameFull: Jasmine Temple
      – PersonEntity:
          Name:
            NameFull: Bridget N. Jules
      – PersonEntity:
          Name:
            NameFull: Anvi Tirunagari
      – PersonEntity:
          Name:
            NameFull: Neha Kissler
      – PersonEntity:
          Name:
            NameFull: Phoebe Pruneda
      – PersonEntity:
          Name:
            NameFull: Keshawn S. Mathews
      – PersonEntity:
          Name:
            NameFull: Gabrielle Haley
      – PersonEntity:
          Name:
            NameFull: Michael J. Brienzo
      – PersonEntity:
          Name:
            NameFull: Iris F. McMillan
      – PersonEntity:
          Name:
            NameFull: Anna Yoder
      – PersonEntity:
          Name:
            NameFull: Casey Mesaeh
      – PersonEntity:
          Name:
            NameFull: Christopher Correia
      – PersonEntity:
          Name:
            NameFull: Sarah McMahon
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 01
              Type: published
              Y: 2025
          Identifiers:
            – Type: issn-print
              Value: 0744-8481
            – Type: issn-electronic
              Value: 1940-3208
          Numbering:
            – Type: volume
              Value: 73
            – Type: issue
              Value: 2
          Titles:
            – TitleFull: Journal of American College Health
              Type: main
ResultId 1