Doing what everyone else does? From silly hats to binge drinking

As Britain recovers from four days of flag waving (does that count as exercise?), students will be turning their thoughts to exams and end of exam celebrations. For many, this will involve drinking alcohol – lots of it. One way to tackle excessive drinking amongst students is through interventions which use ‘social norms feedback’. These address people’s misperceptions – the gap between actual attitudes and behaviours and what people believe to be true about attitudes and behaviours.

Everyone’s doing it

For example, someone landing in the UK over the jubilee weekend might have thought that it was quite normal for people here to sit in the rain eating damp sandwiches, wearing plastic hats or nylon wigs, with tribal marks crayoned on their faces, shouting “Gawd Bless Her Maj”. The gap between this and what is actually true could be addressed by a social norms feedback intervention, which explains how many people really dress and behave like this and how often, the risks associated with it (hypothermia, for starters) and where your behaviour fits into the picture. Probably not worth it in this instance, but it could be a useful tool to address alcohol misuse.

A Cochrane review looked at the evidence from randomised controlled trials (RCTs) on social norms feedback interventions on alcohol misuse in college or university students. Feedback was given to individuals or to a group and in a variety of ways, such as via the internet or computer or face-to-face. Twenty-two RCTs with 7275 participants were suitable for inclusion. Three studies took place in New Zealand, the rest in the US. Social norms feedback was compared with another type of feedback, an alcohol education leaflet or no intervention. Here’s what they found:

  • Web/computer feedback (WF) significantly reduced alcohol misuse in terms of alcohol-related problems, blood alcohol content, frequency and quantity of drinking and binge drinking
  • Mailed feedback did not have a significant effect on any of these factors
  • Individual face-to-face feedback (IFF) significantly reduced drinking frequency and binge drinking only
  • Group face-to-face feedback significantly reduced drinking quantity but not alcohol related problems
  • Drinking norms were assessed in three studies using web feedback, which was found to have a significant positive effect
  • There was mixed evidence on a social norms marketing campaign


  • Studies varied in the intensity and length of the intervention and length of follow-up and there were few studies with longer-term follow-up
  • There were only a few high quality studies; many studies were poorly reported and there were only a few studies for many of the analyses

The authors concluded:

“WF and IFF are probably effective in reducing alcohol misuse. No direct comparisons of WF against IFF were found, but WF impacted across a broader set of outcomes and is less costly so therefore might be preferred.”

It’s a scary thought that, back in 1977, I spent the Silver Jubilee celebrations sporting a polystyrene horse’s head, in public, helping to drag a cart on which sat a more favoured elf, wearing the Jubilee Princess kit. Not that I’m bitter. And no I didn’t think it was normal even then. Fast forward to 2012 and here in the woodland it’s back to normality, but what’s normal for an elf? After all, we wear silly hats every day of the week.


Moreira MT, Smith LA, Foxcroft D. Social norms interventions to reduce alcohol misuse in University or College students. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD006748. DOI: 10.1002/14651858.CD006748.pub2.

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Sarah Chapman

My name is Sarah Chapman. I have worked on systematic reviews and other types of research in many areas of health for the past 17 years, for the Cochrane Collaboration and for several UK higher education institutions including the University of Oxford and the Royal College of Nursing Institute. I also have a background in nursing and in the study of the History of Medicine.

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