Society For The Study Of Addiction

QMJC September 2020 – College student knowledge of blackouts and implications for alcohol intervention: A qualitative analysis.

Article: Mary Beth Miller, Jennifer E. Merrill, Samyukta Singh, Angelo M. DiBello, and Kate B. Carey. 2018. College student knowledge of blackouts and implications for alcohol intervention: A qualitative analysis. Psychology of Addictive Behaviors, 32(8):933–943.


Toronto reading group – September meeting: Carol Strike; Katherine Rudzinski; David Kryszajtys; Rose Schmidt; Jessica Xavier (Dalla Lana School of Public Health, University of Toronto)

Meeting summary:

In September 2020, members of Qualitative Methods Journal Club reviewed Miller at al.’s 2018 paper, College student knowledge of blackouts and implications for alcohol intervention: A qualitative analysis. In this article the authors examine college students’ knowledge of blackouts (“periods of alcohol-induced anterograde amnesia”) due to drinking and investigate their suggestions for intervening on this risk behaviour, through discussions in eight focus groups (N=50, 5–8/group). Blackouts are common in the college context and place young adults at increased risk for alcohol-related harm. Miller et al., recruited college students who had a blackout experience in the past six months and asked them the following questions: “What increases the likelihood of blackouts? If you were worried about a friend’s blackout, what might you do? If campus/university officials wanted to help, what could they do?” (p.934). The authors used an applied thematic analysis and compared themes related to student knowledge about blackouts to the empirical literature (e.g., biological sex, genetic factors, rate of alcohol consumption, poly-substance use, pregaming, drinking location, etc.). Miller et al. found that participants’ knowledge of blackout risk factors was often inconsistent and sometimes inaccurate, especially with understanding the influence of biological sex, genetic factors, drinking speed, co-use of other drugs, dehydration, and sleep, on the occurrence of blackouts. Participants made suggestions for potential interventions to reduce the occurrence and/or potential harm of blackouts among college students, including amnesty policies, bystander interventions among peers, and education campaigns. The authors found crucial knowledge gaps in college students understanding of risk factors for blackouts (i.e., biological risks), which represent key targets for future interventions.

The journal club was surprised to learn that there are no other studies which have examined what young adults know about blackout drinking and related risks. Given this knowledge gap, we appreciated that this study went beyond describing knowledge of risks, to also examine what participants perceived as helpful for programming/interventions. In this case, the authors involved college students who are at increased risk of blackouts in brainstorming potential interventions at the policy, peer, and individual levels. Involving community members in developing interventions is crucial for ensuring that the needs of that community are met in the resulting programs and services.

We valued how concise and easy to read the article was. Most journal club members are not involved in alcohol research, but we all found this paper really accessible. The authors introduced difficult concepts (e.g., biological/neurological aspects of the blackout process) by providing comprehensive definitions and background information to guide readers through the article. This gave us a better understanding of blackouts and what causes them, thereby allowing us to consider how study participants understood this topic.

Rather than using quantitative methods (e.g., surveys) to understand college students’ level of knowledge about blackouts, Miller et al. used a qualitative approach to identify gaps in participants’ knowledge. The authors provided clear justification for this approach, explaining that: “a qualitative research method was chosen to establish a range of possible responses that were not introduced by the research team. Qualitative methods also provide greater depth of understanding, in that participants are able to explain and provide caveats to their perceptions.” (p.934). We valued the level of detail the authors provided in describing their data collection and analysis processes. We enjoyed the openness of their focus group questions and the transparency that comes with sharing these questions with the reader. Miller et al. also provided a thorough description of the process of conducting their focus groups (stratifying by gender, having a note-taker, holding debrief meetings). We were very interested to hear more about any gender differences the authors found in the discussions of blackout risks, especially if there were any conversations around risks of sexual assault or violence.

The journal club also liked how the authors mapped participants’ knowledge of blackout risks against existing scientific knowledge. It was novel to match perspectives against the literature after examining participants’ perspectives, as a way to assess intervention targets. However, we did wonder what the participants might think of the researchers describing their knowledge as inconsistent or inaccurate?

We discussed whether different approaches in qualitative methods (e.g., constructivist grounded theory, symbolic interactionism) would consider the accuracy of participants’ perspectives. For instance, from the constructivist perspective everyone’s view of social reality is different – there are multiple legitimate ways of seeing things – thus the emphasis is on what a participant’s perspective means for that individual or how a participant uses/acts on their knowledge, rather than whether the information is true or not. We appreciated that Miller et al. take a positivist/post-positivist approach and have a clear goal of linking knowledge gaps to potential interventions, which necessitates the comparison of participant perspectives to empirical data.

The journal club discussed how the Miller et al. presented their qualitative data using short excerpts of participant quotations, and effectively building them into the text summarizing their findings. They then provided the fuller version of these quotes, alongside more examples, in well-structured tables. Such an approach is effective at convening qualitative data in a concise and organized manner. We appreciate that this style makes for an appealing read, but acknowledge there may be some concerns with using this approach – as you may be taking short quotes out of context. This is something we always grapple with in qualitative research; how much of the quote to leave in to provide the essence of what the participant is saying, but also to highlight what is interesting /relevant. We also considered how some journals (i.e., psychology) may be more accepting of this approach than others (e.g., sociology, qualitative methods journals), perhaps because it allows for qualitative data to be presented within constraints of restrictive word limits.

We really appreciated how the authors were able to highlight the utility of qualitative studies for applied research. Indeed, Miller et al.’s study has direct applicability to intervention. The study is written in a way that is particularly effective for those who focus on intervention design or programming (e.g., policymakers, frontline workers). It has a workable breakdown – maintaining a clear focus, including a clinical implications section in the discussion, providing accessible data for actionable interventions and/or future research (e.g., a larger quantitative study that looks at these issues more broadly). This approach may be critical in providing the evidence-informed research needed to secure decision-maker and funder buy-in for future programming/services and interventions. In reading this informative paper, we were particularly interested in further research on bystander interventions for blackout drinking in a college context (e.g., how sorority /fraternity membership or underage drinking may affect uptake) as well as norm-based interventions that focus on shifting perceptions about alcohol norms (e.g., particularly with respect to media glorification of blackouts).

Additional reading:

  • Guest, G., MacQueen, K. M., & Namey, E. E. 2012. Applied thematic analysis. Thousand Oaks, CA: Sage.
  • Krueger, R. A., & Casey, M. A. 2014. Focus groups: A practical guide for applied research (5th ed.). Thousand Oaks, CA: Sage.
  • Merrill, J.E. Ward, R.M., & Riordan, B.C. 2020. Posting post-blackout: A qualitative examination of the positive and negative valence of tweets posted after “blackout” drinking. Journal of Health Communication, 25(2):150-158, doi: 10.1080/10810730.2020.1719242
  • Ulin, P. R. 2005. Qualitative methods in public health: A field guide for applied research. San Francisco, CA: Jossey-Bass.