The PEERCARE peer led programme for college students: A qualitative evaluation ofa “chill-out” harm reduction space

In France, alcohol is a legal and easily accessible psychoactive substance, the consumption of which is widely culturally accepted, particularly on festive occasions (World Health Organization, 2018). It is one of the most-consumed psychoactive substances among young people, particularly among those aged 20–24 years (World Health Organization, 2018). Alcohol use begins in adolescence, a particularly high-risk period for example from a brain maturation perspective (Hermens et al., 2013; Meruelo et al., 2017; Tapert et al., 2004). Young people are more likely than adults to engage in binge drinking behaviours—a specific pattern of alcohol consumption characterised by excessive episodic drinking with the primary intention of becoming intoxicated quickly (Hermens et al., 2013; Lannoy et al., 2017; Maurage et al., 2019). As in other European countries, the “culture of intoxication” is present at French universities, with students aware of the fact that alcohol is a big problem on their campuses (Van Hal et al., 2018).

In terms of students in sororities and fraternities (Wechsler et al., 2009), excessive alcohol consumption seems to be even more prevalent among those in competitive academic careers, such as the engineering grandes écoles (Slutske, 2005; Tavolacci et al., 2016). A study conducted in Haute-Normandie between 2009 and 2013 showed that among 601 engineering school students aged 18–25 years, 20.1% reported engaging in binge drinking occasionally (once a month or less) and 15.1% frequently (more than twice a month). Researchers have observed a significant positive association between binge drinking and problematic alcohol use among French college students (Tavolacci et al., 2016). College schools, which involve alternating between years of preparatory classes and campus life, are ideal circumstances for festivities to be held at which alcohol is prominent. That is, students who face intense academic competition in their preparatory classes first adopt ascetic lifestyles in which they overinvest in academics to the detriment of their social lives. However, admission to school is a form of liberation, and this asceticism is replaced by hedonism (Masse, 2002). Festive alcoholic rituals are established and constitute a real rite of passage, particularly during integration weekends and parties. Initiated peers particularly value “knowing how to drink”, or drinking large amounts of alcohol quickly while continuing to participate in the festivities. In this context, acquiring and conforming to school drinking norms allow new students to integrate into a peer group and build a shared identity (Albert et al., 2013). Higher education students also have easier access to psychoactive substances than young adolescents, as they have greater financial resources and legal freedoms and less parental control, a context that favours experimentation (Botvin & Griffin, 2007; White, 2006). Furthermore, living in a campus community can contribute to drinking behaviours that were previously confined to festive events becoming more frequent, especially among students with existing vulnerabilities (Jennison, 2004). Therefore, despite the lack of consensus in the literature, several studies have shown that living on campus is associated with alcohol consumption (Simons-Morton et al., 2015), increased alcohol-related harm (Rickwood et al., 2011) and a greater prevalence of alcohol dependence (Dawson et al., 2004).

Despite these findings, data from meta-analyses have shown that programmes to prevent addictive behaviours are mainly focused on primary prevention and aimed at middle- and high-school students due to the early age of initial experimentation (Das et al., 2016). Few programmes focusing exclusively on addictive behaviours are tailored to young adults in higher education. However, given the short- and long-term risks of excessive alcohol consumption, selective prevention and harm reduction programmes tailored to the student population, especially in grandes écoles, seem necessary.

Studies of existing prevention programmes have recommended methods to prevent substance use disorders in younger populations (Botvin & Griffin, 2007; Das et al., 2016). First, knowledge transfer is important. Previous studies have shown that a substantial proportion of university students lack knowledge about responsible drinking practices, such as the identification of standard drinks, blood alcohol concentration (BAC) limits for driving and actions effective in lowering BAC (Dowling et al., 2006). These results suggest that students can benefit from increased alcohol awareness, which can provide them with the same level of knowledge about responsible drinking practices and aid them in making informed choices about their alcohol consumption (Botvin & Griffin, 2007; Corney & du Plessis, 2022; MacArthur et al., 2016). However, while knowledge transfer appears to affect people's understanding of the risks associated with substance use, it does not necessarily change their behaviours (Bruvold, 1993). For example, a study conducted in Sweden found that despite the existence of alcohol policies and guidelines developed by student unions, risky alcohol consumption among university students remained prevalent (Strandberg et al., 2019). Hence, awareness of the dangers involved in excessive alcohol consumption does not deter risky behaviours (Calvert et al., 2010). Nevertheless, knowledge transfer remains essential, but how knowledge is transmitted among this student population is equally important (Leontini & Corney, 2023). Indeed, studies have demonstrated that traditional approaches based on “one way, top down” methods, transmitting only facts presented as “do's and don’ts”, have limited success in engaging young people (Leontini & Corney, 2023; Wilkinson & Ivsins, 2017). Models based on dynamic educational methods, in which students dialogue and become subjects of knowledge rather than objects or “passive recipients”, can thus lead to the greater appropriation of messages (Corney et al., 2020; Corney & du Plessis, 2022; Matthews, 2014). Second, peer participation is crucial to reaching this age group. The most effective programmes adopt developmental approaches that consider the psychosocial issues related to the construction of young people's identities, which develop mainly through exchanges with their peer groups (Botvin & Griffin, 2007). In these programmes, volunteer peers are trained to be resources for other individuals in their groups. Adolescence, defined as the ages between 12 and 25 years, is a time of identity construction and independence-seeking (Brizio et al., 2015). Therefore, young people more easily identify with and trust people who are similar to them. Moreover, horizontal communication is perceived as less judgemental than vertical communication, or information disseminated by expert adults, and thus promotes better adherence to healthy behaviours (Cuijpers, 2002). Peer educators also know how to tailor communication according to the characteristics of the target population, which contributes to the effectiveness of these programmes (Botvin & Griffin, 2007; MacArthur et al., 2016). Third, the importance of interactivity has been emphasised. Interactive programmes appear to be two to four times more effective than noninteractive programmes and are even more effective when conducted by peers (Hawkins et al., 1992; Tobler et al., 2000).

However, scientific studies evaluating peer-led interventions to prevent alcohol consumption among young people are scarce (MacArthur et al., 2016). In their recent overview, Lavilla-Gracia et al. (2022) identified only 13 quantitative studies conducted in the last three decades, all of which were conducted in the USA, evaluating the effectiveness of nine peer-led interventions for preventing alcohol consumption in a college setting (the Voice of Reason programme, Brief Advice sessions, Peer Theater, the Alcohol Education programme, the Perceptions of Alcohol Norms intervention, the Motivational intervention, the Alcohol Skills Training programme, Lifestyle Management classes and Brief Alcohol Screening and Intervention for College Students). According to the National Institute on Alcohol Abuse and Alcoholism's (NIAA, 2019) guide, three types of interventions have been proposed: education and awareness; cognitive behavioural or skill-based; and motivation or feedback-related approaches. However, these interventions usually take place outside events where alcohol consumption is present. For example, although the French Noz’ambule programme (CIRDDB, 2012) has a prevention module that is conducted by trained students who go out to meet other young people at night in public spaces, as well as a harm reduction module that is conducted by professionals, peer intervention is limited to raising awareness in public spaces before student parties. Currently, professionals conduct risk and harm reduction actions during parties, probably because of the public context in which the parties take place. However, campuses are special environments where student parties occur in private locations. In this context, trained peers can perform risk and harm reduction actions as well, particularly because of the responsibility that student associations bear in the organisation and management of parties at the institution. Finally, as Lavilla-Gracia et al. (2022) highlighted, no existing peer-led intervention evaluates the impact of the intervention on the peer educators themselves, despite evidence showing its positive effect (i.e., improvement of educators’ interpersonal communication and self-esteem) (King & Fazel, 2021; Newton & Ender, 2010). Hence, it is recommended that future studies evaluate the impact of these interventions on the educators conducting them.

Based on these observations and recommendations from the literature reviewed, as well as at the request of institutions for support to address the issue of addictive behaviours on campus (particularly excessive alcohol consumption), a peer-led prevention programme named PEERCARE, a programme for teaching about and mutual aid in the detection of risky behaviours among students, was created and deployed at several French grandes écoles starting in 2017.

The PEERCARE programme is a multi-component peer-led prevention programme intended to reduce alcohol-related risks in the student environment. The programme has three specific prevention objectives: (1) health education: raise awareness about addictive behaviours; (2) indicated prevention: detect substance misuse to prevent substance use disorders; and (3) harm reduction: establish risk and harm reduction measures in party environments (i.e., manage a “chill-out” space during parties).

Student volunteers can join the programme on request throughout the academic year. Each course can accommodate up to 20 students per session. For each objective of the programme, there is a 1-day training module. Practical training courses are accompanied by two sessions of group supervision, during which students can reflect on their experience as peer educators and the questions that they have about or the difficulties posed by this practice. See Table 1 for the content of each module.

The main objective of the harm reduction module is to train peer educators to deploy and manage a “chill-out” space. The chill-out space is a friendly, safe space that students run during parties. It is relatively quiet and removed from the main party, allowing students to rest and chat. They can find assistance in handling alcohol overconsumption or a bad alcohol consumption experience. Depending on the organisers’ objectives, the chill-out space can also be a place to promote health by sharing information about and discussing alcohol consumption.

During training, peer educators are invited to determine the risk reduction objective of the event, the means available for and feasibility of hosting the event, the shape and animation of the space, the rules of the event, and how they want to communicate about or in the chill-out space. They also learn about the different effects of psychoactive substances (such as alcohol, cannabis, ecstasy and cocaine) so that they can better assist students who find themselves in trouble due to the consumption of these substances. Peer educators are trained to assess situations, reassure students and provide students with assistance; they also learn about good communication practices when addressing an impaired student (due to intoxication, anxiety, a coma, etc.) and the immediate responses that are possible in various situations. After the initial training, peer educators are accompanied to install chill-out spaces and manage their first parties. Initially developed for rave parties, this harm reduction device seems to meet the needs of universities whose campuses have a tradition of festive events. To the best of our knowledge, they remain anecdotal in France and, therefore, represent a form of innovation that is important to understand. Hence, the aims of this study, which is part of a wider project to evaluate the PEERCARE programme, were: (1) to understand peer educators’ experiences with the project in terms of its perceived benefits and difficulties; (2) to identify peer educators’ needs; and (3) to document the concrete actions implemented in a chill-out space. Such a study can provide information about the value of such an intervention from the students’ point of view and highlight possible developments in both the chill-out space and student training.

The sociodemographic characteristics of the participants are presented in Table 2. The sample (n = 9) consisted of six men and three women who were aged 19–22 years (M  =  21.0 years, SD  =  0.14) and members of at least one student association. The seven themes and 28 subthemes identified during the thematic content analysis are presented in Table 3. Since all of the themes and subthemes could not be presented in this article, only those that best answered our research questions were developed, resulting in 15 subthemes from six themes.

This study sought to explore peer educators’ subjective experiences during the deployment and management of chill-out harm reduction spaces at parties. We wanted to better understand what these students perceived as useful, the actions that these students performed, the students’ possible needs and what caused difficulties so that we could consider avenues for improving this harm reduction intervention and its training.

Peer educators’ comments on the benefits of horizontal communication that is free of moralising and judgement confirmed the value of peer-led interventions rather than repressive or moralistic approaches. According to the participants, the effectiveness of this approach derived from students’ easy identification with their peers and willingness to adhere to their recommendations because they shared a common language. This result aligns with recommendations suggesting that this type of communication is particularly appropriate for this age group, in which issues of identity construction and peer group relationships are driving factors (Albert et al., 2013; Botvin & Griffin, 2007; Brizio et al., 2015). Moreover, although information transmission alone is insufficient to change behaviours, participants found it helpful for creating a common knowledge base and feeling empowered enough to inform their peers about the risks of alcohol overconsumption (Botvin & Griffin, 2007; Bruvold, 1993; MacArthur et al., 2016). Specifically, how participants informed their peers was different from traditional “one way, top down” information transmission approaches. It was based on a direct peer-to-peer approach, a discussion in which both exchange partners played an active role. These interactions were often more informal and relaxed, which seemed to promote free speech and reduce the fear of punishment and judgement. These exchanges also took place directly during festive evenings and were led by peer educators familiar with their campus environment, which could have made the exchanges more suitable for young people's real-life context (Botvin & Griffin, 2007; MacArthur et al., 2016; Wilkinson & Ivsins, 2017). Another interesting point is that for some participants, a state of intoxication facilitated contact with their peers. Although this may seem counter-intuitive, we can hypothesise that alcohol, because of its disinhibiting and anxiolytic effects, may lead some students to be less reluctant to talk about their alcohol consumption than when they are sober (Babor et al., 1983; Tobore, 2020). Finally, the results of this study, as well as those of a previous French qualitative study on festive settings (Mutatayi, 2019), show that the chill-out space fulfils its theoretical function of providing a sense of safety. Knowing that there is a place to go in case of difficulty, for oneself and for others, is reassuring because students know that they will not be alone and that they will always find someone to help them if necessary. This feeling of safety is present both inside and outside the party because peer educators are present on campus and become a resource that students can approach if they have a problem or a question. In addition, the chill-out space appears to foster the notion of self-support, which can be defined as volunteers gathering around a common goal of providing mutual material, physical and psychological aid for their peers to reduce the risks of consuming alcohol (Hoareau, 2007). However, a specific study on the scale of the student community will allow for a more precise evaluation of the impact of having a chill-out space on attendees’ feeling of safety during parties.

The interviews confirmed that peer educators perform many actions for their peers (e.g., rehydration) that adhere to good practices for risk and harm reduction in party environments (Martens et al., 2005, 2007). Their actions were also performed in collaboration with Mobile First Aid Unit members, which affirms the need to offer these services jointly (CIRDDB, 2008). Such spaces offer a respite without requiring people to leave the party, unlike the aid station, which implies a permanent exit from the party. Moreover, the chill-out space is not exclusively a place of assistance but also a place of socialisation and relaxation. These aspects seem to help reduce the pressure imposed by others’ judgement, which is particularly strong at this age and can reduce investment in such spaces (Albert et al., 2013; White, 2006). Chill-out spaces also permit preventive actions that are compatible with students’ motivations for attending parties, such as conviviality and sociability (Larson & Seepersad, 2003; Pedersen & LaBrie, 2007).

Through the interviews, peer educators expressed certain difficulties in the management and maintenance of the chill-out space. With regard to the difficulty of making the chill-out space more attractive by proposing playful activities on large-scale parties, one solution can be to increase the number of peer educators managing the space or to consider having separate spaces for assistance and socialising within one chill-out space. Peer educators also described difficulties in gaining sufficient legitimacy to offer assistance and information to their peers. This difficulty appears in other programmes as well and seems to be a limitation of peer prevention (Gillaizeau, 2019). That is, knowing that peer educators face the same issues facilitates communication with other students through identification and gives peer educators a certain credibility, but this credibility can be tainted by peer educators’ reputations as copious drinkers or partiers. These students must thus change their peers’ perceptions. Finally, the participants mentioned their difficulties in clarifying the role of the chill-out space when the parties were organised off-campus. This result is consistent with the findings of another study showing that the managers of party establishments can be reluctant to implement risk reduction measures (Gérome & Guilbaud, 2021).

Although the participants talked about their difficulties, they also discussed the benefits of their experiences. First, they highlighted the pleasure and enrichment that managing the chill-out space offered. Peer educators enjoyed the company of their prevention partners, which contributed to their pleasure in helping and supporting them while handling the difficulties that they encountered. This social dimension also seemed to mitigate their impression of being unable to fully enjoy parties, supporting reports from other studies that have indicated that people who like to party seek sociability as much or more than drunkenness (Moreau, 2010). Finally, the benefits from helping peers, such as feelings of usefulness, competence and recognition, were frequently mentioned in the interviews with peer educators and seemed to have compensated for the difficulties that they encountered. The interviews also highlighted what peer educators would need to become more competent in managing the chill-out space. For example, some students wanted to develop skills for managing aggressive behaviours or first aid procedures. The participants also wanted summaries of essential information, as well as a guide on what to do in the most common situations. This information will be particularly useful when training future volunteer peer educators.

Our data also confirm the positive effects of peer support in facilitating actions aimed at reducing the risks and harm associated with alcohol consumption. Furthermore, the experience of managing chill-out spaces gives peer educators a sense of confidence and competence by helping their peers. Indeed, peer educators acquire a greater sense of competence and confidence while they manage these spaces. Regarding the logistics of managing chill-out spaces, our results underline the importance of rotating peer educators during parties, as well as the need to encourage peer educators to take breaks, as managing these spaces is demanding. In addition, it seems important to better differentiate between areas for socialising or activities outside the party and areas dedicated to people who have consumed too much alcohol.

This research also shows the need for prevention programmes whose scope of action is not restricted to alcohol consumption in public spaces but extends to private spaces as well (Porath-Waller et al., 2010). The PEERCARE programme, by being located on campus, seems to fulfil this objective. Indeed, PEERCARE interventions take place at the centre of festive events where alcohol consumption is present, unlike existing peer-led interventions aimed at preventing the overconsumption of alcohol, which are usually conducted outside these events (Lavilla-Gracia et al., 2022). Some participants mentioned students’ habit of drinking hard liquor in their residences before parties (Pedersen & LaBrie, 2007). As the chill-out space was not set up in student residences, it could only address this issue indirectly once the students arrived at the party. However, participants reported using their experience in managing the chill-out space to act in the private setting of residence hall parties as well. This suggests the potential transferability of their skills and the possibility for peer educators to be identified as resources beyond formal parties.

Finally, during the interviews, students confirmed that the overconsumption of alcohol on campus is particularly related to the transition between the 2 years of preparatory classes, which are marked by overinvestment in school, and matriculation from higher education, which is characterised by new possibilities beyond parental control. This context, combined with the need to integrate with a peer group, was described by participants as conducive to the experimental use of new substances or the intensification of existing substance use.

In conclusion, this study's results support the relevance of the implementation of chill-out spaces during parties on campuses. Although exploratory and based on a limited number of students, this study offers interesting initial data on the deployment of this prevention approach, allowing us to better understand its value for risk reduction, as well as the perceived benefits and challenges related thereto in terms of educational support and training. These programmes are particularly well-suited to young adults since they support them in taking responsibility for their health and encourage them to reflect on their substance use (Larimer & Cronce, 2007; Sueur, 2005).

In terms of PEERCARE training, it seems important to (1) enhance peer educators’ sense of legitimacy (preparing them to deal with the role of managing a chill-out space while also being a student who consumes alcohol when not managing a chill-out space); (2) enhance peer educators’ skills in dealing with misbehaviour, especially aggressive behaviours (e.g., through role play); and (3) increase the visibility and function of off-campus chill-out spaces and, eventually, their specificities.

This study provides important data on the deployment and management of other peer-led chill-out space approaches (such as the supervision of peer educators throughout the year, the provision of specific material to aid in managing aggressive behaviour and reflection on the organisation of chill-out spaces). Extending the chill-out concept to other educational settings, such as business schools or medical universities, holds promise for limiting the risks associated with alcohol overuse in party environments and preventing the possible evolution of risky consumption into alcohol use disorders. Finally, as peer educators are the main actors in this approach, recognising their skills can be valuable, for example, by allowing them to earn academic credits (through the European Credits Transfer System) or a certification to show appreciation for their commitment and encourage other volunteers to join the programme (Ministère de l’Education Nationale, de l’Enseignement Supérieur et de la Recherche, 2015). Further research is needed to support and deepen these conclusions. Exploring the experiences of those people whom peer educators have assisted in chill-out spaces would also be particularly informative in clarifying how well this approach meets their needs and identifying new avenues for improvement.

The authors wish to thank all the students who participated in the study.