1. Bystander Intervention in Alcohol Related Emergencies: Barriers and
Facilitators of Intervention in a High Risk College Population
Kiarash P. Rahmanian , Sarah Deatherage , Angela Fulbright , Catherine Walter
Introduction
According to the National Institute of
Health’s 2013 report, 1,825 college students
across the U.S from the age of 18 to 24 years of
age die from alcohol-related unintentional
injuries annually (College Fact Sheet." National
Institute on Alcohol Abuse and Alcoholism,
2013). According to Zeigler’s 2005 research
article, some of the possible alcohol-related
morbidities are alcohol-use disorders, blackouts,
hangovers, neurodegeneration (learning and
memory), neurocognitive deficits, impaired
study habits, impaired functional brain activity,
and impaired transitional skills to adulthood
(Zeigler, Wang, Yoast, Dickinson, McCaffree,
Sterling, 2005). Most often, these morbidities
likely go untreated by medical services.
Changing the scope of our view, the
University of Florida’s alcohol-related incidents
began to get more serious in the 2004-2005
academic year. In this academic year, the death
toll hit five students on the University of
Florida’s campus due to alcohol poisoning. A
few years down the road, in March of 2011 a 19-
year old student was found dead from alcohol
poisoning. Looking at the separation of the
student body by alcohol usage, it can be seen
Abstract
In the years of 2004 to 2005, there were five deaths at the UF campus due to alcohol poisoning.
Then in March of 2011, a 19 year old was found dead from alcohol poisoning. Nationally, 1,825 college
students from the age of 18 to 24 years of age die from alcohol-related unintentional injuries annually as per
the NIH’s 2013 report. The University of Florida rolled out a policy in April of 2011 that would help
alleviate this issue from the UF campus. The Medical Amnesty policy is the “waiving of student
disciplinary action under certain conditions in an effort to help ensure all students call for medical help for
themselves or their friends during alcohol, drug or other health emergencies”. The reasoning for this policy
being implemented was that in the 2010 to 2011 academic school year there were 23 hospital transports due
to alcohol overdose on the UF campus. This number changed to 50 in the 2011 to 2012 year. From 2010/11
to 2011/12, there were 16 more Greek houses that were placed on deferred suspension or probation for
alcohol related incidents. The focus of our study was to look at the barriers & facilitators of bystander
intervention in alcohol-related emergencies in Greek versus non-Greek college undergraduates. For our
sample, we stratified our sampling frame into four strata, Greek males, Greek females, non-Greek females,
and non-Greek males. Our aim for our sampling population was 96 - 160 participants. Using focus groups
comprised of 8 - 10 participants per focus group (3 - 4 focus groups per strata), we had each participant
complete a demographic survey then as a group (led by three moderators) be led through a series of
alcohol-related scenarios. Then each focus group’s responses would be transcribed, coded, and themed and
using interrater reliability they would be analyzed with % agreement and Cohen’s Kappa by using the
SimStat program. Our study intends to provide data that will help assess barriers and facilitators to
bystander intervention in alcohol-related emergencies in Greek versus non-Greek populations stratified by
gender among college undergraduates at a public Florida University.

2. that Greek organizations are more likely to be
involved in alcohol-related incidents. There are
41 total Social Greek organizations from the
Interfraternity Council (25 social fraternities)
and PanHellenic Council (16 social sororitites)
on the University of Florida Campus. All of
these Greek organizations are led, directed, and
governed by their overall council. In the case of
the 25 social fraternities, their head organization
that encompasses all these fraternities is IFC and
for the 16 social sororities their head
organization that encompasses all these
sororities PC. These two head organizations
govern the sanctions that these organizations
receive to a certain extent. The most serious
misconduct or violations of the student
handbook of regulations for UF are directed to
the Dean of Students Office along with the
Office of Sorority & Fraternity Affairs. The acts
of misconduct are then heard by the Greek
Conduct Committee (GCC), which is made up
of the Executive Vice President of the respective
council that the organization on trial is in, and
four randomly chosen Presidents from that
council. The possible sanctions can range from
social probation, probation (meaning bad
standing within their council, preventing that
Chapter President from voting on council
matters), deferred suspension, and suspension
from campus. When a Greek organization is
given deferred suspension as one of their
sanctions that organization is one step away
from being kicked off campus. This means if
that organization does anything that violates any
rule or regulation from the student handbook of
regulations for UF, that organization will be
suspended from campus. Another aspect of
Greek life to keep in mind is that every Greek
organization (including the Multicultural Greek
Council- the MGC, and the National
PanHellenic Council- the NPHC) must present
one educational programming session with at
least 50% of their members present that could
fall in the category of alcohol awareness but
does not always do so.
For the 2010 to 2011 academic school
year there were 23 hospital transports due to
alcohol overdose on the UF campus. This same
year there were 2 Greek houses that were placed
on deferred suspension or probation for alcohol
related incidents. The number of hospital
transports changed to 50 in the 2011 to 2012
year. The second year, from 2010/11 to 2011/12,
there were 16 more Greek houses that were
placed on deferred suspension or probation for
alcohol related incidents, totaling out to 18
Greek houses on deferred suspension or
probation due to alcohol-related incidents.
Therefore, if can be determined that alcohol-
related emergencies are a serious health threat
on college campuses, especially for Greek
organization members. In the 2012-2013
academic year, the Greek community had 67
alcohol-related incidents. According to Scott-
Sheldon’s research 2008 research article, Greek
organization members are more risky with their
alcohol use than those not associated with Greek
organizations. According to a report collected in

3. 2014 by UF’s GatorWell Counseling and
Wellness Center on campus, Greek organization
members are a high-risk population for alcohol-
related emergencies. In a 2011 report done by
UF’s GatorWell Counseling and Wellness
Center, it was stated that bystander intervention
is improving but continues to be low.
Exactly one month later in April of
2011, the University of Florida rolled out a
policy that would help to alleviate this alcohol
issue from the UF campus. This policy was
intended to give students a way to be able to call
911 for help immediately if they are in a
situation where the use of alcohol, drug, or other
health emergencies are pertinent to the reason
that the student would not immediately call for
help. The Medical Amnesty policy states that it
would “waive student disciplinary actions under
certain conditions in an effort to help ensure all
students call for medical help for themselves or
their friends during alcohol, drug or other health
emergencies”.
The research questions that we intended to look
at were the following:
• Do barriers to bystander intervention in
Greek versus non-Greek college
undergraduates differ?
• Are there gender differences in
intervening?
• Do frequently mentioned barriers and
facilitators to helping coincide with the
Situational Model (Latane and Darley,
1970)?
• Does the medical amnesty policy have
any bearing on one’s decision to
intervene or not intervene?
Overall, our study intends to provide data that
will help assess barriers and facilitators to
bystander intervention in alcohol-related
emergencies in Greek versus non-Greek
populations stratified by gender among college
undergraduates at a public Florida University.
Literature Review
Looking at the bystander effect and
bystander intervention per a review of the
literature, I came across the same themes for a
plethora of research articles. For the 2013 Parks
research article, in the case of barroom conflicts,
“intervention was more likely when:
• The aggression was more severe
• The aggression was mutual (vs. one-
sided) aggression
• Only males (vs. mixed gender) were
involved
• Participants were more intoxicated.
Changing the scope of the literature review,
looking at the themes for sexual assault and or
violence, three research articles really stood out.
Burn’s 2009 research article titled “A
Situational Model of Sexual Assault Prevention
through Bystander Intervention”, stated that
there were a lot of differences in intervention
likelihood, barriers, and responsibility between
the male and female genders (Burn, 2009). For
instance, this research article showed that
“barriers were greater for men than women” and
that the likelihood of intervention was based on

4. the value of the victim, especially for men. From
the 2014 Bennett research article, we discover
that the “facilitator and barrier themes fit into
the Situational Model and Barrier Subscales”.
From the 2011 Banyard and Moynihan research
article, sexual violence intervention has been
and continues to be improved by lowering the
belief of rape myths, increasing knowledge
about sexual assault, and increasing the
perceived responsibility to intervene in
situations of interpersonal violence (Banyard,
Plante, and Moynihan, Feb. 2005). From there
we delved deeper into the gender differences in
intervention that could be seen per our literature
review. According to Eagley and Crowley’s
1986 research article titled “The Role of Gender
in Helping Behavior”, men are more likely to
come to the assistance of people in emergency
situations than women are. Burn’s 2009
research article titled “A Situational Model of
Sexual Assault Prevention through Bystander
Intervention”, stated that women reported a
greater intention to intervene in situations that
involve sexual violence than that of men.
According to Latané and Darley’s 1969 research
article titled “Bystander Apathy”, the process of
intervening is a series of decisions that need to
be made in the following order: notice event,
identify the situation as an emergency, decide to
take responsibility, decide how to help, and
lastly implement an action plan. This follows the
situational model and therefore sets the
precedent for bystander intervention (Darley, &
Latane, 1968). The situational model basically
states that even if one has the right intentions,
doesn’t mean that they will actually take action
to intervene. According to the UF Core Alcohol
and Drug Survey published in Fall of 2013, the
facilitators to intervention are being alone (the
presence of friends improves intervention, but
being alone is best), and an increased knowledge
about emergencies. The barriers for the full
completion of the intervention process are: an
audience barrier, punitive barrier, skills deficit
barrier, and shared responsibility barrier.
Another factor that stands unaccounted
for is one’s mood. Looking into
interpersonal/personality in bystander
intervention, a 2009 research article by Vrugt &
Vet titled “Effects of a Smile on Mood and
Helping Behavior”, if one is in a positive mood
then that is directly associated with their
willingness to help in a variety of situations
(Vrugt, Anneke,, Vet, and Carolijn, 2009).
Two of the biggest aspects of our
research project are whether there is already
knowledge there but the hindrance is that of
being worried for your organization or personal
criminal record or there is a lack of knowledge
of alcohol poisoning and the symptoms that go
with it. According to a study done at Cornell
after their Medical Amnesty Policy was put into
play, the survey taken by the students showed
that the number of students that reported that
they “didn’t want to get the person in trouble” as
a barrier to calling for help decreased from 3.8%
to 1.5% on the surveys alongside an increase in
the number of students that went to health center

5. staff after an alcohol-related emergency from
22% to 52% (Lewis, & Marchell, 2006).
Looking at the possibility of a lack of
knowledge in terms of barriers to proper
bystander intervention, from the research article
“Alcohol poisoning among college students
turning 21: do they recognize the symptoms and
how do they help?”, after a large number of
students completed a web-based self-report
assessment prior to their 21st
birthday that
focusing on drinking behaviors (Oster-Aaland,
Lewis, Neighbors, Vangsness, & Larimer,
2009). The results of this survey assessment
were that of:
• Students don’t help their peers because
they perceive that help is not needed.
• Heavier drinkers report a greater
likelihood to help a peer showing
symptoms of alcohol poisoning
• Recommends that medical amnesty
policies be coupled with educational
strategies aimed at recognition of
alcohol poisoning symptoms.
• Most cited reason, as not helping a peer
in this study was that they did not think
their peer was in need of medical
assistance.
Overall, our study set out to explain what the
barriers and facilitators to bystander intervention
in alcohol-related emergencies were in Greek
versus non-Greek populations stratified by
gender among college undergraduate students at
a public Florida University.
Methods
Sampling Frame
According to Collegedata.com, the UF
is made up of 14,709 Male UF Students
(44.9%), and 18,067 Female UF Students
(55.1%) ("University of Florida Overview",
2013). The ethnicity demographic for UF is
59.3%- White, 18.5%- Hispanic/ Latino, 8.1%-
African American, 7.9%- Asian, and 6.2%-
Other ("University of Florida Overview", 2013).
The percentages of UF students that are in Greek
organizations at UF are 19.3% for UF females in
Sororities and 18.7% for UF males in
Fraternities ("University of Florida Overview",
2013).
Recruitment Process
For attaining participants, our
recruitment strategies include putting up flyers
in dorms, bus stops, Greek house doors, and
designated free speech areas all around campus
such as Plaza of the Americas, the Reitz Union
lawn, and Turlington Plaza. Another tactic to
employ would be to announce during Greek
dinners or prior to Chapter meetings on
Mondays for most fraternites and sororities and
Sundays for some sororities. Also, the use of
listservs and email blasting through those
channels would be beneficial as well. We would
also look into publicizing in local media just as
the Independent Florida Alligator, WUFT-
Radio, WUFTV, and on social media sites such
as Facebook, Twitter, and Instagram. The
contents of the flyer would include: our research
purpose, the focus group time and location, the
duration of focus group, the acknowledgements

6. will be included on the flyer (GatorWell Health
Promotion Services & Student Conduct and
Conflict Resolution, and Health Gators), the
incentives (Free Pizza & a Gift Card, which
would be requested from Healthy Gators), and
the contact information for the PI in charge of
the research focus groups. Once the PI is
contacted, he or she would screen for year of
enrollment, gender, and Greek status.
Participants
For our sample, we would stratify our
participant pool into four strata, Greek males,
Greek females, non-Greek females, and non-
Greek males. We would use the 4-way
stratification to look at gender differences and
affiliation differences.
The aim for our sampling population
was 96 - 160 participants, which would mean 8-
10 people in each focus group with 3 to 4 focus
groups per strata.
In the end, not all of the people we need
will necessarily respond. From those that get
called back, not all of the subjects interview
either. According to Duke’s How to Conduct a
Focus Group, for focus groups, there is a “no-
show rate of 10 to 20 percent”.
Because GatorWell has done research
with the Greek community in the past, they have
experienced lack of participation from Greek
males or lack of recruitment of Greek males so
the solution to this would be to move our focus
location to Greek Houses for Greek participants
to make it easier for recruitment. Our non-Greek
participants will meet in the GatorWell
conference room as they would normally.
The focus group process would involve our
participants getting pizza and beverage upon
their arrival. Then, they would sign statements
of informed consent, fill out a demographic
survey, and name tags with alias identities.
Demographics
Using focus groups comprised of 8 - 10
participants per focus group (3 - 4 focus groups
per strata), we had each participant complete a
demographic survey. This demographic survey
would include the following in Figure 1.
Exclusion Criteria
These are the criteria that will be used to
exclude certain participants from being enrolled
in this study. For this study, we will exclude
those of not 18-24 years of age, non-drinkers,
non-UF students, anyone who was initially
enrolled at UF prior to the Summer semester of
2011 (in order to maintain a clear 4 year cycle
for our participants for exposure to the Medical
Amnesty Policy).
Scenarios
Then each focus group, led by three
moderators trained by GatorWell, will be led
through a series of alcohol-related scenarios.
The main moderator will run the group by
reading the statement of purpose and the
informed consent agreement, asking the
questions and prompts. The other two
moderators will monitor the room and record
their views on body language and check the
recording equipment periodically. There will

7. also be three recording devices in the room
placed at strategic locations to be able to record
non-verbal and verbal communication. For the
questions portion, one of the co-moderators will
prompt the members of the focus group for
barriers and facilitators to making helpful
behavior decisions. For example for the first
question, the co-moderator will ask: “assume
you are also drinking. How would that affect
your response?”. The rest of these questions are
displayed in Figure 2 and 3 below. Overall, the
duration of the focus group would be 45 minutes
with an optional educational program session
that would address common alcohol myths, the
signs and symptoms of alcohol poisoning, the
do’s and don'ts for appropriate responses, and
risk Reduction Strategies; all after the entire
focus group’s questions and scenarios. If the
participants chose to not participate in the
follow-up training, then educational materials
were given to them on their way out of the room.
Also, either after the educational training or
immediately after the focus group, the
participants will be awarded their gift cards.
Plans for Analysis
For the analysis of the focus groups data, we
would have graduate assistants and interns
transcribe the group dialog verbatim. Two
members of our research team would code for
all the data. Alongside that, we would have two
members (pre-trained by GatorWell’s coding
team) who are blind to the purpose of the study
would content code 25% of the data.
Our codes will be made up of words,
phrases, intonations, gestures/body language and
other non-verbal gestures. These codes will be
transcribed verbatim, because we want to know
our participants opinions and how they feel
about the topic (filler words like ‘um’ will truly
help capture this). Then these themes will be re-
evaluated a week after creation, and then again 2
weeks after initial evaluation; at that point our
themes can be combined, discarded, expanded,
or decreased, etc. These codes will be compared
between researchers and the GatorWell team to
assess interrater reliability with percent
agreement and Cohen’s Kappa by using SimStat.
The codes/labels would then be discussed by the
research team to combine labels to create
themes. Then they would identify major
components from the minor components by
establishing frequencies with each theme.
Finally, these themes will be tied together to
create a conceptual schema which can be
presented in a final written report.

8. Figure 1: Demographic Survey to be given to all participants Figure 2: Alcohol-Related Scenarios/Questions for Participants
Figure 3: Questions for Participants
Results
Measurement techniques (Validity/Reliability)
Because focus groups tend to be low reliability and
high validity, we had to employ methods to counteract
for this. For having high reliability, we had highly
trained moderators that have gone through special
GatorWell training prior to staffing the focus groups
for our study. We also had very specific questions that
were reviewed by GatorWell to make sure they are
clear and concise to avoid confusion and increase
reliability. We also used interrater reliability through
the use of percent agreement. Percent agreement is the
most widely used mostly because it is simple to
calculate. But this is stated as a “misleading measure
that overestimates true interrater agreement. Thus, we
will also employ Cohen’s Kappa as a secondary
measurement. Cohen’s Kappa is often called the
measure of choice for research that codes behavior.
We will employ percent agreement and Cohen’s
Kappa through the use of Simstat, a statistical software
package that includes the reliability calculations. For
our measurements of validity, we will be using face
validity, which is just does the research study look
valid at face value. Also, we will have our study
reviewed by GatorWell.
Methods for administration of the study

9. For the administration of this study, we would run
everything through GatorWell and employ a good
majority of our study staff from them as well.
Control for bias
There are a plethora of biases that are possible for this
study. We will make sure that we combat each of them
as best as we can. For selection bias, we will address
this through the random selection of our study
participants. For moderator personality/style bias, we
will address this by using as few moderators as
possible, also sharing a common training background.
For observer bias, we will address this by using
interrater reliability as verification. For consistency
bias, we will address this by asking for clarification
and expansion of each participant’s answers. For
stranger bias, we can account for this through our
moderators’ emploring those that are shy to speak up
about their opinions. For dominance bias, we can
account for this through our moderators calling less on
those participants that are very verbal or dominant in
their focus group. For shyness bias, we can account for
this by having our moderators single those shy
indivdiduals out during the focus groups.
Control for confounding
Our study’s possible confounders are those Greek
houses that don’t have houses, the race or ethnicity of
our participants, and the cultural influence that deals
with drinking age and social norms. We will not be
able to control for the lack of a house for the Greek
organizations, as those members are kept anonymous
in the focus groups. For the race and ethnicity of the
members of the focus group and how that affects our
results, we can use the demographic surveys to
counteract this. For the social norms or cultural
differences, we can also use our demographic survey
and get one’s cultural background in that survey as
well.
Discussion
Expected outcomes
The expected outcomes that we have for our study is
that the frequent themes for barriers to bystander
intervention among Greek members will coincide with
the barriers in the situational model as seen in Sexual
violence research. We also believe that the Greek
members will continue to express fear of reprisal if
they come forward and employ the use of the Medical
Amnesty Policy. And lastly, those Greek members will
not demonstrate gender differences in barrier and
facilitator themes amongst their own group.
Alternate Outcomes
Some of the possible alternative outcomes for our
study could be that the frequent themes for barriers to
bystander intervention among Greek members will
coincide with alternate hypotheses of interpersonal
barriers and the level of emergency. We could also
find that Greek members demonstrate gender
differences in barrier and facilitator themes for
bystander intervention. And lastly, we could find that
the bystander intervention will be related to the
severity of the event.
Limitations
There are a few possible limitations to our study. For
instance in the area of biases that could prevent aspects
of our study from getting full reach or reactions. These
are volunter bias, acquaintance bias, and membership
bias. For volunteer (self-selection) bias, we will have
to count this as one of the limitations of our study, but
our moderators might be able to better account for this

10. by not getting that focus group member as involved in
the conversation. For acquaintance bias, we will have
to mark this as a limitation since we cannot very well
account for this. For membership bias, we will have to
mark this as a limitation to our study, since it will be
an inherent possibility with those of the Greek
Community.
Statement of impact
In conclusion, from the time of the implementation of
the Medical Amnesty Policy in April of 2011,
GatorWell and Student Conduct & Conflict Resolution
have been aggressively targeting various student
organizations to promote alcohol safety strategies
through various strategies such as mandated
educational programming, and implementing
repercussions for wrongful behavior or breaking the
student code of conduct. It has been determined that
help-seeking bystander behaviors is proven to be one
of the most effective interventions in the field of
sexual assault prevention. Our research team believes
that the efficacy of this approach is very applicable to
alcohol safety strategies.
Despite the effectiveness of bystander
intervention, a natural phenomenon occurs that is often
referred to as the bystander effect. This effect inhibits
the implementation of helpful bystander behaviors.
Because the Greek community receives more
exposure to alcohol safety training, our research team
believes that there will be differences in the
motivational factors influencing helping behaviors.
Discovering how the motivational factors; based
on behavioral theory, differ between highly structured
and low structured campus communities will provide
insight to campus departments for tailoring materials
to address the specific barriers inhibiting bystander
intervention and to foster any structural philosophies
which facilitate these behaviors.
Future Research
For future research, we would like to look at treatment
pre-tests and post-tests. Asking questions such as: “do
tailored interventions influence rates of helping
bystander behaviors by UF students?”. Looking next at
studies needed to determine age-differences, asking
questions such as: “do underage drinkers intervene
more/less than legal aged drinkers?”. Then looking at
drinking rates, asking questions such as: “do heavy
drinkers intervene more/less than light drinkers?” And
lastly, looking at how the relationship to the victim
affects helping behaviors. Asking questions such as:
“does proximity of relationship (friend vs
acquaintance vs stranger) influence rates of helping
behaviors?”.

11. References
1. Banyard, Victoria L., Elizabethe G. Plante, and Mary
M. Moynihan. "Rape Prevention Through Bystander
Education: Bringing a Broader Community Perspective
to Sexual Violence Prevention." NCJRS (February
2005): n. pag. Web.
2. Burn, S. M. (2009). A Situational Model of Sexual
Assault Prevention through Bystander Intervention.
[Article]. Sex Roles, 60(11-12), 779-792.
3. Darley, J. M., & Latane, B. (1968). BYSTANDER
INTERVENTION IN EMERGENCIES - DIFFUSION
OF RESPONSIBILITY. Journal of Personality and
Social Psychology, 8(4P1), 377-&.
4. Latane, B., & Darley, J. M. (1968). GROUP
INHIBITION OF BYSTANDER INTERVENTION IN
EMERGENCIES. Journal of Personality and Social
Psychology, 10(3), 215-&.
5. Latane, B., & Darley, J. M. (1969). BYSTANDER
APATHY. American Scientist, 57(2), 244-&.
6. Lewis, D. K., & Marchell, T. C. (2006). Safety first: A
medical amnesty approach to alcohol poisoning at a US
university. International Journal of Drug Policy, 17(4),
329-338.
7. Oster-Aaland, L., Lewis, M. A., Neighbors, C.,
Vangsness, J., & Larimer, M. E. (2009). Alcohol
Poisoning Among College Students Turning 21: Do
They Recognize the Symptoms and How Do They
Help? Journal of Studies on Alcohol and Drugs, 122-
130.
8. "University of Florida Overview." Collegedata.com.
NACAC, 2013. Web. 24 Apr. 2014.
9. Vrugt, Anneke,, Vet, and Carolijn. "Effects of a Smile
on Mood and Helping Behavior." Social Behavior and
Personality: An International Journal37.9 (October
2009): n. pag. Web. 24 Apr. 2014.
10. Zeigler, Donald W., PhD, Claire C. Wang, MD,
Richard A. Yoast, PhD, Barry D. Dickinson, PhD,
Mary Anne McCaffree, MD, Carolyn B. Robinowitz,
MD, and Melvyn L. Sterling, MD. "The Neurocognitive
Effects of Alcohol on Adolescents and College
Students." Journal of Preventative Medicine 40.1
(2005): 23-32. Web. 24 Apr. 2014.
11. "College Fact Sheet." National Institute on Alcohol
Abuse and Alcoholism(2013): n. pag. NIH. Web. 24
Apr. 2014.