1. It’s Normal To Be Healthy Two Nationwide Studies of Perceived Norms, Student Alcohol Misuse, Protective Behaviors, and Exposure to Prevention Information Michael Haines Director National College Health Assessment Workshop, Las Vegas, December 1, 2006

2. What are Social Norms? Cultural Traditions Community Standards Societal Customs Collective Mores Group Expectations Shared Beliefs Typical Behaviors Common Practices Public Conduct © Michael Haines 2004

3. Social Norms Premises Every functioning social system (group, community, culture, etc.) has protective social norms. (a majority who hold pro-social attitudes and/or health positive behaviors). Protective norms are misperceived. (Problems are over estimated and solutions are under estimated) © Michael Haines 2004

4. Why Are Social Norms Misperceived? Attribution Error Pop Culture Public Conversation Commercial News Scare Tactics © Michael Haines 2004 Media Advocacy

5. Social Norms Hypothesis Changing Perception of Social Norms (decreasing perception of problems and increasing perception of solutions) Changes Human Behavior. (reduces risk and promotes health) © Michael Haines 2004

6. Misperception of Social Norms Creates Imaginary Peer Pressure Imaginary pressure to adopt the over-perceived problem behavior Imaginary pressure to hide the under-perceived solution behavior © Michael Haines 2006

7. Social Norms Formula Identify + Model + Promote Protective practices and healthy beliefs Pro-social attitudes and health-positive behaviors = Health Enhancement and Risk Reduction © Michael Haines 2004

8. "Misperceiving the College Drinking Norm and Related Problems: A Nationwide Study of Exposure to Prevention Information, Perceived Norms and Student Alcohol Misuse“ Journal of Studies on Alcohol volume 66: Pp 470-478, 2005 PERKINS, H.W., HAINES, M.P. AND RICE, R.

9. Table 1 Students’ Accuracy in Perceiving the Drinking Norm at Their School (Comparing Actual with Perceived Number of Alcoholic Drinks Consumed the Last Time Students “Partied”/Socialized) Actual School Norm (Median Drinks) Accuracy of Perceived Drinking Norm N of Respondents N of Schools Underestimate of 3 or More Drinks (%) Underestimate of 1 to 2 Drinks (%) Accurate Estimate (%) Overestimate of 1 to 2 Drinks (%) Overestimate of 3 or More Drinks (%) 0NA 20.619.559.9=100%18914 1NA10.53.828.557.2=100%25266 2NA7.58.130.653.7=100%834514 33.86.413.537.538.7=100%1885935 43.112.312.637.034.9=100%2035338 54.315.820.624.135.3=100%1148120 66.923.215.023.531.5=100%891212 75.723.39.723.637.8=100%3521 Total Schools3.411.813.831.939.1=100%72719130

10. Table 1a (NCHA Q13 & Q15) Student’s Perception of Drinking Norms (n=72,719, 130 schools) Under Estimation Accurate Estimation Over Estimation 15.2% 13.8% 71.0%

11. Independent Variables Unstandardized Coefficient Standardized Coefficient Perception of how many alcoholic drinks are consumed by the typical student at one’s school the last time they “partied’/socialized.48.33 Actual norm (median) for number of alcoholic drinks consumed last time students at one’s school “partied”/socialized.37.12 Gender (male vs. female)2.18.24 Age-.05-.06 Year in school.08.03 Race (Black vs. White)-1.63-.09 Race (Hispanic or Latino vs. White)-.45-.03 Race (Asian or Pacific Islander vs. White)-1.27-.08 Race (American Indian or Alaskan Native vs. White)-.19-.00 ns Race (Other vs. White)-.57-.02 Fraternity/sorority member (yes vs. no)1.55.11 Student Status (full-time vs. part-time)-.11-.01 ns Hours per week working for pay.00.01 ns Hours per week volunteering-.05 School region (Northeast vs. South).22.02 School region (Midwest vs. South).20.02 School region (West vs. South).11.01 ns Table 2 Unstandardized and Standardized Regression Coefficients Predicting Number of Alcoholic Drinks Consumed Last Time “Partied”/Socialized ns Coefficient is not significant, p >.001.

12. Table 2a (NCHA Q45-58) Standardized Regression Coefficients Predicting Number of Drinks per Party Perception of student drinking norm.33 Gender.24 Actual drinking norm.12 Frat/Sorority member (yes v. no).11 Age -.06 Full-time v Part-time -.01

13. Relative Extent of Misperception with Information Exposure N of Schools % of Students Receiving School Prevention Information Less Misperception among Exposed Students a 1050.6 No Difference between Exposed and Other Students b 8551.5 Greater Misperception Among Exposed Students c 3453.2 Table 3 Distribution of Colleges/Universities Surveyed by Association of Student Exposure to School’s Alcohol and Other Drug Use Prevention Information with Extent of Misperception of the Drinking Norm

14. Table 3a (NCHA Q2b) Distribution of Colleges by Student Exposure to AOD Prevention Information by Perception Misperception by Exposure: Comparing students exposed to alcohol information to those exposed to no information. N of schools % getting info Less misperception among those exposed 10 50.6 No difference between exposed and unexposed 85 51.3 More misperception among those exposed 34 53.2

15. Dependent variables Odds ratio a comparing students at schools with programs that do not affect misperceptions with students at schools with programs that reduce misperceptions Odds ratio a comparing students at schools with programs that inflate misperceptions with students at schools with programs that reduce misperceptions Consumed five or more drinks at a sitting during the last two weeks1.25**1.55** Consumed 7+ alcoholic drinks the last time “partied”/socialized1.18*1.46** Estimated peak BAC level of.08 or higher last time “partied”/socialized1.14*1.38** Alcohol use negatively affected academic performance during the last year1.44**1.55** Experienced other negative consequence as a result of drinking within the last school year b 1.15*1.32** Table 4 Impact of Attending Schools where Program Information Exposure Makes No Difference in Misperceptions or is Associated with Greater Misperceptions of the Drinking Norm in Comparison to Attending Schools Where Exposure to Program Information is Associated with Less Misperception a Odds ratios are reported based on logistic regression controlling for gender, class year in school, race, fraternity/sorority membership, and region of school. b Includes physical injury to self or others, fighting, forgot where one was or what they did, had someone use force or threat of force to have sex or had unprotected sex. * Statistically significant p <.01; **p <.001.

16. Table 4a (NCHA Q18 & Q44a) Impact of attending schools where AOD prevention program had either no affect on or inflated misperceptions Five or more drinks last 2 wks1.251.55 Seven or more last time partied1.181.46 BAC =.08+ last time partied1.141.38 Use negatively affected academics1.441.55 Experienced other negative consequences1.151.32 Odds ratio

17. Summary Students misperceive (71% over-estimate) alcohol consumption norms. Student perceptions of alcohol consumption norms are the strongest known predictor of actual student alcohol consumption behavior. Schools must correct misperceived drinking norms to reduce alcohol-related harm. One of four schools’ alcohol information programs (26%) are associated with increased misperceptions and harm.

18. Prescription 1.Determine if current alcohol information, education, or policies are likely to increase or decrease over-estimations of alcohol consumption norms. 2.Design and implement alcohol information, education, or policies that clearly reduce over-estimations of alcohol consumption norms.

19. The Personal Protective Behaviors of College Student Drinkers: Evidence of Indigenous Protective Norms Michael Haines, M.S., Gregory Barker, Ph.D. Richard Rice, M.A. National Social Norms Resource Center Journal of American College Health July - August, 2006

20. The Clear Majority (70-80%) of College Students Drink Alcohol Monitoring the Future (2002), Core (2000), College Alcohol Study (2002), NCHA (2002)

21. Serious Alcohol Related Harm is Uncommon Perkins, 2002 “Surveying the Damage: A Review of Research on Consequences of Alcohol Misuse in College Populations,” Journal of Studies on Alcohol/Supplement No. 14, 91-100.

22. Serious Alcohol Related Harm is Uncommon 12.8% Hurt or Injured 10.7% Damaged Property 0.08% Required Medical Attention (“as a result of drinking since the beginning of the school year”, College Alcohol Survey, 2001)

23. Serious Alcohol Related Harm is Uncommon 16.6% Physically Injured 7.8% Involved in a fight 2.2% Force or Threat of Force to have Sex (“…within the last school year have experienced…as a consequence of your drinking.”, NCHA, 2002)

24. Prior Evidence of Resilience Biological Factors Psychological Factors (Werner and Smith, 1972) Socially Transmitted/Learned (Weil, 1972; Chafetz, 1976; Dimeff et al., 1999)

25. Logic Model Most students drink alcohol Overwhelming majority avoid serious harm How?

27. Logic Model Most students drink alcohol Most drink moderately Overwhelming majority avoid serious harm Most practice personal protection Using a diverse array of protective behaviors How?

29. Key Findings 1.Most NCHA PPBs Correlate with Reduced Harm 2.Some NCHA PPBs Do Not Correlate with Reduced Harm 3.Using PPBs is Normative (Indigenous Protective Norms) a)73% of Students Employ at Least One PPB b)64% of the Students Who Employ PPBs Use Two or More 4.PPBs correlate with reduced harm across demographics 5.The correlation with harm is consistent and negative (More PPBs used = ever less risk of harm) 6.PPBs reduce harm even as BAC rises 7.Situational Abstinence is a college drinking norm

30. Spring 2002 ACHA ( Drinkers Only) 1 2 3 3 5 6

31. Personal Protective Behaviors (after factor analysis of NCHA data) 1.Avoid drinking games 2.Pace your drinks to 1 or fewer per hour 3.Keep track of how many drinks you are having 3. Choose not to drink alcohol 5. Determine in advance not to exceed a set number of drinks 6.Drink an alcohol look-alike

32. Respondents Who Report Using Protective Behaviors (Percent reporting “Usually” or “Always”)

37. 3 Year NCHA Trend Data for PPB and Harm

38. Situational Abstinence or Everyone Doesn’t Drink Sometimes 68% of College Drinkers “Choose not to drink” (usually or sometimes if “partied/socialized during the last school year) Old definition of abstinence = Anti Alcohol DRINKERSABSTAINERS Always drink + Sometimes drink Never drink New definition of abstinence = Anti Harm DRINKERSABSTAINERS Always drink Sometimes drink + Never Drink

39. Cautions Cross-Sectional Data – Not necessarily generalizable –Robustness of the Findings: 5 National Data Sets Show Same Results Different Time Frames - (Last Time Partied vs. Last School Year) –Other research suggest no significant difference

40. Implications for Health Promotion, Risk Reduction, and Social Norms Projects Indigenous protective norms can reshape health education and health promotion efforts by using successful protective strategies of the population served to inform educational content and public policies. Not all perceived (reported) PPBs are protective so researchers must use qualitative AND quantitative measures together to verify protection. Situational Abstinence is a proven PPB and offers a normative alternative to the abstinence only approach. Further Study: –Non Consumption-Based PPBs –Environmental Protection

45. National Social Norms Resource Center Social Science Research Institute Northern Illinois University Dekalb, IL 60115 815-753-9745 mhaines@niu.edu rrice@niu.edu gbarker1@niu.edu www.socialnorm.org