Prevention Research Center Pacific Institute for Research and Evaluation College Student Drinking Prevention Interventions Bob Saltz Prevention Research Center Berkeley, California

Why Care About College Student Drinking? Over 1,700 deaths among year old college students Over 1,700 deaths among year old college students 590,000 unintentionally injured under the influence of alcohol 590,000 unintentionally injured under the influence of alcohol More than 690,000 assaulted by another student who has been drinking More than 690,000 assaulted by another student who has been drinking More than 97,000 are victims of alcohol-related sexual assault or date rape More than 97,000 are victims of alcohol-related sexual assault or date rape About 25 percent of college students report academic consequences of their drinking including missing class, falling behind, doing poorly on exams or papers, and receiving lower grades overall About 25 percent of college students report academic consequences of their drinking including missing class, falling behind, doing poorly on exams or papers, and receiving lower grades overall

Very Heavy Drinking is Surprisingly Common among College Students Statistical models indicate that 25 or more drinks may be consumed on 5% of drinking occasions among males (1 out of 20 occasions among all drinkers)

"the scope of the problem makes immediate results of any interventions highly unlikely" Wechsler, et al., 1994

Prevention Research Center Pacific Institute for Research and Evaluation M ean Score for 5+ Drinks in a Row in Past 2 Weeks by 4-year College Student Status Wave 1Wave 2Wave 3Wave 4 Measurement Wave (18)(19-20)(21-22)(23-24) Twice Once None College Non-College

Task Force Recommendations Tier 1: Evidence of Effectiveness Among College Students Tier 1: Evidence of Effectiveness Among College Students Tier 2: Evidence of Success With General Populations That Could Be Applied to College Environments Tier 2: Evidence of Success With General Populations That Could Be Applied to College Environments Tier 3: Evidence of Logical and Theoretical Promise, But Require More Comprehensive Evaluation Tier 3: Evidence of Logical and Theoretical Promise, But Require More Comprehensive Evaluation Tier 4: Evidence of Ineffectiveness Tier 4: Evidence of Ineffectiveness

Recommendations – Tier 1 Combining cognitive-behavioral skills with norms clarification and motivational enhancement interventions Combining cognitive-behavioral skills with norms clarification and motivational enhancement interventions Offering brief motivational enhancement interventions Offering brief motivational enhancement interventions Challenging alcohol expectancies Challenging alcohol expectancies

Recommendations – Tier 2 Increased enforcement of minimum drinking age laws Increased enforcement of minimum drinking age laws Implementation, increased publicity, and enforcement of other laws to reduce alcohol- impaired driving Implementation, increased publicity, and enforcement of other laws to reduce alcohol- impaired driving Restrictions on alcohol retail outlet density Restrictions on alcohol retail outlet density Increased price and excise taxes on alcoholic beverages Increased price and excise taxes on alcoholic beverages Responsible beverage service policies in social and commercial settings Responsible beverage service policies in social and commercial settings

…finally The formation of a campus and community coalition may be critical to implement these strategies effectively The formation of a campus and community coalition may be critical to implement these strategies effectively

Sounds like a lot of work… …why bother?

So Why Not Just Go With Tier 1 Strategies? Problems not limited to high-risk drinkers Problems not limited to high-risk drinkers

So Why Not Just Go With Tier 1 Strategies? Problems not limited to high-risk drinkers Problems not limited to high-risk drinkers Some difficult to implement with fidelity Some difficult to implement with fidelity Can be labor intensive & costly for large populations Can be labor intensive & costly for large populations Some individual-level strategies might be compromised in "hostile" environments Some individual-level strategies might be compromised in "hostile" environments Opportunity to create synergy across levels of intervention Opportunity to create synergy across levels of intervention ….work continues on all these limitations ….work continues on all these limitations

Specialized Treatment Primary Prevention Brief Intervention None Mild Moderate Severe Thresholds for Action Spectrum of Intervention Response

Public Health Model Individual AlcoholEnvironment Alcohol-Related Problems

Public Health Model Individual Vehicle Traffic Laws, Roads / Intersections Traffic Safety

…but there are challenges

Typical Hurdles for Comprehensive Prevention Strategy Implicit assumption that the only target is high-risk drinkers Implicit assumption that the only target is high-risk drinkers Ambivalence about student drinking Ambivalence about student drinking Low perceived efficacy of preventive interventions Low perceived efficacy of preventive interventions Challenges of coordination and resource allocation Challenges of coordination and resource allocation Possible fears of backlash Possible fears of backlash

Unique Hurdles for College Prevention Emphasis often on process over outcome Emphasis often on process over outcome Preference for persuasion over control Preference for persuasion over control Universities are complex, diffuse organizations Universities are complex, diffuse organizations Prevention staff trained in education, awareness strategies Prevention staff trained in education, awareness strategies Prevention staff usually lacks authority to launch initiatives Prevention staff usually lacks authority to launch initiatives

Environmental Policies to Reduce College Drinking: An Update of Research Findings Toomey, Lenk, & Wagenaar (2007) Journal of Studies on Alcohol and Drugs

Evidence for Community-Level Prevention Interventions

A Matter of Degree (AMOD) Weitzman et al. American Journal of Preventive Medicine College/ Community Partnerships College/ Community Partnerships Environmental strategies to reduce drinking problems: Environmental strategies to reduce drinking problems: Keg registration Keg registration Mandatory responsible beverage service Mandatory responsible beverage service Police wild party enforcement Police wild party enforcement Substance free residence halls Substance free residence halls Advertising bans Advertising bans

A Matter of Degree (AMOD) Weitzman et al. American Journal of Preventive Medicine AMOD achieved reductions among college students in AMOD achieved reductions among college students in Binge drinking Binge drinking Driving after drinking Driving after drinking Alcohol related injuries Alcohol related injuries Being assaulted by other drinking college students Being assaulted by other drinking college students

Social Norms Marketing Research Project National Institute on Alcohol Abuse and Alcoholism and U.S. Department of Education R01 AA 12471

Decrease in perceived normative expectations to drink Decrease in perceived normative expectations to drink Decrease in alcohol consumption Social Norms Marketing Use campus-based media to report accurate drinking norms

Sample Campaign Materials

Low-Density CampusHigh-Density Campus

Campus Community Strategy to Change the Drinking Culture Western Washington University Bellingham, Washington

Project Components Neighborhoods Engaging with Students (NEST) Neighborhoods Engaging with Students (NEST) Enforcement Enforcement Campus Community Coalition work groups were involved in planning, implementation, and process evaluation. Campus Community Coalition work groups were involved in planning, implementation, and process evaluation.

Comparison 2 nd Intervention

Comparison

Study to Prevent Alcohol Related Consequences: Using a Community Organizing Approach to Implement Environmental Strategies in and around the College Campus Mark Wolfson, et al Wake Forrest University SPARC

SPARC Design 10 universities randomly assigned 5 Comparison 5 Intervention

Larger Environment SPARC Intervention Interventions Environmental Strategies Reduce Availability Address Price/Marketing Improve Social Norms Minimize Harm Elements: Policy, Enforcement, Awareness High-risk Drinking Indicators - Quantity- Social Setting - Frequency- Timing - Physical setting - Underage use Consequences - Health - Legal - Social- Academic - Violence- Victimization Culture / Context Campus cultures Student Administration Alumni Faculty Campus Policies Community cultures Government Neighborhoods Law enforcement Retail/business Community Policies Larger political, socio-economic and historical context Community Organizing Hold one-on-one meetings Understand self-interest Analyze power Build coalition Identify actionable issues Develop strategies Plan & implement actions Intermediate Outcomes Long-term Outcomes SPARC Conceptual Model

Environmental Strategies 1. Reduce Alcohol Availability 2. Address Price/Marketing 3. Improve Social Norms 4. Minimize Harm Expectations of each Intervention School: Include 3 of the 4 areas in strategic plan Most strategies should be comprehensive – i.e., include Policy, Awareness, and Enforcement elements

Environmental Strategies in Plans # of sites

CDS Severe Consequences, due to own drinking (p=.02) Severe Consequences, due to own drinking (p=.02) Alcohol-related Injuries, caused to others (p=.03) Alcohol-related Injuries, caused to others (p=.03) RA Survey Consequences: p=.04 Consequences: p=.04 Environment: p=.01 Environment: p=.01 Aggregate: p=.03 Aggregate: p=.03 I & I Reports Police reports of alcohol-related incidents (p=0.04) Police reports of alcohol-related incidents (p=0.04) Police reports of # of citations for underage alcohol use (p=.008) Police reports of # of citations for underage alcohol use (p=.008) Evidence of Impact: Summary

Safer California Universities Project Goal: To evaluate the efficacy of a Risk Management approach to alcohol problem prevention NIAAA grant #R01 AA12516 with support from CSAP/SAMHSA.

What are we trying to prevent? Intoxication Intoxication Harm related to intoxication Harm related to intoxication

Random Assignment Intervention Sites CSU Chico CSU Chico Sacramento State Sacramento State CSU Long Beach CSU Long Beach UC Berkeley UC Berkeley UC Davis UC Davis UC Riverside UC Riverside UC Santa Cruz UC Santa Cruz Comparison Sites Cal Poly SLO Cal Poly SLO San Jose State San Jose State CSU Fullerton CSU Fullerton UC Irvine UC Irvine UC Los Angeles UC Los Angeles UC San Diego UC San Diego UC Santa Barbara UC Santa Barbara

CSU Chico UC DavisSacramento State UC Santa Cruz San Jose State Cal Poly UC Santa Barbara UCLA UC Irvine CSU Fullerton CSU Long Beach UC Riverside UCSD UC Berkeley

How is risk management a unique approach? Targets times and places instead of individuals Targets times and places instead of individuals Focus on intoxication Focus on intoxication Tied to continuous monitoring and improvement - emphasis on control rather than one shot interventions Tied to continuous monitoring and improvement - emphasis on control rather than one shot interventions

Integrated Intervention Strategies for Off-Campus Parties Compliance Checks Compliance Checks DUI Check Points DUI Check Points Party Patrols Party Patrols Pass Social Host Response Cost Ordinance Pass Social Host Response Cost Ordinance A Social Host Safe Party Campaign A Social Host Safe Party Campaign

Strategies for Implementation Focused on one (at most two) settings Focused on one (at most two) settings Focused on beginning of academic year Focused on beginning of academic year Highly-specified planning and implementation process Highly-specified planning and implementation process Minimal attention to motivation Minimal attention to motivation Maximum attention to tasks and implementation per se Maximum attention to tasks and implementation per se Planned mid-course correction Planned mid-course correction

Outcomes Likelihood of getting drunk at a given generic setting (e.g., Greek parties; residence halls) plus additional aggregate measure across all settings Likelihood of getting drunk at a given generic setting (e.g., Greek parties; residence halls) plus additional aggregate measure across all settings Two baseline years combined vs. two years post-intervention combined Two baseline years combined vs. two years post-intervention combined Controlling for individual-level variables and campus/community variables Controlling for individual-level variables and campus/community variables

Practical Significance At each campus, 900 fewer students drinking to intoxication at off-campus parties and 600 fewer getting drunk at bars/restaurants during the fall semester at intervention schools relative to controls. At each campus, 900 fewer students drinking to intoxication at off-campus parties and 600 fewer getting drunk at bars/restaurants during the fall semester at intervention schools relative to controls. Equivalent to 6,000 fewer incidents of intoxication at off-campus parties and 4,000 fewer incidents at bars & restaurants during the fall semester at Safer intervention schools relative to controls Equivalent to 6,000 fewer incidents of intoxication at off-campus parties and 4,000 fewer incidents at bars & restaurants during the fall semester at Safer intervention schools relative to controls

In addition… No Displacement

Dosage Effects

In Sum… We have the ability to create environments that help young adults make healthy decisions about alcohol consumption We have the ability to create environments that help young adults make healthy decisions about alcohol consumption We have growing evidence that these strategies are effective We have growing evidence that these strategies are effective Our greatest impact will likely come from adopting mutually-reinforcing policies, programs and practices Our greatest impact will likely come from adopting mutually-reinforcing policies, programs and practices

Future Research: Where are we heading? Evaluating Full-Spectrum Comprehensive Interventions Evaluating Full-Spectrum Comprehensive Interventions Replications Replications Diffusion Research Diffusion Research Basic Research on Organizational and Community Change Basic Research on Organizational and Community Change

Thank you!