1. Center for Substance Abuse Prevention (CSAP) Center for the Application of Prevention Technologies West Regional Expert Team Mail Stop 279 University of Nevada, Reno Reno, Nevada 89557-0258 (888) 734-7476 Preventing Alcohol and Drug Abuse among Young Adults Who Have Not Attended College Presenters: Michael R. Duke, Ph.D. © 2010 Wendy Baumbach

2. Center for Substance Abuse Prevention (CSAP) Center for the Application of Prevention Technologies Agenda 1.Introduction to the Population 2.Unique Risk Profiles this Population 3.Challenges in Accessing the Target Population 4.Potential Strategies for Prevention/Intervention

3. Center for Substance Abuse Prevention (CSAP) Center for the Application of Prevention Technologies Learning Objectives Participants will learn the following about 18-25 year olds who have not attended a four-year college or university: Examples of the particular substance use/abuse issues Data regarding prevalence and consequences Potential prevention and outreach strategies

4. Center for Substance Abuse Prevention (CSAP) Center for the Application of Prevention Technologies Introduction to the18-25 Year Old Population Who Have Not Attended a Four-Year College or University

5. Center for Substance Abuse Prevention (CSAP) Center for the Application of Prevention Technologies Defining the Population The target population falls into one of the following categories: Did not graduate from high school Graduated from high school Obtained a GED Attended trade school Received terminal Associates Degree This is a very diverse population in terms of educational attainment!

6. Since 1994, More Young Adults Have Attended College Than Have Not Attended Kiesa, A. & Barrios Marcelo, K. (2009). Youth Demographics - Youth with No College Experience (Fact Sheet). Center for Research and Information on Civic Learning and Engagement http://www.civicyouth.org/PopUps/FactSheets/FS08_YthDemo_CollExp.pdf

7. Center for Substance Abuse Prevention (CSAP) Center for the Application of Prevention Technologies Some Demographic Characteristics Relative to those who attend, or who have graduated from, four year colleges/ universities, this population is more likely to be: In a lower Socio-economic Status (SES) A racial/ethnic minorities (apart from Asian Americans) Male (55% of males 18-29 have no college experience) Living in rural areas (16% vs.12% of 18-29 year olds)

8. Kiesa, A. & Barrios Marcelo, K. (2009). Youth Demographics - Youth with No College Experience (Fact Sheet). Center for Research and Information on Civic Learning and Engagement. http://www.civicyouth.org/PopUps/FactSheets/FS08_YthDemo_CollExp.pdf Young Adults With No College Experience Are More Likely to be Male

9. Kiesa, A. & Barrios Marcelo, K. (2009). Youth Demographics - Youth with No College Experience (Fact Sheet) Center for Research and Information on Civic Learning and Engagement. http://www.civicyouth.org/PopUps/FactSheets/FS08_YthDemo_CollExp.pdf African American and Latino Young Adults Disproportionally Lack College Experience

10. Center for Substance Abuse Prevention (CSAP) Center for the Application of Prevention Technologies Why Focus on This Population? Relatively little is known about their substance abuse attitudes and perceptions relative to college students The range of substance use/abuse attitudes, perceptions, and behaviors are likely to be more diverse than those of college students On-the-job substance abuse in blue collar occupations may cause significant harm to self and others

11. Center for Substance Abuse Prevention (CSAP) Center for the Application of Prevention Technologies Risk Profiles of Young Adults who Have Not Attended College

12. Center for Substance Abuse Prevention (CSAP) Center for the Application of Prevention Technologies First, the Good News… Non-college attending young adults have significantly lower rates of binge drinking than college students* Non-college attending young adults may “age out” of problem drinking/ drug use earlier than college graduates (due to work demands, parenthood, etc). Johnston, L. D., O'Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2007). Monitoring the Future national survey results on drug use, 1975-2006. Volume II: College students and adults ages 19-45 (NIH Publication No. 07-6206). Bethesda, MD: National Institute on Drug Abuse, 307 pp.

13. Center for Substance Abuse Prevention (CSAP) Center for the Application of Prevention Technologies Now the Not So Good News… Those who have not attended colleges are more likely to be smokers* –12th graders with no plans to attend a four year college were 1.45 times more likely to smoke than their peers who planned to complete a four year degree** *Johnston, L. D., O'Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2007). Monitoring the Future national survey results on drug use, 1975-2006. Volume II: College students and adults ages 19-45 (NIH Publication No. 07-6206). Bethesda, MD: National Institute on Drug Abuse, 307 pp. ** Barbeau, E.M., Leavy-Sperounis, A., & Balbach, E.D. (2004). Smoking, social class, and gender: what can public health learn from the tobacco industry about disparities in smoking? Tobacco Control, 13: 115-120.

14. Center for Substance Abuse Prevention (CSAP) Center for the Application of Prevention Technologies Now the Not So Good News… Those who have not attended colleges are more likely to be smokers* –Among adults, smoking prevalence is associated with lower educational attainment, working class occupations, and lower income levels** –The tobacco industry heavily markets to this population** *Johnston, L. D., O'Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2007). Monitoring the Future national survey results on drug use, 1975-2006. Volume II: College students and adults ages 19-45 (NIH Publication No. 07-6206). Bethesda, MD: National Institute on Drug Abuse, 307 pp. ** Barbeau, E.M., Leavy-Sperounis, A., & Balbach, E.D. (2004). Smoking, social class, and gender: what can public health learn from the tobacco industry about disparities in smoking? Tobacco Control, 13: 115-120.

15. Center for Substance Abuse Prevention (CSAP) Center for the Application of Prevention Technologies Now the Not So Good News… They are also more likely to use alcohol and illicit drugs on a daily basis* * Johnston, L. D., O'Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2007). Monitoring the Future national survey results on drug use, 1975-2006. Volume II: College students and adults ages 19-45 (NIH Publication No. 07-6206). Bethesda, MD: National Institute on Drug Abuse, 307 pp.

16. Center for Substance Abuse Prevention (CSAP) Center for the Application of Prevention Technologies Other Risk Factors Many of the employment sectors in which non-college attending young adults work have positive cultural norms in terms of drinking: Restaurants/bars Construction The Military Note: Food service and building trade workers have consistently ranked highest for heavy alcohol use among young adults

17. Young Adults Not Attending a College or University Have Higher Rates of Unemployment Than Those Who Have Attended College Kiesa, A. & Barrios Marcelo, K. (2009). Youth Demographics - Youth with No College Experience (Fact Sheet). Center for Research and Information on Civic Learning and Engagement. http://www.civicyouth.org/PopUps/FactSheets/FS08_YthDemo_CollExp.pdf

18. Center for Substance Abuse Prevention (CSAP) Center for the Application of Prevention Technologies Other Factors Young adults, especially those who have not attended college, are faring poorly in the current recession: Unemployment rates for those under 25 are nearly double their pre-recession levels The youth labor force has contracted by 1.1 million workers Bivens, J., Edwards, K.A., Hertel- Fernandez, A., & Turner, A. (2010). The Class of 2010: Economic prospects for young adults in the recession. Economic Policy Institute Briefing paper #265 (May). http://epi.3cdn.net/bf2c1bd6ad4b54f216_gam6ii89y.pdf

19. Center for Substance Abuse Prevention (CSAP) Center for the Application of Prevention Technologies Other Factors An additional 1.2 million 16-24-year-olds disconnected from both formal schooling and work Current unemployment for college graduates is 9.0%: for high school graduates not enrolled in secondary education, the unemployment rate is 22.5% Bivens, J., Edwards, K.A., Hertel- Fernandez, A., & Turner, A. (2010). The Class of 2010: Economic prospects for young adults in the recession. Economic Policy Institute Briefing paper #265 (May). http://epi.3cdn.net/bf2c1bd6ad4b54f216_gam6ii89y.pdf

20. Center for Substance Abuse Prevention (CSAP) Center for the Application of Prevention Technologies Challenges and Opportunities for Accessing the Target Population

21. Center for Substance Abuse Prevention (CSAP) Center for the Application of Prevention Technologies Given the heterogeneity of the population, two strategies for engagement and intervention: 1.Individual/Behavioral 2.Environmental

22. Center for Substance Abuse Prevention (CSAP) Center for the Application of Prevention Technologies Individual/Behavioral Interventions Selecting a particular subset of non-college attending young adults Examples of employment-based interventions: - seeking partnerships with unions, trade associations, corporations - many employment sectors recognize heavy drinking and drug use as problems: may welcome the opportunity to partner - Employee Assistance Programs (EAP)

23. Center for Substance Abuse Prevention (CSAP) Center for the Application of Prevention Technologies Individual/ Behavioral Interventions Examples of community-focused engagement: -Places where the target population congregates (clubs, bars, Laundromats, street corners, liquor stores) -Importance of building rapport with merchants, community leaders, police

24. Center for Substance Abuse Prevention (CSAP) Center for the Application of Prevention Technologies Individual/ Behavioral Interventions Examples of engagement via Cyberspace: –Facebook, Twitter, text messaging (non- college attending young adults currently use these technologies at virtually the same level as college students/graduates) –Second Life has recently emerged as a potential site for engagement and intervention* *Beard,L., Wilson,K., Morra, D,, & Keelan, J.(2009). A survey of health-related activities on second life. Journal of Medical Internet Research,11(2):e17.

25. Center for Substance Abuse Prevention (CSAP) Center for the Application of Prevention Technologies Individual/ Behavioral Interventions Caveats Regarding Engagement via Cyberspace: Connectivity may be spotty in rural areas Cell phones more common than computers for the target population; limitations of cell phone technology should be taken into account Certain populations of recent immigrants may have had limited exposure to these technologies

26. Center for Substance Abuse Prevention (CSAP) Center for the Application of Prevention Technologies Individual/ Behavioral Interventions Problem: Educational interventions have had limited success in reducing problem drinking or drug use Motivational Interviewing (MI) shows promise for reducing problematic behavior (including alcohol misuse) and/or encouraging healthy behaviors* * Nyamathi, A., Shoptaw, S., Cohen, A., Greengold, B., Nyamathi, K., Marfisee, M., de Castro, V., Khalilifard, F., George, D., & Leake, B. (2010). Effect of motivational interviewing on reduction of alcohol use. Drug and Alcohol Dependency,107(1):23-30.

27. Center for Substance Abuse Prevention (CSAP) Center for the Application of Prevention Technologies Individual/ Behavioral Interventions Brief semi-structured interviews whose goal is to encourage participants to think about concrete changes that they can make in their lives to foster healthy living Although ultimate aim may be abstinence, MI takes a harm reduction approach

28. Center for Substance Abuse Prevention (CSAP) Center for the Application of Prevention Technologies Environmental Interventions Workplace Encourage employers to create an easily understood, enforceable policy regarding drinking or drug use on the job, including coming to work with a hangover Many large companies have written policies, but they are often vaguely written and poorly enforced

29. Center for Substance Abuse Prevention (CSAP) Center for the Application of Prevention Technologies Environmental Interventions Workplace Very few small companies (e.g., “mom and pop” restaurants) have written policies at all Policies may be a conduit for intervention via EAP or other programs

30. Center for Substance Abuse Prevention (CSAP) Center for the Application of Prevention Technologies Environmental Interventions The Built Environment Advocacy around commercial zoning issues can be a powerful tool in reducing problem drinking, drug use, and their associated problems * Campbell,C.A., Hahn, R.A., Elder, R., Brewer, R., Chattopadhyay, S., Fielding, J., Naimi, T.S., Toomey, T., Lawrence, B., & Middleton, J.C. (2009). The effectiveness of limiting alcohol outlet density as a means of reducing excessive alcohol consumption and alcohol-related harms. American Journal of Preventive Medicine, 37(6):556-69.

31. Center for Substance Abuse Prevention (CSAP) Center for the Application of Prevention Technologies Environmental Interventions The Built Environment Alcohol outlet density in low income areas (where non-college attending young adults typically reside) is often much higher than in higher income areas Reducing outlet density reduces many social problems associated with heavy alcohol use* * Campbell,C.A., Hahn, R.A., Elder, R., Brewer, R., Chattopadhyay, S., Fielding, J., Naimi, T.S., Toomey, T., Lawrence, B., & Middleton, J.C. (2009). The effectiveness of limiting alcohol outlet density as a means of reducing excessive alcohol consumption and alcohol-related harms. American Journal of Preventive Medicine, 37(6):556-69.

32. Center for Substance Abuse Prevention (CSAP) Center for the Application of Prevention Technologies THANK YOU!

33. Center for Substance Abuse Prevention (CSAP) Center for the Application of Prevention Technologies Questions and Discussion Michael R. Duke, Ph.D. © 2010 Research Scientist Prevention Research Center Pacific Institute for Research and Evaluation 1995 University Avenue, Suite 450 Berkeley, CA 94704 510-883-5745 mduke@prev.org Wendy Baumbach, Associate Coordinator, CAPT West Regional Expert Team 775-682-8533 wbaumbach@casat.org