1. How can we reduce college student drinking? How can we reduce college student drinking? Lessons learned from the Harvard School of Public Health College Alcohol Study and the “A Matter of Degree” Program Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota

2. College Alcohol Study Harvard School of Public Health Harvard School of Public Health

3. Individual-level Variation in Drinking High Risk Groups Males (Wechsler et al. 1995) Prior drinking history (Wechsler et al. 1995) Other substance users (Wechsler et al. 1995) Fraternity & Sorority members (Wechsler, Kuh & Davenport, 1996) Athletes (Nelson & Wechsler, 2001) Sports Fans (Nelson & Wechsler, 2003) What kinds of interventions do these findings suggest?

4. College Alcohol Study Harvard School of Public Health Harvard School of Public Health

5. High Binge Campuses At one third of campuses, more than half of the students were binge drinkers. College Alcohol Study Harvard School of Public Health Harvard School of Public Health

6. Can We Identify Toxic Alcohol Environments? High binge colleges more likely to: –focus on intercollegiate athletics and fraternity/ sorority life (settings for socializing and drinking) –have a large number of alcohol outlets nearby –have heavy marketing of alcohol –have lax policy and enforcement College Local Community State

7. College Alcohol Study Harvard School of Public Health Harvard School of Public Health Beer kegs and bar specials make alcohol one of the cheapest forms of entertainment at high-binge colleges.

8. Price, by alcoholic drink What’s being sold? (6 sites) 24 centsPer drink from keg 24 cents 37 centsPer can from 12 (24) pack 37 cents 75 centsDrink specials at bars/clubs 75 cents $1.50Entry into Greek party $1.50 $1.88Entry into non-Greek party $1.88

9. Price, compared to other drinks 1 coffee (average cost of $1.09) = 1.5 drinks at a bar* (range 1 to 6) 4.6 drinks from a keg (range 3 to 7) OR 3 cans of beer (range 2 to 4) *based on specials

10. Price, compared to other activities 1 movie ticket--1st run (average cost of $5.86) = 8 drinks at a bar* (range 6 to 31) All you can drink at a party for 3-4 people 25 drinks from keg (range 20 to 36) 16 cans of beer (range 11 to 22) OR *based on specials

11. Iowa City, IA Weitzman et al. (2003)

12. “A Matter of Degree” program Program developed from College Alcohol Study – funded by Robert Wood Johnson Foundation Started in 1996 Goal reduce binge drinking & related harms through changing environment –Advertising/Promotion –Access & Availability –Pricing –Other

13. AMOD Sites 10 Campus-Community coalitions Coalition “agent” of change –Multiple change agents in the community 5-8 year interventions Local problem definition and local solutions

14. Can campus-community coalitions implement environmental prevention? Can environmental prevention reduce drinking and related harm?

15. Public Health Triad AgentHost Environment

16. Knowledge Attitudes Intentions Skills Pricing Composition Labeling Packaging PersonDrug Advertising/ Promotion Physical Context Availability Sociocultural Context Institutions Legal Sanctions Key Influencers Drug-Related Problems Environment Torjman (1986)

17. Findings 255 interventions –Focus on… Host (Knowledge & Intentions) Environment (Sociocultural context) –Relatively few interventions address Advertising/Promotion Availability Only one addressed features of the alcohol itself (Price) –Varied by site… Modest declines in schools with highest environmental implementation No similar decline in low environment sites Weitzman, Nelson, Lee & Wechsler (2004)

18. Changes consistent w/ major policy initiatives Uniform Police Reporting Form Prohibit alcohol ads in campus publications Birthday Bar list Landlord Ordinance Two strikes and suspension Off-campus Transportation Events Policy Parental Notification Party Host Rules 1 st year student Sanction Policy Change

19. Challenges for Environmental Interventions Sites with less initial support among coalition members were less likely to implement Take time to implement Significant barriers to implementation –Students –Public opinion –Key leader opinion –Industry activism Elicit negative reactions Requires efficacy, outcome expectancy and persistence

20. Lessons Learned Sites differ in their implementation Tensions involving program outcomes, interventions and problem definition are inter-related Conceptual frameworks matter AOD prevention staff are not trained for environmental prevention

21. Key features of stronger program development Leadership Evidence-based agenda Strategic plan based Measurable benchmarks Environmental interventions Network ‘savvy’

22. Recommendations Understand community-level change Pursue recommended, evidence-based interventions Dedicated, empowered and appropriately skilled staff Carefully recruit stakeholders Measure and evaluate Be prepared to ruffle feathers

23. Harvard School of Public Health COLLEGE ALCOHOL STUDY http://www.hsph.harvard.edu/cas

24. http://ww.epi.umn.edu/alcohol