Lessons learned about environmental alcohol strategies from the 'A Matter of Degree' Program in College Communities Donald W. Zeigler, Ph.D., Deputy Director.

Lessons learned about environmental alcohol strategies

from the 'A Matter of Degree' Program in College Communities

Donald W. Zeigler, Ph.D., Deputy Director

American Public Health Association Annual Meeting

Boston, MA. Nov 8, 2006

ATOD Session 5149.0. Whether on the Street or in the Classroom:

Your Drinking Behaviors & Solution

A MATTER OF DEGREE: The national effort to reduce high risk drinking

among college students

A partnership of the

American Medical Association

and

The Robert Wood Johnson Foundation

A Matter of Degree goals

1. Test efficacy of environmental model

2. Create sustainable campus-community partnerships to address entire student environmentenvironment

3. Reduce high-risk drinking & 2nd-hand effects

1996 Campuses invited to join. Criteria:

High student binge rates Campus history of addressing alcohol issues Willingness to discuss problems publicly -

“stick necks out” Willingness to collaborate with community

partners Active participation and support of chief

executives (President, Mayor)

Overview of AMOD

10 campus-community coalitions 8-9 year grants [Colorado 5 years] Average grant of $700,000 + school match Evaluation: Harvard School of Public

Health with its on-site evaluators AMA – national program office

University/City Coalitions

U of Delaware - City of Newark Florida State U - City of Tallahassee Georgia Institute of Technology - City of Atlanta U of Iowa - Iowa City Lehigh U - City of Bethlehem Louisiana State U - City of Baton Rouge U of Nebraska - City of Lincoln U of Vermont - City of Burlington U of Wisconsin - City of Madison U of Colorado – City of Boulder

AMOD targeted predictors of college high-risk drinking (Wechsler et al., 1994)

1+ alcohol outlets within 1 mile of campus 1st year undergraduates Males Athletes Sports fans Greeks, especially fraternity members

Underage alcohol market on campus: U of Iowa, Iowa City

60% of students under age 21

Underage spend $235,458/month on alcohol

Wholesale cost: $47,091 = 80% profit

$2.1 million/year est. income on UA drinking

Jim Clayton, Director, Stepping Up ProjectU of Iowa, October 27, 2004

All about price. Drink fast! Iowa City

Price specials every night

Web advertising Text messages on the

cell phone about specials

E mail notices about bar specials

Rates of growth Iowa City1975 9 liquor licenses downtown 6 were bars1981 17 10 1998 33 20 2005 48 32

0%

50%

100%

150%

200%

250%

300%

350%

400%

450%

1974 1998 2005

Iowa City Population

University enrollment

Licenses downtown

AMOD interim evaluation 1997-2001Harvard School of Public Health

Compared drinking and harm patterns from 10 AMOD schools to

32 non-AMOD colleges from the national Harvard College Alcohol Study (CAS)

Evaluation

Divided 10 AMOD program colleges into 2 groups based on their level of program implementation (# and variety of policy changes) as of 2001:

high intervention low intervention sites

Weitzman ER, Nelson TF, Lee H, Wechsler H. (October, 2004). Reducing drinking and related harms in college: Evaluation of the “A Matter of

Degree” program. American Journal of Preventive Medicine, Oct 2004

AMOD Findings (1997-2001):Adapted from Weitzman, Nelson, Lee & Wechsler,

AJPrevMed, 2004

# Interventions High Lowamong all AMOD sites

Availability 26 5Legal sanctions 21 4Physical context 8 2Advertising &

Promotion 7 4Key influencers 16 8Sociocultural context 79 23

5 high intervention schools:

Significant changes noted in drinking & related harms over time when compared to the non-AMOD colleges.

Decreasing relative risk over time Reduced driving after drinking, driving

after 5+ drinks, riding with drunk driver

Reductions did not occur at

the 5 universities that implemented fewer of these changes

nor at the group of 32 comparison colleges

5 high intervention sites:5-11% reductions in 6 consumption outcomes “Binge” drink “Binge” frequently Taking up “binge” drinking in college Drink frequently Get drunk frequently Usually drink at “binge” level

Drinkers at 5 High Implementation Schools:18% reductions in experience of 5 or more alcohol related harms

getting hurt or injured medical treatment for overdose unprotected, unplanned sex miss or fall behind classes getting in trouble with police do something regretted

5 high intervention schools: 10% fewer 2ndhand effects from other students’ heavy alcohol use, e.g.

property vandalized interrupted sleep or study timearguments, insults or assaultsunwanted sexual advancebaby sit a student

Examples of policies and programs found effective to-date: mandatory training for responsible beverage

service required registration for purchasers of kegs prohibit sales of alcohol without a license keep alcohol-related items out of student

bookstores expand substance-free residence halls promote alcohol-free activities.

AMOD comprehensive college/community environmental interventions, “if vigorously pursued, can reduce drinking problems specifically among college students.”

“It can also reduce secondhand effects of alcohol perpetrated on other college students by students who engage in excessive college drinking.”

“This careful and rigorous evaluation is the first to show positive benefits of interventions across entire college populations, not just select subgroups of students.”

Hingson, R. (2004). Advances in Measurement and Intervention forExcessive Drinking. Am J Preventive Medicine. 27(3):261-263.

Plausible mechanisms:

Diminished alcohol availability

Increased enforcement

Heightened scrutiny – self regulation

Moderated peer influences – less tolerance

for drunkenness, more concern about it

Time spent on other things, culture shift

Underlying dynamics supportive of change:Long term voluntary commitment

to coalition efforts & policy changeWillingness of institutions to see

school as activist change agentsShift from individual-only to

include environment approaches

High 5 coalitions

More formal structures & processes Higher member involvement in decisions Assume environment is changeable &

supportive Clear, flexible, detailed strategic & action

plans Staff facilitates rather than directs Responsible, trusted leadership Consensus-driven

Likely causes for lower levels of intervention (differ per site)

Active alcohol industry opposition Fear of angering students Community made up of multiple autonomous

groups and not working as a whole Poor leadership High adult drinking in state Few state policy measures

Potential threats to campus/community coalition (LSU experience)

Changes in top administration may impact ongoing commitment

Untrained and unskilled leadership Inadequate professional staff time & coalition

resources Lack of personal conviction & courage of

partners and staff Lack of ability to withstand public apathy,

cynicism and criticism

AMA helped change how we talk

about alcohol

Empowered universities to take lead in communities

Alcohol - a medical & public health issue

Underage & young adult drinking are medical problems

Physicians should be involved

in patient screening, brief intervention, referrals to treatment

in policy development and advocacy

AMA Study: “Effects of Alcohol on the

Brains of Underage & College Students”: Brain damage and neuro-cognitive deficits Affects learning abilities and intellectual

development of underage drinkers Impaired intellectual development may continue to

affect individuals into adulthood Imperative for policy-makers and organized

medicine to address the problem of underage drinking

Zeigler, DW, Wang, CC, Yoast, RA, Dickinson, BD, McCaffree, MA, Robinowitz, CB, and Sterling, ML. (January. 2005).

The neurocognitive effects of alcohol on adolescents and college students.

Preventive Medicine. 40(1): 23-32.

Responding to Depression, Suicide, Substance Use, and Addiction on College Campuses D-345.995

Full insurance parity for mental health and substance abuse treatment

Colleges: increase availability and ensure the quality and quantity of on-site mental health and substance abuse clinical services &/or improve access to appropriate community services.

End discrimination against students who disclose or seek treatment for depression, SUD, or mental health issues, including mandatory suspension/withdrawal from school for students who request or receive psychiatric or addiction medicine services.

Urges similar programs in medical schools. Urges clinical staff of campus health services and counseling

services to improve their skills in screening, brief intervention and referral for students’ problem drinking.

Partner to educate physicians & media on the linkages of substance use and addiction, mental disorders, and suicide among college students. (CSAPH Rep. 8, A-06)

AMA helped reframe the issues – Underage drinking is

an adult issue “Just because we

hold youth responsible doesn’t mean the rest of us aren’t responsible too”

“The alcohol industry needs to be held accountable”

Alcohol problems are community problems requiring community solutions

New AMA policy: Increasing Taxes on Alcoholic Beverages D-30.995

Supports increases in federal taxes on beer, wine, and liquor, with a substantial portion of the new revenues to be earmarked to the prevention, treatment of dependent or at-risk drinkers, services for vulnerable populations

Urges state & local medical societies to support increases in state and local taxes on beer, wine, and liquor

Support state & local efforts to increase taxes on beer, wine, and liquor

Collaborate with national medical specialty societies, the APHA, the Center for Science in the Public Interest, MADD

Use ballot initiatives in the 24 states that allow such initiatives. (Res. 438, A-05)

New AMA policy: Take Action to End Alcohol Ads on College Sports Telecasts D-30.994

 Goal: end alcohol advertising on sports broadcasts & particularly on college sports; special emphasis on athletic conferences now or soon negotiating contracts,

Appeal directly to the NCAA, all athletic conferences and member schools to end alcohol ads on their broadcasts;

Urge physicians, particularly those in or associated with college communities, express opposition directly to top administrators;

Urge state & local medical associations to contact colleges & press them to end alcohol ads on their broadcasts;

Urge state and local medical associations to get state legislatures to pass resolutions requesting colleges in their state to end alcohol ads on their broadcasts; &

Organize "sign-on" letter from medical societies to the NCAA President and Executive Committee urging an end to alcohol ads on NCAA broadcasts. (Res. 413, A-06)

Statement on Reducing the Global Impact of Alcohol on

Health and Society

submitted by the AMAadopted by the

World Medical AssociationSantiago, Chile, October 2005

Current trends

Growing awareness that environmental change is vital

Decreasing or no private or government funding for policy

work

Growth in alcohol advertising, e.g. cable TV, internet

Barrage of “health benefits” media: wine and beer for the

health conscious

Increased youth access

Active industry push back

Anheuser-Busch controls 50%+ of US market – political

clout at every level

Diageo enters US market and state politics; product

alliances with beer

Intentionally ambiguous “drink responsibly” campaigns

AMA project with medical schools in college towns

Enhance role for medical school, physicians, and medical students in alcohol advocacy in AMOD communities (FSU, WI, IO, VT, GT) and others (e.g., Dartmouth, UFL)

Telecast for medical schools, directors of service learning, & medical student chapters on means to reduce college high-risk and underage drinking & related harms

American Medical AssociationOffice of Alcohol, Tobacco & Other Drug

Abuse Prevention

www.ama-assn.org/go/alcohol

www.alcoholpolicymd.com