Prevention Research Center Pacific Institute for Research and Evaluation College Student Drinking Prevention Interventions Bob Saltz Prevention Research.

Prevention Research CenterPRCPacific Institute for Research and Evaluation

College Student Drinking College Student Drinking Prevention InterventionsPrevention Interventions

Bob SaltzBob SaltzPrevention Research CenterPrevention Research Center

Berkeley, CaliforniaBerkeley, California

Why Care About College Student Why Care About College Student Drinking?Drinking?

Over 1,700 deaths among 18-24 year old college Over 1,700 deaths among 18-24 year old college studentsstudents

590,000 unintentionally injured under the influence 590,000 unintentionally injured under the influence of alcoholof alcohol

More than 690,000 assaulted by another student who More than 690,000 assaulted by another student who has been drinkinghas been drinking

More than 97,000 are victims of alcohol-related More than 97,000 are victims of alcohol-related sexual assault or date rapesexual assault or date rape

About 25 percent of college students report academic About 25 percent of college students report academic consequences of their drinking including missing consequences of their drinking including missing class, falling behind, doing poorly on exams or class, falling behind, doing poorly on exams or papers, and receiving lower grades overall papers, and receiving lower grades overall

Very Heavy Drinking is Surprisingly Very Heavy Drinking is Surprisingly Common among College StudentsCommon 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 "the scope of the problem makes problem makes

immediate results of immediate results of any interventions highly any interventions highly

unlikely"unlikely"Wechsler, et al., 1994Wechsler, et al., 1994

Prevention Research CenterPrevention Research CenterPRCPacific Institute for Research and Evaluation

Mean Score for 5+ Drinks in a Row in Past 2 Weeks by 4-year College Student Status

Wave 1 Wave 2 Wave 3 Wave 4

Measurement Wave

(18) (19-20) (21-22) (23-24)

Twice

Once

None

College

Non-College

Task Force Task Force RecommendationsRecommendations

Tier 1:Tier 1: Evidence of Effectiveness Among Evidence of Effectiveness Among College Students College Students

Tier 2:Tier 2: Evidence of Success With General Evidence of Success With General Populations That Could Be Applied Populations That Could Be Applied

to College Environments to College Environments

Tier 3:Tier 3: Evidence of Logical and Theoretical Evidence of Logical and Theoretical Promise, But Require More Promise, But Require More

Comprehensive Evaluation Comprehensive Evaluation

Tier 4:Tier 4: Evidence of IneffectivenessEvidence of Ineffectiveness

Recommendations – Tier 1Recommendations – Tier 1

Combining cognitive-behavioral skills Combining cognitive-behavioral skills with norms clarification and with norms clarification and motivational enhancement motivational enhancement interventions interventions

Offering brief motivational Offering brief motivational enhancement interventions enhancement interventions

Challenging alcohol expectancies Challenging alcohol expectancies

Recommendations – Tier 2Recommendations – Tier 2 Increased enforcement of minimum Increased enforcement of minimum

drinking age laws drinking age laws Implementation, increased publicity, and Implementation, increased publicity, and

enforcement of other laws to reduce enforcement of other laws to reduce alcohol-impaired driving alcohol-impaired driving

Restrictions on alcohol retail outlet density Restrictions on alcohol retail outlet density Increased price and excise taxes on Increased price and excise taxes on

alcoholic beveragesalcoholic beverages Responsible beverage service policies in Responsible beverage service policies in

social and commercial settings social and commercial settings

……finallyfinally

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

Sounds like a lot of work…Sounds like a lot of work…

……why bother?why bother?

So Why Not Just Go WithSo Why Not Just Go WithTier 1 Strategies?Tier 1 Strategies?

Problems not limited to high-risk Problems not limited to high-risk drinkersdrinkers

RELATIVE PRODUCTION OF PROBLEMS BYFREQUENT BINGE VS. NON-BINGE DRINKERS (CAMPUS SAMPLE, '98 - '99 SCHOOL YEAR)

PROBLEM CATEGORY

NU

MB

ER

S O

F P

RO

BLE

MS

0

200

400

600

800

1000

1200

1400

1600

FREQUENT BINGE DRINKERSNON-BINGE DRINKERSFIFTY-PERCENT CONTROL LINE

So Why Not Just Go WithSo Why Not Just Go WithTier 1 Strategies?Tier 1 Strategies?

Problems not limited to high-risk drinkersProblems not limited to high-risk drinkers Some difficult to implement with fidelitySome difficult to implement with fidelity Can be labor intensive & costly for large populationsCan be labor intensive & costly for large populations Some individual-level strategies might be Some individual-level strategies might be

compromised in "hostile" environmentscompromised in "hostile" environments Opportunity to create synergy across levels of Opportunity to create synergy across levels of

interventionintervention

…….work continues on all these.work continues on all these limitations limitations

Specialized

Treatment

Primary

Prevention

Brief

Intervention

None

Mild

Moderate

SevereThreshold

s for Action

Spectrum of Intervention Response

Public Health ModelPublic Health Model

Individual

Alcohol Environment

Alcohol-Related Problems

Public Health ModelPublic Health Model

Individual

Vehicle Traffic Laws, Roads / Intersections

Traffic Safety

……but there are challengesbut there are challenges

Typical Hurdles for Comprehensive Typical Hurdles for Comprehensive Prevention StrategyPrevention Strategy

Implicit assumption that the only Implicit assumption that the only “target” is high-risk drinkers“target” is high-risk drinkers

Ambivalence about student drinkingAmbivalence about student drinking

Low perceived efficacy of preventive Low perceived efficacy of preventive interventionsinterventions

Challenges of coordination and Challenges of coordination and resource allocationresource allocation

Possible fears of “backlash”Possible fears of “backlash”

Unique Hurdles for College PreventionUnique Hurdles for College Prevention

Emphasis often on “process” over “outcome”Emphasis often on “process” over “outcome”

Preference for persuasion over controlPreference for persuasion over control

Universities are complex, diffuse Universities are complex, diffuse organizationsorganizations

Prevention staff trained in education, Prevention staff trained in education, awareness strategiesawareness strategies

Prevention staff usually lacks authority to Prevention staff usually lacks authority to launch initiativeslaunch initiatives

Environmental Policies to Environmental Policies to Reduce College Drinking: An Reduce College Drinking: An Update of Research FindingsUpdate of Research Findings

Toomey, Lenk, & Wagenaar (2007) Toomey, Lenk, & Wagenaar (2007) Journal of Studies onJournal of Studies onAlcohol and DrugsAlcohol and Drugs

Evidence for Community-Evidence for Community-Level Prevention Level Prevention

InterventionsInterventions

A Matter of Degree (AMOD)A Matter of Degree (AMOD)Weitzman et al. Weitzman et al. American Journal of Preventive MedicineAmerican Journal of Preventive Medicine. .

20042004

College/ Community PartnershipsCollege/ Community Partnerships Environmental strategies to reduce Environmental strategies to reduce

drinking problems:drinking problems: Keg registrationKeg registration Mandatory responsible beverage serviceMandatory responsible beverage service Police wild party enforcementPolice wild party enforcement Substance free residence hallsSubstance free residence halls Advertising bansAdvertising bans

A Matter of Degree (AMOD)A Matter of Degree (AMOD)Weitzman et al. Weitzman et al. American Journal of Preventive MedicineAmerican Journal of Preventive Medicine. .

20042004

AMOD achieved reductions among AMOD achieved reductions among college students incollege students in Binge drinkingBinge drinking Driving after drinkingDriving after drinking Alcohol related injuriesAlcohol related injuries Being assaulted by other drinking Being assaulted by other drinking

college studentscollege students

Social Norms MarketingSocial Norms MarketingResearch ProjectResearch Project

National Institute on National Institute on Alcohol Abuse and Alcohol Abuse and

Alcoholism Alcoholism

andand

U.S. Department of U.S. Department of EducationEducation

R01 AA 12471

Decrease in perceived normative expectations to drink

Decrease in perceived normative expectations to drink

Decrease in alcohol consumptionDecrease in alcohol consumption

Social Norms Marketing

Use campus-based media to report accurate drinking normsUse campus-based media to

report accurate drinking norms

Sample Campaign Materials

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

Mea

n N

umbe

r of D

rinks

Year 1 Year 4 Year 1 Year 4

Mean Number of Drinks When Partyingby Experimental Group & Alcohol Outlet Density

Control Treatment

Low-Density Campus High-Density Campus

Campus Community Strategy Campus Community Strategy to Change the Drinking to Change the Drinking

CultureCulture

Western Washington Western Washington UniversityUniversity

Bellingham, WashingtonBellingham, Washington

Project ComponentsProject Components

Neighborhoods Engaging with Neighborhoods Engaging with Students (NEST) Students (NEST)

EnforcementEnforcement LateNight@WWULateNight@WWU Campus Community Coalition work Campus Community Coalition work

groups were involved in planning, groups were involved in planning, implementation, and process implementation, and process evaluation.evaluation.

ComparisonComparison

22ndnd Intervention Intervention

ComparisonComparison

22ndnd Intervention Intervention

Study to Prevent Alcohol Related Consequences:

Using a Community Organizing Approach to Implement Environmental Strategies in and

around the College Campus

Mark Wolfson, et alWake Forrest University

SPARCSPARC

SPARC DesignSPARC Design

10 universities 10 universities

randomlyrandomly assignedassigned 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 DrinkingIndicators- Quantity - Social Setting- Frequency - Timing- Physical setting

- Underage use

Consequences- Health - Legal- Social - Academic- Violence - Victimization

Culture / Context

Campus cultures

•Student•AdministrationAlumniFaculty

Campus Policies

Community cultures

•Government•NeighborhoodsLaw enforcementRetail/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 ModelSPARC Conceptual Model

Environmental Environmental StrategiesStrategies

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

CDSCDS Severe ConsequencesSevere Consequences,, due to own drinking due to own drinking

(p=.02)(p=.02) Alcohol-related Injuries, caused to others Alcohol-related Injuries, caused to others

(p=.03)(p=.03)

RA SurveyRA Survey Consequences: p=.04Consequences: p=.04 Environment: p=.01Environment: p=.01 Aggregate: p=.03Aggregate: p=.03

I & I ReportsI & I Reports Police reports ofPolice reports of alcohol-related incidentsalcohol-related incidents

(p=0.04)(p=0.04) Police reports of # of citations for underage Police reports of # of citations for underage

alcohol use (p=.008)alcohol use (p=.008)

Evidence of Impact: Evidence of Impact: SummarySummary

Safer California UniversitiesSafer California UniversitiesProject Goal:Project Goal:

To evaluate the efficacy of aTo evaluate the efficacy of a“Risk Management” approach “Risk Management” approach to alcohol problem preventionto alcohol problem prevention

NIAAA grant #R01 AA12516with support from CSAP/SAMHSA.

What are we trying to What are we trying to prevent?prevent?

IntoxicationIntoxication

Harm related to intoxicationHarm related to intoxication

Random AssignmentRandom AssignmentIntervention SitesIntervention Sites

CSU ChicoCSU Chico Sacramento StateSacramento State CSU Long BeachCSU Long Beach UC BerkeleyUC Berkeley UC DavisUC Davis UC RiversideUC Riverside UC Santa CruzUC Santa Cruz

Comparison Comparison SitesSites

Cal Poly SLOCal Poly SLO San Jose StateSan Jose State CSU FullertonCSU Fullerton UC IrvineUC Irvine UC Los AngelesUC Los Angeles UC San DiegoUC San Diego UC Santa BarbaraUC Santa Barbara

CSU Chico

UC Davis Sacramento State

UC Santa Cruz

San Jose State

Cal Poly

UC Santa Barbara

UCLA

UC Irvine

CSU Fullerton

CSU Long BeachUC Riverside

UCSD

UC Berkeley

How is risk management a How is risk management a unique approach?unique approach?

Targets times and places instead of Targets times and places instead of individualsindividuals

Focus on intoxicationFocus on intoxication

Tied to continuous monitoring and Tied to continuous monitoring and improvement - emphasis on “control” improvement - emphasis on “control” rather than “one shot” interventionsrather than “one shot” interventions

Integrated Intervention Integrated Intervention Strategies for Off-Campus Strategies for Off-Campus

Parties Parties Compliance ChecksCompliance Checks

DUI Check PointsDUI Check Points

Party PatrolsParty Patrols

Pass Social Host “Response Cost” Pass Social Host “Response Cost” OrdinanceOrdinance

A Social Host Safe Party CampaignA Social Host Safe Party Campaign

Strategies for Strategies for ImplementationImplementation

Focused on one (at most two) Focused on one (at most two) settingssettings

Focused on beginning of academic yearFocused on beginning of academic year

Highly-specified planning and Highly-specified planning and implementation processimplementation process

Minimal attention to motivationMinimal attention to motivation

Maximum attention to tasks and Maximum attention to tasks and implementation per seimplementation per se

Planned mid-course correctionPlanned mid-course correction

OutcomesOutcomes

Likelihood of getting drunk at a given Likelihood of getting drunk at a given generic setting (e.g., Greek parties; generic setting (e.g., Greek parties; residence halls) plus additional aggregate residence halls) plus additional aggregate measure across all settingsmeasure across all settings

Two baseline years combined vs. two Two baseline years combined vs. two years post-intervention combinedyears post-intervention combined

Controlling for individual-level variables Controlling for individual-level variables and campus/community variablesand campus/community variables

DUI or RWDD Related to Off-Campus Party

0.00

0.05

0.10

0.15

0.20

2003-04 2004-05

Survey years

Intervention

Control

Practical SignificancePractical Significance At each campus, 900 fewer At each campus, 900 fewer studentsstudents

drinking to intoxication at off-campus drinking to intoxication at off-campus parties and 600 fewer getting drunk at parties and 600 fewer getting drunk at bars/restaurants during the fall semester at bars/restaurants during the fall semester at intervention schools relative to controls. intervention schools relative to controls.

Equivalent to Equivalent to 6,0006,000 fewer fewer incidentsincidents of of intoxication at off-campus parties and intoxication at off-campus parties and 4,0004,000 fewer incidents at bars & restaurants fewer incidents at bars & restaurants during the fall semester at Safer during the fall semester at Safer intervention schools relative to controlsintervention schools relative to controls

In addition…In addition…

No DisplacementNo Displacement

Dosage EffectsDosage Effects

In Sum…In Sum… We have the ability to create We have the ability to create

environments that help young adults environments that help young adults make healthy decisions about alcohol make healthy decisions about alcohol consumptionconsumption

We have growing evidence that these We have growing evidence that these strategies are effectivestrategies are effective

Our greatest impact will likely come Our greatest impact will likely come from adopting mutually-reinforcing from adopting mutually-reinforcing policies, programs and practicespolicies, programs and practices

Future Research:Future Research:Where are we heading?Where are we heading?

Evaluating Full-Spectrum Comprehensive Evaluating Full-Spectrum Comprehensive InterventionsInterventions

ReplicationsReplications

Diffusion ResearchDiffusion Research

Basic Research on Organizational and Basic Research on Organizational and Community ChangeCommunity Change

Thank you!Thank you!