Binge Drinking on College Campuses: A Road Map to Successful Prevention. Preventing binge drinking on college campuses: A guide to best practices

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1 Binge Drinking on College Campuses: A Road Map to Successful Prevention Preventing binge drinking on college campuses: A guide to best practices

2 Binge Drinking on College Campuses: A Road Map to Successful Prevention Toben F. Nelson, Sc.D. Division of Epidemiology and Community Health School of Public Health

3 Binge Drinking on College Campuses: A Road Map to Successful Prevention

4

5 Harvard School of Public Health COLLEGE ALCOHOL STUDY New web address!

6 A Matter of Degree Program Evaluation New web address!

7 RISK FACTOR OUTCOME Binge drinking Injury Liver disease Violence, Sexual Assault GI cancers, GI disorders Unintended Pregnancies Cardiovascular disease Child Neglect Crime, legal costs Lost productivity, absenteeism Alcohol Use Disorders

8 Binge drinking clearly dangerous for the drinker and for society. National Institute on Alcohol Abuse and Alcoholism, 2004

9 NIAAA College Drinking Task Force, 2002 Tradition of drinking is entrenched at every level of the college student environment Student drinking consequences affect everyone Death Injury Assault Sexual abuse Drunk driving Vandalism Police calls Alcohol abuse and dependence

10 Annual alcohol-related mortality and morbidity among U.S. college students 1,800 deaths 599,000 injuries 696,000 assaults 97,000 sexual assaults Hingson, Zha & Weitzman, 2009

11 Monitoring the Future (2012)

12 Activity 1 Introduce yourself Name Affiliation Experience working to reduce college student drinking and associated harms Your interest in this session

13 Recommendations for Reducing College Student Drinking Individual interventions for those at-risk for alcohol problems norms clarification cognitive-behavioral skills training motivational interviewing Restricting alcohol outlets Increasing alcohol prices and taxes Responsible beverage service policies Maintaining and enforcing age-21 MLDA Impaired driving laws Compliance checks in bars Source: NIAAA College Drinking Task Force (2002)

14 A: Not too good.

15 Most Schools were aware of NIAAA Recommendations n % Not aware of the recommendations 75 21% Reviewed and implemented all of them 10 3% Reviewed and implemented some of them % Reviewed and are in the process of deciding which can be implemented 55 16% In the process of reading 28 8% Waiting for the recommendations to be mailed to us 14 4% Disagree with the recommendations 1 0% Other 17 5% Missing 14 4% 351

16 Recommendations for Reducing College Student Drinking Task Force Recommendation Individual interventions for those at-risk for alcohol problems Most colleges offered intervention services oncampus (58%) or referred off-campus (30%) Of those 76% offered at least one Norms clarification (66%) Motivational interviewing (62%) Cognitive-behavioral skills training (57%) Expectation challenging programs (38%) Overall only half (50%) offered these programs Nelson et al. (2010)

17 Recommendations for Reducing College Student Drinking Task Force Recommendation Compliance checks of alcohol outlets to monitor sales to underage Conducted by local law enforcement at 1 in 3 colleges (33%) Most (60%) conducted without active participation by the University Nelson et al. (2010)

18 Recommendations for Reducing College Student Drinking Task Force Recommendation Responsible Beverage Service Training in local establishments Conducted in local community at 1 in 7 colleges (15%) Most (55%) conducted without active participation by the University Nelson et al. (2010)

19 Recommendations for Reducing College Student Drinking Task Force Recommendation Restrict alcohol outlets Implemented in the community at 1 in 15 colleges (7%) Nelson et al. (2010)

20 Recommendations for Reducing College Student Drinking Task Force Recommendation Increasing alcohol prices and taxes Implemented in the community at 1 in 50 colleges (2%) Nelson et al. (2010)

21 Few differences by type of school Large (vs. small) schools more likely to implement: Intervention programs Mandatory RBS training Compliance checks Multiple interventions No differences by public vs. private status

22 Other potential interventions?

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29 Successful Interventions Effective interventions (they work!) + Broad reach (lots of students everyone!) = Impact

30 Why aren t colleges implementing recommended interventions?

31 College-based Interventions Focus on Individual Students

32 Education Nearly all colleges educate students about the risks of alcohol use NIAAA College Drinking Task Force found these approaches were not effective.

33 Treating and/or punishing the heaviest drinkers

34 What are colleges doing? Medical amnesty Bystander intervention Establish a task force Alcohol-free alternative events Banning distilled spirits Online education Peer education Safe ride program Social Norms marketing Media awareness campaigns

35 The Strategy of Preventive Medicine: The relationship between Coronary Heart Disease and Blood Pressure

36 Geoffrey Rose London School of Hygiene and Tropical Medicine

37 Blood Pressure & CHD risk Prevalence % Deaths ( n ) BP distribution RISK 60 Risk % dying of CHD DEATHS Systolic BP

38 ... a large number of people exposed to a small risk may generate many more cases than a small number exposed to a high risk -Sir Geoffrey Rose

39 The Prevention Paradox Greatest risk health harms among extreme behavior. HOWEVER, few extreme many have moderate risk. Moderate risk is also risk Vast majority of health harms in a community arise among at moderate or low levels of risk. Greatest health gains in the population come from incrementally moving majority. Rose (1985); Rose (1992)

40 High-risk & Population Approaches High-risk: change extreme, high-risk individuals, treatment Population: change majority, the conditions that shape everyone s behavior.

41 Risk of injury, by usual number of drinks (past 30 days) Population Percent Population Percent Risk ofharm Risk of Being Hurt or Injured or more Usual Number of Drinks 0.00 Weitzman & Nelson (2004)

42 The Prevention Paradox Evidence for findings regardless of: consumption measure Usual drinks Drinking frequency Frequency of drunkenness Negative social/health consequence 14 different outcomes DSM-IV Abuse and Dependence criteria Only the risk trajectory varied Weitzman & Nelson (2004); Wechsler & Nelson (2006)

43 Risk of Harm by Consumption (Wechsler & Nelson, 2006 ACER)

44 High-Risk Approach Advantages Intervention tailored/targeted to the individual Clear benefits (when achieved) to the individual Intuitive Disadvantages Difficult & costly to ID atrisk Effects palliative, temporary Low odds success Modest benefit to the population

45 Population Approach Advantages Large population benefits Broad target audience Longer lasting effects Disadvantages May limit personal freedoms Resistance from invested parties Counter-intuitive

46 High-Risk & Population Approaches Not Mutually Exclusive You Can Do Both

47 Continuum of Intervention Points for Student Alcohol Use Policy, Enforcement, Education Brief Intervention Treatment Adapted from Broadening the Base of Alcohol Treatment (IOM)

48 Existing systems are Within campus Between campus and community fractured / siloed

49 Toomey et al., in press

50 Policy implementation is hard Policies occur off-campus Lots of barriers Negative reaction Policy = punishment College alcohol prevention staff don t have skills to advocate for policy

51 How can we re-frame to move forward?

52 Consider Student Drinking within a Larger Context

53

54 College-level Variation in binge drinking persists over time Colleges with high rates of binge drinking in year 1 also had high rates of binge drinking 4, 6, 8 and 12 years later Wechsler et al., 2002 Nelson et al., 2009

55 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 Wechsler & Nelson, 2008

56 Nelson et al., 2005; AJPH

57 Student drinking part of a larger societal problem with alcohol 3 rd leading cause of preventable death in the US 1,800 college students 79,000 adults Youth tend to drink like the adults around them The causes are the same The solutions the same too

58 College Systems model

59 Integrated theory of drinking behavior Legal Availability Public Policy & Institutional Policies/Structures Formal Social Controls Economic Availability Individual Risk Factors Drinking Behavior Alcohol-related Problems Physical Availability Adapted from Wagenaar & Perry, 1994 Problems that stem from alcohol use are primarily a function of availability

60 Public Health Triad Host Agent Environment

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

62 Individual interventions are unlikely to have sustained effects if we send them back to the same toxic environment

63 Addiction, 102, , 2007 Unfortunately, many popular strategies tend to be ineffective; and the more effective strategies tend to be unpopular.

64 Industrial epidemic framework Focus on public health considerations Draw attention toward upstream sources of damage Embrace the fact that health advocates compete with industry for support from policymakers and the public Jahiel & Babor, 2007

65 Activity 2: By yourself or in a small group- Identify current performance in each area: Strength Weakness Brainstorm 1 new idea in each area Use the Torjman Model

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

67 Identify stakeholders, allies and opponents

68 Purchase and Read this Book ORGANIZING FOR SOCIAL CHANGE Midwest Academy Manual for Activists 4th Edition

69 Activity 3 List allies or stakeholders who might have an interest in the issue of student drinking and related problems Identify their self-interest Identify their barriers to engaging or taking steps to address student drinking

70 Re-frame how you think and talk about policy

71 No one wants to be the fun police

72 Policies are community standards Drinking behaviors that cause problems are not generally acceptable to most in your community Make approach to alcohol consistent with your University mission Talk about standards early and often Engage students in identifying standards

73 Enforcement makes everyone accountable to community standards Informal and formal enforcement Communicate about enforcement efforts Enforce standards for suppliers of alcohol Move away from a bad apples approach

74 Components of Punishment for Deterrence Severity - make the punishment bad Certainty - make the likelihood of punishment high Celerity - make the consequences quick

75 Activity 4 Develop an elevator talk for pursuing interventions to reduce student drinking that work

76 Your quick pitch Who you are What you want to accomplish How your approach is different Why it will work (with data) What you want them to do

77 What else do you need? Strengthen your argument Focus on harms (social and individual) Focus on environmental determinants Availability/suppliers of alcohol Understand and engage others on their self-interest Friends and allies Skilled people Data, data, data

78 Binge Drinking on College Campuses: A Road Map to Successful Prevention Contents Chapter 1: Getting Started Chapter 2: Circles of Influence and Response Model Chapter 3: Laying the Groundwork Chapter 4: Implementing a Screening and Intervention System Chapter 5: Improving the Quality of Policies and Procedures Chapter 6: Restricting Alcohol Access Chapter 7: Influencing Alcohol Prices CD ROM

79 Binge Drinking on College Campuses: A Road Map to Successful Prevention Preventing Binge Drinking on College Campuses: A Guide to Best Practices By Toben F. Nelson, Sc.D. and Ken C. Winters, Ph.D. with Vincent Hyman Softcover, 216 pp., with CD ROM Online Price: $49.95 For more information call or visit: hazelden.org/bookstore

80 Questions and Comments Binge Drinking on College Campuses: A Road Map to Successful Prevention Toben F. Nelson, Sc.D. Division of Epidemiology and Community Health; Minnesota School of Public Health

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