Changing the Culture of Risky Drinking Behavior

Changing the Culture of Risky Drinking Behavior A Strategic Plan to Reduce Alcohol-Related Injuries Among 12-24 Year-olds in La Crosse County, Wisconsin A Partnership of: La Crosse Medical Health Science Consortium Medical College of Wisconsin s Injury Research Center Coulee Council on Addictions CESA #4 La Crosse County Health Department

Changing the Culture of Risky Drinking Behavior Strategic Plan 1. Title: Changing the Culture of Risky Drinking Behavior 2. Timeframe: January 2009-December 2013 3. Coalition The mission of the Changing the Culture Coalition is to reduce and prevent alcoholrelated injury among 12-24 year-olds in La Crosse County. Primary Contacts: Catherine Kolkmeier, Director La Crosse Medical Health Science Consortium 1300 Badger St., Office 3065 La Crosse, WI 54601 (608) 785-5151 Fax: (608) 785-5154 Kolkmeie.cath@uwlax.edu Stephen Hargarten, MD, MPH, Director Injury Research Center Medical College of Wisconsin 8701 Watertown Plank Road Milwaukee, WI 53226-0509 (414) 456-7670 Fax: (414) 456-6470 hargart@mcw.edu 4. Description of local situation Project History This project, Changing the Culture of Risky Drinking Behavior, began in 2007 with the award of a $50,000 Development (planning) Grant from the Healthier Wisconsin Partnership Program at the Medical College of Wisconsin. The grant was awarded to a partnership of the La Crosse Medical Health Science Consortium (a collaboration of Franciscan Skemp Healthcare/Mayo Health System, Gundersen Lutheran, University of Wisconsin-La Crosse, Western Technical College, and Viterbo University) and the Injury Research Center at the Medical College of Wisconsin. Additional partners included Coulee Council on Addictions, CESA #4, and the La Crosse County Health Department. Together, this group assembled a diverse Community Coalition to take on the task of developing this strategic plan, which outlines steps that can be taken over the next three to

five years to reduce the incidence of alcohol-related injuries among 12-24 year-olds in La Crosse County, Wisconsin. Overarching Goal The overarching goal of this one year planning effort was to develop a plan for reducing alcohol-related injuries among 12-24 year-olds in La Crosse County. The key components completed as part of the planning process were the development of: A Community Coalition representing a variety of age groups, public and private sectors, and other stakeholders in La Crosse County A written Burden of Alcohol-Related Injury Report An Inventory of Assets in La Crosse County A written 3-5 year Strategic Plan for accomplishing the overarching goal Burden of Injury Report Summary One of the key tasks before completing this strategic plan was to collect actual data on the burden that alcohol-related injuries have on the resources of La Crosse County, including law enforcement efforts, emergency room and inpatient hospital treatment, and license violations. Below are some highlights from the report, Risky Drinking Behavior Alcohol Use and Injury in La Crosse County : There were 14 alcohol-related injury deaths for 15-24 year olds in La Crosse County for the five year period 2003-2007. For 12-24 year old La Crosse residents, 10% of all emergency department visits for intentional injury and 3% of all emergency department visits for unintentional injury were alcohol-related. For the same group, 34% of all inpatient hospital stays for intentional injury and 21% of all inpatient hospital stays for unintentional injury were alcohol-related. 4,517 police calls in La Crosse County were alcohol-related for 2006-2007. In the city of La Crosse, underage drinking violations were the most common violations. According to the data in the burden report, the most apparent burdens on La Crosse County 12-24 year-olds that were alcohol-related were: Unintentional/accidental deaths Intentional assaults Self-harm injuries and suicides Motor vehicle crashes: o especially on local roads o especially from 2:00-4:00 a.m. o especially in mid-winter and early fall

Asset Inventory Summary Knowing the burden that alcohol-related injuries have on the community offers half of the full picture for La Crosse County. The other, and equally important, half is an inventory of the community s assets those organizations, programs, and projects that help offset the injury burden by offering prevention and treatment services, alternative activities, counseling and self-help options, and community education. One of the key assets of La Crosse County with regard to alcohol-related injuries is the Great Rivers 2-1-1 system, a comprehensive resource database and referral service that connects residents of the La Crosse/Winona region with assistance for substance abuse, mental health, natural disaster, and other human services information. A complete (and updatable) list of community assets was compiled as part of the Changing the Culture project and listed on their website at http://home.lmhsconsortium.org/changingthecultureofriskydrinkingbehavio. Assets we identified in the community tended to focus on treatment of alcohol addiction and abuse and the resulting effects on individuals and their families more than prevention or providing alternatives to the culture of drinking. Assets geared toward the 12-24 year-old population tended to fall into the following categories: Policies and ordinances (community, school, and organizational) Penalties and court programs Counseling programs Activities for youth Training and mentoring programs Informational campaigns, such as Parents Who Host Lose the Most In reviewing these assets, suggested improvements were: Effective geographical coverage for policies that have shown success Consistency in how policies are enforced and penalties issued in the county Non-alcohol-related activities that are attractive to 12-24 year-olds The public health issue approach One of the key reasons our planning efforts to date have received the community and media support they have is that we have addressed the issue of changing the culture of risky drinking not as one of individual behavior but as a public health issue. Public health issues can be viewed as arising from three different areas of influence: the population involved (the host ), the environment in which it occurs, and the vehicle (the agent ) at the root of the issue (in this case, alcohol, its packaging, its contents, etc.). Using the public health model, our planning effort identified problems, assets, and solutions within each of these three areas and found that environmental influences are most within our control and easiest to change at a community level. These are also the most likely to find

broad-scale support from the community because they do not focus on blame and individual behavior, but on the circumstances and environment that allows and encourages a culture of risky drinking. Selecting evidence-based strategies In defining the goals to be accomplished in this strategic plan, we will focus most of our energy on environmental aspects of the culture of risky drinking that is, determining strategies that will impact the burdens we have measured, reinforce the assets we already have and add more as needed, and bring change to the environment that encourages under- 21 youth to drink illegally and youth up to 24 years to drink in a risky and dangerous way. To accomplish this, we will adopt and apply evidence-based strategies that have been proven by scientific studies to have been effective in other communities with similar conditions to ours. These are strategies that, based on data, have been shown to reduce risk in a community. Usually these have been studied through tightly controlled research studies. Such strategies can include education, media campaigns, or alcohol control policies and can influence how beverages are manufactured, packaged, distributed, sold and consumed. We understand that every community is unique, and thus we will focus on strategies that are based on the unique assets and problems within our community of La Crosse County.

Summary of Objectives Note: This is a living document that will change as new information and new leadership become available. Dates and activities are estimates and may change. Overarching Goal Reduce alcohol related injuries among 12-24 year olds in La Crosse County Goal 1 Work with municipalities in La Crosse County to bring consistency county-wide to alcohol-related policies and enforcement Coalition Objective (Use SMART criteria) 1. By December 31, 2013, La Crosse County and its municipalities will consider adoption by resolution a countywide beer keg registration ordinance to include a 31 gallon limit. 2. By December 31, 2013, La Crosse County and its municipalities will seek adoption by resolution a public intoxication ordinance. 3. By December 31, 2013, 50% of liquor licensees (taverns, restaurants and other alcohol licensed establishments) will train employees in evidence-based Responsible Beverage Service in La Crosse County. 4. By December 31, 2013, La Crosse Medical Health Science Center (LMHSC) Changing the Culture Coalition will seek support in a state-wide increase on the alcohol tax. Activities a. Draft ordinance language b. Identify elected official to introduce new ordinance c. Identify community champions to speak at public hearings d. Vote occurs a. Draft ordinance language b. Identify elected official to introduce new ordinance c. Identify community champions to speak at public hearings d. Vote occurs a. Meet with licensees to plan event b. Recruit trainers from La Crosse Police Department c. Develop curriculum or adopt existing curriculum d. Recruit participants through marketing e. Conduct training f. Conduct follow-up evaluation a. Review current resolutions that have been passed b. Identify best practice language c. Identify elected official to introduce resolution d. Identify local champions to speak at public hearings e. Vote occurs Outcomes County and municipalities commit to adopt/not adopt beer keg registration County and municipalities commit to adopt/not adopt public intoxication ordinance At least 300 liquor license holders attend and give feedback on Responsible Beverage Service training. A bill is presented to and voted on by the Wisconsin legislature raising the statewide alcohol tax.

5. By December 31, 2013, law enforcement will conduct alcoholcompliance checks county-wide. a. Meet with La Crosse Police Department staff to determine best practices and discuss technical training assistance with other law enforcement agencies in La Crosse County. b. Organize technical training assistance to all 17 municipalities in La Crosse County based on the need in each community to implement alcohol compliance checks to reduce youth access. Organize a training and discussion about alcohol related issues surrounding underage sales using best practices. c. At least two new municipalities will conduct alcohol compliance checks within La Crosse County. There would be two phases to implement the alcohol compliance checks: completing the training and discussion among municipalities and working with County Sheriff s Department to implement a countywide alcohol compliance check. d. Implement an education and reward program for responsible retailers based on an evidence based model program to identify and educate alcohol establishments that serve or sell alcohol to underage youth. e. Newspaper articles, editorials, and letters to influence community members to increase awareness about how easy it is for underage youth to purchase alcohol and the effectiveness of compliance checks in preventing sales to youth. f. Measure and evaluate the effectiveness of the compliance checks and educational programs, including the licensee training to their employees. 1. Verbal commitment from at least 2 municipalities (other than the City of La Crosse) to conduct alcohol compliance checks. 2. Alcohol Compliance training is conducted for at least 30 law enforcement officers. 3. Compliance checks are conducted and rates are recorded. Citation may be written by law enforcement to either the seller and/or the establishment. Report compliance check results to the local media including radio, newspaper and television. 4. All alcohol licensees will adequately train, supervise, and back up their employees. 5. Newspaper prints articles, editorials, and/or letters. 6. Reduction of illegal underage alcohol sales by 5% each year. 6. By December 31, 2013, La Crosse County and its municipalities will adopt uniform penalties for underage drinkers. a. Review existing ordinance language b. Create a uniform document c. Resolution is introduced d. Vote occurs At least 2 municipalities adopt uniform penalties for underage drinkers.

Goal 2 Work with festivals, schools, school organizations, service and civic groups and employers in the County to adopt best practice strategies to reduce risky drinking and to change the culture of alcohol use. Coalition Objective (Use SMART criteria) 1. By December 31, 2013, LMHSC Changing the Culture Coalition will implement evidenced-based strategies to reduce youth access to alcohol at fifteen festivals or community events in La Crosse County. 2. By December 31, 2013, LMHSC Changing the Culture Coalition will work with Employee Assistance Programs and the La Crosse Chamber of Commerce to help employers establish alcohol policies that discourage the use of alcohol at work-related gatherings. Activities a. Meet with festival organizers to inventory policies and practices in place. Present evidence-based strategies to reduce underage alcohol consumption and sales, and the reduction of injuries. b. Coordinate at least one evidence-based strategy with festival organizers to reduce youth access to alcohol, such as responsible alcohol advertisement or sponsorship other than alcohol. c. Work with La Crosse Police Department and other law enforcement agencies in the county to train ID checkers in practices to eliminate underage sales and consumption at festivals. d. Provide all festival organizers with signage that establish non-drinking areas, prohibit people from leaving drinking areas with alcoholic beverages, educate on the fines associated with purchasing alcohol for minors, and indicating the illegality of providing alcohol to minors and obviously intoxicated persons. e. Evaluate the effectiveness of festival policies in reducing the reported number of alcohol violations, injuries and other accidents associated with underage drinking. a. Meet with EAP and Chamber representatives b. Develop sample policy language c. Develop list of potential employers to reach d. Create marketing information to send out to employers e. Develop feedback method for tracking acceptance of new policies by employers through the internet or mail f. Evaluate feedback for success rate Outcomes a. and b. At least 80% of all festivals agree to adopt at least one new evidencebased practice to reduce underage access to alcohol or to protect legal-age drinkers from alcoholrelated injuries. c. At least half of the festivals will train ID checkers and utilize responsible practices to eliminate underage sales. d. Festivals post signage e. Implementation of evidenced-based strategies to reduce youth access. Data collected on the number of alcohol violations, injuries and other accidents associated with underage drinking. At least 1/3 of all businesses contacted adopt a no-alcohol policy for workrelated gatherings

3. By December 31, 2013, LMHSC Changing the Culture Coalition will work with at least 12 organizations to discourage use of alcohol as a fundraiser through evidence based best practice policies. a. Select and recruit participating organizations b. Meet with fundraisers or development staff c. Jointly devise sample policy language for discouraging alcohol in fundraising activities d. Measure adoption of policies and evaluate success At least 60% of organizations recruited adopt alcohol-free fundraising policies Goal 3 Increase social norms education and alternative activities for youth that supports a change in the culture of risky drinking Coalition Objective (Use SMART criteria) 1. By December 31, 2013, LMHSC Changing the Culture Coalition will implement a social norms campaign in La Crosse County to discourage the negative consequences associated with alcohol consumption. 2. By December 31, 2013, LMHSC Changing the Culture Coalition will implement at least 12 alternative activities for youth to discourage the negative consequences of alcohol consumption. Activities a. Adopt social norms methods from existing evidence-based practices b. Collect data needed to support campaign c. Work with media, schools, and organizations to plan distribution of information d. Prepare timeline for distribution of campaign messages e. Conduct pre-campaign survey of attitudes regarding alcohol consumption and negative consequences f. Develop campaign materials based in part on survey results g. Disseminate materials according to timeline h. Conduct a post-campaign survey to measure changes in attitudes a. Develop means to encourage participation in alternative activities from schools, organizations, businesses, and government agencies b. Recruit teams to implement each activity c. Meet with teams to develop plans for activities and budgets d. Pursue funding for activities e. Implement activities f. Evaluate success by participation rates, surveys requesting satisfaction information, and feedback from participants about likelihood of attending similar events Outcomes Completion of campaign as planned and improvement of attitudes and understanding of alcohol-related consequences by at least 40% Successful implementation of 12 events with at least 80% of intended participation at each. Positive survey results from at least 75% of participants. Feedback collected that can be used to improve activities in future.

Coalition Strategic Plan Goal 1: Work with municipalities in La Crosse County to bring consistency county-wide to alcohol-related policies and enforcement Long-term outcome: Reduce youth access to alcohol and increase responsible service of alcohol through compliance checks and other policies adopted and enforced countywide Timeline: Activities that will lead to achieving objective and long-term outcome(s) Who is responsible to carry out activities? 2009 2010 2011 2012 2013 La Crosse County and its municipalities will consider adoption by resolution a county-wide beer keg registration ordinance to include a 31 gallon limit. La Crosse County and its municipalities will seek adoption by resolution a public intoxication ordinance. 50% of liquor licensees (taverns, restaurants and other alcohol licensed establishments) will train employees in evidencebased Responsible Beverage Service in La Crosse County. Changing the Culture Coalition will seek support in a statewide increase on the alcohol tax. Project Manager, Coulee Council, La Crosse Police Department, Coalition leaders Project Manager, Coulee Council, La Crosse Police Department, Coalition leaders La Crosse Police Department working with Tavern League, Project Manager, Coulee Council, CESA #4, Coalition leaders Project Manager, Coalition leaders, Coulee Council Law enforcement will conduct alcohol-compliance checks county-wide. La Crosse Police ACE Officers, County/Municipal law enforcement, Project Manager, Coalition leaders, media What is the evidence that these activities will lead to the desired outcome? (check all that apply) Published research Appears in Surgeon General's Report on Addressing Underage Drinking Local experience Other: Media plan: Use media to report on policy adoption and/or changes, the Coalition s effort to make these changes, follow bill progress in the legislature, and report results of compliance checks within the larger framework of the project s overall goals.

Coalition Strategic Plan Goal 2: Work with festivals, schools, school organizations, service and civic groups and employers in the County to adopt best practice strategies to reduce risky drinking and to change the culture of alcohol use. Long-term outcome: Reduce underage access to alcohol and alcohol-related injuries by participants in community and school activities Activities that will lead to achieving objective and long-term outcome(s) Changing the Culture Coalition will implement evidencedbased strategies to reduce youth access to alcohol at fifteen festivals or community events in La Crosse County. Changing the Culture Coalition will work with Employee Assistance Programs and the La Crosse Chamber of Commerce to help employers establish alcohol policies that discourage the use of alcohol at work-related gatherings. Changing the Culture Coalition will work with at least 12 organizations to discourage use of alcohol as a fundraiser through evidence based best practice policies. Timeline: Who is responsible to carry out activities? 2009 2010 2011 2012 2013 Project Manager, Project Director, Coalition Members, Festival Organizers, Law Enforcement, Student Groups, Evaluation Team Project Manager, Project Director, Coalition leaders, EAP staff, Chamber staff, Evaluation Team Project Manager, Coalition leaders, Coulee Council, Evaluation Team What is the evidence that these activities will lead to the desired outcome? (check all that apply) Published research Appears in Surgeon General's Report on Addressing Underage Drinking Local experience Other: Media plan: Use media to promote changes in policies for public events (as appropriate), to report on successes in changing employer and organizational policies, and to cover Coalition work with these efforts.

Coalition Strategic Plan Goal 3: Increase social norms education and alternative activities for youth that supports a change in the culture of risky drinking Long-term outcome: Increase understanding and acceptance of negative consequences of alcohol-related injuries and underage use and encourage alternative, alcohol-free activities for underage youth Activities that will lead to achieving objective and long-term outcome(s) Changing the Culture Coalition will implement a social norms campaign in La Crosse County to discourage the negative consequences associated with alcohol consumption. Changing the Culture Coalition will implement at least 12 alternative activities for youth to discourage the negative consequences of alcohol consumption. Timeline: Who is responsible to carry out activities? 2009 2010 2011 2012 2013 Project Manager, Coalition leaders, media, all project partners and volunteers, Evaluation Team Project Manager, Coalition leaders, student group leaders, school administration, Evaluation Team What is the evidence that these activities will lead to the desired outcome? (check all that apply) Published research Appears in Surgeon General's Report on Addressing Underage Drinking Local experience Other: Media plan: Work with media to develop social norms marketing materials, conduct surveys, disseminate campaign data, share results of campaign, promote events

Resources (inputs) What we have: a) Community Coalition: At the core of this project s efforts is a coalition of community members that crosses age and sector boundaries and brings together the history and cultural base of the community with the analytical and research skills of academia to achieve a common goal. Participation in individual meetings has ranged from 30-80 members. b) Burden Report Data: The Changing the Culture of Risky Drinking Behavior project resulted in the report, Alcohol Related Injury and Death in La Crosse County, which demonstrates the burden of alcohol-related injury for 12-24 yearolds in La Crosse County. This Burden Report was based on data collected from local hospitals, law enforcement, and college campuses. c) Potential funding from SAMHSA s STOP Act grant: response to come in September 2008. d) Partner cooperation: La Crosse Medical Health Science Consortium (a collaborative of two medical centers and three higher education institutions), MCW s Injury Research Center, Coulee Council on Addictions, CESA #4, La Crosse City Police Department, and the La Crosse County Health Department. e) Involvement of young people: Over 30 students have been active in the Coalition, and we have formed additional relationships with college-level students through our participation in the Tri-Campus Advocacy Group. In addition, there are three prevention youth groups the Community Youth Initiative, SADD (Students Against Destructive Decisions), and the La Crosse County Health Department s Youth Advisory Council that have implemented various alcohol and advocacy activities within the community. f) In-kind support: The La Crosse County Health Department is providing in-kind time for Director Doug Mormann and Education Director Al Graewin, as well as $1000 in printing, $250 in travel mileage, and $500 in office supplies annually. The La Crosse Police Department (city) is providing in-kind time for three officers (0.15 FTE total) and the use of a meeting hall for two law enforcement conferences. g) Cooperation from the media: The La Crosse Tribune, both television networks, and local radio have attended meetings and shown interest in being part of our continued implementation efforts.

What we need: Additional funding: We will apply for implementation funds from both the HWPP program through the Medical College of Wisconsin and the WPP program through UW-Madison in the 2008-2009 cycles. Additional Coalition members: We will launch a recruiting effort to increase the number of interested and affected community members in the Coalition and encourage them to take on leadership roles in the implementation of this strategic plan. Training: Members of the Project Team will participate in training offered at the annual Wisconsin Prevention Conference whenever feasible.