An Overview of Environmental Prevention Since the NIAAA Call to Action Robert Saltz, Ph.D. Prevention Research Center Pacific Institute for Research & Evaluation Berkeley, California
Why Care About College Student Drinking? Over 1,700 deaths among 18-24 year old college students 590,000 unintentionally injured under the influence of alcohol More than 690,000 assaulted by another student who has been drinking More than 97,000 are victims of alcohol-related sexual assault or date rape About 25 percent of college students report academic consequences of their drinking including missing class, falling behind, doing poorly on exams or papers, and receiving lower grades overall
Twice Mean Score for 5+ Drinks in a Row in Past 2 Weeks by 4-year College Student Status Once College Non-College None Wave 1 Wave 2 Wave 3 Wave 4 (18) (19-20) (21-22) (23-24) Measurement Wave Pacific Institute for Research and Evaluation P RC Prevention Research Center
Task Force Recommendations Tier 1: Evidence of Effectiveness Among College Students Tier 2: Evidence of Success With General Populations That Could Be Applied to College Environments Tier 3: Evidence of Logical and Theoretical Promise, But Require More Comprehensive Evaluation Tier 4: Evidence of Ineffectiveness
Recommendations Tier 1 Combining cognitive-behavioral skills with norms clarification and motivational enhancement interventions Offering brief motivational enhancement interventions Challenging alcohol expectancies
So Why Not Just Take One of Those? Most targeted to high-risk drinkers Difficult to implement with fidelity Labor intensive Costly for large populations.work continues on all these limitations
RELATIVE PRODUCTION OF PROBLEMS BY FREQUENT BINGE VS. NON-BINGE DRINKERS (CAMPUS SAMPLE, '98 - '99 SCHOOL YEAR) CRIME VICTIM 1 POLICE TROUBLE SEX VICTIM 2 PHYSICAL FIGHTS SEX PERP 1 SEX VICTIM 1 UNPROTECT SEX PERFORM POORLY DAMAGE THINGS INJURED ARGUE DUI UNPLANNED SEX WORK HIGH DRINK DRIVING RUDE FORGET CRITICIZED RIDE WITH DUI REGRETS MISS CLASS BEHIND WORK VOMIT DRINK CONTEST HANGOVER 1600 1400 1200 1000 800 600 400 200 0 FREQUENT BINGE DRINKERS NON-BINGE DRINKERS FIFTY-PERCENT CONTROL LINE CRIME VICTIM 2 OVERDOSE SCHOOL TROUBLE SEX PERP 2 PROBLEM CATEGORY NUMBERS OF PROBLEMS
Recommendations Tier 2 Increased enforcement of minimum drinking age laws Implementation, increased publicity, and enforcement of other laws to reduce alcoholimpaired driving Restrictions on alcohol retail outlet density Increased price and excise taxes on alcoholic beverages Responsible beverage service policies in social and commercial settings
Environmental Policies to Reduce College Drinking: An Update of Research Findings Toomey, Lenk, & Wagenaar (2007) Journal of Studies on Alcohol and Drugs
Correlational Studies Outlet density near campuses associated with alcohol consumption and problems Weitzman et al, 2003a; Williams, et.al, 2004; Wechsler et. al, 2002 Price, promotion, taxes related to consumption Weitzman, et al, 2003b; Williams, et.al., 2004; Kuo, et.al. 2003 Reduced access to alcohol Dry Campus tied to lower use (maybe not in high density environments) Wechsler, et. al, 2001a; Williams, et.al, 2004, 2005 Alcohol-Free Residences vs. Substance-Free Residences Williams, et.al., 2004; Wechsler, et.al, 2001a&b Having more local and state alcohol policies is related to lower high-risk drinking (Nelson, et.al, 2005a)
Opportunistic Studies Controlled Access Keg ban increased consumption (Kilmer, et.al, 1999) Alcohol-free residences and Greek housing lowers prevalence, but not high-risk drinking (Odo, et.al, 1999) Stadium ban lowers problems (Borman & Stone, 2001) Social norms campaigns Reduced consumption: Glider, et.al, 2001; Mattern and Neighbors, 2004; Smith et.al, 2006 but not always Clapp, et.al, 2003 Multi-component Interventions Homecoming Game (Johannessen, et.al, 2001) Massachusetts State campuses (Knight, et.al, 2003) Albany Campus-Community Intervention (Gebhardt, et.al, 2000)
Rapid Response Initiative Residence Hall Interventions University of Michigan Residential Learning Communities McCabe/Lange > Fordham Resident Alcohol Prevention Program Fisher/Saltz Social Norms Campaigns Ohio State University - Buettner/Rhodes Minnesota State University Mankato - Connolly/Lange Campus-Community Interventions University of Rhode Island Common Ground Cohen/Wood Western Washington University NEST Program - Saltz/Welker >
Selection effects Socialization effects Source: McCabe et al., 2007
Rapid Response Initiative Residence Hall Interventions University of Michigan Residential Learning Communities McCabe/Lange Fordham Resident Alcohol Prevention Program Fisher/Saltz Social Norms Campaigns Ohio State University - Buettner/Rhodes Minnesota State University Mankato - Connolly/Lange Campus-Community Interventions University of Rhode Island Common Ground Cohen/Wood Western Washington University NEST Program - Welker/Saltz >
Common Ground Status Report Fran Cohen Mark Wood Presented at the February 2008 Steering Committee Meeting for the NIAAA Rapid Response to College Drinking Initiative
Project Summary Aims: Examine effectiveness of environmental management (EM) interventions delivered through an existing campus-community coalition Decrease Access Increase Enforcement Publicized through RhodeMap to Safety Campaign Status U18 Grant: 2004 2007 U01 Grant: 2003 2008 www.uri.edu/alcohol/rhodemap
Outcomes Student surveys Four annual student surveys (N ~ 500) Series of ANOVA s examining awareness of efforts, perceptions of enforcement and alcohol availability, and behaviors Archival data Police reports of student incidents in community
Heard About DUI Enforcement Perc. DUI Enforcement 4 3.5 3 2.5 2 1.5 1 RMS Linear Trend**** 2004 2005**** 2004 2006**** 2004 2005 2006 2007 Year 2004 2007**** **** p <.0001
Likelihood of Drinking and Driving Consequences Likelihood of D & D Cons. 3.5 3 2.5 2 1.5 RMS 2004 2005 2006 2007 Linear Trend**** 2004 2005**** 2004 2006**** 2004 2007**** Year **** p <.0001
Self-Reported Behaviors No significant differences on: Alcohol-impaired driving Composite measure of alcohol use Alcohol use at off-campus parties Reported difficulty finding off campus parties Summary of survey data Consistent effects on awareness and perceptions/consequences of enforcement of EM strategies No evidence for impact on self-reported alcohol use or drinking and driving
Campus Community Strategy to Change the Drinking Culture Western Washington University Bellingham, Washington
Campus Community Strategy to Change the Drinking Culture Primary Aims 1. To test and evaluate the efficacy of limiting college student access to alcohol though increased enforcement of minimum drinking age laws in the WWU-Bellingham campus community. 2. To pilot test and evaluate the efficacy of the Neighborhoods Engaging with Students (NEST) Project, a multi-component environmental intervention that increases the bonds of students to campus and community and enhances their sense of belonging and responsibility.
Project Components Neighborhoods Engaging with Students (NEST) Enforcement LateNight@WWU Campus Community Coalition work groups were involved in planning, implementation, and process evaluation.
Project Evaluation 3 intervention neighborhoods (Bellingham) WWU and two comparison campuses Student Voices Survey,»Online, Fall 05 and Fall 06»Sample size, response rates»incentive structure Enforcement data Implementation/process measures
Comparison
Comparison
Intervention Comparison
Intervention Comparison
Controlled Interventions San Diego DUI Intervention Clapp, et.al., 2005 A Matter of Degree Weitzman, et.al., 2004 Social Norms Marketing DeJong, et.al., 2006 > Safer California Universities Saltz, et.al., under review
Social Norms Marketing Research Project National Institute on Alcohol Abuse and Alcoholism and U.S. Department of Education R01 AA 12471
Students have exaggerated views of how much other students drink Students perceive greater normative expectations to drink Students increase alcohol consumption
Social Norms Marketing Use campus-based media to report accurate drinking norms Decrease in perceived normative expectations to drink Decrease in alcohol consumption
Sample Campaign Materials
Mean Number of Drinks When Partying by Experimental Group & Alcohol Outlet Density Mean Number of Drinks 5 4.5 4 3.5 3 2.5 2 1.5 1 0.5 0 Year 1 Year 4 Year 1 Year 4 Low-Density Campus Control Treatment High-Density Campus
Safer California Universities Project Goal To evaluate the efficacy of a Risk Management approach to alcohol problem prevention NIAAA grant #R01 AA12516 with support from CSAP/SAMHSA.
Random Assignment Intervention Sites CSU Chico Sacramento State CSU Long Beach UC Berkeley UC Davis UC Riverside UC Santa Cruz Comparison Sites Cal Poly SLO San Jose State CSU Fullerton UC Irvine UC Los Angeles UC San Diego UC Santa Barbara
Integrated Intervention Strategies for Off-Campus Drinking Compliance Checks DUI Check Points Party Patrols Social Host Response Cost Ordinance Social Host Safe Party Campaign
Outcomes Likelihood of getting drunk at a given generic setting (e.g., Greek parties; residence halls) plus additional aggregate measure across all settings Two baseline years combined vs. two years post-intervention combined Controlling for individual-level variables and campus/community variables
DUI or RWDD Related to Off-Campus Party 0.20 0.15 0.10 0.05 Intervention Control 0.00 2003-04 2004-05 Survey years
In addition No Displacement
In Sum We are building more evidence in support of Tier 2 interventions for college populations We are building better capability for achieving population-level change We are building capability for more rigorous evaluations of environmental interventions
Part 2 Planning and Evaluation as a Practical Matter
Objectives of the Guide to Planning and Evaluation To facilitate successful adoption by college campuses of NIAAA Task Force recommendations To foster integration of evaluation into prevention programs and policies To increase chances of success for any campus prevention initiative
Reducing Alcohol Problems on Campus: A Guide to Planning and Evaluation Introduction
Reducing Alcohol Problems on Campus: A Guide to Planning and Evaluation Introduction Steps for Effective Prevention Planning and Evaluation
Steps for Effective Prevention Planning and Evaluation Identify Specific Goals and Objectives What exactly is the objective? The role of needs assessment Choose intervention after setting objectives The more specific the better
Steps for Effective Prevention Planning and Evaluation Identify Specific Goals and Objectives Review Research on College Drinking Interventions Consult typology of programs within Social Ecological Framework Match strategy with objectives
Steps for Effective Prevention Planning and Evaluation Outline How the Intervention Will Work Perhaps most important step Develop a Logic Model
Alcohol-involved traffic crashes Distal outcome Media advocacy training Technical assistance Additional officer hours Breathalyzers Training Checkpoints Project inputs DUI news coverage DUI enforcement Community outputs Perceived risk of arrest Drinking and driving Intermediate variables
Alcohol-Related Motor Vehicle Crash Causal Model Alcohol Sales & Service Regulations, Enforcement & Sanctions DUI Enforcement Community activism about DUI enforcement Public Awareness of Drinking/Driving Enforcement Price Retail Availability Alcohol Serving and Sales Practices Perceived Risk of DUI Arrest Community Norms Drinking and Driving Alcohol Promotion Drinking Driving After Drinking Alcohol-Related Motor Vehicle Crashes Community Norms - Drinking Individual Factors Social Availability Strong Relationship Drinking Context Moderate Relationship Minor Relationship Little Empirical Evidence but logical relationship
Why the Logic Model is critical Will pinpoint areas of uncertainty, confusion or disagreement among team Can expose potential false assumptions Help guarantee that activities are linked to specific objectives Can later serve as educational tool Can be used to track changes in intervention Helps inform the evaluation
Steps for Effective Prevention Planning and Evaluation Identify Specific Goals and Objectives Review Research on College Drinking Interventions Outline How the Intervention Will Work Create and Execute a Data Collection Plan Communicate Evaluation Results
Reducing Alcohol Problems on Campus: A Guide to Planning and Evaluation Introduction Steps for Effective Prevention Planning and Evaluation Program Evaluation: The Big Picture
Reducing Alcohol Problems on Campus: A Guide to Planning and Evaluation Introduction Steps for Effective Prevention Planning and Evaluation Program Evaluation: The Big Picture Resources
Typical Hurdles for Comprehensive Prevention Strategy Implicit assumption that the only target is high-risk drinkers Ambivalence about student drinking Low perceived efficacy of preventive interventions Challenges of coordination and resource allocation Possible fears of backlash
Unique Hurdles for College Prevention Emphasis on process over outcome Preference for persuasion over control Universities are complex, diffuse organizations Prevention staff trained in education, awareness strategies Prevention staff usually lacks authority to launch initiatives
Use Evaluation at All Points to Achieve Intervention Success
Future Research: Where are we heading? Evaluating Full-Spectrum Comprehensive Interventions Replications Effectiveness Studies (with emphasis on mediators and moderators) Diffusion Research Basic Research on Organizational and Community Change
Thank You!