Social norms and student substance use interventions in the USA

1. Social norms and student substance use interventions in the USA jennifer bauerle, Ph.D. Director, National Social Norms Institute University of Virginia

2. Outline • Review alcohol trends among US college students • Review University of Virginia (UVa) drinking • Review legal drinking age & binge rates • Review UVa approach to alcohol • Review decade long changes in alcohol at UVa

3. Where is the National Social Norms Institute (NSNI)? Charlottesville, Virginia

4. UVA & Drinking “Their drink at all times water, a young stomach needing no stimulating drinks, and the habit of using them being dangerous.” Thomas Jefferson, June 4, 1819

5. Binge Drinking All US College Students BLUE: Monitoring the Future - Survey 1975-2010; Volume II. College Students and Adults Ages 19-40. 2011. University of Michigan and Department of Health and Human Services.

6. National Binge Drinking Rates by Student Characteristics • Male>Female (48% vs. 39%) • White>Asian>African American (47% vs. 25% vs. 18%) • Age (< 24 years 46% vs. > 24 years 29%) • Residence (Greek 80% vs. Dorms 45% vs. off campus 40%) • Greek member > all students (65% vs. 43%) • Residential > commuter (47% vs. 30%) * • North Central (47%), Northeast (46%), South (41%), West (34%) * • 4 year institution > 2 year institution (39% vs. 34%) ** • Rural/small > suburban/urban (46% vs. 41%) * • Academic rigor, size, public/private, and religious affiliation have no influence *Adapted from Wechsler et al. J. Am. College Health 1998

7. UVa Annual Alcohol-Related ER Experience Undergraduates

8. Alcohol Related Disorders leading to ER visits • Alcohol Dependence- (~4%)tolerance, withdrawal, used over long periods of time, persistent desire to obtain and use, unable to cut down, inability to maintain social, occupational, or recreational activities, continued use despite legal, psychological, and health problems. • Alcohol Abuse- (~4%)recurrent use resulting in failure to fulfill major obligations, use in situations which are physically hazardous (DUI), recurrent alcohol related legal, social, or interpersonal problems. • Alcohol Intoxication- (~92%)isolated and reversible intoxication due to recent ingestion, clinically significant behavioral, psychological, or health problems.

9. Alcohol Related Disorders leading to ER visits UVA Stall Seat Journal • Alcohol Dependence- (~4%) tolerance, withdrawal, used over long periods of time, persistent desire to↙↙↙ obtain and use, unable to cut down, inability to maintain social, occupational, or recreational activities, continued use despite legal, psychological, and health problems. • Alcohol Abuse- (~4%) recurrent use resulting in failure to fulfill major obligations, use in situations which are physically hazardous (DUI), recurrent alcohol related legal, social, or interpersonal problems. • Alcohol Intoxication- (~92%)isolated and reversible intoxication due to recent ingestion, clinically significant behavioral, psychological, or health problems. Readily responds to educationand intervention

10. Turner, Bauerle, Shu. J. of Studies on Alcohol. 65:741-749. 2004

11. Can we stop the drinking? Can we minimize dangerous drinking?

12. Promote Responsibility and Reduce Harm • 21 year old drinking law is a social experiment on college campuses that has failed: • to limit access • to lower drinking • to decrease traffic accidents and fatalities • to decrease health consequences

13. Comparison of Alcohol Purchase Ages In EU and US

14. Use Complementary Strategies and Methodologies • Environmental management (EM) • Policies and laws • Enforcement • Referrals for education and medical evaluation • Community coalitions • Server training • Health Education • Social Norms Marketing (SNM) • Marketing healthy and safe norms (reinforces safer consumption and use of more protective behaviors). • Correcting misperceptions about normative behaviors and attitudes

15. UVa Alcohol Programming • Environmental • Risk management education for Greeks • Police outreach and intervention • SafeRide, Designated Drivers program, Late night programming • Fraternal organization requirements, student athlete mentors • Celebratory drinking events (Halloween, Foxfield, Spring Break) • Judiciary penalties • Health Education • Social Norms Marketing • Peer educators • Parent/student orientation • Stall Seat Journal • Campus posters • Media messages • BAC cards • Online education

16. Examples of misperceptions among UVa students

17. Correcting misperceptions • Accurate info. About frequency & quantity of alcohol

18. Quantity and Frequency 4

19. Signs of alcohol poisoning or injuryCaring for an intoxicated friend Using the ER

20. Need to go the hospital? • UVa officials, Dept. of Student Health clinicians, and ER doctors do not notify police for alcohol related incidents. • Parents or guardians are not notified without student permission unless a situation is deemed life threatening. Whenever an emergency 911 call is made on Grounds, University police officers are dispatched to assist with the response. On occasion, follow up and investigation will take place if deemed necessary….

21. Hoo Knew

22. Hoo Knew

23. Hoo Knew

24. Hoo Knew?

25. BAC cards for self-monitoring

26. Bottom Line

27. Negative Consequences All UVa Undergraduates 2001-2010 .40* .47* .37* .68** .72** Odds Ratios *p<.001 **p<.01

28. Negative Consequences All UVa Undergraduates 2001-2010 .24* .38* .19* .51* .55** Odds Ratios *p<.001 **p<.01

29. Comparative NCHA National Data v. Consortium Aggregate :Negative Consequences

30. UVa Undergraduates: Mean eBAC & 99% CI

31. Campaign exposure predicts outcomesFirst YearUndergraduates 2001-2006(Internal Control Group) Multivariate Analysis: • First year students exposed to the UVa campaign had 24% lower odds of having a BAC ≥ .08 (p = 0.024) • First year students exposed to the UVa campaign had 22% lower odds of suffering two of ten possible negative consequences (p=0.002) Turner, Perkins, Bauerle. J. Am. Coll. Health. 2008. 57:85-93.

32. Emergency room visits at UVa • SNM project has encouraged friends caring for friends and using the ER • ER visits are up > 100% • Hospital admissions are (closed head trauma, alcohol poisoning) decreased • Incident rate of injury has declined mirroring declines in self-reported injury (ref: Keller A, Turner JC, and Bauerle J. Longitudinal comparison of ED admissions for alcohol-related trauma and self-reported alcohol-related injury in a college population. The American Journal of Drug and Alcohol Abuse. 2010. 36:194-198) “More students are seeking appropriate care for themselves and friends.”

33. Another Bottom Line

34. Outbreak of Health? • 2010 compared to 2001: • 2741 fewer students suffered injuries • 2883 fewer students drove under the influence • 711 fewer students had unprotected sex • 2001 to 2010: • 23,300 more students over 10 years no negative consequences related to alcohol. • Significant increases in use of protective behaviors. • Increased use of emergency services, less severe conditions • Twenty Year Trend of decreasing mortality rates due to alcohol-related unintentional injury

35. Thank you! Please contact me with questions at: bauerle@virginia.edu Or visit our web site at: www.socialnorms.org