How can we reduce college student drinking?

1. How can we reduce college student drinking? Lessons learned from the Harvard School of Public Health College Alcohol Study and the “A Matter of Degree” Program Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota

2. College Alcohol Study Harvard School of Public Health

3. Individual-level Variation in Drinking High Risk Groups Males (Wechsler et al. 1995) Prior drinking history (Wechsler et al. 1995) Other substance users (Wechsler et al. 1995) Fraternity & Sorority members (Wechsler, Kuh & Davenport, 1996) Athletes (Nelson & Wechsler, 2001) Sports Fans (Nelson & Wechsler, 2003) What kinds of interventions do these findings suggest?

4. College Alcohol Study Harvard School of Public Health

5. High Binge Campuses At one third of campuses, more than half of the students were binge drinkers. College Alcohol Study Harvard School of Public Health

6. Can We Identify 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

7. Beer kegs and bar specials make alcohol one of the cheapest forms of entertainment at high-binge colleges. College Alcohol Study Harvard School of Public Health

8. Price, by alcoholic drink What’s being sold? (6 sites) • Per drink from keg 24 cents • Per can from 12 (24) pack 37 cents • Drink specials at bars/clubs 75 cents • Entry into Greek party $1.50 • Entry into non-Greek party $1.88

9. Price, compared to other drinks 1.5 drinks at a bar* (range 1 to 6) *based on specials OR 1 coffee (average cost of $1.09) = 4.6 drinks from a keg (range 3 to 7) OR 3 cans of beer (range 2 to 4)

10. Price, compared to other activities 8 drinks at a bar* (range 6 to 31) *based on specials OR 1 movie ticket--1st run (average cost of $5.86) All you can drink at a party for 3-4 people = OR 25 drinks from keg (range 20 to 36) OR 16 cans of beer (range 11 to 22)

11. Iowa City, IA Weitzman et al. (2003)

12. “A Matter of Degree” program • Program developed from College Alcohol Study – funded by Robert Wood Johnson Foundation • Started in 1996 • Goal reduce binge drinking & related harms through changing environment • Advertising/Promotion • Access & Availability • Pricing • Other

13. AMOD Sites • 10 Campus-Community coalitions • Coalition “agent” of change • Multiple change agents in the community 5-8 year interventions • Local problem definition and local solutions

14. Can campus-community coalitions implement environmental prevention? • Can environmental prevention reduce drinking and related harm?

15. Public Health Triad Agent Host Environment

16. Knowledge Pricing Attitudes Composition Intentions Labeling Skills Packaging Advertising/Promotion Legal Sanctions Availability Institutions Physical Context SocioculturalContext KeyInfluencers Drug-Related Problems Person Drug Environment Torjman (1986)

17. Findings • 255 interventions • Focus on… • Host (Knowledge & Intentions) • Environment (Sociocultural context) • Relatively few interventions address • Advertising/Promotion • Availability • Only one addressed features of the alcohol itself (Price) • Varied by site… • Modest declines in schools with highest environmental implementation • No similar decline in low environment sites Weitzman, Nelson, Lee & Wechsler (2004)

18. Changes consistent w/ major policy initiatives • Uniform Police Reporting Form • Prohibit alcohol ads in campus publications • Birthday Bar list • Landlord Ordinance • Two strikes and suspension • Off-campus Transportation Events Policy • Parental Notification • Party Host Rules • 1st year student Sanction Policy Change

19. Challenges for Environmental Interventions • Sites with less initial support among coalition members were less likely to implement • Take time to implement • Significant barriers to implementation • Students • Public opinion • Key leader opinion • Industry activism • Elicit negative reactions • Requires efficacy, outcome expectancy and persistence

20. Lessons Learned • Sites differ in their implementation • Tensions involving program outcomes, interventions and problem definition are inter-related • Conceptual frameworks matter • AOD prevention staff are not trained for environmental prevention

21. Key features of stronger program development Leadership Evidence-based agenda Strategic plan based Measurable benchmarks Environmental interventions Network ‘savvy’

22. Recommendations Understand community-level change Pursue recommended, evidence-based interventions Dedicated, empowered and appropriately skilled staff Carefully recruit stakeholders Measure and evaluate Be prepared to ruffle feathers

23. Harvard School of Public Health COLLEGE ALCOHOL STUDY http://www.hsph.harvard.edu/cas

24. http://ww.epi.umn.edu/alcohol