A STATEWIDE INITIATIVE IN MARYLAND

Establishing a Collaborative to Reduce Excessive Drinking among College Students

Maryland Association of Prevention Professionals and AdvocatesNovember 14,2012

David Jernigan, PhDJohns Hopkins Bloomberg School of Public Health

• Acute adverse health effects:

Acute poisoning Assaults/violence Accidents and

injuries• Increased risk of other

drug use• Alcohol-impaired driving• Harms to others• Loss of study time• Academic failure• Chronic health effects or

disease• Family dysfunction• Unemployment• Alcohol use disorders• Community

disintegration

Excessive drinking can lead to a wide array of consequences

Excessive Alcohol

Consumption:

Heavy Drinking

Underage Drinking

Binge Drinking

Youth (age 12-20) Binge Drinking in the U.S.: Much better than it would have been without community efforts, but not making the progress we should be making

Source: NSDUH 2010 (SAMHSA 2011)

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Trends in NSDUH, 1979-2006

Individuals younger than 20 years have experienced marked reductions in risk for binge drinking, suggesting that changes in the MLDA, as well as other policy changes and public health campaigns, have been successful.

Countering the former trend, risk for binge drinking among girls and young women has been rising, with risk increasing faster for minorities than for whites.

The reduction in risk for binge drinking among youths has not reached college students. (Grucza et al. 2009)

• Many colleges do not use validated assessment tools to screen for alcohol problems.a

• Information-only educational approaches are the most commonly used prevention strategy (98%), but shown to be the least effective.b

• While the research points to interventions that might work, these strategies are often not effectively implemented.b

• For individual-level interventions, there is room for improvement via increased personalization.

• Very few colleges implement community-based alcohol control strategies.baWinters, KC, Toomey, TL., Nelson, TF et al. Screening for Alcohol Problems among 4-Year Colleges and Universities. J

Am Coll Health 2011, 59: 350-357. bNelson, TF, Toomey TL, Lenk KM et al. Implementation of NIAAA College Drinking Task Force Recommendations: How are Colleges doing 6 years later? Alc Clin Exp Research 34:1687-1693,2010.

Nationally, most approaches to reducing college drinking have limited success

The Problem in MarylandA preliminary assessment of 44 institutions of higher

education in Maryland was completed earlier this yeara

• Eleven colleges with two-week prevalence data on high-risk drinking on their campus

• Prevalence estimates ranged from 43.8% to 50.5%, above the national averageb

• Numerous short term and anecdotal indicators

• Like most states, Maryland has a college-age binge drinking problem

aBased on visits to all 44 campuses, personal interviews with campus contacts, and collection of available datab Monitoring the Future Study, National Survey on Drug Use and Health

The National Institutes of Health groups college alcohol prevention strategies into four tiers:

Tiers 1 & 2: Shown effective among college students or among the general population

Tier 3: Showing logical or theoretical promise but unproven

Tier 4: Ineffective when used alone

4 Tiers of Interventions

Where we are Now

In Maryland and elsewhere, Tier 3 & 4 activities are most common;

Tiers 1 & 2 least common

Tier 1: Effective Among College Students

• Cognitive Behavioral Skills Training with norms clarification and motivational interviewing

• Brief Motivational Interviewing

• Challenging Alcohol Expectancies

NIAAA’s College Alcohol Prevention Strategies

Examples of Tier 1 in Maryland IHEs: Effective Among College Students

• Brief Alcohol Screening and Intervention for College Students (BASICS)

• Own alcohol education class that may/may not incorporate some of these strategies

• CHOICES (Choosing Healthy Options in the Campus Environment; group format)

NIAAA’s College Alcohol Prevention Strategies

Tier 2: Effective Among The General Population

• Increased enforcement and publicity of minimum drinking age laws and other laws to reduce alcohol-impaired driving

• Dram shop liability

• Restrictions on alcohol outlet density

• Increased prices and taxes on alcoholic beverages

• Responsible beverage service policies

• Campus and community coalitions

NIAAA’s college alcohol prevention strategies

Examples of Tier 2 in Maryland IHEs: Effective Among The General Population

·Responsible beverage service on-campus·Campus/community coalitions (including multi-campus coalitions)·Campuses involved with a campus/community coalition·Campuses with involvement or potential involvement in an MSPF coalition·Involvement or awareness of compliance checks in the community

NIAAA’s College Alcohol Prevention Strategies

Tier 3: Logical and Theoretical Promise, but unproven

• Social norms marketing campaigns• Increased enforcement and publicity of underage drinking laws

on campus• Alcohol-free housing and activities• Campus ban on alcohol• Class schedule• Further control of alcohol use at sporting events• No industry sponsorship• Information for students at orientation, communication with

parents• Consistent disciplinary action

NIAAA’s College Alcohol Prevention Strategies

Tier 4: Ineffective When Used Alone

·Discussion of alcohol in course curriculum·BAC cards/information·Residence hall programs·Information booths/tabling·Brochures/pamphlets·Student Health 101 newsletter·Safe Spring Break Information·21st Birthday cards·Speakers·Participation in NCAAW (National Collegiate Alcohol Awareness Week)

NIAAA’s College Alcohol Prevention Strategies

Three Areas of Focus:

1) Reducing alcohol use and related problems among underage college students,

2) Among all college students, and

3) De‐emphasizing the role of alcohol and creating positive expectations on campus.

Toomey, Lenk, and Wagenaar

Environmental Strategies And college students

Environmental interventions:underage students

Decreasing commercial access to alcohol Limit alcohol sales

Prohibit sales on campus Restrict/ban home deliveries

Focus on alcohol establishment behavior Check age identification Provide incentives for checking identification Develop monitoring system Train managers/servers Require server license Restrict age of seller

Reduce use of false age-identification cards Penalize users and producers Design cards that are difficult to falsify

Enforce commercial provision laws Implement compliance checks Enact administrative penalties Conduct walk-throughs

Environmental interventions: all college students

Restricting where, when, and how alcohol is sold and distributed Reduce density of alcohol establishments

Increase cost of alcohol license Restrict days/hours of sale Prohibit sales on campus Monitor increases in availability due to privatization or community events

Promote responsible alcohol service Serve standard sizes Prohibit pitchers Cut-off service to intoxicated individuals Promote alcohol-free drinks/food Eliminate last-call announcements Require manager/server training Enact dramshop liability

Reduce flow of alcohol at parties Ban beer kegs Restrict/ban home deliveries Limit quantity of alcohol at events Do not allow self-service Make alcohol-free drinks and food available Serve low-alcohol content drinks

Increasing the price of alcohol Restrict happy hours/price promotions Limit free alcohol Increase alcohol excise tax

Restricting where alcohol is consumed Restrict consumption to specific areas Create dry campuses/residences Prohibit consumption in locations where heavy

drinking occurs

Environmental interventions: all college students

• Decrease Social Access to Alcohol

• Decrease number of large drinking parties

• Prevent underage access at parties

• Increase awareness of laws

• Pass and enforce social provision laws

Toomey, Lenk, and Wagenaar

Environmental Strategies forUnderage College students

• Decrease Commercial Access to Alcohol

• Limit alcohol sales

• Focus on alcohol establishment behavior

• Reduce the use of fake IDs

• Enforce commercial provision laws

Toomey, Lenk, and Wagenaar

Environmental Strategies forUnderage College students continued

Restrict Where, When, and How Alcohol is Sold and Distributed

• Reduce the density of alcohol establishments

• Promote responsible alcohol service

• Reduce flow of alcohol at parties

Toomey, Lenk, and Wagenaar

Environmental Strategies forAll College Students

Increase the Price of Alcohol

Restrict Where Alcohol is Consumed

Toomey, Lenk, and Wagenaar

Environmental Strategies forAll College Students continued

Restrict Where, When, and How Alcohol is Sold and Distributed

• Avoid alcohol industry sponsorship• Restrict alcohol advertising• Prohibit alcohol sales on campus• Offer late night and weekend recreational sports• Conduct social norms campaigns• Encourage students to work, volunteer, or

complete internships• Encourage staff and faculty to live on campus

Toomey, Lenk, and Wagenaar

De-Emphasizing the Role of Alcohol and CreatingPositive Expectations on Campus

• Enlist support of top level leaders• Engage in campus policy development and

enforcement• Recruit and support qualified staff• Attention to process and culture of coalition• Embrace the environmental model

A Matter of Degree Initiative to Reduce Binge Drinking at Colleges andUniversities: Lessons Learned. Princeton: Robert Wood Johnson Foundation; 2008.

A Matter of Degree: Keys to Successful Campus-Community Coalitions

• Collect data to support problem assessment and responses

• Commit to advocacy and policy change• Engage in media advocacy and

communication strategies• Share responsibility for solutions• Think long-term

A Matter of Degree Initiative to Reduce Binge Drinking at Colleges andUniversities: Lessons Learned. Princeton: Robert Wood Johnson Foundation; 2008.

A Matter of Degree: Keys to Successful Campus-Community Coalitions

continued

NCHIP: Dartmouth-led National Learning Collaborative

Colleges “bought in” with initial investment of $20,000 each

Learning collaborative concept – no one is obligated to do anything, all try different mixes of strategies, all get to learn from each other 33 institutions 4 from Maryland

MD Collaborative – learning from other learning collaboratives Participation voluntary Development of common resources and measurement

system

Alcohol Strategies

at

Maryland Colleges

Policies

About a third of Maryland colleges:

Ban kegs Provide responsible beverage service guidelines for

events Notify parents of student policy violations

4 Colleges have medical amnesty/Good Samaritan policies

Data Collection

2010 Clery statistics: Liquor law violations: 0 – 164 arrests Liquor Law Violations resulting in judicial referrals: 0 –

1062

MD IHEs collect data from: NCHA CORE Survey Instrument of their own creation Alcohol Edu/Everfi Other on-line educational program Or Do Not Survey about health-related behavior

Prevention/Intervention Strategies

Most commonly cited: Online education/prevention programs Peer education Information dissemination Provision of alcohol-free activities

Differences appear between 4-yr and 2-yr colleges, and campus size and setting are also influential

4 different campus/community coalitions exist

Common Challenges

Staffing and resource limitations

Sending a clear and consistent message

Changing the culture and combating traditions

Suggestions from the Schools

Provide financial support Funding for programming and conferences Facilitate resource sharing Financial incentives to colleges that get their numbers

down

Provide resources and staffing support Provide additional dedicated staff members Provide access to community resources Provide research expertise and presentations

Suggestions from the Schools (cont’d)

Support knowledge development Highlight best practices Discuss cost-effective prevention and intervention Share successful examples with a “how-to” guide Educate about Maryland/campus laws, policies and

procedures Discuss “what’s hot and what works”

Support skill development Educate about crisis response Offer training about how to implement environmental

strategies

Suggestions from the Schools (cont’d)

Assist with Planning, Monitoring, and Evaluation Assist with data collection and sharing Educate about best practices for measuring outcomes Track high school data Provide technical assistance Assist with trending Help link alcohol-related problems to retention Provide training and assist with program evaluation

Suggestions from the Schools (cont’d)

Foster Broader Collaboration with: Campus representatives at multiple levels Police State agencies (e.g. Highway Administration) Paramedics

Create and Promote a Communication Network Create a directory of policy and security contacts for each

campus Connect people in similar positions across campuses (e.g.

activity directors, counselors) Facilitate information sharing when students transfer (i.e.

violations) Encourage cost-sharing and multi-campus scheduling for events

Suggestions from the Schools (cont’d)

Empower Students Encourage student initiated endeavors Provide positive recognition Subsidize bystander intervention training Discuss message receptivity

Recommendations

Establish a statewide college drinking initiative Encourage cooperative relationships for sharing

best-fit practices and experiences. Build support from broad campus constituencies,

including college presidents and upper-level administration.

Identify additional stakeholders (i.e. support from other established organizations that can help garner sustained interest and leverage curiosity and investment in results).

Consider creating a statewide coalition/consortium to facilitate information sharing among the IHES.

Recommendations (cont’d)

Look at college drinking as a public health issue. Take the burden off individuals and expand the realm

of possible solutions for addressing the problem. Pay attention to the epidemiologic triad and the goal of

population-level change. Incorporate the three core functions: assessment,

policy development, and assurance.

Create a statewide assessment measure (survey) for capturing data about college drinking.

Recommendations (cont’d)

Engage in additional data collectionProvide technical assistance for using assessment

results to engage in strategic planning, as well as monitoring and evaluation methods

Move from best practices to best-fit practicesEnhance SBIRT Improve policies and enforcement

Advocate for state-level policies, such as dram shop liability, social host laws, home delivery procedures, drinks specials laws, commitment to remain independent of industry funding, and availability of alcohol sales at college stadia.

Taking Steps Toward a Solution:

A statewide collaborative

• State-of-the-art, evidence-based, multi-component and multi-level interventions that engage campuses AND the communities that surround them

• State-of-the-art measurement – a standardized system to gather metrics and evaluate the impact of interventions How can we know we are making progress when measurement is inconsistent and unreliable?

• NOT a research project

mm

College Student

Campus

Community

Pare

nt

Influences on college student drinking

Parent

• Expectations• Vigilance• Modeling• Disapproval

Community

• Enforcement of Laws (e.g., false IDs, social hosting, nuisance)• Alcohol availability• Alcohol pricing• Alcohol promotion

Campus

• Norms• Policy enforcement• Availability of

resources• Screening and

intervention services

Student

• Family history• Personality• Mental health• Distorted expectations of consequences

Multi-level approaches are therefore necessary to solve the problem

mm

College Student

Campus

Community

Pare

nt

Parent TrainingPersonalized Interventions

Universal Screening

Reduced Environmental Risk

Clearer and Enforced Policies

Statewide CollaborativeComposition and

Leadership A learning collaborative of willing institutions…

with the leadership and counsel of a governance body of campus leadership (public and private) from across the state

Statewide Collaborative

Operations Operationally, a collaboration between the UMCP School of Public Health and JHU Bloomberg School of Public Health, led by:

UMCP: Dr. Amelia Arria - expert in measurement, assessment and intervention in alcohol problems among college students across the college “life-course”, and Director of the Center on Young Adult Health and Development

JHU: Dr. David Jernigan- internationally-known expert in community-based and environmental approaches to alcohol problems, and Director of the Center on Alcohol Marketing and Youth

Statewide CollaborativeLong-term Goals

• Measurably reduce the current level of excessive alcohol use and alcohol-related harm among all colleges in Maryland

• Mobilize and sustain the commitment of campus

and community leaders toward this goal

TIMELINEPlanning Phase: September 2012- June 2013

Implementation of Interventions: June 2013 onward…

Interventions will be scientifically-supported and tailored to the specific needs of each campus

• Establish governance structure• Produce “A Guide to Best Practices to Reduce College

Drinking”• Produce “Report on College Drinking in Maryland” based on

an assessment of the problem and current strategies being used (all 44 campuses)

• Design a standardized system to gather metrics • Hold a statewide Educational Conference and Leadership

Summit• Develop a sustainability plan to supplement state funds for

the five-year initiative

• Planning phase underway and fully funded by DHMH

• Colleges can start new drinking reduction strategies – we can make ourselves available for consultation in that regard

• Scientifically-supported interventions described in a formal guide for all campuses

• Educational Conference will be held for all institutions

Statewide Collaborative

Key Points

• Excessive alcohol use is a significant threat to: student safety, academic success, well-being, and human capital development

• Evidence-based actions are needed that include:

Science-based individual risk screening and interventions, community-level interventions that target alcohol supply (e.g. problem outlets), drinking places (e.g. nuisance party apartments and buildings), and price discounting.

• Action is urgently needed, but will require leadership in building consensus.

Statewide Collaborative

Key Points

Next Steps

• Leadership from the level of the presidents that this is an important issue, that more needs to be done, and that our approach needs to be based in the best science available

• Insights from the prevention community:

• What prevention initiatives have been effective in reducing alcohol problems in this age group?

• What aspects of what you are doing are working well?

• Where do we all need to focus to move the needle?

TOGETHER, we can make a difference!

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