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
College Alcohol Study
Harvard School of Public Health
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?
College Alcohol Study
Harvard School of Public Health
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
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
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
Price, by alcoholic drink
What’s being sold? (6 sites)
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•
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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
Price, compared to other drinks
1.5 drinks at a bar*
(range 1 to 6)
1 coffee
(average cost of
$1.09)
*based on OR
specials
=
4.6 drinks from a keg
(range 3 to 7)
OR
3 cans of beer
(range 2 to 4)
Price, compared to other activities
8 drinks at a bar* (range 6 to 31)
*based on specials
OR
All you can drink
at a party for 3-4
people
1 movie ticket--1st run
(average cost of $5.86)
=
OR
25 drinks from keg
(range 20 to 36)
OR
16 cans of beer
(range 11 to 22)
Iowa City, IA
Weitzman et al. (2003)
“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
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
• Can campus-community coalitions
implement environmental
prevention?
• Can environmental prevention
reduce drinking and related harm?
Public Health Triad
Agent
Host
Environment
Knowledge
Pricing
Attitudes
Composition
Intentions
Labeling
Skills
Packaging
Person
Drug
Drug-Related
Problems
Advertising/
Promotion
Environment
Availability
Physical Context
Legal Sanctions
Institutions
Sociocultural
Context
Key
Influencers
Torjman (1986)
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)
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
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
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
Key features of stronger
program development
•
•
•
•
•
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Leadership
Evidence-based agenda
Strategic plan based
Measurable benchmarks
Environmental interventions
Network ‘savvy’
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
Harvard School of Public Health
COLLEGE ALCOHOL STUDY
http://www.hsph.harvard.edu/cas
http://ww.epi.umn.edu/alcohol