Social norms and student substance use interventions in the USA jennifer bauerle, Ph.D. Director,...
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Transcript of Social norms and student substance use interventions in the USA jennifer bauerle, Ph.D. Director,...
Social norms and student substance use interventions
in the USA
• jennifer bauerle, Ph.D.• Director, National Social Norms
Institute• University of Virginia
OutlineOutline• 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
Charlottesville, Virginia
Where is the National Where is the National Social Norms Institute (NSNI)? Social Norms Institute (NSNI)?
4
UVA & DrinkingUVA & Drinking
““Their drink at Their drink at all times water, all times water, a young a young stomach stomach needing no needing no stimulating stimulating drinks, and the drinks, and the habit of using habit of using them being them being dangerous.”dangerous.”Thomas Thomas Jefferson, Jefferson, June 4, 1819June 4, 1819
Binge Drinking Binge Drinking All US College StudentsAll 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.
National Binge Drinking Rates by National Binge Drinking Rates by Student CharacteristicsStudent 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
UVa Annual Alcohol-Related UVa Annual Alcohol-Related ER Experience UndergraduatesER Experience Undergraduates
0
50
100
150
200
25020
00-1
2001
-220
02-3
2003
-420
04-5
2005
-620
06-7
2007
-820
08-9
2009
-10
Total ER Visits
Admissions
Alcohol Related Disorders Alcohol Related Disorders leading to ER visitsleading 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.
Alcohol Related Disorders Alcohol Related Disorders leading to ER visitsleading 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.
Readily responds to educationand intervention
UVA Stall Seat Journal
BAC
Pro
babi
lity
0.0 0.1 0.2 0.3 0.4 0.5 0.6
0.0
0.2
0.4
0.6
0.8
1.0
Probability of negative consequences vs BAC level
VOMITEDPERFPOORPOLICEFIGHTINJUREDUNDRINFLUNPROTSXEMERROOM
Turner, Bauerle, Shu. J. of Studies on Alcohol. 65:741-749. 2004
Promote Responsibility and Reduce Promote Responsibility and Reduce HarmHarm
• 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
Comparison of Alcohol Purchase Ages Comparison of Alcohol Purchase Ages In EU and USIn EU and US
0
3
6
9
12
15
18
21
Germ
any
Greec
e
Roman
iaIta
ly
Hunga
ry
Franc
e
Bulgar
ia
Portu
gal
South
Afri
ca
Thaila
nd
Spain
Venez
uela
Engla
ndUSA
Icelan
d
Slovak
ia
Poland
Belgium
Colom
bia
Nethe
rland
s
Irelan
d
Ag
es
0%
10%
20%
30%
40%
50%
60%
70%
Rat
e o
f H
eavy
Dri
nki
ng
Legal Purchase Age Legal Drinking Age Heavy Drinkers
Use Complementary Use Complementary Strategies and MethodologiesStrategies 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
UVa Alcohol ProgrammingUVa 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
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….
Negative Consequences All UVa Undergraduates 2001-2010
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Year 2001
Year 2002
Year 2003
Year 2004
Year 2005
Year 2006
Year 2007
Year 2008
Year 2009
Year 2010
.40* .47* .37* .68** .72** Odds Ratios *p<.001**p<.01
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Year 2001
Year 2002
Year 2003
Year 2004
Year 2005
Year 2006
Year 2007
Year 2008
Year 2009
Year 2010
.24* .38* .19* .51* .55** Odds Ratios *p<.001**p<.01
Negative Consequences All UVa Undergraduates 2001-2010
Comparative NCHA National Data v. Consortium Aggregate :
Negative Consequences
0%
10%
20%
30%
40%2002
2004
2006
2008
2010
UVa Undergraduates: Mean eBAC & 99% CI
0
0.01
0.02
0.03
0.04
0.05
0.06
0.07
0.08
2001 2003 2004 2005 2006 2007 2008 2009 2010
Campaign exposure predicts outcomesFirst Year Undergraduates 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.
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.”
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
Thank you!
Please contact me with questions at: [email protected]
Or visit our web site at:www.socialnorms.org