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Transcript of Lessons learned about environmental alcohol strategies from the 'A Matter of Degree' Program in...
Lessons learned about environmental alcohol strategies
from the 'A Matter of Degree' Program in College Communities
Donald W. Zeigler, Ph.D., Deputy Director
American Public Health Association Annual Meeting
Boston, MA. Nov 8, 2006
ATOD Session 5149.0. Whether on the Street or in the Classroom:
Your Drinking Behaviors & Solution
A MATTER OF DEGREE: The national effort to reduce high risk drinking
among college students
A partnership of the
American Medical Association
and
The Robert Wood Johnson Foundation
A Matter of Degree goals
1. Test efficacy of environmental model
2. Create sustainable campus-community partnerships to address entire student environmentenvironment
3. Reduce high-risk drinking & 2nd-hand effects
1996 Campuses invited to join. Criteria:
High student binge rates Campus history of addressing alcohol issues Willingness to discuss problems publicly -
“stick necks out” Willingness to collaborate with community
partners Active participation and support of chief
executives (President, Mayor)
Overview of AMOD
10 campus-community coalitions 8-9 year grants [Colorado 5 years] Average grant of $700,000 + school match Evaluation: Harvard School of Public
Health with its on-site evaluators AMA – national program office
University/City Coalitions
U of Delaware - City of Newark Florida State U - City of Tallahassee Georgia Institute of Technology - City of Atlanta U of Iowa - Iowa City Lehigh U - City of Bethlehem Louisiana State U - City of Baton Rouge U of Nebraska - City of Lincoln U of Vermont - City of Burlington U of Wisconsin - City of Madison U of Colorado – City of Boulder
AMOD targeted predictors of college high-risk drinking (Wechsler et al., 1994)
1+ alcohol outlets within 1 mile of campus 1st year undergraduates Males Athletes Sports fans Greeks, especially fraternity members
Underage alcohol market on campus: U of Iowa, Iowa City
60% of students under age 21
Underage spend $235,458/month on alcohol
Wholesale cost: $47,091 = 80% profit
$2.1 million/year est. income on UA drinking
Jim Clayton, Director, Stepping Up ProjectU of Iowa, October 27, 2004
All about price. Drink fast! Iowa City
Price specials every night
Web advertising Text messages on the
cell phone about specials
E mail notices about bar specials
Rates of growth Iowa City1975 9 liquor licenses downtown 6 were bars1981 17 10 1998 33 20 2005 48 32
0%
50%
100%
150%
200%
250%
300%
350%
400%
450%
1974 1998 2005
Iowa City Population
University enrollment
Licenses downtown
AMOD interim evaluation 1997-2001Harvard School of Public Health
Compared drinking and harm patterns from 10 AMOD schools to
32 non-AMOD colleges from the national Harvard College Alcohol Study (CAS)
Evaluation
Divided 10 AMOD program colleges into 2 groups based on their level of program implementation (# and variety of policy changes) as of 2001:
high intervention low intervention sites
Weitzman ER, Nelson TF, Lee H, Wechsler H. (October, 2004). Reducing drinking and related harms in college: Evaluation of the “A Matter of
Degree” program. American Journal of Preventive Medicine, Oct 2004
AMOD Findings (1997-2001):Adapted from Weitzman, Nelson, Lee & Wechsler,
AJPrevMed, 2004
# Interventions High Lowamong all AMOD sites
Availability 26 5Legal sanctions 21 4Physical context 8 2Advertising &
Promotion 7 4Key influencers 16 8Sociocultural context 79 23
5 high intervention schools:
Significant changes noted in drinking & related harms over time when compared to the non-AMOD colleges.
Decreasing relative risk over time Reduced driving after drinking, driving
after 5+ drinks, riding with drunk driver
Reductions did not occur at
the 5 universities that implemented fewer of these changes
nor at the group of 32 comparison colleges
5 high intervention sites:5-11% reductions in 6 consumption outcomes “Binge” drink “Binge” frequently Taking up “binge” drinking in college Drink frequently Get drunk frequently Usually drink at “binge” level
Drinkers at 5 High Implementation Schools:18% reductions in experience of 5 or more alcohol related harms
getting hurt or injured medical treatment for overdose unprotected, unplanned sex miss or fall behind classes getting in trouble with police do something regretted
5 high intervention schools: 10% fewer 2ndhand effects from other students’ heavy alcohol use, e.g.
property vandalized interrupted sleep or study timearguments, insults or assaultsunwanted sexual advancebaby sit a student
Examples of policies and programs found effective to-date: mandatory training for responsible beverage
service required registration for purchasers of kegs prohibit sales of alcohol without a license keep alcohol-related items out of student
bookstores expand substance-free residence halls promote alcohol-free activities.
AMOD comprehensive college/community environmental interventions, “if vigorously pursued, can reduce drinking problems specifically among college students.”
“It can also reduce secondhand effects of alcohol perpetrated on other college students by students who engage in excessive college drinking.”
“This careful and rigorous evaluation is the first to show positive benefits of interventions across entire college populations, not just select subgroups of students.”
Hingson, R. (2004). Advances in Measurement and Intervention forExcessive Drinking. Am J Preventive Medicine. 27(3):261-263.
Plausible mechanisms:
Diminished alcohol availability
Increased enforcement
Heightened scrutiny – self regulation
Moderated peer influences – less tolerance
for drunkenness, more concern about it
Time spent on other things, culture shift
Underlying dynamics supportive of change:Long term voluntary commitment
to coalition efforts & policy changeWillingness of institutions to see
school as activist change agentsShift from individual-only to
include environment approaches
High 5 coalitions
More formal structures & processes Higher member involvement in decisions Assume environment is changeable &
supportive Clear, flexible, detailed strategic & action
plans Staff facilitates rather than directs Responsible, trusted leadership Consensus-driven
Likely causes for lower levels of intervention (differ per site)
Active alcohol industry opposition Fear of angering students Community made up of multiple autonomous
groups and not working as a whole Poor leadership High adult drinking in state Few state policy measures
Potential threats to campus/community coalition (LSU experience)
Changes in top administration may impact ongoing commitment
Untrained and unskilled leadership Inadequate professional staff time & coalition
resources Lack of personal conviction & courage of
partners and staff Lack of ability to withstand public apathy,
cynicism and criticism
AMA helped change how we talk
about alcohol
Empowered universities to take lead in communities
Alcohol - a medical & public health issue
Underage & young adult drinking are medical problems
Physicians should be involved
in patient screening, brief intervention, referrals to treatment
in policy development and advocacy
AMA Study: “Effects of Alcohol on the
Brains of Underage & College Students”: Brain damage and neuro-cognitive deficits Affects learning abilities and intellectual
development of underage drinkers Impaired intellectual development may continue to
affect individuals into adulthood Imperative for policy-makers and organized
medicine to address the problem of underage drinking
Zeigler, DW, Wang, CC, Yoast, RA, Dickinson, BD, McCaffree, MA, Robinowitz, CB, and Sterling, ML. (January. 2005).
The neurocognitive effects of alcohol on adolescents and college students.
Preventive Medicine. 40(1): 23-32.
Responding to Depression, Suicide, Substance Use, and Addiction on College Campuses D-345.995
Full insurance parity for mental health and substance abuse treatment
Colleges: increase availability and ensure the quality and quantity of on-site mental health and substance abuse clinical services &/or improve access to appropriate community services.
End discrimination against students who disclose or seek treatment for depression, SUD, or mental health issues, including mandatory suspension/withdrawal from school for students who request or receive psychiatric or addiction medicine services.
Urges similar programs in medical schools. Urges clinical staff of campus health services and counseling
services to improve their skills in screening, brief intervention and referral for students’ problem drinking.
Partner to educate physicians & media on the linkages of substance use and addiction, mental disorders, and suicide among college students. (CSAPH Rep. 8, A-06)
AMA helped reframe the issues – Underage drinking is
an adult issue “Just because we
hold youth responsible doesn’t mean the rest of us aren’t responsible too”
“The alcohol industry needs to be held accountable”
Alcohol problems are community problems requiring community solutions
New AMA policy: Increasing Taxes on Alcoholic Beverages D-30.995
Supports increases in federal taxes on beer, wine, and liquor, with a substantial portion of the new revenues to be earmarked to the prevention, treatment of dependent or at-risk drinkers, services for vulnerable populations
Urges state & local medical societies to support increases in state and local taxes on beer, wine, and liquor
Support state & local efforts to increase taxes on beer, wine, and liquor
Collaborate with national medical specialty societies, the APHA, the Center for Science in the Public Interest, MADD
Use ballot initiatives in the 24 states that allow such initiatives. (Res. 438, A-05)
New AMA policy: Take Action to End Alcohol Ads on College Sports Telecasts D-30.994
Goal: end alcohol advertising on sports broadcasts & particularly on college sports; special emphasis on athletic conferences now or soon negotiating contracts,
Appeal directly to the NCAA, all athletic conferences and member schools to end alcohol ads on their broadcasts;
Urge physicians, particularly those in or associated with college communities, express opposition directly to top administrators;
Urge state & local medical associations to contact colleges & press them to end alcohol ads on their broadcasts;
Urge state and local medical associations to get state legislatures to pass resolutions requesting colleges in their state to end alcohol ads on their broadcasts; &
Organize "sign-on" letter from medical societies to the NCAA President and Executive Committee urging an end to alcohol ads on NCAA broadcasts. (Res. 413, A-06)
Statement on Reducing the Global Impact of Alcohol on
Health and Society
submitted by the AMAadopted by the
World Medical AssociationSantiago, Chile, October 2005
Current trends
Growing awareness that environmental change is vital
Decreasing or no private or government funding for policy
work
Growth in alcohol advertising, e.g. cable TV, internet
Barrage of “health benefits” media: wine and beer for the
health conscious
Increased youth access
Active industry push back
Anheuser-Busch controls 50%+ of US market – political
clout at every level
Diageo enters US market and state politics; product
alliances with beer
Intentionally ambiguous “drink responsibly” campaigns
AMA project with medical schools in college towns
Enhance role for medical school, physicians, and medical students in alcohol advocacy in AMOD communities (FSU, WI, IO, VT, GT) and others (e.g., Dartmouth, UFL)
Telecast for medical schools, directors of service learning, & medical student chapters on means to reduce college high-risk and underage drinking & related harms