The Maryland Collaborative

May 8, 2013 David H. Jernigan, Ph.D. Director, Center on Alcohol Marketing and Youth Johns Hopkins University Bloomberg School of Public Health Amelia M. Arria, Ph.D. Director, Center on Young Adult Health and Development University of Maryland College Park School of Public Health

• Amelia Arria PhD

– Director of the Center on Young Adult Health and Development at the University of Maryland at College Park

– Principal Investigator of the College Life Study, a unique longitudinal prospective study of 1,253 college students interviewed annually for 4 years

• David Jernigan PhD

– Director of the Center on Alcohol Marketing and Youth, a CDC-funded Center at Johns Hopkins Bloomberg School of Public Health focused on alcohol marketing (including price, promotion and physical availability) and its impact on young people

Who We Are

The Planning Year Overview

• Seed funding from DHMH

• Guide to Best Practices – in draft on tables

• Statewide Conference

• Governance Council of college Presidents

• Ten institutions represented

• Advocacy

• Leadership

• Advisory Board

• Assessment of and Report on College Drinking in Maryland – work in progress

Assessment

• Conducted assessments with

38 colleges and universities

• V.P. of Student Affairs or designee

• Structured questionnaire

• Semi-structured interviews

4 Community Coalitions

• Law enforcement

• Liquor Boards

• Students

Assessment (continued)

• Comparison of college attending vs. non-college attending peers in Maryland (from the NSDUH)

• Web-based search on alcohol-related campus policies

• Review of administrative data

• Total of 42 colleges and universities in Maryland

WHERE WE ARE: UNDERSTANDING THE

PROBLEM

“Alcohol plays a part in the majority of conduct cases and major problems. It effects judgment and results in students being belligerent while drunk, DUIs, assaults, and public urination”

- MD College Administrator

Annual National Snapshot of Problems related to college drinking

1825 599,000 696,000

97,000 150,000

400,000 3,360,000

alcohol-related deaths unintentional injuries assaults sexual assaults/date rape alcohol-related health problems students having unprotected sex students driving under the influence

Annual National Snapshot of Problems related to college drinking

25%

11%

19%

Students reporting an alcohol-related academic problem like missing class, falling behind, doing poorly on exams/papers, or receiving lower grades overall Student drinkers reporting damaging property while under the influence Students meeting criteria for alcohol abuse or dependence

10% 11% 13% 12% 10% 10%

4%

9%

14% 18%

27%

34%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

17 18 19 20 21 22Age

Annual Prevalence of Alcohol Abuse and Dependence among College Life Study Participants, by Age

Abuse

Dependence

Source: College Life Study, 2013

WHERE WE ARE: THE PROBLEM IN

MARYLAND

Maryland colleges

• Every residential college in Maryland has a problem with college drinking.

• Most non-residential colleges acknowledge that although they see little evidence of alcohol problems on campus, they don’t have the data to know where it is a problem for their students.

Maryland colleges see a connection between student alcohol use and other

problems, including:

• Assaults • Drug use

• Students passed out on street • Theft

• Lack of motivation • Dropping out of college

• Sexual Assaults • Vandalism

• Noise violations • Lower grades

• Unsafe sex • Fights

• DUI’s • Public urination

• Sleep disruption • Injuries

• Hospitalization • Overcrowded parties

Hospitalizations for alcohol poisoning are a regular occurrence, spiking in the first few weeks of school, at events like Halloween, and again in the spring with campus festivities for the end of year.

Maryland 4-yr colleges

Hospitalizations

Number of Alcohol-related Incidents reported by 4-year IHEs in Maryland, 2009-2012*

Type of Incident

Number of Colleges reporting

Number of Incidents

Alcohol use/violations 4 1893

Ambulance transports 13 470

Arrests 5 240

Citations 5 379

Alcohol-related deaths 11 0

Drunk driving cases 8 147

Emergency department visits 2 39

Assaults 9 127

Residence hall complaints 7 1923

Disciplinary actions 12 3261

* Not all colleges provided data for all years

Number of alcohol-related violations derived from CLERY data for Maryland IHEs (2008-2011)

Type of liquor violation 4-Year n=24

2-Year n=14

Off-campus arrests 25 1

Off-campus disciplinary actions 14 0

On-campus arrests 1153 17

On-campus discipline 15,109 131

Public property arrests 297 5

Public property discipline 61 1

Residence hall arrests 581 4

Residence hall disciplinary actions 14,190 118

Percent of schools (by type) that reported a way to measure and collect data regarding alcohol

consumption

*Over a 4-year period (2009-2013)

Methods

4-Year (Public)

n=12

4-Year (Private)

n=12

2-Year n=14

CORE survey 33% 33% 7%

NCHA survey 50% 8% 7%

Home-grown survey 25% 33% 7%

Judicial/disciplinary/incident statistics 42% 17% 21%

Self-report 17% 25% 7%

NCHIP survey 17% 0% 0%

Online program 33% 25% 0%

No method 17% 17% 57%

Number of schools (by type) that reported a way to measure and collect data around problems related to

alcohol

Methods 4-Year

(Public) n=12

4-Year (Private)

n=12

2-Year n=14

CORE survey 2 1 1

NCHA survey 4 1 0

Home-grown survey 1 3 0

Judicial/disciplinary/incident statistics 9 8 7

Self-report 0 0 0

NCHIP survey 1 0 0

Online program 1 0 0

No method 1 1 4

Off-campus Availability

• Off-campus house parties and friends who are of legal drinking age are the most common source of alcohol for college students.

• Neighborhoods with a high density of alcohol outlets are popular destinations for college students, who often use high-quality fake IDs to gain admission

• Some bars advertise to college students, serve underage students and have frequent hospital transports, fights, etc.

Events

• Some colleges have annual campus events with a tradition of allowing alcohol with few, if any, restrictions.

• The level of excessive drinking is often highest at the beginning of the fall semester, on Halloween, and in the spring when end-of-year celebrations are underway.

Off-campus Availability (cont’d.)

The Maryland judiciary is unwilling to give meaningful sanctions to students charged with alcohol-related violations, frustrating the efforts of law enforcement and reinforcing the students’ view that excessive drinking is acceptable and normative.

Challenges

Challenges

Cultural

• Expectations that excessive drinking is part of the college culture, and attempts to restrict it are seen as infringements on their rights

• Students come to college with established drinking habits in place

Challenges: Off-campus Availability

The Maryland judiciary is unwilling to give meaningful sanctions to students charged with alcohol-related violations, frustrating the efforts of law enforcement and reinforcing students’ view that excessive drinking is acceptable and normative.

Challenges

Financial

• Resources to address alcohol use are scarce

• Measurement systems, staff for programming are costly

Data

• Colleges have limited resources to collect the data necessary to assess the extent of drinking and the effectiveness of their efforts.

Institutional

• 2-yr colleges: students do not spend time on campus – can be hard to reach or know the when an alcohol problem exists

Challenges (cont’d.)

• “No survey data. Without survey data, it's hard to know the extent of alcohol use and problems.”

• “Another barrier is addressing certain behaviors that are allowed at an annual campus celebration. It's hard to address because of tradition.”

Measurement of College Drinking and Related Problems:

Challenges and Opportunities

DATA ARE LACKING TO TRULY UNDERSTAND THE PROBLEM.

• To date, only four colleges of the 38 surveyed provided alcohol use data

• Colleges rely heavily reliance on arrest and citation statistics to measure the magnitude of problems.

• Health measures are sometimes collected, but not systematically

• There is a great opportunity for standardization of methods across colleges in Maryland not only to understand the nature and the magnitude of the problem, but to measure the impact of interventions over time.

• Fidelity monitoring – how well interventions are being implemented – can have a beneficial effect on implementation of evidence-based practices.

General Findings

• High level of recognition that excessive drinking among students

is a problem and has impacts on student functioning… and that the problem needs to be addressed, more so among 4-year colleges.

• 63% of 4-year campuses and 36% of 2-year campuses have a “task force, coalition, or working group” whose purpose it is to address alcohol issues.

• Multiple attempts are being made to address it…

– Many of these do no reflect the science base for what works, and

– There is inconsistency in these attempts, beyond that which can be accounted for by differences in campus characteristics.

• The desire exists to learn more to improve existing approaches.

• Training gaps have been identified.

• The methods being used to measure alcohol use and related problems vary widely.

A Glimpse of the Current Situation

What would be the ideal situation with respect to intervening with high-risk drinkers?

• Identification of high-risk students in a complete and uniform way

• A roadmap for colleges to guide their decision-making about what to do once a problem is identified

• At least annual training for key personnel who come in contact with students- health and counseling center staff, residence hall advisors, and academic assistance staff

• Appropriate parental involvement (in the best interests of the student)

• Standardized method of measuring alcohol use and related problems to evaluate progress

In which contexts are at-risk students being identified?

Context where screening might occur 4-Year n=24

2-Year n=14

Alcohol-related violation 83% 43%

Physical health complaint 75% 7%

Emergency department visit 75% 21%

Mental health complaint 58% 21%

Alcohol-related complaint 50% 14%

Academic assistance center 46% 21%

First-year students (w/the exception of educational programs) 21% 14%

Qualification to participate in athletics 17% 21%

Counseling Center 13% 7%

What screening tools are used?

Standardized Screening Tool

4-Year n=24

2-Year n=14

AUDIT 38% 7%

DSM-IV Diagnostic Screener 17% 14%

SASSI 17% 0%

DAST 13% 7%

CAGE 13% 14%

MAST 8% 7%

CAPS 4% 0%

Use of at least one standardized screening instrument 71% 29%

In-house instrument 33% 0%

When a student is identified, are

evidence-based interventions available?

3 out of the 9 schools (4-year) that have evidence-based interventions do not provide further evaluation/ referral to treatment either on- or off-campus.

Type of Interventions Available

4-Year n=24

2-Year n=14

Evidence-based individual interventions 38% 7%

Peer-education only 8% 14%

The remaining do not offer individual interventions 21% 71%

Education is often is provided, but research has consistently shown

that education alone rarely changes behavior

Alcohol Education provided to..

4-Year n=24

2-Year n=14

Violators of alcohol policies 19/24 4/14

Fraternity/sorority 12/14 0/0

Residence hall residents 18/23 2/2

Athletes 15/21 4/12

Incoming first year students 19/24 8/14

Have students been involved in

prevention/intervention activities?

Student Involvement (all have at least one way of involving students)

4-Year n=24

2-Year n=14

Peer education 18/24 5/14

Planning alcohol prevention 14/24 3/14

Implementing alcohol prevention 13/24 4/14

Class presentations 10/24 4/14

Campus task force 12/24 2/14

Practicums 8/24 1/14

Coalition 5/24 3/14

When are Parents Notified?

*Parental notification for alcohol-related violations at 2-year schools are mostly for those under 18 or if it meets FERPA guidelines of a “health and safety” issue

Parent Notification

4-Year n=24

2-Year n=14

After alcohol-related violations 13 7*

Only after alcohol-related ambulance transport 6 1

Do not notify 5 6

When are Parents Involved?

Parent Involvement

4-Year n=24

2-Year n=14

Personnel available to speak with parents about strategies 15 3

Mailing to parents when students enroll as a first-year student 9 0

Orientation session for parents lasting one hour or less 8 5

Orientation session for parents lasting more than one hour 7 0

Parent-focused website (unsure how often updates are made) 4 0

Mailings to parents more than once a year 4 0

Parent-focused website that is updated with new information on alcohol prevention strategies at least twice a year

2 0

Mailings to parents once a year 2 1

What would be the ideal situation with respect to the alcohol

environment?

• Alcohol is truly seen as “not an ordinary commodity.”

• Alcohol products are oriented and marketed primarily to adults.

• Alcohol pricing reflects alcohol’s extraordinary status, with prices increasing in pace with or ahead of inflation, and discounting limited.

• Alcohol is available at special times and in special settings; alcohol outlet density reflects the population.

• Alcohol promotions emphasize product qualities and avoid lifestyle,

role-modeling (celebrity), peer group and social success appeals.

Student handbook policies- 4 year colleges

• 80% of colleges prohibit alcohol use in residence

halls by underage residents

• 2/3 of colleges prohibit alcohol possession/use in

common areas of residence halls

• Over half of the colleges require responsible

beverage service at events

• 70% of colleges require authorization of alcohol at

student events by campus leadership

Student handbook policies 4 year colleges

• 35% of colleges don’t prohibit public consumption of alcohol by students

• Nearly 2/3 of colleges don’t have policies prohibiting public intoxication for students 21+

• More than 80% of colleges don’t prohibit alcohol at athletic events

• 53% of colleges don’t require ID’s to be checked at events

• Nearly 80% of colleges don’t prohibit alcohol advertising or promotions on campus

• Half of the colleges don’t prohibit alcohol on campus for college-sponsored events

Examples of the Variation in Policies (Based on web-based search)

*Only two community colleges have residence halls.

School Policies

Policy mentioned

Policy not mentioned

Prohibited with

exceptions

4 Year n=26

2 Year n=16

4 Year n=26

2 Year n=16

4 Year n=26

2 Year n=16

Keg/open containers in public spaces are prohibited

16 1 9 15 1 0

Alcohol is prohibited on-campus for all college-sponsored events

2 1 13 5 11 10

Alcohol advertising/promotions are prohibited on campus

6 2 18 13 2 1

Alcohol at student events must be authorized by campus leadership

18 11 8 5 0 0

Alcohol use is prohibited in residence halls for underage residents

20 2* 5 0 0 0

On-campus strategies to reduce alcohol pricing on campus

*Note: dry campuses were excluded from analysis

2 Year Institutions (n=3)

4 Year Institutions (n=21)

Yes (n%) No (n%) Yes (n%) No (n%)

Restrictions on free samples or free tastings

0 100% 14% 85%

Restrictions on happy hour specials 0 100% 19% 81%

Restrictions on all-you-can-drink specials 0 100% 14%

85%

Restrictions on 2-for-1/buy one, get one free specials

0 100%

13%

85%

Restrictions on population-specific specials (e.g., ladies night)

0 100%

19%

81%

None 0 11 (100%) 0 21 (100%)

Off-campus collaboration to reduce alcohol outlet density

2 Year 4 Year

We have held discussions with local law enforcement about reducing alcohol outlets, but have not yet taken action.

1 (7%) 5 (21%)

We are planning restrictions on retail alcohol outlets with local law enforcement, but they have not been conducted yet.

0 1 (4%)

Yes, we have successfully worked with local authorities to place restrictions on the number of retail alcohol outlets.

0 2 (8%)

No 12 (86%) 14 (58%)

Off-campus collaboration to increase the price of alcohol

2 Year 4 Year

We have held discussions with local law enforcement about increasing alcohol prices, but have not yet taken action.

1 (7%) 3 (13%)

We are planning efforts to increase alcohol prices with local or state authorities, but they have not yet been implemented.

0 0

Yes, we have worked with advocacy groups or local or state authorities to increase the price of alcohol in our community.

0 0

No 10 (71%) 17 (71%)

Off-campus collaboration to reduce alcohol sales to minors and intoxicated patrons

2 Year 4 Year

We have held discussions with local authorities or retail alcohol outlets about mandatory responsible beverage service training policies for servers, but have not yet taken action.

0 4 (17%)

We are planning mandatory responsible beverage service training policies for servers with local authorities or retail alcohol outlets, but training has not yet been conducted.

0 0

Mandatory responsible beverage service training policies for servers is already practiced in our community, but the university is not involved.

0 0

Yes, we actively worked with local authorities to establish mandatory responsible beverage service training policies for servers in our community.

0 0

No 10 (71%) 12 (50%)

Philosophy of the Collaborative: Focus on system-wide solutions, not just

programs

• Reducing alcohol use is a shared responsibility

• Bring everyone to the table

• Policies should be clearly communicated and consistently enforced

• A similar message should be given across all settings

• Evidence-based programs, policies and practices should be used

• Think systems, not modules; develop a strategic plan

College Alcohol Systems Model

Adapted from McLeroy et al. 1988 by Toomey et al., U. of Minnesota

TODAY

• Alcohol and the developing brain

• Best practices in individual-level interventions

• Best practices in environmental- and systems-level intervention

• Best practices at Maryland universities and nationwide

• Where do we go from here

How will the Statewide Collaborative help colleges reduce excessive drinking?

The Collaborative will: • Raise the profile of the problem and provide the momentum and

leadership in bringing other partners to the table to be part of the solution;

• Provide public health expertise and support to implement effective

interventions, change alcohol policies, and reduce alcohol problems; • Provide a forum for sharing information and support among

colleges statewide working to reduce college drinking; • Expand funding opportunities for sustainability; • Create a standard measurement tool so that Maryland colleges have

a common language for measuring progress towards their goals;

How will the Statewide Collaborative help colleges reduce excessive drinking?

• Assist colleges in assessing the effectiveness of new strategies on multiple campuses;

• Build synergy among and provide peer and professional support to multiple campuses planning and implementing tailored interventions that best fit their individual environments; and

• Provide a platform for the development of resources and insights that can be useful across all campuses in the state, whether part of the formal Collaborative or not.