Challenges to Prevention of College Drinking

Kim Fromme, Ph.D. UCSD Task Force for Sun God Festival September 26, 2013

College Drinking: Whats the problem?

Some Facts about College Student Drinking

70-90% of college students drink alcohol Many drink moderately and without problems Yet, an estimated 1,800 college students die

annually of alcohol-related injurie

Motor vehicle accidents Alcohol poisoning

Heavy Drinking and Alcohol-related Consequences

56% of college men and 35% of college women

are heavy episodic drinkers

Heavy episodic drinking is associated with

social, academic, and behavioral problems Hangovers Driving after drinking Blackouts Doing something they regret Missing class or work due to drinking

Drunken Behavior is also a Problem

What College Students Bring to College

Family Background Genetics Parental drinking and Individual Factors Gender and race High school alcohol

attitudes Parental involvement in childrens lives

use Personality traits Expectations

About alcohol

About college life

Prospective and reciprocal processes that influence drinking

Selection: People choose environments or people that

have certain patterns of drinking

drinking friends in college Join a Fraternity or Sorority

Heavy drinking friends in high school are replaced with heavy

Socialization: People adapt to their environments and

friends

Alter their drinking to meet expectations Match the drinking rates of friends

What Environmental Characteristics Contribute to College Drinking

Community Outlet density Marketing (e.g., Happy College Peer norms Availability of alcohol Policies and enforcement Residential systems Level of supervision Reputation of dorms and Greek houses

Hour specials, sporting events) Norms and expectations Enforcement

College Residence and Changes in Drinking from HS to College

What about the College Culture Contributes to Heavy Drinking?

Greater personal freedom Few real world responsibilities Drinking is often expected and reinforced College viewed as Time out
Especially for specific times/events (e.g., Spring

Break, Post-exams, Sun God Festival)

Drinking and other behavioral risks increase from

high school through college

Alcohol Use from High School Through College

1.0 0.8 0.6 0.4 0.2 0.0 -0.2 -0.4

Outcome (z-score)

Drinking & Driving Alcohol Frequency Alcohol Quantity

HS

Fresh Fall Soph Fall Junior Fall

Senior Fall

Year 5 Fall

Year 6 Fall

So What do we Know about College Prevention Efforts? What works and what doesnt

What does not work

Information and knowledge-based programs Alcohol awareness programs Facts about alcohol and about laws Scare tactics Threats about dire consequences Frightening images Easiest to implement, but ineffective

Attempts to Convey the Hazards of Heavy Drinking

What might work (but needs further evaluation)

Policies that appear to reduce drinking: Alcohol-free activities and dorms Campus bans (including faculty and alumni events) Mandatory Friday classes Social marketing campaigns to correct peer

norms

Media messages to promote light drinking

NIAAA Task Force on College Drinking Tier 1: Effective Interventions

Brief motivationally-based interventions Skills training programs Multi-component cognitive-behavioral

programs including:

Expectancy challenge Individualized feedback

Primary Targets of Effective Individual-level Prevention Programs

Motivation to drink Skills to moderate use Outcome expectancies Peer norms (e.g., over-estimation effects) Residence (e.g., Greeks)

Reviews of Individual-oriented Prevention Programs

Larimer & Cronce (2007) 41 studies met inclusion criteria Support for skills-based and motivational interventions that incorporated personalized feedback Mixed support for norms-challenging interventions Carey, Scott-Sheldon, Carey, & DeMartini (2007) Meta-analysis of 62 studies Fixed effect sizes ranged from .02 to .22 (with one peak BAC =.41)

Review of Environmental Policies to Reduce College Drinking

(Toomey, Lenk, & Wagenaar, 2007)
36 (of 110) studies with college students Mixed results for reducing access Mixed results for social norms campaigns Multistrategy approaches appear best Server training alone not effective Policies to restrict access not effective alone Social norms campaigns can have iatrogenic effects

Parent Interventions for College Students

(Turrisi, August 2005)

Target - Universal & Selective Written handbook for parents Motivation, knowledge, skills Reduced drinking by students when parents involved

Conclusions about Current Alcohol Prevention Efforts with College Students

The good news
Brief, motivationally based interventions, and multi-

component skills-based programs result in decreased alcohol use and/or associated behavioral consequences

The bad news

Reductions arent dramatic Time accounts for significant effects

Some emerging directions for tackling college drinking

Target selection and socialization processes Involve parents, schools, and communities One size unlikely to fit all Develop targeted interventions by age, personality, and academic/career goals
Consider ways to involve peers and campus leaders
Bystander interventions Athletes; Organizations (e.g., Greeks)

Focus on Event-specific Prevention

Event-specific Prevention (ESP)

College student drinking is highly variable
Overall rates may be low, whereas heavy drinking on single occasions

Community and personal events are often marked by

heavy consumption

New Years Eve, St. Patricks Day, spring break, and Halloween 21st birthdays, graduation, and accomplishments (e.g., finals)

ESP efforts can energize a campus and community

Defined problem(s) to be solved Vs. the daunting task of overall alcohol prevention

Efforts to Target Specific Events

21st Birthday celebrations Students often consume more on 21st birthday than any other high risk drinking events (e.g., New Years Eve; Halloween) Birthday cards with prevention messages (mixed) Internet-based normative feedback (encouraging) In person and web-based BASICS for 21st birthday
In person most significant outcomes

Spring Break A time of peak drinking during the academic year Efforts to change peer norms
Modestly effective

Setting Goals and Developing Strategies for Event-specific Prevention

Possible goals Reduce high levels of consumption Health protection (e.g., alcohol poisoning; ER visits) Limit alcohol-related behavior problems (e.g., aggression; driving) Possible targets/strategies Attitudes and expectations Environmental changes (e.g., availability; enforcement) Medical amnesty Safe ride programs

Unique Challenges and Opportunities for the Sun God Task Force
Primary objective to reduce

risk associated with a single event Significant control over the parameters of the event Support from the upper Administration Involvement by diverse stakeholders Opportunity to translate prevention practices for Sun God to the greater UCSD community

Starting points
Unlikely to change overall drinking at UCSD in a short

period of time Opportunity to decrease harms during Sun God Festival as a huge step forward Importance of framing strategies in ways students accept and promote Need to involve a broad base (students, alumni, parents, faculty, and community) Consider harnessing all available means (e.g., social media)

Reactions, Questions and Moving Forward