Lessons learned about environmental alcohol strategies from the 'A Matter of Degree' Program in Coll

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Lessons learned about environmental alcohol
strategies from the 'A Matter of Degree' Program
in College CommunitiesDonald 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

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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

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A Matter of Degree goals

• Test efficacy of environmental model
• Create sustainable campus-community partnerships
  to address entire student environment
• Reduce high-risk drinking 2nd-hand effects

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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)

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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

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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

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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

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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 Project
• U of Iowa, October 27, 2004

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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

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Rates of growth Iowa City1975 9 liquor
licenses downtown 6 were bars1981 17 10
1998 33 20 2005 48 32
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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)

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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

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AMOD Findings (1997-2001)Adapted from Weitzman,
Nelson, Lee Wechsler,AJPrevMed, 2004

• Interventions High Low
• among all AMOD sites
• Availability 26 5
• Legal sanctions 21 4
• Physical context 8 2
• Advertising
• Promotion 7 4
• Key influencers 16 8
• Sociocultural context 79 23

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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

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Reductions did not occur at

• the 5 universities that implemented fewer of
  these changes
• nor at the group of 32 comparison colleges

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5 high intervention sites5-11 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

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Drinkers at 5 High Implementation Schools18
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

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5 high intervention schools 10 fewer 2ndhand
effects from other students heavy alcohol use,
e.g.

• property vandalized
• interrupted sleep or study time
• arguments, insults or assaults
• unwanted sexual advance
• baby sit a student

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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.

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• 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 for
• Excessive Drinking. Am J Preventive Medicine.
  27(3)261-263.

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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

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Underlying dynamics supportive of change

• Long term voluntary commitment to coalition
  efforts policy change
• Willingness of institutions to see school as
  activist change agents
• Shift from individual-only to include environment
  approaches

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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

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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

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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

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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

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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.

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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)

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AMA helped reframe the issues

• Underage drinking is an adult issue
• Just because we hold youth responsible doesnt
  mean the rest of us arent responsible too

• The alcohol industry needs to be held
  accountable
• Alcohol problems are community problems requiring
  community solutions

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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)

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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)

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Statement on Reducing the Global Impact of
Alcohol on Health and Society

• submitted by the AMA
• adopted by the
• World Medical Association
• Santiago, Chile, October 2005

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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

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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

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American Medical AssociationOffice of Alcohol,
Tobacco Other Drug Abuse Preventionwww.ama-as
sn.org/go/alcoholwww.alcoholpolicymd.com