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Examining the Social Norms Approach for the Prevention and Reduction of Drug Use in University and College Students in seven European Countries

The Social Norms Intervention for the Prevention of Polydrug Use (SNIPE) Study

Claudia R. Pischke, PhD, Stefanie Helmer, MSc, Katharina

Gallois, MSc, Rafael Mikolajczyk, PhD MD, Hajo Zeeb, PhD MD, Guido van Hal, PhD, Bart Vriesacker, MSc, John McAlaney, PhD, Robert Dempsey, PhD,

Bridgette Bewick, PhD, Christiane Stock, PhD, Solveig Boggild Dohrmann,Francisco Guillen Grima, PhD, Olga Orosova, PhD, Ferdinand Salonna, PhD,

Ondrej Kalina, MA, Yildiz Akvardar, PhD

European CommissionDirectorate General Justice, Freedom

and Security (JLS/2009-2010/DPIP/AG)

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Drug Consumption among Young Adults: 12-Months Prevalence

• Licit drugs

Alcohol ~ 94%

Binge drinking ~21%

(at least 1x month)

Tobacco ~ 38% men,

~ 30% women

• Illicit drugs

Any ~ 16%

Cannabis ~15%

Amphetamines ~3%

Ecstasy ~1%

Cocaine ~2%

Spice ~1.9%

Heroin ~0.2%

European Monitoring Centre for Drugs and Drug Addiction, 2010 National Report (2009 Data) EMCDDA National Report Germany 2010 (2009 Data)

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The Role of Peers… The Social Norms Approach

4Perceived Social Norms Re: Legal Drug Use

among College and University Students

• US & Canada & Australia

Binge drinking, Tobacco use, Marihuana usee.g., Haines & Barker, 2003 (In: Perkins, 2003); Kilmer et al., J Stud Alcohol, 2006

• Europe – Scotland, England, Hungary, Slovak Republic, Romania, Czech Republic, Finland, Denmark

Binge drinkinge.g., McAlaney et al., J Stud Alcohol Drugs, 2007; Bewick et al., Addict Behav, 2008; Page et al., Subst Use Misuse, 2008

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Effects of Social Norms Interventions

• Change toward less exaggerated perception of peer alcohol and tobacco use

• Reduced alcohol & tobacco consumption

Perkins, Addict Behav, 2007 Page et al., Subst Use Misuse, 2008

Larimer et al., J Stud Alcohol Drugs, 2009Moreira et al., Cochrane Library, 2009

6Objectives – SNIPE Project

• To assess and compare self-reported frequency of the consumption of licit and illicit drugs among university and college students in seven European countries

• To examine the effects of an internet ‘social norms’ intervention on rates of both licit and illicit drug use over the course of 5 months

• To examine the feasibility of this e-health intervention in the European context

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Design

Intervention Group: Access to a website portal providing individualized social norms feedback(N=1000)

Delayed Intervention Control Group: Access tothe intervention website after study completion(N=1000)

Baseline and 5-months Follow-up Assessments:→ Perceptions of personal and peer drug use→ Rates of personal licit and illicit drug use

8Workstream 0 (University of Bremen):

Project Coordination

• Monitoring of project activities

• Management of internal communication

• Setting up of a steering committee

• Management of financial issues

Workstream 1 (University of Antwerp):

Intervention Development

• Literature review

• Design of the intervention format

Screening

(Personalized) social norms feedback

• Development of website and platform

• Pre-testing of the intervention

• Translation of the intervention

9Workstream 2

(University of Bradford):Survey and Intervention

Application

• Survey design

• Survey testing

• Survey and intervention implementation (baseline, 5-months follow-up)

• Analysis of survey data

Workstream 3 (University of Leeds): Intervention Process

Evaluation• Process evaluation of the

implementation of the social norms intervention

→ Neither involved in the

development of the

survey nor intervention

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Workstream 4 (University of Southern Denmark):

Dissemination

• Development of a flyer

• Workshops / Seminars

• Study website: www.snipe-study.eu

• Exchange program for young researchers in the field of social norms research

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RegistrationIntervention

Intervention Group(s)

RegistrationControl

Control Group(s)

Belgium 441 242 360 168

United Kingdom

185 58 20 6

Germany* 551 311 278 185

Spain 126 47 98 40

Denmark 471 165 351 122

Slovak Republic*

1633 838 1216 464

Turkey* 894 381 897 372

Study Registration vs. Participation

* Germany: 2 control sitesSlovak Republic: 2 intervention, 2 control sites

Turkey: 5 control sites

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• Difficult to get universities on board

• Different channels of recruitment:

Email, lectures/seminars, facebook, postcards/flyer, radio, university homepages

• Novelty of web-based intervention

Challenges during Recruitment

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Male students Female students

Most of the students think that the majority drinks at least…

How often the majority actually drank alcohol

Most of the students think that the majority drinks at least…

How often the majority actually drank alcohol

Belgium Twice a week (67,9%)

Once a week (55,6%)

Once a week (88,2%)

Once every two weeks (54,3%)

United Kingdom

Once a week (68%) Once every two weeks (48%)

Once a week (73%) Twice (51,8%)

Germany Twice a week (53,0%)

Weekly (52,2%) Twice a week (50,6%)

Once every two weeks (50,0%)

Spain Twice a week (53,1%)

Weekly (56,3%) Weekly (72,7%) Once every two weeks (60,0%)

Denmark Weekly (64,6%) Once every two weeks (68,1%)

Weekly (70,8%) Once every two weeks (50,0%)

Slovak Republic

Twice a week (50,8%)

Once every two weeks (56,3%)

Weekly (68,3%) Twice (50,8%)

Turkey Once every two weeks (53,8%)

Not in the last 2 months (56,0%)

Twice (61,0%) Not in the last 2 months (60,9%)

Perceived vs. Actual Rates of Alcohol Consumption

* data refer to the last two months before survey

_____________

Overestimation

Overestimation

in all countries

in all countries

--------------------------

--------------------------

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Male students Female students

Rate of students who think that the majority has used cannabis at least once *

Actual rate of students that have used cannabis *

Rate of students who think that the majority has used cannabis at least once *

Actual rate of students that have used cannabis *

Belgium 67,9% 9,3% 60,6% 6,1%

United Kingdom

68,0% 28,0% 60,6% 7,0%

Germany 70,0% 38,8% 70,0% 20,6%

Spain 75,0% 6,2% 72,7% 4,4%

Denmark 33,3% 6,2% 27,6% 3,7%

Slovak Republic

73,4% 12,6% 57,1% 3,4%

Turkey 22,9% 4,6% 13,4% 3,0%

Perceived vs. Actual Rates of Cannabis Consumption

* data refer to the last two months before survey

Alcohol

Tobacco

Cannabis

Alcohol & Smoking

Did you know?

99% of male students at

the University of Bradford have never used cocaine

Click on the links next to the SPIN-man to find out how you compare

with other students…

Click on the links next to the SPIN-man to find out how you compare

with other students…

I said “I drank alcohol once every two weeks in the last two months”

“I think that the majority of male students at Bradford drank alcohol once a week”

Did you know?

96%96% of male students

from Bradford have NEVER used hallucinogens (e.g., LSD,

acid, mushrooms)Number of alcoholic

drinks consumed

Click here!

Tobacco

Cannabis

Alcohol & Smoking

General Alcohol Use (in the last two months) ?

Most male students Most male students (68(68%)%) at Bradford University saidat Bradford University said::

Actually, most male students from Bradford (60%) drank alcohol once a week or lessdrank alcohol once a week or less!

Actually, most male students from Bradford (60%) drank alcohol once a week or lessdrank alcohol once a week or less!

We think that the majority of male Bradford students drank alcohol at least once a weekat least once a week

Alcohol

What about getting drunk on alcohol?

Click here!

‘I haven’t used cannabis’

‘I think the majority of male students from Bradford use cannabis once every two weeks’

Did you know?

88% of male students at

Bradford think that it is never never OK to use inhalantsOK to use inhalants (e.g., glue,

petrol, paint thinner) 

Smoking Cannabis (in the last two months) ?

We think the majority of male students at the University of Bradford used cannabis at least once at least once

in the past two months

Tobacco

Cannabis

Alcohol & Smoking

AlcoholI said

Most male students (68(68%)%) at Bradford University said:

72%28% Have NOT used

cannabis

Have usedcannabis

What male Bradford students actually do:

‘I smoked cigarettes whilst drinking alcohol once a fortnight’

‘I think the majority of male students from Bradford smoked cigarettes whilst drinking alcohol once in the

past two months’

Did you know?

88% of male students from

the University of Bradford have never used ecstasy

 

Smoking tobacco whilst drinking (in the last two months)

We think that most male Bradford students have smoked cigarettes when drinking alcohol at least smoked cigarettes when drinking alcohol at least

twicetwice in the past 2 months

Actually, most male students from Bradford

(64%) have nothave not smoked cigarettes whilst smoked cigarettes whilst drinking alcoholdrinking alcohol!

Actually, most male students from Bradford

(64%) have nothave not smoked cigarettes whilst smoked cigarettes whilst drinking alcoholdrinking alcohol!

Tobacco

Cannabis

Alcohol & Smoking

AlcoholI said

Most male students (80(80%)%) at Bradford University said:

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• BIPS, Bremen University, Germany

Claudia R. Pischke, Stefanie Helmer, Katharina

Gallois, Rafael Mikolajczyk, Hajo Zeeb

• University Antwerp, Belgium

Guido van Hal, Bart Vriesacker

• University of Bradford, UK

John McAlaney

• University of Leeds, UK

Bridgette Bewick

• University of Southern Denmark, Denmark

Christiane Stock, Solveig Boggild Dohrmann

• University of Navarra, Spain

Francisco Guillen Grima

• University of Kosice, Slovakia

Olga Orosova, Ferdinand Salonna, Ondrej Kalina

• Marmara University, Turkey

Yildiz Akvardar

European CommissionDirectorate General Justice, Freedom

and Security (JLS/2009-2010/DPIP/AG)

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THE END

‘I have been drunk twice in the last 2 months’

‘I think the majority of male students from Bradford get drunk weekly’

Did you know?

96% of male students at

Bradford have NEVER used non-prescribed medication (such as ritalin) to improve academic

performance  

Getting Drunk On Alcohol (in the last two months) ?

Actually, most male Bradford students (76%) got drunk no more than twiceno more than twice in the past 2 months!

Actually, most male Bradford students (76%) got drunk no more than twiceno more than twice in the past 2 months!

We think that the majority of other male Bradford students got drunk at least twicegot drunk at least twice in the past two

months

Tobacco

Cannabis

Alcohol & Smoking

AlcoholI said

Most male students (68(68%)%) at Bradford University said:

Number of alcoholic drinks consumed

Click here!

More info about general alcohol use…?

Click here!

‘I have 5 alcoholic drinks during a typical drinking session’

‘I think most male students at Bradford drank 6 alcoholic drinks during a typical drinking session’

Did you know?

71% of male students at

Bradford think it’s never ok to use ecstacy

Number Of Drinks (in the last two months) ?

“We think most male Bradford students drank at least drank at least 5 alcoholic drinks5 alcoholic drinks during a typical drinking session”

Actually, most male Bradford students (68%) drank no more than 4 alcoholic drinksno more than 4 alcoholic drinks during a

typical drinking session!

Actually, most male Bradford students (68%) drank no more than 4 alcoholic drinksno more than 4 alcoholic drinks during a

typical drinking session!

More info about general alcohol use…?

Click here!

Tobacco

Cannabis

Alcohol & Smoking

Alcohol

What about getting drunk on alcohol?

Click here!

I said

Most male students Most male students (60(60%)%) at Bradford University saidat Bradford University said::

‘I smoked cigarettes twice a week’

‘I think the majority of male students from Bradford smoke cigarettes daily’

Did you know?

96% of male Bradford

students have NEVER used sedatives or sleeping pills

(e.g., diazepam, alprazolam)

 

Smoking Tobacco (in the last two months) ?

Tobacco

Cannabis

Alcohol & Smoking

AlcoholI said

Most male students (76(76%)%) at Bradford University said:

We think most male Bradford students smoke at least one cigarette a fornight

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Harmful Health Consequences of…

• Licit Drug Use

Pulmonary diseases

Cardiovascular problems

Cancers

Mental health disorders

Infertility

Preterm delivery, stillbirth

Liver disease

Memory loss

Accidents

• Illicit Drug Use

Overdose death

Infectious diseases

Kidney damage

Mental health disorders

Neurological damage

European Monitoring Centre for Drugs and Drug Addiction, 2010Center for Disease Control, 2011World Health Organisation, 2011

National Institutes of Health, 2011

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Model of Social Norms Approach to Health Promotion

Baseline

Identify actual and misperceived norms Intervention

Intensive exposureto actual norm Predicted Resultsmessages

Less exaggerated Reduction inmisperceptions harmful behaviorof norms Increase in healthy

behavior

Perkins, 2003, San Francisco: Jossey-Bass, p. 3-17.

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