Social norms and student substance use interventions

in the USA

• jennifer bauerle, Ph.D.• Director, National Social Norms

Institute• University of Virginia

OutlineOutline• Review alcohol trends among US college students • Review University of Virginia (UVa) drinking

• Review legal drinking age & binge rates

• Review UVa approach to alcohol

• Review decade long changes in alcohol at UVa

3

Charlottesville, Virginia

Where is the National Where is the National Social Norms Institute (NSNI)? Social Norms Institute (NSNI)?

4

UVA & DrinkingUVA & Drinking

““Their drink at Their drink at all times water, all times water, a young a young stomach stomach needing no needing no stimulating stimulating drinks, and the drinks, and the habit of using habit of using them being them being dangerous.”dangerous.”Thomas Thomas Jefferson, Jefferson, June 4, 1819June 4, 1819

Binge Drinking Binge Drinking All US College StudentsAll US College Students

BLUE: Monitoring the Future - Survey 1975-2010; Volume II. College Students and Adults Ages 19-40. 2011. University of Michigan and Department of Health and Human Services.

National Binge Drinking Rates by National Binge Drinking Rates by Student CharacteristicsStudent Characteristics

• Male>Female (48% vs. 39%)• White>Asian>African American (47% vs. 25% vs. 18%)• Age (< 24 years 46% vs. > 24 years 29%)• Residence (Greek 80% vs. Dorms 45% vs. off campus 40%)• Greek member > all students (65% vs. 43%)• Residential > commuter (47% vs. 30%) *• North Central (47%), Northeast (46%), South (41%), West (34%) *• 4 year institution > 2 year institution (39% vs. 34%) **• Rural/small > suburban/urban (46% vs. 41%) *• Academic rigor, size, public/private, and religious affiliation have

no influence *Adapted from Wechsler et al. J. Am. College Health 1998

UVa Annual Alcohol-Related UVa Annual Alcohol-Related ER Experience UndergraduatesER Experience Undergraduates

0

50

100

150

200

25020

00-1

2001

-220

02-3

2003

-420

04-5

2005

-620

06-7

2007

-820

08-9

2009

-10

Total ER Visits

Admissions

Alcohol Related Disorders Alcohol Related Disorders leading to ER visitsleading to ER visits

• Alcohol Dependence- (~4%) tolerance, withdrawal, used over long periods of time, persistent desire to obtain and use, unable to cut down, inability to maintain social, occupational, or recreational activities, continued use despite legal, psychological, and health problems.

• Alcohol Abuse- (~4%) recurrent use resulting in failure to fulfill major obligations, use in situations which are physically hazardous (DUI), recurrent alcohol related legal, social, or interpersonal problems.

• Alcohol Intoxication- (~92%) isolated and reversible intoxication due to recent ingestion, clinically significant behavioral, psychological, or health problems.

Alcohol Related Disorders Alcohol Related Disorders leading to ER visitsleading to ER visits

• Alcohol Dependence- (~4%) tolerance, withdrawal, used over long periods of time, persistent desire to↙↙↙ obtain and use, unable to cut down, inability to maintain social, occupational, or recreational activities, continued use despite legal, psychological, and health problems.

• Alcohol Abuse- (~4%) recurrent use resulting in failure to fulfill major obligations, use in situations which are physically hazardous (DUI), recurrent alcohol related legal, social, or interpersonal problems.

• Alcohol Intoxication- (~92%) isolated and reversible intoxication due to recent ingestion, clinically significant behavioral, psychological, or health problems.

Readily responds to educationand intervention

UVA Stall Seat Journal

BAC

Pro

babi

lity

0.0 0.1 0.2 0.3 0.4 0.5 0.6

0.0

0.2

0.4

0.6

0.8

1.0

Probability of negative consequences vs BAC level

VOMITEDPERFPOORPOLICEFIGHTINJUREDUNDRINFLUNPROTSXEMERROOM

Turner, Bauerle, Shu. J. of Studies on Alcohol. 65:741-749. 2004

Can we stop the drinking?

Can we minimize dangerous drinking?Can we minimize dangerous drinking?

Promote Responsibility and Reduce Promote Responsibility and Reduce HarmHarm

• 21 year old drinking law is a social experiment on college campuses that has failed:– to limit access – to lower drinking– to decrease traffic accidents and fatalities– to decrease health consequences

Comparison of Alcohol Purchase Ages Comparison of Alcohol Purchase Ages In EU and USIn EU and US

0

3

6

9

12

15

18

21

Germ

any

Greec

e

Roman

iaIta

ly

Hunga

ry

Franc

e

Bulgar

ia

Portu

gal

South

Afri

ca

Thaila

nd

Spain

Venez

uela

Engla

ndUSA

Icelan

d

Slovak

ia

Poland

Belgium

Colom

bia

Nethe

rland

s

Irelan

d

Ag

es

0%

10%

20%

30%

40%

50%

60%

70%

Rat

e o

f H

eavy

Dri

nki

ng

Legal Purchase Age Legal Drinking Age Heavy Drinkers

Use Complementary Use Complementary Strategies and MethodologiesStrategies and Methodologies

• Environmental management (EM)– Policies and laws– Enforcement– Referrals for education and medical evaluation– Community coalitions– Server training

• Health Education– Social Norms Marketing (SNM)

• Marketing healthy and safe norms (reinforces safer consumption and use of more protective behaviors).

• Correcting misperceptions about normative behaviors and attitudes

UVa Alcohol ProgrammingUVa Alcohol Programming• Environmental

– Risk management education for Greeks

– Police outreach and intervention

– SafeRide, Designated Drivers program, Late night programming

– Fraternal organization requirements, student athlete mentors

– Celebratory drinking events (Halloween, Foxfield, Spring Break)

– Judiciary penalties

• Health Education– Social Norms Marketing

• Peer educators• Parent/student orientation• Stall Seat Journal• Campus posters• Media messages• BAC cards• Online education

Examples of misperceptions Examples of misperceptions among UVa studentsamong UVa students

Correcting misperceptions

• Accurate info. About frequency & quantity of alcohol

Quantity and Frequency

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Signs of alcohol poisoning or injuryCaring for an intoxicated friend

Using the ER

Need to go the hospital?

• UVa officials, Dept. of Student Health clinicians, and ER doctors do not notify police for alcohol related incidents.

• Parents or guardians are not notified without student permission unless a situation is deemed life threatening. Whenever an emergency 911 call is made on Grounds, University police officers are dispatched to assist with the response. On occasion, follow up and investigation will take place if deemed necessary….

Hoo Knew

Hoo Knew

Hoo Knew

Hoo Knew?

BAC cards for self-monitoring

Bottom Line

Negative Consequences All UVa Undergraduates 2001-2010

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Year 2001

Year 2002

Year 2003

Year 2004

Year 2005

Year 2006

Year 2007

Year 2008

Year 2009

Year 2010

.40* .47* .37* .68** .72** Odds Ratios *p<.001**p<.01

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Year 2001

Year 2002

Year 2003

Year 2004

Year 2005

Year 2006

Year 2007

Year 2008

Year 2009

Year 2010

.24* .38* .19* .51* .55** Odds Ratios *p<.001**p<.01

Negative Consequences All UVa Undergraduates 2001-2010

Comparative NCHA National Data v. Consortium Aggregate :

Negative Consequences

0%

10%

20%

30%

40%2002

2004

2006

2008

2010

UVa Undergraduates: Mean eBAC & 99% CI

0

0.01

0.02

0.03

0.04

0.05

0.06

0.07

0.08

2001 2003 2004 2005 2006 2007 2008 2009 2010

Campaign exposure predicts outcomesFirst Year Undergraduates 2001-2006

(Internal Control Group)Multivariate Analysis:• First year students exposed to the UVa

campaign had 24% lower odds of having a BAC ≥ .08 (p = 0.024)

• First year students exposed to the UVa campaign had 22% lower odds of suffering two of ten possible negative consequences (p=0.002)

Turner, Perkins, Bauerle. J. Am. Coll. Health. 2008. 57:85-93.

Emergency room visits at UVa

• SNM project has encouraged friends caring for friends and using the ER

• ER visits are up > 100%• Hospital admissions are (closed head trauma,

alcohol poisoning) decreased• Incident rate of injury has declined mirroring

declines in self-reported injury (ref: Keller A, Turner JC, and Bauerle J. Longitudinal comparison of ED admissions for alcohol-related trauma and self-reported alcohol-related injury in a college population. The American Journal of Drug and Alcohol Abuse. 2010. 36:194-198)

“More students are seeking appropriate care for themselves and friends.”

Another Bottom Line

Outbreak of Health?• 2010 compared to 2001:

2741 fewer students suffered injuries

2883 fewer students drove under the influence

711 fewer students had unprotected sex

• 2001 to 2010:23,300 more students over 10 years no negative consequences related

to alcohol.

Significant increases in use of protective behaviors.

• Increased use of emergency services, less severe conditions

• Twenty Year Trend of decreasing mortality rates due to alcohol-related unintentional injury

Thank you!

Please contact me with questions at: bauerle@virginia.edu

Or visit our web site at:www.socialnorms.org