A STATEWIDE INITIATIVE IN MARYLAND

1. Establishing a Collaborative to Reduce Excessive Drinking among College Students A STATEWIDE INITIATIVE IN MARYLAND Maryland Association of Prevention Professionals and Advocates November 14,2012 David Jernigan, PhD Johns Hopkins Bloomberg School of Public Health

2. Excessive drinking can lead to a wide array of consequences • Acute adverse health effects: • Acute poisoning • Assaults/violence • Accidents and injuries • Increased risk of other drug use • Alcohol-impaired driving • Harms to others • Loss of study time • Academic failure • Chronic health effects or disease • Family dysfunction • Unemployment • Alcohol use disorders • Community disintegration

3. Youth (age 12-20) Binge Drinking in the U.S.: Much better than it would have been without community efforts, but not making the progress we should be making Source: NSDUH 2010 (SAMHSA 2011)

4. Trends in NSDUH, 1979-2006 Individuals younger than 20 years have experienced marked reductions in risk for binge drinking, suggesting that changes in the MLDA, as well as other policy changes and public health campaigns, have been successful. Countering the former trend, risk for binge drinking among girls and young women has been rising, with risk increasing faster for minorities than for whites. The reduction in risk for binge drinking among youths has not reached college students. (Grucza et al. 2009)

5. Nationally, most approaches to reducing college drinking have limited success • Many colleges do not use validated assessment tools to screen for alcohol problems.a • Information-only educational approaches are the most commonly used prevention strategy (98%), but shown to be the least effective.b • While the research points to interventions that might work, these strategies are often not effectively implemented.b • For individual-level interventions, there is room for improvement via increased personalization. • Very few colleges implement community-based alcohol control strategies.b aWinters, KC, Toomey, TL., Nelson, TF et al. Screening for Alcohol Problems among 4-Year Colleges and Universities. J Am Coll Health 2011, 59: 350-357. bNelson, TF, Toomey TL, LenkKM et al. Implementation of NIAAA College Drinking Task Force Recommendations: How are Colleges doing 6 years later? AlcClinExp Research 34:1687-1693,2010.

6. The Problem in Maryland A preliminary assessment of 44 institutions of higher education in Maryland was completed earlier this yeara • Eleven colleges with two-week prevalence data on high-risk drinking on their campus • Prevalence estimates ranged from 43.8% to 50.5%, above the national averageb • Numerous short term and anecdotal indicators • Like most states, Maryland has a college-age binge drinking problem • aBasedon visits to all 44 campuses, personal interviews with campus contacts, and collection of available data • b Monitoring the Future Study, National Survey on Drug Use and Health

7. 4 Tiers of Interventions The National Institutes of Health groups college alcohol prevention strategies into four tiers: Tiers 1 & 2: Shown effective among college students or among the general population Tier 3: Showing logical or theoretical promise but unproven Tier 4: Ineffective when used alone

8. Where we are Now • In Maryland and elsewhere, • Tier 3 & 4 activities are most common; • Tiers 1 & 2 least common

9. NIAAA’s College Alcohol Prevention Strategies • Tier 1: Effective Among College Students • Cognitive Behavioral Skills Training with norms clarification and motivational interviewing • Brief Motivational Interviewing • Challenging Alcohol Expectancies

10. NIAAA’s College Alcohol Prevention Strategies • Examples of Tier 1 in Maryland IHEs: • Effective Among College Students • Brief Alcohol ScreeningandInterventionforCollegeStudents(BASICS) • Own alcoholeducationclassthatmay/may notincorporatesomeofthese strategies • CHOICES (Choosing HealthyOptionsintheCampusEnvironment; groupformat)

11. NIAAA’s college alcohol prevention strategies • Tier 2: Effective Among The General Population • • Increased enforcementandpublicityofminimumdrinkingagelawsandotherlawstoreducealcohol- • impaired driving • Dram shop liability • • Restrictions onalcoholoutletdensity • • Increased prices and taxesonalcoholicbeverages • • Responsible beverageservicepolicies • • Campus andcommunitycoalitions

12. NIAAA’s College Alcohol Prevention Strategies • Examples of Tier 2 in Maryland IHEs: • Effective Among The General Population • Responsible beverage service on-campus • Campus/community coalitions (including multi-campus coalitions) • Campuses involved with a campus/community coalition • Campuses with involvement or potential involvement in an MSPF coalition • Involvement or awareness of compliance checks in the community

13. NIAAA’s College Alcohol Prevention Strategies • Tier 3: Logical and Theoretical Promise, • but unproven • Social norms marketing campaigns • Increased enforcement and publicity of underage drinking laws on campus • Alcohol-free housing and activities • Campus ban on alcohol • Class schedule • Further control of alcohol use at sporting events • No industry sponsorship • Information for students at orientation, communication with parents • Consistent disciplinary action

14. NIAAA’s College Alcohol Prevention Strategies • Tier 4: Ineffective When Used Alone • Discussion of alcohol in course curriculum • BAC cards/information • Residence hall programs • Information booths/tabling • Brochures/pamphlets • Student Health 101 newsletter • Safe Spring Break Information • 21st Birthday cards • Speakers • Participation in NCAAW (National Collegiate Alcohol Awareness Week)

15. Environmental Strategies And college students Three Areas of Focus: Reducing alcoholuseandrelatedproblemsamongunderage collegestudents, 2) Among allcollegestudents, and De‐emphasizing theroleofalcoholandcreating positive expectationsoncampus. Toomey, Lenk, andWagenaar

16. Environmental interventions:underage students • Decreasing commercial access to alcohol • Limit alcohol sales • Prohibit sales on campus • Restrict/ban home deliveries • Focus on alcohol establishment behavior • Check age identification • Provide incentives for checking identification • Develop monitoring system • Train managers/servers • Require server license • Restrict age of seller • Reduce use of false age-identification cards • Penalize users and producers • Design cards that are difficult to falsify • Enforce commercial provision laws • Implement compliance checks • Enact administrative penalties • Conduct walk-throughs

17. Environmental interventions: all college students • Restricting where, when, and how alcohol is sold and distributed • Reduce density of alcohol establishments • Increase cost of alcohol license • Restrict days/hours of sale • Prohibit sales on campus • Monitor increases in availability due to privatization or community events • Promote responsible alcohol service • Serve standard sizes • Prohibit pitchers • Cut-off service to intoxicated individuals • Promote alcohol-free drinks/food • Eliminate last-call announcements • Require manager/server training • Enact dramshop liability • Reduce flow of alcohol at parties • Ban beer kegs • Restrict/ban home deliveries • Limit quantity of alcohol at events • Do not allow self-service • Make alcohol-free drinks and food available • Serve low-alcohol content drinks

18. Environmental interventions: all college students • Increasing the price of alcohol • Restrict happy hours/price promotions • Limit free alcohol • Increase alcohol excise tax • Restricting where alcohol is consumed • Restrict consumption to specific areas • Create dry campuses/residences • Prohibit consumption in locations where heavy drinking occurs

19. Environmental Strategies for Underage College students • Decrease Social Access to Alcohol • Decrease number of large drinking parties • Prevent underage access at parties • Increase awareness of laws • Pass and enforce social provision laws • Toomey, Lenk, andWagenaar

20. Environmental Strategies for Underage College students continued • Decrease Commercial Access to Alcohol • Limit alcohol sales • Focus on alcohol establishment behavior • Reduce the use of fake IDs • Enforce commercial provision laws • Toomey, Lenk, andWagenaar

21. Environmental Strategies for All College Students • Restrict Where, When, and How Alcohol is • Sold and Distributed • Reduce the density of alcohol establishments • Promote responsible alcohol service • Reduce flow of alcohol at parties • Toomey, Lenk, andWagenaar

22. Environmental Strategies for All College Students continued • Increase the Price of Alcohol • Restrict Where Alcohol is Consumed • Toomey, Lenk, andWagenaar

23. De-Emphasizing the Role of Alcohol and Creating Positive Expectations on Campus • Restrict Where, When, and How Alcohol is • Sold and Distributed • Avoid alcohol industry sponsorship • Restrict alcohol advertising • Prohibit alcohol sales on campus • Offer late night and weekend recreational sports • Conduct social norms campaigns • Encourage students to work, volunteer, or complete internships • Encourage staff and faculty to live on campus • Toomey, Lenk, andWagenaar

24. A Matter of Degree: Keys to Successful Campus-Community Coalitions • Enlist support of top level leaders • Engage in campus policy development and enforcement • Recruit and support qualified staff • Attention to process and culture of coalition • Embrace the environmental model • A MatterofDegreeInitiativetoReduceBingeDrinkingatCollegesand • Universities: LessonsLearned. Princeton: RobertWoodJohnsonFoundation; 2008.

25. A Matter of Degree: Keys to Successful Campus-Community Coalitions continued • Collect data to support problem assessment and responses • Commit to advocacy and policy change • Engage in media advocacy and communication strategies • Share responsibility for solutions • Think long-term • A MatterofDegreeInitiativetoReduceBingeDrinkingatCollegesand • Universities: LessonsLearned. Princeton: RobertWoodJohnsonFoundation; 2008.

26. NCHIP: Dartmouth-led National Learning Collaborative • Colleges “bought in” with initial investment of $20,000 each • Learning collaborative concept – no one is obligated to do anything, all try different mixes of strategies, all get to learn from each other • 33 institutions • 4 from Maryland • MD Collaborative – learning from other learning collaboratives • Participation voluntary • Development of common resources and measurement system

27. Alcohol Strategiesat Maryland Colleges

28. Policies • About a third of Maryland colleges: • Ban kegs • Provide responsible beverage service guidelines for events • Notify parents of student policy violations • 4 Colleges have medical amnesty/Good Samaritan policies

29. Data Collection • 2010 Clery statistics: • Liquor law violations: 0 – 164 arrests • Liquor Law Violations resulting in judicial referrals: 0 – 1062 • MD IHEs collect data from: • NCHA • CORE • Survey Instrument of their own creation • Alcohol Edu/Everfi • Other on-line educational program • Or Do Not Survey about health-related behavior

30. Prevention/Intervention Strategies • Most commonly cited: • Online education/prevention programs • Peer education • Information dissemination • Provision of alcohol-free activities • Differences appear between 4-yr and 2-yr colleges, and campus size and setting are also influential • 4 different campus/community coalitions exist

31. Common Challenges Staffing and resource limitations Sending a clear and consistent message Changing the culture and combating traditions

32. Suggestions from the Schools • Provide financial support • Funding for programming and conferences • Facilitate resource sharing • Financial incentives to colleges that get their numbers down • Provide resources and staffing support • Provide additional dedicated staff members • Provide access to community resources • Provide research expertise and presentations

33. Suggestions from the Schools (cont’d) • Support knowledge development • Highlight best practices • Discuss cost-effective prevention and intervention • Share successful examples with a “how-to” guide • Educate about Maryland/campus laws, policies and procedures • Discuss “what’s hot and what works” • Support skill development • Educate about crisis response • Offer training about how to implement environmental strategies

34. Suggestions from the Schools (cont’d) • Assist with Planning, Monitoring, and Evaluation • Assist with data collection and sharing • Educate about best practices for measuring outcomes • Track high school data • Provide technical assistance • Assist with trending • Help link alcohol-related problems to retention • Provide training and assist with program evaluation

35. Suggestions from the Schools (cont’d) • Foster Broader Collaboration with: • Campus representatives at multiple levels • Police • State agencies (e.g. Highway Administration) • Paramedics • Create and Promote a Communication Network • Create a directory of policy and security contacts for each campus • Connect people in similar positions across campuses (e.g. activity directors, counselors) • Facilitate information sharing when students transfer (i.e. violations) • Encourage cost-sharing and multi-campus scheduling for events

36. Suggestions from the Schools (cont’d) • Empower Students • Encourage student initiated endeavors • Provide positive recognition • Subsidize bystander intervention training • Discuss message receptivity

37. Recommendations • Establish a statewide college drinking initiative • Encourage cooperative relationships for sharing best-fit practices and experiences. • Build support from broad campus constituencies, including college presidents and upper-level administration. • Identify additional stakeholders (i.e. support from other established organizations that can help garner sustained interest and leverage curiosity and investment in results). • Consider creating a statewide coalition/consortium to facilitate information sharing among the IHES.

38. Recommendations (cont’d) • Look at college drinking as a public health issue. • Take the burden off individuals and expand the realm of possible solutions for addressing the problem. • Pay attention to the epidemiologic triad and the goal of population-level change. • Incorporate the three core functions: assessment, policy development, and assurance. • Create a statewide assessment measure (survey) for capturing data about college drinking.

39. Recommendations (cont’d) • Engage in additional data collection • Provide technical assistance for using assessment results to engage in strategic planning, as well as monitoring and evaluation methods • Move from best practices to best-fit practices • Enhance SBIRT • Improve policies and enforcement • Advocate for state-level policies, such as dram shop liability, social host laws, home delivery procedures, drinks specials laws, commitment to remain independent of industry funding, and availability of alcohol sales at college stadia.

40. Taking Steps Toward a Solution: A statewide collaborative • State-of-the-art, evidence-based, multi-component and multi-level interventions that engage campuses AND the communities that surround them • State-of-the-art measurement –a standardized system to gather metrics and evaluate the impact of interventions How can we know we are making progress when measurement is inconsistent and unreliable? • NOT a research project

41. Influences on college student drinking mm • Community • Enforcement • of Laws • (e.g., false IDs, • social hosting, nuisance) • Alcohol availability • Alcohol pricing • Alcohol promotion • Student • Family history • Personality • Mental health • Distorted • expectations of • consequences Community College Student Parent • Parent • Expectations • Vigilance • Modeling • Disapproval • Campus • Norms • Policy enforcement • Availability of resources • Screening and intervention services Campus

42. Multi-level approaches are therefore necessary to solve the problem mm Reduced Environmental Risk Community Universal Screening College Student Parent Personalized Interventions Parent Training Campus Clearer and Enforced Policies

43. Statewide Collaborative Composition and Leadership A learning collaborative of willing institutions… with the leadership and counsel of a governance body of campus leadership (public and private) from across the state

44. Statewide Collaborative Operations Operationally, a collaboration between the UMCP School of Public Health and JHU Bloomberg School of Public Health, led by: UMCP: Dr. Amelia Arria - expert in measurement, assessment and intervention in alcohol problems among college students across the college “life-course”, and Director of the Center on Young Adult Health and Development JHU: Dr. David Jernigan- internationally-known expert in community-based and environmental approaches to alcohol problems, and Director of the Center on Alcohol Marketing and Youth

45. Statewide Collaborative Long-term Goals • Measurably reduce the current level of excessive alcohol use and alcohol-related harm among all colleges in Maryland • Mobilize and sustain the commitment of campus • and community leaders toward this goal

46. Timeline Planning Phase: September 2012- June 2013 • Establish governance structure • Produce “A Guide to Best Practices to Reduce College Drinking” • Produce “Report on College Drinking in Maryland” based on an assessment of the problem and current strategies being used (all 44 campuses) • Design a standardized system to gather metrics • Hold a statewide Educational Conference and Leadership Summit • Develop a sustainability plan to supplement state funds for the five-year initiative Implementation of Interventions: June 2013 onward… Interventions will be scientifically-supported and tailored to the specific needs of each campus

47. Statewide Collaborative Key Points • Planning phase underway and fully funded by DHMH • Colleges can start new drinking reduction strategies – we can make ourselves available for consultation in that regard • Scientifically-supported interventions described in a formal guide for all campuses • Educational Conference will be held for all institutions

48. Statewide Collaborative Key Points • Excessive alcohol use is a significant threat to: • student safety, academic success, well-being, and human capital development • Evidence-based actions are needed that include: • Science-based individual risk screening and interventions, community-level • interventions that target alcohol supply (e.g. problem outlets), • drinking places (e.g. nuisance party apartments and buildings), • and price discounting. • Action is urgently needed, but will require leadership in building consensus.

49. Next Steps • Leadership from the level of the presidents that this is an important issue, that more needs to be done, and that our approach needs to be based in the best science available • Insights from the prevention community: • What prevention initiatives have been effective in reducing alcohol problems in this age group? • What aspects of what you are doing are working well? • Where do we all need to focus to move the needle?

50. TOGETHER, we can make a difference! www.camy.org