Prevention Research CenterPRCPacific Institute for Research and Evaluation

Evidence for Community-Evidence for Community-Level Prevention Level Prevention

InterventionsInterventions

Bob SaltzBob SaltzPrevention Research CenterPrevention Research Center

Berkeley, CaliforniaBerkeley, California

Environmental Policies to Environmental Policies to Reduce College Drinking: An Reduce College Drinking: An Update of Research FindingsUpdate of Research Findings

Toomey, Lenk, & Wagenaar (2007) Toomey, Lenk, & Wagenaar (2007) Journal of Studies onJournal of Studies onAlcohol and DrugsAlcohol and Drugs

A Matter of Degree (AMOD)A Matter of Degree (AMOD)Weitzman et al. Weitzman et al. American Journal of Preventive MedicineAmerican Journal of Preventive Medicine. .

20042004

College/ Community PartnershipsCollege/ Community Partnerships Environmental strategies to reduce Environmental strategies to reduce

drinking problems:drinking problems: Keg registrationKeg registration Mandatory responsible beverage serviceMandatory responsible beverage service Police wild party enforcementPolice wild party enforcement Substance free residence hallsSubstance free residence halls Advertising bansAdvertising bans

A Matter of Degree (AMOD)A Matter of Degree (AMOD)Weitzman et al. Weitzman et al. American Journal of Preventive MedicineAmerican Journal of Preventive Medicine. .

20042004

AMOD achieved reductions among AMOD achieved reductions among college students incollege students in Binge drinkingBinge drinking Driving after drinkingDriving after drinking Alcohol related injuriesAlcohol related injuries Being assaulted by other drinking Being assaulted by other drinking

college studentscollege students

Campus Community Strategy Campus Community Strategy to Change the Drinking to Change the Drinking

CultureCulture

Western Washington Western Washington UniversityUniversity

Bellingham, WashingtonBellingham, Washington

Project ComponentsProject Components

Neighborhoods Engaging with Neighborhoods Engaging with Students (NEST) Students (NEST)

EnforcementEnforcement LateNight@WWULateNight@WWU Campus Community Coalition work Campus Community Coalition work

groups were involved in planning, groups were involved in planning, implementation, and process implementation, and process evaluation.evaluation.

ComparisonComparison

22ndnd Intervention Intervention

ComparisonComparison

22ndnd Intervention Intervention

Study to Prevent Alcohol Related Consequences:

Using a Community Organizing Approach to Implement Environmental Strategies in and

around the College Campus

Mark Wolfson, et alWake Forrest University

SPARCSPARC

Larger Environment

SPARC Intervention

Interventions

Environmental Strategies•Reduce Availability•Address Price/Marketing•Improve Social Norms•Minimize Harm

Elements: Policy, Enforcement, Awareness

High-risk DrinkingIndicators- Quantity - Social Setting- Frequency - Timing- Physical setting

- Underage use

Consequences- Health - Legal- Social - Academic- Violence - Victimization

Culture / Context

Campus cultures

•Student•AdministrationAlumniFaculty

Campus Policies

Community cultures

•Government•NeighborhoodsLaw enforcementRetail/business

Community Policies

Larger political, socio-economic and historical context

Community Organizing• Hold one-on-one meetings

• Understand self-interest

• Analyze power• Build coalition• Identify actionable issues

• Develop strategies• Plan & implement actions

Intermediate Outcomes

Long-term Outcomes

SPARC Conceptual ModelSPARC Conceptual Model

Environmental StrategiesEnvironmental Strategies

Reduce Alcohol Availability

Address Price/Marketing

Improve Social Norms

Minimize Harm

Expectations of each Intervention School:

Include 3 of the 4 areas in strategic plan

Most strategies should be comprehensive – i.e., include Policy, Awareness, and Enforcement elements

CDSCDS Severe ConsequencesSevere Consequences,, due to own drinking due to own drinking

(p=.02)(p=.02) Alcohol-related Injuries, caused to others Alcohol-related Injuries, caused to others

(p=.03)(p=.03)

RA SurveyRA Survey Consequences: p=.04Consequences: p=.04 Environment: p=.01Environment: p=.01 Aggregate: p=.03Aggregate: p=.03

I & I ReportsI & I Reports Police reports ofPolice reports of alcohol-related incidentsalcohol-related incidents

(p=0.04)(p=0.04) Police reports of # of citations for underage Police reports of # of citations for underage

alcohol use (p=.008)alcohol use (p=.008)

Evidence of Impact: Evidence of Impact: SummarySummary

Safer California UniversitiesSafer California UniversitiesProject Goal:Project Goal:

To evaluate the efficacy of aTo evaluate the efficacy of a“Risk Management” approach “Risk Management” approach to alcohol problem preventionto alcohol problem prevention

NIAAA grant #R01 AA12516with support from CSAP/SAMHSA.

Random AssignmentRandom AssignmentIntervention SitesIntervention Sites

CSU ChicoCSU Chico Sacramento StateSacramento State CSU Long BeachCSU Long Beach UC BerkeleyUC Berkeley UC DavisUC Davis UC RiversideUC Riverside UC Santa CruzUC Santa Cruz

Comparison Comparison SitesSites

Cal Poly SLOCal Poly SLO San Jose StateSan Jose State CSU FullertonCSU Fullerton UC IrvineUC Irvine UC Los AngelesUC Los Angeles UC San DiegoUC San Diego UC Santa BarbaraUC Santa Barbara

How is risk management a How is risk management a unique approach?unique approach?

Targets times and places instead of Targets times and places instead of individualsindividuals

Focus on intoxicationFocus on intoxication

Tied to continuous monitoring and Tied to continuous monitoring and improvement - emphasis on “control” improvement - emphasis on “control” rather than “one shot” interventionsrather than “one shot” interventions

Integrated Intervention Integrated Intervention Strategies for Off-Campus Strategies for Off-Campus

Parties Parties Compliance ChecksCompliance Checks

DUI Check PointsDUI Check Points

Party PatrolsParty Patrols

Pass Social Host “Response Cost” Pass Social Host “Response Cost” OrdinanceOrdinance

A Social Host Safe Party CampaignA Social Host Safe Party Campaign

OutcomesOutcomes

Likelihood of getting drunk at a given Likelihood of getting drunk at a given generic setting (e.g., Greek parties; generic setting (e.g., Greek parties; residence halls) plus additional aggregate residence halls) plus additional aggregate measure across all settingsmeasure across all settings

Two baseline years combined vs. two Two baseline years combined vs. two years post-intervention combinedyears post-intervention combined

Controlling for individual-level variables Controlling for individual-level variables and campus/community variablesand campus/community variables

DUI or RWDD Related to Off-Campus Party

0.00

0.05

0.10

0.15

0.20

2003-04 2004-05

Survey years

Intervention

Control

Practical SignificancePractical Significance At each campus, 900 fewer At each campus, 900 fewer studentsstudents

drinking to intoxication at off-campus drinking to intoxication at off-campus parties and 600 fewer getting drunk at parties and 600 fewer getting drunk at bars/restaurants during the fall semester at bars/restaurants during the fall semester at intervention schools relative to controls. intervention schools relative to controls.

Equivalent to Equivalent to 6,0006,000 fewer fewer incidentsincidents of of intoxication at off-campus parties and intoxication at off-campus parties and 4,0004,000 fewer incidents at bars & restaurants fewer incidents at bars & restaurants during the fall semester at Safer during the fall semester at Safer intervention schools relative to controlsintervention schools relative to controls

In addition…In addition…

No DisplacementNo Displacement

In Sum…In Sum… We have the ability to create We have the ability to create

environments that help teens and environments that help teens and young adults make healthy decisions young adults make healthy decisions about alcohol consumptionabout alcohol consumption

We have growing evidence that these We have growing evidence that these strategies are effectivestrategies are effective

Our greatest impact will likely come Our greatest impact will likely come from adopting mutually-reinforcing from adopting mutually-reinforcing policies and practicespolicies and practices

……but there are challengesbut there are challenges

Typical Hurdles for Comprehensive Typical Hurdles for Comprehensive Prevention StrategyPrevention Strategy

Implicit assumption that the only Implicit assumption that the only “target” is high-risk drinkers“target” is high-risk drinkers

Ambivalence about student drinkingAmbivalence about student drinking

Low perceived efficacy of preventive Low perceived efficacy of preventive interventionsinterventions

Challenges of coordination and Challenges of coordination and resource allocationresource allocation

Possible fears of “backlash”Possible fears of “backlash”

Unique Hurdles for College PreventionUnique Hurdles for College Prevention

Too much weight on “process” vs. “outcome”Too much weight on “process” vs. “outcome”

Preference for persuasion over controlPreference for persuasion over control

Universities are complex, diffuse Universities are complex, diffuse organizationsorganizations

Prevention staff trained in education, Prevention staff trained in education, awareness strategiesawareness strategies

Prevention staff usually lacks authority to Prevention staff usually lacks authority to launch initiativeslaunch initiatives

Thank you!Thank you!