Mark Pabst, MPHDivision of Gastroenterology and Hepatology

University of California, San Francisco

Who am I? A clinical researcher A behavioral epidemiologist

Why am I here? Nepotism To provide an introduction to some public

health approaches to problem drinking in colleges and universities

Using social norms Changing campus

environments Increasing levels of

social capital

Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals. “

Public health is concerned with threats to the overall health of a community based on population health analysis.

Death: 1,700 college students between the ages of 18 and 24 die each year from alcohol-related unintentional injuries, including motor vehicle crashes (Hingson et al., 2005).

Injury: 599,000 students between the ages of 18 and 24 are unintentionally injured under the influence of alcohol (Hingson et al., 2005).

Assault: More than 696,000 students between the ages of 18 and 24 are assaulted by another student who has been drinking (Hingson et al., 2005).

Unsafe Sex: 400,000 students between the ages of 18 and 24 had unprotected sex and more than 100,000 students between the ages of 18 and 24 report having been too intoxicated to know if they consented to having sex (Hingson et al., 2002).

Suicide: Between 1.2 and 1.5 percent of students indicate that they tried to commit suicide within the past year due to drinking (Presley et al., 1998).

Source: http://www.duke.edu/~amwhite/College/college3.htm

Males Whites Members of fraternities and

sororities Athletes First-year students who have

engaged in binge drinking in high-school.

(Johnston et al., 2001b; Meilman et al., 1994, 1999; Presley et al., 1996a, 1996b; Wechsler et al., 1996, 1997a, 1998, 2000b).

Students at 2-year institutions Those who attend religious schools Students enrolled at commuter schools Students attending historically Black

colleges and universities.

(Meilman et al., 1995; Presley et al., 1996a, 1996b; Wechsler et al., 2000b).

Access to low-cost alcohol Attending a college with a high rate

of binge drinking Feeling a need to “fit in” A belief that most friends binge

drink

Identify problem behaviors Use available statistics to identify specific

behaviors that affect a population’s health The principal of “Harm Reduction”

Educate target audiences about how behaviors are harmful Develop materials aimed at those at-risk that

emphasize potential downsides of the behavior

Harm to health is often secondary

SNM uses commercial advertising techniques to correct misperceptions of social norms, thereby decreasing the perceived pressure to engage in a behavior

Instead of identifying problems, SNM messages contain statistics about the non-problem behavior of a majority of people in order to encourage that behavior in others.

Uses nonjudgmental messages about the behaviors of a majority of a well-identified target audience.

Source: http://www.higheredcenter.org/environmental-management/change/normative/social-norms

Must collect or obtain data showing students overestimate their peers’ binge drinking. If there is no misperception of the norm, then

strategy likely to be unsuccessful. Strategy has been employed widely “Participants should be aware that this

case study is not a request to develop a social norms campaign.”

“Rather than blame students for their behavior or try to persuade them to stop drinking, participants in A Matter of Degree are identifying the environmental factors such as alcohol advertising and marketing, institutional policies and practices, local ordinances—even social and cultural beliefs and behaviors—that converge to encourage alcohol abuse, and work together to create positive changes. “

Source: www.alcoholpolicymd.com/programs/amod.htm

AMOD targets the easy accessibility, low price, and heavy marketing of alcohol in college communities

Creates mandatory responsible beverage-service training

Results in increased monitoring of outlets selling alcohol near campus

Encourages adoption of strict parental notification policies

Implements more stringent accreditation requirements for fraternities/sororities

Sponsors alcohol-free activities Increases substance free space in dorms

Source: (Weitzman et al., 2003c).

What is Social Capital? “The collective value of all social networks and the

inclinations that arise from these networks to do things for each other” -Robert Putnam

The social resources, trust, reciprocity, and mutual aid in a social group.

How is it Measured? Networks Trust Collective action Social inclusion Information and communication

“Social capital may play an important role in preventing binge drinking in the college setting” (Weitzman and Kawachi , 2005)

Campuses with higher-than-average levels of social capital had a 26% lower individual risk for binge drinking High social capital at HBC cause of low rates

of binge drinking? Anti-drinking programs aimed at

increasing social capital have yet to be comprehensively evaluated