Transcript presentation ( format)

Alcohol Education is Working:
10 years of declining negative
consequences and mortality rates.
American College Health Association
June 3, 2010 * Philadelphia, PA
James Turner, MD & jennifer bauerle, Ph.D.
University of Virginia
www.socialnorms.org
Successful Interventions
Have the following characteristics:
– Express empathy
– Offer no argumentation
– Support self-efficacy
– Recognize discrepancy between individual’s
behavior & normative behavior in population
Social Norms Approach: Revealing
Gap Between Perception & Norm
6
5
5.04
4.00
4
Actual
Perception
3
2
1
0
Drinks Last Time Partied
NCHA, Spring 2009, n= 87,105 web & paper surveys
Q.: How many alcoholic drinks did you have/do you think the typical
student at your school had the last time they “partied” or socialized?
What is a Norm?
Perception of Norms
Why Do Misperceptions Matter?
• Misperceived norms can be as powerful as
actual norms in influencing behavior
• Famous Misperceptions:
– Getting cold & wet predisposes you to cold or
flu
– All college students are drinking
Examples of misperceptions
among UVa students
•
•
•
•
Quantity
The Fourth Year Fifth
University policies
Underestimation
How Do Misperceptions Occur
How Do Misperceptions Occur
In health promotion, sometimes we
normalize what we are trying to prevent!
The Normative Version of the Ad
Thanks for Not Smoking!
Whatever we focus on expands
How many times do the people
in the white shirts pass the
basketball to each other?
Social Norms Approach
“I begin with an idea and then it
becomes something else.” - Picasso
• Various ways to implement normative
approach
• Paradigm Shift
– towards positive or majority Fact-Based
messages are corrected, behavior changes
Social Norms Approach
• Social Norms practice is based on long-term
relationships
– Sandboxes
Social Norms
Practitioners
Intended
Audience
PIE Components
Positive: beneficial, constructive, affirmative
Inclusive: embracing, involving,
comprehensive
Empowering: energy, authority, strength
Don’t Turn A Night Out Into A Nightmare
Campaign
*Australia has 2.8 million 1524 year olds
*rate of 7.4 per 100K
Normative Version of Campaign
Most Australian Youth Get Home Safely From A Night Out.
Thanks, Aussies
New UVa Social Norms Marketing
Programs 1999-2008
Social
Norms
Programs
Intended
Audience
Supplemental
Social Norms
Programs
Campus Wide
Campaign
Weekly Campus
Posters, newspaper ads,
BAC cards, & E-mails,
Annual music event,
Facebook
2002-2006
Primary
Campaign
Monthly Dorm
Posters
1999
First Year
Students
All Undergrads
Parents Orientation
Normative statistics
2002
At Risk
Students
Small Group Norms
For Athletes, Fraternities
& Sororities
2003
Social norms marketing
incorporated
into longstanding programs
• RA (240) training and orientation
• Lectures to two substance abuse classes
each year (250 students)
– Results in class projects, web based
presentations, newspaper articles
• Collaboration with Dean of Students, UVa
Police, and ER staff.
• Peer Health Educators
Social Norms at UVA
• Use normative data to highlight
positive, healthy behaviors of
majority
• Encourage protective behaviors,
safety, & responsibility through
empathy and support selfefficacy
• Develop discrepancies
– correct misperceptions between
perceived and actual norms
• Avoid health terrorism (no
arguing)
• Resonates with students and
encourages behavioral change
Stall Seat Journal
Quantity and Frequency
Quantity and Frequency
* Signs of alcohol poisoning or injury
* Caring 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
Stall Seat
Journal
Does it work?
Alcohol-related Negative Consequences
Over Ten Years at UVa
• Interventions since 1999: Social norms marketing, BMI in clinic,
other UVa educational initiatives (CASE)
• Data source: Annual Health Promotion Survey: stratified random
sample
• Statistical analysis: Odds ratios compare the probability of
experiencing a negative consequence in the most recent year to the
probability in the first year (2001):
– Less than 1: less probable
– 1: no change in probability
– Greater than 1: more probable
• Computed within logistic regression equations that
standardize the years in regards to:
–
–
–
–
Gender
Race/ethnicity
Class year
U.S.A. citizenship
Negative Consequences
All UVa Undergraduates 2001-2010
.40*
.47*
.37*
.68**
.72**
Odds Ratios
*p<.001
**p<.01
Negative Consequences
All UVa Undergraduates 2001-2010
.24*
.38*
.19*
.51*
.55**
Odds Ratios
*p<.001
**p<.01
UVa Health Promotion Surveys 2001-2010: Female Undergraduate Drinkers:
Protective Behaviors for Self Used Usually or Always
100
90
*
80
70
2001
2002
*
60
50
2003
2005
2006
40
*
*
30
2007
2008
2009
2010
20
10
0
DD or
alternate
buddy
system
own
drinks
watch
alternate eat before
limit
1</hr
inconv
*p<.005
UVa Health Promotion Surveys 2001-2010: Male Undergraduate Drinkers:
Protective Behaviors for Self Used Usually or Always
80
*
70
*
60
50
*
40
2001
2002
*
2003
2005
2006
2007
30
2008
*
20
2009
2010
10
0
DD or
alternate
buddy
system
own
drinks
watch
alternate eat before
limit
1</hr
inconv
*p<=.01
UVa Undergraduates:
Mean eBAC & 99% CI
0.08
0.07
0.06
0.05
0.04
0.03
0.02
0.01
0
2001 2003 2004 2005 2006 2007 2008 2009 2010
Campaign exposure predicts outcomes
First 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
“More students are seeking appropriate care
for themselves and friends.”
Annual ER Experience
Undergraduates
250
200
150
Total ER Visits
100
Admissions
50
2008-9
2007-8
2006-7
2005-6
2004-5
2003-4
2002-3
2001-2
2000-1
0
UVa Death Rates Over Two Sequential Decades
(18-24 year olds)
12
-34%*
-48%**
-60%
-68%**
10
Rate per 100,000
8
1989-1999
6
1999-2009
4
2
0
UVA All Acc
UVA MVA
UVA Suicide
Accidental death categories
Submitted JACH. 2010. Turner, Keller, Bruce.
* P= 0.03 99/09 vs. 89/99.
** P< 0.001 vs. state and national data.
UVA ETOH
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
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