Dennis Martell Changing Focus

Changing Focus:Using ACHA-NCHA Data and Healthy Campus 2010 Objectives in a Social Norms Context to Challenge the Environment of High-risk Drinking and Reduce Harm: 

Changing Focus: Using ACHA-NCHA Data and Healthy Campus 2010 Objectives in a Social Norms Context to Challenge the Environment of High-risk Drinking and Reduce Harm Dennis Martell, Ph.D. Michigan State University

Overview : 

Overview I. Description of Social Norm Project II. Surveying a population group to select and refine messages III. Results IV. Building objectives consistent with Social Norms Theory and Healthy Campus 2010 Initiatives V. Questions

I. Description of the Social Norm Project: 

I. Description of the Social Norm Project History Project Goals/Design Intervention Strategies

Slide4: 

Michigan State University Student Population Undergraduate students:35,678 Graduate students:9,488 Professional students:1,391 Total enrollment: 45,166 MSU is the largest single campus student body of any Michigan university and among the largest in the country. Women:54% Men:46% 16 percent, are minorities. Nearly 88.6 percent of MSU students are from Michigan. MSU's residence hall system has a capacity of 17,197 students. Students also may live in the 2,340 campus apartments.

MSU History: Series of Unfortunate Events: 

MSU History: Series of Unfortunate Events Gunson Street 1997 Munn Field 1998 Action Team formed Alcohol Poisoning on 21st Birthday 1999 NCAA 2000 NCAA 2005 NCAA

Action Team Process: Philosophy on Alcohol** : 

Action Team Process: Philosophy on Alcohol** Treat Alcohol as a ‘health’ issue Reduce harm\consequences associated with drinking Correct misperceptions Challenge the environment of high-risk drinking-change culture!

Assumptions/Theory/Approaches to High-Risk Drinking: 

Assumptions/Theory/Approaches to High-Risk Drinking Individual Education Harm reduction Social Norms campaign to correct misperceptions/behavior Environmental Management

Alcohol Action Team Process: Recommendations: 

Alcohol Action Team Process: Recommendations Community Relations Coalition Responsible Hospitality Council City involvement in orientation Change in off-campus code of conduct Social-norm marketing campaign Increased late night entertainment on campus Campaign “celebratory drinking”

Goals of the Social Norm Grant Project: 

Goals of the Social Norm Grant Project To implement and evaluate the efficacy of a global and celebratory event targeted social norm campaign at changing perception, behavior and consequences of excessive alcohol use. Targeted celebratory events (Halloween, St. Patrick’s Day and Spring Break) -added tailgating, MSU/UM Football Game, NCAA Tournament, and Welcome Week. Run a global campaign concurrently. Focused on protective behaviors as a way to reduce drinking and harmful consequences based on findings from existing research.

Project Design : 

Project Design 3 year- calendar project Baseline 2002 multiple surveys (NCHA) Final Outcome evaluation 2006 (NCHA) Targeted entire student body Global and celebratory events (quasi-ex.) Multidimensional normative messages>

Descriptive Norms Definition: 

Descriptive Norms Definition What people actually do – Berkowitz, 2004 Individuals’ beliefs about how widespread a particular behavior is among their referent others – Rimal & Real, 2003 Amount of behavior Most drink five or fewer Frequency of behavior Most party once a week or less

Injunctive Norms Definition: 

Injunctive Norms Definition What people feel is right based on morals or beliefs – Berkowitz, 2004 The extent to which individuals feel pressured into engaging in a behavior due to perceived benefits and threats – Rimal & Real, 2003 Misperceptions here greater and more likely to predict drinking behavior and negative consequences of drinking than descriptive norms - Berkowitz, 2004

Protective Behavior Definition: 

Protective Behavior Definition Behaviors that individuals can engage in while drinking alcohol in order to limit negative alcohol-related consequences – Taylor et al, 2004. Protective Behavior Norms: -- Descriptive or injunctive norms pertaining to protective behavior

Protective Behaviors (PB) : 

Protective Behaviors (PB) Rationale for Inclusion in Social Norms Project: Changeable protective factor useful in both prevention and treatment efforts Results of celebratory study indicated use of PB reduced harm independent of consumption Consistent with harm reduction philosophy and objectives Respectful, “client-centered”, audience relevant

Global Campaign: 

Global Campaign General, universal campaign addressing everyday drinking behavior

Celebration Norms Campaign: 

Celebration Norms Campaign Specific campaign addressing drinking on special celebratory occasions: Party Holidays (Halloween, St. Patrick’s) Sports events (Football, Tournament) Beginning of school year Spring break 21st Birthdays

Intervention Strategy to Correct Misperceptions:: 

Intervention Strategy to Correct Misperceptions: Social Marketing Print (NCHA) Electronic (website) Dosage and Distribution Timing Target Classroom Infusion

Dosage and Distribution: 

Dosage and Distribution Number of Message Placements Featuring Four Basic Themes 59 Protective norms 21 Moderately or not at all 15 Celebrate safely 14 0-to-5

Dosage and Distribution (NCHA): 

Dosage and Distribution (NCHA) Proportion of Messages Placed in Three Channels 59% State News (including welcome, orientation, magazine) 34% Posters 7% Table Tent 87% of sample saw one or more message per 2005 Spring survey

II.Surveying a population group to select and refine messages : 

II. Surveying a population group to select and refine messages Survey Plan and Design Select and refine messages

Implementation and Survey Plan: 

Implementation and Survey Plan 2003-04 2004-05 Red: Targeted with Campaign Black: No Campaign NCHA

About the Surveys: Targeted: 

About the Surveys: Targeted Conducted as Web surveys after Thanksgiving and after Spring Break- (NCHA used for global campaign) Cross-sectional probability samples of currently enrolled undergraduates Advance letter, then email invitation to participate with active link (only allow 1 response per person), up to 2 follow-up reminders; incentives offered Questionnaire took approx. 25 minutes to complete Roughly 1,000-1,300 respondents per survey Response rates: 45-60% Take about 2 weeks to complete

Typical Content of the Surveys: 

Typical Content of the Surveys Perceptions of MSU student drinking generally, for particular targeted events Self-reported drinking behavior, use of protective behaviors generally, for particular targeted events Message assessments – each ad/poster separately -(saw, # times, effective, new information, believable) Demographics Other issues (e.g., injunctive statement, latitude of acceptance, hot topics)

Celebration Norms Campaign: MSU Health and Celebration Surveys: 

Celebration Norms Campaign: MSU Health and Celebration Surveys Quasi-experimental 1) Establish PB norms for targeted celebratory events Surveying in non-experimental year 2) Evaluate Outcomes Surveying in experimental year

B. Select & refine messages with formative research: 

B. Select & refine messages with formative research

Slide26: 

Formative evaluation research provides data and perspectives to improve messages during the course of creation Selecting protective behaviors: -- protective efficacy -- normative prevalence -- target audience responsiveness

Protective efficacy : 

Protective efficacy Which behaviors are most closely related to preventing harm? #1 Avoid drinking games #2 Pace to one drink per hour or less #3 Limit number of drinks

Normative prevalence: 

Normative prevalence Which protective behaviors are practiced by substantial majority? (2004 figures) -- 85% Designated driver -- 81% Eat before/during -- 66% Keep track of drinks or 66% practice one+ of following…

Audience responsiveness: 

Audience responsiveness Ease of performing behavior (e.g., Eating) Perceived social acceptability (e.g., Keep track) Belief in effectiveness (e.g., Designated driver)

Refining messages: 

Refining messages Pretesting rough executions with small samples… compare responses to different elements such as: -- “66%” vs. “most” vs. “majority” -- eating vs. keeping track -- large vs. small citation of data source -- male vs. female vs. mixed role -- Drinking vs. partying

III. Results: 

III. Results Perception Measures Behavior Measures Protective Behavioral Norm Measures Consequence Measures

Perception measures (NCHA*): 

Perception measures (NCHA*)

Behavior measures (NCHA*): 

Behavior measures (NCHA*)

C. Protective Behaviors Measures: 

C. Protective Behaviors Measures Protective Behaviors % Always or Usually (undergrads) 2000 2002 2004 2006 A. Alternate drinks 18.9% 25.2% 24.1% 23.7% B. Plan not to exceed limit 31.5% 34.0% 31.7% 32.7% C. Choose not to drink 21.8% 25.8% 21.2% 17.7% D. Have designated driver 78.9% 81.4% 84.7% 81.6% E. Eat before or during 76.0% 77.7% 80.9% 82.0% F. Have friend say when had enough 30.8% 32.9% 27.8% 26.4% G. Keep track of drinks 64.9% 64.4% 66.0% 62.7% H. Pace drinking 23.0% 21.4% 23.1% 21.6% I. Drink look alikes 4.8% 4.1% 4.3% 5.1%

Slide35: 

% Who Always or Usually Did 1 or More Key Protective Behaviors* Among those who drink (undergrads) 2000 2002 2004 2006 Did none of a, b, c, g, h 33.0 31.8 30.6 33.7 Did 1 or More 67.0 68.2 69.4 66.3** (Always or Usually) *collapse this count into 0; 1 or more of these protective behaviors **trend appeared to be that the percent who do at least one protective behavior has increased slightly

Slide36: 

% Who Did and Did Not Do Any Identified Protective Behaviors by Drink Level Those Who Drank 5+ Drinks Last Time Partied 2000 2002 2004 2006 Did none of IPB 38.7 36.4 36.8 35.9 Did 1 or 2 of IPB 49.2 51.4 55.2 54.0

Slide37: 

Mean # of Drinks Last Time Partied/Socialized Did Protective Behaviors 2000 2002 2004 2006 Did none 6.3 6.1 6.4 5.7 Did 1 or 2 5.8 5.8 5.6 5.8 Did 3-5 4.2 3.5 3.2 3.5 The table indicates that, particular in the most recent year, the individuals who weren't doing any of the other protective behaviors were, in fact, doing what is perhaps the most important protective behavior – they were drinking less.

Frequency Measure : 

Frequency Measure

Protective Behaviors:: 

Protective Behaviors: PACING may be the key!! Promising protective behaviors: Staying with same group of friends- Remaining in one location- Consuming only one type of alcohol

D. Consequence Measures* (NCHA): 

D. Consequence Measures* (NCHA)

Consequences Measures*: 

Consequences Measures*

IV:  How to build objectives consistent with Social Norms Theory and Healthy Campus 2010 Initiatives: 

IV: How to build objectives consistent with Social Norms Theory and Healthy Campus 2010 Initiatives

Questions to Begin any Campus Health Initiative!: 

Questions to Begin any Campus Health Initiative! Where are we now? Where do we want to be? How are we going to get there? How will we know when we have arrived?

An Outcome-Based Planning Process: 

An Outcome-Based Planning Process Scan & assess the population/environment Select strategies best suited for outcomes Generate expected outcomes Set long-range outcomes (ultimate goals) Clarify assumptions for individual/environmental change

Outcome-Based planning Product:A Logic Model: 

Outcome-Based planning Product: A Logic Model Current Reality: Pop. IHE Community Theory Model Framework for CORE Functions Efforts to Stimulate Change Vision of Changes for: Pop. IHE Community Context Assumptions Strategies/ Services Outcomes Standards NCHA 2010 Obj.

Slide46: 

Individual: Education Social Norming Harm Reduction 2010 Obj. Reduce mortality & morbidity. Increase academic & social success Environmental Management Current Reality Data (NCHA) Long-Range Outcome Strategies Assumptions Theory/Model Context/ Data

Slide47: 

2010 Objectives were divided into three categories- Broad Mission Objectives relating to dissemination of health information across campus, Health and Academic Impact Objectives concerned with decreasing the negative effect of specific health behaviors on students ability to be successful academically & Programmatic Mission Objectives relating to specific target goals within the service areas currently offered by health education.

Slide48: 

Decrease the percentage of students who experience adverse health consequences as a result of alcohol use: (NCHA*) adverse academic consequences*, injured self, injured other, involved in a fight, regret, blackouts/ memory loss, sexual assault/threat of, & unprotected sex Program Mission Objective Alcohol & Adverse Effects

Slide49: 

Adverse academic performance Targets: National DNC College 6 % Our Campus 5 % Baselines National DNC College 7.6 % Our Campus 9 % Target setting method: National: College: Better than the best (Females = 6 %). Our Campus: Better than the best (Other /race = 5 %). Data sources: National: College: ACHA-National College Health Assessment (NCHA), Spring 2002. Our Campus: ACHA-National College Health Assessment (NCHA), Spring 2004-MSU.

ACHA-National College Health Assessment (NCHA), Spring 2004-MSU: 

ACHA-National College Health Assessment (NCHA), Spring 2004-MSU TABLE 20. % of Respondents Who Had Various Health Problems in Last School Year That Did or Did Not Affect Academic Performance % Who Had and Academic Performance Affected % Did % Had % Had GENDER RACE Health Problem Not Have No Effect Some Effect Male Female White Other Alcohol use 34.3 56.9 8.9 11.2 7.1** 9.9 5*

Slide51: 

Injury to Self Targets: National DNC College 2.5 % Our Campus 9.5 % Baselines National DNC College 13.1 % Our Campus 18 % Involved in a fight Targets: National DNC College 4 % Our Campus 2.7 % Baselines National DNC College 7.3 % Our Campus 6 % Regret Targets: National DNC College 29 % Our Campus 23 % Baselines National DNC College 30 % Our Campus 33 % Adverse Health Affects

Adverse Health Affects: 

Adverse Health Affects Blackouts/ memory loss Targets: National DNC College 25 % Our Campus 17 % Baselines National DNC College 27 % Our Campus 29 % Sexual assault/ threat of Targets: National DNC College 1 % Our Campus 0.3 % Baselines National DNC College 1.3 % Our Campus 0.8 % Unprotected sex Targets: National DNC College 11 % Our Campus 7.7 % Baselines National DNC College 12 % Our Campus 12 %

MSU ACHA - National College Health Assessment (NCHA), Spring 2004% of Respondents Who Drink Who Report Experiencing Various Health Threatening Consequences of Their Drinking Within the Last School Year, Overall and by Background: 

MSU ACHA - National College Health Assessment (NCHA), Spring 2004 % of Respondents Who Drink Who Report Experiencing Various Health Threatening Consequences of Their Drinking Within the Last School Year, Overall and by Background Within the last school year, have you experienced . . . as a consequence of your drinking? Injured Injured Involved Did, later Forgot Forced Unprotected Self Other in Fight Regretted Where, What Sex Sex Overall 18.1 4.6 6.4 32.9 28.7 0.8 12.1 Gender Males 18.9 6.8 11.1 35.4 31.6 0.3 15.0 Females 17.6 3.0** 2.7*** 31.3 26.7 1.4 9.9* Race White 21.0 5.1 6.5 36.3 32.8 0.9 13.6 Other 9.5*** 3.1*** 6.4*** 23.4*** 17.0*** 0.6*** 7.7***

Program Mission Objective: Use of Protective Behaviors: 

Program Mission Objective: Use of Protective Behaviors Increase the percentage of students using one or more protective behaviors to reduce potential harm from alcohol, such as: (Which of the “protective” behaviors as measured by NCHA are really protective when correlated with consequences” as measured by NCHA?)

Program Mission Objective: Use of Protective Behaviors: 

Program Mission Objective: Use of Protective Behaviors Increase the percentage of students using one or more protective behaviors to reduce potential harm from alcohol, such as: setting drink limits, keeping track of the number of alcoholic drinks consumed, pacing drinks to one or fewer per hour, avoiding drinking games, decreasing average amount consumed per occasion*, abstinence or infrequent use of alcohol*.

Protective Behaviors: 

Protective Behaviors Abstinence or infrequent use of alcohol (Infrequent use means they have used alcohol in the past, but not in past 30 days). Targets: National DNC College 33 % Our Campus 23 % Baselines National DNC College 31.5 % Our Campus 21.5 % Setting drink limits Targets: National DNC College 30 % Our Campus 50 % Baselines National DNC College 27 % Our Campus 35 % Keeping track of the number of alcoholic drinks consumed Targets: National DNC College 56 % Our Campus 73 % Baselines National DNC College 51 % Our Campus 67 %

Protective Behaviors: 

Protective Behaviors Pacing drinks to one or fewer per hour Targets: National DNC College 27 % Our Campus 38% Baselines National DNC College 22 % Our Campus 28 % Avoiding drinking games Targets: National DNC College 35 % Our Campus 53% Baselines National DNC College 34 % Our Campus 40 % Decreasing average amount consumed per occasion Targets: National DNC College 3.6 Our Campus 4 Baselines National DNC College 4.3 Our Campus 5

National College Health Assessment (NCHA) MSU 2004The last time you “partied/socialized, how many alcoholic drinks did you have?: 

National College Health Assessment (NCHA) MSU 2004 The last time you “partied/socialized, how many alcoholic drinks did you have? Target setting method: National: College: Better than the best (Race/gender= %). Our Campus: Better than the best (Female = 4). Data sources: National: College: ACHA-National College Health Assessment (NCHA), Spring 2002. Our Campus: ACHA-National College Health Assessment (NCHA), Spring 2004-MSU. Mean Median Std Dev Males 6.12 5.00 4.99 Female 4.07 4.00 3.13 Overall 5.04 4.00 4.24

MSU - ACHA-National College Health Assessment (NCHA), Spring 2004% of Respondents Who Partied Who Always or Usually Took Various Steps to Drink Responsibly, by Background Characteristics: 

MSU - ACHA-National College Health Assessment (NCHA), Spring 2004 % of Respondents Who Partied Who Always or Usually Took Various Steps to Drink Responsibly, by Background Characteristics During the last school year, if you partied, how often did you Determine Keep Track Paced Avoid Choose Drink How Many Drinks< 1 Drinking Not To Limit Ahead Drinks Per Hour Games Drink Gender Males 28.5 60.5 15.1 33.9 16.9 Females 40.3*** 72.7*** 38.2** 45.4*** 29.6 Race White 30.9 65.9 25.6 36.7 18.8 Other 49.8*** 72.4 36.1*** 53.2*** 32.2 Age 18-19 31.7 67.0 20.1 26.5 21.6 20-21 29.3 66.0 21.7 25.5 16.9 22-23 33.5 66.2 29.7 46.0 20.1 24 or older 50.2*** 71.8 48.8*** 81.1*** 30.7 * p( P2) < .05; ** p( P2) < .01; *** p( P2) < .001

Outcome-Based planning Product:A Logic Model: 

Outcome-Based planning Product: A Logic Model Current Reality: Pop. IHE Community Theory Model Framework for CORE Functions Efforts to Stimulate Change Vision of Changes 2010 Obj. Context Assumptions Strategies/ Services Outcomes

Slide61: 

Education Increase in the percentage of students who will use PB that correlate with reduced harm Increase in perceptions about use of protective behaviors. Increase practices and policies that facilitate access and decrease barriers to protective behaviors Increase the proportion of MSU students who report using one or more protective behaviors to reduce potential harm from alcohol. Harm Reduction Environmental Management Social Norming: Current Reality Data on MSU students NCHA 2004 Drinks per party 5 Alternate drinks 18.8% Plan not to exceed limit 24.4% Choose not to drink 20.4% Have designated driver 72.0% Eat before or during 80.1% Have friend say when 31.7% Keep track of drinks 53.0% Pace drinking 20.8% Drink look alikes 5.0% . Long-Range Outcome Intermediate Outcomes Strategies Assumptions Theory/Model Context/ Data

V. Questions: 

V. Questions

Contact Information: 

Contact Information Dennis Martell PhD dennis.martell@hc.msu.edu 517-432-1031 371 Olin Health Center Michigan State University E. Lansing, MI 48824