1 Examining the Social Norms Approach for the Prevention and Reduction of Drug Use in University and College Students in seven European Countries The Social Norms Intervention for the Prevention of Polydrug Use (SNIPE) Study Claudia R. Pischke, PhD, Stefanie Helmer, MSc, Katharina Gallois, MSc, Rafael Mikolajczyk, PhD MD, Hajo Zeeb, PhD MD, Guido van Hal, PhD, Bart Vriesacker, MSc, John McAlaney, PhD, Robert Dempsey, PhD, Bridgette Bewick, PhD, Christiane Stock, PhD, Solveig Boggild Dohrmann, Francisco Guillen Grima, PhD, Olga Orosova, PhD, Ferdinand Salonna, PhD, Ondrej Kalina, MA, Yildiz Akvardar, PhD European Commission Directorate General Justice, Freedom and Security (JLS/ /DPIP/AG)

2 Drug Consumption among Young Adults: 12-Months Prevalence Licit drugs Alcohol ~ 94% Binge drinking ~21% (at least 1x month) Tobacco ~ 38% men, ~ 30% women Illicit drugs Any ~ 16% Cannabis ~15% Amphetamines ~3% Ecstasy ~1% Cocaine ~2% Spice ~1.9% Heroin ~0.2% European Monitoring Centre for Drugs and Drug Addiction, 2010 National Report (2009 Data) EMCDDA National Report Germany 2010 (2009 Data)

3 The Role of Peers…The Social Norms Approach

4 Perceived Social Norms Re: Legal Drug Use among College and University Students US & Canada & Australia Binge drinking, Tobacco use, Marihuana use e.g., Haines & Barker, 2003 (In: Perkins, 2003); Kilmer et al., J Stud Alcohol, 2006 Europe – Scotland, England, Hungary, Slovak Republic, Romania, Czech Republic, Finland, Denmark Binge drinking e.g., McAlaney et al., J Stud Alcohol Drugs, 2007; Bewick et al., Addict Behav, 2008; Page et al., Subst Use Misuse, 2008

5 Effects of Social Norms Interventions Change toward less exaggerated perception of peer alcohol and tobacco use Reduced alcohol & tobacco consumption Perkins, Addict Behav, 2007 Page et al., Subst Use Misuse, 2008 Larimer et al., J Stud Alcohol Drugs, 2009 Moreira et al., Cochrane Library, 2009

6 Objectives – SNIPE Project To assess and compare self-reported frequency of the consumption of licit and illicit drugs among university and college students in seven European countries To examine the effects of an internet ‘social norms’ intervention on rates of both licit and illicit drug use over the course of 5 months To examine the feasibility of this e-health intervention in the European context

7 Design Intervention Group: Access to a website portal providing individualized social norms feedback (N=1000) Delayed Intervention Control Group: Access to the intervention website after study completion (N=1000) Baseline and 5-months Follow-up Assessments: → Perceptions of personal and peer drug use → Rates of personal licit and illicit drug use

8 Workstream 0 (University of Bremen): Project Coordination Monitoring of project activities Management of internal communication Setting up of a steering committee Management of financial issues Workstream 1 (University of Antwerp): Intervention Development Literature review Design of the intervention format Screening (Personalized) social norms feedback Development of website and platform Pre-testing of the intervention Translation of the intervention

9 Workstream 2 (University of Bradford): Survey and Intervention Application Survey design Survey testing Survey and intervention implementation (baseline, 5-months follow-up) Analysis of survey data Workstream 3 (University of Leeds): Intervention Process Evaluation Process evaluation of the implementation of the social norms intervention → Neither involved in the development of the survey nor intervention

10 Workstream 4 (University of Southern Denmark): Dissemination Development of a flyer Workshops / Seminars Study website: Exchange program for young researchers in the field of social norms research

11 Registration Intervention Intervention Group(s) Registration Control Control Group(s) Belgium United Kingdom Germany* Spain Denmark Slovak Republic* Turkey* Study Registration vs. Participation * Germany: 2 control sites Slovak Republic: 2 intervention, 2 control sites Turkey: 5 control sites

12 Difficult to get universities on board Different channels of recruitment: , lectures/seminars, facebook, postcards/flyer, radio, university homepages Novelty of web-based intervention Challenges during Recruitment

13 Male studentsFemale students Most of the students think that the majority drinks at least… How often the majority actually drank alcohol Most of the students think that the majority drinks at least… How often the majority actually drank alcohol Belgium Twice a week (67,9%) Once a week (55,6%) Once a week (88,2%) Once every two weeks (54,3%) United Kingdom Once a week (68%)Once every two weeks (48%) Once a week (73%)Twice (51,8%) Germany Twice a week (53,0%) Weekly (52,2%)Twice a week (50,6%) Once every two weeks (50,0%) Spain Twice a week (53,1%) Weekly (56,3%)Weekly (72,7%)Once every two weeks (60,0%) Denmark Weekly (64,6%)Once every two weeks (68,1%) Weekly (70,8%)Once every two weeks (50,0%) Slovak Republic Twice a week (50,8%) Once every two weeks (56,3%) Weekly (68,3%)Twice (50,8%) Turkey Once every two weeks (53,8%) Not in the last 2 months (56,0%) Twice (61,0%)Not in the last 2 months (60,9%) Perceived vs. Actual Rates of Alcohol Consumption * data refer to the last two months before survey _____________ Overestimation in all countries

14 Male studentsFemale students Rate of students who think that the majority has used cannabis at least once * Actual rate of students that have used cannabis * Rate of students who think that the majority has used cannabis at least once * Actual rate of students that have used cannabis * Belgium67,9%9,3%60,6%6,1% United Kingdom 68,0%28,0%60,6%7,0% Germany70,0%38,8%70,0%20,6% Spain75,0%6,2%72,7%4,4% Denmark33,3%6,2%27,6%3,7% Slovak Republic 73,4%12,6%57,1%3,4% Turkey22,9%4,6%13,4%3,0% Perceived vs. Actual Rates of Cannabis Consumption * data refer to the last two months before survey

Alcohol Tobacco Cannabis Alcohol & Smoking Did you know? 99% of male students at the University of Bradford have never used cocaine Click on the links next to the SPIN- man to find out how you compare with other students…

I said “I drank alcohol once every two weeks in the last two months” “I think that the majority of male students at Bradford drank alcohol once a week” Did you know? 96% 96% of male students from Bradford have NEVER used hallucinogens (e.g., LSD, acid, mushrooms) Number of alcoholic drinks consumed Click here! Tobacco Cannabis Alcohol & Smoking General Alcohol Use (in the last two months) ? Most male students (68%) at Bradford University said: drank alcohol once a week or less Actually, most male students from Bradford (60%) drank alcohol once a week or less! at least once a week We think that the majority of male Bradford students drank alcohol at least once a week Alcohol What about getting drunk on alcohol? Click here!

‘I haven’t used cannabis’ ‘I think the majority of male students from Bradford use cannabis once every two weeks’ Did you know? never OK to use inhalants 88% of male students at Bradford think that it is never OK to use inhalants (e.g., glue, petrol, paint thinner) Smoking Cannabis (in the last two months) ? at least once We think the majority of male students at the University of Bradford used cannabis at least once in the past two months Tobacco Cannabis Alcohol & Smoking Alcohol I said (68%) Most male students (68%) at Bradford University said:

‘I smoked cigarettes whilst drinking alcohol once a fortnight’ ‘I think the majority of male students from Bradford smoked cigarettes whilst drinking alcohol once in the past two months’ Did you know? 88% of male students from the University of Bradford have never used ecstasy Smoking tobacco whilst drinking (in the last two months) smoked cigarettes when drinking alcohol at least twice We think that most male Bradford students have smoked cigarettes when drinking alcohol at least twice in the past 2 months have not smoked cigarettes whilst drinking alcohol Actually, most male students from Bradford (64%) have not smoked cigarettes whilst drinking alcohol! Tobacco Cannabis Alcohol & Smoking Alcohol I said (80%) Most male students (80%) at Bradford University said:

19 BIPS, Bremen University, Germany Claudia R. Pischke, Stefanie Helmer, Katharina Gallois, Rafael Mikolajczyk, Hajo Zeeb University Antwerp, Belgium Guido van Hal, Bart Vriesacker University of Bradford, UK John McAlaney University of Leeds, UK Bridgette Bewick University of Southern Denmark, Denmark Christiane Stock, Solveig Boggild Dohrmann University of Navarra, Spain Francisco Guillen Grima University of Kosice, Slovakia Olga Orosova, Ferdinand Salonna, Ondrej Kalina Marmara University, Turkey Yildiz Akvardar European Commission Directorate General Justice, Freedom and Security (JLS/ /DPIP/AG)

20 THE END

‘I have been drunk twice in the last 2 months’ ‘I think the majority of male students from Bradford get drunk weekly’ Did you know? 96% of male students at Bradford have NEVER used non-prescribed medication (such as ritalin) to improve academic performance Getting Drunk On Alcohol (in the last two months) ? no more than twice Actually, most male Bradford students (76%) got drunk no more than twice in the past 2 months! got drunk at least twice We think that the majority of other male Bradford students got drunk at least twice in the past two months Tobacco Cannabis Alcohol & Smoking Alcohol I said (68%) Most male students (68%) at Bradford University said: Number of alcoholic drinks consumed Click here! More info about general alcohol use…? Click here!

‘I have 5 alcoholic drinks during a typical drinking session’ ‘I think most male students at Bradford drank 6 alcoholic drinks during a typical drinking session’ Did you know? 71% of male students at Bradford think it’s never ok to use ecstacy Number Of Drinks (in the last two months) ? drank at least 5 alcoholic drinks “We think most male Bradford students drank at least 5 alcoholic drinks during a typical drinking session” no more than 4 alcoholic drinks Actually, most male Bradford students (68%) drank no more than 4 alcoholic drinks during a typical drinking session! More info about general alcohol use…? Click here! Tobacco Cannabis Alcohol & Smoking Alcohol What about getting drunk on alcohol? Click here! I said Most male students (60%) at Bradford University said:

‘I smoked cigarettes twice a week’ ‘I think the majority of male students from Bradford smoke cigarettes daily’ Did you know? 96% of male Bradford students have NEVER used sedatives or sleeping pills (e.g., diazepam, alprazolam) Smoking Tobacco (in the last two months) ? Tobacco Cannabis Alcohol & Smoking Alcohol I said (76%) Most male students (76%) at Bradford University said: We think most male Bradford students smoke at least one cigarette a fornight

24 Harmful Health Consequences of… Licit Drug Use Pulmonary diseases Cardiovascular problems Cancers Mental health disorders Infertility Preterm delivery, stillbirth Liver disease Memory loss Accidents Illicit Drug Use Overdose death Infectious diseases Kidney damage Mental health disorders Neurological damage European Monitoring Centre for Drugs and Drug Addiction, 2010 Center for Disease Control, 2011 World Health Organisation, 2011 National Institutes of Health, 2011

25 Model of Social Norms Approach to Health Promotion Baseline Identify actual and misperceived normsIntervention Intensive exposure to actual norm Predicted Results messages Less exaggerated Reduction in misperceptions harmful behavior of norms Increase in healthy behavior Perkins, 2003, San Francisco: Jossey-Bass, p