1. An Evolution of Environmental Prevention Models Bob Saltz Richard McGaffigan Prevention Research Center Berkeley, California Pacific Institute for Research and Evaluation Prevention Research Center

2. Presentation Objectives Planning phase discussion Planning phase discussion Needs assessment Needs assessment Baseline data Baseline data Strategic partners Strategic partners Resource assessment Resource assessment Model programs vs evidence-based strategies Model programs vs evidence-based strategies Evaluation strategy Evaluation strategy

3. Presentation Objectives Outline an evolution of prevention models by: Outline an evolution of prevention models by: Describing the Community Trials project Describing the Community Trials project The Border Project The Border Project Safer California Universities project Safer California Universities project

4. COMMUNITY TRIALS TO PREVENT ALCOHOL-INVOLVED TRAUMA Prevention Research Center Berkeley, CA 1991-1997 Sponsors: National Institute on Alcohol Abuse and Alcoholism & National Institute on Alcohol Abuse and Alcoholism & Center for Substance Abuse Prevention Center for Substance Abuse Prevention

5. Up to 50% of fatal car crashes involve alcohol. More than 20,000 people are killed and 650,000 are injured annually.

6. Alcohol is involved in 22% of all home injuries in the U.S.

7. 56% of injuries from fights or assaults involve alcohol

9. Goal: Reduce Alcohol-involved Trauma Traffic Crashes Injuries -- burns -- falls Drownings Violence    

10. National Community Trial to Prevent Alcohol-involved Trauma

11. Five Prevention Components 1.Community Mobilization 2.Responsible Beverage Service 3.Risk of Drinking and Driving 4.Underage Drinking 5.Alcohol Access

12. Alcohol-involved Trauma at the Community Level: Conceptual Model MOBILIZATIONMOBILIZATION DRINKING AND DRIVING UNDERAGE DRINKING ALCOHOL ACCESS RESPONSIBLE BEVERAGE SERVICE SERVICE Non-Traffic Risk Activities Local News about Alcohol Problems & Enforcement Retail Alcohol Availability (On and Off-premise) Alcohol Intoxication or Impairment or Impairment Alcohol-involved Injury and Death (Traffic and Other) Driving after Drinking Perceived Risk of Arrest Local Law Enforcement Social Access to Alcohol Alcohol Serving and Sales Practices Local Regulation of Alcohol (Density, Hours of Sale)

13. Community Trials Final Results Driving after “Too much to drink” (- 49%) BAC Positive Drivers (- 44%) Heavy Drinking (-6%)    Assaults Nighttime Injury Crashes (-10%)   -- Hospital Cases (-2%) -- Emergency Room Cases (- 43%) -- Emergency Room Cases (- 43%)

14. The San Diego-Tijuana Project to Reduce Teen and Binge Drinking Institute for Public Strategies www.publicstrategies.org Institute for Public Strategies www.publicstrategies.org

15. Strategy Implementation Learning Strategy Selection Recruitment System functional model for community prevention Data Collection & Evaluation Community Mobilization

16. Research / Practice Partnership Pacific Institute Pacific Institute Data collection Data collection Data feedback to programming Data feedback to programming Program design Program design Policy support Policy support Media hook Media hook Institute for Public strategies Institute for Public strategies Design and implement prevention strategy Design and implement prevention strategy Policy Policy Community organizing Community organizing Media Media Law enforcement Law enforcement

17. Border field laboratory 3. Tijuanabars North-boundbordersurvey 4. 2.South-boundbordersurvey San Diego County Telephone Survey1.

18. The Problem Underage and binge drinking in Mexico Underage and binge drinking in Mexico Thousands of US teenagers cross into Tijuana on a weekend evening Thousands of US teenagers cross into Tijuana on a weekend evening Alcohol related problems are the result Alcohol related problems are the result DUI Crashes DUI Crashes Fights, injuries, crime and arrests Fights, injuries, crime and arrests Exposure to STD’s Exposure to STD’s Poor school performance Poor school performance

19. Strategic Change Model Scientific Data & Research Media Advocacy Community Organizing Policy Enforcement Effective Advocacy Campaign

20. Border Project Multiple Interventions Binational Collaboration Southbound Operation Safe Crossing Tijuana RBS training ID training Ban Alcohol Ads Enforcement in Tijuana Bars Northbound Community Policing DUI checkpoint USA Mexico

21. Safer California Colleges and Universities: A risk management approach to college student drinking problems

22. Why Care About College Student Drinking?

23. M ean Score for 5+ Drinks in a Row in Past 2 Weeks by 4-year College Student Status Wave 1Wave 2Wave 3Wave 4 Measurement Wave (18)(19-20)(21-22)(23-24) Twice Once None College Non-College

24. Injury 500,000 students between the ages of 18 and 24 are unintentionally injured under the influence of alcohol (Hingson et al., 2002)

25. Assault More than 600,000 students between the ages of 18 and 24 are assaulted by another student who has been drinking (Hingson et al., 2002)

26. Sexual Abuse More than 70,000 students between the ages of 18 and 24 are victims of alcohol-related sexual assault or date rape (Hingson et al., 2002)

27. Drunk Driving 2.1 million students between the ages of 18 and 24 drove under the influence of alcohol last year (Hingson et al., 2002)

28. Academic Problems About 25 percent of college students report academic consequences of their drinking including missing class, falling behind, doing poorly on exams or papers, and receiving lower grades overall (Engs et al., 1996; Presley et al., 1996a, 1996b; Wechsler et al., 2002)

29. What are we trying to prevent? Intoxication Intoxication Harm related to intoxication Harm related to intoxication

30. Safer California Universities Project Goal To evaluate the efficacy of a “Risk Management” approach to alcohol problem prevention

31. Risk Management Risk Assessment Risk Assessment Risk Reduction Risk Reduction Risk Monitoring Risk Monitoring

32. Risk Assessment Brief interviews with key personnel Brief interviews with key personnel Archival data sources Archival data sources Student survey data Student survey data

34. Risk Reduction Matching intervention to risky settings: Fraternity parties Fraternity parties Drinking in residence halls Drinking in residence halls Drinking associated with athletic events Drinking associated with athletic events Drinking at off-campus bars & restaurants Drinking at off-campus bars & restaurants

35. Risk Monitoring Key role of archival data Key role of archival data Iterative process of evaluation…. Iterative process of evaluation…. …with improved implementation …with improved implementation

36. How is risk management a unique approach? Targets times and places instead of individuals Targets times and places instead of individuals Focus on intoxication Focus on intoxication Tied to continuous monitoring and improvement - emphasis on “control” rather than “one shot” interventions Tied to continuous monitoring and improvement - emphasis on “control” rather than “one shot” interventions

37. Anticipated Hurdles for Prevention Strategy Implicit assumption that “target” is high-risk drinkers Implicit assumption that “target” is high-risk drinkers

39. Anticipated Hurdles for Prevention Strategy Implicit assumption that “target” is high-risk drinkers Implicit assumption that “target” is high-risk drinkers Ambivalence about student drinking Ambivalence about student drinking Low perceived efficacy of environmental interventions Low perceived efficacy of environmental interventions Challenges of coordination and resource allocation Challenges of coordination and resource allocation Possible fears of “backlash” Possible fears of “backlash”

40. Hypothesized Elements Necessary for Purposive Environmental Interventions Organizational Knowledge of Problem Organizational Knowledge of Problem Clear Focus Clear Focus Organizational Efficacy Organizational Efficacy Resources Resources Coordination Coordination Commitment Commitment Perceived Efficacy Perceived Efficacy Continuous Feedback/Evaluation Continuous Feedback/Evaluation

41. REDUCING UNDERAGE DRINKING: A COLLECTIVE RESPONSIBILITY

42. The full report (readable on-line): The full report (readable on-line): National Academies Press www.nap.edu Order by phone: 888-624-7645 FACE’s executive summary publication: FACE’s executive summary publication: www.faceproject.org www.faceproject.orgwww.faceproject.org For copies of:

44. Task Force Recommendations Evidence of Effectiveness Among College Students Tier 1: Evidence of Effectiveness Among College Students : Evidence of Success With General Populations That Could Be Applied to College Environments Tier 2: Evidence of Success With General Populations That Could Be Applied to College Environments : Evidence of Logical and Theoretical Promise, But Require More Comprehensive Evaluation Tier 3: Evidence of Logical and Theoretical Promise, But Require More Comprehensive Evaluation : Evidence of Ineffectiveness Tier 4: Evidence of Ineffectiveness

45. The End

46. Supplemental Slides These slides were not presented, but are included in case anyone might be interested in seeing a bit more on related topics

47. Each state should prohibit: Purchase or attempted purchase, possession, and consumption of alcoholic beverages. Purchase or attempted purchase, possession, and consumption of alcoholic beverages. Possession of and use of falsified or fraudulent identification. Possession of and use of falsified or fraudulent identification. Provision of any alcohol to minors by adults. Provision of any alcohol to minors by adults. Underage drinking in private clubs and establishments. Underage drinking in private clubs and establishments. Access: State Drinking Age Laws

48. Source % Grade 6 % Grade 9 % Grade 12 Friends Friends39.369.372.3 Family Family48.728.818.2 Parties Parties32.155.659.8 Took from home Took from home33.133.211.8 Took from friend’s home Took from friend’s home15.917.75.0 Got someone to buy it Got someone to buy it14.035.352.6 Bought at store Bought at store8.37.68.5 Bought at bar or restaurant Bought at bar or restaurant8.14.67.5 Took from store Took from store10.06.52.5 Access: Sources of Alcohol Used by Underage Drinkers, Past 30 Days Source: Harrison, et al., 2000

49. Strengthen compliance check programs. Strengthen compliance check programs. The federal government should require states to achieve designated rates of retailer compliance. The federal government should require states to achieve designated rates of retailer compliance. All sellers and servers of alcohol complete state-approved training as a condition of employment. All sellers and servers of alcohol complete state-approved training as a condition of employment. Access: Commercial Availability

50. Effects of Compliance Checks and RBS on Underage Sales Source: Grube, 1997

51. Authorize negligence-based civil actions against commercial providers for serving or selling alcohol to a minor who subsequently causes injury to others. Authorize negligence-based civil actions against commercial providers for serving or selling alcohol to a minor who subsequently causes injury to others. Regulate internet sales and home delivery to reduce the likelihood of sales to underage purchasers. Regulate internet sales and home delivery to reduce the likelihood of sales to underage purchasers. Access: Commercial Availability

52. Implement enforcement programs to deter adults from purchasing alcohol for minors. Implement enforcement programs to deter adults from purchasing alcohol for minors. Establish and implement a system requiring registration of beer kegs. Establish and implement a system requiring registration of beer kegs. Adopt and publicize policies for detecting and terminating underage drinking parties. Adopt and publicize policies for detecting and terminating underage drinking parties. Access: Social Availability

53. Facilitate enforcement of zero tolerance laws. Facilitate enforcement of zero tolerance laws. Enact graduated driver licensing laws. Enact graduated driver licensing laws. Implement sobriety checkpoints. Implement sobriety checkpoints. Strengthen efforts to prevent and detect use of false identification. Strengthen efforts to prevent and detect use of false identification. Establish administrative procedures and noncriminal penalties for alcohol infractions by minors. Establish administrative procedures and noncriminal penalties for alcohol infractions by minors. Access: Youth Use

54. Insufficient evidence to support youth-oriented media campaign now: intensive research and development needed. Insufficient evidence to support youth-oriented media campaign now: intensive research and development needed. Fund only evidence-based programs. Fund only evidence-based programs. Information-only interventions, scare tactics, and “delay” messages are not effective. Information-only interventions, scare tactics, and “delay” messages are not effective. Expand the availability of effective clinical services for treating alcohol abuse. Expand the availability of effective clinical services for treating alcohol abuse. Youth Interventions

55. Campuses should adopt comprehensive evidence based approaches: Universal educational approaches as well as selective and indicated approaches Universal educational approaches as well as selective and indicated approaches Screening and brief interventions Screening and brief interventions Limit alcohol availability and access for underage students Limit alcohol availability and access for underage students Consistent enforcement of laws and policies Consistent enforcement of laws and policies NIAAA and SAMHSA should continue to fund evaluation of college-based programs and should maintain list of evidence-based programs. College Interventions

56. Community coalitions can increase the effectiveness of interventions. Community coalitions can increase the effectiveness of interventions. Assess problem locally Assess problem locally Develop comprehensive community-based initiative. Develop comprehensive community-based initiative. Implement strategies tailored to the specific problems and resources in the community. Implement strategies tailored to the specific problems and resources in the community. Community Interventions

57. Involve gatekeepers, businesses, key community leaders, and colleges. Involve gatekeepers, businesses, key community leaders, and colleges. Consider strategies such as: community organizing, public education, strategic use of mass media, and partnerships with faith-based organizations. Consider strategies such as: community organizing, public education, strategic use of mass media, and partnerships with faith-based organizations. Community Interventions

58. Resources are essential: Public and Private partners should support community mobilization to reduce underage drinking Public and Private partners should support community mobilization to reduce underage drinking Federal funding should be available under a national program dedicated to community-level approaches modeled after the Drug-Free Communities Act Federal funding should be available under a national program dedicated to community-level approaches modeled after the Drug-Free Communities Act Community Interventions

59. Alcohol use by young people is dangerous. Alcohol use by young people is dangerous. Committee calls for a deep, unequivocal societal commitment to curtail underage drinking. Committee calls for a deep, unequivocal societal commitment to curtail underage drinking. Need to dedicate the resources commensurate with the magnitude of the problem. Need to dedicate the resources commensurate with the magnitude of the problem. Commit to a comprehensive strategy that involves multiple partners (National, State, Campuses, Local) to achieve long-term results. Commit to a comprehensive strategy that involves multiple partners (National, State, Campuses, Local) to achieve long-term results. Summary

60. Summary Develop national adult-oriented media campaign Develop national adult-oriented media campaign Create national partnership, including industry Create national partnership, including industry Reduce youth exposure, both advertising and entertainment Reduce youth exposure, both advertising and entertainment Government Assistance and Coordination Government Assistance and Coordination Increase compliance, including enforcement on- and off- campus Increase compliance, including enforcement on- and off- campus Implement evidence-based efforts aimed at youth Implement evidence-based efforts aimed at youth Implement effective college campus interventions Implement effective college campus interventions Develop community-specific responses, including campus collaborations Develop community-specific responses, including campus collaborations Increase excise taxes Increase excise taxes Conduct ongoing monitoring and R& E Conduct ongoing monitoring and R& E

61. Safer California Universities Survey Fall 2003 Fall 2003 Internet and Mail Surveys Internet and Mail Surveys Random Samples of Students Random Samples of Students 14 Campuses 14 Campuses N = 28,000 Range 738 - 1291 N = 28,000 Range 738 - 1291 Response rate 51% Response rate 51% Source: Safer California Universities Survey, 2003

62. Safer California Universities Survey Gender: Male 41% Female 59% Gender: Male 41% Female 59% Ages: 18 19.6% 19 18.3% 20 16.2% 21 16.2% >21 28.8% Ages: 18 19.6% 19 18.3% 20 16.2% 21 16.2% >21 28.8% Class: Freshman 21.1% Sophomore 17.9% Junior 28.5% Senior 32% Other.5% Class: Freshman 21.1% Sophomore 17.9% Junior 28.5% Senior 32% Other.5% Ethnicity White 52.1% Black 3.3% Asian Amer. 33.5% Ethnicity White 52.1% Black 3.3% Asian Amer. 33.5% Latino 17.4% Other 17.4% Latino 17.4% Other 17.4% Source: Safer California Universities Survey, 2003

63. Percentage of Safer Students Drinking in Past Semester/Quarter Source: Safer California Universities Survey, 2003

64. Percentage of Drinkers Getting Drunk in Past Semester/Quarter Source: Safer California Universities Survey, 2003

65. Percent of Students “Binge” Drinking Past Two Weeks Source: Safer California Universities Survey, 2003

66. Drinking Problems in Past Semester/Quarter (UC) Source: Safer California Universities Survey, 2003

67. Drinking Problems in Past Semester/Quarter (CSU) Source: Safer California Universities Survey, 2003

68. Secondary Drinking Problems in Past Semester/Quarter (UC) Source: Safer California Universities Survey, 2003

69. Secondary Drinking Problems in Past Semester (CSU) Source: Safer California Universities Survey, 2003

70. Drinking Problems by Setting and Campus