Changing Focus: Challenging the Environment of Highrisk Drinking with the Use of Protective Behavior

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Changing FocusChallenging the Environment of
High-risk Drinking with the Use of Protective
Behaviors
Dennis Martell, Ph.D. Michigan State University
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Overview

• Description of Michigan State Project and
  Discussion of Formative Findings
• II. Surveying a population group to select and
  refine messages
• III. Trend Results
• IV. Questions

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I.Description of the Michigan State Project

• History
• DOE Grant-Celebration
• Social Norms Grant

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Michigan State University Student Population
Undergraduate students35,678 Graduate
students9,488 Professional students1,391 Total
enrollment 45,166 MSU is the largest single
campus student body of any Michigan university
and among the largest in the country. Women54
Men46 17 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.
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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

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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

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Change in Focus Generated by Action Team Process

• Treat Alcohol as a health issue
• Reduce harm\consequences associated with
  drinking
• Correct misperceptions
• Challenge the environment of high- risk
  drinking-change culture!

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Clarify Assumptions Evidenced Based Approaches
to High-Risk Drinking

• Individual/Groups
• Education
• Harm reduction
• Social Norms campaign to correct
  misperceptions/behavior
• Environmental Management

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Formative Research Changing Focus

• A targeted, effective prevention effort begins
  with solid, science-based research. Formative
  research helps you find and understand the needs
  and interests of your audience and design
  programs, services, and products that address
  those needs.
• Formative research calls for rethinking
  assumptions and obtaining feedback about concepts
  and activities
• Formative researchers must pay careful attention
  to design. It often requires a number of
  well-orchestrated inquiries to uncover
  differences and to look closely at certain
  audiences.

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U.S. Department of Education Grant 2001-2003
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• Goals
• to explore celebratory behavior patterns and
  factors influencing drinking patterns.
• To evaluate the efficacy of the 21st birthday
  card intervention methodology.
• To develop, implement and evaluate a prevention
  media campaign targeting the environment of the
  celebrant.

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Ethnographic and Formative Research Findings
Celebratory Occasions
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DRINKING AND DRUNKENNESS ON CELEBRATORY
OCCASIONS Holiday DRINK ?
DRUNK Occasion PREVAL
RATE Halloween 32
(57) St. Patricks 26
(58) Typical Thursday 19
(48)    DRINK PREVAL Percent of all students
that report drinking DRUNK RATE Proportion of
drinkers who report getting drunk
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DRINKING AND DRUNKENNESS ON CELEBRATORY
OCCASIONS Football DRINK ?
DRUNK Occasion PREVAL
RATE Big Gameday 38
(56) Other Games 37
(50) Typical Saturday 23
(39)    DRINK PREVAL Percent of all students
that report drinking DRUNK RATE Proportion of
drinkers who report getting drunk
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DRINKING AND DRUNKENNESS ON CELEBRATORY
OCCASIONS Weeklong DRINK ?
DRUNK Occasion PREVAL
RATE Spring Break 48
(62) Welcome Week 37
(72) End of Semester 23
(55) Typical Week 47
(48)
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Non-Drinking Norm Prevalence 76 End of
Semester 74 St. Patricks 68
Halloween 62 Big Game 60 Welcome Week 52
Spring Break
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Non-Drunkenness Norm Prevalence (Moderately or
not at all) 86 End of Semester 85 St.
Patricks 82 Halloween 79 Big Game 71
Welcome Week 70 Spring Break
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Types of Drinkers   Anytime Drinkers -- 54
  Drink on typical days and special
days   Celebration Drinkers -- 35  
Drink on special days but not typical days  
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Types of Drinkers   Non-Celebration Drinkers
-- 2   Drink on typical days but not
special days   Seldom Drinkers -- 9  
Drinkers who didnt drink on the special or
typical days measured in survey
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Focused Findings

• Identified Protective Behaviors showed a
  reduction in harm independent of consumption
• Normative climate seemed to approve of drinking
  and higher than normal consumption on celebratory
  occasions
• Individuals identified as celebratory/event
  specific drinkers!

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Protective Behaviors

• Promising protective behaviors not related to
  consumption (Celebration 02)
• Staying with same group of friends-
• Remaining in one location-
• Consuming only one type of alcohol.

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Social Norm Grant 2003-2006 The National Social
Norms Resource Center Funded Through Anheuser-Bus
ch Foundation
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Goals

• 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.
• Target celebratory events (Halloween, St.
  Patricks Day and Spring Break) -added
  tailgating, MSU/UM Football Game, NCAA
  Tournament, and Welcome Week.
• Run a global campaign concurrently.
• Focus on protective behaviors as a way to reduce
  drinking and harmful consequences based on
  findings from existing research.

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Project Design

• 3 year- calendar project- now extended 4 years
• Targeted entire student body
• Global and celebratory events (quasi-ex.)
• Multidimensional normative messagesgt

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• Formative Research Findings
• Social Norms Grant
• 2003-05

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Perception of various celebrations SALSA
estimates, Fall Celebration Survey data
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Approval estimates of celebration drinking from
SALSA
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Having more than 5 drinks
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Having more than one drink/hour
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Getting wasted
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Celebration drinking
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Results of Note Injunctive Norms

• 77 of MSU students approve of drinking more than
  usual during celebration events.
• 74 of MSU students approve of getting drunk
  during welcome week.
• 73 of MSU students report they approve of
  getting drunk during Halloween.
• Celebrations Surveys 2003-2006

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• Social Norms Marketing
• Global and Celebratory Campaign

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Descriptive Norms Definition

• What people actually do Berkowitz, 2004
• Amount of behavior
• Most drink five or fewer
• Frequency of behavior
• Most party once a week or less

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Descriptive Norms Posters
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Descriptive Norm Poster
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Injunctive Norms Definition

• What people feel is right based on morals or
  beliefs Berkowitz, 2004
• Misperceptions here greater and more likely to
  predict drinking behavior and negative
  consequences of drinking than descriptive norms -
  Berkowitz, 2004

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Injunctive Norm Poster
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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

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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

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Protective Behavior Norms Poster
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(No Transcript)
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Global Campaign

• General, universal campaign addressing everyday
  drinking behavior

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Global Ad
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(No Transcript)
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Celebration Norms Campaign

• Specific campaign addressing drinking
• on special celebratory occasions
• Party Holidays (Halloween, St. Patricks)
• Sports events (Football, Tournament)
• Beginning of school year
• Spring break
• 21st Birthdays

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Celebration Poster
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Celebration Poster
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Intervention Strategies

• Social Marketing
• Print (NCHA)
• Electronic (website)
• Dosage and Distribution
• Timing
• Target
• Classroom Infusion
• Viral Marketing- host to host
• Individual intervention
• BMI
• E-Chug

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Dosage and Distribution

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

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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

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Respondents Assessments of Social Norming Ads
Distributed in 2003-05
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Respondents Assessments of Social Norming Ads
Distributed in 2003-05
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II.Surveying a population group to select and
refine messages

• Survey Plan and Design
• Select and refine messages

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

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B. Select refine messages with formative
research
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• 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

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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

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Drinkers harmed vs. drinkers safe which
protective measures work

• Data on the following slides exclude abstainers.
• Note Negative correlations indicate behavior is
  protective positive means the behavior is
  irrelevant to protection.
• NCHA

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Avoid drinking gamesharmed or safe
Correlation between harmed and safe -.89
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Alternating drinks harmed or safe
Correlation between harmed and safe -.60
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Limiting drinks harmed or safe
Correlation between harmed and safe -.62
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Pace drinks lt1/hour harmed or safe
Correlation between harmed and safe -.75
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Choosing not to drink harmed or safe
Correlation between harmed and safe .76
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Using a designated driver harmed or safe
Correlation between harmed and safe .94
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Eating before/during drink harmed or safe
Correlation between harmed and safe .93
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Friend say enough harmed or safe
Correlation between harmed and safe .52
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Track drinks harmed or safe
Correlation between harmed and safe .29
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Drink non-alcoholic beverages harmed or safe
Correlation between harmed and safe .99
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(No Transcript)
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Student Identified Protective BehaviorsProtective
Behavior Prevalence

• Stay with Friends 30
• Personal Responsibility 7
• Watch your drink 7
• Party in Familiar Place 5
• Alternate Drinks 3
• Choose Not to Drink 3
• No alcohol from stranger 3
• Dont Party 3
• Friend say enough 3
• Other 20

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Normative prevalence

• Which protective behaviors are practiced by
  substantial majority?
• 
  (2006 figures)
• -- 82 Designated driver
• -- 82 Eat before/during
• -- 78 Stay with Friends
• -- 63 Keep track of drinks
• or 66 practice one of following

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Audience responsiveness

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

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Additional Considerations

• External vs. Internal Consequences
• Top 3 Concerns
• Legal Trouble
• Forced Sex
• Injuring Another Person
• 2006 Celebrations Survey
• Enabling Protective Behaviors
• Designated Driver, Eating

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Refining messages

• Pretesting rough executions
• with small samples compare responses to
  different elements such as
• -- 66 vs. most vs. majority
• -- large vs. small citation of data source
• -- male vs. female vs. mixed role
• -- Drinking vs. partying

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III. Results

• Perception Measures
• Behavior Measures
• Protective Behavioral Norm Measures
• Consequence Measures

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Perception measures (NCHA)
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Behavior measures (NCHA)
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Of MSU Undergraduates Who Drank 0-4 or 8
Drinks Last Time Partied/Socialized
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(No Transcript)
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(No Transcript)
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C. Protective Behaviors Measures

• Protective Behaviors
• Always or Usually (undergrads only)
• 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

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• 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)

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• Who Did and Did Not Do Any Identified
• Protective Behaviors by Drink Level
• Those Who Drank 5 Drinks Last Time Partied
  (undergrads)
• 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
• Did 3-5 of IPB 12.1 12.2 7.9 10.1
• Did 1-5 of IPB 61.3 63.6 63.1 64.1

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• Mean of Drinks Last Time Partied/Socialized
• Did Protective
• Behaviors (undergrads) 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.

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D. Consequence Measures (NCHA)
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Consequences Measures
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V. Questions
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Contact Information

• Dennis Martell PhD
• dennis.martell_at_hc.msu.edu
• 517-432-1031
• 371 Olin Health Center
• Michigan State University
• E. Lansing, MI 48824