Dennis Martell, Ph.D. Michigan State University

1. 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

2. 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

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

4. 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.

5. 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

6. 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!

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

8. 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” Alcohol Action Team Process:Recommendations

9. 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.

10. 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>

11. 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

12. 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

13. 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

14. 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

15. Global Campaign • General, universal campaign addressing everyday drinking behavior

16. 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

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

18. 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

19. 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

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

21. Welcome Week Welcome Week Welcome Week Tailgates Tailgates Tailgates UofM/MSU Football UofM/MSU Football UofM/MSU Football Halloween Halloween Halloween Survey Survey Survey St. Patrick’s St. Patrick’s St. Patrick’s Spring Break Spring Break Spring Break NCAA B-Ball Tournament NCAA B-Ball Tournament NCAA B-Ball Tournament Survey Survey Survey Implementation and Survey Plan 2003-04 NCHA 2004-05 Red: Targeted with Campaign Black: No Campaign

22. 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

23. 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)

24. 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

25. B. Select & refine messages with formative research

26. 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

27. 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

28. 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…

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

30. 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

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

32. Perception measures(NCHA*)

33. Behavior measures (NCHA*)

34. C. Protective Behaviors Measures Protective Behaviors % Always or Usually (undergrads) 2000 2002 2004 2006 A. Alternate drinks18.9% 25.2% 24.1% 23.7% B.Plan not to exceed limit31.5% 34.0% 31.7% 32.7% C.Choose not to drink21.8% 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 drinks64.9% 64.4% 66.0% 62.7% H. Pace drinking23.0% 21.4% 23.1% 21.6% I. Drink look alikes 4.8% 4.1% 4.3% 5.1%

35. % 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

36. % 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

37. 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.

38. Frequency Measure

39. 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

40. D. Consequence Measures*(NCHA)

41. Consequences Measures*

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

43. 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?

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

45. 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 Strategies/ Services Assumptions Outcomes NCHA 2010 Obj. Standards

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

47. 2010 Objectives were divided into three categories- • Broad Mission Objectives relating to dissemination of health information across campus, • Health and Academic Impact Objectivesconcerned 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.

48. Program Mission Objective Alcohol& Adverse Effects 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

49. Adverse academic performance Targets: National DNC College6 % 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.

50. 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 34.356.9 8.9 11.27.1**9.9 5*