Monday, December 28, 2009

UI's Alcohol Abuse: Look to Nebraska

December 28, 2009, 6:00 a.m.

In the 12 years that I spent on the council, I tried several times to get the council to pass a 21 ordinance. University of Iowa presidents Mary Sue Coleman and David Skorton also encouraged the council to pass such an ordinance -- along with the UI College of Public Health, the public school system and numerous others within the community. In fact, every piece of credible evidence presented to the council called for a 21 ordinance -- all of which the council ignored, choosing instead to listen to the bar owners and patrons of the bars.

-- Former Iowa City Mayor, Ernie Lehman, "Council's Moral Character Problem," Iowa City Press-Citizen, December 26, 2009, p. A11

"What Works" to Reduce Students' Alcohol Abuse
(brought to you by*)

And see, "UI's Alcohol Problem: Many Solutions, Little Will," December 16, 2009, with links to 30 related, prior blog entries.

There's good news and bad news about the University of Iowa's serious alcohol problems.

The good news is that UI isn't the only American university with this problem. The bad news is that the UI isn't the only American university with this problem. The devastation of young peoples' lives from alcohol abuse starts in the high schools and spreads across the nation's campuses.

Fortunately, there's even better news. There are solutions.

Last week, Penn State students' alcohol abuse -- and the solutions being used on other campuses -- became the subject of an hour-long NPR radio program of great relevance to Iowans.

"This American Life," with host Ira Glass, is a weekly radio program from Chicago's WBEZ-FM carried nationwide by some 500 NPR stations each week. This award-winning program will soon have been on the air continuously for 15 years. Acknowledging that the program is hard to describe, its Web site makes this effort: "There's a theme to each episode, and a variety of stories on that theme. It's mostly true stories of everyday people, though not always."

Last week's program certainly involved the "true stories of everyday people" and had as its "theme" the scourge of alcohol abuse by college students -- with a focus on those at Penn State, the nation's "number one party school." "#1 Party School," "This American Life,"No. 396, December 18, 2009.

You can listen to the entire program from that linked site. And if this is an issue for which you have actual responsibility you probably should. However, Ira divides the show into "Acts," and for my purposes at the moment I'm going to concentrate on "Act Four" (the last 19 minutes). (If you'd like to limit your listening to that "Act," and your player enables you to see how many minutes into it you are, slide it to minute 46 and start there. Unfortunately, the show does not make transcripts available; although I wish it would do so at least occasionally, and this would have been one of those occasions. What follows is based on my relatively thorough notes from Act Four.)

Act Four focuses on what we can do about it -- here in Iowa City, as well as on other campuses.

Perspectives on Penn State's Problems.

First, some of the facts from Penn State -- most of which are reflected at the UI as well.

Every year 1700 college students die of alcohol related injuries. And the problem seems to be increasing. What used to be five drinks a night at Penn State has become 8, 9 and 10. Students admitted to the Penn State hospital for alcohol poisoning, or other alcohol abuse-related conditions, have been coming in with steadily rising levels of blood alcohol -- now some three times the legal limit. The show notes that normal drinkers could never reach those levels; they would either throw up or fall asleep first.

Like Iowa, Penn State has spent millions attacking the problem. Administrators have tried to teach students about safer drinking, created alcohol-free halls and dorms, task forces and town-gown commissions, alcohol-free late night activities (including stand-up comics and movies) -- but "obviously, this hasn't gotten the job done."

Linda LaSalle, Penn State's coordinator of health education services, has tried teaching students about blood alcohol levels and alcohol poisoning, offers a mandatory online alcohol education program for incoming freshmen ("Alcohol Edu"), and a social norms media campaign that makes the point that most students drink less than incoming first years think they do.

The result? Great knowledge gains (after all, they've been admitted to the university on the basis of their ability to retain and repeat what teachers say) -- but no significant behavior changes. LaSalle says they still drink as much or more than they ever did, and acknowledges that there are many things that contribute to this problem that are out of her control.

As Bob Saltz of the Pacific Institute for Research and Evaluation puts it, universities are not well suited to resolving these problems; academics tend to think they can simply teach kids to drink less; as Penn State's (and Iowa's) experience shows, they can't. Moreover, while Penn State and other schools may have lots of programs, they often fail to evaluate what they're doing, and therefore don't know what works and what doesn't.

Dead drunk. Universities do tend to launch a range of campus responses following alcohol-related student deaths -- and the adverse publicity they bring the school.

But it turns out that even alcohol-related deaths seem to have little impact on students' actual alcohol consumption. This past September a Penn State student died from a fall while climbing a wall at 3:30 a.m., drunk after a frat party. There were similar deaths in 1993, 1987, 1984, 1983.

So what is the student reaction? When a girl fell to her death from sixth story window in 1997 the newspaper expressed it: the death, it said, "may prompt party goers to keep a closer eye on each others' safety." This year students said of the most recent death, not that the dead student shouldn't have consumed so much alcohol, but that "he would be alive today if only he didn't drink alone."

Sadly, this appears to be the primary message of the otherwise very informative, powerful and emotionally moving quality documentary, "Haze," which I watched only after uploading this blog entry. Indeed, the final screen says, simply, "Save a life. Make the call" -- meaning, when your fraternity brothers pass out and are at risk of dying from alcohol poisoning, don't ignore how serious this can be, take some responsibility for them, a major part of which is a call to 911.

In fairness, "make the call" is certainly good advice. Moreover, it's an understandable focus for the film, given that the Gordie Foundation had its genesis in the aftermath of a student's death from alcohol. And as the This American Life program makes clear, to have devoted the film to solutions, rather than the problem and its consequences, would have been a different documentary. Nonetheless, it is a long way from a presentation of solutions, let alone those of UNL and Lincoln, described below.

However, that, and the seemingly constant interruptions from very loud commercials, are the only downside to this otherwise excellent documentary.

It's available near the bottom of this blog entry, and from the Web site of the Gordie Foundation, named for Gordon Bailey, who died from excessive alcohol in a University of Colorado fraternity in 2004. The award-winning documentary was produced by the Colorado Springs film company, Watt Imagination! and directed by Pete Schuermann.

Of course the 1700 college student deaths that are alcohol related are tragic for everyone involved, as this film so dramatically shows. (The knowledgeable John Neff challenges this figure as too high in a comment on this blog entry. My response: (1) it is certainly a widely accepted number, (2) whatever the actual numbers may be, even one death is too many. As Penn State's Linda LaSalle says, no college student should ever die because they had too much to drink, and (3) my instinct is that there is a greater likelihood of under reporting of alcohol-related deaths than over reporting, for example, a student who falls to her death while drunk may be recorded as having died from "an accident" rather than from an "alcohol-related accident." Ditto for injuries from a fight, a reported rape, or an unwanted pregnancy; those reporting, or otherwise discussing such occurances, may not know, or not mention if they do, that alcohol was very much involved.)

But as tragic as college students' needless deaths may be, regardless of their number, they are but a very small percentage of the total number of college students who suffer the unwanted consequences of their own, or others', excessive drinking in the form of alcohol-related accidents, fights, unwanted sex and pregnancy, failing or dropping out of college, alcohol addiction, drunk drivers, crimes of various kinds (alcohol is involved in roughly half of all crimes, give or take), alcohol poisoning (from which they recover rather than die), or other undesirable medical consequences.

And that is where this film shines. It sets out to make the case that college students' excessive alcohol consumption is a serious problem, and it does so with a power I've never before seen in a mere 81 minutes of film and scenes of which most parents are presumably unaware.

You can watch it from this blog, if you wish. It's available near the bottom of this blog entry. Regardless of your attitude about college drinking, I challenge you to watch it and still come away saying the equivalent of, "What's the problem? Boys will be boys. Let the kids have their fun."

Who is most involved in binge drinking? First year entering students who are white and male; the emergency room admissions in September are much higher than for the rest of the year.

A further complexity is that while the heaviest drinkers are naturally at the highest risk of getting hurt, there really aren't that many of them. It is the moderate drinkers, who vastly outnumber them, who are also victims from a rare over consumption by themselves or others -- incidents for which it is very hard to predict who will be involved and when they will occur.

The Solutions

Bob Saltz, from the Pacific Institute for Research and Evaluation, says the answer is sort of a no-brainer: "You reduce risk by limiting kids' access to alcohol; the less alcohol is available the less kids drink; the less they drink the fewer bad things happen." (The Institute is a public health research organization that includes the causes and consequences of college students' alcohol abuse in its definition of "public health.")

Well, great. But how do you limit "kids' access to alcohol"?

In practice what this means is a police crackdown and, just as important, the students' perception of one. Until recently there wasn't much research to back up Saltz' hunch. Now there is.

Saltz' has completed an NIH-funded study at 14 California campuses.

Half the campuses instituted police "party patrols" that broke up large off-campus parties, stepped up drunk driving enforcement, and enforcement of laws against sales to minors in bars. Moreover, they heavily publicized this stepped up enforcement, so students would start self-policing rather than risk getting busted.

The results? Fewer kids were getting drunk. Campuses where the police cracked down reported 6000 fewer drunk students from off-campus parties and 4000 fewer from bars.

Contrary to the oft-repeated theory that strict enforcement will just cause students to select new venues for their binge drinking (see, e.g., John Neff's comment, "advantages and disadvantages of a 21 only ordinance," on my prior alcohol blog entry), the enforcement of the law in bars and at off-campus parties did not lead to those parties just moving elsewhere, such as a public park, or dormitories.

"Go West, young man -- to Nebraska." The show's
Sarah Koenig asked Saltz if he could tell her of any university with sustained success. "Yes," he replied, "University of Nebraska, Lincoln."

In 1998 the University of Nebraska teamed up with the City of Lincoln and together they declared a data-driven, goal-oriented all out war on out-of-control drinking.

What did they do?

Everything. There was a police crackdown. They enlisted the help of bar owners, legislators, liberal arts students, business students, and high school principals. They lobbied to digitize Nebraska's drivers licenses. They even tried to knock down the average number of drinks on a student's 21st birthday from 14 to 7.

Linda Major, Assistant to the Vice Chancellor at UNL, was the general in this war. Breaking up wild parties in residential neighborhoods was one of the most controversial things they did early on, but also one of the most effective. "Over time the party patrol went out very few weekends, but people believed it could happen any weekend."

The results? There have been far fewer complaints from Lincoln residents about UNL students' drunken behavior. Students report they are studying more and getting more sleep. There were fewer drop outs, reports of unwanted sex, and arrests for driving drunk. Way more freshmen were abstaining entirely from alcohol. And the proportion of UNL students engaging in binge drinking sank from 63% of the student body in 1997 down to 42% by 2007.

Why haven't Penn State (and the University of Iowa) had results like this? Because, says Saltz, they refuse to do what UNL has done: "join with the town and declare total war." Why won't they ban alcohol from the dorms? Or take on the widespread underage drinking? Or punish students more harshly; expell them even, when they break the law?

Damon Simms, is Penn State's VP for Student Affairs. He has met with virtually everybody: the town manager, editor of the local paper, city council, student government, university police, faculty, and fraternity leaders. He has a list of ideas that is 72 items long, and says that sacred cows need to be reconsidered: grade inflation, troublesome fraternities, out-of-control tailgating. So far he's established new sanctions for students who break alcohol laws; fraternities have new rules (such as no more Wednesday night parties; on other nights a photo ID required for entry, and there must be bouncers to enforce the rules). But he is not optimistic any, or all, of these ideas will make a major difference.

Proposal and Conclusion.

I have long argued, in some 30 blog entries on this subject, that the University of Iowa's inability to solve its alcohol problem is not the result of a lack of possible solutions or resources. It is the lack of will. There's nothing in This American Life's "#1 Party School" program to change my assessment.

But I do think that the results of Saltz' California study, and the impressive results from the UNL-City of Lincoln effort, help to reenforce my assertions that there are solutions available.

Here are some summary suggestions:

1. Keep in mind Saltz' simple insight and implied goal: "You reduce risk by limiting kids' access to alcohol; the less alcohol is available the less kids drink; the less they drink the fewer bad things happen."

2. Recognize the painful truth that even though we can successfully increase our students' knowledge about the adverse consequences of alcohol abuse, not even the best of this planet's world class universities can "teach" their students into drinking less.

3. As with any successful human undertaking, whatever we decide to do it should be sufficiently data driven and goal oriented that we can evaluate our results and become better informed regarding "what works" based on our own experience here in Iowa City. (UI's Provost Wallace Loh has made some suggestions in this direction.)

4. Recognize that until the leadership of the University (Regents, President and Vice Presidents) and City (City Council and City Manager) really want to actually change student behavior, as distinguished from public relations efforts, it is unlikely any meaningful change in that behavior will occur.

5. If and when that focused determination and agreement occur, it will be useful to designate a "general" to (a) come up with the "data driven, goal oriented" plan, (b) including the range of most promising approaches, and (c) involving the widest possible array of potential stakeholders in the solution.

6. Anything short of "an all out war on out-of-control drinking" is unlikely to be successful in significantly moderating students' drinking behavior. What the data from California and Nebraska suggest is that the most effective strategy for such a war is a combined City and University police crackdown on off-campus parties as well as drunken behavior, and underage drinking, in the bars -- including the enactment of a meaningful "21-only" ordinance. At the outset it would need to be relatively constant; but this could soon become more random (and less demanding of police resources) -- so long as the students' perception is that it could happen to them at any time, and that the consequences are severe. (Note that, while "underage drinking" remains an offense and is included as a target of the "war," the primary focus is on "drunk and disorderly" behavior and its tragic consequences.)

7. Football weekends are their own problem and it, too, is severe, especially for those in neighborhoods adjacent the stadium. It also needs to be addressed. But the football problems are limited to a half-dozen or so weekends a year.

8. From the standpoint of student health and safety (as distinguished from adverse impact on Iowa City residents), the far more serious problem involves the other 45 weekends of student alcohol abuse each year -- "weekends" of what The Daily Iowan describes as "80 Hours" (in a week of 168 hours) that run from Thursday through Sunday nights. There may be some overlap of strategies between the football and other weekends, but the focus of this blog entry -- and the success in California and Nebraska -- is on those far more numerous weekends when we don't have 70,000 additional potential drinkers in town.

Well, here's a plan for doing something meaningful about Iowa City's alcohol problem. Based on the California and Nebraska experience, it looks like it would work as well for Iowa City as it has elsewhere. If you have a better idea, put it in a comment on this blog entry.

Meanwhile, if you're a University administrator, or City Council member, or just generally interested in the issues, I seriously urge you to watch "Haze," the film discussed above, before speaking out, let alone voting, on matters related to alcohol. Here is the film:

If after watching it the leaders of the University of Iowa and City of Iowa City continue to do nothing meaningful about the problem we will then at least know that it is a purposeful and deliberate decision on their part to put the interests of bar owners over the health and safety of our students. It is not for a lack of available remedies.
* Why do I put this blog ID at the top of the entry, when you know full well what blog you're reading? Because there are a number of Internet sites that, for whatever reason, simply take the blog entries of others and reproduce them as their own without crediting the source. I don't mind the flattering attention, but would appreciate acknowledgment as the source, even if I have to embed it myself. -- Nicholas Johnson
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John Neff said...

We can use your figure of 1,700 alcohol related deaths of undergraduate students to compute the expected number of such deaths of UI undergrads. There are an estimated 12 million undergrads giving an expected rate of 14 alcohol related deaths per 100,000 undergraduate students. For 20,300 UI undergraduate the expected death rate would be just under three per year.

I checked with the UI registrar and they request a copy of the death certificate when they are informed of a student death and they then do a records purge. There are about two to three such reports per year for all causes of death. It appears that the estimated alcohol related death rate is too large by at least a factor of ten.

I have talked to people in the medical statistics area and a county medical examiner staff member and they say that there are serious data quality issues with death certificates that depend on the county. As a consequence they are very dubious about estimates of alcohol related deaths based on the analysis of death certificates.

Jim said...

I heard the show too. It was like looking in a municipal mirror. I found some of the stories very upsetting. This is why I avoid downtown on the weekends. That being said, our city council has virtually no spine to stand up to bar owners and beer distributors. I'm no tea totaller, but c'mon, this binge drinking here is just ridiculous.

Julia said...

As I was listening to the program, I hoped you had heard it and would comment. I agree completely with your assessments of what's needed. I only hope the UI and the city council were listening, too, and can finally get together and agree to try the Nebraska approach.

Michelle Maas said...

I agree with the blog. Just a couple of comments:
1) stop calling it a "war"; this is a public health initiative. That is, we aim to PREVENT injury, disease, and death (not cause them, as war is known to do).
2) don't forget to involve the alcohol retail industry. Alcohol retailers and tavern operators have a stake in providing a safe environment for their customers to socialize, listen to music, dance, etc. Out-of-control binge drinkers are a problem for tavern owners, too.
I am optimistic UI can get the drinking numbers down on its campuses.

Nick said...

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