it’s normal to be healthy two nationwide studies of perceived norms, student alcohol misuse,...

It’s Normal To Be HealthyTwo Nationwide Studies of Perceived Norms, Student Alcohol Misuse, Protective Behaviors,

and Exposure to Prevention Information

Michael Haines Director

National College Health Assessment Workshop, Las Vegas, December 1, 2006

What are Social Norms?Cultural Traditions

Community StandardsSocietal CustomsCollective Mores

Group ExpectationsShared Beliefs

Typical BehaviorsCommon Practices

Public Conduct

© Michael Haines 2004

Social Norms Premises

Every functioning social system (group, community, culture, etc.) has protective social norms.(a majority who hold pro-social attitudes and/or health positive behaviors).

Protective norms are misperceived.(Problems are over estimated and solutions are under estimated)


Why Are Social Norms Misperceived?

• Attribution Error

• Pop Culture

• Public Conversation

• Commercial News

• Scare Tactics


Media Advocacy

Social Norms Hypothesis

Changing Perception of Social Norms (decreasing perception of problems and increasing perception of solutions)

Changes Human Behavior.(reduces risk and promotes health)


Misperception of Social Norms Creates Imaginary Peer Pressure

• Imaginary pressure to adopt the

over-perceived problem behavior

• Imaginary pressure to hide the

under-perceived solution behavior


Social Norms Formula

Identify + Model + Promote

Protective practices and healthy beliefs

Pro-social attitudes and health-positive behaviors

= Health Enhancement and

Risk Reduction


"Misperceiving the College Drinking Norm and Related Problems: A Nationwide Study of Exposure to Prevention Information, Perceived Norms and Student Alcohol Misuse“

Journal of Studies on Alcohol volume 66: Pp 470-478, 2005

PERKINS, H.W., HAINES, M.P. AND RICE, R.

Table 1Students’ Accuracy in Perceiving the Drinking Norm at Their School

(Comparing Actual with Perceived Number of Alcoholic Drinks Consumed the Last Time Students “Partied”/Socialized)

Actual School Norm

(Median Drinks)

Accuracy of Perceived Drinking Norm

N of Respondents

N of Schools

Underestimate of 3 or More Drinks (%)

Underestimate of 1 to 2 Drinks

(%)

Accurate Estimate

(%)

Overestimate of 1 to 2

Drinks (%)

Overestimate of 3 or More Drinks (%)

0 NA NA 20.6 19.5 59.9 =100% 1891 4

1 NA 10.5 3.8 28.5 57.2 =100% 2526 6

2 NA 7.5 8.1 30.6 53.7 =100% 8345 14

3 3.8 6.4 13.5 37.5 38.7 =100% 18859 35

4 3.1 12.3 12.6 37.0 34.9 =100% 20353 38

5 4.3 15.8 20.6 24.1 35.3 =100% 11481 20

6 6.9 23.2 15.0 23.5 31.5 =100% 8912 12

7 5.7 23.3 9.7 23.6 37.8 =100% 352 1

Total Schools 3.4 11.8 13.8 31.9 39.1 =100% 72719 130

Table 1a(NCHA Q13 & Q15)

Student’s Perception of Drinking Norms

(n=72,719, 130 schools)

Under Estimation

Accurate Estimation

Over Estimation

15.2% 13.8% 71.0%

Independent VariablesUnstandardized

CoefficientStandardized

Coefficient

Perception of how many alcoholic drinks are consumed by the typical student at one’s school the last time they “partied’/socialized .48 .33

Actual norm (median) for number of alcoholic drinks consumed last time students at one’s school “partied”/socialized .37 .12

Gender (male vs. female) 2.18 .24

Age -.05 -.06

Year in school .08 .03

Race (Black vs. White) -1.63 -.09

Race (Hispanic or Latino vs. White) -.45 -.03

Race (Asian or Pacific Islander vs. White) -1.27 -.08

Race (American Indian or Alaskan Native vs. White) -.19 -.00 ns

Race (Other vs. White) -.57 -.02

Fraternity/sorority member (yes vs. no) 1.55 .11

Student Status (full-time vs. part-time) -.11 -.01 ns

Hours per week working for pay .00 .01 ns

Hours per week volunteering -.05 -.05

School region (Northeast vs. South) .22 .02

School region (Midwest vs. South) .20 .02

School region (West vs. South) .11 .01 ns

Table 2Unstandardized and Standardized Regression Coefficients Predicting Number of Alcoholic Drinks Consumed Last Time “Partied”/Socialized

ns Coefficient is not significant, p > .001.

Table 2a (NCHA Q45-58)

Standardized Regression Coefficients Predicting Number

of Drinks per Party

Perception of student drinking norm .33

Gender .24

Actual drinking norm .12

Frat/Sorority member (yes v. no) .11

Age -.06

Full-time v Part-time -.01

Relative Extent of Misperception with

Information ExposureN of Schools

% of Students Receiving

School Prevention

Information

Less Misperception among Exposed

Studentsa 10 50.6

No Difference between Exposed and Other

Studentsb 85 51.5

Greater Misperception Among Exposed

Studentsc 34 53.2

Table 3Distribution of Colleges/Universities Surveyed by Association of

Student Exposure to School’s Alcohol and Other Drug Use Prevention Information with Extent of Misperception of the Drinking Norm

Table 3a (NCHA Q2b)

Distribution of Colleges by Student Exposure to AOD Prevention Information by Perception

Misperception by Exposure:Comparing students exposed to alcohol information to those exposed to no information.

N of schools

% getting info

Less misperception among those exposed

10 50.6

No difference between exposed and unexposed

85 51.3

More misperception among those exposed

34 53.2

Dependent variables

Odds ratioa

comparing students at schools with programs

that do not affect misperceptions with students at

schools with programs that reduce

misperceptions

Odds ratioa

comparing students at schools with programs

that inflate misperceptions with students at

schools with programs that reduce

misperceptions

Consumed five or more drinks at a sitting during the last two weeks 1.25 ** 1.55 **

Consumed 7+ alcoholic drinks the last time “partied”/socialized 1.18 * 1.46 **

Estimated peak BAC level of .08 or higher last time “partied”/socialized 1.14 * 1.38 **

Alcohol use negatively affected academic performance during the last year 1.44 ** 1.55 **

Experienced other negative consequence as a result of drinking within the last school yearb 1.15 * 1.32 **

Table 4Impact of Attending Schools where Program Information Exposure

Makes No Difference in Misperceptions or is Associated with Greater Misperceptions of the Drinking Norm in Comparison to Attending SchoolsWhere Exposure to Program Information is Associated with Less Misperception

a Odds ratios are reported based on logistic regression controlling for gender, class year in school, race, fraternity/sorority membership, and region of school. b Includes physical injury to self or others, fighting, forgot where one was or what they did, had someone use force or threat of force to have sex or had unprotected sex.* Statistically significant p < .01; **p < .001.

Table 4a (NCHA Q18 & Q44a)

Impact of attending schools where AOD prevention program had either no affect on or

inflated misperceptions

Five or more drinks last 2 wks 1.25 1.55

Seven or more last time partied 1.18 1.46

BAC = .08+ last time partied 1.14 1.38

Use negatively affected academics 1.44 1.55

Experienced other negative consequences 1.15 1.32

Odds ratio

Summary• Students misperceive (71% over-estimate)

alcohol consumption norms.• Student perceptions of alcohol consumption norms

are the strongest known predictor of actual student alcohol consumption behavior.

• Schools must correct misperceived drinking norms to reduce alcohol-related harm.

• One of four schools’ alcohol information programs (26%) are associated with increased misperceptions and harm.

Prescription1. Determine if current alcohol information,

education, or policies are likely to increase or decrease over-estimations of alcohol consumption norms.

2. Design and implement alcohol information, education, or policies that clearly reduce over-estimations of alcohol consumption norms.

The Personal Protective Behaviors of College Student Drinkers: Evidence

of Indigenous Protective NormsMichael Haines, M.S., Gregory Barker, Ph.D.

Richard Rice, M.A.

National Social Norms Resource Center

Journal of American College Health July - August, 2006

The Clear Majority (70-80%) of College Students Drink Alcohol

Monitoring the Future (2002), Core (2000),

College Alcohol Study (2002), NCHA (2002)

Serious Alcohol Related Harm is Uncommon

Perkins, 2002“Surveying the Damage: A Review of Research on

Consequences of Alcohol Misuse in College Populations,”Journal of Studies on Alcohol/Supplement No. 14, 91-100.


12.8% Hurt or Injured

10.7% Damaged Property

0.08% Required Medical Attention

(“as a result of drinking since the beginning of the school year” , College Alcohol Survey, 2001)


16.6% Physically Injured

7.8% Involved in a fight

2.2% Force or Threat of Force to have Sex

(“…within the last school year have experienced…as a consequence of your drinking.”, NCHA, 2002)

Prior Evidence of Resilience

Biological Factors

Psychological Factors(Werner and Smith, 1972)

Socially Transmitted/Learned(Weil, 1972; Chafetz, 1976; Dimeff et al., 1999)

Logic Model

Most students drink alcohol

Overwhelming majority avoid serious harm

How?

Logic Model

Most students drink alcohol

Most drink moderately

Overwhelming majority avoid serious harm

Most practice personal protection

Using a diverse array of protective behaviors

How?

NCHA Items for Study

17. During the last school year, if you “partied”/socialized, how often did you…

Not Applicable/Don’t Drink Always Usually Sometimes Rarely Never 5 4 3 2 1

a) Alternate non-alcoholic with alcoholic beverages b) Determine, in advance, not to exceed a set number of drinks c) Choose not to drink alcohol d) Use a designated driver e) Eat before and/or during drinking f) Have a friend let you know when you’ve had enough g) Keep track of how many drinks you are having h) Pace your drinks to 1 or fewer per hour i) Avoid drinking games j) Drink an alcohol look-alike (non-alcoholic beer, punch, etc.)

Key Findings

1. Most NCHA PPBs Correlate with Reduced Harm

2. Some NCHA PPBs Do Not Correlate with Reduced Harm

3. Using PPBs is Normative (Indigenous Protective Norms)a) 73% of Students Employ at Least One PPB

b) 64% of the Students Who Employ PPBs Use Two or More

4. PPBs correlate with reduced harm across demographics

5. The correlation with harm is consistent and negative (More PPBs used = ever less risk of harm)

6. PPBs reduce harm even as BAC rises

7. Situational Abstinence is a college drinking norm

Spring 2002 ACHA (Drinkers Only)Alternate non-alcoholic with alcoholic beverages

23% -0.15

Determine, in advance, not to exceed a set number of drinks

30% -0.20

Choose not to drink alcohol 20% -0.25

Use a designated driver 73% -0.11

Eat before and/or during drinking

73% -0.11

Have a friend let you know when you’ve had enough

31% -0.09

Keep track of how many drinks you are having

58% -0.25

Pace your drinks to 1 or fewer per hour

24% -0.28

Avoid drinking games 37% -0.30

Drink an alcohol look-alike 5% -0.17

1

2

3

3

5

6

Personal Protective Behaviors (after factor analysis of NCHA data)

1. Avoid drinking games

2. Pace your drinks to 1 or fewer per hour

3. Keep track of how many drinks you are having

3. Choose not to drink alcohol

5. Determine in advance not to exceed a set number of drinks

6. Drink an alcohol look-alike

Respondents Who Report Using Protective Behaviors

(Percent reporting “Usually” or “Always”)

Number of ProtectiveBehaviors Used -

Total Sample Percent

Number of Protective Behaviors Used -

Students Who Use AT LEAST ONE Protective Behavior Percent

0 Behaviors 27%

1 or More Behaviors 73% 1 or More Behaviors 100%





6 Behaviors 2% 6 Behaviors 3%

The Effect of Personal Protective Behaviors on OverallReported Incidence of Alcohol-Related Physical Harm - Gender

0%

10%

20%

30%

40%

50%

60%

0 1 2 3 4 5 6

Number of Protective Behaviors Used

Pe

rce

nt

Re

po

rtin

g A

lco

ho

l-R

ela

ted

Ha

rm

Female Male

The Effect of Personal Protective Behaviors on OverallReported Incidence of Alcohol-Related Physical Harm - By Age

0%

10%

20%

30%

40%

50%

60%

0 1 2 3 4 5 6


Pe

rce

nt

Re

po

rtin

g A

lco

ho

l-R

ela

ted

Ha

rm

Under 21 21 or Older

The Effect of Personal Protective Behaviors on Overall Reported Incidence of Alcohol-Related Physical Harm - By Fraternity/Sorority Membership

0%

10%

20%

30%

40%

50%

60%

70%

0 1 2 3 4 5 6


Pe

rce

nt

Re

po

rtin

g A

lco

ho

l-R

ela

ted

Ha

rm

Fraternity/Sorority Member Non-Fraternity/Sorority Member

The Effect of Personal Protective Behaviors on OverallReported Incidence of Alcohol-Related Physical Harm - By BAC

0%

10%

20%

30%

40%

50%

60%

0 1 2 3 4 5 6


Pe

rce

nt

Re

po

rtin

g A

lco

ho

l-R

ela

ted

Ha

rm

BAC .08 or Higher BAC less than .08

3 Year NCHA Trend Data for PPB and Harm

0

10

20

30

40

50

60

70

Spring 200 Spring 2001 Spring 2002

Keep Track ofdrinksAvoid drinkinggamesSet limit

Pace yourself

SituationalAbstinenceDrink look-alike

Alcohol-relatedharm

Situational Abstinenceor

Everyone Doesn’t Drink Sometimes

68% of College Drinkers “Choose not to drink” (usually or sometimes if “partied/socialized during the last school year)

Old definition of abstinence = Anti Alcohol

DRINKERS ABSTAINERS

Always drink + Sometimes drink Never drink

New definition of abstinence = Anti Harm

DRINKERS ABSTAINERS

Always drink Sometimes drink + Never Drink

Cautions

• Cross-Sectional Data – Not necessarily generalizable– Robustness of the Findings: 5 National Data Sets Show

Same Results

• Different Time Frames - (Last Time Partied vs. Last School Year)– Other research suggest no significant difference

Implications for Health Promotion, Risk Reduction, and Social Norms Projects

• Indigenous protective norms can reshape health education and health promotion efforts by using successful protective strategies of the population served to inform educational content and public policies.

• Not all perceived (reported) PPBs are protective so researchers must use qualitative AND quantitative measures together to verify protection.

• Situational Abstinence is a proven PPB and offers a normative alternative to the abstinence only approach.

• Further Study: – Non Consumption-Based PPBs– Environmental Protection

National Social Norms Resource Center

Social Science Research Institute

Northern Illinois University

Dekalb, IL 60115

815-753-9745

[email protected]

[email protected] [email protected]

www.socialnorm.org

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