Prevention File Alcohol, Tobacco, and Other Drugs Spring 2005 Volume 20, Number 2 This document is also available in pdf format (with images) Contents Transforming Greek Life at Cal State Chico President Paul Zingg is rewriting the script for campus life What Do Students Really Think about Prevention? Students may harbor more agreement with campus prevention strategies than you might think College Students Get MADD College chapters of Mothers Against Drunk Driving are working on prevention Taking a Stand in Ohio OSU President Karen Holbrook tackles celebratory rioting Reducing Alcohol Harm in the Air Force: A Uniformed Approach to Prevention A major Air Force command initiates bold prevention measures Moose Cree's Alcohol Policy: Making Changes Incrementally By Ronald R. Douglas, Margaret Rylett and Rene Lauzon An Aboriginal community in Canada adopts a harm reduction policy Prevention Updates Ten Years Ago in Prevention File (Vol. 10, No. 2, Spring 1995) ------------------------------------------------------------------------ Transforming Greek Life at Cal State Chico THE PRESIDENT OF A STATE UNIVERSITY once identified as the nation's No.1 "party school" is making a bold attempt to rewrite the script for campus life. He is challenging the so-called Greek system on his campus to stop accommodating "drinking clubs masquerading as fraternities and sororities." This outspoken reformer is Paul J. Zingg, PhD, who presides over California State University at Chico. The school known as Cal State Chico is coming to a climax in a long effort to salvage its reputation, an effort that began in 1987 after Playboy magazine identified it as the top spot in the nation for campus partying. Cal State Chico has an enrollment of 14,000 on its campus 80 miles north of Sacramento. In a showdown meeting with leaders of campus organizations Zingg noted the lofty values set forth in their charters-friendship, unity, respect, dignity, service, citizenship, leadership, integrity. "If you are not true to your own self-professed ideals and standards, then you have lost your integrity and forfeited your credibility. If you are not whom you claim to be, then you are frauds." Zingg was responding to what he called the "last straw" in the kind of incidents that hang like a dark cloud over Cal State Chico-and many other campuses throughout the nation. In February of 2005, a Chico student died of water intoxication after being forced to drink five gallons of water in a hazing ritual. It was the low point of a bad season. There was a nearmiss for another tragedy when fraternity pledge wound up in intensive care with a blood alcohol level six times the legal limit. And it was revealed that Chico students who are members of a national fraternity had participated with professional porn actresses in a pornographic movie filmed at their off-campus frat house. "To be sure, it is not just members of the Greek community who have engaged in this kind of behavior," Zingg told the fraternity and sorority leaders. "But rightly or wrongly, fairly or not, the burden of responsibility and the price of notoriety fall squarely on your shoulders. You set the tone, not exclusively but in large part, for perceptions of what kind of institution we are, regarding student behavior, socially and academically." Zingg, whose career as a professor and dean in higher education goes back to the 1970s, laid down ten "non-negotiable" elements of the transformation he was calling for. They ranged from crackdowns on hazing and alcohol use to greater emphasis on academic performance levels and character-building. "This transformation seeks to accomplish, in particular, a strong, shared understanding between the university and the Greek community about the values, goals and purposes of a Greek system," he said (see sidebar. Challenging the organizations to be part of the solution rather than part of the problem, he called on them to "be true to what you say you are-value-centered associations that help develop members into exemplary students, leaders and citizens, organizations which serve their university and surrounding community, and individuals who uphold and act in accordance with the loftiest of behavioral expectations." The stakes are high for Chico's Greek organizations. Whether they comply with the new standards will determine whether they stay as part of the Chico scene. "How you meet these requirements will influence the ultimate question of your recognition and continuation," Zingg said. "It remains for you to demonstrate and for the university to determine whether or not you are relevant to the university's future. You can only be so if you are true to your own promises and obligations." The tougher standards were based on a study by a President's Commission on Campus Life set up after the fatal hazing incident. The Commission includes representatives of Greek organizations, and Zingg assigned it to "look at all student behavior and the conditions that are necessary to keep students safe and healthy, productively engaged in their studies, and succeeding in the classroom and beyond." Greek organizations now recognized by the university have until the fall 2005 semester to get their compliance in place. Some of them, however, began shaping up with new rules soon after Zingg delivered his ultimatum. A reporter for the San Francisco Chronicle found an "overwhelmingly positive response" to the new guidelines among fraternity and sorority members who want to see Greek life continue on the campus. Some appeared to be making changes without waiting for the fall deadline. But some were cynical, and told the Chronicle that they expected to see a few organizations brush off the university's rules and maintain their fraternities without campus recognition. Zingg anticipated such a response among hard-core party animals, and said he was drawing local police and other outside authorities into the effort. "If you think you can choose loss of recognition by the university and continue your ugly ways as rogue organizations, think again. As never before, the university and the city are working together to align and strengthen our cooperation, to enforce ordinances to protect the health and safety of residents and citizens of our community, to expand the jurisdiction of campus discipline authority to behavior occurring offcampus, and to improve our neighborhoods and the quality of life of those who live here." A reporter for the Los Angeles Times found that local city and county authorities were eager to develop new ways to shut down offensive frat houses. The reporter said townspeople were appalled and disgusted with the hazing incident that cost a student's life. "You hear about such things, but seldom the details. Somebody died. Somebody ought to go to jail for that," a resident told the reporter. The law appears to be a strong ally in Zingg's effort to shake up the campus community. Four members of the Chi Tau fraternity were charged with involuntary manslaughter as a result of the hazing death. A member of the Sigma Chi fraternity was charged with ten counts of providing alcohol to minors after a dead-drunk pledge went to intensive care with a .496 blood-alcohol level. The University suspended the Phi Kappa Tau fraternity chapter after learning that its members took part in filming commercial pornography in the frat house. TEN SIMPLE RULES Paul J. Zingg, PhD, the president of California State University at Chico, laid down ten requirements to assure that campus organizations are not "drinking clubs masquerading as fraternities and sororities." He described the ten conditions as "unequivocal and non-negotiable" elements aimed at transforming Greek life on the campus. 1. The terms and conditions apply to all chapters-Interfraternity Council, Panhellenic, and local and ethnic Greek organizations. 2. Organizations will be expected to meet significantly higher academic performance levels than those previously set forth. 3. Each chapter shall have a faculty adviser approved by the University's Office of Greek Life. 4. Each chapter shall have an active alumni board consisting of members who fully support these terms and conditions and the need for reforms. 5. Each chapter shall develop programs of leadership development and hands-on community service. 6. Each chapter with a residence shall have an annual fire and building code inspection, with a written report of compliance to be filed with the Student Activities Office. Chapter houses will abide by all city ordinances dealing with noise, cleanliness, etc. 7. Only currently-enrolled Chico State students will be eligible for membership in social Greek organizations. 8. Each chapter must develop a membership recruitment program that seeks members who support and promote the positive aspects of Greek life. 9. All recruitment events, both formal and informal, must be totally alcohol-free. 10. Hazing will not be tolerated in any form by any student organization. Hazing refers to "any action that involves the abuse, humiliation or embarrassment of another." There will be no distinction between major and minor hazing, and all new-member activities and events must be totally alcohol-free. ------------------------------------------------------------------------ What Do Students Really Think about Prevention? THE ALL-TOO-FREQUENT HEADLINES ARE DISTURBING. "GIRLS GONE WILD AT SPRING BREAKS." "Fraternity hazing results in alcohol poisoning." "Playoff win sparks drunken student riot." Such press accounts paint a picture of widespread out-of-control drinking by college students resulting in a host of problems for students and community members alike. So does prevention even have a chance of influencing a heavy-drinking student population? What are concerned administrators, faculty members, and community leaders to do? Are students really immune to policies aimed at reducing the incidence and consequences of heavy drinking? Hold on a moment, says one researcher who has studied college and university student attitudes about drinking and about prevention policies. He concludes that students may harbor more agreement with campus prevention strategies than assumed by what one sees in media accounts. Yes, students, when asked, may say that their peers don't favor prevention measures. However, they, themselves, often personally voice support for the very same measures. Robert Saltz, PhD, associate director at the Prevention Research Center in Berkeley presented research on approval and perceived approval of alcohol policies in college campus at the 2004 annual conference of the American Public Health Association. Saltz and other PRC researchers surveyed University of California students and found that students' personal approval was higher than their perception of their peers' level of approval for prevention, particularly for alcohol control measures with some "teeth" to them. The notion that prevention policies will be met with universal opposition is largely unfounded, he concluded. Saltz conceded that being a college student does constitute a "primary risk factor." "College-bound students in high school are actually drinking at lower rates than others before they enter college. During college, they not only caught up, but they surpassed their non-college peers. All through these college years, their drinking is elevated above the non-college students until they finally converge again (with the non-college cohort) after they leave college," Saltz told the APHA conference. Part of the explanation for the relatively higher drinking rates among college students, compared to their non-college peers, is a college environment that condones higher-risk drinking. What Saltz termed "pluralistic ignorance," the common belief that other students drink more than they do and would therefore be less likely to favor prevention policies, may support that environment. NOT SO EFFECTIVE Designated driver programs, which encourage groups to designate one person to be the sober driver, are a popular prevention strategy. But the few existing studies of such programs offer little evidence that they are effective in reducing drunk driving, according to a new report from the U.S. Task Force on Community Preventive Services. A research review conducted by Randy Elder, PhD, and colleagues (American Journal of Preventive Medicine, June 2005) found that while publicity campaigns may lead to small, temporary increases in use of designated drivers, few studies offered any indication that designated-driver programs cut drunk driving. Further, the group could find no studies on whether designated-driver programs led to a decrease in alcohol-related car crashes or injuries. Elder said that few designated drivers actually abstain from drinking. "In some cases, the designated driver may be chosen based on who among the group is the least intoxicated," Elder says. "When an intended designated driver becomes intoxicated, this leaves group members with a difficult choice between having the least drunk person drive them home or arranging for alternative transportation." According to Saltz, students perceive that there is less approval of prevention than there really is, which may be tied to their over-estimates of peer drinking. "If you think that all other students are much heavier drinkers, then you might just jump to the conclusion that those other students are less likely to approve of (prevention) policies. That produces a conservative bias on campuses, especially with respect to the enforcement policies," said Saltz. In all cases, survey respondents perceived less peer approval for policy statements than they, themselves, held. Respondents expressed greater self-approval for a range of enforcement and environmental policies than they perceived their peers would endorse. However, the extent of the differential varied by gender and ethnicity, with women, African American, Asian American, and Latino students expressing greater peer support. Saltz suggests that higher education prevention programs might benefit by incorporating normative education about the extent for policy support. In other words, students might be more supportive of prevention if they knew that a majority of their peers shared such support, much as social norms marketing campaigns in place at many campuses are attempting to moderate student drinking by reinforcing the actual normative drinking levels, typically less than students think others are drinking. Saltz warned, however, that some policies would still face some opposition and require careful strategic planning and "marketing" to be implemented successfully. At the same APHA session, Norman Giesbrecht, PhD, Centre on Addiction and Mental Health, Ontario, Canada, reported on general population support of prevention policies from the 2000 National Alcohol Survey. That survey is a random digit dialed telephone interviews of nearly 8,000 adults that is conducted and analyzed by the Alcohol Research Group in Berkeley. Since 1989, ARG has monitored public opinions in support for various policy measures and consistently found high percentages in favor of warning labels, more prevention, and an increase in host liability. Data in 2000 indicate even stronger public support for non-service to impaired persons, government-sponsored counter-ads and education, more treatment paid by third parties, and required warning labels on beverage containers. However, support for alcohol controls was not uniform. For example, women, African Americans, Latinos, and those aged over 50 markedly expressed more support for various prevention measures. Lower support for the measures was related to higher drinking levels, not being married, having more education, and higher income. ------------------------------------------------------------------------ College Students Get MADD WHILE THOUSANDS OF COLLEGE STUDENTS FLOCKED TO FLORIDA for an alcohol-infused spring break holiday in March, representatives from campus chapters of Mothers Against Drunk Driving's university program UMADD gathered in the same state for a different cause. Students from UMADD met in Orlando for a training on preventing underage drinking, binge drinking and drunk driving on their campuses and in their communities. They also met with officials from the Orlando Police Department to urge them to enforce drinking and drunk driving laws during the spring break revelry. "Some students see drinking as a rite of passage, but it's really not," said Christina Dorn, a junior at the University of Central Florida, Orlando, who represented her school's UMADD chapter at the gathering. "They think college is a time to cut loose and be wild, but they may be making mistakes that will change their lives or the lives of others forever." Spring break has become famous for wild partying among college students, but Dorn said it is not the only time students are involved in excessive drinking. Rather, she said, spring break is representative of what goes on during the rest of the year on a smaller scale. "The question used to be, 'What is the popular night to party?'" Dorn said. "Now, the answer is 'Every night.' The bars are offering specials Sunday through Thursday. On Friday and Saturday, there are house parties." Besides UCF, other schools that were represented at the UMADD gathering included Bellarmine University in Louisville; Towson University in Baltimore; East Tennessee University in Johnson City; and North Harris College in Houston. The event was funded by grants from the CarMax Foundation's National Funding Program, which assists nonprofit organizations that work on improving auto safety for families and children. We aren't just working toward building safer schools, but toward building safer communities.* At the Orlando meeting, UMADD representatives learned about proven programs and prevention practices and determined goals for their individual chapters. They also discussed how best to work with residents and business owners in the communities surrounding their campuses. In recent years, some schools have instituted new alcohol policies or required that their campuses be alcohol-free. However, students may still drink excessively off campus. For instance, Dorn said that though her campus is dry, her school still rates among the top "party schools" in the country because of a proliferation of bars and liquor stores within a two-mile radius of the campus. Students don't have to travel far to find an environment where alcohol flows freely, but they do have to travel, and that most likely means drunk driving on the streets of Orlando. "We aren't just working toward building safer schools, but toward building safer communities," she said. MADD President Wendy Hamilton said that the UMADD Chapter Program was launched in 2001 following the release of the MADD College Commission Report. The report indicated that alcohol was the No. 1 problem facing young people, killing 6.5 times more young people than all illicit drugs combined. Indeed, the harm caused by alcohol consumption among college students may exceed the 2001-2002 estimates of the problem, according to a report in the 2005 issue of the Annual Review of Public Health (online at http://arjournals.annualreviews.org/loi/publichealth). A change in college census methodology prompted adjustments to those figures, according to Ralph Hingson, ScD, a professor at the Boston University School of Public Health and Center to Prevent Alcohol Problems among Young People. The new figures show that unintentional fatal injuries related to alcohol increased from about 1,500 in 1998 to more than 1,700 in 2001 among U.S. college students ages 18-24. Over the same period, national surveys indicate the number of students who drove under the influence of alcohol increased by 500,000, from 2.3 million to 2.8 million. Underage students drink approximately half of all alcohol consumed by college students, and, nearly 44 percent of college students say they binge drink. Hamilton said MADD is concerned not just about college students driving drunk, but about the health problems related to excessive drinking and the havoc student drinkers wreak on the community, both on and off campus. "We want to make sure that college kids know what they are doing to their brains and their bodies," Hamilton said. "Research has shown that their brains are still developing at that age. Excessive drinking can interfere with that development." What's more, excessive drinking affects far more people than just those who are imbibing. "A lot of kids are actually at college to learn," Hamilton said. "When there is binge drinking going on around them, it can be very disruptive. We want those who do drink to understand what they are doing to themselves, and we want those who are at college to learn to have a safe environment. Ideally, we want to change the culture." Hamilton said that it hasn't been difficult to garner student interest in MADD at the college level. Many students have already been involved in MADD's work at the high school level through its SADD (Students Against Drunk Driving) chapters. Ban Smoking, Increase Bar Business Bars in Massachusetts not only got cleaner air but also a boost in sales and employment after a statewide ban on indoor smoking went into effect, according to researchers from the Harvard School of Public Health. They found that in 27 bars and restaurants they studied the levels of dangerous airborne toxins fell 93 percent after the smoking ban. A review of state tax records found that tax collections rose 9 percent after the ban, reflecting an increase in sales. The researchers also found that alcohol sales appeared to remain steady, and that employment at bars and restaurants rose during the study period. "Now, we can tell other states considering this kind of law: 'If you implement this law, you're not only going to have a better work environment-you don't have to affect the economics of your hospitality industry,?" said Gregory Connolly, one of the report's authors. The Massachusetts Restaurants Association, which had strongly opposed the ban, acknowledged that the law did not turn out to have a lasting negative impact. "It caused kind of a minor blip in business at first," said the group's communications director, Gail Anastas. "But then they did things to attract people back. Everybody just wanted a level playing field, and when it went statewide, it made it the same for everyone." Other young people become involved when they see the drinking and the problems it causes on campus. Since the program's launch, the goals of a UMADD chapter have remained the same: to engage students in prevention strategies against underage drinking and impaired driving; to limit youth access to alcohol; to increase enforcement of underage drinking and impaired driving laws on campus and in the surrounding communities; and to work with campus leaders to establish clear and effective policies designed to minimize alcohol problems. UMADD chapters are based on a two-part philosophy. First, student leaders work to identify the problems on their individual campuses and in their communities-policies as they relate to underage and high-risk drinking. Second, students work to heighten public awareness and advocate for change through such activities as campus/community coalitions, social norming campaigns and partnerships with law enforcement. While alcohol-fueled spring break revelers may receive a lot of media attention, studies show that most college students support prevention activities. A survey by the Education Development Center Inc. in 2001 showed that a majority of students supported the prohibition of kegs on campus, stricter penalties for students who abuse campus alcohol policies, and restrictions on alcohol advertising on campus. "The belief is that drinking and carrying on are just part of the college experience, but that isn't true for all students," said Christina Dorn. "That is a belief that needs to be changed." Dorn was inspired to become involved in UMADD because of a childhood experience involving drunk driving. She was just nine years old when her mother, who had attended a wine tasting, struck and killed a pedestrian while driving home. The victim's family was devastated and so was Dorn's family. "When you drink and drive you may hurt your whole family," she said. Dorn said her chapter of UMADD plans to work toward more checking of IDs at local bars and liquor stores and also building a relationship with community members and bar owners in an effort to reduce drink specials that attract college students. She said some of the campus area bars offer free drinks to women and "bladder buster" nights when all drinks are free until a patron has to use the rest room. "Bars used to offer entertainment, but now the main focus seems to be on drinking," she said. "We'd like to see that focus change." For more information on UMADD go to www.madd.org . ------------------------------------------------------------------------ Taking a Stand in Ohio WHEN THE OHIO STATE UNIVERSITY BEAT THE UNIVERSITY OF MICHIGAN to crown an undefeated football season in November of 2002, everyone in Columbus, Ohio, expected a big celebration around the OSU campus. What no one expected was the utter mayhem that turned a ten-block off-campus neighborhood into a combat zone-overturned cars, broken windows, deliberately set fires, and the arrest of 48 people. Here was a textbook example of "celebratory rioting." What Columbus has seen in the last three years may serve as a textbook example of something else: how a major university can work with community leaders to prevent student parties from spinning out of control. The effort in Columbus has brought the 2004 award of the Presidents Leadership Group to Karen Holbrook, PhD, the OSU president. The award goes each year to a college or university president in recognition of an important contribution to substance abuse prevention and the difference these efforts make on campus and in the larger community. Holbrook had barely settled in as OSU president in the fall of 2002 when she was confronted with the outbreak of rioting after the OSU Michigan game and embarrassing national publicity for her school and for the city. She made a public apology and promptly appointed a broad-based campus and community Task Force on Preventing Celebratory Riots, persuading the Columbus mayor to join her in a leadership role. Members of the Task Force-people from the university, the city administration, neighborhoods surrounding the campus, and students--were divided into four groups to focus on different aspects of the problem. These four areas included alcohol availability, crowd-control and other celebration-management issues, risk taking and other problem behavior by young adults, and communication issues regarding celebrations and group behavior. After four months, the Task Force issued recommendations touching on all these areas, and these recommendations have stimulated new prevention strategies that have borne fruit in the last two years at OSU. In the past, it had become a tradition that normal laws and rules of civility would be suspended when there were football games at OSU. An "anything goes" atmosphere was taken for granted. Starting in 2003, both campus and city police began issuing tickets for violation of open container laws. This threw a wet blanket on alcohol-fueled tailgate parties that had been a popular prelude and postlude to athletic events, and many students and other fans objected. "What's wrong with having a few beers?" Fortunately, the Task Force could answer that question. Videotapes showed how alcohol consumption at tailgate parties created rowdy and drunken behavior that had blossomed into outright rioting at the 2002 event. The university and the city stuck to their guns with the new enforcement policy. "Dr. Holbrook's efforts to combat the alcohol entrenched game-day culture at OSU demonstrate the depth of her courage and her commitment to this issue," said Helen Stubbs of the Center for College Health and Safety, in announcing the award. "Dr. Holbrook's stance was initially criticized by many who either weren't aware of the extent of the problem or were loath to change this culture of excess. Yet she persevered, knowing her efforts would improve the health of students, Ohio State's fans and the greater Columbus community while fostering a family-friendly environment." The number of arrests and citations for drunkenness and disturbances on game-days at OSU dropped substantially during the 2003 and 2004 football seasons. Fans indicated they were more likely to consider football games a family occasion. Since 2002 Columbus has seen no major incidents of disorder in the aftermath of athletic contests. David Andrews, PhD, dean of OSU's College of Human Ecology, reported on the work of the Task Force at a National Conference Addressing Issues of Celebratory Riots held in Columbus in 2003. He listed the following as some of the major Task Force recommendations bearing fruit at OSU: * Communicate clearly to students the consequences of alcohol violations and illegal behaviors, and mail letters to parents explaining those consequences. * Strictly enforce laws against underage drinking and open containers throughout the campus and surrounding neighborhoods. * Use surveillance measures in potential riot areas to identify participants and use videotapes to identify offenders. * Before riots can occur, discuss with local news media that it is helpful for their reporting to be accurate and thorough without fostering a climate of expectation of riots. * Expand mutual aid agreements between the campus and the city; consider establishing a municipal court so that offenders can be prosecuted at the site. * Establish community policing as an early, visible and nonaggressive presence on bicycles and on foot in areas of concentrated student housing. In accepting the award from the Presidents Leadership Group, Holbrook paid tribute to all the partners in the OSU-Columbus effort for making decisions that were "right but not necessarily popular" to change a culture of excessive fan behavior and alcohol abuse associated with pre-game and post-game events. "It will take time to be confident that the culture of excessive drinking in conjunction with college athletics and activities really has changed," she said. "But we believe we have turned the corner." Ohio's Statewide Initiative The Ohio College Initiative to Reduce High Risk Drinking, with a membership of 42 public and private campuses, has focused developing wellness- promoting, normative environments on college campuses to influence student perceptions on drinking alcohol since 1996. The multi-layered effort seeks to reduce student alcohol use by creating normative environments, limiting alcohol availability, restricting alcohol marketing, consistently enforcing policies and laws, and improving options for free time. The strategy of creating positive environments relies on disseminating educational messages to alter the often exaggerated perceptions students have regarding drinking by their peers. According to Julie Manchester, project director of the Ohio College Initiative, nearly 83 percent of the Initiative members have educational awareness programming on their campuses. A member of the statewide initiative since 1997, the College of Wooster's campus utilizes small-group social norming to correct student misperception. Wooster's Alcohol Prevention Coordinator Beau Dooley says, "It's refreshing to see that students are now starting to realize that excessive drinking on campus isn't as common as they once thought." Dooley engages small student groups by presenting them with campus-specific data. Prior to the sessions, students complete a four-item survey on perceived drinking patterns on campus and self-reported drinking rates. The results are presented along with actual campus drinking rates based on current survey results. Invariably the students overestimate peer-drinking rates. Student surveys found that during the three years Wooster has used this group session approach student estimates of how many of their peers drink five or more drinks per occasion have significantly decreased-from 42 percent to 27 percent. The Ohio College Initiative to Reduce High Risk Drinking is a Program of Ohio Parents for Drug Free Youth, based in Columbus. For more information go to www.ohioparents.org . ------------------------------------------------------------------------ Reducing Alcohol Harm in the Air Force: A Uniformed Approach to Prevention AFTER DIGGING THROUGH QUARTERLY DISCIPLINARY REPORT, a major Air Force command concluded that unacceptable levels of drinking leading to disruption and damage warranted bold prevention measures and a shift in the culture that condones such behaviors. It made a commitment to turn things around and has achieved compelling results in just one year. The U.S. Armed Forces knows it faces drinking problems, especially among its lower age, lower-ranking personnel. The most recent Department of Defense survey, conducted in 2002, found that heavy drinking appears on the rise after two decades of decline (see Prevention File, Summer 2004). However, military commanders, who have wide-ranging responsibilities, may not know how to articulate and enforce safe and healthy drinking norms within their units. Overcoming inertia is how one Air Force command began a concerted and comprehensive campaign based on the knowledge that prevention can make a difference. "Quick fixes don't work. We're in it for the long haul because a new 'freshman' class of airmen arrive on base every week," said Colonel Evan J. Hoapili, commander of the 90th Space Wing, at the American Public Health Association annual meeting in November 2004. Six months after assuming command in August 2003 Hoapili made the commitment to give hope to demoralized field leaders with a new, research-based, campaign for reducing alcohol problems among uniformed personnel and enhancing unit readiness. A New Resource For Colleges and Communities The Center for College Health and Safety assists colleges and universities in developing, implementing, and evaluating prevention policies and programs to address a broad range of health and safety issues at institutions of higher education. The Center also conducts research to expand current knowledge about effective strategies in promoting health and preventing alcohol, tobacco, and other drug use, violence and injuries, and high-risk sexual activity. The Center's services include professional development, technical assistance, publications, and a broad array of electronic communication resources. The 90th Space Wing's military mission is to ensure that intercontinental ballistic missiles or ICBMs can deter any foe that might contemplate an armed attack on the United States. The "Mighty Ninety," headquartered at Frances E. Warren Air Force Base in Cheyenne, WY, is a group of 3,400 active duty service men and women and another 3,600 civilian and dependent personnel assigned to Air Force bases in Colorado, Nebraska, and Wyoming. Nearly half of the active duty service members-1,500-are between 18 and 24 years of age. Hoapili pointed out that these younger aged personnel are quite similar to college students. Like their civilian counterparts, the airmen and women face comparable age and development issues. They frequently find themselves living some distance away from home, on their own, for the first time. And living arrangements mix younger members with those 21 years and older. Similarities don't end with demographics. Both military and college populations at this age are prone to alcohol-related problems. And for both, experts agree that the commitment of top leadership is essential to an environment that does not condone high-risk drinking and related problems and supports the institutional mission, whether it be military or academic. Hoapili told Prevention File that no single event precipitated for the campaign. Rather, the level of incident reports involving personnel under their command disturbed both him and other top officers. In late 2003, Hoapili organized a "tiger team" to analyze the statistics and factors contributing to them, which found that alcohol played a role in many of them. "When many institutions think alcohol they often only think of driving under the influence and don't track other incidents, such as sexual assault and domestic violence. We started looking at other indicators and connecting the dots to drinking," he said. Looking to the research evidence With a nod to the National Institute on Alcohol Abuse and Alcoholism college drinking report and the underage drinking recommendations from the National Academy of Sciences, Hoapili described the 90th Space Wing's Responsible Drinking Culture Campaign, with it's catch phrase "fighting BAC." The goal is for personnel who drink to keep their blood alcohol content below .05 percent for those of legal age and .00 for those under 21. The legal limit for driving is .08 percent in most states. The Campaign message is: * Zero drinks if you're under 21! * Zero DUIs! * 1 drink per hour, max! * 3 drinks in one night, max! "We have an integrated three-prong approach for realizing these norms that addresses individual, base, and community levels," said Hoapili. "On an individual level, the unit is screening all new arrivals with a standardized instrument to identify those in need of treatment or enhanced education," said Hoapili. Each base has designated "unit champions" to model and promote campaign norms and engage fellow airmen to build a culture of shared ownership. Each base and unit develops action plans approved by unit commanders and monitors on- and off-based incidents. Hoapili warns field commanders not to think they can delegate alcohol problem prevention to base social service agencies. Commanders need to be prominently and genuinely involved. Media strategies are an important component at the base level. Media messages change every six weeks, sometimes targeting younger troops, sometimes older, and sometimes the general base population, alternating positive and negative themes. Each message is tested by focus groups. Bases also support alternative transportation, such as the Arrive Alive Taxi, and foster creation of self-run social and recreational groups by and for lower ranking personnel, such as MAD (Making a difference) Crews. These groups develop appealing social and recreational activities for service members under 21 or for those 21 years and older who aren't attracted to the bar scene. Beyond the perimeter: Addressing the larger community The 90th Air Wing includes the surrounding community in its Responsible Drinking Culture Campaign. The community is essential, Hoapili said, for changing the larger social environment over the long term. He and his subcommanders want to see more consistent enforcement of drinking laws-especially underage sales-for military personnel and civilians alike. To achieve this community-wide consistency, coordination with local law enforcement is key. In fact, the Cheyenne Police Department and the F.E. Warren AFB have a 100-year record of wide-scale cooperation, a relationship that has only grown closer in recent years due to mutual concern for homeland security. To gain alliance with the local business community, Hoapili wrote to alcohol outlet owners and managers in four cities adjacent to Air Wing installations encouraging them to engage in responsible beverage service practices. "We got across the board positive response except for one bar owner. Most bar owners are good guys, wanting to do the right thing. One owner thought it was unconstitutional to restrict service members from being present in an establishment," Hoapili said, adding that federal regulations give commanders wide latitude to protect the health and welfare of personnel under their charge. "We also backtrack with service personnel to find out about problem bars. I have sent letters to owners about specific problems, like a particular clerk on a particular shift who doesn't follow management policies. In each of these cases, owners took immediate action and we had no further problems from those locations," said Hoapili. The 90th regularly joins with state health and alcohol regulatory agencies and non-governmental health advocacy groups to pursue a common agenda for reducing illegal and unsafe alcohol sales and service practices. One example of such cooperation is the use of underage service members as decoys to test compliance with laws precluding alcohol sales to minors. The Air Force's concern with underage drinking has also led to an alliance with the national campaign led by the first spouses of governors. "First Lady Nancy Freudenthal, spouse of Governor Freudenthal, has been extremely active on this issue for the state of Wyoming. She has been very supportive and collaborative in working with our base to promote a healthier alcohol culture inside and outside the fence," said Captain Alan Ogle, a physician at the Warren Air Force Base. He serves as a member of the First Lady's task force to reduce underage drinking, which is a part of the Leadership to Keep Children Alcohol Free, an initiative founded by the National Institute on Alcohol Abuse and Alcoholism and The Robert Wood Johnson Foundation (www.alcoholfreechildren.org ). Military Fighting Alcohol Problems According to Stars and Stripes, the Department of Defense is seeking to cut down on binge drinking and other alcohol problems among soldiers. More than 100 military bases took part in National Alcohol Screening day, which took place in April. DOD plans to spend $13.2 million this year for programs aimed at preventing alcohol problems, smoking and obesity. "We're not saying you should or should not have a beer or a glass of wine," said William Winkenwerder Jr., assistant secretary of defense for health affairs. "What we're here to do is educate them on the dangers of excess alcohol consumption." According to Winkenwerder, reducing binge drinking could yield immediate benefits, such as fewer drunk-driving accidents and injuries. Programs need to target young soldiers, sailors, and aviators. "Many young people recognize alcohol can represent a danger to their health, but they just don't appreciate how much and how many are injured in alcohol-related accidents," he said. "When you're young, you think you're invincible.? With results comes recognition For Hoapili, an important part of the effort is keeping track of results. In just the first half year of the project alcohol-related disciplinary incidents were down by 60 percent from baseline, underage drinking has dropped by over 70 percent, and driving under the influence involving base personnel fell by 27 percent. The progress is continuing, Hoapili explained, "with fourth quarter 2004 incidents down 75 over the first quarter 2004, and infractions down 73 percent, underage drinking down 81, and DUIs down 36 percent during the year." According to Hoapili, about 30 percent are repeat offenders, mirroring national statistics. "If I can make a big dent in the repeat rate, those numbers would go even lower. Starting in October and November 2004 penalties got higher for repeat offenders. We will monitor repeaters," he said. "We have been recognized as a best practice for other Air Force installations and have shared our resources and experiences extensively, including the Navy," Ogle said. "Various branches of the service have contacted us, all the way from Germany and Alaska," Hoapili said. "I will be meeting with all the Air Force four-star generals in their conference, which is sponsored by the Air Force chief of staff. We are demonstrating that science based, fact-based social marketing approaches work." What We Can Learn From the 90th Space Wing's Example By William DeJong Both US military and academic leaders face a daunting challenge as they work to combat alcohol-related problems among their ranks. Given the long-standing intractability of these problems, could anyone blame these leaders for giving in to feelings of hopelessness? Enter Colonel Evan J. Hoapili, commander of the 90th Space Wing, which is headquartered at Warren Air Force Base (AFB) in Cheyenne, WY. Any leader who can tout the kind of dramatic decreases in alcohol problems that he reports-a 70 percent reduction in underage drinking, a 60 percent decrease in alcohol-related disciplinary incidents, a 27 percent drop in DUI incidents-deserves our rapt attention. How did Warren AFB do it? Colonel Hoapili's alcohol prevention program is grounded in nine basic principles: * An institution's top leadership must be committed to a long-term effort to reduce drinking problems. The rank and file will make prevention a priority-and keep it so-only when the person in charge demands it. * Broad support for the institution's policies and programs can be built by underscoring how alcohol problems compromise that institution's core mission. Most social problems faced by both military and academic institutions are exacerbated by alcohol use. * An institution's strategic plan should be firmly rooted in science-based knowledge and evaluation research. Planners should build on a foundation of what works, not what is customary or politically expedient. * Resources should be devoted to screening new entrants in order to identify those who could benefit from additional education, a motivational interview, or treatment. Universal screening gets people the help they need, while also communicating that the institution takes the problem seriously. * Meaningful reductions in alcohol-related problems cannot be achieved without reducing alcohol consumption across the entire population. Research has made clear that environmental approaches to prevention work best to achieve this result. * Success cannot be achieved without an active partnership with the surrounding community. Principal areas of focus should include reducing alcohol availability through responsible retailing and beverage service and consistently enforcing underage drinking and DUI laws. * Harm reduction approaches, such as alternative rides and designated driver programs, should be introduced only as part of a comprehensive program that focuses primarily on environmental change. * Supportive media messages are necessary to communicate the institution's expectations, correct misperceptions of drinking norms, and publicize new policies and enforcement efforts. * Resources should be devoted to establishing and monitoring key performance indicators to gauge progress and identify areas needing improvement. Colonel Hoapili states that base commanders and other Air Force brass are paying attention to what is happening at Warren AFB. College and university administrators should pay attention as well. The most vital lesson we can learn from the 90th Space Wing's example is this: effective prevention begins when an entire community declares the difference between acceptable and unacceptable conduct and then takes action to enforce that difference. Both military and academic leaders are well advised to work in common cause with local officials-and with each other-to change community alcohol policies and enforcement. William DeJong, PhD, is a professor of social and behavioral sciences at the Boston University School of Public Health and a senior center advisor to the Higher Education Center for Alcohol and Other Drug Abuse and Violence Prevention. ------------------------------------------------------------------------ Moose Cree's Alcohol Policy: Making Changes Incrementally By Ronald R. Douglas, Margaret Rylett and Rene Lauzon FIRST NATIONS IN CANADA have battled the negative consequences of alcohol use since its introduction by European fur traders. To arrest the prevalence and severity of alcohol-related problems, communities have tended to introduce abstinence through the adoption of policies prohibiting alcohol use. With the exception of prohibition, Aboriginal communities in Canada have not had much experience using alcohol-control policies to prevent alcohol-related problems. On the other hand, non-native communities in the Canadian Province of Ontario have adopted community-based alcohol management policies that reduced alcohol-related problems in municipally owned recreation facilities since the early 1980s (see /Prevention File,/ Winter 2000 and Summer 2004). Approximately two hundred cities, towns and villages reported reductions in: intoxication among event participants; underage drinking; fights/scuffles; acts of vandalism; police interventions; public complaints; injuries; legal actions; unlicensed (illegal) drinking; and drinking and driving. Among Aboriginal communities in the Canadian Province of Ontario, Moose Cree First Nation was the first to develop and implement an alcohol harm reduction policy to manage the drinking environment in its main activity centre. It chose to introduce pragmatic practices to minimize chances that drinkers may inflict harm on themselves and those around them-without having to prohibit alcohol use at community social events. Moose Cree and Perceived Alcohol Problems The community of Moose Cree First Nation, known by many as Moose Factory because of its history of being an early fur-trading center, is located on an island near the mouth of the Moose River where it empties into the arctic waters of James Bay. The community has an on-reserve population of approximately 1,400 people. Their mission statement stresses a vision of creating a healthier community in which people "live together and respect one another." While the community of Moose Cree contains a variety of recreational facilities, the Thomas Cheechoo Jr. Memorial Complex with its arena, curling pads and community hall is the principal activity centre. Drinking in the community occurs in residences and at social functions hosted in the recreation complex. Prior to the 1992 policy initiative, staff at the recreation complex reported problems involving intoxicated participants and related rowdy behaviour, fights, injuries, vandalism, underage drinking, and a need for police assistance. Planning for Change Moose Cree, like 540 other First Nation Communities in Canada has a National Native Alcohol and Drug Abuse Program (NNADAP) community worker. To address the problems being experienced in the recreation complex, the Moose Cree NNADAP worker contacted the Centre for Addiction and Mental Health for assistance; thus initiating the policy development process. In January 1992, the Chief and Band Council formed a committee composed of ten representatives from Council, Band administration, community members, police service, a CAMH consultant, and the NNADAP worker to come up with some policy recommendations. Over a period of five months it gathered information on drinking practices; reviewed proven program interventions such as server intervention programs, discussed community-based policy strategies being adopted in non-native communities; became familiar with the provincial liquor laws; examined their current alcohol management practices; sought suggestions from others in the community; consulted with staff and volunteers; and kept Chief and Band Council informed of their deliberations. Defining the change Within five months, the Chief and Band Council adopted The Thomas Cheechoo Jr. Memorial Complex Alcohol Management Policy. The policy contains a number of regulations stipulating to whom, where and how alcohol is to be provided within the Recreation Complex. They include: * Designating the community hall, curling club lounge, and the curling pads and arena floor when the ice is out as the only alcohol use areas * No dispensing of alcohol at youth and minor sports events * Blocking youth admittance to adult social events where alcohol is served, except in the case of weddings, anniversaries, and family reunions, provided they leave the premises by 10 p.m. * Posting signs to inform participants that event workers cannot serve them to a state of intoxication or provide alcohol to those already intoxicated, thus reminding servers of their legal responsibilities and providing a visible authoritative statement to patrons * Requiring event workers to attend a server training workshop * Making available low-alcohol content beer and non-alcohol drinks as a substitute drink * Providing safe transportation for the intoxicated * Supervising entrances to keep underage, troublemakers, and those already intoxicated from entering * Issuing progressive penalties, ranging from a warning to rental refusals, to event operators who fail to implement the requirements of the policy Prior to the policy's adoption, intoxicated participants that caused problems were the only ones who were penalized. Following the adoption of the policy, penalties could now be assessed against those who operate an event. The Council also endorsed a recommendation calling for a periodic review of the policy to maintain its relevancy. For example, as a result of the 1996 review, the Council decided to limit the total amount of alcohol available at any large event to 50 cases of beer and prohibited spirit sales. As a result of the 1998 review, hired security guards had to possess a server-training certificate. The committee members designed and implemented an information campaign to inform all about the policy requirements and its perceived benefits. Information sessions for the community membership were held, the local newsletter ran an article about the policy change, and over 200 volunteers participated in server training workshops. A reference manual that includes the policy, procedures and rental contract assists recreation complex staff implement the regulations. In surveys completed in 1996, 1999 and 2004 of stakeholder perceptions alcohol-related problems, such as intoxicated patrons, fights and scuffles, verbal abuse and harassment, vandalism, underage drinking, and police interventions, had decreased, documenting a decade of sustained problem reduction. Since the development of the Moose Cree policy in 1992, three other First Nations in Ontario had adopted and implemented equivalent policies by 1996. In surveys conducted in 1996 and 1999, they too reported similarly perceived declines. Since 1996, six other aboriginal communities in Ontario have adopted similar policies. The process of introducing a workable social policy to guide alcohol functions in Moose Cree's Thomas Cheechoo Jr. Memorial Complex appears to be experiencing some success in minimizing alcohol-related problems. Nonetheless, there is some controversy among recovering alcoholics who feel that permitting drinking will contribute to alcoholism and some self-described social drinkers perceive the policy as imposing unnecessarily strict rules; thus indicating the continuing need for an ongoing community dialogue. Editor's note: Authors are affiliated with the Centre for Addiction and Mental Health, Toronto, Ontario, Canada. The opinions expressed in this article are those of the authors and do not necessarily reflect the views or policies of the Centre for Addiction and Mental Health. Permission to publish was granted by the Moose Cree First Nation in consultation with its Healing Centre and the Thomas Cheechoo Jr. Memorial Complex. Direct inquires to Marg Rylett, Social Prevention & Health Policy Research Department, Centre for Addiction and Mental Health, 200-100 Collip Circle, London, Ontario, N6G 4X8. Members of the policy development committee included Doug Cheechoo, Earl Cheechoo, Robert Chilton, Robert Echum, Paula Lesage, Ernest Rickard, Richard Siedel, Jean Wesley and Harold Witham. ------------------------------------------------------------------------ Prevention Updates Smoking Continues to Decline in California California now has the nation's second-lowest smoking rate, trailing only Utah. Smoking among adult Californians has dropped to 15.4 percent of the population, down from 16.2 percent in 2004 and an all-time low. Moreover, 70 percent of those who still smoke say they want to quit. In addition smoking among 18-to-24-year-olds also fell, from 22.2 percent to 18.3 percent, according to a report from the California Department of Health Services. "The decrease in smoking rates is having a profound effect on the health of Californians. As a result of fewer Californians smoking, rates of cancer of the lung or bronchus in California are going down at three times the rate of the rest of the country," said State Public Health Officer Richard J. Jackson, MD. State health officials credit California's smokefree policies, comprehensive local and schoolbased tobacco education programs, aggressive media campaign and increased tobacco taxes as key factors in the unprecedented statewide smoking reductions. Marijuana Use Down After Classified as "Less Harmful" Easing penalties for marijuana use has not caused a feared explosion in use of the drug in the United Kingdom. In fact, according to The Observer, some say that marijuana is less popular now than before the drug was reclassified as a less-harmful substance. Since cannabis was downgraded from a Class B drug to Class C in January 2004, the growth in new users has slowed to 0.5 percent annually. Moreover, user ratings of the drug have declined from 8.8 (out of 10) in 1997 to 7.6 in 2004, even as ratings of drugs like ecstasy, crack, and heroin have risen. "When the user rating falls it is like a drug is going out of fashion," said Matthew Atha, director of the Independent Drugs Monitoring Unit, which conducts the user study. "It is also a good indicator of intention to use and whether someone is likely to become a regular user." Former UK drug czar Mike Trace warned that, "It is dangerous to try and assess overall trends in a 12-month period." However, he added, "One of the fears of reclassification was that there would be a sudden leap in use, and this shows that has not happened." Courting College Students In 2004, students at 118 of 119 colleges surveyed had attended events sponsored by the tobacco industry, according to a report in the American Journal of Public Health (January 2005). Industry representatives claim that they are only trying to get existing smokers to switch brands, but critics say the goal is actually to get casual smokers to become addicts. Camel cigarettes and other brands are a common sight at bars catering to college students. Promoters hand out free lighters and cigarettes in bars, clubs, fraternity events, and even on campus in exchange for scanning the patron's barcoded driver's license for their name, address, and age information. According to the Chronicle of Higher Education (March 18, 2005), some tobacco companies also hold spring-break promotions, with drawings for lavish prizes, as well as promotional giveaways-T-shirts, caps and sunglasses bearing the companies' Logos-at college vacation destinations like Shasta Lake, CA, and Daytona Beach, FL. Since 2002, California has required all tobacco promotional events to be registered with the state; in 2004, the industry ran 35,000 events in the Golden State alone. "It's a great way for them to promote their product while students' inhibitions are lowered by alcohol," said Tess Boley Cruz, an assistant professor of research in preventative medicine at the University of Southern California. Some state-funded schools are using money from the 1998 tobacco settlement between the industry and states to fight back. In Pennsylvania, for example, schools can apply for $18,000 Students Working Against Tobacco grants. Some schools have banned cigarette sales in campus stores, or forbidden smoking in dorms or even in many outdoor locations on campus. Rather than focusing on the harm of smoking or using ineffective scare tactics, many college preventionists are emphasizing the advantages of not smoking. Falsify Driver's License, No Driving until Age 21 Teenagers who doctor their driver licenses so they can buy alcohol would lose all driving privileges until they turn 21 under a law proposed in New York. "If you are 16 . . . and you have a fake driver's license in your possession, you're done driving until you turn 21," said Gov. George E. Pataki. "A teenager's most prized possession is his or her license. We think this will have an enormous impact on underage drinking," said Westchester County District Attorney Jeanine Pirro, who cosponsored the bill with Pataki. Pataki said more than 4,400 drivers under 21-the legal drinking age-were arrested last year statewide for driving under the influence of alcohol. He called underage drinking "the single most grave threat" to teenagers' lives, and said altered licenses were part of the problem. Under current law, a teen caught with an altered license can be charged with criminal possession of a forged instrument and can lose driving privileges temporarily. But such teens often gain youthful-offender status and do not suffer enough consequences, Pirro said. The bill would mandate a suspension until age 21. More Bars, More Violence Neighborhoods where bars, restaurants and liquor and other stores that sell alcohol are close together suffer more frequent incidences of violence and other alcohol-related problems, according to recent research by the Prevention Research Center and others. The strong connection between alcohol and violence has been clear for a long time-research now shows that this connection also relates to the location of places that sell alcohol. The report How Alcohol Outlets Affect Neighborhood Violence says that government agencies with authority over land-use and/or liquor licenses can help fight crime and blight and improve quality of life by controlling licenses to sell alcohol and the location of licensees. Governments can make rules that set minimum distances between alcohol outlets; they can limit new licenses for areas that already have outlets too close together; they can stop issuing licenses when a particular location goes out of business; and they can permanently close outlets that repeatedly violate liquor laws. It turns out that while a larger number of alcohol outlets and a higher rate of violence might be expected in poorer neighborhoods or in neighborhoods with a larger population of young people, even when levels of poverty and the age and the ethnic background of residents are taken into account, a high density of outlets is strongly related to violence regardless of a neighborhood's economic, ethnic or age status. The paper is available at: http://resources.prev.org/documents/AlcoholViolenceGruenewald.pdf You Can't Get from Here to There Without a Roadmap Smoke-free airplane cabins and clean indoor air laws for offices and restaurants, higher taxes on tobacco products to increase the price to consumers, and enforcement of underage access to tobacco laws. These are prevention strategies that have helped reduce smoking rates across the country by modifying the environment or context in which tobacco products are available and consumed. These strategies from tobacco control can also inform the development of public health and safety measures aimed at reducing adverse consequences associated with the sale and service of alcoholic beverages. Solution to Community Alcohol Problems: A Roadmap for Environmental Prevention, a new guide from the Marin Institute and the Youth Leadership Institute, is a how-to manual on the application of effective prevention strategies. To obtain copies, visit www.MarinInstitute.org/roadmap/index.htm . New Support for Alcohol Higher Taxes Some of America's most distinguished economists have called for what they say are long-overdue increases in federal excise taxes on alcoholic beverages to help offset the massive economic and social costs of alcohol. In a declaration to Congress organized by the Coalition for the Prevention of Alcohol Problems, the economists, who include four Nobel laureates, say legislation promoted by the alcohol industry to reduce such taxes would damage public health, increase budget deficits, and threaten the safety of Americans, especially young people. "Through neglect, Congress has allowed effective rates of tax on a substance that does more harm than any illegal drug to fall dramatically, even as the federal budget has sunk far into the red," said Henry Aaron, PhD, senior fellow in economic studies at the Brookings Institution. "As our elected officials deliberate on how to deal with our fiscal woes, they would be well advised to increase a tax that would both help close the federal deficit and discourage the continued epidemic of alcohol abuse." Citing government reports on the effects of alcohol taxes, the economists urged lawmakers to avoid adding to the national debt by rejecting industry appeals to lower federal taxes on alcohol, which have only increased once in 54 years for beer and wine and only twice for liquor. Signatories to the Economists' Declaration on Federal Alcohol Excise Taxes include George Akerlof, Daniel Kahneman, Lawrence Klein, and Robert Solow, all winners of the Nobel Prize for Economics, as well as 55 other leading economists. ------------------------------------------------------------------------ Ten Years Ago in Prevention File (Vol. 10, No. 2, Spring 1995) Making Sense of Sensible Drinking DRINKERS AND NON-DRINKERS ALIKE ARE AWASH IN CONFUSION over recent claims that drinking alcohol is good for our hearts. In 1991 wine imbibers embraced the message of 60 Minutes' Morley Safer on the so-called French Paradox. The apparent paradox is that, despite a high-fat diet, the wine-loving French people have lower rates of heart disease than Americans. The U.S. wine industry quickly picked up on the emerging research findings to promote wine drinking as healthful. In the ensuing months, many Americans took comfort in the idea that their cabernet consumption provided protection against heart disease. Discussion on both sides of this issue has been furious ever since. Public health advocates are quick to point to flaws in the research-some of which was funded by the wine industry. Additional research conducted here and abroad has added more fuel to the fire. In the midst of this furor those concerned about public health are trying to make sense about sensible drinking messages. Benefits for Whom? Many serious questions have been raised about the validity of research pointing to the health benefits of alcohol consumption. For example, studies with male subjects overlook the notable differences between men and women, who distribute alcohol in their bodies differently. And the research findings for men are not necessarily the same for women. Researchers point out that such research does not account for details such as drink size, frequency of drinking, or the context in which drinking occurs. Others point out that cultural differences are not accounted for in studies that rely on White subjects. Limits, Guidelines, or Norms? A central question on this health benefit debate hovers around the issue of quantity. How much alcohol is enough to achieve the apparent benefit? How much increases the risk for adverse consequences, such as cancer, accidents, suicide, and even heart disease? For the most part, the alcohol industry guidelines are limited to general statements, such as "know when to say when" or "think when you drink." The public health community is grappling with ways to convey messages about sensible drinking standards. Moderate Drinking and Health-Questions and Answers promotes the general guideline of "less is better." It places the potential benefits of drinking in the context of gender, body weight, and negative health outcomes associated with alcohol consumption and points out that there are other, potentially less harmful ways to reduce the risk of heart disease, such as decreasing fat consumption and getting regular exercise. ------------------------------------------------------------------------ Editor's Note: Dietary Guidelines for Americans 2005, published jointly by the Department of Health and Human Services and the Department of Agriculture, says that the consumption of alcohol can have beneficial or harmful effects depending on the amount consumed, age and other characteristics of the person consuming the alcohol, and specifics of the situation . . .Alcohol may have beneficial effects when consumed in moderation. The lowest all-cause mortality occurs at an intake of one to two drinks per day. The lowest coronary heart disease mortality also occurs at an intake of one to two drinks per day. Morbidity and mortality are highest among those drinking large amounts of alcohol.