Using Data to Guide and Sustain Community Interventions

Joel W. Grube, Ph.D

.

Prevention Research Center Pacific Institute for Research and Evaluation OJJDP UDETC National Leadership Conference Tucson, AZ August 18-20, 2005 Preparation of this presentation was supported by NIAAA grants AA006282 and AA014958

What is Sustainability?

Sustainability addresses three issues: Maintaining the benefits of a program Continuing a program Building the capacity to continue a program Broadly speaking sustainability refers to: “The process of ensuring an adaptive preventive system … can be integrated into ongoing operations to benefit diverse stakeholders.” (Johnson, Hayes, Center, & Daley, 2004, p. 137)

Key Issues in Sustainability Sustainability is an

ongoing

dynamic process Sustainability is an

adaptive

process Sustainable innovation is

integrated

into normal operations and requires

adequate infrastructure

capacity Sustainable innovation should have proven

benefit

to diverse stakeholders Sustainability requires

commitment

Champions Decision-makers Stakeholders Workers and support: Source: Johnson, Hayes, Center, & Daley, 2004

Assess Plan Implement Evaluate Reassess/Modify Data Model of Sustainability Capacity Building Innovation Integration into System Sustainable Innovation Continuation Stakeholder Benefits Source: Johnson, Hayes, Center, & Daley, 2004

Some Examples Using Data: Oregon Youth Alcohol Access Project Community Trials Project to Reduce Alcohol Trauma Diadema Project

Assess: Is there a problem?

What is the problem?

30-Day Drinking Oregon 11 th Graders

100 90 80 70 60 50 40 30 20 10 0

Half of Oregon 11 report drinking in the past 30 days….

th graders

19 94 19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02 20 03 20 04 20 05 Oregon US (YRBS)

Source: Oregon Healthy Teens Survey 2005 http://oregon.gov/DHS/ph/chs/youthsurvey/yrbsdata.shtml

30-Day 5+ Drinks Oregon 11 th Graders

70 60 50 40 30 20 10 0

Of those Oregon 11 th graders who report drinking in the past 30 days, 60% report having 5+ drinks….

19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02 20 03 20 04 20 05 Year Oregon US (YRBS)

Source: Oregon Healthy Teens Survey 2005 http://oregon.gov/DHS/ph/chs/youthsurvey/yrbsdata.shtml

30-Day Drug Use Among Oregon 11 th Graders

Any Other Illict Drug Inhalants Marijuana 5+ Drinks Alcohol 0

Alcohol is by far the most commonly used and abused drug among Oregon 11 th graders….

10 20 30 40 50 60

Source: Oregon Healthy Teens Survey 2005 http://oregon.gov/DHS/ph/chs/youthsurvey/yrbsdata.shtml

Annual Costs of Underage Drinking in Oregon 2001 (Millions of Dollars)

Work Lost and Other Costs $139 $130 $428 Medical Costs Total Costs: $697 million annually $387 per capita per year Pain & Suffering

Source: Enforcing Underage Drinking Laws Website: http://www.udetc.org/UnderageDrinkingCosts.asp

Annual Costs of Underage Drinking in Oregon (2001)

Problem

Youth Violence Youth Traffic Crashes High Risk Sex Youth Property Crime Youth Injury Poisonings & Psychoses FAS Mothers Age 15-20 Youth Alcohol Treatment

Total Total Costs (Millions)

$351.5

$86.1

$59.6

$49.1

$36.7

$11.8

$11.7

$90.5

$697.2

Source: Enforcing Underage Drinking Laws Website: http://www.udetc.org/UnderageDrinkingCosts.asp

Planning: Where do we intervene?

How?

Ease of Obtaining Alcohol by Oregon 11 th Graders …Over 81% of Oregon 11 th graders say it would be very easy or sort of easy to get alcohol if they wanted… 11.1% 7.5% 28.4% 53.0% Very Easy Sort of Easy Sort of Hard Very Hard

Source: Oregon Healthy Teens Survey 2005 http://oregon.gov/DHS/ph/chs/youthsurvey/yrbsdata.shtml

Sources of Alcohol Past 30 Days by Oregon 11 th Graders 100 90 Commercial 80 70 60

Oregon teens use multiple sources to obtain alcohol…

50 40 30 20 16 16 10 10 4 0 G ro ce C ry on ve ni en ce D ru g St or G e as A S ta ny tio C n om m er ci al 30 55 Social 46 21 20 73 Fr ie nd > 21 Fr ie nd < 2 1 H om e P ar en A t ny S oc ia l

Source: Dent, Grube, & Biglan, 2005

Indicated Points of Intervention Commercial Availability Reward and Reminder Compliance Checks Social Availability Shoulder Taps Party Dispersal MIP Targeted Media

Monitor Implementation What is being done?

What dosage?

160 140 120 100 80 60 40 20 0 Underage Access Activities Community Trials Project Q2 Q3 Q4 Q1 Q2 COMPLIANCE CHECKS CITATIONS ISSUED OUTLETS TRAINED (RBS)

Pre-intervention Intervention Period Source: Grube, 1997

Evaluate/Assess What effects?

What benefits?

Effects of Reward and Reminder on Tobacco Sales 100 90 80 70 60 50 40 30 20 10 0 Baseline T1 T2 T3 Post Intervention T4 T5 T6 T7 T8 T9 T10 T11 T12 T13 T14 Biglan, Ary, Smolkowski, Duncan, & Black, 2000

Effects of Reward and Reminder on Weekly Alcohol Use 20 15 10

R & R + School Based School-Based Only

5 0 T1 T2 T3 T4 T5 Biglan, Ary, Smolkowski, Duncan, & Black, 2000

Homicides per 1,000 Residents: Diadema, Brazil 0.14

0.12

Before Sales Hours Restriction After Restriction 0.10

0.08

0.06

0.04

0.02

There were an average of 301.3 homicides per year before the sales restrictions and 169.6 per year afterward 0.00

Ja n-9 5 Ju l-9 Ja 5 n-9 6 l-9 Ja 6 n-9 7 l-9 Ja 7 n-9 8 Ju l-9 Ja 8 n-9 9 l-9 Ja 9 n-0 0 Ju l-0 Ja 0 n-0 1 l-0 Ja 1 n-0 2 Ju l-0 Ja 2 n-0 3 l-0 Ja 3 n-0 4 Ju l-0 4 Duailibi, Laranjeira, Ponicki, Grube, & Lacey, 2005

Estimated Effects of Reducing Hours of Sales Number of Lives Saved 95% CI % Reduction in Homicides Number of Assaults Prevented 95% CI % Reduction in Assaults 273 208-338 46.1% 224 -66 – 514 25.8% Duailibi, Laranjeira, Ponicki, Grube, & Lacey, 2005

Reassess/Modify What is

not

working?

What should be changed?

Where are more resources needed?

60 50 40 30 20 10 0 Effects of Compliance Checks and RBS on Underage Sales 47 53 45 35 19 16 Comparison (No Treatment) Compliance Checks Compliance Checks + RBS Pretest Posttest

Source: Grube, 1997

Conclusion Data can guide and sustain programs: Define the problem and the solution Plan and target interventions Monitor implementation Evaluate outcomes Reassess and modify interventions Marshall support for increased allocation of resources and infrastructure capacity

Key reference: Johnson, K., Hays, C., Center, H., & Daley, C. (2004). Building capacity and sustainable prevention innovations: A sustainability planning model.

Evaluation and Program Planning, 27

, 135-149.