Transcript An Evolution of Environmental Prevention Models

An Evolution of Environmental
Prevention Models
Bob Saltz
Richard McGaffigan
Prevention Research Center
Berkeley, California
Pacific Institute for Research
and Evaluation
PRC
Prevention Research Center
Presentation Objectives

Planning phase discussion

Needs assessment
Baseline data
 Strategic partners
 Resource assessment



Model programs vs evidence-based strategies
Evaluation strategy
Presentation Objectives

Outline an evolution of prevention models by:
Describing the Community Trials project
 The Border Project
 Safer California Universities project

COMMUNITY TRIALS TO PREVENT
ALCOHOL-INVOLVED TRAUMA
1991-1997
Prevention Research Center
Berkeley, CA
Sponsors:
National Institute on Alcohol Abuse and Alcoholism
&
Center for Substance Abuse Prevention
Up to 50% of fatal car crashes involve alcohol. More than
20,000 people are killed and 650,000 are injured annually.
Alcohol is involved in 22% of all home injuries in the U.S.
56% of injuries from fights or assaults involve alcohol
Goal:
Reduce Alcohol-involved Trauma
 Traffic Crashes
 Injuries
-- burns
-- falls
 Drownings
 Violence
National Community Trial to
Prevent Alcohol-involved Trauma
-
Modesto
Salinas
Orange
Oceanside
. .
.
..
.
Florence
Sumter
Experimental
Comparison
Five Prevention Components
1.
Community Mobilization
2.
Responsible Beverage Service
3.
Risk of Drinking and Driving
4.
Underage Drinking
5.
Alcohol Access
Alcohol-involved Trauma at the Community Level:
Conceptual Model
MOBILIZATION
Local News about Alcohol
Problems & Enforcement
RESPONSIBLE BEVERAGE
SERVICE
DRINKING AND DRIVING
Local Law
Enforcement
Perceived
Risk of Arrest
Social Access
to Alcohol
Driving after
Drinking
Alcohol
Serving and
Sales Practices
UNDERAGE DRINKING
Local Regulation
of Alcohol
(Density, Hours
of Sale)
Retail Alcohol
Availability
(On and Off-premise)
ALCOHOL ACCESS
Alcohol Intoxication
or Impairment
Alcohol-involved
Injury and Death
(Traffic and Other)
Non-Traffic Risk Activities
Community Trials Final Results
 Heavy Drinking (-6%)
 Driving after “Too much to drink” (- 49%)
 BAC Positive Drivers (- 44%)
 Nighttime Injury Crashes (-10%)
 Assaults
-- Hospital Cases (-2%)
-- Emergency Room Cases (- 43%)
The San Diego-Tijuana Project to Reduce
Teen and Binge Drinking
Institute for Public Strategies
www.publicstrategies.org
System functional model for
community prevention
Community
Mobilization
Data Collection
& Evaluation
Learning
Strategy
Implementation
Strategy
Selection
Research / Practice Partnership

Pacific Institute


Data collection
Data feedback to
programming



Program design
Policy support
Media hook

Institute for Public
strategies

Design and implement
prevention strategy




Policy
Community organizing
Media
Law enforcement
Border field laboratory
1.
2.
Southbound
border
survey
San Diego
County
Telephone
Survey
3.
Tijuana
bars
4.
Northbound
border
survey
The Problem



Underage and binge drinking in Mexico
Thousands of US teenagers cross into Tijuana
on a weekend evening
Alcohol related problems are the result
DUI Crashes
 Fights, injuries, crime and arrests
 Exposure to STD’s
 Poor school performance

Strategic Change Model
Policy
Community
Organizing
Scientific
Data &
Research
Effective
Advocacy
Campaign
Enforcement
Media
Advocacy
Border Project
Multiple Interventions
Binational
Collaboration
Southbound
• Operation
Safe Crossing
USA
Mexico
Tijuana
• RBS training
• ID training
• Ban Alcohol Ads
• Enforcement in
Tijuana Bars
Northbound
• Community
Policing
• DUI
checkpoint
Safer California Colleges and
Universities:
A risk management
approach to college student
drinking problems
Why Care About
College Student
Drinking?
Mean Score for 5+ Drinks in a Row in Past 2 Weeks
by 4-year College Student Status
Twice
Once
College
Non-College
None
Wave 1
(18)
Wave 2
Wave 3
Wave 4
(19-20)
(21-22)
(23-24)
Measurement Wave
Injury
500,000 students between the ages of 18 and
24 are unintentionally injured under the
influence of alcohol
(Hingson et al., 2002)
Assault
More than 600,000 students between the ages of 18
and 24 are assaulted by another student who has
been drinking
(Hingson et al., 2002)
Sexual Abuse
More than 70,000 students between the ages
of 18 and 24 are victims of alcohol-related
sexual assault or date rape
(Hingson et al., 2002)
Drunk Driving
2.1 million students between the ages of 18
and 24 drove under the influence of alcohol
last year
(Hingson et al., 2002)
Academic Problems
About 25 percent of college students report
academic consequences of their drinking including
missing class, falling behind, doing poorly on exams
or papers, and receiving lower grades overall
(Engs et al., 1996;
Presley et al., 1996a, 1996b;
Wechsler et al., 2002)
What are we trying to prevent?

Intoxication

Harm related to intoxication
Safer California Universities
Project Goal
To evaluate the efficacy of a
“Risk Management” approach to
alcohol problem prevention
Risk Management

Risk Assessment

Risk Reduction

Risk Monitoring
Risk Assessment

Brief interviews with key
personnel

Archival data sources

Student survey data
SAFER CALIFORNIA UNIVERSITIES STUDY
Big Picture Framework
Risk Management
Strategies
Data Collection
Process
Planning Process
PRC Tech. Assist
and Activities
Proximal
Outcomes
Outcomes
Products
Archival Data
Risk Assessment
Student Surveys
Alcohol problem/
setting reviewed
Assessment toolkit
Tech. assistance
Training
Alcohol problem
settings identified
Evaluation of Risk
Management
Design
Key Informant
Interviews
Risk Prevention
Campus
Readiness Survey
Identify problem
using applied data
Identify policy
solutions
Dev. Risk mgmt.
strategies
Design
interventions
Est. strategic
partners
Dev. Media plan
Intervention toolkit
Tech. assistance
Training
Best practices
review
Conduct risk
management
interventions
Reduction of
intoxication among
students
Reduction of high
risk settings that
contribute to
alcohol-related
problems
Project Process
Manual
Risk Monitoring
Data collection
ongoing
Application of data
to identify problem
and solutions
Application of data
identifies training
needs
Monitors change
Risk Reduction
Matching intervention to risky settings:

Fraternity parties

Drinking in residence halls

Drinking associated with athletic events

Drinking at off-campus bars & restaurants
Risk Monitoring

Key role of archival data

Iterative process of evaluation….

…with improved implementation
How is risk management a
unique approach?

Targets times and places instead of individuals

Focus on intoxication

Tied to continuous monitoring and improvement emphasis on “control” rather than “one shot”
interventions
Anticipated Hurdles for
Prevention Strategy

Implicit assumption that “target” is high-risk
drinkers
E
V
O
C
SC R V ICT
HO IME ER IM
O V DO 2
L IC S
TR T E
PO
I
S
LI EX OU M 1
CE
PE BL
T
PH S R R E
YS EX OU P 2
IC VI BL
AL CT E
SE FI IM
UN SE X P GH 2
PE P X E TS
RF RO VIC RP
DA OR TEC TIM 1
M MP T 1
AG O SE
E OR X
TH L
IN IN Y
JU GS
UN
AR RE
PL
G D
AN
UE
N
DR WO ED DU
IN RK SE I
K H X
DR IG
IV H
IN
RU G
F
RI CR OR DE
DE IT GE
I
W CIZ T
I E
RE TH D
M
D
BE IS GR UI
HI S C ET
ND LA S
DR
W SS
IN
K V OR
C O K
HA ON MI
NG TE T
O ST
VE
R
CR
IM
NUMBERS OF PROBLEMS
RELATIVE PRODUCTION OF PROBLEMS BY
FREQUENT BINGE VS. NON-BINGE DRINKERS
(CAMPUS SAMPLE, '98 - '99 SCHOOL YEAR)
1600
1400
1200
FREQUENT BINGE DRINKERS
NON-BINGE DRINKERS
FIFTY-PERCENT CONTROL LINE
1000
800
600
400
200
0
PROBLEM CATEGORY
Anticipated Hurdles for
Prevention Strategy





Implicit assumption that “target” is high-risk
drinkers
Ambivalence about student drinking
Low perceived efficacy of environmental
interventions
Challenges of coordination and resource
allocation
Possible fears of “backlash”
Hypothesized Elements Necessary for
Purposive Environmental Interventions


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Organizational Knowledge of Problem
Clear Focus
Organizational Efficacy




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Resources
Coordination
Commitment
Perceived Efficacy
Continuous Feedback/Evaluation
REDUCING
UNDERAGE
DRINKING:
A COLLECTIVE
RESPONSIBILITY
For copies of:

The full report (readable on-line):
National Academies Press
www.nap.edu
Order by phone: 888-624-7645

FACE’s executive summary publication:
www.faceproject.org
Task Force Recommendations




Tier 1: Evidence of Effectiveness Among
College Students
Tier 2: Evidence of Success With General
Populations That Could Be Applied
to College Environments
Tier 3: Evidence of Logical and Theoretical
Promise, But Require More
Comprehensive Evaluation
Tier 4: Evidence of Ineffectiveness
The End
Supplemental Slides
These slides were not presented,
but are included in case anyone
might be interested in seeing a bit
more on related topics
Access: Sources of Alcohol Used
by Underage Drinkers, Past 30
Days
Source
% Grade 6
% Grade 9
% Grade 12
Friends
39.3
69.3
72.3
Family
48.7
28.8
18.2
Parties
32.1
55.6
59.8
Took from home
33.1
33.2
11.8
Took from friend’s home
15.9
17.7
5.0
Got someone to buy it
14.0
35.3
52.6
Bought at store
8.3
7.6
8.5
Bought at bar or restaurant
8.1
4.6
7.5
10.0
6.5
2.5
Took from store
Source: Harrison, et al., 2000
Access: Commercial Availability

Strengthen compliance check programs.

The federal government should require states
to achieve designated rates of retailer
compliance.

All sellers and servers of alcohol complete
state-approved training as a condition of
employment.
Effects of Compliance Checks
and RBS on Underage Sales
Percent of Outlets Selling
60
50
40
53
47
45
Comparison
(No Treatment)
35
30
Experimental
(No Training)
20
19
10
16
Experimantal
(Training)
0
Pretest
Posttest
Source: Grube, 1997
Access: Social Availability

Implement enforcement programs to deter adults from
purchasing alcohol for minors.

Establish and implement a system requiring
registration of beer kegs.

Adopt and publicize policies for detecting and
terminating underage drinking parties.
Access: Youth Use

Facilitate enforcement of zero tolerance laws.

Enact graduated driver licensing laws.

Implement sobriety checkpoints.

Strengthen efforts to prevent and detect use of false
identification.

Establish administrative procedures and noncriminal
penalties for alcohol infractions by minors.
Youth Interventions

Insufficient evidence to support youth-oriented media
campaign now: intensive research and development
needed.

Fund only evidence-based programs.

Information-only interventions, scare tactics, and
“delay” messages are not effective.

Expand the availability of effective clinical services for
treating alcohol abuse.
College Interventions
Campuses should adopt comprehensive evidence based
approaches:
Universal educational approaches as well as
selective and indicated approaches
 Screening and brief interventions
 Limit alcohol availability and access for underage
students
 Consistent enforcement of laws and policies

NIAAA and SAMHSA should continue to fund evaluation of
college-based programs and should maintain list of
evidence-based programs.
Community Interventions

Community coalitions can increase the effectiveness of
interventions.

Assess problem locally

Develop comprehensive community-based initiative.

Implement strategies tailored to the specific problems
and resources in the community.
Community Interventions

Involve gatekeepers, businesses, key community
leaders, and colleges.

Consider strategies such as: community organizing,
public education, strategic use of mass media, and
partnerships with faith-based organizations.
Community Interventions
Resources are essential:

Public and Private partners should support community
mobilization to reduce underage drinking

Federal funding should be available under a national
program dedicated to community-level approaches
modeled after the Drug-Free Communities Act
Summary

Alcohol use by young people is dangerous.

Committee calls for a deep, unequivocal societal
commitment to curtail underage drinking.

Need to dedicate the resources commensurate with the
magnitude of the problem.

Commit to a comprehensive strategy that involves
multiple partners (National, State, Campuses,
Local) to achieve long-term results.
Summary










Develop national adult-oriented media campaign
Create national partnership, including industry
Reduce youth exposure, both advertising and
entertainment
Government Assistance and Coordination
Increase compliance, including enforcement on- and offcampus
Implement evidence-based efforts aimed at youth
Implement effective college campus interventions
Develop community-specific responses, including
campus collaborations
Increase excise taxes
Conduct ongoing monitoring and R& E
Safer California Universities Survey
Fall 2003
 Internet and Mail Surveys
 Random Samples of Students
 14 Campuses
 N = 28,000
Range 738 - 1291
 Response rate 51%

Source: Safer California Universities Survey, 2003
Safer California Universities Survey

Gender:
Male 41%
Female 59%

Ages:
18
19
20
21
>21
19.6%
18.3%
16.2%
16.2%
28.8%


Class:
Freshman
Sophomore
Junior
Senior
Other
Ethnicity
White
Black
Asian Amer.
Latino
Other
21.1%
17.9%
28.5%
32%
.5%
52.1%
3.3%
33.5%
17.4%
17.4%
Source: Safer California Universities Survey, 2003
Percentage
Percentage of Safer Students
Drinking in Past Semester/Quarter
100
90
85
80
89 86
81 80
71
70 79
78 79
69
74
70
60
58
50
40
30
20
10
0
A
B
C
D
E
F
G
H
I
J
K
L
M
Safer Campuses
Source: Safer California Universities Survey, 2003
Percentage Drinkers
Percentage of Drinkers Getting
Drunk in Past Semester/Quarter
100
90
85
80
83
70
77
65
64
62
70
60
60
61
59
50 61
58
54
51
40
30
20
10
0
A B C D E F G H I J K L M N
Safer Campuses
Source: Safer California Universities Survey, 2003
Percentage
Percent of Students
“Binge” Drinking Past Two Weeks
100
90
37
80
44
47
58 66 63 66 63
70
62
66
69
77 69 72 80
60
50
44
40
34
35
20
30
20
16 18 16 21
18
16
16
20
10 15 10
10 15 18 18 13 15 13 16 22 20 22 18 19 18 17
10
0
A B C D E F G H I J K L M N
Total
Non-Binge
Drinker
2+ Times
Once
Safer Campuses
Source: Safer California Universities Survey, 2003
Drinking Problems in Past
Semester/Quarter (UC)
RWDD
DUI
Got Sick
Did Poorly on Test
Got Hurt or Injured
Damaged Property
Not Used
Had Unplanned Sex
Taken Advantage
Got Behind in Work
Missed Class
Hangover
44.6
43.8
58
38.3
39.6
36.9
37.1
43.2
35.5
49.7
48.7
65
0
10
20
30
40
50
60
70
Percentage of Drinkers
Source: Safer California Universities Survey, 2003
Drinking Problems in Past
Semester/Quarter (CSU)
RWDD
DUI
Got Sick
Did Poorly on Test
Got Hurt or Injured
Damaged Property
Not Used Protection
Had Unplanned Sex
Taken Advatage of Sexually
Got Behind in Work
Missed Class
Hangover
23
26
38
12
10
6
9
17
4
24
21
51
0
10
20
30
40
50
60
Percentage
Source: Safer California Universities Survey, 2003
Secondary Drinking Problems in
Past Semester/Quarter (UC)
Victim of Crime
Found Vomit
Unwanted Sexual Advance/Assault
Studies or Sleep Disrupted
Take Care of Other
Property Damaged
Physical Violence
Pushed, Hit, Assaulted
Argument
Harassed
Insulted
16
27
28
39
43
17
9
13
16
12
22
0
10
20
30
40
Percentage of Students
Source: Safer California Universities Survey, 2003
Secondary Drinking Problems in Past
Semester (CSU)
Sexual Assault
Found Vomit
Unwanted Sexual Advance
Studies or Sleep Disrupted
Take Care of Other
Property Damaged
Physical Violence
Pushed, Hit, Assaulted
Argument
Harassed
Insulted
1
13
12
26
34
9
2
6
12
4
15
0
10
20
30
40
Percentage
Source: Safer California Universities Survey, 2003
Drinking Problems by Setting and Campus
A
B
C
D
E
F
G
H
I
J
K
L
M
N
900
800
700
600
500
400
300
200
100
0
Greek
Residence Hall
Drinking Problems by Setting and Campus
A
B
C
D
E
F
G
H
I
J
K
L
M
N
1800
1600
1400
1200
1000
800
600
400
200
0
own room, house or apartment
On Campus
Drinking Problems by Setting and Campus
A
B
C
D
E
F
G
H
I
J
K
L
M
N
1200
1000
800
600
400
200
0
Off campus
Restaurant/bar
Outdoor