Transcript Live Long and Prosper: Using Research to Sustain Effective

Live Long and Prosper:
Using Research to Sustain
Effective Strategies
Kathryn Stewart
Prevention Research Center
Underage Drinking Enforcement Training Center
6th Annual National Leadership Conference
PRC Resource Link:
Research in Action
Provides information and practical
guidance
Resource Link Goals:

Make PRC research more well known and more
accessible

Translate findings into practical guidance

Facilitate dialogue between researchers and
practitioners, policy makers, advocates
The Challenge:
How to enhance
sustainability
The Strategy
Solid research and effective
communication of results can enhance
sustainability.
How Research can Help

Research can guide programs and garner
community support
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Research can demonstrate program effectiveness
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Research can support permanent policy change
Research to guide
programs and garner
community support
The Border Project
Preventing alcohol-related
problems at the US/Mexico
Border
Current sites
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San Diego -Tijuana
El Paso – Juarez
Laredo –Nuevo Laredo
Brownsville - Matamoros
The Problem
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Mexico’s drinking age is 18
Some border towns provided plentiful, cheap
sources of alcohol
The Problem
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Mexico’s drinking age is 18
Some border towns provided plentiful, cheap
sources of alcohol
Young people traveled to Mexico to drink
Beverage service not always “responsible”
The Problem
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Mexico’s drinking age is 18
Some border towns provided plentiful, cheap
sources of alcohol
Young people traveled to Mexico to drink
Beverage service not always “responsible”
Heavy drinking occurred
Sometimes resulted in problems in Mexico
The Problem
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Mexico’s drinking age is 18
Some border towns provided plentiful, cheap
sources of alcohol
Young people traveled to Mexico to drink
Beverage service not always “responsible”
Heavy drinking occurred
Sometimes resulted in problems in Mexico
Impaired young people drove home
The Research Strategy
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PIRE studied drinking behavior of young US
residents crossing into Mexico
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Documented the extent of heavy drinking
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Shed light on motivations and behavior of
border crossers
The Implementation Strategy
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The nature and scope of the problem were
explained to groups and agencies on both sides
of the border
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Media advocacy brought the problem to the
attention of the public through compelling news
coverage
The Change Strategies
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Earlier bar closings
Stepped up DUI enforcement efforts on the US
side of the border
Highly publicized enforcement of laws against
crossing by youth under 18
New restrictions on Marines from Camp
Pendleton
The Results
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Dramatic decline in number of nighttime
crossings by young people
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Reduction in nighttime crashes involving drivers
under 18
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90% reduction in number of Marines driving
back from the border
The Follow-up
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Results are fed back to the communities to
sustain action
The take-home message
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Research can provide motivation for change
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Research can provide data to guide program
strategies
Research to
demonstrate program
effectiveness
The Community Trials Project
to Reduce Alcohol-Related
Trauma
The Problem

Impaired driving crashes
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Other unintentional injuries
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Other alcohol-related trauma
The Research Strategy
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Identify strategies with the highest likelihood of
success community-wide
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Implement them vigorously in communities
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Evaluate changes over time and compare to
non-intervention communities
The Implementation Strategy
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Responsible serving practices
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Increased enforcement of drinking and driving laws
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Media coverage to enhance perceptions of increased law
enforcement
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Compliance checks to reduce underage access to alcohol
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Reduced availability through changes in outlet densities, planning
and zoning laws, and challenges to license applications
The Results
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49% reduction in heavy alcohol consumption
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51% reduction in impaired driving
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10% reduction in late night traffic crashes
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6% reduction in the average amount that people reported
drinking
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6% reduction in crashes involving drinking drivers
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43% reduction in injuries resulting from assaults presenting in
emergency rooms
The Follow-up
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Community Trials Project was awarded “model
program status” by the Center for Substance
Abuse Prevention.
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Communities across the country are adopting
this program and receiving federal support
under the State Incentive Grants program.
The take-home message
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Research can provide information on what
strategies are likely to be effective
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Research can provide support for program
effectiveness
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Research can provide positive feedback to
continue programs and to disseminate them
Research to support permanent
policy change
Alcohol Outlet Density and
Alcohol Problems
The Problem
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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.
The Research Strategy
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Demonstrate the link between outlet location
and density and problems
Analyze the nature of the link
The Implementation Strategy
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Make communities aware of the problems
created by alcohol outlets
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Make communities aware of the policy strategies
that can control outlet location and density
Licensing policies
 Land use policies
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The Results
Communities can:
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Set minimum distances between alcohol outlets
Limit new licenses for areas that already have
outlets too close together;
Not issue a new license when an outlet goes out
of business
Permanently close outlets that repeatedly violate
liquor laws
The Follow-up
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Policy changes can permanently change the
environment
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Reductions in alcohol problems can be sustained
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Communities are empowered to take control of
the alcohol environment
The take-home message
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Research can provide support for policy and
environmental changes
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Once a law or policy has been changed, it is
difficult to undo it
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Once an environment has been changed, the
effects are likely to be long-lasting
www.resources.prev.org
More Examples
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Using Data to Guide and Sustain Community
Interventions
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Using research to identify settings and
prevention strategies at California Universities
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:
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Maintaining the benefits of a program
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Continuing a program
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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
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Sustainability is an ongoing dynamic process
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Sustainability is an adaptive process
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Sustainable innovation is integrated into normal
operations and requires adequate infrastructure capacity
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Sustainable innovation should have proven benefit to
diverse stakeholders
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Sustainability requires commitment and support:
Champions
Decision-makers
Stakeholders
Workers
Source: Johnson, Hayes, Center, & Daley, 2004
Model of Sustainability
Assess
Plan
Implement
Evaluate
Reassess/Modify
Capacity
Building
Innovation
Integration into
System
Data
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 11th Graders
Half of Oregon 11th graders
report drinking in the past 30
days….
Oregon
US (YRBS)
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
100
90
80
70
60
50
40
30
20
10
0
Source: Oregon Healthy Teens Survey 2005
http://oregon.gov/DHS/ph/chs/youthsurvey/yrbsdata.shtml
30-Day 5+ Drinks
Oregon 11th Graders
70
60
Percent
50
Of those Oregon 11th graders who
report drinking in the past 30 days,
60% report having 5+ drinks….
40
Oregon
US (YRBS)
30
20
10
0
5 96 97 98 99 00 01 02 03 04 05
9
19 19 19 19 19 20 20 20 20 20 20
Year
Source: Oregon Healthy Teens Survey 2005
http://oregon.gov/DHS/ph/chs/youthsurvey/yrbsdata.shtml
30-Day Drug Use Among Oregon
11th Graders
Any Other Illict Drug
Alcohol is by far the most
commonly used and abused drug
among Oregon 11th graders….
Inhalants
Marijuana
5+ Drinks
Alcohol
0
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
Total Costs (Millions)
Youth Violence
$351.5
Youth Traffic Crashes
$86.1
High Risk Sex
$59.6
Youth Property Crime
$49.1
Youth Injury
$36.7
Poisonings & Psychoses
$11.8
FAS Mothers Age 15-20
$11.7
Youth Alcohol Treatment
$90.5
Total
$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 11th Graders
…Over 81% of Oregon 11th graders say it
would be very easy or sort of easy to get
alcohol if they wanted…
7.5%
11.1%
53.0%
28.4%
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 11th Graders
100
90
Commercial
Social
80
60
50
Oregon teens use
multiple sources to
obtain alcohol…
40
20
10
55
46
30
30
16
21
16
4
20
10
e
Pa
re
A
nt
ny
So
ci
al
om
H
C
Fr
ie
nd
>2
Fr
1
ie
nd
<
21
ro
ce
on
ry
ve
ni
en
D
ce
ru
g
St
G
or
as
e
A
S
ny
ta
t
C
om ion
m
er
ci
al
0
G
Percent
70
73
Source: Dent, Grube, & Biglan, 2005
Indicated Points of Intervention
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Commercial Availability
Reward and Reminder
Compliance Checks
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Social Availability
Shoulder Taps
Party Dispersal
MIP
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Targeted Media
Monitor Implementation
What is being done?
What dosage?
Underage Access Activities
Community Trials Project
Q2
Q3
Q4
Q1
Q2
160
140
COMPLIANCE
CHECKS
120
100
CITATIONS
ISSUED
80
60
OUTLETS
TRAINED
(RBS)
40
20
0
Pre-intervention
Intervention Period
Source: Grube, 1997
Evaluate/Assess
What effects?
What benefits?
Effects of Reward and Reminder
on Tobacco Sales
100
90
80
Baseline
Post Intervention
70
60
50
40
30
20
10
0
T1
T2
T3
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
Percent
15
R & R + SchoolBased
School-Based Only
10
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
0.08
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
nJu 95
Ja l-9
n- 5
Ju 96
Ja l-9
n- 6
Ju 97
Ja l-9
n- 7
Ju 98
Ja l-9
n- 8
Ju 99
Ja l-99
nJu 00
Ja l-0
n- 0
Ju 01
Ja l-0
n- 1
Ju 02
Ja l-0
n- 2
Ju 03
Ja l-0
n- 3
Ju 04
l-0
4
Rate
0.10
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?
Effects of Compliance Checks and RBS on
Underage Sales
Percent of Outlets Selling
60
50
40
53
47
45
Comparison (No
Treatment)
35
30
Compliance
Checks
20
19
10
16
Compliance
Checks + RBS
0
Pretest
Posttest
Source: Grube, 1997
Conclusion
Data can guide and sustain programs:

Define the problem and the solution
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Plan and target interventions
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Monitor implementation
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Evaluate outcomes
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Reassess and modify interventions
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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.
Using Research Data to Identify,
Evaluate, and Sustain Environmental
Alcohol Prevention Strategies in
College Settings
Safer California Universities:
A risk management approach to college
student drinking problems
Robert F. Saltz, Ph.D.
Principal Investigator
Prevention Research Center,
Pacific Institute for Research and Evaluation
Funded by the National Institute on
Alcohol Abuse and Alcoholism
Safer California Universities
Project Goal
To evaluate the efficacy of a
“Risk Management” approach to
alcohol problem prevention
Risk Management

Risk Assessment – using data to
identify intervention targets (settings,
events)
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Risk Reduction – interventions aimed
at reducing alcohol-related problems
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Risk Monitoring – using data to
assess intervention effectiveness and
modify interventions if necessary
Risk Assessment and Monitoring
Data Sources
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Brief interviews with key
personnel
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Archival data sources
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Student survey data
What are we trying to prevent?
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Intoxication at particular settings/events
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Harm related to intoxication at particular
settings/events
Selecting A Problem
Setting
Using assessment data to target
prevention efforts
Web-based Student Survey, Fall 2003
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Administered to ~14,000 students at 14
California universities
Established baseline levels of student drinking
and alcohol-related problems
Identified settings where the majority of
alcohol-related problems are occurring
Survey Modules for Specific Settings
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Residence hall parties
Greek parties
Campus events (e.g., concerts, sporting events)
Off-campus parties (houses, apartments)
Bars/restaurants
Outdoor settings (e.g., parks, beaches)
Questions About Each Setting
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Frequency of going to setting during semester
Frequency of alcohol use
Frequency of intoxication
Frequency of alcohol-related problems
Last time at setting:
How long at setting
 How much alcohol consumed before, during, after
 Number of people, underage drinking, system for
preventing underage drinking (e.g., checking IDs)

Prevalence of Student Intoxication
Last Time at Each Setting
70
60
Percent
50
40
30
20
10
0
Dorm party
Greek party
Campus event
Off-campus
party
Bar/restaurant
Outdoor setting
Source: Safer CA Univerisities Fall 2003 Survey
Drinking Problems in Past
Semester/Quarter
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
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
Percentage of Alcohol Problems by Setting
Fall 2003
Outdoor settings
.8%
Bars/restaurants
5.6%
Dorm parties
18.0%
Campus events
3.7%
Greek parties
Off campus parties
57.2%
14.6%
Why Off-Campus Parties are
Causing the Most Problems
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Over 9,000 students in survey sample went to at
least one off-campus party, 3-4 times as many as
other settings
Statistical analyses indicate that off-campus
parties carry a higher risk for frequent
intoxication and alcohol-related problems than
other settings
Effects of Survey Data on
Decision Making
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Consensus among members of campuscommunity task forces to target interventions to
off-campus settings (e.g., house parties)
Strong support for initiation and long-term
implementation of interventions
Great interest in continuing surveys to assess
intervention effects
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Interventions for Off-Campus Settings
Educational campaign that helps students and others
host safe social gatherings and to know their
responsibility as a host for the safety and well-being of
their guests and neighbors;
Fair but firm enforcement of existing laws that protect
the community from alcohol-related harm:
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DUI enforcement
Party patrols to disperse dangerous crowds
Enforce laws prohibiting alcohol sales or informal provision
of alcohol to minors
Placing the burden of costs to those who repeatedly
require community or police response – a “response
cost” ordinance.
Summary
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Student survey, archival and key informant data
provide an assessment of where and when
alcohol-related problems are occurring
These data can be used to help college
prevention specialists, administrators, campus
police and others to focus intervention efforts
on a particular setting and sustain those efforts
Data can also be used to monitor the effects of
interventions targeted to specific settings
For More Info. About the Safer CA
Universities Project…
Michelle Blackston and Richard McGaffigan
Data-driven Strategic Planning and
Implementation Process
Tuscon Salon H at 10:45