choosing and planning a mix of effective (collegeaim)pip.missouri.edu/mom/docs/presentations/college...
TRANSCRIPT
4/9/2016
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Jason R. Kilmer, Ph.D.
University of Washington
Associate Professor Psychiatry & Behavioral Sciences
Assistant Director of Health & Wellness for Alcohol & Other Drug Education
Division of Student Life
Choosing and Planning a Mix of Effective Strategies to Reduce Alcohol-Related Harms: Using the College Alcohol Intervention Matrix
(CollegeAIM)
Acknowledgements:
NIAAA
Joan Masters, Amy Kiger, Kim Dude, & Dan Reilly
The CollegeAIM teams at UW and Minnesota
The college student drinking prevention field has grown a
great deal – let’s look at some select highlights
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College student drinking hit the radar of researchers in
1945
Fry, C.C. (1945) A note on drinking in the college community. Quarterly Journal of Studies on Alcohol, 6, 243-248.
“These parties are often attended by faculty members, some of whom are selected to respond to the chant, ‘Old Prof. _____ is in the alcohol ward _______, Drink, Drink, Drink.’ Cheers, or moans, and laughter follow this performance according to the speed with which the professor empties his glass. These parties break up after a few hours of song and good fellowship.
They do not occur often, but are part of the life of colleges and are accepted by the community as such.” (p. 244)
Fry (1945)
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“Wine is often served at fraternity dinners in the hope that members will learn to appreciate proper wines with food.” (p. 244)
“Although milk and soft drinks are extremely popular in American colleges – the consumption of them being greater than other beverages – a special snobbism is sometimes to be associated with the appreciation and knowledge of fine wines.” (p. 244)
Fry (1945)
Warns that a “state of intoxication” could be the primary purpose of some events.
Discusses the opportunity for returning veterans to attend college, and speculates on the role alcohol might play related to coping when under pressure in the college setting.
Fry (1945)
Larger, even national studies, investigate the issue
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Strauss & Bacon (1953)
First widespread study of drinking at 27 colleges
Calls for effective prevention options are made,
particularly as laws change
College Alcohol Study – differences from 1979 to 1985
Task force or committee focusing on alcohol education and prevention 1979: 37%
1985: 64%
Dedicated alcohol education coordinator or specialist 1979: 14%
1985: 48%
Gadaleto & Anderson (1986)
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College Alcohol Study – differences from 1979 to 1985
Articles in campus publications (76%)
Films shown on campus (63%)
Speakers (63%)
Workshops focusing on drinking attitudes (61%)
Poster and slogan campaigns (60%)
Educational handouts prepared by campus groups (51%)
Discussion groups (50%).
There was recognition of the need to address college student drinking, yet no clear guidelines on how to best do this. Gadaleto & Anderson (1986)
Legal drinking age changes to 21 for all 50 states in 1988
Increases to the drinking age resulted in decreased traffic crashes and decreased alcohol consumption (Wagenaar & Toomey, 2002)
However, initial evaluations focusing on college students showed everything from shifts in where students did their drinking (George,
Crowe, Abwender, & Skinner, 1989) to students’ efforts to avoid getting caught when policies were enforced, often associated with increases in risk-taking (Brittain & Roberge, 1988).
Dennis Roberts Student Life Southern Methodist University Anthony Nowak Residential Life Radford University Roberts, D.C., Nowak, A.J. (1986). Implications of the change to a minimum drinking age of 21 for the college environment. Journal of College Student Personnel, 27, 484-490.
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Roberts & Nowak (1986)
“Another approach that may help during and after the transition to the minimum drinking age of 21 would be to make funds available to institutions of higher education to develop, test, and disseminate information about model alcohol education programs. Approaches to alcohol education are already in use. These approaches need to undergo rigorous evaluation and then be made available for application throughout college campuses. (p. 489)”
“A Call to Action”
www.collegedrinkingprevention.gov
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www.CollegeDrinkingPrevention.gov
Tier I: Evidence of effectiveness among college students (≥2 studies supporting efficacy)
Tier 2: Evidence of success with other 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
NIAAA College Drinking Task Force Tier System Emphasized Need to Use Evidence-Based Strategies, Measure Outcomes
Tier 1: Evidence of Effectiveness Among College Students
Combining cognitive-behavioral skills with norms clarification and motivational enhancement interventions (ASTP only program mentioned by name as an example).
Offering brief motivational enhancement interventions (BASICS only program mentioned by name as an example).
Challenging alcohol expectancies.
From: “A Call to Action: Changing the Culture of Drinking at U.S. Colleges,” NIAAA Task Force
Mainstream coverage
Estimates of morbidity and mortality in a paper by Hingson and colleagues (2002)
Week of April 9, 2002
New York Times
CNN
San Francisco Chronicle
USA Today
Fox News
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Digging is a gateway to gardening
“I found heirloom seeds in your room…We need to talk.”
“Your mother and I raised you to do more than this…”
Know the warning signs of farming
“Answer me honestly, how long have you been planting?”
“Stop labeling GMO foods at the supermarket!”
“What Colleges Need to Know Now: An Update on College Drinking Research” (2007)
Larimer & Cronce (2002): 44 unique intervention conditions (1984-1999)
Larimer & Cronce (2007): 60 intervention conditions (1999-2006)
Toomey and colleagues showed few studies available at the time of the 2002 review and evaluations of 110 environmental approaches published (of which 36 specifically targeted college students) at the time of the 2007 review.
.
“What Colleges Need to Know Now: An Update on College Drinking Research” (2007)
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What did this translate to on college campuses 8 years
later?
NIAAA College Drinking Task Force Report Leads to Important Progress; Still Room For Improvement
79% of colleges aware of task force report Over half were implementing at least one evidence-based individual strategy Only 1/3 were implementing an evidence-based environmental strategy 98% of colleges provided some sort of education regarding alcohol (most not evidence-based) Larger universities with better resources more likely to implement task force recommendations
Moving beyond the Tiers of effectiveness to compiling a
comprehensive strategic plan
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College Alcohol Intervention Matrix (College AIM)
Overarching Goal of College AIM
Increase the likelihood that research will inform interventions to address drinking on campuses by providing a framework for schools to compare and select evidence-based intervention strategies.
Two Development Teams
Individual Strategies
- Mary E. Larimer
- Jessica M. Cronce
- Jason R. Kilmer
University of Washington
Environmental Strategies
- Traci L. Toomey
- Toben F. Nelson
- Kathleen M. Lenk
University of Minnesota
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• Phase I: identifying interventions to be included in CollegeAIM, finalizing dimensions on which they would be evaluated, and developing coding system
• Phase II: Identifying, reviewing, and rating the substantial research literature on college alcohol interventions
• Ultimately, rated nearly 60 interventions on multiple dimensions
Development Process
Decision Parameters • Relative Effectiveness – insufficient, not effective, limited,
moderate, higher • Amount /Quality of Research – 0, +, ++, +++, ++++
• Relative Monetary Costs for Program and Staff for Adoption and Implementation/ Maintenance – lower, mid-range, higher
• Relative Magnitude of Barriers – higher, moderate, lower • Staffing Expertise – policy advocate, coordinator, health professional
• Strategy Level – federal, state, local, college • Public Health Reach – broad vs. limited
• Targeted Population – underage, all students, individuals, small groups
• Research Population – college vs. general • Short/Long-term Effects (individual-level only) – short-term effects
(yes/no), long-term effects (yes/no), not assessed • Primary Modality (individual-level only) – individual, group, online
• Phase III: Iterative review process
Development Process
• 10 additional college alcohol researchers reviewed
ratings, applied their knowledge and professional
judgment, and provided detailed feedback
• Through multiple rounds of review and revision,
consensus process distilled decades of research
and hundreds of studies into a user-friendly
decision tool
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Strategies
CAMPUS-ONLY (ENV)
Alcohol-free campuses
Prohibition of alcohol use/service/sales at
- campus social events
- sporting events
Standards for alcohol service at social
events
Requirement of Friday morning classes(1)
Campus-wide social norms campaign(1)
Substance-free residence halls(1)
Amnesty policies(1)
Requirement of alcohol-free programming(1)
Bystander interventions(1)
COMMUNITY-BASED ONLY (ENV)
Increase alcohol tax
Retain state-run alcohol retail stores (where
applicable)
Dram shop liability laws pertaining to
- Sales to underage
- Sales to intoxicated
Retain age-21 drinking age
Require unique design for state IDs for age
<21
Responsible beverage service training laws
Increase cost of alcohol license
Limit number/density of alcohol
establishments
Prohibit home delivery of alcohol
Keg registration laws
Social host laws:
- Property
- Provision of alcohol
Noisy assembly laws
Shoulder tap campaigns
CAMPUS OR COMMUNITY-BASED
(ENV)
Prohibition of beer kegs
Restriction of alcohol sponsorship and
advertising
Retain ban on Sunday sales (where
applicable)
Retain restrictions on hours of alcohol
sales
Restrictions on happy hours/price
promotions
Beverage service training programs:
- Sales to underage
- Sales to intoxicated
Minimum age requirements to serve/sell
alcohol
Enforcement of age-21 drinking age,
e.g. compliance check campaigns
Party patrols
Safe-rides program(1)
EDUCATION/AWARENESS
PROGRAMS (IND)
Information/knowledge/education alone
Values clarification alone
Normative re-education: In-person
norms clarification alone
Electronic/mailed Personalized
Normative Feedback (PNF):
- Event Specific Prevention (21st
birthday cards)
- General PNF programs
COGNITIVE-BEHAVIORAL SKILLS-BASED
(IND)
Expectancy challenge interventions (ECI):
- In vivo / experiential expectancy challenge
- By proxy / didactic / discussion expectancy
challenge alone
Self-monitoring/self-assessment alone
Goal/intention-setting alone
BAC feedback alone
Multi-component alcohol skills training:
- Alcohol Skills Training Program (ASTP)
- Alcohol 101 Plus
- Parent-based alcohol communication
training
- General life skills training/lifestyle
balance/coping
MOTIVATIONAL/FEEDBACK-BASED (IND)
In-person Brief Motivational Intervention
(BMI) (e.g., BASICS):
- BMI - Individual
- BMI - Group
Electronic/mailed Personalized Feedback
Intervention (PFI):
- e-CHECKUpToGo (formerly e-CHUG);
-CheckYourDrinking.net (beta 1.0 version);
-College Drinkers CheckUp (CDCU);
- General PFI programs
Multi-component education-focused
programs:
- AlcoholEdu for College
- General MCEFP
INTERVENTIONS DELIVERED BY HEALTH
CARE PROFESSIONALS (IND)
Screening and Behavioral Treatment
Medications for Alcohol Use Disorder
www.collegedrinkingprevention.gov/CollegeAIM
NIAAA’s CollegeAIM
How can schools and/or coalitions use CollegeAIM? Review individual and environmental strategies to
compare approaches
Find new evidence-based options to replace less effective strategies or address gaps
Anyone reviewing CollegeAIM can use the interactive strategy planning worksheet to select a combination of approaches based on needs and budget
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Select
Plan Take
action
Assess
Where does College AIM fit in the planning process?
Assess behavior on campus and
set priorities
Select
Plan Take
action
Assess
Where does College AIM fit in the planning process?
Assess behavior on campus and
set priorities
Select strategies
after exploring evidence-
based interventions
Select
Plan Take
action
Assess
Where does College AIM fit in the planning process?
Assess behavior on campus and
set priorities
Select strategies
after exploring evidence-
based interventions
Plan how to carry out
strategies and measure results
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Select
Plan Take
action
Assess
Where does College AIM fit in the planning process?
Assess behavior on campus and
set priorities
Select strategies
after exploring evidence-
based interventions
Plan how to carry out
strategies and measure results
Implement the chosen strategies,
evaluate them, and refine the
program
“A mix of strategies is best (p. 5)”
Enforce Age 21 Drinking Laws
Brief Alcohol Screening and Intervention for College Students (BASICS)
Alcohol Skills Training Program (ASTP)
Restrict Happy Hours & Price Promotions
Electronic CHECK UP TO GO (eCHECKUP)
Start with a compilation of what is already offered
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Then, consult College AIM!
So what does the matrix look like?
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There are two! One for individually-focused approaches, one for environmental-level
strategies.
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www.collegedrinkingprevention.gov/CollegeAIM
www.collegedrinkingprevention.gov/CollegeAIM
Select a strategy to see ratings,
references, and potential resources
www.collegedrinkingprevention.gov/CollegeAIM
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Click on strategies to
print for reference or discussion
www.collegedrinkingprevention.gov/CollegeAIM
See detailed answers to frequently asked questions
www.collegedrinkingprevention.gov/CollegeAIM
Neo’s school is targeting driving under the
influence (DUI) with a wrecked car display. His
school is considering adding either a “beer
goggles” simulation or a bystander intervention
program
Case example
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Start with individually-focused or environmental-level approaches?
Wrecked car display X --- broad this approach isn’t rated
“Beer Goggles” program X --- focused this approach isn’t rated either
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Wrecked car display X --- broad this approach isn’t rated
“Beer Goggles” program X --- focused this approach isn’t rated either
Bystander approach X too few $$ # --- recommended strategy
Use NIAAA’s CollegeAIM to consider how students are
getting connected to strategies
Five main stages of successful implementation (Fixen, et al., 2005; NREPP/SAMHSA, 2012)
“The use of effective interventions without implementation strategies is like serum without a syringe; the cure is available, but the delivery system is not.”
Fixen, Blase, Duda, Naoom, & Van Dyke (2010)
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After a few national conferences and some major discussions,
what has been the early feedback?
NIAAA’s CollegeAIM – early anecdotal feedback and reactions
Direct access to articles
Worksheet
FAQ page
HTML vs. PDF
Helpful in prioritizing in a tough budget climate
So useful, people wish there were similar tools for marijuana as well as sexual assault prevention efforts
Implications for coalitions
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Implications for coalitions
Coalitions can bring key stakeholders (both on- and off-campus) to the table
Many of the environmental strategies require the involvement of off-campus partners
Reduce barriers to disseminating best practices by raises awareness of “what works”
Any one thing we do is a part of an overall puzzle
Understand high-risk times of year, and
consult the matrix to consider options
New Year’s Week
Spring Break Week
Thanksgiving
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 0
1
2
3
4
5
6
7
Week in Academic Year
College Student Drinking Academic Year Drinking Pattern Among First Year Students
DelBoca et al., 2004
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Daily and weekly alcohol consumption over academic year. Error bars (95% CI) are shown above the mean only. Asterisks (*) refer to significant adjacent week differences (Bonferroni adjusted level of p<.002) (Tremblay, et al., 2010)
What we do about alcohol use on
campus will pay dividends in the
classroom
Relationship between alcohol, sleepiness, and GPA exists in college (Singleton & Wolfson, 2009)
Heavy drinking associated with lower GPA
Students at research universities who are heavy episodic drinkers are less likely to be engaged in
interactions with faculty (Porter & Prior, 2007)
Frequency of binge drinking associated with lower grades in college setting (Pascarella, et al.,
2007)
Relationship Between Alcohol Use and Academic Success
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Individually-focused approached must be
packaged with environmentally-
focused approaches, and vice-versa
Science of College Drinking Prevention Has Come a Long Way, But Our Work Is Not Done
More research needed on…
Strategies with insufficient research
Best practices in training and implementation
Best packaging of approaches
Cultural adaptations
Overlap of alcohol use and other health issues
Overlap of alcohol and other substance use
Use of technology to promote change
Special thanks to: Joan Masters Amy Kiger Kim Dude Dan Reilly Mary Larimer Jessica Cronce Amelia Kilmer Jason Kilmer [email protected]