PATROL Pilot Study: Findings and Future Plans Presented at 135th APHA Annual Meeting and Exposition November 5, 2007 Washington, DC Presented by Michael Pemberton, Ph.D 3040 Cornwallis Street · Research Triangle Park, NC 27709 Phone: 504-947-8150 · pemberton@rti.org · www.rti.org

Goals of PATROL Pilot Study Test the feasibility of rolling out a Web-based alcohol education program in the military Assess the effectiveness of PATROL in reducing alcohol misuse among active duty personnel Pilot study utilized eight installations Army: Fort Bliss, Fort Sill Navy: Hampton Roads - Norfolk, Ventura County Air Force: Hurlburt Field, Tyndall Air Force Base Marine Corps: Camp Pendleton, Cherry Point

Study Design Surveys at three time points Baseline, 1 month follow-up, 6 month follow-up Assign personnel to one of four study conditions: Alcohol Savvy Drinker’s Check-Up Drinking Risk Level Low risk (AUDIT < 8) received Alcohol Savvy High risk (AUDIT => 8) received Drinker’s Check-Up Control

Study Design “Real World” Challenges One installation was restricted to be “program” only Personnel were randomly assigned to one of the three program groups Two installations were restricted to be “control” only Had to allow for those with low-speed internet connections Alcohol Savvy required high-speed connection Personnel with low-speed connections were assigned to Drinker’s Check-Up

Barriers and Facilitators to Participation Barriers to participation Participation in PATROL was voluntary RTI could not offer incentives to personnel Personnel had to provide personal identifiers No incentives offered by installations for participation in follow-up survey Facilitators to participation Incentives offered by installations (i.e., Hurlburt Field offered a 1-day pass) Strong top-down support from individual commanders

Number of Participants Time Component Number Baseline Registered on the study Website 4,263 Completed the baseline survey 3,912 Program group (completed one of the Web programs following the baseline survey) 2,993 Control group (did not complete Web program following baseline) 919 1 Month Follow-Up Returned to study Website for 1-month follow-up 1,431 Completed the 1-month follow-up survey 1,371

Military and Demographic Characteristics of Sample Baseline Sample Follow-Up Sample Characteristic Number Percent Service Army 164 4.2 55 3.8 Navy 1,589 40.6 459 32.1 Air Force 1,351 37.1 715 50.0 Marine Corps 708 18.2 202 14.1 Gender Male 3,236 82.7 1,081 78.9 Female 676 17.3 290 21.2

Military and Demographic Characteristics of Sample Baseline Sample Follow-Up Sample Characteristic Number Percent Pay Grade E1–E3 (junior enlisted) 751 19.2 171 12.5 E4–E6 2,298 58.7 778 56.7 E7–E9 (senior enlisted) 431 11.0 233 17.0 O1–O3 (junior officers) 319 8.2 131 9.5 O4–O10 (senior officers) 110 2.8 57 4.2 Deployed in Past Year Yes 2,907 74.3 1,004 73.2 No 25.7 367 26.8

Findings from Baseline and 1-Month Follow-Up Surveys

Prevalence of Alcohol Use Among Baseline Sample * 5 (4 for women) or more drinks on single occasion at least once in past 30 days **5 (4 for women) or more drinks on single occasion 4 or more times in past 30 days *** AUDIT score of 8 or higher

Program Effects Analysis Longitudinal growth models Key test: Group x Time interactions Also tested “simple slopes” (changes over time within each condition) Combined Program Effects Analysis question: Did those who completed a program show reductions in alcohol misuse relative to controls? Collapsed all three program conditions, compared with control Individual Program Effects Analysis question: Did any of the three program conditions show greater reductions in alcohol misuse than the others? Compared each individual condition with control

Combined Program Effect on Number of Days Drank Alcohol No program effect for frequency of drinking No change in either program or control group

Combined Program Effect on Proportion of Binge Drinkers Statistically significant program effect Significant reduction in program group, no change in control group

Combined Program Effect on Proportion of Heavy Drinkers Statistically significant program effect Significant reduction in program group, no change in control group

Combined Program Effect on Peak Blood Alcohol Concentration (BAC) Statistically significant program effect Significant reduction in program group, no change in control group

Program Effect for Individual Conditions on Proportion of Binge Drinkers Statistically significant program effect for DCU Significant reduction from baseline to follow-up for each program condition

Program Effect for Individual Conditions on Proportion of Heavy Drinkers Statistically significant program effect for DCU, “marginal” effect (p = .051) for AS Significant reduction from baseline to follow-up for each program condition

Program Effect for Individual Conditions on Peak BAC Statistically significant program effect for DCU Significant reduction from baseline to follow-up for each program condition

Program Effect for Individual Conditions on Proportion of Heavy Drinkers, High Risk Drinkers Only Statistically significant program effect for DCU, AS, and RL Significant reduction from baseline to follow-up for each program condition

Conclusions The Web is a feasible method of providing interventions to active duty military personnel PATROL led to significant reductions in multiple measures of alcohol use at the 1-month follow-up Mixed results by program condition More significant program effects for DCU No one program led to a markedly greater decrease in alcohol consumption Providing a program tailored to the risk-level of the user did not increase the effectiveness Programs worked only for high-risk drinkers

Limitations These pilot data are based on a “convenience sample” of volunteers Cannot generalize findings to total United States DoD or the Services Pure random assignment was not possible Data are largely from the Navy and Air Force Lower than expected response rate at 1- month follow-up reduced statistical power to find significant program effects

Next Steps Analyses of 6-month follow-up data Surveys completed by approximately 950 respondents Initial analyses show little change from 1-month follow-up Mediation and moderation analyses

Next Steps Currently in discussions with DoD regarding further rollout / evaluation of the programs Suggestions Personalize the programs for each Service Limited rollout more similar to general rollout, with evaluation Programs used as “stand-alones” rather than as a package

Questions?