Live Long and Prosper: Using Research to Sustain Effective Strategies Kathryn Stewart Prevention Research Center Underage Drinking Enforcement Training Center 6 th 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 Make PRC research more well known and more accessible Translate findings into practical guidance Translate findings into practical guidance Facilitate dialogue between researchers and practitioners, policy makers, advocates 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 Research can guide programs and garner community support Research can demonstrate program effectiveness Research can demonstrate program effectiveness Research can support permanent policy change 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 San Diego -Tijuana San Diego -Tijuana El Paso – Juarez El Paso – Juarez Laredo –Nuevo Laredo Laredo –Nuevo Laredo Brownsville - Matamoros Brownsville - Matamoros

The Problem Mexicos drinking age is 18 Mexicos drinking age is 18 Some border towns provided plentiful, cheap sources of alcohol Some border towns provided plentiful, cheap sources of alcohol

The Problem Mexicos drinking age is 18 Mexicos drinking age is 18 Some border towns provided plentiful, cheap sources of alcohol Some border towns provided plentiful, cheap sources of alcohol Young people traveled to Mexico to drink Young people traveled to Mexico to drink Beverage service not always responsible Beverage service not always responsible

The Problem Mexicos drinking age is 18 Mexicos drinking age is 18 Some border towns provided plentiful, cheap sources of alcohol Some border towns provided plentiful, cheap sources of alcohol Young people traveled to Mexico to drink Young people traveled to Mexico to drink Beverage service not always responsible Beverage service not always responsible Heavy drinking occurred Heavy drinking occurred Sometimes resulted in problems in Mexico Sometimes resulted in problems in Mexico

The Problem Mexicos drinking age is 18 Mexicos drinking age is 18 Some border towns provided plentiful, cheap sources of alcohol Some border towns provided plentiful, cheap sources of alcohol Young people traveled to Mexico to drink Young people traveled to Mexico to drink Beverage service not always responsible Beverage service not always responsible Heavy drinking occurred Heavy drinking occurred Sometimes resulted in problems in Mexico Sometimes resulted in problems in Mexico Impaired young people drove home Impaired young people drove home

The Research Strategy PIRE studied drinking behavior of young US residents crossing into Mexico PIRE studied drinking behavior of young US residents crossing into Mexico Documented the extent of heavy drinking Documented the extent of heavy drinking Shed light on motivations and behavior of border crossers Shed light on motivations and behavior of border crossers

The Implementation Strategy The nature and scope of the problem were explained to groups and agencies on both sides of the border The nature and scope of the problem were explained to groups and agencies on both sides of the border Media advocacy brought the problem to the attention of the public through compelling news coverage Media advocacy brought the problem to the attention of the public through compelling news coverage

The Change Strategies Earlier bar closings Earlier bar closings Stepped up DUI enforcement efforts on the US side of the border Stepped up DUI enforcement efforts on the US side of the border Highly publicized enforcement of laws against crossing by youth under 18 Highly publicized enforcement of laws against crossing by youth under 18 New restrictions on Marines from Camp Pendleton New restrictions on Marines from Camp Pendleton

The Results Dramatic decline in number of nighttime crossings by young people Dramatic decline in number of nighttime crossings by young people Reduction in nighttime crashes involving drivers under 18 Reduction in nighttime crashes involving drivers under 18 90% reduction in number of Marines driving back from the border 90% reduction in number of Marines driving back from the border

The Follow-up Results are fed back to the communities to sustain action Results are fed back to the communities to sustain action

The take-home message Research can provide motivation for change Research can provide motivation for change Research can provide data to guide program strategies 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 Impaired driving crashes Other unintentional injuries Other unintentional injuries Other alcohol-related trauma Other alcohol-related trauma

The Research Strategy Identify strategies with the highest likelihood of success community-wide Identify strategies with the highest likelihood of success community-wide Implement them vigorously in communities Implement them vigorously in communities Evaluate changes over time and compare to non-intervention communities Evaluate changes over time and compare to non-intervention communities

The Implementation Strategy Responsible serving practices Responsible serving practices Increased enforcement of drinking and driving laws Increased enforcement of drinking and driving laws Media coverage to enhance perceptions of increased law enforcement Media coverage to enhance perceptions of increased law enforcement Compliance checks to reduce underage access to alcohol Compliance checks to reduce underage access to alcohol Reduced availability through changes in outlet densities, planning and zoning laws, and challenges to license applications Reduced availability through changes in outlet densities, planning and zoning laws, and challenges to license applications

The Results 49% reduction in heavy alcohol consumption 49% reduction in heavy alcohol consumption 51% reduction in impaired driving 51% reduction in impaired driving 10% reduction in late night traffic crashes 10% reduction in late night traffic crashes 6% reduction in the average amount that people reported drinking 6% reduction in the average amount that people reported drinking 6% reduction in crashes involving drinking drivers 6% reduction in crashes involving drinking drivers 43% reduction in injuries resulting from assaults presenting in emergency rooms 43% reduction in injuries resulting from assaults presenting in emergency rooms

The Follow-up Community Trials Project was awarded model program status by the Center for Substance Abuse Prevention. Community Trials Project was awarded model program status by the Center for Substance Abuse Prevention. Communities across the country are adopting this program and receiving federal support under the State Incentive Grants program. Communities across the country are adopting this program and receiving federal support under the State Incentive Grants program.

The take-home message Research can provide information on what strategies are likely to be effective Research can provide information on what strategies are likely to be effective Research can provide support for program effectiveness Research can provide support for program effectiveness Research can provide positive feedback to continue programs and to disseminate them 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 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 Demonstrate the link between outlet location and density and problems Demonstrate the link between outlet location and density and problems Analyze the nature of the link Analyze the nature of the link

The Implementation Strategy Make communities aware of the problems created by alcohol outlets Make communities aware of the problems created by alcohol outlets Make communities aware of the policy strategies that can control outlet location and density Make communities aware of the policy strategies that can control outlet location and density Licensing policies Licensing policies Land use policies Land use policies

The Results Communities can: 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 Policy changes can permanently change the environment Policy changes can permanently change the environment Reductions in alcohol problems can be sustained Reductions in alcohol problems can be sustained Communities are empowered to take control of the alcohol environment Communities are empowered to take control of the alcohol environment

The take-home message Research can provide support for policy and environmental changes Research can provide support for policy and environmental changes Once a law or policy has been changed, it is difficult to undo it Once a law or policy has been changed, it is difficult to undo it Once an environment has been changed, the effects are likely to be long-lasting Once an environment has been changed, the effects are likely to be long-lasting

More Examples Using Data to Guide and Sustain Community Interventions Using Data to Guide and Sustain Community Interventions Using research to identify settings and prevention strategies at California Universities 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 AA and AA014958

What is Sustainability? Sustainability addresses three issues: Maintaining the benefits of a program Maintaining the benefits of a program Continuing a program Continuing a program Building the capacity to continue 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 ongoing dynamic process Sustainability is an adaptive process Sustainability is an adaptive process Sustainable innovation is integrated into normal operations and requires adequate infrastructure capacity Sustainable innovation is integrated into normal operations and requires adequate infrastructure capacity Sustainable innovation should have proven benefit to diverse stakeholders Sustainable innovation should have proven benefit to diverse stakeholders Sustainability requires commitment and support: Champions Decision-makers Stakeholders Workers Sustainability requires commitment and support: Champions Decision-makers Stakeholders Workers Source: Johnson, Hayes, Center, & Daley, 2004

Model of Sustainability Sustainable Innovation Continuation Innovation Integration into System Source: Johnson, Hayes, Center, & Daley, 2004 AssessPlanImplementEvaluateReassess/ModifyAssessPlanImplementEvaluateReassess/Modify DataData CapacityBuildingCapacityBuilding Stakeholder Benefits

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 Source: Oregon Healthy Teens Survey Half of Oregon 11 th graders report drinking in the past 30 days….

30-Day 5+ Drinks Oregon 11 th Graders Source: Oregon Healthy Teens Survey Of those Oregon 11 th graders who report drinking in the past 30 days, 60% report having 5+ drinks….

30-Day Drug Use Among Oregon 11 th Graders Alcohol is by far the most commonly used and abused drug among Oregon 11 th graders…. Source: Oregon Healthy Teens Survey

Drinking Problems Among Oregon 11 th Grade Drinkers Source: Oregon Healthy Teens Survey

Annual Costs of Underage Drinking in Oregon 2001 (Millions of Dollars) Pain & Suffering Work Lost and Other Costs Medical Costs Source: Enforcing Underage Drinking Laws Website: Total Costs: $697 million annually $387 per capita per year

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 $11.7 Youth Alcohol Treatment $90.5 Total$697.2 Source: Enforcing Underage Drinking Laws Website:

Planning: Where do we intervene? How?

Ease of Obtaining Alcohol by Oregon 11 th Graders Source: Oregon Healthy Teens Survey …Over 81% of Oregon 11 th graders say it would be very easy or sort of easy to get alcohol if they wanted…

Sources of Alcohol Past 30 Days by Oregon 11 th Graders CommercialSocial Source: Dent, Grube, & Biglan, 2005 Oregon teens use multiple sources to obtain alcohol…

Other Key Findings Drinking increases as perceived commercial and social availability increases Drinking increases as perceived commercial and social availability increases Drinking increases as perceived enforcement of MIP laws decreases Drinking increases as perceived enforcement of MIP laws decreases Use of social sources increases as commercial availability decreases Use of social sources increases as commercial availability decreases Use of commercial sources increases as social availability decreases Use of commercial sources increases as social availability decreases Dent, Grube, & Biglan, 2005

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

Monitor Implementation What is being done? What dosage?

Pre-interventionIntervention Period Underage Access Activities Community Trials Project Source: Grube, 1997

Evaluate/Assess What effects? What benefits?

Effects of Reward and Reminder on Tobacco Sales BaselinePost Intervention Biglan, Ary, Smolkowski, Duncan, & Black, 2000

Effects of Reward and Reminder on Weekly Alcohol Use Biglan, Ary, Smolkowski, Duncan, & Black, 2000

Homicides per 1,000 Residents: Diadema, Brazil Before Sales Hours Restriction After Restriction Duailibi, Laranjeira, Ponicki, Grube, & Lacey, 2005 There were an average of homicides per year before the sales restrictions and per year afterward

Estimated Effects of Reducing Hours of Sales Number of Lives Saved Number of Lives Saved273 95% CI 95% CI % Reduction in Homicides % Reduction in Homicides46.1% Number of Assaults Prevented Number of Assaults Prevented224 95% CI 95% CI -66 – 514 % Reduction in Assaults % Reduction in Assaults25.8% 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 Source: Grube, 1997

Public Support Is there public support? Is there public support?

Percent of US Population Supporting Alcohol Policies Proposed Policy Favor Strongly Favor Somewhat Oppose Somewhat Oppose Strongly Increase alcohol taxes by 5 cents to fund prevention Restrict alcohol ads to make drinking less appealing to youth Conduct compliance checks Require keg registration Source: Harwood, Wagenaar, & Zander, 1998

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

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) Risk Assessment – using data to identify intervention targets (settings, events) Risk Reduction – interventions aimed at reducing alcohol-related problems Risk Reduction – interventions aimed at reducing alcohol-related problems Risk Monitoring – using data to assess intervention effectiveness and modify interventions if necessary Risk Monitoring – using data to assess intervention effectiveness and modify interventions if necessary

Risk Assessment and Monitoring Data Sources Brief interviews with key personnel Brief interviews with key personnel Archival data sources Archival data sources Student survey data Student survey data

What are we trying to prevent? Intoxication at particular settings/events Intoxication at particular settings/events Harm related to intoxication at particular settings/events 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 Administered to ~14,000 students at 14 California universities Administered to ~14,000 students at 14 California universities Established baseline levels of student drinking and alcohol-related problems Established baseline levels of student drinking and alcohol-related problems Identified settings where the majority of alcohol- related problems are occurring Identified settings where the majority of alcohol- related problems are occurring

Survey Modules for Specific Settings Residence hall parties Residence hall parties Greek parties Greek parties Campus events (e.g., concerts, sporting events) Campus events (e.g., concerts, sporting events) Off-campus parties (houses, apartments) Off-campus parties (houses, apartments) Bars/restaurants Bars/restaurants Outdoor settings (e.g., parks, beaches) Outdoor settings (e.g., parks, beaches)

Questions About Each Setting Frequency of going to setting during semester Frequency of going to setting during semester Frequency of alcohol use Frequency of alcohol use Frequency of intoxication Frequency of intoxication Frequency of alcohol-related problems Frequency of alcohol-related problems Last time at setting: Last time at setting: How long at setting How long at setting How much alcohol consumed before, during, after How much alcohol consumed before, during, after Number of people, underage drinking, system for preventing underage drinking (e.g., checking IDs) Number of people, underage drinking, system for preventing underage drinking (e.g., checking IDs)

Drinking Problems in Past Semester/Quarter Source: Safer California Universities Survey, 2003

Secondary Drinking Problems in Past Semester Source: Safer California Universities Survey, 2003

Why Off-Campus Parties are Causing the Most Problems Over 9,000 students in survey sample went to at least one off-campus party, 3-4 times as many as other settings 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 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 Consensus among members of campus- community task forces to target interventions to off-campus settings (e.g., house parties) Consensus among members of campus- community task forces to target interventions to off-campus settings (e.g., house parties) Strong support for initiation and long-term implementation of interventions Strong support for initiation and long-term implementation of interventions Great interest in continuing surveys to assess intervention effects Great interest in continuing surveys to assess intervention effects

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; 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: Fair but firm enforcement of existing laws that protect the community from alcohol-related harm: DUI enforcement DUI enforcement Party patrols to disperse dangerous crowds Party patrols to disperse dangerous crowds Enforce laws prohibiting alcohol sales or informal provision of alcohol to minors 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. Placing the burden of costs to those who repeatedly require community or police response – a response cost ordinance.

Summary Student survey, archival and key informant data provide an assessment of where and when alcohol-related problems are occurring 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 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 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