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Lessons Learned: Accessing Sites for Correctional Research

Lessons Learned: Accessing Sites for Correctional Research

Dr. Erin Kitt-Lewis from The Pennsylvania State University College of Nursing presented insights into accessing correctional facilities for research at the 32nd Annual Scientific Sessions virtual conference of the Eastern Nursing Research Society on March 26-27, 2020. Klein Buendel Senior Scientist, Dr. Valerie Myers, was a co-author on the presentation.

Despite the imperative to engage in research in corrections, researchers face many challenges due to the restrictive nature of this setting. Dr. Kitt-Lewis shared many of the lessons learned by this collaborative research team as they worked to secure diverse prison and jail settings to research, develop, and test the Enhancing Care for the Aged and Dying in Prison program.

Lessons learned included the discovery of contextually-specific constraints such as the closing or consolidating of services or facilities, managing staffing constraints, relocating staff, ascertaining and adhering to policies and administrative directives, and working within the guidelines of the review board of the correctional system.

Establishing and maintaining relationships with key stakeholders in corrections were also important aspects of this research. In her presentation, Dr. Kitt-Lewis discussed developing networking opportunities such as connecting via social media like LinkedIn, attending corrections conferences, and discussing potential research opportunities to help build relationships with key stakeholders and decision-makers. Additional perceptions from the field included identifying potential barriers or constraints to accessing correctional sites, and sustaining relationships post-research via ongoing communication such as sharing periodic updates, final reports, and publications with partners.

The correctional system has often been called a “closed” system due to the difficulty faced by researchers in attempting to access and conduct research. However, establishing well-defined strategies to conduct research in the system appears to create efficiency and promote much needed health-related research in the correction setting. Research outcomes that are contextually-specific can support and foster equitable care for people who are incarcerated.

This research was funded by a Small Business Technology Transfer grant to Klein Buendel from the National Institute on Aging at the National Institutes of Health (AG049570; Dr. Susan Loeb and Dr. Valerie Myers, Multiple Principal Investigators). Collaborators on the work presented, in addition to Dr. Erin Kitt-Lewis, include Dr. Susan Loeb and Kaléi Kowalchik from The Pennsylvania State University College of Nursing; Dr. Rachel Wion from Indiana University School of Nursing; Julie Murphy from King College Nursing Program; and Dr. Valerie Myers and Tiffany Jerrod from Klein Buendel.

Implementing E-Training for Geriatric and End-of-Life Care in Corrections

Implementing E-Training for Geriatric and End-of-Life Care in Corrections

Dr. Susan Loeb from The Pennsylvania State University College of Nursing is presenting on the creation of a computer-based learning (CBL) program for corrections staff at the 32nd Annual Scientific Sessions virtual conference of the Eastern Nursing Research Society on March 26-27, 2020. Klein Buendel Senior Scientist, Dr. Valerie Myers, is a co-author on the presentation.

Experts in corrections have identified the care of older individuals who are incarcerated as a high priority area for research and policy. Therefore, there is a need to provide evidence-based training tailored to frontline corrections personnel who are charged with the care and oversight of aged and dying incarcerated individuals. In response, the research team developed, implemented, and tested a CBL program that aligned with contextual environment constraints and the infrastructure-specific needs of corrections.

The virtual presentation will describe how the adoption mechanisms and support systems were integrated from set up to full-scale usability testing of the CBL program, Enhancing Care for the Aged and Dying in Prison (ECAD-P) for corrections staff. Specifically, factors that affect adoption and support systems were identified, examined and implemented at each phase of the development and implementation process of ECAD-P. In the Set-Up phase, the format of a paper-pencil toolkit was not sustainable for long-term, broad dissemination of the program, so support systems were evaluated to determine the capabilities of CBL. Throughout the development, Expert and Community Advisory Boards critically examined the content and programming measures of the product to ensure the product complied with usual practices and institutional constraints.

During testing, small scale usability-testing was conducted to determine human capacity, infrastructure capabilities, reporting systems, and program design and function. In going to full-scale, large-scale usability testing provided valuable insights on implementation considerations, such as leadership, communication, policy, and culture of institution. Consideration of adoption mechanisms and support systems ultimately allowed for researchers to refine ECAD-P for future, effective, large-scale dissemination.

This research was funded by a Small Business Technology Transfer grant to Klein Buendel from the National Institute on Aging at the National Institutes of Health (AG049570; Dr. Susan Loeb and Dr. Valerie Myers, Multiple Principal Investigators). Collaborators on the work presented include Dr. Erin Kitt-Lewis and Kaléi Kowalchik from The Pennsylvania State University College of Nursing; Dr. Rachel Wion from Indiana University School of Nursing; Julie Murphy from King College Nursing Program; and Dr. Valerie Myers and Tiffany Jerrod from Klein Buendel.

A Tablet-delivered Intervention to Reduce Risky Behavior in Adolescents

A Tablet-delivered Intervention to Reduce Risky Behavior in Adolescents

Klein Buendel collaborator, Dr. Christopher Houck from Rhode Island Hospital, will present findings from Project TRAC at the Society of Research on Adolescence Biennial Meeting in San Diego, California, March 19-21, 2020. His presentation will also include a demonstration of the targeted games used in the intervention.

The team initially developed and validated an Emotion Regulation (ER) intervention for reducing risk behaviors among early adolescents. Project TRAC showed that adolescents who learned about sexual health information with ER content were significantly less likely to transition to sexual activity. Despite the promise of targeting ER during early adolescence to prevent risk behaviors, discussions with community partners suggest that the original facilitator-led small-group format is difficult to sustain. Disseminating this prevention approach required a format that was less reliant on specialized training that could be easily implemented to an individual format. Therefore, through advisory panels of early adolescents and consultation from a group of experts in the field, Project TRAC was translated from a small-group format to a tablet-delivered, game-based program.

Acceptability testing took place with ten adolescents followed by 85 adolescents who participated in a small randomized pilot trial to assess the feasibility of the digital intervention as well as preliminary assessment of short-term changes in ER. Those randomized to the intervention condition completed four computerized modules that taught emotion concepts through games and instructional videos. Control participants were waitlisted to complete the intervention at the end of the study and all adolescents completed surveys at baseline and one month later.

Participants positively rated the intervention with a majority completing all four modules. Intervention participants self-reported significant improvements, including emotional awareness, perceived access to ER strategies, use of the strategies taught in the intervention, intentions to use these strategies, emotional knowledge, and perceptions that emotions are changeable. They also reported a moderate effect of poorer perceptions of abilities to manage positive emotions.

Results suggest that a tablet-based intervention providing ER training was able to affect adolescents’ use of ER behaviors, understanding of emotions, and perceptions of emotional competence. Linking ER training to specific areas of risk (sexual health, substance use, or violence prevention) in the developmental window when risk behaviors are beginning, such as early adolescence, may prevent risk behaviors for many young people. Dissemination of evidence-based interventions through tablet formats may also improve the reach of effective interventions.

This research is funded by a grant from the National Institute of Child Health and Human Development (HD089979; Dr. Christopher Houck, Principal Investigator). Other collaborators include Wendy Hadley from the University of Oregon; Crosby Modrowski and Kelsey Bala from Brown University; Brittany Wickham from Villanova University; and Dr. Valerie Myers and Tiffany Jerrod from Klein Buendel.

An Implementation Model for the Cost-effective Scale-up of the Sun Safe Workplaces Program

An Implementation Model for the Cost-effective Scale-up of the Sun Safe Workplaces Program

Dr. David Buller and Dr. Barbara Walkosz from Klein Buendel presented a poster on a new implementation model for the cost-effective scale-up of an occupational sun protection program at the 12th Annual Conference on the Science of Dissemination and Implementation in Health in Washington, DC, December 4-6, 2019. The poster was nominated for Best Poster from the Prevention and Public Health Division.

Scale-up is the effort to increase the impact of successful programs to benefit more people on a lasting basis. Scale-up efforts must increase reach, retain effectiveness, and lower costs to provide greater access to benefits and close the research-to-practice gap between effective programs and real-world application. This project is studying the nationwide scale-up of an occupational sun safety intervention, Sun Safe Workplaces, with state Departments of Transportation (DOTs), a public works sector with thousands of outdoor workers.

Costs of national distribution can be daunting and influence intervention intensity and program effectiveness. Identifying cost-effective scale-up strategies is essential for moving research into practice. The new framework draws upon existing implementation models, including those developed for occupational health and safety, and operationalizes implementation for scale-up within RE-AIM. The RE-AIM framework was adapted for this new framework by incorporating cost as a primary factor.

In a randomized trial, Sun Safe Workplaces (SSW) is assessing implementation rate and costs associated with two methods of scaling-up SSW. The original intervention depended on personal visits with managers, materials promoting sun protection policies and education, in-person sun safety training for employee groups, and on-going follow-up communication with managers supporting sun safety (SSW-IP), a resource-intensive form of intervention. Now SSW-IP is being contrasted to a scale-up strategy that uses web-based and telephone conferencing, responsive training platforms, and electronic resources for virtual contacts and training (SSW-T). Technology-based programs have the potential to deliver standardized, engaging content and increase portability while decreasing cost of delivery to enable reaching more employers when scaled-up to nationwide distribution. Districts within DOTs are randomized to one of the two scale-up methods. The SSW-IP and SSW-T interventions are being delivered in 21 state DOTs with 141 districts.

This research is funded by a grant from the National Cancer Institute (CA134705; Dr. David Buller and Dr. Barbara Walkosz, Multiple Principal Investigators). Additional poster coauthors include Dr. Richard Meenan from the Kaiser Permanente Center for Health Research; and Mary Buller, Rachel Eye, Andrew Grayson, and Savanna Olivas from Klein Buendel.

Parents’ Reports of School Communication on Sun Safety

Parents’ Reports of School Communication on Sun Safety

The U.S. Surgeon General and the Centers for Disease Control and Prevention have called on the nation’s schools to help prevent skin cancer by implementing sun safety practices and policies. The Sun Safe Schools program was designed by Klein Buendel researchers and collaborators in response to those calls to action. The program was implemented and evaluated with 118 public elementary schools in California.

Dr. David Buller, Klein Buendel Director of Research, presented data on the impact of the Sun Safe Schools intervention on parents’ reports of sun safety communication from schools and children’s sun protection behavior at the 12th Annual Conference on the Science of Dissemination and Implementation in Health in Washington, DC, December 4-6, 2019.

Schools randomized to the Sun Safe Schools intervention group (N=58) received support for implementing school sun safety practices by trained coaches over 20 months. Based on Diffusion of Innovations Theory, support and resources for implementation were tailored to school principals’ readiness to implement. Parents completed an online posttest survey through invitations sent by principals or while attending parent-oriented school events. Parents were surveyed to test the hypothesis that parents would report more communication about sun safety at schools receiving the intervention than at control schools.

The Sun Safe Schools program appeared to increase communication on sun safety and the use of student sun protection. Parents in intervention schools were more likely to report receiving information about sun safety from the school and that their children wore sun-protective clothing than in control schools. The improvement in sun safety appeared to result from policy implementation. In schools where principals reported implementing sun safety practices at posttest, parents reported that children spent less time outdoors and had fewer sunburns than at non-implementing schools. Further, parents who received information about sun safety from the school reported more sun protection for their child than parents not receiving the information.

In summary, a school district-level policy, combined with active technical support for schools within the district, appears to be effective at increasing implementation of school sun safety practices to help protect children from solar ultraviolet radiation, the primary risk factor for the development of skin cancer.

The Sun Safe Schools program is a joint research effort of Claremont Graduate University (CGU), the Kaiser Permanente Center for Health Research, and Klein Buendel. The research was funded by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health (HD074416; Dr. Kim Reynolds, CGU, and Dr. David Buller, Multiple Principal Investigators). Other collaborators included Dr. Richard Meenan from the Kaiser Permanente Center for Health Research in Portland, Oregon; Dr. Jeff Ashley from Sun Safety for Kids in Los Angeles, California; Kim Massie previously from Chapman University; and Julia Berteletti and Mary Buller from Klein Buendel.

Responsible Marijuana Vendor Training

Responsible Marijuana Vendor Training

Dr. David Buller, Klein Buendel Senior Scientist and Director of Research, presented recent work by his research team at the Tenth European Society for Prevention Research (EUSPR) Conference and Members’ Meeting in Ghent, Belgium in September. His presentation, “Effects of an Online Responsible Vendor Training for Recreational Cannabis Stores on Sales to Pseudo-intoxicated Customers: Need for Increased Deterrence,” was coauthored by Dr. Gill Woodall, Mr. Andrew Grayson, Ms. Sierra Svendsen, and Ms. Mary Buller from Klein Buendel; and Dr. Robert Saltz from the Pacific Institute for Research and Evaluation.

The advent of recreational cannabis in Canada, Uruguay, and several U.S. states raises the risk of polysubstance-impaired driving. In alcohol markets, training in responsible sales practices is an intervention to reduce sales to intoxicated patrons and thus prevent impaired driving and other harms. Similar training may benefit communities with recreational cannabis sales.

An online responsible marijuana vendor (RMV) training, Train To Tend, was developed with input from state regulators and store personnel. Among its five modules, learning elements taught store personnel to recognize signs of alcohol impairment and intoxication, refuse sales, and understand the risks of driving under the influence of cannabis. A sample of 150 recreational cannabis stores in Colorado, Oregon, and Washington State, USA were enrolled in a randomized controlled trial, half of which were randomly assigned to use the RMV training. Stores were posttested using a pseudo-intoxicated patron (PiP) protocol in which confederate buyers feigned obvious signs of intoxication.

Sales of cannabis to PiPs were refused at only 16 of 144 stores across the three states. There was no difference in refusal rates between intervention and control stores or between stores that used the RMV training or not. In 11 visits, store personnel commented on the buyers’ behavior or expressed concern/suspicion about buyers but sold to them anyway.

Training in responsible sales practices alone did not appear to reduce sales to intoxicated customers. Legal deterrence from making these sales may be insufficient or nonexistent for store management to support adherence to this responsible sales practice. Regulatory actions (such as swift, severe, and certain penalties) may be needed to increase perceived risk with such sales  to achieve training’s benefits.

This research was sponsored by a grant from the National Institute on Drug Abuse at the National Institutes of Health (DA038933; Dr. David Buller, Principal Investigator). Train To Tend was programmed by the Creative Team at Klein Buendel.

Dr. David Buller presenting the RMV training program
Smart Choices 4 Teens

Smart Choices 4 Teens

Three Klein Buendel researchers were part of a team that gave two presentations at the Tenth European Society for Prevention Research (EUSPR) Conference and Members’ Meeting in Ghent, Belgium in September. Dr. David Buller, Dr. W. Gill Woodall, and Ms. Julia Berteletti were part of the Smart Choices 4 Teens research team led by Dr. Brenda Miller from the Prevention Research Center at the Pacific Institute for Research and Evaluation (PIRE).

Smart Choices 4 Teens is an online, interactive, family-based program for parents and older teens designed to reduce teen alcohol use and risky sexual behaviors. The program features three sequential components (parent-teen communication, teen alcohol prevention, and teen romantic relationships) that parents and teens complete separately before working together through a discussion activity at the end of each component. A randomized controlled trial with 411 families found significantly better outcomes for teens in the experimental condition as compared to controls in terms of decreased alcohol use and decreased sexual risk behaviors.

Oral Presentation

Dr. Brenda Miller’s presentation focused on the design of the Smart Choices 4 Teens alcohol prevention component. This module targeted eleven topics: (1) the decision to drink or not drink, (2) social host laws, (3) physical effects of alcohol, (4) signs of alcohol poisoning, (5) social consequences of alcohol, (6) an interactive Blood Alcohol Calculator, (7) myths about alcohol, (8) creating a safety plan for parties, (9) parental influences, (10) refusal skills, and (11) defining a drinking problem. The module incorporated four different activity formats — video narratives, info-gadgets, interactive activities, and structured discussions. Parents and teens engaged in the same materials but did so separately, coming together to choose and discuss hypothetical scenarios that guided the discussion offline. A “nudge” feature was embedded to allow teens to prompt their parent to finish a module and move to the end-of-module offline discussion or vice versa. The nudge feature was used 561 times by 218 users.

Dr. Miller reported that 86% of experimental families began the intervention and 50% of families completed the teen alcohol prevention component. The average time needed to complete the alcohol component was 16 minutes. Parents and teens reported learning new lessons and becoming more comfortable discussing alcohol use together. Barriers to completion included limited understanding of some content and needing additional instructions.

Poster Presentation

Dr. David Buller presented a poster, with analysis led by Dr. W. Gill Woodall, on the effect of teen engagement with Smart Choices 4 Teens. Teens and parents (411 dyads) completed an online baseline survey prior to being assigned to either the intervention or control conditions. Follow-up online surveys were completed 6, 12, and 18 months later. The teen sample was 55% female and 72% non-Hispanic White. The parent sample was comprised predominately of mothers (84.7%).

The Smart Choices 4 Teens website tracked duration of time spent using each of the web-based components. In an analysis of teens who completed the program in the intervention group (n=142), linear regressions tested duration of teens’ time in each online component in the entire program as predictors of teens’ past 30-day alcohol use at the 6-month follow-up. More time spent by teens using interactive activities negatively predicted later alcohol use, as did teens’ time spent viewing videos. Also, teens’ time spent using info-gadget activities had a negative relationship with alcohol use.

The researchers report that activities with interactivity, animations, and video content may produce stronger preventive effects on alcohol use because teens prefer this format over written text in the info-gadgets, have more involvement with them, and/or find characters relatable. These reactions may stimulate deep processing of prevention content.

The Smart Choices 4 Teens research was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (AA020977; Dr. Brenda Miller, PIRE, Principal Investigator). Other authors on Dr. Miller’s research team included Dr. Hilary Byrnes, Ms. Veronica Rogers, and Dr. Joel Grube from PIRE; Dr. Beth Bourdeau from the University of California San Francisco; and Dr. David Buller, Dr. W. Gill Woodall, and Ms. Julia Berteletti from Klein Buendel. Smart Choices 4 Teens was programmed by the Creative Team at Klein Buendel.

Dr. Brenda Miller viewing Smart Choices 4 Teens
Alcohol Sale Refusals to Pseudo-Intoxicated Patrons In Primarily Spanish-Speaking Premises

Alcohol Sale Refusals to Pseudo-Intoxicated Patrons In Primarily Spanish-Speaking Premises

Klein Buendel Senior Scientist Dr. W. Gill Woodall presented data on alcohol over-service from the WayToServe-Español project on a panel discussion at the 42nd Annual Scientific Meeting of the Research Society on Alcoholism held in Minneapolis, Minnesota on June 22-26, 2019.

The over-service of alcohol to individuals who show signs of intoxication is problematic for public health because it contributes to drunk driving and alcohol-related injury and death. In addition, little is known about alcohol over-service in premises where business is conducted primarily in Spanish because these alcohol service situations have been understudied.

Dr. Woodall presented data from a baseline assessment of a randomized trial that investigated Responsible Beverage Service (RBS) training in predominately Spanish-speaking premises in Texas and New Mexico. The research provides a unique opportunity to contrast two states and communities with similar populations, but different alcohol policies and practices.

Hispanic confederates were trained to enact evidence-based signs of intoxication while attempting to purchase an alcoholic beverage in Spanish. Over-service was measured using a pseudo-intoxicated patron protocol. Baseline refusal rates were 12% in Texas and 34% in New Mexico. On the panel, Dr. Woodall discussed the implications of these baseline data for RBS training in minority communities and alcohol policy.

This research is funded by the National Institute of Minority Health and Health Disparities at the National Institutes of Health (MD010405; Dr. W. Gill Woodall, Klein Buendel, Principal Investigator). Collaborating co-authors on the presentation included Dr. Robert Saltz from the Pacific Institute for Research and Evaluation, Dr. David Buller from Klein Buendel, Dr. Victoria Sanchez and Dr. Randall Starling from the University of New Mexico, and Dr. Areli Chacon Silva and Dr. Frank Perez from the University of Texas at El Paso.

Refusal of Pseudo-intoxicated Customers at Retail Marijuana Stores

Refusal of Pseudo-intoxicated Customers at Retail Marijuana Stores

Klein Buendel Senior Scientist, Dr. David Buller presented a poster at the Society for Prevention Research Annual Meeting in San Francisco, California in May. The poster presented insights on whether personnel in recreational marijuana stores refuse sales to buyers who appear to be intoxicated.

Recreational marijuana is sold by state-licensed stores in seven U.S. states. Like alcohol, sales are prohibited to persons younger than age 21 and sometimes to persons who are apparently intoxicated. A sample of 150 licensed retail stores in Colorado, Oregon, and Washington were selected from state regulatory agency lists. A majority of stores sold both recreational and medical marijuana. The sample was stratified between the largest metropolitan area in each state (Denver, Portland, and Seattle) and nearby regions with smaller cities.

Pseudo-patron assessment teams comprised of a ‘buyer’ and an ‘observer’, visited each store once from August to October 2018. Buyers attempted to enter the premises while feigning obvious signs of intoxication (for example: slurred speech, stumbling, dropped change or ID) and attempted to purchase a low-cost cannabis product. Observers recorded whether buyers gained entry and if the clerk offered to sell marijuana (no actual purchases were made).

Refusal rates were rare. Overall, refusal rates were slightly higher in the states of Colorado and Oregon than in Washington. A state law that explicitly prohibited sales in Oregon may have slightly decreased sales there, while refusals in Colorado may be attributed to the wide-scale use of security guards checking IDs at entrances. These high rates of sales to apparently intoxicated customers are a cause for concern, especially in light of research indicating that the combination of alcohol and marijuana intoxication appears to severely impair driver performance.

This research project is funded by a grant from the National Institute on Drug Abuse at the National Institutes of Health (DA038933; Dr. David Buller, Principal Investigator). Additional collaborators include Dr. Robert Saltz from the Pacific Institute for Research and Evaluation in Oakland, California; and Dr. Gill Woodall and Andrew Grayson from Klein Buendel.

Nightlife Risk from Alcohol and Drug Use

Nightlife Risk from Alcohol and Drug Use

Two Klein Buendel researchers are part of a team that presented two posters at the Society for Prevention Research Annual Meeting in San Francisco in May. Dr. David Buller and Julia Berteletti are part of the Nightlife Safety Plans research team led by Dr. Brenda Miller from the Prevention Research Center at the Pacific Institute for Research and Evaluation (PIRE).

Nightclubs are high-risk settings for overuse of alcohol and other drugs and physical and sexual aggression among young adults. Nightlife Safety Plans (NSP) is a group-based, tablet app-delivered intervention designed for patrons arriving together. NSP addresses these unwanted outcomes and encourages social groups to recognize early indicators of risk. Actions steps are provided via tablet app to de-escalate the situation. 

Nightclub Group Gender Composition

The first poster examined the influence of social group gender composition on alcohol outcomes and on the effectiveness of the NSP intervention across different group compositions (all-female, all-male, mixed gender). The sample included 959 nightclub patrons who formed 359 groups recruited from seven clubs, across 41 different events. Less than half of the participants were female and the average age was 26. All data was collected anonymously.

Outcome variables included overall number of the group’s safety actions taken to keep group members safe, the highest number of safety actions by any single group member, and breath alcohol concentration (BAC) at exit.  Mixed model regressions examined the main effect of group composition and its interaction with the intervention as a predictor of outcomes after controlling for individual and group characteristics. Those in the intervention condition reported higher numbers of safety actions by any single member in all female groups and mixed gender groups, but not in all-male groups. There were no significant interactions for intervention status by group composition for either BAC at exit or the number of group actions taken as assessed by the overall group.  This poster was first-authored and presented by Dr. Brenda Miller from PIRE.

Drinking Group Cohesion

The second poster examined the hypothesis that club patrons who perceive greater cohesion in their group implement fewer protective strategies and use higher levels of alcohol and other drugs. Could being part of a more cohesive peer drinking group lead to a false sense of security and letting down one’s guard, which could lead to more risk taking? The sample included 815 nightclub patrons in the San Francisco area, arriving in 324 distinct groups, from seven clubs hosting electronic music dance events across 30 different evenings. Less than half of the participants were female and the average age was 27. Club patrons were surveyed anonymously and completed breath tests as they entered and exited clubs. Oral fluid samples at exit assessed drug use.

Patrons reported perceived cohesion with their group members (for example, people in the group are willing to help each other), as well as use of actions to keep oneself safe, actions to keep group members safe, and actions in response to group alcohol and other drug problems. Mixed model regressions examined group cohesion as a predictor after controlling for individual and group characteristics, and past 30-day drinking/drug use at clubs. Findings partially confirm the hypothesis. Patrons who perceived greater group cohesion engaged in fewer preventive strategies to keep themselves and their group safe during the night and those who perceived greater group cohesion implemented fewer actions in response to group AOD problems. This poster was first-authored and presented by Dr. Hilary Byrnes from PIRE.

The NSP research is funded by a grant to the Prevention Research Center at PIRE from the National Institute on Alcohol Abuse and Alcoholism (AA022331; Dr. Brenda Miller, Principal Investigator). Research team collaborators/authors include Dr. Brenda Miller, Dr. Hilary Byrnes, Dr. Joel Grube, and Dr. Beth Bourdeau, Dr. Mark Johnson, and Veronica Rogers from PIRE; and Dr. David Buller and Julia Berteletti from Klein Buendel. The NSP tablet app was developed by Klein Buendel’s Creative Team.