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A Protocol for Cross-Tailoring Integrative Alcohol and Risky Sexual Behavior Feedback for College Students

A Protocol for Cross-Tailoring Integrative Alcohol and Risky Sexual Behavior Feedback for College Students

A research team led by Dr. Anne Ray from the University of Kentucky, and including Dr. David Buller from Klein Buendel, has published (online ahead of print) the protocol for  an active research project in JMIR Research Protocols. The study is designed to curb drinking and risky sexual behavior by first-year college students using an innovative, cross-tailored, dynamic feedback (CDF) component. The intervention purposefully integrates content on the relationship between alcohol use and risky sexual behavior and leverages technology to incorporate daily assessments of student behavior and deliver weekly dynamic feedback.

Two-thirds of college students are current drinkers of alcoholic beverages. One in three college students report past month binge drinking (five or more drinks in a row), and one in ten report high intensity drinking (ten or more drinks in a row). Greater student alcohol consumption and heavy drinking on a given day are linked to increased sexual activity and risky sexual behavior, such as unprotected sex and sex with casual partners. This puts students at risk for negative health outcomes, such as sexually-transmitted infections, and other harmful consequences, such as sexual victimization.

A hybrid effectiveness-implementation design will allow the investigators to evaluate the effectiveness of the integrated personalized feedback intervention (PFI) with 600 first-year college students at two college sites in a randomized controlled trial. In addition, formative evaluation with local and national stakeholders (such as students and student affairs staff) will help to better understand factors that influence implementation and ensure its success and sustained use.

According the paper’s abstract: “This study utilizes a hybrid type 1 effectiveness-implementation design and will be conducted in three phases. Phase 1 is a stakeholder-engaged PFI+CDF adaptation guided by focus groups and usability testing. In Phase 2, 600 first-year college students who drink and are sexually active will be recruited from two sites (n=300 per site) to participate in a 4-group randomized controlled trial to examine the effectiveness of PFI+CDF in reducing alcohol-related RSB. Eligible participants will complete a baseline survey during the first week of the semester and follow-up surveys at 1, 2, 3, 6, and 13 months postbaseline. Phase 3 is a qualitative evaluation with stakeholders to better understand relevant implementation factors.” Intervention, recruitment, and implementation plans are described in JMIR Research Protocols.

This research is supported by a grant from the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health (AA028246; Dr. Anne Ray, Principal Investigator). Collaborators include Dr. David Buller (Co-Investigator) from Klein Buendel. Klein Buendel’s Creative Team is developing the technology-delivered program for college students.

WayToServe Plus

WayToServe Plus

Among effective interventions to reduce driving while intoxicated (DWI) by alcohol, Responsible Beverage Service (RBS) training of alcohol servers has shown promise. RBS training is currently required or incentivized by 36 states and California will require it starting in 2022.

Klein Buendel and its research collaborators from the University of New Mexico and the Pacific  Institute for Research and Evaluation (PIRE) have shown that an online RBS training, named WayToServe®, was effective in two randomized research trials. WayToServe is currently commercially available in multiple states in English and Spanish.

Now, researchers from Klein Buendel and PIRE are launching a new research project funded by the National Institute on Alcohol Abuse and Alcoholism (AA029364) to develop and test an in-service professional development component for alcohol servers trained by WayToServe to enhance its effectiveness. It is intended to motivate servers to implement the RBS skills in the face of common barriers, provide support for RBS actions from a “community” of alcohol servers, and prevent natural degradation of skills over time. The in-service component – WayToServe Plus – will be delivered through the WayToServe Facebook page that currently is followed by over 20,000 alcohol servers trained by WayToServe.

The Fast-Track SBIR project will complete a 12-month Phase I feasibility study and a 2-year Phase II effectiveness trial in New Mexico and Washington State. The primary outcome will be the effect of WayToServe Plus on refusal of sales to pseudo-intoxicated patrons. The research will be led by Dr. David Buller and Dr. Gill Woodall (Multiple Principal Investigators) from Klein Buendel, and Dr. Robert Saltz from PIRE.

This research is innovative as WayToServe Plus will be the first continuous in-service professional development for RBS training and will increase the WayToServe training’s effectiveness and commercial advantage with alcohol servers and corporate clients.

Collaborator Spotlight:
Dr. Anne Ray

Collaborator Spotlight:
Dr. Anne Ray

Anne Ray, Ph.D., is an Assistant Professor at the University of Kentucky College of Public Health in the Department of Health, Behavior & Society. She earned a B.S. in Psychology from Penn State University in 2004, an M.Ed. in Counselor Education from Penn State in 2010, and a Ph.D. in Biobehavioral Health from Penn State in 2011.

Dr. Ray’s areas of research interest include etiology and prevention of substance use in adolescence and emerging adulthood; self-regulated drinking behaviors and their associations with alcohol use and consequences; gender differences in alcohol use behaviors; mechanisms of change and moderators of program efficacy; and event-specific measurement of health behaviors.

Klein Buendel and Dr. Ray are currently collaborating on two intervention-based research projects. The first intervention is called Parenting Now. It aims to provide an efficient, engaging, and effective means to enhance parents’ ability to reduce prevalence of substance use and its consequences through a digital curriculum for parents of high-school-aged adolescents. Parenting Now is a brief, interactive, self-paced, and digital curriculum for parents of high-school-aged adolescents created from the evidence-based Parent Handbook, available in hard copy and DVD for college-bound youth only. The curriculum is needed because most parent-based prevention interventions target children or young adolescents, neglecting older adolescents, despite that fact that alcohol use increases in frequency and risk through mid-adolescence. This research project is led by Dr. Michael Hecht from Real Prevention and is funded by the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health (AA025293).

The second intervention is a new research project designed to curb drinking and risky sexual behavior by first-year college students. The new study will assess the impact of a brief, personalized intervention utilizing an innovative, cross-tailored, dynamic feedback component. The intervention will purposefully integrate content on the relationship between alcohol use and risky sexual behavior. It will leverage technology to incorporate daily assessments of student behavior and deliver weekly dynamic feedback to help reduce risky behavior. This research project is led by Dr. Ray and is funded by the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health (AA028246)

Curbing College Drinking and Risky Sexual Behavior Using Dynamic Feedback

Curbing College Drinking and Risky Sexual Behavior Using Dynamic Feedback

Two-thirds of college students are current drinkers of alcoholic beverages. One in three college students report past month binge drinking (five or more drinks in a row), and one in ten report high intensity drinking (ten or more drinks in a row). Greater student alcohol consumption and heavy drinking on a given day are linked to increased sexual activity and risky sexual behavior, such as unprotected sex and sex with casual partners. This puts students at risk for negative health outcomes, such as sexually-transmitted infections, and other harmful consequences, such as sexual victimization.

Klein Buendel is collaborating with Dr. Anne Ray at the University of Kentucky on a new research project designed to curb drinking and risky sexual behavior by first-year college students. The new study will assess the impact of a brief, personalized intervention utilizing an innovative, cross-tailored, dynamic feedback component. The intervention will purposefully integrate content on the relationship between alcohol use and risky sexual behavior. The intervention will leverage technology to incorporate daily assessments of student behavior and deliver weekly dynamic feedback. Participating students will be asked to complete four diary entries each week for three months.

A hybrid effectiveness-implementation design will allow the investigators to evaluate the effectiveness of the integrated personalized feedback intervention with 600 first-year college students at two college sites in a randomized controlled trial. In addition, formative evaluation with local and national stakeholders (students and student affairs staff) will help to better understand factors that influence implementation and ensure its success and sustained use.   

This research project is funded by the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health (AA028246; Dr. Anne Ray, Principal Investigator). Collaborators include Dr. David Buller from Klein Buendel. KB’s Creative Team will develop the web-based program for college students.

Preventing Alcohol and Drug Overuse Among Nightclub Patrons

Preventing Alcohol and Drug Overuse Among Nightclub Patrons

Nightclubs are high-risk settings for overuse of alcohol and other drugs. In a July publication in the Journal of Studies on Alcohol and Drugs, collaborators from the Pacific Institute for Research and Evaluation (PIRE), the University of California San Francisco, and Klein Buendel reported the outcomes of their intervention to protect nightclub patrons from substance abuse and harmful consequences.

Nightlife Safety Plans (NSP) is a group-based, tablet app-delivered intervention designed for groups of patrons arriving at nightclubs together. NSP encourages social groups to recognize early indicators of risk and take actions steps to de-escalate risky situations, such as physical and sexual aggression, through peer influence and other methods. The intervention was designed around a simple mnemonic – the three O’s: Outreach, Options, and Out:

  • Outreach: “provide outreach by approaching the friend and checking in, using nonconfrontational approaches”
  • Options: “provide options to a group member if a problem is identified”
  • Out: “know when the group should get out of the club to avoid further problems”

A total of 959 people from 352 social groups participated in the intervention at 41 different electronic music dance events at nightclubs in San Francisco, California. The measures (including breath samples for blood alcohol concentration and oral fluid samples for drug use), methods, analyses, results, discussion, and limitations are detailed in the publication.

In summary, intervening in the right place at the right time with peer influence strategies proved to be effective. The authors report that the NSP app appeared to increase protective actions to keep group members safe from overuse of alcohol and other drugs in these high-risk environments.

This research was 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). Authors of the publication include Dr. Hilary Byrnes, Dr. Brenda Miller, Dr. Mark Johnson, and Veronica Rogers from PIRE; Dr. Beth Bourdeau from the University of California San Francisco; and Dr. David Buller and Julia Berteletti from Klein Buendel. The NSP tablet app was developed by Klein Buendel’s Creative Team.

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
Parenting Now Launch

Parenting Now Launch

Klein Buendel, Inc. is collaborating with Dr. Michael Hecht and his team at REAL Prevention LLC on a new research project to develop and evaluate Parenting Now, a digitized adaptation of Dr. Robert Turrisi’s parent-based teen alcohol prevention program, the Parent Handbook. The Parent Handbook is one of only two family-based interventions recommended in FACING ADDICTION IN AMERICA: The Surgeon General’s Report on Alcohol, Drugs, and Health.

In this new study, the hard copy/pdf-formatted Parent Handbook, which targets parents of college-bound youth, is being adapted for parents of high school-aged children and being programmed for interactive technology-based delivery. “Parenting Now will give parents in the digital age access to content on the go and at convenient intervals through their multiple and mobile devices,” explained Dr. Michael Hecht, the Parenting Now Project’s Principal Investigator.

The Phase II SBIR research team is (1) developing core Parenting Now modules to address essential topics such as improving communication and parent permissiveness toward adolescent drinking, (2) customizing additional topics to parents’ specific interests, and (3) personalizing the program to parents’ communication styles. “Having both core modules and optional content will allow parents to customize or click through the curriculum, a feature of digital information that makes it more engaging,” said Dr. Hecht. “Parenting Now will personalize the skills to match the parent’s existing communication style, a key feature of engaging technology.”

The research project will conduct a rigorous randomized controlled trial using a nationally-representative sample through GfK Global and an active control condition. The study is evaluating Parenting Now’s effects on youth alcohol use and other substance use (marijuana use, nicotine use, and their combined use with alcohol). Researchers are examining the process of how Parenting Now influences parents’ behaviors and how these in turn influence students’ behaviors.

The Parenting Now Project is funded by the National Institute on Alcohol Abuse and Alcoholism (AA025293; Dr. Michael Hecht, REAL Prevention, Principal Investigator). Research collaborators include Dr. Anne Ray from Rutgers University and Dr. David Buller from Klein Buendel. Klein Buendel’s Creative Team is building the latest version of Parenting Now, expanding on the prototype they developed for the companion Phase I SBIR project.

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.

Prevention of Alcohol Use in Older Teens

Prevention of Alcohol Use in Older Teens

The growing incidence of alcohol use among teens is an important public health problem. In a recent publication in Psychology of Addictive Behaviors, Klein Buendel Senior Scientists, Dr. David Buller and Dr. Gill Woodall, joined multiple co-authors to report on the effects of a new alcohol use prevention program for older teenagers. The program is called Smart Choices 4 Teens. The paper reports the results from a randomized controlled trial assessing the impact of this online, interactive, family-based alcohol prevention program with over 400 families on preventing and reducing teen alcohol use.

Smart Choices 4 Teens was designed with three sequential components: general parent-teen communication, teen alcohol use, and teen romantic relationships. The creators adapted two evidence-based programs — Family Matter (1) and Parent Handbook (2) — to appeal to older teens and their parents. Communication skills training was incorporated through videos and interactive activities. The program was designed to have parents and teens go through the online activities separately and then complete a discussion activity together at the end of each component. The Alcohol Component is the focus of this publication.

Use of the program varied across families and components. Families that used more of the program reported better outcomes. Data related to dosage of the program and changes in drinking rates are reported in detail in the paper. Many positive effects were seen at 6-month and 12-month follow-ups with participating families. For example, teens in the experimental group reported fewer friends who had been drunk at six months, and parents in the experimental group reported more communication about social host laws. At 12 months, parents in the experimental group reported consuming fewer alcoholic beverages.

Overall, the findings suggest that Smart Choices 4 Teens was beneficial for families, especially when parents and teens completed more of the program. The authors believe that dissemination and implementation strategies that motivate completion of Smart Choice 4 Teens content, especially the Alcohol Component, can improve outcomes related to older teens’ alcohol use.

A full description of the methods, results, and conclusions of this study can be found in Psychology of Addictive Behaviors. This research was funded by a grant to the Prevention Research Center at the Pacific Institute for Research and Evaluation from the National Institute on Alcohol Abuse and Alcoholism (AA020977; Brenda Miller, Principal Investigator). Authors in addition to Dr. Miller, Dr. Buller, and Dr. Woodall include first author Dr. Hilary Byrnes, Dr. Joel Grube, Dr. Beth Bourdeau, and Dr. Meme Wang-Schweig from the Pacific Institute for Research and Evaluation. The Smart Choices 4 Teens program was produced by Klein Buendel’s Creative Team.

References

  1. Bauman, K. E., Foshee, V. A., Ennett, S. T., Hicks, K., & Pemberton, M. (2001). Family Matters: A family-directed program designed to prevent adolescent tobacco and alcohol use. Health Promotion Practice, 2, 81-96. http://dx.doi.org/10.1177/152483990100200112
  2. Turrisi, R., Jaccard, J., Taki, R., Dunnam, H., & Grimes, J. (2001). Examination of the short-term efficacy of a parent intervention to reduce college student drinking tendencies. Psychology of Addictive Behaviors, 15, 366–372. http://dx.doi.org/10.1037/0893-164X.15.4.366