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The Alcohol Prevention Compass

Kimberley Timpf, Senior Director of Partner Education

August 3, 2016

Considering the Full Spectrum of Evidence

Sites include the Higher Education Center, Social Norms

Institute, Promising Practices Sourcebook,

NIAAA, SAMHSA, Institute of Medicine

Data Collection from Credible Web Sources

•  Practitioners with demonstrated success

•  Notable researchers

•  More than 200 people interviewed at over 150

institutions and organizations

Discussions with Key Informants in the Field

+33 alcohol prevention strategies investigated

+6,000 journals and

magazines

+400 articles reviewed,

summarized and analyzed

Detailed Literature Review and Analysis

Success Is Measured Along Multiple Dimensions

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Changed Minds Changed Actions Changed Outcomes

Attitudes toward drunk driving Frequency of alcohol use ER visits

Knowledge of hard alcohol use risk Drinking to get drunk Blackouts

Awareness of campus policies Pregaming behavior Nausea, vomiting

Willingness to participate in alcohol-free options

Fake ID use DUI’s

Knowledge of genetic factors in alcohol use

Doing shots Alcohol violations

Understanding of BAC Typical BAC Recidivism

Ability to set limits on alcohol use Heavy episodic drinking occurrences Academic performance

Belief that drinking is the “cool thing to do”

Drinking the night before an exam Neighborhood complaints

External Determinants

of Behavior

Quantifying the Impact: Step 1

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Source: National Institute on Drug Abuse (2014)

Step 1: Core Outcomes

Behavior (Alcohol Use)

Negative Consequences

of Behavior

Personal Determinants

of Behavior

Behavioral Intentions

•  26% reduction in total consumption

•  37% decrease in heavy episodic drinking

1 point each, 3 points max

2 points each, 6 points max

1 point each, 3 points max

Quantifying the Impact: Steps 2-4

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Step 2: Effect Size

0 - <10% change = 0 pts

10 - <20% change = 1pt

20+ % change = 2 pts

Step 3: Sustained Effects

< 1 week = 0 pts 8 – 30 days = 1 pt 31 days – 6 months = 2 pts

6 months – 1 year = 3 pts 1 year + = 4 pts

Step 4: Methodology

Anecdotal Evidence = X1 Published Case Study = X2 Quasi-Experimental = X4

Randomized Control Trial = X6

Calculating Average Impact Score Across Articles

Total Impact Scores

# of articles = Final Impact Score

= TOTAL Impact Score per Article

Coding the Research: How it Works

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Step 1: Core Outcome

Step 2: Effect Size

Step 3: Sustained Effects

Step 4: Methodology

Behavior (Alcohol Use) •  26% reduction in total

consumption = •  37% decrease in heavy

episodic drinking =

+2 +2

+2

+2

< 6 months = +2 RCT = 6

Consequences of Alcohol Use •  30% reduction in personal

problems = •  28% reduction in academic

consequences =

+3 +3

+2

+2

Subtotal = 10 8 2

TOTAL = 120

+ + x

Kypri et al. (2004)

Social Norms Marketing is Put to the Test

Determining the Cost of Each Strategy

Sample Strategy Cost Analysis: Social Marketing

Public Sources of Information Anecdotal Data from Campuses

Social Marketing Strategies (HEC) Institution Prorated Cost

Evaluation (Core Survey)

Advertisements: $239 University of Florida $83,235

Newspaper Ads $4,200 University of Virginia $6,569

Flyers & posters $5,210 Purdue University $4,630

Graphic designer $1,375 McCartney University $32,000

TOTAL $11,024

Cost Considerations

Activities Employees Materials/Media Total Cost: Institution Size

Average Cost of Social Marketing Across Sources: $27,491

Cost estimates prorated for institution of 10,000 undergraduates

Caveats, Assumptions and Interpretive Guidance

1 Optimal Implementation 2 Context Matters 3 No Silver Bullets 4 Values Not Static

Cases and studies were discounted where

•  They lacked fidelity

•  Lack of efficacy was attributed to mediating factors

•  Clearly some approaches work best on certain kinds of campuses

•  Literature and cases provide and “average” impact across campuses

•  Individual approaches not as effective as complementary ones

•  The goals was more clarity around approaches, not necessarily their combined synergy

•  The literature and field continues to evolve

•  Partner input is encouraged

STRATEGY Score $ Reach

Breathalyzer Feedback -13.3 $500 10%

Invited Speakers 0.0 $3,000 5%

BAC Cards 3.0 $1,000 10%

Fatal Vision Goggles 3.3 $700 8%

Medical Amnesty 8.0 $7,000 70%

Curriculum Infusion 8.3 $4,500 5%

TIPS for the University 11.0 $33,950 30%

RA Training 11.1 $1,348 49%

21st Birthday Cards 11.1 $5,045 22%

Fake ID Policies 12.0 $0 30%

Parent-Based Interventions 12.8 $2,000 25%

Parental Notification 13.3 $2,000 37%

RBS Training 13.5 $1,225 45%

Safe Rides 14.0 $89,899 21%

Peer Engagement 14.5 $9,473 25%

Substance-Free Housing 15.8 $0 2%

Friday Classes 16.0 $0 60%

STRATEGY Score $ Reach

Limiting Drink Specials 16.5 $0 15%

Social Marketing 17.3 $12,927 60%

Prime For Life 18.5 $3,915 6%

Small Group Social Norms 19.5 $2,340 30%

Policies 21.2 $8,520 40%

Alcohol-Free Options 22.0 $27,570 9%

Bystander Intervention 22.0 $19,746 12%

Social Norms Marketing 27.8 $14,400 60%

Alcohol Price and Taxation 29.6 $0 45%

Alcohol Skills Training Program 35.0 $9,090 6%

Comprehensive Environmental Efforts 36.9 $29,000 50%

Parent-Based Intervention + BASICS 48.0 $17,334 19%

BASICS 51.1 $19,535 3%

Online Education 52.6 $8,690 16%

SBI in Healthcare Setting 56.7 $14,771 35%

Group Motivational Enhancement 72.7 $11,872 28%

The Raw Data of the Analysis

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Do No Harm

A Visual Depiction of the Findings

1. Invited Speakers

2. Safe Rides

3. Breathalyzer Feedback

4. Prime for Life

5. Fake ID Policies

6. Substance-Free Housing

7. Curriculum Infusion

8. BASICS

9. Limiting Drink Specials

10. Parental Notification

11. Comprehensive Environmental Efforts

12. RA Training

13. Parent-Based Intervention + BASICS

14. Bystander Intervention

15. Small Group Social Norms

16. BAC Cards

17. Group Motivational Enhancement

18. TIPS for the University

19. Alcohol Skills Training Program

20. 21st Birthday Cards

21. Online Education

22. Parent-Based Intervention

23. RBS Training

24. Friday Classes

25. Medical Amnesty

26. Social Marketing

27. Peer Engagement

28. Social Norms Marketing

29. SBI in Healthcare Setting

30. Alcohol-Free Options

31. Alcohol Price and Taxation

32. Fatal Vision Goggles

33. Policies

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Do No Harm

Justify and

Evaluate Consider and Execute with Care

Interpreting Placement

Make a case

The Prevention “Sweet Spot”

10 80 20 30 40 50 60 70 0

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Do No Harm

Justify and

Evaluate Consider and Execute with Care

Interpreting Placement

Make a case

The Prevention “Sweet Spot”

Two Tools to Inform Effective Prevention

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EverFi Compass College AIM

33 strategies 60 interventions

Universal, Selective, Indicated Individual and Environmental

Impact Score/Average Cost Effectiveness Rating/Cost Range

Points assigned according to behavioral impact, effect size, effect length, and type of study.

Rating codes assigned based on literature reviews and direct knowledge of strategies

Examining the Intersections

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21st BIRTHDAY CARDS Impact Score: 11

AIM: Lower Effectiveness

SBI IN A HEALTHCARE SETTING

Impact Score: 29 AIM: Higher Effectiveness

Examining the Intersections: Some Direct Comparisons

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Score/Rating $ # Articles

Breathalyzer Feedback -13.3 $500 3 (1)

Skills training, alcohol focus: Blood alcohol concentration (BAC) feedback alone Too few studies Mid-range costs 2

Medical Amnesty 8.0 $7,000 1 (1)

Establish amnesty policies Too few studies Lower costs 1

21st Birthday Cards 11.1 $5,045 8 (1) Normative Re-education: Electronic/mailed personalized normative feedback (PNF)—Event-specific prevention (21st birthday cards)

Lower Effectiveness

Lower Cost 2

Limiting Drink Specials 16.5 $0 6

Restrict happy hour/price promotions Higher

effectiveness Lower costs 10

Alcohol-Free Options 22 $27, 570 17 (1)

Required alcohol-free programming Too few studies/

mixed results Higher Cost 3

Social Norms Marketing 27.8 $14,400 22

Conduct campus-wide social norms campaign Lower

effectiveness Mid-range costs 16

BASICS 51.1 $19,535 16 (2)

Brief motivational intervention (BMI) In-person – Individual (e.g., BASICS) Higher

effectiveness Mid-range cost 20+

Classification

Cost # Articles

Lower Effectiveness

Lower Cost 2

BAC’s higher in one study; students reported they would drink more in 2 of the three studies.

Can resources be redirected to more effective strategies?

Can staff and funding resources be redirected to more effective strategies?

Assess for effectiveness on an individual campus.

Have a clear understanding of whether or not such a policy is needed.

(#)= articles in common

Examining the Intersections: Requires a Closer Look

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Score/Rating $ # Articles

Comprehensive Environmental Efforts 36.9 $29,000 12

e.g., Prohibit alcohol use/sales at campus sporting events Moderate effectiveness Mid-range

costs 6

Online Education 52.6 $8,690 38 (10)

Multi-component education-focused program: AlcoholEdu for College Higher effectiveness Higher costs 5

Personalized feedback intervention, eCHECKUP TO GO (formerly eCHUG) Higher Effectiveness Lower costs 11

Alcohol 101 Plus Too few studies Lower costs 3

Screening and Brief Intervention in Healthcare Setting 56.7 $14,771 7

Brief motivational intervention (BMI) In-person – Individual (e.g., BASICS) Higher effectiveness Mid-range

cost 20+

Individual-level strategies delivered by health professionals – not rated by CollegeAIM NS NS NS

Curriculum Infusion 8.3 $4,500 7

Unable to identify equivalent or similar NA NA NA

Peer Engagement (peers administering MI’s, lifestyle management courses, etc.) 14.5 $9,473 11 (2)

Brief motivational intervention (BMI) In-person – Individual (e.g., BASICS) Higher effectiveness Mid-range

cost 20+

Classification

Cost # Articles

Lower Effectiveness

Lower Cost 2

Understand the differences between the two and also ask: Who is your intended audience? What is your goal? Where can you reduce costs?

Discrepancy likely due to what outcomes are prioritized for each scoring process.

Compass includes all online programs in one category; Matrix specifies. Cost varies based on level of service and support provided, e.g., data and analytics, training, customer support, etc.

Compass category includes studies of multiple policy and enforcement strategies used together (e.g., AMOD); Matrix includes specific strategies under the Environmental category.

(#)= articles in common

Universal Recommendations Apply to Both Tools

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4

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Be intentional with efforts and gather data on whether they succeed Programming with a Purpose

Don’t try to do it all – a few targeted interventions can be very effective The “Comprehensive” Trap

Stay attuned to new research to inform your efforts An Emerging Picture

Implement programs strategically to mitigate costs Knowing How to Spend

Test your messages and strategies against the research base, behavior theory, and your instincts Beyond the Research

6 Prevention efforts must complement each other The Value of Synergy

7 The best strategy is grounded in data Data-driven Success

8 Make decisions based up on your culture, allies, and resources Campus Fit