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Title: Suzanne Zeman, M.S., R.N.


1
The Comparative Effectiveness of Group and
Individual Brief Alcohol Screening and
Intervention for College Students (BASICS)
  • Suzanne Zeman, M.S., R.N.
  • The Pennsylvania State University
  • University Health Services
  • John Hustad, Ph.D.
  • Penn State University - College of Medicine
  • Milton S. Hershey Medical Center
  • Linda LaSalle, Ph.D.
  • Rachel Urwin, Ph.D.
  • The Pennsylvania State University
  • University Health Services

2
Outline
  • Brief background on alcohol use by college
    students nationally and at Penn State
  • Summarize empirically supported techniques for
    college students
  • Discuss the BASICS program at Penn State
  • Outcome data
  • Summarize our findings
  • Future directions

3
Objectives
  • Describe the components of group and individual
    BASICS
  • Identify key behavior outcomes that are relevant
    to assessing the efficacy of group and individual
    BASICS
  • Discuss the differences in effectiveness between
    group and individual delivery mode of BASICS
  • Discuss the implications for college health
    professionals and campus administrators

4
Background
  • Alcohol use is the greatest single contributor to
    college student morbidity and mortality (e.g.,
    Hingson et al., 2009).
  • Individual (one-on-one) motivational interviewing
    (MI) is efficacious (e.g., NIAAA, 2004).
  • Group-delivered MI has limited evidence of
    efficacy (LaChance et al., 2009) and can be
    delivered at a lower cost than one-on-one
    interventions.
  • Group-delivered MI has yet to be compared to a
    one-on-one MI for alcohol use.

5
Alcohol Use by College Students
  • 59.8 of college students reported using alcohol
    in the last 3o days according to the ACHA-NCHA
    Fall 2010 assessment

6
Snapshot of Annual High-Risk College Drinking
Consequences
  • Death  1,825 college students between the ages
    of 18 and 24 die from alcohol-related
    unintentional injuries, including motor vehicle
    crashes.
  • Injury  599,000 students between the ages of 18
    and 24 are unintentionally injured under the
    influence of alcohol.
  • Assault  696,000 students between the ages of 18
    and 24 are assaulted by another student who has
    been drinking.
  • Sexual Abuse  97,000 students between the ages
    of 18 and 24 are victims of alcohol-related
    sexual assault or date rape.
  • Source Hingson et al., 2009

7
Consequences Continued
  • Academic Problems About 25 percent of college
    students report academic consequences of their
    drinking including missing class, falling behind,
    doing poorly on exams or papers, and receiving
    lower grades overall (Engs et al., 1996 Presley
    et al., 1996a, 1996b Wechsler et al., 2002).
  • Health Problems/Suicide Attempts More than
    150,000 students develop an alcohol-related
    health problem (Hingson et al., 2002), and
    between 1.2 and 1.5 percent of students indicate
    that they tried to commit suicide within the past
    year due to drinking or drug use (Presley et al.,
    1998).

8
Alcohol Abuse and Dependence
  • In the past 12 months, according to
    questionnaire based self-reports about their
    drinking
  • 31 percent of college students met criteria for a
    diagnosis of alcohol abuse
  • 6 percent of college students met criteria for a
    diagnosis of alcohol dependence
  • Source Knight et al., 2002

9
Penn State Student Drinking Data
  • From the Student Affairs Research and Assessment,
    PULSE Student Drinking Report 2011

10
High Risk Drinking at Penn State
  • Penn State Pulse Student Drinking 2011 Data
  • 47.5 of students are high-risk drinkers
  • 18.6 of students are frequent high risk drinkers
  • Male high risk drinking
  • 52.6 of high risk drinkers were male
  • Female high risk drinking
  • 42.5 of high risk drinkers were female
  • Source Penn State Student Affairs Research and
    Assessment, Student Drinking Report 2011

11
Alcohol Related Consequences
Within the past 12 months as a consequence of
drinking
Alcohol Related Consequence ACHA-NCHA Fall 2010 Data Penn State Pulse Student Drinking Report 2011
Did something they later regretted 32.4 29.8
Forgot where they were/what they did 29.7 43
Physically injured themselves 15.1 12.3
Source American College Health Association,
2010 Source Penn State Student Affairs Research
and Assessment, Student Drinking Report 2011
12
Nightly Self Reported Alcohol Use During a
Typical Week-Penn State 2011
Variable Wednesday Thursday Friday Saturday
of Students Drinking 14 40 70 69
Average Drinks 0.42 1.69 3.86 3.95
Average Hours Drinking 0.32 1.21 2.75 2.81
Average BAC 0.042 0.064 0.083 0.085
Source Penn State Student Affairs Research and
Assessment, Student Drinking Report 2011
13
Drinks Consumed/Hour During Peak Drinking by Penn
State Students
Number of Drinks of Students
gt0 to 1 drinks 21
gt1 to 2 drinks 43
gt 2 to 3 drinks 22
gt 3 drinks 14
Source Penn State Student Affairs Research and
Assessment, Student Drinking Report 2011
14
Self Reported Alcohol Consequences
Direct Consequences Physical of Students
Had a hangover/headache the morning after drinking 60.5
Felt sick to your stomach or thrown up 45.1
Been unable to remember a part of the previous evening 43.1
Been hurt or injured 12.3
Gotten into a physical fight 5.8
Source Penn State Student Affairs Research and
Assessment, Student Drinking Report 2011
15
Self Reported Alcohol Consequences
Direct Consequences Academic of Students
Missed class 25.2
Gotten behind in schoolwork 22
Had difficulty concentrating in class 9.8
Performed poorly on an assignment or test 2.6
Source Penn State Student Affairs Research and
Assessment, Student Drinking Report 2011
16
Self Reported Alcohol Consequences
Direct Consequences Interpersonal of Students
Done something you later regretted 29.8
Become rude, obnoxious or insulting 28.5
Felt guilty about your drinking 22.8
Source Penn State Student Affairs Research and
Assessment, Student Drinking Report 2011
17
The NIAAA Report on College Drinking
What Colleges Need to Know Now An Update on
College Drinking Research. (2007)
www.collegedrinkingprevention.gov/
18
4 Tiers of Effectiveness
  • Task Force members placed prevention strategies
    in descending tiers on the basis
  • on the evidence available to support or refute
    them.
  • Tier 1
  • Evidence of effectiveness among college
    students. BASICS fits here which is why we are
    using it at Penn State in University Health
    Services.
  • Tier 2
  • Evidence of success with general populations
    that could be applied to college environments.
  • Tier 3
  • Evidence of logical and theoretical promise,
    but require more comprehensive evaluation.
  • Tier 4
  • Evidence of ineffectiveness. Source A Call
    to Action Changing the Culture of Drinking at
    U.S. Colleges, NIAAA Task Force.

19
Nationally Recognized Program
  • National Institutes of Health
  • One of the most promising interventions for
    college students regarding alcohol use
  • Substance Abuse and Mental Health Services
    Administration (SAMHSA)
  • Model Program
  • BASICS is a tier 1 strategy which is why we are
    using it at Penn State in University Health
    Services
  • (Source http//www.samhsa.gov )

20
BASICS Implementation at Penn
State
  • Alcohol intervention programs have been offered
    at UHS since the mid-1980scomponents of BASICS
    have been used 5 years now (AIP I II and PAUSE
    Blue White)
  • Expansion of BASICS has been a collaborative SA
    effort between UHS, Judicial Affairs, Residence
    Life, CAPS and the VP of SA
  • 5 FT health educators were hired to facilitate
    the program in addition to a PT graduate
    assistant
  • 1 new FT Addiction Specialist was also hired in
    CAPS to facilitate referrals from BASICS
  • Dr. John Hustad was hired to do a comprehensive
    evaluation of the BASICS program
  • National experts on BASICS and Motivational
    Interviewing were brought in to do staff training

21
Policy Changes Affecting Referral to BASICS
  • Effective fall 2010
  • all students who have a first time alcohol
    violation (underage possession or use, DUI,
    public drunkenness, supplying to minors, party
    host, etc.) that occurs on or off campus have a
    mandated referral to BASICS
  • all students who go to Mt. Nittany Medical Center
    (local hospital) or alcohol-related treatment
    have a mandated referral to BASICS
  • students complete 2 or 4 mandated sessions based
    on their screenings and experiences with alcohol
  • program fee is 200
  • Weve seen 1500 students so far in BASICS since
    August 2011

22
Referral Sources
  • Judicial Affairs
  • Residence Life
  • Emergency Department (Mt. Nittany Medical Center)
  • Types of policy or legal violations
  • Underage drinking/ underage possession or use
  • DUI
  • Public Drunkenness/ excessive consumption
  • Alcohol-related emergency department treatment
  • Furnishing to minors

23
BASICS Components
24
Traditional BASICS Delivery
  • Every student spent two 1 hour individual
    sessions with a health educator
  • Students that screened 16 on the AUDIT (with an
    alcohol policy/legal violation) were also
    mandated to two 1 hour sessions with a clinician
    in CAPS
  • Students participating in the research had their
    feedback session audio recorded
  • Non-mandatory referrals were also made for
    students screening for symptoms of anxiety or
    depression
  • Satisfaction surveys were also conducted at the
    end of the second session

25
BASICS Session One Assessment
  • Confidentiality
  • Discuss students referral event
  • Review standard drinks
  • Explain monitoring activity
  • Screen for anxiety, depression and alcohol
    dependence
  • Complete a comprehensive computer assessment
    (typical drinking patterns, negative
    consequences, perceptions of alcohol use, risk
    behaviors, etc.)
  • Refer students to CAPS for anxiety and depression
    (if applicable)
  • 1-2 weeks between session one and session two

26
Anxiety Screening
  • The Overall Anxiety Screening and Impairment
    Scale (OASIS) is used to screen for anxiety
  • A student scoring 8 on the screening is given a
    non-mandatory referral to CAPS for further
    evaluation

27
Depression Screening
  • The Patient Health Questionnaire-9 (PHQ-9) is
    used to screen for depression
  • Any student who screens positive for question 9
    (self harm, suicidal ideation) has a phone crisis
    consultation with a CAPS clinician to determine
    appropriate course of action
  • Any student who scores 10 is given a
    non-mandatory referral to CAPS for further
    evaluation

28
Alcohol Abuse Screening
  • The Alcohol Use Disorders Identification Test
    (AUDIT) from the World Health Organization is
    used to screen for alcohol abuse
  • Any student who scores a 16 with an alcohol
    violation is mandated to two additional sessions
    in CAPS with one of the Addiction Specialists
  • Any student who scores a 16 who went to the ED
    but didnt have an alcohol violation is given a
    non-mandatory referral to CAPS for two additional
    sessions

29
BASICS Session Two Feedback
  • Personalized normative feedback (PNF) sheets are
    given to students based on the computerized
    assessment they completed
  • Health educators review the PNF sheets with the
    students and use motivational interviewing
    techniques to assist with behavior change
  • BAC cards and alcohol poisoning cards are given
    out
  • Change/action plans are completed (if applicable)
  • Referral to CAPS made for students with AUDIT
    scores 16 (if alcohol violation)
  • Satisfaction survey

30
Sample PNF sheet for an Actual Student
31
BASICS 3 and 4
  • Extended BASICS (sessions 3 and 4) occurs in CAPS
    with the Addiction Specialists
  • BASICS 3 is an intake consultation
  • BASICS 4 is tailored to the student needs

32
Follow-up Assessment
  • All BASICS participants are required to complete
    a 1 month follow-up assessment as part of their
    sanction requirement
  • Research participants were asked to complete
    additional follow ups

33
Key Behavior Outcomes Relevant to Assessing the
Efficacy of Group and Individual BASICS
34
Behavior Outcomes of BASICS
  • Decreased typical BAC
  • Decreased peak BAC
  • Decreased negative consequences associated with
    alcohol
  • Increased use of protective behaviors while
    drinking

35
Research Background
  • High risk drinking among college students is well
    documented (Hingson, 2005 Johnson, et. al.,
    2008 Nelson, et. al., 2009)
  • There is strong empirical evidence supporting the
    efficacy of one-on-one delivery of BASICS
    (Larimer, et. al., 2007)
  • Recent research suggests that group delivered
    BASICS is promising and cost-effective (LaChance,
    2009).
  • To date, no research has been conducted comparing
    the efficacy of group delivered BASICS to
    individually delivered BASICS.

36
Hypothesis
  • We hypothesized that participants who received
    individual MI would report drinking at lower
    levels on a peak drinking occasion and experience
    reduced levels of alcohol-related problems at
    follow-up compared to the group MI condition.

37
Methods -Procedures
  • Participants were recruited from a sample of
    college students (N 547) who were mandated to
    receive an alcohol intervention following an
    alcohol-related offense (e.g., underage drinking,
    arrested for driving, emergency department visit,
    driving under the influence) during the fall
    semester of the 2010-2011 academic year
  • Eligibility criteria Alcohol Use Disorder
    Identification Test (AUDIT) score lt16, no
    suicidal ideation, and an undergraduate student
    between 18 and 22 years old

38
Study Procedure and Design
A Assessment R Randomization BMI Brief
Motivational Intervention
Follow up Assessment at 1, 3, 6 Months
BMI
A
R
Group BMI
Excluded High Risk Students
39
BASICS Components-Group Condition
40
Group BASICS Condition
  • Session 1 of BASICS was done individually with a
    health educator
  • Session 2 was conducted in a group setting
  • Group characteristics
  • 2-7 students per group
  • Facilitated by a health educator
  • A mixing board was used for recording and all
    participants had individual microphones for the
    group sessions
  • All group participants scored lt 16 on the AUDIT
    and did not endorse suicidal ideation on the
    PHQ-9, question 9

41
BASICS Components-Group Condition
42
Method
  • Participants and Setting
  • Students who were mandated to receive an
    intervention.
  • Incentives
  • 15 gift card for the 30 day follow up survey
  • 20 gift card for the 3 month follow up survey
  • 25 gift card for the 6 month follow up survey
  • Participation in this study fulfilled the campus
    requirement

43
Method
  • Demographics
  • Alcohol use (Past month)
  • Typical Drinks and amount of time spent drinking
  • Peak Drinks and amount of time spent drinking
  • Estimated average and peak blood alcohol
    concentration (e.g., Hustad Carey, 2005)
  • Alcohol-related consequences Young Adult
    Consequences Questionnaire (YAACQ Read et al.,
    2006 Kahler, Hustad et al., 2008)

44
Participant Flow
45
Sample Characteristics
  • Participants randomized to receive
    group-delivered BASICS were more likely to be
    male than participants in the individual BASICS
    condition
  • There were no other significant differences
    between the two conditions according to key
    demographic and baseline characteristics.

46
Sample Characteristics
Variable Percentage
Gender
Male 189 69
Female 93 33
Age Mean 19.04 (SD1.21) -
Race
White 229 81
Asian 15 5
Black/African American 10 4
Hispanic 11 4
Other 27 10
47
Sample Characteristics
Variable
Residence
On-campus 64
Off-campus 29
With parents 0.7
Fraternity house 3.2
Sorority floor 1.42
Other 1
48
Raw Means of Key Outcome Variables Across
Assessments
Variable Individual (N133) Group (N147) p Value
Gender 0.05
male 72.30 61.19 -
female 27.70 38.81 -
Ethnicity ( White) 88.72 82.31 0.13
Year ( Freshman) 52.63 50.34 0.92
Residence ( on campus) 64.66 63.27 0.78
Greek status ( non-Greek) 81.95 80.27 0.84
49
Raw Means of Key Outcome Variables Across
Assessments for Participants
Variable Individual (N133) Group (N147) p Value
Age 18.98 19.11 0.39
Drinks/week 11.14 11.27 0.91
Drinks/ drinking day 5.10 5.04 0.85
Heavy drinking frequency 1.24 1.18 0.78
Typical BAC 0.08 0.08 0.93
Peak BAC 0.14 0.13 0.57
YAACQ total 6.29 5.55 0.23
50
Participant Self Reported Alcohol Related
Consequences
51
Participant Self Reported Alcohol Related
Consequences
52
Self Reported Referral Source
  • Judicial Affairs
  • Residence Life
  • Emergency Department
  • District Magistrate
  • Other

53
Measures
  • Demographics Gender and weight (in pounds)
  • Alcohol Use Disorder Identification (AUDIT
    Saunders et al., 1993) was used to screen
    students for alcohol dependence
  • Alcohol use (past month) Self-reported number of
    peak drinks and amount of time spent drinking.
    These variables were used to estimate peak blood
    alcohol concentration (eBAC) (e.g., Hustad
    Carey, 2005)
  • Alcohol-related consequences (past month) Young
    Adult Consequences Questionnaire (YAACQ Read et
    al., 2006 Kahler et al., 2008)

54
Analysis Plan
  • Investigated differences by group over time using
    General estimating equations (GEE)
  • Investigated whether gender moderated the effect
    of the intervention

55
Primary Outcomes
56
Baseline Characteristics
  • Conditions were not statistically different on
    key
  • demographics and variables
  • Evaluate differences by group over time using two
    separate general estimating equations (GEE)
    models for (1) peak eBAC and (2) alcohol-related
    consequences after controlling for gender

57
Primary Outcomes
  • The effect for time was significant for peak eBAC
    (z -2.07, p .04) and alcohol-related
    consequences (z -2.79, p .005)
  • There was a main effect for gender where female
    participants had significantly higher peak eBACs
    than male participants (z 4.86, p lt .001)
  • The main effect for gender was not statistically
    significant for alcohol-related consequences (z
    0.57, p .57)
  • The condition X time interaction was not
    statistically significant

58
Results Estimated Typical Blood Alcohol
Concentration (BAC)
59
Results Estimated Peak Blood Alcohol
Concentration (BAC)
60
Results Alcohol Problems
61
Results Number of Safer Drinking Strategies
62
Discussion
  • Participants decreased their alcohol use and
    associated harms after they received a MI
  • Group MI was not statistically different than
    individual MI

63
Summary of Main Study Outcomes
  • Both Groups demonstrated decreases on key outcome
    variables
  • No differences between the group versus
    individual conditions
  • No gender by intervention effects
  • Group motivational interviewing appears to be a
    cost effective method
  • Participants decreased their alcohol use and
    related harms after BASICS
  • Despite the lack of a control group, the
    magnitude of these reductions are similar to
    similar studies (e.g., Carey, et. al., 2006)

64
Limitations
  • Results may not generalize to non-mandated
    students
  • Lack of an assessment-only control group
  • Fidelity of the interventionists has not been
    analyzed

65
Implications
  • Results suggest that group MI is a cost-efficient
    intervention strategy

66
Future Directions
  • Evaluate mechanisms and active ingredients of
    behavioral change
  • Look at mediators of change such as alcohol
    norms, motivation to change, self efficacy,
    alcohol beliefs and in-session talk
  • Investigate the effect of time on outcomes
  • Our 6 month follow up is in progress and will be
    finished soon
  • Continue to evaluate the efficacy of BASICS

67
Thank You to Penn State Staff Involved with
BASICS
  • Liz Barton-Staff assistant
  • Alwyn Brittain-BASICS Health Educator
  • Angel Goldian-Staff assistant
  • Rochelle Holmes-BASICS Graudate Assistant
  • John Hustad, Ph.D.-BASICS Researcher
  • Linda LaSalle, Ph.D.-Associate Director of
    Educational Services
  • David Mallen-BASICS Health Educator
  • Jessica Nabozny-BASICS Health Educator
  • Steve Shephard-BASICS Health Educator
  • Katie Tenny-BASICS Health Educator
  • Rachel Urwin, Ph.D.-Coordinator of Educational
    Services

68
  • THANK YOU ?

69
  • Contact information
  • Suzanne Zeman, M.S., R.N.
  • Coordinator of Educational Services
  • The Pennsylvania State University
  • University Health Services
  • slb227_at_sa.psu.edu
  • (814) 863-0461
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