Title: Suzanne Zeman, M.S., R.N.
1The 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
2Outline
- 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
3Objectives
- 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
4Background
- 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.
5Alcohol 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
6Snapshot 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
7Consequences 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).
8Alcohol 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
9Penn State Student Drinking Data
- From the Student Affairs Research and Assessment,
PULSE Student Drinking Report 2011
10High 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
11Alcohol 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
12Nightly 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
13Drinks 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
14Self 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
15Self 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
16Self 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/
184 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.
19Nationally 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
21Policy 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
22Referral 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
23BASICS Components
24Traditional 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
25BASICS 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
26Anxiety 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
27Depression 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
28Alcohol 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
29BASICS 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
30Sample PNF sheet for an Actual Student
31BASICS 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
32Follow-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
33Key Behavior Outcomes Relevant to Assessing the
Efficacy of Group and Individual BASICS
34Behavior Outcomes of BASICS
- Decreased typical BAC
- Decreased peak BAC
- Decreased negative consequences associated with
alcohol - Increased use of protective behaviors while
drinking
35Research 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.
36Hypothesis
- 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.
37Methods -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
38Study 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
39BASICS Components-Group Condition
40Group 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
41BASICS Components-Group Condition
42Method
- 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
43Method
- 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)
44Participant Flow
45Sample 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.
46Sample 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
47Sample Characteristics
Variable
Residence
On-campus 64
Off-campus 29
With parents 0.7
Fraternity house 3.2
Sorority floor 1.42
Other 1
48Raw 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
49Raw 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
50Participant Self Reported Alcohol Related
Consequences
51Participant Self Reported Alcohol Related
Consequences
52Self Reported Referral Source
- Judicial Affairs
- Residence Life
- Emergency Department
- District Magistrate
- Other
53Measures
- 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)
54Analysis Plan
- Investigated differences by group over time using
General estimating equations (GEE) - Investigated whether gender moderated the effect
of the intervention
55Primary Outcomes
56Baseline 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
57Primary 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
58Results Estimated Typical Blood Alcohol
Concentration (BAC)
59Results Estimated Peak Blood Alcohol
Concentration (BAC)
60Results Alcohol Problems
61Results Number of Safer Drinking Strategies
62Discussion
- Participants decreased their alcohol use and
associated harms after they received a MI - Group MI was not statistically different than
individual MI
63Summary 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)
64Limitations
- Results may not generalize to non-mandated
students - Lack of an assessment-only control group
- Fidelity of the interventionists has not been
analyzed
65Implications
- Results suggest that group MI is a cost-efficient
intervention strategy
66Future 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
67Thank 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 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