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Addressing Risky Drinking by Male College Students Through Screening and Brief Interventions. Arthur J. Lurigio, Ph.D. College of Arts and Sciences Susan Cushman, MPH, CHES Wellness Center Molly K. Pachan, M.A. Department of Psychology Loyola University Chicago.

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Addressing risky drinking by male college students through screening and brief interventions

Addressing Risky Drinking by Male College Students Through Screening and Brief Interventions

Arthur J. Lurigio, Ph.D.

College of Arts and Sciences

Susan Cushman, MPH, CHES

Wellness Center

Molly K. Pachan, M.A.

Department of Psychology

Loyola University Chicago


Grant overview

U.S. Department of Education Grant Award Amount: $292,000 (2 years)

Ranked 4th out of 128 submissions (NIAAA inspired)

Original Project Team: Diane Asaro, MSN, RN; Susan Cushman, MPH; Alissa Eischens, MPH; Arthur J. Lurigio, Ph.D.

Collaboration between Student and Academic Affairs

Grant Overview


Philosophical practical underpinnings
Philosophical/Practical Underpinnings (2 years)

  • Powerful Endorsements: Vice President, Deans, Director

  • University’s Message in the Making: Choice. Control. Character.

  • Encouraging prudent decisions about drinking

  • Supports University’s Longstanding Goal: Reduce harm from alcohol–academic, physical, social, emotional, or legal–for students who drink and those around them.

  • Safety Net Committee


Three major components of grant
Three Major Components of Grant (2 years)

  • A program of proactive screening and brief interventions for male, first-year students (individual component) (BASICS based)

  • Strategic engagement of faculty, staff, and parents in alcohol misuse prevention efforts (campus component)

  • Assessment of local environmental factors that either support or discourage high-risk drinking among students (community component)


Alcohol related harm among 18 24 year old college students in us

Each year: (2 years)

1,700 deaths

599,000 injuries

696,000 assaults

97,000 sexual assaults

Unsafe sex:

400,000 unprotected; 100,000 unable to consent

Other:

Vandalism

Academic problems

Abuse and dependence

Alcohol-Related Harmamong 18-24 Year-old College Students in US

* National Institute on Alcohol Abuse and Alcoholism, 2007


Good news loyola students alcohol

29% of undergrads typically don’t drink. (2 years)

Most students (65%) have 0-4 drinks

on a night out.

Most students (89%) drink twice

a week or less.

Most students (59%) do not drink to the

point of impairment, i.e., eBAC <.08%.

2009 Loyola Core AOD Survey and Nat’l

College Health Assessment

Good News: Loyola Students & Alcohol


Not so good news loyola students alcohol
Not So Good News: Loyola Students & Alcohol (2 years)

  • About 7 in 10 students drink alcohol

  • 40% to 50% drink heavily

  • 41% of those who reported drinking were legally impaired (i.e., eBAC >.08%) the last time they partied

  • 18% drink 3 or more nights/week

    2009 Loyola Core AOD Survey and Nat’l College Health Assessment


Implications for academics health safety

32% have had studying interrupted (2 years)

30% missed a class

21% performed poorly on test

38% had memory loss/black-out

16% were hurt or injured

38% engaged in public misconduct

2008 Core AOD Survey, n=1,346 LUC undergraduates

Implications for Academics,Health & Safety


Drinking or drug related problems for first year luc students

Blacked out (37%) (2 years)

Regrets (32%)

Missed class (14%)

Performed poorly on test/project (12%)

Drinking- or Drug-Related Problems forFirst-Year LUC Students

Source: 2008 Core Alcohol & Other Drug Survey; n=372 LUC freshmen


Drinking or drug related problems for first year luc students1

Argument or fight (25%) (2 years)

Hurt or injured (18%)

Unprotected sex (7%)

Drinking- or Drug-Related Problems forFirst-Year LUC Students

Source: 2008 Core Alcohol & Other Drug Survey; n=372 LUC freshmen


A proactive stepped care approach
A Proactive, Stepped-Care Approach (2 years)

3. Referral for

Counseling

2. Motivational

Intervention (MI)

for ‘at-risk’

students

30-45 minutes

1. Screening &

Brief Advice

(SBA)

10-15 minutes


Screening brief advice in residence halls

Screening Using the AUDIT (5 min.) (2 years)

Graduate Student Facilitators

Recruitment Strategies

Standard Messages (up to 10 min.)

If high-risk, invite student to participate in

motivational interviewing.

Screening & Brief Advice in Residence Halls


Motivational interviewing

Student’s Reflections on Screening & Brief Advice Session (2 years)

Personalized feedback

Frequency & quantity, peak BAC

Comparison to LUC first-year males

Misuse/Abuse/Dependence

Negative consequences

Confidence and Importance Rulers

Readiness to Change

Referral (if indicated)

Next steps (What? How?)

Motivational Interviewing




Student participation

291 Screened (2 years)

(39%)

Student Participation

LOW-RISK

n= 124 (43%)

AT-RISK

n= 167 (57%)

Completed

MI

n= 69

(41%)

Decline or

No-Show MI

n= 98 (59%)

Compare those who did not attend the MI…

Posttest did not

match pretest ID

n= 60

Pretest and Posttest

were matched, No MI

n= 38

Pretest and Posttest

were matched

n= 31

Posttest did not

match pretest ID

n= 38

…to those who

completed the MI


Major research questions and design
Major Research Questions and Design (2 years)

  • Did at-risk, first-year, male participants change from pretest to posttest on study’s outcome measures?

  • How did at-risk, first-year, male students who received brief advice only compare with those who received brief advice + MI?


Analytic procedure

A Repeated Measures MANOVA (2 years)

Tested main effects across time (pretest, posttest, and follow-up) for all first-year, at-risk, male students who attended the brief advice session alone and the brief advice and MI sessions.

Tested interactions across time (pretest, posttest, and follow-up) by comparing those who did not attend the MI session (no MI, brief advice-only) with those who did attend the MI session (brief advice and MI).

Analytic Procedure


Students reactions to 45 minute mi intervention
Students’ Reactions to 45-minute MI Intervention (2 years)

  • 82% of students’ comments about the MI were positive.

    • “It was helpful to receive the BAC sheet and it was nice to have a facilitator that understood and helped me.”

    • “Very helpful, actually – I thought that some of the stats were good and did not feel attacked like I sometimes do with these things.”

    • “It made me realize that I drink a lot and that it isn't good. I will stop drinking, well not stop, but much less.”

  • Most students found the MI session to be informative, non-threatening, and well-run.


Favorable responses to facilitators and content

Facilitator-related comments: (2 years)

Felt that the facilitator answered their questions (96%)

Felt at ease (100%)

Felt that the facilitator understood them (97%)

Felt that the facilitator was telling them what to do (3%)

Intervention-related comments:

Raised questions not previously considered (59%)

Believe that others at LUC would benefit (93%)

Thought the session was of no help (21%)

Favorable Responses to Facilitators and Content


Overall effects of brief advice and motivational interviewing

Both brief advice-only and brief advice + MI groups changed on the outcome measures from pretest to posttest.

No statistically significant differences were found on the between-group comparisons (MI vs. no MI.)

Overall Effects of Brief Advice and Motivational Interviewing


Specific effects of the interventions
Specific Effects of the Interventions on the outcome measures from pretest to posttest.


Frequency of binge drinking
Frequency of Binge Drinking on the outcome measures from pretest to posttest.


Number of drinks per week
Number of Drinks Per Week on the outcome measures from pretest to posttest.


Effect of the mi intervention on drinking pre post follow up

Results at follow- up demonstrated that some of the improvement shown at post-test was lost over time. However, MI group showed steeper declines at both post-test and follow-up.

Effect of the MI intervention on Drinking: Pre/Post/Follow-Up


Confidence to change pre post follow up

Confidence to change at post-test shows a non-significant trend, which was reversed at follow-up.

Confidence to Change: Pre/Post/Follow-Up


Consequences of drinking

The study examined self-reported consequences of drinking within the past 30 days.

Less Serious: missed a class, did something that was later regretted, forgot where you were or what you did, felt bad about yourself.

Serious Personal: performed poorly on a test, been hurt or injured, unplanned sex, unprotected sex.

Public Misconduct: arguments, physical altercations

Consequences of Drinking


Research questions consequences of drinking

Did negative consequences of drinking diminish over time for all at-risk participants?

Did the MI intervention affect students’ self-reported, drinking-related consequences above and beyond the brief advice-only intervention?

Research Questions: Consequences of Drinking


Consequences of drinking1
Consequences of Drinking all at-risk participants?

In general, reported consequences of drinking decreased over time for both groups.


Less serious consequences
Less Serious Consequences all at-risk participants?


Serious personal consequences
Serious Personal Consequences all at-risk participants?


Public misconduct consequences
Public Misconduct Consequences all at-risk participants?


Summary consequences of drinking

All at-risk students reported reductions in negative consequences over time.

At posttest, greater improvements were found in the MI group, compared with the no-MI group, on the less serious, more serious personal, and public misconduct measures. The only difference at follow-up was on less serious consequences.

No statistically significant differences or interactions were found but trends are notable.

Summary: Consequences of Drinking


Conclusion 1 intervention was well received

LUC proactively and successfully screened freshman males for at-risk drinking behavior.

A sizable portion of at-risk drinkers (41%) completed a Motivational Interviewing Session.

Students' evaluations of the MI intervention’s facilitators and content were overwhelmingly positive.

Possibly built positive rapport with Wellness Center staff. (We did not test this, but infer it from students’ favorable experiences in the MI session).

Conclusion 1: Intervention Was Well-Received


Conclusion 2 the brief advice intervention mi overall were effective

Freshman males who reported at-risk drinking behaviors and attended the brief advice/MI sessions reported significant reductions in drinking behaviors as well as the negative consequences of drinking.

Most of these gains diminished at follow-up, but they still represented marked improvements over the pretest measures.

“Therapeutic alliance" between one health educator and one student has unique and intangible potency.

Conclusion 2: The Brief Advice Intervention/MI Overall Were Effective


Conclusion 3 both groups mi non mi changed

Brief advice was enough to change student behavior. attended the brief advice/MI sessions reported significant reductions in drinking behaviors as well as the negative consequences of drinking.

The MI was not an effective or a value-added intervention.

At-risk students who declined the MI did not need any additional intervention.

Maturation could account for pre-post changes.

History could account for pre-post changes. (Other LUC interventions were also being implemented.)

The MANOVA had too few at-risk participants to demonstrate MI’s effectiveness (Low Power)

Conclusion 3: Both Groups (MI/non-MI) Changed


Limitations

Groups were self-selected, not randomly assigned. attended the brief advice/MI sessions reported significant reductions in drinking behaviors as well as the negative consequences of drinking.

No control group was used to assess the brief advice-only, MI only, or brief advice/MI interventions.

Recruitment of participants was limited by population size and time.

Attrition was high. (Not permitted to contact participants to remind them of MI appointment.)

Sample size was too small to detect significant results.

Self-report measures are unreliable. (BAC)

Limitations


Future research

Studies should employ random assignment, control groups, and longer follow-up periods.

To Whom? How Long? How Often?

Booster sessions should be tested to determine if they produce longer-term results.

Replications with larger sample sizes and a greater variety of students should be undertaken.

Replications in other schools at LUC and in other AJCU schools would be useful.

Future Research


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