Abstract
MI Theory Driven “REMITT” an App Developed to Prevent Hazardous Drinking among University Students
Donna M. Kazemi, PhD1 and Maureen Levine, Ph.D, ABPP2
(1)University of North Carolina at Charlotte, Charlotte, NC, (2)Central Michigan University, Mt. Pleasant, MI
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background: mHealth apps are an effective means of delivering health interventions, and the college-age population is particularly proficient at using apps. Informed by current theories of Ecological Momentary Interventions (EMI), Motivational Interviewing (MI), and Transtheoretical Model (TTM) of Change, investigators have developed a self-monitoring app—Reductions through Ecological Momentary/Motivational Intervention/Transtheoretical (REMIT)—with the aim of reducing hazardous drinking among college students.
Methods: Five phases from the Integrate, Design, Assess, and Share (IDEAS) framework, which is a step-by-step process for developing digital behavior change interventions, were used by the research team: 1) understand the users; 2) determine target behavior; 3) intervention based in behavioral theory; 4) ideate creative delivery strategies and 5) develop REMIT prototype.
Results: REMIT uses assessments (informed by EMI) and components of MI and TTM to guide administration of nine modules designed to engage users in reducing alcohol use and problems. REMIT users self-monitor their alcohol consumption and develop strategies to change drinking behaviors using a range of easy-to-use features (e.g., Virtual Coach, automated text messages, interactive gaming mechanisms (gamification), drink consumption tracking, and Blood Alcohol Concentration (BAC) calculators).
Conclusion: mHealth interventions have been shown to reduce alcohol use among college students when they are applied in real-life, real-time contexts. REMIT is a theory-based, self-monitoring app which incorporates user-friendly features to reduce hazardous drinking among college students. The next step is to conduct a pilot trial to test the efficacy of the app and enhance the REMIT prototype.
Key Words: Motivational Interviewing (MI), Ecological Momentary Interventions (EMI), Transtheoretical Model (TTM), Alcohol, App, mHealth, College Students
Planning of health education strategies, interventions, and programs Public health or related education Public health or related research
Abstract
Evaluation Outcomes of Georgia’s Alcohol Prevention Program
Darigg C. Brown, PhD, MPH1, Elvira Elek, PhD2, Sharnail Bazemore, MS2, Travis Fretwell, MAC, CAC II, CCS3, Donna Dent, MISM, MS, ICPS3 and Amy Benson, MPA, ICPS3
(1)RTI International, Atlanta, GA, (2)RTI International, Washington, DC, (3)Georgia Department of Behavioral Health and Developmental Disabilities, Atlanta, GA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background: The Georgia Department of Behavioral Health and Developmental Disabilities, Office of Behavioral Health Prevention funded 47 Alcohol Prevention Project (APP) providers to develop partnerships and implement community-based strategies to address three priorities: 1) the early onset of alcohol use among 9-20-year olds, 2) access to alcohol and binge drinking among 9-20-year olds, and 3) binge drinking and heavy drinking among 18-25-year olds. To address these priorities during the 5-year APP (2012-2016), the providers implemented over 18 different individual (prevention education) strategies and over 29 different environmental (media campaign, policy change) strategy interventions.
Methods: The Georgia Student Health Survey (GSHS) and individual strategy pre- and post- survey datasets were analyzed to assess changes over time on alcohol-related outcomes. The logistic regression and analysis of variance GSHS analyses combined middle and high school data to compare changes in APP counties to non-APP counties from 2012 (N = 596,809) to 2015 (N = 629,642). For the individual strategy surveys (N = ~9,000), paired t-tests assessed mean change over time from before to after strategy implementation.
Results: On the GSHS between 2012 and 2015, APP counties decreased significantly more than did non-APP counties on the percentage of youth drinking, drunk driving, and riding with a drunk driver during the past 30 days. The community survey data showed significant pre- to post-strategy implementation changes including an increased likelihood of perceiving risk of binge drinking; disapproving of their same age peers drinking; and perceiving that adults believe it is wrong for youth to get drunk or drink alcohol, along with a lowered likelihood of having ridden with a drunk driver in the past 30 days.
Conclusions: Overall, outcomes from both sets of surveys show positive changes in alcohol-related attitudes and behaviors supporting the use of the strategies employed by APP providers during the project.
Administer health education strategies, interventions and programs Conduct evaluation related to programs, research, and other areas of practice Social and behavioral sciences
Abstract
Alcohol use trajectories during college: Relationship with days kept from normal activity due to injury and illness
Angelica Barrall, Brittany A. Bugbee, MPH, Hannah Allen, MHS, Kathryn B. Vincent, MA and Amelia Arria, PhD
University of Maryland School of Public Health, College Park, MD
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Alcohol consumption increases risk for accidents and injuries as well as susceptibility to infection. The extent to which alcohol use is associated with functional impairment due to injury and illness among youth and young adults is relatively unclear. This study investigates the relationship between typical quantity of alcohol consumed during college and functional impairment due to injury or illness.
Four annual interviews were administered to 1253 undergraduates, beginning their first year of college. Growth mixture modeling identified trajectories for typical alcohol quantity consumed. Functional impairment was operationalized as the number of days in which usual activities were missed due to an accident/injury or to illness, separately. Negative binomial regression models evaluated the relationship between functional impairment and alcohol trajectory group, controlling for demographic variables, living situation, athlete and/or Greek status, general health rating, exercise level, and marijuana and tobacco use.
Four alcohol trajectory groups were identified: High-Intensity (19.9%), Binge (49.0%), Moderate (20.7%), and Low (10.4%). Functional impairment due to injury was significantly related to being male, an athlete, and more intensive drinking among the full sample. Functional impairment due to illness is higher for females, Greeks, and those with a poorer health rating, as well as heavy drinking. Among females, being an athlete and high-intensity drinking were related to more injury impairment, and being a Greek and moderate drinking were related to more illness impairment. Among males, heavy drinking was related to more functional impairment due to both injury and illness. Tobacco use was related to less injury impairment and exercising was related to less illness impairment.
Heavy patterns of alcohol use during college appear to be related to days of impairment from both injury and illnesses. This evidence substantiates the need for universal screening for excessive drinking in college health centers.
Public health or related research Social and behavioral sciences
Abstract
Characterizing teens’ home, school, and activity space contexts: Relations to alcohol use and problem behavior
Hilary F. Byrnes, Ph.D.1, William Ponicki, MA1, Brenda Miller, PhD2, Christopher Morrison, PhD3, Douglas J. Wiebe, PhD3 and Sarah E Wiehe, MD, MPH4
(1)Pacific Institute for Research and Evaluation, Berkeley, CA, (2)Prevention Research Center/PIRE, Oakland, CA, (3)University of Pennsylvania, Philadelphia, PA, (4)Indiana University School of Medicine, Indianapolis, IN
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background: As teens gain freedom to explore new environments, exposures to social disorganization and alcohol outlets may also increase, escalating risks for alcohol use and problem behavior. Assessing activity spaces, places teens spend time, may provide information about relations between contextual exposures and risk behaviors. We examined whether contextual exposures in teens’ activity spaces differ from contextual risks present in home and school contexts and examined relationships between risks in these contexts, alcohol use and problem behaviors.
Methods: Data from two annual waves included annual surveys, approximately 24 ecological momentary assessments (EMA) per wave, and activity-space information from phone-based GPS tracking. This produced a sample size of 416 wave-observations nested within 232 participants (ages 14-16). T-tests compared neighborhood disorganization and other characteristics between teens’ homes, schools, and GPS-measured activity spaces when not at home or school. Multilevel Tobit analyses related neighborhood characteristics to EMA-reported problem behaviors and alcohol use.
Results: Perceived disorganization in home neighborhoods (M=1.60) was significantly lower than in school neighborhoods (M=1.69), while perceived disorganization in activity spaces (M=1.57) was lower than in school areas but not home areas. The average participant encountered 30 times more on-premise and 23 times more off-premise alcohol outlets in their activity space than existed in their home Census tracts (p<0.001). Tobit analyses showed that problem behavior was positively related to off-premise outlets in home tracts and perceived disorganization in activity spaces. Drinking was positively associated with home-tract off-premise outlets, on-premise outlets in activity spaces, and perceived disorganization in activity spaces, but negatively related to activity-space off-premise encounters as well as proportions of their time spent near both home and school.
Conclusions: These findings using integrated GPS-EMA methods may inform adolescent prevention research by providing more information about the contexts where teens spend time and relations to risk behavior.
Epidemiology Social and behavioral sciences
Abstract
Effectively Engaging Youth in Evidence-Based Underage Alcohol Use Prevention
Alicia Rosas, Youth Engagement Specialist
Texans Standing Tall, Austin, TX
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Issue: The Department of State Health Services reported that in 2013, 67 percent of young people in Texas are drinking despite minimum age laws and for students in 7th -12th grade, alcohol use exceeds the use of tobacco and marijuana. Drinking starts at a young age, and according to the CDC, 18 percent of students in grades 9 through 12 reporting having had their first full drink of alcohol for the first time before the age of 13. This is leading to risky behavior, such as driving while under the influence and engaging in unprotected sex. Environmental prevention efforts are needed on local, state and national levels to address these issues caused by underage drinking.
Engaging youth in evidence-based prevention efforts is a long-term process that requires hard work and commitment over. Over the course of several years working with coalition partners across the state of Texas, we have found that while many youth and adults share an interest in preventing underage alcohol use, they do not know how to collaborate in order to accomplish their goals.
Description: This interactive session will cover strategies from Texans Standing Tall's Guide to Effective Engagement on how youth and adults can work together to positively impact their communities. This extensive resource is intended for groups that include both adults and youth.
Lessons Learned: Participants will leave this session with the ability to explain how to set group expectations, group accountability practices, and have effective and positive meetings. Additionally, participants will discuss different strategies on how to work with youth effectively and practically.
Recommendations: Based on best practices, expert input and our Youth Leadership Council, this guide will provide the youth's perspective as well as suggestions for improving engagement and relationship building with youth.
Planning of health education strategies, interventions, and programs Public health or related research
Abstract
It's Little League, not Happy Hour - Raising the Bar - a social marketing campaign developed to shift parental norms in Marin County California around drinking at youth-oriented events
Melissa Struzzo, MPH1 and Jasmine Gerraty2
(1)Marin County Health and Human Services Department, San Rafael, CA, (2)San Rafael, CA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
ISSUE: Adolescent substance use is highly associated with parental use and beliefs. In Marin County, rates of substance use are elevated for both youth and adults. The 2015/16 California Healthy Kids Survey found the rate of Marin County 11th graders consuming alcohol and other drugs (AOD) in the past 30 days was 66 percent, approximately twice the rate of neighboring counties. The 2017 County Health rankings found Marin County 55th of 58 California counties in excessive adult alcohol consumption. This presents an opportunity to break generational cycles of excessive substance use. Local qualitative and observational data indicates that parents celebrate youth-oriented events with alcohol, including birthday parties and athletic league games and fundraisers. DESCRIPTION: Raising the Bar, a local social marketing campaign intended to change norms around celebrating youth-oriented events with substances, was developed by substance use prevention coalitions in the Marin Prevention Network through Marin County Health and Human Services Department. This campaign presents community-level data to organizations explaining the local scope of AOD issues. Participating youth organizations receive a toolkit for parents/guardians discussing the importance of modeling positive AOD behaviors and eliminating AOD use during events. LESSONS LEARNED: Engaging adults in their own behavior is an important and challenging strategy to address youth substance use. Localized data and regional comparisons stimulates necessary dialogue. Raising the Bar has provided a structured approach across the county to changing long-held AOD norms. A baseline survey administered to participating organizations. Annual surveys will evaluate changes in parental norms and alcohol use at youth events. RECOMMENDATIONS: Describe local patterns of adult substance use at youth-oriented events as a component of needs assessment. Consider asocial marketing campaign with common messages and branding to accelerate community wide impact. Also start implementation with community-based organizations prior to school-based organizations to establish a base of participating organizations.
Chronic disease management and prevention Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs Program planning
Abstract
Recreational cannabis business pages on social media: A content analysis applying the Washington Administrative Code
Marina Jenkins, BA1, Aubrey Gower, BS1, Joshua Sheck2, Jaymin Sohal2, Brad Kerr, MS1 and Megan Moreno, MD, MSEd, MPH1
(1)University of Wisconsin-Madison, Madison, WI, (2)University of Washington-Seattle, Seattle, WA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Purpose: Recreational cannabis use was legalized in Washington State in 2012, and Washington Administrative Code (WAC) 314-55-155 was implemented to limit youth exposure to cannabis advertisements. The purpose of this study was to evaluate the content of social media posts by cannabis companies and assess compliance with WAC policy.
Methods: We identified retail cannabis companies with both Facebook and Twitter business pages from Washington State. For each cannabis business page, we applied coding based on key elements of WAC 314-55-155 focused on prohibition of: 1) encouraging over-consumption, 2) promoting therapeutic effects, and 3) appealing to youth; and requirements for 4) warnings about intoxication, driving, health risks and age restrictions for cannabis on all messaging.
Results: Our sample included 1027 posts on Facebook and Twitter from 6 cannabis business pages. The number of followers on Facebook and Twitter ranged from 342 to 2915. Approximately 2% of posts encouraged overconsumption; however, 41% of these derived from one company. Approximately 11% of posts promoted cannabis use for stress relief, and 1.6% explicitly promoted cannabis use for health benefits such as tumor growth reduction. Among these posts, 69% derived from one company. Less than 1% of posts met criteria for youth appeal showing cartoons or young-appearing models. There were no businesses that met the criterion of having warnings on every post.
Conclusions: We found that most cannabis companies did not adhere to the WAC guidelines for warnings, and some repeatedly violated guidelines. Findings can be used to refine or develop implementation strategies for cannabis prevention guidelines to address these influential media messages.
Communication and informatics Public health or related laws, regulations, standards, or guidelines Public health or related public policy Social and behavioral sciences
Abstract
Frequency of lifetime prescription drug misuse associated with non-fatal suicide behaviors among U.S. high school students, 2015 national Youth Risk Behavior Survey
Heather Clayton, PhD, MPH, Francis Annor, MPH, PhD and Michele Bohm, MPH
Centers for Disease Control and Prevention, Atlanta, GA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background: Both prescription opioid misuse and suicidal behaviors are public health issues in the US. Given the impact of these behaviors on morbidity and mortality, there is a need to better understand their relationship, particularly among youth
Methods: Data from the 2015 national Youth Risk Behavior Survey (YRBS), a cross-sectional survey conducted among a nationally representative sample of students in grades 9-12 (n=15,624) were used to examine the association between the frequency of lifetime prescription drug misuse (PDMU) (0 times, 1-2 times, 3-9 times, 10-39 times and 40+ times) and suicide ideation and suicide attempts during the 12 months before the survey. Multivariable models were used to calculate adjusted prevalence ratios (aPRs), and linear contrast analysis was used to explore possible dose-response relationships. Data from the 2017 national YRBS (available summer 2018) will be used to compare and contrast with these results from the 2015 data; the PDMU measure was revised to be specific to prescription opioids for the 2017 YRBS cycle.
Results: In bivariate analyses, lifetime PDMU frequency varied significantly by sex, grade, sexual identity, and suicide variables, but not race/ethnicity. In adjusted analyses, compared to students without lifetime PDMU, students at all levels of PDMU frequency were more likely to report suicide ideation [1-2 (aPR:1.74, 95% CI:1.50-2.02); 3-9 (2.08,1.83-2.36); 10-39 (2.12,1.78-2.52); and 40+ (2.14,1.74-2.64)]. According to linear contrast analysis, no dose response relationship was observed. All levels of PDMU frequency were significantly associated with suicide attempts: [1-2 (2.34,1.83-3.00); 3-9 (2.28,1.69-3.08); 10-39 (3.35,2.44-4.59); and 40+ (3.82,2.76-5.29)]. Linear contrast analysis determined that the 40+ frequency group differed significantly from all frequency levels except 10-39.
Conclusions: All levels of PDMU frequency were associated with both suicide-related behaviors, suggesting that any level of PDMU is a concern. Prevention efforts targeting common risk factors may have cross-cutting effects on suicide ideation and PDMU.
Epidemiology Implementation of health education strategies, interventions and programs Other professions or practice related to public health Planning of health education strategies, interventions, and programs Protection of the public in relation to communicable diseases including prevention or control Public health or related research
Abstract
Prescription drug misuse and illicit drug use in young- and middle-age US adults in the context of the opioid epidemic
Rachel W. Faller, MPH1, Jennifer Toller Erausquin, PhD, MPH1, Thomas P. McCoy, PhD, PStat2, Emily Beamon, MA, MPH2 and Robin Bartlett, RN, PhD2
(1)University of North Carolina at Greensboro, Greensboro, NC, (2)University of North Carolina Greensboro, Greensboro, NC
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background: The United States opioid epidemic continues to escalate both in overdose deaths and its toll on families, employers, emergency response systems, and health care. One challenge in addressing the opioid epidemic is crossover between prescription drug misuse and use of (often cheaper) illicit drugs such as heroin. Current surveillance of the epidemic primarily relies on overdose data from emergency rooms and reports from police encounters. However, these systems often do not distinguish between prescription opioid misuse and illicit drug use. Further, current surveillance can miss those who are using but do not seek medical care or come into contact with police. Self-reported data can help fill this gap.
Methods: We investigated self-reported past 30-day prescription drug misuse and illicit drug use using Wave V of the National Longitudinal Study of Adolescent to Adult Health. We present weighted results of frequency analysis and adjusted prevalence ratios by key demographic characteristics.
Results: Preliminary results show prescription opioids were the most commonly abused prescription medicines (8.52%), followed by sedatives (2.99%) and tranquilizers (2.93%). Across racial/ethnic groups, the majority misusing prescription opioids were white (71.05%). However, opioid misuse affected higher proportions of African Americans (11.05%), Pacific Islanders (10.05%), and American Indians/Alaskan Natives (14.69%) than Whites (8.58%). Roughly two percent of past 30-day prescription opioid misusers reported using heroin in the past 30 days compared to 0.22% of the overall sample. However, the most frequently used illicit drug among prescription opioid misusers was cocaine (6.94%), followed by other illicit drugs (3.68%) and crystal meth (2.69%). Additional analyses will assess differences in prescription drug misuse and illicit drug use by education, sex, and income.
Conclusions: Prescription opioid misusers are at risk for other types of drug use. Further, unlike much prior surveillance data, our analysis of self-reports shows opioid use disproportionately affects minorities.
Epidemiology Public health or related research
Abstract
Testing a longitudinal model of effects of information seeking from media and interpersonal sources on nonmedical cannabis use
Nehama Lewis, PhD1 and Lourdes Martinez, PhD2
(1)University of Haifa, Haifa, Israel, (2)San Diego State University, San Diego, CA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background: The transition to college is a period in which a significant number of college students initiate nonmedical use of cannabis. This study seeks to demonstrate that information seeking about cannabis may represent an early indicator of risk of nonmedical cannabis use among students. Specifically, we identify direct and indirect effects of information seeking from media (mass media, internet, and social media) and interpersonal sources (peers, partner, family, colleagues) on college students’ nonmedical drug use. Measures of information seeking used in this study were validated in a prior study, and are based on the results of a qualitative study among college students.
Methods: Six hundred and ninety-eight Israeli college students ages 18-25 participated in an online survey conducted between October 2012 and October 2013. Participants were undergraduates in their first semester who reported not using cannabis at baseline. We conducted a longitudinal test of the effects of information seeking on nonmedical cannabis use using an autoregressive cross-lagged structural equation model. Our model accounted for a range of known risk factors, including gender, other risk behaviors, number of close friends, general media use, peer and family cannabis use, and sensation seeking.
Results: The model fit the data well, and demonstrated a direct, positive effect of seeking from media sources at baseline on reported nonmedical cannabis use at 12-month follow up, controlling for other predictors. Seeking from interpersonal sources was a significant predictor of nonmedical cannabis use at 6-month follow up, which, in turn, was a significant predictor of use at 12-month follow up.
Conclusions: Findings suggest ways in which (easily accessible) information about cannabis may shape cannabis use trajectories among young adults. Drug prevention efforts may use reported or measured information seeking from media and interpersonal sources as an early indicator of risk, and address informational needs among at-risk young adults.
Communication and informatics Planning of health education strategies, interventions, and programs Social and behavioral sciences