1. Reward & Reminder A Multi-State Experiment in Community Mobilization for Real Prevention Results… For more info, see www.paxtalk.com By Dennis D. Embry, Ph.D.

2. Objectives Learn how and why a low-cost evidence- based community mobilization strategy (behavioral kernel/vaccine) can have large measurable effects Learn some of key principles to apply in other projects to produce results Generalize from tobacco to alcohol and social sources

3. The Original Scientist Dr. Anthony Biglan, President, Society for Prevention Research Senior Scientist, Oregon Research Institute; www.ori.org

4. Reward & Reminder in Action Reward and Reminder in action Video

5. Review of key ingredients What are the key behaviors by teams? How is this the same or different from law enforcement strategies? How is this different from an educational strategy? How is this different from most community efforts?

6. Wyoming case study History of Wyoming Use of science based practice at state level. Show sequence of data

7. Wyoming case study The change created –Policy –Finances –Community mobilization –Legislation Other learnings, innovations and aspects (next slide)

8. Wyoming case study Wyoming TV commercial Meaningful roles for kids Peer-to-peer adaptation Humor cards Getting larger norms, language shift, change Wyoming Communities and state need to be connected.

9. Wisconsin Replication State 10 times the size of Wyoming. Similar limitations: –45-60 days start up –No community input

10. Wisconsin Replication State 10 times the size of Wyoming. Similar limitations: –45-60 days start up –No community input

11. Kansas Replication 105 counties Only 10 counties receive R&R No integrated media campaign

12. The science behind this Effective mobilization is no accident

13. Recipe for Success

14. Building Blocks for Brain and Behavior Change

15. Antecedents & Ancestors Antecedents are the more immediate cues, prompts, language, people and structures in our social and physical environment that signal likely consequences from certain individual or group action. Ancestral stories are the combination people whose customs, behaviors and practices in the past that constrain or amplify present behavior.

16. Brain and Behavior Brain is the macro-structure, such as major functions, micro-structure (such as receptors) and neurochemistry that affects drive, mood, and every type of behavior. Behavior is actions by a person that can be measured or counted.

17. Watching the brain work Machines can now see the living brain work. This technology is becoming more powerful every year.

18. Serotonin When we feel safe or belong to a community or group with intact status, our serotonin rises. If our levels of serotonin go down because of chronic perceived stress, threats, perceived powerlessness or lack of any control, anger from others or humiliation or loss of status, our serotonin tends to decline. Serotonin changes as a result of the social environment and relationships we have with family, peers, and other adults.

19. Dopamine This is molecule of reward, goal setting, learning, movement and inhibition. Some might be surprised to know it controls both Go and Stop in the brain. Dopamine comes from rewarding activities, social reinforcement, sense of control, movement, eating, sex, fighting, and food. Most illegal drugs and many prescription drugs (e.g., stimulant drugs for ADHD) increase dopamine.

20. Changing the Brain Serotonin Drainers –Fighting & violence –Lowered status –High stress –Sex hormones –TV viewing? –Low physical activity –Some foods –Low sunlight Serotonin Makers –Touch –Affection –Increased status –Social connections –Perceived safety –Certain foods –Physical activity

21. R&R Changing the Brain Creating collaboration, cooperation and common goals changes sense of belongingempowering creativity of R&R coalitions Affecting brains of clerks Affecting the brains of youth teams

22. Consequences & Cognitions Consequences (Contingencies) are events or stimuli that follow some behavior that either increase, maintain or decrease the rate, duration or intensity of behaviors. Cognitions are non-verbal or verbal events by a person that can measured by self-report or bio- mechanical means.

23. R&R Consequences What are the consequences used in R&R? –Clerks –Stores –Law enforcement –Coalitions and community –Young people –Communities/state –Elected Officials

24. Thank-You Cards to Clerks

25. Scoreboard Consequence

26. Formula for Consequences The formula for the basic Matching Law.

27. Common Cognitions I can do that. Everyone else is doing it. I am bored. No one likes me. Ill lose my friends. She always… He never… She is (bad word)… He is (good word)… I am ________ We are ______

28. Cognitions in R&R What are cognitions about retailers and clerks? What are the cognitions about the program by its participants? What are the cognitions by the community about R&R? Consider the Relational Frame Network

29. Disposition, Development and Drive Disposition is temperament of an individual, which can involve such characteristics as irritability, extroversion, attention, general anxiety. Drive is the state that an individual is in, such as hungry, fear or contentment. Development is the universal age related limitations on behavior or cognitions.

30. Adolescent Changing Personalities

31. Adolescent Developmental Issues Teens seeing fear versus adults seeing fear. TeensAdults

32. Developmental Interactions

33. Drive & Disposition of Clerks Fearful of employment loss Often harassed by customers Stressed from low-pay, strange hours Fearful of dangerous teens Pressure to have high sales at store Incentives provided by tobacco companies

34. Environment & Ecology Environment is the larger social and economic context that affects the ABCs. Ecology is meta-environment context, such as the plains versus the Pacific Northwest

35. Ecology/Environment Example

36. Depression Data

37. R&R Logic Model

38. Seven Steps of Community Level Change 1.Clear vision and mission 2.Action planning 3.Leadership 4.Responsible community organizers 5.Documentation and feedback on intermediate outcomes 6.Technical assistance 7.Making outcome matter Source: Kansas Work Group/ Community Toolbox

39. RE-AIMing for Public Health

40. Understanding Epidemiology Reward and Reminder Emerges from Careful Epidemiology

41. Epidemiology Underneath Analysis of key predictors of 30-day use in Wyoming by Drs. Kami London, Narina Nunez, & Embry: –Perceived access –Friends who urge you dont smoke, drink or use. –Early antisocial behavior

42. Reduce Perceived Availability How can we reduce perceived availability from retailers? How can we reduced perceived availability from social sources? How can we reduce overall perceived community availability?

43. R&R Extensions Stimulate phone trees Distribute some visits every 1-2 months Older youth patrol for R&R hotspots Dribbled PR on stores that pass Use the R&R Protocol for alcohol, too Use R&R for social sources (e.g., shoulder taps)

44. Summary Good science underlying plan (e.g., Reward and Reminder behavioral vaccine) Good community coalition processes (e.g., adapted from the Kansas Community Tool Box Simple measures and data systems Clear epidemiological model and logic model Simple, simple, simple, and doable and sensible

45. Thank you. We hope we helped you today. Dennis D. Embry, Ph.D. PAXIS Institute 520-299-6770 dde@paxis.orgdde@paxis.org www.paxtalk.com