Using Data to Guide and Sustain Community Interventions Joel W. Grube, Ph.D. Prevention Research Center Pacific Institute for Research and Evaluation OJJDP UDETC National Leadership Conference Tucson, AZ August 18-20, 2005 Preparation of this presentation was supported by NIAAA grants AA and AA014958

What is Sustainability? Sustainability addresses three issues: Maintaining the benefits of a program Continuing a program Building the capacity to continue a program Broadly speaking sustainability refers to: “The process of ensuring an adaptive preventive system … can be integrated into ongoing operations to benefit diverse stakeholders.” () (Johnson, Hayes, Center, & Daley, 2004, p. 137)

Key Issues in Sustainability Sustainability is an ongoing dynamic process Sustainability is an adaptive process Sustainable innovation is integrated into normal operations and requires adequate infrastructure capacity Sustainable innovation should have proven benefit to diverse stakeholders Sustainability requires commitment and support: Champions Decision-makers Stakeholders Workers Source: Johnson, Hayes, Center, & Daley, 2004

Model of Sustainability Sustainable Innovation Continuation Innovation Integration into System Source: Johnson, Hayes, Center, & Daley, 2004 AssessPlanImplementEvaluateReassess/ModifyAssessPlanImplementEvaluateReassess/Modify DataData CapacityBuildingCapacityBuilding Stakeholder Benefits

Some Examples Using Data: Oregon Youth Alcohol Access Project Community Trials Project to Reduce Alcohol Trauma Diadema Project

Assess: Is there a problem? What is the problem?

30-Day Drinking Oregon 11 th Graders Source: Oregon Healthy Teens Survey Half of Oregon 11 th graders report drinking in the past 30 days….

30-Day 5+ Drinks Oregon 11 th Graders Source: Oregon Healthy Teens Survey Of those Oregon 11 th graders who report drinking in the past 30 days, 60% report having 5+ drinks….

30-Day Drug Use Among Oregon 11 th Graders Alcohol is by far the most commonly used and abused drug among Oregon 11 th graders…. Source: Oregon Healthy Teens Survey

Drinking Problems Among Oregon 11 th Grade Drinkers Source: Oregon Healthy Teens Survey

Annual Costs of Underage Drinking in Oregon 2001 (Millions of Dollars) Pain & Suffering Work Lost and Other Costs Medical Costs Source: Enforcing Underage Drinking Laws Website: Total Costs: $697 million annually $387 per capita per year

Annual Costs of Underage Drinking in Oregon (2001) Problem Total Costs (Millions) Youth Violence $351.5 Youth Traffic Crashes $86.1 High Risk Sex $59.6 Youth Property Crime $49.1 Youth Injury $36.7 Poisonings & Psychoses $11.8 FAS Mothers Age $11.7 Youth Alcohol Treatment $90.5 Total$697.2 Source: Enforcing Underage Drinking Laws Website:

Planning: Where do we intervene? How?

Ease of Obtaining Alcohol by Oregon 11 th Graders Source: Oregon Healthy Teens Survey …Over 81% of Oregon 11 th graders say it would be very easy or sort of easy to get alcohol if they wanted…

Sources of Alcohol Past 30 Days by Oregon 11 th Graders CommercialSocial Source: Dent, Grube, & Biglan, 2005 Oregon teens use multiple sources to obtain alcohol…

Other Key Findings Drinking increases as perceived commercial and social availability increases Drinking increases as perceived enforcement of MIP laws decreases Use of social sources increases as commercial availability decreases Use of commercial sources increases as social availability decreases Dent, Grube, & Biglan, 2005

Indicated Points of Intervention Commercial Availability Reward and Reminder Compliance Checks Social Availability Shoulder Taps Party Dispersal MIP Targeted Media

Monitor Implementation What is being done? What dosage?

Pre-interventionIntervention Period Underage Access Activities Community Trials Project Source: Grube, 1997

Evaluate/Assess What effects? What benefits?

Effects of Reward and Reminder on Tobacco Sales BaselinePost Intervention Biglan, Ary, Smolkowski, Duncan, & Black, 2000

Effects of Reward and Reminder on Weekly Alcohol Use Biglan, Ary, Smolkowski, Duncan, & Black, 2000

Homicides per 1,000 Residents: Diadema, Brazil Before Sales Hours Restriction After Restriction Duailibi, Laranjeira, Ponicki, Grube, & Lacey, 2005 There were an average of homicides per year before the sales restrictions and per year afterward

Estimated Effects of Reducing Hours of Sales Number of Lives Saved Number of Lives Saved273 95% CI 95% CI % Reduction in Homicides % Reduction in Homicides46.1% Number of Assaults Prevented Number of Assaults Prevented224 95% CI 95% CI -66 – 514 % Reduction in Assaults % Reduction in Assaults25.8% Duailibi, Laranjeira, Ponicki, Grube, & Lacey, 2005

Reassess/Modify What is not working? What should be changed? Where are more resources needed?

Effects of Compliance Checks and RBS on Underage Sales Source: Grube, 1997

Public Support Is there public support?

Percent of US Population Supporting Alcohol Policies Proposed Policy Favor Strongly Favor Somewhat Oppose Somewhat Oppose Strongly Increase alcohol taxes by 5 cents to fund prevention Restrict alcohol ads to make drinking less appealing to youth Conduct compliance checks Require keg registration Source: Harwood, Wagenaar, & Zander, 1998

Conclusion Data can guide and sustain programs: Define the problem and the solution Plan and target interventions Monitor implementation Evaluate outcomes Reassess and modify interventions Marshall support for increased allocation of resources and infrastructure capacity

Key reference: Johnson, K., Hays, C., Center, H., & Daley, C. (2004). Building capacity and sustainable prevention innovations: A sustainability planning model. Evaluation and Program Planning, 27,