PRC Projects


Recent PRC Projects

Click on a project to view the abstract or click on a PI to review their bio.

A Community Trial in Alaska to Prevent Youth's Use of Legal Products to Get High
National Institute on Drug Abuse
Principal Investigator: Joel Grube
(4/1/2009 - 1/31/2015)

This study tests the efficacy of a community intervention to prevent young adolescents’ use of harmful legal products (HLPs) to get high. The intervention includes (a) a Community Mobilization component designed to increase awareness of the problem of HLPs use and to motivate community leaders and groups to take action and (b) Environmental Strategies in retail outlets, homes, and schools to reinforce community norms and values regarding youth use of HLPs and encourage the adoption of policies to restrict access to these products by adolescents. The study is being implemented in 16 remote rural (frontier) communities in Alaska that contain primarily Caucasian and Alaska Native populations. The proximal outcomes are to (a) increase community readiness to implement environmental strategies to prevent HLP use and (b) reduce the availability of HLPs. The distal outcomes are to reduce the number of young adolescents (5th, 6th, and 7th graders) who use or intend to use HLPs. The research design is a five-year randomized control trial (RCT) in which eight pairs of matched frontier communities will be randomly assigned to experimental and control conditions. The 16 communities are located in various regions of the state, with population sizes that range from 536 to 5,937. This efficacy trial integrates quantitative methods with participatory research principles that honor the unique cultural heritage of each community. The significance of this study is its potential to produce an effective and sustainable intervention to prevent youth’s use of inhalants and other harmful legal products in remote rural communities across the U.S.

A Multidimensional Community-Based Strategy for Preventing Underage Drinking
National Institute on Alcohol Abuse and Alcoholism
Principal Investigator: Joel Grube
(9/15/2014 - 6/30/2019)

Preventing drinking among youth is a major public health priority. The estimated cost of underage drinking in the U.S. is $61.9 billion annually (Miller, Levy, Spicer, & Taylor, 2006). Alcohol is the most commonly used and abused drug in the U.S., with 41% reporting use in the past 30 days (Johnston, O'Malley, Bachman, & Schulenberg, 2012). Underage persons who drink are likely to drink large amounts (Flewelling, Paschall, & Ringwalt, 2004). Drinking by young people results in as many as 5,000 deaths from motor vehicle crashes, homicides, suicide, and other injuries (Hingson & Kenkel, 2004; National Highway Traffic Safety Administration, 2008; National Institute on Alcoholism and Alcohol Abuse, 2007). This project will build on a just-completed experimental evaluation of a community intervention to reduce adolescent access to alcohol (Flewelling et al., 2012). In that study, 36 Oregon communities were randomly assigned to receive or not receive stepped up enforcement of laws regarding sale of alcohol to minors plus a program for rewarding clerks for not selling to minors. The intervention reduced youth access to alcohol. Also, communities that achieved high levels of enforcement and rewards had lower rates of youth use. However, the intervention did little to alter social influences to drink. We believe that the addition of interventions designed to mobilize peer and parent influences would alter risk factors for alcohol use that are not adequately addressed by policy interventions. Therefore, the project would evaluate a strengthened intervention that (a) increases the level of enforcement and rewards for not selling and (b) adds youth activities and family communications that have been shown to enhance social influences. Based on recent research on the value of associating not smoking with social acceptance (Gordon, Biglan, & Smolkowski, 2008), we believe that a novel peer influence intervention that associates not drinking with social acceptance can have a greater deterrent effect than interventions using more traditional harm-related and refusal skills approaches. In addition, our research has identified a brief, positive parent communication activity that does not require significant classroom time, minimizes parent-child conflict, and effectively conveys parental expectations (Biglan et al., 1996). We propose to evaluate the intervention in a randomized trial involving 36 communities. We will assess the impact of the intervention through purchase surveys, surveys of 8th- and 11th-grade students, and law enforcement records.

Addressing High School Marijuana Use in Context of Increasing Social Acceptance
National Institute on Drug Abuse
Principal Investigator: Bettina Friese
(7/1/2014 - 4/30/2017)

Background: Marijuana use among adolescents is associated with a variety of negative health and psychosocial outcomes. The rapidly changing normative context surrounding marijuana use, however, raises significant challenges for prevention. To date, 20 states and the District of Columbia have legalized marijuana for medical use, 17 states have decriminalized marijuana possession, and two states have legalized marijuana for recreational use. Given the momentum towards normalization of marijuana use, new approaches are needed to intervene with youth to reduce marijuana use and risks associated with marijuana use.

Aims: This feasibility study will develop an intervention, using a combination of traditional media and mobile technologies to reduce marijuana use among high school students by increasing knowledge and concern regarding high-risk use and raising awareness of the inconsistency of such behaviors with personal autonomy and agency. Specific aims are (1) adapting previously-tested marijuana communication approaches for use in high schools; (2) testing feasibility of use of smartphone technology to deliver appropriate messages proximate to time of behavioral decision; (3) conducting an efficacy test regarding potential of such a campaign to reduce the prevalence of use and quantity and frequency of marijuana use among high school students, via increasing knowledge and concern regarding high-risk use, and the inconsistency of such behaviors with personal autonomy; (4) assessing whether these approaches have a positive effect on alcohol-use related outcomes.

Approach: We will conduct focus groups to develop the messages and materials for the intervention. Following message development, we will work collaboratively with Klein Buendel (KB), a multi-media development firm that specializes in mobile phone applications for public health interventions, to develop a smartphone app and text messaging platform. The intervention will be implemented in a total of six schools in the San Francisco Bay Area using a cross-over design. The California Healthy Kids Survey, a state-wide survey that allows custom questions, will occur in each school in Years 1-3 of the study, and will be used to assess the efficacy of the intervention. Following the implementation of the intervention in the schools, face-to-face interviews with school administrators will be conducted to ascertain their reactions to and experiences with the intervention.

Innovation: This feasibility study will explore the use of smartphone technology and text messaging as a way to extend the effectiveness of traditional school-based media approaches and disseminate prevention messages to youths at a time and place proximal to behavioral decision regarding marijuana use. This media-based approach does not require classroom or teacher time, making it viable for widespread adoption in an era of growing demands for school academic performance and decreased available school resources for prevention. If successful, this feasibility study will provide the basis for a larger randomized trial.

African American Perceptions of Tobacco Denormalization Approaches
Tobacco-Related Disease Research Program
Principal Investigator: Tamar Antin
(8/1/2013 - 7/31/2016)

Due to comprehensive tobacco control programs, smoking has decreased in the general population. Part of their success is attributable to a denormalization strategy that has made smoking socially unacceptable. In spite of resultant population-level reductions in smoking, high prevalence of tobacco use remains concentrated among the most marginalized groups in California, including African Americans (19.3%) who have the highest smoking prevalence in the state and who experience disproportionate risk from tobacco-related illnesses. Smoking among African American young adults, in particular, is of critical concern given the relatively higher rates of smoking among young adults compared to other age groups, the role of young adulthood in establishing long-term health behaviors, and research indicating that smoking initiation among African Americans occurs in young adulthood which is later than other ethnic groups. Research has not yet considered the impact of denormalization strategies on groups for whom tobacco use remains relatively high. Existing research raises questions about the extent to which denormalization strategies can affect all populations equally because of (1) competing marketing strategies from the tobacco industry that aggressively target communities of color, (2) the establishment of sub-communities where smoking is tolerated and normalized, or (3) attitudes about social exclusion and “otherness” that result from marginalized groups’ previous experiences with discrimination. The proposed research will be among the first to investigate African American young adults’ perceptions of tobacco denormalization strategies, and the extent to which race/ethnicity and gender intersect to shape perceptions of these strategies. To investigate these aims, the research team will conduct 4 focus groups and 60 interviews with African American young adults between the ages of 18-25. A multiple method qualitative approach will be used that includes photo elicitation and cultural consensus activities as well as closed- and open- ended questions to help uncover an extensive array of conscious and unconscious perceptions of denormalization strategies for participants as well as providing a way to triangulate emergent themes from individual methods in order to minimize threats to validity. Narrative data will be coded and then analyzed using a pattern-level analytic technique. Results of the proposed study will shed light on why smoking may persist among members of this marginalized group, and provide important information on how to best target tobacco prevention and treatment for African American young adults in California. A comprehensive dissemination strategy includes the development of manuscripts for publication in peer-reviewed journals as well as the creation of a project website, podcast series, and social media component to disseminate study findings to and elicit feedback from the study population and public health professionals.

Barriers to Alcohol, Drug and PTSD Treatment for Returning National Guard
National Institute on Alcohol Abuse and Alcoholism
Principal Investigators: Roland S. Moore, Genevieve Ames
(9/10/2012 - 1/31/2016)

The goal of this recently-funded 3.5-year program of qualitative research is to identify, explain and thereafter provide guidelines for eliminating individual, socio-cultural, and structural barriers to treatment for alcohol and drug use disorders and Post-Traumatic Stress Disorder among U.S. National Guard service members returning from deployment in Afghanistan and Iraq. Psychological barriers veterans face to seeking treatment include stigma. Socio-cultural barriers may include culturally-prescribed beliefs about help-seeking and the influence of social settings such as the family, community and the civilian workplace. Additionally, treatment access policies, deployment exit procedures, employment policies and other structural factors may also systematically deter soldiers from seeking help, despite substantial efforts by the armed forces and the VA to encourage personnel to seek treatment. The objectives by which we will meet this goal are as follows:

Specific Aim 1: To identify and provide contextual understandings of individual-level barriers (e.g., stigma, fear of jeopardizing future government and civilian employment) that inhibit National Guard members from seeking treatment for PTSD or alcohol or drug use disorders after they return home from deployment.

Specific Aim 2: To identify and describe barriers for treatment-seeking in the cultural and social environment (e.g., workplace, community and family settings) for post-deployment National Guard personnel as they return to civilian life.

Specific Aim 3: To identify and provide understandings of the structural barriers (e.g., military and civilian employer screening procedures, lack of military confidentiality, insurance coverage, promotion policies and procedures, etc.) that impede treatment seeking in this population.

We propose to conduct semi-structured qualitative interviews with a stratified random sample of 100 members of the Army National Guard who indicate symptoms of PTSD or substance use disorders in a screener administered to 1000 personnel with combat exposure during deployment. Interviews will occur at least six months after their return from Afghanistan and Iraq. We will also interview 16 key informants (e.g., family support providers, chaplains, counselors, and officers) who have practical experience regarding treatment-related issues. A dynamic critical incident approach that elicits narratives illustrating the treatment seeking process, including individual, socio-cultural, and structural impediments, will provide evidence for each of the three specific aims.

Barriers to Blue-Collar HMO Smoking Cessation Participation
Tobacco-Related Disease Research Program
Principal Investigator: Carol Cunradi
(8/1/2012 - 1/31/2016)

Californians who are blue-collar workers continue to smoke at elevated rates relative to white-collar workers. Despite later age of initiation, African Americans have one of the highest smoking rates among California's diverse populations. Although statewide smoking prevalence has decreased over the last few decades, significant tobacco-related disparities persist among these groups. A particular paradox is that municipal transit operators, a blue-collar occupational group with a large proportion of African Americans, maintain high rates of smoking even though they have access to free or low-cost HMO-based smoking cessation support programs and activities (e.g., nicotine replacement therapy; cessation support groups). While a considerable amount of research has investigated barriers to cessation, little is known about factors that hinder blue-collar workers from participating in free or low-cost smoking cessation support activities that are available through their HMO as an employee benefit. This proposal seeks to take this research to the next step in order to lay the groundwork for productive tobacco cessation efforts with this blue-collar, largely African American population. The broad, long-term objectives of this study are to identify the extent that aspects of the workplace social environment and structural factors serve as barriers to blue-collar transit worker participation in free or low-cost HMO-based smoking cessation support activities, and to determine how these barriers may be overcome. The study's two Specific Aims are to: (1) Identify and describe barriers (and potential facilitators) in the workplace social environment to participation of transit workers in free or low-cost HMO-based smoking cessation support activities. Examples of barriers and facilitators are job strain and perceived coworker support for smoking cessation, respectively. (2) Identify and provide understandings of the workplace structural barriers that limit participation of transit workers in free or low-cost HMO-based smoking cessation support activities. Examples of workplace structural barriers are perceived work rules tacitly encouraging smoke breaks and non-standard work schedules (e.g., shift work, split shifts). Secondary Aims are to: (1) Disseminate study findings to key stakeholders, including transit agency officials, transit union leaders, Kaiser Permanente Regional Health Education, California Tobacco Control Program staff and the African American Tobacco Control Leadership Council, and to transit workers using videos starring transit workers in transit employee waiting and meeting areas and web forums; and (2) Lay the groundwork for an intervention aimed at increasing transit worker participation in smoking cessation support activities. The project will be conducted among municipal transit workers (bus operators and maintenance employees; n=1500) at the Alameda-Contra Costa Transit District (AC Transit), based in Oakland, California. AC Transit is the third largest public bus system in the state. At the outset of the project, a Union-Management Advisory Group will be formed consisting of research staff, transit agency managers, and transit union representatives. The Advisory Group will meet quarterly and guide all aspects of the project. Sorensen and colleagues' social-contextual model of behavior change offers a theoretical framework for the proposed research. In order to develop a detailed and nuanced understanding of barriers to (and facilitators of) participation in smoking cessation activities among these workers, the study will employ a mixed methods approach, including focus groups of workers, survey data collection, and semi-structured ethnographic interviews of key informants. The dissemination of study findings, including videos produced by and starring transit employees, will provide information that can be used to tailor interventions aimed at increasing blue-collar worker participation in HMO-based smoking cessation activities. We expect the study results will address an important gap in research knowledge, and will have a significant impact across the state and the nation.

Berkeley Building Capacity
Substance Abuse Mental Health Services Administration
Principal Investigator: Robynn Battle
(10/1/2011 - 9/29/2015)

Overview: The "Berkeley Builds Capacity" (BBC) program's main goal is to reduce HIV and the negative consequences associated with related substance use among East Bay college students. The program is a collaboration between the Berkeley Free Clinic and UC Berkeley's University Health Services funded by SAMHSA. The BBC Project is based on three key Evidence-Based Interventions (Stages of Change Model, Community Trials Intervention to Reduce High-Risk Drinking, and Brief Alcohol Screening and Intervention for College Students (BASICS)) that have been identified by SAMHSA and the CDC as best practices, and serve to address risky health behaviors within a broader context of peer and social norms, societal and environmental conditions, and services gaps, and are specifically relevant to the program’s focus populations with regard to age, gender, and culture.

Changing Environmental Influences on Adolescent Alcohol Use and Risk Behaviors
Eunice Kennedy Shriver National Institute of Child Health & Human Development
Principal Investigator: Hilary Byrnes
(8/1/2014 - 6/30/2018)

Teens' increased freedom to explore different environments potentially increases exposure to contextual risks such as social disorganization. Socially disorganized areas, in which residents have difficulty maintaining social and physical order, are related to increased teen ATOD use/delinquency. Alcohol outlets, indicators of disorganization, influence teen alcohol use through increased access and perceptions of alcohol use as normative. In addition, contextual resources such as collective efficacy, a resource based on social ties among neighbors and their willingness to intervene for the good of the neighborhood may protect against teen risk behavior. Prior studies have not considered context dynamically, instead focusing on a static area, typically administrative units (e.g., census tracts around the teen's home as the area of environmental influence. However, these units may not capture contextual risks/resources where teens spend time, potentially missing a key influence on ATOD use/delinquency. By instead measuring all the places teens spend time, termed here "dynamic context," we will address this gap in past research. The aims of the study are to: 1) Test whether teens' dynamic context includes different geographical areas and reflects greater levels of social disorganization and lower levels of collective efficacy than their residential context; 2) Test whether teens' dynamic contexts broaden and shift to areas of greater social disorganization and fewer contextual resources as they progress into older adolescence; and 3) Test whether: a) increases in exposure to social disorganization and decreases in exposure to collective efficacy in the dynamic context contribute independently to increases in ATOD/delinquency throughout adolescence; and b) these changes in exposure in the dynamic context are more predictive of teen risk behaviors than social disorganization/collective efficacy in the residential space, controlling for covariates. 325 14-16 year olds will be tracked for one month over 3 annual waves. GPS-enabled smartphones will be used to measure teen travel patterns to delineate teens' dynamic contexts, and allow measures of disorganization and collective efficacy to be appended to location points, thus quantifying exposure to contextual influences. Using the phones will also allow ecological momentary assessment (EMA) through text-prompted web surveys to assess ATOD use/delinquency to determine how these behaviors assessed in real-time are linked to exposure to disorganization and collective efficacy. The study will build on an ongoing funded grant that provides an existing sampling frame and archival contextual data. The proposed study expands traditional views of contextual influences by using a novel GPS- EMA integrated approach to examine the importance of considering exposures where teens spend time, as these may be more relevant for risk behaviors. This must be understood in order to inform prevention efforts/policy. This study could guide future prevention efforts that use the phones to deliver prevention messages proximal to risk behaviors by identifying precursors of risk behavior through teens' travel patterns.

Cigarette Warning Labels: Research Synthesis an Impact on Smoking Behavior
National Cancer Institute
Principal Investigators: Al Stein-Seroussi, Chris Morrison
(12/1/2013 - 11/30/2015)

PIRE is conducting a randomized control trial (RCT) to study the effects of cigarette warning labels on smoking-related attitudes and behaviors. Half the participants receive graphic warning labels and half receive text warning labels during a 28 day period, and we administer a survey once per week for five weeks. We are recruiting 2200 participants across two research sites (Chapel Hill and Oakland).

Community Alcohol Outlet Density, Drunken Driving and Violence: Core Group Theory
National Institute on Alcohol Abuse and Alcoholism
Principal Investigator: Juliet P. Lee
(9/20/2011 - 6/30/2015)

Overview: The aim of this study is to understand how drunken driving and alcohol-related violence are maintained in communities. Through a combination of bar patron surveys and bar-based ethnography in all bars across six mid-sized California cities, the study aims to test these three hypotheses: (1) Higher rates of neighborhood "social disorganization" (based on relative socio-economic status of residents) will be related to higher rates of drunken driving and aggression among bar patrons; (2) More bars in an area will be related to more clustering, within these bars, of patrons according to their likelihood for problematic drinking, drunken driving, and violence; and (3) More clustering by patrons in this way will result in tighter social relations among people in bars identified with drunken driving and violence.

Current Findings: Bar scouting assessments, unobtrusive observations in bars, and systematic social observations at bars, coordinated with arrest data on violent assaults show that characteristics of bar and bar environments are related to violent crime events; these events take place just outside most bar environments, especially in areas with greater bar densities. "Take it outside" is the take-away message. Analyses of data from ethnographic observations and interviews with bar patrons and staff found that (1) Greater social disorder in bars was associated with increased incidence of assault in a univariable model, but this relationship was explained by other aspects of the bar environments. Greater social interaction and more patrons in the bars predicted greater incidence of assaults. Greater proximity to other outlets around a bar was also associated with the count of assaults. Bar managers described strategies to locate aggression outside the bar environment in order to minimize liability of the bar. (2) Many venues in our study evidenced a distinct late night transition which entailed a more lively and potentially disordered bar environment. These included establishments operating under restaurant licenses. (3) Characterizations of barroom environments as risky based on investigator-generated criteria were sometimes at odds with perceptions of risks based on qualitative assessments by bar observers.

Conclusions: Density of bars may increase risks for neighborhood assaults by promoting between-bar competition for patrons, including increased alcohol sales with no increase in bar responsibilities to public health outcomes. Additionally, loopholes in alcohol policy may enable "morphing" of restaurants into bars which may in turn increase concentration of risks for DUI and other problems in high density entertainment zones. However, conceptualizations of disorder and risk from a public health perspective may be at odds with the lived experience of staff and patrons, who may find risky environments to be "fun." Interventions that diagnose bar environments in exclusively public health science terms may alienate staff and patrons, limiting their potential to win public support.

Confronting Cigarette Packaging: A Comparative Study of the Ethics and Effects of Fear-based Warning Labels
The University of British Columbia
Principal Investigators: Roland S. Moore, Dr. Kirsten Bell
(3/1/2013 - 2/28/2015)

The purpose of this comparative study is to generate objective, expert social science knowledge about the ethics and effects of recent legislated changes to cigarette labeling and packaging requirements in Canada, the USA, Australia and the United Kingdom. Accordingly, the objectives of this study are to:

  1. Analyze the policy environment in all four countries to compare and contrast the legislation under development, including its intended aims, expected outcomes and whether legislators have been sensitive to diversity in the smoking population;

  2. Explore the views of smokers in a naturalistic rather than contrived setting to examine their perceptions of and perspectives on the new labels;

  3. Provide policy makers with preliminary data on some of the effects of the legislation and recommend practical action to improve equitability through policy refinements.

Culturally Adapted Brief Motivational Intervention for Heavy Drinking Latinos
Principal Investigator: Raul Caetano
(1/1/2015 - 5/14/2017)

Economic Contraction and Alcohol-Related Suicides: A Multilevel Analysis
Principal Investigator: Raul Caetano
(1/1/2015 - 6/30/2016)

Raul Caetano will work with PI Kaplan and other co-investigators in all phases of data analysis, interpretation of results and manuscript writing. Caetano is a psychiatrist and alcohol epidemiologist with expertise in measurement of alcohol consumption and associated consequences, drinking among ethnic groups in the U.S., intimate partner violence and the association between alcohol-related problems and socioeconomic conditions. He has expertise on quantitative research methods and data analysis, which will also be employed in the present contract.

Environmental Approaches to Prevention (Years 31-35)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Principal Investigator: Paul Gruenewald
(1/1/2013 - 11/30/2017)

In the current Center round (2012 - 2017) we offer a research program which builds upon our previous research in our ecological laboratory, 50 cities in California. We focus upon micro- and macro-social ecological conditions that affect use and problems in four research components: “Environmental Strategies to Reduce Community Alcohol Problems: A Randomized Trial” – Assesses the impacts of environmental prevention programs upon alcohol use and problems using a matched subset of intervention and comparison cities in the 50 city database (Mallie J. Paschall and Robert Saltz, Component Directors). “The Role of Drinking Contexts in Alcohol-Related Problems among Youth” – Examines the day-to-day conditions that affect underage access to and use of alcohol (Sharon Lipperman-Kreda and Melina Bersamin, Component Directors). “Maladaptive Parenting, Activity Spaces, Alcohol and the Substance Use Environment” – Examines the social and behavioral mechanisms by which the routine drinking activities of parents lead to maladaptive parenting and child abuse and neglect (Bridget Freisthler, Component Director). “Direct, Indirect and Total Impacts of Alcohol Outlets on Related Problems” – Considers the multi-year regional social and economic processes that couple alcohol outlets to problems (Paul J. Gruenewald, Component Director). In addition, we support an “Education and Dissemination Component in Support of Community Action” - Providing education and dissemination activities directed at the community level and supporting environmental prevention interventions. Each of these research components is described under the names of each of the Component Directors.

The rich and varied ecological conditions for drinking and problems that arise across neighborhoods and cities in California provide an ideal environment in which to conduct these studies. The Center enables us to conduct these integrative and integrated research activities in a suitable multi-disciplinary environment. PRC provides the best coordinating environment in which to study the global social and economic conditions that affect access to alcohol in community settings, the social and behavioral processes that affect adult and youth drinking, and the choice of particular environmental contexts for drinking all interact to affect drinking and problems.

Center Grant

Environmental Approaches to Prevention, Component #2: Environmental Strategies to Reduce Community Alcohol Problems: A Randomized Trial
National Institute on Alcohol Abuse and Alcoholism
Principal Investigators: Mallie J. Paschall, Bob Saltz
(1/1/2013 - 11/30/2017)

Hazardous drinking and alcohol-related problems such as drinking and driving remain prevalent among adolescents and young adults in the U.S. A number of promising environmental strategies have been identified to address these problems, including party dispersal operations, underage decoy operations at retail establishments, and penalties for underage possession and consumption of alcoholic beverages and drinking and driving. Although research indicates that some alcohol control policies (e.g., raising minimum legal drinking age to 21, lowering legal blood alcohol limit for driving) have beneficial effects on alcohol misuse and related problems among young people, much less is known about the effectiveness of local enforcement activities. Research on the effectiveness of local alcohol policy enforcement is limited by substantial variability in the implementation and intensity of enforcement activities, and by methodological challenges in measuring their intensity. The proposed five-year study will advance our understanding of how effective local enforcement strategies are in reducing hazardous drinking and alcohol-related problems such as drinking and driving by young people. The study will capitalize on the Strategic Planning Framework/State Incentive Grant (SPF/SIG) in California from the Center for Substance Abuse Prevention, and will involve 24 cities that are part of the 50-city sample meeting criteria for the "Environmental Approaches to Prevention" center grant. Half of the cities will be randomly assigned to implement environmental interventions such as party patrol operations, underage decoy operations, and DUI sobriety checkpoints. Archival data will be used to examine intervention effects on alcohol problems among young adults and teens in the 24 cities from 2012 to 2016, such as alcohol-related motor vehicle crashes, violent assaults, injuries, and underage drinking estimates from the California Healthy Kids Survey. Pre- and post-intervention interviews also will be conducted with 2,400 18- to- 30-year-olds to examine intervention effects on possible intervening mechanisms through which local enforcement strategies may affect alcohol use and related problems, including perceived enforcement of alcohol policies, perceived ease of obtaining alcohol, use of social and commercial alcohol sources, and drinking locations. Study aims are: (1) to determine whether there is a significant reduction in community alcohol problems (alcohol-related motor vehicle crashes, violent assaults, injuries, underage drinking), particularly among young people in SPF/SIG intervention cities relative to controls; and (2) to investigate the intervening mechanisms through which local enforcement strategies may affect alcohol use and related problems among young people (e.g., perceived enforcement of alcohol laws).

Environmental Approaches to Prevention, Component #3: The Role of Drinking Contexts in Alcohol-Related Problems among Youth
National Institute on Alcohol Abuse and Alcoholism
Principal Investigators: Sharon Lipperman-Kreda, Melina Bersamin
(1/1/2013 - 11/30/2017)

Previous studies about the relationship between alcohol drinking contexts and drinking-related problems among young people are limited in that they have (1) focused primarily on young adult college students, (2) relied on retrospective recall of past events and behaviors, (3) not focused on separating out the unique effects of drinking location (e.g. beach, or house party) and setting characteristics (e.g. group size, gender composition), (4) typically focused on a small number of drinking contexts and drinking-related problems (e.g. aggression or risky sex only), and (5) been cross-sectional and have not studied dynamic relationships over time. These shortcomings limit our understanding of the contribution of drinking context to alcohol-related problems among youth and what approaches can be used to target high risk drinking contexts.
The proposed research addresses these shortcomings by studying drinking contexts, alcohol consumption, and alcohol-related problems among adolescents and obtaining longitudinal real-time data to reduce recall errors and better capture the dynamic relations among drinking contexts, consumption, and problems. Specifically, the aims of the proposed study are: (1) to identify and describe youth drinking contexts and setting characteristics; (2) to examine the dynamic relationship between youth drinking contexts and alcohol-related problems; and (3) to study the independent contribution of drinking location and setting characteristics and the potential interaction among them in predicting youth alcohol-related problems.
A mixed-method approach with telephone surveys and ecological momentary assessments (EMA) will be used. Telephone survey data will be obtained at two time points from youth (N = 1,200) in 24 mid-sized California cities. Wave 1 of the survey will allow to initially investigate drinking contexts, consumption, and problems cross-sectionally, as well as to identify drinking and non-drinking youth (N = 216) for an in-depth study using EMA to obtain real-time data about alcohol use, drinking locations and contexts, and alcohol-related problems. The EMA study will allow us to (1) investigate the dynamic relationships among drinking contexts, consumption, and problems, and (2) inform the development of a comprehensive drinking contexts instrument for Wave 2. Wave 2 of the survey will allow us to investigate the relationships between context and alcohol-related problems at the population level. The longitudinal design will also allow us to investigate changes across time in adolescents’ drinking contexts and whether the selection of drinking contexts differs across periods of adolescent development. Results from the proposed study will guide prevention efforts in targeting high risk drinking contexts.

Identifying how drinking contexts and youth characteristics change over time
Medical press, March 17, 2015

Environmental Approaches to Prevention, Component #4: Maladaptive Parenting, Activity Spaces, Alcohol and the Substance Use Environment
National Institute on Alcohol Abuse and Alcoholism
Principal Investigator: Bridget Freisthler
(1/1/2013 - 11/30/2017)

Current research suggests that a relationship exists between alcohol use and child maltreatment. To date, however, a dearth of information exists on how much of maltreatment occurs when a parent has been drinking or how local alcohol environments, including how where a parent spends their time exposes him or her to various drinking locations and contexts. In this application we build upon and extend that work in three important ways: (1) The proposed study assesses maladaptive parenting and related alcohol use during discipline events, allowing us to make statements about the incidence of alcohol-related harsh and neglectful parenting practices; (2) This prospective study uses individuals own activity spaces to understand how drinking locations and contexts may affect these relationships over time; and (3) building upon our findings related to drinking locations, this study will explicitly examine parents’ use of their local alcohol environments, including how social relationships may exacerbate or hinder drinking behaviors that are related to maladaptive parenting. Sixty semi-structured ethnographic interviews will allow us to assess and determine the range of parent activity and related drinking spaces, drinking contexts, and social supports to enable to development of survey questions on these topics. Two waves (Years 2 and 4) of multi-modal (telephone and web) survey data collection with 2,100 parents of children (birth to 10 years) sampled throughout 30 communities across the state of California will provide information about maladaptive parenting, alcohol use, activity spaces, and drinking locations and contexts that will address the following specific aims:

  1. Investigate whether or not parents are more likely to use abusive or neglectful parenting techniques immediately before, during and after parenting discipline events compared to when no drinking has occurred;

  2. Determine if the size and use of activity spaces by parents moderates the relationship between density of alcohol outlets, use of drinking venues and maladaptive parenting; and how changes in activity spaces affect use of outlets and drinking venues controlling for other known correlates of maladaptive parenting; and

  3. Examine how characteristics of social support networks (location to parent, drinking behavior, frequency of contact) moderate drinking behaviors and exposure to alcohol environments to affect maladaptive parenting.

Environmental Approaches to Prevention, Component #5: Direct, Indirect and Total Spatial Impacts of Alcohol Outlets on Related Problems
National Institute on Alcohol Abuse and Alcoholism
Principal Investigator: Paul Gruenewald
(1/1/2013 - 11/30/2017)

The research proposed in this component will explicate some large scale social and economic dynamics that affect geographic distributions of alcohol outlets, expose populations to risks associated with those outlets, and increase rates of alcohol problems. We will measure the spatial and temporal scale of outlet effects to estimate the direct, indirect and total impacts of physical availability on problems. Theoretical and empirical work suggests that the social and economic forces that affect outlet distributions involve spatial interactions between people and places that take place over multiple years. Studies of problems related to alcohol outlets suggest that similar spatial and temporal effects underlie outlet effects. If so, previous studies that focused on single years and small areas may have underestimated the impacts of outlet densities on problems. Current empirical work also indicates that outlets are over-concentrated in low income minority neighborhoods, in populations which are known to consume less alcohol. This suggests spatial displacement in market response to demand as outlets open in retail areas near to, but not in, high income neighborhoods with populations which consume more alcohol. If so, residents of low income neighborhoods may bear excess social costs related to outlets in the form of greater problems.

The proposed research will assess the temporal and spatial impacts of the demand for alcohol upon outlet growth, MVCs, assaults, IPV and CAN from through 2016. The Specific Aims of the project are to:

(1) Assess the growth of outlet densities, by type, in response to known population surrogates for alcohol demand over space and time,

(2) Assess the growth of four problems related to alcohol outlets in response to surrogates for alcohol demand and outlet densities (MVCs, assaults, IPV, and CAN) over space and time, and

(3) Calculate direct, indirect and total space-time effects from these model

Statistical models and methods used in this component will also:

(4) Support archival evaluations of community-based environmental prevention programs (Component #2) and assist in the analysis of outcomes related to maladaptive parenting (CAN, Component #4).

The short term goals of the project are to provide estimates of the size and significance of space-time lags in statistical assessments of effects related to outlet densities for four alcohol related problems. The long term goal is to develop a sense of scale for these effects in order to grasp their full public health impacts.

Environmental Approaches to Prevention, Component #6: Education and Dissemination in Support of Community Action
National Institute on Alcohol Abuse and Alcoholism
Principal Investigator: Kathryn Stewart
(1/1/2013 - 11/30/2017)

The Education and Dissemination Component will capitalize on the knowledge generated by the previous Center Grants and research at PRC and elsewhere as well as the emerging information provided by the new research components to better inform alcohol prevention efforts at the community level. We will strengthen the translational efforts needed to incorporate knowledge of the social ecology of alcohol problems into policy and practice in communities through the development of innovative tools that link research findings to decisions in communities. The proposed research components have important implications for prevention, especially related to underage drinking and risky drinking among young adults.

The aims of the Education and Dissemination Component are to develop and strengthen translational processes for this research through (1) Developing web-based tools to guide community prevention leaders in planning and decision making processes using a logic model approach; (2) Developing guidance materials based on key research findings from past and on-going PRC projects; and (3) Disseminating guidance materials using communication channels found to be useful and effective, including a dissemination website; an electronic newsletter tailored to the interests of communities by highlighting community efforts; and promotion of materials to gatekeepers and opinion leaders at the national level.

Specific Aim 1 will be accomplished in coordination with the Component 2 of the proposed Center Grant renewal, Environmental Strategies to Reduce Community Alcohol Problems: A Randomized Trial. Component 2 will develop tools for community planning related to underage and young adult drinking that will be adapted for web-based use by the Education and Dissemination component. Pilot sites will be selected and will be given access to the planning tools in three waves in Years 3-5. Sites in each wave will be asked for feedback and the tools will be refined based on that input.

Specific Aims 2 and 3 will coordinate with all research components to summarize and synthesize existing and emerging findings on the social ecology of alcohol problems and disseminate them through channels found in previous experience to be most useful and accessible to community audiences.

Establishing Smokefree Policy in California Indian Casinos
California Tobacco Related Disease Research Program
Principal Investigator: Roland S. Moore
(8/1/2011 - 10/31/2015)

Through lowered exposure to secondhand smoke, smokefree indoor space policies aim to reduce worker health risks, as shown by research on the global expansion of smokefree workplace laws. However, worker and customer protection from secondhand smoke is still limited in the gaming industry in California and elsewhere, because the sovereignty of California Indian tribes means that they are not subject to state tobacco control policy, and fears of business loss have kept most tribes from eliminating smoke from their casinos. The pioneering fieldwork of Pritsos and others has shown that as smoking prevalence has dropped in the general population, old assumptions promoted by the tobacco industry about loss of business following smokefree casino policies may be entirely unwarranted.

A promising intervention has been developed by ETR Associates, with funding from the California Tobacco Control Program, to work collaboratively with a Northern California gaming tribe's council, through its casino management team, to implement smokefree workplace policies. The overall goal of this proposed study, therefore, is to conduct research that will enhance, refine, and establish the feasibility of a standardized version of this intervention for working collaboratively with gaming tribes' councils through their associated casino management to establish smoke-free workplace policies in their casinos.

The objectives by which we will meet this goal are as follows:

Specific Aim 1: To conduct formative research by interviewing Northern California tribal leaders and their casinos' management teams on specific barriers to implementing casino smokefree policies, and to elicit their feedback on the most culturally acceptable and business sensitive methods to formulate, implement and uphold policies to eliminate secondhand smoke from their premises.

Specific Aim 2: To build casino management teams’ capacity for influencing smokefree policy changes at the level of the tribal council. These interventions will incorporate feedback from tribal leaders and casino managers, results from surveys with casino patrons regarding their attitude towards smokefree policies in these casinos, and measurements of airborne particulates in different areas of their casinos.

Specific Aim 3: To assess the effectiveness of these policy change interventions through pre- and post- observations of smoking behavior and measurements of tobacco-related air quality in two distinctly different Northern California casinos. Qualitative interviews with casino managers will provide process evaluation as the interventions proceed.

To meet our study goals, we will analyze qualitative interviews with 2 casino managers per 8 reservations randomly selected from the 37 tribally-owned casinos in Northern California. Incorporating their suggestions, we shall implement a structured intervention with two Northern California casinos, which will be included in the research team's pre- and post-observations and air quality, ambient nicotine, and cotinine monitoring.

This collaborative feasibility research addresses a gap in California’s comprehensive smokefree workplace law by seeking to restrict smoking in sovereign Native-owned casinos which are not subject to this state law. Findings from this study can be used to establish a standardized protocol for implementing tobacco control policy change in tribally-owned casinos through capacity building in the casino management team. These findings represent the necessary groundwork for larger-scale research efforts to test such feasible smokefree casino policies. In this systematic, step-by-step manner, it will be possible to enable tribes elsewhere to create smokefree workplace policies in new and existing casinos, thereby strengthening worker health protection.

Ethnic Differences in Drinking and Diabetes Care Activities
National Institute on Alcohol Abuse and Alcoholism
Principal Investigator: Patrice Vaeth
(7/1/2012 - 2/28/2015)

Background: A growing body of research indicates that alcohol consumption may affect diabetes self-management and control, yet this association has not been examined in relation to ethnicity. This is an important area of study because there are significant ethnic differences in drinking practices between Whites, Blacks, and Hispanics which may impact diabetic management practices. Diabetes disproportionately affects Blacks and Hispanics relative to non-Hispanic Whites, in terms of its prevalence, and its associated morbidity and mortality. In order to prevent the morbidity and mortality associated with this disease, a thorough understanding of factors associated with its optimal management and control is required.

Project Aims: This study describes and compares the drinking practices (abstention, drinks consumed per week, and binge drinking) of those with diagnosed diabetes in relation to ethnicity and health status, while controlling for the effects of known correlates of drinking practices (age, sex, socioeconomic status, employment, and marital status). In addition, this study characterizes adherence to 8 diabetic clinical and self-care activities of Black, White, and Hispanic diabetics and examines how these activities vary in relation to drinking practices and ethnicity. The clinical care activities include: 1) annual hemoglobin A1c (HbA1c) testing; 2) annual dilated eye examinations; 3) annual examination of feet by a health professional; 4) annual dyslipidemia screening; and 5) ever having visited a diabetes educator. The self-care activities under investigation include: 1) daily glucose self-monitoring; 2) at least weekly self-examination of feet; and 3) smoking abstention.

Findings: This study has found no significant ethnic differences in abstention rates among male and female diabetics and among female diabetics there were no significant differences in the number of drinks consumed per week or binge drinking. Among men, Mexican Americans consumed more drinks per week than whites (approximately 5 versus 3 drinks per week for Mexican American and white men, respectively) and were more likely to engage in binge drinking (approximately 37% versus 21% for Mexican American and white men, respectively). Regarding diabetes clinical and self-care activities, the bivariate analysis found that for each care practice examined, with the sole exception of smoking, non-adherence was highest among Mexican Americans. Regarding smoking, black diabetics were most likely to be current smokers. Bivariate associations between drinking status and non-compliance showed that for 5 of the 8 clinical and self-care activities non-adherence was highest among binge drinkers. Particularly, diabetics who binged one or more time in the previous year were more likely to be non-compliant with daily glucose self-monitoring and smoking abstention and were more likely to have not received annual dilated eye examinations, annual examinations of feet by a health professional, and annual dyslipidemia screening.

Conclusion: Binge drinking is prevalent among Mexican American male diabetics. Mexican American male and female diabetics are at increased risk for poor adherence to diabetes clinical and self-care activities. Binge drinking appears to be a risk factor for non-adherence to several diabetes clinical and self-care activities.

Evaluating the Geography of Medical Cannabis Facilities on Crime, Price and Use
National Institute on Drug Abuse
Principal Investigator: Bridget Freisthler
(9/15/2011 - 5/31/2016)

In 1996, California was the first state to pass a Compassionate Use Act which allowed for the legal use of cannabis for medicinal or medical purposes. Despite leading the way for the use of cannabis in the treatment of many chronic disorders, little systematic research has been conducted that has examined how the opening and closing of these dispensaries change the ecological landscape of the neighborhoods in which they are located. The current study takes advantage of a natural experiment occurring in Long Beach, Los Angeles, and Sacramento Cities to assess how both the growth of and subsequent reduction in these dispensaries has resulted in changes in crime and cannabis use and dependence over a thirteen-year period. The research is examining the relationship between the density and location of these dispensaries, prices of marijuana and related products, and crime in multiple contexts. Five specific aims are being tested. We list them below along with current research findings:

(1) Examine whether the density of cannabis dispensaries is related to increases in rates of violent and property crimes;

Using data from Sacramento, we examined the relationship between density of MMDs and crime at the Census tract level. This cross-sectional study found no statistically significant relationship between the MMDs and violent or property crime (Kepple & Freisthler, 2012). In a second publication that discusses how to use spatial analysis methods to study environmental change policies, we also assessed how various security measures taken by dispensaries may be related to numbers of violent crimes within various buffer distances (e.g., 100 feet, 250 feet). This study found that some security measures, primarily having security cameras and requiring an identification prescription card were related to lower levels of violent (Freisthler et al., 2012).

(2) Examine whether the changing density of cannabis dispensaries is related to similar changes in rates of cannabis dependence and abuse;

Availability of medical marijuana through store-front dispensaries and delivery services was related to a greater likelihood of using marijuana and more frequent marijuana use among about 8000 survey participants in 50 cities in California (Freisthler & Gruenewald, 2014). Mair and colleagues (in review) found that an additional one dispensary per square mile in a ZIP code was cross-sectionally associated with a 6.5% increase in the number of marijuana hospitalizations (95% credible interval 1.033, 1.098) with a marijuana abuse/dependence code. Other local characteristics, such as the unemployment rate, median household income, and age and racial/ethnic distributions, were associated with marijuana hospitalizations in cross-sectional and panel analyses.

(3) Determine whether or not neighborhood characteristics (including location and density of other dispensaries) are related to price differences across dispensaries;

In support of this aim, one manuscript (Morrison et al., 2014) has been completed that examines demand for marijuana is related to supply (via dispensaries) for 50 cities in California. This study on the economic geography found that dispensaries were located in block groups with greater marijuana demand, higher rates of poverty, alcohol outlets, and in areas just outside city boundaries. A 10% increase in demand within a block group was associated with 2.4% greater likelihood of having a dispensary, and a 10% increase in the city-wide demand was associated with a 6.7% greater likelihood of having a dispensary. The next step is to examine prices of dispensaries in relation to demand.

In a related project (Lipperman-Kreda at al., 2014), we studied how medical marijuana policies (e.g., allowing dispensaries and cultivation or not) and density of dispensaries and delivery services was related to the availability of marijuana cigars (blunts). This study found that having a policy allowing dispensaries or cultivation was related to higher availability of tobacco products for blunts. However, the density of dispensaries and delivery services were negatively to availability of blunts. These results are not surprising as medical marijuana dispensaries are likely in competition with tobacco outlets for customers who use blunts. Given the specialized nature of dispensaries, tobacco outlets located in the same cities may choose not to sell these products.

(4) Investigate whether or not there is greater clustering by patron characteristics consistent with niche theory in high density areas;
Using pilot data from four Long Beach dispensaries and 132 exit surveys the following questions were assessed: 1) Do dispensaries serve patients who are different from the neighborhood in which they are located? And 2) Do dispensaries serve different types of patients from each other? Essentially three of the four dispensaries are more significantly likely to serve male patients (compared to their percent of males in the general population of the Census tract), younger patients, and patients with different racial/ethnic backgrounds. The results related to question 2 show that the dispensaries differ by their response rate for participation in the survey and the distance patients traveled. Combined, these results suggest that dispensaries attract patients for areas not just within the Census tract and either target specific groups (young Black males) that live in the Census tract or who come to the Census tract for other purposes. (Freisthler, 2012).

(5) Determine whether or not patterns of medical cannabis use correspond to overall health levels and/or diagnosis of medical cannabis patients.

Analyses are being conducted to assess this study aim.

Evaluation of California Community Colleges Student Mental Health Program (CCC SMHP)
CA Mental Health Svcs. Auth.
Principal Investigator: Bob Saltz
(6/18/2012 - 4/30/2015)

In 2004, California voters passed Proposition 63, the Mental Health Services Act (MHSA), which includes a mandate that the state provide prevention and early intervention (PEI) services and education for people who experience mental illness in the state of California. The California Mental Health Services Authority (CalMHSA) established funding to improve student mental health across K-12 public schools, the University of California, the California State University system, and the California Community College system.

The California Community Colleges (CCCs) serves 2.6 million students annually. CCC students are older, ethnically more diverse and less likely to be insured compared to four-year college students. Mental health factors most likely to affect CCC performance are stress, anxiety, and depression. The CCC system is addressing these mental health issues that impact quality of life, school retention, and success.

PIRE’s evaluation of the California Community College School Mental Health Program (CCC SMHP) developed a baseline measurement of mental health services across the CCC system so we can monitor changes over the time of the project, including faculty / staff’s experience and attitudes related to student mental health issues.

Group-based Intervention for Alcohol, Drugs and Aggression among Club Patrons
National Institute on Alcohol Abuse and Alcoholism
Principal Investigator: Brenda Miller
(7/15/2014 - 5/31/2019)

This study will focus on high risk behaviors (excessive alcohol use, drug use, physical and/or sexual aggression, and unsafe exit behaviors-e.g., drinking and driving, riding with a drinking driver) of young adults who patronize clubs. These risk behaviors are prevalent in clubs and drinking establishments (see Significance). Our goals are twofold: (1) to develop a screener that accurately assesses a group's level of risk for one specific night of club attendance and based upon this assessment, (2) to provide naturally occurring social groups with the necessary skills to identify vulnerability to these high risk behaviors and to provide them with tools to protect their members against those risks by being prepared to implement the 3 O's: (a) Outreach-approach fellow group members who are at risk, (b) Options-to suggest alternatives that would increase safety and (c) Out-to increase awareness of when it is time to leave. This brief, interactive intervention will be delivered by small tablet computers that utilize mobile application technology and cellular wireless service. This will facilitate later adoption in the real world, in a way to provide a low cost delivery and in a manner that will engage the young adult population. Specific Aim I is designed to test and reduce the number of screening questions necessary to develop a risk algorithm (for our high risk behaviors) for social groups and to test the feasibility of immediate onsite compilation of individual results into a group risk algorithm. A data collection method is used that intercepts participants as they enter and exit a location and links these data, while maintaining anonymity. For Specific Aim 1 a total of 300 groups (n=720 participants) will be given a short survey and biological measures of alcohol and drug use will be collected, while maintaining anonymity for the participants. The survey data will be linked for the group. With Specific Aim II, the brief, group-based intervention is designed and the feasibility tested. With a new sample of 300 groups, randomly assigned to intervention and control conditions, both entrance and exit data collection will include survey data, oral fluid samples (for drug analyses), and breath tests (for alcohol). These data will be compared for the intervention and control groups to determine if the intervention was successful in helping groups to assess their vulnerability for high risk situations inside the club, whether they implemented more actions based upon the skills they learned, and whether the intervention group had fewer high risk behaviors than the control group.

Latino Migrant Laborers' Use of Drug Abuse Recovery Houses
National Institute on Drug Abuse
Principal Investigators: Anna Pagano, Victor Garcia
(8/1/2014 - 7/31/2016)

Mexican and Central American migrant laborers (both urban day laborers and farmworkers) are at high risk for developing substance use disorders (SUDs). When they seek treatment for severe SUDs, they encounter substantial barriers (e.g., employment demands, limited English proficiency, lack of health insurance, non-eligibility due to citizenship status). Given the significant size of the Latino migrant laborer population in the U.S. (estimated at around 3 million), their importance to the US economy, and the high cost of substance use-related health problems, it is critically important to identify SUD recovery resources that are cost-effective, culturally accepted, and accessible for migrant laborers with SUDs. The proposed exploratory study will investigate a transnational recovery model that is widely used by Mexican and Central American migrant laborers, but is absent from the literature: anexos (annexes). The anexo is a modified Mexican recovery program that was introduced into the U.S. twenty years ago by migrant laborers struggling with SUDs. These residential, mutual-help recovery programs provide a structured daily routine, peer support, and daily Spanish-language Alcoholics Anonymous (AA) meetings that incorporate specific language, rituals, and other cultural elements from AA in Mexico. The proposed qualitative R21 study will explore (1) the structure and practices of these transnational recovery programs, and (2) how and why Latino migrant laborers access them. The specific aims of this exploratory study are: (1) to identify the individual-level factors (e.g., age, marital status, migration history, income), program-level factors (e.g., program language and rituals), and structural factors (e.g., immigration policy, health access policy, labor conditions) that shape the help-seeking pathways of Mexican and Central American migrant laborers who use anexos; (2) to examine the recovery-promoting practices (e.g., AA meetings, peer support, rules, daily routine) of U.S.-based anexos and identify variations in practices (if any) across the anexos; and (3) to ascertain clients’ perceptions of the benefits (e.g., low cost, Spanish language, cultural familiarity) and possible drawbacks (e.g., overcrowding, wait list, non-professional staff) of the anexos. We will use ethnographic research methods (participant observation, exploratory interviewing, and case studies) to gather qualitative exploratory data at 3 California anexos. Our long-term goal is to use our exploratory findings to design and conduct a nationwide study of anexos, thereby refining knowledge of low-cost, culturally accepted and accessible SUD treatment options for Latino migrant laborers.

Native American Tribe Alcohol Legalization
National Institute on Alcohol Abuse and Alcoholism
Principal Investigators: Juliet P. Lee, Roland Moore
(9/17/2014 - 11/30/2014)

This administrative supplement to our current center grant is in support of research to evaluate the impacts of potential legalization of alcohol sales and use on a presently “dry” reservation. We propose a community-based participatory evaluation of the impacts of legalization using a priori defined public health outcomes (e.g. alcohol-involved injuries, assaults, and roadway collisions) and health indicators identified by tribal members to assess the personal, social and economic impacts of this historic change in alcohol policy. Alcohol sales have been prohibited, yet people who live on the reservation experience substantial problems related to alcohol use.

The research includes four data collection components designed to be executed rapidly and in partnership with local organizations on and near the reservation. These include: (1) a Formative Ethnography which will collect in-depth interview data from key tribal leaders to identify tribal data sources, assemble a list of outcomes that will be meaningful and useful to the tribe, and identify potential Community Advisory Board members; (2) Archival Health Indicators assembled from (a) locally accessed Indian Health Service (IHS) data systems in collaboration with the Black Hills Center on American Indian Health (BHCAIH), a non-profit Native American health research center under the direction of Dr. Jeffrey Henderson (Cheyenne River Sioux), (b) tribal police data on violence, public drunkenness and drinking and driving, and (c) other publically available data including statewide and local hospital discharge records, arrest data, school performance, and demographic data; (3) a Rapid Rural Appraisal via contract with a tribal non-profit to identify data sources at the level of local communities, to identify current local sources and systems of alcohol distribution (e.g. bootlegging) and consumption on and near the reservation, and to assemble a supplementary list of health indicators meaningful and useful to the tribe; and (4) a comprehensive Alcohol Sales Outlet Assessment that enables the identification and characterization of all alcohol sales outlets in the immediate vicinity of the reservation (buffer defined), other key off-reservation retail markets identified by community members, and all commercial venues across the reservation likely to become locations of alcohol sales post-legalization (e.g., food stores).

Preventing Underage Drinking by Southwest California Indians
National Institute on Alcohol Abuse and Alcoholism
Principal Investigator: Roland S. Moore
(9/1/2006 - 8/31/2015)

Objectives: Rural American Indian youth are at high risk for problem drinking. In a collaborative effort to prevent underage drinking among youth in a set of rural California American Indian reservations, prevention science and tribal health experts developed a culturally-appropriate prevention project which deploys both community-level and individual-level prevention strategies.
Methods. The project trained clinic and coalition members in techniques of quantitative survey design and implementation and qualitative data collection, analysis and utilization in order to develop in-clinic capacity to implement brief surveys to assess the extent and nature of underage drinking on the reservations, including where and how reservation youth obtain the alcohol they consume. Community-level strategies focused on enforcing alcohol sales laws and community mobilization of norm change around underage drinking, while individual-level strategies focused on brief motivational interviewing for tribal youth. Program impact was assessed with regression models by comparing anonymous California Healthy Kids Survey data for Native American and non-Native American students in the intervention catchment area, with an additional comparison group of Native American students from reservations near but outside the program area.

Results: Regression analyses found a significant and substantial decline in the intervention group’s frequency of past 30-day drinking, vs. none in the comparison groups (p<.02). Similarly, heavy episodic drinking dropped in the intervention group relative to the comparison groups (p<.003); in both analyses, the intervention group’s 30 day drinking and heavy episodic drinking moved from the drinking levels of the comparison Native American students converging at or near the much lower levels of those of the non-Native American students in the study catchment area.

Conclusions: Similar prevention approaches to reduce underage drinking that incorporate both individual- and community-level interventions may be effective in reducing underage alcohol use among American Indians living in and around rural reservations.

Reducing Availability and Misuse of Prescription Drugs on California Reservations
National Institute on Drug Abuse
Principal Investigators: Roland S. Moore, Daniel Calac, MD
(9/1/2013 - 8/31/2018)

Overview: In response to the rising prevalence of prescription opiate painkiller diversion and misuse, the goal of this NARCH VII component is to implement and evaluate an intervention designed to reduce the availability of prescription pain medication in the homes of Native Americans residing in and around nine contiguous Indian reservations served by an innovative tribally-run clinic in a rural Southern California County. Employing an availability theory perspective, this study aims to assess attitudes in the clinic’s service area towards safely discarding unused opiate and other pain relievers (a survey has been completed with an n of 300), then design and deploy a culturally tailored version of existing availability reduction strategies including easy-to-use secure drop boxes, the contents of which will be periodically emptied, weighed and passed by San Diego Sheriff’s Deputies to their contracted disposal services. These efforts will be bolstered by media advocacy strategies to change community norms surrounding prescription drugs. We hypothesize that focused environmental interventions on reducing availability of prescription opiates will a) create convenient options for American Indians to help make prescription pain medicine more difficult for youth and other family members to access for non-prescribed use; b) demonstrate feasibility of a culturally tailored take-back campaign in American Indian communities; and c) alter norms around the acceptability of giving prescription pain pills to family members or friends.

The specific aims of the proposed project are: (1) To implement a culturally-tailored environmental preventive intervention to reduce availability and misuse of prescription drugs in the IHC service area by designing and deploying a culturally-tailored drug take-back program and media advocacy and community mobilization campaign; and (2) To assess the effectiveness, acceptability and potential sustainability of the intervention with respect to the reduction of prescription drug availability, analyzing pre-/post- surveys (N=300 each wave) about pain medication storage and disposal to assess the extent to which the intervention influenced attitudes and behavior about opiate availability. Ethnography and objective secondary data analysis will evaluate effects of these interventions on prescription drugs norms and misuse.

Relevance: Prescription drug misuse is a global problem which is increasingly common throughout the US and in American Indian communities as well. Building upon successful capacity building efforts, the proposed 5 year study will implement and evaluate interventions designed to address prescription pain medication diversion and misuse in and around 9 Indian reservations in a rural southern California County. The proposed culturally appropriate environmental interventions offer significant potential reductions in harm resulting from prescription pain medication diversion and misuse among rural Native Californians.

Responsible Retailing Program for Alcohol Retailers
National Institute on Alcohol Abuse and Alcoholism (subcontract from Responsible Retailing Forum- Field Services)
Principal Investigator: Joel Grube
(10/1/2012 - 2/29/2016)

The Responsible Retailing Forum ("RRF") has developed a new model to reduce sales of alcohol products to minors. Derived from recommendations contained in the Report on Best Practices for Responsible Retailing, prepared as a federal guidance document for the Center for Substance Abuse Prevention in 2002, the model employs a quality improvement approach to assist retailers improve age-verification. In test communities, the model has shown significant promise as a way of improving ID-checking and underage sales refusal. Phase I focus groups indicated that alcohol regulators, retailers, their associations and suppliers all support the RRF model for a community-based RR system providing licensees with RR resources and feedback on actual staff performance in checking IDs, and a cooperative, problem-solving approach to underage alcohol sales and use. The proposed study will employ a randomized cross-over design to examine the effects of the RRF model upon ID-checking behavior by alcohol beverage licensees. The project will: (1) Identify 2 pairs of demographically matched communities in each of 4 states: CA, MA, NM, WI. (2) Identify and randomly select alcohol licensees in each community and recruit 15 on-premise licensees (that serve alcohol on-premises) and 15 off-premise licensees (that sell for off-premises consumption). (3) Conduct pretest and posttest surveys with licensees and public agency stakeholders on attitudes and perceptions on underage alcohol sales and use and stakeholder roles in their communities. (4) Conduct 3 monthly Mystery Shop inspections by young, legal-age inspectors who attempt to purchase an alcohol beverage to establish baseline ID-checking performance. (5) Randomly assign one community in each pair to receive the 6-month intervention immediately (Cohort 1) and the other to a delayed intervention 6 months later (Cohort 2). During the first intervention period, outlets in Cohort 1 will receive the retailer assistance intervention, including monthly Mystery Shop visits with feedback after each visit. Outlets in Cohort 2 will receive Mystery Shop visits during intervention period 1 to document ID-checking rates but will not receive feedback or any assistance. (6) During the second intervention period, conduct the retailer assistance intervention with outlets in Cohort 2. Cohort 1 outlets will no longer receive any other assistance during this time but unreported Mystery Shop inspections will continue in order to investigate decay of effects. We expect ID-checking rates will increase significantly in Cohort 1 communities, relative to Cohort 2, during the first 6 months of the intervention. ID-checking rates in Cohort 2 will similarly increase once the RR intervention is implemented in those communities in months 7-12. We also expect ID-checking rates to gradually decay to baseline levels in Cohort 1 communities during months 7-12. This finding will help make the business case to retailers for a long-term commitment to the RRF model.

School-based Health Clinics: Effects on Youth and Young Adult Sexual Behavior
National Institute of Child Health & Human Development
Principal Investigator: Melina Bersamin
(5/1/2017 - 6/30/2019)

Interventions targeting structural or contextual variables have been associated with significant reductions in problem behaviors (e.g., Celentano et al., 1998); however, the preventive value of such approaches has not been studied extensively with respect to unintended pregnancy among youth, and across time to young adulthood. School-based health clinics with a family planning component (SBHC-FPCs) may promote the use of family planning services as they (1) are embedded within schools, the only public institution with the capacity to reach a majority of youth (Satcher, 1995); (2) are designed to reduce barriers associated with accessing reproductive services (e.g., finances, confidentiality concerns; Kirby, 2002); and (3) directly or indirectly expose youth to family planning resources and services that exist in their community. Research on SBHC-FPCs and reproductive behaviors has been mixed, largely due to methodological weaknesses (Kirby, 2002). The current study aims to examine whether the presence of SBHC-FPCs in high school is associated with positive short- term effects in adolescence on (A) mediating cognitive variables (e.g., reproductive attitudes, perceived sexual norms), (B) perceived availability and use of family planning services, and (C) pregnancy risk behaviors including age of sexual initiation, number of partners, and contraceptive use. We will also investigate whether students who have access to more comprehensive SBHC-FPC services in high school have (A) greater perceived availability and use of family planning services, and (B) engage in fewer pregnancy risk behaviors including delayed age of sexual initiation, fewer number of partners, and effective contraceptive use, compared to those with less comprehensive services both in high school and later. In addition, by following adolescents as they transition into young adulthood we will be able to examine if lagged and/or carry-over effects of exposure to SBHC-FPCs persist into young adulthood and assess whether family planning behaviors and unplanned pregnancy rates differ among those who attended schools with an SBHC-FPC and those who did not. A secondary goal is to assess the role of clinic characteristics (e.g. staffing, hours, perceived cultural competence of staff) on outcome variables such as family planning self-efficacy, reproductive health seeking behaviors, and family planning behaviors and intentions. Our proposed study goes beyond earlier research by 1) developing a rigorous school matching procedure thus addressing issues associated with lack of adequate comparison schools; 2) recruiting a large sample to detect small effects; 3) using a list-assisted sample to encompass both clinic users and non-users; and 4) measuring use of all family planning providers, which will allow us to capture substitution effects. Findings will increase understanding of the effects f SBHC-FPCs on reproductive health-seeking behavior and effective SBHC-FPC services. Additionally, results will provide important data that can be used in efforts to help better understand how access to medical services more generally influences health behaviors.

Social, Family, Neighborhood Factors and Drinking in Puerto Rico
National Institute on Alcohol Abuse and Alcoholism
Principal Investigator: Raul Caetano
(5/15/2012 - 4/30/2015)

Alcohol-related problems, abuse and dependence are an important public health problem in Puerto Rico. Unfortunately, public health authorities on the island lack the epidemiological data on drinking and its consequences that are necessary to respond to these problems. To cover this gap in knowledge, this application proposes an in-depth household epidemiological survey of drinking among adults 18 years of age and older in San Juan, Puerto Rico (sample N=1,500). A set of four innovative aims is proposed, which together will examine social, familial and neighborhood factors associated with drinking and its consequences on the island.

The proposed specific aims are:

(1) To examine the influence of attitudes and expectancies about drinking and of family cohesion and support on the association between drinking and alcohol-related problems, and DSM-IV abuse and dependence;

(2) To examine the impact of the present economic recession on drinking behavior and associated consequences by examining the association between unemployment and underemployment, stress, depression, drinking, alcohol-related problems, abuse and dependence;

(3) Expanding aims 1 and 2 to examine the association between neighborhood collective efficacy (social cohesion and social control), neighborhood disadvantage (as represented by the census-level variables poverty, under education and unemployment), volume of drinking, binge drinking, and alcohol abuse and dependence;

(4) Given the specific cultural circumstances of Puerto Rico, some of which are described in aims 1, 2 and 3, above, test the cross-cultural applicability of the dimensionality of the newly proposed DSM-V substance use disorder criteria and examine the proportion and characteristics of diagnostic "orphans".

Results from this study will greatly enhance the ability of treatment providers and prevention professionals to understand more about alcohol problems in Puerto Rico. The study will collect detailed epidemiological data on individual- and neighborhood-level predictors of drinking, alcohol-related problems, abuse and dependence. These data will be shared with public health professionals in Puerto Rico, which will enable these professionals to plan effective treatment responses as well as prevention strategies to address alcohol problems on the island. With this in mind, the research team is composed of researchers on the U.S. mainland and in Puerto Rico so that translational application of this research is enhanced. Finally, the knowledge produced will also be applicable to understanding drinking and its consequences among Puerto Ricans as well as other Hispanic groups on the U.S. mainland.

The Strategic Prevention Framework State Incentive Grant
State of California
Principal Investigator: Bob Saltz
(10/1/2010 - 9/30/2015)

The Substance Abuse and Mental Health Administration’s (SAMHSA) Strategic Prevention Framework – State Incentive Grant (SPF SIG) is given to states to build capacity in the adoption of evidence-based prevention strategies. The Prevention Research Center (PRC) working with California’s Department of Health Care Services has designed and implemented a randomized trial of a comprehensive community intervention to reduce excessive drinking among 15 to 25 year-olds involving 24 randomly-selected cities throughout the state. Beyond evaluating the efficacy of the intervention, the goal of this project will be to define procedures and work to institutionalize the strategic prevention planning and implementation throughout the state.

Web-based Family Prevention of Alcohol and Risky Sex for Older Teens
National Institute on Alcohol Abuse and Alcoholism
Principal Investigator: Brenda Miller
(9/5/2012 - 6/30/2017)

There is a need for interventions for older teens (16-17) who are engaging in alcohol and/or sexual risk behaviors. Older teens become more autonomous and the role of the parent becomes more difficult as they balance providing guidance while relinquishing control. Parents struggle with the right mix of monitoring and guidance. If a family-based approach to address these teen behaviors is effective, this new program could potentially provide a low cost and important strategy for improving the health and safety of older teens. This study will develop a web-based intervention for 16-17 year old youth and their parents. The aims are as follows: Specific Aim 1: To adapt two parent-based prevention strategies (Family Matters and Parent Handbook) to provide a family-based approach for addressing older teen alcohol related risk behaviors and sexual risk behaviors and sex in combination with alcohol use (hereafter called alcohol and/or sexual risk behaviors) using the web as the program delivery mode. Specific Aim 2: To test whether exposure to the program leads to expected changes in targeted teen beliefs and behaviors, including reductions in alcohol and/or sexual risk behaviors. Specific Aim 3: To examine whether program effects on teen alcohol and/or sexual risk behaviors are mediated through changes in intermediate program targeted beliefs (parents and teen) and behaviors (parent-teen--communication). Program fidelity and process measures may also mediate these outcomes. Phase I integrate and adapt the two parent-based approaches and creates a web-based interactive delivery of materials. Expert panels, focus groups, and usability assessments will inform the process. Phase II is an RCT with 500 families with the web-based intervention. Surveys will be conducted at baseline, and for three follow-up periods (6, 12, & 18 months). Analyses will examine teen outcomes related to alcohol and/or sexual risk behaviors. Changes in mediators directly impacted by the program for both teens and parents will be examined. Process and fidelity information will be collected and assessed.

Youth-led Tobacco Prevention among CA Southeast Asians
Tobacco-Related Disease Research Program
Principal Investigator: Juliet P. Lee
(8/1/2012 - 7/31/2015)

Overview: The goal of this study, a collaboration between the Pacific Institute for Research and Evaluation and Community Health for Asian Americans (CHAA) funded as a Community Academic Research Award (CARA), is to develop and implement a youth-led tobacco prevention program with Southeast Asian youth and young adults in the East San Francisco Bay Area. The participants receive trainings and scientific and programmatic support to conduct their own research on tobacco and health disparities and develop and implement an intervention that is age- and culturally-appropriate to reduce and prevent tobacco use in their community.

Findings: Following on the pilot, the Full CARA project partnered the scientific expertise of PIRE's Prevention Research Center scientists with the cultural expertise of CHAA’s Southeast Asian Young Leaders (SEAYL). SEAYL youths and PRC scientists co-developed, co-conducted, and co-analyzed: (1) Southeast Asian American community surveys on tobacco use, access, and exposures (n=200); (2) store observations in all 65 tobacco retail outlets in the city of Richmond, CA; (3) PhotoVoice data collection analysis of environmental tobacco influences, in particular focused on high school environments for SEAYL compared to youths in more affluent nearby communities; and (4) interviews with key stakeholders from city and county tobacco regulation and enforcement and with key school officials. The team collaboratively interpreted these data and developed an action plan which focuses on supporting smoke-free policies at Richmond High School within a campaign to prevent tobacco use and increase sense of self-worth among RHS students. SEAYL youths have reflected both expanded understanding of tobacco influences and inequities and a developed sense of self-efficacy.

Conclusions: Youth participatory research can help to develop a sense of critical consciousness to reduce harmful tobacco influences and engage in health-promoting activities. More than just educational institutions, schools may be seen as micro-environments within which youths have specialized knowledge as well as privileged access and influence.

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