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1.  Disseminating Organizational Screening and Brief Intervention Services (DO-SBIS) for Alcohol at Trauma Centers Study Design 
General hospital psychiatry  2012;35(2):174-180.
Objective
In 2005 the American College of Surgeons passed a mandate requiring that Level I trauma centers have a mechanism to identify patients who are problem drinkers and have the capacity to provide an intervention for patients who screen positive. The aim of the Disseminating Organizational Screening and Brief Intervention Services (DO-SBIS) cluster randomized trial is to test a multilevel intervention targeting the implementation of high quality alcohol screening and brief intervention (SBI) services at trauma centers.
Method
Twenty sites selected from all US Level I trauma centers were randomized to participate in the trial. Intervention site providers receive a combination of workshop training in evidence-based motivational interviewing (MI) interventions and organizational development activities prior to conducting trauma center-based alcohol SBI with blood alcohol positive injured patients. Control sites implement care as usual. Provider MI skills, patient alcohol consumption, and organizational acceptance of SBI implementation outcomes are assessed.
Results
The investigation has successfully recruited provider, patient, and trauma center staff samples into the study and outcomes are being followed longitudinally.
Conclusion
When completed, the DO-SBIS trial will inform future American College of Surgeons’ policy targeting the sustained integration of high quality alcohol SBI at trauma centers nationwide.
doi:10.1016/j.genhosppsych.2012.11.012
PMCID: PMC3594343  PMID: 23273831
Acute care medical trauma centers; Injury; Alcohol; Screening and brief intervention; American College of Surgeons
2.  Substance Use and PTSD Symptoms in Trauma Center Patients Receiving Mandated Alcohol SBI 
In an effort to integrate substance abuse treatment at trauma centers, the American College of Surgeons has mandated alcohol screening and brief intervention (SBI). Few investigations have assessed trauma center inpatients for comorbidities that may impact the effectiveness of SBI that exclusively focuses on alcohol. Randomly selected SBI eligible acute care medical inpatients (N=878) were evaluated for alcohol, illegal drugs, and symptoms consistent with a diagnosis of posttraumatic stress disorder (PTSD) using electronic medical record, toxicology, and self-report assessments; 79% of all patients had one or more alcohol, illegal drug, or PTSD symptom comorbidity. Over 70% of patients receiving alcohol SBI (n=166) demonstrated one or more illegal drug or PTSD symptom comorbidity. A majority of trauma center inpatients have comorbidities that may impact the effectiveness of mandated alcohol SBI. Investigations that realistically capture, account for, and intervene upon these common comorbid presentations are required to inform the iterative development of College policy targeting integrated substance abuse treatment at trauma centers.
doi:10.1016/j.jsat.2012.08.009
PMCID: PMC3528356  PMID: 22999379
3.  Nationwide Survey of Alcohol Screening and Brief Intervention Practices at US Level I Trauma Centers 
BACKGROUND
In 2007, the American College of Surgeons (ACS) Committee on Trauma implemented a requirement that Level I trauma centers must have a mechanism to identify patients who are problem drinkers and the capacity to provide an intervention for patients who screen positive. Although the landmark alcohol screening and brief intervention (SBI) mandate is anticipated to impact trauma practice nationwide, a literature review revealed no studies that have systematically documented SBI practice pre-ACS requirement.
STUDY DESIGN
Trauma programs at all US Level I trauma centers were contacted and asked to complete a survey about pre-ACS requirement trauma center SBI practice.
RESULTS
One hundred forty-eight of 204 (73%) Level I trauma centers responded to the survey. More than 70% of responding centers routinely used laboratory tests (eg, blood alcohol concentration) to screen patients for alcohol and 39% routinely used a screening question or standardized screening instrument. Screen-positive patients received a formal alcohol consult or had an informal alcohol discussion with staff members approximately 25% of the time.
CONCLUSIONS
The investigation observed marked variability across Level I centers in the percentage of patients screened and in the nature and extent of intervention delivery in screen-positive patients. In the wake of the ACS Committee on Trauma requirement, future research could systematically implement and evaluate training in the delivery of evidence-based alcohol interventions and training in development of trauma center organizational capacity for sustained delivery of SBI.
doi:10.1016/j.jamcollsurg.2008.05.021
PMCID: PMC3104599  PMID: 18954773
4.  Brief Alcohol Interventions With Mandated or Adjudicated College Students 
This article summarizes the proceedings of a symposium presented at the 2003 RSA Meeting in Ft. Lauderdale, Florida, organized and chaired by Nancy Barnett. The purpose of the symposium was to present information and efficacy data about approaches to brief intervention with students who get into trouble on their campuses for alcohol and as a result are required to attend alcohol education or counseling. Presentations were (1) Differences Between Mandated College Students and Their Peers on Alcohol Use and Readiness to Change, by Tracy O’Leary Tevyaw; (2) An Effective Alcohol Prevention Program for Mandated College Students, by Kim Fromme; (3) Two Brief Alcohol Interventions for a Referred College Population, by Kate Carey; and (4) Brief Motivational Intervention With College Students Following Medical Treatment or Discipline for Alcohol, by Nancy Barnett. The data presented in this symposium indicated that students who are evaluated or disciplined for alcohol use are on average heavy drinkers who drink more heavily than their closest peers. Brief intervention approaches described by the speakers included group classroom sessions, individual motivational intervention, individual alcohol education, and computerized alcohol education. Reductions in consumption and problems were noted across the various intervention groups. Brief motivational intervention as a general approach with mandated students shows promise in that it reduced alcohol problems in a group of mandated students who were screened for being at risk (in the Borsari and Carey study) and increased the likelihood that students would attend further counseling (in the Barnett study).
PMCID: PMC2726616  PMID: 15218881
College; Brief Intervention
5.  Alcohol Use and Problems in Mandated College Students: A Randomized Clinical Trial Using Stepped Care 
Objective
Over the past two decades, colleges and universities have seen a large increase in the number of students referred to the administration for alcohol policies violations. However, a substantial portion of mandated students may not require extensive treatment. Stepped care may maximize treatment efficiency and greatly reduce the demands on campus alcohol programs.
Method
Participants in the study (N = 598) were college students mandated to attend an alcohol program following a campus-based alcohol citation. All participants received Step 1: a 15-minute Brief Advice session that included the provision of a booklet containing advice to reduce drinking. Participants were assessed six weeks after receiving the Brief Advice, and those who continued to exhibit risky alcohol use (n = 405) were randomized to Step 2, a 60–90 minute brief motivational intervention (BMI) (n = 211) or an assessment-only control (n = 194). Follow-up assessments were conducted 3, 6, and 9 months after Step 2.
Results
Results indicated that the participants who received a BMI significantly reduced the number of alcohol-related problems compared to those who received assessment-only, despite no significant group differences in alcohol use. In addition, low risk drinkers (n = 102; who reported low alcohol use and related harms at 6-week follow-up and were not randomized to stepped care) showed a stable alcohol use pattern throughout the follow-up period, indicating they required no additional intervention.
Conclusion
Stepped care is an efficient and cost-effective method to reduce harms associated with alcohol use by mandated students.
doi:10.1037/a0029902
PMCID: PMC3514601  PMID: 22924334
6.  The Basics of Alcohol Screening, Brief Intervention and Referral to Treatment in the Emergency Department 
Nearly eight million emergency department (ED) visits are attributed to alcohol every year in the United States. A substantial proportion is due to trauma. In 2005, 16,885 people were killed as a result of alcohol-related motor vehicle crashes. Patients with alcohol-use problems (AUPs) are not only more likely to drive after drinking but are also at greater risk for serious alcohol-related illness and injury. Emergency departments have an important and unique opportunity to identify these patients and intervene during the “teachable moment” of an ED visit. The American College of Emergency Physicians, Emergency Nurses Association, American College of Surgeons-Committee on Trauma, American Public Health Association, and the National Highway Traffic Safety Administration, have identified Alcohol Screening, Brief Intervention and Referral to Treatment (SBIRT) as a pivotal injury- and illness-prevention strategy to improve the health and well-being of ED patients. We provide a general overview of the basis and need for integrating SBIRT into EDs. Models of SBIRT, as well as benefits and challenges to its implementation, are also discussed.
PMCID: PMC2672213  PMID: 19561690
7.  The Comparative Effectiveness of Individual and Group Brief Motivational Interventions for Mandated College Students 
Individual brief motivational intervention (iBMI) is an efficacious strategy to reduce heavy drinking by students who are mandated to receive an alcohol intervention following an alcohol-related event. However, despite the strong empirical support for iBMI, it is unknown if the results from rigorously controlled research on iBMI translate to real-world settings. Furthermore, many colleges lack the resources to provide iBMI to mandated students. Therefore, group-delivered BMI (gBMI) might be a cost-effective alternative that can be delivered to a large number of individuals. The purpose of this study was to conduct a comparative effectiveness evaluation of iBMI and gBMI as delivered by staff at a university health services center. Participants (N = 278) were college students who were mandated to receive an alcohol intervention following an alcohol-related incident. Participants were randomized to receive an individual (iBMI; n = 133) or a Group BMI (gBMI; n = 145). Results indicated that both iBMI and gBMI participants reduced their peak estimated blood alcohol concentration (BAC) and the number of negative alcohol-related consequences at 1-, 3-, and 6-months postintervention. The iBMI and gBMI conditions were not significantly different at follow-up. These findings provide preliminary support for the use of iBMI and gBMIs for college students in real-world settings.
doi:10.1037/a0034899
PMCID: PMC4062841  PMID: 24731111
brief intervention; personalized feedback; college drinking; mandated students; comparative effectiveness
8.  Psychophysiological Reactivity to Emotional Picture Cues Two Years after College Students Were Mandated for Alcohol Interventions 
Addictive behaviors  2010;35(8):786-790.
This study examined alcohol use behaviors as well as physiological, personality, and motivational measures of arousal in students approximately 2 years after they were mandated to a brief intervention program for violating university policies about on-campus substance use. Students were categorized into serious (medical referrals, n=13) or minor (residence advisor referrals, n = 30) infraction groups based on the nature of the incident that led to their being mandated. Self-report measures of arousal, sensation seeking, reasons for drinking, and past 30-day alcohol use were completed. Physiological arousal during exposure to emotional picture cues was assessed by indices of heart rate variability. The minor infraction group reported significantly escalating alcohol use patterns over time and a pattern of less regulated psychophysiological reactivity to external stimuli compared to the serious infraction group. The serious infraction group was higher in sensation seeking and there was some evidence of greater disparity between their physiological and self-reported experiences of emotional arousal in response to picture cues than in the minor group. Thus, the two infraction groups represent different subsets of mandated students, both of whom may be at some risk for using alcohol maladaptively. The findings suggest that intervention strategies that address self-regulation may be beneficial for mandated college students.
doi:10.1016/j.addbeh.2010.03.017
PMCID: PMC2872043  PMID: 20409645
emotional reactivity; affective cue; self-reported arousal; heart rate variability; psychophysiology; college students
9.  Incident-Specific and Individual Level Moderators of Brief Intervention Effects with Mandated College Students 
Brief Motivational Interventions (BMI) and Computer-delivered interventions (CDI) have been successful in reducing drinking behaviors with mandated college students. However, research examining moderators of intervention effects have found mixed results. The current study sought to replicate and extend the research on moderators of intervention efficacy with mandated students. Baseline alcohol-related problems, readiness to change, gender, incident consequences, and participant responses to the event (personal attributions about the incident, aversiveness of the incident) were examined as moderators of intervention and booster condition efficacy on alcohol use and problems. Mandated students (N = 225) were randomized to complete either a BMI or CDI (Alcohol 101; Century Council, 1998), with or without a 1-month booster session, following a campus alcohol sanction. Outcomes were measured 3 months after baseline. Attributions moderated intervention condition such that participants low in personal attributions for their incident showed significantly less drinking following a CDI than a BMI. Men and individuals who reported low incident aversiveness showed higher drinks per occasion after receiving a booster, while individuals high in alcohol-related problems reported fewer heavy drinking days after completing a booster session. Findings suggest that identifying specific characteristics related to the precipitating event may inform intervention approaches in this high-risk population, however additional research is needed to offer concrete guidance to practitioners in the field.
doi:10.1037/a0024508
PMCID: PMC3676278  PMID: 21766975
10.  Individual and Situational Factors that Influence the Efficacy of Personalized Feedback Substance Use Interventions for Mandated College Students 
Little is known about individual and situational factors that moderate the efficacy of Personalized Feedback Interventions (PFIs). Mandated college students (N = 348) were randomly assigned to either a PFI delivered in the context of a brief motivational interview (BMI; n = 180) or a written PFI only (WF) condition and followed up at 4 months and 15 months post-intervention. We empirically identified heterogeneous subgroups utilizing mixture modeling analysis based on heavy episodic drinking and alcohol-related problems. The four identified groups were dichotomized into an improved (53.4%) and a non-improved (46.6%) group. Logistic regression results indicated that the BMI was no more efficacious than the WF across all mandated students. However, mandated students who experienced a serious incident requiring medical or police attention and those with higher levels of alcohol-related problems at baseline benefited more from the BMI than from the WF. It may be an efficacious and cost-effective approach to provide a written PFI for low-risk mandated students and an enhanced PFI with a BMI for those who experience a serious incident or with higher baseline alcohol-related problems.
doi:10.1037/a0014679
PMCID: PMC2818838  PMID: 19170456
alcohol; college students; brief intervention; personalized feedback intervention; evidence-based treatment
11.  Effectiveness of a Web-Based Brief Alcohol Intervention and Added Value of Normative Feedback in Reducing Underage Drinking: A Randomized Controlled Trial 
Background
Current insights indicate that Web-based delivery may enhance the implementation of brief alcohol interventions. Previous research showed that electronically delivered brief alcohol interventions decreased alcohol use in college students and adult problem drinkers. To date, no study has investigated the effectiveness of Web-based brief alcohol interventions in reducing alcohol use in younger populations.
Objective
The present study tested 2 main hypotheses, that is, whether an online multicomponent brief alcohol intervention was effective in reducing alcohol use among 15- to 20-year-old binge drinkers and whether inclusion of normative feedback would increase the effectiveness of this intervention. In additional analyses, we examined possible moderation effects of participant’s sex, which we had not a priori hypothesized.
Method
A total of 575 online panel members (aged 15 to 20 years) who were screened as binge drinkers were randomly assigned to (1) a Web-based brief alcohol intervention without normative feedback, (2) a Web-based brief alcohol intervention with normative feedback, or (3) a control group (no intervention). Alcohol use and moderate drinking were assessed at baseline, 1 month, and 3 months after the intervention. Separate analyses were conducted for participants in the original sample (n = 575) and those who completed both posttests (n = 278). Missing values in the original sample were imputed by using the multiple imputation procedure of PASW Statistics 18.
Results
Main effects of the intervention were found only in the multiple imputed dataset for the original sample suggesting that the intervention without normative feedback reduced weekly drinking in the total group both 1 and 3 months after the intervention (n =575, at the 1-month follow-up, beta = -.24, P = .05; at the 3-month follow-up, beta = -.25, P = .04). Furthermore, the intervention with normative feedback reduced weekly drinking only at 1 month after the intervention (n=575, beta = -.24, P = .008). There was also a marginally significant trend of the intervention without normative feedback on responsible drinking at the 3-month follow-up (n =575, beta = .40, P =.07) implying a small increase in moderate drinking at the 3-month follow-up. Additional analyses on both datasets testing our post hoc hypothesis about a possible differential intervention effect for males and females revealed that this was the case for the impact of the intervention without normative feedback on weekly drinking and moderate drinking at the 1-month follow-up (weekly drinking for n = 278, beta = -.80, P = .01, and for n = 575, beta = -.69, P = .009; moderate drinking for n = 278, odds ratio [OR] = 3.76, confidence interval [CI] 1.05 - 13.49, P = .04, and for n = 575, OR = 3.00, CI = 0.89 - 10.12, P = .08) and at the 3-month follow-up (weekly drinking for n = 278, beta = -.58, P = .05, and for n = 575, beta = -.75, P = .004; moderate drinking for n = 278, OR = 4.34, CI = 1.18 - 15.95, P = .04, and for n = 575, OR = 3.65, CI = 1.44 - 9.25, P = .006). Furthermore, both datasets showed an interaction effect between the intervention with normative feedback and participant’s sex on weekly alcohol use at the 1-month follow-up (for n = 278, beta = -.74, P =.02, and for n = 575, beta = -.64, P =.01) and for moderate drinking at the 3-month follow-up (for n = 278, OR = 3.10, CI = 0.81 - 11.85, P = .07, and for n = 575, OR = 3.00, CI = 1.23 - 7.27, P = .01). Post hoc probing indicated that males who received the intervention showed less weekly drinking and were more likely to drink moderately at 1 month and at 3 months following the intervention. For females, the interventions yielded no effects: the intervention without normative feedback even showed a small unfavorable effect at the 1-month follow-up.
Conclusion
The present study demonstrated that exposure to a Web-based brief alcohol intervention generated a decrease in weekly drinking among 15- to 20-year-old binge drinkers but did not encourage moderate drinking in the total sample. Additional analyses revealed that intervention effects were most prominent in males resulting in less weekly alcohol use and higher levels of moderate drinking among 15- to 20-year-old males over a period of 1 to 3 months.
Trial Registration
ISRCTN50512934; http://www.controlled-trials.com/ISRCTN50512934/ (Archived by WebCite at http://www.webcitation.org/5usICa3Tx)
doi:10.2196/jmir.1465
PMCID: PMC3057308  PMID: 21169172
Web-based brief alcohol intervention; adolescents; normative feedback; moderate drinking; alcohol use
12.  Main Report 
Genetics in Medicine  2006;8(Suppl 1):12S-252S.
Background:
States vary widely in their use of newborn screening tests, with some mandating screening for as few as three conditions and others mandating as many as 43 conditions, including varying numbers of the 40+ conditions that can be detected by tandem mass spectrometry (MS/MS). There has been no national guidance on the best candidate conditions for newborn screening since the National Academy of Sciences report of 19751 and the United States Congress Office of Technology Assessment report of 1988,2 despite rapid developments since then in genetics, in screening technologies, and in some treatments.
Objectives:
In 2002, the Maternal and Child Health Bureau (MCHB) of the Health Resources and Services Administration (HRSA) of the United States Department of Health and Human Services (DHHS) commissioned the American College of Medical Genetics (ACMG) to: Conduct an analysis of the scientific literature on the effectiveness of newborn screening.Gather expert opinion to delineate the best evidence for screening for specified conditions and develop recommendations focused on newborn screening, including but not limited to the development of a uniform condition panel.Consider other components of the newborn screening system that are critical to achieving the expected outcomes in those screened.
Methods:
A group of experts in various areas of subspecialty medicine and primary care, health policy, law, public health, and consumers worked with a steering committee and several expert work groups, using a two-tiered approach to assess and rank conditions. A first step was developing a set of principles to guide the analysis. This was followed by developing criteria by which conditions could be evaluated, and then identifying the conditions to be evaluated. A large and broadly representative group of experts was asked to provide their opinions on the extent to which particular conditions met the selected criteria, relying on supporting evidence and references from the scientific literature. The criteria were distributed among three main categories for each condition: The availability and characteristics of the screening test;The availability and complexity of diagnostic services; andThe availability and efficacy of treatments related to the conditions. A survey process utilizing a data collection instrument was used to gather expert opinion on the conditions in the first tier of the assessment. The data collection format and survey provided the opportunity to quantify expert opinion and to obtain the views of a diverse set of interest groups (necessary due to the subjective nature of some of the criteria). Statistical analysis of data produced a score for each condition, which determined its ranking and initial placement in one of three categories (high scoring, moderately scoring, or low scoring/absence of a newborn screening test). In the second tier of these analyses, the evidence base related to each condition was assessed in depth (e.g., via systematic reviews of reference lists including MedLine, PubMed and others; books; Internet searches; professional guidelines; clinical evidence; and cost/economic evidence and modeling). The fact sheets reflecting these analyses were evaluated by at least two acknowledged experts for each condition. These experts assessed the data and the associated references related to each criterion and provided corrections where appropriate, assigned a value to the level of evidence and the quality of the studies that established the evidence base, and determined whether there were significant variances from the survey data. Survey results were subsequently realigned with the evidence obtained from the scientific literature during the second-tier analysis for all objective criteria, based on input from at least three acknowledged experts in each condition. The information from these two tiers of assessment was then considered with regard to the overriding principles and other technology or condition-specific recommendations. On the basis of this information, conditions were assigned to one of three categories as described above:Core Panel;Secondary Targets (conditions that are part of the differential diagnosis of a core panel condition.); andNot Appropriate for Newborn Screening (either no newborn screening test is available or there is poor performance with regard to multiple other evaluation criteria).
ACMG also considered features of optimal newborn screening programs beyond the tests themselves by assessing the degree to which programs met certain goals (e.g., availability of educational programs, proportions of newborns screened and followed up). Assessments were based on the input of experts serving in various capacities in newborn screening programs and on 2002 data provided by the programs of the National Newborn Screening and Genetics Resource Center (NNSGRC). In addition, a brief cost-effectiveness assessment of newborn screening was conducted.
Results:
Uniform panel
A total of 292 individuals determined to be generally representative of the regional distribution of the United States population and of areas of expertise or involvement in newborn screening provided a total of 3,949 evaluations of 84 conditions. For each condition, the responses of at least three experts in that condition were compared with those of all respondents for that condition and found to be consistent. A score of 1,200 on the data collection instrument provided a logical separation point between high scoring conditions (1,200–1,799 of a possible 2,100) and low scoring (<1,000) conditions. A group of conditions with intermediate scores (1,000–1,199) was identified, all of which were part of the differential diagnosis of a high scoring condition or apparent in the result of the multiplex assay. Some are identified by screening laboratories and others by diagnostic laboratories. This group was designated as a “secondary target” category for which the program must report the diagnostic result.
Using the validated evidence base and expert opinion, each condition that had previously been assigned to a category based on scores gathered through the data collection instrument was reconsidered. Again, the factors taken into consideration were: 1) available scientific evidence; 2) availability of a screening test; 3) presence of an efficacious treatment; 4) adequate understanding of the natural history of the condition; and 5) whether the condition was either part of the differential diagnosis of another condition or whether the screening test results related to a clinically significant condition.
The conditions were then assigned to one of three categories as previously described (core panel, secondary targets, or not appropriate for Newborn Screening).
Among the 29 conditions assigned to the core panel are three hemoglobinopathies associated with a Hb/S allele, six amino acidurias, five disorders of fatty oxidation, nine organic acidurias, and six unrelated conditions (congenital hypothyroidism (CH), biotinidase deficiency (BIOT), congenital adrenal hyperplasia (CAH), classical galactosemia (GALT), hearing loss (HEAR) and cystic fibrosis (CF)). Twenty-three of the 29 conditions in the core panel are identified with multiplex technologies such as tandem mass spectrometry (MS/MS) or high pressure liquid chromatography (HPLC). On the basis of the evidence, six of the 35 conditions initially placed in the core panel were moved into the secondary target category, which expanded to 25 conditions. Test results not associated with potential disease in the infant (e.g., carriers) were also placed in the secondary target category. When newborn screening laboratory results definitively establish carrier status, the result should be made available to the health care professional community and families. Twenty-seven conditions were determined to be inappropriate for newborn screening at this time.
Conditions with limited evidence reported in the scientific literature were more difficult to evaluate, quantify and place in one of the three categories. In addition, many conditions were found to occur in multiple forms distinguished by age-of-onset, severity, or other features. Further, unless a condition was already included in newborn screening programs, there was a potential for bias in the information related to some criteria. In such circumstances, the quality of the studies underlying the data such as expert opinion that considered case reports and reasoning from first principles determined the placement of the conditions into particular categories.
Newborn screening program optimization
– Assessment of the activities of newborn screening programs, based on program reports, was done for the six program components: education; screening; follow-up; diagnostic confirmation; management; and program evaluation. Considerable variation was found between programs with regard to whether particular aspects (e.g., prenatal education program availability, tracking of specimen collection and delivery) were included and the degree to which they are provided. Newborn screening program evaluation systems also were assessed in order to determine their adequacy and uniformity with the goal being to improve interprogram evaluation and comparison to ensure that the expected outcomes from having been identified in screening are realized.
Conclusions:
The state of the published evidence in the fast-moving worlds of newborn screening and medical genetics has not kept up with the implementation of new technologies, thus requiring the considerable use of expert opinion to develop recommendations about a core panel of conditions for newborn screening. Twenty-nine conditions were identified as primary targets for screening from which all components of the newborn screening system should be maximized. An additional 25 conditions were listed that could be identified in the course of screening for core panel conditions. Programs are obligated to establish a diagnosis and communicate the result to the health care provider and family. It is recognized that screening may not have been maximized for the detection of these secondary conditions but that some proportion of such cases may be found among those screened for core panel conditions. With additional screening, greater training of primary care health care professionals and subspecialists will be needed, as will the development of an infrastructure for appropriate follow-up and management throughout the lives of children who have been identified as having one of these rare conditions. Recommended actions to overcome barriers to an optimal newborn screening system include: The establishment of a national role in the scientific evaluation of conditions and the technologies by which they are screened;Standardization of case definitions and reporting procedures;Enhanced oversight of hospital-based screening activities;Long-term data collection and surveillance; andConsideration of the financial needs of programs to allow them to deliver the appropriate services to the screened population.
doi:10.1097/01.gim.0000223467.60151.02
PMCID: PMC3109899
13.  Two Brief Alcohol Interventions for Mandated College Students 
Encouraging but limited research indicates that brief motivational interventions may be an effective way to reduce heavy episodic drinking in college students. At 2 campuses, students (83% male) mandated to a substance use prevention program were randomly assigned to 1 of 2 individually administered conditions: (a) a brief motivational interview (BMI; n = 34) or (b) an alcohol education session (AE; n = 30). Students in the BMI condition reported fewer alcohol-related problems than the AE students at 3- and 6-month assessments. Trends toward reductions in number of binge drinking episodes and typical blood alcohol levels were seen in both groups. Process measures confirmed the integrity of both interventions. The findings demonstrate that mandated BMIs can reduce alcohol problems in students referred for alcohol violations.
doi:10.1037/0893-164X.19.3.296
PMCID: PMC2663045  PMID: 16187809
mandated; student; alcohol; college; brief intervention
14.  Magnitude and Prevention of College Drinking and Related Problems 
Alcohol Research & Health  2010;33(1-2):45-54.
In 2002, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) issued a report entitled A Call to Action: Changing the Culture of Drinking at U.S. Colleges. Data on the magnitude of college drinking problems in 1998 to 1999 were reported. From 1999 to 2005, the proportion of college students aged 18–24 who drank five or more drinks on a single occasion in the past month increased from 41.7 percent to 45.2 percent. The proportion who drove under the influence of alcohol increased from 26.1 percent to 29.2 percent. Higher percentages of 21- to 24-year-olds engaged in those behaviors than 18- to 20-year-olds, and between 1999 and 2005 the percentage increased among 21- to 24-year-olds but not among those aged 18–20. From 1998 to 2005, unintentional alcohol-related injury deaths increased 3 percent (from 1,442 to 1,825) per 100,000 college students aged 18–24. Alcohol misuse by college students often harms other people through traffic crashes and sexual/other assaults. Research regarding ways to reduce college drinking problems has shown that individual-oriented interventions, particularly screening and brief motivational counseling interventions, social norms interventions, environmental policy changes such as the minimum legal drinking age of 21 and drinking-and-driving laws, and comprehensive college–community programs, can reduce college drinking and related morbidity and mortality. There is a growing need for colleges and surrounding communities to implement interventions shown through research to reduce alcohol misuse among college-aged people.
PMCID: PMC3887494  PMID: 23579935
Underage drinking; college student; undergraduate student; problematic alcohol and other drug (AOD) use; AOD use (AODU) patterns; heavy episodic drinking; binge drinking; AOD-related (AODR) consequences; AODR injury; interventions; policy
15.  Brief Alcohol Interventions for Mandated College Students: Comparison of Face-to-Face Counseling and Computer-Delivered Interventions 
Addiction (Abingdon, England)  2010;106(3):528-537.
Aims
College students who violate alcohol policies are often mandated to participate in alcohol-related interventions. This study investigated (a) whether such interventions reduced drinking beyond the sanction alone, (b) whether a brief motivational intervention (BMI) was more efficacious than two computer-delivered interventions (CDIs), and (c) whether intervention response differed by gender.
Design
Randomized controlled trial with four conditions (BMI, Alcohol 101 Plus™, Alcohol Edu for Sanctions, delayed control) and four assessments (baseline, 1, 6, and 12 months).
Setting
Private residential university in the USA.
Participants
Students (n = 677; 64% male) who had violated campus alcohol policies and were sanctioned to participate in a risk reduction program.
Measurements
Consumption (drinks per heaviest and typical week, heavy drinking frequency, peak and typical blood alcohol concentration), alcohol problems, and recidivism.
Findings
Piecewise latent growth models characterized short-term (1-month) and longer-term (1–12 months) change. Female but not male students reduced drinking and problems in the control condition. Males reduced drinking and problems after all interventions relative to control, but did not maintain these gains. Females reduced drinking to a greater extent after a BMI than after either CDI, and maintained reductions relative to baseline across the follow-up year. No differences in recidivism were found.
Conclusions
Male and female students responded differently to sanctions for alcohol violations and to risk reduction interventions. BMIs optimized outcomes for both genders. Male students improved after all interventions, but female students improved less after CDIs than after BMI. Intervention effects decayed over time, especially for males.
doi:10.1111/j.1360-0443.2010.03193.x
PMCID: PMC3058775  PMID: 21059184
brief intervention; computer-delivered intervention; college drinking; alcohol abuse prevention; mandated students; gender
16.  Do Brief Personalized Feedback Interventions Work for Mandated Students or Is It Just Getting Caught That Works? 
Studies evaluating the efficacy of brief interventions with mandated college students have reported declines in drinking from baseline to short-term follow-up regardless of intervention condition. A key question is whether these observed changes are due to the intervention or to the incident and/or reprimand. This study evaluates a brief personal feedback intervention (PFI) for students (N = 230), who were referred to a student assistance program because of infractions of university rules regarding substance use, to determine whether observed changes in substance are attributable to the intervention. Half the students received immediate feedback (at baseline and after the 2-month follow-up) and half received delayed feedback (only after the 2 mo. follow-up). Students in both conditions generally reduced their drinking and alcohol-related problems from baseline to the 2 mo. follow-up and from the 2 mo. to the 7 mo. follow-up; however, there were no significant between-group differences at either follow-up. Therefore, it appears that the incident and/or reprimand are important instigators of mandated student change, and that written PFIs do not enhance these effects on a short-term basis, but may on a longer-term basis.
doi:10.1037/0893-164X.22.1.107
PMCID: PMC2804481  PMID: 18298236
College Students; Alcohol; Drugs; Brief Interventions; Mandated Students
17.  Extreme College Drinking and Alcohol-Related Injury Risk 
Background
Despite the enormous burden of alcohol-related injuries, the direct connection between college drinking and physical injury has not been well understood. The goal of this study is to assess the connection between alcohol consumption levels and college alcohol-related injury risk.
Methods
12,900 college students seeking routine care in 5 college health clinics completed a general Health Screening Survey. 2,090 of these students exceeded at-risk alcohol use levels and participated in a face-to-face interview to determine eligibility for a brief alcohol intervention trial. The eligibility interview assessed past 28-day alcohol use and alcohol-related injuries in the past 6 months. Risk of alcohol-related injury was compared across daily drinking quantities and frequencies. Logistic regression analysis and the Bayesian Information Criterion were applied to compute the odds of alcohol-related injury based on daily drinking totals after adjusting for age, race, site, body weight and sensation seeking.
Results
Male college students in the study were 19% more likely (95% CI: 1.12–1.26) to suffer an alcohol-related injury with each additional day of consuming 8 or more drinks. Injury risks among males increased marginally with each day of consuming 5–7 drinks (Odds ratio=1.03, 95% CI: 0.94–1.13). Female participants were 10% more likely (95% CI: 1.04–1.16) to suffer an alcohol-related injury with each additional day of drinking 5 or more drinks. Males (OR=1.69, 95% CI: 1.14–2.50) and females (OR=1.81, 95% CI: 1.27–2.57) with higher sensation seeking scores were more likely to suffer alcohol-related injuries.
Conclusions
College health clinics may want to focus limited alcohol injury prevention resources on students who frequently engage in extreme drinking, defined in this study as 8+M/5+F drinks per day, and score high on sensation seeking disposition.
doi:10.1111/j.1530-0277.2009.00981.x
PMCID: PMC2757258  PMID: 19485974
Alcohol; College drinking; Injury; Heavy drinking; Sensation-seeking
18.  How Does the Brief CEOA Match With Self-Generated Expectancies in Mandated Students? 
Addictive behaviors  2012;38(1):1414-1417.
Alcohol expectancies, defined as a person’s beliefs about the effects of drinking, can influence alcohol consumption and help predict problem drinking in college students. However, there are concerns that current expectancy measures do not adequately capture mandated student expectations about alcohol use. This study examined the correspondence of 412 self-generated expectancies from mandated students (n = 64) to items on the Brief Comprehensive Effects of Alcohol (B-CEOA; Ham, Stewart, Norton, & Hope, 2005). Self-generated expectancies were reviewed by raters who attempted to match each expectancy with a single B-CEOA item based on the qualitative essence of each statement. Most mandated student expectancies were not represented by the B-CEOA. All expectancies were then classified into 6 categories based on themes and categories from the alcohol expectancy literature. Mandated student expectancies emphasized the physiological aspects of drinking, whereas the B-CEOA assesses expectancies about intrapersonal factors. The findings suggest the B-CEOA may exclude alcohol expectancies that are important and relevant to this population. Self-generated alcohol expectancies from the target population should be considered when developing or administering expectancy questionnaires.
doi:10.1016/j.addbeh.2012.07.009
PMCID: PMC3493850  PMID: 23006244
alcohol; alcohol expectancies; college alcohol beliefs; college student drinking; mandated student
19.  The Motivational Context for Mandated Alcohol Interventions for College Students by Gender and Family History 
Addictive behaviors  2009;35(3):218.
Objective
Alcohol interventions to reduce drinking for college students sanctioned for alcohol use reduce drinking and/or problems. However, intrinsic motivation to change cannot be assumed if students are mandated to receive interventions. The purpose of this study was to explore the influence of both gender and family history on motivational variables prior to a mandated intervention.
Method
Participants were 677 students (63% male) who violated residence hall alcohol policy and were mandated to participate in an alcohol abuse prevention intervention. During a baseline assessment, students described their drinking patterns and completed an assessment of biological risk for alcohol problems; they also reported attitudes regarding the sanction event, perceived peer norms regarding sanctions, resistance to influences on their alcohol use, motivation to change alcohol use, and decisional balance regarding current alcohol use.
Results
Many gender differences emerged on the motivational variables suggestive of more motivation to change among female students; family history was related only to drinking patterns and decisional balance.
Conclusions
If motivational factors influence receptivity and response to mandated interventions, then these finding suggest that greater attention to enhancing motivation to change in male students is warranted.
doi:10.1016/j.addbeh.2009.10.011
PMCID: PMC2815154  PMID: 19914002
brief intervention; college drinking; alcohol abuse prevention; mandated students; gender; family history
20.  Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: Comparison at intake and six months 
Drug and alcohol dependence  2008;99(1-3):280-295.
Objectives
Alcohol screening and brief interventions in medical settings can significantly reduce alcohol use. Corresponding data for illicit drug use is sparse. A Federally funded Screening, Brief Intervention, Referral to Treatment (SBIRT) service program, the largest of its kind to date, was initiated by the Substance Abuse and Mental Health Services Administration (SAMHSA) in a wide variety of medical settings. We compared illicit drug use at intake and six months after drug screening and interventions were administered.
Design
SBIRT services were implemented in a range of medical settings across six states. A diverse patient population (Alaska Natives, American Indians, African-Americans, Caucasians, Hispanics), was screened and offered score-based progressive levels of intervention (brief intervention, brief treatment, referral to specialty treatment). In this secondary analysis of the SBIRT service program, drug use data was compared at intake and at a six month follow-up, in a sample of a randomly selected population (10%) that screened positive at baseline.
Results
Of 459,599 patients screened, 22.7% screened positive for a spectrum of use (risky/problematic, abuse/addiction). The majority were recommended for a brief intervention (15.9%), with a smaller percentage recommended for brief treatment (3.2%) or referral to specialty treatment (3.7%). Among those reporting baseline illicit drug use, rates of drug use at 6 month follow-up (4 of 6 sites), were 67.7% lower (p < 0.001) and heavy alcohol use was 38.6% lower (p < 0.001), with comparable findings across sites, gender, race/ethnic, age subgroups. Among persons recommended for brief treatment or referral to specialty treatment, self-reported improvements in general health (p < 0.001), mental health (p < 0.001), employment (p < 0.001), housing status (p < 0.001), and criminal behavior (p < 0.001) were found.
Conclusions
SBIRT was feasible to implement and the self-reported patient status at six months indicated significant improvements over baseline, for illicit drug use and heavy alcohol use, with functional domains improved, across a range of health care settings and a range of patients.
doi:10.1016/j.drugalcdep.2008.08.003
PMCID: PMC2760304  PMID: 18929451
services; treatment; prescription drug abuse; preventive medicine; marijuana; cocaine; heroin; methamphetamine; CPT® codes; primary health care; trauma centers
21.  The effect of perceived person-job fit on employee attitudes towards change in trauma centers 
Health care management review  2013;38(2):115-124.
Background
Employee attitudes towards change are critical for health care organizations implementing new procedures and practices. When employees are more positive about the change they are likely to behave in ways that support the change, whereas when employees are negative about the change they will resist the changes.
Purpose
This study examines how perceived person-job (demands–abilities) fit influences attitudes towards change following an externally-mandated change. Specifically, we propose that perceived person-job fit moderates the negative relationship between individual job impact and attitudes towards change.
Methodology
We examined this issue in a sample of Level I trauma centers facing a regulatory mandate to develop an alcohol screening and brief intervention (SBI) program. A survey of 200 providers within 20 trauma centers assessed perceived person-job fit, individual job impact, and attitudes towards change approximately one year after the mandate was enacted.
Results
Providers who perceived a better fit between their abilities and the new job demands were more positive about the change. Further, the impact of the alcohol SBI program on attitudes towards change was mitigated by perceived fit, where the relationship between job impact and change attitudes was more negative for providers who perceived a worse fit as compared to those who perceived a better fit.
Practical Implications
Successful implementation of changes to work processes and procedures requires provider support of the change. Management can enhance this support by improving perceived person-job fit through ongoing training sessions that enhance providers’ abilities to implement the new procedures.
doi:10.1097/HMR.0b013e318249aa60
PMCID: PMC3370148  PMID: 22310485
Person-job fit; attitudes toward change; organizational change; trauma centers
22.  The Effectiveness of Community Action in Reducing Risky Alcohol Consumption and Harm: A Cluster Randomised Controlled Trial 
PLoS Medicine  2014;11(3):e1001617.
In a cluster randomized controlled trial, Anthony Shakeshaft and colleagues measure the effectiveness of a multi-component community-based intervention for reducing alcohol-related harm.
Background
The World Health Organization, governments, and communities agree that community action is likely to reduce risky alcohol consumption and harm. Despite this agreement, there is little rigorous evidence that community action is effective: of the six randomised trials of community action published to date, all were US-based and focused on young people (rather than the whole community), and their outcomes were limited to self-report or alcohol purchase attempts. The objective of this study was to conduct the first non-US randomised controlled trial (RCT) of community action to quantify the effectiveness of this approach in reducing risky alcohol consumption and harms measured using both self-report and routinely collected data.
Methods and Findings
We conducted a cluster RCT comprising 20 communities in Australia that had populations of 5,000–20,000, were at least 100 km from an urban centre (population ≥ 100,000), and were not involved in another community alcohol project. Communities were pair-matched, and one member of each pair was randomly allocated to the experimental group. Thirteen interventions were implemented in the experimental communities from 2005 to 2009: community engagement; general practitioner training in alcohol screening and brief intervention (SBI); feedback to key stakeholders; media campaign; workplace policies/practices training; school-based intervention; general practitioner feedback on their prescribing of alcohol medications; community pharmacy-based SBI; web-based SBI; Aboriginal Community Controlled Health Services support for SBI; Good Sports program for sports clubs; identifying and targeting high-risk weekends; and hospital emergency department–based SBI. Primary outcomes based on routinely collected data were alcohol-related crime, traffic crashes, and hospital inpatient admissions. Routinely collected data for the entire study period (2001–2009) were obtained in 2010. Secondary outcomes based on pre- and post-intervention surveys (n = 2,977 and 2,255, respectively) were the following: long-term risky drinking, short-term high-risk drinking, short-term risky drinking, weekly consumption, hazardous/harmful alcohol use, and experience of alcohol harm. At the 5% level of statistical significance, there was insufficient evidence to conclude that the interventions were effective in the experimental, relative to control, communities for alcohol-related crime, traffic crashes, and hospital inpatient admissions, and for rates of risky alcohol consumption and hazardous/harmful alcohol use. Although respondents in the experimental communities reported statistically significantly lower average weekly consumption (1.90 fewer standard drinks per week, 95% CI = −3.37 to −0.43, p = 0.01) and less alcohol-related verbal abuse (odds ratio = 0.58, 95% CI = 0.35 to 0.96, p = 0.04) post-intervention, the low survey response rates (40% and 24% for the pre- and post-intervention surveys, respectively) require conservative interpretation. The main limitations of this study are as follows: (1) that the study may have been under-powered to detect differences in routinely collected data outcomes as statistically significant, and (2) the low survey response rates.
Conclusions
This RCT provides little evidence that community action significantly reduces risky alcohol consumption and alcohol-related harms, other than potential reductions in self-reported average weekly consumption and experience of alcohol-related verbal abuse. Complementary legislative action may be required to more effectively reduce alcohol harms.
Trial registration
Australian New Zealand Clinical Trials Registry ACTRN12607000123448
Please see later in the article for the Editors' Summary
Editors' Summary
Background
People have consumed alcoholic beverages throughout history, but alcohol use is now an increasing global public health problem. According to the World Health Organization's 2010 Global Burden of Disease Study, alcohol use is the fifth leading risk factor (after high blood pressure and smoking) for disease and is responsible for 3.9% of the global disease burden. Alcohol use contributes to heart disease, liver disease, depression, some cancers, and many other health conditions. Alcohol also affects the well-being and health of people around those who drink, through alcohol-related crimes and road traffic crashes. The impact of alcohol use on disease and injury depends on the amount of alcohol consumed and the pattern of drinking. Most guidelines define long-term risky drinking as more than four drinks per day on average for men or more than two drinks per day for women (a “drink” is, roughly speaking, a can of beer or a small glass of wine), and short-term risky drinking (also called binge drinking) as seven or more drinks on a single occasion for men or five or more drinks on a single occasion for women. However, recent changes to the Australian guidelines acknowledge that a lower level of alcohol consumption is considered risky (with lifetime risky drinking defined as more than two drinks a day and binge drinking defined as more than four drinks on one occasion).
Why Was This Study Done?
In 2010, the World Health Assembly endorsed a global strategy to reduce the harmful use of alcohol. This strategy emphasizes the importance of community action–a process in which a community defines its own needs and determines the actions that are required to meet these needs. Although community action is highly acceptable to community members, few studies have looked at the effectiveness of community action in reducing risky alcohol consumption and alcohol-related harm. Here, the researchers undertake a cluster randomized controlled trial (the Alcohol Action in Rural Communities [AARC] project) to quantify the effectiveness of community action in reducing risky alcohol consumption and harms in rural communities in Australia. A cluster randomized trial compares outcomes in clusters of people (here, communities) who receive alternative interventions assigned through the play of chance.
What Did the Researchers Do and Find?
The researchers pair-matched 20 rural Australian communities according to the proportion of their population that was Aboriginal (rates of alcohol-related harm are disproportionately higher among Aboriginal individuals than among non-Aboriginal individuals in Australia; they are also higher among young people and males, but the proportions of these two groups across communities was comparable). They randomly assigned one member of each pair to the experimental group and implemented 13 interventions in these communities by negotiating with key individuals in each community to define and implement each intervention. Examples of interventions included general practitioner training in screening for alcohol use disorders and in implementing a brief intervention, and a school-based interactive session designed to reduce alcohol harm among young people. The researchers quantified the effectiveness of the interventions using routinely collected data on alcohol-related crime and road traffic crashes, and on hospital inpatient admissions for alcohol dependence or abuse (which were expected to increase in the experimental group if the intervention was effective because of more people seeking or being referred for treatment). They also examined drinking habits and experiences of alcohol-related harm, such as verbal abuse, among community members using pre- and post-intervention surveys. After implementation of the interventions, the rates of alcohol-related crime, road traffic crashes, and hospital admissions, and of risky and hazardous/harmful alcohol consumption (measured using a validated tool called the Alcohol Use Disorders Identification Test) were not statistically significantly different in the experimental and control communities (a difference in outcomes that is not statistically significantly different can occur by chance). However, the reported average weekly consumption of alcohol was 20% lower in the experimental communities after the intervention than in the control communities (equivalent to 1.9 fewer standard drinks per week per respondent) and there was less alcohol-related verbal abuse post-intervention in the experimental communities than in the control communities.
What Do These Findings Mean?
These findings provide little evidence that community action reduced risky alcohol consumption and alcohol-related harms in rural Australian communities. Although there was some evidence of significant reductions in self-reported weekly alcohol consumption and in experiences of alcohol-related verbal abuse, these findings must be interpreted cautiously because they are based on surveys with very low response rates. A larger or differently designed study might provide statistically significant evidence for the effectiveness of community action in reducing risky alcohol consumption. However, given their findings, the researchers suggest that legislative approaches that are beyond the control of individual communities, such as alcohol taxation and restrictions on alcohol availability, may be required to effectively reduce alcohol harms. In other words, community action alone may not be the most effective way to reduce alcohol-related harm.
Additional Information
Please access these websites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001617.
The World Health Organization provides detailed information about alcohol; its fact sheet on alcohol includes information about the global strategy to reduce the harmful use of alcohol; the Global Information System on Alcohol and Health provides further information about alcohol, including information on control policies around the world
The US National Institute on Alcohol Abuse and Alcoholism has information about alcohol and its effects on health
The US Centers for Disease Control and Prevention has a website on alcohol and public health that includes information on the health risks of excessive drinking
The UK National Health Service Choices website provides detailed information about drinking and alcohol, including information on the risks of drinking too much, tools for calculating alcohol consumption, and personal stories about alcohol use problems
MedlinePlus provides links to many other resources on alcohol
More information about the Alcohol Action in Rural Communities project is available
doi:10.1371/journal.pmed.1001617
PMCID: PMC3949675  PMID: 24618831
23.  The role of the African-American physician in reducing traffic-related injury and death among African Americans: consensus report of the National Medical Association. 
ISSUE: Traffic-related injuries and fatalities disproportionately affect the African American community. These high rates of traffic-related death and injury among African Americans manifest in multiple areas of traffic safety, including: Failure to use seat belts and child restraints. High incidence of alcohol-impaired driving. Failure to follow child passenger and seat belt safety laws and recommendations. High rates of pedestrian accidents, ofen brought on by impairments of drivers and/or pedestrians. Research indicates that national public information campaigns, with general messages only slightly modified for African American audiences, have not been culturally appropriate or effective in changing traffic safety behavior. In addition, traditional distribution mechanisms for these messages have not effectively reached the target population. Evidence suggests that in the African American community, there is a pervasive lack of knowledge of the devastating impact of traffic-related accidents on the overall health status of the community. This lack of information has resulted in a tragic cycle, in which parents fail to model safe operation of motor vehicles, and generation after generation copy this behavior, increasing the community's vulnerability to serious injuries and untimely deaths. This trend toward improper traffic safety habits among African Americans persists despite federal, state and local laws to enforce and promote sound traffic safety practices. OBJECTIVE: To study the existence of disparities in traffic-related injury and death among African Americans and to determine what kinds of traffic safety messages and campaigns will be effective in encouraging African Americans to respond to safety laws in sufficient numbers to reduce the disproportionately high rate of injury and death. Traffic safety issues were examined to effectively recommend policy, address barriers, best practices, and intervention strategies for the National Medical Association, its physician members, their patients, and their communities. CONSENSUS PROCESS: A literature review, driven by research instruments from numerous organizations included reports and materials from the National Highway Traffic Safety Administration (NHTSA), American Academy of Pediatrics, National Committee for Injury Prevention and Control, U.S. Centers for Disease Control and Prevention (CDC), Mothers Against Drunk Driving (MADD), and the National SAFE KIDS Campaign. Both the Meharry Medical College report, Achieving a Credible Health and Safety Approach to Increasing Seat Belt Use Among African-Americans, and the U.S. Department of Transportation's Blue Ribbon Panel to Increase Seat Belt Use Among African Americans: A Report to the Nation, provided substantial background for the panel. More than 60 pieces of traffic safety literature have been examined to date. Based on the literature review, a short list of the most relevant issues affecting African Americans and traffic safety was devised. It includes: The disproportionately high rate of traffic-related injury and death among African Americans. The cost in health, monetary costs and other associated costs of traffic safety accidents and injuries. The number of traffic-related injuries and deaths that could be prevented if more African Americans observed good traffic safety practices. Barriers to practicing good traffic safety habits among African Americans. Failure of laws and public information campaigns to influence improved traffic safety practices among African Americans sufficient to reduce disparities in traffic-related injury and death. In July 2001, NMA convened a consensus panel of experts in St. Thomas, U.S. Virgin Islands, to review a briefing document summarizing the most salient traffic safety issues among African Americans. The panel elaborated on key issues, including existing policy and standards for the use of child restraint devices to secure infants and toddlers, existing data regarding disparities in traffic-related injury and death among African Americans, and the cultural, age and developmental appropriateness of existing safety campaigns. SUMMARY: Public information campaigns have successfully improved traffic safety practices among the general public but in large part have been unsuccessful among minority populations-including African Americans. This may be due to: A failure to use techniques and messages that are culturally sensitive to African Americans. Campaigns that have targeted geographic and social centers where African Americans are not broadly present. Lack of awareness of the disproportionate effect motor vehicle crashes are having on African Americans. Scientifically based, culturally appropriate intervention strategies need to be devised and implemented by African American institutions and organizations to improve traffic safety practices and reduce the high rate of traffic-related injury and deaths among African Americans.
PMCID: PMC2594128  PMID: 11858225
24.  Hostility in mandated students: Exploratory analysis and implications for treatment 
College students mandated to receive an intervention following an alcohol-related campus violation are a high-risk group of students experiencing the negative effects of alcohol. Understanding the psychological properties associated with mandated students’ alcohol use may provide useful clinical information. Hostility is a trait that has shown association with heavy drinking in adults but has gone unstudied in mandated students. We examined the relationship between hostility and a variety of drinking-related variables in mandated students (N = 466). Results indicated that individuals reporting higher levels of hostility reported riskier drinking and alcohol-related problems, yet exhibited ambivalence regarding their alcohol use. Findings are discussed in the context of treating mandated students exhibiting high hostility and risky drinking, a particularly challenging population.
doi:10.1016/j.jsat.2010.01.004
PMCID: PMC3143369  PMID: 20116962
Hostility; Mandated students; Alcohol use
25.  Correlates of Alcohol-Related Regretted Sex among College Students 
The prevalence of alcohol-related regretted sex in college students warrants a better understanding of the characteristics of students who report such experiences. Therefore, the present study examined correlates of regretted sexual experiences involving alcohol use among two specific high-risk college student samples: Students mandated to alcohol intervention (N = 522) and volunteer first-year students transitioning to college (N = 481). Results indicated that alcohol-related regretted sex occurred in similar rates in mandated and volunteer students, with approximately 25% of the students reporting at least one occurrence in the past month. Women were more likely to report alcohol-related regretted sex compared to men. The belief that alcohol use would result in “liquid courage” was associated with alcohol-related regretted sex among college students, even after accounting for greater alcohol use and problem alcohol use behaviors. These findings have significant implications for intervention efforts and future research.
doi:10.1037/a0027840
PMCID: PMC3521839  PMID: 22448762
Regretted sex; alcohol use; college students

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