Marshall Social and Behavioral Aspects of Health of African American Population Paper The paper should address behavioral, psychological, political, econom

Marshall Social and Behavioral Aspects of Health of African American Population Paper The paper should address behavioral, psychological, political, economic, and social factors that contribute to a health problem in a specific population (for example, obesity in African American children). You should propose a theory-based intervention to address the problem. You should use (1) your textbook (2) at least two course readings and (3) a minimum of 2 additional journal articles from library databases (not internet websites). You must have a minimum of three citations from each of these sources. The paper should be 6-8 pages in length typed double-spaced (not including the cover page or list of references). Attached are a few of the course readings.Also, here is a link to the text which includes access to a couple chapters that can be used. JOURNAL OF AMERICAN COLLEGE HEALTH, VOL. 57, NO. 6
Clinical and Program Note
A Night to Remember: A Harm-Reduction
Birthday Card Intervention Reduces High-Risk
Drinking During 21st Birthday Celebrations
Joseph W. LaBrie, PhD; Savannah Migliuri, BA; Jessica Cail, PhD
Abstract. Objective: In collaboration with Residence Life, the
Heads UP research team developed a 21st birthday card program to
help reduce the risky drinking often associated with these celebrations. Participants: 81 students (28 males, 53 females) completed
a post-21st birthday survey. Of these, 74 reported drinking during
their 21st birthday and were included in the analyses. Methods:
During the 2005–2006 school year, the authors assigned students
celebrating 21st birthdays to either receive an alcohol risk-reduction birthday card or to a no-card condition. The students completed a survey after their birthday. Results: Students who received
the card consumed fewer drinks and reached lower blood alcohol
content (BAC) levels on their birthday than did students who did
not receive it. Female students who received the card consumed
40% fewer drinks and reached nearly 50% lower BAC levels than
women who did not receive it. Conclusion: This program is easily
replicated, inexpensive, and may be used by universities to reduce
risk related to celebratory alcohol consumption.
drinking alcohol, and 72.3% engaged in drinking behaviors that could be categorized as heavy episodic drinking
(4 [for females] and 5 [for males] or more drinks in a 2hour period). More alarming, 1 in 4 students had achieved
blood alcohol content (BAC) levels that frequently result
in blackouts, coma, and death.
As a result, some colleges have initiated risk-prevention
efforts such as 21st birthday card campaigns in which cards
containing alcohol information, social norms, or responsible
drinking messages are mailed to students with upcoming
birthdays. The most widely used of these campaigns is the
Be Responsible About Drinking (BRAD) card, which was
inspired by the death of Michigan State student Bradley
McCue, who died of alcohol poisoning on his 21st birthday.
The BRAD card tells Bradley’s story as a cautionary tale that
provides information on the symptoms of alcohol poisoning
and offers a reminder to celebrate responsibly. Although
more than 100 institutions have distributed BRAD cards,
research on its effectiveness has shown mixed results.1,5
Evaluation of other 21st birthday card campaigns has been
hindered by methodological limitations, most notably a lack
of adequate comparison groups.5 As a consequence, student
health administrators in search of effective and empirically
tested 21st birthday card campaigns have been met with
limited data. Therefore, the present investigation aims to
develop and test the efficacy of a harm-reduction 21st
birthday card campaign in order to reduce risky drinking.
We hypothesized that students receiving a 21st birthday
card will drink at more moderate levels than will those who
do not receive the birthday card.
Keywords: alcohol, birthday card, celebration drinking, college
students, harm reduction, intervention, 21st birthday
C
ollege students frequently report that the celebration of special events is one of the most important
reasons to drink alcohol.1,2 These celebratory occasions such as sporting events, holidays, graduation, homecoming, spring break, and birthdays often involve hazardous and sometimes fatal levels of alcohol consumption.
In particular, the 21st birthday marks a transition to the
legal age for drinking, and, as such, alcohol consumption
is often considered a rite of passage during these events.3
In a study investigating the prevalence of acute alcohol
intoxication during 21st birthday celebrations, Neighbors
and colleagues4 found that 90.3% of students reported
METHODS
The 21st birthday card program was inspired by a student
resident advisor (RA) who came to Heads UP with an idea
to create a 21st birthday card campaign for fellow students.
Dr LaBrie, Ms Migliuri, and Dr Cail are with the Department
of Psychology at Loyola Marymount University in Los Angeles,
California.
Copyright © 2009 Heldref Publications
659
LaBrie, Migliuri, & Cail
660
social normative information was included in an attempt
to reduce misperceptions the students might have held
about college drinking and partying and, thus, to decrease
consumption. The card was embossed by Heads UP and
Student Housing. Further, each card included a personal
note from the individual’s respective RA.
RESULTS
Of the 192 students included in the study, 81 (42%; 28
males, 53 females) completed the survey. Further, 39 of the
88 (44%) students who received a card (intervention condition) completed the survey, whereas 42 of the 104 (41%)
students who did not receive a card (control condition)
completed the survey. Seventy-four of the respondents (23
males, 51 females) reported consuming alcohol during their
21st birthday celebration and were included in the subsequent drinking analyses (see Figure 1).
12
Average # of Drinks on 21st Birthday
# of Drinks
10
8
6
4
2
0
Intervention
men
Control
men
Intervention
women
Control
women
Condition, by Gender
.20
Average BAC on 21st Birthday
.18
.16
.14
BAC %
Heads UP serves as the alcohol prevention and evaluation
arm of the university and works campus-wide to raise
alcohol awareness and prevent risky drinking.6 The team
administers and participates in various campus activities
and programs during the academic year, such as socialnorms feedback sessions in residence halls, dormitory poster
campaigns, and clinical interventions mandated by Judicial
Affairs. In addition, Heads UP continues to have a positive
presence on campus by attending campus-community
events as well as maintaining an easily approachable team
and readily available resources.
The RA proposed ideas for a 21st birthday card that
would contain an effective harm-reduction message that
would be well received by the students. In an attempt to
prevent immediate dismissal by students who planned on
drinking during their celebration, the card did not promote
100% abstinence, but rather it encouraged moderate consumption for those who chose to drink. Consistent with the
Heads UP program’s ideals and objectives, it also provided
helpful tips and protective behavioral strategies in hopes of
reducing risky drinking during this event.
To evaluate the efficacy of the birthday card program,
we piloted this program with students of 4 residence halls
on campus. The local Institutional Review Board (IRB)
approved this pilot study, and students in 2 residence halls
were randomly chosen to receive the birthday card (n = 88),
with students in the other 2 serving as a comparison group
that did not receive birthday cards (n = 104). One week
following their birthday, all students received an e-mail
requesting their participation in a survey regarding their
21st birthday celebration. First, the students received an
IRB-approved informed consent form, which they electronically signed. Next, the survey assessed drinking behaviors
during their 21st birthday celebration, such as the decision
to drink or not, the quantity of alcohol consumed, and the
amount of time spent drinking. To ensure that each student
fully understood the operational definition of a standard
drink, the survey included a chart detailing the amount in
ounces of beer, wine, and liquor that equal a standard drink.
It also included examples of how many standard drinks
compose certain cocktails, such as margaritas or Long
Island iced teas.
The front of the birthday card read, “Happy 21st
Birthday! Make it a night to remember.” The inside of the
card contained 8 location-specific ideas for celebrating a
21st birthday that were unrelated to drinking. Examples
included seeing a movie at a nearby theater or attending a
local team’s soccer game. The inside of the card also listed
“10 Tips to Party Smart” for those students who planned
to consume alcohol. Examples included “sip your drink,”
“skip a drink now and then,” and “accept a drink only
when you really want one.” The back of the card contained
a campus-specific drinking norm, “18% of LMU students
drink 5 or less drinks during a typical night of drinking/
partying. Where do you fit in?” (See the Appendix.) As
social norms have been found to be among the strongest
predictors of alcohol consumption by college students,7
.12
.10
.08
.06
.04
.02
.00
Intervention
men
Control
men
Intervention
women
Control
women
Condition, by Gender
FIGURE 1. Average number of drinks and percentage
of blood alcohol content (BAC) on 21st birthday
celebrations.
JOURNAL OF AMERICAN COLLEGE HEALTH
Harm-Reduction Birthday Card
Overall, there were significant differences between those
students who received the card and those who did not
regarding number of drinks consumed, F(1, 72) = 4.37, p < .05, and BAC level, F(1, 72) = 6.53, p < .05. Specifically, male students who received the birthday card reported consuming 23.4% fewer drinks (8.58 drinks vs 11.19 drinks) and had a 22.1% lower BAC level (.14% vs .18%) than did male students who did not receive the card. Females receiving the card experienced even greater reductions, consuming 40.2% fewer drinks (4.07 drinks vs 6.80 drinks) and reaching a 46.4% lower BAC level (.08% vs .17%), than did females who did not receive the card. It is interesting that 6 of the 7 students who chose not to drink on their 21st birthday were in the intervention group. Although this sample is small, it suggests that the intervention may have had some effect on students’ decision to drink, and it may warrant further implementation and evaluation. COMMENT Our 21st birthday card program combined several components to create an innovative and effective card that differentiated it from other interventions. It incorporated a social norms statistic, provided ideas for birthday activities unrelated to alcohol, and suggested protective behavioral strategies for drinking moderately in the event that the student decided to drink. Overall, students who received the card drank less and reached lower BAC levels than did those who did not receive the card. In all, 61% of students who did not receive the card achieved BACs above .15%, which is often associated with nausea/vomiting, impaired judgment, and blackouts. Furthermore, of those who exceeded that BAC, 23% exceeded a .25% BAC level, at which point severe sensory and motor impairment, comas, and even death by respiratory arrest can occur. In contrast, among students receiving the card, only 27% overall exceeded .15%, and only 8% drank to a BAC of .25%. This 21st birthday card not only reduced alcohol consumption, but most likely contributed to reductions in the alcohol-related negative effects associated with extreme BAC levels. Given that innate physiological differences place women at a greater risk for alcohol-related negative consequences at equivalent BAC levels than men, our finding of greater effectiveness in women is noteworthy. Although it is possible that this result was due to the relatively low number of males who took the follow-up survey, the finding is consistent with Grizzell8 and suggests the need for future investigations to test whether these birthday card interventions are more effective for women than for men and, if this is the case, to devise ways of engaging men more effectively. Our findings are tempered by certain limitations. First, although the response rate was consistent with response rates of other online surveys, many students who received cards or were in the control condition did not complete the post-21st birthday survey. The results might be more believable if more students had completed the survey. Additionally, the survey relied on student self-report, which might be prone to underreporting, especially with regard VOL 57, MAY/JUNE 2009 to major celebrations. However, previous research has shown that self-reports9 are reliable and valid indicators of current alcohol use in college students. Future research might explore whether students can accurately report on their drinking behavior during major celebrations. Further, the card was created collaboratively by an RA and Heads UP staff without student input and included both harmreduction and social norms information. Future birthday card programs may wish to utilize student focus groups to come up with messaging that is even more salient to students than the present card. In conclusion, the overall efficacy of the card was most likely strengthened by the fundamental interrelationship among Heads UP, Resident Life, and the student population. Heads UP helped to craft an effective harm–reduction message. The personal note from each student’s RA may also have helped to make the students more receptive to the message. The card is also cost-effective; each card costs less than $.50 to create and can be produced in little time. Efficiency may be further improved through the use of electronically delivered e-cards, which could be created quickly, require no postage, and may reach more students than would traditional mail, although future research will need to investigate the efficacy of these cards. In the meantime, we encourage other universities to use this 21st birthday card program because it is easily replicated, inexpensive, requires little effort, and has demonstrated success at reducing alcohol consumption among college students during the high-risk event of 21st birthday celebrations. ACKNOWLEDGEMENT This research was funded by a Model Award from the US Department of Education (Grant Q184N050003) and by Grant U18 AA015451-01 from the National Institute of Alcohol Abuse and Alcoholism. NOTE For comments and further information, address correspondence to Dr Joseph LaBrie, Department of Psychology, Loyola Marymount University, and 1 LMU Drive, Los Angeles, CA 90045, USA (e-mail: jlabrie@lmu.edu). REFERENCES 1. Hembroff L, Atkin C, Martell, D, McCue C, Greenamyer J T. Evaluation results of a 21st birthday card program targeting high-risk drinking. J Am Coll Health. 2007;56:325–333. 2. Institute for Public Policy and Social Research. Executive summary: college students and “celebration drinking.” http:// www.ippsr.msu.edu/osr/celebrationdrinkingstudy.htm. Published April 11, 2002. Accessed March 17, 2009. 3. Neighbors C, Walters S, Lee C, et al. Event-specific prevention: addressing college student drinking during known windows of risk. Addict Behav. 2007;32:2667–2680. 4. Neighbors C, Spieker CJ, Oster-Aaland L, Lewis M, Bergstrom RL. Celebration intoxication: an evaluation of 21st birthday alcohol consumption. J Am Coll Health. 2005;54:76–80. 5. Smith BH, Bogle K, Talbott L, Gant R, Castillo H. A randomized study of four cards designed to prevent problems during college students’ 21st birthday celebrations. J Stud Alcohol. 2006;67:607–615. 661 LaBrie, Migliuri, & Cail 6. LaBrie JW, Pedersen ER, Lamb TF, Bove L. Heads UP! A nested intervention with freshmen male college students and the broader campus community to promote responsible drinking. J Am Coll Health. 2006;54:301–304. 7. Neighbors C, Lee CM, Lewis MA, Fossos N, Larimer ME. Are social norms the best predictor of outcomes among heavy-drinking college students? J Stud Alcohol Drugs. 2007;68:556–565. 8. Grizzell J, California State University, Pomona. Cal State Pomona 21st birthday card: drinking social norms and alcohol use safety tips. http://www.csupomona.edu/~jvgrizzell21/card. htm. Published April 2000. Accessed March 17, 2009. 9. O’Hare T. Measuring alcohol consumption: a comparison of the retrospective diary and the quantity-frequency methods in a college drinking survey. J Stud Alcohol. 1991;52:500–502. APPENDIX The Birthday Card Ouside: (appendix continues) 662 JOURNAL OF AMERICAN COLLEGE HEALTH Harm-Reduction Birthday Card APPENDIX (continued) Inside: VOL 57, MAY/JUNE 2009 663 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Hooking Up and Sexual Risk Taking Among College Students: A Health Belief Model Perspective Qualitative Health Research Volume 19 Number 9 September 2009 1196-1209 © 2009 The Author(s) 10.1177/1049732309344206 http://qhr.sagepub.com Teresa M. Downing-Matibag Brandi Geisinger Iowa State University, Ames, Iowa, USA “Hooking up” with friends, strangers, and acquaintances is a popular way for college students to experience sexual intimacy without investing in relationships. Because hooking up often occurs in situations in which prophylactics against sexually transmitted infections (STIs) are not available or in which students’ judgment is impaired, it can involve risky behaviors that compromise student health. As such, in-depth studies of the factors related to sexual risk taking during hookups are needed, to advance preventive research and programming. Based on semistructured interviews with 71 college students about their hooking-up experiences, the findings of this study demonstrate that the Health Belief Model can serve as a useful framework for understanding sexual risk taking during hooking up, and offers suggestions for sexual risk-prevention programs on college campuses. The results demonstrate why students’ assessments of their own and their peers’ susceptibility to STIs are often misinformed. The findings also show how situational characteristics, such as spontaneity, undermine students’ sexual self-efficacy. Keywords: campus health; health behavior; health education; HIV/AIDS, prevention; intervention programs; interviews; risk, perceptions; sexual health; sexually transmitted diseases; young adults I n today’s efficiency-oriented society, many college students are choosing an alternative to old-fashioned dating, which some claim ties them down and constrains their time. Rather, they are having casual sexual relationships and saving their time and money for other pursuits (Gilmartin, 2006; Glen & Marquardt, 2001). These sexual encounters, known as “hookups,” involve a range of intimate behaviors, from kissing and fondling to sexual intercourse, between partners who do not have relational commitments (Flack et al., 2007; Manning, Giordano, & Longmore, 2006). Because hookups commonly involve alcohol consumption and binge drinking, they are associated with high levels of sexual risk taking (Lambert, Kahn, & Apple, 2003; Paul & Hayes, 2002) or, in cases where students are too inebriated to give consent, involuntary risk exposure (Flack et al., 2007). According to the Task Force of the National Advisory Council on Alcohol Abuse and Alcoholism (2002) and the Centers for Disease Control and Authors’ Note: We acknowledge the Iowa State University Department of Sociology and the Institute for Social and Behavioral Research for supporting this study. 1196 Prevention ([CDC],1995b), in addition to having sex while under the influence of alcohol, sexual risk taking among college students involves having unprotected sex and multiple sex partners. Consequently, those who hook up might experience unwanted pregnancies, sexually transmitted infections (STIs), and sexual violence (Flack et al., 2007; CDC, 1995b). As hooking up threatens the sexual, physical, and psychological health of college-age youth, understanding sexual risk taking within the context of this popular practice is important. In this study we explored college students’ rationales for sexual risk taking during hooking up using the theoretical framework of the Health Belief Model (HBM; Lin, Simoni, & Zemon, 2005; Rosenstock, 1974; Rosenstock, Strecher, & Becker 1988). In doing so, we explored and now demonstrate how this model can be applied through qualitative research to identify the factors that contribute to sexual risk taking in hookup relationships. Although casual sexual intimacy is generally risky, some behaviors are riskie... Purchase answer to see full attachment