Heads Up! Women

Introduction

Heads UP! Women is a multi-faceted intervention that combines several empirically validated approaches to problem drinking reduction (i.e., Motivational Interviewing Strategies, Social Norms Strategies, Decisional Balance, and Relapse Prevention) into one comprehensive program. The format is non-confrontational and non-judgmental; allowing students to both assess their drinking and build motivation for changing their behavior.

The goal of Heads UP! Women is to intervene with high-risk women [(1) underclass females and (2) women sanctioned by Judicial Affairs for drinking-related violations] to reduce their level of drinking and the incidence of resulting problems. This project also seeks to promote a change in the campus culture with respect to alcohol and its impact on healthy development.

Method

The following initiatives are being conducted simultaneously.

1. Administrative Initiative:

                 a. Letters from the University President are sent to both entering female freshmen and their parents highlighting gender specific consequences of drinking and encouraging discussion of drinking before entering college.

2. Intervention with High Risk Women:

                  a. Judicial Offenders: Female students receiving judicial sanctions for violating university alcohol policies are referred to Heads UP! Women.

                  b. Underclass Females: During the fall semesters, the program recruits 250-350 underclass female students, and these students will receive a nominal stipend for participating in the program. Once enrolled, these students will participate in the same brief motivational enhancement group with follow-up sessions as the judicial offenders, in order to promote responsible drinking choices and a clearer understanding of reasons for drinking. Some students will be randomly selected for a control group assessment only condition.

3. Campus Outreach:

                 a. Staffing of a women’s alcohol programming coordinator position to oversee campus programming geared directly towards women

                 b. The implementation of social norms and women’s health education programs targeted to women’s organizations on campus (e.g., sororities, service organizations).

                 c. Foster campus dialogue on women’s health and alcohol Issues through monthly Heads UP! Women events that will include speakers and discussion. These events will be open to faculty, staff, students, and others in the campus community.

                d. The development of a social norms poster campaign to raise awareness of alcohol and health issues specific to women and to provide accurate normative information regarding alcohol use among women.

4. Evaluation:

                a. Specific aims of this intervention include: (1) reduce incidence of alcohol violations in female students receiving intervention as compared to peers and previous underclass records; (2) reduce drinking and problems related to drinking in female students; (3) reduce occurrence of alcohol poisonings among women receiving intervention; and (4) reduce recidivism of alcohol violations and alcohol poisonings among judicial offenders sanctioned to group intervention.

              Procedure: Women participate in one 90-120 minute awareness/motivational enhancement focus group. Each group is led by two facilitators trained in Motivational Interviewing and includes 6-10 participants.

              The group meeting consists of obtaining informed consent, the completion of the initial questionnaire, focus group discussion, a decisional balance exercise, a Timeline Followback calendaring of drinking, and the statement of behavioral goals.

              a. Initial questionnaire: The data collection instrument includes the following measures: (1) demographics, (2) self-reported alcohol use and sexual activity for past month, (3) intended drinking over the next 30 days, (4) the Rutgers Alcohol Problem Index (RAPI), (5) four general health rulers, (6) a Readiness to Change Ruler, (7) the Reasons for Drinking Scale, (8) alcohol expectancies, and (9) sex-related alcohol expectancies.

              b. Timeline Followback: Participants complete a Timeline Followback (TLFB, Sobell & Sobell, 1992) of drinking behavior for three months pre-intervention. Though addressed as a group, participants are instructed to complete their TLFB individually. The TLFB allows computation of several significant variables and serves as an intervention by fostering awareness of drinking behavior over the past three months.

              c. Normative Reeducation: Normative reeducation consists of highlighting discrepancies between perceptions of normative drinking behavior and actual data for their University community. Participants are also provided with feedback regarding the percentage of time alcohol is involved in incidents of regretted sexual experiences, forced sex, vandalism, and physical violence on campus.

             d. Expectancy Challenges

             e. Health Education: Presentation and discussion of gender specific health concerns/risks related to alcohol use among women (e.g., alterations in menstrual period, increased risk for victimization). This includes information on women’s physiology and its affects on alcohol metabolism and behavior.

             f. Blood Alcohol Content: The concept of Blood Alcohol Concentration (BAC) is introduced in such a way that is useful in understanding the effects of alcohol on women’s bodies. To facilitate this discussion, gender and weight specific blood alcohol content cards are distributed to give a specific approximation of typical blood alcohol levels.

            g. Reasons for Drinking Focus Group: Participants are lead through a series of open-ended questions consistent with MI techniques and principles to heighten awareness of their reasons for drinking and to facilitate a discussion of how alcohol operates (positively and negatively) in women’s lives.

            h. Decisional Balance: The decisional balance component of the intervention begins with a group exercise in which participants are encouraged to generate a list of reasons for (Pros) and against (Cons) reducing their current levels of drinking. After the group dialogue, participants are asked to document, on a decisional balance worksheet, the Pros and Cons that resonated with them. Each participant then individually rates the personal importance of each Pro and Con on a Likert scale.

             i. Motivational Statement/Behavioral Goal: Participants are asked to write down a behavioral goal for how they will drink in the next 30 days and share it with the group.

            Monthly Drinking Diaries: Group participants are required to keep a monthly drinking diary for three months post-intervention. They are asked to record for each day they drink: how many drinks they consumed, if the episode met the criteria for binge drinking, whom they drank with, and where they drank. The diary forms will also include the RAPI, a measure of intended drinking in the next 30 days, as well as a Readiness to Change Ruler.

            Final Questionnaire: At three months, participants receive a final questionnaire including several measures from the initial questionnaire including: (1) the Reasons for Drinking Scale, (2) general alcohol expectancies, (3) sex-related alcohol expectancies, and (4) four general health rulers.