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.