reducing drinking among junior enlisted air force members in five communities: early findings of the...

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Reducing Drinking Among Junior Enlisted Air Force Members in Five Communities: Early Findings of the EUDL Program’s Influence on Self-Reported Drinking Behaviors*

CHRISTOPHERSPERA,PH.d.,†KEITAFRANKLIN,L.c.s.W.,KAZUAKIUEKAWA,PH.d.,JOHNF.KUNZ,M.a.,RONALDZ.SZOC,PH.d.,RANDALLK.THOMAS,PH.d.,andMILTONH.CAMBRIDGE,PH.d.†

ICF International, 9300 Lee Highway, Fairfax, Virginia 22030

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ABSTRACT. Objective: In the fall of 2006, the Office of JuvenileJusticeandDelinquencyPreventionawardeddiscretionarygrantstofivecommunitiesinfourstatesaspartoftheEnforcingUnderageDrinkingLaws initiative.These 3-year grants were designed to support imple-mentation of a set of interventions using an environmental strategiesapproachtoreducedrinkingandassociatedalcohol-relatedmisconductsamongactive-dutyAirForcemembersages18-25,withaspecificfocusontheunderagepopulation.ThecurrentarticlepresentsfindingsfromYear1oftheevaluation.Method:Dataonalcoholusewereobtainedfromalarge-scale,anonymoussurveythatfieldedinthespringof2006(i.e., pretest) and the spring of 2008 (i.e., posttest) from a stratified

random sampleofAirForcemembers atfivedemonstration andfivecomparison communities. Results:The percentage of junior enlistedpersonnelatriskforanalcoholproblemdropped6.6%intheAirForceoverallduringthelast2yearsbutdroppedasmuchas13.6%and9.8%intwoArizonademonstrationcommunitiesthatimplementedtheinter-vention.Conclusions:Thefirst-yearresultssuggestthattheEnforcingUnderageDrinkingLaws interventionmayhavebeenone factor thathelpedtoreducethepercentageofjuniorenlistedAirForcemembersatriskforanalcoholprobleminthedemonstrationcommunities.(J. Stud. Alcohol Drugs, 71,373-383,2010)

Received:April20,2009.Revision:August25,2009. *Thecurrentstudywasfundedunderacontract(contractno.GS-23F-806-2H,HHSN267200700003T)toICFInternationalbytheNationalInstituteonAlcoholAbuseandAlcoholism(NIAAA),incollaborationwiththeU.S.AirForce(USAF)andtheOfficeofJuvenileJusticeandDelinquencyPreven-tion(OJJDP).ThethreefederalagenciescollaboratedonthisprojectviaamemorandumofunderstandingdatedFebruary2006.Datapresentedwithinthisarticlewerecollectedundera separatecontract (no.GS-23F-0115K,

FA7014-07-F-A043)toICFInternationalfortheconductoftheAirForceCommunityAssessmentSurvey,fundedbytheAirForceMedicalOperationsAgency,OfficeoftheSurgeonGeneral.Thefindings,thoughts,andopinionsexpressedwithinthisarticlesolelyrepresenttheviewsoftheauthorsanddonotrepresenttheviewsofNIAAA,USAF,OJJDP,orICFInternational. †CorrespondencemaybesenttoChristopherSperaattheaboveaddressorviaemailat:cspera@icfi.com.MiltonH.CambridgeiswiththeAirForceMedicalOperationsAgency,OfficeoftheSurgeonGeneral,FallsChurch,VA.

IN THE FALL OF 2006, the Office of Juvenile Justiceand Delinquency Prevention (OJJDP) awarded discre-

tionarygrantstofivecommunitiesinfourstatesaspartofthe Enforcing Underage Drinking Laws (EUDL) initiativeto design and implement a set of interventions using anenvironmental strategies approach to reduce drinking andassociated alcohol-related misconducts among active-dutyAirForcemembersages18-25,withafocusontheunderagepopulation.Thecommunitiesselectedtoreceiveawardspart-neredwithalocalAirForcebase(AFB)totargetactive-dutymemberslivinginthecommunity,bothon-andoff-base,anddevelopedabroad-basedcoalition(e.g.,lawenforcementof-ficials,governmentofficials,alcoholandbeveragecommis-sionrepresentatives,andAirForcehumanserviceproviders)toimplementtheinterventionacrossthe3-yeargrantperiod.The five communities that received grant awards includedthefollowing:(a)Phoenix,AZ/LukeAFB;(b)Tucson,AZ/

Davis-Monthan AFB; (c) Honolulu, HI/Hickam AFB; (d)greater Sacramento area in California/BealeAFB; and (e)GreatFalls,MT/MalmstromAFB. Oneyear after thesegrantswere awarded, theNationalInstitute onAlcoholAbuse andAlcoholism (NIAAA), thefederal agency sponsoring the evaluation, in collaborationwith the U.S.Air Force and OJJDP, selected ICF Interna-tionalastheexternalentitytoconductanevaluationoftheEUDL activities implemented in these five communities(communityinthisarticleisdefinedasthegeographicareaofthelargerciviliancommunityinwhichtheU.S.AFBlies,andthereforeincludesboththebaseandthesurroundingci-viliancommunity).Thegoaloftheevaluationistomeasuretheeffectivenessof the interventionsondrinkingbehaviorand associated alcohol-related misconducts by active-dutypersonnel.ThecurrentarticlepresentsfindingsfromYear1of theevaluationonself-reporteddrinkingbehaviorsgath-

374 JOURNALOFSTUDIESONALCOHOLANDDRUGS/MAY2010

eredfromalarge-scale,anonymoussurveyofjuniorenlistedactive-dutymembers.

Drinking among junior enlisted active-duty members

Despitethenationalminimumlegaldrinkingage,alcoholremainsthedrugofchoiceamongadolescents,with18-to20-year-olds having the highest prevalence of alcohol de-pendenceofanyagegroup(U.S.DepartmentofHealthandHuman Services, 2007). Given this problem, much of theresearchonunderagedrinkingfocusesoncollegestudents(Goldstein and Flett, 2009; LaBrie et al., 2009). CollegestudentsoftodaysharemanydemographicsimilaritieswithU.S.Air Force junior enlisted population. In the U.S.AirForce,thejuniorenlistedranks(i.e.,E1-E4)arecomprisedpredominantlyofyoungmenandwomenbetween18and25yearsold.Active-dutymemberswhovolunteerformilitaryservicecomefromcitiesandtownsacrosstheUnitedStates,including urban, suburban, and rural communities. Afterbasictraining,active-dutymembersrelocatetomilitaryin-stallationsandresideindormitory-stylehousing,similartocollegefacilities,andbegintheworkoftheU.S.AirForce. In many regards, however, junior enlisted active-dutymembersarequitedifferentfromtheirciviliancounterparts.Uniquetothispopulationistheintenselevelofstressplacedonyoungactive-dutymembers,particularlyduringwartime.Active-dutymembers in today’sAirForceperform in jobswithahighoperationstempo,oftencontributinglonghoursincombat-intensiveenvironments.Researchershavefoundthat working in a stressful and intense work environment,suchasthecasewithmilitarymembers,isariskfactorforincreasedlevelsofalcoholconsumption(Brayetal.,2006).This high level of stress is associated with increased riskbehaviors suchasheavyepisodicdrinkingduringoff-dutyhours,particularlyaftercombat,oronreturnhomefromadeployment(Amesetal.,2007). TheAirForcehasa“zero-tolerance”policytowardunder-age drinking and problem use of alcohol.When problemsarise, the Air Force applies a two-pronged approach oftreatmentandprevention.AnintegralpartofthepreventionapproachistheAirForce’s“CultureofResponsibleChoices”(CoRC)program,whichservesasapreventionandaware-nesscampaignacrosseveryAFB,emphasizingdrinkingasone of many lifestyle choices active-duty members makeeachandeverydaythatcouldaffectcombatreadiness(U.S.AirForce,2006).Astandardizedcomponentofthisinitiativewithrespecttodrinkingisthe0-0-1-3campaign.Thebasicpremisebehindthiscampaignisamessageof“0”underagedrinking; “0” driving-under-the influence (DUI) incidents;and if you are of legal drinking age and choose to drinkalcohol,guidancefordrinkingresponsiblyis“1”drinkperhour,withamaximumof“3”drinkspernightforanaver-agemanof175pounds.Despitezerotoleranceforunderagedrinkingandaggressivetreatmentandpreventionefforts,the

AirForce,likeallpartsofthelargersociety,facesproblemsassociatedwithexcessivedrinkingandalcohol-relatedmis-conducts,includingDUIsordriving-while-intoxicated(DWI)incidents, domestic violence, and sexual assault (Hoge etal., 2004; Rosen, 2007). In fact, a recentAir Force reportindicatedthat33%ofsuicides,57%ofsexualassaults,29%ofdomesticviolence incidents, and44%ofmotorvehicleaccidentsarealcoholrelated(U.S.AirForce,2006).

Environmental strategies to reduce drinking

Whether inaciviliancommunityoronanAFB,drink-ing has clear implications for broad community systems.Key community entities (e.g., hospitals, law enforcement,and service agencies) devote countless resources to theinterventionandtreatmentofalcohol-relatedincidentsthatarisefromhighlevelsofalcoholconsumption.Attheotherend of the spectrum is prevention programming, which iscommunity based, environmental in nature, and aimed atreducing incidents of drinking. Environmental approacheshave increased in popularity over the last 15 years andinclude interventions aimed at the overall community thatultimately have an impact on the individual drinker. Asopposed to traditionalpreventionand treatment initiatives,community-levelinterventionsusinganenvironmentalstrate-giesapproachplaceanemphasisonmacro-orsystems-levelentities,suchaspolicyinfluences,establishmentsthatservealcohol,andculturesorsocialnetworksthatperpetuateat-titudesorbehaviorstowarddrinking. The three overarching principles of an environmentalapproach include (a) media efforts targeted toward policymakers,(b)jointcommunity-levelcollaboration,and(c)anemphasisonthesupplyofalcohol(Gruenwaldetal.,2003).Thisapproach,firstempiricallytestedinthemid-1990s,hasshownpositiveresultswithincivilianU.S.communitiesinanumberofstates,includingMassachusetts,Minnesota,andWisconsin. One such program, the Saving Lives Project (Hingsonetal.,2006),founda39%reductioninfatalcrashinjuriesamong16- to25-year-olds in theexperimentalcommunityinMassachusetts,ascomparedwiththerestofthestateovera5-yearperiod.Anevaluationofanotherprogramaimedatreducing alcohol-related misconducts, using a communitytrialsapproachthatmatchedthreeexperimentalcommunitieswith threecomparisoncommunities,also foundpromisingresults.Resultsfromthisstudyincludeda10%reductioninnighttimecrashesinvolvinganalcohol-relatedinjury,a43%reductioninalcohol-relatedassaultinjuriesasevidencedbyemergencyroomvisits,anda49%reductionincommunitymembers’ self-reportofdrivingafter “having toomuch todrink”(Holderetal.,2006;TrenoandLee,2002).Athirdexample, the Communities Mobilizing for Change onAl-coholproject,whichfocusedonactivatingthecitizenryofcommunitiestoachievechangesinlocalpublicpoliciesand

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practicesofmajorcommunityinstitutions,showedthattheprojectsignificantlyandfavorablyaffectedthebehaviorof18- to 20-year-olds (e.g., less likely to purchase alcohol,frequentbars,anddriveunder the influence)and thealco-holsalespracticesofbarsandrestaurants(Wagenaaretal.,2000). Similarly, the Safer California Universities Project,whichusedanenvironmentalapproachtomitigatedrinkingbycollegestudents,foundarelationshipbetweentheinter-ventionandasignificantdeclineinseveralkeyoutcomes,in-cludingalcoholconsumption(CaliforniaStateUniversityatChico,2007).Twoothercommunity-basedenvironmentallydesignedinterventions—(a)theBorderProject(InstituteforPublicStrategies,2002)and(b)theSacramentoNeighbor-hoodAlcoholPreventionProject,knownasSNAPP(Trenoetal.,2007)—reporteddecreasesinaccesstoandconsump-tionofalcohol,aswellasassaultsandotherviolentcrimes.Specifically,SNAPPfoundsignificantreductionsinassaultsasreportedbypolice,aggregateemergencymedicalservices(EMS) outcomes, EMS assaults, and EMS motor vehicleaccidents. These studies conducted in civilian communities laythefoundationforthecurrentstudyontheeffectivenessofenvironmental approaches within civilian towns/cities thatare heavily occupied with active-dutyAir Force membersand their families.Howdoesanenvironmental“lens” thatincorporates both civilian and military entities workingin collaboration, inside and outside the gates of anAFB,influence the reduction of drinking and associated conse-quences in that community?Anecdotal evidence indicatesthat,withanincreasedfocusfromseniorleadershipandthecommunity at-large, underage drinking and the associatedconsequencesamongactive-dutymemberscanbelessenedsignificantly.Thiswasfirstdemonstratedbythesuccessofaprogram implementedbyF.E.WarrenAFB,wherebase-level senior leadership placed an increased emphasis oncurbing drinking among junior enlisted personnel throughtheinitiationofkeyenvironmentalstrategies,suchasreach-ingouttocommunityagenciesinsideandoutsidethegates,sending letters to localbars asking forpolicycompliance,andofferingalternativeactivities todrinkingduringhourswhenjuniorenlistedpersonneltraditionallyseekoutalcohol.Acrossa2-yearperiod,theinterventionactivitiesresultedina74%declineinalcohol-relatedincidents,81%fewercasesof underage drinking, and 45% fewer DWI cases (OJJDP,2005).Basedon this “success story,”OJJDPsubsequentlyfundedfivecommunities,throughtheirstateEUDLoffices,to implementasimilarsetof interventionsacrossa3-yearperiod,whichisthefocusofthecurrentarticle.

Primary research question

Buildingon thebodyof literaturediscussedpreviously,thecurrentstudysoughttoaddressthefollowingoverarch-ing research question: Did the activities implemented by

eachof thefive communitieshave ameasurable influenceontheirrateofproblemdrinkingrelativetotheirrespectivecomparisoncommunityandrelativetotheAirForceoverallrateofproblemdrinking?Themethodologyusedtoanswerthisprimaryresearchquestionispresentedbelow.

Method

Evaluation conceptual framework and design

Theconceptualframeworkforthisevaluationwasdrivenbya theoryof changeapproach focusingon thepathwaysby which context, process (i.e., activities), and outcomesarelinked.Theframeworkispredicatedonextantriskandprotectivefactorsinthecommunity,aswellastheincidenceandprevalenceofunderagedrinking,whichestablishesourbaselineandmustbemeasuredbefore the implementationoftheinterventionactivities.Onceimplementedacrossthe3-yeargrantperiod,theinterventionactivitiesareintendedtoraiseawarenessandincreaseknowledgeofthedangersofunderage drinking and its associated consequences, whichwillultimatelyimpacttheoutcomesofinterest. The evaluation design is a repeated cross-sectionalwithin-site (i.e., each community) design comparing out-yeardatawithbaselinedataforeachdemonstrationsite,aswell as drawing comparisons between each demonstrationsiteandacomparisoncommunityandbetweeneachdem-onstrationsiteandtheAirForceoverall.ThedemonstrationsiteswereawardedfundinginOctober2006foraperiodof3years(2006-2009).Thedemonstrationsitesspentthefirst6-12monthsofthefundingperioddevelopingtheircommu-nitycoalitionandcreatingadetailedworkplanspecifyingthemanner to implement the intervention,withsomesitesgettingtheircoalitionupandrunning(mostnotablyArizonaandMontana)earlierthanothers.Asaresult,thedemonstra-tion sitesbegan implementing their intervention sometimein the summer or fall of 2007, with the last site (Hawaii)receivingapprovaloftheirworkplanfromOJJDPinJanuary2008.

Selecting comparison communities

Theselectionofacomparisoncommunityforeachdem-onstrationsitewasaccomplishedbyselectingcommunitiesthatcouldbeapotentialmatchtoeachdemonstrationsite,basedonthefollowingfourfactors:(a)urban/ruraltypology,(b)missionoftheAFB,(c)sizeoftheAFBandsurroundingcommunity,and(d)rateofproblemdrinkingamongjuniorenlistedpersonnelatpretest(i.e.,spring2006).Theprocessresultedinamatchoffivetoeightcommunitiesthatcouldserveasapotentialcomparisonsiteforeachdemonstrationcommunity.Followingthisprocess,weworkedinconjunc-tionwith the federal partners (OJJDP,U.S.AirForce, andNIAAA)toselectthebestcomparisoncommunitybasedon


the available data on the five factors listed above.Table 1presents the relevant characteristicsof eachdemonstrationsiteanditsrespectivecomparisonsite.

Intervention activities

Each demonstration community implemented a set ofenvironmental strategies to reduce drinking among under-ageand18-to25-year-oldactive-dutyAirForcemembers.Interventionactivitiesatallsitesincludedthefollowing: (a)enforcementaimedatreducingthesocialavailabilityofalcohol(e.g.,shoulder-tapdrinkeridentificationverifica-tion operations, controlled party dispersal operations); thedemonstrationsitesconductedshoulder-tapoperationsinatleastthreelocationsperyearandcontrolledpartydispersalsataminimumoftwotimesperyear; (b) compliance checks of local alcohol establishmentstoensure that theestablishmentsarenotsellingalcohol tounderageactive-dutymembers(usingcovertunderagebuy-ers); demonstration sites conducted a minimum of two tothree compliance checks at key identifiedalcohol retailers(i.e.,onesnearthebaseandinareasfrequentedbyunderageactive-dutymembers)eachgrantyear; (c)impaireddrivingenforcement(i.e.,increasednumberandfrequencyofDUIchecksinthecommunity);appropri-ateDUI enforcement operations conducted aminimumofatleasttwoDUIpatroloperationsperyeartargetedatyouthalcoholpartiesandsubsequentdriving inandaround theirrespectiveareas/communities;

(d)localpolicydevelopment,suchasworkingtoeducatestate legislatures on the issues of underage drinking thatmayleadtochangesinpoliciesandlaws(e.g.,orientingthephotosonlicensesofunderageandadultdriversdifferently,suchashead-onvs.profileorleftsidevs.rightside); (e)developmentanddeploymentofacommunity-basedawareness/media campaign to reduce drinking, includingheavydrinking;all sitesused the0-0-1-3message in theircampaign,aswellaswebsitesdiscouragingunderagedrink-ing;and (f) offering of alternative activities that do not includedrinking(e.g.,sportsactivities). Althoughalldemonstrationsites implemented thesesixinterventions(withaminimumnumberofeventsperactivityasdescribedabove),giventhevaryingsizeofeachdemon-strationsite (AFBplussurroundingcommunity),eachsiteimplementedtheseactivitiesatafrequencyproportionaltothesizeof theircommunity(e.g.,Arizona, themosturbangranteestate,conductedshoulder-tapoperationsinasmanyas80 locationsperyear).Althoughnotan intervention, insupportof theirefforts,allcommunitiesreceivedintensivetraining and technical assistance services provided by theUnderage Drinking Enforcement Training Center at thePacificInstituteforResearchandEvaluation.Theresourcesprovided by the Underage Drinking EnforcementTrainingCenter included disseminating publications about “bestpractices” in reducing alcohol use through environmentalstrategies approaches, hosting audio-teleconferences, andproviding “hands-on” training and technical assistance for

TaBLe1.Descriptionofthecommunities

Site

Site1 Phoenix,AZ/LukeAFB Comparisonsite Urban/rural Urban Urban Mission Combatops.andtrg. Combatops. Size(persons) 4,782 3,604 Problemdrinkingatpretest(E1-E4) 21.5% 17.5%

Site2 Tucson,AZ/Davis-MonthanAFB Comparisonsite Urban/rural Urban Urban Mission Combatandsupportops. Combatandsupportops. Size(persons) 6,005 4,727 Problemdrinkingatpretest(E1-E4) 22.3% 21.4%

Site3 Honolulu,HI/HickamAFB Comparisonsite Urban/rural Urban Urban Mission Combatsupport Combatops. Size(persons) 3,738 2,067 Problemdrinkingatpretest(E1-E4) 18.9% 22.3%

Site4 Sacramento,CA/BealeAFB Comparisonsite Urban/rural Rural Rural Mission Combatsupportops. Combatandsupportops/trg. Size(persons) 3,172 3,151 Problemdrinkingatpretest(E1-E4) 20.0% 17.8%

Site5 GreatFalls,MT/MalmstromAFB Comparisonsite Urban/rural Rural Rural Mission Operationalmissilebase Combatsupportops. Size(persons) 3,379 2,148 Problemdrinkingatpretest(E1-E4) 24.6% 20.8%

Notes:AFB=AirForcebase;ops.=operations;trg.=training.Source:AirForcePersonnelCommand.

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coalitionworkplandevelopmentandinterventionimplemen-tationefforts.

Data collection

Data for thecurrentstudywerecollectedaspartof theAirForceCommunityAssessmentsurvey,abiannualanony-moussurveyofactive-dutypersonnelthatwasconductedinspring2006(i.e.,pretest)andinspring2008(i.e.,posttest)acrossallAirForcecommunities.AlthoughtheCommunityAssessmentsurveycollectsdatafromallactive-dutymem-bersacrossallbasesworldwide,thisarticlefocusesondatafromjuniorenlistedmembersinthe18-to25-year-oldrangewithinthefivedemonstrationsitesandthefivecomparisoncommunities(n=2,008in2006and2,112in2008),aswellastheAirForceoverall(n=11,964in2006and12,993in2008).TheCommunityAssessmentsurveyincludedapproxi-mately160itemsonarangeofcommunityandwell-beingissues, which included questions on alcohol use. In boththe2006and2008versionsoftheCommunityAssessmentsurvey,arandomstratifiedsampleofactive-dutymembers(stratified by rank, gender, and deployment status withineachAFB)wasselectedandinvitedtocompletethesurveyviatheWeb.In2006,thefinalresponserateacrossallbasesforactive-dutymemberswas48.5%;in2008,itwas49.0%. Following the data collection, data were weighted byrank,gender,deployment,andbasetoadjustfordifferencesinthedemographicsoftherespondentscomparedwiththedemographicsoftheoverallpopulation.Thesampleweight(overall Air Force weight) was applied when conductingall analyses for this article. Given the sensitive nature ofquestions about alcohol consumption, we conducted anitem nonresponse analysis. Based on this assessment, wefound thatapproximately16.5%of juniorenlistedperson-nel skipped the alcohol questions, and, thus, we were notable to develop an alcohol summary scale score for theseindividuals.Althoughdata for all itemscouldbeanalyzedbyincludingonlythosewithfullycompletedsurveys,touseallthedatathatwasgathered,weusedmultipleimputationtoimputethemissingdatasothatallcasescouldbeanalyzed,withtheprimarybenefitbeingthatitproducesunbiasedes-timatesofeffectsandsignificantlyreducesitemnonresponsebias(SchaferandGraham,2002).Thisprocessinvolvedtwosteps:(a)generatingfivecompletedatasetsinwhichmiss-ingvalueswereimputedbysimulatingvaluesfromafittingprobabilitydistributionand (b) analyzing themultiple im-puteddatasetsandaveragingresultsfromanalysestoformoverallconclusionsforthevariablesofinterest.WeusedtheSAS-callableIVEwarepackage(Raghunathanetal.,2000),whichreadilyhandles large,complexdatasetscomprisingvariablesofvarioustypes(e.g.,continuous,semicontinuous,categorical, dichotomous, and count). IVEware performsmultipleimputationsusingthesequentialregressionimputa-tionmethod.

Measure of rate of alcohol problems

TherateofalcoholproblemsontheCommunityAssess-ment surveywasmeasuredvia theAlcoholUseDisordersIdentificationTest(AUDIT),developedbytheWorldHealthOrganization (Babor et al., 2001). The AUDIT has beenused in research and clinical practice to identify those atrisk forproblemdrinking,basedon self-reporteddrinkingbehaviors and associated consequences. The AUDIT wasdevelopedandevaluatedoverthelast2decadesusinglargemultinationalsamplesandconsistsof10questions.Specifi-cally,therearethreequestionsaboutdependencesymptoms,threequestionsaboutrecentalcoholuse,andfourquestionsabout alcohol-related problems. Relevant to the currentstudy,theAUDIThasproventobevalidindetectingalcoholdependence in persons ages 18-25 (Fleming et al., 1991).TheAUDIT was included on the CommunityAssessmentsurveyinboth2006and2008forthecurrentstudyandwasaskedofallsurveyparticipants.Eachitemusesfiveorderedresponsecategoriesandassignsascoreof0to4,whichisthensummedacross the10 items togivea total scoreperpersonofaminimumof0andamaximumof40.Basedontheguidelinesprovidedinthescoringmanual,andconsistentwithpreviousresearchstudies,ascoreof8andabovewasused in the current study to signify individuals at risk forproblemdrinking.AsindicatedintheAUDITmanual,“totalscoresof8ormorearerecommendedasindicatorsofhaz-ardousandharmfulalcoholuse,aswellaspossiblealcoholdependence”(Baboretal.,2001,p.19).

Results

To determine the effects of the intervention, our majorresearch questions were whether the prevalence rate forproblem drinking among junior enlisted personnel (as aproportion scoring 8 or higher) changes over time (i.e.,comparing each demonstration community at pretest andposttest)andisdifferentbetweensites(i.e.,comparingeachdemonstrationsitewithitscorrespondingcomparisoncom-munityandtheAirForceoverall).Therewereanumberofimportantanddifferentiatingfactorsthatledustotreateachdemonstration site separately in our analyses rather thanpoolalldemonstration sites together.Among these factorswere the following: (a) some demonstration sites startedimplementingtheirinterventionearlierthanothersbasedongettingtheirworkplanapprovedbyOJJDPatanearlystage;(b) although each demonstration site conducted the samesetofinterventionactivities,eachcommunityimplementedtheinterventionatadifferentmagnitudebasedonthesizeof their respective community (e.g., larger communitiesconductedmoreDUIchecks);(c)eachdemonstrationsiteisverydifferent fromoneanother (e.g., ruralcommunityvs.largeurbancommunity);(d)alldemonstrationsitesstartedatdifferentpointsontheAUDITcontinuum,withsomehav-


inghigherdrinkingratesthanothersatbaseline—therefore,poolingthecommunitieswouldcomplicatethisaspectoftheanalysis;and(e)eachcomparisoncommunitywasselectedtobestmatchaspecificdemonstrationsiteinaone-on-onecomparison.As a result of all these collectivedifferences,we determined that an independent examination of eachdemonstrationsitewaswarranted. BecausetheAUDITindicatorisadichotomousvariableofeither“problemdrinker”or“notaproblemdrinker,”thecalculationoftheAUDITpercentageswasbasedon(a)thenumber of junior enlisted personnel with a score of 8 orabove,indicatingbeingatriskforproblemdrinkingdividedby (b) the number of junior enlisted members. Data wereweighted with sample weights; therefore, the analyticalsample represented the targeted population. Because themultiple-imputation technique produced five data sets, theAUDITpercentageswereobtainedbyaveragingthepercent-ages from each of the five imputed data sets.Two sampleproportiontests(i.e.,ztests)wereconductedtoevaluatethegroupdifferencesinthepercentages. Table2presentstheAUDITpercentages(i.e.,prevalenceforproblemdrinking)forthreegroupunits:(a)demonstra-tionsite,(b)comparisonsite,and(c)overallAirForce.Theresultsarereportedseparatelyforthepretestperiod(2006)and the posttest period (2008). Each panel in the tablepresents results for each demonstration community andcomparison community. In addition, we summarize threecomparisonsineachpanel.Thecross-sectionalcomparison,Comparison A, indicates whether a demonstration com-munity isdifferent fromthecomparisonsiteand fromAirForceoverallforeachofthetwopointsintime.ThissetofcomparisonsassessestheextenttowhichthedemonstrationandcomparisonsitesweredifferentatTime1andTime2.Theover-timecomparison,ComparisonB, reports thedif-ferenceinthepercentagevaluesbetween2006(pretest)and2008(posttest).Inthiscomparison,anegativevaluesigni-fiesadecreaseinthepercentageofindividualsclassifiedatriskforproblemdrinkingwithinagivencommunityacrosstime.ComparisonC,labeledcomparisonofchanges,reportsthe between-group differences in the percentage changesreportedinSectionB.Hypothetically,if thedemonstrationsiteandthecomparisonsitechangedtheproblem-drinkingrate by -10% and -5%, respectively (minus signs indicateratereduction),thevaluewouldbethedifferenceofthetwo,namely,-5%(whichisaresultof-10%minus-5%).Largenegativevaluesindicateafavorableinterventionresult(i.e.,ademonstrationsitemanaged to lower theprevalence ratemoresuccessfullythanacomparisonsite). AsTable2 reveals, in theAirForceoverall, the rateofindividualsclassifiedasaproblemdrinkerdroppedby6.6%frompretesttoposttest,witharateof20.4%atTime1and13.8%atTime2, indicatinga statistically significantdropatthep<.001level.WithrespecttothePhoenix,AZ/LukeAFBcommunity,thepercentageofproblemdrinkersatthis

demonstration community was not significantly differentfromeither thecomparisonsiteor theAirForceoverallatpretest;but,atposttest,thepercentageofproblemdrinkerswas7.7%lessthanthecomparisonsite(p<.05)and5.9%lessthanAirForceoverall(p<.001).Whencomparingthechanges across time, the Phoenix,AZ/LukeAFB commu-nity had a drop of 13.6% in problem drinkers (p < .001),comparedwithadropof1.9%forthecomparisonsiteand6.6%forAirForceoverall(seeFigure1).Whencomparingthesedropsacrosstime,theprevalenceratedroppedinthePhoenix,AZ/LukeAFBcommunitytoalargerdegreethanat the comparisoncommunity (p< .05) and theAirForceoverall(p<.05). With respect to the Tucson, AZ/Davis-Monthan AFBcommunity,thepercentageofproblemdrinkersinthisdem-onstration community was not significantly different fromeitherthecomparisonsiteortheAirForceoverallatpretestandposttest.Whencomparingthechangesacrosstime,theTucson,AZ/Davis-MonthanAFBcommunityhadadropof9.8%inproblemdrinkers(p<.01),comparedwithadropof11.2%forthecomparisonsiteand6.6%forAirForceoverall(seeFigure2).Whencomparingthesedropsacrosstime,theprevalenceratedropintheTucson,AZ/Davis-MonthanAFBcommunitywasnotsignificantlydifferentfromthecompari-sonsiteandtheAirForceoveralldrop. FortheHonolulu,HI/HickamAFBcommunity,theper-centageofproblemdrinkersat thisdemonstrationsitewasnotsignificantlydifferentfromeitherthecomparisonsiteortheAirForceoverallatpretest;but,atposttest,thepercent-ageofproblemdrinkerswas7.0%lessthanthecomparisonsite(p<.05)and4.3%lessthanAirForceoverall(p<.10).When comparing the changes across time, the Honolulu,HI/HickamAFBcommunityhadadropof9.4%inproblemdrinkers (p < .05), compared with a drop of 5.8% for thecomparisonsiteand6.6%forAirForceoverall.Whencom-paringthesedropsacrosstime,theprevalenceratedropintheHonolulu,HI/HickamAFBcommunitywasnotsignifi-cantlydifferentfromthecomparisonsiteandtheAirForceoveralldrop. IntheSacramento,California/BealeAFBcommunity,thepercentage of problem drinkers at this demonstration sitewas not significantly different from either the comparisonsite or theAir Force overall at pretest and posttest.Whencomparing thechangesacross time, theSacramento,Cali-fornia/BealeAFBcommunityhadadropof8.1%inproblemdrinkers (p < .05), compared with a drop of 9.3% for thecomparisonsiteand6.6%forAirForceoverall.Whencom-paringthesedropsacrosstime,theprevalenceratedropintheSacramento,California/BealeAFBcommunitywasnotsignificantlydifferentfromthecomparisonsiteandtheAirForceoveralldrop. Finally, in the Great Falls, MT/Malmstrom AFB com-munity, thepercentageofproblemdrinkersat thisdemon-stration site was not significantly different from either the

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TaBLe2.AUDITresultsfordemonstrationsitesinrelationtocomparisonsitesandAirForce:Juniorenlistedresults

A.Phoenix,AZ/LukeAFBCommunity 2006 2008

N % N %

LukeAFB 195 21.5% 292 7.9% -13.6%****Comparisonsite 166 17.5% 186 15.6% -1.9%OverallAirForce 11,964 20.4% 12,993 13.8% -6.6%****

A:Cross-sectionalcomparison C:Comparisonofchanges

2006 2008 %Difference %Difference %Difference

LukeAFBvs.comparisonsite 4.0% -7.7%** -11.7%**LukeAFBvs.overallAirForce 1.1% -5.9%**** -7.0%**

B.Tucson,AZ/Davis-MonthanCommunity 2006 2008

N % N %

Davis-Monthan 218 22.3% 269 12.5% -9.8%***Comparisonsite 201 21.4% 175 10.2% -11.2%***OverallAirForce 11,964 20.4% 12,993 13.8% -6.6%****



Davis-Monthanvs.comparisonsite 0.9% 2.3% 1.4%Davis-Monthanvs.overallAirForce 1.9% -1.3% -3.2%

C.Honolulu,HI/HickamCommunity 2006 2008

N % N %

Hickam 129 18.9% 148 9.5% -9.4%**Comparisonsite 254 22.3% 271 16.5% -5.8%*OverallAirForce 11,964 20.4% 12,993 13.8% -6.6%****



Hickamvs.comparisonsite -3.4% -7.0%** -3.6%Hickamvs.overallAirForce -1.5% -4.3%* -2.8%

D.Sacramento,CA/BealeCommunity 2006 2008

N % N %

Beale 307 20.0% 248 11.9% -8.1%**Comparisonsite 230 17.8% 183 8.5% -9.3%***OverallAirForce 11,964 20.4% 12,993 13.8% -6.6%****



Bealevs.comparisonsite 2.2% 3.4% 1.2%Bealevs.overallAirForce -0.4% -1.9% -1.5%

E.GreatFalls,MT/MalmstromCommunity 2006 2008

N % N %

Malmstrom 151 24.6% 159 19.3% -5.3%Comparisonsite 157 20.8% 181 32.1% 11.3%**OverallAirForce 11,964 20.4% 12,993 13.8% -6.6%****



Malmstromvs.comparisonsite 3.8% -12.8%*** -16.6%**Malmstromvs.overallAirForce 4.2% 5.5%* 1.3%

Notes:AUDIT=AlcoholUseDisordersIdentificationTest;AFB=AirForcebase.*p<.10,**p<.05,***p <.01,****p<.001.

B:Over-timecomparisonChange2006-2008

%


%


%


%


%


FiGure1.Changesinprevalenceofproblemdrinkers:Phoenix,AZ/LukeAirForce(AF)basecommunity.Comp.=comparison.***p<.001.

FiGure2.Changesinprevalenceofproblemdrinkers:Tucson,AZ/Davis-Monthan(DM)AirForce(AF)basecommunity.Comp.=comparison.**p<.01;***p<.001.

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FiGure3.Changesinprevalenceofproblemdrinkers:GreatFalls,MT/MalmstromAirForce(AF)basecommunity.Comp.=comparison.*p<.05;***p<.001.

comparisonsiteortheAirForceoverallatpretest;however,atposttest, thepercentageofproblemdrinkerswas12.8%lessthanthecomparisonsite(p<.01)but5.5%morethanAir Force overall (p < .10).When comparing the changesacrosstime,theGreatFalls,MT/MalmstromAFBcommu-nityhadadropof5.3%inproblemdrinkers,comparedwithanincreaseof11.3%forthecomparisonsiteandadropof6.6%forAirForceoverall(seeFigure3).Whencomparingthesedropsacrosstime,theprevalenceratedroppedintheGreat Falls, MT/Malmstrom AFB community to a largerdegreethanatthecomparisoncommunity(p<.05).

Discussion

The current study provides an early indication (Year1 of the evaluation) of the potential effects of the EUDLinterventions within the five communities with respect toself-reporteddrinkingbehavior.Datafromout-yearsoftheevaluation,includingdatafromabroaderrangeofvariables(e.g., data on problem behaviors such as DUIs), are cur-rentlybeingcollectedand,onceavailable,willbeanalyzedand reported. With respect to the current article, the firstnoteworthyfindinginthisstudyisthatthepercentageofAirForcejuniorenlistedpersonnelatriskforadrinkingproblemhasdecreasedsignificantlyoverthelast2years(a6.6%dropfrom2006to2008).Specifically,in2006,approximatelyoneinfivejuniorenlistedactive-dutymembers(20.4%)wereat

risk foranalcoholproblem,comparedwith2008,when itdroppedtooneinseven(13.8%).Itisdifficulttoempiricallyidentify the reasons for this sizeabledropAirForcewide;however,althoughspeculative,thedropmaybe,inpart,theresult of the implementation of CoRC and the use of the0-0-1-3campaignacross theAirForce.CoRCemphasizestheAirForce’szero-tolerancepolicyforthoseyoungerthan21 and provides guidance for safe levels of drinking forthose21orolder, including21- to25-year-oldactive-dutymembers,whooftensocializewiththeunderagepopulation.ThedropintherateofpersonsatriskforproblemdrinkingmayalsobetheresultofdecreasednumbersofdeploymentswithintheAirForcefrom2006duringtheheightofwarinIraqto2008(O’BryantandWaterhouse,2008),wherebyre-ducednumbersofdeploymentsandassociatedstressesmaybe related to a lower propensity for active-duty memberstobeclassifiedatriskforbeingaproblemdrinker.Finally,althoughresearchershavefoundthatself-reporteddrinkingbehaviors within the military has good criterion validity(Belletal.,2003)suchthatmembersreportthemaccuratelyonanonymoussurveys, it ispossible that the increasedat-tentiononthedangersofdrinkingpertheEUDLandCoRCprogramssince2006hasinflatedthenumberofjuniorper-sonnelunderreportingproblem-drinkingbehaviorsin2008. Whenexaminingwhethertheprevalencerateforproblemdrinkingamongjuniorenlistedpersonnelisdifferentacrosstimebycomparingeachdemonstrationcommunityatpretest


andposttestwithitscorrespondingcomparisoncommunityand Air Force overall, it is first important to discuss thebest “yardstick.”For communities that are typicalofmostAirForcecommunities,usingtheAirForceaverageasthebenchmarkforthedemonstrationsitesmaybeoptimal,be-cause averaging allAir Force communities smoothes overany variance and measurement error across sites. On theother hand, for communities that are unique, such as in asmallcitywithinalargerruralarealiketheGreatFalls,MT/MalmstromAFBsite,comparisonstotheAirForceaveragemaybemisleading,andthebestbenchmark,infact,mightbeanothercommunitywithanAFBwithasimilarmissionand in an area with a similar small city/rural profile.Theissue of the best “yardstick” is important to discuss whenevaluatingtheresultspresentedinthisarticle,becausetwomeasuresofcomparisonwereprovidedforeachdemonstra-tionsite(i.e.,aselectedcomparisonsiteandtheAirForceoverall). This issue is highlighted in the findings for theGreat Falls, MT/Malmstrom AFB community, which hada smaller percentage drop from pretest to posttest in theprevalenceratecomparedwiththeAirForceoverallbuthadasignificantlylargerdropthanthecomparisoncommunity(anotherruralareawithalargeconcentrationofactive-dutymembers), where the prevalence rate of problem drinkingactuallyincreasedoverthepast2years. Althoughallfivesiteshaveseendecreasesinthepercent-ageofjuniorenlistedpersonnelatriskforproblemdrinkingoverthepast2years,themostpromisingearlyfindingsfromthe evaluation are within the two Arizona communities,where the Phoenix,AZ/LukeAFB community had a dropof 13.6% and the Tucson, AZ/Davis-Monthan AFB com-munityhadadropof9.8%overthelast2years,comparedwith adropof6.6% forAirForceoverall.Thesedrops inthe percentage of individuals at risk for problem drinkingrepresent promising, but not necessarily cause-and-effect,relationshipsbetweentheinterventionandanonymousself-report data on drinking for junior enlisted personnel. TobetterunderstandandexplorethepotentialreasonswhytheearlyresultsseemtobemostpromisinginthesetwoArizonacommunities,wereviewedinformationfromtheworkplansandmeetingminutespreparedbythecommunitycoalitionsformedandoperatedtoimplementtheinterventions.Fromareviewofthisinformation,afewuniquethemesemerged.First,welearnedthatArizona,alongwithMontana,wasoneof the two states thatwerequickest after grant funding todevelop their coalition(s), get their work plan(s) approvedbyOJJDP,andbeginimplementingtheirinterventionactivi-ties.Second,welearnedthat,inbuildingtheircoalition,thetwoArizonacommunitiesusedguidancefromtheUnderageDrinkingEnforcementTrainingCenteratthePacificInstitutefor Research and Evaluation, input from the Federal part-ners (i.e., OJJDP, NIAAA, and U.S.Air Force), and “bestpractice”guidelinesfromtheSubstanceAbuseandMentalHealth Services Administration (2006) on building state-

basedcoalitionstopromotecommunitypreventionusinganetwork analysis. Related to this,Arizona had an existingunderage-drinkingtaskforceinexistencebeforethefundingoftheEUDL/AirForcediscretionarygrantproject;therefore,the state had an existing network focused on this issue tobuild upon.Third, in addition to drawing on the technicalassistance provided at that national level by the UnderageDrinkingEnforcementTrainingCenter, these twocommu-nities hired anoutside local partner (i.e., PimaPreventionPartnership) to help implement their activities. Having anexperiencedandwell-establishedentityoutsideofthestateandAFB infrastructureassistwith thegrantactivitieswasreportedbythecoalitionmembersinArizonaaskeytotheirefforts.Fourth,giventhatbothofthesecommunitiesareinurban areas (Phoenix andTucson), they have had successwith readily identifying and offering alternative activitiestodrinkingforyoungactive-dutymembers,comparedwithsitesinmoreruralareas,wherethenumberofpossibilitiesforalternativeactivitiesmaybeperhapslimited.Finally,aswasthecasewiththe“successstory”ofF.E.WarrenAFB,thetwoArizonacommunitieshavereceivedstrongsupportfrombase-levelleadershipontheEUDLproject. Although these early findings are promising for EUDLwithincommunitiescontainingalargepopulationofactive-dutyAir Force members, it is important to be cautious inoverinterpreting these findings for many reasons. First,given the quasi-experimental nature of the study, it is notpossible to establish cause-and-effect relationships or toindicatetheinterventionsarecausingthedropintherateofproblemdrinkers. Itwillbe important tocontinue tomea-sureprevalenceratesovertimetoseeiftheeffectsreportedinthisarticleremainstableorincreaseinordertoprovidefurtherevidencefortheeffectoftheintervention;however,ultimately cause-and-effect cannot be established. Second,becauseCoRChasbeenimplementedacrosstheAirForceandtheEUDLcommunitiesareoffering,inasense,CoRCplusEUDLactivities,itishardtoteaseouttheimpactfromCoRCversustheimpactfromEUDL.Finally, itshouldbenotedthatthefindingspresentedinthisarticlefocussolelyon rates of problem drinking and do not include data onalcohol-relatedmisconducts,suchasDUI/DWIs,underage-drinkingincidents,trafficaccidents,emergency-departmentvisits,anddomesticviolence.Thesetypesofoutcomedataarecurrentlybeingcollected,andwhen theyareavailable,the findings presented in this study need to be corrobo-ratedwiththesedatatofurthersupporttheearlyevaluationfindings.

Acknowledgments

TheauthorsthankOJJDP,andtheirleadership,specificallyMs.SharieCantelonandothers(e.g.,KellieDressler,JanetChiancone).WethanktheU.S.Air Force, led by Dr. Milton Cambridge and Col.Terry Stottler. Inaddition,we thank the followingU.S.AirForce individuals:TSgt. James

SPERAETAL. 383

Bridwell,Maj.RachelFoster,Maj.NicoleFrazer,Col(retired)EvanHoa-pili,Maj.DavidLinkh,Maj.MarkMartello,Col.FredStone,andLt.Col.JayStone.We thankNIAAA, ledon this project byDr.MichaelHilton,Mr. Roger Hartman (retired), and Dr. Ralph Hingson.Thank you to Mr.Bill Patterson, Ms. Mary Gordon, Ms. HollyTorske, and Ms. JohnnettaDavis-JoycefromthePacificInstituteforResearchandEvaluationfortheirexcellent technical support to the grantees.Within ICF International, wethankthefollowingmembersfortheirmethodologicalwork(e.g.,sampling,weighting,imputation):BryanHiggins,LauraLeach,JoPrabhakaran,BorisRachev, Marissa Shuffler, and MichaelYang.Thank you to Drs. RichardHeyman,JefferySnarr,andAmySmith-SlepfromtheStateUniversityofNewYorkatStonyBrookfortheirconsultationonthemultipleimputationtasks.WethankAlanSchreckandAllanPorowskifortheirearlierworkontheEUDLproject.

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