Evaluation of brief alcohol abuse strategies.

Abstract

The purpose of the evaluation was to examine the process that two campuses went through as a result of implementing alcohol abuse strategies. Specifically, the evaluation focused on the implementation and administrative experiences of those charged with preventing alcohol abuse on each campus. The results suggest that the evidence-based prevention grant program is a valuable tool for pushing campuses with prevention infrastructure forward.

An institution's infrastructure is a key element in the successful adoption of new practices.

Introduction

The challenge of institutions of higher education ameliorating the harm associated with high-risk student behavior is illuminated by a lawsuit claiming negligence by the University of Wisconsin--LaCrosse. A UW-LaCrosse student passed away on April 9, 2003 after falling in the Mississippi River following a night of heavy drinking on his twenty-first birthday (2004, August 31). The student's parents are suing claiming the University encourages heavy drinking through its programs and policies. The University had already engaged in alcohol education along with programs such as safe rides to and from local businesses late at night. A conundrum emerges for the university. The university supported safe rides and other programs to help ensure the safety of students, yet stands accused of aiding heavy alcohol use due to the existence of a program that helps intoxicated students return to campus. This situation illuminates how it is no longer enough for institutions to do something, without evidence that an action functions to positively ameliorate harm associated with heavy alcohol use.

Prominent media attention and scholarship point toward alcohol abuse on college campuses as a pressing public health concern laced by institutions of higher education (Wechsler, Dowdall & Maenner, 1998). As indicated in the case of the University of Wisconsin-LaCrosse, university leaders are charged with addressing student alcohol use due both to public health concerns and increasing legal liability (Bickel & Lake, 2001). The problem of student alcohol use is displayed by findings that there is increasing heavy, abusive alcohol use by college students and in the assertion that up to 1,400 college students die each year due to alcohol related incidents (NIAAA, 2002; Hingston, Heeren, Zakocs, Kopstein, & Wechsler, 2002). Most concerning is the finding that students who attend college see an increase in heavy use that is not equaled by their non-college attending peers (O'Malley & Johnston, 2002). The negative consequences academically, socially and individually have a vast impact on the culture of what it is to be a college student (Perkins, 2002). Equipping university leaders to address student alcohol use means having them understand the human capital lost by college students related to alcohol use and providing them with tools to ameliorate the associated harm (Powell & Wechsler, 2003).

Literature Review

Program and policy efforts to ameliorate alcohol use and its negative consequences in higher education are increasingly reported on in academic journals. Program literature can be characterized as trying to reduce student demand for alcohol (Wechsler, Seibring, Liu & Ahl, 2004). Among approaches working to reduce student demand for alcohol, strategies with evidence of efficacy include brief intervention and alcohol skills training involving normative feedback. In comparison to program efforts, policy approaches are more likely to limit access to alcohol or create supportive environments for health behavior. Brief interventions, or those programs involving one or two sessions with students, are programs consistently showing efficacy when evaluated in the higher education setting (McNally & Palfai, 2003). Brief intervention approaches reappearing in the literature include programs based upon skill building, attitude change, and feedback to students (Waiters, Bennett & Noto, 2000; NIAAA, 2002; NIAAA, 2002b). Brief programs that are based upon education and abstinence have shown far less effectiveness (Waiters, Bennett & Noto, 2000). In general approaches that focus on moderation of consumption are more effective than those based on prohibition (Krohn & Pyc, 2000). The specific brief programs that have been evaluated and shown evidence of effectiveness include screening and non-confrontational interventions, screening and brief intervention, challenging alcohol expectancy and cognitive behavior skill building programs. Longer more intensive formats of cognitive behavior skill building and feedback programs such as Alcohol Skills Training Program have also shown efficacy among college students (Baer, Kivlahan, Blume, McKnight, & Marlatt, 2001; Dimeff, Baer, Kivlahan, & Marlatt, 1999; Kivlahan, Marlatt, Fromme, Coppel & Williams, 1990).

Background and Objectives

In August 2002 the Illinois Higher Education Center (IHEC) for Alcohol, Other Drug and Violence Prevention at Eastern Illinois University initiated a grant competition targeted at institutions of higher education in the state of Illinois. This grant competition called for institutions to propose, implement, and evaluate alcohol prevention strategies that were based upon empirical evidence. With funding supported by the Illinois Department of Human Services, the evaluation was commissioned to examine the experience of two of the five grantees that ultimately submitted successful applications for evidence-based program implementation. IHEC commissioned this evaluation as a means of documenting the experiences of campuses as they work to implement programs and practices for alcohol abuse prevention in the collegiate setting that have been shown, through outcomes evaluation, to have efficacy.

The evidence-based prevention grant program is an outgrowth of a programs and practice survey conducted by IHEC in conjunction with the Center for Prevention Research and Development at the University of Illinois in the spring of 2002 (Wall, 2002b). The survey of programs and practices indicated that among institutions of higher education in Illinois, dedicated staff time to alcohol abuse prevention was limited, as were the different types of prevention activities. As the survey data collection was being completed, in April of 2002, the National Institute of Alcohol Abuse and Alcoholism (NIAAA) issued a landmark report entitled "A Call To Action." This report provided an overview and synthesis of the existing research literature associated with collegiate alcohol abuse. Specifically, the report put forward three tiers of programs in relationship to evidence of behavior change efficacy (NIAAA, 2002b). This report, coupled with the survey was being conducted in the spring of 2002, and an independent IHEC review of the literature on program efficacy published in the summer of 2002 (Wall, 2002), set the stage for the evidence-based prevention grant competition.

The grant competition offered $5,000 for implementation of an evidence-based prevention strategy. The request for proposals issued in September 2002, along with a bidder's conference held around the same time, outlined multiple evidence-based strategies for considerations. Materials also encouraged schools to propose and provide rationale as to why their strategy would fit into an evidence-based adoption grant competition. Proposals were collected in November 2002, with notification of awards taking place in late November. Five institutions were selected to be funded and each of them attended a two day retreat in December of 2002 to further orient them to the grant guidelines and to provide them additional guidance on adopting an evidence-based prevention program or strategy on their campus. The project officially began on the five campuses in January of 2003. The purpose of the evaluation was to examine the process that campuses went through as they implemented new programs and practices. This process examination focuses on the implementation and administrative experiences of those charged with preventing alcohol abuse on each campus. The questions guiding the evaluation and formation of study themes included: 1) what is the experience of campuses adopting evidence-based prevention?; and 2) what is the experience of administrators in relationship to evidence-based prevention approaches?

Evaluation Approach and Methodology

In order to examine the experience of evidence-based program implementation prompted by the grant competition, the experiences of two institutions is described as a part of this evaluation. The two cases under examination were selected due to their perceived success by staff from IHEC in adopting an evidence-based prevention program. Specifically, the cases were Near Urban Community College (NUCC) and Urban Private College (UPC). These names are used as pseudonyms to protect the identity of the institution. The primary data source was from five interviews conducted with program staff and administrators from two campuses with job titles including: health educator, counselor/advisor, instructor, and student program coordinator. Interview data were tape recorded, or when not possible for practical considerations, extensive notes were taken and typed immediately following the interview. Additional data and program context information were gathered through document review of IHEC grant materials, campus grant reports and program materials. Interview notes or transcripts, along with documents, were analyzed for key emerging themes associated with the evaluation questions.

Transcripts along with typed interview notes were iteratively reviewed in the analysis. First, the texts from all five interviews underwent full read through so as to develop a set of general themes emerging from the text. Second, following the full read through an initial eleven themes were developed. Following identification of the eleven themes, transcripts and typed notes were returned to such that data were coded into the eleven general themes. In the middle of coding data into emerging themes, four themes were combined into two, thus reducing the total themes in coding to nine. Following the fitting of text into themes, descriptions of each theme were written drawing upon coded text but not directly quoting text to protect the identity of evaluation respondents. An initial version of findings was sent to evaluation participants for their review and comment, but no objections to the findings were received.

Case Study One Description

Near Urban Community College (NUCC) is a public two-year college that enrolls approximately 15,000 students each year. With 135 full-time and 600-700 part-time faculty and 59 associate degree programs, NUCC serves 24% of high school graduates in its district. Near Urban is located in a suburb of a major metropolitan area, and serves a growing minority student population. Illegal substance use has not been noted by the community college as a major institutional issue, but is acknowledged in the surrounding community as a significant health and social concern. The concern over substance abuse and related problems in the community helped to spur the creation of a community coalition to address the issue ten years ago. Four of the founding members of that coalition are still active, with the total coalition size being upwards of fifty. This group is a key vehicle in the acquisition of substance abuse prevention funding, community program delivery and the application for the evidence-based prevention grant.

For Near Urban the receipt of the evidence-based grant funding has facilitated the institution in implementing the Alcohol Skills Training Program (ASTP), which was developed by the University of Washington in the late 1980's and early 1990's (Baer, Kivlahan, Fromme, & Marlatt, 1994). Research on the ASTP has indicated that increased skill in consuming alcohol can reduce harm associated with use and decrease consumption among college students (Baer, Marlatt, Kivlahan, Fromme, Larimer, and Williams, 1992; Kivlahan, Marlatt, Fromme, Coppel & Williams, 1990). The ASTP has eight sessions that are intended to be 90 minutes in length and teach a series of skills associated first with identification of social situations that involve alcohol in a problematic way, then acquiring skills and strategizing how to prevent alcohol abuse, and finally to work towards maintaining a healthy lifestyle. ASTP was implemented in fall 2003 and spring 2004 by a part-time instructor hired by the grant with college student athletes. Student athlete reception of the ASTP program varied according to the implementation cycle where rigid adherence to program intended design yielded less than enthusiastic response and modification of the skills program to fit with athletes led to a more positive implementation experience.

Case Study Two Description

The second case study site of the evidence-based grant program is at Urban Private College (UPC). Urban Private College is a liberal arts institution that has 5,000 undergraduates and 1,000 graduate students enrolled in its five colleges. The college is located on 75 acres within a midsized city with a heavy industrial production orientation. UPC has an alcohol and other drug program that has been nationally recognized in the years preceding receipt of the evidence-based prevention grant. Their alcohol and other drug prevention program feature a strong peer education group and a full-time (10 month employee) staff member to lead the program.

UPC chose to implement a year long brief screening and feedback program previously pilot tested at the institution on a small scale. The Portable Breathalyzer Test (PBT) program was targeted at students living in the freshman residence hall on campus on five different Saturday evenings during the 2003-04 academic years. Each PBT program involves students completing a breathalyzer test to examine their blood alcohol level in the late hours of a Saturday evening. In addition to the breathalyzer, students go through a series of stations where they receive feedback about their behavior during the night. Each student has a report card that they are given feedback on during the late night program. Once students go through the late night program, feedback from students is tallied and positive normative messages are shared with the freshman residence hall, based upon data gathered during the PBT program. As a result, students receive feedback about their consumption and they are allowed the opportunity to compare their use to their peers through the group feedback provided following the event. During the time that the program was in operation, a male student who was involved in a fraternity function passed died from an alcohol overdose during the fall of 2003.

Findings

The evaluation findings respond through the development of nine themes to the evaluation questions related to the experience of the two campuses in adopting evidence-based programs and the perspective of administrators in the process. The first five themes respond to the evaluation question related to the experience of the campus in adopting evidence-based practices. The two cases in this study point to the importance of existing institutional capacity around alcohol abuse prevention as central to successfully implementing a new prevention strategy. Campus capacity is described through existing organization supports, staff attitude and knowledge, and the influence of grant funding relative to existing program resources.

Theme One: Existing Infrastructure The first theme emerging from interview data is related to the importance of pre-existing prevention infrastructure within higher education, in the adoption of evidence-based practices. At the Near Urban Community College the existence of a long term campus-community coalition was described as a key component of all of their prevention efforts. The campus-community coalition at Near Urban has been in existence for over a decade, during that time the coalition was successful in leveraging a national multiyear, multi-million dollar grant, along with smaller grants. The coalition helped to bring support to the primary counseling staff member at Near Urban in charge of prevention of alcohol abuse. Further, they provide the social network of expertise to write the original evidence-based grant application. Along with support for writing the grant, the instructor of their evidence-based program was identified through his involvement in coalition activities. Without staff time dedicated to the community coalition at Near Urbana, the ability of staff to foster prevention activities through external funding would be very limited. At Urban Private Liberal Arts College the existence of a strong health promotion office as a part of the division of student affairs provided the basis for the development of an evidence-based program. With a full-time ten month employee committed to alcohol and other drug abuse prevention, Urban Private College was well positioned to respond to a call for proposals related to implementing an evidence-based program. The program implementation infrastructure already in place through a peer education program, existing campus relationships and a very supportive counseling center director overseeing the health promotion unit are central to the story of evidence-based program adoption. Prior developed infrastructure elements at both case study institutions are important to the story of success of campus grant implementation.

Theme Two: Importance of Modest Resources, With key relationships and support in place, Near Urban and Urban Private were compelled to apply for funding and while $5,000 may be a modest grant award it represented a 100% and 50% increase in prevention programmatic funds available at each institution. At Near Urban Community College there is no dedicated staff time, nor programmatic budget for alcohol abuse prevention programming. The receipt of external grant funds provides 100% of the funding for activities to promote the responsible use of alcohol. In fact, $5,000 at Near Urban has been utilized to facilitate programming over the course of three semesters. None of this would have occurred, regardless of it being evidence-based or not, without receipt of external funds. At Private Urban College there is significant institutional support for programmatic infrastructure in the form of commitment of one 10-month FTE employee. The programmatic, or activity, budget for this staff person is $5,000. This budget includes allocations for consumables, student staff and activities. The addition of $5,000 doubles the programmatic funds available for alcohol abuse prevention at the four year institution. This theme responds to the first evaluation question in finding that even a modest grant of $5,000 is a dramatic fiscal increase at each institution.

Theme Three: Program Facilitation Ability Staff conducting prevention at both Near Urban and Urban Private College are highly committed to preventing alcohol abuse and related harm. At Near Urban, the counseling center staff member in charge of alcohol and other drug prevention indicates she would do prevention full-time, if she were funded to do so. This perception of the value of prevention work held by individuals is indicative of the personal and professional commitment described in interviews. The receipt of a grant to conduct evidence-based programming, which was described as being at the forefront of programmatic offerings, is a key symbolic statement of reinforcement for these individual efforts and personal commitment for each campus. Staff indicate that while the programs they intended to implement with their grant funds are made possible by the receipt of funding, these programs in and of themselves are not expensive to implement or operate. The receipt of a grant is important not just for the financial support of new programmatic effort, but also provides the impetus for staff members to push prevention approaches new to them. At Near Urban the prevention approach of Alcohol Skills Training Program was a completely new program to the campus. Staff had to go out and learn about the program, including acquiring materials, gathering background information and planning for implementation. Funds did support this process, but the investment of time by project partners to learn and acquire the knowledge to conduct the program was certainly not covered by the grant. The grant facilitated the acquisition of this new knowledge and program implementation. In the case of Urban Private College, the PBT program had been implemented in a pilot effort, but had not been rigorously evaluated nor implemented in a full-scale version. The grant provided support for implementation and the staff engagement in modification of past brief screening efforts and evaluation. The impetus to adapt this programmatic tool all occurred through project implementers' desire to push themselves to find programs that have efficacy in their home environment. One strength of the modest grant awards is the in-kind commitment of project partners to put into practice their own knowledge and experiences associated with alcohol abuse prevention. The psychological reward of being recognized on campus for receipt of external funds is part of the reward, as is the recognition associated with fulfilling a commitment to do what one writes about in their initial program proposal. Professionals consistently discussed the limitations they face on campus in their efforts to prevent alcohol abuse. With limited staff time and resources it is difficult to continue to adopt new programs and knowledge. The reward of external recognition for their efforts appears to have tangible benefits as it relates to on-going learning, validation of efforts and focusing time on innovative approaches all built upon evidence of efficacy.

Theme Four: Evidenced-Based Learning Curve The psychological impetus to adopt new evidence-based approaches to prevention does not grow simply out of the request for proposals, rather the two institutions in this case study described their campus efforts as having grown out of an existing knowledge and desire to use emerging evidence of efficacy in their campus efforts. In the case of Urban Private College, their effort to adopt evidence-based prevention practices was under way prior to receipt of the evidence-based grant. They describe the receipt of the grant as pushing them further down the road of integrating evidence of efficacy into their programs. In fact, the key staff person charged with overseeing alcohol abuse prevention programming indicated that after their experiences prior to and during the grant period, they had reached a place where all prevention program decisions factor in the evidence of effectiveness as part of their choice in whether or not to engage in a particular program element. At Near Urban Community College, experience with a multi-year national grant and other state funded grant efforts, the coalition had become familiar with the language and approaches often mentioned in conjunction with evidence-based alcohol abuse prevention. Cognitive-behavioral programs, such as Botvin's Life Skills targeting K-12 students were already familiar to this group, and as such acquisition of higher education specific strategies with efficacy were simply an extension of existing understanding (Botvin, Baker, Filazzola, & Botvin, 1990). The commitment to these approaches was clear, but dampened by the need to make appropriate modifications in programs so as to have them positively received.

Theme Five: Modify Model to Fit Institutional Context Building upon finding four is that case study institutions had a working knowledge of evidence-based prevention practices is the emerging reality that these practices must be adopted in context. Adopting a program in context means that appropriate modifications are made to the program format so as to help it fit institution specific circumstances. At Near Urban Community College the ASTP instructor described in great detail how his efforts to implement the program specifically as directed in materials manifested during the first program implementation cycle in a program that "missed." "Missed" in the sense that it did not conform to the unique athlete audience with which the instructor was working. The first cycle of ASTP implementation was frustrating and not rewarding for the instructor. Subsequently the instructor modified the timing and delivery format of the program, but not the central content, so as to make the program fit the community college athlete population. The instructor was careful to describe his modifications as more related to delivery approach, rather than shitting the key content or conceptual basis for the program. The concern of the instructor for program fidelity was clear, but this was tempered by the need to make the program palatable to the participants. In the case of Urban Private College the adoption of brief screening ideas to their pre-existing PBT program is one of an integration of ideas surrounding feedback about drinking behavior (Agostinelli, Brown, & Miller, 1995; Waiters, Bennett, & Miller, 2000). The key idea related to the PBT program is that of providing actual behavioral feedback to students. Literature associated with brief screening bases feedback on self-reported behavior in comparison to sell-reported peer behavior. The integration of these two ideas saw PBT information gathered and then reported back to students immediately through a feedback sheet on the night of the program and through publicized feedback that provided normative information on blood alcohol level and associated behaviors following a PBT program event. The effort of grant recipients to intelligently adapt programs while maintaining key conceptual ideals shows the promise of professionals' ability to use evidence of efficacy to inform locally implemented programs. The next four themes respond to the administrative experience with the grant project. These themes tell a story of the value of positive news in an arena of college student life that all too often is full of tales of negative alcohol related news. Administrative response works to capitalize on not only the resources and potential for positive student behavior change associated with the grant award, but also on the positive feelings associated with being on the cutting edge of knowledge and practice associated with student alcohol abuse prevention.

Theme Six: Modest External Resources External resources are highly valued by institutions of higher education and theme six reflects the particular importance of external support to student affairs divisions within the institution. In the two case study institutions alcohol abuse prevention is located within the student affairs division of the institution. The student affairs division is described as not being a typical external grant receiver within the institution. Therefore, the receipt of external funding by one of the units of the division has a high level of awareness by the senior student affairs officer. The receipt of external support reinforces the importance of the student alcohol abuse issue within each institution.

Theme Seven: Talking Point for Institutions In the case of Near Urban Community College external support represents the only dollars administratively allocated to an acknowledged student dynamic. The student affairs division within this community college is a very small operation, with only a few full time counseling staff providing student support outside of the classroom. The limited budget to support student activities that are not directly curricular related is a key limitation of the structure of the environment. It is also this very limitation that keeps the community college tuition low enough to facilitate access. Administrative awareness of student issues and the need to address these issues is greatly limited by organization and fiscal constraint. External resources have a particularly significant impact in this context. In the case of Urban Private College administrative awareness of the external funding further supported the perception of the office of health promotion and the student affairs division in general as one of pursuing excellence. The health promotion office on this campus described taking pride in their efforts to be on the cutting edge of health promotion efforts nationally. The receipt of external resources for the program is an important reinforcement of this belief. It is also acknowledged that there is an issue with alcohol and other drug use on the Urban Private campus that needs to be addressed. With a tight economy, resources to add programs are limited and as such seeking external or alternative support for new initiatives displays staff competence and initiative.

Theme Eight: Sense of Pride for Student Affairs Division The eighth theme appearing in interview data builds upon the described belief at Urban Private College that institutions should remain on the cutting edge of practice. Each institution's staff spoke of the importance of the perception that their program is on the cutting edge of practice. At Near Urban this meant that community college staff is part of a community coalition that provides leadership in the community related to alcohol and other drug use among youth. The mission of this coalition and involvement of the staff from the community college is broader than simply preventing alcohol abuse and related harm among college students, rather the mission extends to youth of all ages in the community. It is a source of pride for staff; and one that is supported financially, through staff time and professional development support that the coalition is in place to assist the community in ameliorating harm to youth associated with alcohol and other drug use along with associated problems. The use of evidence-based practices as a part of the coalition's efforts is spoken of with pride and with a sense of command of knowledge over the type of efforts and results of those efforts.

Theme Nine: Push Toward Evidence-Based Initiatives In the private college environment administrative awareness of program efforts includes that efforts are based upon evidence of efficacy. With the student alcohol death tragedy at Urban Private College, administrations confidence in the programmatic efforts of the health services offices remained in tact. The ability of staff to provide a rationale for program adoption based upon empirical evidence is particularly valued in a setting where the stakes for prevention are raised to the level of life and death. The rational supporting programming based upon empirical evidence is described as a key administrative outcome of the grant program. Making programs, or at least justifying the allocation of resources, based upon empirical support for behavior change or a value-added component is described as having administrative support. For staff involved in implementation of the evidence-based program means that their project enjoys a rationale for support. For administrators, this means that they talk about these programs with an acknowledged rationale. For both groups, the adoption of programs with evidence of efficacy plays well in the academic environment, where alcohol abuse prevention has largely been considered an ad hoc activity.

Conclusion

The adoption of evidence-based programs to prevent alcohol abuse and related harm happens in context. The context illuminated by the cases of Near Urban Community College and Urban Private College include significant resource limitations for prevention, but strong professional commitment that underpins developing staff knowledge and existing institutional infrastructure. An important finding of this examination is that modest grants of $5,000 provide significant programming resources to campuses. The receipt of a grant is a significant impetus to work to adopt new prevention practices. The impetus is not just financial, though this is important, rather it is also important recognition and motivation for campus based prevention staff: Grants of this size are an important element and affordable way to push campuses forward in their prevention efforts. Grants were not significant enough for campuses to develop infrastructure elements in the form of staff that need on-going financial support, rather they facilitated the shift in practices whereby it would be possible after the grant period ends for campuses to continue to implement the grant funded programs through institutional resources.

This study also revealed that the existence of infrastructure elements were essential to implementation of the evidence-based grant program and in the adoption of new prevention practices. The evidence-based prevention grant helped to develop staff knowledge, but did not specifically aim for increased infrastructure elements including coalitions, need assessment data, or full-time equivalent staff. With a focus on advancing practices, with the implication here is that those campuses with infrastructure in place are better positioned to adopt new policies and practices that conform to the best research available. Funding will still be needed to develop campuses with limited infrastructure elements to prepare them to shift their programs and practices. The final significant element to note that emerged is the importance of the attitudes of prevention staff on each campus. This grant competition tapped into highly committed prevention staff that had a sincere commitment to have their practice be cutting edge. Their attitude toward adoption of new practices put them on the early end of the adoption curve. Attention to fostering the knowledge and willingness of the broad community of higher education prevention staff is needed to grow a successful evidence-based prevention initiative. The evidence-based prevention grant program is a valuable tool for pushing campuses with prevention infrastructure forward. It is likely that this infrastructure is a key element in the successful adoption of new practices. Efforts should be made to continue to push the adoption of cutting edge approaches to prevention and the development of infrastructure that will facilitate advancement.

There are three important implications for policy makers and prevention program implementers in higher education. First, with the acknowledged alcohol abuse problem among traditional age college students prevention infrastructure development should be supported. An important finding of this study is that existing campus capacity in terms of organized staff and community were a important in adopting new evidence based prevention strategies. It is not assumed that all or even most institutions have a well developed infrastructure in terms of staff knowledge, institutional support and community awareness of alcohol abuse problems. Among the cases in this evaluation, the existence of a significant existing capacity related to alcohol abuse prevention was central to their ability to enter a grant competition and then implement new prevention strategies. Second, modest resources directly administered matter. Policy makers should take heed that even modest additional resources dedicated to emerging individually focused evidence-based strategies in higher education appear in this evaluation appear to significantly support existing staff in their efforts and advancing their practice. While additional research is necessary, it is not unreasonable to interpret an on-going influence related to shifts in desire to implement strategies with evidence of efficacy given the pride expressed by participants in their desire to remain on the cutting edge. Finally, practitioners can learn from the two examples of adopting evidence-based strategies that appropriate local modifications to delivery of evidence-based strategies is essential to making palatable an intervention. Both institutions sought to integrate new practices into their alcohol abuse prevention repertoire, in doing so they found it necessary to tweak the evidence-based curriculum or idea they sought to implement. This tweaking must be completed with careful consideration to the underlying conceptual frame from which program emerge, but appears from this analysis to be central to successful adoption. The prevention practitioner in higher education must truly be both an environmental and content expert to appropriately adopt emerge prevention ideas.

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Andrew F. Wall, University of Illinois at Urbana-Champaign Frankie Santos Laanan, Iowa State University 

Wall, Ph.D., is director of teacher assessment at Eastern Illinois University, and Laanan, Ph.D., is assistant professor of higher education at Iowa State University.