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Interactive journaling as a brief intervention for Level-II DUI and DWI offenders.

ABSTRACT

This study sought to evaluate the acceptability and effectiveness of a brief alcohol intervention in increasing basic alcohol-related knowledge, and the intention to change high-risk drinking behaviors, among a sample of DUI and DWI offenders. Pre- and post-test data, in addition to program evaluation data, from 872 Level-II DUI and DWI offenders mandated to receive a brief alcohol intervention were examined. The intervention consisted of the use of Interactive Journaling, a structured and experiential writing process, which combined educational content with motivational enhancement techniques designed to elicit change. Overall, offenders rated Interactive Journaling as helpful and reported that they planned to keep their journals for future reference following program completion. Although both knowledge regarding alcohol's effects, and positive attitudes related to behavior change increased following completion of the brief intervention, there was no correlation found between these two components. Preliminary findings suggest that Interactive Journaling appears widely accepted by Level-II DUI and DWI offenders, and the acquisition of knowledge alone is not necessarily associated with the intention to positively change current drinking behavior.

Keywords: Alcohol; Interactive Journaling; treatment; brief intervention; impaired-driving.

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Alcohol-impaired driving remains a serious public safety concern in the United States. According to recent estimates from the National Highway Traffic Safety Administration (NHTSA; 2012), over 10,000 persons in the U.S. general population were killed as a result of alcohol-impaired (i.e., blood alcohol concentration [BAC] of .08 g/dL or higher) driving crashes in 2010, which accounted for nearly one-third of all traffic fatalities that year. Specifically, an average of one alcohol-impaired driving fatality occurred every 51 minutes in 2010. Drivers involved in fatal crashes with a BAC level of .08 or higher were also four times more likely to have a prior conviction for driving while intoxicated (DWI), relative to non-alcohol-impaired drivers (NHTSA, 2012). Also noteworthy is the immense economic burden posed by alcohol-impaired driving crashes, given that the total estimated cost of both fatal and non-fatal crashes involving alcohol reached nearly $16 billion in 1998 alone (Harwood, 2000). These statistics are not unfamiliar to the U.S., considering that alcohol-related fatalities have received a great deal of attention for nearly a century (Williams, 2006). Such high fatality and recidivism rates, coupled with the vast economic burden, present the need for an effective process to reduce alcohol-impaired driving and perhaps, most importantly, recidivism.

Recent estimates from the National Survey of Drug Use and Health (Substance Abuse and Mental Health Services Administration, 2010), found that approximately 12.0% of persons aged 12 or older in the U.S. general population drove while under the influence of alcohol at least once in the past year. Further, over 1.4 million U.S. drivers were arrested on charges of driving under the influence (DUI) of alcohol or illicit drugs in 2010, which represented an arrest rate of 1 for every 149 licensed drivers (Federal Bureau of Investigation, 2011). Still, it is quite apparent that many instances of alcohol-impaired driving may go unnoticed (i.e., one may drive under the influence of alcohol a great number of times before being arrested and subsequently penalized for one's actions). For those who are caught, penalties and court sanctions fall into four categories: (1) penalties to produce deterrence (e.g., fines), (2) education programs, (3) alcohol treatment programs, and (4) incapacitating sanctions (e.g., license suspensions; Voas & Fisher, 2001).

While DUI intervention programs differ in duration, intensity, and frequency (Dill & Wells-Parker, 2006), a meta-analysis of several programs aimed to reduce recidivism found a positive effect in the reduction of driving-impaired incidents. Further, a combination approach (i.e., education, psychotherapy, and follow-up contact) appears to possess a greater potential for positive change than single-session intervention methods alone (Wells-Parker et al., 1995). Irrespective of treatment modalities, it is important to tailor the intervention to the specific individual needs of each offender (Babor et al., 1999).

Mandated treatment has received mixed responses. That is, while some researchers view mandated treatment as an effective means of addressing alcohol-related problems, others argue that the apparent lack of motivation often results in poor outcomes (Hon, 2003). In order to achieve successful treatment outcomes, some researchers posit that the individual must first be motivated to change (DiClemente et al., 2004). Motivation of these individuals is based on their "personal considerations, commitments, reasons, and intentions that move [them] to perform certain behaviors" (DiClemente et al., 2004, p. 104). Thus, once a sufficient level of motivation to address addictive behaviors has been cultivated, many individuals progress through five stages of change, though not always in a linear fashion, with the ultimate goal of building long-term maintenance abilities (Prochaska & DiClemente, 1982; Prochaska et al., 1992).

One potential treatment option that has been used in the past as an intervention for distressing and challenging life events is written emotional disclosure- also commonly referred to in the research literature as "passive journaling." While alterations' of the writing process have been reported, the core of many journaling studies often involves the approach initially established by James Pennebaker, in which participants are instructed to write about a given topic for approximately 15 to 30 minutes for an average of 3 to 5 days (e.g., Greenberg & Stone, 1992; Pennebaker & Francis, 1996; Spera et al., 1994). Accumulating evidence suggests that journaling is a valuable component of many effective learning strategy methods and can have beneficial psychological and physical health effects (Ames et al., 2008; Frattaroli, 2006; Pennebaker & Graybeai, 2001; Sloan & Marx 2004). Additional behaviors, not related to health, have also been found to be positively impacted by various interventions involving the use of journaling. For instance, students demonstrating poor grades improved their academic performance, professionals who lost their jobs were able to attain employment more quickly, and university workers were absent less often following a brief journaling intervention (Francis & Pennebaker, 1992; Pennebaker & Francis, 1996). There has been limited success, however, in changing health-related behavior patterns (e.g., smoking, exercise; Ames et al., 2005; Frattaroli, 2006; Pennebaker, 1997).

Although passive journaling has received a great deal of attention, a new form of journaling is now being integrated into therapeutic settings. Interactive Journaling, a more responsive and active approach to disclosure and exploration of issues, is a structured and experiential writing process in which individuals receive guided assistance to achieve positive life change. Interactive Journaling focuses on providing "a stimulus for personal exploration and interpersonal feedback" (Parr et al., 2000, p. 232). Trust, cohesiveness, self-understanding, interpersonal learning, and hope are instilled in individuals through this active process of disclosure, and may prove a valuable component of small group interactions (Parr et al., 2000). Further, by bolstering participant motivation and providing structure, Interactive Journaling aids individuals in making significant life changes and building the skills for continuous change upon termination of the program (Parr et al., 2000).

Interactive Journaling encompasses elements from the Transtheoretical Model of Change (TMC; Prochaska & Velicer, 1997) and Motivational Enhancement Therapy (MET; Miller et al., 1995). The TMC postulates that change occurs in a pattern beginning with precontemplation and progressing thorough contemplation, preparation, action, maintenance, and finally termination. MET is a non-confrontational approach whereby individuals are led through the process of assessing their current situation and determining what strategies might be employed to assist in identifying and achieving change goals. Interactive Journaling builds on this foundation through guided questioning and restructuring strategies designed to aid individuals in examining the emotions and cognitions surrounding maladaptive behaviors via Interactive Journaling booklets. Thus, an MET approach appears quite appropriate and may facilitate an individual's progression through the various stages of change included in the TMC.

Preliminary support for the use of Interactive Journaling can be gleaned from the findings from a randomized controlled trial of male inmates incarcerated in a local jail facility (Proctor et al., 2012). All inmates met DSM-IV-TR (American Psychiatric Association [APA], 2000) criteria for substance dependence, had their current offense indicate substance involvement (i.e., were under the influence at the time of offense and/or committed the offense for which they were currently incarcerated to obtain or get money for substances), and had a minimum of one previous arrest in the 12 months prior to incarceration. Inmates were allocated to either an Interactive Journaling condition or a control group in which they received a federal brochure on addictions and offending as a placebo. Results revealed that inmates assigned to the Interactive Journaling condition, as contrasted to the control condition, had a significantly lower criminal recidivism rate during the 12-month observation period following their release (51% vs. 66%, respectively). Thus, Interactive Journaling appears to show promise as a brief treatment intervention strategy for substance dependence in local jail settings and may have the potential for reducing recidivism. The use of Interactive Journaling has also been found effective in reducing the likelihood of engaging in serious forms of misconduct during incarceration among Federal prison inmates (Camp et al., 2008), and in lowering the recidivism rate for driving under the influence among DUI offenders (Loudenburg, 2008). However, the use of this particular approach has not been evaluated among DUI and DWI offenders mandated to receive an alcohol education program.

The combination of emotional and cognitive expression utilized in Interactive Journaling has been shown to be more effective than cognitive processing alone in regard to behavior change (Frattaroli, 2006). Previous research also suggests that self-help materials can be as effective as group or individual treatment for alcohol problems (Heather et al., 1986; Miller & Taylor, 1980). Together, these findings suggest that Interactive Journaling may be a particularly appealing brief intervention strategy for use with mandated DUI and DWI offenders given its non-confrontational, non-judgmental approach and most importantly, the fact that it is time efficient. In the context of the present evaluation, the Interactive Journal utilized was developed and tailored specifically for DUI and DWI offenders. Thus, the present study has two aims; to evaluate whether offenders assigned to the Level-II programs that used Interactive Journals demonstrated increased (1) knowledge about the effects and risks of alcohol use and (2) motivation to change, based on pre- and post-test measures of knowledge and attitude.

METHOD

The state of Oklahoma uses the DWI designation for those drivers producing a BAC between the .06 and .07 g/dL level. Drivers with a BAC over .08 are designated as DUI; however, this designation is also applicable to drivers under the age of 21 with a BAC of .02 or higher. State guidelines place DUI/DWI offenders who are not dependent on alcohol or other drugs into one of two program tracks based on assessment findings. First time offenders with minimal alcohol or drug involvement as indicated by alcohol and drug scale scores on the Driver Risk Inventory-II (DRI-II; Behavior Data Systems, 2003) in the lower 35th percentile are eligible for a 10-hour Level-I program. Offenders with a prior offense and/or a score on the DRI-II in the 36th to 49th percentile are mandated to receive Level-II programming.

Offenders mandated to receive Level-II programming are required to attend 24 hours of education and group sessions during which they are asked to complete Interactive Journals. Thus, as noted previously, the delivery vehicle of all program content is a guided, experiential writing process known as Interactive Journaling, in which each offender receives a full-color and durable booklet, or journal, that presents the core information of the program via graphics, focused questioning strategies, and discussion of relevant topic issues in a group format. Offenders are then asked to provide written responses with the purpose of promoting group involvement through discussion and homework. This approach to journaling, as applied to the DUI/DWI programs, is designed to equip offenders with accurate information, inform them of their level of exposure to harm, and stimulate motivation for change relative to drinking and driving behaviors. Journals were designed to be completed by each offender with the assistance of a professional trained in the delivery of Interactive Journaling, and the implementation of such an approach is supported by a highly structured facilitator guide to ensure intervention integrity. It is important to note that this evaluation follows the standard procedure as implemented in the field being studied. Thus, a non-treatment control group is neither ethically nor legally possible given policies of the state of Oklahoma.

Participants

The total sample consisted of 872 DUI and DWI offenders mandated by the state of Oklahoma in 2005 to receive Level-II programming. Although data regarding the total number of offenders mandated to receive Level-II programming during calendar year 2005 are not available, approximately 7,000 journals were purchased by Level-II programs in the state of Oklahoma during the 12-month data collection period. Thus, data were derived from offenders' program tests for only those whom anonymous evaluation forms were provided by participating Level-II programs to the publisher of Interactive Journaling as part of their contractual agreement. The sample was predominantly male (82.7%) and most were Caucasian (74.9%). Native Americans constituted the largest ethnic-minority group (13.5%), followed by African Americans (5.6%) and Hispanics (4.5%). The remaining cases were Asian or of other ethnic-minority groups. Age was recorded in decade groups with the 20-29 year group containing more than one-third (35.4%) of cases, followed by those 40-49 (24.2%), and those 30-39 (22.1%) years of age. Of the Level-II offenders, only 3.9% were under the age of 20 and fewer than 15% were 50 years of age or older.

Given that data for the present study included only those from offenders who completed all 24 hours of the mandated program, offenders that terminated their involvement prior to completion of the required 24 hours were not included in the provided data set and, thus, were not considered in the planned data analyses to assess study aims. Therefore, all offenders included in the present study completed both pre- and post-test assessments. Unfortunately, data regarding dropout rates and characteristics of those offenders who prematurely terminated participation in the program were not available. However, given that regaining driving privileges was contingent upon successful completion of the program, coupled with the fact that alternative treatment options were not offered or available, it is reasonable to suspect that completion rates were high.

Procedure

Offenders mandated to receive Level-II programming are required to complete both a pre- and post-test assessment involving knowledge questions about alcohol, driving, and legal issues, along with attitudinal measures designed to assess the offenders' perceived intention to change behaviors related to drinking and driving. Anonymous offender evaluation forms from the participating Level-II programs are sent to the developer and publisher of Interactive Journaling (i.e., The Change Companies) at the conclusion of each program as part of their contractual arrangement with the state of Oklahoma. The anonymous data forms are then drawn for analyses in order to provide the state with detailed reports of outcome findings. This sample of data was utilized in the present study to examine the indications of change and relationships among the various educational and attitudinal measures.

The evaluation forms used by the state programs to appraise knowledge and motivation for change consisted of 25 items; of which, 14 items covered knowledge about alcohol, its influence on driving, and legal facts related to driving while impaired. The remaining 11 items addressed attitudes about drinking, driving, and the intent to change behavior in the future. In addition to the pre- and and post-test information, offenders also completed an additional evaluation form in which they rated the program, instructor, and various components of the program. Offenders were also asked whether they shared their journals with others and whether they intended to keep the journal following completion of the program.

Data Analyses

The pre- and post-test data were analyzed as group comparisons, given that the forms were anonymous and, therefore, pre- and post-test data could not be matched for each individual offender. This procedure precluded documenting the proportion of offenders whose knowledge or attitude measures changed in a given direction, but still afforded the ability to compare the measures as a whole. The knowledge items were grouped within content areas to form three composite subscales. Among the knowledge items, 14 items addressed general knowledge of alcohol (e.g., "What percentage of the U.S. population does not drink?"), four dealt specifically with drinking and driving (e.g., the motor task affected by alcohol consumption), and four covered legal issues (e.g., penalties for possession of illicit drugs, legal BAC levels). All knowledge items were presented in a multiple-choice format consisting of five available responses.

Composite subscales were also compiled from those attitude items that have commonalities. Three items focused on the need and intent to change drinking behaviors (e.g., need to change use patterns). Two items dealt with the dangers associated with drinking and driving issues (e.g., not feeling safe riding with someone who has had six or more drinks). Five items focused on the intent to change overall behavior (e.g., changing behavior involves more than making promises). Response options for the attitude items utilized a five-point Likert-type scale, with "strongly disagree" representing no intent to change behavior, and "strongly agree" showing a strong desire to change drinking behaviors, such that the higher score reflected the most positive attitudes.

Individual knowledge items were dichotomized to indicate correct vs. incorrect responses and subjected to chi-square analyses to determine whether there were significant differences between the pre- and post-test results. A similar method was utilized to analyze each individual attitude item. The composite subscales compared the pre- and post-test scores using t-tests. Finally, bivariate correlations among the scales were conducted to explore the relationships between the knowledge and attitude composite subscales.

RESULTS

At the item level, most knowledge items showed statistically significant positive change from pre- to post-test (i.e., p < .00001). Stringent criteria for statistical significance were chosen due to the large sample size, which allows relatively small differences to appear significant at lower levels. Two items differed at the p < .005 level, which indicated a much smaller, but statistically significant change between pre- and post-test responses. Four of the knowledge questions were not significant at p < .005, due largely to the fact that 80% or more of the offenders knew the correct answer on the pre-test, leaving little opportunity for improvement on the post-test. Specifically, two of the four items involved legal issues- factors that increase penalties, and consequences of refusing to take a Breathalyzer[TM] test. The other two items broadly concerned various addiction-related topics (i.e., signs of addiction, and individual differences in response to alcohol consumption). The percentage of the sample that answered each individual item correctly at both pre- and post-test assessment is presented in Table 1. Regarding the attitude items, all items demonstrated significant positive change at the p < .005 level, although most were significant at the p < .0001 level. Table 2 presents percentages of offenders that answered with "agree" or "strongly agree" for pre- and post-test measures, demonstrating the overall increase in their intention to change their current drinking behaviors.

The composite subscales were all statistically significant (p < .0001), even when the individual items with high initial base rates were included. The scale composed of all knowledge items, as well as the two scales consisting of only the DUI or legal items, all showed significant improvement in the number of correct responses (Table 3). Attitude scales reflecting offenders' drinking behaviors, overall behavioral issues, and the danger of drinking and driving all showed significant improvement from pre- to posttest assessment, as well. Table 4 presents scores on each attitude composite subscale.

Of particular interest was the finding that the post-test scores for the knowledge scales did not significantly correlate with the post-test attitude composite scores (r = .052). Not only did the relationships fail to reach statistical significance, the Pearson-product moment correlation coefficients between the total knowledge score and the three attitudinal subscale scores were all less than r = . 100. When correlated with total knowledge, attitude questions pertaining to both the dangers associated with alcohol consumption and actual drinking behaviors showed correlation coefficients of r = .075; both of which were not statistically significant. The attitude items which comprised these subscales included items pertaining to the effect of a few drinks on driving, safety of riding with a driver who had been drinking, and the importance of having support to achieve positive behavior change.

Regarding the findings from the program evaluation form, a separate questionnaire completed at the time of the post-test assessment, over half of the participants (52.3%) rated the program materials as "very valuable," with 78.5% stating that they learned "a lot" from the program. Interestingly, approximately one-fourth (25.5%) reported that they had shared their journaling information with others, and an additional 54.7% indicated that they intended to share their results with someone else. An overwhelmingly large proportion of the sample (88.4%) indicated that they intended on keeping their journals following completion of the program, and nearly all offenders (94.7%) felt that the program would help them change their drinking behaviors.

DISCUSSION

Interactive Journaling as a component of this 24-hour program for Level-II DUI and DWI offenders appears to be a useful approach for both increasing knowledge and improving attitudes favorable to behavior change. Of particular clinical interest was the finding that having knowledge regarding the effects and risks of drinking was not significantly associated with positive changes in attitude following completion of the program. Thus, DUI and DWI programs focusing exclusively on educational content as the primary method to promote change are not likely to decrease the likelihood of future drinking and driving incidents, given that education alone does not appear to be the key component in facilitating change. In order to successfully increase intent to change, one would expect that a greater focus be placed on methods beyond education (e.g., perceived drinking norms, alcohol expectancies). Due to the relatively weak correlation observed between knowledge and attitude, it is possible that education does not instill a sufficient level of motivation to promote successful behavior change. Future programs designed to reduce high-risk drinking behaviors may be better suited to shift their focus from education-based alone to one centered on increasing motivation. Thus, while knowledge may be considered a necessary and helpful component in the promotion of change, addressing attitudes and utilizing motivational strategies appear to be a requisite for this goal.

Based on offenders' responses to subjective items, offenders rated the program as excellent, with its most useful components consisting of creating a change plan, class discussion, and the Interactive Journaling format itself. Offenders reported that they learned a lot, and felt that the knowledge they had gained would be useful in the future. Further, many offenders planned not only to keep their journals following program completion, but also to share their journals with others. Most importantly, a majority of offenders reported that the program helped them change their behavior, which is the general aim of such an intervention. From these generally positive comments, the use of Interactive Journaling may be viewed as a potentially effective intervention and at the very least, a user-friendly method for this population.

The findings from the present study should be considered in light of several limitations which warrant further investigation in the evaluation of Interactive Journaling as an intervention for DUI and DWI offenders. Most importantly, given the anonymous nature of the data, it was not possible to pair the pre- and post-test data for each individual offender. Having the ability to link data would provide the means to compare individual fluctuation in knowledge or attitude as a result of the intervention and the extent to which individuals increased or decreased in these areas. A second limitation concerns the inability to link the amount of change participants presented to their overall rating of the program; this information may have been valuable regarding the relationship between changes in knowledge and/or attitudes and program satisfaction. Also, anonymous data preclude a prospective study in which results from the data collected on the evaluation of the program could be linked with recidivism data concerning subsequent arrests for driving while under the influence of alcohol or while impaired.

Third, demographic data regarding educational attainment were not available in the data set provided to the publisher as part of their contractual arrangement with the state of Oklahoma's participating Level-II programs. Similarly, reading level was not formally assessed prior to distributing the interactive journals. This limitation may have presented difficulties regarding the integrity of the intervention and in completing the journal as directed for those offenders with lower levels of educational attainment or those who could not read. However, all text included in the journal is intended for individuals with a reading level between the grades of 5 and 7, and Interactive Journaling materials have been used with a wide range of populations who have historically evinced lower levels of educational attainment (e.g., indigent individuals served through Adult Rehabilitation Centers of The Salvation Army, local jail and state prison inmates housed in segregated and mental health specialty units). It is also reasonable to suspect that any offender who was not literate would not have been able to successfully pass the written portion of the process outlined by the state of Oklahoma to obtain a driver's license. Further, given the user-friendly format and unique learning process inherent to Interactive Journaling, participants are able to obtain a basic grasp of the specific concepts covered in the journal via the colored graphics and the breaking of paragraphs into short copy blocks that frequently appear throughout the journal. A logical next step for future work would be to utilize a brief literacy check prior to the distribution of the journals to screen for illiterate individuals, and subsequently, exclude them from program participation.

Finally, this study is limited to an evaluation of practices routinely employed by the state of Oklahoma, rather than as a formal, randomized controlled trial. Thus, the lack of a non-treatment control group presents the inability to compare treatment effects from offenders who completed the program with those who did not receive the intervention. It is important to note, however, that from an ethical standpoint, the implementation of a control group was not feasible in this context given that the intervention evaluated in the present study was the only treatment option available to Level-II DUI and DWI offenders in the state of Oklahoma at the time of data collection.

The preliminary findings and implications derived from the present study suggest that Interactive Journaling may be a helpful and user-friendly method of treatment for Level-II DUI and DWI offenders. With alcohol-related driving accidents accounting for such a large proportion of driving fatalities, interventions such as Interactive Journaling may reduce recidivism and be a worthwhile investment for treating Level-II DUI and DWI offenders. The findings also suggest that placing greater emphasis on promoting attitude changes and instilling an adequate level of motivation to change drinking behavior may strengthen this approach with respect to achieving positive behavior change. Given the high rate of favorable responses to Interactive Journaling, this approach appears to be widely accepted by Level-II DUI and DWI offenders. Future evidence in the form of prospective work is warranted, however, regarding the efficacy of Interactive Journaling as a prevention strategy in reducing high-risk drinking behaviors and impaired-driving recidivism.

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Amy Mary Scheck, MA and Norman G. Hoffmann, Ph.D.

Western Carolina University

Steven L. Proctor, M.A.

Louisiana State University

&

Ryan J. Couillou, M.A.

University of Georgia

Correspondence concerning this article should be address to: Steven L. Proctor, Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA 70803, USA; Email: sproct2@tigers.lsu.edu.
TABLE 1
Percentage of Correct Responses on Individual Knowledge Items

                                            Assessment Interval

                                            Pre-test   Post-test
Knowledge Item Content                        (%)         (%)

What will sober up a drinker *                76.5       86.6

Driving tasks affected by alcohol *           86.4       95.1

Standard alcohol content of beverages *       65.7       89.0

Percentage of nondrinkers in the U.S.         34.3       64.3
population *

Reaction time results **                      60.8       70.5

Drug possession penalties                     86.0       87.7

Convicted of DUI given what situation ***     59.1       66.8

Signs of alcohol addiction                    93.2       93.2

Action of alcohol on the body *               50.5       73.0

Aftereffects for a BAC of .20 *               67.4       92.8

Synergistic effects of drugs ***              75.2       80.8

License reinstatement requirements *          45.9       75.4

Consequence for refusal to take BAC test      94.4       92.3

If different people drink same amount         81.8       83.7

Note. p [greater than or equal to] .005 was considered not
significant. * p < .00001, ** p < .00005, *** p < .005

TABLE 2
Percentage of Responses on Individual
Attitude Items Reflecting Intent to Change

                                            Assessment Interval

                                       Pre-test (%)     Post-test (%)

                                              Strongly         Strongly
Attitude Item Content                  Agree   Agree    Agree   Agree

Driving is affected by 1-2 drinks *    54.1     18.8    48.9     34.2
Riding with a drinking driver *        51.6     37.4    34.9     54.8
Arrest was my fault ***                38.0     51.2    36.4     57.7
Need to change drinking/drug use *     41.4     34.0    39.5     49.5
Confident in change plan *             39.2     55.6    28.5     69.8
Impaired driving is dangerous *        33.8     62.7    27.0     71.3
Less likely to abuse alcohol *         31.2     53.6    35.6     60.3
Support is important ***               37.8     52.9    32.4     60.7
Opportunity to learn *                 41.8     47.1    34.0     61.0
Will not drink and drive again *       36.5     55.2    27.6     70.8
Change involves more than promises **  40.6     51.0    34.1     61.6

* p < .00001, ** p < .00005, *** p < .0001, **** p < .005

TABLE 3
Mean Number of Correct Responses on Knowledge Composite Subscales

                                                Assessment Interval

Knowledge Subscale                          Pre-test       Post-test
                                             M(SD)           M(SD)

Basic alcohol knowledge (14 items)        9.77 (2.357)   11.51 (2.421)
Alcohol and driving knowledge (4 items)   2.91 (0.988)    3.45 (0.809)
Legal knowledge (4 items)                 2.85 (0.917)    3.22 (0.982)

Note. All mean differences are significant at p < . 0001

TABLE 4
Mean Scores on Attitude Composite Subscales

                                       Assessment Interval

                                   Pre-test        Post-test
Attitude Subscale                    M(SD)           M(SD)

Commitment to change drinking    12.62 (2.146)   13.48 (1.807)
  behaviors (out of 15 points)
Dangers of drinking and           8.76 (1.166)    9.01 (1.327)
  driving (out of 10 points)
Total attitude score             21.41 (3.251)   22.70 (2.762)
  (out of 25 points)

Note. All mean differences are significant at p < . 0001
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Author:Scheck, Amy Mary; Hoffmann, Norman G.; Proctor, Steven L.; Couillou, Ryan J.
Publication:Journal of Alcohol & Drug Education
Article Type:Report
Date:Dec 1, 2013
Words:5923
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