Measuring the Intensity of Community Interventions to Reduce Underage Binge Drinking

Introduction: The adoption of community-based approaches to address adolescent substance use has heightened the interest and need to measure the impact of community prevention interventions. Although the literature elucidates various methods of examining the intensity of community-based interventions, there are still limited empirical exemplars of methodological approaches for measuring the dose-response relationship in substance abuse prevention interventions. This study describes an approach to measuring the intensity of community-wide changes in a multi-site, underage drinking prevention initiative.

Methods: Representatives from 14 Kansas community coalition recorded the implementation of community changes—program, policy, and practice changes- in an online documentation system. The documented community changes were characterized by intensity dimensions related to duration, behavior change strategy, target population, and reach.  Each intensity dimension was assigned a score based on the potential strength of the community change activity. The composite intensity score for each community change was calculated by adding scores for target, duration, and strategy; the sum was multiplied by the reach score. The overall community score was calculated by summing the intensity scores for all community changes for a given year. Finally, the annual intensity scores were added together to obtain an overall intensity score representative of the coalitions’ efforts throughout the implementation period.

Results: The communities collectively implemented 802 discrete community changes. Most of the implemented community changes were program and practice changes, with coalitions implementing an almost identical amount of each. Approximately 9.2% of the total changes were related to new or modified policies. The cumulative intensity for all community changes increased by a factor of 2.26 in 2012 compared to 2009, and binge drinking decreased 23.4% during the same period.

Conclusions: The results suggest that implementing community changes of longer duration, greater reach, and stronger behavior change strategies, are  can yield improvements in underage drinking outcomes. To date, limited studies in the substance abuse prevention literature delineate a standard protocol for measuring such an association with respect to community-based interventions that address adolescent alcohol use. There is a need for identifying and documenting a dose-response relationship between implemented interventions and changes in outcomes. Additionally, understanding the potential impact of prevention interventions as a formative measure may enhance and guide strategy implementation and effectiveness. Understanding of how to support implementation efforts of sufficient intensity may yield improvements in underage drinking-related outcomes.