B B EVALUATING THE EFFECTIVENESS OF A MULTI-COUNTY ALCOHOL SAFETY EDUCATION PROGRAM IN RURAL MIDDLE TENNESSEE HARSHA N.

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1 1987 Elsevier Science Publishers B.V. (Biomedical Division) Alcohol, drugs and traffic safety - T 86 P.C. Noordzij and R. Roszbach, editors. B EVALUATING THE EFFECTIVENESS OF A MULTI-COUNTY ALCOHOL SAFETY EDUCATION PROGRAM IN RURAL MIDDLE TENNESSEE HARSHA N. MOOKHERJEE Department of Sociology & Alcohol Safety Education Program, Tennessee Technological University, Cookeville, Tennessee 38505, U.S.A. INTRODUCTION Statistics indicate that drinking-driving is a large contributing factor (more than 50% of all fatalities) to highway accidents and fatalities in the United States. The number of fatalities, injuries, hospitalization, and work days lost; the property damage; and the overall cost to society are staggering (cf. Fell, 1982; 1985; Franklin, 1985). Western societies are trying hard to control the behavior of drinking-drivers. Federal Government as well as State Governments have invested millions of dollars in research and special alcohol countermeasures programs. Legislators have toughened the laws: convictions become mandatory, fines have been increased and the jail sentences become longer, but neither the drinking-driving has decreased nor the alcohol related highway accidents and fatalities are stopped in the nation. As a result, the Department of Transportation and other public organizations have engaged in an extensive, nationwide public information and education program to combat the drinking-driving accidents and fatalities. These programs have included research into public knowledge and attitudes on various alcohol safety issues; cooperative public education programs with governmental and private organizations; and many independent public education and countermeasure programs conducted by local Alcohol Safety Action Projects. Another apporach, a corrective program for persons convicted of drinkingdriving [Driving while intoxicated (DWI) or Driving under the influence (DUI)], has shown promise not only for reducing drinking-driving, but also for dealing with the problem-drinking and/or alcoholics (cf. Malfetti and Winter, 1976). The Alcohol Safety Education Program for the Upper Cumberland region of middle Tennessee is one of such attempts. This experimental program is a joint effort of the Tennessee Governor's Highway Safety Planning Division and the Tennessee Technological University. This program is in operation in 12 counties in rural middle Tennessee. It is intended to reduce the approximately 1,300 traffic fatalities in each year, about half of which are directly related to alcohol abuse. THE PROGRAM The Alcohol Safety Education Program (ASEP), an educational rehabilitation program, is an alternative approach to the traditional punitive measures since B 25957

2 550 punishment alone does not seem to work. Participation in this program is mandatory to restore the revoked driving license. Before the trial judge tries the case of the DWI/DUI, through this program, he evaluates the defendant s present status regarding alcohol abuse and alcoholism and accordingly tries to help the defendant by referring him to proper treatment/counseling/rehabilitation/education program(s). After conviction for the DWI/DUI charge, the judge refers the offender to the Alcohol Safety Education Program, if he finds the offender is a suitable candidate for the Program. If the offender completes the program satisfactorily, the judge then reconsiders the case and often suspends or reduces the jail sentence for the offender, but the offender pays the usual fines and court costs, and serves the mandatory jail sentence. During the period the offender attends the Alcohol Safety classes, he remains on probation. The class is held once a week for 4 consecutive weekday evenings at different centers in these rural counties. Each class lasts 3 hours and is conducted by professional personnel from the university. The primary intention of this program (ASEP) is to help identify drinking- drivers and to modify their drinking-driving behavior. At the same time, through this program, the drinking-drivers who have drinking problems are being identified and are referred to professional counseling and treatment. The Alcohol Safety classes are designed mainly for the first offender drinking-drivers, as it is believed that these persons are most likely to be helped by educative information. However, a judge may refer multiple offenders to this program if he finds them to be suitable candidates for the program. The classes are conducted in a way which encourages a participant to analyze his/her own drinking habits against the opinions of his/her peers and instructors, and to examine ways in which he/she might modify his/her behavior. Several tests and inventories are administered at the classes, and the results are used to assist in evaluating the classes, as well as for the programs and referral/counseling purposes. THE EFFECTIVENESS OF THE PROGRAM The evaluative studies (ASAP, 1972; Haight, 1985; Franklin, 1985; Wolfe, 1985; and others) that are available today suggest that, in general, compared to the baseline period before the alcohol countermeasures began, there have been some improvements in combating some aspects of the alcohol related accidents and fatalities. However, it is noted that the difficulty in assessing the effectiveness of the countermeasure programs is a lack of sufficient objective information regarding the target population, the baseline data, especially the social and demographic informations are not addressed properly. There are also some questions being raised regarding the baseline data, whether the right communities are chosen for comparison, and why no attempt is made to build in

3 551 such a comparison initially (cf. ASAP Effectiveness, 1974; Waller, 1975). In addition, Brown, et. al. (1975) have pointed out the methodological problems in the evaluative studies and contend that the traditional approaches have limited our understanding of the implications and impact of the alcohol countermeasure programs. The present study, however, follows the alternative approaches indicated by Brown, et. al. (1975). In general, these approaches acknowledge the multiplicity of functions and objectives in a single project, and the utilization of information available from the feedback process for program development is emphasized (cf. Larkin, 1974; Scriven, 1967; and Stake, 1967). Following the above technique, the effectiveness of the Alcohol Safety Education Program (ASEP) in the rural middle Tennessee is determined on the basis of the program goal achievement, including the acceptance of the program by the communities, the judges, the law enforcement personnel; the success of the implementation of the program; the improvement of the behavior pattern of the participants, and the participants' evaluations of the program. The evaluation of this program is conducted for a period of six years ( ), and the convicted drinking-drivers who participated in this program have been followed up for a minimum of 12 months and a maximum of 72 months to study the recidivism rate. The effectiveness of this program is further evaluated in the following ways: (1) participation of the judges and the law enforcement officials are measured through the number of referrals to the program; (2) public interests in the program; (3) rate of alcohol related fatal accidents in this area during this period; (4) participants' improvement of knowledge regarding the problems of drinking-driving, alcohol abuse and alcoholism; (5) identifying the degree of drinking problem among the participants; and (6) the evaluation of the program by the participants. The participation of judges and law enforcement officials are encouraging. Although the judges and some of the law enforcement positions are elected positions, their participation through referrals remains continuous. Total referrals during these six years period are as follows: , , , , , and However, the completion rate is highly impressive: %, %, %, %, %, and %. From our discussion with the judges, law enforcement officials, court clerks, and the district attorney's office, it is understood that the program is highly successful and the public officials and the leaders of the communities are highly satisfied with the program. Public interests toward this program have been in the upward trend. Local civic clubs, church organizations, lawyers, and the members of the Board of Education in these communities are in support of this program. To achieve a

552 part of the goal, we have extended the Alcohol Safety Program to the senior high school as an educational program for the prevention of alcohol abuse and alcoholism.

4 552 part of the goal, we have extended the Alcohol Safety Program to the senior high school as an educational program for the prevention of alcohol abuse and alcoholism. This educational program has been approved by the County Board of Education and been highly accepted by the principals and teachers of the high schools since its initiation. In addition, new courses on prevention of alcohol abuse and alcoholism, and drug education have been introduced in the university as regular courses. The number of alcohol related fatal accidents in this region has been in the downward trend since the inception of this program. As reported by the Highway Safety Department, alcohol related fatal accidents occurred in these twelve rural counties during the six years period ( ) are as follows: , , , , , and The percentages of alcohol related fatal accidents with respect to the total fatalities in this area during this period almost follow a similar pattern as that of the State of Tennessee: %, %, %, %, %, and %. The knowledge inventory test comprising 30 true-false choice items to measure knowledge of relationships between drinking alcoholic beverages and driving. Scores of the Knowledge Inventory have a possible range of 0 to 30. A person's score is the number of correct responses. The difference of pre- and post-test results of the participants' indicated an average gained points of 3.12 which is significant at the.05 level of probability (pre-test mean score = 21.82, SD=2.84, and post-test mean score = 24.89, SD=3.47). The Michigan Alcoholism Screening Test, a modified version of the MAST (Selzer, 1971), is used to identify the degree of drinking problem of the participants. The other measure, Numerical Drinking Profile (NDP) is used to identify the degree of drinking problem of the participants. This measure is a composite of six factors, each contributing to a score designed to reveal an individual's position along a problem drinking continuum. The six factors include five additional statements to the MAST. The relationship between MAST and NDP was explored by cross-tabulation, and there is a fairly close relationship found. Data in hand indicated that about 35 percent of the participants (787) had "no drinking problem", 36 percent (810) had "potential or emerging problem", and 29 percent (652) had "evident drinking problem". These participants were informed about the tests scores and accordingly had been advised to contact the counselors through our program or through the Plateau Mental Health Center or the Department of Public Health. The participants may also like to consult their own counselors or their house physicians for their advice. The program participants are also encouraged to evaluate the program at the end of the last session of each class. This evaluation is used as a means of the feedback process, and the program improvements are made on the basis of the

553 suggestions received. In an attempt to elicit truthful responses and gainful cooperation from the participants, they are asked not to disclose their identities in the questionnaires.

5 553 suggestions received. In an attempt to elicit truthful responses and gainful cooperation from the participants, they are asked not to disclose their identities in the questionnaires. Students' evaluations suggest that: (a) the course should be definitely continued; (b) the Alcohol Safety Education Program is both helpful and informative as it is offered; (c) the overwhelming suggestion is the program should be offered to the public at large; (d) several felt that this program would be of great benefit to high school students; and (e) the overall program, as it is conducted, is of benefit to both those with little education and those with higher levels of education, even those who have college degrees. The overall analysis indicates a considerable accomplishment in the program development and public relations. The recidivism rate is 4 percent (90 out of 2,249 participants), which is highly encouraging considering the percentage of problem drinkers (22%, 506 out of 2,249) referred to this program. Although the results are highly impressive regarding the effectiveness of this program, it needs continuous improvement in data collection, program development, public relations, further implementation of the laws, and the use of modern evaluation techniques. REFERENCES 1. Alcohol Safety Action Projects, Evaluation of Operations , vol. II, Detailed Analysis. Office of Alcohol Countermeasures, NHTSA, U.S. Dept, of Transportation, Washington, D.C. 2. ASAP Effectiveness, National Traffic Safety Newsletter, August NHTSA, U.S. Dept, of Transportation, Washington, D.C. 3. Brown, P., Zelhart, P.F., and Schurr, B.C. Evaluating the effectiveness of reeducation programs for convicted impaired drivers. Alcohol, Drug, and Traffic Safety edt. by S. Israelstam and S. Lambert. Addiction Research Foundation of Ontario, Toronto, Canada, pp , Fell, S.C. Alcohol involvement in traffic crashes: National Highway Traffic Safety Administration. American Association for Automotive Medicine Quarterly Journal, 4:4, Alcohol involvement in United States traffic accidents: where it is changing. Alcohol, Drugs and Traffic Safety edt. by S. Kaye and G.W. Meier. NHTSA, Department of Transportation, Washington, D.C. pp , Franklin, S. Techniques for maximizing the effectiveness of alcohol countermeasures programs. Alcohol, Drugs and Traffic Safety edt. by S. Kaye and G.W. Meier. NHTSA, Department of Transportation, Washington, D.C. pp , Haight, F.A., Impediments to effective drinking driving countermeasures with a proposal for a driver's license interlock. Alcohol, Drugs and Traffic Safety edt. by S. Kaye and G.W. Meier. NHTSA, Department of Transportation, Washington, D.C. pp , 1985

554 8. Larkin, E. J., Three models of evaluation. Canadian Psychologist 15, 89-94, 1974. 9. Malfetti, J. L. and Winter, D. J. Counseling Mannual For DWI Counterattack Programs.

6 Larkin, E. J., Three models of evaluation. Canadian Psychologist 15, 89-94, Malfetti, J. L. and Winter, D. J. Counseling Mannual For DWI Counterattack Programs. Safety Research and Education Project, Columbia University, New York, Selzer, M. L. The Michigan Alcoholism Screening Test - The quest for a new diagnostic instrument. American Journal of Psychiatry 127, , Scriven, M. S. Methodology of Evaluation. Rand McNally & Co., Chicago, Stake, R. E. The countenance of education evaluation. Teachers College Record 68, , Waller, J. A. Epidemiologic issues about alcohol, other drugs and highway safety. Alcohol, Drugs, and Traffic Safety edt. by S. Israelstam and S. Lambert. Addiction Research Foundation of Ontario, Toronto, Canada, pp 3-11, Wolfe, A.C. Evaluation of the special alcohol enforcement/education project in Oakland County, Michigan. Alcohol, Drugs and Traffic Safety edt. by S. Kaye and G. W. Meier. NHTSA, Department of Transportation, Washington, D.C. pp , 1985

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