An empirical evaluation of the US Beer Institute's self-regulation code governing the content of beer advertising.

OBJECTIVES: We evaluated advertising code violations using the US Beer Institute guidelines for responsible advertising. METHODS: We applied the Delphi rating technique to all beer ads (n = 289) broadcast in national markets between 1999 and 2008 during the National Collegiate Athletic Association basketball tournament games. Fifteen public health professionals completed ratings using quantitative scales measuring the content of alcohol advertisements (e.g., perceived actor age, portrayal of excessive drinking) according to 1997 and 2006 versions of the Beer Institute Code. RESULTS: Depending on the code version, exclusion criteria, and scoring method, expert raters found that between 35% and 74% of the ads had code violations. There were significant differences among producers in the frequency with which ads with violations were broadcast, but not in the proportions of unique ads with violations. Guidelines most likely to be violated included the association of beer drinking with social success and the use of content appealing to persons younger than 21 years. CONCLUSIONS: The alcohol industry's current self-regulatory framework is ineffective at preventing content violations but could be improved by the use of new rating procedures designed to better detect content code violations.

A new method for evaluating compliance with industry self-regulation codes governing the content of alcohol advertising.

BACKGROUND: This study evaluated the use of a modified Delphi technique in combination with a previously developed alcohol advertising rating procedure to detect content violations in the U.S. Beer Institute Code. A related aim was to estimate the minimum number of raters needed to obtain reliable evaluations of code violations in television commercials. METHODS: Six alcohol ads selected for their likelihood of having code violations were rated by community and expert participants (N = 286). Quantitative rating scales were used to measure the content of alcohol advertisements based on alcohol industry self-regulatory guidelines. The community group participants represented vulnerability characteristics that industry codes were designed to protect (e.g., age <21); experts represented various health-related professions, including public health, human development, alcohol research, and mental health. Alcohol ads were rated on 2 occasions separated by 1 month. After completing Time 1 ratings, participants were randomized to receive feedback from 1 group or the other. RESULTS: Findings indicate that (i) ratings at Time 2 had generally reduced variance, suggesting greater consensus after feedback, (ii) feedback from the expert group was more influential than that of the community group in developing group consensus, (iii) the expert group found significantly fewer violations than the community group, (iv) experts representing different professional backgrounds did not differ among themselves in the number of violations identified, and (v) a rating panel composed of at least 15 raters is sufficient to obtain reliable estimates of code violations. CONCLUSIONS: The Delphi technique facilitates consensus development around code violations in alcohol ad content and may enhance the ability of regulatory agencies to monitor the content of alcoholic beverage advertising when combined with psychometric-based rating procedures.

Sustaining Screening, Brief Intervention and Referral to Treatment (SBIRT) services in health-care settings.

AIMS: To assess the sustainability of Screening, Brief Intervention and Referral to Treatment (SBIRT) services after cessation of initial start-up funding. DESIGN: Descriptive study with quantitative and qualitative data collected from 34 staff participants from six grantees (comprising 103 sites) funded previously through a large, federally supported SBIRT program. SETTING: Primary care out-patient clinics and hospitals in the United States. PARTICIPANTS: Thirty-four grantee-related staff members, including administrators, evaluators, key stakeholders and SBIRT service providers from six grantees. MEASUREMENTS: Changes to levels and types of service delivery activities after federal funding stopped, alternative sources of funding and obstacles to delivery of services. FINDINGS: Of the 103 original sites in the six SBIRT grantee programs, 69 sites continued providing services in some capacity (same as before, reduced, modified or expanded). Most of the 69 sites (67%) adapted and redesigned the delivery of SBIRT services post-initial grant funding. In addition, new sites were added after grant funding ended, bringing the total number of sites to 88. Analysis of participant responses identified four primary factors that influenced SBIRT sustainability: presence of champions, funding availability, systemic change and SBIRT practitioner characteristics. CONCLUSIONS: Almost 70% of the Screening, Brief Intervention and Referral to Treatment (SBIRT) services in the United States funded initially through a federal program were able to sustain operations after federal funding ceased and some expanded SBIRT services beyond the original sites. The key factors related to sustainability were securing new funding, having champions, adapting and making system changes and managing program staffing challenges.

The SBIRT program matrix: a conceptual framework for program implementation and evaluation.

BACKGROUND AND AIMS: Screening, Brief Intervention and Referral to Treatment (SBIRT) is a comprehensive, integrated, public health approach to the delivery of services to those at risk for the adverse consequences of alcohol and other drug use, and for those with probable substance use disorders. Research on successful SBIRT implementation has lagged behind studies of efficacy and effectiveness. This paper (1) outlines a conceptual framework, the SBIRT Program Matrix, to guide implementation research and program evaluation and (2) specifies potential implementation outcomes. METHODS: Overview and narrative description of the SBIRT Program Matrix. RESULTS: The SBIRT Program Matrix has five components, each of which includes multiple elements: SBIRT services; performance sites; provider attributes; patient/client populations; and management structure and activities. Implementation outcomes include program adoption, acceptability, appropriateness, feasibility, fidelity, costs, penetration, sustainability, service provision and grant compliance. CONCLUSIONS: The Screening, Brief Intervention and Referral to Treatment Program Matrix provides a template for identifying, classifying and organizing the naturally occurring commonalities and variations within and across SBIRT programs, and for investigating which variables are associated with implementation success and, ultimately, with treatment outcomes and other impacts.

Screening, brief intervention and referral to treatment (SBIRT): implementation barriers, facilitators and model migration.

AIMS: To identify barriers and facilitators associated with initial implementation of a US alcohol and other substance use Screening, Brief Intervention, and Referral to Treatment (SBIRT) grant program, and to identify modifications in program design that addressed implementation challenges. DESIGN: A mixed-method approach used quantitative and qualitative data, including SBIRT provider ratings of implementation barriers and facilitators, staff interview responses and program documentation. SETTING: Multiple sites within the first seven programs funded in a national demonstration program in the United States. PARTICIPANTS: One hundred and two SBIRT providers were surveyed; 221 SBIRT stakeholders and staff were interviewed. MEASUREMENTS: Mean ratings of barriers and facilitators were calculated using provider survey responses. An inductive content analysis of interview responses identified factors perceived to support and challenge implementation; program modifications that occurred over time were recorded. FINDINGS: Providers rated pre-selected implementation facilitators higher than barriers. Content analysis of interview responses revealed six themes: committed leaders; intra- and inter-organizational communication/collaboration; provider buy-in and model acceptance; contextual factors; quality assurance; and grant requirements. Over time, programs tended to: adopt more efficient 'pre-screen' item sets; screen for risk factors in addition to alcohol/substance use; use contracted specialists to deliver SBIRT services; conduct services in high-volume emergency department and trauma center settings; and implement on-site and telephonic treatment delivery. CONCLUSIONS: Screening, Brief Intervention and Referral to Treatment program implementation in the United States is facilitated by committed leadership and the use of substance use specialists, rather than medical generalists, to deliver services. Many implementation challenges can be addressed by an adequate start-up phase focused on comprehensive education and training, and on the development of intra- and inter-organizational communication and collaboration; opinion leader support; and practitioner and host site buy-in.