Sarah Nagaratnam MPH report Project 21

1 Project 21 Internship Report


ABSTRACT ............................................................................................................................................ 6

INTRODUCTION & BACKGROUND ............................................................................................... 7

Introduction ......................................................................................................................................................................... 7

Internship Site: The University of Arizona Campus Health Service .......................................................................... 9

Literature Review .............................................................................................................................................................. 10

Prevalence of binge drinking during 21st birthday celebrations ................................................................. 10

Factors associated with binge drinking during 21st birthday celebrations ................................................ 11

Negative outcomes for high-risk 21st birthday drinking .............................................................................. 12

Project 21 as a Public Health Intervention .................................................................................................... 13

Pros and Cons of Web-Based Interventions for 21st Birthday Drinking ................................................. 15

Project 21 Needs Assessment ........................................................................................................................................... 16

Goals, Objectives and Activities .................................................................................................................................... 17

DESIGNING PROJECT 21 ................................................................................................................ 20

Project 21 Content .............................................................................................................................................................. 20

Homepage .......................................................................................................................................................................... 21

Plan Your Night and BAC Calculator ........................................................................................................................... 25

Alcohol IQ and Mocktail Recipes .................................................................................................................................. 28

Birthday Ideas and Resources & FAQ .......................................................................................................................... 29

Project 21 Email Invitations and Surveys ..................................................................................................................... 30

DISCUSSION ........................................................................................................................................... 32

Challenges .......................................................................................................................................................................... 33

Contributions to the Existing Field of Knowledge ..................................................................................................... 34

CONCLUSION ........................................................................................................................................ 35

APPENDICES ..................................................................................................................................... 36

REFERENCES ................................................................................................................................... 58

TABLE OF CONTENTS


LIST OF FIGURES

Figure 1. Negative Outcomes Associated with 21st Birthday Drinking. ................................................................. 12

Figure 2. Benefits to Using a Web-Based Intervention for Project 2117,19 .............................................................. 16

Figure 3. Project 21 Homepage Concept Art from Undergraduate Internship ........................................................ 21

Figure 4. Example of a Mobile Version of a Website ................................................................................................. 22

Figure 5. Example of Responsive Website Design ...................................................................................................... 22

Figure 6. Project 21 Homepage Concept Art, Chalkboard Style (June 2013) ........................................................... 23

Figure 7 Project 21 Homepage Concept Art, Minimalist Style (August 2013) .......................................................... 24

Figure 8. Plan Your Night Final Design (Without Background) .............................................................................. 25

................................. 26

Figure 10. Plan Your Night Results, What Other Students Say ................................................................................ 26

Figure 11. Plan Your Night Results: BAC, Birthday Horoscope, Signature Recipe .............................................. 27

Figure 12. Plan Your Night Results, Responsive Design ........................................................................................... 27

Figure 14. Mocktail Recipes (Cropped Version) .......................................................................................................... 28

Figure 13. Alcohol IQ (Cropped Version) .................................................................................................................... 28

Figure 15. Birthday Ideas ................................................................................................................................................. 29

Figure 16. Resources & FAQ .......................................................................................................................................... 29

Figure 17. Project 21 Email Invitation .......................................................................................................................... 30

Figure 18. Early Concept Art for Project 21, Featuring Coupons and Taxi Resources ........................................ 36

LIST OF TABLES

Table 1. Upstream, Midstream and Downstream Interventions14,16 ......................................................................... 14

Table 2. Internship Goals, Learning Objectives, and Actions ................................................................................... 18

Table 3 Public Health Core Functions and Essential Services to be Addressed in Internship ............................ 19

Table 4. Project 21 Content ............................................................................................................................................... 20

Table 5. Project 21 Evaluation Survey ........................................................................................................................... 32


Introduction -

- -

- -

-

ABSTRACT

Methods

Output

Goals


T HERE ARE MANY COLLEGE EXPERIENCES that are associated with high-risk, heavy episodic drinking (also known as binge drinking) typically defined

as five or more drinks in a row for men and four or more drinks in a row for women 1 from tailgating at football games to holidays and special events like New Year's Day, Spring Break, and Graduation. On a more regular basis are the parties and casual drinking events (e.g., "Thirsty Thursday") that may also encourage students to binge drink 2. A student's 21st birthday is a particularly noteworthy opportunity for high-risk drinking since drinking on this particular occasion is considered by many to be a rite of passage carried out in celebration of reaching legal drinking age. Many of the traditions associated with 21st birthdays involve binge drinking: drinking 21 shots of alcohol in one sitting; drinking at several bars in one location (known

the "Power Hour" (the objective here is to drink a shot of beer every sixty seconds for one hour, or to drink as much as possible in the hour after midnight) 3. Studies have found that, on their 21st birthdays, students are more likely to consume alcohol than to abstain from it, and tend to drink more on their 21st birthday compared to any other previous occasion 4,5. Students who binge drink on their 21st birthday face a greater risk for alcohol poisoning, unintentional injuries (e.g., car crashes, falls, drowning), intentional injuries (e.g., physical assault, sexual assault), and other health consequences6.

The University of Arizona (UA) Campus Health Service (CHS), whose mission is to promote the health and wellbeing of students at the UA through its services and programs, is developing a Web-based intervention titled Project 21 in an effort to address high-risk 21st birthday drinking among students at the university. Project 21, which is being developed by the Health Promotions and Preventive Services Office (HPPS) in CHS, is a website that will encourage students to plan the amount of drinks they will have on their birthday (if they do intend to drink); take precautions during their celebrations; and incorporate alternative activities to drinking into their birthday celebrations. On their 21st birthday, UA students will receive an email invitation encouraging them to visit the Project 21 website and plan their birthday celebrations. Students will also be encouraged to provide feedback, through an online survey, on the website's appeal and usefulness. This feedback will be used by CHS to improve upon the website and, eventually, perform case-control studies to evaluate how effective Project 21 is at reducing student intentions to binge drink on their 21st birthday as well as actual birthday drinking behaviors.

INTRODUCTION


I worked on the design elements of Project 21 as a

volunteer in the Fall semester of 2011, and as an intern in

the Summer of 2012 while completing my Bachelor of

Science degree in Public Health. Much of this time was

spent familiarizing myself with the software I would use

to design the website (Adobe Photoshop and Illustrator).

I continued my work during a second internship this

time while completing my Master of Public Health

degree. My goals for this internship were to:

1. Finalize the designs for the website, email invitations,

and evaluation surveys using content and research

findings provided by the Project 21 team (HPPS

Outreach Specialist, Melanie Fleck, and HPPS

Director David Salafsky)

2. Collaborate with the University of Arizona Student

Affairs Systems Group (SASG) on the development

of the website; and

3. Facilitate the live release of the website (including the

collection and analysis of the student surveys).

I was very eager to work on this project as it granted me

the opportunity to contribute to the development of a

public health intervention and apply myself towards

addressing the public health core competencies and

essential services in a practical setting.

The University of Arizona Campus Health Service promotes health, wellness and safety at the University of Arizona and in the surrounding community through its health care services, health education, and contributions toward health-related policy development at the University16. CHS is the first fully accredited college health service in the country, and was accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in 1978 as well as the Accreditation Association for Ambulatory Health Care (AAAHC) in 1981 17. Students enrolled at the UA have a number of options for accessing health care at CHS: fee-for-service, CampusCare Supplement, Student Health Insurance, and Commercial Insurance. Costs to the student vary for each system. Students are not required to have health insurance in order to access health care at CHS, though CHS recommends that students "maintain adequate health insurance to cover unexpected medical expenses". The fee-for-service option is automatically available to all currently enrolled UA students. CHS fees are generally less expensive than those charged by other providers in the community, and CHS accepts a number of payments, including cash, check credit card (only for faculty and staff) or Bursar billing (only for registered students). CHS also offers after-hours telephone medical assistance by means of an on-call physician or nurse practitioner18.

The Health Promotion and Preventive Services (HPPS) office within CHS offers a number of programs and services to promote the health and wel lbe ing o f the university's student population. These include health education materials; presentations; individual and group instruction; counseling; and referrals. HPPS covers an array of heath topics, including those related to mental health, sexual health, nutrition, sleep health, violence prevention and substance use including alcohol use. Project 21 will be HPPS' first program designed to address high-risk alcohol consumption specifically among 21-year-olds at the UA.

Internship Site: The University of Arizona Campus

Health Service


In general, college students tend to drink more alcohol compared to their non-college peers, and several factors such as peer and media influences have been found to contribute to high-risk drinking among college students 10. The following literature review examines the prevalence of high-risk 21st birthday drinking among students, potential risk factors for this behavior, and the research-supported benefits (as well as disadvantages) of Web-based interventions that have been used to address it.

Prevalence of binge

drinking during 21 st birthday

Study findings suggest that students are more likely to drink alcohol on their 21st birthday than to abstain from it. One study involving over 3,000 undergraduate students found that over 80% drank on their 21st birthday. Nearly half of the participants reported drinking more on their 21st birthday compared to any other previous occasion5. Another study, involving over 1,000 undergraduate students who were turning 21 between January and August 2008, observed that over 90% of the participants drank on their 21st birthday, and that participants' BAC levels due to 21st birthday drinking was 50% higher than their BAC levels during normal drinking (0.186 vs. 0.08) 11. Finally, a third study involving over 2,000 students found that 83% drank on their 21st birthday, compared to 79% of their non-college peers 5.

This study also observed the prevalence of binge drinking associated with 21st birthdays: 79% of men and 68% of women engaged in binge drinking on their 21st birthday 5. In this study, women were more likely to drink than men, but male students who drank consumed more drinks than women (14.6 vs 11.4 drinks). 12% of both male and female students who drank on their birthday reported that they consumed exactly 21 drinks (which may be attributed to the tradition of having 21 drinks on

st birthday), while an additional 22% of male birthday drinkers and 12% of female birthday drinkers reported having more than 21 drinks 5.

Factors associated with

binge drinking during 21 st

birthday celebrations

Male gender Fraternity/sorority membership Younger drinking initiation Normative misperceptions (e.g., overestimating the number of drinks consumed by peers on their 21st birthdays) Heavier pre-celebration intentions

"..situational/contextual factors such as patronizing bars, larger celebration groups, engaging in drinking traditions, and peer encouragement for drinking" 9.

Brister, Sher and Fromme suggest that heavy event- st birthday, may be more strongly influenced by peer motivation and environmental factors than individual attitudes and social norms 12. Lewis et al. observed

likely to consume more drinks, spend more hours drinking, reach higher [estimated BACs], and

Brister, Sher and Fromme observed that experienced drinkers (who have had one or more heavy drinking episodes) were more likely to experience negative outcomes than inexperienced drinkers 12,13.

Factors that are associated with heavier 21st birthday drinking include the following:


Some of the negative physical and behavioral outcomes reported by students in the 2011 Brister, Sher and Fromme study are illustrated in Figure 1. 35% of students reported vomiting after drinking; 41% blacked out; and 45% experienced a hangover the day after their 21st birthday.

Negative Outcomes for high -risk 21st birthday

In addition to the physical consequences of heavy 21st birthday drinking, students may face a number of behavioral risks and other negative consequences as well, which are also presented in Figure 1, and include flirting with others (23% of students); making out with one or more people (29%); and drunk dialing or posting on Myspace/Facebook. In another study, involving 244 students who drank on their 21st birthday, 27.8% reported missing school or work the day after their birthday; 27.2% neglected responsibilities; and 17.4% found themselves in a place they could not remember arriving at10. These studies strongly suggest that students, by engaging in heavy drinking on their 21st birthday, may place themselves at a greater risk for injury, unsafe behaviors (including unsafe sexual activities), and consequences related to school and/or work. These

consequences may range from minor to severe, and in some cases may place the individual at a greater risk for serious injury or death (due to alcohol poisoning, accidents, physical assault, etc.).

Figure 1. Negative Outcomes Associated with 21st Birthday Drinking. Data from "21st birth-day drinking and associated physical consequences and behavioral risks", by Brister, Sher and Fromme (2011). n = 150


Public health interventions may be classified as

depending on their method of addressing the health issue and the scope of their influence (Table 1). Interventions that use policy approaches to change the circumstances that contribute to adverse health behaviors for example, establishing a nation-wide legal drinking age are considered upstream interventions. Downstream interventions focus on changing adverse health behaviors at the individual level through services such as individual counseling. Midstream interventions focus on individuals within a particular setting or organization, such as a university, and utilize organizational channels to prevent adverse health behaviors 14.

Project 21 incorporates elements of both midstream and downstream interventions in that it

targets a specific group of people (students at the UA) through an organizational channel (the University of Arizona Campus Health Service), and provides individual-level self-help/educational resources that students can use when planning their 21st birthday celebrations. The Project 21 team wished to utilize a Web-based intervention to address this issue since there are many advantages to its use (e.g., easy access for students via computers and mobile devices) and since Web-based interventions, along with other electronic health (e-health) interventions, have demonstrated effectiveness at reducing the quantity and frequency of alcohol consumption among college students 15.

Project 21 as a Public Health Intervention

Type of intervention

This intervention

Examples include...

Upstream Large populations Macro-level policy approaches (e.g., government regulation, economic incentives) that promote healthy behaviors while redirecting "unhealthy societal and industry counterforces"11.

Laws that prohibit alcohol vendors from selling alcohol to minors.

Midstream Everyone within a defined population or setting (e.g., within a university or worksite)

Population-level interventions that seek to change and/or prevent adverse health behaviors through important organizational channels or natural environments (e.g., worksite, schools, communities).

Alcohol-related health resources (such as Project 21) that are provided by CHS specifically for students at the UA

Downstream Individuals (particularly targeted higher-risk individuals)

Individual-level interventions "with an emphasis on changing rather than preventing health-damaging behaviors"11 (e.g., group/individual counseling, self-help programs, patient health education, pharmacologic treatments).

Project 21, as a form of patient health education/cognitive-behavioral intervention

Table 1. Upstream, Midstream and Downstream Interventions 14, 16


A meta-analysis of 35 manuscripts with 43 separate computer-delivered interventions (CDIs) to reduce alcohol use among college students found that CDIs "[reduced] the quantity and frequency of drinking among college students", producing small to moderate within-group effect sizes at short-term and longer-term follow-ups. The authors concluded that "CDIs are generally equivalent to alternative alcohol-related

14. A Web-based randomized controlled trial involving 295 college students all of whom reported that they planned to have 2 or more drinks on their 21st birthday observed that the Web-based personalized intervention was effective at reducing estimated BAC levels reached by the students on their birthday. This was especially noticeable among students who reported intentions to reach higher BAC levels10.

While this study successfully demonstrated the efficacy of Web-based personalized feedback, Neighbors et al. note that "the effects were relatively small but comparable in magnitude to those of more general individual approaches to alcohol prevention among college students" and that interventions

involving personalized feedback might have a larger effect size when delivered in person. When experiencing in-person interventions, compared to Web-based interventions, students may be more likely to go over each feedback component, ask questions about the feedback, and change their behaviors in response to the feedback. Other benefits to using an in-person intervention include being able to monitor the students' level of attention when they receive the feedback (these observations can be applied towards making the intervention more engaging), and being able to recruit students' friends to administer or support the intervention efforts (this incorporates the beneficial influence friends can have on drinking behaviors). Despite the advantages to in-person interventions, the Web-based delivery of Project 21 is arguably more feasible for CHS due to its cost efficiency and easy access for the target population. Students at the UA may be more inclined to visit an alcohol education website than to attend a similarly-themed in-person activity.

Pros and Cons of Web -Based Interventions for 21st

Birthday Drinking

Figure 2. Benefits to Using a Web-Based Intervention for Project 21


Project 21 Needs Assessment

of the Project 21 website. For example, the website's BAC calculator was influenced by the UA Alcohol Coalition's interest in a BAC calculator smartphone

section of the Plan Your Night Results page was influenced by student-reported interest in tips for students who are planning to celebrate their 21st birthday15.

An analysis of alcohol-related behaviors among UA students (based on annual CHS Health and Wellness surveys from 2002 to 2011) found that students who are over 21 years old tend to drink more frequently than their younger peers, though students under 21 tend to reach significantly higher BAC levels despite having a lower average of drinks consumed per week (3.7 versus 4.9). These findings suggest that interventions for UA students who are under 21

should emphasize high-risk episodic drinking, while interventions for UA students over 21 should emphasize sustained typical drinking behaviors15. While these findings do not specifically address 21st birthday drinking among UA students, they arguably support the use of an event-based intervention, such as Project 21, to address the high-levels of alcohol consumption that occurs uniquely during 21st birthday celebrations, rather than an intervention that focuses more on typical drinking. drinking among UA students, they arguably support the use of an event-based intervention, such as Project 21, to address the high-levels of alcohol consumption that occurs uniquely during 21st birthday celebrations, rather than an intervention that focuses more on typical drinking.

The content for Project 21 was developed by Melanie Fleck who previously spearheaded the project during her own Master of Public Health internship and David Salafsky, Director of Campus Health Promotions and Preventive Services. In assessing the needs of the target population and relevant stakeholders, Ms. Fleck performed three main investigations:

1. An evaluation of data from the 2011 CHS annual Health and Wellness Survey

2. An online survey involving varied University and community stakeholders from the UA Alcohol Coalition, and

3. Student intercept surveys on Project 21 and perceptions regarding 21st birthday-related alcohol consumption.

The overarching goal of this internship was to collaborate with HPPS and SASG to develop the Web-based

intervention Project 21, which is intended to provide interactive and personalized feedback to UA students who are

turning 21 years old so that they can better plan their birthday celebrations, especially if they plan to drink alcohol.

Internship goals, learning objectives and activities are summarized in Table 2, while public health core functions and

essential services to be addressed by the internship are summarized in Table 3.

Goals, Objectives and Activities


Learning Objectives Internship Activities Goal 1: Design, Develop and Promote Project 21

1. Develop necessary skills for creating a Web-based intervention.

Collaborate with SASG in developing the website. Develop skills in relevant software (namely Adobe Illus-trator).

2. Tailor a Web-based intervention to a specific tar-get audience.

Evaluate the visual presentation of the website to deter-mine if it is age-appropriate, accessible, easy to under-

Obtain the input of the target audience regarding the

tent (to be conducted after live release of website).

3. Develop skills in the accurate visual presentation of health information on alcohol-related topics.

Collaborate with the Project 21 team to ensure that the material is accurate and appropriately presented.

4. Improve upon written communication skills in order to engage effectively with collaborators on a virtual/remote project.

Maintain regular correspondence via email with the SASG team and with the rest of the Project 21 team.

Goal 2: Develop and Disseminate Evaluation Surveys

5. Develop necessary skills for conducting a litera-ture review on evaluations of Web-based interven-tions similar to Project 21.

Utilize online databases such as PubMed to find studies, meta-analyses, and literature reviews that have been con-ducted for Web-based interventions similar to Project 21 to determine how best to evaluate the effectiveness of the website.

6. Evaluate the integrity and comparability of data. Evaluate the data obtained in the literature review (e.g., look for gaps in data, study limitations)

7. Develop necessary skills for conducting a study to evaluate the effectiveness of an intervention.

Work with preceptor to generate survey questions, com-plete the human subjects approval process, prepare the electronic means of delivery, and arrange for compensa-tion of study participants (if possible).

8. Improve upon written communication skills in order to convey evaluation questions accurately and clearly.

Review evaluation questions for accuracy and clarity; solicit feedback from rest of Project 21 team and other collaborators. Solicit feedback from target audience by including ques-tions in the survey regarding the wording and presenta-tion of the survey questions.

Goal 3: Analyze and Apply Survey Findings 9. Gain experience analyzing data; apply necessary statistical methods to make relevant inferences from data.

Compile data from surveys and perform statistical anal-yses to determine if the intervention was associated with a decrease in student intent to engage in high-risk birth-day drinking.

10. Apply study findings towards improving an inter-vention.

Work with HPPS and SASG to make relevant changes to the website based on the feedback of the target audience.

Table 2. Internship Goals, Learning Objectives, and Actions


Core Function Essential Services Project 21

Policy Development #3. Inform, educate and em-power people about health issues.

#5. Develop policies and plans that support individual and community health ef-forts.

The purpose of the website is to inform and empower students about high-risk 21st birthday drinking and to provide them with resources on how to enjoy alcohol responsibly as well as resources on alternatives to alcohol consumption.

Assurance #7. Link people to needed personal health services and ensure the provision of per-sonal health services when otherwise unavailable.

This project will connect students to a resource (the website) that ad-dresses a health concern (high-risk drinking during 21st birthday cele-brations). The effectiveness of this resource will be evaluated over the course of the project and improved upon based on the feedback of the target audience as well as other stakeholders.

Assessment #1. Monitor environmental and health status to identify and solve community envi-ronmental health problems.

Following the live release of the website, and the implementation of the email invitations, Campus Health Service will be able to plan for an ongoing means of monitoring student intent to engage in high-risk 21st birthday drinking, and use this information to modify and im-

ing higher-risk groups that have been identified within the target audi-ence).

Table 3. Public Health Core Functions and Essential Services to be Addressed in Internship


Project 21 Feature

Content

BAC Calculator consumed, and 3) number of hours spent drinking. The BAC calculator also features a

them).

Plan Your Night

st birthday celebration, including

birthdate), and ideas from fellow students.

Alcohol IQ Debunks various myths about alcohol consumption on 21st birthdays. Mocktail Recipes

Presents a list of alcohol-free mocktail recipes as an alternative to alcoholic beverages.

Birthday Ideas

Offers non-alcohol-related activities that students can add to their birthday celebrations.

Resources & FAQ well as details regarding the Project 21 website.

Several designs were considered for the Project 21 homepage. Figure 3 presents an early concept design I made for Project 21 during my undergraduate internship with HPPS: the everyday objects in the design (e.g., smartphone, calculator) serve as links to the features of the website (e.g., the smartphone links to the Plan Your Night feature while the cocktail umbrellas link to the recipes page).

Project 21 Homepage

Figure 3. Project 21 Homepage Concept Art from Undergraduate Internship

Table 4. Project 21 Content

There are six features in the Project 21 website: BAC Calculator, Plan Your Night, Alcohol IQ, Mocktail Reci-pes, Birthday Ideas, and Resources & FAQ (Frequently Asked Questions). A summary of the content for each feature is presented in Table 4, with the complete written content available in Appendix E. My role during my undergraduate and graduate internships at HPPS was to design the website around this content.


I used a hand-drawn style and "ink wash" background to convey a relaxed atmosphere, and an

ultimately proved unfeasible due to the difficulties it posed in adapting the website to tablet and mobile devices. My subsequent designs took into greater consideration the responsiveness of the website design so that this could be more readily achieved.

The Project 21 team and SASG wanted to achieve a design that could be compatible with a variety of devices from computers to tablets to smartphones so that a mobile version of the site would not be needed. An example of a website with a mobile version is presented in Figure 4, with the mobile site (http://en.m.wikipedia.org/wiki/University_of_Arizona) on the left and the regular site (http://en.wikipedia.org/wiki/University_of_Arizona) on the right. Figure 5 presents an example of a website with a responsive design; users visit the same address (http://www.arizona.edu/apply) regardless of the device they use.

Figure 4. Example of a Mobile Version of a Website

Figure 5. Example of Responsive Website Design

One of my later designs which was presented to the Project 21 team two months prior to the start of my intern-ship used a "chalkboard lettering" style that was inspired by sidewalk sandwich-board menus used by restau-rants, bars and cafes (Figure 5). This design took into consideration the responsiveness of the website: as shown in Figure 3, the links are arranged in a grid, which could be rearranged depending on the width of the browser. While the Project 21 team liked the aesthetic of this design, we quickly realized with feedback from SASG that the image-heavy design could lengthen browser loading times, which would be burdensome to users.


Figure 6. Project 21 Homepage Concept Art, Chalkboard Style (June 2013)

At SASG's suggestion of simplifying the design, I replaced the link-illustrations with

minimalist icons (e.g., a cake slice). Three different designs were considered using this new style (Figure 7). Ms. Fleck conducted an informal survey among the HPPS staff to obtain feedback on the most appealing design. The design with the light grey background and dark grey icons received the most votes, and was used as the basis for the design of the other pages. I worked on these designs throughout the Fall 2013 semester, and Appendices A through C chart the progression of my work. The finalized designs, which were shared with SASG in February 2014, are presented in Appendix D.

Figure 7 Project 21 Homepage Concept Art, Minimalist Style (August 2013)


Plan Your Night is the main feature of the website, and

provides personalized feedback that students can use to

plan their 21st birthday celebrations regardless of whether

they plan to drink or not. Upon arriving the Plan Your

Night page the link in the email invitation will take the

users to this page first rather than the homepage users

will see only the first two questions shown in Figure 8: 1)

Do you plan on drinking alcohol on your birthday?, and

question1, question 3 will appear, prompting the user to

enter details about the number of drinks they plan to

have, as well as other relevant information needed to cal-

culate their BAC. As the user enters this information, the

red box at the bottom of question 3 will update their

BAC output with both the BAC level and a brief descrip-

tion of what it means.

Earlier drafts of Plan Your Night included an

additional question, which prompted students to select a

number of activities they planned to do on their birthday,

including ways they planned to enjoy alcohol safely (if

they intended to drink) (Figure 9). This section was ulti-

mately excluded from the Plan Your Night questionnaire

which offers students suggestions on how to have a safe

and enjoyable 21st birthday (Figure 10).

Plan Your Night & BAC Calculator

Figure 9. Plan Your Night Deleted Section,

Figure 10. Plan Your Night Results, What Other Students Say

Figure 8. Plan Your Night Final Design (Without Background)


In the final version of the Results page, the BAC section will be displayed at the top of the page (see Appendix D), so that the user sees their BAC results first (since this is the most important aspect of the Plan Your Night feature). and Signature Recipe (selections shown in Figure 11). The BAC feedback in the Results section pro-

Project 21

dicating that they do not plan to drink on their 21st birthday, will still see the BAC feedback section, though the BAC level reported will be .00, with the accompanying description congratulating the user on choosing not to drink. The concept design presented in Figure 12 illustrates the responsiveness of the Plan Your Night Results page: the images, which serve as anchors to the various sections of page (e.g., clicking on the cake illustration will take the user further down the page to the horoscope section) , adapt to chang-es in browser size, thus allowing users to easily access the feature on a variety of devices. This ease of

town. If a student decides to visit a bar on their birthday, they can easily access the BAC calculator to calculate their estimated BAC levels depending on the number of drinks they plan on having.

Figure 11. Plan Your Night Results: BAC, Birthday Horoscope, Signature Recipe

Figure 12. Plan Your Night Results, Responsive Design


The Alcohol IQ page presents a few myths and facts about alcohol consumption related to 21st birthday celebrations, citing research findings. When users visit this page, only the red text boxes, each presenting a potential myth or fact, will be visible (see Figure 13 for a cropped version of the page, and Appendix D for the full version). Clicking on a text box will reveal its corresponding answer. These collapsible accordion-style content panels encourage the user to first think about whether the statement is true or not before they see the answer. It also infuses some interactivity into the page while being very touch-screen-friendly, allowing for

upon in future modifications to the site with more myths/facts and other interactive elements to promote user interaction with the page and retention of the information presented.

The Mocktail Recipes page (Figure 14) is presented in the same format as the Alcohol IQ page: users

the bottom of the panel to make it collapse again. There are 12 mocktail recipes in this page, which are also used in the Plan Your Night feature (each recipe is matched with horoscope dates). Earlier concept designs for this feature included cocktail recipes as well, but this was ultimately excluded since the inclusion of alcoholic recipes might encourage users to try them over the non-alcoholic ones.

Alcohol IQ and Mocktail Recipes

Figure 14. Mocktail Recipes (Cropped Version)

Figure 13. Alcohol IQ (Cropped Version)


The Birthday Ideas page presents a handful of ideas that students might add to their celebration plans. The purpose of this page is to encourage students to celebrate their birthdays in unique, memorable ways that do not necessarily involve alcohol. Some of the birthday ideas, as shown in Figure 15, provide links to external sites where users can get more information about these activities. There are currently six birthday ideas listed on the page, and the Project 21 team may add more in the future. The page could also be improved upon with more interactive features (e.g., embedded videos, interactive content panels)

Birthday Ideas and Resources &FAQ

Figure 15. Birthday Ideas

Figure 16. Resources & FAQ

The final page on the Project 21 website is the Resources & FAQ feature (Figure 16), which provides further information about Project 21 (e.g., why students are receiving Project 21 email invitations; the purpose of Project 21) as well as information on other alcohol-related resources provided by CHS. As the Project 21 team begins to receive feedback from students via the online surveys, the Resources and FAQ page may be updated with answers to common questions or concerns received from students.


Upon the live release of the Project 21 website, UA students who are turning 21 will receive the Project 21 email invitation (Figure 17), wishing them a happy birthday and encouraging them to visit the Project 21 website to plan their birthday celebrations. The Project 21 team is currently working with SASG to plan the logistics of this process, from identifying students in the university records who are turning 21 to disseminating the email invitations. Student feedback on Project 21 student intent to engage in high-risk drinking on their 21st birthdays. Students receiving the Project 21 email invitations will be encouraged to provide feedback on the website's appeal and usefulness through an online survey, which will be sent to them shortly after the initial email invitations. The survey is currently intended to be delivered via Google Forms. Initial drafts of the survey included a number of multiple choice and short answer questions regarding each feature of the

perceptions of the website. However, the survey was condensed to 5 multiple choice questions that the Project 21 team deemed most critical (Table 5). The team felt that a longer questionnaire might discourage students from taking the time to complete it. Formal focus group studies may be conducted on Project 21 at a later date to obtain more input on the effectiveness of each feature of the website. Case-control studies may also be conducted to evaluate

st birthday drinking behaviors when compared to control-group interventions (e.g., pamphlets). The Project 21 team and I had hoped to begin student evaluations of the website during my internship; however, the design and development stage took a longer time than expected, and so we modified our project plan and moved the evaluation stage to a later date. As of March 2014, the website is currently being developed by SASG, while the materials for the evaluation stage including the email invitations and surveys are being developed by the Project 21 team. The team hopes to be able to disseminate the invites and surveys to students soon after the website is completed.

Project 21 Email Invitations and Surveys

Figure 17. Project 21 Email Invitation

Documents

Sarah Nagaratnam MPH report Project 21