Kazemi et. al. (2013) stated two research questions for this study. (A) Is there a reduction in blackouts over six months while participating in the MI program? (B) Is there an association between the prevalence of blackouts in the consumption of alcohol and drugs by freshmen college students based on race and gender?
The independent variable in the study by Kazemi et. al. (2013) was using a Motivational Interviewing program as an intervention in college freshmen. The dependent variables in Kazemi et. al. (2013) study were the associations between the rate of blackouts and time, ethnicity, gender, illicit drug use, and alcohol consumption. Kazemi et. al. (2013) did not explicitly state any extraneous or confounding variables in the report nor were any made obvious.
The design of this study by Kazemi et. al. (2013) is qualitative and longitudinal. It is qualitative because it follows a sample group for one college, and uses three different questionnaires for measuring effects of MI on the number of blackouts in college freshmen. The Daily Drinking Questionnaire, Rutgers Alcohol Problem Index, and the Government Performance and Results Act were completed by the participants after the baseline therapy session and then again after the six-month therapy session to review efficiency of MI. Qualitative design was appropriate for this study because questionaries’ were needed to assess the number of drugs used and alcohol consumed and number of blackouts participants had throughout the six-month period to see if MI interventions effected these numbers.
Population, Sample, and Setting
Kazemi’s et. al. (2013) study was conducted at a public university in a southern state using a purposive sample. Three hundred freshmen students were recruited from residence halls and seminar classrooms. Students that wanted to participate were told to call and were screened for eligibility. Criteria for this study were full-time freshmen status students willing to participate between the ages of 18-20 years old, they must have consumed alcohol in the last 30 days, been able to read and speak English, and attend all four sessions. Of the initial 300 students, 98 were excluded because they did not meet the criteria requirements. Fourteen more students were excluded because they were unable to attend all four sessions. The final sample size for the study was 188 students. The mean age of participants was 18.5 years. 95% of students lived on campus. The ethnic distribution is as follows: 57.4% European American, 17.6% African American, 9.6% multicultural, 3.2% Latino American, and 2.1% Asian American. The study by Kazemi et. al. (2013) was comprised mostly of female participants, making up 66% of the sample, males represented 34% of the sample.
Institutional review board approval was needed for this study by Kazemi et. al. (2013) and participants had to sign an informed consent prior to their first baseline questionnaire. The students that expressed interest was given copies of the consent form. Kazemi et. al (2013) read the consent forms aloud, and provided a question-and-answer session afterwards. It was also discussed with the participants that the study was voluntary. The risks and benefits were verbalized along with the importance of confidentiality. For their participation in the study, the students were awarded a $20 gift card to their university bookstore after every session they completed.
Data Collection Procedures
The MI program was given in two 50-minute therapy sessions following the initial baseline assessment and one at the two-week visit. The two other sessions were done at 3 months and 6 months from the 2-week visit. Trained peer interventionist delivered the MI program individually to participants. These MI programs included education on alcohol and personalized feedback for the participants. The baseline interview was where the interventionist explained the MI program to the participants, built rapport with them, gathered their drinking behavior and history, and encouraged participation in Kazemi’s et al. (2013) study. At the two-week visit the students were given information about blood alcohol concentration levels by sex, weight, and number of standard drinks. The students completed questionnaires to assess their alcohol use and the consequences from their use. The participants were given the opportunity to ask questions regarding the BAC information given to them at the baseline visit, and were taught how to use the self-monitoring alcohol tracking card associated with BAC levels. Participants discussed their reactions to feedback and issues related to their alcohol use with the interventionists. At the 3 and 6 month visits participants had similar interactions like the 2-week visit with the interventionists minus the personalized feedback.
Date Collection Instruments
The students used the Rutgers Alcohol Problem Index (RAPI), Daily Drinking Questionnaire(DDQ), and the Government Performance and Results Act (GPRA) at the baseline and 6-month visit for the study by Kazemi et. al. (2013).
Rutgers Alcohol Problem Index is a 23-item measure with psychometric properties that takes approximately 5 minutes to complete. The RAPI is designed to assess the frequency of negative drinking consequences occurrences and measures the impact of drinking on social and health indicators. It is scored from 0-3, zero being never, and three being 10 times or more. The total RAPI score is between 0 and 69. Cronbach’s alpha for the RAPI is 0.88, meaning it has good internal reliability. Validity was not discussed.
Daily Drinking Questionnaire measures quantity and frequency of drinking and drinking patterns. The DDQ measures alcohol consumption patterns including, frequency and peak drinking events daily over a week, and then averages those over the past month. Sizes of drinks are standard. One drink is equal to 1-ounce of liquor, 12-ounces of beer, or 4-ounces of wine. On the Cronbach’s scale the DDQ received alphas ranging between 0.66 and 0.75 which shows that the DDQ is reliable. This questionnaire has also proven its reliability and validity when used with college students.
Government Performance and Results Act is used to collect demographic information. The GPRA collects information on mental and physical health problems, social connectedness, unprotected sexual history, and drug or alcohol use. This tool was used to collect information regarding drug use in the past 30 days by the participants. Drugs that were screened for included, cocaine/crack, opiates, marijuana, hallucinogens, methamphetamine, and nonprescription methadone. It takes approximately 30 minutes to complete the GPRA. Validity and reliability were not stated for the GPRA.
Data Analysis & Results
Data Analysis: Two questions specifically from the RAPI were used to determine the presence or absence of blackouts in the participants. If the at least one of the two questions were answered with a nonzero or nonmissing response, it was considered that a blackout had occurred (Kazemi et. al. 2013). According to literature review and preliminary analyses there is an association with drug use and blackouts. Data was not collected about drug use on the 3-month visit so associations were analyzed with the data collected from the baseline and 6-month visit. Blackout rates were compared using generalized estimating equations. Associations between blackouts and drug use were compared using marginal models and person-specific models. A logistic regression model (LRM) was used to analyze the association of drug use, alcohol use, and gender to blackouts for the first time at 6 months. Another LRM was used to investigate the connection of alcohol and drug use to not having blackouts at 6 months. A final model was selected using the Bayesian information criterion. In the 188 patients, there was over a 99% power to see a drop in correlated blackout rates between baseline and 6 months. This study by Kazemi et. al. (2013) was considered statistically significant because the alpha value was less than 0.05.
Results: 40% of patients had experienced a blackout at baseline. At the end of the 6 months the rate of blackouts had decreased to 16%. At baseline the average amount of drinks per week was 11.1, it had dropped to 7.3 per week at 6 months. Average drinking time decreased from 7.6 to 5.5 hours from baseline to 6 months. The average amount of drinking days over the last 30 days decreased from 6.0 to 4.4 days per month. The average maximum number of drinks remained at 3.5 drinks during the week. Drug use decreased from 27.1% to 23.4%, however drug-using days increased from 1.3 to 1.5 per month. 72% of the 76 participants that experienced blackouts at baseline did not experience blackouts in 6 months. 8% of the 112 students that reported not having blackouts at baseline reported having blackouts at 6 months. The marginal (p= 0.0002) and person-specific model (p=0.0001) showed that there was a decrease in blackouts related to drug use and alcohol consumption over time. Participants were more likely to have blackouts when their alcohol (p <0.0001, p=0.002) and drug use (p<0.0001, p=0.0012) was increased at 6 months. Race and gender showed no link. Number of drinks was the only measure of alcohol consumption left in the final model. The results showed that MI resulted in fewer blackouts at the 6 months then at baseline. Only participants that used drugs at 6 months reported blackouts at 6 months. Female participants consuming a smaller number of drinks at baseline and the ones that decreased drinking at 6 months were less likely to experience blackouts at the second-time point.
The results of the study by Kazemi et. al. (2013) show there was a significant decrease in weekly number of drinks, number of hours drinking, and drinking days. Drug use frequency decreased from 27.1% to 23.4%. According to Kazemi et. al., these findings are consistent with prior research showing that MI intervention impacts drinking and drug use. The researchers stated it was unclear as to what elements of the MI program made these positive results. This study also showed that the frequency of blackouts was related to gender. Male participants drank more than female participants, but they did not experience as many alcohol induced blackouts. The intervention had shown to be more effective with decreasing female drinking frequency and blackouts. Altogether the results showed that interventions should address the different gender issues.
A small number of participants (9 of 112) who did not have blackouts at baseline reported having blackouts at 6 months. The cause is unknown and the researchers state that further examination needs to be done. The researchers suggest that future studies may want to expand to include multidisciplinary intervention approaches to prevent or assess blackouts. They also state that including research on the neuropsychological or neuroimaging assessments of blackouts may show students the effects of blackouts neurologically, making that a deterrent.
Including information on longitudinal academic and psychosocial outcomes of blackouts would be beneficial for prevention and intervention programs. Personality determinants like high-risk behavior or impulsivity should also warrant attention, along with addressing these issues in a younger population.
According to Kazemi et. al. (2013), the MI program is relevant for registered nurses, physicians, community health nurses, and emergency room healthcare workers seeing patients with alcohol or drug toxicity to be able to educate and help reduce the number of hospitalizations due to alcohol and drug use. Nursing research was recommended by Kazemi et. al. (2013) to see if MI interventions related to alcohol and drug abuse are being taught in nursing schools.
There were several limitations that were pointed out by Kazemi et. al. (2013). The first was generalizability of findings to universities in other regions being restricted. Another limitation was the self-selection in the sample and the lack of a control group. Study measures were reported by the participants themselves, so the researches had to depend on participants being truthful. Future studies should consider using more objective measures for determining blackouts, alcohol consumption, and drug use. Another possible limitation was the low alphas of the DDQ. Labor intensity was said to be a limitation for this study as well, because six interventionists were needed to conduct the four sessions over a 6-month period with 188 participants. Kazemi et. al. (2013) suggested that labor intensity could possibly be resolved if small-group intervention sessions were used.
Strengths of this study included the participants’ positive response to the MI program, the longitudinal design of the study, the large sample size, and the lack of attrition of participants between baseline and 6 months.
Assessment of the Research Article
I agree with the researches and their study findings saying that MI interventions help decrease blackout occurrences. After 6 months of MI intervention 72% of students that said they experienced blackouts no longer did. That percentage is too high to ignore the positive outcomes of MI interventions. There was not anything in this research article that I felt was inappropriate. The problem that Kazemi et. al. (2013) were addressing was made clear and the research questions fit the problem well. I believe the study design fit the research questions being asked. However, I do believe the sampling plan could have been better. If I were conducting this research study and wanted to target freshmen students, I would have generated a mass email to be sent to all college freshmen. By using a mass email, it would have broadened the search giving the researchers more students to choose from, with more diversity. It would be able to target all the freshmen students that do not live on campus, that were possibly taking full time classes online, or the students that were skipping class. I do agree with the researches, that the external validity was weak in this study. This was a sample taken from a single public college in a southern state. This makes the population being targeted narrow. To have had more accurate findings to support MI interventions, it would have been better to take students from multiple colleges, private and public, in multiple regions of the country. I also did not like how there was no control group, but I am not sure how that could have been incorporated within this study. I agree with the reasons the researchers gave for the results, and I cannot think of any other reasons for the results.
Presentation and Stylistic Dimensions of the Article
The findings in the study by Kazemi et. al. (2013) were communicated clearly. Results were well organized, easy to follow, and easily understood. Information given on the study was not spotty and allowed readers to fully understand what the study was about and how it was conducted. The information was concise and to the point. This article was well-presented.
Kazemi, D. M., PhD, RN, Levine, M. J., PhD, ABPP, Dmochowski, J., PhD, Nies, M. A., PhD,
RN, FAAN, FAAHB, & Sun, L., PhD. (2013). Effects of Motivational Interviewing on
Blackouts Among College Freshmen. Journal of Nursing Scholarship, 45(3), 221-229.
Retrieved July 6, 2017.