Reframing How We Talk About Alcohol

Form Approved

OMB No. 0920-1154

Exp. Date: 01/31/2020

CDC Alcohol Reframing Study

Phase 1: Descriptive Research Moderator Guide

The Phase 1 interviews and group discussion will be comprised of the following steps:

1. Welcome (5 mins)

   1. Welcome - The moderator will welcome the participant(s) and explain the purpose of the interview/group discussion.

   2. Consent Form – The moderator will review highlights, address questions, and confirm continued consent.

   3. Ground rules -The moderator will provide additional guidelines for the group- e.g., speaking one at a time, turning off cell phones and other electronics, etc.

2. Warm-up: [For Group Discussions] Participants will introduce themselves and provide a little information about themselves. (5 mins)

3. Discussion: In the design, participants will discuss the following topics: (75 mins)

   1. Risk from Alcohol (25 mins)

   2. Alcohol Use Personas (30 mins)

   3. Level of Drinking (20 mins)

4. Closing (5 mins)

Thank you and incentives

Welcome (5 min)

Thank you for coming today. I’m _____, and I’m from RTI International, a non-profit research organization based in Durham, North Carolina. This is _____ who will be helping me with today’s discussion. Today’s discussion is part of a research study that is being sponsored by the Centers for Disease Control and Prevention (CDC).

The purpose of today’s session is to discuss your thoughts about alcohol use. We are not necessarily interested in your personal use of alcohol, though you can feel free to share your experiences as we are talking. We are more interested in understanding how you think about alcohol use and the things you have learned or observed about how others drink. This information will be used to improve communication efforts and programs about alcohol use.

Before we get started with the discussion, you should have received a consent form for today’s discussion when you checked in. Do you/does anyone have any questions or concerns? Just a few highlights…

• Participation. Your participation is voluntary and you can stop participating at any time. If at any time you are uncomfortable with any question, you can choose not to answer.

• Privacy. Your name and contact information will not be given to anyone else and no one will contact you after this session is over. As part of this study, we will write a report for the CDC summarizing what we learned from these discussions. The report will not identify individuals or what a specific person said by name.

• Audio Taping. We would like to record today’s discussion. At the end of all our sessions, we want to summarize what everyone has to say. I want to give you my full attention and not take a lot of notes, so I will refer to the recording when writing the summary. Do I have your permission to audio record today’s session?

Finally, I want to review a few ground rules for our discussion:

1. There are no right or wrong answers. We want to hear what you have to share.

[For Group Discussions] We recognize people may have different ideas or opinions about a topic. This is fine. We want to know what each of you thinks about the issues we discuss.

2. [For Group Discussions] Speaking. Please try to speak one at a time. I may occasionally interrupt you when two or more people are talking in order to be sure everyone gets a chance to talk and that responses are accurately recorded.

3. [For Group Discussions] We would also ask that you protect each other’s privacy by not discussing what you hear in the discussions today.

4. Cell Phones. As a courtesy to everyone, please silence or turn off your cell phones, PDAs, and pagers.

5. Restrooms. If you need to go to the restroom during the discussion, please feel free to leave.

[For Group Discussions] However, I’d appreciate it if you would go one at a time.

6. Do you/does anyone have any questions before we begin?

Warm up (5 min) [For Group Discussions]

I would like to begin our discussion by asking you to introduce yourself. Please tell us:

• Your first name

• Where you grew up

• Since the topic of our discussion today is the use of alcohol and everyone here indicated that they periodically consume alcohol, I am going to ask you to share what your number one reason is for personally consuming alcohol. By alcohol, I am referring to beer, wine, mixed-drinks or spirits. For example, a wine cooler or a drink mixed with vodka or gin.

Risk from Alcohol Questions (30 mins)

Thanks for sharing about yourself, now I want to turn our discussion to risks associated with alcohol use.

[FOR INTERVIEWS: Share definition of alcohol—beer, wine, mixed-drinks or spirits]

Questions		Prompts/Probes
My first question to you [all of you] is “what risks are there to consuming alcohol” What are some of the negative things that can happen when you consume alcohol?		Any others? I see you have listed X . . . Y, what else?
[Moderator or note taker will list on a board the items suggested by the interviewee(s)]
This is a great list. I want to ask if anyone sees any types of categories or groupings among the risks you have listed?		What makes those similar/different?
[Moderator will compare interview/group generated list to list of known risks and ask about one or possible two items that participants did not bring up in their discussion] Example: Long term impacts were not mentioned. What do you see as some possible long-term effects? Do you consider these risks? I did not hear much mention of items like X and Y? Why do you think these did not come up? Are there things beside one’s physical health that you think people should consider as a risk? Why or why not?		Expert List of potential alcohol risks: Injuries: Motor vehicle crashes Pedestrian injuries Drowning Falls Homicide Suicide Assault Intimate partner violence Child abuse and neglect Legal/Social/Economic Problems: Arrest/Legal problems Damage to relationships with family or friend Embarrassment Financial costs Impact on job performance Immediate Health Blackouts Hangovers Vomiting Alcohol poisoning Birth defects Addiction Long-Term Health Cancer Damage to organs Dementia Depression/anxiety Worsen chronic diseases (e.g. diabetes) Heart Damage HIV/STDs Lowered immune system Sleep disorders Weight gain
I am now going to ask you to think about a couple of things related to the list of risks that has been created. You each have three yellow post-it notes and three blue post-it notes, I would like you to put your yellow post-it notes next to the risks listed that would be most important to you when considering consuming alcohol. Then, put the blue post-it notes next to the items that are least important to you when considering consuming alcohol? [Moderator may decide to use two or three post-it notes depending on the amount of items listed]		[Review results and probe on why different risks were selected]
Each of you also have two green post-it notes, I would like you to place them next to the items on the list that you think are most common or likely risks? Or in other words, which of these do you think is most likely to happen to someone who consumes alcohol?		[Review results and probe on why different risks were selected and how participant(s) defined “important.”]

[After this exercise, move the list of risks if needed; but keep it visible so that it can be referred to later.]

Alcohol Use Personas (30 mins)

For the next part of our discussion, I am going to be showing you four different boards, each of which share some details about a person, including their regular drinking habits.

I will show you a single board and read it out loud and then ask you some questions about that person described on the board.

Any questions before we begin?

[If asked, the moderator will explain that person being described is not a real person]

The following set of questions will be asked for each persona. The order of the persons will be alternated, as well as the gender of the persona.

Questions		Prompts/Probes
Describe for me in your own words this person’s drinking behaviors.		Share more about what you just shared. What makes you say that about them? [INTERVIEWER NOTE: Probe as needed to determine if where a person drinks impacts how their behavior is judged]
Any particular words come to your mind when you hear about this person’s drinking?		Any others?
Going back to our list of risks, which of the risks that you identified do you think apply to this person when they drink?		Can you share more why you selected that particular risk? What do you see as their greatest risk? Would you see their risk being different if they were a man/woman instead of a man/woman? What if this person was young/older? Would other risks then apply or not apply to them?
How do you think this person’s drinking compares to most people?		How so? In what other ways is it different?
Let’s say we need to give this person’s drinking a label, what label would you give it?		Are there other similar labels you might use? Any words you absolutely would not use to describe this person’s drinking?

[After reviewing all four personas, place them someplace so they all can be viewed]

Questions		Prompts/Probes
Which of these four personas would you say drinks too much?		[Try to clarify perceived difference in judgments about levels of drinking]
Would you consider any of these four personas to be dependent on alcohol or, in common language, an alcoholic?
Now that we have seen all four personas, I want revisit the labels that you gave each of these people’s drinking. Would you change any?		What would you call this one now? [Contrast to other personas to try to identify new language or descriptive terms]

Level of Drinking (15 mins)

Having viewed these personas and talked about them, I now want to ask you some more general questions about alcohol use.

Questions		Prompts/Probes
What would you define as drinking too much?		How do you tell when someone has drunk too much? Does this differ from person to person? If so, how? [Probe as needed: gender, weight, age, health, lifestyle, pregnancy status, etc.]
If you had to define drinking too much in terms of a quantity (how much someone drinks) what would you say is too much?		Over what time period is that too much? [ASK ABOUT PER DAY IF NOT DISCUSSED] Would it matter if they are drinking beer, wine, or mixed drinks, or spirits?
How about frequency, how often is too much?		Over what time period is that too much? What amount would you need to drink for it to be too much?
What does it mean to be an “alcoholic”? If you had to define what an alcoholic is by the amount they drink what would you say? [Ask about quantity and frequency]		What is the difference between drinking too much and being an alcoholic? [Ask about amount and frequency]

Closing (5 min)

Is there anything else we should know that we didn’t discuss today?

Thank you for participating. Your input was extremely valuable, and we really appreciate your time.

Also, if you have any questions about the guidelines for alcohol consumption, we have a resource available here for you. Please feel free to come take one.

Alcohol Use Personas

Persona 1: Drinking regularly at a level that is in line with the NIAAA drinking limits.	Glenn/Gloria: 41 Years of age Married with two children Works in an office A big night out is dinner and movie, which may include a couple of drinks in an evening. A couple of nights of the week, will have one or two beers at home with dinner.
Persona 2: Drinking at a level that exceeds the single-day limit, including an experience of an alcohol-related harm but not showing alcohol abuse or dependence symptoms. (e.g., five to six drinks in one night, but not regularly).	Steve/Stephanie: 24 Years of age Has a steady job and is not married Uses free time to go out with friends two or three nights a week, especially live music shows on the weekend When out, it is time to have fun, which can include four to five drinks with alcohol. Passed out at a friend’s house last week after drinking shots of liquor during an “amazing night out on the town.”
Persona 3: Drinking at a level much higher than Persona 1; This persona should be exceeding the weekly limits, but remains in control and can function after drinking (Drinking 3 or more drinks several nights a week).	Mark/Mary: 57 Years of age Professional Kids are grown-up and out of the house, leaving time in the evenings to enjoy books and catch up on television shows. Prefers to drink wine and cracks open a new bottle almost every night, consuming 3 to 4 glasses over the course an evening. May have some additional drinks on weekends, when dining out. Has kidney condition, but sees a doctor regularly to monitor it.
Persona 4: Drinking should exceed single-day and weekly limits.	Jim/Jenny: 32 years of age Married and parent of one child Works a shift job, one that often comes with additional hours Often goes out after work with co-workers to unwind and drinks four or five drinks when out with others, or on weekends. Likewise, keeps a box of wine at home and every night drinks two or three glasses to help unwind and go to sleep. It is sometimes hard to go into work in next day after going out for drinks morning, but the alternative of not sleeping is not much better.

Public reporting burden of this collection of information is estimated to average 90 minutes, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74,  Atlanta, Georgia 30333; ATTN:  PRA (0920-1154).