Discussion Guide

Attachment E: Discussion Guide

Form Approved

OMB No. 0920-xxxx

Exp. Date xx/xx/XXXX

Developing Effective Messages about Excessive Alcohol Consumption: Formative Focus Groups with Adult Drinkers and Abstainers
Discussion Guide

Public reporting burden of this collection of information is estimated to average 1.5 hours per response, 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-xxxx)

Project Objective: Conduct focus groups with adults ages 21 to 64 to discuss their understanding, perceptions, and attitudes toward excessive alcohol consumption. Specific focus will be given to identifying behavioral and attitudinal similarities or differences between audience segments. Additional discussions will focus on perceptions of “others” as risk takers, community impact, and defining the public health “problem.”

NOTES TO REVIEWER:

This discussion guide is not a script and therefore will not be read verbatim. The moderator will use these questions as a roadmap and probe as needed to maintain the natural flow of conversation. Question probes are italicized.

Moderator instructions are highlighted in yellow. Materials are highlighted in blue.

Session Overview: Total time—90 minutes

SECTION A: Introduction and Icebreaker (5 min.)

The interviewer will explain the purpose of the focus group, present the ground rules, and allow participants to ask any questions.

SECTION B: Drinking Behaviors Generally (5 min.)

The purpose of this section is to get participants warmed up and to ease them into discussion of excessive alcohol consumption. Participants will discuss what they would consider topics related to drinking.

SECTION C: Knowledge and Attitudes toward Excessive Drinking (20 min.)

The purpose of this section is to get a basic understanding of how participants define and perceive excessive drinking. Participants will be asked to discuss what excessive drinking means to them, define various drinking terms, and react to standard definitions of those terms.

SECTION D: Perceptions of the Problem (20 min.)

The purpose of this section is to capture participants’ perspectives of how excessive drinking might be problematic at the community level. Participants will be asked to discuss the prevalence and impact in their communities, the extent to which this prevalence is a concern, and who is impacted by excessive drinking. Participants will also be asked to reflect on if and how these problems extend beyond their community to the U.S. as a whole.

SECTION E: Perceptions of Excessive Drinkers (15 min.)

In this section, participants will complete a profile of the “typical excessive drinker.” Participants will then discuss as a group their perceptions of excessive drinkers in terms of risk factors, normative influence(s), perceived benefits to excessive drinking, and perceived barriers to abstaining from excessive drinking.

SECTION F: Segment-Specific Questions (20 min.)

The purpose of this section is to delve deeper into specific topic areas based on audience segment and will include discussion of individual drinking behavior.

SECTION G: Conclusion (5 min.)

Moderator ensures that all questions are answered and all comments have been heard.

Section A. Introduction and Icebreaker (5 minutes)

Thank you all for coming to talk to us today, your time is greatly appreciated. My name is _____, and I work for Fors Marsh Group, which is an independent company that conducts hundreds of groups like these each year. This means that I’m here to listen to you and what you have to tell me, and I have no stake in how you respond. Today, we would like to hear from you about how you think and feel about drinking alcohol.

We will have about 90 minutes for our discussion. Before we get started, I want to go over a few things:

• First, I want to emphasize that we are here today because each of you reported that you [DO/DO NOT] drink alcohol. There are no wrong answers in this room and we are not here to evaluate or judge each other. Our whole purpose is to hear your perspectives, opinions, and experiences.

• What we talk about here is confidential. That means that you will not be personally identified in any of the summary reports or other materials we might prepare based on our discussions today.

• Likewise, we want to respect the privacy of everyone in this room, and would therefore ask that you please not share any of our discussions with others.

• Your participation is voluntary and you have the right to withdraw from the group at any time.

• You don’t have to answer every question, but I do want to hear from everyone, so I might call on you at some point. Please speak one at a time and clearly so I may hear you.

• You might have already noticed the glass behind me. There are some people from my team who are observing and taking notes so I can be present in our discussion. Even though people are observing, please speak openly about your opinions and experiences. We want to learn from you, so it is important that you share your honest opinions.

• We are also audio-recording this session. I will be speaking with people across the country for this project, and it will be impossible for me to remember everything. The audio files will be transcribed, but any information that could identify you will be removed from the transcripts. At the end of our discussion, I have to write a report and will refer to the recordings and transcripts when writing the report.

• Please turn your cellphone off or switch to silent mode.

• If you need to go to the restroom during the discussion, please feel free to do so.

Does anyone have any questions before we begin?

Okay, great. First, I’m going to have everyone introduce themselves. Please tell us your name and something you like to do in your free time. I’ll go first.

[Introductions and Icebreaker]

It’s wonderful to meet you all—let’s get started.

Section B. Drinking Behaviors Generally (5 minutes)

So to start off our discussion, I’d like to do a brainstorming activity with you on the flip chart. I would like to hear from you about any topics related to alcohol consumption that you’ve heard about—such as on the news or in the media. These could be good or bad things. Right now we’re just going to make a list so feel free to share as many ideas as you can think of. I will write down your responses and then we can talk about them.

[Participants list the items and moderator writes on chart. Allow brainstorming for approx. 1-2 minutes or until group has exhausted options. Moderator then focuses on selection of items and uses prompts as needed to fully understand idea.]

Great, thank you! Let’s talk about what [X] is.

• What have you learned or what do you know about [X]?

• Is this a positive thing? Negative? Neither?

• Is [X] a problem?

  • Who is [X] a problem for?

  • Who is affected by it?

  • If not a problem, how so?

• Where is [X] a problem? (i.e., in your community? Nationally in the U.S.?)

Are there any other items we’ve missed? [Probe as needed.]

Section C. Knowledge and Attitudes toward Excessive Drinking (20 min.)

Now, I’d like us to dive in and talk generally about drinking too much

• What does drinking too much mean to you?

• Is drinking too much a problem?

  • Who is drinking too much a problem for?

  • Who is affected by it?

• If not a problem, why not? [Probe extensively]

• At what point does drinking too much become a problem?

  • Who is likely to perceive drinking too much becoming a problem? [Probe to differentiate others (e.g., spouse, significant other) vs. drinker]

Next, I want to talk a little about some terms related to drinking. I’d like to understand what these terms mean to you and how you’ve heard them used.

• What does the term excessive drinking mean to you?

  • How is that similar or different than drinking too much?

  • How have you heard this term used?

  • If we are trying to define drinking too much by number of drinks—how many drinks is that?

    1. Probe to understand category. (e.g., per day/week/occasion)

• What does the term binge drinking mean to you?

  • How is that similar or different than drinking too much?

  • How have you heard this term used?

  • How many drinks is that?

    1. Probe to understand category. (e.g., per day/week/occasion)

• What does the term heavy drinking mean to you?

  • How is that similar or different than drinking too much?

  • How have you heard this term used?

  • How many drinks is that?

    1. Probe to understand category. (e.g., per day/week/occasion)

I’d like you to think where you might have seen or heard any sort of messaging about excessive drinking.

[We are interested in “messaging” broadly defined. This may include media coverage, movies, music, advertising, etc.]

• What, if anything, have you seen or heard that discourages excessive drinking? Explain.

  • What type of messaging? (e.g., news, pop culture, advertising)

  • Where was the messaging (e.g., online, television)

• What, if anything, have you seen or heard that encourages excessive drinking? Explain.

  • What type of messaging?

  • Where was the messaging (e.g., online, television, movies, music, magazines or other print media)

I’d now like to share with you some “official” definitions for each of the terms we talked about a minute ago and get your reactions. These definitions are from the Centers for Disease Control and Prevention (CDC) website. Before we look at definitions, I want to make sure we are all on the same page on what one drink means. [Moderator projects Definition Stimuli on screen for each term. First, show the “What is a drink”. Then, randomize order of “Binge” and “Heavy” to show first/second and show “Excessive” third.]

[Read each definition out loud and ask for reactions using probes below.]

• What are your initial thoughts?

• What do you agree with in this definition? What makes sense to you?

• What do you disagree with in this definition? What does not make sense to you?

• What do you think about the number of drinks mentioned?

• What do you think about the different number of drinks for women and men?

Thank you for your critical thinking here. It is very helpful to understand what these terms mean to people. For the rest of today’s conversation, we’ll be talking a lot about “excessive drinking.” [Show and read definition again; review definitions for heavy and binge drinking as needed.]

Section D. Perceptions of the Problem (20 minutes)

Next, I would like to talk a little more about problems related to excessive drinking. I have a worksheet that lists problems that could be associated with excessive drinking and I’d like to hear what you think is an issue in your community.

There are a lot of ways to think about community and we all may explain it in different ways. So, for the purpose of tonight’s discussion, let’s think about community as your social circles—so your friends, family, coworkers, neighbors, people you know through school or other organizations.

[Hand out List Worksheet.]

I want you to think about what problems on this list may be relevant to your community—that is your social circles. I’d like you to use the green highlighter to highlight what you believe are the most important problems related to excessive drinking in your community. Do not highlight any items if you don’t see them as being an important problem. You can also write in any additional important problems that you might think of, but don’t see on this sheet.

[Allow 2-3 minutes to highlight items on sheet]

OK great, I’d like you to look at the issues that you highlighted as important problems in your community related to excessive drinking, and think now about which ones are the worst for your community. Please take a moment and rank the top three problems in your community, by numbering them from 1 to 3, with #1 being the worst problem related to excessive drinking.

[Allow participants 1-2 minutes to rank.]

Who would like to share what they consider to be the #1 problem in their community? [Probe on participants’ responses with emphasis on items 1–5 using probes below as needed. If #1-5 do not come up naturally and time allows, probe on #X]

1. Economic cost (e.g., lost workplace productivity, healthcare expenses, criminal justice costs, motor vehicle crash costs)

2. Violence, injuries, and motor vehicle crashes

3. Risky sexual behaviors (e.g., unintended pregnancies, miscarriage, stillbirth)

4. Chronic conditions (e.g., cancer, heart disease, high blood pressure)

5. Death

• Why is [X] a problem in your community?

  • [Probe for if this is an attribute of the community or the problem.]

• What impacts has [this problem] had on your community?

  • [Probe for specific examples/anecdotes.]

• What makes [X] the biggest alcohol-related problem in your community?

• Why is it more important or problematic than others?

• Do you know of any activities or efforts in your community to address this problem? Please explain.

  • Have these efforts/activities been effective? Why or why not?

  • What proof would you need to feel confident an activity was successful in reducing this alcohol-related problem?

• What would you like to see done to address [X]?

  • What would this effort entail?

  • Who do you think would lead this effort?

• Have you experienced [X] to be a problem in your family or among close friends?

• Think about some of the alcohol-related problems you didn’t highlight: What were those? Tell me more about why they are not a problem. [Probe extensively.]

Alright, so we have been thinking about how excessive drinking affects our communities; let’s take a moment now and think about the U.S. as a whole. What are some of the items on this list that you think are problems related to excessive drinking for the U.S. as a whole?

• Are there any items on this list that you didn’t highlight as being a problem for your community, but that you think are a problem for the U.S. as a whole?

  • Why aren’t these problems relevant to your community?

• What about items that you highlighted as being relevant to your community, but that you don’t think apply to the U.S. as a whole?

  • How is this problem relevant to your community but not the U.S.?

Thank you for your willingness to share about your community and inner circle. I appreciate your honesty and your input is very important to me.

Section E. Perceptions of Excessive Drinkers (15 min.)

For this next part, we’re going to do a quick individual activity and then discuss as a group. For this activity, I’d like you to think about who is the “typical excessive drinker.” Remember that excessive drinking includes binge drinking, heavy drinking, any alcohol use by people under age 21 and any alcohol use by pregnant women. As you are filling this out, think about what the typical excessive drinker might be thinking, feeling, or saying when he or she is drinking.

[Moderator hands out Profile Worksheet and gives participants at most 5 minutes to complete.]

Let’s talk about what you filled out: [Probe as needed for group discussion.]

• How old is the typical excessive drinker?

• What motivates this person to drink excessively?

  • What situations?

• What are excessive drinkers thinking about when they excessively drink?

• What they are feeling when they drink excessively?

• Are they able to drink moderately?

• Are they alcohol dependent or alcoholics? If so, why? [Probe extensively]

• How easy is it for them to limit or abstain from drinking?

• Who influences the typical excessive drinker (when drinking)?

• What are the risks they face from excessive drinking? [Skip if already addressed]

• What are the risks to others from their excessive drinking? [Skip if already addressed]

• What might influence them to drink less?

  • [Probe extensively: messages/individuals/environmental factors.]

Section F. Segment Specific Questions (20 min.)

So far today we’ve talked about how drinking affects our society, communities, and others. Now I’d like us to focus on our individual experiences with drinking, and how drinking is part of our life. Again, please remember we are not here to judge or evaluate each other in any way, so please feel free to be honest about your feelings and experiences. On the other hand, if you do not wish to answer a specific question, I will respect that.

Questions for Drinkers:

[Remind as needed, this is about drinking in general—not excessive drinking.]

• Generally speaking, what do you enjoy about drinking?

  • [Probe for: outcomes for self/others, e.g., health, emotional, legal]

• What about drinking do you dislike?

  • [Probe for: outcomes for self/others, e.g., health, emotional, legal]

• Are there positive outcomes of your drinking?

  • Who do these outcomes affect?

• Are there negative outcomes of your drinking?

  • Who do these outcomes affect?

• How do you weigh the aspects you like about drinking against the aspects you dislike about drinking?

Questions for Excessive Drinkers Only:

• Are there any rewards or benefits (not previously mentioned) to drinking excessively?

  • How are these beneficial?

  • [Probe for sensation seeking.]

• Are there any downsides or consequences of drinking excessively (not previously mentioned)?

  • How likely are those consequences to occur?

• When are you most likely to drink excessively?

  • Under what circumstances?

  • With whom?

• What factors are most likely to affect the amount you drink?

• The cost of alcohol (e.g., the cost per drink)

• Whether alcohol is readily available (e.g., if there’s an open bar)

• Alcohol advertising (e.g., how drinking is portrayed in the media or in advertising)?

• What are the risks, if any, to you when drinking excessively? [IF NEEDED, refer to List Worksheet to facilitate discussion]

  • How bad are these risks?

  • How likely are the risks to happen to you?

  • Are these long-term risks—that is, something likely to happen a considerable time after you’ve been drinking?

  • Are these short-term risks—that is, something likely to happen shortly after you’ve been drinking?

  • How do the long-term risks differ from the short-term risks?

  • IF NO RISK, probe on reasoning. Throughout conversation about perceptions of risk (or no risk), probe on (1) the extent to which context matters (as in OK if not drinking and driving?) and (2) if focus is on short-term outcomes.

• What are the risks, if any, to others when you drink excessively?

  • How bad are the risks?

  • How likely are the risks to happen to others?

  • Are these long-term risks—that is something likely to happen a considerable time after you’ve been drinking?

  • Are these short-term risks—that is something likely to happen shortly after you’ve been drinking?

  • How do the long-term risks differ the short-term risks?

  • IF NO RISK, probe on reasoning.

• Who is most likely to influence your drinking behavior?

  • Who is most likely to approve of you drinking excessively? Why?

  • How important is their approval?

  • Who is most likely to disapprove of you drinking excessively? Why?

  • How important is their disapproval?

• How easy or difficult is it to abstain from drinking (or not drinking)? Why?

  • What factors make it easy/hard to say no/abstain from drinking?

• How easy or difficult is it to limit or moderate your drinking? Why?

  • What factors make it easy/hard to say no or limit how much you drink? How so?

Questions for Moderate Drinkers Only:

• When are you most likely to drink moderately?

  • Under what circumstances?

  • With whom?

• What are the risks to you when drinking moderately?

  • How bad are the risks?

  • How likely are the risks to happen to you?

  • Are these long- or short-term risks?

  • How are long-term risks different than short-term risks?

• What are the risks to others when you drink moderately?

  • How bad are the risks?

  • How likely are the risks to happen to others?

  • Are these long- or short-term risks?

  • How are long-term risks different than short-term risks?

• Are there occasions or situations when you might be likely to drink too much/excessively? Please explain.

• How easy or difficult is it for you to limit or moderate your drinking?

  • What factors make it easy/hard to limit or moderate how much you drink?

• How important is it for you to limit or moderate your drinking?

• Are there occasions or situations when you might be likely to abstain or not drink? Please explain.

• How easy or difficult is it to say no to, or abstain from, drinking?

  • What factors make it easy/hard to say no/abstain from drinking?

• Who is most likely to influence your drinking habits?

  • Who is most likely to approve of you drinking moderately? Why?

• How important is their approval?

• Who is most likely to disapprove of you drinking moderately? Why?

• How important is their disapproval?

Questions for Abstainers Only:

• How does excessive drinking impact your life?

• How long have you been abstaining from drinking alcohol?

• What is the primary reason you choose to not drink?

• What has influenced this decision?

  • Specific past experiences?

  • Health reasons?

  • Family history/alcoholism?

  • Religious or moral reasons (upbringing)?

• How easy or difficult is it to abstain from drinking?

  • Why? [Probe for: circumstantial or environmental factors.]

  • How do you feel when you’re around others who are drinking?

• Have you felt supported by others in your decision to abstain from drinking?

  • If YES, what have they done to make you feel supported?

  • If NO, what have they done to make you feel alone in this decision?

• Who is most likely to approve of you abstaining? Why?

  • How important is their approval?

• Who is most likely to disapprove of you abstaining? Why?

  • How important is their disapproval?

Section G. Conclusion (5 min.)

This has been a very helpful session. Thank you so much for taking time out of your day to be with me and share your perspectives and experiences. Before we wrap up, is there anything else that you would like to share or that we might have missed?

We’ve talked about some things today that are sensitive so please be reminded to not discuss this session with others who did not attend.

[TIME PERMITTING] If you don’t mind, I am going to step out for just a moment to see if my team has any additional follow up questions for you all. [Ask any additional questions.]

Ok, thank you again for your time. Are there any final questions? If not, you are free to go. Please leave behind your worksheets and writing utensils. Have a wonderful evening!

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