The Robert Wood Johnson Foundation and Boston University are longtime partners. The foundation has awarded more than 100 grants totaling over $60 million to BU since 1972 for research and outreach in substance abuse prevention and health care policy. “The Johnson Foundation has been absolutely crucial to supporting health-related activities here and across the country,” says Robert Meenan, dean of the School of Public Health.

Fighting Back

In 1989, the foundation launched Fighting Back, which initiated dialogue among fourteen communities nationwide, helping them pool their resources to boost their substance abuse programs. In 1997, the national program office moved to the School of Public Health, where it designs training programs for each facility, organizes annual meetings, maintains the group’s Web site (www.fightingback.org), and manages program funding. Since moving to BU, Fighting Back has allocated over $27 million in foundation grants to partner programs, its administrative team, and a study at Brandeis University evaluating the effectiveness of the Fighting Back program.

	David Rosenbloom, professor of social and behavioral sciences.

Joining Together

Having selected fourteen communities for Fighting Back from hundreds of applications from around the country, the foundation asked SPH Professor David Rosenbloom for help in meeting the tremendous demand. Rosenbloom saw that community groups were hampered by difficulties in getting and using current information on effective strategies. “The academic literature on substance abuse was generally inaccessible and hard to translate,” he says. In 1991, following his hunch that the primordial World Wide Web would expedite the exchange of information, Rosenbloom initiated a foundation-funded sister program to Fighting Back called Join Together to provide news, information, and technical support to hundreds of community groups fighting substance abuse. To date, the Robert Wood Johnson Foundation has contributed more than $33 million to Join Together’s research and outreach.

An Electronic Pioneer

In pre-Internet days, Join Together used a closed-circuit electronic bulletin board. “I laugh now,” Rosenbloom says, “but our original hope was that within the first five years, 800 people would be connected.” In 1994, Join Together shifted to the nascent Web. Join Together Online (www.jointogether.org) now has 6,000 individual users every day, and 45,000 subscribers to one or more of its weekly e-newsletters. With 100 new items posted every week, Join Together Online currently features over 35,000 daily news and fundraising articles, resource listings, and in-depth feature stories going back eight years. In 1999, the Web site won a Global Information Infrastructure (GII) Award for innovative use of technology to increase participation in community life.

Join Together’s Web site QuitNet is the world’s most popular smoking cessation Web site, with more than 250,000 users registered in the first three months of this year. Created by Nathan Cobb (MED’01), QuitNet is now freestanding, operating in association with BU. Its key feature is a computerized coaching and feedback service that charts a person’s progress, with Quit Tips and anniversary messages sent along the way. The popular support forum posts over 1,200 messages daily from former smokers and those now trying to quit.

QuitNet’s success prompted Join Together to launch Alcoholscreening.org, an online service that helps individuals assess their own alcohol consumption patterns via a free, confidential self-test. Personalized feedback from the automated system helps them find local treatment programs from a database of 12,000 facilities worldwide.

Demanding Treatment

As Join Together has extended into cyberspace, it has also put down roots in thirty communities across the country. In 2000, Join Together added Demand Treatment! to its Web site to increase demand for substance abuse treatment at the community and national levels. Over 75 percent of Americans with serious alcohol and drug problems go without treatment because they believe they can deal with the problem on their own or are not aware that treatment exists or that it would help them, Rosenbloom says. And there are more insidious barriers. “Many people think if they seek treatment they will be discriminated against in employment and housing, and they are correct. Insurance companies discriminate by not covering treatment at all, or by providing huge barriers to appropriate treatment.”

The premise of Demand Treatment! is simple: get someone — community leaders, consumers, family members — to take responsibility for driving up demand for substance abuse treatment. Demand Treatment! has jump-started local efforts in thirty cities across the country by funding programs designed to increase the number of people receiving treatment. “Our first goal is to orient our community teams to think about treatment from the consumer’s perspective, so they begin to influence provider behavior,” Rosenbloom says. “We’re building onto the Web site, for example, information and tools that families can use to develop expectations for what they should be getting from the care system. In most communities, this is a foreign concept.”

As Join Together grew, it also began working to prevent gun violence. Join Together’s Web site disseminates information about the connection between guns and other social ills, such as suicide, domestic violence, and drug abuse. “There is no question in our minds that people working at the state and local level on gun violence prevention are now significantly better informed and have a stronger peer network than before we started doing this,” Rosenbloom says.

Catching alcohol problems in the ER

Often a sieve for people injured while under the influence, the emergency room is an ideal place for steering people toward treatment. Ralph Hingson, an SPH professor of social and behavior sciences and associate dean of research, is starting a program in the pediatric emergency department to screen adolescent patients for alcohol problems. He recently received a Robert Wood Johnson Foundation Innovators Combating Substance Abuse Award of $300,000. In collaboration with Edward Bernstein, professor and vice chair for academic affairs in the emergency medicine department, and Judith Bernstein, an associate professor in maternal and child health, Hingson is using his award to support project RAP (Reaching Adolescents for Prevention), a pilot study of whether kids with alcohol problems benefit from brief interventions in the emergency room. Hingson’s earlier studies found that the younger adolescents are when they begin to drink, the more likely they are to experience alcohol dependence at some point and the higher their risk of having unplanned and unprotected sex, and of being injured in fights and motor vehicle crashes.

Judith Bernstein, associate professor of maternal and child health; Sigmund Kharasch, assistant professor of pediatrics and chair of the pediatric emergency department; Marc Petit-Frere, community youth outreach worker; Stephanie Passaro, clinical coordinator for project RAP; Edward Bernstein, professor and vice chair for academic affairs in the emergency medicine department; and Ralph Hingson, professor of social and behavioral sciences and SPH associate dean of research (from left).

Project RAP is modeled after ASSERT (Alcohol and Substance Abuse Service and Education for Provider Referral to Treatment), started by Edward Bernstein in 1994. When an adult arrives at the Boston Medical Center’s emergency room with signs of a drug or alcohol problem, a counselor comes to the bedside, and with the patient’s permission, conducts a brief negotiation interview. If the patient agrees, the counselor arranges for a cab to a local detox center that night. “The idea in ASSERT is that by being respectful and nonjudgemental, you can encourage patients to take their health and their lives into their own hands,” Bernstein says. “We’re encouraging them to have a life and a voice.”

Like project ASSERT, RAP has a staff of peer educators, who meet with adolescents in the emergency department to talk about how their alcohol habits relate to unsafe sex or fights or crimes, and whether they’d be willing to participate in a study. RAP’s peer educators are in their twenties and reflect the preponderance of the ethnic and cultural population — Haitian, Cape Verdean, and African-American — that uses that emergency department. When patients leave the hospital, peer educators encourage them to get involved in groups and community activities that provide alternatives to alcohol. Since RAP started in January it has worked with eighty adolescents. The goal is to enroll about 200 patients and follow them through March 2003.

Ongoing support from the Robert Wood Johnson Foundation, now the nation’s largest foundation sponsoring public health initiatives, has not only been vital to the school’s research and outreach, says SPH Dean Meenan, it has also enhanced the school’s stature. “Their funding has had an impact on national perceptions of the school,” he says. “Our relationship with the Johnson Foundation has had a positive effect on how SPH is viewed across the country.”

— Tim Stoddard