By Danielle M. Dick, Ph.D.
Project Director, Spit for Science
Director, College Behavioral and Emotional Health Institute
In 2011, I launched a university-wide research project focused on substance use and emotional health outcomes among college students with my colleague Dr. Ken Kendler. Over four years, we invited all incoming freshmen to be a part of this university-wide opportunity, with high rates of participation (approaching 70%) at our diverse, urban, public university. We have now collected longitudinal survey information and DNA from nearly 10,000 participants.
Further, the project has led to an extensive series of collaborations among faculty from multiple divisions across the university. In 2015 we launched the College Behavioral and Emotional Institute (COBE) to formalize and grow these research collaborations, and to translate research findings into coursework, programming, and policy designed to promote well-being in our students.
I have recently been contacted by multiple investigators from other universities who are interested in starting “Spit for Science” projects at their own universities, and who want to gain a deeper understanding about how we launched the project.
In going through old files, I discovered the following “Lessons Learned” document that I put together at the time we were initiating the project. I publish them here in the event that they could be of use to investigators hoping to initiate similar projects at their own universities.
Before we ever launched the project we met with multiple stakeholders across the university, including administrators at multiple levels including the President, Provost, Vice Presidents, Deans, the registrar’s office, faculty and staff, the public relations and media offices, and the IRB, to name a few.
This project would not have been possible without support from the highest levels of the administration at the university, as these individuals opened doors to relevant faculty and staff across the campus who were necessary for implementation of the project. This included everyone from staff who worked with us to find space for the data collection, to persons involved with admissions who helped us obtain the contact information for eligible participants.
We made particular efforts to raise awareness of the project with faculty and staff who interfaced with incoming students (and potentially parents). This was very helpful, as these individuals were often more connected to where the students spend time, how best to get information out to them, and other logistical aspects regarding the undergraduates.
We created a website and a Facebook page for the project, which contained extensive information about the study, including all project materials and documents (mailings to students/parents, consent forms, etc). We held multiple focus groups to solicit feedback on the project, both student-focused, and open to the university as a whole. We thought this was particularly critical since projects with genetic components have greater potential for misunderstanding.
Accordingly, raising awareness about the project, involving individuals across the campus in its development, and striving for complete transparency was key. My advice to other faculty who want to launch a similar project: start by getting buy-in from the top. You are likely to encounter resistance and/or you will certainly need the assistance of many people across the university; having strong support at the highest level of the university is critical.
Lesson #2: Expect Resistance
This one surprised me. I thought the idea of applying our research expertise to study substance use and emotional health challenges – issues known to be problems on college campuses – would be universally met with the enthusiasm that we had for the project. Not so. A variety of different concerns were raised when we first began speaking to individuals around the university about the project.
Common concerns involved the possibility of bad press or upset parents resulting from misunderstanding about the project (primarily the genetic component), concern about minority involvement in genetic research, and concern that we were “using the students as guinea pigs”.
In response to concerns about misunderstanding about the study by parents, we mailed letters to the parents of all incoming freshman informing them about the project and also used this as an opportunity to send them information about how to talk to their children about alcohol use on college campuses and to educate them about the resources available on the campus.
This material was developed in collaboration with The Wellness Resource Center at VCU, and the materials for parents was mailed at the same time that we separately sent letters to the incoming students explaining the project. We also developed a handout on Frequently Asked Questions about the DNA component, which was included in the student mailing, made available at the data collection site, and available on the website.
We worked with a minority faculty member who led focus groups with African American students, parents, and faculty/staff to solicit thoughts and feedback about the project. This feedback contributed to the creation of a section of the study website addressing concerns about minority (most specific to the African American community) participation in genetic research.
We took steps to ensure that our students understood that although the project was university-supported, it was not university-sponsored, i.e., it was not mandatory and that their class performance would not be adversely affected in any way if they chose not to participate. We took the extra precaution when setting up the confidentiality procedures that no faculty member (including the PIs) would ever have access to the names of the students who had participated.
Accordingly, the project/registry coordinator(s) are the only individuals who have access to student names and contact information. We took this step to further ensure that students would feel no pressure to participate. Finally, and perhaps most importantly, we thought critically about how to use the project to enhance the educational experience to our university’s students, as detailed further below.
Having honest and hard discussions about concerns raised by individuals across the university ultimately improved the study on multiple fronts, as we worked to address and think through potential challenges collaboratively with our university partners. By preemptively reaching out to multiple groups, including students, parents, faculty, and staff, we believe that we minimized the potential for misunderstanding about the project.
In addition to the efforts described above to heighten understanding about the project, coinciding with the mailing of the initial information about the study to incoming freshman and their parents, the university launched a media release about the project. We contacted local newspaper outlets and also did interviews for the student paper, for local radio, and the local magazine.
In the six years that we have been running the project we have had, to my knowledge, only one parent contact the university to raise concern about the project (we worked with our IRB to prepare a response to the parent that I believe satisfactorily addressed their concern). I think it’s also fair to say that the project has now been warmly and rather universally embraced as something innovative and fun that is part of the fabric of our university.
When I meet new people at VCU and introduce myself, I generally start with the standard route of telling them what department I am in and what my research is on, and inevitably I eventually say “I run Spit for Science”, to which the response is nearly universally, “Oh! You’re the Spit for Science lady!”. My parents must be so proud.
Although the scientific aims of the project were the original impetus for launching the study, as we met with individuals around the university, it became clear that launching a project of this magnitude, which necessitated assistance from individuals across many facets of the university, required that the project be about more than the science. It also needed to be about the unique learning opportunities that the project would afford the students.
In other words, it had to be good for the university to justify the large amount of effort of so many around the campus, not just good for the researchers.
We used the project as a way to introduce students to the importance of research at universities. It also provided a means to raise awareness about substance use and emotional health issues on college campuses and to get students talking about these issues.
Further, it provided a venue to talk about the importance of genetics in health related outcomes, and to increase understanding about complex genetic outcomes – outcomes that are genetically influenced, but don’t follow simple single gene inheritance patterns. If genetic information will ultimately be useful for prevention, intervention, and practice, there needs to be greater understanding by the public about how complex genetics works.
The project was used as an impetus for initiating these discussions. The PIs spoke on these topics at sessions during the students’ Welcome Week activities, and also in guest lectures across many undergraduate classes. We planned monthly educational forums on topics related to the project. We tried to make these activities both fun and educational. For example, we hosted a movie night showing of the movie GATTACA with free popcorn, and discussed what might be feasible and what was unrealistic about the use of genetics in the movie. We presented a seminar on Genes, Substance Use, and Morality.
We did multiple seminars presenting results from the project. We found that providing free food was the best way to increase student attendance! We also gave out free Spit for Science t-shirts at all educational forums, which were open to everyone across the university. This also provided a means for upperclassman to get involved in the project even though the data collection was limited to the incoming freshman class. Finally, we created newsletters at the end of each semester with information about the project and preliminary results.
In addition to the opportunity for all incoming students to participate in the research project, a select group of students also has the opportunity to be a part of the undergraduate research team each semester. We structured this experience as a 3 credit independent research class, for which students could receive credit across multiple departments.
After training them about the project and its goals, as well as conducting human subjects training, the students become a critical part of recruitment for the project, passing out flyers and being stationed outside dorms and in central university buildings to talk about the project and answer questions. The students are also split into teams and come up with a research question of interest using the Spit for Science data, analyze the data, write up the results, and then present these results in both poster and oral form at the end of the semester.
We also have faculty from across the university who are engaged in research related to behavioral health come in and discuss an article/topic of interest from their field, so that the students are exposed to various related areas of research.
In addition, we have the student teams come up with their own educational and outreach programming for their fellow students on topics related to the study goals. Accordingly, they get exposure to many aspects of the research process.
The way the course is structured allows them to take it either for a single semester or for multiple semesters. Research teams are each supervised by a graduate student, allowing one to expand the number of students involved (we aim for ~5 students/team). The students come from multiple majors including psychology, chemistry, biology, biomedical engineering, anthropology, forensic science, international studies, sociology, bioinformatics and marketing, suggesting that interest in the project is far-ranging. Since the launch of the project we have had >150 students involved in the project; this spring we had over 100 students apply for 15 slots!
Finally, we found that university support for the project was strong because it aligned with the university’s strategic plan of creating unique learning opportunities for students, furthering the research mission, cutting across multiple disciplines (as well as the undergraduate and medical campuses) and had a focus on improving human health, all of which are central themes in the university’s strategic plan. We found that thinking about how the project would benefit the university, in addition to the science, increased support across the various levels of the administration that were ultimately necessary to successfully launch the project.
Lesson #4: Get the Word Out!
The ultimate success of a project of this sort comes down to marketing as much as anything else. Students are inundated with information, opportunities, and requests when they start college, so the project had to stand out and be widely recognized. In some ways, this task is simplified by the fact that the target population is largely concentrated in a known area: on campus.
We worked with a graphic designer to create t-shirts and logos for the project that were well-received by undergraduates. We came up with a catchy project name: Spit for Science. We also ensured that the marketing materials were representative of the diverse student body and included different minority groups and both sexes. We saturated the campus with Spit for Science banners and flyers.
We worked with the residence hall directors to have all resident assistants (upperclass students who live in the freshman dorms and assist incoming freshmen with welcome week activities when they arrive at campus) informed about the project and wearing Spit for Science t-shirts on the first day of welcome week. We had door hanging tags put on every freshman dorm room the day before the common reimbursement area opened. We put out ground signs during the day to direct students to the reimbursement area from various locations around the campus (“Spit for Science this way!”). We gave out free Spit for Science t-shirts to every participant. The students were excited about the t-shirts, and this also helped to increase visibility of the project around the campus.
In the fall semester, all participants get the “classic” Spit for Science t-shirt. In the spring semesters we hold t-shirt contests and select a student design for the t-shirt. We had random days throughout the semester when we gave out coupons, free food, and other small tokens of appreciation to anyone wearing a Spit for Science t-shirt. We also gave t-shirts to administrators and staff around the university who helped in various ways with launching the project and supporting it.
We had a Spit for Science appreciation party with free food, music, and games for everyone who had participated in the project; wearing one’s Spit for Science t-shirt was the ticket for admittance. We had the undergraduate research team position themselves at high traffic areas around the university (targeting freshman residence halls and activities planned for incoming freshman) to hand out flyers about the project and answer any questions that students had. The undergraduate research team also staffed an informational table in the student building for the duration of data collection.
We are continually looking for new ways to raise awareness about the project across the campus.
Lesson #5: Develop a Close Working Relationship with your IRB
Launching a project of this magnitude created unique circumstances that represented challenges for many of the policies and procedures that were in place with our institutional review board. Data collection is time-sensitive, occurring in the two week window when students arrive on campus. Accordingly, traditional turn around times for review of IRB protocols would jeopardize the project.
Despite extensive advanced planning, there were inevitably issues that arose when data collection was launched on a sample of thousands of individuals simultaneously invited to participate in a short window of time. For example, despite extensive pre-testing, when we launched the survey, we discovered that there was a bug with a particular internet browser that caused the survey to freeze for some students, with all data lost. We wanted to send out an e-mail notification to students to make them aware of this issue and indicate that they should use a different browser.
Contact with participants of course requires IRB approval. Even turnaround times traditionally considered quick (e.g., within a week) would mean that for a 2 week data collection period, half of the critical study period would have elapsed. Accordingly, developing a flexible plan by which the IRB and the research team worked together collaboratively to address these challenges was key to the success of the project.
Lesson #6: Get to Know your IT Office
We worked closely with the university information technology office to develop and launch the on-line survey. The survey software was used to program the survey, e-mail all invitations (to >3000 students simultaneously) and reminders, and collect survey responses in a secure and confidential manner. It also needed the capability to allow the temporary workers who staffed the reimbursement area to access the names of completed participants without access to their data, in order to dispense reimbursement payments while maintaining confidentiality of survey responses.
Each of these steps presented a number of complex challenges. Faculty and staff at our informational technology office were exceedingly helpful in going the extra mile to ensure the success of the project.
Based in large part on the tremendous work that went into launching the project, with assistance from countless individuals across the campus, the project has been a huge success. We have nearly 10,000 students, representing nearly 70% of incoming freshmen, who participated in our first four years of data collection 2011-2014.
After taking a break from new data collection to launch the College Behavioral and Emotional Health Institute (COBE), we plan to launch a new data collection with incoming freshmen this fall.
We currently have 62 faculty and 32 trainees (pre and post-doctoral) from 18 different departments working with the Spit for Science data. 31 faculty have contributed new item content to the surveys over the years, underscoring the inclusive, collaborative nature of data collection and research expertise across the project.
There have been 9 spin off studies, where data from the surveys are used to select students for more intensive study, ranging from ecological momentary assessments of smokers, to brain imaging studies, to prevention trials. There have been 19 awarded grants, include 6 training grants, related to the project, with 8 additional grants submitted for review.
Each month we spotlight results from Spit for Science in our university Stall Seat Journal, placed on the back of bathroom stalls in over 1300 bathrooms across the campus every month, in collaboration with the Wellness Resource Center at VCU. This is part of our effort to give the science back to our students and our university.
We launched the COBE Connect lunch lecture series as a way to facilitate and build collaborations between researchers with shared interests in behavioral and emotional health outcomes, and to present this research to the broader community. Since 2015, the series has featured 19 presenters across 9 departments and 3 divisions with a total attendance of more than 450 people.
Further, last spring we launched the COBE Town Hall meeting in an effort to bring together researchers with members of the community, to discuss issues related to substance use and mental health outcomes in young people. We were overwhelmed to have >300 people attend, and this year we are hosting our second annual town hall with joint sponsorship from the Virginia Department of Behavioral Health Services.
Additionally, COBE has created new coursework for students that grows out of our faculty expertise and research findings, as well as extensive research training and mentoring opportunities.
It’s been a wild ride, but also one of the most rewarding endeavors of my career thus far.