Selecting and Implementing Effective Community Prevention Strategies. How to Use Science in Practice"

Transcription

1 Selecting and Implementing Effective Community Prevention Strategies How to Use Science in Practice" Harold D. Holder, Ph.D. Prevention Research Center Berkeley, California USA

2 Biggest current mistakes in prevention? Doing many things which have little or no effect. Not incorporating best prevention research into assessment, planning, and evaluation

3 What are our options to prevent community alcohol, tobacco, illegal drug problems? 1. Personal change strategies change people individually one at a time 2. Alcohol policy or public health strategies change environment, e.g., reduce alcohol availability & heavy or unsafe drinking settings

4 Just what is environmental prevention, anyway? Environmental strategies in a community seek: (a) to bring about system level change (including physical space, local community policies, availability and convenience of illegal drugs, tobacco, & alcohol, enforcement of laws, etc.), in order (b) to reduce substance abuse problems at the population level. That is Public Health. Both conditions must be met.

5 Public Health Model of Substance Abuse Problem Prevention Individual (drinker, smoker, user) Environment (Context of Use and availability) Agent (Substance)

6 Problem Prevention Strategies: Solid Evidence Retail price of alcohol or tobacco Minimum drinking/purchase age Training of servers in restaurants, bars, pubs, and clubs to reduce heavy drinking among customers. Drinking/driving deterrence (RBT) Lower BAC limits for driving Density & location of alcohol outlets Form and style of retail sale, e.g., hours and days of retail sale.

7 Unlikely to be effective alone for public health and safety effects-- Mass communication and public education

8 International Examples of Local Prevention Projects Utilizing Community Organizing and Public Health Approaches

9 EXAMPLES OF COMMUNITY ACTION PROJECTS FROM AROUND THE WORLD 6 community trial, Norway Stockholm, Sweden.. Malmo, Sweden 6 Community Trial, Sweden Minnesota, USA California, USA South Carolina, USA Ontario, Canada Ireland U K Massachusetts, USA PAKKA, Finland Lahti, Finland Florence, Italy Israel Queensland Diadema & Paulinia, Brazil Western Australia New Zealand

10 National Community Trial To Prevent Alcohol-Involved Injury and Death - Modesto Salinas.. Orange Oceanside.... Florence Sumter Experimental Comparison

11 Between 30 and 50% of fatal car crashes involve alcohol.

12 Up to one half of home fires involve drinking and smoking

13 40-50% of injuries from fights or assaults involve alcohol

14 Alcohol-involved Trauma at the Community Level: Logic Model````````` MOBILIZATION Local News about Alcohol Problems & Enforcement Local Law Enforcement DRINKING AND DRIVING Perceived Risk of Arrest RESPONSIBLE BEVERAGE SERVICE Alcohol Serving and Sales Practices Social Access to Alcohol UNDERAGE DRINKING Driving after Drinking Local Regulation of Alcohol (Density, Hours of Sale) Retail Alcohol Availability (On and Off-premise) Alcohol Intoxication or Impairment Alcohol-involved Injury ALCOHOL ACCESS Non-Traffic Risk Activities

15 Five Prevention Components 1. Community Mobilization

16 Community Mobilization Community Organizing Local News (Media Advocacy) Goal: Community Awareness of Alcohol Problems and Support for Local Policy Actions

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18 Five Prevention Components 1. Community Mobilization 2. Responsible Beverage Service

19 Responsible Beverage Service

20 Highly visible & increased actual drinking and driving enforcement

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22 Underage Drinking In Salinas California, 90% of students who drink report attending parties where minors drank

23 Outcomes What were final results?

24 Newspaper Factor Score - Local Stories 4 3 Organizational Development and Planning Training, Additional Planning Training and 1st Media Events Ongoing Advocacy Efforts J F M AM J J A S O N D J F M AM J J A S O N D J F M AM J J A S O N D J F M AM J J A S O N D J F M AM J P RC Experimental Sites Comparison Sites

25 Underage Alcohol Prevention Activities Q2 Q3 Q4 Q1 Q2 ENFORCEMENT VISITS CITATIONS ISSUED OUTLETS TRAINED

26 Mountain of Beer

27 Percent Selling Underage Alcohol Purchase Survey -Experimental and Comparison Communities- 60 PRETEST POSTTEST Comparison Experimental No Training Experimental Training Comparison Experimental No Training Experimental Training Holder, et al., J. American Medical Association, 2000

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30 Community Trials Final Results Heavy Drinking (-6%) Driving after Too much to drink (- 49%) BAC Positive Drivers (- 44%) Holder, et al J. Amer. Medical Assoc. Total Consumption (+2%) Nighttime Injury Crashes (-10%) Assaults -- Hospital Cases (-2%) -- Emergency Room Cases (- 43%)

31 Examples of International Community Action Projects for Alcohol Prevention COUNTRY GOALS STRATEGIES RESULTS Finland Pakka project Reduce heavy drinking and underage drinking and associated problems Reduce alcohol sales to underage persons Reduce sales and service to drunken persons Reduced sale of alcohol to youth Reduce service to drunken person from 23 to 42% Increased local collaboration Finland Lathi Sweden Stockholm-- Kungsholmen Reduce heavy drinking Reduce heavy drinking and youth drinking Primary health care Community education News School education Public education Reductions in heavy drinking Greater news coverage Modest effect on heavy drinking

32 Examples of International Community Action Projects for Alcohol Prevention COUNTRY GOALS STRATEGIES RESULTS Sweden Malmö Reduce alcohol problems Public education Primary health care screening Reduce alcohol access Low effects on problem indicators Reduced male consumption and problems in (a) screening program and (b) general population Stockholm City-- STAD Reduce alcohol and drug problems Youth Program Secondary prevention in health care Responsible Beverage Service Modest effect in medium strength beer sales to youth Reduction in sales to intoxicated patrons (5% to 47%) Violent crime down by 29%

33 Examples of International Community Action Projects for Alcohol Prevention COUNTRY GOALS STRATEGIES RESULTS New Zealand Waikata Rural Drink/ Drive Project Reduce drink/drive problems Public awareness using local news Highly visible drink/drive enforcement Investigation of onlicense premises based upon place of last drink data Fatal alcohol crashes reduced from 22 to 14% Public perception of risk of being caught increased Alcohol positive breath checks decreased by 600% Australia Surfers Paradise Safety Action Project Lower alcohol involved violence Community Forum & alcohol safety audit Model serving policies Increased enforcement of alcohol licensed premises Violent events: --original site from 9.8 to replication sites from 12.2 to 3.0

34 What have we learned? Local prevention can produce measurable results Local prevention must be based on scientific evidence about key factors and variables. Environmental strategies must be selected which have been shown to work that is, impact key factors variables. Do few things well. High dosage to be effective