Selecting, Implementing, and Evaluating Environmental and Population-Based Prevention

Strategies

How To Use Science in PracticeHow To Use Science in Practice

Selecting, Implementing, and Evaluating Environmental and Population-Based Prevention

Strategies

How To Use Science in PracticeHow To Use Science in Practice

Harold D. Holder, Ph.D.Prevention Research Center

Berkeley, California

GoalsGoals

Goal 1: Learn about population-based prevention Goal 1: Learn about population-based prevention approaches and “environmental strategies”approaches and “environmental strategies”

Goal 2: Learn what local prevention need to do in Goal 2: Learn what local prevention need to do in assessing, implementing, and evaluating assessing, implementing, and evaluating environmental strategies, i.e., strategic planning.environmental strategies, i.e., strategic planning.

Goal 3: Learn how to evaluate environmental Goal 3: Learn how to evaluate environmental strategiesstrategies

What are some popular beliefs What are some popular beliefs about environmental prevention about environmental prevention

strategies?strategies?1.1. Environmental strategies are difficult to Environmental strategies are difficult to

implement. Too costly.implement. Too costly.

2. Environmental strategies will not work in 2. Environmental strategies will not work in our community.our community.

3. We are already doing environmental 3. We are already doing environmental strategies.strategies.

4. ATOD abuse is more an individual problem 4. ATOD abuse is more an individual problem and environmental strategies are not and environmental strategies are not relevant.relevant.

5. Environmental strategies can not be 5. Environmental strategies can not be evaluated.evaluated.

6. Environmental strategies do not work with 6. Environmental strategies do not work with children and pre-teen youth.children and pre-teen youth.

Biggest Current Mistakes in Biggest Current Mistakes in Prevention?Prevention?

Doing many things that have little or no Doing many things that have little or no effect….effect….

““Not incorporating best prevention Not incorporating best prevention research into assessment, research into assessment, planning, and evaluation”planning, and evaluation”

Current Challenges and Opportunities Current Challenges and Opportunities for Preventionfor Prevention

Public Requirement of OutcomesPublic Requirement of Outcomes

Recommendation: Develop outcome data to show Recommendation: Develop outcome data to show resultsresults

Health Care ReformHealth Care Reform

Recommendation: Take advantage of emphasis on Recommendation: Take advantage of emphasis on prevention and outcomes in Health Care Reform prevention and outcomes in Health Care Reform documentationdocumentation

State Budget CutbacksState Budget Cutbacks

Recommendation: Demonstrate cost-effectivenessRecommendation: Demonstrate cost-effectiveness

Just What Just What IsIs Environmental Prevention, Environmental Prevention, Anyway?Anyway?

Environmental strategies in a community seek: Environmental strategies in a community seek:

1.1. To bring about system-level change (including To bring about system-level change (including physical space, local community policies, physical space, local community policies, availability of drugs and alcohol, etc.) availability of drugs and alcohol, etc.)

in order in order

2.2. To reduce substance abuse problems at the To reduce substance abuse problems at the population level. That is population level. That is Public Health.Public Health.

Both conditions must be met.Both conditions must be met.

Substance-related

consequences and substance

use

Intermediate variables

Programs/ policies/practices

Implementing the Strategic Prevention Framework

Planning, Monitoring, Evaluation, and Replanning

Outcomes-Based PreventionOutcomes-Based Prevention

States are familiar with logic models:States are familiar with logic models:

Tools for assessing, planning, Tools for assessing, planning, implementing, and evaluating prevention.implementing, and evaluating prevention.

Logic models are composed of:

3. Intervention strategies to change intermediate variables.

1. Prevention goal, i.e., specific ATOD outcome to be reduced or changed

2. Intermediate variables or factors, which need to be changed (or considered) in order to achieve the goal

Example Logic Model for Substance Abuse Prevention

Alcohol-Related Traffic

CrashesAmong 15- to 24-Year-Olds

Youth Frequent Exposure to Internet

School Bonding for Youth

Awareness of Risk of Drinking

Increased Abstinence

Family Training

Public Education About Drinking and Driving

Risks

Perceived Risk of Drinking and Driving

Enforcement

School Drug Resistance Training

Underage and Young Adult

Driving After Drinking

Highly Visible DUI Enforcement

Responsible Beverage Service To Reduce Overserving

Youth 30-Day Cannabis Use

Number of DUI Arrests

Intermediate Variables

StrategiesSubstance-

Related Consequences

SubstanceUse

Low Personal Self-Esteem

Youth and Young Adult

Lifetime Drinking

Underage and Young Adult

Binge Drinking

What is wrong with this picture?

Alcohol Sales and Service Regulations, Enforcement, and

Sanctions

Alcohol Serving and

Sales Practices

Drinking

Price

Community Norms– Drinking

Drinking Context

DUI Enforcement

Public Awareness of Drinking/Driving Enforcement

Community Norms–

Drinking and Driving

Driving After DrinkingAlcohol-RelatedMotor Vehicle

Crashes

Individual Factors

Social Availability

Retail Availability

Alcohol-Related Motor Vehicle Crash Model

Perceived Risk of DUI Arrest

Strong Relationship

Moderate Relationship

Minor Relationship

Little Research Evidence but Logical Relationship

Research Evidence

Review of Research Evidence forReview of Research Evidence for Logic Models Logic Models

WWW.PIRE.orgWWW.PIRE.org

Under “Under “Featured Websites” to “Logic Models Featured Websites” to “Logic Models for the Prevention of Alcohol, Tobacco, and for the Prevention of Alcohol, Tobacco, and

Other Drug Problems,Other Drug Problems,””select tab in right-hand column.select tab in right-hand column.

Underage Drinking Logic Model

Underage drinking

Social availability of alcohol to youth (parties, peers,

families)

Retail sale of alcohol to youth

Underage drinking

laws

Community concerns about youth drinking

Visible enforcement

Compliance checks, citations, license loss

Party patrol,shoulder taps,

beer keg registration

Legal risks for providing alcohol to underage youth

Retailer training & rewards

Local alcohol policy

Media advocacyMedia advocacy

Price

Discount bans

Examples of Effective Local Prevention Examples of Effective Local Prevention Projects Utilizing Environmental Projects Utilizing Environmental

StrategiesStrategies

National Community Trial To Prevent National Community Trial To Prevent Alcohol-Involved TraumaAlcohol-Involved Trauma

OrangeOrange

OceansideOceanside..

..

..

-

ExperimentalExperimentalComparisonComparison

ModestoModesto

SalinasSalinas

FlorenceFlorence

SumterSumter

Alcohol-Involved Trauma at the Community Level: Alcohol-Involved Trauma at the Community Level: Logic Model`````````Logic Model`````````

MOBILIZATIONMOBILIZATIONMOBILIZATIONMOBILIZATION DRINKING AND DRIVINGDRINKING AND DRIVINGDRINKING AND DRIVINGDRINKING AND DRIVING

UNDERAGE DRINKINGUNDERAGE DRINKINGUNDERAGE DRINKINGUNDERAGE DRINKING

ALCOHOL ACCESSALCOHOL ACCESSALCOHOL ACCESSALCOHOL ACCESS

RESPONSIBLE BEVERAGE RESPONSIBLE BEVERAGE SERVICESERVICE

RESPONSIBLE BEVERAGE RESPONSIBLE BEVERAGE SERVICESERVICE

Non-Traffic Risk ActivitiesNon-Traffic Risk Activities

Local News About AlcoholLocal News About AlcoholProblems and EnforcementProblems and Enforcement

Retail Alcohol Retail Alcohol AvailabilityAvailability

(on- and off-premise)(on- and off-premise)

Alcohol IntoxicationAlcohol Intoxication or Impairmentor Impairment Alcohol-InvolvedAlcohol-Involved

Injury Injury

Alcohol-InvolvedAlcohol-InvolvedInjury Injury

Driving AfterDriving AfterDrinkingDrinking

Perceived Perceived Risk of ArrestRisk of Arrest

Local LawLocal LawEnforcementEnforcement

Social Access Social Access to Alcoholto Alcohol

Alcohol Alcohol Serving and Serving and

Sales PracticesSales Practices

Local Regulation Local Regulation of Alcoholof Alcohol

(density, hours (density, hours of sale)of sale)

Restaurant Service Restaurant Service

Highly visible and increased actual drinking and driving

enforcementenforcement

Underage Drinking

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

Intermediate Variable and Strategy Data

Underage Alcohol Prevention Activities

0

20

40

60

80

100

120

140

160

Q2 Q3 Q4 Q1 Q2

ENFORCEMENTVISITS

CITATIONSISSUED

OUTLETSTRAINED

“Mountain of Beer”

Underage Alcohol Purchase SurveyExperimental and Comparison Communities

0

10

20

30

40

50

60

Perc

en

t S

ellin

g

4747 4545

5353

3535

19191616

Comparison

ExperimentalNo Training

ExperimentalTraining

Comparison

ExperimentalNo Training

ExperimentalTraining

PRETEST PRETEST POSTTESTPOSTTEST

Holder, et al., Holder, et al., J. American Medical Association,J. American Medical Association, 2000 2000

OutcomesOutcomes

What were final results?What were final results?

Examples of Community Action Projects Examples of Community Action Projects for Environmental Preventionfor Environmental Prevention

COUNTRYCOUNTRY GOALSGOALS STRATEGIESSTRATEGIES RESULTSRESULTS

• • DUI enforcementDUI enforcement •• Alcohol service Alcohol service •• News coverage News coverage •• Underage sales Underage sales •• Alcohol outlets Alcohol outlets

United StatesUnited States

California,California,South CarolinaSouth Carolina

Reduce alcohol Reduce alcohol injury and deathinjury and death

10% reduction in 10% reduction in alcohol crashesalcohol crashes

43% reduction in 43% reduction in violenceviolence

Lower alcohol Lower alcohol sales to youthsales to youth

• • News coverageNews coverage•• DUI enforcement DUI enforcement•• Alcohol outlet Alcohol outlet surveillance surveillance

MassachusettsMassachusetts Reduce alcohol Reduce alcohol crashescrashes

25% reduction in 25% reduction in fatal crashesfatal crashes

•• Local sales policies Local sales policies and enforcement and enforcement

MinnesotaMinnesota Reduce youth Reduce youth drinkingdrinking

Lower alcohol Lower alcohol sales to youthsales to youthReduced traffic Reduced traffic crashescrashes

Examples of International Community Action Examples of International Community Action Projects for Alcohol PreventionProjects for Alcohol Prevention

COUNTRYCOUNTRY GOALSGOALS STRATEGIESSTRATEGIES RESULTSRESULTS

• • Responsible Responsible Beverage Service Beverage Service

• • Joint parent/police Joint parent/police enforcement of enforcement of sales to youthsales to youth

• • Club policy and Club policy and drug recognition by drug recognition by door securitydoor security

Reduced local Reduced local alcohol and alcohol and drug problemsdrug problems

Reduction in sales to intoxicatedpatrons (47% to 5%)

Violent crime down by 29%

• • Community forum Community forum and alcohol safety and alcohol safety auditaudit

• • Model house policiesModel house policies •• Increased enforce-Increased enforce-

ment of alcohol-ment of alcohol-licensed premiseslicensed premises

AustraliaAustraliaSurfers Surfers Paradise Paradise Safety Action Safety Action ProjectProject

Lower Lower alcohol- alcohol- involved involved violenceviolence

Reduction in Reduction in violent events: violent events: original siteoriginal site from from 9.8 to 4.7 and9.8 to 4.7 and

Refusals of drug Refusals of drug impaired patrons impaired patrons increased by 300%increased by 300%

replication sitesreplication sites from 12.2 to 3.0from 12.2 to 3.0

SwedenSwedenSTAD Project Stockholm

What Have We Learned to This Point?What Have We Learned to This Point?

Environmental prevention can produce measurable results.Environmental prevention can produce measurable results.

Environmental strategies must be selected that have been Environmental strategies must be selected that have been shown to work—that is, impact shown to work—that is, impact keykey intermediate variables. intermediate variables.

Logic Model in environmental prevention must be based on empirical evidence about intermediate variables.

Do few things well. High “dosage” to be effective.Do few things well. High “dosage” to be effective.

NextNext

Learn tools and approaches to monitor and Learn tools and approaches to monitor and evaluate environmental strategies.evaluate environmental strategies.

Discuss ways for communities in more effective Discuss ways for communities in more effective in environmental prevention.in environmental prevention.