Young Adult Drinking Prevention

Learning from Local Efforts
by National Institute of Health

(Page 3 of 3)

The three NIAAA-sponsored community prevention projects described provide strong evidence of the positive effects of research-based local prevention efforts that take a comprehensive approach using a combination of strategies. Studies by other researchers have demonstrated that comprehensive strategies can effect substantial changes in alcohol-related behavior.

For example, Clapp and colleagues studied a year-long intervention designed to prevent driving under the influence on a university campus. The intervention consisted of increased law enforcement (DUI checkpoints and roving DUI patrols) combined with extensive media advocacy (placement of stories on local television news broadcasts and in the campus newspaper) and a student-designed advertising campaign, both intended to heighten awareness of the increased enforcement. The researchers found that self-reported instances of DUI decreased significantly at the intervention school; DUI rates at a comparison university remained stable.

Recently, Hingson and colleagues examined alcohol-related traffic fatality data from a subset of communities that were awarded substance abuse prevention grants through the Robert Wood Johnson Foundation's Fighting Back program. Investigators selected five communities that implemented a concentrated communitywide effort to restrict alcohol availability and expand treatment services. Comparing rates of fatal traffic crashes during the 10 years of the study with rates during the 10-year period before the study, the researchers found that alcohol-related fatal crashes declined significantly during the years of the program in both intervention and comparison communities. Overall, the declines ranged from 17 percent to 22 percent, depending on the blood alcohol concentration associated with the crash. In the three communities in which the intervention targeted the entire city, alcohol-related fatal crashes declined from 31 percent to 39 percent, depending on BAC. Communities with less comprehensive intervention programs did not experience such improvements relative to their comparison communities.

These projects' findings confirm that local policies to reduce young adult drinking or alcohol-related problems are most likely to be effective when they are adequately enforced and when the intended targets of the intervention are aware of both the policies and their enforcement.

Community action projects are intended to address the total community system and are not naturally limited to a specific target group or service group. To reduce alcohol problems in the entire community, local leadership is required in designing, implementing, and supporting new alcohol policies. To ensure that the strategies were research based, the research teams for the Saving Lives, Community Trials, and CMCA projects designed (or identified) prevention strategies that research had shown to be effective and supported (or assisted) the communities in implementing those activities and policies. Communities took responsibility for determining how best to implement each strategy.

Although local alcohol policy strategies have the best chances for success when they draw on scientific evidence, many community prevention projects involve interventions that research has indicated are unlikely to reduce alcohol-related problems. For example, many communities pursue public education efforts designed to produce attitude change. Such educational strategies often are focused on information alone, based on the assumption that an informed community will necessarily experience a reduction in alcohol-related problems. However, there is no evidence that education alone can reduce alcohol-related problems at the community level.

Enforcement of underage drinking laws can be significantly enhanced with modest increases in community support (e.g., when elected officials publicly endorse the effort and work to implement the policies, or when community residents give public support via letters to the editor). Even moderate increases in enforcement can reduce outlet sales of alcohol to minors, especially when combined with media campaigns and other community and policy activities.

Communication with the entire community is essential. The most effective and inexpensive way to increase public support for strategies that reduce alcohol availability is to use local newspapers, radio, and television - a strategy sometimes called media advocacy. Without skillful media work, it is very difficult, and perhaps impossible, to implement policy-driven structural changes within a community because such strategies depend upon the support and leadership of the community to effectively implement and reinforce the effort. Media advocacy can be used to make retailers, underage buyers, parents, and other adults more aware of the likelihood of legal consequences for selling or providing alcohol to people who are underage, and to enhance community perceptions of ownership of intervention strategies.

The long-term test of successful community prevention is whether local governments continue to implement the policies after the project ends, and whether the policies themselves continue to be effective. Once implemented, local policies often can have a longer life than services that must be maintained and funded each year. Because policies typically affect communities' administrative codes and procedures (e.g., local zoning and land use regulations governing alcohol retailers), their maintenance does not necessarily require additional funds. Thus, for example, a local policy requiring training for alcohol beverage servers in bars and restaurants, to be provided by an existing adult education system, could be effective for a longer period than a professionally planned public education campaign that must be renewed annually.

Even when a strategy becomes less effective over time - as compliance, regulation, or enforcement declines - it can continue to have a sustained effect even without reinforcement. For example, enforcing bans on selling alcohol to minors increases retailers' compliance with the law. But even if enforcement drops off, there may be residual compliance. A second illustration concerns drinking-and-driving trends after the minimum legal drinking age was raised to age 21 for all U.S. States. O'Malley and Wagenaar found that the incidence of drinking and driving declined when the drinking age was raised to 21, despite varied and often low levels of enforcement. Further, young people in States with a higher minimum drinking age actually sustained lower average drinking levels even after they reached the legal drinking age and were no longer prohibited from drinking.

In the final analysis, complementary strategies such as those described above, where local government implements and enforces alcohol-related policies aimed at restructuring the community's total alcohol environment, are more likely to be effective in achieving their goals than single-intervention strategies that are only in place for the duration of a special project.

About the Author

NIH is the nation's medical research agency - making important medical discoveries that improve health and save lives. The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the primary Federal agency for conducting and supporting medical research.