Abstract
Environmental approaches to the reduction of alcohol problems such as the Community Trial Intervention to Reduce High Risk Drink differ from more traditional individual based approaches.First, environmental approaches seek to implement policy changes designed to reduce such use.Second, the goal of the environmental approach is to effect system change within the community.Third, the environmental approach targets community leaders and policy makers.Fourth, the environmental approach seeks to harness and mobilize their energies in the pursuit of desired policy change.Finally, the environmental approach seeks to alter supply.
Community Trials Intervention To Reduce High-Risk Drinking (RHRD) is a multicomponent, community-based program developed to alter alcohol use patterns of people of all ages and related problems.
The program uses a set of environmental interventions including:
- Alcohol Access: Assists communities in using zoning and municipal regulations to restrict alcohol access through alcohol outlet (bars, liquor stores, etc.) density control.
- Responsible Beverage Service: Through training and testing, RBS assists alcohol beverage servers and retailers in the development of policies and procedures to reduce intoxication and driving after drinking.
- Risk of Drinking and Driving: Increases actual and perceived risk of arrest for driving after drinking through increased law enforcement and sobriety checkpoints.
- Underage Alcohol Access: Reduces youth access to alcohol by training alcohol retailers to avoid selling to minors and those who provide alcohol to minors, and through increased enforcement of underage alcohol sales laws.
- Community Mobilization: Provides communities with the tools to form the coalitions needed to implement and support the interventions that will address the previous four prevention components.
The basic research design for evaluation is longitudinal utilizing pre-program data in each experimental community as a source for the no-treatment baseline and utilizes the matched comparison community as a control for the history threat to internal validity. This provides both a pre/post design for the experimental community as well as a time-series designed with a matched comparison community. Each prevention component has its own evaluation and data collecting design.
The Community Trials Project has demonstrated that an environmentally directed approach to prevention, using policies as the form of intervention, can reduce alcohol problems at the local level.
Intervention details
Community at large
Nightlife staff, police officers.
Actions included:
- Community mobilization: Media advocacy campaigns, Media training and technical assistance;
- Responsible beverage service: Manager and server training, Voluntary local training, Local certification of servers and establishments, Local publicity concerning training, Training sponsorship by hospitality group, Increased enforcement against serving intoxicated patrons, Mandatory training;
- Reduction of underage drinking: Community awareness of alcohol access for minors, Voluntary off-premise policy and clerk training, Law enforcement to reduce underage alcohol sales;
- Drinking and driving: Citizen task force promotes DUI (driving under the influence) enforcement, Training programs for officers, Use of breath testers and/or passive sensors, Distribution of educational materials, Regular use of sobriety checkpoints;
- Access to alcohol, outlet densities and alcohol consumption: Computer mapping of outlet locations and problems, Publication of mapping results, Community education on alcohol availability, Community coalitions monitor outlet density.
The theoretical basis for these community trials is environmental, i.e. it focuses on changes in the social and structural contexts of alchol use that can alter individual behaviour; it does not target specific groups. There is solid empirical evidence that environmental strategies can reduce alcohol-involved trauma (Edwards et al., 1994).
Additional costs, depending upon local needs, could include office space, telephone, copying, postage and local travel. These could be contributed by the community or by other organizations if the community alcohol prevention effort were imbedded in an existing local organization. In addition, from time to time, the project could be enhanced by unique one-time funding for training manuals, technical assistance and staff training, or a special project locally defined. Other areas which could benefit from special founding include the purchase of breathalyzers and other equipment to enhance drinking and driving enforcement, the provision of beverage server and manager training in RBS and the provision of clerk and manager training for preventing sales to underage people.
Evaluation details
A project process evaluation was used to describe global characteristics of the community and factors affecting project implementation. The success of this trial relied heavily on the ability of the community coalition to actively engage and mobilize key organizations in the community (e.g. schools, law enforcement, health care agencies) to support and promote the goals of the project. Within the general prevention protocol described above, each experimental community was expected to develop its own local action plan based on this general plan to effectively implement these components. Successful strategies relied heavily on the ability of the existing coalition, with its community interests, concerns and social networks, to effectively communicate and promote the goals of the project. The coalitions were comprised of key decision makers, health professionals, community interests and other members of the community at large. In addition, each community was expected to make use of technical assistance provided by the project.
As a result of community training in techniques for working with local news media, there was a statistically significant increase in coverage of alcohol issues in local newspapers and on local TV in the experimental communities over their matched comparison communities. Increased media coverage was important to gain leaders' support of specific alcohol policies and to increase public awareness of drinking and driving enforcement. Early findings show that the project has reduced alcohol-involved traffic crashes. A statistically significant reduction in such crashes was found overall, comparing experimental communities with their matched comparison communities. The introduction of special and highly visible drink and drive enforcement with new equipment and special training produced the significant reduction. Key support came from increased news coverage.
The overall reduction in alcohol-involved traffic crashes was 78 crashes over a 28-month intervention period from September, 1993 to December, 1995. This represents an approximate annual reduction in alcohol-involved crashes of 10%. There was a significant reduction in alcohol sales to minors. Overall, off-premise outlets in experimental communities were half as likely to sell alcohol to minors as in the comparison sites. This was the joint result of special training of clerks and managers to conduct age identification checks, the development of effective off-premise outlet policies and, especially, the threat of enforcement of lawsuits against sales to minors.
There was increased adoption of responsible alcohol serving policies in the experimental communities over the comparison communities. There were limited but promising results in reducing alcohol service to heavy-drinking patrons. Such reductions in service may require longer follow-up than was possible at this time. Overall, the Community Trials Project has demonstrated that an environmentally directed approach to prevention, using policies as the form of intervention, can reduce alcohol problems at the local level.
As an example of the potential cost effectiveness, the following illustration is provided. Approximately US$90 000 each year was the cost of local prevention staff in each of the three experimental communities. A replication project would need 3-4 years in one local community at a cost of between US$270 000 to US$360 000 in total. In the Community Trials Project, the local community staff cost over 4 years was a total of US$1 080 000 (US$360 000 for each experimental community). This included the staff cost for local implementation of all four components. At this time the distal effects of only the drinking and driving component are known, because of its early implementation. Across all communities over the first 4 years of the project, the net reduction in alcohol involved traffic crashes was 78 crashes. If one uses an average cost of US$39 905 per crash (an estimate based upon medical, legal and insurance costs as well as lost wages during rehabilitation but not lost productive years due to early death), then the savings from just these 78 fewer alcohol-involved traffic crashes in the three experimental communities relative to their matched comparison communities was US$3 112 590 (US$39 905 per crash times 78 crashes).
It should be carefully noted that this is a simplistic cost/effectiveness analysis. The costs shown do not include opportunity costs such as taking law enforcement officers away from other duties to do DUI enforcement. There is no estimate of the contributed value of the time of many community volunteers. This illustration does not include the cost of data collection used for evaluation but also partially used as management information to aid community staff. If we subtract the cost of the intervention across all three communities (noting that this implementation cost includes the costs of the other prevention components whose effects are not yet accounted for), then we get a net total saving of US$2 032 590. Thus, every US dollar invested in this Community Trials Project returns US$2.88 in savings, just from reduced traffic crashes alone. The total community program cost remains constant as described in this simple calculation. Any further reductions in injuries or deaths will improve the cost/effectiveness ratio.
Implementation experiences: Replications of this project without the same types of quantitative intermediate and outcome data developed in this project would limit the ability of community staff to objectively determine their progress or early effectiveness.
Treno. A.J and Holder. H.D (1997) Community mobilization: evaluation of an environmental approach to local action, Addiction 92(2):s173-s18
An abstract for this journal article can be found in the HNT literature section here.
Roeper, P.J., Voas, R.B., Padilla-Sanchez, L. & Esteban, R. (2000). A long-term community-wide intervention to reduce alcohol-related traffic injuries: Salinas, California. Drugs: education,prevention and policy, 7(1), 51-60.
An abstract for this journal article can be found in the HNT literature section here.
