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“Selecting and Implementing Effective
Community Prevention Strategies”
How to Use Science in Practice"
Harold D. Holder, Ph.D.
Prevention Research Center
Berkeley, California USA
Biggest current mistakes in
prevention?

Doing many things which have little or
no effect….
 “Not
incorporating best prevention
research into assessment,
planning, and evaluation”
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
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.

Public Health Model of Substance
Abuse Problem Prevention
Individual
(drinker, smoker, user)
Environment
Agent
(Context of Use and
availability)
(Substance)
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.
Unlikely to be effective alone for public health and
safety effects--

Mass communication and public
education
International Examples of Local
Prevention Projects Utilizing
Community Organizing and Public Health
Approaches
EXAMPLES OF COMMUNITY ACTION
PROJECTS FROM AROUND THE WORLD
6 community trial, Norway
Stockholm, Sweden
..
Malmo, Sweden
Ontario, Canada
Minnesota, USA
PAKKA, Finland
Lahti, Finland
Ireland
UK
California, USA
6 Community Trial, Sweden
Florence, Italy
Massachusetts, USA
Israel
South Carolina, USA
Queensland
Diadema &
Paulinia,
Brazil
Western Australia
New Zealand
National Community Trial To Prevent
Alcohol-Involved Injury and Death
-
Modesto
Salinas
Orange
Oceanside
. .
.
..
.
Florence
Sumter
Experimental
Comparison
Between 30 and 50% of fatal car crashes involve alcohol.
Up to one half of home fires involve drinking and smoking
40-50% of injuries from fights or assaults involve alcohol
Alcohol-involved Trauma at the Community Level:
Logic Model`````````
MOBILIZATION
Local News about Alcohol
Problems & Enforcement
DRINKING AND DRIVING
Perceived
Risk of Arrest
Local Law
Enforcement
RESPONSIBLE BEVERAGE
SERVICE
Social Access
to Alcohol
Driving after
Drinking
Alcohol
Serving and
Sales Practices
UNDERAGE DRINKING
Local Regulation
of Alcohol
(Density, Hours
of Sale)
Retail Alcohol
Availability
(On and Off-premise)
ALCOHOL ACCESS
Alcohol Intoxication
or Impairment
Alcohol-involved
Injury
Non-Traffic Risk Activities
Five Prevention Components
1.
Community Mobilization
Community Mobilization
Community Organizing
Local News
(Media Advocacy)
Goal: Community
Awareness
of Alcohol Problems
and
Support for Local
Policy Actions
Five Prevention Components
1.
Community Mobilization
2.
Responsible Beverage Service
Responsible Beverage Service
Highly visible & increased
actual drinking and driving
enforcement
Underage Drinking
In Salinas California, 90% of students who drink
report attending parties where minors drank
Outcomes
What were final results?
Newspaper Factor Score - Local Stories
44
Organizational
Organizational Development
Development and
and
Planning
Planning
33
Training,
Training, Additional
Additional
Planning
Planning Training
Training
and
and 1st
1st
Media
Media
Events
Events
Ongoing
Ongoing Advocacy
Advocacy Efforts
Efforts
22
11
00
-1
-1
-2
-2
JJ FF M
MA
AM
M JJ JJ A
A SS O
ON
ND
D JJ FF M
MA
AM
M JJ JJ A
A SS O
ON
ND
D JJ FF M
MA
AM
M JJ JJ A
A SS O
ON
ND
D JJ FF M
MA
AM
M JJ JJ A
A SS O
ON
ND
D JJ FF M
MA
AM
M JJ
1993
1992
1994
1995
1996
1993
1992
1994
1995
1996
P
RC
Experimental
Experimental Sites
Sites
Comparison
Comparison Sites
Sites
Underage Alcohol Prevention Activities
160
140
ENFORCEMENT
VISITS
120
100
CITATIONS
ISSUED
80
60
OUTLETS
TRAINED
40
20
0
Q2
Q3
Q4
Q1
Q2
“Mountain of Beer”
Underage Alcohol Purchase Survey
-Experimental and Comparison Communities-
60
Percent Selling
50
PRETEST
POSTTEST
53
40 47
45
35
30
20
19
10
16
0
Comparison
Experimental
No Training
Experimental
Training
Comparison
Experimental
No Training
Experimental
Training
Holder, et al., J. American Medical Association, 2000
Community Trials Final Results
Holder, et al. 2000. J. Amer. Medical Assoc.
 Total Consumption (+2%)
 Heavy Drinking (-6%)

Driving after “Too much to drink” (- 49%)
 BAC Positive Drivers (- 44%)

Nighttime Injury Crashes (-10%)
 Assaults
-- Hospital Cases (-2%)
-- Emergency Room Cases (- 43%)
Examples of International Community
Action Projects for Alcohol Prevention
COUNTRY
GOALS
STRATEGIES
RESULTS
Finland
Pakka project
Finland
Lathi
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
Reduce heavy
drinking
 Reductions in
• Primary health care
heavy drinking
• Community education
• News
 Greater news
coverage
Reduce heavy
drinking and
youth drinking
• School education
 Modest effect on
•Public education
heavy drinking
Sweden
Stockholm-Kungsholmen
Examples of International Community
Action Projects for Alcohol Prevention
COUNTRY
GOALS
STRATEGIES
Sweden
Malmö
Stockholm
City-- STAD
Reduce alcohol
problems
Reduce alcohol
and drug
problems
• Public education
• Primary health care
screening
• Reduce alcohol
access
•Youth Program
• Secondary prevention
in health care
•Responsible Beverage
RESULTS

Low effects on
problem indicators

Reduced male
consumption and
problems in (a)
screening program
and (b) general
population
 Modest effect in
medium strength
beer sales to youth
 Reduction in sales
to intoxicated
patrons (5% to 47%)
Service

Violent crime
down by 29%
Examples of International Community Action Projects for Alcohol
Prevention
COUNTRY
New Zealand
Waikata Rural
Drink/ Drive
Project
GOALS
Reduce
drink/drive
problems
STRATEGIES
• Public awareness
using local news
 Fatal alcohol
• Highly visible
drink/drive
enforcement
 Public perception
•Investigation of onlicense premises
based upon “place of
last drink” data
Australia
Surfers
Paradise
Safety Action
Project
Lower
alcohol
involved
violence
RESULTS
• Community Forum &
alcohol safety audit
• Model serving policies
• Increased enforcement
of alcohol licensed
premises
crashes reduced
from 22 to 14%
of risk of being
caught increased
 Alcohol positive
breath checks
decreased by 600%

Violent events:
--original site from
9.8 to 4.7
--replication sites
from 12.2 to 3.0
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