Community Efforts to Address Alcohol Problems in the United States Maria G. Carmona Center for Policy Analysis and Training Pacific Institute for Research and Evaluation March 21, 2003

Where does policy change occur? Policy change occurs at Federal level State level Local community level

What do communties do when they change alcohol policy? Identify specific alcohol problem(s) Identify the causes of problems Implement interventions to change those causes

Community-based Prevention Strategies to address causes Problem Perceived causes Long-term goal Intermediate Goal

Alcohol-Related Problems Traffic crashes Cirrhosis Suicide Alcohol dependence Binge drinking Interpersonal violence Fetal Alcohol Syndrome Work productivity loss Underage drinking

Why do these problems occur? Four types of community-level causes of alcohol problems: Alcohol availability Attitudes or social norms about alcohol use Poor alcohol regulations or policies Lack of alcohol enforcement

Availability What is the availability of alcohol in the community? Is alcohol more available for particular segments of the community? What is needed to obtain alcohol?

Attitudes What are common attitudes about alcohol use in the community? Do attitudes about alcohol use differ across different ages groups and between genders? If yes, why do attitudes differ?

Regulations or Policies What regulations control the availability of alcohol? What regulations control the promotion of alcohol?

Enforcement Are alcohol regulations on promotion and availability enforced? If not, why? When someone violates the law, what happens?

Example 2: Impaired Driving Causes Problem Strategies Impaired driving patrols High-profile sobriety checkpoints targeting minors Merchant education Increased compliance checks Public education campaign to raise awareness of laws and enforcement efforts Media coverage of sobriety checkpoints, community-based merchant education campaign Lack of impaired driving enforcement Easy access to alcohol Lack of awareness of impaired driving laws Alcohol-related traffic crashes

Example 3: Binge Drinking Problem Perceived Causes Strategies High density of bars Abundance of Happy Hours Failure to check IDS Older adults providing alcohol for parties attended by underage youth Low perception of risk and harm from binge drinking Lack of enforcement of MPA law New ordinance restricting outlet density Merchant education Party Patrols College policy of parental notification of all alcohol-related offenses Compliance checks Keg registration ordinance Use of media advocacy with all interventions. Binge Drinking

Two Key Points Efforts to implement policy change depend largely on community support for change. Media advocacy can be used to generate community support for change.

Community Support Community support begins with as little as two dedicated adults or a few passionate teenagers. Community support is best harnessed through formation of a coalition of: Government officials Representatives of key community organizations Respected community leaders or opinion- makers Parents Youth Other allies (for example, medical professionals)

Media Advocacy The strategic use of media to advance a policy goal Consists of earned media coverage (free!) or use of free media space

Media Advocacy Coverage of problems and causes can be used to generate: Discussion about policy change Awareness of policy change Support for policy change Changes in community awareness and attitudes (or norms)

The Utility of Research to Communities Baseline data can help communities: understand the nature of problems raise awareness about the problem.

Alcohol and Young People is a Dangerous Mix Car crashes are the number one killer of teens, and one-third to one-half of those accidents involve alcohol. In 1996, 29 % of Maryland 12th graders reported driving after drinking alcohol. In 1996, 56 % of 12th graders reported having been a passenger with a driver who had been drinking alcohol. Source: Maryland Adolescent Survey

In St. Mary’s County, 120 youth entered the juvenile justice system on alcohol-related offenses in 1997. That’s 4 classrooms of students. Source: Maryland Department of Juvenile Justice

Liquor stores in Maryland 213 public high schools2 178 public libraries3 102 movie theatres1 1 U.S. Census, County business patterns for Maryland, 1996 2 U.S. Department of Education, Digest of Education Statistics, 1997; data for 1995-1996 school year 3 Maryland Manual On-line, reporting 1997 data

The Utility of Research to Communities Follow-up data: Documents outcomes Enables communities to refine efforts Makes it possible to stories to be told

Lessons Learned The experiences of one community inform other communities. The experiences of communities inform efforts directed at the state. Federal-level policy change happens when the documented success of communities and states can no longer be ignored.