1. Community Prevention II Design and Implementation of Strategies
Harold D. Holder, Ph.D.
Prevention Research Center
Berkeley, California USA
Associação Brasileira de Estudos de Álcool e Outras Drogas,
Sao Paulo
September 5, 2003

2. Traditional Approach to Prevention
Action
Desired Results
BETTER FUTURE CHOICES FOR YOUTH ABOUT SUBSTANCES AND THUS REDUCED ABUSE
BLACK BOX OF COMMUNITY
PUBLIC SCHOOL EDUCATION
Systems Approach to Prevention
Search for Action
Community Systems Model
Desired Results X Z Y Q
REDUCED HIGHWAY DEATHS RELATED TO DRINKING

3. One might say a “systems output”
Systems Principle 1
Substance abuse problems are not simply the actions of high-risk individuals—
-- rather, the result of complex social, cultural, and economic factors within the overall community-system.
One might say a “systems output”

4. Systems Principle 2 Community systems by nature are:
1. adaptive—adjust to changes including local prevention efforts
2. transformational—create new results and outcomes
3. unpredictable—do not follow expected courses, i.e., are counter-intuitive

5. Prevention Intervention and Outcome
Direct Effect on Outcomes
Dose or Strength of Intervention

6. Prevention Intervention and Outcome
“Barrier”
“Threshold”
Direct Effect on Outcome
“Step”
Dose or Strength of Intervention

7. Public Health Model of Substance Abuse Problem Prevention
Individual
(User)
Environment (Context)
Agent (Substance)

8. Individual Approaches1.
School-Based Education 2.
Mass Communication and Public Education 3.
Family Education/counseling 4.
Alcohol and Tobacco Warning labels 5.
Deterrence: Possession or sale of drugs, Drinking and driving Laws, Sale of tobacco or alcohol to minors. 6.
Brief Intervention in health care or workplace

9. Public Health Model of Substance Use Prevention
Individual(User)
Agent (Substance)
Environment (Context)

10. Environmental Approaches1.
Retail Access to substances, e.g., price, outlet locations, minimum purchase laws. 2.
Restrictions or constraints on the Drinker’s or Smokers Behavior, e.g., drinking & smoking locations, drink drive 3.
Reduce Risk or Problem Severity

11. Public Health Model of Substance Use Prevention
Individual(User)
Environment (Context)
Agent (Substance)

12. Agent Approaches 1.
Low or No Alcohol Beverages or lower tar tobacco products 2.
Alcohol container size or tobacco package restrictions 3.
Restrictions on Product Advertising

13. Alcohol-involved Trauma at the Community Level: Conceptual Model`````````
MOBILIZATION
DRINKING AND DRIVING
Local News about Alcohol Problems & Enforcement
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-involved
Injury
Alcohol Intoxication
or Impairment
ALCOHOL ACCESS
Non-Traffic Risk Activities

14. General Timeline of Program Implementation Community Trials Project 1991 - 1996
1992
1993
1994
1995
1996
Funding Secured
Evaluation Data Collection
Mobilization & Media Advocacy Component
Drinking and Driving Component
Responsible Beverage Service Component
Underage Drinking Component
Access Component

15. Community Mobilization
Goal: Community Awareness
of Alcohol Problems
and
Support for Local
Policy Actions
Community Organizing
Local News
(Media Advocacy)

16. Community Mobilization
Increase general community awareness and
concern about alcohol-involved unintentional
trauma 
Increase community support for environmental
prevention 
Mobilize community to support specific
interventions

17. Community Mobilization Question: Who should be included in a community project to prevent alcohol-involved trauma?
What is their interest or investment in such a local problem?
What political, social, or economic resource can they bring?

18. Friday, December 10, 1993

19. Five Prevention Components
1. Community Mobilization
2. Responsible Beverage Service

20. Restaurant Service

21. Responsible Beverage Service
Goal:
Reduce alcohol intoxication or impairment for
patrons of bars and restaurants
Actions: 
Server and manager training 
New alcohol serving policies (price promotions, reduce serving sizes, promote non-alcoholic beverages and food) 
Enforcement of no service to underage and obviously
intoxicated patrons

22. Responsible Beverage Service Policy:
Refuse Service to Intoxicated Patrons 5 10 15 20 25
Pretest
(1993)
Posttest
(1995)
Experimental
Comparison
Mean % Yes
Northern California Communities
Southern California Communities
South Carolina Communities

23. Five Prevention Components
1. Community Mobilization
2. Responsible Beverage Service
3. Risk of Drinking and Driving

24. Source: Prevention Research Center Community Survey

25. Drinking and Driving Goals:   
Reduce number of community drinking and
driving events 
Increase perceived risk of DWI detection 
Increase community support of DWI enforcement

28. DRINKING AND DRIVING COMPONENT
ACTION MODEL
Enforcement
News
Perceived Risk
Of DUI Arrest
Drinking & Driving
Driver BAC
Crashes

29. Enforcement & News to Perceived Risk
DRINKING AND DRIVING COMPONENT
ACTION MODEL
Enforcement & News to Perceived Risk
California Sites
Enforcement: F 11.65, p < .076*
Publicity: F , p < .095*
Enforcement
News
Perceived Risk
Of DUI arrest
South Carolina Site
Enforcement: F , p < .287*
Publicity: F , p < .891*
*Analysis of variance

30. Perceived Risk to Drinking and Driving
DRINKING AND DRIVING COMPONENT
ACTION MODEL
Perceived Risk to Drinking and Driving
All 6 Sites
Experimental and Comparison
Enforcement
News
Self-Reported
Driving after drinking: t , p < .001*
Driving while intoxicated: t , p < .001* *Tobit regression
Perceived Risk
Of DUI arrest
Drinking & Driving
Driver BAC

31. Drinking and Driving vs. Crashes
DRINKING AND DRIVING COMPONENT
ACTION MODEL
Drinking and Driving vs. Crashes
Northern California: G , p < .001*
Enforcement
News
Southern California: G , p < .001*
Perceived Risk
South Carolina: G , p < .006*
*SURE Analysis
Drinking & Driving
Driver BAC
Crashes

32. Enforcement and News vs. Crashes
DRINKING AND DRIVING COMPONENT
ACTION MODEL
Enforcement and News vs. Crashes
All Communities: G , p < .025*
Enforcement
News
California Communities: G , p < .025*
Perceived Risk
South Carolina Communities: G , p < .711*
*SURE Analysis
Drinking & Driving
Driver BAC
Crashes

33. DRINKING AND DRIVING COMPONENT ACTION MODEL
Enforcement
News
Increased enforcement & news = -10% injury crashes
Perceived Risk
Of DUI arrest
Drinking
& Driving
G , p < .025*
*SURE Analysis
Crashes

34. Five Prevention Components
1. Community Mobilization
2. Responsible Beverage Service
3. Risk of Drinking and Driving
4. Underage Drinking

36. Underage Drinking Goals:    
Increase community awareness of underage
drinking 
Reduce adolescent drinking, especially in
risky situations 
Reduce physical availability of alcohol to minors 
Increase awareness of retail establishments and
adults of the legal and social risks of providing
alcohol to minors

37. Sunday, February 27, 1994

38. Current Access Intervention Status
All experimental communities have intervened to reduce alcohol access 
Community-wide changes in availability have occurred 
Major neighborhood-specific changes in availability have occurred.
For example: New alcohol outlets denied

39. What have we learned?
Evaluation Results