A Review of Environmental-Based Community Interventions

By Toomey, Traci L.; Lenk, Kathleen M. | Alcohol Research, Fall 2011 | Go to article overview

A Review of Environmental-Based Community Interventions


Toomey, Traci L., Lenk, Kathleen M., Alcohol Research


Alcohol use and related problems are affected by a myriad of both individual- and environmental-level risk factors (Wagenaar and Perry 1994). Prevention interventions that focus solely on individual-level risk factors generally do not affect community-level outcomes and need to be reinforced by changes in the broader environment in order to achieve sustained population-level effects (Room et al. 2005; Wagenaar and Perry 1994). In contrast, research suggests that prevention interventions that focus solely on altering the alcohol-related environment can be effective in reducing alcohol-related problems at a population level on their own (Babor et al. 2003).

Much of the research evidence demonstrating the effectiveness of changing the alcohol-related environment comes from studies of State-level alcohol policies (e.g., the age 21 minimum legal drinking age and alcohol excise taxes) (Elder et al. 2010; Wagenaar and Toomey 2002; Wagenaar et al. 2009). However, interventions that change the alcohol environment at the community level also can be effective (Hingson and Howland 2002). This review summarizes interventions that focus primarily on changing the community alcohol environment.

ALCOHOL-RELATED COMMUNITY INTERVENTION STUDIES

As described by Holder (2002, p. 906), "a 'community' is viewed as a set of persons engaged in shared social, cultural, political, and economic processes." An environment-based community intervention focuses on modifying this system such that the likelihood of alcohol use and/or related problems is reduced. Some of the issues addressed in these interventions include the following:

* Reducing underage access to alcohol from commercial (e.g., bars, restaurants, and liquor stores) or social providers (e.g., friends, parents, and coworkers);

* Decreasing alcohol availability among adults (e.g., by promoting responsible service of alcohol and increasing enforcement of alcohol-control policies);

* Increasing enforcement of drinking-and-driving laws; and

* Implementing awareness campaigns or expanding media coverage to increase awareness of and focus on alcohol-related issues.

No curricula or manuals exist that specify how to make these changes in the community. Moreover, each community is unique, complex, and not always predictable. But it is clear that without changing the community system--or the environmental determinants of behavior--the community system will continue to generate more individuals who need to be educated or treated in order to reduce alcohol use and related problems (Holder 2002; Wagenaar and Perry 1994).

Six environment-based community interventions that specifically focus on reducing alcohol use and alcohol-related problems have been developed and evaluated and are reviewed here, including Communities Mobilizing for Change on Alcohol (CMCA), the Community Prevention Trial (CPT), the Sacramento Neighborhood Alcohol Prevention Project (SNAPP), Saving Lives, Operation Safe Crossing, and Fighting Back.

CMCA focused on underage youth (i.e., those under the legal drinking age of 21). From 1993 to 1994, the program used a grassroots community-organizing approach to implement multiple strategies to prevent underage individuals from obtaining alcohol in order to ultimately reduce alcohol use and related problems (Wagenaar et al. 2000a). Communities located in Minnesota and Wisconsin were selected for the study on the basis of their size and geographic location--not on the basis of their readiness to work on this issue. Seven of these communities were randomly assigned to the intervention condition and eight to the comparison condition. In the intervention communities, various institutional policy and practice changes were implemented to reduce access to alcohol, such as alcohol compliance checks by law enforcement agencies at bars and liquor stores and enforcement of stricter drinking policies at community festivals (for a full description of the CMCA intervention, see Wagenaar et al. …

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