Environmental Approaches to Prevention: Useful Findings and Practical Guidance
Communities all across the country are increasingly aware of the health and social problems related to alcohol use. Alcohol related traffic crashes, of course, are a visible and well-known consequence of the risky or inappropriate use of alcohol. Other problems also have costly and sometimes tragic consequences, including other accidental injuries, violence, risky sexual behavior, addiction, and chronic disease.
The Prevention Research Center (PRC) of the Pacific Institute for Research and Evaluation is funded by the US National Institute on Alcohol Abuse and Alcoholism to carry out research on alcohol problems and ways to prevent these problems. The emphasis of most PRC projects is on the reduction of alcohol-related problems through the changing social environments rather than through working with individuals who have or who may develop alcohol-related problems. The distinction between these two types of strategies is explained further below.
What are environmental strategies?
Society often looks to individual solutions to alcohol problems, trying to educate and persuade individuals to abstain or to drink more responsibly. These approaches are important and are often essential to helping people in crisis. On the other hand, individual approaches tend to be inefficient since they only affect those specific people who participate in the program. Moreover, it is extremely difficult to change the behavior of individuals or to protect them from risk when the social environment makes alcohol easily available, attractive, inexpensive, and socially and legally acceptable.
A group of strategies that focus on changing social environments with regard to alcohol have been shown to be highly effective. These strategies change the availability of alcohol in states and communities and the ways in which alcohol is promoted. They also enhance the enforcement of laws concerning alcohol. Using these strategies can empower states and communities to take charge of their own environment and help them to provide a healthier setting for their residents.
An analogy may help clarify the difference between environmental and individual strategies. In the case of a physical disease, such as malaria, it is important to provide treatment for people who have contracted the disease. It is also be important to inoculate as many people as possible to prevent the occurrence of the disease. Campaigns to persuade people to use mosquito netting and insect repellent might also help prevent malaria. But perhaps the most efficient and effective way of preventing the disease is to change the environment to prevent mosquitoes from breeding and spreading the disease. In the same way, while a community provides treatment for people with alcohol problems and prevention programs to help young people avoid alcohol problems, it also takes steps to create a healthier environment for everyone.
A healthy alcohol environment makes it easier for people with alcohol problems to avoid alcohol abuse and some of the most serious consequences of abuse. It makes it easier for young people under 21 to abstain from alcohol. It makes it is easier for everyone to make safe and healthy decisions about alcohol use.
What progress have we made in reducing alcohol problems in this country?
Alcohol consumption has actually declined in recent decades, as have some of the most visible and obvious consequences of alcohol abuse. For example, alcohol-related traffic crashes have decreased dramatically in the last 25 years (1). One area in which significant progress has been made has been among young people. Since the drinking age was raised to 21, there have been decreases in alcohol-related traffic crashes (2), other traumatic injuries, and other alcohol-related problems (3). This progress indicates how a policy change can reduce alcohol use and problems. Obviously, serious problems related to drinking are still all too common. Alcohol use is associated with violence, suicide, risky sexual behavior, birth defects, and other health and social problems (4). The problem of alcohol dependency is still widespread. Fortunately, we have developed a variety of effective strategies to help ameliorate these problems and therefore there is the potential for further progress.
What are key environmental strategies?
Because alcohol is a legal product regulated by law, there are many strategies that can be used to change the environment and thus change drinking behavior and problems. These strategies can be classified in four general categories:
- Controls on availability and access
- Controls on price
- Controls on promotion
- Controls on behavior under the influence of alcohol
PRC scientists have carried out research in all of these areas. Each of these categories is described briefly below.
Controls on availability and access
Availability of and access to alcohol can be controlled at the federal, state, and local levels through:
- limitations on the number, type, density, and location of retail alcohol outlets,
- controls on hours of sale,
- restrictions on venues in which alcohol is sold,
- restrictions on the type of product sold (e.g., no sales of single chilled cans of beer),
- Restrictions on people who may purchase (no sales to minors or intoxicated persons).
There is considerable evidence to indicate that changes in availability and access can affect drinking behavior and problems (5). Strategies can involve changing laws and policies to restrict availability and access or changing practices to make existing laws and policies more effective.
In Salinas, California, a community group concerned about the over-concentration of alcohol outlets was successful in blocking the liquor license of a retailer wishing to locate in the neighborhood. Instead, a childcare center was opened on the site.
Many communities around the country are reconsidering the role of alcohol in public festivals and celebrations. For example, in Ellis County, Kansas, citizens became concerned about the toleration and even encouragement of public drunkenness and underage drinking at their Oktoberfest celebration. They changed alcohol service policies and improved the atmosphere of the event. In Salinas, California, concerns about drunkenness, drinking and driving, and underage drinking led the community to limit alcohol sales at its Big Hat Barbecue. Today the event is popular, enjoyable, and safer for everyone.
Controls on price
The research evidence consistently shows that consumers respond to the price of alcohol – they drink more when alcohol is cheap and less when alcohol is expensive (6). Price can be controlled through taxation at the federal, state, and local levels. It can also be controlled by laws or policies with regard to allowable retail pricing. For example, some jurisdictions have outlawed all-you-can-drink or two-for-one price promotions in bars. Price policies can also be changed through the voluntary action of retail establishments.
A PRC project is working with city government and retailers in Tijuana, Mexico to develop more responsible beverage service practices, including limiting low price and all-you-can-drink promotions. The establishments in Mexico often draw young and underage drinkers from the US, who put themselves and others at risk by excessive drinking.
Controls on promotion
Alcohol is promoted through a variety of means including advertising in the mass media, billboards, sponsorship of public events (e.g., community festivals, sporting events), and in-store displays. There is research evidence that exposure to alcohol advertising makes children more likely to have positive attitudes towards alcohol and to drink as they grow older (7). The research evidence on the impact of controls on promotion is not clear, but changes in alcohol promotion have been viewed as one way of reducing positive messages about alcohol in the social environment and expressing community norms about alcohol.
In New Mexico, “The Gathering of Nations,” a major Native American celebration, chose to eliminate a beer company as one of its sponsors, instead accepting donations from a dairy product manufacturer.
Young people in Oceanside, California mailed letters to stores requesting that they avoid in-store displays exploiting Halloween images to advertise beer. The young people followed up with personal visits to store managers to persuade them to remove the displays.
Controls on behavior under the influence of alcohol
Society has recognized that drinking can cause problems when it is combined with some activities, such as driving. Therefore there are laws and policies to restrict alcohol consumption when carrying out these activities. Besides laws prohibiting driving under the influence of alcohol, there are policies and rules prohibiting drinking while performing some jobs.
Strengthened laws related to drinking and driving as well as more vigorous and effective enforcement of these laws has been effective in dramatically reducing impaired driving crashes. There is also evidence that some workplace rule changes with regard to alcohol have reduced accidents and problems in these workplaces.
Besides having needed laws on the books, states and communities have worked for better enforcement of these laws.
The Checkpoint Tennessee campaign implemented well-publicized sobriety checkpoints all over the state every weekend. This vigorous enforcement campaign resulted in a 20% reduction in alcohol-related fatal crashes statewide.
1. National Highway Traffic Safety Administration (2000), Traffic Safety Facts, 1999. U.S. Department of Transportation, Washington, D.C.
3. Jones, N., Pieper, C., and Robertson, L. (1992). The effect of legal drinking age on fatal injuries of adolescents and young adults. American Journal of Public Health 82:112-115.
4. Costs of Underage Drinking (1999), prepared by Pacific Institute for Research and Evaluation for OJJDP’s Enforcing the Underage Drinking Laws Program, U.S. Department of Justice.
5. For discussion of these issues, see Edwards, et al. (1994), Alcohol Policy and the Public Good. New York: Oxford University Press.
6. See Edwards, et al. (1994) above.
7. Grube, J. W., & Wallack, L. (1994). Television beer advertising and drinking knowledge, beliefs, and intentions among schoolchildren. American Journal of Public Health, 84(2), 254-259.