SHOWCASE OF EVIDENCE-BASED ENVIRONMENTAL STRATEGIES

1. SHOWCASE OF EVIDENCE-BASED ENVIRONMENTAL STRATEGIES Presented by: Workgroup on Evidence-Based Practice (WEB) Presented for CAST Date: January 26, 2011

2. Agenda • Brief history/goals of WEB group • Definitions of evidence-based • Logic models for preventing DUI and underage drinking • Overview of enforcement strategies • Lunch • Review of additional environmental strategies • Question and Answers • Next Steps

3. Background on WEB • WEB (Workgroup on Evidence-Based) began in January 2010 as condition of SPF-SIG. • Wanted the Cohort 4 states to learn from previous states about what works. • Wanted continued update of the literature. • WEB should work to compile literature that is customize for each state’s priorities.

4. Who is on the WEB? • Co-chairpersons: Drs. Pam Imm and Abby Fagan • Community and state-level experts • See handouts of presenters/agencies • Coaches attend WEB meetings • Staffed by PIRE and other DAODAS staff • Report to the Executive Committee and to the Governor’s Council

5. Goals of WEB • Compile literature on the evidence-based practices for the state’s priorities. • Ensure the use of EBP in the counties • Current Roles: • Compile literature on EBP for CAST • Provide training on EBP for CAST • Provide recommendations for SC Toolkit • Provide recommendations to Governor’s Council about the county strategic plans

6. Format for Showcase • Overview of strategy • Key terms/definitions • Relation to logic model and needs/conditions • Needs assessment data sources to review • How do we know it is evidence-based? • Current status in South Carolina • What are the key elements of implementation?

7. WEB MEMBERS • Dr. Pam Imm, Chair LRADAC • Dr. Abigail Fagan, Co-Chair University of South Carolina • Barbara Brown Clemson University • Ann Crawley Community Initiatives, Inc. • Regina Creech Region 4 Capacity Coach, Ernest E. Kennedy Center • Rhonda DiNovo West Columbia Police Dept. • Dawn Hancock Region 3 Capacity Coach, Circle Park Behavioral Health Services

8. WEB MEMBERS (cont.) • Donna Herchek Counseling Services of Lancaster • Lou Anne Johnson Region 1 Capacity Coach, The Phoenix Center • Beth Mackinem SC Dept. of Education • Pam Rush Axis 1 Center of Barnwell • Curtis Reece The Phoenix Center • Eunika Simons Richland School District 2 • Kim Smith SC Dept. of Education • Kristy Stoneburner Region 2 Capacity Coach, LRADAC • Lorene Welch SC PTA

9. WEB STAFF • Steven Burritt PIRE • Michael George PIRE • Crystal Gordon DAODAS • Kerry McLoughlin DAODAS • Elaine Dowdy Melvin PIRE • Michelle Nienhius DAODAS • Brenda Powell DAODAS

10. Overview of Evidence-Based Strategies Dr. Abigail Fagan, University of South Carolina Dr. Pam Imm, Lexington/Richland Alcohol and Drug Abuse Council Prepared for CAST: Jan 26, 2011

11. What Does Evidence-Based Mean? OVER THE LAST THREE YEARS, OVER 220 COMMUNITIES HAVE STARTED NEW D.A.R.E. PROGRAMS! “Even little ones can think and respond when guided with Love and Logic." -Linda, Anderson, CAGrandparent The Community Trials Intervention produced significant results, including: decreased alcohol sales to youth and decreased binge drinking.

12. Program Evaluation On the one hand…. On the other hand… Ask two questions: • Does it work? • How do you know it works?

13. Does it Work? • Yes (“Pretty good” evidence) • There are meaningful changes in the outcomes you are interested in for participants or communities who received the intervention • Look for actual statements regarding changes (e.g., statistics and graphs) • There are no harmful effects on participants

14. Effects of the Life Skills Training Program on Adolescent Alcohol Use Source: Botvin, Baker, Dusenbury, Botvin, & Diaz, 1995

15. Does it Work? • YES! (the “Best” evidence) • Effects were sustained over time • Effects were replicated in multiple studies • And were shown for a variety of populations • And were assessed by independent evaluators

16. How do you know it works? • Effects were found during a strong, carefully conducted study • One group, pre/post test design: the most common type of study; results may not be as valid • Quasi-experimental design: participants are non-randomly assigned to intervention and “comparison” groups • Experimental research design: participants are randomly assigned to receive the intervention or not (i.e., involves a “control group”)

17. Why have a comparison group? • Guards against falsely concluding that an effective program didn’t work • Guards against falsely concluding that an ineffective program did work • Helps rule out other possible explanations for the change

18. How do you know it works? • Other important questions to ask: • How many participants were involved in the study? • How many participants dropped out of the research project (why?)? • What happened to participants in the control group?

19. How is this relevant for your work? • The WEB group has reviewed the evidence and will summarize what works regarding environmental strategies • It’s still important to look at the details of how well and for whom these strategies are effective. Fortunately, much of the research has been done for you and the WEB has consolidated the research for you.

20. What is meant by environmental strategies? • Looks to change the conditions in the environment. • Individual change: • Focus: Individual behavior • Goal: Personal control of alcohol • Tools: Education, treatment, small group activities • Who: Professional and client; educator and student

21. What is meant by environmental strategies? (cont.) • Move from individual to environmental • Environmental change • Focus: policy, laws, norms • Goal: Community control of alcohol • Tools: Media and policy advocacy, social pressure • Who: Coalitions, stakeholders, community organizers

22. Foundation of Key Principles • Substance use is a public health challenge requiring a public health approach. Select Sources: IOM, 2004; SAMHSA/CSAP, SPF Grants, 2004 - Host(individual) Environment (social, physical, other contexts of use) Agent (ATOD)

23. Foundation of Key Principles (Cont.) • A complex system of factors produces substance use and related problems. Select Sources: Birckmayer et al., 2004; IOM, 2004 • Multiple points of intervention • Varied levels of influence • Assessment • Then comprehensive and synergistic approach

24. Foundation of Key Principles (Cont.) • Prevention requires a shift from “select an intervention” to “prevention by design” for widespread impact • From “intervention-based” approach focused on individuals • To a “diagnostic” approach focused on population-level change Select Sources: SAMHSA/CSAP, SPF Grants, 2004 - ; Green & Kreuter, 1999 Intervening Variables, R/P Factors SUBSTANCE USE and RELATED CONSEQUENCES SCIENTIFIC KNOWLEDGE ABOUT PREVENTION STRATEGIES

25. Existing Products, Research, and TAExamples of Advances in the Last Five Years The Surgeon General’s Call To Action Logic Model on Underage Drinking Trends in Underage Drinking NIAAA $’s and Cents Cost Benefit Analyses Assessing The Fidelity SPF Cross-Site Reducing Underage Drinking 2006 2007 2005 2008 2010 IOM Report on Preventing Disorders Task Force on Prevention Services Findings Assessing Drug Abuse NIDA / CEWG Environmental Strategies Guide Epidemiology Workgroup Toolkit Getting To Outcomes: SPF 2009

26. Underage Drinking/DUI What do we know? • Economic availability – Strong evidence that PRICE reduces use and associated harms • Retail availability – Strong evidence that physical and commercial access reduces use and associated harms • Minimum purchase age laws • Outlet density restrictions • Prohibition of minors from bars • Controls on who can sell and when • Internet monitoring • Enforcement is directly related to policies – strong evidence that threat of and actual enforcement deters use and reduces associated harms

27. Underage Drinking/DUI What do we know? (Cont.) • Social availability and access (intervention evidence is limited yet evolving) • Minor in possession laws • Penalizing adult procurement for youth • Interventions evolve as sources evolve • Media/Promotion most effective when supporting specific policies or enforcement efforts • By itself, little effect on behavior • Some lessons to be learned from tobacco • Norms are related to policies and behavior, but temporal relationship less clear

28. What types of environmental strategies work to reduce underage drinking and DUI? • Enforcement (compliance checks, traffic safety checkpoints) • Happy Hour restrictions • Restricting sales at Public Events • Responsible Beverage Service • Social Host Laws • Graduated Drivers’ License Laws • Keg Registration • Reducing Alcohol Outlet Density • Increasing Taxes on Sales of Alcohol

29. How do I know which to pick? • Pull out logic models (DUI/underage drinking) • You are to create a strategic plan (it will never be one strategy) • Pick your strategies based on the data collected from needs/resource assessment • Should be a match between what needs assessment data are telling you and what environmental strategies you choose. • Examples of good match and not so good

30. INCREASING TAXES ON SALES OF ALCOHOL Eunika Simons Reconnecting – Richland 2

31. Increasing Taxes on Sales of Alcohol • Overview: The overall price of alcohol affects how much people will consume, which in turn, affects the level of alcohol-related problems. • The primary way to make alcohol more expensive is through increasing taxes on the sale of alcohol. • Research indicates that higher taxes lead to a reduction in the levels and frequency of drinking and heavy drinking among youth, lower traffic fatality rates and reduced incidence of some types of crime.

32. Terms • Adjusting taxes to the rate of inflation: One way to raise taxes is to “catch up” the current tax rate to what it should be after accounting for inflation and then index the alcohol taxes to increase with inflation for future years. • Alcoholic Beverage Control States: Certain states have a state monopoly over the wholesale and/or retail pricing and distribution of some or all categories of alcoholic beverages. (Southeastern control states: Alabama, North Carolina, Mississippi)

33. How does it work? • Decreasing access/availability of alcohol by raising prices through tax increases.

34. South Carolina Alcohol Sales Tax Rates (per gallon) January 2009 In short, South Carolina has close to an average sales tax on spirits, a high tax on wine, and a very high tax on beer. Current Status in SC

35. Key Elements of Implementation • Determine what the current tax rate is for your state/community. • Learn what the exact rate is in your state. • Conduct analysis on what tax rate should be raised to.

36. Key Elements of Implementation (cont.) • Compile data and evidence that supports alcohol tax increases. • Begin building community support for this strategy from lawmakers, key stakeholders and the public at large. • Identify immediate, intermediate and long-term outcomes of the strategy.

37. Relation to Logic Model • Key Risk Factors • Social norms favorable toward use • Easy retail/social access • Low or discount pricing • Data Sources • Environmental Scan • Community/Key Leader Surveys • Department of Revenue • Alcohol Commission

38. Alcohol Tax Increases • Implemented at state and federal levels • Are beverage-specific • Based on the amount of beverage purchased • Not on the sales price • Effects erode over time • Inflation • Industry promotions • Price reductions to offset taxes • Need to adjust tax amount • Support based on 73 studies • Reductions in consumption and harms

39. Controlling Alcohol Outlet Density and Location • Overview: Geographic areas with increased alcohol outlet density have increased levels of heavy drinking and alcohol-related problems, including violence, crime, alcohol-related traffic crashes and injuries. Geographic buffers between alcohol establishments and youth-related areas (schools, parks) help reduce accessibility by making it less prevalent in their immediate environment.

40. Definitions/Terms • Alcohol licensee: Paid $ to receive a license to serve alcohol on premise or off-premise (or both) from Department of Revenue (DOR). • Alcohol outlet density: Number of outlets that can sell alcohol within a given geographic area • Geographic density • Economic density • Population density

41. Relation to Logic Model • Key risk factors: • Social norms favorable toward use • Easy retail/social access • Insufficient enforcement • Data sources: • Youth surveys (CTC) • Environmental scan • Community/key leader surveys • Crash data

42. How do we know it is evidence-based? • Higher density contributes to increased alcohol-related problems including sales to minors. Both Off and On premise outlet density is positively related to frequency of underage driving after drinking and riding with drinking drivers among 16-20 year old youth. • Outlet density related to drinking and drinking- related problems among college students.

43. Evidence (continued) • The CDC Task Force on Community Preventive Servicesrecommends the use of regulatory authority (e.g., through licensing and zoning) to limit alcohol outlet density on the basis of sufficient evidence of a positive association between outlet density and excessive alcohol consumption and related harms. 

44. Resources • Campbell CA, Hahn RA, Elder R, Brewer R, Chattopadhyay S, Fielding J, Naimi TS, Toomey T, Briana Lawrence B, Middleton JC, Task Force on Community Preventive Services. The effectiveness of limiting alcohol outlet density as a means of reducing excessive alcohol consumption and alcohol-related harms.Am J Prev Med 2009;37(6):556-9. • Task Force on Community Preventive Services. Recommendations for reducing excessive alcohol consumption and alcohol-related harms by limiting alcohol outlet density.Am J Prev Med 2009;37(6):570-1.

45. Application for License/Permit • Public notification of intention to sell alcohol (e.g., newspaper) • Who is applying and address of location • To object, written protest must be notified by (date) including: • Name, address, and telephone number of person filing • Specific reasons why the application should be denied • That the person protesting is willing to attend a hearing (if requested by the applicant) • That the person resides in the same county where the proposed place of business is located or within five miles of the business, and name/address of applicant and location

46. Address • Protests must be mailed to Department of Revenue • Attn: ABL • P O Box 125 • Columbia, SC 29214 • Fax: 803-898-5899

47. Key elements of implementation • Determine law (local and state) • Get champions on your side • Ensure a geographic buffer zone of about 1000 feet between outlet and schools, playgrounds, residential neighborhoods, etc • Work to restrict these outlets • Consider conditional permits • Increase community’s awareness/knowledge that they can protest issuance (newspaper)

48. Media • Media is a powerful resource but is NOT EFFECTIVE on its own. • Couple media efforts with other activities; publicize the activities of other activities (e.g., compliance check activities, merchants who don’t sell, school TV stations, sobriety checkpoints). • Combined with multi-component community efforts /variety of new media options • Deterrent effect – increase perceived risk of detection

49. Take-Away Messages • A complex system [still] produces substance use • Prevention is more than packaged programs and strategies – it is a strategic, comprehensive design process of planning, implementation, and evaluation • No single program component or strategy can prevent multiple and complex risk behaviors, reduce related harms, and achieve widespread and lasting change. • Need individual and population-based approaches that target high risk situations and use in general

50. Take-Away Messages Cont. • Education programs (alone, small, limited effects) should be used within broader environmental approaches to address availability of alcohol • Policies need to target both underage drinkers AND the general population • Help eliminate adult suppliers and role models • Reduce social acceptability of adult provision • Researchers, policymakers, and practitioners all have important perspectives. We can advance the field by working and learning together!