Strengthening Families and Protecting Children from Substance Abuse

APPENDIX B

Environmental Strategy 1: Policy
Environmental Strategy 2: Enforcement
Environmental Strategy 3: Education
Environmental Strategy 4: Communication
Environmental Strategy 5: Collaboration
Endnotes

Environmental change theory (described in Section I, Science-Based Prevention) holds that by altering the larger environment that many people share in their communities and their society as a whole, it is possible to bring about broad change that over time can dramatically affect the health and well-being of many people. As Michael Klitzner points out, "The shared environment [community and society] supports some behaviors and thwarts others."^[1]   Individuals, professional and community groups, and state and national organizations all can play a role and get involved in improving the environment in ways that contribute to prevention.

Environmental approaches focus on changing three interrelated factors in the shared environment: norms, availability, and regulations. Norms are defined as "basic orientations concerning the rightness, or wrongness, acceptability or unacceptability, and/or deviance of specific behavior for a specific group of behaviors."^[2]  For example, universities are using environmental strategies to change the accepted belief among college students that "binge" drinking is acceptable and normal behavior for themselves and their peers.

Availability refers to the effort and expenditure required to obtain a commodity. Banning cigarette vending machines from public places, cracking down on retailers who sell cigarettes to minors, and raising cigarette prices all make it more difficult for minors to smoke. This, in turn, could have an effect on the norms surrounding smoking: with fewer youth inclined to expend the effort necessary to smoke, the habit would become less common among youth and less obviously acceptable.^[3]

Regulations are the formalized laws or policies, such as those described above, that are used to control norms and availability. In addition to restricting availability of cigarettes, policies such as nonsmoking areas, restaurants, and workplaces can contribute to the perception of smokers being ostracized, which may affect the norms surrounding smoking.^[4]

Environmental strategies as a group

offer an attractive and effective complement to strategies targeted at individuals. They can help create communities and societies that are more conducive to bringing about and maintaining desired behavior changes. There are several reasons for the effectiveness of environmental strategies as a complement to strategies aimed at individuals and families:^[5]

Broad reach.

Compared to prevention strategies that focus on individuals or families, which seek to make changes in one person at a time, environmental strategies have the ability to reach entire populations, bringing about behavior changes among large numbers of people.

Enhanced effects.

Communities can achieve more substantial reductions in substance use when environmental influences are consistent with and reinforce the prevention messages directed at individuals. Many environmental strategies have been shown to substantially reduce consumption and use-related problems, including traffic crashes, unintentional injuries, suicide, cirrhosis mortality, and assault offenses.

Enduring effects.

Environmental strategies have the potential for long-term as well as short-term effectiveness. When states and communities succeed in making changes in the legal, economic, and social structures that affect substance use, these changes in turn may foster important shifts in both individual attitudes and community norms. In time, this change in the system may result in fewer opportunities and inducements to use substances.

Ease of maintenance and cost-effectiveness.

Environmental strategies have the potential to reach many people at comparatively low costs.

The following five types of environmental strategies can have a significant impact on climate and context:

• Policy

• Enforcement

• Education

• Communication

• Collaboration

Each is discussed in detail below, with a focus on how individuals can get involved in changing the larger environment. NOTE: These environmental strategies for preventing, reducing, or eliminating substance abuse also contribute to violence prevention.

Environmental Strategy 1: Policy

Public policies, laws, and regulations can be designed to limit access to substances and to decrease the problems associated with their use. You are probably familiar with many existing laws, such as:

• minimum purchase ages for tobacco and alcohol

• excise or "sin" taxes on alcohol and cigarettes to raise their prices

• "dram shop" laws, which hold institutions legally responsible for serving minors or visibly intoxicated patrons

• driving while intoxicated (DWI) laws

• restrictions on alcohol and tobacco advertising

• "zero tolerance" laws, which charge minors with DWI if they drive after consuming any alcohol at all

Some environmental policies, like the ones listed directly above, are developed and implemented by the government, usually at the state level. But there are many other regulations that can be put into place at the local level to achieve similar goals. These include:

• restrictions on smoking in public places (e.g., movie theaters and restaurants)

• open container laws prohibiting alcohol consumption in public places

• limits on the location, density, and hours of operation of liquor stores

• rules governing the use and placement of cigarette vending machines

• regulations on advertising and billboard placements in the community

Certain environmental policies can also be implemented by institutions or organizations: companies can declare themselves smoke-free workplaces; universities can decline to serve alcohol at their functions.

How People Can Get Involved

Just as environmental strategies take place at many different levels (government, community, institution), there are many ways in which individuals can get involved in developing and implementing policies that contribute to prevention.

Issues surrounding substance abuse have become important political topics in recent years. The offense of driving under the influence, for example, has received a lot of attention; many states, in response to local pressure, have recently reduced the legal blood alcohol content (BAC) limits for operating a vehicle. State congress people want to hear what their constituents think about issues like these. Writing letters to your representatives can be remarkably effective. Group lobbying can be even more effective; Mothers Against Drunk Driving (MADD) has been largely credited with bringing the problem of DWI into public view. Anyone can join MADD and similar groups.

Communities are run by the people who live in them. Any group can start a campaign like MADD, from the PTA to a neighborhood association or book club.

Similarly, a company is only as good as its employees. Towns like Brookline, Massachusetts, became smoke-free largely through the efforts of a group of local residents who successfully orchestrated a ballot initiative. In Brookline, the movement was started by employees at the town's Department of Health and was quickly joined by a variety of community members, including teachers, business owners, and private citizens. A group of employees can submit a petition to management that shows how many workers are negatively affected by smoking in the workplace. These kinds of environmental changes can certainly be effected by small groups of motivated employees.

Policy Illustration: Community Officials Pass Ordinances Restricting Outdoor Tobacco and Alcohol Advertising^[6]

A stroll through almost any inner-city neighborhood demonstrates what researchers know to be true. Alcohol and tobacco billboards saturate many communities, particularly urban and less affluent communities that lack the zoning regulations or the clout to keep billboards out. On one of these walks, it would be hard to miss the images of attractive people, often people of color, portrayed in images of sex, wealth, and happiness. You might also notice amusing, friendly characters such as the Budweiser Frogs or, until recently, Joe Camel.

It is impossible to shield children from these images. Unlike television or radio, billboards cannot be turned off. Unlike print ads, they cannot be restricted to adult-targeted magazines. In fact, many activists charge that alcohol and tobacco billboards deliberately target children when they use cartoon characters and talking animals. One study in an urban Latino community found that children passed as many as 60 alcohol advertisements on their way to school every day.^[7]

Four cities . Baltimore, Chicago, Compton (CA), and Inglewood (CA) . have passed ordinances that limit outdoor advertising for alcohol and tobacco. Other cities, including Seattle, Cincinnati, and Contra Costa County (CA), have voluntary agreements with billboard companies to remove tobacco billboards in areas frequented by children. Still other communities have similar arrangements or are in the process of drafting legislation. More than 30 communities nationwide have taken action against alcohol and tobacco outdoor advertising in child-sensitive areas.

Baltimore, one of the first communities to implement local ordinances against outdoor advertising of alcohol and tobacco, became the target for a lawsuit by Anheuser-Busch, the world's largest brewer. A company spokesperson warned that the brewer would "vigorously defend our right to advertise to adult consumers throughout the nation and in all media." Anheuser-Busch's lawyers argued that alcohol is a legal product, and therefore its advertising should not be treated differently than any other form of advertising.

The court disagreed. The decision was based on a precedent set by the U.S. Supreme Court in 1980 which allowed regulations to restrict commercial speech under certain conditions. The ruling in Anheuser-Busch vs.Schmoke found that the ordinance was legal for reasons including the following:

• Baltimore's goal of protecting the welfare and temperance of children is in the government's interest.

• The ban was limited to areas in the city where children are likely to be present.

• The regulations do not limit the company's ability to advertise in other venues.

• Billboards are an appropriate target for regulation because of their intrusiveness in a community.

• Children deserve special protections from aggressive marketing practices.

Anheuser-Busch appealed the decision in Anheuser-Busch vs. Schmoke, but it was upheld by the Fourth Circuit Court of Appeals. The brewer then appealed to the Supreme Court, which refused to hear the case.

It is likely that eventually the Supreme Court will hear a case on the rights of commercial speech with respect to products that are illegal for children. For now, however, two lower courts have stood in favor of Baltimore, and other cities are following its lead.

Environmental Strategy 2: Enforcement

If laws and regulations are to deter people and businesses from illegal behaviors, they must be accompanied by significant penalties and they must be enforced. Many more people would speed, for example, if speeding tickets cost only $5 or if police didn't use radar guns. Instead, drivers who might otherwise speed are deterred by the possibility of being pulled over and receiving a big fine and license "points."

Many of the laws designed to reduce the problems of alcohol, tobacco, and other drug use are not enforced or are enforced only sporadically, including:

• minimum purchase ages for alcohol and tobacco

• DWI and zero tolerance laws

• laws against possession and sales of illicit drugs

Furthermore, in some states the penalties for breaking these laws are not severe enough. If a retail alcohol outlet makes $400 a month from sales to minors but gets caught approximately once a year and fined $1000, those sales are still profitable; the store may well choose to risk being caught. On the other hand, if the fines were increased to $5000 or the likelihood of being caught increased to approximately once a month, the store would probably change its practice.

Just as the likelihood of being caught influences people's decisions to obey the law, so does their perception of the chances of being caught. For example, it has been estimated that the probability of a driver with a BAC of over 0.10 percent being arrested is between 1/1000 and 1/200; in other words, extremely low. Some people refrain from driving under the influence only for fear of being caught; if they actually knew the low probability, they might be more inclined to go ahead and drive. However, surveys show that driver perceptions of the likelihood of being caught are closer to 1/10.^[8]

The notion of perceived risk as a deterrent to criminal behavior has led to a variety of initiatives designed to improve awareness of laws and law Enforcement. Examples include:

• highway postings that notify drivers of helicopter speed patrols

• empty police cars parked on the roadside to act as speed trap decoys

• highly visible roadside sobriety checkpoints

• billboards and public-service announcements that describe penalties for certain offenses

How People Can Get Involved

As with Policy development, much of the burden of law Enforcement rests on the state. Yet pressure from constituents can encourage politicians and law Enforcement officials to crack down on these offenses. Here are some things you can encourage your law Enforcement agencies to do:

• conduct sting operations that target merchants who sell alcohol and tobacco to minors

• establish well-publicized sobriety checkpoints on popular roads and outside bars

• set up surveillance of areas known for illegal drug sales

• increase building inspections and enforce regulations to force landlords to improve or demolish run-down buildings

• make use of civil and criminal "nuisance abatement" statues, which require landlords to evict tenants involved in narcotics-related activities or risk personal prosecution

Law Enforcement officials, however, are not the only people who can help enforce laws designed to reduce access to alcohol, tobacco, and other drugs and the problems they cause. Individuals and community organizations can contribute by:

• conducting citizen patrols in neighborhoods known for illegal drug sales

• observing whether retail outlets are abiding by minimum age laws (e.g., do they check ID) and reporting those that do not

• organizing letter-writing campaigns to local and state politicians

Enforcement Illustration: Coalition Seeks to Raise Perceived Risk of Underage Drinking^[9]

Zero tolerance laws exist in every state and the District of Columbia.^[10] These laws make it illegal for youth under the age of 21 to drive after consuming any alcohol at all (usually measured as a BAC of 0.02 percent). Under zero tolerance, police officers may require a breath test from any driver under 21 who they suspect may have been drinking; the law does not require that the officer have probable cause to suspect actual impairment. Drivers who are found to have consumed alcohol may have their drivers. license revoked or suspended.

Young drivers place a high value on their drivers. license. The threat of losing it for three months would be a substantial deterrent for most young drivers. But many young people, unfamiliar with zero tolerance, do not know that they could lose their license for driving after consuming just one alcoholic beverage, even if they were pulled over for an unrelated offense.

The Connecticut Coalition to Stop Underage Drinking recently joined forces with the state Department of Transportation to increase public awareness of two sets of laws: the zero tolerance laws passed in Connecticut in 1995 and related laws against providing minors with alcohol, for which parents or other adults can be fined up to $1500 or go to jail for up to 18 months.^[11]  While these laws have been on the books for over three years, in the past they have not been strictly enforced.

The Coalition's campaign focuses much of its attention on outreach to local police departments, encouraging them to ambitiously enforce zero tolerance laws and laws that make it illegal to provide alcohol to minors.^[12]

The Coalition has also produced a series of print ads for newspapers, posters for community organizations, an outdoor billboard message, and two public service messages to be played on the radio. It has submitted many articles about the campaign to local Connecticut newspapers. The ads and articles describe the laws and their penalties as well as the dangers of underage drinking and driving. The intention of this media barrage is to dramatically increase awareness of the laws. Studies show that zero tolerance laws are particularly effective in reducing underage drinking and driving when the laws have been amply publicized.^[13]

According to the Coalition's project director, the campaign is looking to achieve several outcomes.^[14]  The most obvious is to increase compliance by raising awareness of the state's underage drinking laws. By calling attention to the dangers of drinking and driving, furthermore, the campaign hopes to increase public support for Enforcement of those laws. Police and other law Enforcement officials are more likely to arrest, convict, or revoke licenses if there is a clear public mandate to enforce youth drinking and driving laws.

Environmental Strategy 3: Education

In any situation that requires individuals to take action, Education is crucial. In order for environmental strategies such as Policy changes, Enforcement, and community Collaborations to be successful, the public must know what measures are available to them and what policies they are expected to follow.

Public awareness campaigns are discussed in more detail under Environmental Strategy 5. A variety of more specific Educational programs can contribute to successful environmental strategies. They include:

• server training programs that work with bartenders and wait staff to reduce service to minors and intoxicated customers

• Education of merchants about the laws and penalties for selling to underage customers

How People Can Get Involved

Educational strategies first and foremost require a recognition of need. Community members, as patrons of businesses in their communities, are in a good position to determine whether laws are being respected and whether business owners and employees are aware of their responsibilities and the potential penalties for failing to uphold them.

Educational programs are often conducted by knowledgeable professionals, but that does not exclude members of the community from becoming involved. They can:

• point out to the owners of businesses they patronize (e.g., restaurant owners) that their employees are not obeying laws (e.g., waiters are serving drinks to minors)

• suggest employee training to business owners

• in Collaboration with other community members and business owners, encourage the municipal government to provide server or owner training, or set up such training independently of the government

Education Illustration: University Implements Widespread Campaign to Encourage Responsible Beverage Service and Consumption^[15]

Binge drinking, the practice of consuming multiple drinks over a short period of time, is a serious problem at colleges and universities nationwide. A 1993 national survey of over 17,000 students at 140 four-year colleges and universities, conducted by the Harvard School of Public Health, found that 44 percent of the students surveyed were binge drinkers. Binge drinking was defined for men as consuming 5 or more drinks in a row in the past two weeks, and for women as drinking 4 or more, where a drink was 12 ounces of beer, 4 ounces of wine, or one shot of liquor.^[16]

Alcohol-related deaths on campus have figured prominently in the news in recent years, alongexposésxposés on date rape, drunk driving, and other dangerous behaviors associated with binge drinking. Students often attribute their drinking to the stress of academic responsibilities, peer pressure, or social structures such as fraternities and sororities, which encourage drinking to excess. Enforcement of a minimum drinking age is particularly difficult on college campuses, where there are students of all ages hosting parties and a limited number of Enforcement personnel.

In 1991, Stanford University received a three-year grant from the California State Office of Traffic Safety to reduce problems related to student drinking by encouraging responsible alcoholic beverage service. The Stanford Community Responsible Hospitality Project aimed to encourage members of the Stanford community to party safely, with or without alcohol, and to present a clear and consistent message of responsible drinking and hospitality.

One way to shift the focus away from alcohol consumption is to be more creative in planning parties by developing party themes, providing entertainment, and serving food and nonalcoholic beverages as well as alcohol. To this end, the project sponsored the development of a group of trained student peer educators called the Party Pro's. These students serve as consultants to students who are planning parties, by offering help in selecting themes, entertainment, decorations, food, and beverages as well as in budgeting, fund-raising, and promoting the parties.

The Party Pro's offer services well beyond party planning. Peer educators ensure that their fellow students are familiar with state and campus alcohol policies and laws, and help student groups such as fraternities and sororities develop policies for their social activities. They train student bartenders, as well as sober party monitors, who oversee the guests. They also train escort coordinators, who ensure that guests are using designated drivers or have other safe transportation at the end of the evening.

To further facilitate successful party planning, the project also sponsored quarterly Event Planning Fairs. The Fairs included presentations on liability issues and school policies and an overview of the services provided by The Party Pro's and the Office of Student Activities, as well as a trade show where local businesses, such as disc jockeys, party suppliers, caterers, and florists . promoted their services.

To ensure that students receive a clear and consistent message about responsible hospitality, the Stanford Community Responsible Hospitality Project established the Hospitality Alliance with local businesses and public safety officials. Members agree to promote responsible drinking and beverage service, and sometimes take action against those who do not. For example, student members of the Alliance joined with a local restaurant to voice complaints about another local establishment's ads in the campus newspaper, which offered 25-cent shots; the ads were subsequently dropped.

Although the project is no longer funded by the Office of Traffic Safety, the Hospitality Alliance and the Party Pro. s continue to function at Stanford. Findings from the project showed a positive change in the university's drinking environment; students are holding smaller and more controlled parties; using sober monitors and trained bartenders; checking IDs; and serving food and nonalcoholic beverages.

Environmental Strategy 4: Communication

Public perceptions about alcohol, tobacco, and other drugs play a significant role in their use. Glamorization of smoking, for example, has been linked to an increase in youth tobacco use. Policies restricting tobacco and alcohol advertising can begin to reduce the flood of positive portrayals of substance use that assaults us. Community organizations, lobbying groups, and other collaborative efforts can encourage the television and film industries to reduce their portrayals of drinking, smoking heroes. But these images are still pervasive: famous actors are photographed holding cigarettes and, lately, cigars, while many rock stars glamorize drug and alcohol use.

One way to counteract these omnipresent positive images is to educate the public about the true dangers of substance use. Public awareness can be developed in several ways:

• social marketing — using the principles of commercial advertising in public health or public service campaigns to make the message more effective

• media advocacy — using mass media to advance a public Policy initiative or message

• media literacy — fostering the ability to analyze and evaluate messages in the media

How People Can Get Involved

One of the most important things individuals can do to contribute to substance abuse prevention is be vocal. If two hundred people have the same opinion on a subject, but none of them make their beliefs known, the group will never know that they are united in thought and will not have the opportunity to organize. Youth often feel pressured to abuse substances because they are under the impression that "everybody is doing it." Ways in which individuals can affect public perceptions include:

• speaking up — talking about the dangers of substance abuse and what strategies you would like to take against them — at town meetings, and school or PTA functions, sharing opinions with friends, neighbors, and acquaintances and encouraging others to do the same

• writing it down — sending letters to the editor, op-ed pieces, and articles for community newsletters and anyplace else opinions might be read

• critically analyzing messages in the media — thinking about the images of alcohol, tobacco, and other drug use in the movies, on television, and in print media, and talking to fellow audience members, especially children, about whether those messages are accurate, whether they reflect reality, and whether they take into account the negative aspects of substance abuse

• informing local prevention groups and other community groups that you would be interested in participating in public outreach campaigns, message-testing focus groups, and other events

Communication Illustration: State Partnership Conducts Campaign to Counter Pro-Alcohol Messages Associated with the Mexican Holiday Cinco de Mayo^[17]

CalPartners, a California partnership of community substance abuse prevention organizations, began a campaign in 1998 to counter pro-alcohol messages and promote the true meaning of the Mexican holiday Cinco de Mayo, a family holiday of remembrance. It began with a list of six goals:

• promote alcohol- and tobacco-free Cinco de Mayo celebrations

• replace alcohol and tobacco sponsorships of holiday events with other sponsors

• encourage responsible service of alcoholic beverages at celebrations that do serve alcohol, and abstinence or moderate consumption among participants

• meet with alcohol and tobacco distributors and retailers to encourage them to market responsibly during Cinco de Mayo and not market it as a drinking holiday

• foster general awareness of the true meaning and family nature of Cinco de Mayo

• hold public protests of celebrations and advertisements that demean Mexican symbols and Latinos

To achieve their goals, CalPartners designed an action plan, with activities that people can take part in as individuals or members of community agencies or larger Collaborations. The following were among their suggestions:

• hold a kick-off press event

• secure endorsements from elected officials, the faith community, ethnic and health groups, and other local organizations

• send letters to and request meetings with event organizers, distributors, retailers, and advertising outlets (newspapers, radio and TV stations) asking them to not market or sell products that are marketed in an objectionable way

• seek sponsorships for alternative, alcohol-free events

• ask local Beverage Control representatives or local authorities to decline licenses for celebrations with records of past problems due to alcohol availability

• communicate with community, health, and business reporters at TV and radio stations and local newspapers about the mission

• hold public events that praise supporters; promote safe and positive celebrations; and protest celebrations and advertisements that are objectionable

• volunteer to help police departments administer and monitor responsible beverage service at celebrations serving alcohol, and promote awareness among attendees

CalPartners actively distributes information to help people join in its campaign. It has compiled a brief history about the true meaning of Cinco de Mayo as well as research about the effects of alcohol on Latinos. The group has also designed sample statements that can be sent to the press. All of this information is available on the World Wide Web (www.calpartners.org) or by mail. The organizers of the initiative are available to answer questions, supply promotional materials, coordinate statewide coalitions, and even travel to California communities to help organize.

Environmental Strategy 5: Collaboration

Individual members of a community can do many things to help prevent substance abuse. Groups of people working together can have an even greater effect. There are many types of possible Collaborations, and they can take place between any and all groups of people who have an interest in the community:

• parents

• police

• teachers, administrators, and other school personnel

• municipal agencies (e.g., departments of health and Education)

• community service providers

• business owners

• community groups (e.g., PTA, church groups, volunteer societies)

How People Can Get Involved

Professional Collaborations, for example among community service providers, can ensure that organizations avoid duplicating services and reallocate scarce resources to provide a wider variety of services. Police can work with schools to keep substances off school grounds. Business owners can unite and agree to prohibit smoking on their property. Organized groups of community members can do many things, including:

• encourage businesses to prohibit smoking

• make every effort to patronize businesses that act in accordance with community goals and not patronize those that do not

• pressure local officials to develop policies and improve Enforcement of laws designed to reduce the problems associated with substance abuse

• work with municipal officials and private landlords to improve, rebuild, or raze abandoned buildings that are used to engage in drug use, adolescent alcohol use, and other illegal activities

• reclaim public spaces such as parks and vacant lots by picking up trash, planting gardens, and in general spending time in the areas to discourage others from using the space for illegal activities

• make use of civil and criminal "nuisance abatement" statues, which require landlords to evict tenants involved in narcotics-related activities or risk personal prosecution

Collaboration Illustration: Community Group Uses Nuisance Abatement Laws to Clean Up the Neighborhood^[18]

Nuisance abatement has been part of common law since the sixteenth century. This concept can be applied to any vacant property that creates a nuisance to neighbors by interfering with their right to the quiet enjoyment of their property. A property might reasonably be considered a nuisance if, for example, it is used for drug dealing, has become infested by insects or rodents, or otherwise presents a physical danger or health threat to neighbors.

Any neighbor of such a property, whether an individual person or group, business owner, church, or other entity in the vicinity of the nuisance, can sue the owner of the property. Nuisance abatement law provides that as long as the neighbors provide adequate notice to the property owner, behave reasonably, and do not disturb the peace, they have the right to deal with the nuisance in an appropriate fashion if the owner does not, and then sue the owner for the cost of remedying the nuisance; the court then has the authority to order the owner to repay those costs. "Abating" the nuisance might include cleaning up the yard around the property, boarding up the building, or turning off the water.

The process an individual, group, or business follows for this type of nuisance abatement is to:

• identify nuisance property

• gather evidence, such as answers to the questions: Who owns the property? What is the nuisance? Are the police aware of the problem? Has the property been raided by the police?

• give the owner notice and request that the nuisance be abated

• after a reasonable amount of time, take action to abate the nuisance

• sue the owner for the cost of the action

Members of the Butcher's Hill Community of Baltimore put this common law to good use. An abandoned house in their neighborhood had become a magnet for drug use, drug sales, and other criminal activities, attracting undesirables from all over the city. After notifying the owner that they would board the property if he failed to do so, a group of residents sealed off all possible entrances to the house, using construction techniques specifically developed to keep buildings secure from trespassers. They also cleaned the yard and sealed the entrance to the property.

The community residents then sued the owner for the cost of labor and materials, approximately $350, and the District Court awarded them the full amount. The group now plans to use this technique to clean up other drug houses in their community.

Endnotes:

^[1]Klitzner, M. (1998). Integrating environmental change theory into prevention practice. Northeast CAPT Regional Summit: Environmental Strategies to Reduce Youth Substance Abuse. Providence, RI. Dec. 2-3, 1998.

^[2] Klitzner, M. (1998). Integrating environmental change theory into prevention practice.

^[3] Klitzner, M. (1998). Integrating environmental change theory into prevention practice.

^[4] Klitzner, M. (1998). Integrating environmental change theory into prevention practice.

^[5] Fischer, D. (1998). Environmental prevention strategies: An introduction and overview (draft). Rockville, MD: National Center for the Advancement of Prevention.

^[6] Abramson, H. (1997). Showdown on Main Street.The Marin Institute for the Prevention of Alcohol and Other Drug Problems Newsletter. 12; Abramson, H. (1997). Can They Ban These Boards?The Marin Institute for the Prevention of Alcohol and Other Drug Problems Newsletter.12; Mosher, J. and Jernigan, D. (1998). Overcoming the barriers: Implementing environmental approaches to prevent alcohol, tobacco, and illegal drug problems (draft, unpublished paper). Rockville, MD: National Center for the Advancement of Prevention.

^[7] Gregory, D. (1997). Triumph over billboards. San Rafael, CA: Marin Institute.

^[8] Ross, H. L. (1992).Confronting drunk driving.New Haven: Yale University Press, 68.

^[9] Connecticut Coalition to Stop Underage Drinking. (1998). Zero tolerance public awareness campaign launched. Press release, Dec. 1.

^[10] Alcohol-Related Injury and Violence Center (ARIV) (1998). Drinking and driving: A brief review of the literature. The Trauma Foundation.

^[11] Sciarretta, J. (1998). Zero tolerance public awareness campaign launched. Press release, Dec. 1, Connecticut Coalition to Stop Underage Drinking.

^[12] Straw, J. (1998). Drive aims to halt booze-wheels mix.New Haven Register,Dec. 8, C1.

^[13] Hingson, R., Heeren, T., and Winter, M. (1994). Lower legal blood alcohol limits for young drivers.Public Health Reports,109:6, 738-744.

^[14] Personal correspondence, Dawn Homer-Bouthiette.

^[15] Responsible Hospitality Service (July 1996).Prevention Updates.Higher Education Center for Alcohol and Other Drug Prevention; Preventing alcohol-related problems on campus: Impaired driving. Higher Education Center for Alcohol and Other Drug Prevention; Kiner, S. (1993). Stanford's new way to party ...safely.Prevention File, 17-20.

^[16] Wechsler, H., Dowdall, G., Davenport, A., and DeJong, W. Binge drinking on campus: Results of a national study.Bulletin Series: Alcohol and Other Drug Prevention. Higher Education Center for Alcohol and Other Drug Prevention

^[17] Available online: http://www.calpartners.org, CalPartners Coalition, Sacramento, CA. 1998.

^[18] Available online: http://www.baltimoremd.com/community/claw, Community Law Center, Inc., Baltimore, MD. 1997.