PREVENTION:
WHAT’S SCIENCE GOT TO DO WITH IT?

CSAP’s Northeast Center for the Application of Prevention Technologies

Funded by the Center for Substance Abuse Prevention (CSAP), Substance Abuse and Mental Health Services Administration Grant # UD1SPO8999-01.

© 2001 Education Development Center, Inc. All rights reserved.

 

THE PURPOSE OF THIS PACKET

Around the northeast region, community practitioners and State leaders in a range of fields—e.g., transportation, criminal justice, social services and public health—are exploring ways to build collaborations and develop support for their initiatives.

CSAP’s Northeast Center for the Application of Prevention Technologies (CAPT) works in the region to effectively transfer knowledge to the local level and strengthen local capacity to prevent and reduce alcohol and other drug use in youth ages 12–17. Part of Health and Human Development Programs at Education Development Center, Inc. (EDC), Newton, Massachusetts, the Northeast CAPT serves the six New England and five mid-Atlantic States to improve substance abuse prevention.

There are four key features of CSAP’s Northeast CAPT:

• Collaboration: Supporting collaboration among State agencies and among State partners and national organizations
• Science-based prevention: Translating the research on prevention, and applying this knowledge to product development, trainings, and technical assistance
• Systems development: Increasing States’ capacity to support and sustain the application of effective practices
• Technology: Increasing access to and use of technology by maintaining a strong, user-friendly website that offers products and services

This packet was designed to provide a succinct set of materials to help spread the word about what works in prevention and what people can do to support prevention that works.

We hope that you will share this packet with colleagues in your State. When agency leaders, media representatives, legislators, State and local decision makers, prevention practitioners, and ordinary citizens know what does work, they can concentrate their efforts, time, and dollars on the prevention strategies that are most likely to get results.

Q. WHAT WORKS IN SUBSTANCE ABUSE PREVENTION?

A. SEVEN KEY STRATEGIES ARE SUPPORTED BY RESEARCH THAT SHOWS THEY CAN BE EFFECTIVE.

Over a 25-year history of substance abuse prevention, some efforts have paid off and others have not. Researchers have now made great strides in identifying effective programs, strategies, and principles that focus on preventing and reducing substance abuse and related risky behaviors. For the Center for Substance Abuse Prevention (CSAP), Gardner and Brounstein have identified some key principles of effective substance abuse prevention.¹ From these, CSAP’s Northeast CAPT has specified the following seven effective prevention approaches:

• Policy
• Enforcement
• Collaboration
• Communications
• Education
• Early Intervention
• Alternatives

Not all strategies are equally strong. All are more effective when used in conjunction with others. Policy is most effective if paired with collaboration and communications. Education, usually insufficient to produce long-lasting change on its own, works best when paired with a strategy such as enforcement of laws against service to intoxicated patrons and sales to minors. Communications is most likely to be effective if combined with more interactive strategies, such as education, policy, and/or enforcement.

Using multiple strategies in multiple settings, working toward a few common goals, offers the best chance to prevent young people from using alcohol, tobacco, and other drugs.

What Is "Science-Based Prevention"?

Science-based prevention is an approach to making change.

• It is guided by several theories of change:

– Individual change theories, including theories of addiction, risk, and resiliency

• Intra- and interorganizational change theories
• Community change theories, including community organizing, policy change, and public health theories
• It applies evidence from rigorous evaluation research on prevention practices.
• It follows a process of strategic planning that focuses on integrating thoughtful assessment, design, implementation, and evaluation into every program.

Multiple strategies in multiple settings, working toward a few common goals.

POLICY FACT SHEET

Public policies—laws and regulations—can be designed to limit access to substances and to decrease the problems associated with their use. One reason policies work is that they create a change in the environment itself (in contrast to efforts that aim at individual behavior change). Policy strategies are most likely to be effective if they do one or more of the following:

• Increase the price of alcohol or tobacco
• Set the legal blood alcohol content (BAC) limit to 0.08
• Set the legal BAC limit to 0.00 (or no higher than 0.02) for people under the age of 21
• Provide deterrents to using alcohol or provide incentives for not using
• Limit the location and density of alcohol retail outlets
• Restrict the use of tobacco in public and private workplaces

Some environmental policies are developed and implemented by the government, usually at the State level. But many other regulations can be put into place at the community level to achieve similar goals. For instance:

• 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 placement in the community
• Institutions or organizations can implement certain environmental policies; for example, companies can declare themselves to be smoke-free workplaces, and universities can decline to serve alcohol at their functions.

POLICY ILLUSTRATION

Officials Pass Ordinances Restricting Outdoor Tobacco and Alcohol Advertising²

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 neighborhood mobilization to keep such billboards out. On one of these walks, it would be hard to miss the images of attractive people, often people of color, portrayed as sexy, wealthy, and happy. 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. And, unlike print ads, they cannot be restricted to adult-targeted magazines. In fact, many activists charge that alcohol and tobacco billboards deliberately target children by using 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.³

Baltimore, one of the first communities to implement local ordinances against outdoor advertising of alcohol and tobacco, became the target of 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 from any other form of advertising. The court disagreed, basing its decision on a precedent set by the U.S. Supreme Court in 1980, allowing regulations to restrict commercial speech under certain conditions. The ruling in Anheuser-Busch v. Schmoke found that the ordinance was legal for several reasons, including the following:

• Baltimore’s goal of protecting the welfare and temperance of children was in the government’s interest.
• The ban was limited to areas in the city where children were likely to be present.
• The regulations did 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 v. 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 the Supreme Court will eventually 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.

ENFORCEMENT FACT SHEET

If laws and regulations are actually going to deter people and businesses from illegal behaviors, they must be accompanied by significant penalties and they must be enforced, through surveillance, community policing, and arrests. Many more people would speed 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 insurance penalties.

Enforcement strategies are most likely to be effective if they do one or more of the following:

• Ensure that retailers comply with minimum purchase age laws for tobacco and alcohol
• Limit driving privileges for those who violate minimum purchase age laws
• Limit driving privileges for those caught driving under the influence (DUI) of alcohol or other drugs
• Involve public enforcement of impaired driving laws
• Pair enforcement of the laws against service to intoxicated patrons and sales to minors with server training
• Employ citizen surveillance and nuisance abatement programs

Many of the laws designed to reduce the problems of alcohol, tobacco, and other drug use—e.g., minimum purchase ages for alcohol and tobacco, DUI and zero-tolerance laws, and laws against possession and sales of illicit drugs—are not enforced or are enforced only sporadically. In some States, weak penalties for breaking these laws do not act as deterrents. If a liquor store makes $400 a month from sales to minors but gets caught and fined $1,000 only once a year, those sales are still profitable. On the other hand, if the fine was increased to $5,000, 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 more than 0.10 percent being arrested is approximately 1 in 1,500—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 odds of being caught are closer to 1 in 10.⁴

The idea that perceived risk deters criminal behavior has led to initiatives designed to improve awareness of laws and law enforcement, such as the following:

• 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

ENFORCEMENT ILLUSTRATION

Coalition Seeks to Raise Perceived Risk of Underage Drinking⁵

Zero-tolerance laws exist in every State and the District of Columbia.⁶ 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 driver’s licenses revoked or suspended.

The Connecticut Coalition to Stop Underage Drinking recently joined forces with the State Department of Transportation to increase public awareness about 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 $1,500 or go to jail for up to 18 months.⁷ While these laws have been on the books for more than three years, until recently they were not 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.⁸ The Coalition has 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 also submitted many articles about the campaign to newspapers throughout Connecticut. 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 such laws are particularly effective in reducing underage drinking and driving when they have been amply publicized.⁹

According to the Coalition’s project director, the campaign is looking to achieve several outcomes.¹⁰ The most obvious is to increase compliance by raising awareness of the State’s underage drinking laws. Furthermore, by calling attention to the dangers of drinking and driving, the campaign hopes to increase public support for enforcement of these laws. Police and other law enforcement officials are more likely to arrest or convict offenders or revoke licenses, if there is a clear public mandate to enforce youth drinking and driving laws.

COLLABORATION FACT SHEET

If 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. "Collaboration is a mutually beneficial and well-defined relationship entered into by two or more organizations to achieve results they are more likely to achieve together than alone," say two experts on collaboration.¹¹

Community, interagency, and intra-agency collaborations are three common types. Collaborations often begin with just informal networking. Agencies may next develop cooperative agreements and share information, but not define a shared mission or structure. They may then move into a phase of coordination that includes some planning and division of roles. Ultimately, these partners may arrive at a full collaboration, which may include a shared mission statement and set of goals; interagency agreements that spell out tasks and responsibilities for each member agency; commitments of resources; and revised policies, procedures, and systems (e.g., for record-keeping) that are compatible and mutually supporting.

One study of organizations across States, each involved in at least one collaboration, identified these characteristics of an effective partnership:¹²

• The collaboration addresses an important need and has broad support and involvement from the community.
• Membership is inclusive (8 to 14 partners is not unusual).
• Decision-making is shared; decisions are made by the group, not by a small cadre or one person.
• Members focus on how to work well together: They are committed to taking time and building trust, and they see the collaboration as a long-term effort.
• Participants are frequently required to change the way they do things.

COLLABORATION ILLUSTRATION

Community Group Uses Nuisance Abatement Laws to Clean up the Neighborhood¹³

Nuisance abatement has been part of common law since the 16th century. 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. After notifying the owner that they would board up 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. 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.

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 own living space. A property might reasonably be considered a nuisance if, for example, it is used for drug dealing, has become infested with 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 should follow for this type of nuisance abatement is as follows:

1. Identify the nuisance property.
2. Gather evidence, such as: Who owns the property? What is the nuisance? Are the police aware of the problem? Has the property been raided by the police?
3. Give the owner notice and request that the nuisance be abated.
4. After a reasonable amount of time, take action to abate the nuisance.
5. Sue the owner for the cost of the action.

COMMUNICATIONS FACT SHEET

Public perceptions about alcohol, tobacco, and other drugs play a significant role in the use of these substances. Famous actors are photographed holding cigarettes or lately, cigars, while many rock stars glamorize drug and alcohol use—glamorization of, for example, smoking 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. Lobbying groups and other collaborative efforts can encourage the television and film industries to limit their portrayals of drinking, smoking heroes.

Communication strategies are more likely to be effective if they do one or more of the following:

• Reach many people in the community
• Present messages that appeal to the motives of young people for using substances, or refute their perceptions of substance abuse
• Place messages where young people are likely to see and hear them
• Tailor messages to the particular audience
• Avoid the use of authority figures and admonishments, as well as the demonstration of harmful substances

Four types of communications activities can help educate the public about the real dangers of substance abuse:

• Public education campaigns attempt to increase knowledge and awareness of a particular health issue. A campaign can communicate information about personal risk factors, or publicize new laws or programs that promote protective behaviors. Campaigns can target a wide range of people, including youth, parents, teachers, and others involved in the lives of youth.
• Social marketing campaigns apply techniques that have been successful in the field of commercial advertising to advance social and public health causes. These campaigns try to convince the public to adopt a new behavior (such as wearing seat belts or using condoms) by showing them the benefit they will receive in return (e.g., protection in a car accident, or avoidance of an unwanted pregnancy or STD).
• Media advocacy activities employ mass media to advance a public policy initiative or message, frame the debate, and build support for changes in public policy. By working directly with local newspapers, television and cable channels, and radio stations, media advocates try to impact the way people talk and think about a social or public policy initiative.
• Media literacy programs teach young people to analyze and understand media messages, and empower them to make decisions independent of the media’s overwhelming influence. Young people learn how programs and advertisements are developed, and what strategies producers use to make media messages more persuasive.

COMMUNICATIONS ILLUSTRATION

Partnership Counters Pro-Alcohol Messages Associated with the
Mexican Holiday Cinco de Mayo¹⁴

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

• Promote alcohol- and tobacco-free Cinco de Mayo celebrations.
• Replace alcohol and tobacco sponsors of holiday events with other sponsors.
• Encourage responsible service of alcoholic beverages at the celebrations where alcohol is served, and encourage 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 to 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 its goals, CalPartners designed an action plan that listed activities people could take part in as individuals or members of community agencies or larger collaborations. 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 (such as newspapers, and radio and TV stations), asking them not to sell products that are marketed in an objectionable way, or to market products that way themselves.
• 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
• Protest celebrations and advertisements that are objectionable.
• Volunteer to help police departments administer and monitor responsible beverage service at celebrations serving alcohol, and to promote awareness among attendees.

CalPartners actively distributes information to help people join its campaign, including a brief history of the true meaning of Cinco de Mayo, and research on the effects of alcohol on Latinos.

EDUCATION FACT SHEET

Historically, schools have played an important role in preventing substance abuse among young people. Schools offer opportunities to reach the most children and also serve as important settings for specific at-risk groups, such as children with behavior problems and learning disabilities. Prevention education programs can impart knowledge and develop skills, though research shows that alone they are insufficient to produce far-reaching and long-lasting change.¹⁵ Besides school-based health and prevention education for students, education and training efforts aimed at adults who interact with youth also contribute to prevention.

Education strategies are most likely to be effective if they do one or more of the following:

• Foster young people’s social skills and attachment to the school and community
• Include an educational component for parents, with information about drugs for both them and their children
• Focus on training servers and other adults to improve selling and serving practices

Thinking, Social, and Resistance Skills for Students

Certain skills are emerging as critical to preventing substance abuse, including empathy and perspective taking, social problem solving, anger management or impulse control, communication, stress management and coping, media resistance, assertiveness, and character/belief development. Instructional programs tend to be more effective when they:

• Reach children from kindergarten through high school
• Reach young people during nonschool as well as school hours
• Use age and culturally appropriate, interactive teaching materials
• Use a well-tested science-based curriculum, with detailed lesson plans and student materials
• Combine social and thinking skills instruction with resistance skills training
• Include an adequate "dosage" of at least 10 to 15 sessions per year and another 10 to 15 booster sessions offered no later than three years after the original program
• Include peer education components that are led by students
• Offer professional development or training opportunities for school faculty and staff

Education and Professional Training for Adults

Education for adults can play a significant role as well; public education can raise awareness among broad numbers of people and strengthen environmental approaches to prevention. For instance:

• Server training programs can teach bartenders and wait staff to avoid serving minors and intoxicated customers.
• Merchants can be educated about the laws and penalties for selling alcohol or tobacco to underage customers

EDUCATION ILLUSTRATION

University Implements Widespread Campaign to Encourage
Responsible Beverage Service and Consumption¹⁶

High-risk (or "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 more than 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 high-risk drinkers.¹⁷ Alcohol-related deaths on campus have figured prominently in the news in recent years, along with exposés on date rape, drunk driving, and other dangerous behaviors associated with high-risk drinking. Campus enforcement of a minimum drinking age is difficult, as students of all ages host parties, and the number of enforcement personnel is limited.

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 and to present a clear and consistent message of responsible drinking (where legal) and hospitality. The project had five important strategies:

• Developing a group of trained student peer educators, called the Party Pro’s. Serving as consultants to students who were planning parties, the Party Pro’s offered help in selecting themes, entertainment, decorations, food, and beverages, as well as in budgeting, fund-raising, and promoting the parties.
• Training peer educators to ensure that their fellow students were familiar with State and campus alcohol policies and laws, and to help student groups such as fraternities and sororities develop policies for their social activities.
• Training student bartenders, as well as sober party monitors to oversee the guests. "Escort coordinators" were also trained to ensure that guests used designated drivers or had other safe transportation at the end of the evening.
• Sponsoring quarterly Event Planning Fairs, with presentations on liability issues and school policies. The Fairs included a trade show where local businesses—such as disc jockeys, party suppliers, caterers, and florists—promoted their services.
• Establishing the Hospitality Alliance with local businesses and public safety officials, who agreed to promote responsible drinking and beverage service—and to occasionally take action against those who did 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, offering 25-cent shots; the ads were subsequently dropped.

Findings from the project showed a positive change in the university’s drinking environment; students were holding smaller and more controlled parties, using sober monitors and trained bartenders, checking IDs, and serving food and nonalcoholic beverages. Even after the Office of Traffic Safety funding ended, the Party Pro’s and the Hospitality Alliance continued to function at Stanford.

EARLY INTERVENTION FACT SHEET

Research has begun to verify the notion that money and effort spent early in the life of a family may result in more effective prevention, yield more positive outcomes, and ultimately cost States and communities less.

Early intervention includes such strategies as screening, assessment, referral, and treatment of youth at risk for substance abuse and related risk factors; home visitation; early education (e.g., Head Start); student assistance programs; employee assistance programs; and treatment and counseling services. Early intervention often focuses not only on the mother-child interaction and the needs of the child, but also on the psychological needs of the mother, especially her sense of mastery and competence. It can also address the life situations and stressors that can interfere with parents’ positive adaptation to pregnancy, birth, and the early care of their child.

Some important findings about the effects of early intervention come from research on juvenile crime and delinquency, which has implications for substance abuse prevention as well. Studies find that while the more troubling risk factors may become evident after children reach adolescence, the most chronic and serious offenders often show signs of antisocial behavior as early as the preschool years.

Early Intervention Strategies are more likely to be effective if they do one or more of the following:

• Target families considered at risk for using, or who are already using, alcohol, tobacco, and other drugs
• Include skill-building components for both parents and children
• Identify and build on the strengths of the family
• Offer incentives for participation
• Strive to be culturally appropriate
• Address the relationship between substance abuse and other adolescent health issues

EARLY INTERVENTION ILLUSTRATION

An Effective Program Teaches Children a Problem-Solving Approach
to Guiding Their Behavior and Resolving Their Differences

I Can Problem Solve (ICPS) at MCP Hahnemann University in Philadelphia, Pennsylvania, was developed by Dr. Myrna B. Shure. It is both a preventive and a rehabilitative program to help children from preschool to grade 6 resolve interpersonal problems and prevent antisocial behavior. Specifically, ICPS focuses on impatience, aggression, over-emotionality, and social withdrawal. The program has been extensively evaluated over.

"We have found that it makes a difference when children are involved in the process of thinking about what they’re doing, as opposed to receiving demands, commands, even suggestions, even explanations," says Shure. "Instead of the adult doing all the talking and all the thinking for the child, the child is doing the thinking, with guidance from adults."

ICPS is available for three levels: preschool, kindergarten and primary grades, and intermediate elementary grades. Initial lessons focus on defining vocabulary and making sure that children understand specific words, terms, and concepts. To do this children may play games but the games also teach them basic vocabulary that will help them later on to settle disputes. For instance, children learn the word pair "before and after." They may play games with the words, making up funny examples they like, such as, "I cannot brush my teeth before I get out of bed in the morning." Once they’ve mastered the meanings of the word pair, they can begin to apply the ideas of "before and after" to disputes that occur—such as when a teacher asks, "What happened before Peter hit you?" (instead of the more traditional question, "Peter, why did you hit Luke?"). Peter now connects the word "before" with the fun he had with the word, and he’s more likely to answer the question.

ICPS, while it concentrates on concepts, cognition, and reasoning, also focuses on children’s feelings, helping the children see connections between feelings and actions and thus changing how they act. Observers of the program see that the children, overall, become much calmer and quieter, and that the classroom environment becomes a more understanding and peaceful environment for learning. Evaluations showed that a year of training was effective in enhancing both cognitive problem-solving and behavioral skills. Children in the program, compared to a control group, showed fewer high-risk behaviors, improvement in pro-social behaviors, and better test performance (suggesting that children whose behavior improved could concentrate on the task-oriented demands of the classroom).

ALTERNATIVES FACT SHEET

Increasingly, schools and communities are working together to incorporate recreational, enrichment, and leisure activities into their approach to prevention. Drop-in recreation centers, after-school and weekend programs, dances, community service activities, tutoring, mentoring, and other events are offered in these programs as alternatives to dangerous activities, such as substance abuse and violence. While many alternative approaches have not been evaluated with rigor, researchers have learned some valuable lessons about elements that increase an approach’s likelihood of success.

Alternative strategies are most likely to be effective if they do one or more of the following:

• Target youth at high risk who may not have adequate adult supervision or access to a variety of activities
• Target the particular needs and assets of individuals
• Provide intensive approaches that combine many hours of involvement with access to related services

Researchers conclude that alternative approaches alone are not enough to prevent substance abuse among youth. Enrichment and recreational activities must be paired with other strategies that have been proven effective, such as policies that reduce the availability of alcohol, tobacco, and other drugs, as well as social and personal skill- building instruction. Nevertheless, certain alternative approaches have proven to be successful in meeting the needs of young people at risk— the following, in particular:

• Mentoring programs related to reducing substance use and increasing positive attitudes toward others, the future, and the school
• Recreational and cultural activities associated with decreasing substance abuse and delinquency by providing alternatives to substance use
• Community service associated with an increased sense of well-being and more positive attitudes toward people, the future, and the community

One way to ensure that activities interest and meet the needs of young people is to involve them directly in creating the activities and in selecting community service opportunities.

ALTERNATIVES ILLUSTRATION

An Intergenerational Program for Middle-School Students Combines
Mentoring, Classroom Lessons, and Community Service

Across Ages is a school-based, intergenerational program in Philadelphia, Pennsylvania, that has found ways to bring young students together with older adults and with their parents, siblings, and other family members. Targeting sixth graders at high risk, it seeks to increase resiliency and reduce the likelihood that students will drop out of school, become adolescent parents, or use alcohol, tobacco, or other drugs.

The core feature of the program is the mentoring component: recruiting and training older adults (age 55 and up), and matching them as mentors with sixth grade students. Empirical evidence demonstrates that mentoring has a positive effect on young lives. Mentors can help youth overcome personal and social barriers, expose them to new relationships and opportunities, and assist in the development of problem-solving and decision-making skills. "We provide fairly intensive in-service training for our mentors," says Andrea Taylor, principal investigator at the Center for Intergenerational Learning, Temple University. "Then we match them with the students and very carefully monitor the relationships during the course of the school year."

Trained teachers implement the classroom component with students once a week for 26 weeks. The Social Problem Solving and Substance Abuse Prevention modules of the Positive Youth Development Curriculum address such topics as stress management, peer resistance skills, and substance abuse and health information.

The community service component arranges for students to visit with residents in nursing homes, in keeping with the program philosophy about understanding people across the life span. Students become providers of service to their elder partners in the nursing home, as well as the recipients of service from their mentors.

The family component, which involves parents, siblings, and other family members of the students in regular weekend activities, is a way of helping families support the mentor-youth relationships and also get them involved in positive activities with their children.

Evaluations over three years show that youth in the full program were absent fewer days of the year and demonstrated greater improvements in their attitudes toward school, the future, and the elderly; their knowledge of older people; their sense of well-being; their reactions to situations involving drug use; and their performance of community service.

"Across Ages is a wonderful program," concludes Taylor, "and I think it’s had a tremendous impact on the lives of many, many children and many, many adults. It can work in a school setting, it can work as an afterschool program, it can work in a community setting. It can work in a church setting, and, as such, I think it has a very important place in a community’s prevention plan. I also believe that it’s one strategy, and that for a community to really address its drug prevention issues, or any number of things that it has to, programs have to be incorporated as part of a broader design."

Q: WHAT CAN YOU DO TO SUPPORT PREVENTION THAT WORKS?

A: TALK ABOUT WHAT WORKS

Collaboration partners, State and local prevention advisory board members, community leaders, and decision makers at every level can contribute to a climate of support for effective prevention by spreading the word about what works.

Here’s what you can do:

• Share information about effective prevention strategies with colleagues.
• Look for opportunities to speak to State and local groups, for example, State chapters of national associations and organizations and voluntary associations, and chamber of commerce and other business groups.
• Speak up for environmental strategies. Lend your support to policy, enforcement, collaboration, and communications—four of the strongest strategies for preventing substance abuse.
• Promote the idea of "multiple strategies, in multiple settings, targeted toward a common goal." Look for ways to integrate strategies in your efforts to tackle a tough local problem, such as underage drinking or marijuana use.
• Track bills introduced in the legislature, and lend support to any that will strengthen prevention.Policy, especially policy in the form of legislation, is one of the most potent forces in prevention. Legislators and other significant decision-makers in the State are in a unique position to change the environment; they can examine the laws that affect the availability and use of alcohol, tobacco, and other drugs, as well as support new ones.
• Look for opportunities to begin or support collaboration. At the State or local level, collaboration among a range of partners—agencies, organizations, and strong leaders—can address the need for systemic change in the way that prevention works.

Q: HOW CAN YOU GET MORE INFORMATION?

A: CONTACT CSAP, CSAP’S NORTHEAST CAPT OR A LEADER IN YOUR STATE

CSAP’s Decision Support System (DSS) at http://www.preventiondss.org promotes scientific methods and programs for substance abuse prevention for use within communities and State prevention systems.

You can reach CSAP’s Northeast CAPT by calling (888) EDC-CAPT.

You can contact the following person in your State:

Connecticut—Dianne Harnad; ph: (860) 418-6828; e-mail: dianne.harnad@po.state.ct.us

Delaware—Jack Kemp; ph: (302) 577-4465, ext. 46; e-mail: jkemp@state.de.us

Maine—William Lowenstein; ph: (207) 287-6484; e-mail: william.lowenstein@state.me.us

Maryland—Eugenia Conolly; ph: (410) 767-6912; e-mail: conollye@dhmh.state.md.us

Massachusetts—Steve Keel; ph: (617) 624-5141; e-mail: stefano.keel@state.ma.us

New Hampshire—Alice Bruning; ph: (603) 271-6111; e-mail: abruning@dhhs.state.nh.us

New York—John Ernst; ph: (518) 485-2132; e-mail: ernst@oasas.state.ny.us

New Jersey—Barry Hantman; ph: (609) 292-4414; e-mail: bmh@dh.state.nj.us

Pennsylvania—Joseph Powell; ph: (717) 787-2606; e-mail: jpowell@state.pa.us

Rhode Island—Sheila Whalen; ph:(401) 462-5685; e-mail: swhalen@mhrh.state.ri.us

Vermont—Marcia LaPlante; ph: (802) 651-1560; e-mail: marcia@adap.adp.state.vt.us

ENDNOTES

¹Gardner, S. E. and Brounstein, P. J. (2001). Principles of substance abuse prevention. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention, Division of Knowledge Development and Evaluation.

²Abramson, 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: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention.

³Gregory, D. (1997). Triumph over billboards. San Rafael, CA: Marin Institute.

⁴Ross, H. L. (1992). Confronting drunk driving. New Haven: Yale University Press, 68.

⁵Sciarretta, J. (Dec. 1, 1998). Zero tolerance public awareness campaign launched (Press release). Connecticut Coalition to Stop Underage Drinking.

⁶Alcohol-Related Injury and Violence Center (1998). Drinking and driving: A brief review of the literature. San Francisco: The Trauma Foundation.

⁷Sciarretta, J. (Dec. 1, 1998). Zero tolerance public awareness campaign launched.

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

⁹Hingson, R., Heeren, T., and Winter, M. (1994). Lower legal blood alcohol limits for young drivers. Public Health Reports,109(6), 738–744.

¹⁰Personal correspondence, Homer-Bouthiette, D.

¹¹Winer, M. and Ray, K. (1994). Collaboration handbook: Creating, sustaining, and enjoying the journey. St Paul: Amos H. Wilder Foundation, 24.

¹²The National Association of Community Action Agencies (1998). National study on collaboration. Washington, D.C.

¹³For a more complete discussion of nuisance abatement and related laws see Community Law Center, Inc. (1997). Baltimore, MD. Available online: http://www.baltimoremd.com/community/claw

¹⁴CalPartners Coalition (1998). Sacramento, CA. Available online: http://www.calpartners.org

¹⁵Tobler, N. S. (1986). Meta-analysis of 143 adolescent drug prevention programs: Quantitative outcome results of program participants compared to a control or comparison group. Journal of Drug Issues, 16, 537–567; Tobler, N. S. (1988). A meta-analysis of school-based prevention programs (unpublished document). Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention.

¹⁶Responsible hospitality service (July, 1996). Washington, DC: U.S. Department of Education, Higher Education Center for Alcohol and Other Drug Prevention; Preventing alcohol-related problems on campus: Impaired driving. Washington, DC: U.S. Department of Education, Higher Education Center for Alcohol and Other Drug Prevention; Kiner, S. (1993). Stanford’s new way to party . . . safely. Prevention File. Washington, DC: U.S. Department of Education, Higher Education Center for Alcohol and Other Drug Prevention, 17–20.

¹⁷Wechsler, H., Dowdall, G., Davenport, A., and DeJong, W. (2000) Binge drinking on campus: Results of a national study. Bulletin Series: Alcohol and Other Drug Prevention. Washington, DC: U.S. Department of Education, Higher Education Center for Alcohol and Other Drug Prevention. Available online at: http://www.edc.org/hec/pubs/binge.htm