Policy can be broadly defined as “standards for behavior that are formalized to some degree (that is, written) and embodied in rules, regulations, and procedures.”¹ In order to work, these standards must reflect the accepted norms and intentions of a particular community. Imagine, for example, trying to regulate smoking in public places 50 years ago, when smoking was not only acceptable but chic. It would have been impossible! Now that the dangers of smoking—particularly exposure to secondhand smoke—are so well-documented, people are ready and willing to limit where and when others light up. So, policy represents a kind of social compact, codifying our collective expectations for the kind of world we want to live in.

There are six major types of policy we use to prevent alcohol and other drug use:

• The first, economic policies, focus on increasing the cost of items so that fewer people can afford to buy them. Pricing policies are the most common, and successful, economic policies. Research shows, for example, that when you raise the price of tobacco or alcohol, you see a drop in both the number of people using these products and the amount consumed.² Another way to increase cost is by attaching a special tax to the item, sometimes called a “sin” tax. The revenue from these taxes often goes to support prevention and treatment services. Finally, communities can establish laws that prohibit the sale of individual units of alcohol and tobacco products, such as single beers or individual cigarettes. This makes it harder for people on limited incomes—like kids—to afford these products.

• Another type of policy involves restrictions on access and availability. For example, some towns enact policies that ban vending machines in public places. A number of stadiums, like Boston’s Fenway Park, restrict drinking beer after the seventh inning. There are also laws that set the legal drinking age at 21 or prevent merchants from selling to youth under 21.³

• Policies can also address issues of location and density. When there are fewer places around where people can purchase alcohol, consuming alcohol becomes less convenient, and so less is consumed. In San Jose, California, for instance, a grassroots group called the Association for Responsible Alcohol Control worked to promote a law that would require new businesses to apply for a conditional-use permit in order to be allowed to make off-site alcohol sales.⁴ They garnered support for the bill by promoting awareness of the problems associated with alcohol outlets, especially among San Jose’s Latino population. As a result of the group’s efforts, the city council voted unanimously in favor of implementing the law.

• Policies that focus on deterrence usually involve setting standards or establishing parameters for appropriate behavior, and they also establish clear penalties or consequences for violating these standards. For example, in October, 2000, Congress adopted a .08 blood-alcohol level as the national standard for drunken driving—a significant change from the 0.10 limit most states had in place at that point. The new standard was established based on research establishing a relationship between lower blood-alcohol levels and reductions in impaired driving incidence, alcohol-related crashes, and traffic deaths.⁵ In many states, drivers whose blood alcohol levels exceed these legal standards will immediately lose their licenses.

• Policies can also focus on restricting use. For example, restaurants can create smoke-free areas or become entirely smoke-free. Many communities also create drug-free zones in the vicinity of schools. Restricting the settings in which smokers can use tobacco has been shown to be effective in reducing cigarette sales and tobacco use and in lowering average daily cigarette consumption among adults and youth.⁶

• Finally, many policies are designed to limit the marketing of alcohol and tobacco products. Alcohol and tobacco billboards saturate many communities, particularly urban and less affluent communities that lack the zoning regulations to keep billboards out. 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 Studies have shown that exposure to alcohol advertising can affect people’s attitudes toward alcohol and their intention to use it.⁸

Many prevention practitioners don’t take advantage of the policy strategy as aggressively as they might, because they see policy as something that elected officials create. But “regular” people influence policies every day by becoming advocates. Advocates can be instrumental in creating policy change at the organizational, community, and state levels. For example, in Gloucester, Massachusetts, a group of high school students, working with the Gloucester Prevention Network, was instrumental in having cigarette vending machines banned from public places.

In summary, policy can be an effective prevention strategy—as long as the laws and regulations you put in place are consistent with community norms and beliefs about the “rightness” or “wrongness” of the behavior you want to legislate. But before moving on a particular policy, make sure that you understand the problem and are prepared to make changes based on that understanding.

You have completed Module 2.
Please proceed to Activity 2: Applying Policy Strategies.

References

1. Toomey, T. and Wagenaar, A. (1999). Policy options for prevention: The case of alcohol. Journal of Public Health Policy, 20(2), 193–212.
   
   
2. Chaloupka, F. J. and Grossman, M. (1996). Price, tobacco control policies, and youth smoking. Unpublished Working Paper No. 5740, National Bureau of Economic Research, Cambridge, MA; and Edwards, G., Anderson, P., Babor, T. F., Casswell, S., Ferrence, R., Giesbrecht, N., Godfrey, C., Holder, H. D., Lemmens, P., Makela, K., Midanik, L. T., Norstrom, T., Osterberg, E., Romelsjo, A., Room, R., Simpura, J., and Skob, O. (1994). Alcohol policy and public good. New York: Oxford University Press.
   
   
3. O’Malley, P. M., and Wagenaar, A. C. (1991). Effects of minimum drinking age laws on alcohol use related behaviors and traffic crash involvement among American youth: 1976–1987. Journal of Studies on Alcohol, 52, 478–491; and Wagenaar, A. C. (1993). Minimum drinking age and alcohol availability to youth: Issues and research needs. In M.E. Hilton and G. Bloss (Eds.), Economics and the prevention of alcohol-related problems: Proceedings of a workshop on economic and socioeconomic issues in the prevention of alcohol-related problems, October 10–11, 1991 (NIAAA Research Monograph No. 25, pp. 17–200). Rockville, MD: National Institute on Alcohol Abuse and Alcoholism.
   
   
4. Neigron, D., Canela, J., and Aguirre-Molina, M. (1997). Giving communities a voice in alcohol sales: The Association for Responsible Alcohol Control. In D. Jernigan and P.A. Wright (Eds.), Making news, changing policy: Case studies of media advocacy on alcohol and tobacco issues. Rockville, MD: Center for Substance Abuse Prevention.
   
   
5. Preusser, D. F., Ulmer, R. G., and Preusser, C. W. (1992). Obstacles to enforcement of youthful (under 21) impaired driving. Washington, DC: National Highway Traffic Safety Administration.
   
   
6. Shaw, R. A., Rosati, M. J., Salzman, P., Coles, C. R., and McGeary, C. (1997). Effects on adolescent ATOD behaviors and attitudes of a 5-year community partnership. Evaluation and Program Planning, 20(3), 307–313.
   
   
7. Gregory, D. (1997). Triumph over billboards. San Rafael, CA: Marin Institute.
   
   
8. Grube, J. W. and Wallack, L. (1994). Television beer advertising and drinking knowledge, beliefs, and intentions among school children. American Journal of Public Health, 84(2), 254–259.