Harold D. Holder

Alcohol: No ordinary commodity research and public policy

From a public health perspective, alcohol is a major contributor to morbidity and mortality. This book describes recent advances in alcohol research which have direct relevance for the development of effective alcohol policies at the local, national and international levels. The central purpose of the book is to empower those responsible for public health and social welfare.

The Effect of Alcohol Beverage Restrictions on Consumption: A 25-Year Longitudinal Analysis

This project analyzed the impact of state regulation and control measures on per capita apparent distilled spirits consumption using a 25-year period, 1955-1980. The project was an effort to determine if statistically significant associations between regulation of spirits and per capita consumption could be found for the 48 states of the continental United States. A series of regression models was employed to obtain estimates of the effects of a set of independent variables, including alcoholic beverage control laws, price and price-related variables, and social/cultural control variables on apparent distilled spirits consumption. Most previous studies of the relationship of restrictions on spirits availability have led to a belief that control efforts have little or no impact on per capita consumption. This study was undertaken with the expectation of similar findings. What was found instead was that certain laws and regulations do seem to play a significant role in holding down distilled spirits consumption. The regression models developed predict a decrease of about two drinks per month per person if the state was to shift its regulatory laws (including the price of liquor, which is not always subject to regulation) from being relatively loose to being relatively strict. This decrease in drinking would cut down the level of consumption in the median state by nearly one-fourth.

Evaluation of media advocacy efforts within a community trial to reduce alcohol-involved injury. Preliminary newspaper results.

This article examines coverage of alcohol-related topics in local newspapers as applied to a conceptual model of media advocacy being tested in a five-component community trial to reduce alcohol-involved injuries. Based on a literature review of determinants of exposure of newspaper articles, it uses a composite measure that takes into account the likelihood that given articles will be read. This measure is evaluated in terms of the timing of media advocacy training, technical consultation, and resulting media advocacy efforts. Three hypotheses find support. First, postintervention levels of coverage across expertmental communities appear generally higher than similar preintervention coverage. Second, although postintervention local and county coverage appears higher across experimental communities, no equivalent effect is present across comparison communities. Third, increases in local and county coverage in experimental communities were not matched by increases in state and national coverage in these communities.

PREDICTING DRUG USE AT ELECTRONIC MUSIC DANCE EVENTS: SELF-REPORTS AND BIOLOGICAL MEASUREMENT

Most information on the prevalence of drug use comes from self-report surveys. The sensitivity of such information is cause for concern about the accuracy of self-report measures. In this study, self-reported drug use in the last 48 hr is compared to results from biological assays of saliva samples from 371 young adults entering clubs. The relationship between self-reports and drug presence in oral fluid was determined for three substances as follows: cocaine, marijuana, and amphetamine. Forty-one percent of the participants with drugs detected in their oral fluids reported no use in the last 48 hr. The significance of these results is discussed.

A COMMUNITY PREVENTION INTERVENTION TO REDUCE YOUTH FROM INHALING AND INGESTING HARMFUL LEGAL PRODUCTS

Youth use of harmful legal products, including inhaling or ingesting everyday household products, prescription drugs, and over-the-counter drugs, constitutes a growing health problem for American society. As such, a single targeted approach to preventing such a drug problem in a community is unlikely to be sufficient to reduce use and abuse at the youth population level. Therefore, the primary focus of this article is on an innovative, comprehensive, community-based prevention intervention. The intervention described here is based upon prior research that has a potential of preventing youth use of alcohol and other legal products. It builds upon three evidence-based prevention interventions from the substance abuse field: community mobilization, environmental strategies, and school-based prevention education intervention. The results of a feasibility project are presented and the description of a planned efficacy trial is discussed.

Community Mobilization, Organizing, and Media Advocacy: A Discussion of Methodological Issues

Community Mobilization refers to those activities that prepare communities to accept, receive, and support prevention interventions designed to reduce alcohol-involved trauma. Media advocacy refers to the strategic use of media by those seeking to advance a social or public policy initiative. Within the Community Prevention Trial, both of these activities were critical elements. This article presents the evaluation design for communcty mobilization and media advocacy implemented for the project. Here the authors argue for the need to include both structured and unstructured community monitoring instruments, coding of local alcohol-related news coverage, and surveying community members about the exposure to alcohol-related problems, and support for project interventions. This article also presents an audience segmen tation analysis and discusses the implications of this analysis for media advocacy efforts.

Evaluation Design for a Community Prevention Trial An Environmental Approach to Reduce Alcohol-Involved Trauma

The Community Prevention Trial was 5-year effort to reduce alcohol-involved injuries and death through a comprehensive program of community awareness and policy activities. The three experimental communities were of approximately 100,000 population each (one in Northern California, one in Southern California, and one in South Carolina). Matched comparison communities were used for each experimental community. This article describes the evaluation approach used in a program that sought to change environmental factors not a specific population or target group. This approach demanded unique evaluation approaches for deter mining overall community aggregate effects, that is, distal outcomes, as well as changes in key mediating variables, that is, process effects. The problem of trending and lagged effects of community prevention programs are discussed.

Summing Up Recommendations and Experiences for Evaluation of Community-Level Prevention Programs

This article provides recommendations and observations about evaluation of a locally based prevention project to reduce problems at a total community or aggregate level. The shift from targeting specific individuals or subpopulations to the overall structure and environment of a community is most demanding. Evaluation tools and analysis techniques have lagged behind program development because community-level interventions are not linked to a specific target group who can be separately studied. Thus assumptions about using random assignment and/or comparison communities as means to control for confounding variables are weakened when the unit of analysis is the community itself and dependent measures are subject to trending and the effects of history.

PREVENTION OF ALCOHOL-RELATED TRAFFIC PROBLEMS: COMPUTER SIMULATION OF ALTERNATIVE STRATEGIES

Strategies to reduce alcohol-related traffic problems were evaluated for Wake County, North Carolina, Alameda County, California, and Washington County, Vermont. Computer simulation was utilized, employing primary data from national studies and local sources, as well as research findings. Increasing the perceived risk of sanctions against drinking and driving had significant but short-term impact, while increasing actual sanctions without purposefully raising perceived risk had low impact.

Evaluating Efforts To Reduce Community-Level Problems Through Structural Rather Than Individual Change A Multicomponent Community Trial to Prevent Alcohol-Involved Problems

Preventing health problems at the community level and evaluating the effectiveness of community-based prevention present a considerable challenge in behavioral science research. The best known community-based prevention trials to date include those undertaken to reduce cardiovascular disease (CVD) and cancer. Health professionals now have accumulated over 20 years of experience in community programs to prevent chronic diseases. Some studies successfully reduced risk factors in high-risk subsets of the population and were carried out in clinical settings or in work sites (Benfari 1981). Other studies, directed at entire populations in communities, used comprehensive approaches combining community organizations and multichannel health education (Carlaw et al. 1984; Farquhar et al. 1990; Puska et al. 1985).’