Traci L. Toomey

Project Northland: outcomes of a communitywide alcohol use prevention program during early adolescence.

OBJECTIVES Project Northland is an efficacy trial with the goal of preventing or reducing alcohol use among young adolescents by using a multilevel, communitywide approach. METHODS Conducted in 24 school districts and adjacent communities in northeastern Minnesota since 1991, the intervention targets the class of 1998 (sixth-grade students in 1991) and has been implemented for 3 school years (1991 to 1994). The intervention consists of social-behavioral curricula in schools, peer leadership, parental involvement/education, and communitywide task force activities. Annual surveys of the class of 1998 measure alcohol use, tobacco use, and psychosocial factors. RESULTS At the end of 3 years, students in the intervention school districts report less onset and prevalence of alcohol use than students in the reference districts. The differences were particularly notable among those who were nonusers at baseline. CONCLUSIONS The results of Project Northland suggest that multilevel, targeted prevention programs for young adolescents are effective in reducing alcohol use.

The Effectiveness of Limiting Alcohol Outlet Density As a Means of Reducing Excessive Alcohol Consumption and Alcohol-Related Harms

The density of alcohol outlets in communities may be regulated to reduce excessive alcohol consumption and related harms. Studies directly assessing the control of outlet density as a means of controlling excessive alcohol consumption and related harms do not exist, but assessments of related phenomena are indicative. To assess the effects of outlet density on alcohol-related harms, primary evidence was used from interrupted time-series studies of outlet density; studies of the privatization of alcohol sales, alcohol bans, and changes in license arrangements-all of which affected outlet density. Most of the studies included in this review found that greater outlet density is associated with increased alcohol consumption and related harms, including medical harms, injury, crime, and violence. Primary evidence was supported by secondary evidence from correlational studies. The regulation of alcohol outlet density may be a useful public health tool for the reduction of excessive alcohol consumption and related harms.

The Effectiveness of Tax Policy Interventions for Reducing Excessive Alcohol Consumption and Related Harms

A systematic review of the literature to assess the effectiveness of alcohol tax policy interventions for reducing excessive alcohol consumption and related harms was conducted for the Guide to Community Preventive Services (Community Guide). Seventy-two papers or technical reports, which were published prior to July 2005, met specified quality criteria, and included evaluation outcomes relevant to public health (e.g., binge drinking, alcohol-related crash fatalities), were included in the final review. Nearly all studies, including those with different study designs, found that there was an inverse relationship between the tax or price of alcohol and indices of excessive drinking or alcohol-related health outcomes. Among studies restricted to underage populations, most found that increased taxes were also significantly associated with reduced consumption and alcohol-related harms. According to Community Guide rules of evidence, these results constitute strong evidence that raising alcohol excise taxes is an effective strategy for reducing excessive alcohol consumption and related harms. The impact of a potential tax increase is expected to be proportional to its magnitude and to be modified by such factors as disposable income and the demand elasticity for alcohol among various population groups.

The effect of the Safer Bars programme on physical aggression in bars: results of a randomized controlled trial

The purpose of this study was to evaluate the effectiveness of Safer Bars, an intervention to reduce aggression in bars. A total of 734 pre - post-intervention observations were conducted by trained observers on Friday and Saturday nights between midnight and 2 a.m. in 18 large capacity ( > 300) Toronto bars and clubs assigned randomly to receive the intervention (69% participation rate of the 26 assigned) and 12 control bars. As part of the intervention, owners/managers completed the risk assessment workbook to identify ways of reducing environmental risks, and 373 staff and owners/managers (84% participation rate) attended a 3-hour training session focused on preventing escalation of aggression, working as a team and resolving problem situations safely. The main outcome measures were rates of severe aggression (e.g. punching, kicking) and moderate physical aggression (e.g. shoving, grappling). Hierarchical linear modelling (HLM) comparing pre - post aggression for intervention versus control bars indicated a significant effect of the intervention in reducing severe and moderate aggression. This effect was moderated by turnover of managers and door/security staff with higher post-intervention aggression associated with higher turnover in the intervention bars. The findings indicate the potential for a stand-alone relatively brief intervention to reduce severe and moderate physical aggression in bars.

Communities mobilizing for change on alcohol: Lessons and results from a 15-community randomized trial

Communities Mobilizing for Change on Alcohol (CMCA) is a 15-community randomized trial designed to develop, implement, and evaluate a 2½ year community organizing intervention to change policies and practices of major community institutions. Pre- and post-data were collected via: surveys of high school students, surveys of youth age 18–20, surveys of alcohol retailers, alcohol purchase attempts, content analyses of media coverage, arrest and car crash indicators, surveys of strategy team members, and process records. Organizers and local strategy teams changed policies and practices of community institutions such as law enforcement agencies, alcohol merchants, and sponsors of community events, leading to significant changes in alcohol-related behaviors among 18- to 20-year-olds, and significant reductions in the propensity of alcohol establishments to serve alcohol to youth.

Effectiveness of Policies Restricting Hours of Alcohol Sales in Preventing Excessive Alcohol Consumption and Related Harms

Local, state, and national policies that limit the hours that alcoholic beverages may be available for sale might be a means of reducing excessive alcohol consumption and related harms. The methods of the Guide to Community Preventive Services were used to synthesize scientific evidence on the effectiveness of such policies. All of the studies included in this review assessed the effects of increasing hours of sale in on-premises settings (in which alcoholic beverages are consumed where purchased) in high-income nations. None of the studies was conducted in the U.S. The review teams initial assessment of this evidence suggested that changes of less than 2 hours were unlikely to significantly affect excessive alcohol consumption and related harms; to explore this hypothesis, studies assessing the effects of changing hours of sale by less than 2 hours and by 2 or more hours were assessed separately. There was sufficient evidence in ten qualifying studies to conclude that increasing hours of sale by 2 or more hours increases alcohol-related harms. Thus, disallowing extensions of hours of alcohol sales by 2 or more should be expected to prevent alcohol-related harms, while policies decreasing hours of sale by 2 hours or more at on-premises alcohol outlets may be an effective strategy for preventing alcohol-related harms. The evidence from six qualifying studies was insufficient to determine whether increasing hours of sale by less than 2 hours increases excessive alcohol consumption and related harms.

Policy Options for Prevention: The Case of Alcohol

Reducing the availability of alcohol through alcohol control policies such as excise taxes and the minimum legal drinking age has been effective in reducing a wide range of alcohol-related problems, including traffic crashes, liver cirrhosis, and violence. Alcohol control policies may be classified into two overlapping categories-public and institutional policies. Some policies such as alcohol server training may be either mandated by governmental jurisdictions or voluntarily adopted by individual institutions, which include alcohol retail establishments, other businesses, worksites, schools, colleges/universities, law enforcement agencies, religious institutions, insurance agencies, and alcohol producers. Public policies may be mandated by national, state/provincial, or local governments to regulate where, when, and how alcohol is sold and consumed. This paper describes the wide array of public and institutional policies available to reduce alcohol-related problems. Summaries of research evaluating specific alcohol control policies are provided when available.

Social exchange of cigarettes by youth

Objective: This study seeks to determine the magnitude, nature, and correlates of social exchange of cigarettes among youth who smoke. Design: Cross sectional survey. Setting: Schools in 29 Minnesota communities. Participants: All students in grades 8, 9, and 10 (ages 13–16 years) in each participating school. The parent/child response rate for the survey was 90%. Analyses included 4124 respondents who smoked at least one cigarette in the month before the survey. Outcome measures: Social exchange scale, consisting of 16 items assessing aspects of social provision and acquisition of cigarettes. Results: Almost 90% of youth in this study had obtained a cigarette from, and about 75% of them had provided cigarettes to, another teen in the prior month. Daily smokers provided to more teens and provided more often than those who smoked less than daily. Daily smokers also reported having more social sources, both teens and adults, than lighter smokers, and were more likely to have both bought from and sold cigarettes to other teens (p < 0.0001 for all comparisons between daily and less than daily smokers). In a multivariate analysis, social exchange was associated with grade, whether siblings and friends smoke, level of smoking, age of smoking initiation, parental influences and community norms about teen smoking, and buying cigarettes. Conclusions: Social provision and acquisition of cigarettes among teens are widespread, reciprocal behaviours. Parental and community expectations about smoking influence social exchange, possibly by providing opportunities or barriers for social smoking. Commercial and social availability are not mutually exclusive; rather social exchange extends the reach of commercial sources.

Neighborhood Level Spatial Analysis of the Relationship Between Alcohol Outlet Density and Criminal Violence

Misuse of alcohol is a significant public health problem, potentially resulting in unintentional injuries, motor vehicle crashes, drownings, and, perhaps of greatest concern, serious acts of violence, including assaults, rapes, suicides, and homicides. Although previous research establishes a link between alcohol consumption increased levels of violence, studies relating the density of alcohol outlets (e.g., restaurants, bars, liquor stores) and the likelihood of violent crime have been less common. In this paper we test for such a relationship at the small area level, using data from 79 neighborhoods in the city of Minneapolis, Minnesota. We adopt a fully Bayesian point of view using Markov chain Monte Carlo (MCMC) computational methods as available in the popular and freely available WinBUGS language. Our models control for important covariates (e.g., neighborhood racial heterogeneity, age heterogeneity) and also account for spatial association in unexplained variability using conditionally autoregressive (CAR) random effects. Our results indicate a significant positive relationship between alcohol outlet density and violent crime, while also permitting easy mapping of neighborhood-level predicted and residual values, the former useful for intervention in the most at-risk neighborhoods and the latter potentially useful in identifying covariates still missing from the fixed effects portion of the model.

Worksite Environment Intervention to Prevent Obesity Among Metropolitan Transit Workers

OBJECTIVE The results of an 18-month worksite intervention to prevent obesity among metropolitan transit workers are reported. METHODS Four garages in a major metropolitan area were randomized to intervention or control groups. Data were collected during the fall of 2005 prior to the start of the intervention and during the fall of 2007, after the intervention ended. Intervention program components at the garage included enhancement of the physical activity facilities, increased availability of and lower prices on healthy vending machine choices, and group behavioral programs. Mixed model estimates from cross-sectional and cohort samples were pooled with weights inverse to the variance of their respective estimates of the intervention effects. RESULTS Measurement participation rates were 78% at baseline and 74% at follow-up. The intervention effect on garage mean BMI change was not significant (-0.14 kg/m(2)). Energy intake decreased significantly, and fruit and vegetable intake increased significantly in intervention garages compared to control garages. Physical activity change was not significant. CONCLUSION Worksite environmental interventions for nutrition and physical activity behavior change may have limited impact on BMI among transit workers who spend most of their workday outside the worksite.