A community prevention model to prevent children from inhaling and ingesting harmful legal products.

Children's misuse of harmful legal products (HLPs), including inhaling or ingesting everyday household products, prescription drugs, and over-the-counter drugs, constitutes a serious health problem for American society. This article presents a community prevention model (CPM) focusing on this problem among pre and early adolescents. The model, consisting of a community mobilization strategy and environmental strategies targeting homes, schools, and retail outlets, is designed to increase community readiness and reduce the availability of HLPs, which is hypothesized to reduce HLPs use among children. The CPM is being tested in Alaskan rural communities as part of an inprogress eight-year National Institute on Drug Abuse randomized-controlled trial. This paper presents the CPM conceptual framework, describes the model, and highlights community participation, challenges, and lessons learned from implementation of the model over a 21-month period.

Effect of community-based interventions on high-risk drinking and alcohol-related injuries.

CONTEXT: High-risk alcohol consumption patterns, such as binge drinking and drinking before driving, and underage drinking may be linked to traffic crashes and violent assaults in community settings. OBJECTIVES: To determine the effect of community-based environmental interventions in reducing the rate of high-risk drinking and alcohol-related motor vehicle injuries and assaults. DESIGN AND SETTING: A longitudinal multiple time series of 3 matched intervention communities (northern California, southern California, and South Carolina) conducted from April 1992 to December 1996. Outcomes were assessed by 120 general population telephone surveys per month of randomly selected individuals in the intervention and comparison sites, traffic data on motor vehicle crashes, and emergency department surveys in 1 intervention-comparison pair and 1 additional intervention site. INTERVENTIONS: Mobilize the community; encourage responsible beverage service; reduce underage drinking by limiting access to alcohol; increase local enforcement of drinking and driving laws; and limit access to alcohol by using zoning. MAIN OUTCOME MEASURES: Self-reported alcohol consumption and driving after drinking; rates of alcohol-related crashes and assault injuries observed in emergency departments and admitted to hospitals. RESULTS: Population surveys revealed that the self-reported amount of alcohol consumed per drinking occasion declined 6% from 1.37 to 1. 29 drinks. Self-reported rate of "having had too much to drink" declined 49% from 0.43 to 0.22 times per 6-month period. Self-reported driving when "over the legal limit" was 51% lower (0. 77 vs 0.38 times) per 6-month period in the intervention communities relative to the comparison communities. Traffic data revealed that, in the intervention vs comparison communities, nighttime injury crashes declined by 10% and crashes in which the driver had been drinking declined by 6%. Assault injuries observed in emergency departments declined by 43% in the intervention communities vs the comparison communities, and all hospitalized assault injuries declined by 2%. CONCLUSION: A coordinated, comprehensive, community-based intervention can reduce high-risk alcohol consumption and alcohol-related injuries resulting from motor vehicle crashes and assaults. JAMA. 2000;284:2341-2347.

Social control and workplace drinking norms: a comparison of two organizational cultures.

OBJECTIVE: This article reports on an investigation of the relationship of social control mechanisms at work to drinking practices of 10,000 salaried and hourly employees working in the same U.S. industry, with the same union, but in two different work environments. One work environment reflected an organizational culture that is traditional to U.S. management; the other was based on a nontraditional Japanese transplant model. METHOD: The research team used a combination of methods including in-home surveys (N = 1,723; 1,378 men) and ethnography (110 semistructured interviews and 200 hours of direct observation inside the plants). Respondents were asked about general and work-related drinking, perceptions of drinking norms, strengths or weaknesses of alcohol-related policies and procedures for policy enforcement. RESULTS: Although overall consumption rates in both populations were similar, significant differences between the two samples existed regarding work-related drinking. The Traditional (i.e., U.S.) model was associated with more permissive norms regarding drinking before or during work shifts (including breaks) and higher workplace drinking rates than the Transplant (i.e., Japanese) model. Analyses revealed that alcohol policies, and the extent to which policies are actually enforced, predicted drinking norms and alcohol availability at work. Drinking norms, in turn, predicted work-related drinking and accounted for differences in alcohol consumption between the two worksites. Analyses of ethnographic data provided descriptive understandings of aspects of the two organizational cultures that disabled mechanisms for social control of drinking in one setting and enabled those mechanisms in the other. CONCLUSIONS: These understandings of how social control mechanisms predict work-related drinking practices provide guidelines for alcohol problem prevention in a specific kind of occupational environment. However, our identification of aspects of social control that successfully regulate workplace drinking is applicable to other kinds of occupational settings as well.

Alcohol availability and workplace drinking: mixed method analyses.

OBJECTIVE: This article investigates the relationship between subjective social and physical availability of alcohol at work and work-related drinking. METHOD: We integrated survey and ethnographic methods to determine if and why physical and social availability of alcohol predicted work-related drinking in a manufacturing plant with approximately 6,000 employees. Survey data were obtained from in-home interviews with 984 randomly selected workers. Respondents were asked about their overall and work-related drinking, their perceptions of the ease of obtaining or consuming alcohol in the plant, the work-related drinking of others and their approval/disapproval of work-related drinking by co-workers. Ethnographic data were obtained from 3 years of periodic onsite observations and semistructured interviews with key informants to investigate factors underlying alcohol availability and drinking at work. RESULTS: Structural equations modeling of the survey data revealed that subjective social availability of alcohol at work, and particularly perceived drinking by friends and co-workers, was the strongest predictor of work-related drinking. Typical frequency and quantity of alcohol consumption and heavy drinking were predictive also. Subjective physical availability of alcohol was not significantly related to drinking at or before work. Findings from the ethnographic analyses explained survey findings and described characteristics of the work culture that served to encourage and support alcohol availability and drinking. CONCLUSIONS: These results are the first to show significant relationships between alcohol availability and drinking at work, to explain dynamics of that relationship and to demonstrate the potential risks of using only quantitative or only qualitative findings as the basis for prevention.

Predicting likelihood of seeking help through the employee assistance program among salaried and union hourly employees.

AIMS: This research investigated belief, social support and background predictors of employee likelihood to use an Employee Assistance Program (EAP) for a drinking problem. DESIGN: An anonymous cross-sectional survey was administered in the home. Bivariate analyses and simultaneous equations path analysis were used to explore a model of EAP use. SETTING: Survey and ethnographic research were conducted in a unionized heavy machinery manufacturing plant in the central states of the United States. PARTICIPANTS: A random sample of 852 hourly and salaried employees was selected. MEASUREMENTS: In addition to background variables, measures included: likelihood of going to an EAP for a drinking problem, belief the EAP can help, social support for the EAP from co-workers/others, belief that EAP use will harm employment, and supervisor encourages the EAP for potential drinking problems. FINDINGS: Belief in EAP efficacy directly increased the likelihood of going to an EAP. Greater perceived social support and supervisor encouragement increased the likelihood of going to an EAP both directly and indirectly through perceived EAP efficacy. Black and union hourly employees were more likely to say they would use an EAP. Males and those who reported drinking during working hours were less likely to say they would use an EAP for a drinking problem. CONCLUSIONS: EAP beliefs and social support have significant effects on likelihood to go to an EAP for a drinking problem. EAPs may wish to focus their efforts on creating an environment where there is social support from coworkers and encouragement from supervisors for using EAP services. Union networks and team members have an important role to play in addition to conventional supervisor intervention.

A community prevention trial to reduce alcohol-involved accidental injury and death: overview.

The 5-year "Preventing Alcohol Trauma: A Community Trial" project in the United States was designed to reduce alcohol-involved injuries and death in three experimental communities. The project consisted of five mutually reinforcing components: (1) Community Mobilization Component to develop community organization and support, (2) Responsible Beverage Service Component to establish standards for servers and owner/managers of on-premise alcohol outlets to reduce their risk of having intoxicated and/or underage customers in bars and restaurants, (3) Drinking and Driving Component to increase local DWI enforcement efficiency and to increase the actual and perceived risk that drinking drivers would be detected, (4) Underage Drinking Component to reduce retail availability of alcohol to minors, and (5) Alcohol Access Component to use local zoning powers and other municipal controls of outlet number and density to reduce the availability of alcohol. This paper gives an overview of the rationale and causal model, the research design and outline of each intervention component for the entire prevention trial.

Preventing sales of alcohol to minors: results from a community trial.

This paper reports an evaluation of a community-based approach to prevent underage sales of alcohol. The interventions focused on (a) enforcement of underage sales laws, (b) responsible beverage service (RBS) training and (c) media advocacy. The interventions were implemented in three experimental communities located in California and South Carolina. Purchase survey data were obtained before and after the interventions in each experimental community and in three matched comparison communities. Logistic regression analyses of the purchase survey data for the individual community pairs and for the combined communities showed that sales to apparent minors were significantly reduced in the experimental sites. The findings indicate that these environmental interventions are promising prevention tools for communities that seek to reduce underage drinking.

Summing up: lessons from a comprehensive community prevention trial.

This paper presents the findings and lessons from a community prevention trial involving three experimental communities in the United States to reduce alcohol-involved trauma. The paper provides recommendations for other community prevention efforts. Effectiveness was demonstrated by: (a) 78 fewer alcohol-involved traffic crashes as a result of the Drinking and Driving Component alone (approximately a 10% reduction); (b) a significant reduction in underage sales of alcohol, i.e. off-premise outlets sold to minors about one-half as often as in comparison communities; (c) increased implementation of responsible beverage service policies by bars and restaurants; and (d) increased adoption of local ordinances and regulations to reduce concentrations of alcohol outlets.

Correlates of change in adolescent alcohol consumption in Ireland: implications for understanding influences and enhancing interventions.

Studies of two similar cohorts of students in Ireland in 1984 and 1992 showed a dramatic increase in the consumption of alcohol, especially in the frequency with which students reported being drunk. A comparison of measures obtained at both times showed that there were major changes with regard to beliefs about consequences of alcohol consumption in a direction favorable to consumption as well as increases in the perceived social support for drinking. However, there were no strong indications that changes in problem behavior were associated with the observed increases in drinking patterns. These results are supportive of some explanatory models of initiation to substance use and have associated implications for programs designed to reduce consumption.

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 determining 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.

Monitoring youth behavior in response to structural changes. Alternative approaches for measuring adolescent drinking.

Random digit dial (RDD) telephone and self-administered school-based surveys of drinking and drinking and driving were compared for adolescents from two Northern California communities. The RDD and school-based surveys resulted in very different samples. The telephone sample contained a greater proportion of European Americans and a smaller proportion of Asian Americans and "other" ethnicities. Respondents to the telephone sample also tended to be older and of higher socioeconomic status (SES). The telephone survey captured very few school dropouts. Moreover, it resulted in lower self-reports of drinking and drinking and driving. Survey mode appeared to influence respondents equally, regardless of their gender, age, ethnicity, or SES.

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.

The relationship of drinking and hangovers to workplace problems: an empirical study.

OBJECTIVE: This article reports on the relationship between drinking patterns and workplace problems in a manufacturing facility operated by a Fortune 500 industry. METHOD: The data come from a survey of 832 hourly employees (88% male) and from ethnographic research in the plant. This study is distinctive because it examined a large random sample of workers, rather than an impaired subpopulation. Moreover, the study is among the few that has asked employees how much they drank prior to and during working hours and how frequently they had been hungover at work. Respondents were also asked about their overall alcohol consumption and their experience of various problems in the workplace. RESULTS: Bivariate analyses indicated that overall drinking, heavy drinking outside of work, drinking at or just before work and coming to work hungover were related to the overall number of work problems experienced by respondents, and to specific problems such as conflicts with supervisors and falling asleep on the job. Multivariate analyses revealed that workplace drinking and coming to work hungover predicted work-related problems even when usual drinking patterns, heavy drinking and significant job characteristics and background variables were controlled. Overall drinking and heavy drinking outside the workplace did not predict workplace problems in the multivariate analyses. The analyses show that workplace problems were also related to age, gender, ethnicity, work shift and departments. Survey results are explicated with findings from a plant ethnography. CONCLUSIONS: Although the relationships are modest, they support the hypothesis that work-related drinking and hangovers at work are related to problems within the workplace and may lead to lowered productivity and morale.

Predicting underage drinking and driving behaviors.

A social-psychological model of underage drinking and driving (DUI) and riding with drinking drivers (RWDD) was tested with data from a random digit dial telephone survey of 706 16-20-year-old drivers from seven western states in the United States. Consistent with the model, a structural equations analysis indicated that DUI and RWDD were primarily predicted by (a) expectancies regarding the physical risks of DUI, (b) normative beliefs about the extent to which friends would disapprove of DUI, (c) control beliefs about the ease or difficulty of avoiding DUI and RWDD and (d) drinking. Expectancies concerning enforcement had a significant effect on RWDD, but not on DUI. Among the background and environmental variables included in the analysis, only night-time driving and age had significant direct effects on DUI and RWDD. Drinking and involvement in risky driving had indirect effects on DUI and RWDD that were mediated through expectancies and normative beliefs. Males, European Americans, Latinos, respondents who drove more frequently and respondents who were less educated held beliefs that were more favorable toward DUI and RWDD, drank more and engaged more frequently in risky driving. As a result, such individuals may be at greater risk for DUI and RWDD.

Alcohol expectancies and adolescent drinking: differential prediction of frequency, quantity, and intoxication.

Although alcohol expectancies have been shown to be consistently related to drinking and problematic drinking among underage youth, some studies suggest that they are more predictive of quantity than of frequency of drinking. However, this hypothesis has not been formally tested. This study examines the differential prediction hypothesis using a sample of 1,781 high school students from the San Francisco Bay Area. Measures included yearly and monthly frequency of drinking and intoxication and usual quantity consumed per drinking occasion. Alcohol expectancies were measured with 11 items asking about the likelihood that having 2 or 3 whole drinks of alcohol would lead to specific personal consequences. Structural equations analyses indicated that expectancies were better predictors of quantity than of frequency or intoxication. The results also show that positive and negative expectancy subscales were differentially associated with the drinking measures and the patterns were somewhat different for males and females.

Television beer advertising and drinking knowledge, beliefs, and intentions among schoolchildren.

OBJECTIVES: The relationships between television beer advertising and drinking knowledge, beliefs, and intentions were investigated in a survey of schoolchildren. The research was guided by a theoretical model specifying that awareness of advertising, and not mere exposure, is necessary for it to have an effect on beliefs or behaviors. METHODS: Participants were a random sample of 468 fifth- and sixth-grade schoolchildren from a northern California community. Data were collected in the home with a combination of self-administered questionnaires and structured interviews. RESULTS: Nonrecursive statistical modeling indicated that awareness of television beer advertising was related to more favorable beliefs about drinking, to greater knowledge of beer brands and slogans, and to increased intentions to drink as an adult. The effects of advertising awareness on knowledge, beliefs, and intentions were maintained when the reciprocal effects of beliefs, knowledge, and intentions on awareness were controlled. CONCLUSIONS: The findings suggest that alcohol advertising may predispose young people to drinking. As a result, efforts to prevent drinking and drinking problems among young people should give attention to countering the potential effects of alcohol advertising.

The frequency and nature of alcohol and tobacco advertising in televised sports, 1990 through 1992.

This study examines the frequency and nature of alcohol and tobacco advertising in a random sample of 166 televised sports events representing 443.7 hours of network programming broadcast from fall 1990 through summer 1992. More commercials appear for alcohol products than for any other beverage. Beer commercials predominate and include images at odds with recommendations from former Surgeon General Koop. The audience is also exposed to alcohol and tobacco advertising through the appearances of stadium signs, other on-site promotions, and verbal or visual brief product sponsorships. Moderation messages and public service announcements are rare.

Portrayals of alcohol on prime-time television.

Alcohol portrayals were analyzed for a 3-week composite sample of prime-time fictional television programs aired in the fall of 1986. Approximately 64% of the 195 episodes contained one or more appearances of alcohol. Alcohol was ingested on 50% of all programs. Overall, there were 8.1 alcohol drinking acts per hour. Movies made-for-television had the highest rate of drinking acts per hour (10.0) followed by situation comedies (9.2) and then theatrical movies (7.4) and dramas (7.4). Within the category of dramas, evening soap operas stand out with 13.3 acts per hour. Drinking and nondrinking characters were compared on a number of attributes relevant to role modeling. Regularly appearing characters were more likely to drink than nonregular characters. Drinking characters also tended to be of high status, largely being white, upper-class professionals. A time trend analysis showed a regular increase in alcohol on television from 1976 to 1984, reaching 10.2 acts in 1984. After 1984 the trend appears to reverse.

The structure of problem behaviours among Irish adolescents.

Problem behaviour theory proposes that adolescent substance use and other problem behaviours comprise a single dimension reflecting a general underlying tendency towards deviance. This general deviance hypothesis was tested with survey data obtained from 2731 adolescents from Dublin, Ireland. A series of hierarchical maximum likelihood factor analyses indicated that three specific factors were necessary to account for the covariation among problem behaviour measures. These factors corresponded to substance use (drinking, smoking, marijuana use, and other drug use), relatively minor problem behaviours (swearing, lying), and relatively serious problem behaviours (stealing, vandalism). Contrary to the general deviance hypothesis, a second order factor representing general deviance accounted for only 14% of the variance in substance use, on the average, as opposed to 74% of the variance in minor and serious problem behaviours. These findings thus indicate that substance use among these Irish adolescents is relatively independent of a general tendency toward deviance. They also suggest that the general deviance hypothesis, as it usually is applied, may be culturally specific and relevant only for adolescents from the United States and similar cultural contexts.