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					Exploring Environmental Strategies:
Identification, Selection and Implementation of
Environmental Strategies for Substance Abuse
                   Prevention



                       Kristianna Pettibone, PhD
                       The MayaTech Corporation




                                            July 2007
What is an environmental
strategy?

CSAP: Prevention efforts that aim to change or
 influence community standards, institutions,
 structures, attitudes that shape individuals
 behavior (alter policies, procedures, systems,
 attitudes)

CDC: changes to the economic, social, or
 physical environments.
5 Categories of Environmental
Strategies

 To truly affect the environment, you should aim to include a variety of
 categories in your intervention.

1.   Policies
2.   Enforcement
3.   Education
4.   Communication
5.   Collaboration

http://pathwayscourses.samhsa.gov/ev/ev_intro_pg1.htm
Environmental Strategies –
Unique Opportunities


   Comprehensive prevention

   Potential for transformation of infrastructure

   Community-wide change

   Engagement of policy makers (and other new
    groups) in prevention
Environmental Strategies –
Challenges


   Time and resource-intensive

   Evaluation systems have been designed around
    program level interventions

    –   Implementation process is large-scale, broad-based

    –   Outcome assessment across communities
Selecting appropriate environmental
strategies


      Substance-Use           Risk &              Strategies
      Behaviors and         Protective/          (Programs,
         Related              Causal               Policies,
      Consequences           Factors              Practices)


An outcome based logic model for substance abuse prevention maps a
     strategic approach for addressing priorities in terms of three
     components:
    –    A clear definition of problem(s) to be addressed (consequences
         and behaviors)
    –    Risk and protective factors/causal factors which have scientific
         evidence of contributing to the problem, and
    –    Prevention strategies (programs, policies, practices) with
         evidence of effectiveness to impact one or more risk and
         protective factors/causal factors and/or the targeted problems.
Overlap of Categories and Causal
Factors

   Keep in mind that categories and causal
    factors overlap
    –   Strategies that address retail access, for example,
        may include enforcement, communication, and
        policy.
The BINDER

   How to access it
   Limitations
   Overview of contents
   How to use it
How to access it

   Developed as part of CSAP’s SPF SIG grant
    initiative
   Available as an electronic PDF at:
         www.spfsig.net
       Under the Cross-Site Column
       Select Grantee Committees
       Expand the Environmental Strategies Folder
       Expand Environmental Strategies Binder
       Select the PDF for the Binder and/or the articles you want
Limitations – (User Beware)

   Not an exhaustive list of environmental strategies
   Only includes environmental strategies that were
    implemented in the substance abuse prevention
    field.
   Tends to focus on environmental strategies that
    relate to alcohol and tobacco use.
   Limited time and resources went into development
   Does not included workplace strategies
Overview of Contents

   Selecting an appropriate strategy
   Literature on environmental strategies
   Introduction and methods
   Selection guide
   Effectiveness analysis
   Reference list
   Implementation guidelines resources
   Other useful publications
   Another resource list
Selection Guide

   Criteria assessed include:
    –   General description provided
    –   Implementation guidelines provided
    –   Output measures defined
    –   Effectiveness assessed
    –   Evidence-based
    –   Substance: targeted, could be adapted for
    –   Target audience
   Column to be added indicating CSAP category
Sample of Selection Guide
                                                                        Evidence-Based                Substance
                                                          Eff
                                                                         NR                                  Other    Appr
                                                          ecti
                                  Implementat   Output                   EP                                 Substan   opriat
                     General                              ven    Jou
Environmental                         ion       Measure                   P                                   ces       e
                    Description                           ess    rnal                    Oth
  Strategy                         Guidelines      s                      or    CAPT           Targeted      Could    Popul
                     Provided                             Ass    arti                    er
                                    Available   Defined                  oth                                  be      ation
                                                          ess     cle
                                                                          er                                Applied     s
                                                           ed
                                                                         list                                  to
                                                    ENFORCEMENT
Business/Merchant
Compliance
checks of
alcohol or             a             a           a        a a                            a       A,T                   All
tobacco
retailers
                                                   RETAIL ACCESS
Minimum age
of purchase for
alcohol and            a                                  a a                                  A, T                    <21
tobacco
Effectiveness Analysis

   Column in selection guide only indicates if effectiveness was
    analyzed for a specific strategy
   Selection guide does NOT indicate if the findings were positive
    or negative or mixed
   After the first review by the SPF SIG grantees, we were asked
    to include an effectiveness analysis that provides a brief
    summary of the findings of effectiveness
   This is ONLY for those strategies for which examples of
    Implementation Guidelines were found
   Enables communities to determine if the effectiveness is
    appropriate for their situation
Reference List

   Organized by intervening variable
   Includes all resources reviewed that included
    at least one criteria
    –   General description (GD)
    –   Implementation guidelines provided (IG)
    –   Effectiveness analyzed (E)
    –   Output measures defined (OM)
Sample of Reference List

SOCIAL ACCESS (Intervening Variable)
Alcohol Restrictions at Community Events
Institute for Public Strategies. (2003). Issue briefing: Keeping your
   special event festive and safe: A planning guide for Ventura
   County communities.
   http://www.publicstrategies.org/pdfs/ventura_special_events_u
   pdated.pdf GD, IG

Toomey, T. L., Erickson, D. J., Patrek, W., Fletcher, L. A., &
  Wagenaar, A. C. (2005). Illegal alcohol sales and use of alcohol
  control policies at community festivals. Public Health Rep., 120,
  165-173. GD, OM, E
Implementation Guideline Resources

   List of those strategies for which
    Implementation Guidelines were identified
   Implementation Guidelines were defined as
    step-by-step instructions or guidance on how
    to implement an intervention
   Source documents provided
    –   Links to sources when available
    –   PDF when links are not available
Sample of Implementation Guidelines

RETAIL ACCESS
Conditional Use Permits/Land Use Ordinance for Alcohol
  Outlets
The Marin Institute. (2006). Land-Use Ordinances Action Pack. 7-
  27-2006.
  http://www.marininstitute.org/action_packs/land_use.htm

SOCIAL NORMS
Social Norms Campaigns/Social Marketing
Haines, M. P., Perkins, H. W., Rice, R. M., & Barker, G. (2005). A
  Guide to Marketing Social Norms for Health Promotion in
  Schools and Communities National Social Norms Resource
  Center. http://www.socialnorms.org/pdf/Guidebook.pdf
Let’s put you to work

   Identify a substance use behavior or
    consequence to target
    –   Underage binge drinking
    –   Alcohol related traffic fatalities
    –   Marijuana use among college students
    –   Cigarette smoking by pregnant women
Next task…

   Identify causal factors (also known as risk and
    protective factors or intervening variables) that
    contribute to the problem
    –   Retail access
    –   Social access
    –   Social norms
    –   Promotion
    –   Perceived risk
    –   Pricing
    –   Enforcement
    –   Other
Then…

   Refer to Selection Guide
   Choose a strategy that addresses the
    outcomes and causal factors identified
   If resources allow, select several strategies
    to ensure that a variety of methods (CSAP
    categories) are used to change the
    environment: Policies, Enforcement, Education,
    Communication, Collaboration
Next Steps…not included in the binder

   Implementation fidelity
   Data collection
   Evaluation
Thanks

   Anne Rogers, SPF SIG Coordinator, Maine
   Shelly Kowalczyk, MayaTech

				
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