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					Florida Substance Abuse Response Guide 2007 – Phase I


Phase I Contents


        Community Needs (Problem) Assessment Overview

        Assess Substance Use Behaviors and Consequences

        Determine Contributing Factors

        Develop an Initial Local Logic Model

        Assess Resources and Capacity Overview

        Assess Resources

        Assess Capacity

                                    Appendices
   A. SARG Phase I Checklist

   B. Community Data Partner and Data Source
      Recommendations

   C. Assessment Committee Responsibilities

   D. Identify Consequence(s) of Prioritized Substance Use
      Problem

   E. Identify Characteristics of the Population at Risk

   F. Brainstorming Contributing Factors

   G. Identifying and Measuring Contributing Factors

   H. Initial Logic Model

   I.   Guidelines for Qualitative Data Collection
                       Phase I – SARG 2007              -1-
Florida Substance Abuse Response Guide 2007 – Phase I
Phase I: Local Needs (Problem) Assessment

Overview of Needs (Problem) Assessment Steps
Problem assessment is an ongoing, strategic process that serves as a critical first step
in the outcomes based planning process. In order to focus and strategically apply
resources, the Florida Prevention System, through the work of Florida’s State
Epidemiology Workgroup (FL SEW), examined multiple sources of data as part of its
baseline ―Epidemiological Analysis for Substance Abuse Prevention.‖ Based on this
analysis, the FL Substance Abuse Advisory Council (FL SAPAC) identified the following
critical substance use issues for immediate intervention by state and local prevention
systems:

       Underage drinking
       Adult heavy alcohol use and binge drinking
       Risky drinking, including drinking and driving, by youth and adults that results in
        alcohol related motor vehicle crashes
       Middle school inhalant use

                                             The goal of the local problem assessment is to
The FL SEW was able to identify the
                                            further define your county’s prioritized substance
counties where rates of these
                                            use problem and related consequences and to
problems were higher than the state’s       identify the local factors contributing to this
rate. However the SEW was not able          problem. The more specific details you can
to collect data to identify specific        gather, the more specifically you can identify
populations at risk in each county.         and assess these factors and develop a strategic
Through the state’s SARG Call to            plan to address them.
Action process, your coalition used
state and local data to prioritize one of
these problems. Now it is your coalition’s turn to use local data to target specific
populations that are contributing to and at risk for these problems and to reduce the
conditions contributing to these behaviors.

The goal of your local problem assessment is to further define your county’s prioritized
substance use problem in order to address it most effectively. Developing a clear
understanding of your prioritized problem will make it easier identify the underlying
causes of the problem and the points where there is the greatest opportunity for
effective intervention. There is so much information out there that it is easy to get off
track. You need to stay focused on the problem your coalition prioritized in your Call to
Action response. Establish a team that can focus on the assessment, create a plan to
collect any information critical to your assessment, and help your coalition fully
understand the conditions contrbuting to the problem.

The major steps in the problem assessment are to:

       Establish a committee or team to oversee and assist in the needs (problem)
        assessment activities. You will want to invite partners that regularly collect data
        in your community as well as others that have experience gathering and
        interpreting data. Depending on the geographic and demographic nature of your
                        Phase I – SARG 2007                       -2-
Florida Substance Abuse Response Guide 2007 – Phase I
       county, you may need to develop multiple neighborhood specific teams to gather
       this data.
      Gather and analyze existing local assessments and data that are relevant to the
       problem your coalition has prioritized. Gathering existing data will help your
       coalition clarify data capacity that already exists in your county and avoid
       duplicating data gathering efforts.
      Begin to identify the patterns of adult or youth alcohol or inhalant use, depending
       upon your priority, and the consequences resulting from this drug use in your
       county. If your coalition has prioritized alcohol related motor vehicle crashes,
       this will be the focus of your consequence assessment.
      Pinpoint the areas where you need information to specify the age group and
       other aspects of the population that is contributing to the problem and gather this
       information in order to identify a target population that is most involved in the
       behavior.
      Consider how the intervening variables identified in the state’s generic logic
       model for your prioritized issue may be a problem in your county. To do this you
       may need to collect more in-depth, county-specific information to identify the
       local conditions that are contributing to each of these variables.
    Consider whether there is a specific geographic area within your county where
     the problem is more significant and that should be the focus of your efforts.

       Develop an initial Local Logic Model that depicts the problem behavior(s) and
       related consequences, intervening variables of concern, and local contributing
       factors. This logic model will serve as a working theory of change during the
       assessment phases and will become the blueprint for your Comprehensive
       Community Action Plan.
       Submit your problem assessment and logic model for feedback and review by
       state prevention professionals.

      Integrate the feedback you receive and present your problem assessment and
       initial Local Logic Model to your coalition board for acceptance.




                       Phase I – SARG 2007                     -3-
Florida Substance Abuse Response Guide 2007 – Phase I
Problem Assessment

The effectiveness of the strategies your coalition puts in place to address your
prioritized problem will depend greatly on your ability to understand the factors that are
contributing to the problem in your community. Your coalition will need to examine a
variety of data in order to identify the key factors contributing to the problem in your
county. The data your coalition needs to collect will be determined by the information
gaps you identify and how you decide to get that information.

At each step of the assessment process, you should consider with your team members
what you already know, what data verifies these assumptions, or whether you need to
collect additional information to verify or clarify what you know. At points along the way,
you may determine that there is no readily available data source to answer your
question. Instead, you may need to rely on local ―experts‖ who have information to help
you answer your question. In order to gain a greater depth of understanding, your team
may need to collect additional information by holding focus groups, interviewing local
leaders, making direct observations or re-examining existing data to identify patterns or
to understand the reasons the data appear as they do. The tools in the appendices will
help you answer the important questions and indicate points where you should pause to
identify information gaps


    Action Step:              Establish an Assessment Committee
 Establish a needs            Before you begin to collect or analyze data, you should
 (problem) assessment         establish an assessment committee to oversee and
                              conduct the problem assessment for your county.
 committee
                              Representatives from the various collaborative partner
                              organizations in your county, including county government
and some members from the community are potential members. For a list of suggested
data partners and the contributions they could make to your data collection effort, see
Appendix B.
                                                           The key is to ensure that your
 Form a Local Drug Epidemiology Network (DEN)              team has geographic
                                                           coverage, members who can
 Your county may be interested in creating a Drug          speak to the problem and age
 Epidemiology Network (DEN) to act as an ongoing           group you have prioritized and
 data gathering and drug surveillance workgroup in         members who have an array
 order to help the state identify emerging drug use        of experiences so your work
 issues and consequences before they become                can be conducted in a
 widespread problems. Trough participation in              culturally competent way.
 Florida’s Drug Epidemiology Network (DEN),                One of your first agenda items
 counties can collect data needed for surveillance         should be to agree on a
 purposes and communicate this information to state        decision-making process for
 leaders so that resources can be mobilized as             the committee and to
 needed. The SEW and the DENs will be critical             determine an acceptable
 partners informing decision making at all levels. To      timeline for completion of the
 find out more about organizing or joining a DEN in        draft problem assessment
 your county or region, contact your SARG coach.
                                                           Your team will need to
                       Phase I – SARG 2007                      -4-
  Florida Substance Abuse Response
Consequences of Underage Drinking          Guide 2007 – Phase I
                                                           establish roles and articulate who will
Underage alcohol use contributes to a variety of injury    be responsible for making sure each
and social consequences and is more likely to kill
young people than all illegal drugs combined. National     portion of the data collection and
data indicates that the consequences of underage           assessment gets completed. Make
drinking include:                                          sure that these agreements are
Drinking and Driving. Motor vehicle crashes are the        recorded and that everyone
leading cause of death among youth ages 15 to 20.          understands the purpose of the
Adolescents already are at increased risk through their
relative lack of driving experience, and drivers younger   problem assessment so that the
than 21 are more susceptible than older drivers to the     process runs as smoothly as possible.
alcohol–induced impairment of driving skills. The rate     Appendix C provides a simple table you
of fatal crashes among alcohol–involved drivers            may wish to use to track roles and
between 16 and 20 years old is more than twice the         responsibilities of your committee
rate for alcohol–involved drivers 21 and older.
                                                           members.
Suicide. Alcohol use interacts with conditions such as
depression and stress to contribute to suicide, the        Gather Existing Data and
third leading cause of death among people between          Assessments
the ages of 14 and 25. In one study, 37 percent of         The SARG process depends on data-
eighth grade females who drank heavily
reported attempting suicide, compared with 11 percent      driven decision making. Your problem
who did not drink.                                         assessment team will need to review
                                                           more specific data from your county to
High-Risk Sex. Research has associated adolescent          clarify your target population. To do
alcohol use with high–risk sex (for example, having        this, you’ll want to begin with recent
multiple sexual partners). The consequences of high–       local assessments that may already
risk sex also are common in this age group,
particularly unwanted pregnancy and sexually               have been conducted (during the past
transmitted diseases, including HIV/AIDS. According        3 years) about your prioritized problem
to a recent study, the link between high–risk sex and      or data that your coalition already has
drinking is affected by the quantity of alcohol            collected in order to identify what you
consumed. The probability of sexual intercourse is         know about the prioritized problem, the
increased by drinking amounts of alcohol sufficient to
impair judgment, but decreased by drinking heavier         populations involved, and where the
amounts that result in feelings of nausea, passing out,    problem seems to be occurring. What
or mental confusion.                                       you find will help shape your
                                                           subsequent data collection efforts.
Sexual Assault. Sexual assault, including rape,
occurs most commonly among women in late                   Identify the Consequences of the
adolescence and early adulthood, usually within the
context of a date. In one survey , approximately 10        Prioritized Substance Use Behavior
percent of female high school students reported            Outcome based planning begins with a
having been raped. Research suggests that alcohol          specific problem of concern and then
use by the offender, the victim, or both, increases the    identifies the conditions or intervening
likelihood of sexual assault by a male acquaintance        variables that are contributing to that
                                                           problem so that interventions can be
Alcohol’s Effects on the Brain. Exposing the brain to
alcohol during this period may interrupt key processes     put in place that specifically address
of brain development, possibly leading to mild             those conditions. You will want to
cognitive impairment as well as to further escalation of   consider the negative consequences
drinking. Subtle alcohol–induced adolescent learning       your community is experiencing as a
impairments could affect academic and occupational         result of the substance use behavior
achievement.
                                                           you have prioritized. These
                                                           consequences will shape your
                                                           community’s strategic response to the
                                                           problem.

                               Phase I – SARG 2007                      -5-
  Florida Substance Abuse Response
Consequences of Inhalant Abuse               Guide 2007 – Phase I

   Dependence and escalation to use of other illicit
    drugs
                                                           While alcohol and drug use by youth in
                                                           and of itself is a problem, your team
Inhalant abusers risk an array of devastating              needs to understand the problems that
medical consequences, including brain damage and           the prioritized drug use behavior is
death: Prolonged sniffing of the highly concentrated       causing in your community so that you
chemicals in solvents or aerosol sprays can induce         can put comprehensive strategies in
irregular and rapid heart rhythms and lead to heart
                                                           place that will reduce the impacts of
failure and death within minutes of a session of
prolonged sniffing. This syndrome, known as                substance use. If your coalition has
"sudden sniffing death," can result from a single          already prioritized alcohol related motor
session of inhalant use by an otherwise healthy            vehicle crashes, take this opportunity to
young person. Sudden sniffing death is particularly        understand the characteristics of these
associated with the abuse of butane, propane, and
                                                           events in your county. What are the
chemicals in aerosols.
                                                           patterns associated with their location
Inhalant abuse also can cause death by:                    time of year, week and day.
   Asphyxiation - from repeated inhalations,
    which lead to high concentrations of inhaled           Identifying consequences of the problem
    fumes displacing the available oxygen in the           will also help you better target the
    lungs;                                                 populations that are involved in the
   Suffocation - from blocking air from entering          behavior. The target population will
    the lungs when inhaling fumes from a plastic           become the focus of your intervention.
    bag placed over the head;                              Identifying the consequences of youth
   Convulsions or seizures - caused by                    alcohol use or adult abuse and the costs
    abnormal electrical discharges in the brain;           to the community can also help build
   Coma - the brain shuts down all but the most           community support for effective
    vital functions;                                       prevention measures.
   Choking - from inhalation of vomit after
    inhalant use; or                                       If your coalition has prioritized underage
 Fatal injury - from accidents, including motor           drinking, for example, you’ll want to
   vehicle fatalities, suffered while intoxicated.         consider whether this behavior is
Source:                                                    resulting in a large number of school
http://www.nida.nih.gov/ResearchReports/Inhalants/Inhala
nts2.html#patterns                                         problems, such as disciplinary incidents
                                                           and academic failure, injuries due to
                                                           drinking and driving, falls or boating
Consequences of Adult Heavy and Binge                      accidents, unwanted pregnancies or the
Drinking                                                   spread of STD’s. While your aim will be
                                                           to reduce youth alcohol use,
Research consistently shows that people tend to            understanding the consequence patterns
drink the heaviest in their late teens and early to        that result from underage drinking in your
mid-twenties. Young adults are especially likely to
                                   1
binge drink and to drink heavily Risky drinking by
                                                           county will help you focus your efforts on
adults often leads to tragic consequences—most             particular populations and the contexts
notably alcohol-related traffic fatalities. Nationally,    (places, times, and situations) in which
51 percent of drivers ages 21–24 who died in traffic       consumption occurs that contributes to
crashes in 2003 had measurable alcohol in their            these consequences.
blood. Adult heavy drinking also leads to other types
of debilitating injuries, addiction and death from
accidents violence, cirrhosis of the liver, and            As you initially brainstorm a list of
suicide,                                                   potential local consequences, your team
                                                           should ask, ―how do we know that the
Source:                                                    drug use problem we prioritized (e.g.
http://pubs.niaaa.nih.gov/publications/aa68/aa68.htm
                                Phase I – SARG 2007                       -6-
Florida Substance Abuse Response Guide 2007 – Phase I
alcohol use by youth) is contributing to these problems?‖ Look for local data and expert
knowledge that can help you to confirm this relationship.

To determine the consequences your community is experiencing as a result of
underage drinking, adult heavy and binge drinking, or drinking and driving your team
could review school disciplinary reports, interview school counselors with knowledge of
academic failures, review arrest records and crime data and talk with law enforcement
and court officials. As you collect data indicating
consequences, be sure to identify the alcohol using
behaviors (alcohol type, frequency of use and
                                                           Note: It may be difficult to
volume consumed) that are most associated with
                                                           demonstrate reductions in
the consequences you identify you identify. For            problems with low rates of
example, if the consequence of focus is alcohol            occurrence (e.g. one or two
related motor vehicles crashes, injuries and               fatalities in a one to three
deaths, do these consequences in your county               year period). You may want
result from drivers with relatively low blood alcohol      to focus on a related
content (less than .1%), heavy drinkers (1- 1.5%),         consequence (e.g.
or binge drinkers (1.5%+)? Are these underage              emergency room or hospital
drivers (under 21), young adults (21 to 24) or             admissions) that would
adults? Are most crashes caused by first time or           logically precede the fatality
repeat offenders?                                          consequence and that you
                                                          would expect to reduce if
                                                          your efforts are successful.
You may need to consult with local experts from           Mapping the relationships
the law enforcement, the Public Health                    between the behaviors and
Department, Schools, Medical Examiner’s Office,           consequences in your Local
hospitals and emergency rooms, and who are                Logic Model can help to
most knowledgeable about drug related                     determine this sequence
consequence. . Public health officials and rape           and focus your team on
crisis centers can provide data on teen pregnancy,        consequences that you can
STD rates and sexual battery and can provide              realistically impact in the
insight into the role of alcohol.                         short term and show
                                                          reductions in.
Data from these sources have pluses and minuses.
You may find that their data is not computerized
and may raise privacy concerns. You may have to reach agreements with the
organizations or agencies in order to gain access to the records. However, these
records can be rich sources of information to help you pinpoint substance-related
consumption patterns and related consequences in your county. For example, obtaining
the number of emergency room visits that involved treatment for inhalant use would be
an appropriate and data-driven way to identify the types of inhalants that are commonly
used in your county and the consequences resulting from their abuse.

Record the consequence(s) for which local data indicates a relationship with your
coalition’s targeted substance use behavior and prioritize one or more for reduction.
You’ll want to consider whether the rates of various consequences appear to be going
up or down or have been stable over a number of years. If you can get state measures
of the consequence or rates for other counties similar to yours, consider whether your
county’s rates of the consequence are higher or lower that the state or similar counties.
Comparing your county’s rates with state and other county rates can help give you

                       Phase I – SARG 2007                     -7-
Florida Substance Abuse Response Guide 2007 – Phase I
valuable perspective about the relative extent of the problem in your county. Your team
will also want to consider the extent of the impact of these consequences in your
county. Consider both the actual number experiencing the consequence as well the
economic and social costs of the consequence. Even low numbers can have a large toll
when you consider years of potential life lost to early death or to disability or the cost
borne by local social service systems. Record your county’s prioritized consequence(s)
in Appendix D.

Once you have identified one or more consequences that is documented by local data
and that appears to be impacting a substantial percentage of the population involved,
your team will want to identify the characteristics of the population. Understanding the
characteristics of the population will be important for targeting those at risk for the
behavior and its consequences.

Identify the Target Population
Understanding the characteristics of the populations at risk is important for identifying
the root causes of the problem as well as for identifying the most relevant and effective
interventions. Use data from FYSAS, Behavioral Risk Factor Surveillance Survey
(BRFSS) or Youth Risk Behavior Survey (YRBS) if it provides data for your county
specifically, the CORE campus survey, and other local surveys of drug use to identify
the characteristics of the populations engaged in the problem drinking or inhalant use
behavior. Is there a pattern of consumption among certain grades or age groups that is
of particular concern? Does the behavior and consequence appear to be happening
more among males or females? Are there other demographic characteristics about the
population that could help identify those at greatest risk? If survey data is not available
for the population of concern, look to other sources including arrest data, treatment
data, emergency room, medical examiner data. If your team is unable to identify the
characteristics of the target population using existing data, you may need to turn to
more qualitative data collection methods. You might interview several key community
experts who have experience with the population involved in the prioritized behavior and
consequences for their knowledge about the characteristics of the population most at
risk. Record the characteristics of the target population and supporting data sources in
Appendix E.

By now you have probably come to the conclusion that the data you have reviewed is
beginning to fill in a picture, and perhaps confirm your team’s assumptions about the
substance use behavior and its consequences in your community and the populations
most at risk. The next phase of the problem assessment asks your team to begin to
think about intervening variables or risk factors. These are the root causes of the
problem in your community, but specifically causes your community can act to change.
In this next step, your team will build upon what you have already learned and further
focus your information gathering efforts.

Identify Intervening Variables of Concern
Epidemiological and intervention research point to a number of factors that contribute to
the increase and/or reduction of specific substance use behaviors among populations.
Recent reviews of this literature point to a set of common risk factors that appear to
contribute to substance use (alcohol, tobacco and illicit drugs) but evaluation evidence


                       Phase I – SARG 2007                     -8-
Florida Substance Abuse Response Guide 2007 – Phase I
suggests may be altered with certain interventions (e.g. programs, policies, practices).1
Based on this research, Florida has adopted the following generic outcome based logic
models addressing the state’s prioritized substance use issues and indicating the risk
factors of concern.

Florida’s Logic Model to Reduce Underage Drinking

                                                                         Intervening Variables
         Consequence                      Consumption                    (contributing factors)


                                                                        Individual Attitudes and
            Examples:                          Youth                    Beliefs about Alcohol Use
                                         early initiation of
        Lack of school/work                 alcohol use
              success                                                    Social Norms favorable
                                             Youth                            to alcohol use
          Alcohol Related
          crashes, injuries,
                                       30 day alcohol use
               deaths                                                    Easy Social Availability

      Risky Sexual Behavior,                  Youth                     Easy Retail Availability
      Teen pregnancy, STD’s               Binge Drinking
       Falls and other injuries                                          Low or discount pricing
                                                                               of alcohol
                                         Drinking in risky
         Violence, including
         Suicide Attempts,                situations and                Laws, policies don’t limit
               Death                         contexts                    access, possession, use

               Crime
                                                                         Promotion of alcohol use
          Addiction, Co-                                                   (advertising, movies,
        occurring disorders                                                    music, etc.)
                                                                          Low enforcement and
                                                                          adjudication of alcohol
                                                                                   laws




1
  Birckmayer, J.D., Holder, H.D., Yacoubian, GS, & Friend, K.B., (2004). A general causal model to guide alcohol,
tobacco, and illicit drug prevention: Assessing the research evidence. Journal of Drug Education, 34, 121-153.
                               Phase I – SARG 2007                             -9-
Florida Substance Abuse Response Guide 2007 – Phase I


Florida’s Logic Model to Reduce Alcohol Related Motor Vehicle Crashes, Injuries,
and Fatalities

                                                                Intervening
        Consequence                      Consumption             Variables



                                             Youth          Individual Attitudes
                                       Drinking              and Beliefs about
                                                                Alcohol Use


                                        Adult Heavy and         Social Norms
                                       Binge Drinking        favorable to alcohol
                                                                     use

        Alcohol Related                                             Easy Social
        crashes, injuries,
                                       Drinking in risky
                                       situations and               Availability
             deaths
                                       contexts:

                                       Drinking and                 Easy Retail
                                       Driving                      Availability

                                       Riding with            Low or discount
                                       impaired driver        pricing of alcohol

                                       Drinking while
                                       boating                Laws and policies
                                                              don’t limit access
                                       Pedestrian
                                       drinking
                                                            Promotion of alcohol
                                                              use (advertising,
                                                             movies, music, etc.)

                                                              Low enforcement
                                                             and adjudication of
                                                                alcohol laws




                             Phase I – SARG 2007           - 10 -
Florida Substance Abuse Response Guide 2007 – Phase I

Florida’s Logic Model for Adolescent Inhalant Use

                                                              Intervening
          Consequence                  Consumption             Variables



            Examples:                    Adolescent       Individual Factors-
                                       Inhalant Use       Alienation and
        Brain injury                Huffing/Sniffing:    rebelliousness
        Addiction                   glue                 -Depression or other
        Asphyxiation/               shoe polish          co-existing mental
         Suffocation                 gasoline             illness
                                                          -Experimentation/
        Convulsions or              nitrous oxide
                                                          dependence on other
         seizures                    lighter fluid
                                                          drugs
        Coma                        spray paints
        Choking                     correction fluid
        Heart failure
                                     paint solvents
        Sudden sniffing                                  Family Management
         death                                            and Communication
        Motor vehicle                                    (especially in Foster
         fatalities,                                      Families)
         suffered while
         intoxicated.




Begin to Identify Intervening Variables and Contributing Factors

Remember, intervening variables represent a group of factors that social scientists have
identified as influencing the occurrence and magnitude of substance use and its
consequences. Your problem assessment team will need to consider the presence of
these intervening variables in your community and how these particular risk factors work
to contribute to the substance use behavior among your targeted population(s). The
Strategic Prevention Framework and the SARG process are based on the idea that
making changes to these intervening variables at the community level will cause
changes in substance use and related problems. Intervening variables already
identified as priorities in the State needs assessment include:

      Laws and policies and their enforcement;
      Retail access/availability;
      Social access/availability;

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Florida Substance Abuse Response Guide 2007 – Phase I
       Price and promotion of substances;
       Social norms:
           o Community norms;
           o Family norms; and
       Individuals’ perceptions of risk and harm and other attitudes and beliefs about
        substance use

                                         Intervening variables are broad factors that
                                         manifest differently in different communities. It
        Action Step: Look at the         is your job to define what it is about each
  information you have gathered so       intervening variable that contributes to
  far in terms of intervening            substance use and consumption in your
  variables and contributing factors.    county. Using underage drinking as an
                                         example: the issue may be that in one
community youth who drink may believe that they will not get caught because even
though the police are working hard to enforce the laws nobody hears about anyone who
got caught (perception about enforcement). In another community, police may not in
fact spend their time enforcing laws around youth drinking because other substances
pose a bigger problem (focus of police enforcement). Both of these factors contribute to
the intervening variable of enforcement (perceived or actual) related to underage
drinking.

       Enforcement includes the enforcement of the rules, laws and policies
        surrounding substance use and its consequences, as well as the public
        perception of the levels of enforcement and how likely people are to believe they
        will get caught if they violate the rules, laws and policies.

       Retail access/availability refers to the accessibility of alcohol, tobacco and
        drugs from retail sources (i.e., where money is exchanged.2 Examples are: the
        ability of underage youth to obtain alcohol from stores as well as the ease of
        purchasing alcohol for adults; and, the sale of drug paraphernalia, such as rolling
        papers.

       Social access/availability refers the access one has to substances through
        social networks. In this case money is rarely exchanged. For example, parents
        who throw house parties provide social access to alcohol for youth.

       Price refers to economic availability such as special deals and discounts for
        alcohol in particular, such as “2 for 1” specials or discounted happy hour prices.




2
 A General Causal Model to Guide Alcohol, Tobacco and Illicit Drug Prevention: Assessing the Research
Evidence. Strategic Prevention Framework State Incentive Grant State Epidemiological Workgroup
Workshop. Washington, DC: March 16-17, 2006.
                         Phase I – SARG 2007                          - 12 -
Florida Substance Abuse Response Guide 2007 – Phase I
       Promotion attempts to increase the attractiveness of drinking, smoking or using
        illicit drugs.3 It can include advertising that promotes excessive, illegal and/or
        unsafe use as well as sponsorship of events that promote excessive, illegal
        and/or unsafe use.

       Social norms are informal standards or values regarding the acceptability or
        unacceptability of certain behaviors including substance use.4

           o Family norms include parental attitudes towards substances (e.g. kids will
             be kids), parental monitoring and involvement, parental/sibling use of
             substances.
           o Community/peer norms include attitudes of peers and adults in the
             community towards substance use (e.g. belief that most people drink/use
             drugs or that social events must include substances), peer/community use
             of substances, and the perceived social benefits of substance use (the
             “coolness” factor).

       Perceived risk - if individuals do not feel substance use poses a great risk,
        they tend to underestimate the potential consequences. For example, if
        individuals believe that they won’t get in a crash while driving under the
        influence, they may be more likely to engage in that behavior.




3
 A General Causal Model to Guide Alcohol, Tobacco and Illicit Drug Prevention: Assessing the Research
Evidence. Strategic Prevention Framework State Incentive Grant State Epidemiological Workgroup
Workshop. Washington, DC: March 16-17, 2006.



                         Phase I – SARG 2007                          - 13 -
Florida Substance Abuse Response Guide 2007 – Phase I

Each of the intervening variables (e.g., social access, promotion and community norms)
is shaped by contributing factors as well. The following illustrates potential
contributing factors for the intervening variable of retail access/availability.

                        Sample Local Contributing Factors to the
                    Intervening Variable of Retail Access/Availability


Retail Access/Availability: Retailers’ responsibility/ accountability; product placement/display;
security; responsible beverage service practices; outlet density; hours/days of retail sale,
container/serving size;


                                                          1. High number of
                                                          alcohol outlets
                     Retail                               2. Convenience stores
                    Access/                               selling to minors
                   Availability
                                                          3. Lack of security of
                                                          product display

                                                          4. Limited responsible
                                                          beverage service
                                                          practices
          Potential Data Sources: Outlet density;
          compliance sales data; observation scan
          placement practices of sample of
          convenience stores; observations at
          bars/restaurants.




Appendix G provides a series of tools to help you brainstorm and identify the
contributing factors in your county that are associated with each intervening variable.
Use the data you have already collected and/or reviewed to inform your selection of
contributing factors for each intervening variable. A description of possible contributing
factors is provided for each intervening variable. Do not dismiss factors simply because
you have little to no data to support them. It is these factors and gaps in knowledge
which may be used to shape additional data collection needs, the focus of the next
section of the Guide.

You will note that the intervening variables              Identifying the contributing
identified for inhalant use are substantially             factors is key to selecting
different than those for alcohol. These are risk          appropriate prevention efforts to
factors identified in national epidemiological            employ in your county.
studies concerning the characteristics of the


                         Phase I – SARG 2007                       - 14 -
Florida Substance Abuse Response Guide 2007 – Phase I
population identified with inhalant abuse and dependence.5 The target population for
inhalant abuse is a selected and indicated population, having one or more specific risk
factors, rather than a general, universal population of youth and adults. Until more is
known about risk factors more specific to Florida’s youth, interventions should be
targeted to youth with these risk factors. Your problem assessment may reveal
additional risk factors for this target population.

Indentifying the local contributing factors is key to selecting appropriate prevention
efforts. Once you have brainstormed the list of possible local contributing factors to
each intervening variable, you will need to determine whether your team has enough
information to support your assumption. If your target population is youth aged 12 to
17, you should begin by considering your county’s Florida Youth Substance Abuse
Survey (FYSAS) data.

Examine the FYSAS results for the intervening variables you began to think about.
These data can be examined by individual question and/or by scale (e.g., laws and
norms favorable to drugs). A scale is made up of a set of questions. For example, the
laws and norms favorable to drugs scale is a set of questions that includes the
following:

       If a kid drank some beer, wine or hard liquor (for example, vodka, whiskey, or
        gin) in your neighborhood, would he or she be caught by the police?
       If a kid smoked marijuana in your neighborhood, would he or she be caught by
        the police?
       If a kid carried a handgun without permission in your neighborhood would he or
        she be caught by the police?
       How wrong would most adults (over 21) in your neighborhood think it is for kids
        your age: to use marijuana? to drink alcohol? to smoke cigarettes?

FYSAS data can be accessed via the website, located at: http://cdrc.med.miami.edu/x58.xml.
State, regional and county reports are available to the public; the school district and
school reports are provided directly to School Superintendents and school building
principals. Responses to FYSAS survey questions can give you indications of whether
some of these intervening variables are problematic in your county:

       Perceived risk: Do perceived risks from alcohol and drug use vary by grade
        and/or gender?
       Social norms and disapproval:
             o    Do perceptions of social norms and attitudes about alcohol vary by grade
                 and/or gender?
             o Do youth perceive that their parents would disapprove if they drank?



5
 “NIDA Research Identifies Factors Related to Inhalant Abuse, Addiction.” National Institutes of Health,
September 28, 2004. http://www.nih.gov/news/pr/sep2004/nida-28.htm
                             Phase I – SARG 2007                               - 15 -
Florida Substance Abuse Response Guide 2007 – Phase I
          o Do youth report that their parents communicate their disapproval of
            alcohol and other drug use to them?
      Retail/Social Availability: Do youth perceive that alcohol is easily available?
      Enforcement: Do youth perceive they would get caught if they drank?


FYSAS data cannot tell you what is contributing to these risks in your county, however.
That is where your assessment of local contributing factors comes in to play. Is
perceived risk low because youth do not receive adequate prevention education? Are
the norms in your community tolerant of youth alcohol use? How is this communicated
to youth by their families and peers, by the community and its culture? Do adults
perceive drinking to be a rite of passage that is harmless? Do adults in the community
provide alcohol to youth without impunity? Do law enforcement prioritize alcohol misuse
by youth and adults? Is alcohol cheap and readily available to youth and adults? Do
local ordinances effectively regulate youth access to and use of alcohol? Only by
answering these questions about the attitudes and beliefs, availability and use in the
context of your community will you understand the conditions that are contributing to
your local problem in the context of your community and its local culture.

State priorities also include a focus on adult heavy and binge drinking, particularly as it
relates to alcohol related motor vehicle crashes, FYSAS only provides data on middle
and high school students, however. You will need to turn to other data to identify
intervening variables and local contributing factors that influence adult alcohol misuse.

Where you identify gaps in your knowledge about an intervening variable or potential
contributing factor, you may need to collect more information to fill your knowledge gap.
To determine whether your team’s assumptions about a potential contributing factor are
correct, you may want to conduct interviews with key ―community experts‖
knowledgeable about the situation, focus groups or surveys, or make observations of
businesses, public areas, local media or other environments.

Following is an overview of the different methodologies and some tips for employing
them you may use to collect additional information. Each of these data collection
methods has benefits and drawbacks. Selecting which methods to use, and how you
choose to use them, will be determined in large part by what knowledge gaps you
identify after your review of existing data and your preliminary exploration of intervening
variables and contributing factors.




                       Phase I – SARG 2007                      - 16 -
Florida Substance Abuse Response Guide 2007 – Phase I

                        Summary of Data Collection Methods
    Type                   Pros                               Cons
                                                              Time consuming to develop
                           Supplements data findings with
                                                              questions and arrange groups. It
    Focus groups           personal experiences and
                                                              can be difficult to recruit
                           perspectives.
                                                              participants.
                           Collects on-the-ground
                                                              Data are based on interviewee’s
    Expert Interviews      knowledge of policies and
                                                              perceptions/biases.
                           practices.
                           Efficient way to measure           Difficult to conduct for a large
    Environmental scans    availability and promotion.        geographic area.

                           Collects the information you       Require technical knowledge to
                           want; allows for statements such   design. Can be very time
    Surveys                as ―20% of residents responded     consuming and too few
                           that…‖; can be compared to         responses can make results
                           other data.                        invalid. Can be costly.


For any of these collection methods, it is important to focus your data collection to
obtain information for a purpose. For the SARG process, the main purpose of data
collection is to clarify consumption and consequence patterns, to identify priorities and
to further define intervening variables and contributing factors. Your team should seek
at least one data source to support your assumptions about each potential local
contributing factor.

See Appendix H for some suggested tools and guidelines for collecting qualitative data
using focus groups, key informant interview, and observations.

Once your team has gathered the information needed to determine which intervening
variables and contributing factors are problems in your county, indicate these in
Appendix F.

Your team is now ready to develop your initial Local Logic Model for your county. Your
county’s initial Local Logic Model should include the intervening variables that appear to
be problematic in your county and the factors that you identified that are contributing to
each variable. Complete your initial Local Logic Model using the template in Appendix

Submit your problem assessment and logic model for feedback and review. This review
will help to ensure that your data analysis team has fully considered the problem and its
causes and has gathered adequate information to support the relationships identified in
your logic model. The review team will also assess whether the relationships depicted
in your logic model are supported by research and confirmed with local data.




                        Phase I – SARG 2007                         - 17 -

				
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