Northeast > Resources > Prevention Materials > Prevention Strategies > Policy > Policy Paper

POLICY:

A Strategy for Prevention Practitioners

Developed by
CSAP’s Northeast Center for the Application of
Prevention Technologies (CAPT)

  

We are pleased to welcome you to CSAP’s Northeast Center for the Application of Prevention Technologies (CAPT). Since 1997 we have been working with six New England and five mid-Atlantic States, to effectively transfer knowledge to the local level and strengthen their capacity to prevent and reduce alcohol and other drug use in youth ages 12–17.

 

The Center for Substance Abuse Prevention (CSAP) in the Substance Abuse and Mental Health Services Administration is the nation’s lead agency for substance abuse prevention. In addition to funding studies to test research-based models, CSAP spreads the word about proven program interventions that will enhance the efforts of prevention practitioners, policymakers, and evaluators. We hope you will visit the CSAP website at www.samhsa.gov. CSAP’s Decision Support System (DSS) promotes scientific methods and programs for substance abuse prevention for use within communities and state prevention systems. To learn more about CSAP’s DSS, visit their website at www.preventiondss.org.

This series includes documents on Policy, Enforcement, Collaboration, Communications, Education, Early Intervention, and Alternatives. Special thanks to Dan Finkelstein at CSAP’s Northeast CAPT for his assistance in creating this module.

Funded by the Center for Substance Abuse Prevention (CSAP), Substance Abuse and Mental Health Services Administration Grant #UD1-SPO8999-01.

© Copyright 2001 Education Development Center, Inc. All rights reserved.

 

POLICY:

One of Seven Science-Based Prevention Strategies

WHAT WORKS IN PREVENTION?

Researchers at the national level are making great strides toward answering this important question. In recent years, they have distilled effective strategies and principles from the many programs that seek to prevent and reduce substance abuse. Now, across the country, more and more practitioners are coming to understand how critical it is to identify and use science-based strategies that are likely to be effective in meeting the needs of the people they serve.

For the Center for Substance Abuse Prevention (CSAP), Gardner and Brounstein have identified principles of effective substance abuse prevention.¹ From these, CSAP’s Northeast CAPT has specified seven effective prevention approaches. (See chart before endnotes.) They are:

• Policy
• Enforcement
• Collaboration
• Communications
• Education
• Early Intervention
• Alternatives

A policy, for instance, can make it difficult for young people to obtain alcohol, or it can impose real penalties for drunk driving. Specifically, policies can be used to do the following:

• Restrict access to and the availability of alcohol, tobacco, and other drugs
• Target the prices of alcohol and tobacco products
• Limit the location and density of retail alcohol outlets
• Create a deterrence against breaking the law
• Place restrictions on alcohol, tobacco, and other drug use in public places
• Restrict marketing of alcohol and tobacco in public places

As communities around the country are learning, the key to effective prevention is to use multiple strategies, in multiple settings, toward one common goal. Communities should examine their local situations, identify their specific needs, and look for ways to combine seven strategies that have proven effective: policy, enforcement, collaboration, communications, education, early intervention, and alternatives.

Multiple strategies, in multiple settings, toward one common goal.

WHAT IS POLICY?

For many years, communities depended primarily on prevention strategies that focused on the individual—teaching young people about the dangers of substance use and the skills they need to resist social pressure.² Some of these programs have been shown to be effective in reducing the likelihood that a young person will use alcohol, tobacco, and other drugs, though many more fail to demonstrate their actual effectiveness. But even a model program’s effectiveness can be undermined in a community where children and young people can easily purchase alcohol, tobacco, and other drugs, and perceive no penalties associated with using them.³

In recent years prevention experts have begun to recognize the importance of addressing the social and environmental conditions that give rise to substance use. In particular, research has focused on alcohol availability and its impact on various health and safety problems, including general public consumption, crime, traffic crashes, and youth access to alcohol; these findings have led to a new focus on policy as a prevention strategy.⁴ "Policies" can be broadly defined as "standards for behavior that are formalized to some degree [i.e., written], and embodied in rules, regulations, and operations procedures."⁵ Government regulations are one type of such policies, but they can also include non-governmental regulations put into place at institutions like schools, colleges, liquor stores, bars, restaurants, and workplaces.⁶ Ultimately, policy can be used to effect environmental change, thereby reducing substance use.

While individual strategies continue to be an important component of community prevention, changing the environment—rather than just individual behavior—can have a significant impact on consumption and use. Communities can take important steps to change the environment by enacting policies that make it difficult for young people to obtain alcohol, tobacco, and other drugs, and that impose real penalties, such as the penalties for drunk driving. Research suggests that by enforcing such policies, communities can reduce both the level of consumption and the drinking-related problems that ensue, such as public drunkenness, assaults, and driving while under the influence.⁷

National and State laws establish a base for local policies: They address minimum drinking ages, the legal blood alcohol level for drivers, and restrictions on advertising to youth.⁸ Local policymakers can decide how their community will take action to reduce young people’s substance use.⁹ Local policy often focuses on implementing and enforcing existing laws.¹⁰ It may also focus on establishing new ordinances and regulations. Six policy-related strategies, in particular, have been shown to be effective in reducing substance use among youth:

• Restricting access to and the availability of alcohol, tobacco, and other drugs
• Targeting the prices of alcohol and tobacco products
• Limiting the location and density of retail alcohol outlets
• Creating a deterrence against breaking the law
• Placing restrictions on use in public places
• Restricting the marketing of alcohol and tobacco in public places

We discuss each strategy in this document.

BENEFITS OF POLICY

There are some clear benefits to using policy to change the environment:¹¹

• Policies can reach more people and have a more substantial impact. Compared to prevention strategies that focus on individuals or families, seeking to make changes in one person at a time, environmental strategies may reach entire populations and bring about behavior changes among large numbers of people.¹²

• Policies can enhance prevention strategies aimed at individuals. Communities can achieve more substantial reductions in substance use when environmental influences are consistent with and reinforce the prevention messages already directed at individuals.¹³

• Policies can be relatively inexpensive and easy to maintain. Even when you take into account the costs of implementation, monitoring, and political action, the costs of policy efforts are considerably lower than those associated with educational and therapeutic efforts aimed at individuals.¹⁴ Elected officials, especially, are receptive to strategies that effectively address local problems and require few local funds.¹⁵

GUIDELINES FOR MAKING POLICY AT THE LOCAL LEVEL

Community prevention coalitions or other cross-agency community groups can establish a panel to explore ways to enact policy that will create environmental change. Join Together, a national resource center for communities working to reduce substance abuse and gun violence, offers the following tips to communities interested in establishing a successful community panel to develop specific policy recommendations:¹⁶

• Select key stakeholders within your community who are very knowledgeable about the pressing issues your community faces.

• Develop a mission statement for your panel so members will understand the purpose of their participation.

• Hold a public hearing in your community as part of the process for preparing recommendations.

• Prepare a report containing evidence to support your panel’s recommendations. Include resources and examples.

• Develop a media strategy, including editorial board meetings and talk radio interviews, which can assist your panel in recruiting new allies and reinforcing existing relationships.

• Once your panel releases its report, look for opportunities to promote its findings. The panel chair and members can play important roles in making presentations at legislative committee hearings, conferences, and other important events.

Certain changes in policies and laws, such as modifying excise tax laws, tend to occur at the State level. Prevention advocates can identify ways to impact policymaking at the State level through the use of other strategies; for example, media advocacy, a communications strategy, can be used to target a particular group of people to make specific policy changes.

The Need to Establish Data Sources

To be effective, prevention efforts must be tailored to local needs. Local substance abuse problems are difficult to detect, quantify, and categorize, and communities need to establish data sources to assess local trends and emerging problems. Certainly, to justify proposed changes in policy, advocates need data that show how seriously a problem is affecting the local environment. The National Institute on Drug Abuse (NIDA) is working with communities to establish Community Epidemiology Surveillance Networks, multi-agency work groups that study the spread, growth, and development of drug use and related problems.¹⁷ Network members gain access to existing information from many sources, including treatment agencies, hospital emergency departments, and local school and household surveys. These data are then used to make a case for the need to implement a particular policy.

POLICIES THAT RESTRICT ACCESS AND AVAILABILITY

One way to reduce young people’s use of alcohol and tobacco products is to make it more difficult for them to obtain these products from stores, vending machines, and other sources in their community. Communities can use a variety of approaches to limit this access:

• Placing restrictions on establishments and community events where these products are readily available
• Enacting community-wide policies that require restaurants and retail outlets to train clerks and merchants on how to avoid selling to underage customers
• Allocating funds for enforcement efforts, such as regular compliance checks (sometimes called "sting operations") that assess local outlets’ compliance with underage purchasing laws

"We were worried about our friends and worried that they would start smoking, and we thought a good way to keep them from smoking would be if they didn’t have access to the cigarettes . . . So, we decided we wanted to do something about that in our community, and we realized that a lot of kids get cigarettes from vending machines, because they are unsupervised."

—Lisa Bryant and Christine MacNeil, Peer Leaders
Gloucester Prevention Network
Gloucester, Massachusetts

Targeting Availability: An Illustration

In 1997, the town of Gloucester, Massachusetts succeeded in passing a local ordinance that banned cigarette vending machines in public places. An inspiring component of this successful community initiative was the effort of four middle school students, participants in a peer leadership program, who advanced this policy. They knew that many youth their age were gaining access to harmful tobacco products through unsupervised vending machines. The students worked with staff at the Gloucester Prevention Network (GPN), a community partnership comprised of local government and community agencies, which developed and planned prevention initiatives throughout the city.¹⁸ Together they worked to advance the policy that banned the sale of cigarettes from vending machines. GPN provided technical assistance to the students as they circulated a petition outlining the proposed policy and collected signatures. Having rallied support from their fellow citizens, the students then presented the proposed initiative to the Gloucester City Council. The City Council accepted the proposal and enacted a citywide ban on cigarette vending machines. Shortly thereafter, First Lady Hilary Rodham Clinton recognized these students for their efforts.

How Can This Kind of Policy Be Used to Support Prevention in My Community?

Ban or restrict cigarette vending machines
Like Gloucester, Massachusetts, many communities have passed laws restricting the placement of cigarette vending machines. Some States have enacted statewide restrictions. Centers for Disease Control and Prevention (CDC) data from the second quarter of 2000 show that of the 50 States, 21 ban cigarette machines from areas accessible to minors, 10 have no restrictions at all on the placement of these machines, and the remainder have some restrictions (e.g., requiring a locking device or supervision by an adult).¹⁹ Even in States without such laws, communities can still pass local ordinances that restrict the placement of vending machines.

"They talked to their health teacher; then they went down to City Hall and said, 'How do we make this happen, we want to make a law. We want to make the city pass a law that says that you can’t have these machines any more.' "

—Carol R. Coles, Assistant Director
Gloucester Prevention Network
Gloucester, Massachusetts

Train merchants who sell alcohol and tobacco products
Communities can set aside public funds to train merchants to comply with underage purchasing laws that prohibit the sale of alcohol and tobacco to minors. Studies show that training clerks can be effective in preventing the sale of tobacco to young people.²⁰ In many States and local communities, training for alcohol servers is now mandated.²¹ The Responsible Beverage Service program was an important component of the Community Trials project, implemented in three cities in Northern California, Southern California, and South Carolina during the early 1990s.²² This comprehensive community intervention project used policy, media, and other prevention strategies. Responsible Beverage Service training was provided to store clerks, owners, and managers. Training for clerks sought to improve their awareness of the State underage purchasing laws, teach them appropriate procedures for checking identification (ID) and detecting fake IDs, and teach them how to refuse sales to minors. Training for owners and managers covered similar content; in addition, it included issues of legal liability, store policies that prevent sales to minors, and systems to monitor employees’ compliance with store policy. In a large sample of outlets from the Midwest, one study found that off-sale outlets (i.e., grocery and liquor stores, as opposed to restaurants and bars) that reported having such systems were less likely to sell to customers who appeared to be young than those that reported not having these systems in place.²³

Monitor merchants who sell alcohol and tobacco products
In all 50 States, it is illegal to sell alcohol to anyone who is under 21 years old, and to sell cigarettes to anyone who is under 18 years old. Communities can monitor retail establishments’ sales through regular compliance checks, where youth are sent to outlets to attempt to buy alcohol. Any clerk that sells to the youth is fined, and the violation is recorded on the outlet owner’s license. Compliance checks can be mandated though a local ordinance that details the process for conducting the checks, the people or agencies responsible for carrying them out, and penalties for establishments, servers, and sellers who illegally sell or serve to underage customers.²⁴ (With alcohol, such efforts are generally approved by the State Alcohol Beverage Control agency and administered by local law enforcement agencies.) Studies show that compliance checks can substantially reduce illegal sales of alcohol and tobacco to minors.²⁵

Restrict the practices of alcohol retail outlets
Communities can require retailers to follow certain selling guidelines. They can, for instance, implement keg registration laws that require alcohol stores to assign identification numbers to beer kegs.²⁶ The stores record this information along with the name and address of the person who purchases the keg, enabling police to identify and punish adults who purchase kegs and then allow underage drinkers to consume the beer. Communities can also prohibit or limit the delivery of alcohol to people’s homes.²⁷ Home delivery provides opportunities for alcohol to be sold to minors, since delivery people may be more likely than in-store clerks to make illegal sales or be careless in checking identification.

Restrict alcohol availability at community events
Communities can place restrictions on the serving of alcohol at community or special events targeted at young people, such as parades, street fairs, and open-air events.²⁸ In these situations, it is difficult to place controls on alcohol servers who may not have had training in refusing sales to minors.²⁹ To reduce the likelihood that young people will drink at such events, community policies can limit consumption and sales to a restricted area, limit the number of servings sold to individuals, reduce the size of servings, sell low-alcohol beverages only, prohibit individuals from bringing their own alcoholic beverages, and/or require legal drinkers to wear a wristband^.30

How Do I Know that This Strategy Works?

Research indicates that initiatives to restrict the availability of alcohol and tobacco can significantly decrease the number of young people who use these products. Studies on communities that have used this strategy to address youth access have demonstrated the following:

• Compliance checks have been shown to increase the number of alcohol and tobacco retailers who comply with underage purchasing laws.³¹
• Training employees on responsible beverage service is an effective method for reducing alcohol-related traffic accidents.³²
• Requiring that cigarette vending machines have electronic locking devices has been shown to encourage merchants not to sell cigarettes to young people^.33

POLICIES THAT TARGET THE PRICES OF ALCOHOL AND TOBACCO PRODUCTS

A basic rule of economics states that when a product becomes more expensive, the number of people who buy that product decreases. Research shows that this principle can also be applied to prevention efforts. By making it more expensive to purchase alcohol and cigarettes, it is likely that fewer people will be willing to buy them.

Targeting Prices: An Illustration

In 1991, local activists in Gallup, New Mexico, petitioned the State legislature to allow the city to institute a local alcohol sales tax if local voters supported this initiative. In the next election, an overwhelming majority of voters supported the proposal for a 5 percent tax. Gallup used the new revenue for a local alcohol treatment center. Follow-up data show that this tax, along with a number of other community efforts, resulted in substantial reductions in alcohol-related crime, violence, and injury.³⁴

How Can This Kind of Policy Be Used to Support Prevention in My Community?

Both States and communities can institute laws that have the effect of raising the prices of alcohol and tobacco products. At the State level, this can be done through excise taxes on alcohol and cigarettes. (See more on this, below). At the local level, communities can charge outlets a fee to acquire a license to sell alcohol products; they can also ban promotions that offer rebates or bar-sponsored "happy hours" bargains.

Increase excise taxes on the sale of alcohol and cigarettes
Increasing the price of alcohol and tobacco through taxes is an effective way to reduce consumption: (it reduces both the number of people who use and the amount consumed by users.³⁵ Research suggests that young people are particularly responsive to an increase in cigarette prices.³⁶

Alcohol excise tax hikes are primarily paid by the small number of drinkers who drink the most alcohol (and who are responsible for the highest concentration of alcohol-related problems and their costs to society).³⁷ Most consumers do not detect a difference in price; rather, consumers pay in proportion to the amount they consume. The resulting revenue can then fund key State or community programs.³⁸ For example, in 1993, New Mexico instituted a State alcohol excise tax increase that now generates $15 million annually in new revenues; the State allocates about one-third of this to local prevention and treatment activities.³⁹

Similarly, many States have raised the excise tax on cigarettes and used these revenues to fund tobacco prevention activities. California and Massachusetts were among the first States to approve a significant, statewide increase in its tobacco excise tax. In 1988, voters in California approved a referendum that called for a 25-cent increase in the State cigarette tax, with one-fourth of the $600 million annual revenue designated for tobacco research and prevention efforts designed to reduce the prevalence of smoking. Following this tax increase, total per-capita smoking in California fell at a higher rate than in the rest of the United States.⁴⁰ While it is difficult to determine whether this decrease can be attributed to the tax alone or to the prevention and cessation activities, researchers assume that the price increase played a significant role in this downward trend.⁴¹

Require licensing fees for alcohol outlets and tobacco vendors
While State agencies rarely grant local communities the power to impose taxes on alcohol, local jurisdictions do have the power to charge permit filing and business-license fees to cover the administrative and enforcement costs of regulating and monitoring alcohol sales activities.⁴² This can have the same end result—an increase in the retail price of alcohol—and is a feasible policy option for local communities. Some communities also charge nonrefundable permit-filing fees, from a few hundred to a few thousand dollars, which cover the costs of processing and enforcing applications for zoning permits.⁴³ In Shoreview, Minnesota, for instance, a local ordinance requires tobacco vendors to be licensed by the city. License fees, at $250 per year, are used to fund merchant education efforts and compliance checks. A vendor’s license may be suspended if he or she receives three or more violations within 24 months.⁴⁴

Ban discounts on alcohol and tobacco products
Promotions such as "happy hour" and "women drink for free" increase consumption of alcohol by lowering alcohol prices for short periods of time.⁴⁵ Communities can prevent restaurants and bars from hosting happy hours and other price promotions, or require that they restrict the promotion to free food instead of lower alcohol prices.⁴⁶

How Do I Know that This Strategy Works?

Studies indicate that raising the price of alcohol and tobacco is associated with reduced numbers of people who buy and consume these products, as well as the number of problems related to the use of these products. Specifically, research has demonstrated the following:

• Increases in taxes on the price of beer have been associated with decreases in beer consumption, violent crime, and deaths from traffic crashes among young drivers. ^47,48,49
• Increases in the price of cigarettes have been associated with a decrease in the number of cigarettes purchased.⁵⁰

POLICIES THAT LIMIT THE LOCATION AND DENSITY OF RETAIL ALCOHOL OUTLETS

Communities can take steps to reduce alcohol consumption by permitting fewer numbers of alcohol outlets in a given neighborhood. Research has shown that neighborhoods in which many stores sell alcohol tend to have higher rates of drinking and more alcohol related-problems.⁵¹ When there are fewer places where people can purchase alcohol, alcohol consumption becomes less convenient and the amount consumed will decrease.

Targeting Location and Density: An Illustration

In San Jose, California, a grass-roots group called the Association for Responsible Alcohol Control (ARAC) worked to promote new laws to limit the density of alcohol outlets within the city.⁵² ARAC focused on certain Latino neighborhoods where there were many alcohol outlets and high arrest rates for alcohol-related offenses among Latinos. ARAC wanted to create a policy that could reduce the number of outlets selling alcohol and give residents some say in these decisions. It developed and promoted a potential citywide ordinance that would require new businesses to apply for a conditional-use permit in order to be allowed to make off-site alcohol sales. The group attracted media coverage and took part in community events to increase public support for these permits and promote awareness of the problems associated with alcohol outlets, especially among San Jose’s Latino population. As a result of ARAC’s efforts, the San Jose city council voted unanimously in favor of implementing the conditional-use permit law.

How Can This Kind of Policy Be to Used to Support Prevention in My Community?

Communities can take important steps toward reducing alcohol consumption by reducing the number of stores and restaurants that are allowed to sell or serve alcohol. In recent years, local zoning and land-use ordinances have become popular methods for restricting the availability of alcohol.⁵³

Restrict the density of alcohol outlets
Local communities have substantial power to create zoning laws that determine where alcohol outlets are allowed to set up shop and how close they are allowed to be to one another. Research shows that neighborhoods with a higher density of alcohol outlets tend to have higher rates of alcohol sales.⁵⁴ Restrictions can be written into zoning ordinances that require outlets to be spaced a certain distance apart, restrict bars and alcohol outlets from certain locations (e.g., residential areas or near schools), and restrict the hours of operation during which alcohol can be sold.⁵⁵

Restrict the location of alcohol outlets
Alcohol outlets are often concentrated in low-income neighborhoods.⁵⁶ It is worthwhile for communities to assess the distribution and concentration of outlets across neighborhoods and to look at the existing zoning laws within poorer communities.⁵⁷ As illustrated in San Jose, local communities that identify alcohol-related problems in their area can establish conditional-use permits in order to limit the number of permits that are issued to prospective retail outlets.

How Do I Know that This Strategy Works?

Research suggests that decreasing the number and density of alcohol outlets can decrease alcohol consumption levels. Specifically, studies have shown that placing limitations on the location and density of retail outlets may contribute to reductions in overall alcohol consumption, traffic crashes, assault offenses, and suicide. ^58,59,60,61

POLICIES THAT DETER CITIZENS FROM BREAKING THE LAW

Communities can institute policies and laws that discourage both store owners and young people from breaking underage purchasing laws. For shop owners, communities should designate penalties and fees to be imposed on retail outlet staff if they are caught making illegal sales. Communities can also institute laws that penalize young people for alcohol-related offenses.

Creating a Deterrence: An Illustration

The city of Bloomington, Minnesota, has designated public funds to support police in conducting compliance checks on bars, restaurants, and liquor stores at various times throughout the year. In the course of these checks, if an establishment makes an illegal sale to a young person, police issue a complaint against the server or seller, whose licensee is prosecuted through the court system. Licensees who are caught selling to underage customers must also attend a public hearing, where they have the opportunity to acknowledge their failure to comply with the laws and to present their plan for avoiding future incidents. They are also fined an administrative fee. For a first offense, off-sale outlets are typically fined $500 and on-sale outlets are fined $1,000. However, the fines can be considerably higher, and sometimes the outlet’s license to sell alcohol is suspended.⁶²

How Can This Policy Be Used to Support Prevention in My Community?

It is important for communities to have penalties that deter individuals from breaking underage purchasing laws. For outlets, strategies like compliance checks are successful because owners who sell to underage patrons receive a penalty; likewise, the laws that regulate the use of these products must also have a penalty in place for the underage buyers.

Impose administrative penalties on outlets that sell alcohol and tobacco to youth As the Bloomington, Minnesota, example suggests, local communities can penalize alcohol license holders when they fail to comply with the State laws or ordinances that govern the sale of alcohol products.⁶³ This penalty can be a fine and/or a suspension or complete revocation of the vendor’s alcohol license. These penalties are generally enforced by a local governing body, such as a city council or county board, rather than by the court system. Such policies can deter outlets from selling to minors, while at the same time encourage them to create internal policies and practices that prevent the sales of these products to underage customers.⁶⁴

Enact zero-tolerance laws
Many States have lowered the blood alcohol content (BAC) limits for drivers who are not of legal age to drink. In States with zero-tolerance laws, any amount of alcohol in the body of a driver who is under 21 is an offense, and the young person’s driver’s license can be suspended.⁶⁵ These laws have been effective in reducing the number of alcohol-related traffic crashes and fatalities among young people. In particular, zero-tolerance laws that set BAC levels at .00 to .02 percent have been shown to reduce nighttime single-vehicle crashes among young drivers.⁶⁶ These laws can be further strengthened when States enact administrative license revocation laws, allowing an arresting officer to confiscate the license of any driver who tests over the legal BAC or who refuses to take the blood test.⁶⁷

Enact "use and lose" laws
Another effective way to deter youth from breaking minimum purchase age laws is through "use and lose" laws.⁶⁸ A young person’s driver’s license can be suspended if he or she is under 21 and convicted of using, possessing, or attempting to purchase alcohol, with or without a false ID.

How Do I Know that This Strategy Works?

Studies that have examined deterrence laws for retail outlets and young people have found two things:

• Administrative penalties for outlets that break underage purchasing laws are an important adjunct to compliance checks, research has shown that compliance checks, can reduce noncompliance with underage purchasing laws.⁶⁹
• Zero-tolerance laws for underage drivers that set BAC limits at .00 to .02 have been shown to significantly reduce traffic deaths among young people.⁷⁰

POLICIES THAT PLACE RESTRICTIONS ON USE IN PUBLIC PLACES

Communities can pass local ordinances that prohibit citizens from drinking and smoking in public places. By viewing public areas as part of the greater community, and therefore different from private space, and seeking to determine the kind of behavior that can and cannot take place in these areas, local government can influence drinking and smoking behavior.

Restricting Use in Public Places: An Illustration

In 1991, the city of Alexandria, Virginia passed an ordinance that prohibited citizens from having open alcohol containers on city streets, in public parks, and on playgrounds. Before the open container ordinance was passed, a police officer had to actually witness a person drinking alcohol in public in order to bring charges. The city council passed this ordinance to combat public drunkenness and other alcohol-related problems, such as urinating in public and destroying property. The ordinance received strong support from city council members, the city’s vice mayor, and several citizens’ groups.⁷¹

How Can This Kind of Policy Be Used to Support Prevention in My Community?

Prohibit or restrict alcohol possession and consumption in public places
Policies can be created to govern the availability and consumption of alcohol at public events, such as concerts, street fairs, and sporting events. These can be one-time restrictions implemented by event organizers, or they can be part of local. (States do have the power the power to regulate alcohol consumption in public, but they generally leave it up to local jurisdictions to set their own regulations.)⁷² Examples of such policies include totally banning alcohol at an event, restricting drinking in areas where youth are not allowed, limiting cup size to 12 ounces, and banning alcohol consumption in parking lots.⁷³

Prohibit cigarette smoking in public places and private workplaces
As illustrated earlier, many communities are enacting local ordinances that prohibit smoking in public places, such as restaurants and workplaces. Such laws make it less convenient for people to smoke, and they also protect other people from exposure to second hand smoke, which research shows causes heart disease, lung cancer, and other cancers in people who have never smoked.⁷⁴ In 1998, Boston, Massachusetts enacted a ban on smoking in all of the city’s 1,400 restaurants, requiring restaurants that did not include bars to become 100 percent smoke-free. The Boston Tobacco Control Program was responsible for educating restaurant owners and managers about the new regulation, (including the penalty: Restaurants that did not comply were (and are) required to pay $300 for the first offense, $500 for the second offense and $1,000 for any additional offenses within a 12-month period.

Similar policies are being advanced in many workplace settings.⁷⁵ As of 1996, such large corporations as Continental Airlines, Dunkin’ Donuts, IBM, Prudential, and Taco Bell have all implemented smoke-free workplaces.⁷⁶

Prohibit cigarette smoking within school areas
Many communities across the country are passing local ordinances to create smoke-free school zones. In Barrington, Rhode Island, for example, the use of tobacco products is prohibited in all school buildings, playgrounds, the school administration building, indoor athletic facilities, school gymnasiums, locker rooms, school buses, and other school vehicles. Tobacco use is also prohibited within 25 feet of any school building. This law applies to all school staff, students, and visitors, and a set of penalties has been developed for each violation.⁷⁷

How Do I know that This Strategy Works?

Studies that have examined the restriction of cigarette smoking in public places found that this restriction effective in reducing both cigarette sales and cigarette use. ^78,79

Further studies need to be conducted to verify that restricting alcohol in public places has a similar resulting.

POLICIES THAT RESTRICT MARKETING OF ALCOHOL AND TOBACCO
IN PUBLIC PLACES

Studies have shown that exposure to alcohol advertising can affect people’s attitudes toward alcohol and their intention to use it.⁸⁰ Unfortunately, alcohol and tobacco billboards saturate many communities, particularly urban and less affluent communities that lack the zoning regulations or the clout to keep billboards out. A study in one urban Latino community found children passed as many as 60 alcohol advertisements on their way to school every day.⁸¹ Throughout the United States, many communities are taking steps to regulate the placement of this type of advertising.

Restricting Marketing: An Illustration

In 1994, Baltimore, Maryland, became one of the first communities to implement local ordinances against outdoor advertising of alcohol and tobacco. Endorsing an initiative led by a grass-roots coalition of more than 100 community groups, the Baltimore City Council passed an ordinance banning alcohol and tobacco billboards anywhere near urban area schools and recreation halls; these ads could now be displayed only along a few thoroughfares, in heavy industrial zones, and near major sports areas. In sum, the ordinance allowed only 70 of the city’s 2,000 billboards to display such ads. After this ordinance was passed, the city became the target of a lawsuit by a local advertiser and Anheuser-Busch, the world’s largest brewer, claiming that such a ban restricted free speech and thus violated the First Amendment. The court, however, found in favor of the City of Baltimore. Anheuser-Busch appealed this decision, but the Fourth Circuit Court of Appeals upheld it. The brewer then appealed to the Supreme Court, which refused to hear the case.⁸²

How Can This Kind of Policy Be Used to Support Prevention in My Community?

Restrict advertisements on billboards and in other public areas
Many communities are taking steps to regulate the placement of this type of advertising. The cities of Baltimore; Chicago; Compton, California; and Inglewood, California, have passed ordinances that limit outdoor advertising for alcohol and tobacco. Seattle, Cincinnati, and Contra Costa County, California, have voluntary agreements with billboard companies to remove tobacco billboards in areas frequented by children.⁸³ Still other communities have similar arrangements or are in the process of drafting local legislation.

How Do I know that This Strategy Works?

Studies that have examined the impact of alcohol advertising on young people found that:

• Exposure to alcohol advertising can affect a person’s intention to consume alcohol.⁸⁴ Therefore, it is in a community’s best interest to limit (or eliminate) this exposure to the best of its ability.

• There is evidence that counteradvertising campaigns about the dangers of tobacco products and the tobacco industry may result in a reduction in cigarette sales.⁸⁵

POLICY RESOURCES

Print Materials

Center for Science in the Public Interest (1996). State alcohol taxes and health: A citizen’s action guide. Washington, DC

Fisher, D. (1998). Environmental prevention strategies: An introduction and overview. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention. Available online: http://www.northeastcapt.org/csap/papers/fisher.pdf

Gardner, S. E., and Brounstein, P. J. (2001). Science-Based Prevention Practices. Principles of Substance Abuse Prevention. Rockville, MD: Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention, Division of Knowledge Development and Evaluation. Available online: http://www.northeastcapt.org/csap/papers/gardner-cover2.asp

Holder, H. & Reynolds, R. (1997). Application of local policy to prevent alcohol problems: Experiences from a community trial. Addiction, 92(Supp. 2), S285– S292.

Join Together (1996). Fixing a failing system. National policy recommendations: How the criminal justice system should work with communities to reduce substance abuse. Boston.

National Institute on Drug Abuse (1998). Assessing drug abuse within and across communities: Community epidemiology surveillance networks on drug abuse. Washington, DC: National Institutes of Health, U.S. Department of Health and Human Services.

Pacific Institute for Research and Evaluation (1999). Strategies to reduce underage alcohol use: Typology and brief overview. Washington, DC: U.S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention’s Enforcing Underage Drinking Laws Program.

Prevention Enhancement Protocols System (1999). Preventing problems related to alcohol availability: Environmental approaches. Rockville, MD: Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention. Available online: http://www.health.org/govpubs/PHD822/

Toomey, T. and Wagenaar, A. (1999). Policy options for prevention: The case of alcohol. Journal of Public Health Policy, 20(2), 193–212.

Training

CSAP’s Northeast CAPT is developing a series of trainings, with videos, that will build practitioners' capacity to incorporate each of the seven prevention strategies into their efforts.

Web Resources

The Alcohol Epidemiology Program (AEP) is a research program within the School of Public Health at the University of Minnesota. The AEP conducts policy-relevant research on specific initiatives to prevent alcohol-related problems. Their website http://www.epi.umn.edu/alcohol/ contains a variety of information on policies to reduce youth access to alcohol and the development of ordinances that regulate the use of alcohol.

The Center for Substance Abuse Prevention (CSAP) provides national leadership in the development of policies, programs, and services to prevent the onset of illegal drug use, to prevent underage alcohol and tobacco use, and to reduce the negative consequences of using substances. CSAP is one of three Centers in the Substance Abuse and Mental Health Services Administration (SAMHSA) in the U.S. Department of Health and Human Services (HHS). CSAP promotes comprehensive programs, community involvement, and partnership among all sectors of society. Through service capacity expansion and knowledge development, application, and dissemination, CSAP works to strengthen the Nation's ability to reduce substance abuse and its associated problems. Available online at: http://prevention.samhsa.gov

CSAP’s Decision Support System (DSS) at http://www.preventiondss.org promotes scientific methods and programs for substance abuse prevention for use within communities and State prevention systems. You can use this site to learn how to assess your needs, gain insight into how to further develop your agency capacity, and choose among effective prevention programs.

Join Together Online at http://www.jointogether.org is a national resource center for communities working to reduce substance abuse and gun violence. Their site includes news, advocacy tools, and funding resources related to prevention and treatment.

The Marin Institute for the Prevention of Alcohol and Other Drug Problems conducts training, provides in-depth technical assistance, develops publications, and tracks actions of the alcohol beverage industry. Their work primarily focuses on policy and economic development as it pertains to alcohol and other drug issues. http://www.marininstitute.org

Mothers Against Drunk Driving (MADD) at http://www.madd.org is a national organization dedicated to preventing drunk driving and underage drinking as well as supporting the victims of drunk driving. Their site includes an in-depth section on public policy that tracks legislation across the country as well as the records of key legislators.

The Underage Drinking Enforcement Training Center (UDETC) at http://www.udetc.org provides training and technical assistance to States and communities involved in enforcing underage alcohol access and use laws.

CSAP’s Northeast CAPT	CSAP
Policy	Environmental Approaches
Enforcement	Environmental Approaches
Collaboration	Community-Based Processes
Communications	Information Dissemination
Education	Prevention Education
Early Intervention	Problem Identification & Referral
Alternatives	Alternatives

ENDNOTES

¹Gardner, S. E., and Brounstein, P. J. (2001). Science-Based Prevention Practices. Principles of Substance Abuse Prevention. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention, Division of Knowledge Development and Evaluation. Available online: http://www.northeastcapt.org/csap/papers/gardner-cover2.asp

²Greenfield, T. K. and Zimmerman, R. (Eds.) (1993). Experiences with community action projects: New research in the prevention of alcohol and other drug problems. CSAP Prevention Monograph 14. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services, Center for Substance Abuse Prevention; Holder, H. and Reynolds, R. (1997). Application of local policy to prevent alcohol problems: Experiences from a community trial. Addiction, 92(Supp. 2), S285–S292.

³Fisher, D. (1998). Environmental prevention strategies: An introduction and overview. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention.

⁴Prevention Enhancement Protocols System (1999). Preventing problems related to alcohol availability: Environmental approaches. Rockville, MD: Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention.

⁵Toomey, T. and Wagenaar, A. (1999). Policy options for prevention: The case of alcohol. Journal of Public Health Policy, 20(2), 193–212.

⁶Toomey, T. and Wagenaar, A. (1999). Policy options for prevention: The case of alcohol.

⁷Edwards, G., Anderson, P., Babor, T. F., Casswell, S., Ferrence, R., Giesbrecht, N., Godfrey, C., Holder, H. D., Lemmens, P., Mäkelä, K., Midanik, L. T., Norström, T., Österberg, E., Romelsjö, A., Room, R., Simpura, J., and Skog, O. (1994). Alcohol policy and the public good. New York: Oxford University Press; Prevention Enhancement Protocols System (1999). Preventing problems related to alcohol availability: Environmental approaches.

⁸Holder, H. and Reynolds, R. (1997). Application of local policy to prevent alcohol problems: Experiences from a community trial.

⁹Holder, H. and Reynolds, R. (1997). Application of local policy to prevent alcohol problems: Experiences from a community trial.

¹⁰Holder, H. and Reynolds, R. (1997). Application of local policy to prevent alcohol problems: Experiences from a community trial.

¹¹Fisher, D. (1998). Environmental prevention strategies: An introduction and overview; Holder, H. and Reynolds, R. (1997). Application of local policy to prevent alcohol problems: Experiences from a community trial.

¹²Fisher, D. (1998). Environmental prevention strategies: An introduction and overview.

¹³Fisher, D. (1998). Environmental prevention strategies: An introduction and overview.

¹⁴Fisher, D. (1998). Environmental prevention strategies: An introduction and overvew; Holder, H. and Reynolds, R. (1997). Application of local policy to prevent alcohol problems: Experiences from a community trial.

¹⁵Holder, H. and Reynolds, R. (1997). Application of local policy to prevent alcohol problems: Experiences from a community trial.

¹⁶Join Together (1996). Fixing a failing system. National policy recommendations: How the criminal justice system should work with communities to reduce substance abuse. Boston.

¹⁷National Institute on Drug Abuse (1998). Assessing drug abuse within and across communities: Community epidemiology surveillance networks on drug abuse. Washington, DC: National Institutes of Health, U.S. Department of Health and Human Services.

¹⁸Join Together (1995). Community action guide to policies for prevention. Boston.

¹⁹State Tobacco and Activities Tracking and Evaluation System (1998). Centers for Disease Control and Prevention, Office on Smoking and Health. Available online: http://www2.cdc.gov/nccdphp/osh/state.

²⁰Biglan, A., Henderson, J., Humphreys, D., Yasui, M., Whisman, R., Black, C., and James, L. (1994). Experimental evaluation of a community intervention to reduce youth access to tobacco. Unpublished manuscript; Keay, K. D., Woodruff, S. I., Wildey, M. B., and Kenney, E. M. (1993). Effects of a retailer intervention on cigarette sales to minors in San Diego County, CA. Tobacco Control, 2, 145–151; Skretny, M. T., Cummings, K. M., Sciandra, R., and Marshall, J. (1990). An intervention to reduce the sale of cigarettes to minors. New York State Journal of Medicine, 90, 54–55.

²¹Toomey, T. L., Kilian, G. R., Gehan, J. P., Perry, C. L., Jones-Webb, R., and Wagenaar, A. C. (1998). Qualitative assessment of training programs for alcohol servers and establishment managers. Public Health Reports, 113(2), 162–169; Toomey, T. and Wagenaar, A. (1999). Policy options for prevention: The case of alcohol.

²²Saltz, R. F. and Stanghetta, P. (1997). A community-wide Responsible Beverage Service program in three communities: Early findings. Addiction, 92(Supp. 2), S237–S249.

²³Wolfson, M., Toomey, T. L., Murray, D. M., Forster, J. L., Short, B. J., and Wagenaar, A. C. (1996). Alcohol outlet policies and practices concerning sales to underage people. Addiction, 91(4), 589–602; Toomey, T. and Wagenaar, A. (1999). Policy options for prevention: The case of alcohol.

²⁴Alcohol Epidemiology Program (2000). Alcohol compliance checks procedures manual. Minneapolis, MN: University of Minnesota.

²⁵Preusser, D. F., Williams, A. F., and Weinstein, H. B. (1994). Policing underage alcohol sales. Journal of Safety Research, 25(3), 127–133; Center for Research in Disease Prevention, School of Medicine, Stanford University (1994). San Jose STAT (Stop Teenage Addiction to Tobacco). Paper presented at the Information Exchange Conference: Breaking the Grip of Tobacco State by State, San Francisco, Calif.; Cummings, K. M. and Coogan, K. (1992). Organizing communities to prevent the sale of tobacco products to minors. International Quarterly of Community Health Education, 13, 77–86; Feighery, E., Altman, D., and Saffer, G. (1991). The effects of combining education and enforcement to reduce tobacco sales to minors: A study of four Northern California communities. Journal of the American Medical Association, 266, 3168–3171; Forster, J. L., Murray, D. M., Wolfson, M., Blaine, T. M., Waggener, A. C., and Hennrikus, D. J. (1997). The effects of community policies to reduce youth access to tobacco. Manuscript submitted for publication; Jason, L. A., Ji, P. Y., Anes, M. D., and Birkhead, S. H. (1991). Active enforcement of cigarette control laws in the prevention of cigarette sales to minors. Journal of the American Medical Association, 266, 3159–3161; Preusser, D. F., Ulmer, R. G., and Preusser, C. W. (1992). Obstacles to enforcement of youthful (under 21) impaired driving. Washington, DC: National Highway Traffic Safety Administration.

²⁶Toomey, T. and Wagenaar, A. (1999). Policy options for prevention: The case of alcohol.

²⁷Fletcher, L. A., Toomey, T. L., Wagenaar, A.C., Short, B., and Willenbring, M. L. (2000). Alcohol home delivery services: A source of alcohol for underage drinkers. Journal of Studies on Alcohol, 61(1), 81–84; Toomey, T. and Wagenaar, A. (1999). Policy options for prevention: The case of alcohol.

²⁸Cassady, D., Flora, J., and Foote, D. (1987). Alcohol use at community events: Creating policies to prevent problems. San Diego, CA: San Diego Alcohol Program and Applied Communication Technology; Wittman, F. D. and Harding, J. R. (1997). The environmental approach to AOD prevention. Sacramento, CA: California Department of Alcohol and Drug Programs, Pub. No. 97-3501; Prevention Enhancement Protocols System (1999). Preventing problems related to alcohol availability: Environmental approaches.

²⁹Toomey, T. and Wagenaar, A. (1999). Policy options for prevention: The case of alcohol.

³⁰Toomey, T. and Wagenaar, A. (1999). Policy options for prevention: The case of alcohol.

³¹Radecki, T. (1993). Compliance checks and other enforcement methods to deter underage drinking. Rockville, MD: CSAP; Alcohol Epidemiology Program (2000). Alcohol compliance checks procedures manual; Preusser, D. F., Williams, A. F., and Weinstein, H. B. (1994). Policing underage alcohol sales. Journal of Safety Research, 25(3), 127–133; Center for Research in Disease Prevention, School of Medicine, Stanford University (1994). San Jose STAT (Stop Teenage Addiction to Tobacco); Cummings, K. M. and Coogan, K. (1992). Organizing communities to prevent the sale of tobacco products to minors; Feighery, E., Altman, D., and Saffer, G. (1991). The effects of combining education and enforcement to reduce tobacco sales to minors: A study of four Northern California communities; Forster, J. L. et al. (1997). The effects of community policies to reduce youth access to tobacco; Jason, L. A. et al. (1991). Active enforcement of cigarette control laws in the prevention of cigarette sales to minors; Preusser, D. F., Ulmer, R. G., and Preusser, C. W. (1992). Obstacles to enforcement of youthful (under 21) impaired driving.

³²Holder, H. S. and Wagenaar, A. C. (1994). Mandated server training and reduced alcohol-involved traffic crashes: A time series analysis of the Oregon experience. Accident Analysis and Prevention, 26(1), 89–97.

³³Forster, J. L., Hourigan, M. E., and Kelder, S. (Sept., 1992). Locking devices on cigarette vending machines: Evaluation of a city ordinance. American Journal of Public Health, 82(9), 1217–1219; DiFranza, J. R., Savageau, J. A., Aisquith, B. F. (Feb., 1996). Youth access to tobacco: The effects of age, gender, vending machine locks, and "it's the law" programs. American Journal of Public Health, 86(2), 221–224.

³⁴Pacific Institute for Research and Evaluation (1999). How to use local regulatory and land use powers to prevent underage drinking. Washington, DC: U.S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention’s Enforcing Underage Drinking Laws Program.

³⁵Chaloupka, F. J. and Grossman, M. (1996). Price, tobacco control policies, and youth smoking. Unpublished Working Paper No. 5740. Cambridge, MA: National Bureau of Economic Research; Edwards, G. et al. (1994). Alcohol policy and the public good; National Cancer Institute (May, 1993). The impact of cigarette excise taxes on smoking among children and adults: Summary report of a National Cancer Institute expert panel. Paper presented at the annual information exchange; U.S. Department of Health and Human Services (1989). Reducing the health consequences of smoking: 25 years of progress. A report of the Surgeon General. Atlanta, GA: Office on Smoking and Health, Centers for Disease Control and Prevention; U.S. Department of Health and Human Services (1992). Youth access to tobacco. Washington, DC: Office of Evaluation and Inspectors, Office of Inspector General; U.S. Department of Health and Human Services (in press). The context for change: The efficacy of the interventions for smoking prevention and control. A report of the Surgeon General. Atlanta, GA: Office on Smoking and Health, Centers for Disease Control and Prevention.

³⁶Lewit, E. M., Hyland, A., Kerrebrock, N., and Cummings, K. M. (1997). Price, public policy, and smoking in young people. Tobacco Control, 6(Suppl. 2), S17–24; Gardner, S. E., and Brounstein, P. J. (2001). Science-Based Prevention Practices. Principles of Substance Abuse Prevention.

³⁷Center for Science in the Public Interest (1996). State alcohol taxes and health: A citizen’s action guide. Washington, D.C.

³⁸Center for Science in the Public Interest (1996). State alcohol taxes and health: A citizen’s action guide; Toomey, T. and Wagenaar, A. (1999). Policy options for prevention: The case of alcohol; Gardner, S. E., and Brounstein, P. J. (2001). Science-Based Prevention Practices. Principles of Substance Abuse Prevention.

³⁹Center for Science in the Public Interest (1996). State alcohol taxes and health: A citizen’s action guide.

⁴⁰Elder, J. P., Edwards, C. C., Conway, T. L., Kenney, E., Johnson, C. A., and Bennett E. (1996). Independent evaluation of the California Tobacco Education Program. Public Health Reports, 111(4), 353–358.

⁴¹Elder, J. P., Edwards, C. C., Conway, T. L., Kenney, E., Johnson, C. A., and Bennett E. (1996). Independent evaluation of the California Tobacco Education Program.

⁴²Prevention Enhancement Protocols System (1999). Preventing problems related to alcohol availability: Environmental approaches.

⁴³Prevention Enhancement Protocols System (1999). Preventing problems related to alcohol availability: Environmental approaches.

⁴⁴Jacobson, P. D and Wasserman, J. (1997). Tobacco control laws: Implementation and enforcement. Santa Monica, CA: RAND.

⁴⁵Babor, T. F., Mendelson, J. H., Greenberg, I., Kuehnle, J. (1978). Experimental analysis of the "happy hour": Effects of purchase price on alcohol consumption. Psychopharmacology, 58(1), 35–41; Toomey, T. and Wagenaar, A. (1999). Policy options for prevention: The case of alcohol.

⁴⁶Toomey, T. and Wagenaar, A. (1999). Policy options for prevention: The case of alcohol.

⁴⁷Cook, P. and Moore M. (1993). Taxation of alcohol beverages. Research Monograph 25—Economic research on the prevention of alcohol-related problems. Washington, DC: National Institute on Alcoholism and Alcohol Abuse; Saffer, H. and Grossman, M. (1987). Beer taxes, the legal drinking age, and youth motor vehicle fatalities. Journal of Legal Studies, 16, 351–374.

⁴⁸Saffer, H. and Grossman, M. (1987). Beer taxes, the legal drinking age, and youth motor vehicle fatalities.

⁴⁹Cook, P. and Moore M. (1993). Taxation of alcohol beverages.

⁵⁰University of California, San Diego. Cancer Prevention and Control Program. (1998). Tobacco control in California: Who’s winning the war. An independent evaluation of the Tobacco Control Program, 1989–1996. La Jolla, CA: University of California, San Diego.

⁵¹Gruenewald, P. J., Ponicki, W. R. and Holder, H. D. (1993). The relationship of outlet densities to alcohol consumption: A time series cross-sectional analysis. Alcoholism Clinical Experimental Result, 17(1), 38–47 and 1996–S264; Gruenewald, P. J., Millar, A. B., Treno, A. J., Yang, Z., Ponicki, W. R., and Roeper, P. (1996). The geography of availability and driving after drinking. Addiction, 91(7), 967–983.

⁵²Neigron, D., Canela, J. and Aguirre-Molina, M. (1997). Giving communities a voice in alcohol sales: The Association for Responsible Alcohol Control. In D. Jernigan and P. A. Wright (Eds.) Making news, changing policy: Case studies of media advocacy on alcohol and tobacco issues. Rockville, MD: Center for Substance Abuse Prevention.

⁵³Prevention Enhancement Protocols System (1999). Preventing problems related to alcohol availability: Environmental approaches.

⁵⁴Gruenewald, P. J., Ponicki, W. R., and Holder, H. D. (1993). The relationship of outlet densities to alcohol consumption: A time series cross-sectional analysis; van Oers, J. A, Garretsen, H. F. (1993). The geographic relationship between alcohol use, bars, liquor shops and traffic injuries in Rotterdam. Journal of the Studies of Alcohol, 54(6), 739–744; Toomey, T. and Wagenaar, A. (1999). Policy options for prevention: The case of alcohol.

⁵⁵Reynolds, R. I., Holder, H. D., Gruenewald, P. J. (1997). Community prevention and alcohol retail access. Addiction, 92(Suppl. 2): S261–S272; Wittman, F. (1994). Development and use of conditional use permits to prevent problems related to retail alcohol outlets: An overview. Berkeley: University of California, Institute for the Study of Social Change; Prevention Enhancement Protocols System (1999). Preventing problems related to alcohol availability: Environmental approaches.

⁵⁶Gorman, D. M. and Speer, P. W. (1997). Concentration of liquor outlets in an economically disadvantaged city in the Northeastern United States. Substance Use and Misuse, 32(14), 2033–2046; Toomey, T. and Wagenaar, A. (1999). Policy options for prevention: The case of alcohol.

⁵⁷Toomey, T. and Wagenaar, A. (1999). Policy options for prevention: The case of alcohol.

⁵⁸Gruenewald, P. J., Ponicki, W. R., and Holder, H. D. (1993). The relationship of outlet densities to alcohol consumption: A time series cross-sectional analysis.

⁵⁹Gruenewald, P. J., and Ponicki, W. R. (1995). The relationship of the retail availability of alcohol and alcohol sales to alcohol-related traffic crashes. Accident Analysis & Prevention, 27(2), 249–259; Scribner, R., MacKinnon, D., and Dwyer, J. (1994). Alcohol outlet density and motor vehicle crashes in Los Angeles County cities. Journal of Studies on Alcohol, 55(4), 447–453.

⁶⁰Scribner, R. A., MacKinnon, D. P., and Dwyer, J. H. (1995). Risk of assaultive violence and alcohol availability in Los Angeles County. American Journal of Public Health, 85(3), 335–340.

⁶¹Gruenewald, P. J., Ponicki, W. R., and Mitchell, P. R. (1995). Suicide rates and alcohol consumption in the United States, 1970–89. Addiction, 90(8), 1063–1075.

⁶²The Alcohol Epidemiology Program of the School of Public Health, University of Minnesota in Minneapolis (1997). Policies to reduce youth access. Available online: http://www.epi.umn.edu/alcohol/policy/default.html.

⁶³The Alcohol Epidemiology Program of the School of Public Health, University of Minnesota in Minneapolis (1997). Policies to reduce youth access.

⁶⁴The Alcohol Epidemiology Program of the School of Public Health, University of Minnesota in Minneapolis (1997). Policies to reduce youth access.

⁶⁵National Highway Traffic Safety Administration. (1996). Zero tolerance laws to reduce alcohol impaired driving by youth: State legislative fact sheet. Washington, DC: U.S. Department of Transportation; Pacific Institute for Research and Evaluation (2000). A guide to zero tolerance and graduated licensing: Two strategies that work. Washington, DC: U.S. Department of Justice, Office for Juvenile Justice and Delinquency Prevention’s Enforcing the Underage Drinking Laws Program.

⁶⁶Hingson, R., Heeren, T. and Winter, M. (1991). Reduced BAC limits for young people (impact of night fatal crashes). Alcohol, Drugs and Driving, 7, 117–127; Pacific Institute for Research and Evaluation (2000). A guide to zero tolerance and graduated licensing: Two strategies that work.

⁶⁷Hingson, R. (1993). Prevention of alcohol-impaired driving. Alcohol Health and Research World, 17(1), 28–34; Klein, T. M. (1989). Changes in alcohol-involving fatal crashes associated with tougher state alcohol legislation. Brookeville, MD: Sigmastat, Inc.; Ross, H. L. and Gilliland, E. M. (1991). Administrative license revocation for drunk drivers: Options and choices in three states. Washington, DC: AAA Foundation for Traffic Safety; Zador, P. L.; Lund, A. K.; Fields, M. and Weinberg, K. (1989). Fatal crash involvement and laws against alcohol-impaired driving. Arlington, VA: Insurance Institute for Highway Safety; Gardner, S. E., and Brounstein, P. J. (2001). Science-Based Prevention Practices. Principles of Substance Abuse Prevention.

⁶⁸Preusser, D. F., Ulmer, R. G., and Preusser, C. W. (1992). Obstacles to enforcement of youthful (under 21) impaired driving; Gardner, S. E., and Brounstein, P. J. (2001). Science-Based Prevention Practices. Principles of Substance Abuse Prevention.

⁶⁹Pacific Institute for Research and Evaluation (1999). How to use local regulatory and land use powers to prevent underage drinking.

⁷⁰Hingson, R., Heeren, T., and Winter, M. (1994). Lower legal blood alcohol limits for young drivers. Public Health Reports, 109(6), 738-744; Blomberg, R. D. (1992). Lower BAC limits for youth: Evaluation of the Maryland .02 law. Washington, DC: National Highway Traffic Safety Administration; Gardner, S. E., and Brounstein, P. J. (2001). Science-Based Prevention Practices. Principles of Substance Abuse Prevention.

⁷¹The Alcohol Epidemiology Program of the School of Public Health, University of Minnesota in Minneapolis (1997). Policies to reduce youth access.

⁷²Prevention Enhancement Protocols System (1999). Preventing problems related to alcohol availability: Environmental approaches.

⁷³The Alcohol Epidemiology Program of the School of Public Health, University of Minnesota in Minneapolis (1997). Policies to reduce youth access.

⁷⁴U.S. Environmental Protection Agency (1993). Respiratory health effects of passive smoking: Lung cancer and other disorders. The report of the Environmental Protection Agency. Washington, DC: U.S. Environmental Protection Agency, Office of Research and Development.

⁷⁵Boston Health Commission (1998). Restaurant smoking restrictions. Available online: http://www.bphc.org/health/atoz.asp?id=11.

⁷⁶Centers for Disease Control and Prevention, Office on Smoking and Health (1996). Making your workplace smoke-free: A decision-maker’s guide. Available online: http://www.cdc.gov/tobacco/research_data/environmental/etsguide.htm.

⁷⁷Rhode Island Department of Health. Available online: http://www.health.state.ri.us.

⁷⁸Chaloupka, F. J. and Saffer, H. (1992). Clean indoor air laws and the demand for cigarettes. Contemporary Policy Issues, 10, 72–83; Gardner, S. E., and Brounstein, P. J. (2001). Science-Based Prevention Practices. Principles of Substance Abuse Prevention.

⁷⁹Chaloupka, F. J. (1992). Clean indoor air laws, addiction, and cigarette smoking. Applied Economics, 24, 193–205; Chaloupka, F. J., and Grossman, M. (1996). Price, tobacco control policies, and youth smoking; Unpublished Working Paper No. 5740, National Bureau of Economic Research, Cambridge, MA; Chaloupka, F. J., and Pacula, R. L. (1998). Limiting youth access to tobacco: The early impact of the Synar Amendment on youth smoking. Paper presented at the Third Biennial Pacific Rim Allied Economic Organizations Conference, Bangkok, Thailand, January 14, 1997; Evans, W. N., Farrelly, M. C., and Montgomery, E. (1996). Do workplace smoking bans reduce smoking? Unpublished Working Paper No. 5567. Cambridge, MA: National Bureau of Economic Research; Ohsfeldt, R. L., Boyle, R. G., and Capilouto, E. I. (in press). Tobacco taxes, smoking restrictions, and tobacco use. In F. J. Chaloupka, W. K. Bickel, M. Grossman, and H. Saffer (Eds.), The economic analysis of substance use and abuse: An integration of econometric and behavioral economic research. Chicago: The University of Chicago Press for the National Bureau of Economic Research; Wasserman, J., Manning, W. G., Newhouse, J. P., and Winkler, J. D. (1991). The effects of excise taxes and regulations on cigarette smoking. Journal of Health Economics, 10, 43–64; Gardner, S. E., and Brounstein, P. J. (2001).Science-Based Prevention Practices. Principles of Substance Abuse Prevention.

⁸⁰Grube, J. W. and Wallack, L. (1994). Television beer advertising and drinking knowledge, beliefs, and intentions among schoolchildren. American Journal of Public Health, 84(2), 254–259.

⁸¹Gregory, D. (1997). Triumph over billboards. San Rafael, CA: Marin Institute; Pacific Institute for Research and Evaluation (1999). Strategies to reduce underage alcohol use: Typology and brief overview.

⁸²Abramson, H. (1997). Showdown on Main Street. The Marin Institute for the Prevention of Alcohol and Other Drug Problems Newsletter, 12; Abramson, H. (1997). Can they ban these boards? The Marin Institute for the Prevention of Alcohol and Other Drug Problems Newsletter, 12; Lang, C. and Krongard, M. (1999). Strengthening families and protecting children from substance abuse. Newton, MA: Education Development Center, Inc.; Garner, D. W. and Whitney, R. J. (1997). Protecting children from Joe Camel and his friends: A new First Amendment and federal preemption analysis of tobacco billboard regulation. Emory Law Journal, 46(2), 479–585. Available online: http://www.law.emory.edu/ELJ/volumes/spg97/garner.html.

⁸³Mosher, J. and Jernigan, D. (1998). Overcoming the barriers: Implementing environmental approaches to prevent alcohol, tobacco, and illegal drug problems. Working draft, unpublished paper. Rockville, MD: National Center for the Advancement of Prevention.

⁸⁴Grube, J. W. and Wallack, L. (1994). Television beer advertising and drinking knowledge, beliefs, and intentions among schoolchildren.

⁸⁵Lewit, E. M., Coate, D. and Grossman, M. (1981). The effects of governmental regulation on teenage smoking. Journal of Law and Economics, 24, 545-569.