Underage Drinking Prevention Strategies (page 2)

Following is a description of a variety of prevention strategies that are categorized according to the risk and protective factor framework.

Community Based Strategies (CB)

Underage drinking community based prevention strategies need to address the following issues. Organizations with limited resources will need to determine which strategies are most important and prioritize these activities.

1. Reduce access to alcohol.
2. Establish community laws and norms that disapprove of underage drinking.
3. Increase awareness about the nature and extent of underage drinking.
4. Mobilize communities to develop neighborhoods where atmosphere, appearance, and safety are important.
5. Increase supervision of young people.
6. Provide opportunities for youth to contribute to the community.

The following are “best practices” or suggested strategies for preventing underage drinking. Again, it will be necessary to prioritize based on available resources. Many of these strategies are discussed in greater detail in the Community How To Guides on Underage Drinking Enforcement, Public Policy and Media Relations. There is a wealth of data and information that supports the effectiveness of these strategies and practices.

CB 1  Reduce access to alcohol

• Limit the hours of sale or number of licensees (universal)

  Availability is a great predictor of alcohol use. If large numbers of alcohol outlets are located in a given area, alcohol-related problems will generally increase. Communities that need to control the general availability of alcohol — to adults and to youth — can implement licensing and control strategies including limiting hours of sale or the number of licensees in an area, pass laws that limit the age of servers and other prevention strategies.

• Compliance checks (also known as “stings” or decoy operations) (universal)

  Compliance checks with law enforcement and alcohol beverage control agencies can “check” the sales policy and practices of stores, bars, restaurants and hotels that sell alcohol. Conducting these checks and publicizing the findings has proven to reduce sales of alcohol to minors.

• “Cops in Shops” and similar programs (universal)

  “Cops in Shops” programs work in cooperation with vendors to place law enforcement officers, liquor agents, or inspectors in stores to pose as clerks. The officer trains the clerk(s) to detect false, altered, or fraudulent identification and if a minor attempts to purchase alcohol, the law enforcement officer cites the minor.

• Third party, shoulder tap and “Mister, Will You?” programs (universal)

  Shoulder-tap or “Mister, will you…?” programs are designed to discourage adults from buying for youth and to discourage young people from asking adults to buy for them.

• Adult responsibility laws (universal)

  States or local jurisdictions can enact laws to hold adults, who are in charge of the premises, responsible for any illegal drinking which takes place while they are present. They can also vigorously enforce laws related to providing alcohol for minors or contributing to the delinquency of a minor.

• Server/seller training (universal)

  Server/seller training educates merchants on their legal responsibilities and on effective techniques for controlling sales to minors and to individuals who are intoxicated. This education is most effective when used in conjunction with compliance checks. The fact sheet, Preventing Sales of Alcohol to Minors: What You Should Know About Merchant Education Programs, developed for the Office of Juvenile Justice and Delinquency Prevention’s (OJJDP) Enforcing Underage Drinking Laws Program has several recommendations such as educational programs for merchants that includes information about laws and penalties, information indicating the importance of avoiding sales to minors to protect the health and well-being of the entire community, an emphasis on proper management techniques, information on how to recognize fake IDs, and tips on how to refuse a sale safely and comfortably.

  The Maryland Hospitality Education Foundation developed a special “young adult server training” that includes tips for young people who may feel intimidated by their friends or by older, intoxicated customers. The classes provide information on how to avoid confrontation and peer pressure as well as management skills and responsible alcohol service. The training involves off-sale and package good establishments, hotels, country clubs, caterers, and restaurants.

• Consistent penalties for merchants who break the law (selective)

  Citing clerks and shop owners who break the law is only effective if serious consequences are imposed by the board of license commissioners, liquor board, or other alcohol licensing authority.

• Dram shop liability laws for sales to minors (universal)

  Dram shop liability laws hold merchants accountable when intoxicated drivers they serve cause crashes after leaving their establishment.

• Keg registration laws (universal)

  Keg registration laws require that an adult who takes a keg out of an alcohol outlet must fill out a form that contains their name, address, and other information. Although keg registration offers enforcement agencies an additional tool, it is primarily designed to reduce the availability of alcohol to minors by discouraging adults from providing kegs for minors and by making it less attractive for youth to attempt to secure kegs by presenting fake IDs.

CB 2  Establish community laws and norms that disapprove of underage drinking.

• Zero tolerance laws (universal)

  Every state has now passed some version of “zero tolerance” legislation that sets a blood alcohol limit for youth in that state which is lower than the blood alcohol limits set for adults in the state. These “zero tolerance” laws can be very effective in reducing alcohol-related traffic crashes among youth if they are vigorously enforced and well publicized.

• Alcohol enforcement units or special “party patrols” (universal)

  Party patrols and other enforcement strategies to break up parties and cite the youth involved signal strong community disapproval of underage drinking and seek to reduce the opportunities for drinking. Publicizing these efforts helps to build awareness of the underage drinking problem and the efforts underway to curb it.

• End alcohol-industry sponsorship of, and prohibit or restrict, alcohol sales at public events such as fairs, festivals, sporting events, etc. (universal)

  In many communities, local beer distributors or manufacturers sponsor events for adults and youth. Some communities have been successful in preventing alcohol-industry sponsorship of large sports activities. The Troy Community Coalition in Troy, Michigan learned that an alcohol-industry-sponsored sports event was scheduled for their town and succeeded in preventing the activity from taking place until alternate sponsors could be recruited.

  Alcohol sales at large public events are also popular and many are poorly monitored. Minors often find it easy to obtain alcohol and the large numbers of people drinking sometimes leads to fighting, rowdiness, vandalism, and impaired driving as people leave the scene. Ending or closely monitoring alcohol sales at these events demonstrates the community’s strong disapproval of illegal underage drinking and irresponsible adult drinking and may also help to reduce access to alcohol and related problems.

  In Washington, D.C., organizers of the city’s Latino Festival decided to eliminate alcohol service and sales at the Festival after episodes of alcohol-related violence. Although some people in the community predicted that the Festival would lose sponsors and participants if alcohol was banned, the Festival has continued to flourish since alcohol was eliminated and attendees have reported that they feel safer than they did when alcohol was served and sold at the event.

• Restrict billboards and other forms of alcohol advertising (universal)

  Billboards, advertising on bus backs and sides and in bus shelters, and banners and placards to advertise alcohol in public places are widespread in many communities and often are especially prevalent in minority communities and near schools. In recognition of the fact that exposure to these advertising tools has been demonstrated to affect attitudes towards using alcohol, many communities are enacting ordinances or laws to restrict billboards and other forms of advertising.

  The Coalition Against Billboard Advertising of Alcohol and Tobacco (CABAAT) in Detroit, Michigan targeted the issue of alcohol advertising. One of their activities was to conduct a survey of the number of billboards in the city and publicize the number that advertised alcohol. The media was used to publicize their findings as well as publicize the harm these ads were causing in the community.

• Fake ID laws (selective)

  Enforcing laws about possessing, using, manufacturing, and selling fake IDs can signal the community’s strong disapproval and may curtail the availability and use of the IDs.

  ýThe RAAM (Reducing Alcohol Availability to Minors) in Ocean City, Maryland targets ID checks in the stores and has enlisted cooperation from landlords for evicting underage drinkers during “Beach Week,” a high risk time for underage drinking. The result has been a decrease in alcohol-related deaths.

• Sobriety checkpoints (selective)

  Although police may actually arrest only a few impaired drivers during individual sobriety èheckpoints, checkpoints have been demonstrated to be very effective in reducing crashes and impaired driving. Well-publicized checkpoints also help to express the community disapproval of impaired driving and underage drinking.

• >Use/lose laws (indicated)

  ýIn some jurisdictions, youth who are cited or arrested for drinking may lose their driving privileges or be subject to other penalties through the motor vehicle administration, juvenile courts, or juvenile justice administration. Local prevention organizations can work to ensure that appropriate penalties exist and are consistently used.

• Diversion programs (indicated)

  Diversion programs are designed to keep underage drinking cases from clogging the justice system and to provide needed rehabilitation without giving the young person a criminal record. They are especially appropriate because of the large percent of underage drinkers who can benefit from substance abuse and/or mental health treatment. It will be necessary to develop at least two programs, one for juveniles (under age 18 in most states) and one for older offenders (18-20 years of age, in most states).

• A court watch program (indicated)

  A court watch program is a tool that can be used by community groups in finding out the disposition of underage drinking cases. They can also be used to engage the justice system in an underage drinking effort. A court watch is appropriate when:

• Information is not available on what is happening to offenders.
• It is necessary to draw attention to what is happening to offenders.
• Attention is needed to the connection between alcohol and other offenses.

Special permission will need to be granted to attend a juvenile hearing since most are not open to the public.

Appendix #2 includes Tips on Establishing Diversion and Court Watch Programs supplied by the Combating Underage Drinking Program in Maryland. Mothers Against Drunk Driving (MADD) also has information on establishing a court watch program.

CB 3  Increase awareness about the nature and extent of underage drinking.

• Publicize underage enforcement efforts (universal)

  Publicizing strong enforcement efforts targeted at underage drinking, including compliance checks, Cops In Shops programs, sobriety checkpoints (which take place at locations and times identified as high-risk) and other campaigns, can build awareness of the underage drinking issue. It can also create a “healthy paranoia” among potential offenders and generate support for the enforcement campaigns from the media, policy makers, and the public.

  The Travis County Underage Drinking Prevention Program in Austin, Texas, publicizes intensive underage drinking enforcement programs at prom time and other “high risk” times of the year by sending out news releases and arranging for coverage on a cable television show hosted by the project’s director.

• Conduct media and targeted public information campaigns (universal)

  ýThe traffic safety community has successfully used media campaigns to enhance enforcement efforts for many years. One of the most successful programs in recent years has been the “Click It or Ticket” campaign in North Carolina to encourage the use of seat belts.

  Public service campaigns to prevent impaired driving by encouraging friends to take a drinker’s keys or utilize other intervention techniques have been more effective against impaired driving, but may not stop underage consumption.

  The Detroit City Council Task Force on Substance Abuse Prevention developed a media campaign to target alcohol consumption entitled “Denounce the 40-Ounce.” The campaign, whose slogan was recognized by over 50 percent of city residents in just a year, persuaded the Everfresh Juice Company to reconsider marketing iced tea in pint-sized flasks resembling liquor bottles. For its efforts, the program was recognized by Office of National Drug Control Policy (ONDCP) and the Crime Prevention Association of Michigan.

  Media coverage can also be an extremely effective tool for advocating changes in laws, policies and procedures that will enhance prevention efforts. Project Extra Mile in Omaha, Nebraska (See Pilot Projects), alerted the public to serious flaws in the laws regarding underage drinking by launching a media campaign to highlight the problems.

  Media relations campaigns can also help generate support and attention for new underage drinking prevention programs. In some cases, the best way to secure coverage is to ask members of the media what they think about the underage drinking issue. In Hermantown, Minnesota, Lenoir County, North Carolina, and Tippecanoe County, Indiana coalitions that were launching new underage drinking prevention efforts invited members of the media to talk with them and to explain how the media viewed underage drinking in the community. Each of the reporters who were invited to talk to coalition members also produced large and important stories about the new programs.

More information on media is available in the Community How to Guide on Media Relations.

Several studies have been published about informing students of normative behavior that differs from the perception. More information is available in an article entitled, Designing Alcohol and Other Drug Prevention Programs. Information on obtaining the article is included in the Resource Section of this book.

CB 4  Mobilize communities to develop neighborhoods where atmosphere, appearance and safety are important.

• Communities That Care, Developmental Research Programs, Seattle, Washington (universal)

  Communities That Care is a program from Developmental Research Programs, an organization founded by Dr. J. David Hawkins and Dr. Richard F. Catalano. It is a model that builds on the knowledge gained from successful community prevention efforts and provides an effective process for mobilizing communities to address adolescent problem behaviors. Communities That Care includes the following components:

  • Involves a broad spectrum of individuals, groups, and organizations who represent the diversity of the community
  • Builds support for the risk and protective factor-focused prevention from key leaders as well as grassroots community members
  • Promotes widespread communication and collaboration
  • Utilizes a data-driven assessment process
  • Promotes a long-term community commitment

CB 5  Increase supervision of young people

• After-school programs (universal)

  One way to enhance prevention efforts is to get youth involved in healthy pursuits that reduce their exposure to risky situations that promote the use of alcohol and other drugs, especially during their leisure time. Today’s youth especially need alternative activities. Shrinking funding caused many youth service organizations to scale back their activities and profound changes in American life have increased the need for supervised after-school activities. After school programs and activities decrease the amount of unsupervised time during the high-risk hours of 3:00 p.m. to 6:00 p.m. when many adolescents take their first drinks.

Appendix #3 lists some of the Characteristics of Effective After-School Programs taken from the U.S. Department of Education’s Safe and Smart program which included information from the 1998 “Beyond Prevention Curricula: A Guide to Developing Alternative Activities.”

CB 6  Provide opportunities for youth to contribute to the community

• Community Service Projects (universal)

  The Save Our Youth Coalition in Salt Lake City, Utah works with the Salt Lake County Public Schools in providing financial support to forty-four high school and junior high school peer leadership teams. These teams conduct a number of activities, some of which focus on underage drinking or substance abuse, but many on helping the community. These activities range from a clean up of an area, trash pick up along a designated highway, or visits to senior citizen centers. Community activities are viewed as an important way for the youth to feel connected to the community at large, and help them see that their actions, such as underage drinking, can negatively impact others.

• Extra-curricular activities (selective)

  Participation in extra-curricular activities such as Students Against Destructive Decisions (SADD) also provide young people with an opportunity to contribute to their community. SADD chapters conduct a number of programs and activities both in schools and in the community by raising awareness about the dangerous consequences of underage drinking.

Family Based Strategies

Underage drinking family based prevention strategies need to address the following issues:

1. Parent education to influence attitudes and behavior toward underage drinking.
2. Family structure and function problems, such as how to set limits in age appropriate ways.
3. Family conflict, including substance abuse, violence, divorce, and illness.

FB 1  Parent education to influence attitudes and behavior toward underage drinking.

Broad-based parenting education programs may substitute for parenting education that in previous generations was supplied by family members. Parent education can be delivered by the media, through health promotion strategies, in large group settings such as church groups, parent education nights at schools, or through the development of parent networks.

When the issue is underage drinking, many parents do not think it is a serious problem and view it as a “right of passage.” They also may not see how their own attitude and behavior towards adult alcohol use shapes the attitudes and behaviors of their children. Topics to cover in a parenting education effort could include information on the dangerous consequences of underage drinking, how to be a good role model, what to look for when your child needs help, the normal “rules testing,” and the need for children to have opportunities to experience risk without breaking the law.

FB 2  Family structure and function problems, such as how to set limits in age appropriate ways.

• Parents and Children Videotape Series – The Incredible Years (universal)

  The short-term objectives in the program are for parents to improve communication skills with their children, improve limit-setting skills by means of nonviolent discipline techniques, improve their own problem-solving skills, and learn effective methods of anger management. For children, short-term objectives include reduction of the frequency and number of conduct problems and improvement of pro-social skills. The basic and advanced series consists of 16 videotape programs, each building on the last.

• Safe and Sober Youth (SASY) Driver’s License Program (selective)

  SASY and Children at Risk Today (CART) work to provide parents of Central Virginia with the tools they need to help teens avoid at-risk behavior. The focus of the program is to fight substance abuse, teen crime, and impaired driving. Through the Virginia License Presentation Program, SASY is able to provide every new teen driver household in Chesterfield and Powhatan Counties with educational safe driving information. One focus of the program is to train parents to be better driving instructors for their children. The group also runs the “DUI Means” campaign to help teens understand the consequences of impaired driving.

FB 3  Family conflict, including substance abuse, violence, divorce, and illness.

• Strengthening Families Program (selective)

  The Strengthening Families program is an example of a multi-component, family-focused program for 6- to 10-year old children of substance abusers. The program includes a parent training program, a children’s skills training program, and a family skills training program and is presented in 14 consecutive weekly sessions. Research suggests that parent-child relationships improve more when programs work with the entire family than when only the parents receive training or when the programs involves separate child skills training and parent training.

• Functional Family Therapy (FFT) (indicated)

  Functional Family Therapy is a family-based intervention program for acting-out youth. A major goal of the therapy is to improve family communication and supportiveness while decreasing the intense negativity so often characteristic of these families. Other goals include helping family members identify what they desire from each other, identifying possible solutions to family problems and developing powerful behavior change strategies.

• Parenting Adolescents Wisely (indicated)

  Parenting Adolescents Wisely (PAW) is an interactive CD-Rom based program designed for families at risk with children from early elementary to high school age. PAW seeks to help families enhance relationships and decrease conflict through behavior management and support. Through a self-administered, self-paced CD-Rom program, parents view video scenes of common family problems. For each problem, parents choose a solution and see it enacted and listen to a critique. The video program covers communication skills, problem solving skills, speaking respectfully, assertive discipline, reinforcement, chore compliance, homework compliance, and supervising children. The program is designed to be used by parents totally unfamiliar with computers as well as those with experience.

Appendix #5 is a list of Recommendations for Working With Parents taken from the Center for Substance Abuse Prevention’s (CSAP) Monograph 5 “Prevention Primer: Parents and Prevention,” 1997, for underage drinking prevention coalitions and organizations who want to work with parents.

Individual/Peer Group Based Strategies

Underage drinking individual and peer/group based prevention strategies need to address the following issues:

1. Building personal competence (decision making, “people skills”).
2. Mentoring programs.
3. Appropriate use of time (healthy ways to take risks).
4. Individual reasons for underage drinking (self-medication, testing the rules, etc).

IB 1  Building personal competence (decision making, “people skills”).

• Project Status (selective)

  Project Status (Student Training Through Urban Strategies) is a school-based program that helps students become active, responsible members of their community. Based on the belief that isolating students in book-learning environments fails to inspire commitment to schools and belief in social rules, the project provides a more challenging and relevant educational experience. It increases students’ pro-social behaviors by providing contact with positive adult role models, enhancing stakes in conformity, and altering peer relationships. An evaluation of the project showed significant beneficial effects for intervention students, compared to control students.

IB 2  Mentoring programs

Mentoring programs that link high-risk youth with caring adults have demonstrated some success in reducing substance abuse among youth. If a young person bonds with a caring adult who is a positive role model and consistent presence in the child’s life, that bond is a significant protective factor for the child.

• Big Brothers/Big Sisters (selective)

  According to an evaluation of the Big Brothers/Big Sisters conducted by the Center for Substance Abuse Prevention, the organization’s mentoring program revealed that youth who spent 12 hours with a mentor each month for a year were 27% less likely to begin using alcohol. Boys who lack fathers or children who lack legitimate role models should be special targets for mentoring programs.

IB 3  Appropriate use of time (healthy ways to take risks).

• Alcohol-free activities for youth (universal)

  Studies show that some community partnerships devote a large portion of their resources to sponsoring alcohol-free activities for youth. Ensuring that an adequate number of attractive, alcohol-free activities is available can help youth understand alcohol is not a necessary component for fun. The best activities promote skill building, or group bonding.

  The Spring Party Challenge at the University of Maryland in College Park, Maryland is designed to promote alcohol-free events for students; increase students’ skills in planning parties, and demonstrate to students that they can have a good time without alcohol. Each year the University Health Center sponsors the “challenge” for the best alcohol-free party held on or off campus.

  The contest is open to any group of registered students—including campus organizations, resident hall floors, fraternities and sororities, clubs, sports teams, or groups of friends. Each group identifies a “party planner” who registers the party and attends a required party-planning workshop. The party-planning workshop is run by peer educators who explain the rules of the competition. The workshop content also includes tips for having a successful party and information about problems associated with alcohol use on campus.

  Marketing for the event includes sending flyers to all campus resident assistants and resident directors, all students who live in substance-free housing, and representatives of each of the 300 student organizations. Advertisements are also placed in the campus newspaper.

  Parties are evaluated based on standardized scoring criteria, which include attendance, theme, entertainment and activities, refreshments, and guests’ level of enjoyment. The party with the highest score wins a cash prize of $300. Honorable mentions of $100 are also awarded. All groups who register are sent a letter commending their participation.

  This activity is well received on campus, with many student groups indicating their continued support for the contest.

IB 4  Individual reasons for underage drinking (self-medication, testing the rules, etc).

• Residential Student Assistance Program (indicated)

  The Residential Student Assistance Program in Westchester County, New York was based on successful Employee Assistance Programs (EAPS) used by industry to identify and aid employees whose performance and lives had been adversely affected by substance abuse. Also feeding into the design of this effort were the successful experiences the county had when it initially implemented a Student Assistance Program (SAP) in the county’s high schools. These approaches were adapted for high-risk, institutionalized adolescent youth, age 14-17. Evaluation conducted by the Center for Substance Abuse Prevention in the unpublished document “Understanding Substance Abuse Prevention Toward the 21st Century: A Primer on Effective Programs” demonstrated that services offered by the residential SAP were a key ingredient in a marked decrease in substance abuse among participants. Further, youth who participated in multiple services showed an additional decline in substance abuse.

Appendix #6 is a Prevention Program Matrix of the various community, school, family and individual based strategies described in the preceding pages.

Comprehensive Prevention Programs

Modern prevention involves all segments of the community and infuses prevention into the community, family and social environment. As Dr. Alan Leshner, Director of the National Institute on Drug Abuse says, “Simple strategies do not work. You need to have a comprehensive strategy with multiple goals to be accomplished simultaneously. We need to have comprehensive approaches that involve the whole community. Families, schools, whole communities and the media need to work together.”

Designing and implementing an underage drinking prevention program can seem to be an overwhelming task, especially in a community where many people — including those in positions of power or influence — may view underage drinking as a “rite of passage.” In addition, the growing problem of alcohol use among youth and shrinking resources can make the task of assessing a current program’s effectiveness and planning for future needs appear to be difficult. Appendix #7, Prevention Principles Checklist, adapted from the 1999 “Preventing Drug Use Among Children and Adolescents,” is designed to help prevention planners determine whether specific programs include research-based prevention principles.

Conclusion

Thanks to a growing recognition of the importance of preventing underage drinking and its consequences, knowledge about effective prevention strategies is constantly expanding. There is no “silver bullet” to prevent the problem — no single program has yet been identified that will prevent drinking by all youth — but research and experience have revealed that carefully targeted, consistently applied prevention programs do work.

Years of prevention and practice show that:

• The effectiveness of prevention programs is enhanced when they are comprehensive and include community-wide policies such as laws, regulations, sanctions and the establishment of formal and informal norms.
• Effective prevention programs should seek to minimize or eliminate as many risk factors as possible and enhance those factors that work to insulate people from substance abuse.
• Prevention needs to begin early and to be reinforced throughout a child’s development.
• Prevention programs can take place in the school, workplace, family, recreational settings, and the wider community.
• Programs seem to be most effective when they are focused on individuals and groups of individuals that are clearly defined by age, sex, race/ethnicity/nationality/culture, risk and protective factors, and other identifying characteristics.

Every community across America is unique in its makeup, needs and resources. By employing effective prevention strategies targeted to the unique profile of each community and its residents, prevention practitioners can reduce the onset of underage drinking, curb the terrible toll that underage drinking exacts on the highways and in other settings and, ultimately, prevent young people from enduring a lifetime of alcohol-related problems.