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CORK Bibliography: Community Action Initiatives

79 citations. January 2006 to present

Prepared: December 2009

Allamani A; Sani IB; Centurioni A; Ammannati P. Preliminary evaluation of the educational strategy of a community alcohol use action research project in Scandicci (Italy). Substance Use & Misuse 42(12-13): 2029-2040, 2007. (11 refs.)

A community project aiming to promote responsible drinking and to prevent alcohol use-related problems in three districts of Scandicci, a town west of Florence, was undertaken between 2000 and 2004. The community totaled 21,851 residents. Among other initiatives, 8,000 carousels that provided information on different levels of alcohol consumption and more than 1,000 prints of nine drawings by local school children that promoted moderate consumption were distributed in the community, during February-July 2002 and May-June 2003. These formed part of a community educational strategy, spreading messages in keeping with the project's aims. Project process and impact evaluation studies documented firstly that the carousel was visible, interesting, and retained by the community members one year after distribution, while the children's drawing prints were visible and also retained some months later. Secondly, both educational tools were effective in mobilizing the local population because they were locally produced, widely distributed, and displayed in prominent community locations. Thirdly, a change in community opinion occurred during the course of the project from a more rigid idea in 2000 that only alcoholism is a problem toward a more comprehensive understanding in 2003 of community risk from alcohol consumption.

Anker J. Active drug users: Struggling for rights and recognition. IN: Anker J; Asmussen V; Kouvonen P; Tops D, eds. Drug Users and Spaces for Legitimate Action. NAD Monograph no. 49. Helsinki, Finland: Nordic Alcohol and Drug Council, 2006. pp. 37-60. (31 refs.)

This article investigates the processes through which a group of drug users seek to gain recognition and legitimacy as an interest organisation via The Danish Drug User's Union (DDUU) (BrugerForeningen for aktive stofbrugere). The case of the Danish Drug User's Union is particularly interesting because the organisation seeks to organise and represent a group of citizens that are normally excluded from channels of participation and interest mediation.3 From a broader perspective the attempt to form an interest organisation of drug users is interesting because it may form part of a process whereby different excluded groups and social clients attempt to gain rights to participation and voice in the welfare state. What is of particular interest here is how the DDUU attempts to change their stigmatised position as drug users into a position, where they are recognised as a legitimate collective actor/interest organisation. The article describes the position, aims and strategies of the DDUU. It explores how the DDUU seeks to advance an alternative image of drug users as able, respectable and active, thereby opposing the dominant image of drug addicts as irrational, passive and irresponsible. The article also provides an insight into the strategic dilemmas of the DDUU. On the one hand the organisation receives public funding and seeks to use formal channels of interest representation, on the other hand the organisation struggles for an alternative drug policy, which challenges the official drug policies in Denmark. Three questions will guide the discussion: First, the article seeks to explain why and how an organisation of drug users is enabled to emerge, in spite of the strong stigmatisation of drug users in society. Second, the article will dwell with the question of how the drug users attempt to overcome stigmatisation. Third, the article offers an account of the impact of the organisation.

Anker J; Asmussen V; Kouvonen P; Tops D, eds. Drug Users and Spaces for Legitimate Action. NAD Monograph no. 49. Helsinki, Finland: Nordic Alcohol and Drug Council, 2006. (Chapter refs.)

In our society it is very rarely that people who use opiates, cocaine and amphetamine or any combination of these and other substances are invited to speak up and play an active role in the formulation of policies and practices in the drug field. On the contrary, drug users are often treated as second-rate citizens; not as subjects with rights, a voice and an identity, but rather as passive recipients or objects of help or measures of control, punishment and discipline. This publication aims to generate greater interest in and increase awareness and knowledge about the existence of drug users as a group with an active voice. It explores the spaces where such voices are given an opportunity to evolve with a minimum of legitimacy and recognition. Through its various articles, therefore, this publication seeks to provide an improved understanding of the possibilities, limitations, advantages and dilemmas of user participation and user organisation. Organisations for active drug user are not, however, the only actor on the drug policy scene to speak up for drug users. Several of the articles in this publication focus not only on organisations for and by active drug users, but also on organisations run by former drug users, by drug users in substitution treatment or by drug users' relatives. Many of the contributions trace the historical development of different organisations, explore their relationship with the authorities, as well as the relationship between different but interrelated organisations in the field. A further important aspect covered in this publication is the involvement of drug users in different kinds of social services, which offers interesting insight into drug users' interaction with the official system. The articles look at user participation both from the point of view of user consultation, where users are asked their opinion and where they respond to the demands expressed, and from the point of view of direct action, without any clear demands on the part of the system. In the Nordic countries, the first organisations for active drug users were formed during the 1990s in Denmark and Norway, and in Sweden in the early 2000s. In Finland, the first user-driven organisation was established in 2004. These drug user organisations have been founded by heroin users, they are run by heroin users and users in maintenance treatment, and they also cater for active drug users, mainly heroin users. Representing active drug users, the aim of these organisations is to raise issues where the situation of drug users is considered unacceptable in relation to treatment systems, control policies or the criminal justice system, for example. In this sense the organisations serve as interest organisations and a mouthpiece for active drug users. This publication aims to provide a deeper understanding of the background for the emergence of these organisations, what they mean in a broader sense, and how they help and empower drug users. It is a guiding assumption in this publication that user organisations and the patterns of participation they provide for have to be understood and studied in close relation to the social, cultural and political context in which they emerge. An important aim of this publication is hence to draw attention to some aspects of drug policy and some trends in drug use in different national contexts that 6 enable the emergence and continuity of drug user organisations. Examples are included from Denmark, Finland, Norway and Sweden. To sharpen the comparative focus, a contribution is also included on drug user organisations in the Netherlands, where the first drug user organisations emerged much earlier than in the Nordic countries.

Baezconde-Garbanati L; Beebe LA; Perez-Stable EJ. Building capacity to address tobacco-related disparities among American Indian and Hispanic/Latino communities: Conceptual and systemic considerations. Addiction 102(Supplement 2): 112-122, 2007. (23 refs.)

Aim: To discuss systemic and conceptual issues that surround capacity building for tobacco control in traditionally underserved communities, by presenting two case studies, one in an American Indian community and another in a Hispanic/Latino community. Design: Key informant interviews, cross-sectional surveys and case study methods were used to create community-specific conceptual frameworks for building capacity for tobacco control. These models of capacity building serve as the backdrop for the development of the two case studies. Setting, participants, measurements: Interview and survey participants were identified through convenience and snowball sampling, using a community-based participatory process in an American Indian community in Oklahoma and among the Hispanic/Latino Tobacco Education Partnership (H/LTEP) organizations in California. Using qualitative and quantitative methods, two case studies were created based on the results of interviews with key informants in each of the respective communities, outcomes of efforts to build capacity in tobacco control are presented. Findings: The extent to which American Indian and Hispanic/Latino communities have the capacity to address effectively the disproportionate burden of tobacco abuse is contingent upon the presence of leadership, collaboration, programs, distribution of funds and resources, development of policies and an underlying understanding of community strengths, history, values and participation. Common characteristics emerge from the case studies that help bridge differences in definition and measurement across both populations and programs. Conclusion: The conceptual frameworks for capacity building presented provide insight that enhances the ability of priority populations to engage in tobacco control strategies using culturally and language appropriate interventions.

Baldwin JA; Johnson JL; Benally CC. Building partnerships between indigenous communities and universities: Lessons learned in HIV/AIDS and substance abuse prevention research. American Journal of Public Health 99(Supplement 1): S77-S82, 2009. (41 refs.)

Many HIV/AIDS and substance abuse prevention studies in American Indian and Alaska Native communities have been directed by academic researchers with little community input. We examined the challenges in conducting HIV/AIDS-related research in American Indian and Alaska Native communities and the benefits of changing the research paradigm to a community-based participatory model. The lessons we learned illustrate that the research process should be a cyclical one with continual involvement by community members. Steps in the process include (1) building and sustaining collaborative relationships, (2) planning the program together, (3) implementing and evaluating the program in culturally acceptable ways, and (4) disseminating research findings from a tribal perspective. These steps can enhance the long-term capacity of the community to conduct HIV/AIDS and substance abuse prevention research.

Burris S; Burrows D. Drug policing, harm reduction and health: Directions for advocacy. (editorial). International Journal of Drug Policy 20(4): 293-295, 2009. (20 refs.)

Burrus B; Northridge ME; Hund L; Green M; Braithwaite K; Sabol B et al. Perspectives from the front lines of tobacco control. Journal of Health Care for the Poor and Underserved 17(1 Supplement S): 124-142, 2006. (29 refs.)

This research is designed to share valuable experiences and transferable principles from program staff of the Legacy/Community Voices initiative who have been involved in planning, implementing, evaluating, and sustaining tobacco control activities in underserved communities. Interviews were conducted with 13 front line staff from 9 sites: Alameda County, California; Detroit, Michigan; El Paso, Texas; Ingham County, Michigan; Miami, Florida; New Mexico; North Carolina; Northern Manhattan; and West Virginia. A model emerged from these interviews that places the life cycle of a program in a central position, with many of the identified themes (working with local champions, obtaining support from multiple partners, increasing organizational capacity) repeated throughout, albeit in different forms at different stages. Reflecting upon wisdom gained and identifying best processes for such work may help ensure that tobacco control programs are developed that are culturally safe and effective in meeting the needs of diverse communities throughout the United States.

Calhoun JG; Kolker JL; McGowan JM; Sohn W; Ismail AI. Tobacco-free community coalitions: Opportunities for enhancing oral cancer prevention programs. Journal of Cancer Education 24(4): 275-279, 2009. (28 refs.)

Background. This study identified oral cancer (OC) education and tobacco reduction collaboration within tobacco-free community coalitions (TFCC). Methods. Data from 4 TFCC were collected via educational intervention surveys and structured focused group Interviews. Results. Of the 52 participants, 96% were aware that tobacco products are risk factors for OC, yet 33% were unaware of the high OC impact locally. About 90% agreed that primary care providers and dentists should provide OC screenings and tobacco cessation. Conclusion. There is a need for provider endorsement and public demand for OC screenings. Opportunity exists for partnering and collaborative OC prevention with TFCC.

Chapman S. Public Health Advocacy and Tobacco Control: Making Smoking History. Boston: Blackwell Publishing, 2007

This book is organized into two section. It lays out a strategy and accompanying tactics for denormalising smoking and the tobacco industry. Part I addresses the major challenges for tobacco control. It addresses ethical principles, the role of advocacy, the potential pitfalls for harm reduction and product regulation, increasing smoking cessation and prevention, the denormalization of smoking, and control of the tobacco industry. Part II is a compendium of key components of advocacy efforts. It begins with examination of ten basic questions for planning an advoacy strategy, followed by a dictionary-style, organized from A-Z, examination of sixty-five different elements. These range from Accuracy; to Analogies, metaphors, similes and word pictures; Celebrities, Editorials, Fact sheets, Letters to politicians, Mailing lists, Opinion polls, Private sector alliances, Slow news days, to Wolves in sheep's clothing.

Clark S. Youth access to alcohol: Early findings from a community action project to reduce the supply of alcohol to teens. Substance Use & Misuse 42(12-13): 2053-2062, 2007. (24 refs.)

The Youth Access to Alcohol (YATA) project was implemented in 2002 by the Alcohol Advisory Council of New Zealand (ALAC) in thirty communities' in New Zealand, with the aim of reducing the harm experienced by young people as a result of alcohol misuse in New Zealand through reducing the supply of alcohol by adults to young people. The communities include a mix of rural and urban from both Islands in New Zealand. The project uses a community action approach, which has included setting tip collaborative partnerships of key agencies, the delivery of key strategies, and multimedia awareness raising campaigns. The communities are encouraged to identify unique issues in their community regarding alcohol abuse and young people and to develop action plans incorporating a range of strategies that include tested strategies as well as innovative ideas. Communities are trained to implement several tools to monitor changes in their community over time. The study's limitations are noted and future needed research is suggested.

Collins D; Johnson K; Becker BJ. A meta-analysis of direct and mediating effects of community coalitions that implemented science-based substance abuse prevention interventions. Substance Use & Misuse 42(6): 985-1007, 2007. (54 refs.)

This article reports results of a meta-analysis of the effects of a set of community coalitions that implemented science-based substance use prevention interventions as part of a State Incentive Grant (SIG) in Kentucky. The analysis included assessment of direct effects on prevalence of substance use among adolescents as well as assessment of what "risk" and "protective" factors mediated the coalition effects. In addition, we tested whether multiple science-based prevention interventions enhanced the effects of coalitions on youth substance use. Short-term results (using 8th-grade data) showed no significant decreases in six prevalence of substance use outcomes-and, in fact, a significant though small increase in prevalence of use of one substance (inhalants). Sustained results (using 10th-grade data), however, showed significant, though small decreases in three of six substance use outcomes -- past month prevalence of cigarette use, alcohol use, and binge drinking. We found evidence that the sustained effects on these three prevalence outcomes were mediated by two posited risk factors: friends' drug use and perceived availability of drugs. Finally, we found that the number of science-based prevention interventions implemented in schools within the coalitions did not moderate the effects of the coalitions on the prevalence of drug use.

Conway K; Greenaway S; Casswell S; Liggins S; Broughton D. Community action - challenges and constraints - implementing evidence-based approaches within a context of reorienting services. Substance Use & Misuse 42(12-13): 1867-1882, 2007. (36 refs.)

Community action on alcohol use-related projects face significant challenges in focusing efforts where they are most likely to be effective -- on environmental strategies for optimum impact and sustainable institutional change. Reorienting and enhancing the efforts of existing services is a crucial issue for all countries with limited resources. This paper evaluates the use of a public health partnerships model to reorient resources and enhance cross sector collaboration to reduce alcohol consumption-related harm in a large New Zealand city from 2001-2004. The evaluation assessed changes in the management practices of participating health provider organisations, the reorientation of activities and the redeployment of provider resources, in light of evaluation evidence from collaborative initiatives undertaken by key stakeholder organisations. Despite the considerable challenges inherent in reorienting existing health sector resource and encouraging more evidence-based practice, this evaluation found encouraging signs of positive systemic changes, both within the health sector and with external stakeholders, in the redirection of priorities and resources. The focus on collaborative environmental strategies has also contributed to some limited, hat promising structural changes to reduce harm in the licensed alcohol availability, accessibility and promotion environment.

Cramer M; Roberts S; Xu LY. Evaluating community-based programs for eliminating secondhand smoke using evidence-based research for best practices. Family & Community Health 30(2): 129-143, 2007. (21 refs.)

Extensive research has been conducted on the hazardous effects of tobacco use, and more recently attention has focused on the harmful effects of secondhand smoke (SHS). A growing body of evidence-based research supports best practices for eliminating SHS. This article describes the evaluation and outcomes of a community-based coalition in the midwest that used best practices to educate and change public attitudes on SHS, and thereby promote social policy change for tobacco-free environments. The evaluation model incorporated evidence-based indicators as measures for coalition goal achievement and found the best practices program to be effective for eliminating SHS exposure.

Cramer ME; Atwood JR; Stoner JA. A conceptual model for understanding effective coalitions involved in health promotion programing. Public Health Nursing 23(1): 67-73, 2006. (36 refs.)

Funding agencies are increasingly focused on community coalitions as effective entities for promoting public health programs. Yet, there has been no conceptual model for understanding how effective coalition infrastructure works to facilitate a learning environment, wherein coalition members and leaders receive ongoing training and technical assistance needed to accomplish their external programing goals. This article presents a conceptual model for measuring the internal effectiveness of coalitions [Internal Coalition Outcome Hierarchy (ICOH)]. The ICOH model served as the basis for development of the evaluation instrument, Internal Coalition Effectiveness, which measures internal coalition effectiveness based on achievement of organizational outcomes at each of the model's seven hierarchical levels. The ICOH conceptual model has broad application for public health nurses who are frequently called on to serve as evaluators for community coalitions engaged in health programing. The model has implications for evaluators to use in teaching coalition members and leaders about their internal strengths and areas for improvement, so that coalitions can develop more effective internal structures and thereby promote long-term sustainability.

Espey DK; Baum SL; Jung AM; Kozoll RL. The New Mexico clinical prevention initiative: A statewide prevention partnership. Public Health Reports 122(3): 292-301, 2007. (13 refs.)

The New Mexico Department of Health and the New Mexico Medical Society invited organizations to participate in an initiative to promote clinical preventive services. The Clinical Preventive Initiative (CPI) focuses on the following interventions based on burden of illness, preventability of the condition, cost, current level of services, availability of leadership, and programmatic support: adult pneumococcal vaccination, tobacco use prevention and cessation, mammography screening, colorectal cancer screening, healthier weight, screening and treatment for chlamydia and gonorrhea, screening and intervention for problem drinking, childhood immunization, and prevention of unintended pregnancy. Specific workgroups plan and implement interventions directed at New Mexico medical practices, practitioners, and health-care systems. Several state measures suggest effectiveness of CPI efforts. CPI is a successful public-private collaboration providing an active forum for statewide clinical prevention policy development, an effective mechanism to achieve greater awareness of prevention and improved delivery of preventive services.

Fagan AA; Van Horn ML; Hawkins JD; Arrhur M. Using community and family risk and protective factors for community-based prevention planning. Journal of Community Psychology 35(4): 535-555, 2007. (40 refs.)

Research has identified risk and protective factors related to adolescent substance use using individual-level data, but it is uncertain whether or not these relationships exist when data are aggregated to a community level. Using data from adolescents in 41 communities, this article found that most community and family risk and protective factors, measured at the community level, predicted student prevalences of tobacco, alcohol, and marijuana use 2 years later, whether using information from the same or different groups of students, although the predictive power was stronger within cohorts. The findings support community-level prevention planning that uses epidemiological information on levels of community and family risk and protective factors to identify areas of elevated risk and low protection to be targeted for community-based preventive interventions.

Fahey D. Temperance Internationalism: Guy Hayler and the World Prohibition Federation. The Social History of Alcohol and Drugs 20(2): 247-275, 2006. (89 refs.)

The World Prohibition Federation, organized in 1909, and the "International Record", published from 1917 to 1968, sought to internationalize the temperance movement by collecting and disseminating anti-drink news from around the globe. The Federation was based in London, and most of its activists were English-speakers. A British reformer named Guy Hayler served as its honorary president for thirty years and edited the "International Record" until his death in 1943. The Federation emphasized that prohibitionists comprised a moral community, united regardless of race, religion, nationality, or politics. Poorly funded, the Federation had difficulty competing with the World League against Alcoholism after the Anti-Saloon League of America organized this rival propaganda society in 1919.

Florin P; Celebucki C; Stevenson J; Mena J; Salago D; White A et al. Cultivating systemic capacity: The Rhode Island Tobacco Control Enhancement Project. American Journal of Community Psychology 38(3-4): 213-220, 2006. (12 refs.)

This paper describes the Rhode Island Tobacco Control Enhancement Project (TCEP), a state-university-community technical assistance system. TCEP was developed under the auspices of the Rhode Island Department of Health's Tobacco Control program and was designed to build capacity among nine community-based organizations to mount comprehensive tobacco control interventions in five diverse communities within the state. This paper: (1) provides a description of community mobilization; (2) presents a logic model for planning and decision making used by state-university-community partners; (3) describes training, technical assistance services and implementation; and, (4) describes the evaluation and program improvement activities used to support on-going project development.

Ford JM; Beveridge AA. Varieties of substance use and visible drug problems: Individual and neighborhood factors. Journal of Drug Issues 36(2): 377-391, 2006. (11 refs.)

This paper examines whether the individual and neighborhood factors associated with visible drug problems are also related to drug use. It also looks at how the relationship between individual and neighborhood characteristics and substance use may vary depending upon type of substance under consideration (e.g., marijuana versus cocaine). Using data from the evaluation of the "Fighting Back" national demonstration program, our findings indicate that while neighborhood disadvantage, minority concentration, and density are strongly related to increased levels of visible drug problems, these characteristics are not significantly related to drug use. One implication of these findings is that law enforcement tactics aimed at reducing drug-related "incivilities" in a neighborhood are unlikely to have a substantial impact on residents' rates of drug use. The results also suggest that intervention programs targeting demand reduction among residents in a given neighborhood are likely to have little impact on visible drug problems in that area.

Giesbrecht N. Community-based prevention of alcohol problems: Addressing the challenges of increasing deregulation of alcohol. Substance Use & Misuse 42(12-13): 1813-1834, 2007. (67 refs.)

This article focuses on the erosion of alcohol management policies and the implications for local prevention efforts. It draws lessons from three large-scale multi-year multi-site programs in Canada, e.g., local addiction prevention projects, heart health programs, and tobacco control experiences. It explores five themes: getting alcohol on the agenda and implementing effective local responses to alcohol problems; assessing conceptual frameworks in order to identify the essential components of an effective prevention strategy; developing a system of local prevention initiatives that give priority to long-lasting structural changes; generating accurate information on alcohol-related damage in order to set priorities; and developing a prevention action plan in order to support local initiatives.

Giesbrecht N; Haydon E. Community-based interventions and alcohol, tobacco and other drugs: Foci, outcomes and implications. Drug and Alcohol Review 25(6): 633-646, 2006. (61 refs.)

The social, health and economic burdens from alcohol, tobacco and other drugs have impacts globally, national and locally. Effective interventions are needed at each level in order to reduce the extensive harm and attendant costs. This paper examines four topics: options available to the local community, evidence of effectiveness, links between local experiences and national and regional initiatives and implications for future research and intervention. It appears that there are a substantial number of options available at the local level. However, evaluation of them is not standard practice, and the results of the higher quality evaluations indicate that many, but not all, interventions have modest or equivocal impact. There is also not a consistent relationship between local and national interventions, although some themes are apparent: in tobacco control there may be good synergy across jurisdictional levels, for alcohol there is evidence that as national control measures are eroded local communities are encouraged or required to take up these agendas, and with regard to illicit drugs there may be tension between law enforcement priorities at the national level and harm reduction orientations locally. Future initiatives need to have appropriate evaluations as a standardised part of prevention initiatives, and include the development of national databases of what is going on locally. These initiatives should promote national policies that include setting parameters and guidelines, but nevertheless do not dictate specific steps and strategies how to achieve local goals in reducing risk and harm.

Gliksman L; Rylett M; Douglas RR. Aboriginal community alcohol harm reduction policy (ACAHRP) project: A vision for the future. Substance Use & Misuse 42(12-13): 1851-1866, 2007. (31 refs.)

Four First Nation communities in Ontario, Canada, formulated alcohol management policies between 1992 and 1994. An alcohol management policy is a local control option to manage alcohol use in recreation and leisure areas. Survey results indicate that decreases in alcohol use-related problems related to intoxication, nuisance behaviors, criminal activity, liquor license violations, and personal harm were perceived to have occurred. Furthermore, having policy regulations in place did not have an adverse effect on facility rentals. Bond administrators and facility staff in each community felt the policy had had a positive effect on events at which alcohol was sold or served.

Goldberg A. A collaborative model for community action against methamphetamine. Journal of Psychoactive Drugs Supplement 4: 327-335, 2007. (17 refs.)

San Diego County has a long history of chronic use of methamphetamine, and thus also has a track record in organizing an effective community response. This article discusses the formation and structure of the Methamphetamine Strike Force, and discusses its multidisciplinary collaborative problem solving model. Four strategies-prevention, intervention, treatment and interdiction-form a comprehensive set of recommendations that have guided action over the last decade. The Strike Force provides the region with a structure to mobilize its rich in-kind resources towards a shared plan of action. Data, organizing, media, policy and law enforcement are all central to the emerging model.

Gordon R; McDermott L; Stead M; Angus K. The effectiveness of social marketing interventions for health improvement: What's the evidence? Public Health 120(12): 1133-1139, 2006. (34 refs.)

Objectives: To review the effectiveness of social marketing interventions designed to improve diet, increase physical activity, and tackle substance misuse. Study design and methods: This article describes three reviews of systematic reviews and primary studies that evaluate social marketing effectiveness. All three reviews used pre-defined search and inclusion criteria and defined social marketing interventions as those which adopted six key social marketing principles. Results: The reviews provide evidence that social marketing interventions can be effective in improving diet, increasing exercise, and tackling the misuse of substances like alcohol, tobacco, and illicit drugs. There is evidence that social marketing interventions can work with a range of target groups, in different settings, and can work upstream as well. as with individuals. Conclusions: Social marketing provides a very promising framework for improving health both at the individual level and at wider environmental and policy-levels. Problems with research design, lack of conceptual understanding or implementation are valid research concerns.

Gripenberg J; Wallin E; Andreasson S. Effects of a community-based drug use prevention program targeting licensed premises. Substance Use & Misuse 42(12-13): 1883-1898, 2007. (31 refs.)

This study evaluated the effects of a community-based drug use prevention program on the frequency with which door men at licensed premises intervene in cases of obviously drug use-impaired patrons. Doormen were trained in recognizing signs of drug use impairment to he able to stop, drug use-impaired patrons to enter the premises. The study included 28 trendy nightclubs in Stockholm, Sweden, that used doormen to screen patrons. Two male actors were instructed to act as if they were obviously drug use-impaired (cocaine/amphetamines) while attempting to enter nightclubs. Data were collected at pretest when 40 entry attempts were made (2003) and posttest (2004) when 48 attempts were made. At follow-up, the doormen intervened in 27% of the attempts, a significant improvement compared to the intervention rate of 7.5% at baseline. The results indicate that the intervention has had effect on doormen's behavior. However, in the majority of the attempted visits, the doormen still did not intervene. Limitations of the study were the lack of a control group and problems with identifying the training status for the individual doormen. Further research is necessary to explore the effectiveness of community-based drug use prevention programs targeting licensed premises.

Gustafson DL; Goodyear L; Keough F. When the dragon's awake: A needs assessment of people injecting drugs in a small urban centre. International Journal of Drug Policy 19(3): 189-194, 2008. (27 refs.)

Background: St. John's, Newfoundland and Labrador is one of the smallest Canadian provincial capitals. Like other Canadian coastal communities, St. John's has been affected by dramatic economic and institutional restructuring that negatively impacted community health. Marginalized populations including people who inject drugs are more negatively affected by the gap between health needs and available services. Methods: A mixed methods needs assessment began with a survey and key informant and focus group interviews to determine attitudes, knowledge, and practices of people with current or previous experience injecting drugs. An environmental scan of programmes and services was conducted followed by a community consultation with key stakeholders, community agencies, study participants, the media, and members of the public to share and validate findings, solicit feedback, and gather data about future knowledge transfer activities. Results: This paper examines two of the five barriers to health and health services for people injecting drugs: First, there was a discrepancy amongst people injecting drugs between awareness and use of safer practices, and second, there was a limited formalized network of health and social programmes and services. Conclusion: Accurate and timely information about safer practices, whilst an essential component of a harm reduction approach, is insufficient to reduce the risk of negative health outcomes for people injecting drugs. Funding new programmes and services, although desirable, is not always feasible in small urban centres with limited human and material resources. Recommendations for promoting health, reducing harm, and building local capacity must consider these limitations. Registered nurses are well positioned to provide leadership through collaborative community-based research, education and advocacy.

Hacker K; Collins J; Gross-Young L; Almeida S; Burke N. Coping with youth suicide and overdose - One community's efforts to investigate, intervene, and prevent suicide contagion. Crisis. The Journal of Crisis Intervention and Suicide Prevention 29(2): 86-95, 2008. (40 refs.)

From 2000 - 2005, Somerville, MA, experienced a number of youth overdoses and suicides. The community response followed CDC recommendations for contagion containment. A community coalition, Somerville Cares About Prevention, became a pivotal convener of community partners and a local research organization, the Institute for Community Health, provided needed expertise in surveillance and analysis. Mayoral leadership provided the impetus for action while community activists connected those at risk with mental health resources. Using a variety of data sources ( including death certificates, youth risk surveys, 911 call data, and hospital discharges) overdose and suicide activity were monitored. Rates of suicide and overdose for 10-24-year-olds were higher than in previous years. Using case investigation methods, the majority of suicide victims were found to be linked through common peer groups and substance abuse. Subsequent community action steps included: a community-based trauma response team, improved media relationships, focus groups for suicide survivors, and prevention trainings to community stakeholders. Youth suicide and overdose activity subsided in May of 2005. The community partnerships were critical elements for developing a response to this public health crisis. This collaborative approach to suicide contagion used existing resources and provides important lessons learned for other communities facing similar circumstances.

Holder HD. Alcohol and the Community: A Systems Approach to Prevention. Cambridge: Cambridge University Press, 2006

An individual's decision to use alcohol and the frequency, quantity and situation in which drinking takes place are the result of a combination of biological and social factors. Drinking is not only a personal choice, but also a matter of custom and social behaviour, and is influenced by access and economic factors including levels of disposable income and cost of alcoholic beverages. Until prevention efforts cease to focus narrowly on the individual and begin to adopt broader community perspectives on alcohol problems and strategies to reduce them, these efforts will fail. The author challenges the current implicit models used in alcohol problem prevention and demonstrates an ecological perspective of the community as a complex adaptive system composed of interacting subsystems, an appreciation and understanding of which offers a new approach to the prevention of alcohol dependence and alcohol-related problems. The book is organized into 8 chapters. following an introduction, the author begins the discussion a discussion of the patterns of consumption and influences on consumption patterns. Attention then turns to what are considered different subsystems influencing consumption, each a subject of an individual chapter. These include retail sales, and the role of alcohol availability and promotion; formal regulations, including rules, their administration and enforcement; social norms, and community values that influence drinking patterns; legal sanction that are involved in the prohbition of drinking; and the social/economic/health consequences as they are recognized by the community. The concluding chapter addresses the need for and community level approaches to alcohol problems.

Holmila M; Warpenius K. A study on effectiveness of local alcohol policy: Challenges and solutions in the PAKKA project. Drugs: Education, Prevention and Policy 14(6): 529-541, 2007. (33 refs.)

To an increasing degree, alcohol policy and prevention in the Nordic countries is expected to be carried out on the local level as the free-trade agreements and international harmonization of alcohol taxes and regulations are limiting the scope of traditional national alcohol policies. In recent reviews on the effectiveness of alcohol political interventions the recommended strategy for local communities is to combine community mobilization with various types of environmental strategies focused on the supply of alcoholic beverages. The PAKKA project continues the international tradition of research on community-based prevention of alcohol-related harms. In this paper we discuss the challenges and solutions of evaluating community-based prevention projects, using the recently started 'PAKKA' (Local Alcohol Policy) project as a concrete example. The PAKKA project relies on a mixed-intervention strategy attempting to change the local social, economic and physical environment related to risky and under-age drinking. In measuring the project's effectiveness a quasi-experimental research design is used. In our research design we have had to tackle three interconnected problems: the problems of causality in a multi-component population level study, the problem of generalizability and the complex role of the researcher.

Horn K; McCracken L; Dino G; Brayboy M. Applying community-based participatory research principles to the development of a smoking-cessation program for American Indian teens: "Telling our story". Health Education & Behavior 35(1): 44-69, 2008. (50 refs.)

Community-based participatory research provides communities and researchers with opportunities to develop interventions that are effective as well as acceptable and culturally competent. The present project responds to the voices of the North Carolina American Indian (AI) community and the desire for their youth to recognize tobacco addiction and commercial cigarette smoking as debilitating to their health and future. Seven community-based participatory principles led to the AI adaptation of the Not On Tobacco teen-smoking-cessation program and fostered sound research and meaningful result s among an historically exploited population. Success was attributed to values-driven, community-based principles that (a) assured recognition of a community-driven need, (b) built on strengths of the tribes, (c) nurtured partnerships in all project phases, (d) integrated the community's cultural knowledge, (e) produced mutually beneficial tools/products, (f) built capacity through co-learning and empowerment, (g) used an iterative process of development, and (h) shared findings /knowledge with all partners.

Huckle T; Greenaway S; Broughton D; Conway K. The use of an evidence-based community action intervention to improve age verification practices for alcohol purchase. Substance Use & Misuse 42(12-13): 1899-1914, 2007. (15 refs.)

Alcohol purchase surveys were undertaken as part of two New Zealand community action projects (one in a large metropolitan area and one in a small town) that aimed at reducing alcohol consumption-related harm for young people. Baseline surveys in both places indicated poor age verification practices. The two follow-up surveys in the metropolitan area showed a decrease in sales made without age identification between 2002 (60%) and 2003 (46%). However, an increase between 2003 (46%) and 2004 (55%) occurred. In the metropolitan area, regulatory staff in three out of seven jurisdictions increased enforcement due to the 2002 survey and follow-up work; this did not happen following the 2003 survey. In the small town, results indicated positive changes in verification practices over time. In addition, licensee meetings, host responsibility training, and a regional project all occurred following the surveys. The surveys have also had important indirect effects. Closer monitoring and enforcement activity due to the surveys has contributed to the amendment of alcohol legislation in New Zealand.

Ivers RG; Castro A; Parfitt D; Ballie RS; D'Abbs PH; Richmond RL. Evaluation of a multi-component community tobacco intervention in three remote Australian Aboriginal communities. Australian and New Zealand Journal of Public Health 30(2): 132-136, 2006. (12 refs.)

Objectives: To assess the effect of community tobacco interventions in Aboriginal communities. Methods: The study consisted of a pre- and post-study of the effect of a multicomponent tobacco intervention conducted in six Aboriginal communities in the Northern Territory (NT). The intervention included sports sponsorship, health promotion campaigns, training health professionals in the delivery of smoking cessation advice, school education about tobacco, and policy on smoke-free public places. The study was conducted in three intervention communities and three matched control communities. Surveys were used to measure changes in prevalence of tobacco use, changes in knowledge, and attitudes to cessation in intervention communities. Results: Tobacco consumption decreased in one intervention community compared with the matched control community; the trends of consumption (as measured by tobacco ordered through points of sale) in these communities were significantly different (t=-4.5, 95% CI -33.6 - -12.5, p <= 0.01). Community samples in intervention communities included 920 participants. There was no significant change in the prevalence of tobacco use, although knowledge of the health effects of tobacco and readiness to quit increased. Conclusions: Although it is difficult to demonstrate a reduction in tobacco consumption or in the prevalence of tobacco use as a result of multi-component community tobacco interventions delivered in Aboriginal communities, such interventions can increase awareness of the health effects of tobacco and increase reported readiness to cease tobacco use.

Jason LA; Pokorny SB; Adams ML; Topliff A; Harris CC; Hunt Y. Effects of youth tobacco access and possession policy interventions on heavy adolescent smokers. International Journal of Environmental Research and Public Health 6(1): 1-9, 2009. (23 refs.)

This study evaluated the effects of tobacco PUP (purchase, use and possession) laws on tobacco use patterns among students in twenty-four towns, which were randomly assigned into an experimental and a control group. The experimental group involved both PUP law enforcement and reducing minors' access to commercial sources of tobacco, and the condition for the control group involved only efforts to reduce minors' access to commercial sources of tobacco. The present study found that adolescents in the control group had a significantly greater increase in the percentage of youth who smoked 20 or more cigarettes per day when compared to the experimental group.

Jiwa A; Kelly L; St Pierre-Hansen N. Healing the community to heal the individual - Literature review of aboriginal community-based alcohol and substance abuse programs. (review). Canadian Family Physician 54(7): 1000-U22, 2008. (40 refs.)

OBJECTIVE: To understand the development of culturally based and community-based alcohol and substance abuse treatment programs for aboriginal patients in an international context. SOURCES OF INFORMATION MEDLINE: HealthSTAR, and PsycINFO databases and government documents were searched from 1975 to 2007. MeSH headings included the following: Indians, North American, Pacific ancestry group, aboriginal, substance-related disorders, alcoholism, addictive behaviour, community health service, and indigenous health. The search produced 150 articles, 34 of which were relevant; most of the literature comprised opinion pieces and program descriptions (level III evidence). MAIN MESSAGE: Substance abuse in some aboriginal communities is a complex problem requiring culturally appropriate, multidimensional approaches. One promising perspective supports community-based programs or community mobile treatment. These programs ideally cover prevention, harm reduction, treatment, and aftercare. They often eliminate the need for people to leave their remote communities. They become focuses of community development, as the communities become the treatment facilities. Success requires solutions developed within communities, strong community interest and engagement, leadership, and sustainable funding. CONCLUSION: Community-based addictions programs are appropriate alternatives to treatment at distant residential addictions facilities. The key components of success appear to be strong leadership in this area; strong community-member engagement; funding for programming and organizing; and the ability to develop infrastructure for long-term program sustainability. Programs require increased documentation of their inroads in this developing field.

Johnson B. The development of user influence on Swedish drug policy, 1965-2004. IN: Anker J; Asmussen V; Kouvonen P; Tops D, eds. Drug Users and Spaces for Legitimate Action. NAD Monograph no. 49. Helsinki, Finland: Nordic Alcohol and Drug Council, 2006. pp. 131-151. (47 refs.)

The aim of this article is to investigate the degree to which Swedish drug users have been able to influence Swedish drug policy from the mid 1960s onwards, the time during which drug abuse was established as a social problem. I will also try to determine in which areas their influence manifests itself. Influence is meant in a political sense and the article does not shed any light on whether individual users have managed to exert an influence over their own situation. The focus is rather on the relationship between public drug policy and the opportunities of the users to carry clout as a collective. In the last decade, Scandinavia has experienced a mobilization of drug users. This mobilization was initiated in Denmark where the first Scandinavian association of drug users was founded in 1993. Since then user associations have sprung up also in Norway (1996) and Sweden (2002). It may perhaps seem natural to interpret this development in light of the increased interest in user influence and other forms of civic participation that followed on from the discussions about participatory democracy during the 1990s. However, in this study I show that such an interpretation would be insufficiently rigorous. Ever since the early 1980s, Swedish users have had little say when it comes to drug policy, and in later year this influence has diminished rather than increased.

Kerr T; Small W; Peeace W; Douglas D; Pierre A; Wood E. Harm reduction by a "user-run" organization: A case study of the Vancouver Area Network of Drug Users (VANDU). International Journal of Drug Policy 17(2): 61-69, 2006. (30 refs.)

The Downtown Eastside of Vancouver has experienced ongoing epidemics of HIV infection and illicit drug overdoses since the mid 1990s. In 1997, in response to the emerging health crisis among injection drug users (IDU) and government inaction, individuals gathered in Vancouver to Form a drug user-run organization. This group eventually became known as the Vancouver Area Network of Drug Users (VANDU). Because of the growing interest in drug user organizations, this case study was conducted to document the genesis, structure, and activities of VANDU. In accordance with VANDU's philosophy of "user involvement and empowerment," we employed a community-based case study methodology to achieve these aims. The findings demonstrate that through years of activism, advocacy, and public education, VANDU has repeatedly voiced the concerns of drugs users in public and political arenas. VANDU has also performed a critical public health function by providing care and support programmes that are responsive to immediate needs of their peers. This study indicates that greater efforts should be made to promote the formation of drug user organizations, and that health authorities and policy makers should explore novel methods for incorporating the activities of drug user organizations within existing public health, education, and policy making frameworks.

Knickman JR. "Fighting back": A funder's perspective. Journal of Drug Issues 36(2): 469-484, 2006. (20 refs.)

This article is authored by a member of the Robert Wood Johnson Foundation that funded the Fighting Back initiative, an effort to address neighbor substance use problems through the activities of a community coalition. The evaluation of this initiative is the theme of this issue. Overall the results indicate the initiative was not effective. The author describes the origins of the initiative, its key elements, as well as the governmental policies that were then being followed. Different topics addressed are the Foundation's management of what was a very large-scale multi-site program, including the creation and role of a national program office, and the roles of a national advisory council and foundation staff. Also addressed are the impacts of environmental changes, changes within the Foundation staffing, the emergence of differing expectations across the life of the initiative, and the challenges that confronted the evaluation efforts. Some of the factors that may have contributed to the lack of positive findings are noted, including from the possibly too narrow focus of the evaluation design.

Kouvonen P; Skretting A; Rosenqvist P. Overview of main findings. IN: Kouvonen P; Skretting A; Rosenqvist P, eds. Drug Users and Spaces for Legitimate Action. NAD Monograph no. 49. Helsinki, Finland: Nordic Alcohol and Drug Council, 2006. pp. 7-10. (1 refs.)

The countries described in this report share the same geographical position in the sense that they all lie in Northern Europe. Apart from the geographical similarities, there are also historical and cultural similarities. For example, the Baltic countries and the St. Petersburg region share a common modern history under Soviet rule until the fall of the Iron Curtain in 1989, while the Nordic societies share a common set of values that underlies their political systems. However in terms of current patterns of drug use, perceptions of drugs and their correlations with people's health and well-being, this is a decidedly heterogenous group. The following provides a brief outline of the main themes covered in this report, starting with the trends in the demand and supply of drugs; proceeding to the consequences of drug use; and finally moving on to the responses to drug use.

Laanemets L. Organisation among drug users in Sweden. IN: Anker J; Asmussen V; Kouvonen P; Tops D, eds. Drug Users and Spaces for Legitimate Action. NAD Monograph no. 49. Helsinki, Finland: Nordic Alcohol and Drug Council, 2006. pp. 105-130. (33 refs.)

The purpose of this article is to describe and discuss drug user organisation in Sweden, a country that enforces a highly restrictive drug policy. The first wave of client movements in Sweden began to rise in the latter half of the 1960s. Among the earliest was the National Association for Aid to People Addictive to Drugs and Pharmaceuticals (RFHL), which also involved people who had no personal experience of drug use. Self-help movements began to expand and gain increasing influence in the field a couple of decades later. However, it was not until the concept of "welfare service users" emerged on the (social) policy agenda that the views and opinions of drug users, in their capacity as care and service users, began to receive more serious attention in the political and public realm.1 Service users have been officially consulted by the Swedish Minister of Public Health and Social Services, for example, and social projects have been set up around the country to support and promote the empowerment and influence of drug users. In this sense the political environment for organisation is favourable indeed. On the other hand for drug users the heavy emphasis on the drug-free concept means that opportunities for organisation are quite restricted, at least if the aim is to gain official legitimacy. In principle, organisation among drug users is only possible insofar as they are former drug users, or at the very least are committed to quitting drugs. This means that most organisations in which users are actively involved consist of former users. As well as working to persuade public and political opinion, many of them serve as complements and extensions to the official system of professional care for drug abusers. The focus of the discussion here is on the extent that opportunities exist for organisation among drug users in Sweden. Is this a new phenomenon? What kinds of organisations are there ? The question of how far the demand for participation has translated into a real influence, is touched upon? What forms do these organisations take and how do they relate to state power?

Lee KSK; Conigrave KM; Clough AR; Wallace C; Silins E; Rawles J. Evaluation of a community-driven preventive youth initiative in Arnhem Land, Northern Territory, Australia. Drug and Alcohol Review 27(1): 75-82, 2008. (27 refs.)

Introduction and Aims. We evaluated a community-driven initiative established to prevent substance misuse and increase respect for culture and their elders among young people in a group of remote Aboriginal communities in Arnhem Land, Northern Territory (NT), Australia. The Youth Development Unit provided a range of training, recreational and cultural activities within a community development framework to all young people in the community. Design and Methods. Methods of operation, community acceptability, perceived impact and likely ability to meet goals were assessed. Data included community, staff and stakeholder interviews and observation. School attendance, youth apprehension rates and information on levels of substance use were compared 2 years before and after the initiative was implemented. Results. Interviewees reported increased youth training and recreational opportunities, increased communication between local agencies, overall satisfaction with programme delivery and optimism that it could achieve its goals. Suggested improvements included even more training, cultural programmes and other activities and employment of more community-based Indigenous staff. The importance of key staff, involvement of a respected Indigenous staff member and community engagement were noted as probable contributors to its success. Discussion and Conclusions. Indigenous young people in Australia remain one of the most disadvantaged and vulnerable groups. Community-driven preventive initiatives offer enhanced youth resilience and connectedness in remote Aboriginal communities and alternatives to substance use.

Lindholm ML. Establishing program legitimacy in multiethnic settings: The Robert Wood Johnson Foundation's "Fighting Back" program. Journal of Drug Issues 36(2): 351-375, 2006. (27 refs.)

While there is a plethora of literature on program models, evaluation strategies, evaluation outcomes, and lessons learned regarding anti-alcohol and drug community coalitions, case studies of implementation are rare. This paper analyzes multiple case histories of implementation of the Robert Wood Johnson Foundation's (RWJF) "Fighting Back" (FB) program with particular attention to issues in multiethnic sites. A common theme in the case histories was minority challenge to the legitimacy of local grantees' (lead agency) leadership in addressing local alcohol and other drug (AOD) problems facing minorities. The local projects adopted a range of strategies to increase their legitimacy with minorities: sharing policy making with or turning it over to minority leadership, recruiting minorities for positions on staff and committees, and subcontracting or making grants to minority-run organizations to implement project activities. These responses reduced challenges to the local projects' legitimacy but also produced unanticipated consequences; most significantly, the nature of project activity expanded well beyond the original scope of FBs mission to reduce demand for AOD. The discussion addresses the implications of legitimacy issues related to political control of FB, allocation of the grant's resources, and how AOD problems and solutions were framed in the context of urban multiethnic U.S. settings.

Livert D; Winick C. Changes in the number of methadone maintenance slots as measures of "Fighting Back" program effectiveness. Journal of Drug Issues 36(2): 313-330, 2006. (32 refs.)

This study examined trends in the number of available methadone maintenance treatment (MMT) slots to evaluate a community-based drug prevention program. In the 1990s, the "Fighting Back" (FB) initiative sought to reduce substance use and harm through community-based coalitions in 14 sites across the U.S. Nine state agencies provided MMT data for 28 FB and control communities for a 10-year period prior to and -during the program. Opioid use data from a general population survey conducted in the same communities by the national evaluation team were also examined. Counter to expectation, implementation of the FB program was associated with significantly less expansion of MMTslots when compared to control communities. This trend was not attributable to opioid use in those communities, which did not change during the same period. The implication of the findings as well as the historical context of methadone maintenance treatment since the 1990s is also discussed.

Midford R; Midford S; Farringdon F. School leaver (Graduate) celebrations in Margaret River, Western Australia: A community approach to management. Substance Use & Misuse 42(12-13): 1915-1932, 2007. (10 refs.)

In recent years, an increasing number of young Western Australians have chosen the tourist town of Margaret River, about 300 kilometers south of the Perth, as the place to celebrate completing school. Typically, the celebrations involve intense socializing and considerable binge drinking. In 2001, the community developed a comprehensive management strategy to minimize the impact of the celebrations, while still facilitating an enjoyable experience for the leavers (recent graduates). This incorporated community members providing supervised activities for the leavers. Evaluation of the intervention employed a mixed methodology, comprising surveys of school leavers, interviews with community stakeholders, and participant observation. The findings indicated that the leavers generally got what they wanted from the experience and the community felt it had maintained control. Providing activities built a relationship between the leavers and the community and seemed important in minimizing problems for both groups. An added bonus was the community developed greater confidence and capacity.

Milne S; Greenaway S; Conway K; Henwood W. What next? Sustaining a successful small-scale alcohol consumption harm minimization project. Substance Use & Misuse 42(12-13): 1933-1944, 2007. (24 refs.)

Engaging communities in alcohol consumption-related action projects requires the application of a range of flexible and responsive evidence-based methods. These include: establishing collaborative relationships, implementing strategies to improve age verification practices, encouraging organizational change, and raising awareness of local alcohol issues. The focus of this article is the sustainability of (in alcohol harm minimization project for young people in Hawera (a small New Zealand town) that has produced some encouraging results. The Hawera Alcohol and Young People project began in 2000 along with external formative and impact evaluation components. This article will draw on the evaluation findings to date and the experience of community action projects in New Zealand to explore what makes a sustainable community action project and to examine the extent to which this has been achieved by the Hawera Alcohol and Young People project. The limitations of the study are noted.

Mistral W; Velleman R; Templeton L; Mastache C. Local action to prevent alcohol problems: Is the UK Community Alcohol Prevention Programme the best solution? International Journal of Drug Policy 17(4, Special Issue): 278-284, 2006. (21 refs.)

Increasing evidence indicates that the UK has a serious alcohol problem. This crosses many patterns of drinking and all ages, whereas the public debate about alcohol tends to focus almost exclusively on binge drinking and on young people's alcohol-related anti-social behaviour. This paper addresses the interventions and policy developments currently implemented in the UK to reduce alcohol-related anti-social behaviour. There are two main approaches: a national (England) change in the licensing laws; and local harm reduction projects seeking to effect change independently of central Government initiatives. This paper describes the critique currently mounted against the expected efficacy of new licensing laws and describes the theoretical and practical developments of some local prevention initiatives that are part of the United Kingdom Alcohol Prevention Programme (UKCAPP), funded by the Alcohol Education and Research Council (AERC). Although it is too early to draw conclusions as to the effects of either of these developments, initial reports suggest that changes in the licensing regime have not yet created the increase in alcohol-related problems some commentators have argued would occur; and the local prevention initiatives have led to the formation of extremely strong community partnerships, with a range of innovative and integrated actions to tackle alcohol-related anti-social behaviour. Fundamental criticisms of both the new licensing laws and the National Alcohol Strategy remain, however. Even if the above interventions lead to reductions in alcohol-related anti-social behaviour, it is not clear how they might deal with the rising levels of alcohol-related health harms reported within the UK. Nevertheless, the community partnership approach may be the best possibility for dealing with at least some of the alcohol-related problems caused by the rise in availability and accessibility of alcohol within the UK.

Nygaard P; Bright K; Saltz R; McGaffigan R. Archival data: Collection and use in community alcohol projects. Substance Use & Misuse 42(12-13): 1945-1953, 2007. (6 refs.)

Archival data are considered useful for identifying problem areas, assessing levels of problems, and evaluation of interventions. However, few publications describe the process of collecting them and related potential obstacles. For the Safer California Universities study, archival data is expected to play a major role in identifying problem settings and the extent of alcohol use-related problems on the campuses. The project has experienced a number of obstacles in collecting these data. This article discusses strategies for collecting data, obstacles related to collecting them, solutions to these obstacles, and communication with partners on the campuses. The study's limitations are noted.

Ogilvie KA; Moore RS; Ogilvie DC; Johnson KW; Collins DA; Shamblen SR. Changing community readiness to prevent the abuse of inhalants and other harmful legal products in Alaska. Journal of Community Health 33(4): 248-258, 2008. (46 refs.)

This paper presents results from an application of the Community Readiness Model (CRM) as part of a multi-stage community mobilization strategy to engage community leaders, retailers, parents, and school personnel in preventing youth use of inhalants and other harmful legal products in rural Alaska. The CRM is designed to assess readiness to address a single social problem, based on a limited set of key informant interviews. In this study, researchers conducted 32 baseline and 34 post-intervention community readiness assessment interviews in four rural Alaskan communities. These interviews with key informants from the communities were coded and analyzed using CRM methods to yield readiness scores for each community. The aggregate results were analyzed using hierarchical linear modeling (HLM), and the individual community scores were analyzed in the context of the overall study. Significant positive changes in community readiness were found across six readiness dimensions as well as for the overall readiness score. Variation in the degree of changes in readiness across the four communities is attributed to differences in the intervention's implementation. The implications of these results include the potential for CRM assessments to serve as an integral component of a community mobilization strategy and also to offer meaningful feedback to communities participating in prevention research.

Osborn B; Small W. "Speaking truth to power": The role of drug users in influencing municipal drug policy. (editorial). International Journal of Drug Policy 17(2): 70-72, 2006. (5 refs.)

Palm J. The consumer, the weak, the sick, and the innocent: Constructions of 'the user' by the Swedish Users Union. IN: Anker J; Asmussen V; Kouvonen P; Tops D, eds. Drug Users and Spaces for Legitimate Action. NAD Monograph no. 49. Helsinki, Finland: Nordic Alcohol and Drug Council, 2006. pp. 159-182. (62 refs.)

Drug users are often described as a socially marginalised group in Swedish

Plested BA; Edwards RW; Thurman PJ. Disparities in community readiness for HIV/AIDS prevention. Substance Use & Misuse 42(4): 729-739, 2007. (11 refs.)

HIV and AIDS as a community(1) issue have not been dealt with extensively in the literature. One model that offers promise for development of effective prevention and intervention efforts is the Community Readiness Model, a nine-stage model that assesses the level of readiness of a community to develop and implement prevention programming. Data are presented from a Community Readiness assessment of 30 rural U.S. communities: 10 African American, 10 Mexican American, and 10 White non-Mexican American. Four to five key respondent interviews were conducted via telephone in each community using the Community Readiness Assessment protocol during 1999-2000. Limitations of the study and implications for prevention are discussed. This study was funded by the National Institute on Drug Abuse.

Quinby RK; Hanson K; Brooke-Weiss B; Arthur MW; Hawkins JD et al. Installing the Communities that Care prevention system: Implementation progress and fidelity in a randomized controlled trial. Journal of Community Psychology 36(3): 313-332, 2008. (32 refs.)

This article describes the degree to which high fidelity implementation Of the Communities That Care (CTC) prevention operating system was reached during the first 18 months of intervention in 12 communities in the Community Youth Development Study, a 5-year group randomized controlled trial designed to test the efficacy of the CTC system. CTC installation in these communities included the delivery of six CTC trainings from certified CTC trainers at each site, the active involvement of locally selected and community-based CTC community coordinators, ongoing monitoring of progress using the CTC milestones and benchmarks, and proactive technical assistance and coaching. CTC implementation fidelity ratings averaged across three groups of raters show that between 89% and 100% of the CTC milestones in the first four phases of CTC implementation were "completely met" or "majority met" in the 12 intervention communities, indicating that the first four phases of the CTC system have been well implemented in the communities in this trial.

Rindskopf D. Heavy alcohol use in the "Fighting back" survey sample: Separating individual and community level influences using multilevel latent class analysis. Journal of Drug Issues 36(2): 441-462, 2006. (6 refs.)

In this article, multilevel latent class analysis is used to examine the structure of heavy alcohol use. A model with three latent classes (types) of people fits the data well: those who seldom suffer major consequences from heavy drinking, those who typically suffer only a small number of major consequences, and those who suffer serious consequences in a large number of areas of their lives. Individuals in the first class tend to be older, female, with domestic partners, more highly educated, employed, and either Catholic, Muslim, or Baptist.

Roffo AH. The carcinogenic effects of tobacco. (reprint). Bulletin of the World Health Organization 84(6): 500-502, 2006. (5 refs.)

This is a reprint of an article published in 1940 speaking to the relationship of smoking to lung cancer, published in Monatisschrift fur Krebsbekampfung, Vol 8, Issue 5, 1940. It summarizes numberous experiments carried out at the Cancer Institgd public aenos Aitions to reduce alcohol related harm, bred. The experimental work using fractiased on societal consensus. Background: Alcohol abuse is an avoidable behaviour that can threaten health. In Slovenia, only a few public campaigns against drinking alcohol are under way. It is important to establish which community measures are acceptable to society in Slovenia in order to reduce alcohol-related risks. Methods: A Delphi study with 45 professionals from different disciplines was conducted. Participants offered many suggestions to improve the current situation. After three rounds of questionnaires, 86 participant statements were accepted as a consensus. Results: Actions such as: state monopolies, alcohol taxation, legislative restrictions on availability and purchase of alcohol, age-related restriction on sales, drink-driving laws, school-based alcohol education and media information campaigns are most likely to be achieved by consensus. The main target populations for implementation of alcohol-related educational programs are children, young people and employees. Conclusions: As a result of the study, a number of community actions against drinking alcohol that could be acceptable for society can now be suggested. They vary across different target populations, change agents (individuals, organizations and institutions) and methods of implementation.

Public Domain

Ryan D. "Everything here is so political...." Separating the organizationally normal from the political in communities of organizations. Journal of Drug Issues 36(2): 331-349, 2006. (33 refs.)

The rhetoric of "community" is common in talk of social programs. With it comes imagery of common interests, overcoming turf battles, working together, and getting along. When programs fail to achieve goals or turn into outright flascos, personal, organizational, and community pathology, or simply "politics" are common explanations. Problems are assumed to be endemic and intractable or remediable only by gifted leadership or transcendence of business as usual. This article argues that such thinking is rooted in a false assumption. "Community" needs to be reconceptualized as a community of organizations, not people, and organizations as constrained actors not analogous to individuals. Organizations interact in peculiar, but analyzable ways, giving rise to unanticipated outcomes that could be labeled pathology or mere politics. Community alcohol and other drug AOD programs might be more successful if their logic models were based on realistic concepts of community that can distinguish the actually political from the organizationally normal.

Sharma A; Botzet AM; Sechrist RAJ; Arthur N; Winters KC. Community readiness survey: Norm development using a Q-sort process. Journal of Child & Adolescent Substance Abuse 16(1): 25-38, 2006. (22 refs.)

This study reports on norms developed for the Minnesota Institute of Public Health's (1999) Community Readiness Survey. Prevention experts from ten states and the Red Lake Nation sorted data from 50 communities into high and low readiness groups using a Q-sort process. High inter-rater agreement was achieved on communities sorted. Tests of significance between the high and low readiness groups resulted in significant differences on the five scales of readiness: community members' perception of an alcohol, tobacco, and other drug problem; permissiveness of attitudes toward substance use; support for prevention; perceived access of alcohol and tobacco products for adolescents; and overall community commitment. Communities that implement a readiness assessment can use these results to target resources to areas in which high readiness is indicated and seek to increase readiness in areas in which lower scale scores are evidenced.

Small D; Palepu A; Tyndall MW. The establishment of North America's first state sanctioned supervised injection facility: A case study in culture change. International Journal of Drug Policy 17(2): 73-82, 2006. (33 refs.)

The serious adverse health consequences associated with illicit drug use in Vancouver has brought international attention to the city. It is now widely recognized that innovative and bold strategies are required to confront epidemics of drug overdose, HIV and Hepatitis C infections, and injection-related bacterial infections. The establishment of North America's first supervised injection facility (SIF) required a major cultural shift in the way drug addiction is viewed. The story behind the SIF in Vancouver is a complex and interconnected series of events brought about by the activities of advocates, peers, community agencies, politicians, journalists, academics and other key players to bring about social change. The aim of this narrative is to highlight the ideas, processes and historical events that contributed to a cultural transformation that was critical to opening the SIF in Vancouver. By doing this, we hope to encourage other communities to take the bold steps necessary to reduce the devastating health and social consequences of injection drug Use.

Smith KC; Wakefield M. Newspaper coverage of youth and tobacco: Implications for public health. Health Communication 19(1): 19-28, 2006. (29 refs.)

The presentation of smoking as a "youth" issue is a powerful component of current tobacco-control efforts. Agenda setting theory demonstrates that the media serve as a potent forum in which the consideration and presentation of perspectives of social problems take place. This analysis of 643 U.S. youth-focused newspaper articles examines the messages being conveyed to the public and policymakers through coverage of tobacco issues focused on youth. Data illustrate that the issue of youth tobacco use is newsworthy but also suggest that youth-focused issues garner little commentary coverage. Rather, straightforward reports of "feel good" stories dominate the coverage, and youth-focused articles tend to conceptualize the problem of tobacco as being one of a need for greater individual-level education rather than structural or policy changes.

Spak F; Blanck P. Implementing a national alcohol consumption prevention program at the local level: What does early evaluation tell us? Substance Use & Misuse 42(12/13): 2063-2072, 2007. (13 refs.)

The current Swedish national plan for preventing alcohol consumption-related problems puts greater emphasis on community-level prevention measures. This report describes early results from the implementation of this plan in the county of 11 Vastra Gotaland, in southwestern Sweden. During 2002-2004 interviews were conducted with the main project representative in each of the county's 49 municipalities. In addition, more extensive data gathering, involving interviews with a broad range of stakeholders and systematic examination of project-related documentation, was undertaken in four representative municipalities. Findings indicated that community alcohol consumption prevention has been strengthened and that the activity level is high in all municipalities, especially in relation to Youth. However, problematic alcoholic beverage consumption by adults was rarely targeted; the limited resources were dispersed over too many projects; there was too little collaboration between stakeholding authorities and adherence to evidence-based practice still is lacking.

Stafstrom M; Ostergren PO; Larsson S; Lindgren B; Lundborg P. A community action programme for reducing harmful drinking behaviour among adolescents: the Trelleborg Project. Addiction 101(6): 813-823, 2006. (34 refs.)

Aims" To evaluate a 3-year community intervention programme by measuring changes in drinking patterns in a 15-16-year-old population. Design, setting, participants and measurement: The action programme included five demand-reducing and one supply-reducing interventions. Cross-sectional, non-repeated data were collected from a questionnaire distributed in classrooms from 1999 to 2001 and 2003 (n = 1376, 724 boys and 652 girls; response rate = 92.3%). Stepwise logistic regression analyses were used to determine the relationship between different risk factors and excessive drinking, heavy episodic drinking, purchaser of alcohol and alcohol provided by parents. The results from the intervention community were also compared with similar Swedish cross-sectional data sets. Findings The results of our analyses indicated a decrease in harmful drinking behaviour in Trelleborg when comparing baseline with postintervention measurements. The comparison with other studies showed that the changes in these indicators were more rapid and consistent in Trelleborg. Finally, the multivariable logistic regression analyses showed that the outcomes were not likely to be attributed to changes in environmental factors. Conclusions: We concluded that a community action programme based on the systems approach reduced hazardous alcohol consumption effectively among adolescents in Trelleborg.

Sterling KL; Curry SJ; Emery S; Sporer AK; Mermelstein RJ; Berbaum M et al. Internally-developed teen smoking cessation programs: Characterizing the unique features of programs developed by community-based organizations. International Journal of Environmental Research and Public Health 6(3): 1026-1040, 2009. (18 refs.)

We have compared the unique features of teen tobacco cessation programs developed internally by community-based organizations (N=75) to prepackaged programs disseminated nationally (N=234) to expand our knowledge of treatment options for teen smokers. Internally-developed programs were more likely offered in response to the sponsoring organization's initiative (OR=2.16, p<0.05); had fewer trained cessation counselors (OR=0.31, p<0.01); and were more likely found in urban areas (OR=2.89, p=0.01). Internally-developed programs more often provided other substance-abuse treatment services than prepackaged programs and addressed other youth-specific problem behaviors (p <= 0.05). Studies that examine the effectiveness of internally-developed programs in reducing smoking and maintaining cessation for teen smokers are warranted.

Stigler MH; Perry CL; Komro KA; Cudeck R; Williams CL. Teasing apart a multiple component approach to adolescent alcohol prevention: What worked in Project Northland? Prevention Science 7(3): 269-280, 2006. (44 refs.)

This paper presents the results of a post hoc component analysis designed to tease apart the effects of different intervention strategies used in Project Northland, a group-randomized, community-wide, multi-level intervention trial originally conducted in the 1990's to prevent and reduce alcohol use among a cohort of mainly White students in rural Minnesota. This study focuses on Phase I, when students were in 6th-8th grade. The intervention during this phase included five components: classroom curricula, peer leadership, youth-driven/led extra-curricular activities, parent involvement programs, and community activism. Student exposure to/participation in these components was followed over time using reliable process measures. These measures were used as time-varying covariates in growth curve analyses to estimate the effects of the intervention components over time. Multi-item scales from annually-administered student surveys were used to measure relevant outcome variables, like alcohol use. The impact of the components appears to have been differential. The strongest effects were documented for the planners of extra-curricular activities and parent program components. The classroom curricula proved moderately effective, but no effects were associated with differential levels of community activism. The interactions tested here did not provide support for synergistic effects between selected intervention components. Care must be taken when selecting and combining intervention strategies meant to reduce adolescent alcohol use.

Sullivan LE; Bruce RD; Haltiwanger D; Lucas GM; Eldred L; Finkelstein R; . Initial strategies for integrating buprenorphine into HIV care settings in the United States. Clinical Infectious Diseases 43(Supplement 4): s191-s196, 2006. (30 refs.)

The Centers for Disease Control and Prevention's HIV Prevention Strategic Plan Through 2005 advocated for increasing the proportion of persons with human immunodeficiency virus (HIV) infection and in need of substance abuse treatment who are successfully linked to services for these 2 conditions. There is evidence that integrating care for HIV infection and substance abuse optimizes outcomes for patients with both disorders. Buprenorphine, a recently approved medication for the treatment of opioid dependence in physicians' offices, provides the opportunity to integrate the treatment of HIV infection and substance abuse in one clinical setting, yet little information exists on the models of care that will most successfully facilitate this integration. To promote the uptake of this type of integrated care, the current review provides a description of 4 recently implemented models for combining buprenorphine treatment with HIV primary care: (1) an on-site addiction/HIV specialist treatment model; (2) a HIV primary care physician model; (3) a nonphysician health professional model; and (4) a community outreach model.

Susic TP; Svab I; Kolsek M. Community actions against alcohol drinking in Slovenia - a Delphi study. Drug and Alcohol Dependence 83(3): 255-261, 2006. (45 refs.)

Aim: To define the national stratey ancute in Buenos Aitions to reduce alcohol related harm, bred. The experimental work using fractiased on societal consensus. Background: Alcohol abuse is an avoidable behaviour that can threaten health. In Slovenia, only a few public campaigns against drinking alcohol are under way. It is important to establish which community measures are acceptable to society in Slovenia in order to reduce alcohol-related risks. Methods: A Delphi study with 45 professionals from different disciplines was conducted. Participants offered many suggestions to improve the current situation. After three rounds of questionnaires, 86 participant statements were accepted as a consensus. Results: Actions such as: state monopolies, alcohol taxation, legislative restrictions on availability and purchase of alcohol, age-related restriction on sales, drink-driving laws, school-based alcohol education and media information campaigns are most likely to be achieved by consensus. The main target populations for implementation of alcohol-related educational programs are children, young people and employees. Conclusions: As a result of the study, a number of community actions against drinking alcohol that could be acceptable for society can now be suggested. They vary across different target populations, change agents (individuals, organizations and institutions) and methods of implementation.

Tammi T. Who is the expert? Patient groups and Finnish substitution treatment policy. IN: Anker J; Asmussen V; Kouvonen P; Tops D, eds. Drug Users and Spaces for Legitimate Action. NAD Monograph no. 49. Helsinki, Finland: Nordic Alcohol and Drug Council, 2006. pp. 23-36. (27 refs.)

A literature review in 1999 concluded that theclient's experience of drug treatment is the single most uncharted area in drug treatment research. Although substitution treatment (with methadone) is one of the most investigated treatment modalities, research on clients' perceptions and experiences is virtually non-existent: researchers have been more concerned with documenting the use and efficacy of treatment services and less concerned with the clients' perspective on the treatment they receive. However, the rare - often ethnographic - studies that have been conducted on the methadone clientele show how clients are not passive recipients, but instead active participants within the world of the clinic, and they may successfully resist the surveillance as well as the new particular identity offered to them as clients or patients. This article contributes to the limited research on client experiences of substitution treatment. It describes the claims-makings of two Finnish client organisations with regard to substitution treatment. These organisations were born out of dissatisfaction with the slow progress and poor quality of substitution treatment in Finland at the turn of the millennium: they are an association for the support of opiate addicts and an association for the support of substitution treatment. As is described below, both of these groups emerged in response to dissatisfaction with their treatment. The author gives voice to the two user groups in Finland. My data consist of documents produced by the groups, as well as of interviews, discussions and e-mail exchanges with group members. This article provides background of these groups, their formation, composition and activities, and then move to examine their claims for a role in development of drug policy. It concludes with a general discussion of drug policy and user participation in Finland.

Tighe E. "Fighting back" national evaluation bibliography: 1995 to 2006. Journal of Drug Issues 36(2): 463-467, 2006. (0 refs.)

Bibliography

Toomey TL; Fabian LA; Erickson DJ; Wagenaar AC; Fletcher L; Lenk KM. Influencing alcohol control policies and practices at community festivals. Journal of Drug Education 36(1): 15-32, 2006. (27 refs.)

The goal of this study was to assess the feasibility and effectiveness of two interventions aimed at reducing alcohol-related risks at community festivals -- a training program for festival planners and a community organizing campaign. We randomly selected four festivals for each intervention and had 24 comparison festivals. Our assessment included process evaluation to track and evaluate types of alcohol policies resulting from each of the interventions, pre and post telephone surveys of key festival planners and law enforcement agencies, and pre and post pseudo-underage and pseudo-intoxicated purchase attempts. Analyses showed that both interventions were feasible and were successful in influencing adoption of written policies and improving alcohol-related practices. However, neither intervention appeared to decrease propensity for illegal alcohol sales at these events, likely due, in part, to the short time frame of the interventions. Future research should assess effects of the interventions on alcohol-related problems and effects of enforcement interventions.

Toomey TL; Lenk KM; Wagenaar AC. Environmental policies to reduce college drinking: An update of research findings. (review). Journal of Studies on Alcohol and Drugs 68(2): 208-219, 2007. (124 refs.)

Objective: We provide an overview of environmental strategies that may reduce college drinking. The identified environmental strategies fall into three categories: (1) reducing alcohol use and related problems among underage college students, (2) reducing risky alcohol use and related problems among all college students, and (3) de-emphasizing the role of alcohol and creating positive expectations on campus. At the time of our 2002 review, few studies had assessed environmental policies and strategies in the context of college student alcohol use and related problems. The present article summarizes recent research on the effects of environmental policies and strategies affecting college students. Method: We updated our previous literature searches to identify peer-reviewed research studies evaluating the effects of environmental strategies on college and general populations. Results: We identified 110 new studies addressing environmental strategies published between 1999 and 2006. Thirty-six of these studies focused on the college population. The extant research indicates that many environmental strategies are promising for reducing alcohol-related problems among the general population. Several recent studies suggest that these strategies, particularly combined strategies, also may be effective in decreasing alcohol-related problems among college populations. Conclusions: Further research is needed to continue expanding our understanding of environmental strategies to identify the most effective individual and combined strategies.

Tops D. Stretching the limits of drug policies: An uneasy balancing act. IN: Anker J; Asmussen V; Kouvonen P; Tops D, eds. Drug Users and Spaces for Legitimate Action. NAD Monograph no. 49. Helsinki, Finland: Nordic Alcohol and Drug Council, 2006. pp. 61-84. (36 refs.)

Organisations for and by hard drug users have been a common phenomenon in the Netherlands ever since the late 1970s. The user organisation in focus in this article, the Amsterdam-based Interest Association for Drug Users or MDHG was founded almost 30 years ago. Unlike most Scandinavian user organisations, the MDHG is neither a self-help group/client organisation, nor closely related to a treatment system or treatment issue. Instead, it proclaims to represent and defend the interests and rights of drug users, and its main goal is a political one, namely the legalisation of hard drugs. This makes the MDHG a particularly interesting case from a Nordic perspective, for such an objective is taboo or would at least not be explicitly declared by user organisations in the Nordic countries. My purpose in this article is to describe how the Dutch context has made possible the emergence of a relatively autonomous group of user organisations. I will illustrate how user organisations are influenced by general drug policy and by the institutional structure of the political system. Based on the principles of harm reduction, Dutch drug policy differs quite considerably from the Swedish goals of a drug-free society and therefore provides an interesting backdrop for an analysis of how it influences the modus operandi and goals of user organisations. The harm reduction approach does not focus on illegal drug use as such, but on preventing and reducing the risks of drug use to both users themselves, the immediate environment and society. Apart from drug policy, another important aspect facilitating the emergence of user organisations is the institutional structure of the political system. In this 61 case, both the Nordic countries and the Netherlands can be characterised as cooperative states with long traditions of involving civic organisations in the policy-making process. A third relevant factor concerns the constituency of drug user organisations. Although drug use does not necessarily and automatically imply individual or social problems, the constituency of organisations for and by hard drug users usually consist of marginalised people with multiple problems, including drug use, homelessness, psychiatric disorders, etc. This presents a special challenge to these organisations in terms of encouraging users to get involved and to sustain that involvement. This article describes the ways in which the MDHG is working to stretch the limits and possibilities imposed by society by focusing on its organisational form, the issues that are raised, its action repertoire and aims in relation to the local context.

Treno AJ; Gruenewald PJ; Lee JP; Remer LG. The Sacramento Neighborhood Alcohol Prevention Project: Outcomes from a community prevention trial. Journal of Studies on Alcohol and Drugs 68(2): 197-207, 2007. (28 refs.)

Objective: This article reports the results of the Sacramento Neighborhood Alcohol Prevention Project (SNAPP). SNAPP set as its goal the reduction of alcohol access, drinking, and related problems in two low-income, predominantly ethnic minority neighborhoods, focusing on individuals between the ages 15 and 29, an age group identified with high rates of alcohol-involved problems. Method: Two neighborhoods in Sacramento were selected to be the intervention sites because they were economically and ethnically diverse and had high rates of crime and other drinking-related problems. The quasi-experimental design of the study took a "phased" approach to program implementation and statistical examination of outcome data. Outcome-related data were collected in the intervention sites as well as in the Sacramento community at large. Five project interventions included a mobilization component to support the overall project, a community awareness component, a responsible beverage-service component, an underage-access law enforcement component, and an intoxicated-patron law enforcement component. Archival data were collected to measure and evaluate study outcomes and to provide background and demographic information for the study. Results: Overall, we found significant (p < .05) reductions in assaults as reported by police, aggregate emergency medical services (EMS) outcomes, EMS assaults, and EMS motor vehicle accidents. Conclusions: Results from the Sacramento Neighborhood Alcohol Prevention Project demonstrate the effectiveness of neighborhood-based interventions in the reduction of alcohol-related problems such as assaults, motor vehicle crashes, and sale of alcohol to minors.

Valente TW; Chou CP; Pentz MA. Community coalitions as a system: Effects of network change on adoption of evidence-based substance abuse prevention. American Journal of Public Health 97(5): 880-886, 2007. (40 refs.)

Objectives. We examined the effect of community coalition network structure on the effectiveness of an intervention designed to accelerate the adoption of evidence-based substance abuse prevention programs. Methods. At baseline, 24 cities were matched and randomly assigned to 3 conditions (control, satellite TV training, and training plus technical assistance). We surveyed 415 community leaders at baseline and 406 at 18-month follow-up about their attitudes and practices toward substance abuse prevention programs. Network structure was measured by asking leaders whom in their coalition they turned to for advice about prevention programs. The outcome was a scale with 4 subscales: coalition function, planning, achievement of benchmarks, and progress in prevention activities. We used multiple linear regression and path analysis to test hypotheses. Results. Intervention had a significant effect on decreasing the density of coalition networks. The change in density subsequently increased adoption of evidence-based practices. Conclusions. Optimal community network structures for the adoption of public health programs are unknown, but it should not be assumed that increasing network density or centralization are appropriate goals. Lower-density networks may be more efficient for organizing evidence-based prevention programs in communities.

Van Vleck VNL; Brinkley GL. Alert eyes and DWIs: An indirect evaluation of a DWI witness reward program in Stockton, CA. Accident Analysis and Prevention 41(3): 581-587, 2009. (35 refs.)

We evaluate a "grassroots" anonymous reward program targeting drunken driving in Stockton, CA. The time-series cross-sectional data covers 19 years for Stockton and six other California cities. Exploiting interrupted time-series regression, Zellner's seemingly unrelated regression (SUR) framework, and boot-strapped standard errors, we test for an impact of this program on alcohol-related injury or fatality accidents, the proportion of all accidents involving alcohol, and the number of DWI arrests. In its first decade, the citizen reward program appears to have averted some 275 alcohol-related accidents for social cost savings of between $21,000 and $5.6 million. Further, possibly 4495 arrests were precluded, saving some $1-3 million in arrest-related costs. Incentivized public monitoring of driving-after-drinking may be an effective drunken driving abatement program though our exploratory findings need further confirmation.

Villadsen K. The 'human' touch: Voluntary organizations as rescuers of social policy? Public Management Review 11(2): 217-234, 2009. (49 refs.)

This article critically discusses the almost mythical conception of voluntary and 'grass-roots' organizations as problem solvers in current welfare policy-a myth, which over the last twenty years has become increasingly dominant in social policy programmes in advanced liberal welfare states. In particular, the article examines the assumption that voluntary and local organizations are permeated by a different rationality that enables human beings to act as 'real humans' rather than as professionals and clients-a rationality which is, however, permanently at risk of being contaminated by bureaucratic influence. It is demonstrated that among the conditions of possibility for this discourse are explanatory models and concepts in modern organizational theory and in voluntary sector studies. The article argues that the conceptualizations of power, rationality and social change dominant in these studies are unsatisfactory. Instead, it applies a Foucauldian approach to the domain of drug addiction treatment, analysing a social work 'regime' that transgresses the traditional boundaries between state and voluntary sector.

Wagenaar AC; Erickson DJ; Harwood EM; O'Malley PM. Effects of state coalitions to reduce underage drinking: A national evaluation. American Journal of Preventive Medicine 31(4): 307-315, 2006. (50 refs.)

Introduction: Drinking by youth remains prevalent. The Reducing Underage Drinking through coalitions (RUD) project funded ten states for 8 years to form coalitions designed to change the policy and normative environment regarding youth access to alcohol. An independent national outcome evaluation of this $21-million effort was conducted. Methods: Using a longitudinal quasi-experimental design, the ten intervention states were compared with the other 40 states, with repeated annual measures of outcomes from 1995 to 2004. Measures included print news media coverage, legislative bills enacted, youth drinking behavior, and youth alcohol-related driving behaviors and traffic crash mortality. Analyses using latent growth curve modeling methods were conducted in 2005. Results: Significant differences in slopes between treatment and comparison states were found for several outcome measures, particularly in the more-proximal outcome domains. Across all outcome domains, the pattern of effects was in the direction of positive effects of the RUD coalitions, although for most individual measures the differences were not statistically significant. The magnitude of observed differences associated with the RUD coalitions were sizable, with an estimated effect size of 1.10 on media coverage, 0.46 on state policies enacted, -0.44 on youth drinking behaviors, and -0.16 on alcohol-related driving and fatal car-crash mortality. Conclusions: The pattern of results and the magnitude of estimated effects provides evidence of effect of the RUD coalitions. The lack of statistically significant differences for most individual outcome measures indicates the difficulty of unambiguously demonstrating the full effects of an effort designed to change behaviors and health outcomes of the entire youth population of multiple states.

Wallin E. Dissemination of prevention: Community action targeting alcohol use-related problems at licensed premises. Substance Use & Misuse 42(12-13): 2085-2097, 2007. (21 refs.)

In 2003, a community action program targeting alcohol use-related problems at licensed premises was disseminated to municipalities in Stockholm County. The intervention program includes local mobilization, training in responsible beverage service, and stricter enforcement of extant alcohol laws. This research studies the dissemination process, which was based on Diffusion of Innovations Theory. The communities followed a systematic model for dissemination: engaging a local coordinator, conducting interviews with owners of licensed premises, creating an action group, presenting results from studies to the local media, and initiating training in responsible beverage service. Evaluation of uptake is based on meeting minutes from local action groups and activity reports. Preliminary results indicate that the dissemination strategy has been fairly successful. Half of the communities (7 of 14) contacted are implementing the model program. Farther research is needed to more fully explore the potential of the use of the Diffusion of Innovations Theory, taking into consideration different stages of community readiness.

White WL. The new recovery advocacy movement in America. (editorial). Addiction 102(5): 696-703, 2007. (8 refs.)

This article describes what the author describes as a "new' recovery movement in the U.S. It's origins are seen as lying in the funding of community efforts by the Center for Substance Abuse Treatment between the years 1998-2002. The goals are described as (1) portraying alcoholism and addictions as problems for which there are varied recovery solutions; (2) providing living role models that illustrate the diversity of those recovery solutions; (3) countering public attempts to dehumanize and stigmatize persons with alcohol/drug problems; (4) increasing the vailability and quality of community treatment and recovery services; and (5) removing social barriers to recovery by promoting laws and social policies that reduce alcohol problems and support recovery.

Willersrud AB; Olsen H. Democracy or closer control? Emergence of drug user participation in Norway. IN: Anker J; Asmussen V; Kouvonen P; Tops D, eds. Drug Users and Spaces for Legitimate Action. NAD Monograph no. 49. Helsinki, Finland: Nordic Alcohol and Drug Council, 2006. pp. 85-104. (48 refs.)

This paper provides an account of the current status in Norway on drug user participation in drug-related policy making and intervention design. The past ten to fifteen years have seen major developments not only in respect to public policy means and ends, but also in treatment, health and social care legislation. Alongside these developments, in the last decade user organizations and active drug users are increasingly prepared to go public in defence of their interests. Political and healthcare authorities increasingly express the view that user interests are important. The paper considers why the authorities want to bring a historically so marginalized group on board at this particular point in time. It also questions what started the ball rolling in Norway in the mid-1990s. The authors compare user organizations to be extant 1996- 2004, asking what unites them and, conversely, what divides them. Do user organizations foster a sense of empowerment among individual users? How well do they discharge their role as participants in public policy making? Is society ready to listen to what users really think, including views which even by today's liberal standards could be called politically incorrect? Or are politically "safe" organizations more likely to catch the ear of policy makers? There is a discussion of the relevance of concepts of power and social control in relation to the user perspectives.

Winick C. Overview of the evaluation of "Fighting back" and introduction to this issue. Journal of Drug Issues 36(2): 249-261, 2006. (28 refs.)

During the last few decades, community coalitions have increasingly emerged as program vehicles for coping with alcohol and other drug problems. The Robert Wood Johnson Foundation supported "Fighting Back," a community coalition program between 1992 and 2002 that was developed at each community and operated at 15 sites in 11 states. The program's goal was the reduction of alcohol abuse and illegal drug use through coalitions. An outside interdisciplinary evaluation of the Fighting Back and matched comparison sites concluded that the program had no significant effect on substance abuse. Various aspects of the evaluation are discussed. For the last 15 years, the federal government has supported hundreds of anti-substance abuse coalitions. In the articles that follow, different features of the evaluation dealing with results, treatment of substance abusers, community structure, correlative factors, research methodology, bibliography, and a funder's perspective are set forth.

Wittman FD. Community control of alcohol and drug risk environments: The California experience. Substance Use & Misuse 42(12-13): 1835-1849, 2007. (28 refs.)

This article describes California community (city, county) uses of local powers and resources to prevent alcohol and other drug (AOD) problems by managing AOD risk environments in retail, public, and social domains. The article presents a promising framework used in several counties dedicated to community environment approaches to prevention. A case example of its application is provided. The framework has developed locally since the mid 1980s through AOD prevention demonstration grant research, policy advocacy, and state support for local initiatives. Data for this article come from the author's experience observing and consulting with California cities and counties over 25 Years.

Zakocs RC; Guckenburg S. What coalition factors foster community capacity? Lessons learned from the Fighting Back Initiative. Health Education & Behavior 34(2): 354-375, 2007. (32 refs.)

Coalitions build community capacity by encouraging local organizations to expand services, programs, or policies (i.e., organizational capacity). The aim of the study was to identify coalition factors-resources, lead agency, governance, and leadership-that foster organizational capacity. Thirteen coalitions funded by Robert Wood Johnson Foundation's Fighting Back (FB) Initiative were examined in a multiple-site case study where coalition served as the unit of analysis. Organizational capacity was measured by creating a scale for each community based on changes in programs, services, or policies among eight types of organizations. Both qualitative and quantitative analyses were conducted to identify relationships among organizational capacity and coalition factors. FB sites with greater organizational capacity shared seven characteristics: received more funds for coalition building; delayed establishing new lead agencies; were housed in agencies supportive of FB; maintained stable, participatory decision-making bodies; cultivated active involvement of local government; practiced collaborative leadership; and had effective, long-serving project directors.

society. This condition is sometimes blamed on the country's restrictive drug policy. Although there are large number of associations and nongovernmental organisations in Sweden, only very few organisations have been primarily aimed at drug users (see the article by Laanemets in this publication). There are, however, several associations for former drug users and parents of drug users, many of which have been influential in the drug policy debate and some of which claim to advocate the interests of drug users. The focus of this paper is on a relatively new association, i.e. the Swedish Users Union (Svenska Brukarf_reningen - SBF). The SBF was founded in 2002 in Stockholm as an interest organisation for opiate users with or without substitution treatment (methadone or buprenorphine, which in Sweden is called Subutex2). It is the first and only association in Sweden whose board consists of active users of opiates (including methadone and Subutex). Before the SBF, drug users in Sweden had lacked a public voice. The SBF is committed to defending the interests of drug users among others in relation to the caregivers in charge of substitution treatment. According to Berne St�lenkrantz3, head of the union since it was founded, the main background and motivation for the establishment of the SBF came from the difficulties in obtaining methadone and the problems in the Stockholm methadone programme: its high levels of control, strict demands on users, and punitive actions. Furthermore, no one was available to advocate the patients' interests.