# Presentation: 493903

## 14 BARRIERSAnd Some Suggested Strategies/Facts

***for***
**Environmental Programs on ATOD**
***by***
***James F. Mosher, David H. Jernigan and Robert W. Dennison***

## Barriers Defined

**Obstacles, dilemmas, questions, problems...**
**Something that hinders...*****not fence or wall***
**The hurdles that communities anticipate or are likely to face as they develop and implement specific environmental strategies**

## Environmental Strategies Defined

**It is best defined using the public health model...*****Host-Agent- Environment***

## Host

**The individual suffering from a health problem**
***(drug user or person harmed by user)***

## Agent

**That which is necessary or sufficient to cause harm to the *****host***
***(alcohol, tobacco, illegal drugs)***

## Environment

**Consists of social, economic, physical, political, and cultural settings in which the *****host***** and *****agent *****interact**

## Environmental Strategies continued

**Seek to change the context in which the agent and host operate so there is either no interaction or the interaction does not cause harm**
**In environmental strategies, alcohol, tobacco and illegal drugs are viewed as community issues...reflections of the community’s norms and practices**

## Examples (past 10 years)

***National minimum purchase age for alcohol***
***State and local restrictions on alcohol availability***
***Law enforcement against sales of tobacco to minors***
***State and Federal excise taxes on alcohol***
***Campaigns to remove ATOD billboards***

## Some Background

***There’s a solid research foundation now which establishes the effectiveness of various environmental strategies for ATOD***
***There is, however, little experience in applying these strategies...............why?***

## Barrier 1. Confusing terminology

**“****Environment” suggests protecting green spaces and parklands**
**Associated with ecological concerns**
**What does ATOD policy have to do with environmentalists?**

## Suggested Strategies

**Provide new audiences with the necessary background to minimize the confusion**
**Define “environment” clearly using the public health model**
**Combine or substitute other terms such as “community”, “public health”, or “systems” approach to prevention**

**Notes:**
		Provide new audiences with the necessary background to minimize the confusion. When introducing “environmental prevention,” first present the public health model, so that the term “environment” is clearly defined.
	 Combine or substitute other terms such as “community,” “public health,” or “systems” approach to prevention. Prevention theory has actually progressed well beyond the public health triad, which suggests a static relationship among host, agent, and environment. Wallack and Holder (1987) and Holder (1998) favored the term “systems approach” and Mosher (1996) and Mosher and Yanagisako (1991) used the term “public health approach” to describe the complex interactions that underlie alcohol and illegal drug problems. These problems result from a dynamic interaction within numerous interdependent subsystems operating at various levels of society: the individual, family, neighborhood, community, State, region, and nation. Within a community, for example, various institutions (e.g., schools, workplaces, courts, voluntary associations) establish policies and norms for alcohol and illegal drug use and behavior. A concrete example of the public health concept of environment describes the dynamic subsystems that make up a community. The terminology “systems,” “public health,” or “community” model of prevention can then be used in place of the term “environmental prevention.” For further discussion, see Holder (1998), Mosher (1996), Wallack and Holder (1987).

	Examples
        The Marin Institute has designed a resource for making slide presentations that includes a graphic illustrating the levels of the environment and the “community,” “public health,” and “systems” concepts (Mosher, 1997).

Pacific Institute for Research and Evaluation (PIRE) is developing computer simulation models of health and social problems connected to alcohol and tobacco. As an adjunct to this effort, PIRE has developed a video presenting a community systems perspective on alcohol-related problems (PIRE, 1990).

## Barrier 2. Too abstract

**They address social forces outside the individual**
**They often do not put human face on the problem**
**No one person can testify that the new streetlights saved his/her life**

**Notes:**
Background
A common criticism of environmental approaches is that they are too abstract. Traditional prevention programs target individuals at risk or in trouble. When they work, such programs bring visible change to the lives of people with problems and enormous satisfaction to those who have helped them make those changes. Environmental prevention, on the other hand, focuses on community norms, physical features (such as crack houses or an excess of alcohol outlets), and the like. When an environmental strategy is successfully implemented (for example, passage of a law mandating better street lighting to discourage open-air drug markets), proponents cannot point to specific individuals who have benefited or been saved. There is no young person who can testify, “That street light saved my life.” 

Yet environments are only abstract as long as they go unrecognized by the people who live within them. The environment is as close as a person’s fingertips—constantly visible and a part of daily experience. One reason why environmental change is so important and so effective is precisely because environments seem immutable until they change, so their significance goes undetected. One of the challenges of environmental prevention is to give the social forces their human faces, to make them part of people’s daily experience, real and visible, so they can be assessed and, if necessary, changed. 

One problem with traditional prevention approaches has been that they have actually limited the human face of the problem to those who experience it directly. Illegal drug users and people with alcohol- and tobacco-related problems do not exist in isolated environments. They share the same physical spaces as the rest of the community. Environmental prevention recognizes that everyone in that community has a problem as long as the environment is problematic. If a local park has been overrun by the drug trade, it is not only the drug users but also the local children, parents, and entire community who are suffering.

## Suggested Strategies

**Take people on a guided tour of their own environments...show pictures, do skits, dramas, and ask them to relate to problems**
**Present case studies of the practical benefits a community can experience from implementing environmental strategies**

**Notes:**
Suggested Methods1. Use participatory or experiential learning techniques to help people make their environments visible. A strong tradition supports the role of participatory or experiential learning in addressing social problems Asking people to relate the history of a problem in their community will often bring out the environmental factors in the problem and the fact that the environment has changed over time. Taking people on a guided tour of their own environments can also be effective. Sometimes this can be accomplished by presenting pictures of the environment as the basis for discussion. Showing discarded drug paraphernalia next to a swing set or alcohol billboards next to an elementary school, for example, makes the dangerous or unhealthy features of the environment stand out. Another technique is to present skits or simple dramatizations of a drug or alcohol problem, followed by a guided discussion including questions that point people’s attention to environmental features. Why is the problem happening in this way? What policies or community agreements contribute to the problem’s happening in this way? Who has the power to change these? Who benefits from the way things are now?
 2. Relate individual stories to the environment in which the problem occurs. The presentation of environmental approaches can easily fall into an abstract discussion of models and theories. Yet concrete problems provide an excellent opportunity to illustrate the importance of environmental factors and the potential power of environmental strategies. For example, analysis of a fatal drug-related shooting involving young people could uncover various environmental influences such as a neighborhood saturated with crack houses; a public park that is inadequately patrolled; or a public housing unit with unlit hallways, abandoned units, and deteriorating conditions.
 3.       Present case studies of the practical benefits a community can experience from implementing environmental strategies. Proponents are perhaps unable to identify the individuals whose lives were protected by a successful environmental policy, but they can point to the policy’s positive impact on community life and norms. For example, a neighborhood that changes the design and increases public surveillance of a public park possibly is unable to identify individuals who reduced their drug use or drug-related violence. However, community residents perhaps report that they now can use the park without fear and have a safe place for children to play.
 Examples
        In its introductory trainings on environmental approaches, the Marin Institute introduces the topic with a slide show that illustrates aspects of the alcohol environment. Participants then visit actual settings in the community near the training site, such as a problem liquor store or a bar. Participants do a nonintrusive assessment of the site, determining how alcohol is presented, promoted, and priced. What else is in the surrounding neighborhood, particularly what other outlets sell alcohol? What health risks, if any, exist in the current situation, and what policies might reduce those risks? 
 	Let’s Clean It Up (LCIU), a neighborhood antidrug effort in Philadelphia uses environmental strategies that have reaped practical benefits to the community. LCIU activities included (1) organizing residents to protest drug dealing in the community; (2) building a resident-based system for reporting drug activities; (3) developing a strong link with the police department to shut down drug houses and eliminate the drug trade using community policing principles; (4) organizing residents to improve the physical appearance of the neighborhood by boarding up vacant buildings, removing abandoned cars, and cleaning up trash and graffiti; (5) approaching landlords with requests to evict tenants who are dealing drugs; and (6) successfully petitioning city government to issue citations to owners of rowdy bars who refuse requests to curb their patrons’ behavior. Researchers conducted a telephone survey to assess the impact of the program on residents’ perception of their neighborhood. The survey found a significant reduction in fear of crime and increases in the perception of social control, social cohesion, empowerment, and neighborhood satisfaction.

## Barrier 3. The Prevention Paradox is counterintuitive and too difficult to explain

**Many question prevention efforts that target the entire population of a community because they appear to punish moderate and light drinkers**
**Many argue that programs should concentrate on identifying heavy users and targeting preventive activities to them**

**Notes:**
Background
Many in the prevention field argue that programs should concentrate on identifying heavy users and targeting preventive activities primarily to them. The “prevention paradox,” on the other hand, holds that the biggest gains in reducing many alcohol and illegal drug problems will be achieved by focusing on entire populations rather than on heavy users. The reasoning behind the paradox is: Moderate and light drinkers have a lower risk than heavy users of suffering or causing alcohol-related harms. Yet they experience and cause more problems overall because they comprise such a large part of the entire population. Of course the validity of the paradox varies according to the type of problem. Risk of developing breast cancer, for example, increases steadily as consumption rises (Smith-Warner et al., 1998); risk of becoming alcohol dependent, on the other hand, only begins to show up at high levels of consumption (for discussion, see Edwards et al., 1994, pp. 76–77). 

The prevention paradox contradicts the common understanding of alcohol problems and, to a lesser extent, illegal drug problems. Alcohol problems are popularly associated with heavy drinkers and alcoholics. Many question prevention efforts that target the entire population of a community or a society (for example, by raising alcohol taxes or reducing physical availability) because they appear to punish moderate and light drinkers. But for moderate or light drinkers or drug users who drink or use until intoxication once per year or once per month, there is no invisible force field protecting them from the ill effects of heavy drinking or drug use. In fact, while heavy drinkers have the highest personal risk of alcohol-related motor vehicle crashes, they do not cause the majority of these crashes (Edwards et al., 1994; Perrine, Peck, & Fell, 1989). A young person who drinks to intoxication in an early experiment with alcohol can easily cause an alcohol-related crash, yet such a drinker could hardly be classified as alcohol-dependent.

## Suggested Strategies

**Develop simple graphics and explanations *****(emphasize that all ATOD users are at risk for alcohol/health problems, and give concrete egs.)***
**Place the prevention paradox in a broader perspective                                                 *****(highlight its benefits to young people, its reduction of incentives for heavy consumption, its support of treatment programs etc.)***

**Notes:**
Suggested Methods
1.       Develop simple graphics and explanations of the prevention paradox to facilitate presentation of these counterintuitive research findings. Emphasize that all drinkers and illegal drug users, including light and moderate users, are at risk for alcohol problems and provide concrete examples. Note that heavy users are responsive to environmental strategies and benefit most from them (Coate & Grossman, 1988).

2.       Place the prevention paradox in a broader perspective. Changing a community’s alcohol and illegal drug environment will reduce the number of incentives and cues for drinking and drug taking. This will, in turn, (a) benefit young people, who are heavily influenced by environmental messages and prevention strategies; (b) reduce incentives for heavy consumption, thereby encouraging moderation and abstinence among heavy users; and (c) support treatment programs and abstinence among recovering alcoholics and drug addicts.

Examples
         Project Northland, a community alcohol prevention program targeting underage youth conducted by the University of Minnesota, sent postcards to community residents explaining the prevention paradox. The card shows three teens in a game show and asks viewers to answer the following question: Which of these teens is more like those who die or are injured by alcohol use each year? One teen is a heavy drinker, the other two are lighter drinkers but consume alcohol in high-risk situations. The back of the card states that the lighter users are more like those who die or are injured by alcohol use and gives a brief explanation of the prevention paradox (Project Northland, n.d.).

         During the last decade, community groups in McKinley County, NM, have successfully implemented various environmental strategies in response to the community’s serious alcohol problems: increasing alcohol taxes, closing drive-up windows at alcohol outlets, and banning alcohol sales on Sunday. A portion of the alcohol tax revenues is dedicated to the Na’nizhoozhi treatment center. The center is active in both prevention and treatment efforts and encourages those in recovery to take part in prevention activities. County alcohol-related mortality and other alcohol-related problems have dropped significantly (and at a much greater rate than for the entire State) during this same period (Northwest New Mexico Fighting Back, 1997).

## Barrier 4. ES tend to challenge the free enterprise system, addressing economic issues not usually within public health area 

**Some belief that public health has little or no involvement in econ policy decisions**
**State ATOD agencies fall within a gray area having both econ & envirn policy decision-making authority**
**Many states give their public health agencies low role priority in envirn issues**

**Notes:**
Background
This barrier, promoted particularly by the alcohol and tobacco industries, assumes that economic policies are outside the scope of public health. The argument mirrors the structure of governmental agencies: public health departments typically have little or no involvement in economic policy decisions. State alcohol control agencies fall within a gray area, having both public health and economic policy decisionmaking authority. However, in many States these agencies give their public health role low priority, responding primarily to economic concerns of the alcohol industry (Mäkela, Room, Single, Sulkunen, & Walsh, 1981).

## Suggested Strategies                 -Three Facts-

**Public health and economic issues are intertwined...*****public health agencies can’t do their jobs without paying attention to economic policies***
**The free enterprise system is dependent on government intervention... *****such as***** *****fraud & competition protection, promotion of market stability, etc***
**Private enterprise and public health are not incompatible**

**Notes:**
Suggested Methods
1.  Public health and economic issues are intertwined, and public health agencies cannot do their job without paying attention to economic policies. Within the alcohol, tobacco, and illegal drug arena, for example, research has established that the price of a substance will effect both use and problem rates (see, e.g., Chaloupka, 1993). A community’s economic circumstances will influence, in particular, its experience of alcohol, and illegal drug problems. Open drug markets and overconcentration of alcohol outlets are more common in communities in economic distress. Illegal drug prevention programs have often included job training programs and other community economic development projects 
	The free enterprise system is in fact very dependent on government intervention, to promote market stability and protect against unfair competition, fraud, and other potential dangers in a corporate capitalist economy. In the case of alcohol, government ensures product safety, regulates product classifications, and mediates unfair competition claims, among other responsibilities, many of which are supported by industry and address public health concerns (Bunce et al., 1981). State and Federal agencies provide tax incentives and other programs that promote alcohol production and sales (Morgan, 1988). Governments also promote and regulate community business opportunities. In middle- and upper-income neighborhoods, governments are more likely to provide financial incentives to a diverse mix of retail outlets and enforce regulations designed to protect public health and safety. In low income neighborhoods, governments are much less likely to address public nuisance problems and provide economic incentives. The lack of government oversight encourages businesses such as liquor stores and recycling centers, both of which are associated with illegal drug and alcohol problems (Lee, 1998; Troutt, 1993). Thus, the argument that government should not interfere with a free market economy ignores the nature of our economy today.
      Private enterprise and public health interests are not incompatible. Many local alcohol retailers, for example, support responsible beverage service programs, which include restrictions on retail marketing practices (Mosher, 1991). These public-health based efforts can improve the atmosphere of a local retail establishment, attract new customers, and increase sales of nonalcoholic products. Jobs programs for young people, increased investments in community businesses, and strict enforcement of public nuisance laws (to curtail drug dealing and business practices that foster neighborhood decay) are examples of environmental strategies that both enhance a community’s business climate and prevent illegal drug problems. 
Examples
     Community organizations in South Central Los Angeles are working together to improve the area’s business climate as one aspect of a broad prevention effort. Activities include increasing enforcement of public nuisance laws, targeting dilapidated or unmaintained businesses that foster neighborhood decay and illegal drug and alcohol problems; promoting investments in businesses that will improve the community’s quality of life (such as light industry, laundromats, and grocery stores that do not sell alcohol).     

## Barrier 5. Alcohol and tobacco should be treated like other legal products

**An alcohol and tobacco industries argument *****that ES restrict their marketing practices, that alcohol and tobacco not be viewed as illegal drugs etc***
**The assumptions found under *****Barrier 4 *****underlie this argument**

**Notes:**
Background
The alcohol and tobacco industries argue that environmental strategies that restrict their marketing practices are inappropriate because their products are legal and should be treated like other legal products. The industries are deeply concerned that alcohol and tobacco not be viewed in the same category as illegal drugs and contend that there is a sharp divide between legal and illegal products. The assumptions found in barrier 4 regarding the free market economy underlie this argument.

## Suggested Strategies

**Demonstrate that legal products are treated differently based on analysis of their potential for social benefit and social harm**
**Emphasize importance of developing prevention strategies not based on a prohibition model...*****remember the Prohibition Era***

**Notes:**
Demonstrate that legal products are treated differently based on an analysis of their potential for social benefit and social harm. While it is true that there is a fundamental difference between legal and illegal products, this does not mean that all legal products are treated the same. Responding to this barrier involves analyzing the potential strategies for regulating legal products. Public health regulations are in fact commonly used to minimize the potential harm of a wide variety of consumer goods, industrial operations, and services. Explosives, fireworks, prescription drugs, foods, pesticides, and dry cleaning operations are just a few examples of products and industries that are strictly regulated to balance their social benefits with their potential for social harm. The regulation of potentially harmful products is a widely accepted practice even when it impinges on property and free speech rights. Alcohol is a significant contributing factor to major social problems including death, long-term illness, injuries, violence, and family and workplace disruptions. The risks it poses far exceed those created by other consumer products. Local, State, and Federal Governments have a wide latitude in determining how to regulate alcohol production, distribution, sale, and use (for discussion, see Bunce et al., 1981; Holder, 1987, 1998). Similarly, tobacco is a major contributor to health problems and therefore its distribution and sale are regulated.
 Emphasize the importance of developing prevention strategies that are not based on a prohibition model. The Prohibition Era provides an excellent case study of the pitfalls of relying on legal prohibition as a drug prevention strategy. While alcohol-related problems declined significantly, those years produced a thriving underground market, criminal syndicates, increases in violent crime, threats to social order, and widespread contempt for the law (Moore & Gerstein, 1981). Although Prohibition had significant problems, the rates of alcohol-related problems increased significantly in the decades following Repeal. It is imperative that society develop effective models for regulating legal psychoactive drugs such as alcohol, accepting its role in social intercourse and its potential for reducing heart disease, and still minimizing the devastating harm it can cause to communities and society at large. Environmental prevention strategies provide the means for accomplishing this goal.
Examples
Pensylvania maintains a State monopoly system; wine and distilled spirits are available only at State-operated retail stores. The public health mission of the State agency operating the outlets is reflected in many of its operating procedures. Research demonstrates that State monopoly systems result in lower rates of alcohol-related problems (Wagenaar & Holder, 1995). Privatization proponents argue that alcohol is a legal product that should be treated the same as other legal products. Public health and safety organizations have successfully resisted this argument by noting the special risks alcohol poses to the State (Staver, 1997).
 Robert Solomon, a public health attorney, lecturer, and professor at the University of Western Ontario, London, Ontario, Canada, highlights the differences between ordinary consumer products and alcohol by asking this question: “Have you ever heard of butter-related traffic crashes or egg-related violence?”

## Barrier 6. State/fed tax laws and the lobbying process are too difficult to deal with

**Organizations don’t want to be fined or lose their nonprofit status for violation**
**Organizations sometimes decide to avoid any action involving policy change in order to ensure that no illegal lobbying has occurred**

**Notes:**
Background
As previously discussed, environmental strategies involve changing policies, the formal and informal rules and agreements that govern social interactions. Some policies require action by local, State, and Federal legislative bodies. Federal tax law limits the lobbying activities of nonprofit organizations. If an organization violates these provisions, it can be fined or even lose its nonprofit status. Because the consequences can be severe, nonprofit organizations sometimes decide that it is better to avoid any action involving policy change in order to ensure that no illegal lobbying has occurred.

The first step in overcoming this barrier is understanding how the Internal Revenue Service (IRS) defines lobbying. A nonprofit organization lobbies when it: (1) states its position on specific legislation to legislators or other government employees who participate in the formulation of legislation; (2) urges its members to contact government employees or legislators regarding legislation; or (3) states its position on legislation to the general public and asks the public to make contact with government employees or legislators. The government terms the first two activities “direct lobbying” and the third “grassroots lobbying.” 

## Suggested Strategies            -Some facts-

**Most ES don’t require legislative action**
**Fed tax code doesn’t require activities involving development of legislation**
**Nonprofit organizations are allowed to dedicate portion of their budget to lobbying  *****20% 1st $500,000 & 15% on the next $500,00’s***
**Advocates can join and support lobbying efforts**

**Notes:**
	Most environmental prevention strategies do not require action by legislative bodies and therefore do not necessitate lobbying. Changing community environments involves a multiplicity of activities and targets. Closing down a crack house, for example, may require conducting vigils and surveillance, working with law enforcement, pressuring the landlord to evict the drug dealing tenants, and requesting that a planning department institute public nuisance proceedings. Environmental change includes enforcing existing regulations and promulgating new ones, changing policies at various community institutions, developing voluntary agreements with landowners and retail businesses, redesigning physical spaces, and increasing the effectiveness of law enforcement and other government agencies. None of these activities involve legislation or lobbying.
	Lobbying as defined by the Federal tax code does not include various activities that relate to the development of legislation. Developing legislation is one important aspect of environmental prevention. There are four major categories of legislative activities by nonprofit organizations that do not constitute lobbying :
(1) Communications to members that do not encourage members or others to lobby. A nonprofit, membership-based organization is allowed to inform members of legislation and announce its position so long as the communication does not include a call to action. 
 (2) Nonpartisan analyses. Many groups conduct analyses of legislation that include direct positions on the merits of the legislation. This is not considered lobbying so long as the organization: 
(a) presents facts fully and fairly; (b) makes the material generally available; and (c) does not include a direct call for contacts with legislators. 
 (3) Discussions of broad social, economic, and similar policy issues whose resolution requires legislation. This is not lobbying even if specific legislation on the matter is pending, so long as the discussion does not address the merits of that legislation. 
 (4) Responses to legislative requests. Organizations may respond to written requests from legislative bodies for technical advice regarding pending legislation, and, in this context, take a direct position on the legislation. 
Nonprofit organizations are allowed to dedicate a portion of their total budget to lobbying. The tax laws do not prohibit lobbying by nonprofit organizations. Rather, the laws actually support lobbying, by establishing clear rules for when and how it is permissible. They limit the percentage of a nonprofit organization’s budget that can be spent on lobbying. After filing the proper papers with the IRS, an organization can spend up to 20 percent of the first $500,000 of its annual budget, and up to 15 percent of the next $500,000 on lobbying. Federal law prohibits nonprofit organizations from using Federal grant revenues for lobbying purposes; similar restrictions may apply to grants from private foundations. In some circumstances, an additional filing may be required, which discloses the extent of Federal lobbying. Nonprofit organizations need to file the necessary forms with the IRS (including Form 5768, which provides that the organization elects to come under the lobbying provisions of the 1976 lobbying law) and adopt accounting procedures that document lobbying expenditures and ensures that only nonrestricted funds are used. Several resources are available to ensure that an organization is in compliance.
 Advocates can join and support lobbying organizations. There are numerous such organizations in the alcohol and illegal drug field. They are established in part to permit lobbying and raise funds within the guidelines established by the IRS.

## 4 legislative activities by ngo’s that do not constitute lobbying

***Communications that do not require anyone to lobby***
***Group’s analysis of legislation that include direct positions on the merit of the legislation***
***Discussion of broad social, economic, and similar policy issues whose resolution requires legislation***
***Response to legislative requests***

**Notes:**
Examples
        Several documents exist that provide clear guidelines for determining what constitutes lobbying and how to comply with Federal tax laws. (See Smucker [1991, an update available in 1999]; Harmon 1991, and O’Keefe 1992.) Charity Lobbying in the Public Interest, a project of Independent Sector, also provides excellent resources on these topics, that can be accessed at Independent Sector’s website: www.indepsec.org. Numerous nonprofit organizations in the alcohol and illegal drug field have successfully used these resources to ensure that their efforts to implement environmental strategies adhere to the tax rules. The rules may, at first glance, appear confusing, but in fact are easy to comply with.

        The National Association for Public Health Policy is a membership-based lobbying organization. It includes a Council on Alcohol Policy and Council on Drug Policy, both of which are permitted to lobby at local, State, and Federal levels.

Activists started Action on Alcohol and Teens (AAT), a Minnesota lobbying organization in 1995, partly in response to attacks on the lobbying efforts of nonprofit organizations in the State that had been active in tobacco control. Although they had engaged in no illegal activity, the attacks caused many alcohol policy proponents to shy away from any advocacy activities. AAT is a membership organization, and its lobbying is conducted by volunteers working on their own time. It has built a Statewide alert system of 300 people and is now seeking funding to hire staff and conduct other lobbying activities. 

## Barrier 7. Proponents of ES are do-gooders who blame the system and let bad people off

**The misperception is that an environment approach does not hold individuals responsible for their behavior and blames irresponsibility or negligence on the society or community at large**

**Notes:**
Background
Environmental prevention targets the social, political, economic, physical, and cultural forces that contribute to alcohol and illegal drug problems. One of its fundamental premises is that individual behavior is shaped by the environment. This proposition can lead to a misperception that an environmental approach does not hold individuals responsible for their behavior and blames irresponsibility or negligence on the society or community at large. The power of environmental approaches should not be overstated, and environmental and individual approaches should be seen as complementary rather than in opposition to each other.

## Suggested Strategies            -Some facts-

**ES hold individuals responsible for their own actions *****(they compliment not replace)***
**In ES all people are responsible for their behaviors and character of their community **
**Nothing wrong with “doing good”**
**If ES are ignored, those who benefit from unhealthy and illegal ATOD use are let off the hook**

**Notes:**
Environmental prevention does hold individuals responsible for their own actions; environmental strategies complement rather than replace individual strategies. As discussed in the introduction and the suggested approaches to barrier 1, the public health model of prevention has three key components: host, individual, and environment. Proponents of environmental strategies should emphasize that individual responsibility is an integral part of a comprehensive strategy for addressing alcohol, tobacco, and illegal drug problems. Environmental approaches complement individual strategies. An environment that limits open drug dealing, provides alternative activities and job training for teens, and strictly enforces public nuisance laws reduces the risks that young people will experiment with drugs and become involved in drug dealing. Similarly, a community that supports alcoholism recovery programs and strictly enforces laws prohibiting drinking and driving contributes to an environment that discourages problematic drinking behavior. Environmental approaches do not excuse irresponsible behavior but rather promote and reinforce individual responsibility.
In environmental prevention, all people are responsible for both their own behavior and for the character of the community and their shared social environments. Environmental approaches actually demand more of individuals than being responsible for their own behavior. Each citizen shares responsibility for the state of their shared community and social environments. In an environmental model, individuals do not just receive programs designed to assist them in making healthy and safe choices, they take action to change the circumstances that put individuals in their communities at risk. Individuals are responsible for identifying those risks, developing strategies for change, and taking leadership roles to implement those strategies. The key to a successful campaign is citizen involvement and activism, promoting collective as well as individual responsibility.
 There is nothing wrong with “doing good.” Proponents of environmental strategies can take pride in their efforts to improve their communities and society. Successful campaigns will reduce the toll of alcohol, tobacco, and illegal drug problems, particularly among young people. They promote the best traditions of our society: community service, collective responsibility, democratic action, and protection of our most vulnerable populations.
 If we ignore environmental strategies, we let those who benefit from an unhealthy alcohol, tobacco, and illegal drug environment off the hook. Environmental strategies challenge those who benefit from unhealthy conditions to change their behavior. Landlords can increase their profits by neglecting their properties and allowing drug dealing on their premises, but the community suffers from the increase in crime and violence associated with the drug dealing. City officials can benefit from lighter workloads and increased campaign donations if they fail to enforce public nuisance ordinances. Environmental strategies spotlight such behavior and demand accountability.

## Barrier 8. ES threatens individual civil liberties and the pursuit of happiness

**Many see ES as an intrusion upon their lives when decisions made by the government agencies restrict their individual choices**

**Notes:**
Environmental strategies can be seen as intruding on individuals’ lives when decisions made by government agencies restrict individual choice. They can appear patronizing, by doubting that individuals will make healthful decisions. Many traditional prevention strategies, on the other hand, seek to be persuasive in their message and respect individual choice and responsibility. People have a right to pursue their own happiness unimpeded so long as they do not violate the rights of others. 

## Suggested Strategies          -Some facts-

**The best environmental strategies are passive rather than intrusive**
**ES serve as alternatives to coercive policies**
**Most ES restructure, rather than limit individual choices**
**ES that threaten civil liberties or stigmatize individuals have limited effectiveness and should be avoided**

**Notes:**
The best environmental strategies are passive rather than intrusive. Most people take their community environment as a given and are not conscious (at least on a daily basis) of its structure. A boarded-up building becomes a feature of the landscape; a poorly lit parking lot or public park is simply avoided; an overconcentration of alcohol outlets and the closing of a bank are events beyond any individual’s control. The presence of cigarette vending machines in restaurants is commonplace. Environmental strategies that seek to improve community life include removing public nuisances, enhancing the retail mix of businesses, creating safer public spaces, and reducing drug-taking opportunities. When such remedies are implemented, most community members either do not notice the changes or approve of them.

Environmental strategies serve as alternatives to coercive policies. U.S. illegal drug policy for the last two decades has concentrated on punishing drug users and dealers using criminal justice sanctions. The focus is on individual behavior and largely ignores environmental influences. The result has been a dramatic increase in incarcerations, mostly among young African-American and Latino men, which has led to charges of discriminatory enforcement practices and the unnecessary stigmatizing of minority youth (Mosher & Yanagisako, 1991). In some cases, aggressive police sweeps to catch drug dealers and users have resulted in arrests of innocent citizens (Pothier, 1987, cited in Davis, 1998, p. 34; Tonry, 1994). There is little or no evidence that this expensive approach has succeeded in reducing drug problems (for discussion, see Mosher & Yanagisako, 1991). Environmental strategies shift the focus to the underlying community and societal conditions that foster drug dealing and use. They seek to limit the opportunities for drug dealing and use, lessen the perceived rewards, and increase the viability and attractiveness of alternative behaviors.

Most environmental strategies restructure, rather than limit, individual choice. Community environments structure the choices made by those who live in them. Changing the environment changes the range of choices available. In most cases, the range of choices either increases or stays the same. For example, a program to deter drug dealing by increasing surveillance of public parks or adding light to dark hallways in public housing limits people’s access to dark, private space even as it increases the choices of others to use those spaces without fear of violence. Responsible beverage service programs make it more difficult for barroom customers to drink heavily, but they increase the choices of those who seek public space free of intoxicated individuals. Limitations on the number of alcohol outlets decreases the availability of alcohol for prospective customers as it increases the choices of other consumer goods and the safety of the streets for others. Nonsmoking areas in restaurants limit places where patrons can smoke but make the atmosphere more pleasant for all. 

Environmental strategies that threaten civil liberties or stigmatize individuals have limited effectiveness and should be avoided. Some environmental strategies do constitute unwarranted invasions of personal privacy and civil rights. For example, some drug forfeiture laws mandate confiscating property used in drug trafficking even if the owner had no knowledge—or reason to know—that the property was being used for this purpose. Strategies such as these have only limited effectiveness and can create fissures within a community group. In general, proponents should seek interventions with the positive characteristics described above—ones that are effective, nonintrusive, do not stigmatize individuals, and restructure choice in a positive, pro-health manner.

## Examples

**Wallmart**
**US Navy**

**Notes:**
        Wal-Mart, a national consumer product retail giant, showed how a large company can also be good citizens by voluntarily limiting purchases of certain products that allow medicine to be altered into illegal drugs. In 1997, Wal-Mart placed limits on sales of products containing chemical compounds that can be used in manufacturing methamphetamine. Label scanners at 2,300 Wal-Mart pharmacies across the country have been programmed to limit sales of products such as Sudafed, which has been associated with the manufacture of “crack,” “ice,” “speed,” and other street drugs. Additionally the company has also discontinued sales of large-quantity bottles of diet-aid products. The company’s self-imposed control efforts were aimed at drug traffickers and promised that cold and allergy sufferers, as well as dieters, would not be inconvenienced or harmed (Hedges, 1997).

        The U.S. Navy instituted a comprehensive responsible beverage service program at a high-risk naval bar in San Diego County. Changes in service practices included discontinuance of pitcher service, increased surveillance by staff, increased food service, smaller alcohol serving sizes, pacing drink service, and cutting off service to intoxicated patrons. The program showed a substantial decline of intoxication among patrons, including those driving to the bar. Customers reported increased satisfaction with the bar environment and staff service (Saltz, 1987).

## Barrier 9. ES threatens limited funds needed for individual strategies

**The fact that America’s drug problem is being highlighted in the face of shrinking funds, many think that ES proponents are in an awkward and unaffordable luxurious position**

**Notes:**
In recent years, while high-profile media campaigns have highlighted America’s drug problems, the pot of funds available to communities to deal with alcohol and illegal drug problems at the local level has shrunk. In this context, people working in prevention and treatment are vulnerable to competing for scarce resources and could denigrate approaches taken by others in the field. Environmental approaches begin to look like luxuries the field cannot afford. They sometimes require long-term commitment, the outcomes of some approaches are not immediately evident, and even their short-term impacts are often greatest on people who have not yet developed problems.

## Suggested Strategies            -Some facts-

**Effective ES complement individual-based prevention approaches and can aid in the success of treatment programs**
**ES can be cost-effective and revenue enhancing**
**ES increase collaboration and power**
**ES can have immediate impact**

**Notes:**
Effective environmental prevention complements individual-based prevention approaches and can aid in the success of treatment programs. An environment that is not laced with alcohol and tobacco promotions is also more supportive of individual recovery. A community that has drawn together to address problem parks, street corners, or houses has also learned to establish norms against drug use and to uphold them, whether they apply to neighborhoods or to individuals. This cohesion helps accomplish the real job of primary prevention: to keep people from developing the problem in the first place. (See also suggested approaches to barrier 7.)
 Environmental prevention can be cost-effective and even revenue enhancing. Educational strategies, for example, must be reiterated with each new group of at-risk youth. An environmental intervention (such as rehabilitating run-down parks or housing projects) is a permanent change that needs to be done only once to have an effect. Raising taxes on alcohol is another cost-effective environmental strategy that has been shown to reduce youth alcohol problems and can actually increase the funds available for other preventive strategies.
 Effective environmental prevention coalitions increase collaboration and cooperation and build collective power. Environmental prevention campaigns provide opportunities for coalition- and bridge-building. At the individual level, a drug problem is often seen simply as an individual or perhaps a family problem. But at the environmental level, drug problems become visible as issues of violence, poverty, neighborhood blight, and economic development, to name a few. All the constituencies working on these issues can be brought into antidrug efforts as well, when the universe of solutions under consideration includes environmental approaches. Because the resulting coalitions often take on existing stakeholders in the political process and because they organize to challenge entrenched political forces, they demonstrate the political efficacy of the environmental prevention constituency. This in turn helps build an effective political voice to advocate for increased funding for a comprehensive societal response to alcohol and illegal drug problems.
Some environmental strategies can have immediate impact. For example, closing down one problem alcohol outlet can significantly reduce crime in a community right away. Strategies with short-term payoffs can be balanced with strategies that take longer to show results.

Example
       A citizens’ group in Gallup, NM, enacted a 5-percent local option alcohol excise tax and dedicated most of the funds to the Na’nizhoozhi Center, a protective custody facility that operates alcohol and illegal drug treatment and prevention programs (Northwest New Mexico Fighting Back, 1997).

## Barrier 10. ES can conflict with traditional research focused on individual approaches

**Some believe that ES do not preclude the need to identify and treat persons at risk**
**That they do not produce environments that limit risk for individuals**

**Notes:**
The bulk of current federally funded research on alcohol and illegal drug problems uses biomedical approaches to seek to understand the physiological process of addiction, in order to learn how to identify populations potentially at risk and intervene with them early in the process. Two other major traditions of alcohol and illegal drug research focus on the effectiveness of educational and treatment approaches respectively. Environmental approaches take a very different tack. They instead attempt to preclude the need for identifying or treating persons at risk, by producing environments that limit risk regardless of individual susceptibility. Research in this arena involves different research questions, methodologies and expertise, which fall outside the mainstream of alcohol and illegal drug research.

## Suggested Strategies             -Some facts-

**ES research draws on and is grounded in its own research tradition**
**ES outside the mainstream of ATOD research doesn’t diminish its importance**
**Preventionists seek research support rather than fight over limited resources**
**Preventionists gather support by translating research findings into lay language for community wide dissemination**

**Notes:**
The fact that research on environmental approaches is outside the mainstream of alcohol and illegal drug research does not diminish its importance to the field. Environmental strategies hold great promise for reducing alcohol, tobacco, and illegal drug problems at community and society levels.  
Research on environmental approaches draws on and is grounded in its own research tradition. As epidemiologists began to look at alcohol and illegal drug use in the late 1960s, it became apparent that individuals experiencing alcohol and illegal drug problems existed at widely varying levels of use Evidence began to accumulate that linked alcohol-related problems such as cirrhosis to the total consumption of alcohol in a population.A major international review of research literature published in 1975 concluded that increases in alcohol availability were linked to increases in rates of alcohol-related problems 
Preventionists need to work together to increase and expand sources of research support for alcohol, tobacco, and illegal drug issues overall, rather than fight turf battles over limited resources. This expansion opens up possibilities for support from funders who have not supported the other traditions of substance abuse research.
 Preventionists need to increase the understanding of and support for research on environmental strategies by translating the research findings into lay language and disseminating them widely. Much of the research supporting environmental approaches has appeared only in the scientific literature. As communities take this research and publicize it by applying it to their local situations, they increase the support for continued research.
Examples
        In part in response to, and in part to encourage its own grant recipients’ ventures into environmental strategies, the Robert Wood Johnson Foundation has begun the second round of a major research initiative on policy approaches to substance abuse problems. The foundation has devoted millions of dollars to this initiative, representing a new source of funds for alcohol and illegal drug research.

        The California Wellness Foundation has funded numerous research endeavors addressing the underlying causes of youth violence, including at least four research studies on alcohol and illegal drug problems. The program was designed to complement governmental research programs and focused particularly on policy and environmental issues.

## Barrier 11. Some ES seem controversial and divisive even in collaboration

**The issue here is change**
**ES accept that social change is necessary**
**Change threatens those who are entrenched in or benefit from the status quo**

**Notes:**
Background
The environmental approach to prevention accepts that social change is necessary. Change threatens those who are entrenched in or benefit from the status quo. Individual-based approaches do not pose the same threat. Implementation of a school-based prevention curriculum threatens fewer people than organizing to clear drug markets from a neighborhood by demanding that slumlords improve building maintenance, police increase patrols in a local park, or a school or recreation department change priorities and use some of its resources to improve lighting and supervision at a school in the evening hours so that children can use the playgrounds and athletic facilities.

Other environmental strategies are even more controversial, particularly when they confront the right of entrenched interests to profit from the alcohol, tobacco, and illegal drug trade (see discussion in barriers 12–14). Shifting police resources from wealthy to poor neighborhoods or shifting the cost burden of alcohol from the public to the private purse by increasing alcohol taxes or limiting advertising tax deductibility, threatens the status quo and those who benefit from it.

Many community-based prevention efforts start from a premise that action should emanate from a coalition that represents as many sectors of the community as possible. Since most environmental strategies are controversial and will probably threaten the interests of at least some coalition members, they are the most likely to be dropped from the coalition’s agenda. Coalitions are more likely to compromise on individual-based strategies such as education or because members can agree on their importance. 

## Suggested Strategies

**Develop new coalitions whose members share a commitment to developing and implementing ES**
**Take advantage of the broad scope of the ES to expand your coalition**
**Build on the ability of ES and community organizing to increase citizen participation in the decision-making process**

**Notes:**
Take advantage of the broad scope of the environmental approach to expand the coalition for prevention. Ventures into new areas of social action can alienate some traditional allies for prevention, but they will also open up new opportunities for alliances in other directions. Groups working on job creation, economic development, and housing reform are natural allies to environmental strategies to reduce illegal drug problems. 

Develop new coalitions whose members share a commitment to developing and implementing environmental strategies. Embarking on new strategies that could generate opposition or controversy can require building a new organizational base that does not include those with an interest in maintaining the status quo. If community members want to clean up vacant lots where drug dealing is occurring, the landlords of the properties or the city officials charged with enforcing litter regulations would perhaps not be the best choice to promote this agenda. Many communities have found that organization and confrontation were required to bring pressure to act on the gatekeepers. Campaigns require careful identification of potential allies to be included and potential opponents to be confronted or approached through negotiation. 

Build on the ability of environmental strategies and community organizing to increase citizen participation in the community’s decisionmaking process. Community organizing is an important tool for implementing environmental strategies. Building strong citizen participation in and support for community policy change provides a means for overcoming the opposition of powerful community sectors and the indifference or apathy of decision makers. Community organizing can threaten and diminish the power of current community stakeholders, but it rests on the fundamental values of democracy and citizen involvement in governmental decisions
 Example: Civil rights leaders, community activists, people in recovery, and alcohol and drug treatment providers in South Central Los Angeles became increasingly frustrated with the open drug dealing, prostitution, crime, alcohol problems, and public nuisance activities in their neighborhoods. Major contributors to these problems were the large numbers of liquor stores, unsanitary recycling centers, and rundown motels that dominated South Central’s commercial strips and the city’s inattention to the needs of this predominantly African-American and Latino area. In response, they formed the Community Coalition for Substance Abuse Prevention and Treatment. Using basic community organizing techniques, coalition members visited hundreds of residents door-to-door to inform them of the new organization and to determine their concerns and priorities. What emerged was a campaign to restrict the number of liquor stores in the neighborhood and to close down or reform existing liquor stores that contributed to neighborhood blight, intoxication, and drug dealing and use. The coalition membership expanded rapidly to include neighborhood residents who took leadership roles in the campaign, which eventually led to new city enforcement and oversight procedures. The coalition has since been active in numerous other campaigns, collaborated with a wide variety of groups, and built a strong grassroots foundation. 

## Barrier 12. Profits from illegal drug sales make that market impossible to control

**When a grower or dealer is caught, another takes his/her place**
**If drug dealers are removed from one neighborhood, they set up shop elsewhere**
**Some law enforcement efforts have possibly inadvertently encouraged the development of large, violent drug cartels**

**Notes:**
The nation’s drug policies have focused on curtailing illegal drug importation, eradicating illegal drug production both here and abroad, and apprehending traffickers and dealers. Research suggests that efforts directed at drug importation and production have had only minimal success in lowering the price or restricting the availability of illegal drugs in communities (Caulkins, Crawford, & Reuter, 1993; Davis, 1998; Reuter & Kleiman, 1986). Distribution channels are easily changed, and because of the large profits involved, new recruits and organizations quickly replace those incapacitated by police. In fact, law enforcement efforts have possibly inadvertently encouraged the development of large, violent drug cartels (Davis, 1998).

## Suggested Strategies

**Societal focus needs to shift tot the local level  *****                                                                         This has the added benefit of building community empowerment and improving neighborhood conditions                                                                 The argument that drug markets simply move to other neighborhoods is not necessarily true by close examination***

**Notes:**
Environmental prevention strategies that target the practices of producers and reduce availability by increasing prices can be implemented in the case of legal drugs such as alcohol and tobacco. However, as suggested above, these strategies do not work to control illegal drugs such as marijuana and cocaine because many of the control mechanisms used in alcohol and tobacco policy are not available. Still, communities have succeeded in disrupting the drug trade locally using various environmental and criminal justice approaches. To overcome this barrier, the societal focus needs to shift to the local level. This has the added benefit of building community empowerment and improving neighborhood conditions. Arguments that drug markets simply move to adjacent neighborhoods are not generally borne out by close examination (Davis, 1998).

Examples
        Union Miles Development Corporation in Cleveland, OH, implemented numerous environmental strategies as part of a determined effort to reduce drug availability in its community, including increased citizen reporting of drug activity, monitoring police activity, collaboration with landlords in rehabilitating and winterizing buildings, and creating drug-free zones (Rosenbaum et al., 1994).

Residents in a Washington, DC, neighborhood, frustrated by the open drug dealing that was disrupting their community, created G-FEDS, a grassroots group, and sued the owners and tenants of the crack houses for creating a public nuisance. The tenants moved out shortly before trial (Carlson, 1995).

## Barrier 13. Many societal vested interests promote strategies that punish SA victims, thus undermining the ES for controlling illegal drug use

**Huge sums of money are indeed being poured into other strategies/programs that are not directed at changing the environment, while ES receive relatively little attention or support**

**Notes:**
Barriers 13 and 14 share a common theme: powerful forces that may oppose environmental strategies. As barrier 13 suggests, many institutions and individuals may benefit from current illegal drug policies, which rely on strategies that punish the victims of drug abuse problems. For example, the prison industry is becoming a powerful force in State and Federal politics, and a large percentage of prison inmates are incarcerated for violating drug laws. Politicians may fear being labeled “soft on drugs” unless they take a strict, lockup approach to all drug users. Some Government programs reflect these attitudes, as huge sums are directed to strategies not directed at changing the environment, while environmental strategies receive relatively little attention or support.

## Suggested Strategies

**Develop a strong research base that documents the effectiveness of ES in reducing illegal drug problems**
**Use community organizing political advocacy to build grassroots support for ES**
**Build regional, statewide, national support for ES through coalition building, political advocacy, and media advocacy**

**Notes:**
Develop a strong research base that documents the effectiveness of environmental strategies in reducing illegal drug problems. As noted in the introduction, this research is in its infancy. Research provides support for responses to assertions that criminal justice strategies are the most effective and efficient means for reducing illegal drug problems.
 Use community organizing and political advocacy to build grassroots support for environmental strategies. Political support for reform must begin at the grassroots level, organizing community support, new leadership, and citizen activism to overcome the social forces that favor criminal justice approaches to illegal drug policy. There are numerous examples of successful community organizing to address illegal drug problems. Typically, these efforts begin by seeking better enforcement tactics, using community policing techniques. Once the immediate goal of reducing open drug dealing is met, the groups move to other environmental strategies to benefit the community and its residents. Police at the 
local level are increasingly interested in developing alternative approaches to illegal drug prevention that do not rely primarily on traditional law enforcement strategies (Drug Strategies, n.d.; Green, 1996; NIJ, 1994).
Build regional, statewide, and national support for environmental strategies through coalition building, political advocacy, and media advocacy. Developing a strong community base for environmental approaches is the first step toward reforming State and Federal policies. Regional, State, and national coalition campaigns operate from a position of strength based on the political clout of their community base. Media advocacy is an important tool for changing the media’s portrayal of illegal drug problems and its presentation of viable responses.
 Examples
        The police in Houston, TX, became increasingly frustrated by the lack of progress being made in controlling the rising drug problems in Link Valley, an inner-city neighborhood that had become an open-air, drive-through drug bazaar. Abandoned housing units, broken fences, litter, and disrepair made it a convenient location for drug dealers. The murder of an elderly resident in 1988 finally spurred a search for alternatives to traditional law enforcement practices. Representatives from nine neighborhood associations organized themselves against drugs and formed the Stella Link Revitalization Coalition. Assisted by the police, the coalition implemented several environmental strategies, including cordoning off the neighborhood to through traffic to prevent drive-through drug buys, conducting a massive litter and graffiti cleanup of the area, and strict enforcement of city health and housing ordinances. Police and residents report that the cocaine market has virtually vanished (NIJ, 1994).

## Barrier 14. The alcohol and tobacco industries oppose ES that restrict their marketing

**They will do anything, go anywhere and stop at nothing**
**After all, they’re not in the health business, but in the money business**

**Notes:**
Background
The alcohol and tobacco industries are a powerful political and economic force in our society, particularly at State and Federal levels. They have traditionally opposed environmental strategies that would limit marketing strategies—availability restrictions, controls on advertising, and tax increases. For example, the tobacco industry created and funded a citizens’ organization, “Californians for Statewide Smoking Restrictions,” which successfully placed a statewide voter initiative on the 1994 California ballot. Proposition 188 was designed to look like a strong clean indoor air law but in reality was a weak State law that would have preempted and replaced many stronger local laws. The tobacco industry contributed $18 million to put Proposition 188 on the ballot and promote it. The measure was eventually turned down by voters.

Given the alcohol and tobacco industries’ formidable financial and political clout, many argue that pursuing environmental strategies that require legislative action is fruitless and unnecessarily confrontational. The industries are willing to cooperate on many traditional prevention approaches, including education and public service announcements. The alcohol industry has promoted designated driver programs, and tobacco companies have sponsored campaigns such as “It’s the Law” and “Tobacco: Helping Youth Say No.” Both industries urge those pursuing environmental strategies to work cooperatively in developing mutually agreeable strategies instead of pursuing a confrontational course. 

## Suggested Strategies

**Continue building and improving on Barrier 13 strategies**

**Notes:**
Continue to build a research base for environmental prevention strategies and make current research readily available to the public, community groups, and policymakers. There is now a solid research foundation for advocating environmental strategies to address alcohol- and tobacco-related problems (Edwards et al., 1994; Stewart, 1997). Strategies that have been shown to be effective in reducing alcohol-related violence, injuries, and long-term health problems include raising alcohol taxes, restricting the density and location of alcohol outlets, enforcing minimum-age drinking laws, restricting sales and consumption at public events, and implementing responsible beverage service programs. Strategies shown to be successful in reducing tobacco use and problems include restrictions on access, increased taxes, and enforcement of minimum purchase age laws (Chaloupka, 1993).
Use community organizing and political advocacy skills to build grassroots support for environmental strategies. Surveys show that most people support environmental strategies. The challenge is to translate that support into public policy. This is most easily accomplished at the local level, where policymakers are more responsive to citizens’ concerns. 
 Build regional, statewide, and national support for environmental strategies through coalition building, political advocacy, and media advocacy. See suggested approaches section of barrier 13.
 Examples
Citizens in Baltimore, MD, organized the City Wide Liquor Coalition for Better Laws and Regulation (CWLC) to address the loitering, litter, and drug dealing that liquor stores were bringing to their community. In 1992, CWLC turned its attention to alcohol and tobacco billboards, which they considered a blight in their inner-city neighborhoods. Using community organizing, media advocacy, and political advocacy techniques, CWLC overcame formidable industry opposition and convinced the city council to enact the first ordinance in the country that banned alcohol and tobacco billboards in areas most frequented by children, such as schools and playgrounds. The industry filed an unsuccessful lawsuit that delayed the ordinance’s implementation, but, early in 1998, the billboards were removed (Marin Institute, 1997; Seevak, 1996).

## Conclusion. Remember 4 things

**Regardless of barrier(s), the implementation of these ES also brings enormous rewards**
**Environmental change takes time**
**Communities have the resources to succeed**
**You’re not alone**

**Notes:**
Even though implementation may encounter hurdles and obstacles, the process also brings enormous rewards as well: building partnership among diverse constituencies; creating positive change in a community that improves the quality of life, particularly for young people; reducing the toll of alcohol, tobacco, and drug problems; and creating community cohesion. Community members find real satisfaction when they succeed in rebuilding an abandoned building, eliminating a crack house or problem alcohol outlet, and transforming a park from a dangerous hangout for drug dealing to a safe place for children and families. Environmental change is tangible and involves collective victories and celebration.

Environmental change takes time. In 1988, Surgeon General Koop announced the recommendations of his Workshop on Drunk Driving, which included a comprehensive set of environmental change policies. He predicted, based on the experience with tobacco policy, that many of the recommendations would take 25 years to implement (Office of Surgeon General, 1989). We have made good progress in the subsequent decade, and drinking-driving crashes are on the decline, but there is clearly more work to be done. We need to anticipate setbacks and delays, but positive change is occurring. New barriers may appear as old ones recede, but this is a sign of progress, of building a foundation for future change.

Communities have the resources to succeed. Environmental change does not require special expertise, or huge grants. It requires organizing and working together with neighbors, colleagues, and fellow community members. You will need to learn about your community – its values, priorities, and experience with alcohol, tobacco and illegal drugs. And you will need to become involved in your community’s decision-making process. When you need outside resources, they are available. Excellent materials now exist on the process of community change, on what prevention strategies work and how they can be implemented, and on what others communities are doing. 

Finally, you are not alone. Communities across the country are implementing environmental change policies. Their stories can be sources of inspiration, learning, and support. Our challenge is to work together and to build a citizen’s movement for change so that our children can grow up in healthy communities free of environments that put them at undue risk for alcohol, tobacco, and illegal drug problems.