Changing the Environment
to Support Healthier
Decisions
Presented by:
Debbie Moellendorf
4-H Youth Development Educator
Lincoln County UW-Extension
Need
“The majority of high school students have little to do
in this city for fun that’s supervised. This is why so
many kids drink alcohol as a means of
entertainment. It is something to occupy their time.
Likewise middle school students need a place
where they can hang out, yet are supervised – if
kids aren’t into sports or lots of school clubs to keep
them busy they are making unhealthy choices.”
(Good Samaritan Hospital Newsletter Libraries,
Community Survey, 2003)
Need (continued)
“Cut down alcohol use by addressing ingrained
community attitudes on alcohol and drinking.”
(Lincoln County Partners Against Tobacco Coalition,
Town Hall Meeting, May 2003)
“We need to promote positive attitudes about healthy
choices instead of exclusively focusing on the
DON’Ts about alcohol and other drugs.”
(Lincoln County Interagency Advisory Council, Focus
Group, 2004)
Need (continued)
• High levels of poverty and
unemployment
• Limited availability of recreational and
enrichment activities
• Lack of alcohol and other drug
treatment services
• Community attitudes towards alcohol
and other drugs
Need (continued)
Substance
2000 Merrill
Search
Survey
2000
Tomahawk
Search
Survey
2003
Tomahawk
Search
Survey
2004 Merrill
Search
Survey
Alcohol
40%
40%
46%
38%
Cigarettes
26%
31%
28%
20%
Smokeless
Tobacco
12%
21%
17%
7%
Marijuana
11%*
22%*
27%*
15%*
Survey was issued to all 6-12th graders.
* - Use reported once or more in the last 12 months. All other
percentages are past 30 day use.
How did we respond?
• Merrill Area Healthy Initiative applied and
received a five year Federal Drug-Free
Communities grant (October 2004 through
September 2009) ($100,000 per year)
• Initiative expanded and the Lincoln County
Drug Free Coalition formed in 2006
• Coalition applied for five year Federal DrugFree Communities grant in 2009, but did not
receive funding (plan to reapply in 2010)
How did we respond?
(continued)
• March 2009, Coalition received a 6-month
planning grant focused on addressing
underage drinking among 12-20 year olds
through the State of Wisconsin Division of
Mental Health and Substance Abuse
Services under the Strategic Prevention
Framework Incentive Grants ($87,000)
• Coalition submitted and received 2-year
implementation grant (October 2009 through
September 2011) ($125,000 each year)
Do you currently work with a local
coalition to address AODA issues?
10
1. Yes
2. No
0%
Yes
0%
No
SAMSHA’s Strategic Prevention
Framework
(www.coalitioninstitute.org/SPF_Elements/SPFElementsHome.asp)
Are you familiar with this
framework?
10
1. Yes
2. No
0%
1
0%
2
ASSESSMENT ELEMENT
Collect data to define problems,
resources, and readiness within a
geographic area to address
needs and gaps.
Our Assessment
• Review of Prior Surveys and Assessments
• Discussion and data brought by Coalition
members to monthly meetings
• Merrill Social Norms Student, Parent and
Staff Surveys (2007, 2008 and 2009)
• Town Hall meetings hosted by Coalition on
underage drinking (March 2008) and
prescription drug misuse/abuse (April 2008)
Our Assessment (continued)
• Community supper hosted by Tomahawk
Together (September 2008)
• Identifying existing data sources (e.g.
emergency rooms, arrest data, etc.) and
garnering their help in collecting
different/additional data
• Key informant interviews with law
enforcement, judges, district attorney and
city attorney
• Focus groups with middle and high school
youth
Our Assessment (continued)
• Creating list of community events that serve
alcohol and serving practices
• Map of licensed alcohol outlets in City of
Merrill and City of Tomahawk (collecting
from townships)
• Environmental scans of sampling of
restaurants, convenience stores, grocery
stores, bars and other locations
• Gather information about local policies
• Scanning local media sources
Analyze Problem
CAPACITY ELEMENT
Mobilize and/or build capacity
within a geographic area
to address needs.
Our Membership
DFC Coalition Required Sectors:
•
•
•
•
•
•
•
•
•
•
•
•
Youth
Parents
Business community
Media
Schools
Youth-serving organizations
Law enforcement agencies
Religious or fraternal organizations
Civic and volunteer groups
Healthcare professionals
State, local or tribal government
Other organizations involved in reducing substance abuse
Our Organizational Structure
• Clear roles and organizational structure for
members (memorandums of understanding)
and staff (position descriptions)
• Good meeting and communication habits
(regular meetings, agendas distributed in
advance, committee reports, minutes, emails in between, process of creating a
website for coalition)
• Appropriate legal and fiscal organization
(partnered with Merrill School District to
serve as fiscal manager)
Our Initial Structure
Our Emerging Structure
Leader as…
•
•
•
•
•
•
•
Facilitator
Content meta-expert
Visionary
Strategist
Broker
Spokesperson
Coordinator
PLANNING ELEMENT
Develop a comprehensive strategic plan
that includes policies, programs, and
practices creating a logical, datadriven plan to address problems
identified in assessment element.
Sample Logic Model
Seven Strategies for Community
Change
•
•
•
•
•
•
•
Provide information
Enhance skills
Provide support
Enhance access/reduce barriers
Change consequences
Change physical design
Modify/change policies
Develop an Action Plan
• What changes or actions will occur?
• Who is responsible to carry out these
changes?
• By when will they take place and for how
long?
• What resources (i.e. money, staff, technical
assistance, etc.) are needed to carry out
these changes?
• Who should know what?
IMPLEMENTATION ELEMENT
Implement evidence-based
prevention programs,
policies, and practices.
Two Kinds of Environments
Public Health Triangle
Individual Prevention:
Environment focuses on changes to the
host
Environmental Prevention:
Focuses on change
to the agent and
environment
Agent
Host
The most common source of
alcohol is youth buying it
themselves?
1. True
2. False
10
0%
True
0%
False
False
14
12
10
8
6
4
2
0
Source
Friend 21 or older
Mother or father
Friend who is under 21
Purchased themselves
How easy was it for youth to
get alcohol, if they drank …
10
1.
2.
3.
4.
Very Easy
Easy
Difficult
Very Difficult
0%
Very Easy
0%
0%
Easy
Difficult
0%
Very Difficult
Easier than you would think…
30
25
20
15
10
5
0
Very Easy
Easy
Difficult
Very Difficult
Availability
• Can I get it? When? Where? Cost?
• Alcohol and other substances
(prescription drugs) are readily
available to youth from both
commercial sources (stores) and social
sources (homes, shacks, older
friends/siblings, parents).
• Underage drinkers are most likely to
obtain their alcohol from others versus
purchasing themselves.
Decreasing Availability of
Alcohol
How easy is it for youth to
obtain prescription drugs?
1.
2.
3.
4.
Very Easy
Easy
Difficult
Very Difficult
10
0%
Very Easy
0%
0%
Easy
Difficult
0%
Very Difficult
Easier than you think…
14
12
10
8
6
4
2
0
Very Easy
Easy
Difficult
Very Difficult
Decreasing Availability of
Prescription Drugs
• Drug Round-ups (2007 - 139 pounds; 2008
- 99 pounds)
• Community Roundtable Hosted lead too:
– Discussion with local doctors about
reducing prescriptions or amount issued
– Production and distribution of “Stop
Prescription Drug Abuse” brochures
– Alternative drug disposal option
– Continued discussion on establishing
collection/drop off locations
Decrease Availability of
Tobacco
• Statewide changes in tax/cost of
cigarettes
• Local tobacco compliance checks
Norms
• Shared understanding of what is
acceptable and unacceptable
behaviors
• Is this how most people act, think and
feel?
Director of the “Most of Us” program at Montana State University
Tell me a story about this
picture…
What percentage of students believe
the “typical student” has used alcohol
in the past 30 days?
10
1.
2.
3.
4.
5%
25%
93%
47%
0%
0%
0%
5%
25%
93%
0%
47%
What percentage of parents/guardians
believe the “typical student” has
used alcohol in the past 30 days?
10
1.
2.
3.
4.
47%
95%
25%
5%
0%
47%
0%
0%
0%
95%
25%
5%
What percentage of staff believe the
“typical student” has used alcohol in
the past 30 days?
10
1.
2.
3.
4.
25%
98%
47%
5%
0%
25%
0%
0%
0%
98%
47%
5%
Social Norms Project
To challenge and correct
misperceptions about alcohol,
tobacco and other drug use.
To use positive peer pressure.
“Seek the truth (survey) and
tell the truth (marketing
campaign) about
responsible health and
safety being the norm.”
- Michael Haines
Former Director, National Social Norms Research
Center, Northern Illinois University
Merrill Social Norms Marketing
•
•
•
•
•
•
•
•
•
•
Billboards (community)
Chamber and Church newsletter articles
(community)
Classroom posters (students, staff)
Computer login screens (students, staff)
Foto News ads and articles (community)
Movie Theater ads (students, community)
Presentations and displays (students, parents,
staff and community)
Radio ads (community)
School newsletter (parents, staff)
Television ads (students, parents, community)
Go to Lincoln County 4-H website at
www.lincolncounty4h.com and scroll to
bottom of page
Regulations
•
•
•
•
Am I allowed to do this? Encouraged or
discouraged?
Laws, regulations and other policies are
determined by schools, churches, youth
group boards, businesses, city councils,
legislature.
If I do this will I get caught? What will
happen to me if I do this?
Does the community support enforcement
of laws and issuing of tickets for
violations?
Efforts Focused on Regulations
• Tomahawk 5th Grade Leadership class
initiated change in City Ordinance to allow
law enforcement to issue tickets for smoking
on school grounds
• School Boards adopted zero tolerance
policies regarding prescription drug
• Facilitating three law enforcements agencies
meeting to discuss laws, how they enforce,
and what coalition can do to help them
more uniformly enforce throughout the
county
Seven Strategies for Community
Change
•
•
•
•
•
•
•
Provide information
Enhance skills
Provide support
Enhance access/reduce barriers
Change consequences
Change physical design
Modify/change policies
EVALUATION ELEMENT
Measure the impact of the
Strategic Prevention Framework
and the implemented programs,
policies, and practices.
Four Core Measures
•
•
•
•
Average age of onset of any drug use
Past 30-day use
Perception of risk or harm
Perception of parental disapproval of
use
When they were in….
8th
grade
9th
grade
10th
grade
11th
grade
12th
grade
In the last 30 days, had at least one drink of alcohol
Class of 2007
55%
Class of 2008
51%
55%
45%
48%
41%
35%
37%
45%
45%
Class of 2009
Class of 2010
Class of 2011
29%
41%
Class of 2012
23%
42%
Class of 2013
26%
Perception Parental Disapproval Alcohol
100
80
60
40
20
0
2007
Not at all Wrong
2008
Little Wrong
2009
Wrong
Very Wrong
Perception Parental Disapproval Tobacco
100%
80%
60%
40%
20%
0%
2007
Not at all wrong
2008
Little Wrong
Wrong
2009
Very Wrong
Perception Parental
Disapproval Marijuana
100%
80%
60%
40%
20%
0%
2007
Not at all Wrong
2008
Little Wrong
2009
Wrong
Very Wrong
Process Evaluation
• Ensure coalition has good structure.
• Participants and members have a real
and equitable voice, and their opinions
are valued and listened too.
• Ensure that the process improves over
time – no coalition starts out perfect
and should work toward doing
business in a better way.
SAMSHA’s Strategic Prevention
Framework
(www.coalitioninstitute.org/SPF_Elements/SPFElementsHome.asp)
SUSTAINABILITY ELEMENT
The ability to maintain the
human, social and material
resources needed to achieve
your coalition’s long-term goals
for community change.
CULTURAL COMPETENCE
ELEMENT
“A set of behaviors, attitudes and policies that
come together in a system, agency, or
program or among individuals, enabling
them to function effectively in diverse
cultural interactions and similarities within,
among, and between groups.”
U.S. Department of Health and Human Services
THANK YOU!!!
Examples of Other Coalitions Efforts?
Comments?
Suggestions?
Questions?