BACKGROUNDEstimates of economic and social costs related to alcohol and other drug (AOD) use and abuse are usually made at state and national levels. Ecological analyses demonstrate, however, that substantial variations exist in the incidence and prevalence of AOD use and problems including impaired driving, violence, and chronic disease between smaller geopolitical units like counties and cities. This study examines the ranges of these costs across counties and cities in California.METHODSWe used estimates of the incidence and prevalence of AOD use, abuse, and related problems to calculate costs in 2010 dollars for all 58 counties and an ecological sample of 50 cities with populations between 50,000 and 500,000 persons in California. The estimates were built from archival and public-use survey data collected at state, county, and city levels over the years from 2009 to 2010.RESULTSCosts related to alcohol use and related problems exceeded those related to illegal drugs across all counties and most cities in the study. Substantial heterogeneities in costs were observed between cities within counties.CONCLUSIONSAOD costs are heterogeneously distributed across counties and cities, reflecting the degree to which different populations are engaged in use and abuse across the state. These findings provide a strong argument for the distribution of treatment and prevention resources proportional to need.

Aim: To provide more in-depth information about students' experiences with AlcoholEdu and in particular to assess if students perceive that the course gives them tools to better control their drinking-related behavior. Methods: Focus group interviews with freshmen at three California universities. Findings: 1) The course provides so much information that everyone can find some of it relevant; 2) participants prefer information presented in ways they can identify with; 3) participants report problems with surveys in the program pointing to redundancy and length; and 4) participants did not expect the course to impact their behavior relating to alcohol. Conclusion: AlcoholEdu provides valuable information for freshmen in college about how to avoid problems with alcohol. However, the course could have much more impact if closer to college reality.

Aims: To investigate the use and the obstacles to use of screening and brief interventions (SBI) for alcohol misuse among Norwegian general practitioners (GP). Methods: A questionnaire with 68 questions about the use and barriers to use of SBI in general practice was mailed to 2000 randomly selected Norwegian GPs. Results: The survey response rate was 45%. There was a much higher prevalence of using interventions (mean = 4.47 on a seven-point Likert scale) than of screening for alcohol problems (mean = 2.10 on a seven-point Likert scale). Regression models showed that knowledge and self-efficacy were the main predictors for GPs' use of screening instruments and use of interventions, respectively, in particular with regard to use of screening. However, GPs' views of their relationship with their patients, and structural factors were significant predictors. Conclusions: (i) Norwegian GPs do not necessarily see the link between screening for alcohol problems and conducting interventions. (ii) Factors on at least three levels, i.e. personal, social and structural, play significant roles for understanding the problems related to implementing the use of SBI in general practice. (iii) Training GPs in the use of SBI is important but may not increase GPs' use of SBI due to social and structural barriers.

Wine is increasing in popularity among young adults in the United States. Previous research has shown that when young adults consume wine, they typically do so in moderation. This article reports on the findings of an exploratory, qualitative study conducted in 2006 that investigated factors associated with moderate wine drinking occasions among young adults. We conducted semistructured interviews with 15 young adults between the ages of 18–26 from Northern California university communities. Using a pattern-level analytic approach, interviews revealed two modes in which these young adults drink: outcome-oriented and process-oriented drinking. These two drinking outcomes were associated with different beverages, consumption patterns, drinking settings, sociability, and levels of maturity, as perceived by study participants. This article considers moderate drinking occasions among young adults in order to develop strategies to reduce harm associated with heavy consumption. Our pilot study offers insight into this perspective and provides a basis for future research.

AIMSThe qualitative component of this mixed methods study aimed at obtaining more in-depth information about the barriers of implementation of screening and brief interventions (SBI) in general practice identified in the quantitative component by giving general practitioners (GPs) the opportunity to discuss and report on the particular difficulties they experience in relation to identification and treatment of alcohol problems in their daily work.METHODSFocus-group interviews were performed with seven groups of GPs in different parts of Norway, encompassing 40 participants. The interviews were transcribed and analyzed using the QDA Miner software.RESULTSThe analysis revealed five major groups of factors influencing GPs' reluctance to use SBI for alcohol problems: (a) perception of alcohol problems, (b) integration of SBI into existing routines, (c) prevention vs. treatment, (d) structural issues and (e) the relationship between practitioner and patient.DISCUSSIONThe analysis showed that problems of implementing SBI in general practice are a complex issue. The quantitative part of the project revealed a strong association between knowledge/self-efficacy and the use of SBI. However, in the qualitative study, we were able to look in more detail at some of the findings from the first part. Even if the lack of knowledge of SBI was still significant, the five factors identified in this study appeared important for the GPs' decisions to use SBI in individual cases.

Context: Potentially effective environmental strategies have been recommended to reduce heavy alcohol use among college students. However, studies to date on environmental prevention strategies are few in number and have been limited by their nonexperimental designs, inadequate sample sizes, and lack of attention to settings where the majority of heavy drinking events occur.Purpose: To determine whether environmental prevention strategies targeting off-campus settings would reduce the likelihood and incidence of student intoxication at those settings.Design: The Safer California Universities study involved 14 large public universities, half of which were assigned randomly to the Safer intervention condition after baseline data collection in 2003. Environmental interventions took place in 2005 and 2006 after 1 year of planning with seven Safer intervention universities. Random cross-sectional samples of undergraduates completed online surveys in four consecutive fall semesters (2003-2006).Setting/participants: Campuses and communities surrounding eight campuses of the University of California and six in the California State University system were utilized. The study used random samples of undergraduates (similar to 500-1000 per campus per year) attending the 14 public California universities.Intervention: Safer environmental interventions included nuisance party enforcement operations, minor decoy operations, driving-under-the-influence checkpoints, social host ordinances, and use of campus and local media to increase the visibility of environmental strategies.Main outcome measures: Proportion of drinking occasions in which students drank to intoxication at six different settings during the fall semester (residence hall party, campus event, fraternity or sorority party, party at off-campus apartment or house, bar/restaurant, outdoor setting), any intoxication at each setting during the semester, and whether students drank to intoxication the last time they went to each setting.Results: Significant reductions in the incidence and likelihood of intoxication at off-campus parties and bars/restaurants were observed for Safer intervention universities compared to controls. A lower likelihood of intoxication was observed also for Safer intervention universities the last time students drank at an off-campus party (OR=0.81, 95% CI=0.68, 0.97); a bar or restaurant (OR=0.76, 95% CI=0.62, 0.94); or any setting (OR=0.80, 95% CI=0.65, 0.97). No increase in intoxication (e. g., displacement) appeared in other settings. Further, stronger intervention effects were achieved at Safer universities with the highest level of implementation.Conclusions: Environmental prevention strategies targeting settings where the majority of heavy drinking events occur appear to be effective in reducing the incidence and likelihood of intoxication among college students. (Am J Prev Med 2010; 39(6): 491-499) (C) 2010 American Journal of Preventive Medicine

Many community-based intervention studies experience problems with collaboration between researchers and practitioners. A preferred strategy appears to be to form community coalitions to carry out the proposed interventions in the community, but doing so risks shifting the focus from intervention objectives to coalition process. As a by-product, coalitions often lack understanding of the project goals and are not given specific instructions on how to implement the intervention. In contrast to conventional wisdom, the Safer California Universities study implemented a very directive approach in collaboration with local liaisons on the participating campuses, even though this approach is seen to risk cooperation or commitment from collaborators. This paper reports on the findings of a qualitative study based on interviews with campus liaisons of how the directive approach was perceived on the participating campuses. Findings indicate that the strategy was successful in terms of “getting things done” but could have been improved in terms of liaison involvement in setting objectives, and in finding the optimal level of specificity.

This study identifies social mechanisms that might help prevent youth from being involved in driving under the influence of alcohol (DUI) and riding with drinking drivers (RWDD). Data collected through telephone surveys with 1534 adolescents and young adults aged 15-20 years (mean=17.6, S.D.=1.6) in California, USA, were analyzed. Structural equation modeling analyses showed that DUI and RWDD were strongly related to drinking in unstructured situations, modeling of DUI by peers and parents, and perceived peer approval or disapproval of DUI. DUI outcome expectancies were indirectly related to DUI and RWDD through situational drinking. Parental monitoring and DUI law enforcement were also indirectly related to DUI and RWDD through DUI expectancies and other mechanisms. The findings, overall, suggest that parental influence remains important even through late adolescence. Parental monitoring, in particular, might help to reduce unstructured socializing with peers, drinking, and affiliation with peers who engage in DUI. Parental monitoring may also foster beliefs about the risks of DUI. Conversely, parents' own DUI behavior may normalize drinking and DUI behaviors, thus countering monitoring efforts.

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.

Screening and brief intervention (SBI) as a method within secondary prevention of alcohol use-related problems has experienced enormous attention and interest over the past 20 years. Initial results were very promising and great effort was put into designing screening instruments and developing different kinds of interventions. However, at the same time, the approach has generated problems in its own right. Some of these problems relate to standardization of instruments and some to criteria of inclusion into samples; others relate to the focus on the individual drinking style independent from social influences. In light of these problems, it is necessary to elaborate on the theoretical foundation, as well as on the methods used in SBI. This article introduces a method for intervening in social networks with important implications for SBI. By putting emphasis on the motivational part of SBI and including social networks in the field of intervention, it may be assumed that the approach will produce better results than heretofore. The results from a Danish qualitative study on intervening into the social network of social drinkers are presented. This study was carried out between 1991 and 1999 and involved 13 adult Danes between 35 and 45 years of age. They all had a weekly alcohol consumption of 120 to 360 g of pure alcohol and they all considered themselves to be social drinkers. The results of this study show that enhanced awareness of the person's own drinking, as well as that of peers, may influence decisions about specific drinking situations. These findings and the perspectives for SBI are discussed. Recommendations for further research are also presented.

Alcohol policy refers to (1) formal legal and regulatory mechanisms, rules, and procedures for reducing the consumption of alcohol or risky drinking behaviors; and (2) enforcement of these measures. Policy approaches to preventing and reducing drinking and drinking problems among youth have traditionally focused on limiting access to alcohol or on direct deterrence of young drinkers or those who supply alcohol to them. The aim of such policies is to increase the "full price" of alcohol to young people by increasing resources necessary for them to obtain it or the potential costs for possessing or consuming it. More recently, policies have begun to focus on harm reduction. Harm reduction policies attempt to prevent or reduce alcohol problems by targeting heavy drinking, drinking in risky situations, or by moderating the relationship between drinking and problem outcomes, without necessarily affecting overall consumption.Based on the available evidence, the most effective policies appear to be: (1) taxation or price increases; (2) increases in the minimum drinking age; (3) zero tolerance; and (4) graduated licensing. Random breath testing, sobriety check points, and dram shop liability appear promising for reducing drinking and drinking problems based on studies with the general population, although there is less evidence for their effectiveness specifically with young people. The evidence is growing for the effects of license restrictions (e. g., limiting outlet density or hours of sale). There is some support for responsible beverage service programs, particularly those that are mandated or motivated by reduction of liability. The evidence on advertising restrictions is conflicting. Evidence that designated driver and safe rides programs, warning labels, social host liability, and keg registration are effective strategies for preventing drinking or drinking problems among young people is lacking.Overall, there is insufficient research to evaluate the effects of many alcohol policies on alcohol consumption or problems among young people. Such research should be conducted to inform policy and evaluate policies as they are implemented. Finally, it is clear from the available research that policies cannot be effective unless accompanied by enforcement and by awareness on the part of the intended targets of the policy and enforcement efforts.

The prelims comprise: Summary Alcohol Policy and Youth Drinking: Overview of Effective Interventions for Young People Alcohol Policies for Reducing Youth Drinking Public Health Policies Harm Reduction Policies Conclusion Acknowledgement References

Policy approaches to prevention have considerable promise for addressing underage drinking and its associated problems. Based on the available evidence, the most effective policies appear to be (a) taxation or price increases, (b) increases in the minimum drinking age, and (c) graduated licensing or zero tolerance. Random breath testing and sobriety checkpoints also appear promising, although there is little evidence for their effectiveness specifically with young people. Major changes in the conditions of sale (e.g., privatization) may also affect the availability of alcohol to young people and thus underage drinking. The evidence is less convincing, however, for the effects of more modest license restrictions (e.g., limiting outlet density, hours of sale), responsible beverage service, advertising restrictions, warning labels, keg registration, and school policies. It is clear from the available research that no policy can be effective unless it is accompanied by enforcement and by awareness on the part of the intended targets of both the policy and the enforcement efforts.

Policy approaches to prevention have considerable promise for addressing underage drinking and its associated problems. Based on the available evidence, the most effective policies appear to be (a) taxation or price increases, (b) increases in the minimum drinking age, and (c) graduated licensing or zero tolerance. Random breath testing and sobriety checkpoints also appear promising, although there is little evidence for their effectiveness specifically with young people. Major changes in the conditions of sale (e.g., privatization) may also affect the availability of alcohol to young people and thus underage drinking. The evidence is less convincing, however, for the effects of more modest license restrictions (e.g., limiting outlet density, hours of sale), responsible beverage service, advertising restrictions, warning labels, keg registration, and school policies. It is clear from the available research that no policy can be effective unless it is accompanied by enforcement and by awareness on the part of the intended targets of both the policy and the enforcement efforts.