This paper summarizes what is known about community-based approaches for the prevention of ATOD problems and how the current practices in the field reflect these approaches. The first section of the chapter provides a brief summary of events early in this century when community-based approaches were central to addressing alcohol and other public health problems. The second section contains an overview of current research and empirical findings that yield consensus as to what conceptually and in practice constitutes a comprehensive, community-based prevention program for the prevention of ATOD problems. The third section reviews the literature of existing programs to assess the extent to which they include the salient elements and employ interventions determined to be fundamental to comprehensive community-based prevention programs. The final section discusses some of the challenges that confront researchers and practitioners when developing prevention initiatives and programs in high-risk environments.
While overall alcohol consumption and alcohol-related automobile deaths have declined, rates of alcohol dependence, liver cirrhosis, and alcohol-related problems remain high among adults, and binge drinking continues as a major health risk for high school and college students. Some individual-level downstream interventions have been evaluated with sufficient rigor to recommend widespread dissemination, and widened availability of new pharmacotherapies could further increase effectiveness. Midstream population-based programs, such as screening and brief interventions in hospitals and managed care organizations, may have greater public health impact than tertiary treatment because of early identification and low cost. Upstream programs and policies that place limits on alcohol availability (e.g., higher legal purchasing age) have the greatest potential to reduce morbidity and mortality at the least cost to society.
This article describes the Perth Amboy Community Partnership for Youth (PACPY), a comprehensive community-based intervention designed to reduce risk factors for alcohol, tobacco, and other drug use among Latino youth. The intervention is grounded in the principles of community empowerment and participatory education, and attempts to facilitate within the community a broad understanding of the societal factors that increase risk of drug use and related problems among young people. PACPY attempts to bring about change at both the individual level and the environmental level within the domains of the school, the family, and the community. The present article describes the types of interventions introduced through PACPY within each of these domains, and examines their impact on individual and environmental changes in the use and availability of tobacco products. We conclude with a discussion of some of the methodological issues that have arisen over the course of the evaluation, and outline the changes that have occurred in our underlying conceptual framework.
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