Shifting our focus
Since at least 1934, the Minnesota legislature and public schools have attempted to prevent problems caused by alcohol use by educating individual students about "the effects of alcohol on the human body, character, and society."1,2 In the past two decades, there has been a remarkable expansion of prevention efforts focused on helping individual young people acquire knowledge and skills believed to be necessary to avoid substance use. There are many examples of programs designed to increase students' awareness of negative consequences of substance use and to help them develop skills to resist opportunities to use.
However, most of these efforts have demonstrated limited success in reducing substance use by youth. Program evaluations and prevention research projects have often produced disappointing results. Despite the popularity and social acceptance of many prevention programs aimed at strengthening individual youth to resist substance use, many prevention specialists, educators and policy makers are questioning their effectiveness.
Throughout the country and in many Minnesota communities, there is an intentional shift occurring in the target of prevention efforts. This shift is away from prevention programs targeted toward individuals at risk for substance use toward an environmental approach to prevention. These environmental approaches address community policies and practices that promote or restrict substance use. This approach attempts to alter the community environment to make it less supportive of substance use. The environmental approach is grounded in the public health model and the theory that substance use and subsequent problems will increase in environments that tolerate or encourage use. Conversely, use and related problems will decrease in environments that discourage use that leads to problems.
This shift in focus reflects an emerging understanding of the power of social determinants of health and is not limited to substance use prevention approaches. The rationale for focusing on the environment is based on the belief that since most behavior is socially determined, individual behavior will only be changed by changing the social environment. Even with our knowledge of the impact of individual risk factors and assets on behavior, in the long run, it may be most helpful to address the reduction of risk factors and the development of assets at a societal level.
Environmental Prevention StrategiesExamples of environmental prevention strategies currently being implemented include
What are the Challenges?
A key challenge for those working to promote health and prevent health problems is to "tackle the environment that establishes levels of exposure to risk."3 This is not an easy challenge to accept or manage. There are strong competing influences supporting the status quo.
Efforts to change substance use behavior require multiple efforts at multiple levels within communities. Community policies and norms about substance use have a powerful effect on how individual adults and youth make choices about alcohol and tobacco products. Efforts to influence both policies and norms are essential to the success of prevention. Enactment and enforcement of laws, regulations and policies are key elements of an environmental approach to prevention. Discussion of social norms about substance use and education of youth and adults are also important strategies. Government, schools, work-sites, religious institutions and social organizations each need to consider their opportunities and responsibilities to create a safe and healthy environment in their community. There are many opportunities for each of us to become involved in influencing our community norms and policies. Formally working to influence statewide legislation, working to youth access to alcohol and tobacco, and modeling the kind of behavior we want to see in our community are all ways that we can positively affect the environment of our state and communities.
Many communities are currently wrestling with how to blend environmental and individually focused approaches to prevention in ways that will effectively reduce substance use problems. Environmental approaches to prevention cannot simply replace efforts to equip individuals with the knowledge and skills needed to maintain their own health. American society is grounded in a commitment to individual responsibility. Yet, our increasing understanding of the influence of the social environment on individual health behavior is a strong incentive to continue to explore and expand the use of environmental approaches to prevention. The shifting focus of prevention strategies toward changing community policies, practices and norms about substance use holds great promise in our efforts to promote health and reduce problems.