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) Substance2000 Merrill Search Survey 2000 Tomahawk Search Survey 2003 Tomahawk Search Survey 2004 Merrill Search Survey Alcohol40% 46%38% Cigarettes26%31%28%20% Smokeless Tobacco 12%21%17%7% Marijuana11%*22%*27%*15%* Survey was issued to all 6-12 th 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 Drug- Free 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 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? 1.Yes 2.No 10

SAMSHA’s Strategic Prevention Framework (

Are you familiar with this framework? 1.Yes 2.No 10

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, e- mails 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, data- driven 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

HostAgent Environment Public Health Triangle Individual Prevention: focuses on changes to the host Environmental Prevention: Focuses on change to the agent and environment

The most common source of alcohol is youth buying it themselves? 1.True 2.False 10

False

How easy was it for youth to get alcohol, if they drank … 1.Very Easy 2.Easy 3.Difficult 4.Very Difficult 10

Easier than you would think…

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.Very Easy 2.Easy 3.Difficult 4.Very Difficult 10

Easier than you think…

Decreasing Availability of Prescription Drugs Drug Round-ups ( pounds; 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? 1.5% 2.25% 3.93% 4.47% 10

What percentage of parents/guardians believe the “typical student” has used alcohol in the past 30 days? 1.47% 2.95% 3.25% 4.5% 10

What percentage of staff believe the “typical student” has used alcohol in the past 30 days? % 2.98% 3.47% 4.5%

Social Norms Project To challenge and correct misperceptions about alcohol, tobacco and other drug use. To use positive peer pressure.

Former Director, National Social Norms Research Center, Northern Illinois University “Seek the truth (survey) and tell the truth (marketing campaign) about responsible health and safety being the norm.” - Michael Haines

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 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 5 th 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…. 8 th grade 9 th grade 10 th grade 11 th grade 12 th grade In the last 30 days, had at least one drink of alcohol Class of % Class of %55% Class of %48%41% Class of %37%45% Class of %41%45% Class of %42% Class of %

Perception Parental Disapproval Alcohol

Perception Parental Disapproval Tobacco

Perception Parental Disapproval Marijuana

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 (

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?