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east county rural

Action Kit / Body Text / Introduction & Overview
PURPOSE
This Action Kit has been created to assist rural communities in their efforts to prevent underage drinking.  It is meant to be a “how-to-guidebook” for community members.  Included in this Action Kit are examples that can be utilized by community leaders, a step-by-step outline for implementing environmental prevention in rural communities and a slide show with presenter notes.  Specific and unique issues faced by rural areas will be addressed.
Why do these issues need to be addressed in your rural community?
Underage drinking is especially prevalent in rural communities given the lack of other activities for teenagers, as well as limited funding and services for alcohol and other drug prevention programs.  Teenagers get their alcohol from older friends and siblings, local stores and parents.  Given this, community members, parents, youth and law enforcement must work together to prevent the problems associated with underage drinking.   Preventing these problems involves more than enforcing DUI laws, it involves preventing youth access to alcohol in the first place.  This is why it is imperative that all facets of the community work together to change community norms around providing youths with access to alcohol.
As in the case in nonrural areas, drinking and drinking-related problems are not confined to youth.  Therefore addressing drinking-related problems also means focusing some efforts on adults and general alcohol-related problem reduction; roving DUI patrols, service to over-intoxicated people and controls on alcohol service at community events.
There are a number of public health and safety problems related to teen drinking including:

  • deaths and injuries resulting from impaired driving

  • unplanned pregnancy;

  • drowning;

  • sexually transmitted infections, including HIV;

  • poor performance or drop out from school;

  • addiction to alcohol and other drugs;

  • alcohol-related crime and violence, including rape and murder. 
Underage drinking and driving in rural communities can be especially deadly given the following: poorer road quality, greater distances traveled by youth, and greater distance from hospitals or emergency care facilities resulting in a high number of deaths from alcohol-related crashes.1 In fact, drivers under 21 involved in fatal crashes on rural roads are 18.4% more likely to be under the influence of alcohol than drivers under 21 on nonrural roads.2
RUAPP:  One model for rural environmental prevention

The Rural Underage Alcohol Problem Prevention Project (RUAPP) is a cross-disciplinary, multiple-intervention demonstration project targeting rural East San Diego County, California.  This project was designed to impact underage drinking through a public health and safety approach of enhanced community collaboration, high-visibility law enforcement and increased public information.  Uniquely, it applied an environmental prevention model to the rural communities, instead of a traditional individual-behavior focused prevention model.  RUAPP was a seed project that involved exploration and getting to know the community.  This was necessary before policy goals could be set for the project and work toward these goals could actually begin.

Throughout this action kit, examples from RUAPP will be discussed.  While this is only one example of an underage drinking prevention project, it provides examples to assist rural communities in their own work.
Environmental prevention in rural communities
Environmental prevention is a prevention approach proven to reduce the problems associated with underage consumption of alcohol.  It does so by changing the underlying environment and social conditions contributing to alcohol consumption by minors.  It changes the way alcohol problems are addressed from an individual focus to an environmental focus.  Unlike individual-behavior focused prevention, environmental prevention seeks to create permanent change in the underlying environmental conditions linked to the problems by achieving policy and social norm changes in the community and results in the broad, long-term changes necessary to prevent recurrence of the problem. 
Environmental prevention also assumes that reducing alcohol availability will reduce alcohol consumption or modify the conditions under which alcohol is consumed, consequently reducing alcohol-related problems.3 Some environmental variables that can be addressed are community attitudes and traditions, alcohol-retailer practices, public event practices, public policy, marketing strategies, lack of public awareness, enforcement procedures, and access to appropriate resources. 
One tool utilized in environmental prevention is media advocacy.  Media advocacy is the strategic use of newsmaking through TV, radio, print and the Internet to promote public debate and generate community support to change community norms or policies.  This topic will be discussed in more detail in Section III:  Media Advocacy as a Prevention Tool.
Why is environmental prevention effective?
The more alcohol is available in the environment and the more socially acceptable alcohol use is, the more likely it is that the community will have a high rate of alcohol consumption and therefore a higher rate of alcohol-related problems.4 Rural communities are faced with high rates of underage drinking and limited resources to prevent the problems associated with this risky behavior.  Environmental prevention can be used in rural communities to change social and community norms surrounding youth access to alcohol and driving under the influence of alcohol.
Rural communities also have unique circumstances that make environmental prevention challenging.  For example rural areas tend to: have few media outlets and/or be a large distance from media outlets; have a large geographic area with a widely dispersed population and few law enforcement officers; and few organized community, youth and parent groups.  These are barriers that will be addressed in this action kit.
RUAPP applied environmental prevention through use of data, high-visibility law enforcement, media advocacy, and social norm modification around underage alcohol consumption.  With the exception of its proximity to the U.S./Mexico border, San Diego’s backcountry is like many other rural communities in social attitudes and demographics.  For example:  students are geographically separated by many miles and are served by a unified school district with only one high school; many high school students report that they drank alcohol at parties where parents were present, or that parents purchased alcohol for them. 
1 Kelleher, K.J., Robbins, J.M. “Social and Economic Consequences of Rural Alcohol Use.”  National Institute of Alcohol Abuse and Alcoholism (NIAAA).
2 Unpublished document, data from National Highway Traffic Safety Administration (NHTSA). 1997, February.  1995 Youth fatal crash and alcohol facts (DOT HS 808 525). Washington, D.C.: US Department of Transportation, National Highway Traffic Safety Administration. National Center for Statistics and Analysis, Fatal Accident Reporting System.
3 Grover, P.L., Ph.D. “Preventing Problems Related to Alcohol Availability: Environmental Approaches”, Practitioners Guide. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention.  DHHS Publication No. (SMA) 99-3298.
4 Grover, P.L., Ph.D. “Preventing Problems Related to Alcohol Availability: Environmental Approaches”, Practitioners Guide. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention.  DHHS Publication No. (SMA) 99-3298.

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