Environmental Prevention

    The Environmental Approach to Prevention: Implementing Alcohol Policies
    Environmental prevention uses policy interventions to create an alcohol environment that supports healthy, safe behavior. Research over the last two decades demonstrates that these policy reforms work. They reduce the problems associated with youth drinking (1).

    For example:
  • Increasing alcohol taxes and reducing discount drink specials substantially reduce heavy and hazardous drinking among college and high school students. (2)
  • Decreasing the number of alcohol outlets in a community is closely associated with reduction in rates of alcohol-related youth violence. (3)
  • Holding retailers liable for damage inflicted on others by intoxicated and underage patrons (asserting dram shop liability) promotes responsible server practices and reduces alcohol-related traffic crashes. (4)
  • Increasing the minimum legal drinking age to 21 substantially reduces youth alcohol-related motor vehicle crashes; and increasing enforcement of laws prohibiting sales to underage drinkers reduces youth access to alcohol. (5)
  • Reducing noncommercial forms of youth access to alcohol (e.g., parties, older friends) shows promise in reducing youth drinking problems.(6)
  • Reducing the amount of youth exposure to alcohol advertising and increasing the number of alcohol counter-ads have a positive impact on youth beliefs and intentions regarding alcohol use and may influence drinking decisions. (7)
  • Combining environmental strategies such as those listed above and implementing them in a comprehensive community program results in substantial reduction in underage drinking and alcohol-related problem rates.(8)

    Various federal agencies and non-governmental organizations have recommended these and other alcohol policies, most of which receive strong support in national opinion surveys. (9)

    Many are being implemented as the local level, responding to community concern and pressure for action. Local reforms include reduced numbers of alcohol billboards and other kinds of outdoor advertising, restrictions on the number and location of alcohol outlets, and reforms in alcohol practices. (10)

    Environmental strategies complement, rather than replace, strategies targeting individual behavior (such as social norms and other educational programs). Individual-based programs can have only limited impact if environmental forces undermine and contradict their messages and advice. Conversely, environmental strategies enhance individual-based strategies, by creating a social climate that reinforces the educational messages.


    (1) Edwards, G., et al. Alcohol Policy and the Public Good. New York, NY: Oxford University Press, 1994. Stewart, K. Environmentally oriented alcohol prevention policies for young adults, pp. 107-57 in: Substance Abuse and Mental Health Services Administration/Center for Substance Abuse Prevention, Secretary's Youth Substance Abuse Prevention Initiative Resource Papers. Rockville, MD: SAMSHA, 1997. Wagenaar, A., & Toomey, T. Alcohol Policy and intervention research: Issues and research needs. Paper presented at the National Institute on Alcohol Abuse and Alcoholism (NIAAA) Extramural Scientific Advisory Board Meeting on Prevention, Washington, D.C., October 21-22, 1998. Minneapolis, MN: University of Minnesota, School of Public Health, Division of Epidemiology.

    (2) Laixuthai, A. & Chaloupa F., supra n. 41;Grossman, M., Saffer, H., & Chaloupa, F. Alcohol, Regulation, and Motor Vehicle Mortality. Final report for grant no. 5R01AA07593. Rickville, MD: National Institute on ALcohol Abuse and Alcoholism, 1991. Chaloupa, F., Saffer, H., & Grossman, M. Alcohol-control policies and motor vehicl fatalities. Journal of Legal Studies 22: 161-86, 1993. Wechsler, H. et al., supra n. 42

    (3) Alaniz, M., Cartmill, R., & Parkwer, R. Immigrants and violence: The importance of neighborhood context. Hispanic Journal of Behavioral Sciences 20(2): 155-74, 1998. Scribner, R., Cohen, D., Kaplan, S., & Allen, S. Alcohol availability and homicide in New Orleans: Conceptual considerations for small area analysis of the effect of alcohol outlet density. Journal of Studies on Alcohol 60(3): 310-16, 1999.

    (4) Wagenaar, A., & Holden, H. Effects of alcoholic beverage server liability on traffic crash injuries. Alcoholism: Clinical and Experimental Research 15: 942-47, 1991.

    (5) Wagenaar, A., Alcohol, Young Drivers, and Traffic Accidents: Efforts of Minimum Age Laws. Lexington, MA: Lexington, Bks., 1983. Grube, J. Preventing sales of alcohol to minors: Results from a community trial. Addiction 92 (Suppl. 2): S251-S260, 1997.

    (6) Mosher, J., & Stewart, K. Regulatory Strategies for Preventing Youth Access to Alcohol: Best Practices. Report prepared for the OJJDP National Leadership conference in support of the OJJDP Enforcing the Underage Drinking Laws Program. Rockville, MD> Pacific Institute for Research and Evaluation, 1999.

    (7) Grube, J. Television alcohol portrayals, alcohol advertising, and alcohol expectations among children and adolescents, pp. 105-22 in Martin, S., ed., The Effects of the Mass Media on the Use and Abuse of Alcohol. Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism, Research Monograph No. 28, 1996. Grube, J., & Wollack, L. Television beer advertising and drinking knowledge, beliefs, and intentions among schoolchildren. American Journal of Public Health 84: 252-259, 1994. Slater, N. et. al. Male adolescents' reactions to TV beer advertisements: The effects of sports content and programming context. Journal of Studies on Alcohol 57: 425-433, 1996. Saffer, H. Studying the effects of alcohol Advertising on consumption. Alcohol, Heatlh & Research World 20: 266-272, 1996. Saffer, H. Alcohol advertising and motor vehicle fatalities. Review of Economics and Statistics 79: 431-442, 1997.

    (8) Holder, H., et al. Effect of community-based interventions on high-risk drinking and alcohol-related injuries. Journal of the American Medical Association 284: 2341-2347, 2000. Wagenaar, A., et. al. Communities Mobilizing for Change on Alcohol (CMCA): Lessons and results from a 15-community trial. Journal of Studies on Alcohol 61: 85-94, 2000. Wagenaar, A., Murray, D., & Toomey, T. Communities Mobilizing fro Change on Alcohol (CMCA): Effects of a randomized trial on arrests and traffic crashes. Addiction 95: 209-217, 2000.

    (9) U.S. Surgeon General. Surgeon General's Workshop on Drunk Driving: Proceedings. Rockville, MD: Office of the Surgeon General, U.S. Department of Health and Human Services, 1998. Edwards, G., et al., supra n. 42. Moore, M., & Gerstein, D., eds. Alcohol and Public Policy: Beyond the Shadow of Prohibition. Washington, DC: National Academy Press, 1981. Wagenaar, A., Harwood, E., Toomey,T., Denk, C., & Zander, K. Public opinion on alcohol policies in the Unitee States: Results from a national survey. Journal of Public Health Policy 21(3): 303-327, 2000.

    (10) Streicker, J., ed. Case Histories in Alcohol Policy. San Francisco, CA: Trauma Foundation, 2000.

    © 2002 American Medical Association