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Treno, Andrew J.; and Holder, Harold D. In International Handbook of Alcohol Dependence and Problems pgs. 771-783 , New York, NY.: John Wiley and Sons, Ltd. (2001) Editor(s): Heather, N.; Peters, T.J.; and Stockwell, T.R. The prevention of alcohol problems at the local level has a relatively short but rich history compared to the community efforts to reduce other health problems. For example, health professionals concerned with the prevention of chronic diseases have accumulated over 20 years of experience in local programs designed to reduce cardiovascular disease (CVD). Typically, these have been directed toward either high-risk subsets of the population, carried out in clinical settings or in worksites, or directed at the entire populations in communities. Based upon the successes of studies, similar programs have been developed over the past 10 years or so to address problem drinking and alcohol-related problems. However, few of these have been characterized by: (a) the development of a careful baseline planning and pre-intervention period; (b) well-defined community-level alcohol-involved problems as targets; (c) a long-term implementation and monitoring period; (d) a follow-up or final scientific evaluation of changes in target problems; and (e) an empirically documented successful result in the target that can be attributed to the intervention. Thus it is difficult to say with certainty whether these programs have been effective. This chapter presents the project designs and findings of programs designed to address problem drinking and alcohol-related problems and include all five of the above characteristics. Specifically, for each study we consider the presence of a baseline measurement period, the specific problem targeted and its operationalization, the implementation and monitoring period, the structure of scientific evaluation of expected program effects, and the extent to which such effects were found to be attributable to program efforts. The chapter is organized in the following manner. It begins by presenting a brief discussion of the pre-history of local alcohol programs. Here we note the success of local efforts addressing other chronic health problems, such as heart disease, smoking and adolescent pregnancy, and note that the success of such programs provided optimism concerning the potential for local efforts to combat problem drinking and alcohol-related problems. The chapter then notes that alcohol programs designed to alter individual use of alcohol, either through school-based education or the media campaigns following the chronic health problem model, have found only limited success. As an alternative approach, the chapter then discusses a number of alcohol programs designed around environmental approaches. The chapter concludes with a summary of what is currently known about the efficacy of local alcohol programs and a discussion of potential areas for future research.
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