About Causal Areas

About Causal Areas

Following the path-breaking work of Birckmayer, Holder, Yacoubian, and Friend (2004), WYSAC organized the environmental strategies in accordance with the general causal model in which each strategy is identified by causal area.

Seven causal areas make up the causal area prevention model. These include…

  • availability (economic availability, retail availability, social availability)
  • community norms
  • enforcement
  • promotion and media
  • individual factors

The general causal model is intended to assist prevention professionals by helping explain the complexities associated with substance abuse and illuminate multiple intervention points within the system (Birckmayer et al., 2004).

The following section contains a description of each causal area.

Availability

Disrupting the availability of alcohol, tobacco, and other drugs is one way to prevent use of these substances. If a substance is not available, the substance cannot be used and problems associated with use are likely to diminish.

The availability of alcohol, tobacco, and other drugs depends on the price of the substance, the supply of the substance through retail means, and the supply of the substance through other social outlets—such as family and friends (Birckmayer et al., 2004).

Accordingly, availability is broken down into three separate areas: economic availability, retail availability, and social availability. While these areas are dynamic, individually they each provide a potential point of intervention to prevent alcohol and other drug use.

Economic Availability

As a general rule, the demand for a good is dependent on the price of the good. The demand for some goods is extremely sensitive to price, whereas the demand for other goods remains relatively stable despite fluctuations in price.

In the case of alcohol and tobacco, there is a wide range of evidence from econometric research that demonstrates price is strongly associated with alcohol and tobacco use and related problems. A higher price is associated with lower use (Birckmayer et al., 2004).

Environmental prevention strategies that focus on increasing the price of alcohol, tobacco, and other drugs are categorized under the causal area of economic availability.

Retail Availability

Retail availability refers to the accessibility of alcohol, tobacco, and other drugs through retail markets. Retail markets include formal markets such as restaurants, bars, and other legal venues, as well as informal and illegal markets such as private homes and unlicensed businesses (Birckmayer et al., 2004).

Restricting retail availability limits consumers’ access to substances, thereby limiting use. Restricting retail availability can be achieved through multiple environmental prevention strategies. Strategies that impose restrictions on the purchaser include requiring a minimum age for purchase of a substance or entry into retail outlets.

Prevention strategies targeting the physical availability of the substance within the retail market include limiting the density of retail outlets, restricting the hours of retail operation, limiting conditional use permits, and restricting “happy hour” promotions. Finally, prevention strategies may also restrict the seller/server of the substance through liability laws and seller/server training requirements.

Social Availability

Social availability refers to the procurement of alcohol, tobacco, and other drugs through “social” sources outside of retail markets, including family, friends, and other acquaintances (Birckmayer et al., 2004). Unlike retail availability, social availability does not rely on the exchange of money or goods for the product and is not regulated at the state or local level. Therefore, interventions that are effective in the retail market may not be effective in social markets.

Some examples of environmental prevention strategies that aim to restrict social availability include alcohol restrictions at community events, alternative events for youth, texting tip lines, and responsible event assessment. Because social availability of a substance occurs outside regulated markets, it is much more difficult to measure the amount of product available and the extent to which it is reaching the consumer.

Most of the research on social availability remains in the early stages of investigation and relies on self-reported data (Birckmayer et al., 2004).

Community Norms

Norms shape the level of acceptance of alcohol, tobacco, and other drug use within a community. This level of community acceptance is translated into individual use of the substance through the collective desire to conform to social and group norms (Birckmayer et al., 2004).

Norms can vary across different social groups and may reflect differing levels of acceptable substance use between social groups. Public policies, laws, and regulations are based on norms and ultimately affect the availability and promotion of substances within a community (Birckmayer et al., 2004). In this way, the availability, promotion, and norms surrounding substance use all interact to determine the level of use and associated problems within a community.

Active coalition building is one example of an environmental prevention strategy that focuses on changing community norms around the use of alcohol, tobacco, and other drugs. For example, a key component of Communities Mobilizing for Change on Alcohol (CMCA), a community-organizing program designed to reduce teens’ access to alcohol, is to communicate a clear message to the community that underage drinking is inappropriate and unacceptable (NREPP, 2012).

While it remains difficult to accurately measure community norms surrounding substance use, more research is necessary to determine the link between community norms and substance use.

Enforcement

Public policies, laws, and regulations governing alcohol, tobacco, and other drug availability, promotion, and use rely on active enforcement for effective implementation. Enforcement may include surveillance of substance sales at retail outlets, issuing penalties and fines for violations, community policing of local ordinances, and providing incentives for upholding substance-related policies. While it remains unclear whether actual enforcement or simply the perceived threat of enforcement motivates individuals to comply with laws related to alcohol, tobacco, and other drugs, research shows that as the likelihood of detection, arrest, and/or citation increases, so does compliance (Birckmayer et al., 2004).

Enforcement prevention strategies take many forms. Strategies focused on impaired driving include the use of sobriety checkpoints, revoking licenses of impaired drivers, impounding or immobilizing vehicles of impaired drivers, open container laws, and lower legal blood alcohol concentration laws (<.08).

Enforcement efforts aimed at preventing underage drinking include compliance checks, shoulder tap operations, graduated license policies, teen party ordinances, and curfew ordinances.

Enforcement policies focused on the prevention of use and abuse of alcohol, tobacco, and other drugs are associated with increased reductions in substance use and related problems above and beyond simply the passage or existence of laws targeting these substances (Birckmayer et al., 2004).

Promotion and Media

In addition to availability, use of alcohol, tobacco, and other drugs is influenced by promotion of substance use and abuse in the media. Here, promotion refers to increased consumer exposure to a product through advertisements, discounts, and/or event sponsorship. For example, many alcohol and tobacco companies depict enjoyable use of their product through different promotional methods in order to recruit new users and retain current users, while improving attitudes about overall product use (Birckmayer et al., 2004).

Environmental prevention strategies can impose restrictions on the promotion of alcohol, tobacco, and other drug use. Restrictions can limit where advertisements are located, including restrictions in public places, sporting-event sponsorship, the type of media used to display the advertisement, and when the advertisements are viewed.

Environmental prevention strategies may also include the use of counter-marketing campaigns or require retailers to display warning posters. There is limited evidence about the relationship between illicit drug-market promotion and illicit drug use but it is likely the relationship is similar to the relationship between promotion and use of legal substances (Birckmayer et al., 2004).

Mitigating the promotion of alcohol, tobacco, and other drugs provides a means of intervention unrelated to substance availability.

Individual Factors

Individual factors make up the seventh and final area in the general causal area model. However, because the objective of this catalog is to assess environmental prevention strategies, strategies that target individual factors are not included in this resource.