An Evolution of Environmental Prevention Models Bob Saltz Richard McGaffigan Prevention Research...

An Evolution of Environmental An Evolution of Environmental Prevention ModelsPrevention Models

Bob SaltzBob SaltzRichard McGaffiganRichard McGaffigan

Prevention Research CenterPrevention Research CenterBerkeley, CaliforniaBerkeley, California

Pacific Institute for Research

and Evaluation PRCPrevention Research CenterPrevention Research Center

Presentation ObjectivesPresentation Objectives

Planning phase discussionPlanning phase discussion Needs assessment Needs assessment

Baseline dataBaseline data Strategic partnersStrategic partners Resource assessmentResource assessment

Model programs vs evidence-based Model programs vs evidence-based strategiesstrategies

Evaluation strategyEvaluation strategy

Presentation ObjectivesPresentation Objectives

Outline an evolution of prevention Outline an evolution of prevention models by:models by: Describing the Community Trials Describing the Community Trials

projectproject The Border ProjectThe Border Project Safer California Universities projectSafer California Universities project

COMMUNITY TRIALS TO PREVENTCOMMUNITY TRIALS TO PREVENT ALCOHOL-INVOLVED TRAUMA ALCOHOL-INVOLVED TRAUMA

Prevention Research CenterPrevention Research CenterBerkeley, CABerkeley, CA

1991-19971991-1997

Sponsors:Sponsors: National Institute on Alcohol Abuse and Alcoholism National Institute on Alcohol Abuse and Alcoholism

&& Center for Substance Abuse PreventionCenter for Substance Abuse Prevention

Up to 50% of fatal car crashes involve alcohol. More than Up to 50% of fatal car crashes involve alcohol. More than 20,000 people are killed and 650,000 are injured annually.20,000 people are killed and 650,000 are injured annually.

Alcohol is involved in 22% of all home injuries in the U.S.Alcohol is involved in 22% of all home injuries in the U.S.

56% of injuries from fights or assaults involve alcohol56% of injuries from fights or assaults involve alcohol

Goal: Goal: Reduce Alcohol-involved Reduce Alcohol-involved

Trauma Trauma Traffic CrashesTraffic Crashes

InjuriesInjuries-- burns-- burns-- falls-- falls

DrowningsDrownings

ViolenceViolence

National Community Trial National Community Trial to Prevent Alcohol-to Prevent Alcohol-

involved Traumainvolved Trauma

OrangeOrange

OceansideOceanside..

..

..

-

ExperimentalExperimentalComparisonComparison

ModestoModesto

SalinasSalinas

FlorenceFlorence

SumterSumter

Five Prevention Five Prevention ComponentsComponents

1.1. Community MobilizationCommunity Mobilization

2.2. Responsible Beverage ServiceResponsible Beverage Service

3.3. Risk of Drinking and DrivingRisk of Drinking and Driving

4.4. Underage DrinkingUnderage Drinking

5.5. Alcohol AccessAlcohol Access

Alcohol-involved Trauma at the Community Level: Alcohol-involved Trauma at the Community Level: Conceptual ModelConceptual Model

MOBILIZATIONMOBILIZATIONMOBILIZATIONMOBILIZATION DRINKING AND DRIVINGDRINKING AND DRIVINGDRINKING AND DRIVINGDRINKING AND DRIVING

UNDERAGE DRINKINGUNDERAGE DRINKINGUNDERAGE DRINKINGUNDERAGE DRINKING

ALCOHOL ACCESSALCOHOL ACCESSALCOHOL ACCESSALCOHOL ACCESS

RESPONSIBLE BEVERAGE RESPONSIBLE BEVERAGE SERVICESERVICE

RESPONSIBLE BEVERAGE RESPONSIBLE BEVERAGE SERVICESERVICE

Non-Traffic Risk ActivitiesNon-Traffic Risk Activities

Local News about AlcoholLocal News about AlcoholProblems & EnforcementProblems & Enforcement

Retail Alcohol Retail Alcohol AvailabilityAvailability

(On and Off-premise)(On and Off-premise)Alcohol IntoxicationAlcohol Intoxication or Impairmentor Impairment

Alcohol-involvedAlcohol-involvedInjury and DeathInjury and Death

(Traffic and Other)(Traffic and Other)

Driving afterDriving afterDrinkingDrinking

Perceived Perceived Risk of ArrestRisk of Arrest

Local LawLocal LawEnforcementEnforcement

Social Access Social Access to Alcoholto Alcohol

Alcohol Alcohol Serving and Serving and

Sales PracticesSales Practices

Local Regulation Local Regulation of Alcoholof Alcohol

(Density, Hours (Density, Hours of Sale)of Sale)

Community Trials Final Community Trials Final ResultsResults

Driving after “Too much to drink” (- 49%)Driving after “Too much to drink” (- 49%)

BAC Positive Drivers (- 44%)BAC Positive Drivers (- 44%)

Heavy Drinking (-6%)Heavy Drinking (-6%)

AssaultsAssaults

Nighttime Injury Crashes (-10%)Nighttime Injury Crashes (-10%)

-- Hospital Cases (-2%)-- Hospital Cases (-2%) -- Emergency Room Cases (- 43%)-- Emergency Room Cases (- 43%)

The San Diego-Tijuana Project The San Diego-Tijuana Project to Reduce to Reduce

Teen and Binge DrinkingTeen and Binge Drinking

Institute for Public Strategieswww.publicstrategies.org

Institute for Public Strategieswww.publicstrategies.org

StrategyImplementation

Learning StrategySelection

Recruitment

Recruitment

System functional System functional model for community model for community

preventionprevention

Data Collection& Evaluation

CommunityMobilization

Research / Practice Research / Practice PartnershipPartnership

Pacific InstitutePacific Institute Data collectionData collection Data feedback to Data feedback to

programmingprogramming Program designProgram design Policy supportPolicy support Media hookMedia hook

Institute for Public Institute for Public strategiesstrategies Design and Design and

implement implement prevention strategyprevention strategy

PolicyPolicy Community Community

organizingorganizing MediaMedia Law enforcementLaw enforcement

Border field laboratoryBorder field laboratory

3.3.TijuanaTijuana

barsbars

North-North-boundboundborderbordersurveysurvey

4.4.2.2.South-South-boundboundborderbordersurveysurvey

San DiegoCounty

TelephoneSurvey

1.1.

The ProblemThe Problem

Underage and binge drinking in MexicoUnderage and binge drinking in Mexico Thousands of US teenagers cross into Thousands of US teenagers cross into

Tijuana on a weekend eveningTijuana on a weekend evening Alcohol related problems are the resultAlcohol related problems are the result

DUI CrashesDUI Crashes Fights, injuries, crime and arrestsFights, injuries, crime and arrests Exposure to STD’sExposure to STD’s Poor school performancePoor school performance

Strategic Change ModelStrategic Change Model

Scientific Data & Research

Media Advocacy

Community

Organizing

Policy

EnforcementEffective

Advocacy Campaign

Border ProjectBorder ProjectMultiple InterventionsMultiple Interventions

BinationalCollaboration

Southbound• Operation Safe Crossing

Tijuana• RBS training• ID training• Ban Alcohol Ads• Enforcement in Tijuana Bars

Northbound• Community Policing• DUI checkpoint

USA

Mexico

Safer California Safer California Colleges and Colleges and Universities:Universities:

A risk management A risk management approach to college approach to college

student drinking student drinking problemsproblems

Why Care About Why Care About College Student College Student

Drinking?Drinking?

Mean Score for 5+ Drinks in a Row in Past 2 Weeks by 4-year College Student Status

Wave 1 Wave 2 Wave 3 Wave 4

Measurement Wave

(18) (19-20) (21-22) (23-24)

Twice

Once

None

College

Non-College

InjuryInjury

500,000 students between the 500,000 students between the ages of 18 and 24 are ages of 18 and 24 are

unintentionally injured under the unintentionally injured under the influence of alcoholinfluence of alcohol

(Hingson et al., 2002)(Hingson et al., 2002)

AssaultAssault

More than 600,000 students between More than 600,000 students between the ages of 18 and 24 are assaulted by the ages of 18 and 24 are assaulted by

another student who has been drinking another student who has been drinking


Sexual AbuseSexual Abuse

More than 70,000 students More than 70,000 students between the ages of 18 and 24 are between the ages of 18 and 24 are victims of alcohol-related sexual victims of alcohol-related sexual

assault or date rapeassault or date rape


Drunk DrivingDrunk Driving

2.1 million students between the 2.1 million students between the ages of 18 and 24 drove under the ages of 18 and 24 drove under the

influence of alcohol last year influence of alcohol last year


Academic Academic ProblemsProblems

About 25 percent of college students About 25 percent of college students report academic consequences of their report academic consequences of their

drinking including missing class, drinking including missing class, falling behind, doing poorly on exams falling behind, doing poorly on exams or papers, and receiving lower grades or papers, and receiving lower grades

overall overall

(Engs et al., 1996; (Engs et al., 1996; Presley et al., 1996a, 1996b; Presley et al., 1996a, 1996b;

Wechsler et al., 2002)Wechsler et al., 2002)

What are we trying to What are we trying to prevent?prevent?

IntoxicationIntoxication

Harm related to intoxicationHarm related to intoxication

Safer California Safer California UniversitiesUniversitiesProject GoalProject Goal

To evaluate the efficacy of To evaluate the efficacy of aa

“Risk Management” “Risk Management” approach to alcohol approach to alcohol problem preventionproblem prevention

Risk ManagementRisk Management

Risk AssessmentRisk Assessment

Risk ReductionRisk Reduction

Risk MonitoringRisk Monitoring

Risk AssessmentRisk Assessment

Brief interviews with key Brief interviews with key personnelpersonnel

Archival data sourcesArchival data sources

Student survey dataStudent survey data

Data CollectionProcess

Planning ProcessPRC Tech. Assist

and ActivitiesProximal

OutcomesOutcomes Products

Evaluation of RiskManagement

Design

Project ProcessManual

SAFER CALIFORNIA UNIVERSITIES STUDYBig Picture Framework

Risk ManagementStrategies

Risk Assessment

Archival Data

Student Surveys

Key InformantInterviews

Alcohol problem/setting reviewed

Assessment toolkitTech. assistance

Training

Alcohol problemsettings identified

Risk PreventionCampus

Readiness Survey

Identify problemusing applied data

Identify policysolutions

Dev. Risk mgmt.strategies

DesigninterventionsEst. strategic

partnersDev. Media plan

Intervention toolkitTech. assistance

TrainingBest practices

review

Conduct riskmanagementinterventions

Reduction ofintoxication among

studentsReduction of highrisk settings that

contribute toalcohol-related

problems

Risk MonitoringData collection

ongoing

Application of datato identify problem

and solutions

Application of dataidentifies training

needsMonitors change

Risk ReductionRisk Reduction

Matching intervention to risky settings:Matching intervention to risky settings:

Fraternity partiesFraternity parties

Drinking in residence hallsDrinking in residence halls

Drinking associated with athletic eventsDrinking associated with athletic events

Drinking at off-campus bars & restaurantsDrinking at off-campus bars & restaurants

Risk MonitoringRisk Monitoring

Key role of archival dataKey role of archival data

Iterative process of evaluation….Iterative process of evaluation….

……with improved implementationwith improved implementation

How is risk management How is risk management a unique approach?a unique approach?

Targets times and places instead of Targets times and places instead of individualsindividuals

Focus on intoxicationFocus on intoxication

Tied to continuous monitoring and Tied to continuous monitoring and improvement - emphasis on “control” improvement - emphasis on “control” rather than “one shot” interventionsrather than “one shot” interventions

Anticipated Hurdles for Anticipated Hurdles for Prevention StrategyPrevention Strategy

Implicit assumption that “target” Implicit assumption that “target” is high-risk drinkersis high-risk drinkers

RELATIVE PRODUCTION OF PROBLEMS BYFREQUENT BINGE VS. NON-BINGE DRINKERS (CAMPUS SAMPLE, '98 - '99 SCHOOL YEAR)

PROBLEM CATEGORY

NU

MB

ER

S O

F P

RO

BLE

MS

0

200

400

600

800

1000

1200

1400

1600

FREQUENT BINGE DRINKERSNON-BINGE DRINKERSFIFTY-PERCENT CONTROL LINE

Anticipated Hurdles for Anticipated Hurdles for Prevention StrategyPrevention Strategy

Implicit assumption that “target” is Implicit assumption that “target” is high-risk drinkershigh-risk drinkers

Ambivalence about student drinkingAmbivalence about student drinking Low perceived efficacy of Low perceived efficacy of

environmental interventionsenvironmental interventions Challenges of coordination and Challenges of coordination and

resource allocationresource allocation Possible fears of “backlash”Possible fears of “backlash”

Hypothesized Elements Hypothesized Elements Necessary for Purposive Necessary for Purposive

Environmental InterventionsEnvironmental Interventions Organizational Knowledge of Organizational Knowledge of

ProblemProblem Clear FocusClear Focus Organizational EfficacyOrganizational Efficacy

ResourcesResources CoordinationCoordination CommitmentCommitment

Perceived EfficacyPerceived Efficacy Continuous Feedback/EvaluationContinuous Feedback/Evaluation

REDUCING REDUCING UNDERAGE UNDERAGE DRINKING: DRINKING:

A COLLECTIVE A COLLECTIVE RESPONSIBILIRESPONSIBILITYTY

The full report (readable on-line): The full report (readable on-line):

National Academies PressNational Academies Press

www.nap.eduwww.nap.edu

Order by phone: 888-624-7645Order by phone: 888-624-7645 FACE’s executive summary publication: FACE’s executive summary publication:

www.faceproject.orgwww.faceproject.org

For copies of:For copies of:

Task Force Task Force RecommendationsRecommendations

Tier 1: Evidence of Effectiveness Among Evidence of Effectiveness Among College StudentsCollege Students

Tier 2:: Evidence of Success With General Evidence of Success With General Populations That Could Be Applied Populations That Could Be Applied to College Environmentsto College Environments

Tier 3:: Evidence of Logical and Theoretical Evidence of Logical and Theoretical Promise, But Require More Promise, But Require More Comprehensive EvaluationComprehensive Evaluation

Tier 4:: Evidence of IneffectivenessEvidence of Ineffectiveness

The EndThe End

Supplemental Supplemental SlidesSlides

These slides were not These slides were not presented, but are presented, but are

included in case anyone included in case anyone might be interested in might be interested in seeing a bit more on seeing a bit more on

related topicsrelated topics

SourceSource % Grade 6% Grade 6 % Grade % Grade 99

% Grade % Grade 1212

FriendsFriends 39.339.3 69.369.3 72.372.3

FamilyFamily 48.748.7 28.828.8 18.218.2

PartiesParties 32.132.1 55.655.6 59.859.8

Took from homeTook from home 33.133.1 33.233.2 11.811.8

Took from friend’s Took from friend’s homehome

15.915.9 17.717.7 5.05.0

Got someone to buy itGot someone to buy it 14.014.0 35.335.3 52.652.6

Bought at storeBought at store 8.38.3 7.67.6 8.58.5

Bought at bar or Bought at bar or restaurantrestaurant

8.18.1 4.64.6 7.57.5

Took from storeTook from store 10.010.0 6.56.5 2.52.5

Access: Sources of Alcohol Access: Sources of Alcohol Used by Underage Drinkers, Used by Underage Drinkers,

Past 30 DaysPast 30 Days

Source: Harrison, et al., 2000

Strengthen compliance check Strengthen compliance check programs.programs.

The federal government should require The federal government should require states to achieve designated rates of states to achieve designated rates of retailer compliance. retailer compliance.

All sellers and servers of alcohol All sellers and servers of alcohol complete state-approved training as a complete state-approved training as a condition of employment.condition of employment.

Access: Commercial Access: Commercial AvailabilityAvailability

Effects of Compliance Effects of Compliance Checks and RBS on Checks and RBS on

Underage SalesUnderage Sales

4753

45

35

1916

0

10

20

30

40

50

60

Per

cen

t o

f O

utl

ets

Sel

lin

g

Pretest Posttest

Comparison(No Treatment)

Experimental(No Training)

Experimantal(Training)

Source: Grube, 1997

Implement enforcement programs to Implement enforcement programs to deter adults from purchasing alcohol for deter adults from purchasing alcohol for minors.minors.

Establish and implement a system Establish and implement a system requiring registration of beer kegs.requiring registration of beer kegs.

Adopt and publicize policies for detecting Adopt and publicize policies for detecting and terminating underage drinking and terminating underage drinking parties.parties.

Access: Social AvailabilityAccess: Social Availability

Facilitate enforcement of zero tolerance Facilitate enforcement of zero tolerance laws.laws.

Enact graduated driver licensing laws.Enact graduated driver licensing laws.

Implement sobriety checkpoints.Implement sobriety checkpoints.

Strengthen efforts to prevent and detect Strengthen efforts to prevent and detect use of false identification.use of false identification.

Establish administrative procedures and Establish administrative procedures and noncriminal penalties for alcohol noncriminal penalties for alcohol infractions by minors.infractions by minors.

Access: Youth UseAccess: Youth Use

Insufficient evidence to support youth-Insufficient evidence to support youth-oriented media campaign now: intensive oriented media campaign now: intensive research and development needed.research and development needed.

Fund only evidence-based programs.Fund only evidence-based programs.

Information-only interventions, scare Information-only interventions, scare tactics, and “delay” messages are not tactics, and “delay” messages are not effective.effective.

Expand the availability of effective clinical Expand the availability of effective clinical services for treating alcohol abuse.services for treating alcohol abuse.

Youth InterventionsYouth Interventions

Campuses should adopt comprehensive evidence based Campuses should adopt comprehensive evidence based approaches:approaches:

Universal educational approaches as well asUniversal educational approaches as well as selective selective and indicated approaches and indicated approaches Screening and brief interventions Screening and brief interventions Limit alcohol availability and access for underageLimit alcohol availability and access for underage students students Consistent enforcement of laws and policiesConsistent enforcement of laws and policies

NIAAA and SAMHSA should continue to fund evaluation NIAAA and SAMHSA should continue to fund evaluation of college-based programs and should maintain list of of college-based programs and should maintain list of evidence-based programs.evidence-based programs.

College InterventionsCollege Interventions

Community coalitions can increase the Community coalitions can increase the effectiveness of interventions.effectiveness of interventions.

Assess problem locallyAssess problem locally

Develop comprehensive community-based Develop comprehensive community-based initiative.initiative.

Implement strategies tailored to the Implement strategies tailored to the specific problems and resources in the specific problems and resources in the community.community.

Community InterventionsCommunity Interventions

Involve gatekeepers, businesses, key Involve gatekeepers, businesses, key community leaders, and colleges.community leaders, and colleges.

Consider strategies such as: community Consider strategies such as: community organizing, public education, strategic organizing, public education, strategic use of mass media, and partnerships use of mass media, and partnerships with faith-based organizations.with faith-based organizations.


Resources are essentialResources are essential::

Public and Private partners should support Public and Private partners should support community mobilization to reduce community mobilization to reduce underage drinkingunderage drinking

Federal funding should be available under Federal funding should be available under a national program dedicated to a national program dedicated to community-level approaches modeled after community-level approaches modeled after the Drug-Free Communities Actthe Drug-Free Communities Act


Alcohol use by young people is dangerous.Alcohol use by young people is dangerous.

Committee calls for a deep, unequivocal Committee calls for a deep, unequivocal societal commitment to curtail underage societal commitment to curtail underage drinking.drinking.

Need to dedicate the resources commensurate Need to dedicate the resources commensurate with the magnitude of the problem.with the magnitude of the problem.

Commit to a comprehensive strategy that Commit to a comprehensive strategy that involves multiple partners (National, State, involves multiple partners (National, State, Campuses, Campuses, Local) to achieve long-term results.Local) to achieve long-term results.

SummarySummary

SummarySummary Develop national adult-oriented media campaignDevelop national adult-oriented media campaign Create national partnership, including industryCreate national partnership, including industry Reduce youth exposure, both advertising and Reduce youth exposure, both advertising and

entertainment entertainment Government Assistance and CoordinationGovernment Assistance and Coordination Increase compliance, including enforcement on- Increase compliance, including enforcement on-

and off-campusand off-campus Implement evidence-based efforts aimed at Implement evidence-based efforts aimed at

youthyouth Implement effective college campus Implement effective college campus

interventionsinterventions Develop community-specific responses, Develop community-specific responses,

including campus collaborations including campus collaborations Increase excise taxesIncrease excise taxes Conduct ongoing monitoring and R& EConduct ongoing monitoring and R& E

Safer California Safer California Universities SurveyUniversities Survey

Fall 2003Fall 2003 Internet and Mail Surveys Internet and Mail Surveys Random Samples of StudentsRandom Samples of Students 14 Campuses14 Campuses N = 28,000N = 28,000

Range 738 - 1291Range 738 - 1291 Response rate 51%Response rate 51%

Source: Safer California Universities Survey, 2003

Safer California Safer California Universities SurveyUniversities Survey

Gender:Gender:Male 41%Male 41%Female 59%Female 59%

Ages:Ages:1818 19.6% 19.6%1919 18.3% 18.3%2020 16.2% 16.2%2121 16.2% 16.2%

>21 >21 28.8% 28.8%

Class:Class: Freshman 21.1% Freshman 21.1% Sophomore 17.9% Sophomore 17.9% Junior Junior 28.5% 28.5% Senior Senior 32% 32% Other Other .5% .5%

EthnicityEthnicity White White 52.1% 52.1% Black Black 3.3% 3.3% Asian Amer. 33.5% Asian Amer. 33.5% LatinoLatino 17.4%17.4% Other 17.4% Other 17.4%


Percentage of Safer Percentage of Safer Students Drinking in Past Students Drinking in Past

Semester/QuarterSemester/Quarter

7989 86

7078 79

7481 80

85

71

58

69

0

10

20

30

4050

60

70

80

90100

Per

cen

tag

e

A B C D E F G H I J K L M

Safer CampusesSource: Safer California Universities Survey, 2003

Percentage of Drinkers Percentage of Drinkers Getting Drunk in Past Getting Drunk in Past

Semester/QuarterSemester/Quarter

61

7770

54 58 5951

61

83

85

6560 62 64

0102030405060708090

100

Per

cen

tag

e D

rin

kers

A B C D E F G H I J K L M N

Safer CampusesSource: Safer California Universities Survey, 2003

Percent of StudentsPercent of Students “Binge” Drinking Past Two “Binge” Drinking Past Two

WeeksWeeks

15

16

69

18

35

47

18

20

62

13

10

77

15

16

69

13

15

72

1010

80

16

18

66

22

34

44

20

44

37

22

20

58

18

16

66

19

18

63

18

16

66

17

21

63

0102030405060708090

100

Per

cen

tag

e

A B C D E F G H I J K L M N Total

Safer Campuses

Non-BingeDrinker

2+ Times

Once


Drinking Problems in Past Drinking Problems in Past Semester/Quarter (UC)Semester/Quarter (UC)

65

48.7

49.7

35.5

43.2

37.1

36.9

39.6

38.3

58

43.8

44.6

0 10 20 30 40 50 60 70

Percentage of Drinkers

Hangover

Missed Class

Got Behind in Work

Taken Advantage

Had Unplanned Sex

Not Used

Damaged Property

Got Hurt or Injured

Did Poorly on Test

Got Sick

DUI

RWDD


Drinking Problems in Past Drinking Problems in Past Semester/Quarter (CSU)Semester/Quarter (CSU)

51

21

24

4

17

9

6

10

12

38

26

23

0 10 20 30 40 50 60

Percentage

HangoverMissed Class

Got Behind in WorkTaken Advatage of Sexually

Had Unplanned SexNot Used ProtectionDamaged PropertyGot Hurt or InjuredDid Poorly on Test

Got SickDUI

RWDD


Secondary Drinking Secondary Drinking Problems in Past Problems in Past

Semester/Quarter (UC)Semester/Quarter (UC)

22

12

16

13

9

17

43

39

28

27

16

0 10 20 30 40

Percentage of Students

InsultedHarassedArgument

Pushed, Hit, AssaultedPhysical Violence

Property DamagedTake Care of Other

Studies or Sleep DisruptedUnwanted Sexual Advance/Assault

Found VomitVictim of Crime


Secondary Drinking Problems Secondary Drinking Problems in Past Semester (CSU)in Past Semester (CSU)

15

4

12

6

2

9

34

26

12

13

1

0 10 20 30 40

Percentage

Insulted

Harassed

Argument

Pushed, Hit, Assaulted

Physical ViolenceProperty Damaged

Take Care of Other

Studies or Sleep Disrupted

Unwanted Sexual AdvanceFound Vomit

Sexual Assault


0

100

200

300

400

500

600

700

800

900

Greek Residence Hall

ABCDEFGHIJKLMN

Drinking Problems by Setting and CampusDrinking Problems by Setting and Campus

0

200

400

600

800

1000

1200

1400

1600

1800

own room, house or apartment On Campus

ABCDEFGHIJKLMN


0

200

400

600

800

1000

1200

Off campus Restaurant/bar Outdoor

ABCDEFGHIJKLMN


An Evolution of Environmental Prevention Models Bob Saltz Richard McGaffigan Prevention Research...

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