Alcohol, tobacco and local control: A comparison of several community-based prevention trials

Abstract

In North America there are significant similarities and differences in attitudes with regard to alcohol and tobacco on several dimensions, including the view taken of producers, suppliers and retailers, the products, and in the patterns of use. There are also contrasting as well as overlapping tendencies with regard to perceived problems associated with alcohol versus tobacco consumption, intervention initiatives and the resources available. These secular developments and forces provide a context for examining 10 community-based prevention trials which have sought to reduce harm from alcohol or tobacco using a range of strategies. The strategies have included education and information campaigns, media advocacy, counter-advertising and health promotion, controls on selling and consumption venues and other regulations reduced access to alcohol or tobacco, enhanced law enforcement and surveillance, and community organizing and coalition development. The paper outlines the challenges of undertaking community-based trials and interpreting their findings. It notes that interventions which show promise are those that pay particular attention to controls on access, include the environmental contexts of where the products are sold and distributed, and involve enforcement of public health polices. Controlling tobacco use may be made somewhat easier, than is the case for alcohol, with the vilification of the tobacco industry and marginalization and victimization of smokers. Nevertheless, the community trial provides opportunities for reducing harm related to alcohol and tobacco, particularly if resources are oriented in a coordinated way to those control measures and policies with the widest scope and greatest effectiveness.