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Partners in Prevention of Substance Abuse (PIPSA) Theory of Change: A Formative Evaluation in Implementing Community Ant...


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PARTNERS IN PREVENTION OF SUBS TANCE ABUSE (PIPSA) THEORY OF CHANGE: A FORMATIVE EVALUATIO N IN IMPLEMENTING COMMUNITY ANTI-DRUG COALITIONS OF AM ERICAS STRATEGIC PLANNING FRAMEWORK By KELLY ANN DEVER A THESIS PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLOR IDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS UNIVERSITY OF FLORIDA 2006

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Copyright 2006 by Kelly Ann Dever

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iii ACKNOWLEDGMENTS I would like to sincerely thank Gwen L ove and Cindy Grant for sharing their knowledge and experience of th e Partners in Prevention of Substance Abuse (PIPSA) program with me. They guided me ever so pa tiently through the production of this project and I would like to show my appreciation fo r their dedication to the social issue of substance abuse. PIPSA is a considerat e approach to improving Alachua County substance abuse problems and should be appla uded for its efforts. With more support, cooperation, and resources the program is capable of providing more physically and emotionally healthy community members. Last ly, I would like to thank my supervisory committee members, Drs. Barbara Zsembik and Jodi Lane, for their encouragement throughout the research process. Without them, this study would not have been possible.

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iv TABLE OF CONTENTS page ACKNOWLEDGMENTS.................................................................................................iii LIST OF TABLES............................................................................................................vii LIST OF FIGURES.........................................................................................................viii ABSTRACT.......................................................................................................................ix CHAPTER 1 INTRODUCTION........................................................................................................1 2 LITERATURE REVIEW.............................................................................................6 Substance Abuse Among Youth...................................................................................6 Social Issue Of Substance Abuse..........................................................................7 Alcohol As A Substance........................................................................................9 Current research on the underage dri nking scene in the United States........10 Current research on underage drinking in Alachua County.........................18 Theoretical Framework Of PIPSA..............................................................................22 Criminological Theory........................................................................................22 Learning Theory..................................................................................................22 Life-Course Perspective......................................................................................24 Community-Based Coalitions.....................................................................................26 Effectiveness Of Commun ity-Based Coalitions..................................................27 Suggested Strategies Employing Community-Based Coalitions........................29 3 PARTNERS IN PREVENTION OF SUBSTANCE ABUSE (PIPSA) COALITION...............................................................................................................36 Program History..........................................................................................................36 Alachua County...................................................................................................37 Program Theory...................................................................................................39 Program impact theory.................................................................................41 Program process theory................................................................................43 PIPSAs New Focus: Underage Drinking...........................................................45 Formative Evaluation..................................................................................................46

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v 4 STUDY DESIGN.......................................................................................................49 Ontology.....................................................................................................................49 Epistemology..............................................................................................................50 Methodology...............................................................................................................50 Qualitative Design...............................................................................................51 Methods...............................................................................................................52 Focus Group As A Method..................................................................................53 Historical and contemporary uses of focus groups......................................53 Benefits of using focus groups.....................................................................53 Limitations in using focus groups................................................................57 Focus Group Design............................................................................................60 Focus group questions..................................................................................65 Materials used in focus groups.....................................................................67 Sampling design...........................................................................................67 Analysis Procedures............................................................................................70 Grounded Theory: background considerations............................................70 Application of Strauss and Corbins Grounded Theory...............................72 Limitations Of Study Design...............................................................................74 5 RESULTS...................................................................................................................76 Theory Of Change...............................................................................................76 Culture Of Drinking In Alachua County.............................................................80 Difficulties Reaching Community Members.......................................................81 Strategies For Decreasin g Underage Drinking....................................................82 6 FORMATIVE EVALUATION..................................................................................85 Suggestions For Evaluating PIPSA Process...............................................................85 Suggestions For Evaluating PIPSA Impact................................................................86 Suggestions For PIPSA Program Improvement.........................................................86 Implement Scientifically-Based Strategies..........................................................87 Improve PIPSA Attendance And Dialogue.........................................................87 Encourage Collaboration Within PIPSA.............................................................88 Extend PIPSA Membership.................................................................................88 Foster community-school partnerships........................................................89 Include business community........................................................................89 Involve media...............................................................................................90 Form youth advisory committee..................................................................90 Target specific populations of youth............................................................91 Consider Adding Additional Activities To The PIPSA Program........................91 Provide thrill-seeking activities....................................................................91 Host an annual Alachua County Health Fair................................................91 Use school facilities during off times.......................................................92 Increase excise tax........................................................................................92 Showcase all PIPSA efforts..........................................................................92

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vi Draft Process And Impact Instruments................................................................93 Base Instruments On A Comprehe nsive List Of PIPSA Activities.....................93 Include Newly Suggested Resources In Coalition..............................................95 Encourage Better Communication Between Coalition Members.......................96 7 DISCUSSION...........................................................................................................100 Summary Of Results.................................................................................................100 Limitations Of Study................................................................................................101 Participation.......................................................................................................101 Incomplete Representation Of PIPSA Coalition...............................................101 Question Influence.............................................................................................102 Limited Multivocality........................................................................................102 Researcher Influence.........................................................................................102 Benefits Of Study.....................................................................................................103 Collaboration.....................................................................................................103 Member Checking.............................................................................................103 Community Assessment....................................................................................103 Informative And Exciting Nature Of Study......................................................104 Conclusion................................................................................................................104 Theory Of Change.............................................................................................104 Future Research.................................................................................................104 APPENDIX A PROTECTIVE AND RISK FACTORS...................................................................106 Protective Factors.....................................................................................................106 Risk Factors..............................................................................................................106 B GAINESVILLES DRINKING SCENE..................................................................107 C FOCUS GROUP HANDOUTS................................................................................109 D EXAMPLE PROCESS MEASURES.......................................................................113 E EXAMPLE IMPACT MEASURES.........................................................................130 F EXAMPLE STRATEGIC PLAN.............................................................................136 LIST OF REFERENCES.................................................................................................138 BIOGRAPHICAL SKETCH...........................................................................................144

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vii LIST OF TABLES Table page 1 Drinking Patterns among Adults and Youths (In Percent).......................................12 2 Drinking Frequency and Intensity for Youths and Adults (Current DrinkersOnly)...........................................................................................................13 3 Alcohol Consumption in the United States, 1999....................................................20 4 Alachua County Statistics........................................................................................38 5 Focus Group Characteristics....................................................................................62 6 Focus Group Participation........................................................................................64 7 Formative Evaluation Suggestions...........................................................................97

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viii LIST OF FIGURES Figure page 1 Long-Term Trends in Prevalence of Drinking among Twelfth Graders..................12 2 Any Use of Alcohol in the Past 30 Da ys for 12to 20-year-olds, by Gender, Race or Ethnicity, and Age Group: 2000.................................................................14 3 Program Theory: Social Development Strategy.......................................................40 4 Impact Theory..........................................................................................................42 B-1 Gainesvilles Drinking Scene Picture 1.................................................................107 B-2 Gainesvilles Drinking Scene Picture 2.................................................................108 C-1 Alachua County Problem Diagram........................................................................111 C-2 PIPSAs Service Utilization Plan...........................................................................112

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ix Abstract of Thesis Presen ted to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Master of Arts PARTNERS IN PREVENTION OF SUBS TANCE ABUSE (PIPSA) THEORY OF CHANGE: A FORMATIVE EVALUATIO N IN IMPLEMENTING COMMUNITY ANTI-DRUG COALITIONS OF AM ERICAS STRATEGIC PLANNING FRAMEWORK By Kelly Ann Dever August 2006 Chair: Barbara Zsembik Cochair: Jodi Lane Major Department: Sociology A qualitative study of coalition members fr om Alachua Countys community-based coalition, Partners in Prevention of Substan ce Abuse (PIPSA), on the topic of substance abuse was undertaken during April and May of 2006 at the University of Florida. The sample was comprised of 70 coalition member s listed as active participants in the coalition. The purpose was to understand PIPSAs theory of change regarding its newly declared focus on underage drinking, to offer a formative evaluation of the program, and provide suggestions as to the necessary steps it will take to structure the program in a way that can be evaluated in the future. Resu lts indicated that coalition members place a strong emphasis on education as a strategy to decrease underage drinking in Alachua County, targeting youth at an even earlier age than they currently do. Evaluation results suggest priority be given to finalizing feasib le activities the PIPSA coalition is able to

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x accomplish and to develop instruments that measure the process and impact of these very activities, to evidence program strengths and weaknesses, and to ensure future funding

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1 CHAPTER 1 INTRODUCTION Substance addiction is not an individual problem, but stems from a larger community issue and should be handled in a comprehensive community-based approach. The National Survey on Drug Use and Hea lth, conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA), states: of the 21.1 million people who needed but did not receive treatment in 2004, an estimated 1.2 million reported that they felt they needed treatment for their alcohol or drug use problem. Of the 1.2 million persons who felt they needed treatment, 441,000 (35.8%) reported that they made an effort but were unable to get treated (Subs tance Abuse and Mental Health Services Administration 2005:7). These numbers indicate a need for substance abuse programs to consistently be available and successfully create an awareness of their services, so individuals are able to seek help for problems that may af fect their quality of life. It is important to note these numbers are conserva tive considering ther e are those who do not seek treatment services but might be willing to go if they were aware of the services. The Partners in Prevention of Substance Abuse (PIPSA) program is a communitybased coalition serving the re sidents of Alachua County, Fl orida. Community Anti-Drug Coalitions of America (CADCA) defines a coalition as a formal arrangement for collaboration between groups or sectors of a community in which each group retains its identity but all agree to work together toward a common goal of building a safe, healthy, and drug-free community (National Commun ity Anti-Drug Coalition Institute 2006). PIPSA is comprised of seventy coalition me mbers, representing nine sectors in the

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2 Alachua County community: Youth Services, School Board, Law Enforcement, Business and Media, Federal State and Local Agencies Civic and Volunteer Agencies, Religious Groups, Healthcare, and Pare nts and Community. The members meet to discuss substance abuse issues specific to Alachua County and organize efforts of prevention, volunteering services individually an d from their respective agencies. An immediate priority for PIPSA is to or ganize the program in a way that can be evaluated in terms of program growth. Insight into program strengths and weaknesses is useful in building the effectiv eness of the program as well as increasing the possibility for future funding, since most funding sources en courage evaluative pieces to be included with grant applications. A ccording to CADCA trainings, PIPSAs first step toward becoming evaluative is creating a program that has assessed its resources, understands its capacity, and has logically developed an organi zational plan that is feasible and reaches community members in a reasonable manner. The program is in the process of revising its goals (broad statements of what the coalition project intends to accomplish) a nd objectives (what is to be accomplished during a specific period of time to move to ward achievement of a goal, expressed in specific, measurable terms) to more eff ectively address substance abuse in Alachua County (Rossi, Lipsey, and Freeman 2004). Curre ntly, their goals are too broad to be realized and their objectives fo r reaching those goals are not de fined in measurable terms, making evaluation impossible. CADCA is a nationwide organization that offers trainings and guidance for strengthening and improving community coali tions. Many drug coalitions throughout the United States are adopting their program and stru cturing or restructuri ng their coalition to

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3 reflect their model. CADCAs guidance and s upport coupled with th eir acceptance, on a national level, makes them not only appeal ing from the coalitions standpoint, but desirable from funding sources due to its structure. At the suggestion of CADCA, the PIPSA program has decided to focus specifica lly on one issue: to follow their Strategic Planning Framework Model to determine th e programs effectiveness in reaching Alachua County residents. It has declared underage drinking to be the primary concern. Children and youth are more vulnerable to pr oblems associated with alcohol and drug abuse than any other group in society (H awkins, Catalano, and Miller 1992). Current research shows that a higher percentage of youth aged 12 to 20 use alcohol (29% nationally) than use tobacco (24%) or illicit drugs (14%), making underage drinking a leading public health problem in the United States (Department of Children and Families 2003). According to the 2004 Florida Youth Substance Abuse Survey (FYSAS), the number of youth in Alachua County who ar e engaging in alcohol use is even higher (32.7%) than the national or state averag e (Department of Children and Families 2003). Focusing on this specific issue will allo w PIPSA to create a program that delivers services with a logical theory guiding activit ies that are capable of being evaluated. The PIPSA program has not reevaluated their pr ogram since its incep tion, seven years ago. With the new focus it was essential to speak with coalition members regarding their approach to Alachua County community members. This study offered a platform for member s to reach consensus regarding PIPSAs theory behind program activities and to con ceptualize underag e drinking, in terms of the contributing agencies involved in PIPSA. All seventy coalition members were asked to participate in the focus group representing the sector in which they were listed on

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4 PIPSAs membership roster. In order for coal ition members to feel a part of the program, they must be involved in its organization. CADCA trainings emphasized that maintaining a collaborative process throughout the asse ssment, capacity, and planning phases is essential for agreement among members in the later phases of implementation and evaluation. This process was not only informa tive, giving coalition members an overview of member perspectives, but it encouraged participation, since they had drafted the plan and offered their individual time as well as their respective agencys resources. Using a grounded theory methodology (Strau ss and Corbin 1998), analyses focused on themes generated in the focus groups. Re sults were in the form of suggestions coalition members made regarding new strategi es that are reasonabl e and appropriate to the problem behavior of unde rage drinking in Alachua County. They should use these results to guide their revisions of the program regarding new goals and objectives in their planning stage of the Strategic Planning Framework. Results of the study show PIPSA coaliti on members have a working knowledge of current research pertaining to underage dr inking prevention strategies. The coalition emphasizes educating community members in the hopes of changing the normative party culture presen t in Alachua County. Early, inter active education across various sectors of the community is a key strategy th e coalition is hoping to employ in decreasing underage drinking. If the suggestions re garding untapped resources and innovative activities made by coalition memb ers are implemented in the program design, benefits to the coalition may include greater program awareness and particip ation. With greater program awareness, individuals will be provided the knowledge of where to seek treatment when they are willing. Treatment of community members with substance abuse

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5 problems will not only improve the quality of life on an individual level, but will improve the overall productivity and health of the comm unity. For a new soci al structure should be established, where enhancing the general welfare is thought to be an admirable goal (Vega and Murphy 1990:152). The process of the study may be duplicated by PIPSA in the future if new problem behaviors are deemed primary to the PIPSA program and new goals and objectives are needed. Also, insights from this study can be used to inform a variety of intervention programs, especially those that are geared to youth populations or communities with similar composition to Alachua County. Many argue the issue of substance abuse is best dealt with on a community level, because d rug abuse is a social behavior, embedded in the larger framework of community norms and social support systems that regulate the occurrence of these behaviors (Zunyou, Detels, Jiapeng, Virginia, and Jianhua 2002:1952). Also, they state, community intervention has proven effective for health problems such as smoking (Zunyou et al. 2002: 1952). Since it is not confined to any single campus or community a collaborativ e effort from campuses and communities dealing with similar issues may benefit from effective, shared solutions. By using this studys research findings, communities may elim inate wasted effort and time related to discovering similar information.

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6 CHAPTER 2 LITERATURE REVIEW Substance Abuse Among Youth This chapter emphasizes literature relating to three major areas concerning this study: substance abuse as a social issue, the theoretical framework of the PIPSA coalition, and the strengths and weaknesses of community-coalitions. The literature on substance abuse considers the social implicat ions it may have on the community and the individual. Particular focus has been placed on alcohol, the substance the coalition is most concerned with at this time. Current research is presented highlighting underage drinking in the United States, as well as specific information about Alachua County. Current strategies the litera ture suggests as successful in combating underage drinking are offered to help understand the PIPSA coa litions efforts on a broader scale and point out possible strengths and w eaknesses of their program they may need to consider. Literature addressing the theo retical background of the PIPSA coalition is essential in understanding its motivation and the applicability of its effo rts. Criminological theory, Learning theory, and Life-course perspect ive are all necessary to include when considering the efforts of the coalition. Lastl y, this chapter addresse s the effectiveness of community-based coalitions and suggested st rategies for employing them. This is to consider whether the coalition, even at its most refined stat e, should be used in dealing with the social issue of underage drinking, and in what ways might be more effective.

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7 Social Issue Of Substance Abuse Substances may be defined as any drug used to alter a person's mood or perception (how they feel and experience things) (Depar tment of Education and Childrens Services 2003). Substances, such as alcohol, tobacc o, and drugs, satisfy an inner need for experiencing other modes of consciousne ss (Weil 1986). Research has shown that, initially, substance abuse is most often a si gn of deeper emotional troubles or concerns within the individual. Kornbl um (1998) lists some major re asons people use substances: to ease pain, relax tension, lose weight, and fight depression. For many, this emotionally-charged need to escape from reality, whether it is due to professional, familial, or social pressures, manifests itself in the use of substances. After continued use the individual may develop a physical dependence on the substance, and begin to participate in alcohol abuse, which may be defined in its most basic description as a pattern of problem drinki ng that result in health conseq uences, social problems, or both (Medical Network Incor porated 2006). Therefore, both alcohol use and abuse in underage drinking populations is the primary c oncern of the coalition, since they may not have the capacity to understand the differe nce at these ages. With both physical and emotional dependence on a substance the individual may, at the very least, lose their ability to self-regulate emotions and ac tions. Depending on the age of initiation, substance abuse may also disrupt normal developmental processes, jeopardizing cognitive ability and physical maturation. In addition, it is also linked to anti-social behavior. Research has shown that subs tance abuse has strong associations with crime, illness, and interpersonal viol ence (Kornblum 1998). For these reasons, the coalition finds it necessary to safeguard certai n populations in order to prevent these lifealtering consequences of alcohol use and abuse.

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8 Some research suggests that interventi ons may be considered synonymous with social control. Vega and Murphy (1990:149) state: Clearly incarceration is a m eans of social control, but interventions, particularly those that are truly community-based, do not perform this function. In fact, just the opposite is supposed to occur. Simply put, through interventions social conditions are supposed to be changed, so that persons can lead productive lives. Rather than controlling individuals, the intention should be to pr ovide new opportunities. Since substance abuse has such strong asso ciations with crime, it is important to realize the goal should be to rehabilitate a nd not force individuals to conform, to create any long-lasting, meaningful change to soci al conditions. According to Vega and Murphy (1990:149): Nonetheless, someone who needs help has come to be equated with a deviant or a threat to order. So even when rehabilit ation is undertaken, as opposed to overt social control, the usual expectation is c onformity in the guise of adequate social functioning. Order is simply reified. On the other hand, order is defied by real intervention, for providing assistance is intended to help persons to develop, and development is often idiosyncratic and can proceed in any number of directions. By allowing people to abuse their bodies we allow them to destroy their potential lives. This is especially alarming when considering populations too young to recognize the implications of their actions. Research suggests that socialization guard s against desires to alter a persons conscious state (Weil 1986). Every community has basic values and norms expressed to its community members in forms of media, school, and parental guidance, with social expectations implicitly and explicitly made to the individual. Social support guarding against substance use and abuse can be e ducation of its dangers, encouragement and acknowledgment of participa tion in non-substance related activities, so cial service organizations helping individua ls to deal with issues l eading to emotional problems such as family, marriage, or financial counseling. According to Vega and Murphy

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9 (1990:152), interventions that are community-sensitive are supposed to be liberating. Clients are supposed to be given a modicum of control over their liv es, as a result of having the ability to regulate ever y aspect of their treatment. Strong and effective programs need to first be in place. Vega and Murphy (1990:145) suggest, the maintenance of health, in short, should not be left to chance by any society that wants to improve the produc tivity of all its members. Then programs must continually broadcast the message of the dangers of substance use and abuse. Kornblum (1998) introduces the idea of in ter-generational forgetting in regards to substance use and abuse. He argues that each new generation is newly vulnerable and needs to be educated with the same or more effort than the previous one. In addition, unless changes are made in conceptualizing illness, and citizens ar e integral to this process, even community-based interven tions may merely serve to identify and rehabilitate deviants (Vega and Murphy 1990:152). Alcohol As A Substance In the United States, the pa st decade has seen somewhat of an expansion of focus regarding substance abus e, with licit drugs now being targ eted as harmful to the physical body. Tobacco companies have publicly admitted the health hazards relating to nicotine and have begun to pay reparations, funding the American Legacy Foundations Truth campaign and Philip Morriss Think. Dont Smoke campaign (Farrely, Healton, Davis, Messeri, Hersey, and Haviland 2002). Even t hough alcohol has had similar discoveries relating to addiction and harm to the physical body, society has not dealt with it in a reciprocal fashion. Alcohol warnings may be too soft, consid ering the cultural backdrop of our society, which works to normalize drinking on a consistent basis. Many coalitions across America

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10 are declaring the importance of considering the deleterious effects of attracting underage drinkers to a lifestyle of addiction. B onnie and OConnell (2004:79) suggest, young people are exposed to a steady stream of imag es and lyrics presenting alcohol use in an attractive light. But if this message is not consistent acro ss informational sources (i.e. media, peers, parents), the social suppor t deterring alcohol use begins to become fragmented and unclear to the child. A more thorough disc ussion of underage drinking and its current rates further highlight th e importance of addressing this issue. Current research on the underage drinki ng scene in the United States It has been suggested that alcohol is the most commonly used drug among Americas youth (Bonnie and OConnell:2004:35 ). For this reason, research has looked at various factors relating to underage drinking and preventative approaches. Cognitive influences. The cognitive influences on adolescents must first be addressed. Bonnie and OConnell (2004:72) consider the rite of passage that adolescents face: During adolescence, individuals are going through rapid physical, social, and cognitive changes. These enormous cha nges to body, friendship and thinking about the world are juxtaposed against changing expectations for beha vior and increases in need and opportuni ties for autonomy. This period is also marked with an increase in time spent with peers and decreased time spent with parents. This unmonitored tim e parents allow their children, reinforce societal beliefs suggesting that adolescence is a time to practice adult roles (Bonnie and OConnell 2004). Historically, alcohol use has been an impor tant symbol of adult status (Bonnie and OConnell:2004). The legal drinking age has been adjusted to reflect the perceived age of an adult. Following Prohibition, the lega l drinking age was twenty-one. In 1971, the

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11 voting age was lowered to 18 to match the milita ry draft age, encouraging some states to lower the drinking age as well. Alcohol-re lated problems stirred a push for federal regulation to increase the dri nking age. By 1988, the majority of the states had re-raised the legal drinking age to twenty-one, which is where it has stayed for close to 20 years. This current law suggests that society agrees that even older teens lack judgment when it comes to the use of alcohol. More specifical ly, they lack judgment between substance use and abuse, and should therefore delay experi menting with this s ubstance until they are mature enough to handle its consequences. Rese arch agrees with th is notion. Bonnie and OConnell (2004:40) state: Individuals who begin dri nking before the age of 15 are more likely to have substance abuse problems in th eir lifetimes, to engage in risky sexual behavior, and to suffer other negative consequences in comparison with those who begin drinking at a later age. Although this research gives some credence to the legal drinki ng age being set at age twenty-one, it is un known whether this is a causal issu e or just an association. In addition to the cognitive influe nces that have been characte ristic throughout history, there are some newly diagnosed challenges to curr ent populations of youth. Clark, Kirisci, and Moss (1998) conducted a study of children aged 8 to 15 which found antisocial personality disorder has been linked to al cohol misuse among adolescents, suggesting conduct disorder often predates and predicts later alcohol use. Also, in non-clinical populations, a major personality characteristic that has been related to adolescent risk taking is sensation seeking, defined by seek ing novel, complex, or risky situations (Zuckerman 1979). Social influences. Statistics show that large numbers of teens are consistently choosing to drink. According to 2002 Monito ring the Future data, almost half (48.6%)

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12 of twelfth graders reported recent (within the past 30 days) alcohol use (Bonnie and OConnell 2004:38). Figure 1: Long-Term Trends in Prevalence of Drinking among Twelfth Graders. (Regents of the University of Michigan 2006). Since the early 1990s, past 30-day prev alence rates have hovered around the 50% mark, with adolescent social pressures probably contributing greatly to the steadiness of these rates. Some notable differences in patterns of usage do remain though. Youth appear to be drinking at an earlier age. B onnie and OConnell (2004:38) explain: The average age of first alcohol use ha s generally decreased since 1965, indicating youth are starting to drink at a younger age. NHSDA data indicate that the average age of self-reported first us e of alcohol among individuals of all ages reporting any alcohol use decreased from 17.6 year s to 15.9 years between 1965 and 1999. If this pattern continues, society will be gin to see an even greater increase in developmental problems related to adolescent drinking. Table 1: Drinking Patterns among A dults and Youths (In Percent) Age Drinking Pattern 12-14 15-17 18-20 21-25 26+ Nondrinkers 93 74 51 38 51

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13 Table 1. Continued Drinking Pattern Age Drinkers Alcohol use but no heavy drinking in past 30 days 51 32 29 36 61 Heavy drinking in past 30 days 42 49 45 44 29 Frequent heavy drinking in past 30 days 8 19 26 21 10 Data from the 2000 NHSDA. (United States De partment of Health and Human Services 2006b). Not only are youth drinking at an earlier age, but they are drinking in heavier doses than previous years. Bonnie and OConnell ( 2004:39) state, undera ge drinkers of all ages are much more likely to drink heavily than are adults. Table 2: Drinking Frequency and Intensity for Youths and Adults (Current DrinkersOnly) Age Frequency and Intensity 12-20 21 and older Mean number of drinking days per month 5.79 (6.03) 8.02 (8.32) Mean number of usual drinks on a drinking day* 4.48 (2.75) 2.78 (2.07) *If respondents indicated that their usual number of drinks per occasion was some number greater than 12, that response was recoded as missing. Missing values were imputed, using means for the same sex and age group. SOURCE: National Household Survey on Drug Abuse. (United States Depa rtment of Health and Human Services 2006b). In addition to the gender gap closing betw een girls and boys in terms of alcohol usage, biological differences should be mentioned to highlight the alarm this brings. Bonnie and OConnell (2004:49) suggest, males do report engaging in heavy drinking at a higher rate than females, but consideri ng differences in body composition and alcohol metabolism, with women, on average, weighi ng less and processing al cohol slower, girls may feel the same effects as boys even if they are consuming less. Much like the patterns of alcohol usag e relating to gender, Bonnie and OConnell (2004:38) explain, recent studies also suggest that ethnic di fferences are diminishing and

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14 that these groups with histor ically low drinking rates are moving toward the higher rates of non-Hispanic white males. As shown in Table 2, among youths aged 12-20, drinking of all types (recent, heavy, frequent heavy) is highest for non-Hispanic whites, followed closely by Native Americans. Asian American s and African Americans have the lowest prevalence of any racial or ethnic group (Bonnie and OConnell 2004:48). Research shows that adolescents, regardless of race, et hnicity, or gender, have a common interest in alcohol. Figure 2: Any Use of Alcohol in the Past 30 Days for 12to 20-year-olds, by Gender, Race or Ethnicity, and Age Group: 2000. (F lewelling, Paschall, and Ringwaldt 2004). Environmental influences. Just as there are cognitive and social influences leading the adolescent to init iate drinking, there are envir onmental influences as well. Bonnie and OConnell (2004:55) although the proportion of eighth graders who report that alcohol is fairly easy or very easy to get decreased over the past decade, it remains more than 60 percent. There are many locations youth may have ease of access in getting alcohol. The easiest access is probabl y their parents kitchen. Wagenaar and Wolfson (1994:38) state, results showed that the initial alcohol us ed by those in their

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15 early teens is obtained from pa rents stocks or from olde r siblings and friends. In addition, they may be able to access al cohol throughout their neighborhood, depending on community acceptance. Wagenaar a nd Wolfson (1994:39) further note: Methods used to purchase alcohol repor ted by underage students include using false identification, buying from stores that are known for selling to underage youth, and seeking young clerks. The extant literature shows that most persons under the age of 21 are able to obtain alcohol, suggesti ng that this law is not rigorously enforced. A community may be considered a dry or wet drinking environment, as suggested by Bonnie and OConnell (2004:79): A wet community environment is one in which drinking is prevalent and common, public opinion is generally tolerant or posit ive, and alcohol is r eadily available both commercially and at private social occasions and is advertised as available. A dry community would be one in which drinking at social occasions is not the norm and is generally frowned on, and alcohol outlets are relatively scarce. The drinking environment is important to consider when noting the prevalence of underage drinking. It suggests important i ssues surrounding underage drinking, such as accessibility and availability. Consequences of underage drinking. The deleterious effects of underage drinking have been partially noted previousl y, but should be addresse d in greater detail. There are both short-term and long-term consequences to underage drinking. Alcohol impairs an indivi duals decision-making capac ity which could possibly result in accident, death, in jury, illness, or arrest. Wh en judgment is impaired, the individual is less likely to guard against impul ses, which could lead to vandalism, assault, risky sexual behavior, or dr unk driving. Also, adolescents, with less experience behind the wheel, pose a higher risk when drinking a nd driving. The crash risk associated with driving after drinking is highe r for youths than for adults at all blood alcohol content (BAC) levels (Hingson and Kenkel 2004). P oor decision-making, as a result of one

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16 drinking occasion, could lead to a life-altering consequen ce. Wagenaar and Wolfson (1994:37) explain, other leadi ng causes of death and long-term disability for youth, such as suicide, homicide, assault, drowning, a nd recreational injury, involve alcohol in substantial proportion. Accumulated effects of chronic drinki ng could lead to long-term social consequences, such as a breakdown in family relationships or poor school performance (Brown and Tapert 2004). Long term health consequences from unde rage drinking could result as well. Recent research suggests that adolescent drinking can inflict permanent damage on the developing brain (Brown and Tapert 2004), foreshadowing problems with memory and reaction time. Other health problems are related to underage drinking as well. Bonnie and OConnell (2004:64) note: Heavy drinking during adolescen ce, especially if this behavior is continued in adulthood, places a person at risk of such health problems as pancreatitis, hepatitis, liver cirrhosis, hypertension, and anemia. Recent research suggests that drinking during puberty may have deleterious e ffects on bone density development for young women, failing to develop maximal bone density during adolescence puts them at risk later in life for osteoporosis. Addiction may play a serious part in these long-term health problems surfacing. Early onset of alcohol use greatly in creases the probability of adult alcohol dependence, as Bonnie and OConnell s uggest (2004:59); young people who begin drinking before age 15 are significantly more likely to develop alcohol dependence than those who begin drinking at older ages. Grant and Dawson (1997) further note that youth who begin drinking before the age of 15 have a 41 percent chance of future alcohol dependence, compared with a 10 percent ch ance for those who begin after the legal drinking age. Another important considerati on is how pregnant t eens abusing alcohol

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17 may also contribute to health complications in the child, possibly resulting in developmental problems or later addiction. Although biological considerations contribu te to a deeper understanding of how different people may be affected by alcohol use, it is essential not to be reductionistic in attributing these characteristics to be reas ons why people use initially and continuously. Vega and Murphy (1990:147) explain, as a c onsequence of explaining social problems in biological terms, individualism is stress ed. Social issues are equated with personal faults or maladaptation. Vega and Murphy (1990:147) further note: For if the individual is believed to be the source of most problems, the effects of sexism, racism, and other forms of institutional discrimination are not seen as worthy of attention. The focus of interv entions can thus be extremely narrow, because the complex relationship between personal motives and social practices can be ignored. Biological considerations may aid in targ eting certain populations over others, but it is important to keep in mind the social im plications to explain alcohol use, so that society does not escape blame for contributing to the social is sue of substance abuse. Strategies to combat underage drinking. Research suggests some possible strategies for decreasing the underage drinking rates. Of significant im portance is the role of the family in socializing the adolescen t to postpone drinking until the legal age. Bonnie and OConnell (2004) suggest parent al monitoring and involvement as key components in reducing adolescent alc ohol use. In addition, community-based approaches involving parents, communications media, and the community in promoting norms against use seem to be e ffective (Hawkins et al. 1992). Researchers are suggesting that changi ng the adolescent normative conception of alcohol usage may result in a decrease in underage drinking. Programs that teach young people skills for resisting influences to us e alcohol help them develop strong norms

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18 against use (Hawkins et al. 1992). Also, rese arch conducted by Cial dini and colleagues (Cialdini et al. 1990; Kalgren, Reno and Cialdini 2000) point to the need to distinguish between descriptive norms (perceptions of wh at most others are doing) and injunctive norms (perception of what other people th ink one should be doing or not doing). They argue that focusing on injunctive norms is more effective at changing behavior than targeting only descriptive norms. Also, extra-curricular activi ties may further distract t eens from underage drinking. Youth who participate in afte r-school programs, such as sports, clubs, library-based activities, and youth-se rving organizations are less likely to use alcohol than nonparticipants (Eccles and Barber 1999). A key strategy is for community-based efforts to be dependable. Hawkins et al (1992:7) propose, students ne ed to be provided with consistent, extended drug education programs. One-shot approaches, such as those that attempt to influence behavior only after one se ssion or educational activity, seem to be ineffective at making any long-term beha vior changes among adolescents. Current research on underage drinking in Alachua County Nationally, a higher percentage of youth aged 12 to 20 reported using alcohol (29%) than using tobacco ( 24%) or illicit drugs (14%), making underage drinking a leading public health problem in the Unite d States. In Alachua County, the number of youth reporting engaging in alcohol use is ev en higher (32.7%) than the national or state average (National Community Anti-Drug Coalition Institu te 2006). The social and environmental factors contributi ng to these statistics should be considered. It is important to note that the following cogni tive, social and environmenta l influences may not only be present in Alachua County, but are found in various communities across the country. The point of significance is that there are actual signs of these issues (based on data from

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19 surveys) being present in Alachua County. In addition, other issues may be present as well that are immeasurable or undetected at th is time that, in the future, turn out to be relevant. Since the following influences do pr esent themselves in Alachua County they will be discussed. Cognitive influence specific to Alachua County. Key findings from the Florida Youth Substance Abuse Survey (FYSAS) de scribe reported antisocial behavior among Alachua Countys youth, indica ting youth are less likely to become involved with prosocial organizations and positive role models in their communities in comparison to previous years. Keeping in mind the literature linking antisocial behavior to substance abuse, Alachua County youth are reporting greater percentages of drug use and delinquent behavior that coul d negatively affect their liv es and the larger community (Department of Children and Families 2003). These, as well as other adolescent cognitive influences always present in co mmunities, contribute to these high rates of alcohol use. Social influences specific to Alachua County. Research during the past 30 years supports the view that delinquency, alc ohol, tobacco, and othe r drug use, school achievement, and other important outcomes in adolescence are associated with risk and protective factors (Appendix A) in th e students community, school and family environments, as well as with characteristics of the indivi dual (Hawkins et al. 1992). In fact, these risk and protective factors have been shown to be more important in understanding these behaviors than ethnicit y, income or family structure (Blum, Beurhing, Shew, Bearing, Sieving, and Resnic k 2000). There is a s ubstantial amount of research showing that adoles cents exposure to a greater number of risk factors is

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20 associated with more drug use and delinquency. There is also evidence that exposure to a number of protective factors is associated with lower prevalence of these problem behaviors (Bry, McKeon and Pandina 1982; Newcomb, Maddahian and Skager 1987; Newcomb and Felix Ortiz 1992; Newcomb 1995; Pollard, Hawkins, and Arthur 1999). Environmental influences specific to Alachua County. Florida plays host to two of the top party schools in the nation, Florida State Un iversity and University of Florida. Specifically, Alachua County is home to the University of Florida, a powerhouse in football, and r ecently crowned winner of the NCAA Mens National Title in basketball has much to celebrate (Appendix B). Table 3: Alcohol Consumption in the United States, 1999 State or Area Ethanol* Per Capita Alabama 6,656 1.88 Alaska 1,346 2.88 Arizona 9,971 2.68 Arkansas 3,725 1.82 California 57,195 2.20 Colorado 8,305 2.57 Connecticut 5,953 2.26 Delaware 1,812 2.96 District of Columbia 1,647 3.74 Florida 32,773 2.66 Georgia 14,019 2.27 Hawaii 2,212 2.31 Idaho 2,355 2.39 Illinois 22,337 2.32 Indiana 9,371 1.97 Iowa 4,601 1.98 Kansas 3,925 1.85 Kentucky 5,662 1.76 Louisiana 8,678 2.50 Maine 2,348 2.26 Maryland 8,740 2.11 Massachusetts 12,290 2.45 Michigan 16,625 2.11 Minnesota 9,189 2.41 Mississippi 4,801 2.19 Missouri 9,962 2.26

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21 Table 3. Continued State or Area Ethanol* Per Capita Montana 1,828 2.55 Nebraska 2,979 2.24 Nevada 5,765 4.06 New Hampshire 3,943 4.07 New Jersey 14,416 2.20 New Mexico 3,308 2.43 New York 28,187 1.92 North Carolina 12,241 2.00 North Dakota 1,264 2.45 Ohio 18,203 2.01 Oklahoma 4,624 1.72 Oregon 6,239 2.32 Pennsylvania 18,723 1.91 Rhode Island 1,936 2.41 South Carolina 7,590 2.41 South Dakota 1,354 2.32 Tennessee 8,468 1.91 Texas 35,677 2.29 Utah 2,105 1.33 Vermont 1,144 2.34 Virginia 11,107 1.99 Washington 9,962 2.16 West Virginia 2,492 1.66 Wisconsin 11,664 2.75 Wyoming 961 2.48 Ethanol is the alcohol consumption measure used. Data from National Institute on Alcohol Abuse and Alcoholism (2002). (Bonnie and OConnell 2004). Unfortunately, its wet environment, with the density of bars and the consistent marketing and advertising of alcohol further no rmalizing its use, Alach ua County is a ripe environment for underage drinking to occu r. Bonnie and OConnell (2004:81) note: Research suggests that a wetter environm ent may provide adolescents with more social occasions to drink, more positive attitudes about drinki ng, more advertising and outlets, and more lenient regulations concerning the sale and consumption of alcohol. In short, such environments have an enabling effect on underage drinking. As suggested, Alachua Count ys environmental influen ce on adolescents should also be taken into account when considering ra tes of alcohol use, if any true initiative is to be made. In addition, environmental influe nces and how they relate to social and

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22 cognitive influences should be noted. Acco rding to the October 2003 issue of High Times Magazine, the University of Florida is the number one Counterculture College in America. This fact highlights the availabi lity of substances and makes the countys middle and high school students more at-risk fo r substance abuse, as they attempt to emulate the college students and model up to their behavior in a se arch for individual autonomy. These previously mentioned influences shoul d be conceptualized as interrelated in contributing to the issue of substance abuse in Alachua County. All of these factors make this community unique, and these characteri stics should be considered when coalition building efforts are being designed. Theoretical Framework Of PIPSA Criminological Theory Within the field of criminology there are many theories and conceptions of crime. Cullen and Agnew (2003:1) suggest: Like much social behavior, crime is mu ltifaceted and potentially shaped by a range of factors that operate insi de and outside individuals, that exist on the macro and the micro level, and that have effects across various points in the life cycle. PIPSA has two main theories central to its program: Social Learning Theory with a Life Course Perspective. Both will be explained in more detail in the following paragraphs. Learning Theory Even within learning theory, there are many theorists with varying viewpoints. However, the underlying beliefs among the th eorists are similar in a few important respects. Behavior is learne d through interaction with ot her social actors, and more importantly, crime is learned in the sa me way. Cullen and Agnew (2003:6) explain,

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23 crime is learned through associations with criminal definitions. These definitions might be generally approving of criminal conduct or be neutralizations th at justify crime only under certain circumstances. Thus, interacting with individuals who participate in crime encourages a person to conduct criminal behavi or, since the interac tions are reinforcing this behavior, whatever the degree may be. Particularly relevant to PIPSAs progra m is Catalano and Hawkins Communities That Care strategy. It is a community-bas ed strategy to create long-term support for behavior change. Hawkins et al. (1992:19) explain: Involving the whole community facilitates widespread communication to achieve consistent norms about drug use and the n eed for prevention, as well as knowledge about risk and protective f actors. A community-wide a pproach can also promote the development of strong bonds to famil y, school, and the community itself among young people. Because community approach es are likely to involve a wide spectrum of individuals, gr oups, and organizations, they create a broad base of support for behavior change. Unhealthy behaviors like underage alcohol use are looked at as unacceptable among a wider audience, guarding against the behavior. Akers (1990:660) states, the full behavioral formula in social learning theory includes both positive and negative punishment and positive and negative reinfor cement. Catalano and Hawkins risk and protective factors rely on this basic premise. In theory, this support from those involved in the behavior change process leads to long-term change. Hawkins et al. (1992:19) st ate, programs and strategies gradually become integrated into the regular services and activities of lo cal organizations and institutions. With this in mind, the impor tance of a thoughtful st rategy, tailored to the specific community it hopes to address, should be stressed. Catalano and Hawkins advocate for every community to develop th eir own programs and strategies that are relevant to the community it hopes to reach. Also, the community mobilizations strategy

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24 of Communities That Care is not meant to be a rigid approach (Hawkins et al. 1992:19). As expressed by the authors, the design allows for flexibility. Life-Course Perspective Jary and Jary (1991:277) explain, life-cour se is the process of personal change from infancy through to old age and death, broug ht about as a result of the interaction between biographical events and society events. Its focus is on sociohistorical processes contributing to human action at various poi nts over the life-course. Sampson and Laub (1997:9) suggest, individual lives are studied through time, with particular attention devoted to aging, cohort effects, historical context, and the so cial influence of age-graded transitions. Sampson and Laub (1997:8) further note: The long-term view embodied by the lifecourse focus on trajectories implies a strong connection between childhood even ts and experiences in adulthood. However, the simultaneous shorter-term view also implies that transitions or turning points can modify life trajecto ries they can redirect paths. Although this view is not accepted by all life-co urse theorists, this offers incredible hope to community-based approaches as th ey attempt to prevent initial users and redirect current substance abusers. Programs will be most effective if they are sensitive to the developmental needs and capabili ties of particular age populations. Life-course criminologists st udy crime over the life span. As previously mentioned, people are thought to be influenced differently by events at different stages in the lifecourse. More importantly, what may be an effective intervention for someone at one point may not be at another. Community-based programs that attempt to incorporate the life-course perspective should reflect these considerations.

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25 Life-course criminologists gene rally speak in terms of th ree stages of development: childhood, adolescence, and adulthood. The goa l is to understand the stability and changes in criminal behavior through time and over different stages of development. Cullen and Agnew (2003:7) state, crime causati on is a developmental process that starts before birth and continues throughout the life course. Individual factors interact with social factors to determine the onset, length, and end of criminal careers. Life-course proponents agree childhood is a time when crim inal behavior begins, but they argue over why continuity or change in behavior varies over the life-course, creating either lifecourse persistent offenders or adolescent limited offenders. Some researchers believe criminal behavior is predet ermined while others believe it is context-dependent. Arguing the former statement, Moffitt (1990:100) states, most recently, neuropsychological measures have come to be used as research tools for identifying brain dysfunctions that may characterize groups who display syndromes of deviant or pathological behaviors. Adolescent limited offenders use crim inal behavior as a statement of independence throughout their adolescent years. Although they begin to resist anti-social behavior in adulthood as the maturity gap closes by adult conventional norms becoming available. A job to pay for purchas es may decrease the likelihood of stealing, marriage may limit risky sexual activity, and becoming a parent may encourage maintaining job security limiting actions th at may disrupt employment. Life-course persistent offenders may experience a gap between biological a nd social maturity, creating a source of disconten t and motivation towards crime or deviance over the lifecourse. Sampson and Laubs age-graded theory of informal social control suggests that

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26 deviance is natural. People must be controlled from following their natural feelings; otherwise theyll participate in anti-social deviant behavior. Over the life-course, people experience di fferent types of social control. In childhood, social bonds with parents and fam ily are primary. Social bonds between parent and child are important sources of control. Children who are bonded well to parents and report strong attachment to schoo l are less likely to commit delinquent acts than those who have weak social bonds (Haw kins et al. 1992). In adolescence, peers appear to have a greater influence affec ting social controls Hawkins et al. 1992). Adulthood offers marriage and employment as primary sources of control. Sampson and Laub (1997) suggest that change can occur at any stage in the life-course, as long as strong conventional bonds are de veloped in the individual. Life-course research suggests that if crime prevention is the goal, intervention should start early and focus on fostering social bonds between childre n and their families. Since late adolescents/early adults are more willing to seek conven tional behavior, timing is crucial in knowing what stra tegies to employ when targe ting this group. Within each developmental stage, priority must be give n to building and strengthening positive social bonds between the appropriate community members. Each developmental stage requires unique support systems that may be useful only during that stage. Community-Based Coalitions Community-based coalitions are vehicles for creating cohesion among its members. Bonnie and OConnell (2004:216) advocate, in a democratic society, the mobilization of communities in civic life is in and of itself of significant value. Democratic life relies on civic participation and an active informed citizenry. Through open dialogue, community members are able to set acceptable standards of its people, and work to encourage the

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27 rehabilitation of those who need it most, in order to ensure the h ealth of its citizenry. Bogenschneider (1996:132) states, consistent with the notion that development occurs in context, consensus seems to be emerging th at the most appropri ate place for solving problems is where they occur in communitie s. Lerner and Miller (1992) suggest the increase in local collaborative efforts has led some to call the 1990s the decade of community coalitions for children. Many agree with the current research showing that loca l residents are capable of bringing about change in areas important to them (Bellah, Ma dsen, Sullivan, Swidler, and Tipton 1985; Gardner 1989; Lofquist 1983; McKnight and Kretzman 1992). Also, in some large states, such as California, local coalitions have sometimes had greater success than statewide efforts (Bonnie and OConne ll:218). A more localized approach makes the strategy more personal and allows it to take a shape that is more tailored to the problems present in the community it hopes to address. The effort needs to be community-wide to make a lasting impact on it residents. Research shows, that even when school programs change behavior, this success is short-lived in the absence of community norms that support the progr am goals (Bogenschneider 1996:133). Effectiveness Of Community-Based Coalitions We have previously addressed the st rength community coalitions have in mobilizing community efforts. Now it is impor tant to suggest their effectiveness in dealing with issues relati ng to youth. Solutions to youth problem behaviors are too complex to be dealt with by any one singl e organization (Albee 1983). Community-based coalitions involving varied agencies and organizations throughout the community are necessary in dealing with the issues more comprehensively.

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28 Community coalitions have broad goals of changing the infrastructure to the social issue being addressed. Bonnie and OConnell (2004:217) further explain, communitybased prevention research points to the im portance of broad efforts to reshape the physical, social, economic, and legal envir onment affecting alcoholism. Also, they attempt to generate public awareness, knowle dge and concern for the issue to ensure long-term efforts. Gwaltney (2005:8) explains, despite truth campaigns, Surgeon General warnings, multiple treatments, and other important advances, too many adolescents still start smoking annually and relapse is still the norm following a quit attempt. Unlike one-shot educational a pproaches like the American Legacy Foundations Truth campaign or Philip Mo rriss Think. Dont Smoke campaign, or extended programs like the D.A.R.E. program, which have been suggested to be ineffective, the PIPSA coalition is aiming to change the physical, social, economic, and political climate of drinking in Alachua County, particularly within underage youth populations in the hopes of ma king long-term changes in the community relating to alcohol use. The General Acc ounting Office (2003:3) pulled t ogether a literature review on the D.A.R.E. program, in which they cite d six long-term evalua tions done during the 1990s that found no significant difference be tween students who received the D.A.R.E. program and those who did not. Community-based coalitions have been e ffective in dealing w ith substance abuse issues, more specifically, alcohol-related pr oblems. As Bonnie and OConnell (2004:216) note: Although most community coalitions have not been rigorously evaluated, several community trials provide ev idence that community coali tions can affect alcoholrelated outcomes and also document the elem ents that make community initiatives

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29 successful. In addition, numerous case studies and substantial qualitative research attest to the effectiveness of community coalitions. Pentz, Dwyer, MacKinnon, Flay, Hansen, Wang, and Johnson (1989) further note, comprehensive community collaborations ha ve proven to be an effective method for preventing such youth problems as alcohol a nd drug abuse. In more specific ways, a community-based coalition can contribute to reductions in undera ge drinking. Bonnie and OConnell (2004:217) suggest: It can help to create the political will and organizational support for developing and implementing proven strategies for d ecreasing underage drinking (such as minimum age drinking laws, zero tolerance laws, and measures to reduce physical availability and outlet concentration). It can help change the normative climate surrounding the acceptability of underage drinking, and crea te greater awareness of, and publicity about, enforcement activities, such as random breat h testing and sting operations. It also helps to establish th e idea that alcohol a nd other drugs are a community problem that local people can solve, thereby incr easing the likelihood that people will support and sust ain efforts they help create. Community-based coalitions clearly have credibility in addressing substance abuse issues like underage drinking. Research suggests that certain strategies are more effective than others though. Suggested Strategies Employing Community-Based Coalitions Research has suggested many successful st rategies in employing community-based coalitions. Hingson and Howard (2002) suggest that if community coalitions are to be successful, they must employ a variety of t echniques such as educational programs, community organization, environmental po licy changes, use of media, and law enforcement practices that correspond to the poli cies in place. It is in the combination of the strategies that success is gained. As disc ussed, there is no one way to reduce underage drinking. Successful community-based groups should include various techniques from a variety of sources in the community.

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30 It is important for communities to co llaborate with neighboring colleges and universities, such as in Gainesville wher e a college affects drinking behavior, to effectively impact the community at larg e. Bonnie and OConne ll (2004:226) note: Effective restrictions on underage access to alcohol in a community may be severely undermined by the ease of alcohol in the campus living communities. The reverse is also true: even a substantia l campus-based alcohol prevention strategy cannot succeed if it is surrounded by a co mmunity with easy access to alcohol. Also, college-community partnerships may save time and money by developing joint grant proposals, giving further credence to the initiative by s howing its overlapping support by both the college and community. It is for these reasons collaboration with neighboring institutions is str ongly suggested. Research show s that consistency of policy between campus and community contribu tes to success. As Bonnie and OConnell (2004:227) state, colleges working with lo cal police can enhance the consistency of enforcement efforts by notifying one another of alcohol-related incidents and by seeking timely and meaningful sanctions. This commun ication is small in terms of cost, but has been known to improve the drinking scene dr amatically and rein force the collective efforts both the local police and campus police are working towards. There has also been success in employing media to target underage drinking. Bonnie and OConnell (2004:217) note: Case studies have documented how communities have organized and used the news media to support changes in alcohol availa bility, reductions in outdoor advertising of alcohol, increased compliance checks on re tailers regarding se rvice and sales of alcohol to minors, ke g registration laws. The media can be a wonderful vehicle for getting important details out regarding upcoming activities as well. In addition, they may broadcast or recap important efforts by community-based coalitions, like town hall meetings.

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31 School-based initiatives have had a long history in targeting underage drinking. Bonnie and OConnell (2004:193) suggest, d elivery of such programming through schools offers the benefits of reaching a wide (and captive) audience, as most young people (especially elementary and middle-schoo l-aged children) are enrolled in school. Also, school-based initiatives allow progr ams to be disseminated at specific developmental intervals. Some would argue th is is essential considering the life-course perspective (Steinberg 1991). Since youth are reporting initial drinking between the ages 12 to 14, programs need to begin reaching them prior to this age. Bonnie and OConnell (2004:193) state what does not seem to work in school-based initiatives: Many early drug education curricula that relied on factual information about alcohol and other drugs, in cluding information on the ne gative consequences of use, or fear arousal were based on the theory that adol escents who used alcohol and drugs had insufficient knowledge about the consequences of use and that increased information would make them more lik ely to decide not to use drugs. These programs have not been shown to affect behavior, for cognitive reasons previously mentioned for adoles cents beginning to use initially. School-based initiatives that use normative education to undermine yout h beliefs that alcohol use is prevalent among their peers and that peers universally ap prove of this behavior appear to have promise (Bonnie and OConnell 2004:194). Also, programs that take a critical look at the cultural messages the media is sending and the targeting tactics used to capitalize, monetarily, on a wider audience may even wor k. Regardless of the content, it has been suggested that educational pr ograms demonstrated to reduce alcohol use and abuse have all been highly interactive (Bonnie and OConnell 2004:197). Dryfoos (1990) suggests intervention needs to be early, and continuous for it to facilitate long-term change. Also, Empowerment theory offers that youth s hould be involved in the decision-making process in order to get them invested (Lofquist 1983).

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32 Federal and state governments may also be instrumental in decreasing underage drinking. Community-based coalitions may sugge st they do a variety of tasks to improve the well-being of the people they serv e. Bonnie and OConnell (2004:232) note: Federal and state governments should c oordinate and monitor the various components, including providing the data and research needed to assess and improve the strategy. The third role is to increase alcohol excise taxes to both reduce consumption and provide funds to support the strategy. There is strong and well-documented evidence of the effect s of raising taxes on consumption, particularly among youth. The federal government oversees three nati onal surveys, reporting the prevalence of underage drinking: the National Survey on Drug Use and Health (NSDUH), Youth Risk Behavior Survey (YRBS), and Monitoring the Future (MTF). Overall trends seem generally consistent acro ss surveys. Bonnie and OC onnell (2004:236) further note, currently the federal government does not report regularly on activities across the various agencies that fund targeted underage drinking activities, and evaluating the effect of those activities, as it does for illegal dr ugs. Efforts from the government to report findings, especially discrepancies between ag encies, would provide a clearer picture of what the underage drinking scene is like. With this knowledge, programs can more effectively plan strategies. Within a community coalition, a broad range of organizations may be acceptable, or a focused selection may work best together, depending on the needs of the community. Bonnie and OConnell (2004:218) expl ain, there is some evidence that coalition partners with strong ties to alc ohol producers may not suppor t effective environmental interventions. Sometimes it is counterproductive to have members who have vested interests in alcohol production or sales, si nce they may be given the power to veto alternative intervention strategies that might affect their productivity. Bonnie and

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33 OConnell (2004:217) further note having the flexibility to choose ones partners has been an important ingredient in the succe ss of many effective coalitions. Also, workbased interventions may also serve to r each a population of young people who are not exposed to school-based interventions (Bonnie and OConnell 2004:210). It is the employers duty to the community to provide work-place alcohol prev ention programs to warn against the dangers and repercussions it might have on job productivity and possibly job security. The employer know s, a full-or part-time job provides discretionary money that young people ma y choose to spend on alcohol (Bonnie and OConnell 2004:210). The business segment of a community has many resources and should be considered when de veloping community coalitions. Although not much research has been c onducted with faith-based approaches, family involvement in faith-based institutions religiosity, and spirituality all have been shown in research to reduce the risk for adolescent substance use (Bonnie and OConnell 2004:196). Also, parents have shown to be a positive source of socialization. Community-based programs can provide parent s with skills and motivation for actively monitoring and supervising th eir children (Bonnie and O Connell 2004:196). Both faithbased approaches and parental involvement have been shown to be successful in decreasing underage drinking. Strategies employing healthcare staff and facilities are sugg ested to be successful as well. Healthcare staff may come across to a dolescents as impartia l, possibly allowing them to hear the dangers of alcohol use and abuse in a more sincere manner. As noted by Bonnie and OConnell (2004:209), emerging resear ch suggests that physician rates of screening adolescents for alcohol use can be improved (from an average of 59 percent to

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34 76 percent) by training physicia ns on knowledge, attitudes, an d skills that are necessary to create behavior change. This is anothe r area of community-based initiatives that has only recently been addressed. Scientifically-based strategies are strongly recommended when implementing alcohol prevention programs. It is important for communities to rely on scientificallybased strategies to reduce underage drinki ng, combining environmental and social change with theory-based approaches (Bonnie and OConnell 2004:217). Employing strategies that have been proven ineffective could lead to an exhaustion of resources and wasted time, without any real social change. Attention to irresponsible sa le, promotion, and marketing of alcohol are essential to eliminating the culture of underage drinki ng, in addition to controlling the alcohol availability to youth. As suggested by Bonnie and OConnell (2004:218), recent crosssectional research has sh own a correlation between ou tlet density and underage drinking. Decreasing the number of bars ma y lessen market competition, resulting in fewer alcohol specials trying to attract unde rage drinkers to th eir establishment over another. Key leaders in the community are important to include. Some may not be able to participate regularly, but just by their affilia tion they give the coalition credence. Key leaders who are active particip ants can increase support a nd awareness in ways other coalition members may not have the contacts to do. This chapter laid out the implications of alcohol use and abuse among underage populations. It also described the drinking s cene in Alachua County, the target population of the PIPSA coalition. PIPSAs suggested theoretical framework expressed the

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35 foundations the coalition was based on, as well how the coalition ge nerally intends to approach its community members. Literature describing the effec tiveness of community coalitions in response to soci al issues such as underage drinking was provided to show the worth of PIPSA efforts and to expre ss what this coalition aims to accomplish. Suggestions for strengthening the coalition, based on prior literature, were presented. These will be addressed in later chapters to highlight the PIPSA programs strengths and weaknesses. Before this can be done, a d eeper insight into the PIPSA program is necessary. The following chapter expresses PI PSAs immediate prior ity and the goal of the study in more detail.

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36 CHAPTER 3 PARTNERS IN PREVENTION OF SUBSTANCE ABUSE (PIPSA) COALITION The following chapter provides a more in-d epth look at the PIPSA coalition. The program history is outlined and a description of the Alachua County setting is detailed. Also, attention is called to PIPSAs program theory, both in the form of its program impact theory and its program process theo ry. Their new focus on underage drinking is explained as well as PIPSAs immediate priority, program evaluation. A formative evaluation in the form of this study is offere d as a necessary step in moving towards an evaluative program. Program History Partners in Prevention of Substance A buse (PIPSA) was established in 1999 by founding partners Corner Drug Store, Inc., UF Center for Cooperative Learning and Department of Psychiatry, and the School Board of Alachua County. Originally, it received funding through an Office of J uvenile Justice and Delinquency Prevention (OJJDP) Drug Free Communities Grant, which was part of a five-year project that aimed to create a coalition in ev ery county by the year 2004 that dealt with local problems specific to that community. The grant was matched dollar for dollar by the Ounce of Prevention Fund of Florida. PIPSA is a combination of several local agencies, businesses and community members in the Alac hua County area that meet to discuss and plan ways to make our community drug free (Corner Drug Store Incorporated 2006). It is a level one prevention program that is nonclient specific, mean ing they do not track individual client outcomes.

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37 PIPSAs original mission was to reduce th e prevalence of problem behaviors (such as alcohol, tobacco, and other drug use) among the communitys youth and to strengthen PIPSA and develop a long-term (over the lifecourse) anti-drug initiative with citizen involvement. The term prevalence refers to the total number of existing cases of problem behaviors in Alachua County (R ossi et al. 2004). PIPSA hoped to focus primarily on the youth of Alachua County, with program activities geared to them, but also welcomed all residents of Alachua C ounty to make a life-long commitment to this community initiative. The progr am is currently not funded a nd is hoping to procure future funding once evaluation pieces may be done to show the programs merit. Alachua County First I will describe the setting. Next I will discuss PIPSAs program theory. Alachua County includes the cities of Alac hua, Archer, Gainesville, Hawthorne, High Springs, La Crosse, Melrose, Micanopy, Ne wberry, Waldo and significant non urban areas. In Table 4 the total estimated population in 2004 was 223, 090, with 20.2% making up the under 18 population (Department of Child ren and Families 2003). Considering the underage drinking level is twenty-one, PIPSAs target population is a slightly larger percentage than 20.2% (Department of Children and Families 2003). This means slightly more than 20 out of every one hundred people PIPSA hopes to reach in order to intervene or prevent their use of alc ohol. In terms of income, the median household income of Alachua County residents is approximately se ven thousand less than the Florida average. Roughly twenty-three percent of the Alac hua County population is below the poverty level, as compared to Floridas state averag e of 12 percent (Department of Children and Families 2003). Considering transportation a nd participation costs, free and easily accessible prevention programs should be espe cially available in Alachua County. Age,

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38 gender and race categories for Alachua County al l have similar rates when compared to the Florida average. Therefore, there are no not able considerations that need to be made for Alachua County in regard to changing the curr ent allocation of funding resources based on these categories. Focus group part icipants suggested Alachua County to be currently the highest funded county within its surrounding 11 counties, due to its population. Attention should be focused on the patterns found in juvenile offenses in Alachua County. Most crimes are committed during the week and in the daytime (Department of Children and Families 2003). Su ccessful prevention activities need to accommodate youth at times they are most vulne rable to participate in crime. With 11 percent of drug offenses being committ ed by youth in Alachua County, it may be suggested that preventio n activities from the PIPSA coalitio n could be more successful in reaching its target audience. Table 4: Alachua County Statistics Alachua County Florida LAND AREA Square miles (2000 est.) 874 53, 927 Persons per square mile (2000 est.) 249.3 296.4 POPULATION Alachua County Florida Population (2004 est.) 223, 090 17,019,068 Population, percent ch ange (20002004) 2.4%+ 8.8%+ Households (2000 est.) 87,509 6,337,929 Persons per household 2.34 2.46 AGE Under 5 years old (2000 est.) 5.1% 5.9% Under 18 years old (2000 est.) 20.2% 22.8% 19-64, percent (2000 est.) 70.2% 59.6% 65 years old and over (2000 est.) 9.6% 17.6% GENDER Female (2000 est.) 51.2% 51.2% Male (2000 est.) 48.8% 48.8% RACE %White (2000 est.) 73.5% 78% % Black/African American (2000 est.) 19.3% 14.6% % of Hispanic or Lati no origin (2000 est.) 5.7% 16.8%

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39 Table 4. Continued Alachua County Florida Persons reporting two or more races (2000 est.) 2% 2.4% INCOME Median household income (1999 est.) $31, 426 $38, 819 EDUCATION High school graduates, % 25+ (2000 est.) 88.1% 79.9% Bachelors degree or higher, %25+ (2000 est.) 38.7% 22.3% POVERTY PREVALENCE Persons below poverty, percent (1999 est.) 22.8% 12.5% Children below poverty, percent (1997 est.) 23% 21.8% JUVENILE OFFENSES (2004 est.) 2,180 (2% ^) Two most common days of the week to commit Offense (2004 est.) Thursday (16.6%) Friday (16.7%) Three most common time of day to commit Offense 3-6pm freq. 399 (18.3%) 12-3pm freq. 393 (18%) 9-12n freq. 320 (14.7%) Drug offense (2004 est.) 240 (11% of offenses committed by juveniles) (Department of Children and Families 2003). 2004 Alachua County Statistics. Program Theory In this section, I outline PIPSAs program theory. This explains why the program does what it does and provides the rationale for expecting that doing so will achieve the desired results (Rossi et al. 2004). PIPSA follows Catalano and Hawkinss Social Development Theory (see Figure 3). The stra tegy is to begin w ith a goal of healthy behaviors for all children and youth. In order for young people to develop healthy behaviors, adults must communicate healthy behaviors and clear standards for behavior to young people. Bonding (an attached, committe d relationship) betw een a child and an adult who communicates healthy beliefs and clear standards motivates the child to follow healthy beliefs and clear standards. A child who creates this bond with an adult is less likely to threaten the relations hip by violating the beliefs a nd standards held by the adult

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40 (Catalano and Hawkins 1996). Hawkins and Ca talano suggest that bonding is dependent on three conditions (Catalano and Hawk ins 1996). Children need appropriate opportunities for meaningful involvement with a positive social group, such as their community, family, and school. Children need the emotional, cognitive, social and behavioral skills to successfully take advantage of opportunities. Lastly, children must be recognized for their involvement. Figure 3: Program Theory: Social Development Strategy Start with (strong support system*): Healthy Beliefs and Clear Standards (in families, schools, communities and p eer g rou p s ) Build: Bonding* (Attachment & Commitment to families, schools, communities and peer groups) By providing : Skills in families, schools, communities and peer groups (Ex. workshops, counseling, good parenting skills from community agencies) By providing : Recognition in families, schools, communities and peer groups (Ex. Certification in community programs Informed Families, Knight Vision) And by nurturing : Individual Characteristics (Protective factors based on cultural values) By providing : Opportunities in families, schools, communities and peer groups (Ex. jobs, social situations, etc) The Goal : Healthy Behaviors* for all children an d y outh

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41 Healthy Behaviors include being totally fr ee from substance abuse, promoting the same in others, raising drug-free children. (Sin ce social norms encourage the escalation of substance abuse, it is ideal to curb initiation of these behaviors.) Theory of affecting social norms: It may take years to change the ideas in the population, but the community must start with a strong support system that provides clear standards and healthy beliefs. (Ex. of values that are not healthy or clear standards Collecting keys at a party, so children may st ay and drink all evening encourages binge drinking and lack of responsibility). Bonding is created among community memb ers. When clear messages (as opposed to mixed messages) are conveyed, a sense of safety is maintained (Catalano and Hawkins 1996). Program impact theory In this section, I explain PI PSAs impact theory (see Figure 4). An impact theory consists of assumptions about the change process actuated by the program and the improved conditions that are expected to resu lt (Rossi et al. 2004). PIPSAs stated impact theory is that by providing information to community members (through community agencies) it will build strong protective factors (possibl y changing attitudes/motivation regarding substances) as barriers to risk factors to prevent initial or continued drug abuse (see Appendix A).

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42 Figure 4: Impact Theory Catalano and Hawkins Social Developmen t Strategy seems to emphasize focusing on protective factors, in orde r to prevent initial or conti nued drug abuse. In practice, PIPSA activities actually focus both on p rotective factors and risk factors. Educational workshops and Drug Summits incl ude information regarding examples from Alachua County Community Agencies Recruit Participants to Attend PIPSA Events (by word-ofmouth, flyers, posters, etc) Attendance and Participation at Educational Events (workshops, drug summits, red ribbon week) Builds Pro-social Environment Builds Protective Factors or Assets (encouraging opportunity/skills/recognition for activities not involving substance abuse) No Substance Abuse Creating a Barrier to Risk Factors Physically Healthy Community Members

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43 both categories. CADCA suggests focusing on bo th, with the goal of prevention to be changing the balance so protective fact ors outweigh risk factors (National Community Anti-Drug Coalition Institute 2006). Alachua County community agencies recr uit youth to atte nd PIPSA events by interagency, e-mails, word-of-mouth, flye rs, and posters. In theory, attendance and participation at these educational ev ents (workshops, drug summits, Red Ribbon Awareness activities) lead to a pr o-social environment for the individual with protective factors being built. These strong protective factors guard against risk factors and prevent the initial or continued use of substa nces. Without substance abuse, the individual is more capable of being physically and em otionally healthy, both individually and for his/her community. Measurable outcomes showing the individua ls healthy lifestyle may be either proximal or distal. Proximal outcomes would be the attitudes, knowledge, skills, and behavioral intentions. For example, youth may model their mentors values and behavior, or youth may use their leisure time more c onstructively (i.e. hanging out with family, going to church, doing homework) strengtheni ng the protective factors even more. Distal outcomes might be a decrease in problem behaviors (alcohol, tobacco and drug use) over an extended period of time. Program process theory In order for any outcome to occur, the se rvices must be delivered to the target populations. The service utilization plan is constituted by the programs assumptions and expectations about how to reach the targ et population, provide and sequence service contacts, and conclude the relationship when services are no longer ne eded or appropriate (Rossi et al. 2004). Currently, participants are recruited by local advertising in ways

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44 discussed below. These are considered th e best ways (considering the resources available) to reach PIPSAs large target population. Alachua County residents (both youth and adults) are offered the same type s of educational training and awareness activities. This should lead to the strengthening of th e individuals pro-social environment (building protective factors as barriers to risk factor s), since there is a clear message being broadcast to all who may come in contact with the individual. The process does not conclude, but is cyclical. Each year the same activities are offered, with the idea in mind that, the more an individua l participates, the str onger their pro-social environment will become. Examples of educational trainings include bi-monthly educational workshops and the Annual Regional Drug Summit, advertised through flyers, posters, and list-serve emails to community agencies (that they post and announce as well). Adults are always able to become members of the coalition, as are youth, but youth also have a special invite offered to them at the Annual Regi onal Drug Summit that encourages them to become peer leaders and to join the Yout h Advisory Committee (a sub-committee within PIPSA). If they join this, th ey are expected to: attend bi-w eekly meetings to discuss youth problems in the community; help the comm ittee develop/revise youth goals for their peers in Alachua County; and implement activities that will achieve these goals. Currently, the sub-committee is being forme d, so goals and activities have not been established. Adults and youth are also encouraged to par ticipate in substance abuse community awareness activities. Examples of awareness activities include legislative activities, Family Day, and Red Ribbon Week. Legislative activities en courage community members to take action

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45 to combat substance abuse in forms of lette r campaigns (highlighti ng the irresponsibility of print and radio ads that advocate binge drin king), Op Ed pieces, Letters to the Editor, and trips to Washington, D.C. (Day at the Capital). Family Day encourages families to make dinner time a family affair. The goal of the project is to have 5,000 families pledge to eat together on Family Day (last year it was Monday, September 26, 2005) and to make eating together a family a priority throughout the year. Increasing time spent strengthening a pro-social e nvironment builds protective fa ctors as barriers to risk factors. Red Ribbon Week is a campaign honoring Enrique Camarena, a DEA agent who lost his life while worki ng undercover in Mexico investigating a major drug cartel. The belief behind this campaign is that even one person can make a difference. Activities include youth poster and essay contests that encourage and reward creative ways to get out the message of substance abuse. A lunc heon is held at the end of the week to acknowledge and applaud the efforts of those particip ating, in an effort to recognize community members (further strengthe ning their pro-social environment). PIPSAs New Focus: Underage Drinking PIPSA would like to specifically focus activities on combating underage drinking, since this is their new primary concern. This study will aid PIPSA in brainstorming for new activities, as well as connecting these ac tivities with the organizational plan. The organizational plan relates to program re sources, personnel, administration, and the general organization of the program (Rossi et al. 2004). Factors th at are important for PIPSA to maintain this service delivery syst em are interagency collaboration and citizen involvement. It is crucial for PIPSA to have each sector (law enforcement, education, social services, health, parents, government, civic, faith-based, and business) of the community represented in th e coalition. Their efforts n eed to be coordinated by a

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46 governing body the executive board of PI PSA. This board organizes educational trainings and awareness activities and enc ourages the sectors to disseminate this information to community members they have contact with. Monthl y meetings (at an Executive Board members place of workpresently The Corner Drug Store) are important for this transaction of information to take place. They then can go back to their respective agencies (with no a dditional facilities required) and broadcast the importance of the upcoming events in the community, encourage participation and offer these opportunities for community members to seek information regarding a prevalent social issue that may exist as close as their very home. Formative Evaluation PIPSA is currently in the pr ocess of revising their organi zational plan in order to more effectively reach their targ et population and to develop a plan that can eventually be evaluated in terms of its process and impact Evaluation is essential to ensure future funding, since most grants are now awarded to evidence-based programs. The program is not capable of being evaluated based on its current program struct ure. Even though this program has been in Alachua County for seven year s, it is still in need of a more refined program design. The past two years the pr ogram has been completely unfunded and PIPSA is going through changes still, adopting CADCAs Strategic Prevention Framework. Also, a Youth Advisory Committ ee was just newly appointed as a PIPSA sub-committee and has yet to draft goals a nd objectives. These changes in goals and objectives no doubt will affect the service utilization and organization aspects of the PIPSA program. It is necessary to speak with coalition members to coordinate feedback on the changes of the coalition and the re sources and possible ac tivities PIPSA could offer the community, centered on the new pr imary concern of underage drinking.

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47 Most often evaluations provide a si ngular focus on program improvement, accountability or knowledge generation. Scrive n (1991) notes, a formative evaluation is intended to furnish information for guiding program improvement and its purpose is to help form or shape the program to perform be tter. A formative evaluation is best suited for PIPSA to help clarify the needs of th e target population, improve program operations, and enhance the quality of service delivery (R ossi et al. 2004) since impact assessments are most appropriate for mature, stable progr ams with a well-defin ed program model and a clear use for the results that justify the effort required (Rossi et al. 2004). Rossi et al. (2004:34) explain, the audien ces for formative evaluations typically are program planners, administ rators, oversight boards, or funders with an intent in optimizing the programs effectiveness. Fo llowing the idea of a formative evaluation, this study will explore the n eeds of the target population, improvements in program operations, and service delivery possibilities thro ugh the eyes of the coalition members. It will incorporate feedback from them regarding program operations and service delivery in order to create a comprehensive list of cu rrent as well as newly suggested activities that are directly related to the programs process and impact theories concerning to underage drinking. At this poi nt, the PIPSA program does no t coordinate the available resources from participating coalition memb ers and their respective agencies in a comprehensive effort to reduce problem beha viors in Alachua County, let alone their new goal. Following CADCAs Strategic Preventi on Framework, it is first necessary to identify the resources available to PIPSA through its coalition members, and their participating agencies. The goal of the study is to develop a comprehensive response to the problem behavior addresse d (currently underage drinking ). The duty of the coalition

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48 will be to use this formative evaluation to cr eate a feasible organizational plan including only the activities they agr ee to include in the program, and monitor the process and impact of these activities over periods of time to evaluate the programs strengths and weaknesses. With feedback from all sector s, PIPSA can offer a more community-based approach and increase the awareness and i nvolvement of the program in Alachua County, further strengthening its impact. This chapter expressed the PIPSA coalition s efforts in more detail, allowing for a better understanding of its history and its desire d future. The next chapter will present the ontological, epistemological and methodological a pproaches that will be employed in this study, as well as any accompanying limita tions that may be associated.

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49 CHAPTER 4 STUDY DESIGN This chapter gives the ontological, epistemological, and methodological background of the study. Since focus groups we re the primary method in this study, time is dedicated to explaining the benefits a nd limitations of this method. More specific details regarding the focus group design employed in this study are offered as well, such as focus group questions and materials us ed in the study. Following this, analysis procedures in applying Strauss and Corbins Grounded Theory are described. Lastly, overall limitations of the study design are addressed. Ontology The principal investigator approached th is study within a constructivist paradigm. As Schwandt (1994:118) notes: Proponents of these persuasions share the goal of understanding the complex world of lived experience from the point of vi ew of those who live it. This goal is variously spoken of as an abiding concern for the life world, for the emic point of view, for understanding meaning, for graspi ng the actors defini tion of a situation, for Verstehen. The world of lived reality and situation-specific meanings that constitute the general object of investiga tion is thought to be constructed by social actors. That is, particular act ors, in particular places, at particular times, fashion meaning out of events and phenomena through prolonged, complex processes of social interaction involving history, language, and action. This constructivist paradigm assumes a relativist ontology, suggesting multiple realities do exist. Hazelrigg (1989) stresses the importance in keeping this mindset by focusing on the practice of the researcher: who we are, what we do, what world we make. By distancing research from the Gods ey e point of view, we accept the logic that research is dependent on both the social and historical setting. More importantly,

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50 whatever results researchers produce because of this should be dealt w ith in a considerate manner. Denzin and Lincoln (2003:441) note, t he problem is that to continue to employ the language of a discovered world is to con tinue a passivity in re gard to responsibility for the world. This is not to say that rese arch is unproductive, but that a multiplicity of realities exists and all studie s, especially within the social sciences, should approach knowledge with this notion, since it is a result of perspective. Epistemology A subjectivist epistemology was employed, understanding that the researcher and respondent co-created meanings throughout th e focus groups. As mentioned previously, these constructions are influenced by sp ecific historical, geopolitical, and cultural practices and discourses, and by the intentions noble and ot herwiseof those doing the constructing (Denzin and Lincoln 2003:598). It is the researchers responsibility to understand peoples construction of meanings in the context being studied. This constructivist (or interpretivist) approach is undeniably subjecti vist the inquirers worldview becomes part of the constructi on and representation of meaning in any particular context, with inquirer bias, experi ence, expertise, and in sight all part of the meanings constructed and inscribed (Denzi n and Lincoln 2003:598). With this in mind, a different researcher would most likely yi eld different results, with interpretation stemming from individual beliefs and values. Methodology Natural settings are considered the best context for researchers employing constructivism, with the huma n inquirer as the primary ga therer and in terpreter of meaning, with qualitative methods, with emerge nt inquiry designs, and with contextual, holistic understanding, in contrast to interven tionist prediction and c ontrol, as the overall

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51 goal of inquiry (Denzin and Lincoln 2003:598). The focus is on quality and understanding, with questions of purpose and role, rather than technique and implementation. Since this study has an eval uative shadow to it, and evaluators are particularly concerned about criteria a nd methods of warranting their evaluative knowledge claims as empirically based represen tations of program experiences and not as biased inquirer opinions, constructivist evalua tion techniques will be highlighted in the Analysis section and the Formative Evaluati on chapter (Denzin and Lincoln 2003:599). Qualitative Design Dewey (1934:2) comments on the importan ce of keeping an open mind during the research process, if the artist does not pe rfect a new vision in hi s process of doing, he acts mechanically and repeats some old model fixed like a blueprint in his mind. It is important to explain the methodology, or ways to study the social re ality of substance abuse used in this research study. As noted by Strauss and Corbin (1998:11), qualitative research is a type of research that pro duces findings not arrived at by statistical procedures or other means of quantificati on. This does not mean that statistically gathered sources of information were not refe rred to, but that the bulk of the analyses were interpretative, with focus groups inte rpreted by the principa l investigator. These rich, thick descriptions were necessary to understand more fully coalition members views regarding the topic of s ubstance abuse. Secondary sources of information, such as the 2004 Florida Youth Substance Abuse Survey were incorporated to further strengthen interpreted results of focus groups and to s ee if coalition members had differing accounts in terms of what is occurring in Alachua County, according to statistical measures. The purpose of qualitative research is to discover concepts and relationships in raw data that preplanned quantitativ e analysis might not allow for, and organize them into a

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52 theoretical explanatory scheme that offers new insight into the area under study. It not only allows for but stresses the socially cons tructed nature of reality. Strauss and Corbin (1998) suggest that qualitative research be used in research that attempts to understand the meaning or nature of experience of persons with problems such as chronic illness, addiction, divorce to get out into the fi eld and find out what people are doing and thinking. The purpose of these focus groups is to get inside the minds of the PIPSA coalition members to understand more cl early how they envision the coalitions contribution to the community. The ideal way to encourage this is to approach the individuals with no preconcei ved notions of underage dri nking in Alachua County, and learn from what they are willing to share, wh ile also noting relevant topics they are not addressing. Qualitative research allows the researcher to glimpse an individuals feelings and thought processes that may not be possible to uncover within strict er, more quantitative research methods. Patton (1987:11) notes, the narrative comments from open-ended questions are typically meant to provide a forum for elaborations, explanations, meanings, and new ideas. Not only do openended questions allow for closed-ended responses, but they also offer the opportunity for fresh new ways of conceptualizing the topic by giving the respondent ability to e xpress them in a more detailed and fuller manner. Methods Focus groups comprised of coalition memb ers accounted for the bulk of the data gathered. In addition, fieldnot es were documented during the focus groups, as well as PIPSA events, noting physical gestures and re actions of coalition members that may have been useful in understanding emphasis in later analysis of verbal dialogue.

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53 Focus Group As A Method Denzin and Lincoln speak of the signifi cance the structure of a method has on the outcome of the dialogue. They explain wh en choosing the method of research, in a culture that highlights individualism and sepa ration, shifting the rese arch agenda in the direction of commonality and t ogetherness is, in itself, s ubversive (Denzin and Lincoln 2003:373). They appear to suggest an importan ce of getting people to think in terms of commonality and togetherness. I believe this strategy would only strengthen the support of coalition members in the fo cus groups of this study. Historical and contemporary uses of focus groups The focus group has seen changes in it s implementation throughout its history. Initially, focus groups were used by social scie ntists to develop surv ey questionnaires in the 1920s, with the final result being a purely quantitative res ponse to the social issue at hand. It wasnt until the 1970s that market researchers began to find value in focus groups, hoping to find peoples wants and needs in an effort to capitalize on them. The 1980s to present day has seen an increase in focus group usage across disciplines to research varied social issu es. Denzin and Lincoln (2003: 367) explain, in the social sciences, group interviews developed as rese rvations concerning the effectiveness of individual information gathering technique s grew. Such reservations focused on the influence of the interviewer on research pa rticipants and the limitations imposed by closed-ended questions. It is evident that so cial scientists have begun to consider the focus group to be an important qua litative research technique. Benefits of using focus groups Focus groups have many benefits to thei r approach as a method. Arguably the most important aspect of their nature is that they make it possible for the researcher to observe

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54 the interactive processes occurring within th e group, and among the participants. Morgan (1997:2) clearly states, the hallmark of focus groups is their explicit use of group interaction to produce data and insights that would be less accessible without the interaction found in a group. Krueger (1988:44 ) argues that, focus groups place people in natural, real-life si tuations as opposed to the controlled experimental situations typical of quantitative studies. He suggests that hierarchy within the organization, that may present itself in various forms throughout th e interactions taking place in the focus groups, may even be lessened by employing an outsider to the organization to conduct the focus groups. In addition to producing large amounts of information during a relatively short period of time (compared to individual inte rviewing), focus groups produce concentrated amounts of information on the topic of interest to the researcher in highly focused (by sector) groups. Morgan (1997:10) offers, g roup discussions provi de direct evidence about similarities and differences in the participants opinions and experiences as opposed to reaching such conclusions from post hoc analyses of sepa rate statements from each interviewee. An open discussion of th e research topic is available to the participants. As discussed prev iously, the researcher as an outsider has the ability to appear less knowledgeable about the subject and is forgiven for probes intended for clarification purposes. This flex ibility in the focus group allo ws for unanticipated topics to be explored more fully that might not have been addressed using other research techniques. Since it is unreasonable to get all coali tion members to meet at one locale to productively discuss these issues in such a focused manner, focus groups provide a

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55 technique that is not only efficient, but productive as well including many viewpoints in a relatively short period of time. Focus gr oups are traditionally considered a less expensive research technique as well. If th e researcher already has access to a room to conduct the groups in, only a tape recorder is needed. No additional materials, such as questionnaire copies are necessary, since the recorded dialogue is the main source of data. Focus groups are exploratory in nature. Morgan (1997:11) notes, this ability to give the group control over the direction of the interview is especially useful in exploratory research in which the researcher may not initia lly even know what questions to ask. Rather than testing hypotheses, focu s groups offer the participants, those closest to the issue, to tell the researcher what the im portant aspects are. It is a way to allow for marginalized voices to be heard without forcing the researchers agenda upon the participants and possibly aff ecting social policy in the pr ocess. Although th e researcher may not escape influencing the discussion, by providing power to the group, focus groups minimize researcher bias (such as preconcei ved notions, opinions, words, and concepts) that could ultimately affect results. They allow the researcher to know the language participants employ and encourage the research er to conceptualize the issue within the framework they provide. Denzin and Linc oln (2003:372) explain, language is of particular importance because a sensitive unde rstanding of peoples lives requires shared symbols, meanings, and vocabularies. When all this is taken into considerat ion, focus groups can improve the planning and design of new programs and provide means of evaluating existing programs (Krueger 1988:15), allowing for future evalua tions of the program to accurately measure

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56 the intentions of the program. Also, an uni ntended benefit of focus groups might be in getting participants newly excited and inform ed about the issue, w ith the participants encouraged to sit and think critically about the issue be ing addressed. They might not have this luxury throughout the course of their average work day, and may not be challenged to consider others ( possibly opposing) viewpoints. Multiple viewpoints allow for contradictions to be dealt with throughout the data collection period and not relegated to the resear cher sorting it out in analyses, as is the case in individual interviewi ng. Also, what Morgan calls member checking may take place in a group environment, allowing the re searcher to comment on the implementation (or lack) of program activities as a way to hol d participants accountab le for what they are supposed to be doing within the program, co mpared to what is actually done. Unlike surveys and telephone interviews focus groups allow the resear cher to note the degree of irregular particip ation from certain participants as well as nonverbal cues, body language and patterns of turn taking, which may provide valuable insight into the content and style of responses the participants offer. Since pa tterns were only able to be noted on a limited basis because the researcher did not have an assistant at her disposal, no notable patterns worthy of mention were found in the focus groups. As a final note on the benefits of focus groups, they are typically considered as having high face validity. As Krueger (1988:42) explains, Fred Reynolds and Deborah Johnson (1978) reported on a comparison of focus group discussions with a large-scale mailout survey. The two studies were both nationwide in scope-a mail survey of 2000 females with a 90% response rate compared to a series of 20 focus groups in 10 cities. When these two market research studies were compared, there wa s a 97% level of agreement, and, in the area of discrepancy, the focus group result s proved to have greater predictive validity when compared to later sales data.

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57 The high face validity may be attributable to the comments from participants appearing more believable, since people provide more detail and open up more, suggesting many possibilities. As outlined, focus groups have many bene fits as a research technique. Coupled with these benefits also comes limitations. Th ese are important to note as well, in an attempt to be reflexive about the problems re lated to the research design of the study. Limitations in using focus groups Focus groups are difficult to assemble. Ev en careful planning in terms of location, time, and date will not guard against nonpa rticipation. People may even confirm their attendance, but are unable to show up due to unexpected work responsibilities, home responsibilities, or personal illness. When the researcher expects a certain number of participants but, in actuality gathers far less, it poses a dilemma to the researcher. Should the researcher cancel, in the hopes that more people will sh ow up at a rescheduled time, or should s/he conduct the focus group knowing that this could mean compromising the data? The size of the focus group is extremely important to its success. The more people attending the focus group the greater the opportu nity for a diverse amount of ideas shared and included in analyses. Due to the study needing to be accomplished in a reasonable amount of time, it is unlikely that the resear cher has the flexibility to continue to reschedule focus groups until all participants are in attendance. The larger problem with continuing on with small focus groups is the possibility of saturati on not being reached. Strauss and Corbin (1998) state this is the point at which da ta collection no longer generates a new understanding of the issue. The data collection phase is considered complete.

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58 As mentioned earlier, focus groups are gene rally considered to occur in a natural setting, unlike in experimental studies. It shou ld also be noted that groups like a coalition, where a group of people representing other or ganizations gather toge ther, may be viewed as being in an unnatural soci al setting. In actuality they are not being observed or questioned in their own work environment but a mutually agreed upon location. This location may not be where they regularly inte ract with program participants. Also, the conversation is managed by the researcher a nd is not conducted as a regular coalition meeting. Inexperience of the researcher may further jeop ardize the results and the comfort level of the participants furthe r distancing participants from the natural environment they are used to and affecting th eir behavior, ultimately affecting results. Another major limitation to focus groups is that the group may influence the data it produces. Krueger (1988:23) notes, evidence from focus group interviews suggests that people do influence each other with their comm ents, and, in the course of a discussion, the opinions of an individual might shift. It is strongly suggested th at the researcher pay close attention when this happens in order to document what the influencing factors were in creating the shift of opinion. They may ev en reverse their opini on after interacting within the focus group. Also, it is suggested that people tend to report more extreme views in focus groups than they actually ho ld, in an attempt to convince others or conform to their stance. Morgan (1997:15) states: The concerns for focus groups include both a tendency toward conformity, in which some participants w ithhold things that they mi ght say in private, and a tendency toward polarization, in which so me participants express more extreme views in a group than in private. Krueger highlights the dangers of resear ching existing groups, suggesting people with more years of experience in the fiel d may tend to dominate the discussion (Krueger

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59 1988). Those who are less experienced may defe r to them for a response, assuming they know the issue in more nuanced ways. Power is sues relating to experience or job title may influence participants level of invol vement. People holding higher offices may be accustomed to controlling the group, while t hose in less senior positions are accustomed to listening. The purpose of the focus group is to get everyones inpu t, but power issues may pose a threat to this task. Individuals may have their own agenda within the focus group, such as lobbying for a certain outcome If the researcher allows for a less structured format and allows individuals to manipulate the focus, this makes analyses more difficult when attempting to compare across groups. All of these aforementioned problems foreshadow difficulties with validity and generalizability. Validity is the degree to wh ich the procedure actually measures what it intends to measure. Krueger (1988:41) suggest s, people are not al ways truthful, and sometimes they give answers that seem best for the situation. Other times, people hold back important information because of appreh ensions or social pressure. Because data are group dependent, it is difficult to comment on the validity of the data derived from focus groups. Focus groups are generally though t to lack generalizability for this same reason. This is not to say they do not offer valu able insight into the issue studied, but that the results should not be used to generalize to other populations outside of the one under study. These are all limitations th at influence the results and implications of focus groups. More limitations of focus groups include their reliance on verbal communication. Certain questions may not be asked that w ould encourage respondents to respond in an accurate and thorough way (Krueger 1988). Reasons for this may be due to a misunderstanding of the questions posed. A limitation related to relying on verbal

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60 communication is the quality of data they produce. As mentio ned earlier, self-report data, as is gathered in focus groups, may not be accurate whether intentional or unintentional (Fallon and Schwab-Stone 1994). Focus Group Design The data collected for this study were gathered through semi-structured focus groups. A guide was used to focus group di scussion. Morgan (1997:47) suggests, the structure that a guide imposes on discussions is valuable both in channeling the group interaction and in making comparisons acro ss groups in the analysis phase of the research. Considering the philosophical und erpinnings previously suggested, moderator involvement should be somewhat limited, in or der to lessen researcher values framing the discussion. A semi-structured guide allows for a somewhat focused, yet unconstrained discussion. The study consisted of nine focus groups, each one representing a sector within PIPSA. This was in an attempt to allow each sector to collectively explain their contributions to the coalition. Although there should be a difference of opinion among the sector participants, the idea is that they will be more similar than across sectors. Categorization of members into professional sectors was done by PIPSA executive members prior to the study. E ach coalition member was list ed as having their current professional experience lying within one sect or. As Krueger (1988:26) explains, focus groups are best conducted with participants who are similar to each other, and this homogeneity is reinforced in the introduction to the group di scussion. An ice breaker at the beginning of each focus group, allowing for participants to introduce themselves and their affiliation with PIPSA, was a chance for them to relate on an occupational level. Also, an announcement from the researcher re garding the purpose of the project, their

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61 commitment to the social issue of substan ce abuse, reinforced homogeneity on a more personal level. The focus groups were conducted at the Corner Drug Store conference room, at scheduled meeting times that were convenien t for coalition members (see Table 5). The Corner Drug Store is where PIPSAs bi-mont hly meetings are held and access of the room was granted by PIPSAs executive chai rperson, an employee of the Corner Drug Store.

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62 Table 5: Focus Group Characteristics Focus Group Members Total Members Members Members Organizations Date Length By Sector within Sector Participating Pa rticipating Participating Repres ented (minut es) from Sector outside Sector Law 7 4 2 2 Gainesville Police Dept 04/19/06 45 Enforcement Alachua Sheriffs Office Corner Drug Store, Inc. Youth 19 4 3 1 Corner Drug Store, Inc. 04/24/06 50 Services Alachua Sheriffs Office Schools 11 7 2 5 Corner Drug Store, Inc. 05/02/06 75 UF Student Health Care Center Parent School Board of Alachua UF College Advocacy Initiative Family/ 3 5 1 4 Parent 05/02/06 45 Community Corner Drug Store, Inc. Religious 2 5 2 3 Act of Faith Production 05/03/06 50 Mt. Pleasant United Methodist Church Meridian Behavioral Healthcare Corner Drug Store, Inc. Healthcare 2 4 2 2 University of Florida 05/11/06 60 UF/Area Health Education Center Corner Drug Store, Inc.

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63 Table 5. Continued Focus Group Members Total Members Members Members Organizations Date Length By Sector within Sector Participating Pa rticipating Participating Repres ented (minut es) from Sector outside Sector Business/ 5 4 1 3 Gainesville Hospitality 05/25/06 35 Media Group Corner Drug Store, Inc. Federal/State/ 16 2 2 0 Dept. of Children & 05/25/06 70 Local Agency Families Civic/ 5 0 0 0 None 05/25/06 Volunteer Group ______________________________________________________________________________________________________ Totals 70 35 15 20 *All focus groups were conducted at the Corn er Drug Store in Gainesville, Florida.

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64 Table 6: Focus Group Participation ______________________________________________________________________________________________________ Focus Group by Sector 1st Time Participants Addition al Sector Participants Law Enforcement 4 0 Youth Services 2 2 Schools 4 3 Family/Community 2 3 Religious 3 2 Healthcare 2 2 Business/Media 0 4 Federal/State/Local Agency 2 0 Civic/Volunteer Group 0 0 Total 19 16 Note: Some participants contributed in mo re than the focus group they were invited to. This table indicates how many in each fo cus group were participating in a focus group for the first time a nd how many were providing feedback for additional times.

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65 Focus group questions Since a grounded theory approach was to be used in analysis, the interview questions were adapted to include topics th at arose during earlier focus groups and to follow-up unanticipated issues. The basic questi ons were placed in a logical order, with the coalition members being asked about thei r approach to Alachua County residents, followed by a more in-depth look at what their needs are, what resources are available to aid them, and what activities could be planne d for them. Five broad questions were asked in each focus group to begin the dialogue, with secondary follow-up questions to guide discussion. Question one was asked in orde r to determine how coalition members actually reach Alachua County residents and wh at problems they seem to encounter. This question generated suggestions for improving program process. Question two was asked in order to determine if the coalition was in agreement regarding their new direction. This allowed coalition members to express what PIPSA should focus on. Questions two and three allowed them to brainstorm ho w PIPSA should go about reducing underage drinking in Alachua County, if they deemed it a necessary directi on for the coalition to take. Question five encouraged the coalition me mbers to think about the feasibility of the brainstormed activities and reflect on th e importance of each coalition members involvement in implementing them. Overall, these five questions allowed coalition members an opportunity to express the new di rection the coalition should take and what the coalitions priori ties should be in implementing th e activities relating to reducing underage drinking in Alachua County.

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66 1 How does your sector attempt to reach Alachua County residents? How do you broadcast PIPSAs meaning and activities? What difficulties arise when reaching residents? How do you combat these difficulties? 2 Is underage drinking a pr oblem in Alachua County? If so, why is it a problem here? 3 What resources (from your respective ag encies) are available to PIPSA to reduce underage drinking in Alachua County? 4 What activities (from your respective ag encies) are available to PIPSA to reduce underage drinking in Alachua County? 5 Are the activities feasible base d on your sectors resources? Morgan suggests this to be an appr opriate number of questions for a semistructured focus group, in a more structured group, the limit should probably be four or five distinct topics or questions, with preplanned probes under each major topic (Morgan 1997:47). It is important to note that consensus within the focus group is not the goal. In understanding the thought processes, deeper meaning is possible. As Krueger (1988:30) explains: One of the unique elements of focus groups is that there is no pressure on the moderator to have the group reach consen sus. Instead attention is placed on understanding the thought proces ses used by participants as they consider the issues of discussion. All focus groups were audio-taped. Th ey lasted approximately 1 hour, but continued until all five questions had been addressed. After all questions from the guide were asked and all serendipitous questions were acknowledged, the researcher offered the opportunity for any final comments re garding the discussion. As a final step, respondents were thanked and th e tape recorder was turned off to indicate the data collection period was over.

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67 Materials used in focus groups Two documents were provided to the focus group participants. Both were constructed by the researcher with information derived from executive PIPSA staff prior to the focus groups being conducted. The firs t document was PIPSAs service utilization plan, which diagrammed PIPSA activities th roughout the course of a one-year period. This was shown to focus group participants to refresh their memories of PIPSA activities. The second document declared and explained PIPSAs ne w focus on underage drinking. PIPSA executive coalition members came to consensus on this new priority at the Community Anti-Drug Coalitions of Ameri ca (CADCA) coalition training in January 2006. The document suggested that both the soci al and physical environments in Alachua County contributed to underage drinking (Appe ndix C). It is impor tant to note that instruments did not affect focus group discus sion. It was observed that coalition members did not rely on them or even refer to them. In addition to the two documents guidi ng focus group discussion, every coalition member was provided an informed consent form to sign prior to their participation in the focus group. This form explained the purpose of the research study, the time required to participate, potential risks a nd benefits to participating, th e voluntary nature of the study, the right to withdraw from the study at any time, and contact information of the principal investigator and her supervisors if they had any further questions following the focus group. One copy was retained by the researcher and one copy was provided to the participant for their personal records. Sampling design The executive members of the PIPSA coa lition encouraged involvement in the study. They provided contact info rmation for all coalition members to allow the principal

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68 investigator to contact them and sche dule meeting times. Since there are only 70 members total in the PIPSA coalition, it was feas ible to invite all of them to participate (Appendix D). Originally, there were ni ne scheduled focus groups, with each representing a different sect or within the PIPSA coaliti on: Youth Services, Alachua County School Board, Law Enforcement, Busine ss/Media, Federal/State/Local Agencies, Civic/Volunteer, Religious, Healthcare, and Pa rents. Representatives from each sector were contacted and focus groups were sc heduled and rescheduled based on their availability. Gathering a wide range of coalition memb ers is important to get a comprehensive view of what resources are available and to get input that might not have been represented when the original goals and object ives were developed, eight years ago. Also, within individual sectors, it was easier to focus the discussion on particular issues involving specific issues, rather than discussing underage dr inking in Alachua County as a broad issue. Since this approach was more organized than regularly scheduled meetings, it seemed to be more productive to the ultimate goal of understanding what resources their individual sect or could contribute, what activ ities they could plan, what impact this will have on the youth, and if PIPSA is employing a comprehensive approach, from their perspective. They hinted at PIPSAs program theory at various times throughout the focus group in discussing what new activities could be introduced by the coalition. The study comprised data from 35 partic ipants from the PIPSA coalition focus groups, with only 19 different indi viduals, since some participated in more than one focus group. It should be noted that some key l eaders from within the community and outside

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69 the community are listed as PIPSA members, but are rarely available to attend coalition meetings (i.e. Senator Rod Smith). They are important to the coal ition because of the support and endorsement they gi ve to PIPSA, but are not invol ved in the workings of the coalition on a regular basis. They may attend PIPSA activities as guest speakers, but are more or less honorary members. Another th ing limiting participation was that some members were representing more than just themselves when they attended the focus groups. Even though all coalition members were strongly encouraged to participate, some organizations that had multiple members on th e coalition most often sent only one to represent the entire organization. Also, some were unabl e to attend focus groups due to family obligations, personal illnesses, and conflicting work schedules. So, in reality the coalition has more active members than are included in the study. Therefore, it is important not to solely consider its strength as a coalition based on participation in the focus groups. Limitations regarding this will be addressed in the discussion chapter. Eight focus groups were conducted throughout the course of the study, instead of the original design of nine focus groups. Th e civic and volunteering agency sector is comprised of five coalition members. Due to low participation from these members, their focus group was combined with federal, st ate, and local agencies. Unfortunately, no members from the civic and volunteering agency sector were able to participate in the combined focus group. This limitation will be disc ussed in fuller detail in the Discussion chapter. All other sectors were conducted sepa rately, consistent with the original design of the study. Some coalition members partic ipated in more than the focus group they were originally scheduled for, if they felt their experience could c ontribute to additional focus groups (see Table 5 and 6). The principal investigator approved of this, since they

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70 could possibly offer insight that might improve dialogue within the focus group. Limitations regarding this will be discusse d in the discussion section. Patton (1987:15) explains, within program s an inductive approach begins with questions about the individual experiences of participants. Between programs [or sectors], the inductive approach looks for unique institutiona l characteristics that make each setting a case unto itself. As stated in the introduction, the goal for PIPSA was to conceptualize underage drinking in terms of the contributing agencies, determine untapped resources that are available to the coalition, and brainsto rm innovative activities to be offered by the coalition. Analysis Procedures Grounded Theory: background considerations Barney Glaser and Anselm Strauss origin ally introduced this methodology as an alternative strategy to more traditional approaches which relied heavily on hypothesis testing and more quantitative forms of anal ysis. Babchuk (1996:2) suggests, Grounded Theory is a qualitative methodology which de rives its name from the practice of generating theory from research which is g rounded in data. Epistemological debates between Glaser and Strauss have introduced different ways of utilizing grounded theory as it was originally intended. There are 3 major differences between Glaser and Strauss and Corbins understandings of Grounded Theo ry. Since they are st ill recognized today as the leading researchers of this approach, it is important to dis tinguish between the two, and explain why Strauss and Corbins appro ach is more suitable to this study design. Glaser critiques Strauss and Corbins appr oach to addressing the initial research problem. Strauss and Corbin believe that t he research question in a Grounded Theory study is a statement that identifies the phenom enon to be studied, while Glaser stresses

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71 that the research problem itself is disc overed through emergence as a natural byproduct of open coding, theoretical sampling, and constant comparison (Babchuk 1996:4). Glasers approach seems rather idealistic, wi th the research question stemming from only a basic wonderment of the phenomena under study. Strauss and Corbin stress that theory s hould inform the coding process, and the previous literature of the social phenomena should not be ignored. Glaser argues that Strauss and Corbins overemphasis on extracting detail from the data by means of a prestructured paradigm yields full conceptual description at the expense of theory development or generation (Babchuk 1996:4). Since PIPSA had declared the life course perspective as its theoretical underpinnings, it seemed more appropriate and informative to primarily use theories relevant to this type of literature to guide analysis. Glaser suggests that Strauss and Corbin have a st rong emphasis on verifica tion and validation of theory. Babchuk (1996:4) notes in Glasers opinion, veri fication falls outside the parameters of grounded theory, which instead should be directed at the discovery of hypotheses or theory. This hi ghlights Strauss and Corbins priority of including the literature of the phenomena under study and refe rring back to it thr oughout the analysis process. Strauss and Corbin do not offer a ri gid structure with verification and validation of theory at the core of the research, as suggested by Glaser. They allow for the opportunity of relevant literatu re to provide for a deeper understanding of the important issues the phenomena may be related to, and offer important linkages experts in the field have suggested exist. Denzin and Lincoln (2003:279) explain, Gr ounded Theory is an iterative process by which the analyst becomes more and more grounded in the data and develops

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72 increasingly richer concepts and models of how the phenomenon being studied really works. Categories and terms are defined by the participants under study, while the researcher begins to link them together in theoretical models. Denzin and Lincoln (2003:280) further note, the end results of Grounded Theory are of ten displayed through the presentation of segments of text verbatim quotes from informants as exemplars of concepts and theories. Also, visual mappi ngs of the concepts and their connections allow for a clear presentation of final results. Strauss and Corbins approach seems most relevant to the research desi gn after considering the epistemological differences that exist in the field of Grounded Theory. The next section will provide further detail into ways their methodology will guide the analys is of this research project. Application of Strauss and Corbins Grounded Theory While this study was not a formal exercise in grounded theory (Glaser and Strauss 1967), it did follow the grounded theory method in some important respect. The goal was neither to test logically dedu ced hypotheses nor to provide statistical verification. This study represents an exploratory investigati on into the problem behavior of underage drinking in Alachua County, w ith coalition members contri buting their current working knowledge of the issue as it related to their professional experience, and highlighting the important themes that were necessary to a ddress. Elements of Strauss and Corbins grounded theory were utilized to analyze this data and create an explanatory scheme of PIPSAs approach to the community. Because this study employs a grounded theory method, data analysis was conducted simultaneously with data collec tion, with coding following individual focus groups. The constant comparative method was us ed for data analysis which allowed for comparing incidents and their categories (Str auss and Corbin 1998). This allowed for any

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73 changes in coding to be made throughout the data collection periods, as new information presented itself. The grounded theory met hod proposed by Strauss and Corbin (1998) was used to guide the coding process. Final codi ng analyses were presen ted to the principal investigators committee members as a form of inter-coder reliability, and to allow for modifications in the interpretations of the data (Miles and Huberman 1994). Open coding. The coding process involved three stages: open coding, axial coding and selective coding. The goal of open coding was to capture emergent categories and organize substantive themes that were f ound in the focus groups. These categories were abstractions from the raw data and were initially relatively sp ecific concepts that underlie the concrete examples and experiences that made up the data. They depict the problems, issues, concerns, and matters that are impor tant to those being studied (Strauss and Corbin 1998:114). The point at this stage was to distinguish between the possible themes considering the possible relevance to theore tical frameworks. Open coding can take on many forms. Strauss and Corbin sugges t open coding may be done line-by-line, paragraph-by-paragraph, or document-by-documen t. The important concept is to begin to separate groups of data into more manag eable pieces between units of analysis. Axial coding. Axial coding occurred simultaneous ly with open coding and helped to refine categories, revealing how they were associated with sub-categories. The various dimensions and properties of a category were expl ored and detailed in this stage. Analytic tools such as the flip-flop technique and the comparative technique of systematic comparison were used to further refine categor ies. The flip-flop technique indicates that a concept is turned inside out or upside down to obtain different perspective on the event, object, or action/interaction (S trauss and Corbin 1998:94). In other words, the researcher

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74 focuses on opposites and extremes to understand connections between different ways of looking at the same topic. The systematic co mparison means, comparing an incident in the data to one recalled from experience or from the literature (Strauss and Corbin 1998:95). Theories discussed previously in th e literature chapter were used to help distinguish among coalition members theore tical underpinnings and deconstruct their thought processes. Selective coding. Selective coding was used to id entify core themes that were consistent with the studys primary focus on coalition members approach to reducing underage drinking in Alachua County. Upon co mpletion of all focus groups and all three stages of coding, themes emerged that guided the principal investigat or in developing a theoretical framework of PIPSAs approach to the community, based on the raw data (recorded words of coalition members) collected in the focus groups. Limitations Of Study Design A major limitation of the study is that so me sectors are more represented than others in the PIPSA coalition. The Youth Serv ices sector is comprised of 19 coalition members, while the religious sector has only 2 active members. This either suggests that PIPSA considers some sectors as more importa nt than others, or that participation in some sectors is harder to achieve. This was looked at during the focus groups and will be addressed in detail in the di scussion section. Also, time constraints only allowed for one focus group from each sector. More focus groups would have allowed the principal investigator to revisit topics that needed more cl arification. Since this was not feasible, the data may be organized in ways that may not have been intended by the coalition members. Detail will be provi ded in the results chapter rega rding topics that coalition members need to discuss at future coali tion meetings, such as program process and

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75 impact measurements and what newly sugge sted activities should be adopted by the program. It is important to note that add itional focus groups would have allowed more discussions that most likely would ha ve generated new suggestions. As mentioned earlier, the quali tative design to this study suggests the constructivist nature it follows. While this can be considered a major streng th to the data gathered, it can also be regarded as a major limitation of the results produced. Only emergent patterns and themes, or those that are addressed in the focus groups, will be discussed. Patterns that may seem more relevant but do not appear in the data will not be emphasized in this study. Also, Krueger (1988) suggests pred ictive validity and generalizability, usual sources of a studys strength, are not appropriate for this research design. While Krueger (1988) maintains focus groups are genera lly thought to have high face validity, researchers should be cautioned as to the results having predictiv e validity. Readers who insist on the importance of a study having pr edictive validity and generalizability may have difficulty seeing the inherent value in the data gathered with this approach. This chapter offered the design in greater detail and drew atte ntion to possible ontological, epistemological, and methodological limitations of the study. The following chapter outlines thematic patterns found th roughout the focus groups after following Strauss and Corbins open, axial, and se lective coding.

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76 CHAPTER 5 RESULTS This chapter outlines four broad patterns that emerged throughout the focus groups. Participants tended to center conversation around the coalit ions theory of change, the culture of drinking in Alachua County, the difficulty in reaching community members, and new strategies for decreasing underage dr inking. These patterns will be discussed in further detail in the following sections. In terms of the results, facts do no t merely embody reality, but must be interpreted (Vega and Mur phy 1990:146). The principal inve stigator interpreted these results as indicated in previous sections, and patterns within topics were analyzed. As for the presentation of the topics Morgan (1997:63) explains: There are three basic factors that infl uence how much emphasis a given topic should receive: how many groups mentione d the topic, how many people within each of these groups mentioned the topic, and how much energy and enthusiasm the topic generated among the participants. The best evidence that a topic is worth emphasizing comes from a combination of a ll three of these f actors that is known as group-to-group validation. These factors will be considered and results will be presented in order of coalition emphasis in this section. Four broad thematic patterns were stressed by participants in the focus groups. Theory Of Change There were variations in how coalition members descri bed their approaches to youth. Some viewed underage drinking as a na tural act the youth was drawn to, while others saw it as a learned behavior, drawi ng heavily on social learning theory. It was

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77 suggested that it was important to separate adults and child ren to better target their needs. Certain strategies influence adults a nd children differently at different points in their lives. The prevalent feeling was that adolescence, and maybe even the pre-teen years, is a critical point in an individual s life-course where al cohol should not be available. The individual is at a point in their lives where s/he does not understand the consequences of their behavior and how it ma y affect his or her future. In terms of adolescents, coalition members felt that if programs were in place that changed their social norms and provided activities subs tituting drinking, rates would decrease. Some coalition members stated altering consciousness is part of the human experience while some felt that drinking is h ealthy in moderation, possibly at any age. Others agreed, stating sensation seeking is natu ral, and activities that satisfy this innate need must be presented to the adolescent if drinking is to be avoided. Echoing this same idea, one participant stated, they have acces s to everything in their house while their parents work, stressing the need for su mmer programs and suggesting that the community currently has inade quate resources to keep them busy. The use of churches and youth groups were suggested as a way to get the message out that fun can be without substances. A natu ral curiosity leads to use, with drinking used as an expression in us, an expression of being fr ee. An attitude of dr inking as a rite of passage was often stated. One participant stated a genetic pr edisposition guiding behavior, stating that someone is times more likely to become an addict if their parent was an addict. Also, some coalition members faulted parents today pushing kids faster socially, stating not only a hum an desire to mature faster, but a parental pressure as well.

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78 Mention was made in a few focus groups whether repression breeds a drinking problem, with repression encouraging youth. Pa rticipants pointed to Europe as an example of a healthy environment, unlike the United States, that does not enforce consequences that repress youth for substance use. Others pointed out that it was a myth that Europe does not have problems similar to the United States in regard to substance use, and consequences dont repress youth, bu t help guide them to healthy behaviors. Europes great transportation system was highlighted as be ing a factor contributing to fewer alcohol-related accidents than the United States. Another participant stated Polands low acceptable Blood Alcohol Concentration (BAC) of .02 was a reason for fewer alcohol-related incidents, stating har sher consequences lead to awareness of acceptable amounts of alcohol and more respon sible drinking behavior. This theme of consequences correcting deviant behavior was found often in focus groups. Many coalition members emphasized the need for consequences and strict enforcement of them. A need to supervise j uveniles was mentioned as well as a lack of consequences in our culture. Some suggest ed the enforcement of consequences as a way to identify those in need to resour ces and treatment and educate them of the problems related to underage drinking. Also, some participants emphasized the need to get out the dangerous message of the evils of drinking suggesting its deviant nature. One participant mentioned the need, alt hough seemingly impossible, for a curfew, stating they need to know they dont have total freedom and liberty to do whatever. Year-round schooling for adolescents was also s uggested as a way to decrease free time for adolescents and monitor them on a continuous basis.

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79 Reasons for preventing underage drinking were varied throughout the focus groups as well. A wide range of feelings were shared, with some coalition members suggesting it was a moral duty to protect the community members, stating Am I not my brothers keeper? Others seemed to highlight the fi nancial benefit the co mmunity would receive in protecting its members from underage drin king, with future in carceration and health costs being lessened. Drawing on current res earch, it was suggested that funding go to underage drinking programs since federal agen cies already know a certain percentage will surely grow up to be alcoholics. Comm unity members representing local businesses originally faulted individuals for substance abuse problems, but have recently retracted from this notion because of pressures from the University of Florida threatening to attack marketing strategies employed by the owne rs. Alachua County business owners are currently recognizing underage drinking as a community problem and have recently developed the Gainesville Hospitality Gr oup, which works to m onitor responsible business practices relating to the issu e throughout the community. Hints of Catalano and Hawkins social learning theory were scattered throughout the focus groups, with some participants stat ing the necessity for rewards for those not using and the impact of the Hippodromes HITT program, which provides protective factors to youth in the form of a prevention program. Thos e suggesting a change in the normative structure of underage drinking explai ned its lengthy process. The Stages of Change Model, employed by health professionals of the University of Florida, states that, change happens gradually. This was disc ussed by coalition members representing the education and health care sectors of PIPSA. It is unrealistic to have one talk and make a change, but you need to develop skills. Th e Stages of Change Model teaches students

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80 skills to be able to approach in a nonjudgm ental manner, to get the underlying meaning regarding personal feelings involving pa tients with substance abuse problems. Culture Of Drinking In Alachua County Many coalition members felt it very importa nt to address the current attitude surrounding drinking in Alachua County. A more blatant a ttitude regarding underage drinking and a not me attitude regarding addiction further complicates the issue. Young people are more talkative about thei r behavior, almost proud of it. Also, younger people are declaring s ubstance abuse issues. With the message of drinking normalized on a continuous basis, through video games, pharmaceutical advertisements, musi c lyrics, and television shows like the Sopranos, mixed messages are sent to youth at risk. One partic ipant talked of the reality show where parents go back to college, sta ting how parents are pr acticing misuse of alcohol because the peer pre ssure is too great, even fo r them. Some emphasized the new parenting styles that are contributing to this privilege d generation that gets what they ask for on a regular basis. Alcohol is readily available, and youth may take alcohol from home to pharming parties, where adults are not mon itoring their children. Alachua County is host to Gainesvilles dow ntown scene, with its density of bars. The leniency of local bars was mentioned repeatedly, with allowing fake arm bands, bouncers letting anyone in and th e fact that there are just too many people to monitor on a consistent basis. Some suggested that kids look and dress older also, complicating the job of carding underage youth. Many ci ted the Universitys influence and that students feel its cool when hanging from street lights (see Appendix B), never realizing the influence this behavior may have on peopl e witnessing it. The college culture is advertised through these pictures. Some explai ned the universitys transient

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81 population, hinting that college kids dont ca re about the town because they are only here for a short while (see Appendix B). A few mentioned the City Commissioners recent DUI citation and the acceptability skybox drinking of notable community members contributing to even more mixed messages regarding drinking. It was stressed that you rarely hear of people dying or suffering from alcohol abuse. Unlike the tobacco campa ign, alcohol is not demonized but often glamorized, with ads equivalent to Joe Camel, marketing wine coolers as tasting li ke Kool-aid. Also, it was suggested that beer is t oo cheap these days, allowing for easy access to minors. Difficulties Reaching Community Members Coalition members often pointed out some difficulties they have had in reaching the community. Apathy from parents and youth, transportation difficulties, and a chaperone shortage make it difficult to pl an activities. Also, increased emphasis on FCAT scores makes it difficult to get into the schools to educate or encourage participation in PIPSA activities. A basic u nawareness of what can be done together influences the degree of participation. It was suggested that the pub lic is not present at importa nt events, like town hall meetings. This might suggest poorly advertised events or possible status differentials, which will be discussed in more detail later, do not encourage attendance rates. Ways to address these issues should be looked into further by the coalition. Low attendance at parenting classes may be a result of this as well. Targeting of thes e populations should be done more effectively. A major problem affec ting long-term treatment is the absence of youth residential treatment centers in the area. This makes it difficult for them to receive intensive, focused treatment away from the environment they are using in.

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82 Strategies For Decreasing Underage Drinking Mirroring current research, the PIPSA coalition places a strong emphasis on education, family-based interventions, and community-college partnerships, since these initiatives have been successful over the year s. Funding sources encourage activities to be scientifically-based strategies, further pressu ring the coalition to advocate these strategies as well. The literature, as well as th e coalition, suggests that education alone is not enough, but it needs to be interactiv e. Youth are knowledgeable abou t drinking but need to feel personal relevance if their behavior is to be affected. Kids get bored hearing the same thing every year. One coalition member e xplains she has students raise their hands, asking them who has drunk to the point of feeling sick? She then tells those with their hands up that they have poisoned their bodies. The coalition also emphasized the need to impact youth through education, done in a variety of ways. Examples such as Mock car crashes and impai red-vision goggles were mentioned as being effective. It was stressed that these messages should be infused in all classes, not just one health class, that the student ma y or may not remember. Also, graduate health students from the University of Florida ha ve explained the drawbacks of drinking in other ways, such as the caloric content of alcohol and the expenses related to its use. These in your face consequences are necessary for impact. The coalition repeatedly stressed the importance of e ducating earlier age groups. One member explained patterns of beha vior are established at a young age. Prevention programs should be in place prior to these patterns of behavior becoming set in order to prevent certain behaviors. Another coalition memb er explained underage drinking prevention needs to be a generational a pproach, with an entire cohort in a twelve year program,

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83 not a 5-year program, which is currently done. Prevention ne eds to start earlier, with 5th and 6th grade youth falling in the middle of the pr evention efforts, not the beginning. Family-based prevention has consistently been cited as effective in decreasing underage drinking. Coalition members explaine d that in addition to starting early, prevention needs to focus on children and fam ilies, building social norms and fostering them throughout the life-course. An affiliate of the PIPSA coalition, The Corner Drug Store, offers these family-based prevention programs. The coalition could work to create a greater awareness of this resource. It was s uggested that all people should research their personal history and have the knowledge of what they may be predisposed to. The church was suggested as a great resource for reaching families. Throughout the focus groups coalition me mbers pointed to the college and community relationship. Severa l participants strongly felt th at underage drinking was due to the Universitys influence on the community. Recently the Universitys President has put forth initiatives to decrease underage drinking in the community. Many coalition members felt that the community could bene fit from a stronger partnership with the University in these efforts. A University Police Department representative on the coalition was strongly recommended, to fo ster communication with the Gainesville Police Department and maintain consistenc y throughout the commun ity in relation to enforcement practices. The University has ma de it a priority to present to neighborhood associations in an effort to affect comm unity attitudes towards the college community, further encouraging a partnership. No me ntion was made regarding neighboring community colleges, but these should be considered as well.

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84 This chapter outlined themes coalition members stressed throughout the focus groups. The following chapter will provide mo re specific activities and resources coalition members addressed throughout the focus groups, as well as priorities the coalition should note when attempting to mon itor the process and impact of the program for future evaluations.

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85 CHAPTER 6 FORMATIVE EVALUATION Considering the data gathered throughout the focus groups, the following chapter outlines ten overall suggestions for improvi ng program process and program impact, in hopes of strengthening the coalition for futu re stages of evaluation. All of these suggestions should be discussed at upcomi ng PIPSA meetings. PIPSAs main priority should be to vote on what activities the program will continue to implement, considering its new focus on underage drinking. They s hould consider and vote on new suggestions raised in the focus group. Lastly, they shoul d develop a comprehensive strategic plan, with the help of a researcher, much like th e example listed in A ppendix F. This should list every PIPSA activity, how the activity relates to decr easing underage drinking in measurable terms, and what the coalition woul d consider a success or failure based on the measured outcomes. The example in the Appendix is based on PIPSAs most recent goals and should be revised once new goals have been declared by the coalit ion. At the end of this chapter will be a summary of the overa ll suggestions offered in this formative evaluation to PIPSA. They will be listed in or der of priority, so at tention should be paid to each in the order they are suggested. Suggestions For Evaluating PIPSA Process Before future evaluations may be conduc ted with PIPSA, coalition members should make it a priority to document its process, si nce it currently does not have any baseline data to project goals from. In terms of pro cess, it is necessary for PIPSA to document every event and activity in te rms of its content, attenda nce, and length. The coalition

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86 should come to a consensus on what they c onsider successful from each event, after baseline data have been collected. This should be monitored over the course of the program to chart progress in terms of program implementation. Also, activity announcement methods should be documented and analyzed after baseline data have been collected to evaluate who was invited to the event, how they were told, and when they were told. Over time, the coalition should be able to detect what methods work best for Alachua County, making it a more tailored approach to the community it hopes to address. These methods then may be used to increase participation at events. Some examples of process measures can be found in the appendix in Appendix D. Suggestions For Evaluating PIPSA Impact Appropriate impact assessments should be made in addition to monitoring PIPSAs process, to evaluate the performance or im pact the program has on the community. Based on data from the three national surveys on substance use, local school-based surveys conducted by PIPSA, and relevant local statistics (arrest rates, DUI ra tes, and hospital intake rates for alcohol-related incidences), consensus within PIPSA should be reached in regards to success. Specific rates and percentages cons idered successful should be declared yearly to have clear and manageab le goals that monito r the progress of the program. Some example impact meas ures can be found in Appendix E. Suggestions For PIPSA Program Improvement Suggestions, from both current research a nd feedback from coalition members, for implementing these goals are provided in th is formative evaluation. These range from ways to implement the program to get better attendance to ways to get the coalition to work together in a more collaborative way.

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87 Implement Scientifically-Based Strategies It is suggested that programs should not employ strategies previously proven ineffective, like school-based initiatives me ntioned earlier that are information-only, or those using scare tactics about the dangers of alcohol. While most of the literature relating to underage drinking s uggests using scientif ic-based strategies that have been proven effective, some researchers suggest not limiting strategies to this. Vega and Murphy (1990:145) note: Yet essential to the success of commun ity-based interventi ons are novel plans. Practitioners who are community-based s hould be innovative and willing to try untested strategies. Gaining access to communities and creating sensitive methodologies sometimes requires that unorthodox practices be adopted. Those who are reluctant to take risks and explore novel suggestions-question the prevailing status quo-will not likely be su ccessful at this type of intervention. This is worthy of note, since focus group participants created new strategies not currently being used by PIPSA. With this in mind, hopefully these ideas will be considered by the coalition as possible al ternatives to decreasing underage drinking. Improve PIPSA Attendance And Dialogue Ways to improve attendance and dialogue at PIPSA events should also be considered. Significant effort should be ma de in trying to reach underage youth. Most likely there are community members that woul d attend activities and meetings if they were aware of them and if it was convenie nt for them to get to. Vega and Murphy (1990:134) note: The time and location of board meetings are supposed to be advertised before these sessions are convened. But most often th is requirement has not been taken seriously. One notice may be placed in a newspaper that is marginal to a communitys key sources of information. As a result, attendance at these gatherings has been generally low, thereby indicati ng further to bureaucrats that community members are not interested in public affa irs. When those who are not employed by an agency do attend, their presence has b een given nominal attention. Surely the

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88 status differentials that ar e visible at these meetings do not encourage citizens to participate in discussions. These status differentials that may presen t themselves at town hall meetings or other PIPSA events are important to consider as well. Underage youth should be given a voice at these events also. This may be done in panel discussions with community members following a PIPSA event. Underage y outh can offer valuable insight and further participation if these status differentials ar e recognized and dealt with in a responsible fashion. Encourage Collaboration Within PIPSA The linking-pin strategy, as sugge sted by Vega and Murphy (1990) links departments of an organization, or in this case sectors of a coalition, who were formerly indirectly related and directly join them t ogether. Since the PIPSA coalition is project driven, it could utilize this strategy in linki ng coalition members from varying sectors in an attempt to merge different knowledge bases together. Coalition members mixing together to coordinate activi ties provides the opportunity for different approaches to be incorporated. PIPSA should not rely on ju st one sector to organize an activity. Extend PIPSA Membership The coalition emphasized its pr iority of extending member ship to segments of the community that are not currently involved, but should be included to strengthen the coalition in number and res ources. It is important to note that PIPSA has a large membership, but is missing necessary segments of the population. As mentioned previously, key leaders in the community can generate support and awareness for the coalition.

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89 Foster community-school partnerships Community-college partnerships. The President of the University of Florida should be invited to join the coalition. Key leaders like, Pr esident Bernie Machen would bring great publicity and streng th to PIPSA. In addition, colla boration with University of Floridas new alcohol programs could prove beneficial to the coalition. Community colleges in the area have large numbers of underage students. They should also be represented in the coalition. An added benefit would be the possible use of their facilities. Also, representatives from the University Police Department shoul d be included in the coalition to allow for communica tion with the Gainesville Police Department, in an effort to maintain enforcement consistency across the community. Elementary and middle school personnel. Requests to have school nurses join the coalition was met with enthusiasm by coalition members. School nurses were explained to have valuable insi ght into what happens to adolescents over the course of the school day. In addition, they are in positio ns to educate adolescents about alcohol. Having a few on the coalition could provide yet another perspectiv e regarding underage peoples practices. Also, any other elementa ry and middle school personnel who could contribute to the co alition should be invited to join. Include business community The PIPSA coalition has been unfunded fo r the past two years, relying on donations to coordinate progr am activities. Including more community businesses could result in more money for the coalition and better public relatio ns. A few focus groups suggested participation from the banking community, Shands Hospital and Dominos Pizza would benefit the coalition, as well as encouraging current coalition members to invite their spouses, broadening the resour ce pool even more. As for the Gainesville

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90 Hospitality Group, coalition members suggest ed speaking with them regarding the training of bouncers to effective target undera ge drinking. They recently declared local businesses involved in the group would make it a priority to train wait staff. A push to train bouncers as well is st rongly recommended since thes e employees may serve as a buffer between underage youth and alcohol. Involve media Involving the media is a necessary step as well. The coalition currently has members representing local news and print me dia. According to the literature, PIPSAs affiliations with these members should be st rengthened. Also, PIPSA receives discounted prices for advertisements preceding movie tra ilers. This should be utilized for upcoming events as much as possible, with donati ons from local businesses going towards this resource. Form youth advisory committee The Youth Advisory Committee should be strengthened considering the coalitions new focus. The Truth campaign is evidence of how effective youth can be in changing norms relating to substances. Insight from the Youth Advisory Committee should provide excellent feedback for ways to reach youth, a nd messages they need to hear if behavior change is to occur long-ter m. The committee may be more productive if it is comprised of students who participate in few extracurricular activities, to ensure they will be able to hold meetings on a regular basis. Also, it may be more effective if it draws from pools of youth who have histories of alcohol use, so they make speak from experience. Local S.A.D.D. groups may offer assistance to the committee by offering suggestions for getting youth involved and by participating in program activities to draw greater community support.

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91 Target specific populations of youth As well as extending PIPSAs network, it s hould make it a priority to target specific groups of adolescents. One partic ipant suggested not only forwarding PIPSA activity e-mails to more agencies and connectio ns, but extending invitations to those most in need. Focus groups suggested the importan ce of including juvenile detention centers, halfway, and foster homes, as well as ch ildren diagnosed with ADD and ADHD, since the literature suggests these populations have been linked with the alcohol misuse. Also, since prevention needs to start earlier, some mentioned beginning in Head Start programs. Consider Adding Additional Activities To The PIPSA Program Some alternative strategies to decrease underage drinking were presented in the focus groups and should be given adequate consideration in upcoming PIPSA meetings. If these are added to PIPSAs strategic pla n, goals and objectives should be declared and instruments measuring their proce ss and impact should be developed. Provide thrill-seeking activities Some participants suggested thrill-seeking act ivities to be offered to youth, such as rock-climbing, ropes courses, and sky-diving. Th ese are meant to repl ace the thrills of drinking and satisfy the natural need for excitement. Host an annual Alachua County Health Fair An organized health fair was suggest ed, acknowledging resources available to community members, as well as future town hall meetings, that will be funded by Nationwide Insurance. Coalition members e xplained that events plant the seed.

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92 Use school facilities during off times Some coalition members explained that during the summer months or holidays, school facilities could be used for PIPSA events or other programming, since the liability insurance has already been paid. Sports activities could be planned for the gyms and reading and board game tournaments could be offered in the libraries. The coalition also mentioned the need for more after-sc hool programs, especially for middle-school children. Suggestions included sports programs, youth groups, and theater and dance programs that have better focus to encour age youth to participate in a variety of activities. Increase excise tax The coalition should make it a priority of getting the excise tax increased. Current excise taxes and prices are t oo low not only by historical, but also and more importantly by the standard that prices (i nclusive of tax) should refl ect the full social cost of production and consumption: if an item is unde r priced, then too much will be purchased and consumed (Bonnie and OConnell 2004:241). Some coalition members mentioned the significance of beer being so cheap to adolescents, with many holding part-time maybe even full-time work positions. This ch ange could slightly affect access for some youth and should be discusse d within the coalition. Showcase all PIPSA efforts Organization is essential to the success of the PIPSA coalition. Some participants mentioned the necessity of coalition member s communicating effectively, spreading the word of their respective ag encys activities to encourag e greater involvement in the coalition. A stationary PIPSA bulletin board or a circulating cale ndar of PIPSA events was strongly suggested as a way for everyone to keep in contact regarding upcoming

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93 events. These issues should be discussed in further detail at upcoming PIPSA coalition meetings as possibilities in expanding th e program to better reach youth at risk. Draft Process And Impact Instruments These previously mentioned suggestions should be addressed throughout the upcoming PIPSA meetings. As a coalition, me mbers should decide which activities are feasible to implement and prepare forms that will allow for documentation noting the process and impact of these activities. I would recommend a researchers help who is familiar with evaluation to help with instru ment design. After a predetermined period of time, the coalition should have considerable baseline data to projec t goals and objectives relating to these activ ities. These goals and objectives should be agreed upon by the coalition and documented. Program growth can be monitored in terms of these measurements. An overall program strategic pl an, listing all goals and objectives with activities directly relating to them, should be the finished product. An example of a strategic plan, based on PIPSAs previously de clared goals and objecti ves is available in Appendix F. The strategic plan is a summar y of program process and how these goals directly relate to the programs impact on its clients, which are in th is case underage youth in Alachua County. It needs to answer why th is is a good plan to reach underage youth, including not only coalition members prof essional expertise, but the literature on decreasing underage drinking and scientifically-based st rategies that have proven effective in reaching this population. Base Instruments On A Comprehensi ve List Of PI PSA Activities As a final note, it is crucial to record all activities and resources the PIPSA coalition offers to Alachua County. Focus gr oup data suggested activities and resources indirectly related to the coal ition. These need to be includ ed in the evaluation of the

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94 program as well, since they may be contribu ting to alcohol misuse awareness, and more specifically PIPSA awareness. PIPSAs strategi c plan should show the extensions of the coalition. It is also importan t to note that Alachua County is the highest funded county in District 3 because of its popul ation. The coalition should make it a priority to be fully aware of where this money is going, a nd where it may be better directed. All programs affiliated with the coa lition should be acknowledged in the evaluation. PIPSA needs to include the T oo Good For Drugs research-based program survey instruments as an indication of co alition awareness as well as the D.A.R.E. program law enforcements officers in the coa lition administer to area elementary and middle schools. Also, mock car crashes performed by law enforcement should be included since the Sheriffs Department and Ga inesville Police Department are affiliated with the coalition. Instrume nts measuring the impact of these educational programs should be drafted by the coalition, with re searcher help, implemented and monitored. Information regarding DUI checkpoints, rela ting to underage dri nking, and Prom Night educational initiatives should be documented in terms of its process and impact of the coalition as well. Advertisements for checkpoi nts may be in the form of commercials, billboards and radio announcements, creating awareness and publicity about enforcement activities. This context is important to r ecord, to note the process and determine the impact it has had on the community. It may be determined that more commercials are related to fewer underage drinking arrests, leading the coaliti on to encourage law enforcement to spend more on commercial advertising. Programs like the Afternoon of Learning, wh ere college students in the medical field go into middle school s and teach over fifteen t housand students a year, the

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95 Hippodromes HITT prevention program, and th e Corner Drug Stores family-based prevention programs should all be included in terms of the coalitions process and impact, since they all are considered aff iliated with PIPSA. Even church announcements to the congregation regardi ng substance abuse activities should be reported and documented by coalition members. Future Town Hall Meetings and Alcohol Summits need to be documented in terms of its process and impact also. Actions from the Gainesville Hospitality Group, such as the signing of the business covenant, should be documented to show strides the affiliat es of the PIPSA coalition are making. Include Newly Suggested Resources In Coalition Coalition members offered the idea of en forcement seizure money being donated to PIPSA, since this money is often redirected anyway. Law enforcements support of the coalitions message suggests they may be will ing to contribute to the funding of some activities. Law enforcement coalition memb ers should work on getting seizure money donated to the PIPSA coalition. Movie theater trailer discounts may also ease the budget of PIPSA. Advertisements should be direct ed through discounted sources as much as possible. Future community focus groups, town hall meetings, and PIPSA coalition meetings should be announced in venues such as this. Resources that are not in the traditional form should also be considered by the coalition. Coalition members mentioned the Un iversity of Florida s political capital it may offer to the coalit ion if it were to be more invol ved in their activities, further emphasizing the need for fostering the co mmunity-university partnership. Also, key leaders in the community affilia ted with the coalition could be a valuable resource as well and should be used to further increase the awareness and participat ion, encouraging other members of the community to c ontribute to the coalition.

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96 Encourage Better Communication Between Coalition Members Not only should all of these activities and resources be documented, but the coalition should have a working knowledge of what is occurri ng in the community. Comprehensive announcements at coalition m eetings and disbursements of coalition minutes are crucial to keeping everyone w ho was not in attendance updated. If people do not feel they are contributing members of the coalition, and they are not aware of activities affiliated with the coalition, a det achment, much like the coalition has seen in the past, may occur with its members. This de tachment could have si gnificant affects in terms of its resources, which have a direct influence on the strength and impact of the coalition. The following table will provide a summary of the suggestions offered to PIPSA. It should be noted they are numb ered in order of priority. After these suggestions are addressed the coalition should be at a stage where they may begin to document program process and impact, according to their stra tegic plan, which outlines their specific program goals.

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97Table 7: Formative Evaluation Suggestions TYPE OF IMPROVEMENT (numbered in order of priority) SOURCE OF SUGGEST ION (Lit.=Literature, FGs=Focus Groups, R=Researcher) PROCESS IMPROVEMENTS (to ensure services are delivered to its intended populations in Alachua County) 2. Extend PIPSA Membership Lit. -Foster Community-School Partnerships Lit. Community-College Partnerships Lit./FGs *Invite Bernie Machen FGs/R *Invite University Police Dept. FGs Invite Elementary & Middle School Personnel FGs *Invite School Nurses FGs *Invite School Principals/Counselors R -Include Business Community Lit./FGs *Invite Banking Community FGs *Invite Shands Hospital FGs *Invite Dominos Pizza FGs *Invite Gainesville Hospitality Group FGs/R -Involve Media Lit./FGs/R *Use Discounted Movie Trailers to Advertise PIPSA Events FGs -Form Youth Advisory Committee FGs/R *Include Youth Not Involved in Ex tracurricular Activities/Draw from Youth R Who Have Histories of Alcohol Use -Target Specific Populations of Youth (those liste d below plus any other pop. linked with FGs alcohol misuse) *ADD/ADHD classes FGs *Juvenile Detention Centers FGs 3. Include Newly Suggested Resources in Coalition R *Seizure $ (from drug raids) FGs *Co-sponsor University Events to Save $ FGs

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98 Table 7. Continued 5. Draft Process and Impact Instruments Lit./R *Create an Instrument for Every PIPSA Activity and Begin to Document R 6. Base Instruments on a Comprehensive List of PIPSA Activities Lit./R *Create a Strategic Plan (with all PI PSA activities matching goals directly) Lit./R 8. Encourage Better Communication between Coalition Members FGs/R *Create a Bulletin Board Showcasing All PIPSA-related Events FGs 9. Encourage Collaboration within PIPSA Lit. -linking-pin strategy Lit. 7. Improve PIPSA Attendance & Dialogue Lit./FGs -More Effective Advertising of PIPSA Events Lit. -Be Careful of Status Differentials Lit. IMPACT IMPROVEMENTS (to improve program imp act on underage drinking in Alachua County) 1 Implement Scientifically-Based Strategies Lit./FGs/R *Early, Interactive, Family-Based Approaches Lit./FGs/R 4. Employ Alternative Strategies Suggested by Coalition Members FGs/R *Thrill-seeking activities FGs *Host an Annual Alachua County Health Fair FGs *Use School facilities during off times FGs *Increase excise tax Lit./FGs

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99 This chapter outlines specific suggestions of program improvement for the PIPSA coalition. This study offered a formative eval uation of the program and stressed what needs to be done in order for program evaluatio n in the future to produce results that are tied directly to PIPSA program activities. The following chapter provides a summary of results of the study and discu sses possible limitations and be nefits it may have had.

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100 CHAPTER 7 DISCUSSION This chapter presents a summary of both th e thematic results found in chapter five and the formative evaluation suggestions fr om chapter six. It offers limitations and benefits the study may have had and concl udes with PIPSAs theory of change, as presented by coalition members throughout th e focus groups. Possibilities in future research regarding this study are presented as a final note. Summary Of Results The coalition appears to be knowledgeable and capable of e ffective approaches, according to current research, in decreas ing underage drinking in Alachua County. Monitoring newly declared evaluation standard s will contribute to the coalition showing its effectiveness in the community. Until this is accomplished, it is difficult to comment on the progress the coalition has brought to the community. Use of untapped resources, like additional money from police confiscatio ns, and unused faciliti es like the school cafeteria during summer months, may allow for additional coalition activities, which in turn should lead to an increase in PIPSA awareness and participation. Overall, the coalitions emphasis is on educating comm unity members in the hopes of changing the normative party culture Alachua County pr esents to its youth. Early, interactive education is a key strategy that the coal ition has suggested in decreasing underage drinking in the community.

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101 Limitations Of Study Participation A major limitation of the study lies in the participation of coalition members. Not all coalition members opinions were in cluded in the study. Even though various techniques were employed to attract particip ation (i.e. e-mail, personal phone calls from executive coalition members), less than half of the coalition membership was able to contribute to the focus groups. Study results may not include feedback from crucial segments of the PIPSA coaliti on that may hold varying perspec tives than those presented. The study included thirty-f ive participants, with feedback coming from nineteen different coalition members. Individual work experi ences inspired some coalition members to attend more than the focus group they were or iginally listed by. Th ese nineteen members who participated in the study may hold very di fferent views than thos e not taking part in it. In short, twenty-seven percent of the coal ition were able to offer their views, but these may be dramatically different than the ot her seventy-three percent whose views were unable to be included in the study. Incomplete Representation Of PIPSA Coalition The civic and local agency sector, because of its limited number of coalition members and their inability to participate in scheduled and resche duled focus groups, was unable to be represented in the study. Theref ore, valuable insight from these coalition members is excluded from the results. This sector includes representatives from Alachua Countys Black on Black Crime Task Force, th e Rotary Club, and Black Aids Services and Education. The Black on Black Crime Task Force representatives contribute to the coalition by expressing at-risk minority youth in put, and assisting with recruitment of minority coalition members. The Rotary Club representatives specialize in locating local

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102 resource for fundraising, grant writing and evaluation. A representative from the Black Aids Services and Education offers the coal ition a minority health perspective. Without their valuable input, the re sults are further limited. Question Influence Considering those who participated in th e study, questions asked in the focus group may not have provided them the opportunity to respond in an accurate and thorough way regarding their conception of the social issue of al cohol use in underage youth. Limited Multivocality Also, multivocality was not encouraged by the study design. Participants were asked to respond in a way that reflected their respective agency and the sector they were listed as in the coalition member roster. Coal ition members may not have felt comfortable speaking from other perspectives they may hold through various other roles they play (i.e. parent, community member, or addict ). Although some transcended these boundaries by speaking of their other role s, with sectors sometimes overlapping, the majority spoke from the role they were expected to repres ent. Therefore, results may not include all perspectives that coalition members may have, but may show only their perspective from the professional occupati on they currently hold. Researcher Influence It is important to note the influence the pr incipal investigator may have contributed to the focus groups, outside of interpreti ng results. Consideri ng the researchers affiliations with the University of Florida, coalition members may have been hesitant to suggest the college cultures contributions to underage drinking in the community. On the other hand, coalition members may have been reminded of the college culture by the presence of the researcher. Many times coal ition members apologized when pointing to

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103 the University as problem in the community. Also, because of the researchers closeness in age to college students and the youth, coalition members may not have disclosed information about their practices, possibly assuming this was common knowledge to her. Therefore, age may have also infl uenced the results of the study. Benefits Of Study Collaboration This study offered coalition members an oppor tunity to express their perspectives on the social issue of underage drinking and re work their conceptions in light of fellow coalition members perspectives. In the proc ess, it encouraged suggestions for improving the program to better reach community memb ers, particularly yout h, considering the new focus. Also, it helped put a human face on the coalition. Member Checking In addition, this study allowed for mem ber checking (Krueger 1988). Underage drinking was declared a problem by executive coalition members at a coalition training prior to the focus groups. This study presented th is idea in the focus groups to validate if the coalition members agreed. If they did not this study would ha ve suggested a new focus for the coalition, based on the results. The prevalent feeling from the coalition members was that underage drinking in Alac hua County should be the top priority of PIPSA. Consensus seemed to be that ch anging youths norms regarding underage drinking would result in a generational change in norms for the future. Community Assessment The strategic planning framework advocates first assessing community needs and resources, analyzing the problems and goa ls of the community and understanding the model of change the coalition hopes to em ploy. By accomplishing this stage, the study

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104 allowed the coalition to get closer to the evaluation stage, which is important to the coalition in terms of monitoring pr ogress and future funding opportunities. Informative And Exciting Nature Of Study This study also served to get people informed and excited about the new direction the coalition should take. Many coalition members were apologetic of their limited involvement in the coalition recently, and brainstormed throughout the focus groups of ways they could contribute better, offering pr omises of more productive participation for the future. Conclusion Theory Of Change This study gave insight into the theo ry behind the Alachua County communitybased coalition, PIPSA, from the coalition member s perspective. Mostly these involved agency approaches to decreasing under age drinking in the community, employing scientifically-based strategies to educat e community members, distract them with activities that encour age alcohol-free behavior, and to reward them if they are participating in healthy ac tivities, but make them unders tand the consequences they may be subjected to if they partic ipate in unhealthy behaviors. Future Research Future research focusing on community members perspectives will broaden the conception of the social issue of underage drinking present in Al achua County. It is highly advised to give community members a chance to offer their ideas. Morgan (1997:29) states, by hearing the perspective of the program participants themselves, is wiser than simply assuming that the program worked for the reasons that its designers intended. Input from community members ma y address strengths and weaknesses within

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105 the program, which coalition members were unw illing or unable to address. Also, they may provide innovative approaches in deali ng with substance abuse. Their involvement in the program construction process may furt her integrate community members into the program, and extend PIPSA awareness and participation.

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106 APPENDIX A PROTECTIVE AND RISK FACTORS Protective Factors Community Rewards for pro-social Involvement Family Attachment Family Opportunities for Pro-social Involvement Family Rewards for Pro-social Involvement School Opportunities for Pro-social Involvement School Rewards for Pro-social Involvement Religiosity Social Skills Belief in Moral Order Risk Factors Low Neighborhood Attachment Community Disorganization Personal Transitions and Mobility Laws and Norms favorable to Alcohol Perceived Availability of Alcohol Poor Family Supervision Poor Family Discipline Family History of Antisocial Behavior Parental Attitudes Favor able toward Alcohol Use Parental Attitudes Favorabl e toward Antisocial Behavior Poor Academic Performance Lack of Commitment to School Rebelliousness Friends Delinquent Behavior Friends Use of Alcohol Peer Rewards for Antisocial Behavior Favorable Attitudes toward Antisocial Behavior Favorable Attitudes toward Alcohol Use Low Perceived Risk s of Alcohol Use Early Initiation (of Alcohol Use and Antisocial Behavior) Sensation Seeking

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107 APPENDIX B GAINESVILLES DRINKING SCENE Figure B-1: Gainesvilles Drinking Scene Picture 1

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108 Figure B-2: Gainesvilles Drinking Scene Picture 2

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109 APPENDIX C FOCUS GROUP HANDOUTS Project Title: Partners in Prevention of Substa nce Abuse (PIPSA) Evaluation Program Purpose of the research study: The purpose of this study is to evaluate the process and impact of the PIPSA coalition in Alachua county. I plan to invite no more than 70 coalition members to focus groups throughout the course of this study. What will you be asked to do in this study: You will be asked to particip ate in a focus group. You will be asked questions regarding your knowledge of the coalition and strategies to improve the program, as well as your experiences working with the program. Time required: The interviews will last between approximately 60 minutes. Confidentiality: Your identity will be kept confidential to the extent provided by law. All focus groups will be tape recorded. The data from the fo cus groups will be analyzed by the Principal Investigator using qualitative da ta analysis techniques. Identi fiers will not be used on the actual data transcriptions; they will onl y have a code number on them. A list of identification numbers with the participant na mes will be kept separately in a locked filing cabinet behind a locked door. The tapes wi ll be destroyed once they are transcribed. Potential benefits and anticipated risk: There is no compensation for participating in this study. There are no anticipated risks to you for participating in this study. Anticipat ed benefits include providing coalition members a chance to voice their opinions a bout the structure of the program and any strategies to improve it. Any possible improve ment of the program may result in a higher degree of drug abuse prevention. Voluntary participation: Your participation in this study is complete ly voluntary. You may choose not to answer any question and you may end your participation at anytime. There is no penalty for not participating. Right to withdraw from the study: You have the right to withdraw from th e study at anytime without consequence. Whom to contact if you have questions about this study:

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110 Principal Investigator: Kelly Dever, Department of Sociology, Univer sity of Florida, 3219 Turlington Hall, P.O. Box 117330, Gainesville, FL 32611, (352) 392-0265 ext. 163, dever06@ufl.edu Supervisors: Barbara Zsembik, Ph.D., Associate Professo r and Associate Chair, Department of Sociology, 3219 Turlington Hall, Phone: (352) 392-0251, ext. 226, zsembik@soc.ufl.edu Jodi Lane, Ph.D., Associate Professor, Depa rtment of Criminology, Law and Society, 212 Walker Hall, Phone: (352) 392-1025, ext. 212, jlane@crim.ufl.edu For questions about your rights as a research participant: Please contact the IRB at 352-392-0433 or PO Box 112250, Gainesville, FL 32611. Agreement: I have read the procedure described above. I voluntarily ag ree to participate in the procedure and I have receiv ed a copy of this description. Participant: ___________________________________________ Date: _________________ Principal Investigator: ___________________________________ Date: _________________

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111 Figure C-1: Alachua C ounty Problem Diagram

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112 Figure C-2: PIPSAS Serv ice Utilization Plan

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113 APPENDIX D EXAMPLE PROCESS MEASURES EXECUTIVE COUNCIL MEETING FORM Held? # In attendance Length of Mtg? August 2006 yes no ______ ____ __________ September 2006 yes no ______ ____ __________ October 2006 yes no ______ ____ __________ November 2006 yes no ______ ____ __________ December 2006 yes no ______ ____ __________ January 2007 yes no ______ ____ __________ February 2007 yes no ______ ____ __________ March 2007 yes no ______ ____ __________ April 2007 yes no ______ ____ __________ May 2007 yes no ______ ____ __________ June 2007 yes no ______ ____ __________

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114 COALITION MEETING FORM Held? # In attendance? Length of Mtg? August 2006 yes no __________ ___________ September 2006 yes no __________ ___________ October 2006 yes no __________ ___________ November 2006 yes no __________ ___________ December 2006 yes no __________ ___________ January 2007 yes no __________ ___________ February 2007 yes no __________ ___________ March 2007 yes no __________ ___________ April 2007 yes no __________ ___________ May 2007 yes no __________ ___________ June 2007 yes no __________ ___________ *Reasons for meeting not held (include month) __________________ _____________________ _______________ __________________ _____________________ _______________ __________________ _____________________ _______________ __________________ _____________________ _______________ __________________ _____________________ _______________ __________________ _____________________ _______________ ______________________________

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115 MEETING ATTENDANCE ROSTER ________________________________ _____________________________ Partner Agencies Name of Attendee ________________________ ______________________ ______ _________ Alachua County Court Services Alachua County Health Department Alachua County Sheriffs Office Alachua Learning Center, Inc. Alachua County Schools Beasley Middle School Big Brothers/ Big Sisters of Greater Gainesville Black on Black Crime Task Force Boys and Girls Club of Alachua County Cedar Ridge 4-H Club Center for Cooperative Learning Childrens Home Society City of Alachua City of Gainesville Columbia County Schools Corner Drug Store, Inc. Crescent City Jr/Sr High School Department of Children and Families Department of Juvenile Justice Drug Enforcement Administration FADAA

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116 Families Against Drugs FDLE Gainesville Branch Office Gainesville Housing Authority Gainesville Job Corps Center Gainesville Police Department Gateway School Hippodrome State Theatre HRH Insurance Juvenile Assessment Center Makare Publishing Martin Luther King Commission Meridian Behavioral Healthcare Metamorphosis NE Florida Education Consortium Office for a Drug Free Community Office of the State Attorney PACE Center for Girls People in Transition Counseling PK Yonge Developmental Research School Planned Parenthood Putnam County Sheriffs Office Santa Fe Community College School Board of Alachua County Seminole County Sheriffs Office

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117 Shands Heathcare Shands at Vista S. J. Lawrence Consulting Suwannee County School Board Suwannee River Area Health Education Center United Church of Gainesville United Way of Alachua County United Way of Suwannee Valley University of Florida Worthington Pediatrics *Additional* Creation Two (after-school program for youth) Department of Health and Human Services

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118 COMMUNITY REPRESENTATIVES FORM Community Representatives invited to address gaps in the current coalition membership? 1. Name: __________ Title: ___________ Topic: __________ Date: ___________ 2. Name: __________ Title: ___________ Topic: __________ Date: ___________ 3. Name: __________ Title: ___________ Topic: __________ Date: ___________ 4. Name: __________ Title: ___________ Topic: __________ Date: ___________ 5. Name: __________ Title: ___________ Topic: __________ Date: ___________ Total: ____________

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119 EDUCATIONAL WORKSHOP FORM 07/0606/07 1. Workshop Subj ect: ___________ Date of Pres entation: __________ Length of Presentation: ________ Facilitator: _______________ 2. Workshop Subj ect: ___________ Date of Pres entation: __________ Length of Presentation: ________ Facilitator: _______________ Additional Workshops 3. Workshop Subj ect: ___________ Date of Pres entation: __________ Length of Presentation: ________ Facilitator: _______________ 4. Workshop Subj ect: ___________ Date of Pres entation: __________ Length of Presentation: ________ Facilitator: _______________

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120 STATE AND NATIONAL CONFERENCE FORM National PIPSA representatives sent: 1. Name: __ ____________________ Signature: ___________________ Dates of conference: ___________ 2. Name: ______________________ Signature: ___________________ Dates of conference: ___________ State PIPSA representatives sent: 1. Name: __ ____________________ Signature: ___________________ Dates of conference: ___________ 2. Name: ______________________ Signature: ___________________ Dates of conference: ___________

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121 YOUTH COALITION SUB-COMMITTEE MEMBER ROSTER Members: 1. _______________ 2. _______________ 3. _______________ 4. _______________ 5. _______________ 6. _______________ 7. _______________ 8. _______________ 9. _______________ 10. ______________

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122 VOLUNTEER SPEAKERS BUREAU MEMBER FORM Members: ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________

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123 UF CAMPUS ALCOHOL AND SUBSTANCE ABUSE RESOURCE CENTER FORM Meeting Meeting minutes disseminated? Other Communication? August, 2006 no yes no yes Type: __________ Length: ________ Topic: _________ September, 2006 no yes no yes Type: __________ Length: ________ Topic: _________ October, 2006 no yes no yes Type: __________ Length: ________ Topic: _________ November, 2006 no yes no yes Type: __________ Length: ________ Topic: _________ December, 2006 no yes no yes

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124 Type: __________ Length: ________ Topic: _________ January, 2007 no yes no yes Type: __________ Length: ________ Topic: _________ February, 2007 no yes no yes Type: __________ Length: ________ Topic: _________ March, 2007 no yes no yes Type: __________ Length: ________ Topic: _________ April, 2007 no yes no yes Type: __________ Length: ________ Topic: _________

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125 May, 2007 no yes no yes Type: __________ Length: ________ Topic: _________ June, 2007 no yes no yes Type: __________ Length: ________ Topic: _________

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126 REGIONAL ALCOHOL SUMMIT FORM (2006) Date: _____________ Location: __________ Attendance (based on registration): Adults ________ Youth ________ Theme: ___________

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127 RED RIBBON WEEK FORM (2006) Activities: Poster Contest # of participants __________ # of schools represented ________ Essay Contest # of participants __________ # of schools represented ________ Lectures # of student participants __________ # of adult participants __________ # of schools represented ________

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128 FAMILY DAY FORM 1. # of families regi stered _________________

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129 LEGISLATIVE ACTIVITIES FORM 1. How many letters sent out? ____________ 2. How many articles from coalition members were published? _______________

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130 APPENDIX E EXAMPLE IMPACT MEASURES PIPSA AWARENESS/PARTICIPATIO N/ALCOHOL USE/ATTITUDINAL SURVEY I. Demographic Information 1. Date: _____________ 2. Gender: ___________ 3. School:____________ 4. Age: ______________ 5. Grade: ____________ 6. Race/Ethnicity: ______ Social Information: 1. Have you ever been arrested? For what? ___________________ 2. What neighborhood do you live in? _____________ 3. What social organizations are you part of? _____________________________________________________________________ 4. Grade Point Average (weighte d)/Average grade (if middle/jr. high):_________ 5. Do you attend church regularly? no yes 6. Do your friends use alcohol? no yes 7. Is alcohol available at your school? no yes 8. How many days of school did you miss last year? II. Awareness (open-ended questions) 1. What do you know about Partners in Prevention of Substance Abuse (PIPSA)? __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ ________________________ 2. Have you ever heard of: PIPSA Activity No Yes A. PIPSA Educational Workshop B. PIPSA Youth Drug Summit C. PIPSA Youth Advisory Committee D. PIPSA Letter Campaigns

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131 E. PIPSA Red Ribbon Week Poster contest F. PIPSA Red Ribbon Week Essay contest G. PIPSAs Family Day III. Participation 1. Have you ever participated in: PIPSA Activity No Yes A. PIPSA Educational Workshop a.If so, which? ____ B. PIPSA Youth Drug Summit b If so, what year? C. PIPSA Youth Advisory Committee c.If so, what year? D. PIPSA Letter Campaigns d If so what issues?) E. PIPSA Red Ribbon Week Poster contest e.Did you place?___ F. PIPSA Red Ribbon Week Essay contest f Did you place? G. PIPSAs Family Day IV. Marketing 1. Have you ever seen/heard: Sources No Yes A. E-mail announcement re: above activities a. If so, which? B. Flyer re: above activities b. If so, which? bb.Where? C. Banner re: above activities c. If so, which? cc. Where? D. School announcement re: above activities d. If so, which? E. Commercial re: above activities e. If so, which? F. Letter re: above activities f. If so, which? V. Alcohol Use/Attitudinal Survey (Instructions: Read each statement. Check off the answer that best shows how you feel.) YES! =You REALLY agree with the statement yes = You sort of agree with the statement no = You sort of disagree with the statement NO! = You REALLY disagree with the statement NO! no yes YES! 1. a. I have tried to smoke a cigarette at least once in my life. b. PIPSA activities/workshops have influenced my decision. 2. a. It is OK for kids my age to drink beer and wine. b. PIPSA activities/workshops have influenced my decision. 3. a. I think I might drink some beer or wine in the next year. without my family knowing. b. PIPSA activities/workshops have influenced my decision.

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132 4. a. Cigarette smoking is good for my body. b. PIPSA activities/workshops have influenced my decision. 5. a. Lots of people my age smoke. b. PIPSA activities/workshops have influenced my decision. 6. a. I hate school. b. PIPSA activities/workshops have influenced my decision. 7. a. I love my family. b. PIPSA activities/workshops have influenced my decision. 8. a. I can get cigarettes to smoke if I want to. b. PIPSA activities/workshops have influenced my decision. 9. a. I tried at least one drink of beer or wine in my life. b. PIPSA activities/workshops have influenced my decision. 10.a. It is OK for kids my age to smoke marijuana. b. PIPSA activities/workshops have influenced my decision. 11.a. I think I might smoke cigarettes in the next year without my family knowing. b. PIPSA activities/workshops have influenced my decision. 12.a. It could hurt me to drink a lot of beer or wine all at once. b. PIPSA activities/workshops have influenced my decision. 13.a. Lots of people my age smoke cigarettes. b. PIPSA activities/workshops have influenced my decision. 14.a. My teacher likes me. b. PIPSA activities/workshops have influenced my decision. NO! no yes YES! 15.a. My family loves me. b. PIPSA activities/workshops have influenced my decision. 16.a. I can get marijuana to smoke if I want to. b. PIPSA activities/workshops have influenced my decision. 17.a. It is OK for kids my age to smoke cigarettes. b. PIPSA activities/workshops have influenced my decision. 18.a. Lots of people my age drink beer and wine.

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133 b. PIPSA activities/workshops have influenced my decision. 19.a. I like school. b. PIPSA activities/workshops have influenced my decision. 20.a. Smoking marijuana is good for my body. b. PIPSA activities/workshops have influenced my decision. NO! no yes YES! 21.a. I like to talk to my family. b. PIPSA activities/workshops have influenced my decision. 22.a. I can get beer or wine to drink if I want to. b. PIPSA activities/workshops have influenced my decision. 23.a. I think I might smoke marijuana in the next year without my family knowing. b. PIPSA activities/workshops have influenced my decision. 24.a. I disobey my teachers. b. PIPSA activities/workshops have influenced my decision. 25.a. I have tried to smoke marijuana at least once in my life. b. PIPSA activities/workshops have influenced my decision. 26.a. School is a happy place. b. PIPSA activities/workshops have influenced my decision. 27.a. I listen to my family. b. PIPSA activities/workshops have influenced my decision.

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134 Educational Workshop Survey Topic: _________________ Presenter:_______________ Date: __________________ PRE-TEST I. Demographic Questions: 1. Name___________ 2. Age: ___________ 3. Race/Ethnicity: ____________ 4. School/Job Position: ________ II. Open-ended Questions: 1. What experiences do you ha ve with this issue/topic? _________________________ __________________________ _________________________ __________________________ _________________________ __________________________ _________________________ __________________________ _________________________ __________________________ _________________________ __________________________ _________________________ __________________________ _________________________ __________________________ ______________________ __________________ 2. What do you expect to ge t out of this workshop? _________________________ __________________________ _________________________ __________________________ _________________________ __________________________ _________________________ __________________________

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135 Educational Workshop Survey (POST-TEST) Instructions: Please rate the presen ter based on the following scale. (Likert Scale 1= poor or not likely ; 2= fair or somewhat likely ; 3= good or likely ; 4= excellent or highly likely; 5= not applicable ) I. Presenter Evaluation: 1. Presenter was knowledgeable regarding course content? ______ 2. Presenter answered question s clearly and completely? ______ 3. Presenter gave clear instructions for each exercise? _____ 4. Presenter defined terms a nd concepts clearly? _____ 5. Presenter was well prep ared and organized? _____ II. Presentation Content: 1. I will be able to implement th e concepts learned in my work? ____________________________ 2. The training was releva nt to my needs? ______ 3. Presentation objectives were stated? ______ 4. The content fulfilled the pr esentation objectives? ______ 5. Length of the presentatio n was appropria te? ______ 6. Presentation had the right combination of theory and practice? ___ 7. The logic and sequence of t opics was appropriate? _____ 8. Do you feel like you know more about this topic than when you came in? _____ Open-E nded Questions: 1. What did you learn?__ __________________ ____________ 2. Is this relevant to y ou? Why or Why not? 3. What topics would you like to see in an educational workshop in the futu re?_____________ _________________ 4. Do you have any additional co mments about this workshop? ________________ _______________________

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136 APPENDIX F EXAMPLE STRATEGIC PLAN Primary Agency Goals (Process): 1. To continue to coordinate the efforts of the Partners in Prevention of Substance Abuse (PIPSA) Coalition to develop and provide a full continuum of substance abuse prevention, intervention, and treatment programs. Objectives : Hold monthly PIPSA Executive Council meetings Hold Bi-monthly meetings with the full Coalition Conduct on-going program evaluation of the progress of the Coalition and its prevention, intervention and treatment components 2. Increase collaboration among youth, families and other citizens, and local and state anti-drug initiatives in the plan ning and development of community antidrug efforts. Objectives : Invite additional community representati ves to address gaps in the current coalition membership (performance criterion not set) Host two community workshops on s ubstance abuse prevention per year Send two PIPSA Coalition members to national and state conferences to network and gain ideas Develop a Youth Coalition to be a sub-committee of the PIPSA coalition Develop a Volunteer Speakers Bureau as part of the PIPSA coalition Establish and maintain the relatio nship with the Higher Education Coalitions through the UF Campus Alcohol and Substance Abuse Resource Center 3. Bring about community awareness of the causes, nature and extent of substance abuse. Objectives : Host one Regional Drug Summit per year Red Ribbon Week Activities (poster and essay contest, recognition luncheon) Participate in Family Day Encourage Legislative Activities (letter campaigns, Op Ed pieces) Primary Client Goals (Impact): 1. To reverse the trend and stop the increase in alcohol use in Alachua County. Objective : To decrease by 5% the alcohol use trend (past 30 day use) by Alachua County students.

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137 2. To reverse the trend and stop the increase in marijuana use in Alachua County. Objective : To decrease by 5% the marijuana use tr end (past 30 day use) by Alachua County students. Secondary Client Goals (Impact): 1. Increase awareness of the PIPSA program Objective : Any increase in awareness from time 1 and time 2 2. Increase participation at PIPSA activities Objective : Any increase in participation at PIPSA activities between time 1 and time 2 3. Educate workshop attendees regard ing substance abuse issues Objective : Performance criterion dependent on goa ls of workshop & pre/post surveys

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142 Pentz, M. A., J. H. Dwyer, D. P. MacKinnon, B. R. Flay, W. B. Hans en, E. Y. Wang, and C. A. Johnson. 1989. A Multicommunity Trial for Primary Prevention of Adolescent Drug Abuse. Journal of the American Medical Association 261:32593266. Pollard, J. A., J. D. Hawkins, and M. W. Arthur. 1999. Risk and Protection: Are Both Necessary to Understand Diverse Beha vioral Outcomes in Adolescence? Social Work Research 23:145-158. Regents of the University of Michigan. 2006. Monitoring the Future: A Continuing Study of American Youth. URL: (http://www.monitoringthefuture.org/ ). Last accessed April, 2006. Rossi, Peter H., Mark W. Lipsey and Howard E. Freeman. 2004. Evaluation Research: A Systematic Approach Thousand Oaks, CA: Sage Publications. Sampson, Robert J. and John H. Laub. 1993. Crime in the Making: Pathways and Turning Points Through life. Cambridge, MA: Harvard University Press. Schwandt, T. A. (n.d.). Evaluation Practice Reconsidered. Baltimore, MD: Peter Lang. Scriven, M. 1991. Evaluation Thesaurus 4th ed. Newberry Park, CA: Sage Publications. Steinberg, L. 1991. Adolescent Transitions and Alcohol and Other Drug Use Prevention. Preventing Adolescent Drug Use: From Theory to Practice. Office of Substance Abuse Prevention Monograph 8:13-51. Wa shington, DC: U.S. Department of Health and Human Services. Strauss, Anselm L. and Juliet M. Corbin. 1998. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. 2nd ed. Thousand Oaks, CA: Sage Publications. Substance Abuse and Mental Hea lth Services Administration. 2005. Overview of Findings from the 2004 National Survey on Drug Use and Health. (Office of Applied Studies, NSDUH Series H27, DHHS Publication No. SMA 05-4061). Rockville, MD. United States Department of Health and Human Services. 2006a. Office of Applied Studies: Substance Abuse and Me ntal Health Statistics. URL: (http://www.oas.samhsa.gov/ ). Last accessed May, 2006. ____2006b. Office of Applied Studies: National Survey on Drug Use and Health. URL: (http://www.oas.samhsa.gov/nhsda.htm ). Last accessed April, 2006. Vega, William A. and John W. Murphy. 1990. Culture and the Restructuring of Community Mental Health Westport, CT: Greenwood Press.

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143 Wagenaar, Alexander C. and Mark Wolfs on. 1994. Enforcement of the Legal Minimum Drinking Age in the United States. Journal of Public Health Policy 15 (1):37-53. Weil, Andrew. 1986. Why People Take Drugs. The Natural Mind 1:17-38. Zuckerman, M. 1979. Sensation Seeking: Beyond Th e Optimal Level of Arousal. Hillsdale, NJ: Lawrence Erlbaum. Zunyou, Wu, Roger Detels, Jiapeng Zhang, Virginia Li, and Jianhua Li. 2002. Community-Based Trial to Prevent Dr ug Use Among Youths in Yunnan, China. American Journal of Public Health 92 (12):1952.

PAGE 154

144 BIOGRAPHICAL SKETCH Kelly Ann Dever is a second-year graduate student in the Department of Sociology at the University of Florida. Her curren t work focuses on program development and evaluation research that addr ess public health and community-based approaches to the prevention of health problems, particularly substance abuse issues. Prior to graduate school, she worked at a social science resear ch company, Westat, as an interviewer. Her research there included studi es contracted by the Centers for Disease Control, the National Institutes of Health, the Centers for Medicare and Medicaid Services, the Roswell Park Cancer Institute, the United States Environmental Protection Agency, the United States Department of Education, and the Treasury Department. She received her Bachelor of Arts degree at Stetson University in 2002 from the Department of Sociology. During her studies there, she worked for Stet sons Institute for Social Research (SISR), conducting telephone interviews for various projects. Kelly is planning to begin her Ph.D. course work in the fall semester of 2006. In addition, she will gain valuable teaching experience, since she has been aske d to teach an introductory level sociology class of University of Florida undergraduates.


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Physical Description: Mixed Material
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PARTNERS IN PREVENTION OF SUBSTANCE ABUSE (PIPSA) THEORY OF
CHANGE: A FORMATIVE EVALUATION IN IMPLEMENTING COMMUNITY
ANTI-DRUG COALITIONS OF AMERICA'S STRATEGIC PLANNING
FRAMEWORK















By

KELLY ANN DEVER


A THESIS PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS

UNIVERSITY OF FLORIDA


2006

































Copyright 2006

by

Kelly Ann Dever















ACKNOWLEDGMENTS

I would like to sincerely thank Gwen Love and Cindy Grant for sharing their

knowledge and experience of the Partners in Prevention of Substance Abuse (PIPSA)

program with me. They guided me ever so patiently through the production of this project

and I would like to show my appreciation for their dedication to the social issue of

substance abuse. PIPSA is a considerate approach to improving Alachua County

substance abuse problems and should be applauded for its efforts. With more support,

cooperation, and resources the program is capable of providing more physically and

emotionally healthy community members. Lastly, I would like to thank my supervisory

committee members, Drs. Barbara Zsembik and Jodi Lane, for their encouragement

throughout the research process. Without them, this study would not have been possible.
















TABLE OF CONTENTS



A C K N O W L E D G M E N T S ................................................................................................. iii

LIST OF TABLES .............. ................. ........... ................ .......... vii

L IST O F FIG U R E S .............. ............................ ............. ........... ... ........ viii

ABSTRACT .............. .......................................... ix

CHAPTER

1 INTRODUCTION ............... ................. ........... ................. ... ..... 1

2 LITERA TURE REVIEW .......................................................... ..............6

Substance A buse A m ong Y outh ............................................................................. 6
Social Issue O f Substance A buse ........................................ ....... ............... 7
Alcohol As A Substance........................................................ 9
Current research on the underage drinking scene in the United States........10
Current research on underage drinking in Alachua County .........................18
Theoretical Fram ew ork Of PIPSA ......................................................... .......... 22
C rim in logical T h eory ............................................................. .....................22
L earning Theory ........................................ ................. .... ....... 22
L ife-C ourse P erspectiv e ........................................................... .....................24
C om m unity-B asked C oalitions.............................................. ........................... 26
Effectiveness Of Community-Based Coalitions................................................27
Suggested Strategies Employing Community-Based Coalitions ......................29

3 PARTNERS IN PREVENTION OF SUBSTANCE ABUSE (PIPSA)
C O A L IT IO N ......................................................................................................... 3 6

Program H istory................................................. 36
A lachua C county ......................................................... .. ............ 37
Program Theory ..................................................... ... .. ........ .... 39
Program im pact theory ......................................................................41
P program process theory ............................................ ....................................43
PIPSA's New Focus: Underage Drinking..........................................................45
F orm ative E valuation........... ........................................................ .... .. .... ..... 46









4 ST U D Y D E SIG N ............................................................................ ...... ............49

O n to lo g y ..............................................................................4 9
E pistem ology ................................................................... 50
M methodology .............................................................................................. ........50
Qualitative Design ................................. .......................... .... ...... 51
M methods ...............................................................................................................52
Focus Group As A M ethod......................................53
Historical and contemporary uses of focus groups ................. ................. 53
Benefits of using focus groups ........................................53
Lim stations in using focus groups .............................. ...........57
Focus G group D design .................................... .......... .. ....... .. ........ .... 60
Focus group questions ........................................................ ............... 65
M materials used in focus groups.................................. ....................... 67
Sam pling design .............. .................................... .......... ...............67
A analysis Procedures .............. ........ .. .. ......................................... .. ... 70
Grounded Theory: background considerations ...........................................70
Application of Strauss and Corbin's Grounded Theory .............................72
L im stations O f Study D design ................... ..................................................... 74

5 R E S U L T S .............................................................................7 6

Theory Of Change ............................................... .......... ........................... 76
Culture Of Drinking In Alachua County ......................................................80
Difficulties Reaching Community Members....................................81
Strategies For Decreasing Underage Drinking ...........................................82

6 FORM ATIVE EVALUATION ........................................................ ............... 85

Suggestions For Evaluating PIPSA Process ..........................................................85
Suggestions For Evaluating PIPSA Impact ................ .............................8... 6
Suggestions For PIPSA Program Improvement............... ..................................86
Im plem ent Scientifically-Based Strategies............................. ..................... 87
Improve PIPSA Attendance And Dialogue ....................................................... 87
Encourage Collaboration W within PIPSA ........................................................... 88
Extend PIPSA M em bership ..................................................................... 88
Foster community-school partnerships ..................................... ......... 89
Include business community ............................................ ...............89
Involve m edia ........................................................ ................... 90
Form youth advisory com m ittee ........................................ .....................90
Target specific populations of youth ...........................................................91
Consider Adding Additional Activities To The PIPSA Program ........................91
Provide thrill-seeking activities ........................................................91
Host an annual Alachua County Health Fair........................................... 91
Use school facilities during "off times ................................................. 92
Increase excise tax..................................... ............... ............... 92
Show case all PIPSA efforts...................................... ........................ 92



v









D raft Process And Im pact Instrum ents.................................... ..... .......... 93
Base Instruments On A Comprehensive List Of PIPSA Activities.................93
Include Newly Suggested Resources In Coalition ...........................................95
Encourage Better Communication Between Coalition Members .....................96

7 DISCUSSION ......................... ...... .. .... .................. 100

Sum m ary O f R esults.......... ............................................................ ...... .... ...... 100
L im stations O f Study .......................................... .. .. .... ..................101
Participation......................................................... 101
Incomplete Representation Of PIPSA Coalition................. ...... ............101
Q question Influence............ .... ...................................................... .... .... .... .. 102
L im ited M ultivocality .................................................................................. 102
R researcher Influence .......................................................... ............... 102
B benefits O f Study ............................................ .. .. ............. .......... 103
Collaboration .................................................................. ... ......... 103
M em ber Checking ............................................... ... .... .......... .... 103
Com m unity A ssessm ent ............................................................................ 103
Informative And Exciting Nature Of Study ............................................... 104
C onclu sion ..................................................................................................... 104
Theory Of Change ..................................... ...... .. ..... .... .......... .... 104
Future R research ............................................... .. ........ ................ 104

APPENDIX

A PROTECTIVE AND RISK FACTORS ......................................................106

Protective Factors ..................................... ... .......... .............. .. 106
R isk F a cto rs ..............................................................................................................1 0 6

B GAINESVILLE'S DRINKING SCENE ............ .............................................107

C FOCU S GROUP HANDOUTS.......................................... .......................... 109

D EXAMPLE PROCESS MEASURES .............................................. ...............113

E EXAMPLE IMPACT MEASURES.....................................................................130

F EXAM PLE STRATEGIC PLAN .................................... .......................... ......... 136

L IST O F R E FE R E N C E S ....................................................................... .................... 138

BIOGRAPHICAL SKETCH ............................................................. ............... 144
















LIST OF TABLES

Table p

1 Drinking Patterns among Adults and Youths (In Percent).................. ............ 12

2 Drinking Frequency and Intensity for Youths and Adults (Current
DrinkersOnly).................................... ................................ .........13

3 Alcohol Consumption in the United States, 1999 ................................................20

4 A lachua C county Statistics ............................................... ............................. 38

5 Focus Group Characteristics .............................................................................. 62

6 Focus Group Participation...................... ....... .............................. 64

7 Form ative Evaluation Suggestions.................................. .............................. ........ 97
















LIST OF FIGURES


Figure page

1 Long-Term Trends in Prevalence of Drinking among Twelfth Graders.................. 12

2 Any Use of Alcohol in the Past 30 Days for 12- to 20-year-olds, by Gender,
Race or Ethnicity, and Age Group: 2000. ..................................... ............... 14

3 Program Theory: Social Development Strategy................................................40

4 Im pact T theory ........................................................................42

B- Gainesville's Drinking Scene Picture 1 ...................................... ............... 107

B-2 Gainesville's Drinking Scene Picture 2 ...................................... ............... 108

C-l Alachua County Problem Diagram ................. ....................................

C-2 PIPSA's Service Utilization Plan.................................. .... .................112















Abstract of Thesis Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Master of Arts

PARTNERS IN PREVENTION OF SUBSTANCE ABUSE (PIPSA) THEORY OF
CHANGE: A FORMATIVE EVALUATION IN IMPLEMENTING COMMUNITY
ANTI-DRUG COALITIONS OF AMERICA'S STRATEGIC PLANNING
FRAMEWORK

By

Kelly Ann Dever

August 2006
Chair: Barbara Zsembik
Cochair: Jodi Lane
Major Department: Sociology

A qualitative study of coalition members from Alachua County's community-based

coalition, Partners in Prevention of Substance Abuse (PIPSA), on the topic of substance

abuse was undertaken during April and May of 2006 at the University of Florida. The

sample was comprised of 70 coalition members listed as active participants in the

coalition. The purpose was to understand PIPSA's theory of change regarding its newly

declared focus on underage drinking, to offer a formative evaluation of the program, and

provide suggestions as to the necessary steps it will take to structure the program in a way

that can be evaluated in the future. Results indicated that coalition members place a

strong emphasis on education as a strategy to decrease underage drinking in Alachua

County, targeting youth at an even earlier age than they currently do. Evaluation results

suggest priority be given to finalizing feasible activities the PIPSA coalition is able to









accomplish and to develop instruments that measure the process and impact of these very

activities, to evidence program strengths and weaknesses, and to ensure future funding














CHAPTER 1
INTRODUCTION

Substance addiction is not an individual problem, but stems from a larger

community issue and should be handled in a comprehensive community-based approach.

The National Survey on Drug Use and Health, conducted by the Substance Abuse and

Mental Health Services Administration (SAMHSA), states: of the 21.1 million people

who needed but did not receive treatment in 2004, an estimated 1.2 million reported that

they felt they needed treatment for their alcohol or drug use problem. Of the 1.2 million

persons who felt they needed treatment, 441,000 (35.8%) reported that they made an

effort but were unable to get treated (Substance Abuse and Mental Health Services

Administration 2005:7). These numbers indicate a need for substance abuse programs to

consistently be available and successfully create an awareness of their services, so

individuals are able to seek help for problems that may affect their quality of life. It is

important to note these numbers are conservative considering there are those who do not

seek treatment services but might be willing to go if they were aware of the services.

The Partners in Prevention of Substance Abuse (PIPSA) program is a community-

based coalition serving the residents of Alachua County, Florida. Community Anti-Drug

Coalitions of America (CADCA) defines a coalition as a formal arrangement for

collaboration between groups or sectors of a community in which each group retains its

identity but all agree to work together toward a common goal of building a safe, healthy,

and drug-free community (National Community Anti-Drug Coalition Institute 2006).

PIPSA is comprised of seventy coalition members, representing nine sectors in the









Alachua County community: Youth Services, School Board, Law Enforcement, Business

and Media, Federal State and Local Agencies, Civic and Volunteer Agencies, Religious

Groups, Healthcare, and Parents and Community. The members meet to discuss

substance abuse issues specific to Alachua County and organize efforts of prevention,

volunteering services individually and from their respective agencies.

An immediate priority for PIPSA is to organize the program in a way that can be

evaluated in terms of program growth. Insight into program strengths and weaknesses is

useful in building the effectiveness of the program as well as increasing the possibility for

future funding, since most funding sources encourage evaluative pieces to be included

with grant applications. According to CADCA training, PIPSA's first step toward

becoming evaluative is creating a program that has assessed its resources, understands its

capacity, and has logically developed an organizational plan that is feasible and reaches

community members in a reasonable manner.

The program is in the process of revising its goals (broad statements of what the

coalition project intends to accomplish) and objectives (what is to be accomplished

during a specific period of time to move toward achievement of a goal, expressed in

specific, measurable terms) to more effectively address substance abuse in Alachua

County (Rossi, Lipsey, and Freeman 2004). Currently, their goals are too broad to be

realized and their objectives for reaching those goals are not defined in measurable terms,

making evaluation impossible.

CADCA is a nationwide organization that offers training and guidance for

strengthening and improving community coalitions. Many drug coalitions throughout the

United States are adopting their program and structuring or restructuring their coalition to









reflect their model. CADCA's guidance and support coupled with their acceptance, on a

national level, makes them not only appealing from the coalition's standpoint, but

desirable from funding sources due to its structure. At the suggestion of CADCA, the

PIPSA program has decided to focus specifically on one issue: to follow their Strategic

Planning Framework Model to determine the program's effectiveness in reaching

Alachua County residents. It has declared underage drinking to be the primary concern.

Children and youth are more vulnerable to problems associated with alcohol and drug

abuse than any other group in society (Hawkins, Catalano, and Miller 1992). Current

research shows that a higher percentage of youth aged 12 to 20 use alcohol (29%

nationally) than use tobacco (24%) or illicit drugs (14%), making underage drinking a

leading public health problem in the United States (Department of Children and Families

2003). According to the 2004 Florida Youth Substance Abuse Survey (FYSAS), the

number of youth in Alachua County who are engaging in alcohol use is even higher

(32.7%) than the national or state average (Department of Children and Families 2003).

Focusing on this specific issue will allow PIPSA to create a program that delivers

services with a logical theory guiding activities that are capable of being evaluated. The

PIPSA program has not reevaluated their program since its inception, seven years ago.

With the new focus it was essential to speak with coalition members regarding their

approach to Alachua County community members.

This study offered a platform for members to reach consensus regarding PIPSA's

theory behind program activities and to conceptualize underage drinking, in terms of the

contributing agencies involved in PIPSA. All seventy coalition members were asked to

participate in the focus group representing the sector in which they were listed on









PIPSA's membership roster. In order for coalition members to feel a part of the program,

they must be involved in its organization. CADCA training emphasized that maintaining

a collaborative process throughout the assessment, capacity, and planning phases is

essential for agreement among members in the later phases of implementation and

evaluation. This process was not only informative, giving coalition members an overview

of member perspectives, but it encouraged participation, since they had drafted the plan

and offered their individual time as well as their respective agency's resources.

Using a grounded theory methodology (Strauss and Corbin 1998), analyses focused

on themes generated in the focus groups. Results were in the form of suggestions

coalition members made regarding new strategies that are reasonable and appropriate to

the problem behavior of underage drinking in Alachua County. They should use these

results to guide their revisions of the program regarding new goals and objectives in their

planning stage of the Strategic Planning Framework.

Results of the study show PIPSA coalition members have a working knowledge of

current research pertaining to underage drinking prevention strategies. The coalition

emphasizes educating community members in the hopes of changing the normative

"party culture" present in Alachua County. Early, interactive education across various

sectors of the community is a key strategy the coalition is hoping to employ in decreasing

underage drinking. If the suggestions regarding untapped resources and innovative

activities made by coalition members are implemented in the program design, benefits to

the coalition may include greater program awareness and participation. With greater

program awareness, individuals will be provided the knowledge of where to seek

treatment when they are willing. Treatment of community members with substance abuse









problems will not only improve the quality of life on an individual level, but will improve

the overall productivity and health of the community. For "a new social structure should

be established, where enhancing the general welfare is thought to be an admirable goal"

(Vega and Murphy 1990:152).

The process of the study may be duplicated by PIPSA in the future if new problem

behaviors are deemed primary to the PIPSA program and new goals and objectives are

needed. Also, insights from this study can be used to inform a variety of intervention

programs, especially those that are geared to youth populations or communities with

similar composition to Alachua County. Many argue the issue of substance abuse is best

dealt with on a community level, because "drug abuse is a social behavior, embedded in

the larger framework of community norms and social support systems that regulate the

occurrence of these behaviors" (Zunyou, Detels, Jiapeng, Virginia, and Jianhua

2002:1952). Also, they state, "community intervention has proven effective for health

problems such as smoking" (Zunyou et al. 2002:1952). Since it is not confined to any

single campus or community a collaborative effort from campuses and communities

dealing with similar issues may benefit from effective, shared solutions. By using this

study's research findings, communities may eliminate wasted effort and time related to

discovering similar information.














CHAPTER 2
LITERATURE REVIEW

Substance Abuse Among Youth

This chapter emphasizes literature relating to three major areas concerning this

study: substance abuse as a social issue, the theoretical framework of the PIPSA

coalition, and the strengths and weaknesses of community-coalitions. The literature on

substance abuse considers the social implications it may have on the community and the

individual. Particular focus has been placed on alcohol, the substance the coalition is

most concerned with at this time. Current research is presented highlighting underage

drinking in the United States, as well as specific information about Alachua County.

Current strategies the literature suggests as successful in combating underage drinking

are offered to help understand the PIPSA coalition's efforts on a broader scale and point

out possible strengths and weaknesses of their program they may need to consider.

Literature addressing the theoretical background of the PIPSA coalition is essential in

understanding its motivation and the applicability of its efforts. Criminological theory,

Learning theory, and Life-course perspective are all necessary to include when

considering the efforts of the coalition. Lastly, this chapter addresses the effectiveness of

community-based coalitions and suggested strategies for employing them. This is to

consider whether the coalition, even at its most refined state, should be used in dealing

with the social issue of underage drinking, and in what ways might be more effective.









Social Issue Of Substance Abuse

Substances may be defined as any drug used to alter a person's mood or perception

(how they feel and experience things) (Department of Education and Children's Services

2003). Substances, such as alcohol, tobacco, and drugs, satisfy an inner need for

experiencing other modes of consciousness (Weil 1986). Research has shown that,

initially, substance abuse is most often a sign of deeper emotional troubles or concerns

within the individual. Kornblum (1998) lists some major reasons people use substances:

to ease pain, relax tension, lose weight, and fight depression.

For many, this emotionally-charged need to escape from reality, whether it is due to

professional, familial, or social pressures, manifests itself in the use of substances. After

continued use the individual may develop a physical dependence on the substance, and

begin to participate in alcohol abuse, which may be defined in its most basic description

as a pattern of problem drinking that result in health consequences, social problems, or

both (Medical Network Incorporated 2006). Therefore, both alcohol use and abuse in

underage drinking populations is the primary concern of the coalition, since they may not

have the capacity to understand the difference at these ages. With both physical and

emotional dependence on a substance the individual may, at the very least, lose their

ability to self-regulate emotions and actions. Depending on the age of initiation,

substance abuse may also disrupt normal developmental processes, jeopardizing

cognitive ability and physical maturation. In addition, it is also linked to anti-social

behavior. Research has shown that substance abuse has strong associations

with crime, illness, and interpersonal violence (Kornblum 1998). For these reasons, the

coalition finds it necessary to safeguard certain populations in order to prevent these life-

altering consequences of alcohol use and abuse.









Some research suggests that interventions may be considered synonymous with

social control. Vega and Murphy (1990:149) state:

Clearly incarceration is a means of social control, but interventions, particularly
those that are truly community-based, do not perform this function. In fact, just the
opposite is supposed to occur. Simply put, through interventions social conditions
are supposed to be changed, so that persons can lead productive lives. Rather than
controlling individuals, the intention should be to provide new opportunities.

Since substance abuse has such strong associations with crime, it is important to

realize the goal should be to rehabilitate and not force individuals to conform, to create

any long-lasting, meaningful change to social conditions. According to Vega and Murphy

(1990:149):

Nonetheless, someone who needs help has come to be equated with a deviant or a
threat to order. So even when rehabilitation is undertaken, as opposed to overt
social control, the usual expectation is conformity in the guise of "adequate social
functioning." Order is simply reified. On the other hand, order is defied by real
intervention, for providing assistance is intended to help persons to develop, and
development is often idiosyncratic and can proceed in any number of directions.

By allowing people to abuse their bodies we allow them to destroy their potential

lives. This is especially alarming when considering populations too young to recognize

the implications of their actions.

Research suggests that socialization guards against desires to alter a person's

conscious state (Weil 1986). Every community has basic values and norms expressed to

its community members in forms of media, school, and parental guidance, with social

expectations implicitly and explicitly made to the individual. Social support guarding

against substance use and abuse can be education of its dangers, encouragement and

acknowledgment of participation in non-substance related activities, social service

organizations helping individuals to deal with issues leading to emotional problems -

such as family, marriage, or financial counseling. According to Vega and Murphy









(1990:152), "interventions that are community-sensitive are supposed to be liberating.

Clients are supposed to be given a modicum of control over their lives, as a result of

having the ability to regulate every aspect of their treatment."

Strong and effective programs need to first be in place. Vega and Murphy

(1990:145) suggest, "the maintenance of health, in short, should not be left to chance by

any society that wants to improve the productivity of all its members." Then programs

must continually broadcast the message of the dangers of substance use and abuse.

Kornblum (1998) introduces the idea of inter-generational forgetting in regards to

substance use and abuse. He argues that each new generation is newly vulnerable and

needs to be educated with the same or more effort than the previous one. In addition,

"unless changes are made in conceptualizing illness, and citizens are integral to this

process, even community-based interventions may merely serve to identify and

rehabilitate deviants" (Vega and Murphy 1990:152).

Alcohol As A Substance

In the United States, the past decade has seen somewhat of an expansion of focus

regarding substance abuse, with licit drugs now being targeted as harmful to the physical

body. Tobacco companies have publicly admitted the health hazards relating to nicotine

and have begun to pay reparations, funding the American Legacy Foundation's "Truth"

campaign and Philip Morris's "Think. Don't Smoke" campaign (Farrely, Healton, Davis,

Messeri, Hersey, and Haviland 2002). Even though alcohol has had similar discoveries

relating to addiction and harm to the physical body, society has not dealt with it in a

reciprocal fashion.

Alcohol warnings may be too soft, considering the cultural backdrop of our society,

which works to normalize drinking on a consistent basis. Many coalitions across America









are declaring the importance of considering the deleterious effects of attracting underage

drinkers to a lifestyle of addiction. Bonnie and O'Connell (2004:79) suggest, "young

people are exposed to a steady stream of images and lyrics presenting alcohol use in an

attractive light." But if this message is not consistent across informational sources (i.e.

media, peers, parents), the social support deterring alcohol use begins to become

fragmented and unclear to the child. A more thorough discussion of underage drinking

and its current rates further highlight the importance of addressing this issue.

Current research on the underage drinking scene in the United States

It has been suggested that "alcohol is the most commonly used drug among

America's youth" (Bonnie and O'Connell:2004:35). For this reason, research has looked

at various factors relating to underage drinking and preventative approaches.

Cognitive influences. The cognitive influences on adolescents must first be

addressed. Bonnie and O'Connell (2004:72) consider the rite of passage that adolescents

face:

During adolescence, individuals are going through rapid physical, social, and
cognitive changes. These enormous changes to body, friendship and thinking about
the world are juxtaposed against changing expectations for behavior and increases
in need and opportunities for autonomy.

This period is also marked with an increase in time spent with peers and decreased

time spent with parents. This unmonitored time parents allow their children, reinforce

societal beliefs suggesting that adolescence is a time to practice adult roles (Bonnie and

O'Connell 2004).

Historically, alcohol use has been an important symbol of adult status (Bonnie and

O'Connell:2004). The legal drinking age has been adjusted to reflect the perceived age of

an adult. Following Prohibition, the legal drinking age was twenty-one. In 1971, the









voting age was lowered to 18 to match the military draft age, encouraging some states to

lower the drinking age as well. Alcohol-related problems stirred a push for federal

regulation to increase the drinking age. By 1988, the majority of the states had re-raised

the legal drinking age to twenty-one, which is where it has stayed for close to 20 years.

This current law suggests that society agrees that even older teens lack judgment when it

comes to the use of alcohol. More specifically, they lack judgment between substance use

and abuse, and should therefore delay experimenting with this substance until they are

mature enough to handle its consequences. Research agrees with this notion. Bonnie and

O'Connell (2004:40) state:

Individuals who begin drinking before the age of 15 are more likely to have
substance abuse problems in their lifetimes, to engage in risky sexual behavior, and
to suffer other negative consequences in comparison with those who begin drinking
at a later age.

Although this research gives some credence to the legal drinking age being set at

age twenty-one, it is unknown whether this is a causal issue or just an association. In

addition to the cognitive influences that have been characteristic throughout history, there

are some newly diagnosed challenges to current populations of youth. Clark, Kirisci, and

Moss (1998) conducted a study of children aged 8 to 15 which found antisocial

personality disorder has been linked to alcohol misuse among adolescents, suggesting

conduct disorder often predates and predicts later alcohol use. Also, in non-clinical

populations, a major personality characteristic that has been related to adolescent risk

taking is sensation seeking, defined by seeking novel, complex, or risky situations

(Zuckerman 1979).

Social influences. Statistics show that large numbers of teens are consistently

choosing to drink. According to 2002 Monitoring the Future data, "almost half (48.6%)










of twelfth graders reported recent (within the past 30 days) alcohol use" (Bonnie and

O'Connell 2004:38).

100
90








&.
20
10

0 0

Year
Annual 30-day Five drinks in a row in last 2 weeks
Figure 1: Long-Term Trends in Prevalence of Drinking among Twelfth Graders. (Regents
of the University of Michigan 2006).
Since the early 1990's, past 30-day prevalence rates have hovered around the 50%


mark, with adolescent social pressures probably contributing greatly to the steadiness of

these rates.

Some notable differences in patterns of usage do remain though. Youth appear to

be drinking at an earlier age. Bonnie and O'Connell (2004:38) explain:

The average age of first alcohol use has generally decreased since 1965, indicating
youth are starting to drink at a younger age. NHSDA data indicate that the average
age of self-reported first use of alcohol among individuals of all ages reporting any
alcohol use decreased from 17.6 years to 15.9 years between 1965 and 1999.

If this pattern continues, society will begin to see an even greater increase in

developmental problems related to adolescent drinking.

Table 1: Drinking Patterns among Adults and Youths (In Percent)
Age
Drinking Pattern 12-14 15-17 18-20 21-25 26+
Nondrinkers 93 74 51 38 51









Table 1. Continued
Drinking Pattern Age
Drinkers
Alcohol use but no heavy drinking in past 30 days 51 32 29 36 61
Heavy drinking in past 30 days 42 49 45 44 29
Frequent heavy drinking in past 30 days 8 19 26 21 10
Data from the 2000 NHSDA. (United States Department of Health and Human Services
2006b).

Not only are youth drinking at an earlier age, but they are drinking in heavier doses

than previous years. Bonnie and O'Connell (2004:39) state, "underage drinkers of all

ages are much more likely to drink heavily than are adults."

Table 2: Drinking Frequency and Intensity for Youths and Adults (Current DrinkersOnly)
Age
Frequency and Intensity 12-20 21 and older
Mean number of drinking days per month 5.79 8.02

(6.03) (8.32)
Mean number of "usual" drinks on a drinking day* 4.48 2.78

(2.75) (2.07)
*If respondents indicated that their usual number of drinks per occasion was some
number greater than 12, that response was recorded as "missing." Missing values were
imputed, using means for the same sex and age group. SOURCE: National Household
Survey on Drug Abuse. (United States Department of Health and Human Services
2006b).

In addition to the gender gap closing between girls and boys in terms of alcohol

usage, biological differences should be mentioned to highlight the alarm this brings.

Bonnie and O'Connell (2004:49) suggest, "males do report engaging in heavy drinking at

a higher rate than females", but considering differences in body composition and alcohol

metabolism, with women, on average, weighing less and processing alcohol slower, girls

may feel the same effects as boys even if they are consuming less.

Much like the patterns of alcohol usage relating to gender, Bonnie and O'Connell

(2004:38) explain, "recent studies also suggest that ethnic differences are diminishing and










that these groups with historically low drinking rates are moving toward the higher rates

of non-Hispanic white males." As shown in Table 2, "among youths aged 12-20, drinking

of all types (recent, heavy, frequent heavy) is highest for non-Hispanic whites, followed

closely by Native Americans. Asian Americans and African Americans have the lowest

prevalence of any racial or ethnic group" (Bonnie and O'Connell 2004:48). Research

shows that adolescents, regardless of race, ethnicity, or gender, have a common interest

in alcohol.





f FavJmam P mai
40



2O-







dwh PIrv panic ihe Ain.-rw, MHr&,c Wh\i AMcan krtipanic
Amncan AUncarf Ar ncamma
IL4 nl l-M l An 15 '. 1. %. rM c f A n> rn- rm ofM 4"r ,
Figure 2: Any Use of Alcohol in the Past 30 Days for 12- to 20-year-olds, by Gender,
Race or Ethnicity, and Age Group: 2000. (Flewelling, Paschall, and Ringwaldt
2004).

Environmental influences. Just as there are cognitive and social influences

leading the adolescent to initiate drinking, there are environmental influences as well.

Bonnie and O'Connell (2004:55) "although the proportion of eighth graders who report

that alcohol is fairly easy or very easy to get decreased over the past decade, it remains

more than 60 percent." There are many locations youth may have ease of access in

getting alcohol. The easiest access is probably their parent's kitchen. Wagenaar and

Wolfson (1994:38) state, "results showed that the initial alcohol used by those in their









early teens is obtained from parents' stocks or from older siblings and friends." In

addition, they may be able to access alcohol throughout their neighborhood, depending

on community acceptance. Wagenaar and Wolfson (1994:39) further note:

Methods used to purchase alcohol reported by underage students include using
false identification, buying from stores that are known for selling to underage
youth, and seeking young clerks. The extant literature shows that most persons
under the age of 21 are able to obtain alcohol, suggesting that this law is not
rigorously enforced.

A community may be considered a "dry" or "wet" drinking environment, as

suggested by Bonnie and O'Connell (2004:79):

A wet community environment is one in which drinking is prevalent and common,
public opinion is generally tolerant or positive, and alcohol is readily available both
commercially and at private social occasions and is advertised as available. A dry
community would be one in which drinking at social occasions is not the norm and
is generally frowned on, and alcohol outlets are relatively scarce.

The drinking environment is important to consider when noting the prevalence of

underage drinking. It suggests important issues surrounding underage drinking, such as

accessibility and availability.

Consequences of underage drinking. The deleterious effects of underage

drinking have been partially noted previously, but should be addressed in greater detail.

There are both short-term and long-term consequences to underage drinking.

Alcohol impairs an individual's decision-making capacity which could possibly

result in accident, death, injury, illness, or arrest. When judgment is impaired, the

individual is less likely to guard against impulses, which could lead to vandalism, assault,

risky sexual behavior, or drunk driving. Also, adolescents, with less experience behind

the wheel, pose a higher risk when drinking and driving. The crash risk associated with

driving after drinking is higher for youths than for adults at all blood alcohol content

(BAC) levels (Hingson and Kenkel 2004). Poor decision-making, as a result of one









drinking occasion, could lead to a life-altering consequence. Wagenaar and Wolfson

(1994:37) explain, "other leading causes of death and long-term disability for youth, such

as suicide, homicide, assault, drowning, and recreational injury, involve alcohol in

substantial proportion."

Accumulated effects of chronic drinking could lead to long-term social

consequences, such as a breakdown in family relationships or poor school performance

(Brown and Tapert 2004). Long term health consequences from underage drinking could

result as well. Recent research suggests that adolescent drinking can inflict permanent

damage on the developing brain (Brown and Tapert 2004), foreshadowing problems with

memory and reaction time.

Other health problems are related to underage drinking as well. Bonnie and

O'Connell (2004:64) note:

Heavy drinking during adolescence, especially if this behavior is continued in
adulthood, places a person at risk of such health problems as pancreatitis, hepatitis,
liver cirrhosis, hypertension, and anemia. Recent research suggests that drinking
during puberty may have deleterious effects on bone density development for
young women, failing to develop maximal bone density during adolescence puts
them at risk later in life for osteoporosis.

Addiction may play a serious part in these long-term health problems surfacing.

"Early onset of alcohol use greatly increases the probability of adult alcohol

dependence", as Bonnie and O'Connell suggest (2004:59); "young people who begin

drinking before age 15 are significantly more likely to develop alcohol dependence than

those who begin drinking at older ages." Grant and Dawson (1997) further note that

youth who begin drinking before the age of 15 have a 41 percent chance of future alcohol

dependence, compared with a 10 percent chance for those who begin after the legal

drinking age. Another important consideration is how pregnant teens abusing alcohol









may also contribute to health complications in the child, possibly resulting in

developmental problems or later addiction.

Although biological considerations contribute to a deeper understanding of how

different people may be affected by alcohol use, it is essential not to be reductionistic in

attributing these characteristics to be reasons why people use initially and continuously.

Vega and Murphy (1990:147) explain, "as a consequence of explaining social problems

in biological terms, individualism is stressed. Social issues are equated with personal

faults or maladaptation." Vega and Murphy (1990:147) further note:

For if the individual is believed to be the source of most problems, the effects of
sexism, racism, and other forms of institutional discrimination are not seen as
worthy of attention. The focus of interventions can thus be extremely narrow,
because the complex relationship between personal motives and social practices
can be ignored.

Biological considerations may aid in targeting certain populations over others, but

it is important to keep in mind the social implications to explain alcohol use, so that

society does not escape blame for contributing to the social issue of substance abuse.

Strategies to combat underage drinking. Research suggests some possible

strategies for decreasing the underage drinking rates. Of significant importance is the role

of the family in socializing the adolescent to postpone drinking until the legal age.

Bonnie and O'Connell (2004) suggest parental monitoring and involvement as key

components in reducing adolescent alcohol use. In addition, community-based

approaches involving parents, communications media, and the community in promoting

norms against use seem to be effective (Hawkins et al. 1992).

Researchers are suggesting that changing the adolescent normative conception of

alcohol usage may result in a decrease in underage drinking. Programs that teach young

people skills for resisting influences to use alcohol help them develop strong norms









against use (Hawkins et al. 1992). Also, research conducted by Cialdini and colleagues

(Cialdini et al. 1990; Kalgren, Reno and Cialdini 2000) point to the need to distinguish

between descriptive norms (perceptions of what most others are doing) and injunctive

norms (perception of what other people think one should be doing or not doing). They

argue that focusing on injunctive norms is more effective at changing behavior than

targeting only descriptive norms.

Also, extra-curricular activities may further distract teens from underage drinking.

Youth who participate in after-school programs, such as sports, clubs, library-based

activities, and youth-serving organizations are less likely to use alcohol than non-

participants (Eccles and Barber 1999). A key strategy is for community-based efforts to

be dependable. Hawkins et al. (1992:7) propose, "students need to be provided with

consistent, extended drug education programs." One-shot approaches, such as those that

attempt to influence behavior only after one session or educational activity, seem to be

ineffective at making any long-term behavior changes among adolescents.

Current research on underage drinking in Alachua County

Nationally, a higher percentage of youth aged 12 to 20 reported using alcohol

(29%) than using tobacco (24%) or illicit drugs (14%), making underage drinking a

leading public health problem in the United States. In Alachua County, the number of

youth reporting engaging in alcohol use is even higher (32.7%) than the national or state

average (National Community Anti-Drug Coalition Institute 2006). The social and

environmental factors contributing to these statistics should be considered. It is important

to note that the following cognitive, social and environmental influences may not only be

present in Alachua County, but are found in various communities across the country. The

point of significance is that there are actual signs of these issues (based on data from









surveys) being present in Alachua County. In addition, other issues may be present as

well that are immeasurable or undetected at this time that, in the future, turn out to be

relevant. Since the following influences do present themselves in Alachua County they

will be discussed.

Cognitive influence specific to Alachua County. Key findings from the Florida

Youth Substance Abuse Survey (FYSAS) describe reported antisocial behavior among

Alachua County's youth, indicating youth are less likely to become involved with pro-

social organizations and positive role models in their communities in comparison to

previous years. Keeping in mind the literature linking antisocial behavior to substance

abuse, Alachua County youth are reporting greater percentages of drug use and

delinquent behavior that could negatively affect their lives and the larger community

(Department of Children and Families 2003). These, as well as other adolescent

cognitive influences always present in communities, contribute to these high rates of

alcohol use.

Social influences specific to Alachua County. Research during the past 30 years

supports the view that delinquency, alcohol, tobacco, and other drug use, school

achievement, and other important outcomes in adolescence are associated with "risk" and

"protective factors" (Appendix A) in the student's community, school and family

environments, as well as with characteristics of the individual (Hawkins et al. 1992). In

fact, these risk and protective factors have been shown to be more important in

understanding these behaviors than ethnicity, income or family structure (Blum,

Beurhing, Shew, Bearing, Sieving, and Resnick 2000). There is a substantial amount of

research showing that adolescents' exposure to a greater number of risk factors is









associated with more drug use and delinquency. There is also evidence that exposure to a

number of protective factors is associated with lower prevalence of these problem

behaviors (Bry, McKeon and Pandina 1982; Newcomb, Maddahian and Skager 1987;

Newcomb and Felix -Ortiz 1992; Newcomb 1995; Pollard, Hawkins, and Arthur 1999).

Environmental influences specific to Alachua County. Florida plays host to

two of the top party schools in the nation, Florida State University and University of

Florida. Specifically, Alachua County is home to the University of Florida, a

powerhouse in football, and recently crowned winner of the NCAA Men's National Title

in basketball has much to celebrate (Appendix B).

Table 3: Alcohol Consumption in the United States, 1999
State or Area Ethanol* Per Capita
Alabama 6,656 1.88
Alaska 1,346 2.88
Arizona 9,971 2.68
Arkansas 3,725 1.82
California 57,195 2.20
Colorado 8,305 2.57
Connecticut 5,953 2.26
Delaware 1,812 2.96
District of Columbia 1,647 3.74
Florida 32,773 2.66
Georgia 14,019 2.27
Hawaii 2,212 2.31
Idaho 2,355 2.39
Illinois 22,337 2.32
Indiana 9,371 1.97
Iowa 4,601 1.98
Kansas 3,925 1.85
Kentucky 5,662 1.76
Louisiana 8,678 2.50
Maine 2,348 2.26
Maryland 8,740 2.11
Massachusetts 12,290 2.45
Michigan 16,625 2.11
Minnesota 9,189 2.41
Mississippi 4,801 2.19
Missouri 9,962 2.26









Table 3. Continued
State or Area Ethanol* Per Capita
Montana 1,828 2.55
Nebraska 2,979 2.24
Nevada 5,765 4.06
New Hampshire 3,943 4.07
New Jersey 14,416 2.20
New Mexico 3,308 2.43
New York 28,187 1.92
North Carolina 12,241 2.00
North Dakota 1,264 2.45
Ohio 18,203 2.01
Oklahoma 4,624 1.72
Oregon 6,239 2.32
Pennsylvania 18,723 1.91
Rhode Island 1,936 2.41
South Carolina 7,590 2.41
South Dakota 1,354 2.32
Tennessee 8,468 1.91
Texas 35,677 2.29
Utah 2,105 1.33
Vermont 1,144 2.34
Virginia 11,107 1.99
Washington 9,962 2.16
West Virginia 2,492 1.66
Wisconsin 11,664 2.75
Wyoming 961 2.48
*Ethanol is the alcohol consumption measure used. Data from National Institute on
Alcohol Abuse and Alcoholism (2002). (Bonnie and O'Connell 2004).

Unfortunately, its wet environment, with the density of bars and the consistent

marketing and advertising of alcohol further normalizing its use, Alachua County is a ripe

environment for underage drinking to occur. Bonnie and O'Connell (2004:81) note:

Research suggests that a 'wetter' environment may provide adolescents with more
social occasions to drink, more positive attitudes about drinking, more advertising
and outlets, and more lenient regulations concerning the sale and consumption of
alcohol. In short, such environments have an enabling effect on underage drinking.

As suggested, Alachua County's environmental influence on adolescents should

also be taken into account when considering rates of alcohol use, if any true initiative is

to be made. In addition, environmental influences and how they relate to social and









cognitive influences should be noted. According to the October 2003 issue of High Times

Magazine, the University of Florida is the number one "Counterculture College" in

America. This fact highlights the availability of substances and makes the county's

middle and high school students more at-risk for substance abuse, as they attempt to

emulate the college students and "model up" to their behavior in a search for individual

autonomy.

These previously mentioned influences should be conceptualized as interrelated in

contributing to the issue of substance abuse in Alachua County. All of these factors make

this community unique, and these characteristics should be considered when coalition

building efforts are being designed.

Theoretical Framework Of PIPSA

Criminological Theory

Within the field of criminology there are many theories and conceptions of crime.

Cullen and Agnew (2003:1) suggest:

Like much social behavior, crime is multifaceted and potentially shaped by a range
of factors that operate inside and outside individuals, that exist on the macro and
the micro level, and that have effects across various points in the life cycle.

PIPSA has two main theories central to its program: Social Learning Theory with a

Life Course Perspective. Both will be explained in more detail in the following

paragraphs.

Learning Theory

Even within learning theory, there are many theorists with varying viewpoints.

However, the underlying beliefs among the theorists are similar in a few important

respects. Behavior is learned through interaction with other social actors, and more

importantly, crime is learned in the same way. Cullen and Agnew (2003:6) explain,









"crime is learned through associations with criminal definitions. These definitions might

be generally approving of criminal conduct or be neutralizations that justify crime only

under certain circumstances." Thus, interacting with individuals who participate in crime

encourages a person to conduct criminal behavior, since the interactions are reinforcing

this behavior, whatever the degree may be.

Particularly relevant to PIPSA's program is Catalano and Hawkins' "Communities

That Care" strategy. It is a community-based strategy to create long-term support for

behavior change. Hawkins et al. (1992:19) explain:

Involving the whole community facilitates widespread communication to achieve
consistent norms about drug use and the need for prevention, as well as knowledge
about risk and protective factors. A community-wide approach can also promote
the development of strong bonds to family, school, and the community itself among
young people. Because community approaches are likely to involve a wide
spectrum of individuals, groups, and organizations, they create a broad base of
support for behavior change.

Unhealthy behaviors like underage alcohol use are looked at as unacceptable

among a wider audience, guarding against the behavior. Akers (1990:660) states, "the full

behavioral formula in social learning theory includes both positive and negative

punishment and positive and negative reinforcement." Catalano and Hawkins' "risk" and

"protective factors" rely on this basic premise.

In theory, this support from those involved in the behavior change process leads to

long-term change. Hawkins et al. (1992:19) state, "programs and strategies gradually

become integrated into the regular services and activities of local organizations and

institutions." With this in mind, the importance of a thoughtful strategy, tailored to the

specific community it hopes to address, should be stressed. Catalano and Hawkins

advocate for every community to develop their own programs and strategies that are

relevant to the community it hopes to reach. Also, "the community mobilizations strategy









of "Communities That Care" is not meant to be a rigid approach" (Hawkins et al.

1992:19). As expressed by the authors, the design allows for flexibility.

Life-Course Perspective

Jary and Jary (1991:277) explain, "life-course is the process of personal change

from infancy through to old age and death, brought about as a result of the interaction

between biographical events and society events." Its focus is on socio-historical processes

contributing to human action at various points over the life-course. Sampson and Laub

(1997:9) suggest, "individual lives are studied through time, with particular attention

devoted to aging, cohort effects, historical context, and the social influence of age-graded

transitions."

Sampson and Laub (1997:8) further note:

The long-term view embodied by the life-course focus on trajectories implies a
strong connection between childhood events and experiences in adulthood.
However, the simultaneous shorter-term view also implies that transitions or
turning points can modify life trajectories they can redirect paths.

Although this view is not accepted by all life-course theorists, this offers incredible

hope to community-based approaches as they attempt to prevent initial users and

"redirect" current substance abusers. Programs will be most effective if they are sensitive

to the developmental needs and capabilities of particular age populations.

Life-course criminologists study crime over the life span. As previously mentioned,

people are thought to be influenced differently by events at different stages in the life-

course. More importantly, what may be an effective intervention for someone at one

point may not be at another. Community-based programs that attempt to incorporate the

life-course perspective should reflect these considerations.









Life-course criminologists generally speak in terms of three stages of development:

childhood, adolescence, and adulthood. The goal is to understand the stability and

changes in criminal behavior through time and over different stages of development.

Cullen and Agnew (2003:7) state, "crime causation is a developmental process that starts

before birth and continues throughout the life course. Individual factors interact with

social factors to determine the onset, length, and end of criminal careers." Life-course

proponents agree childhood is a time when criminal behavior begins, but they argue over

why continuity or change in behavior varies over the life-course, creating either "life-

course persistent offenders" or "adolescent limited offenders." Some researchers believe

criminal behavior is predetermined while others believe it is context-dependent. Arguing

the former statement, Moffitt (1990:100) states, "most recently, neuropsychological

measures have come to be used as research tools for identifying brain dysfunctions that

may characterize groups who display syndromes of deviant or pathological behaviors."

"Adolescent limited offenders" use criminal behavior as a statement of

independence throughout their adolescent years. Although they begin to resist anti-social

behavior in adulthood as the "maturity gap" closes by adult conventional norms

becoming available. A job to pay for purchases may decrease the likelihood of stealing,

marriage may limit risky sexual activity, and becoming a parent may encourage

maintaining job security limiting actions that may disrupt employment. "Life-course

persistent offenders" may experience a gap between biological and social maturity,

creating a source of discontent and motivation towards crime or deviance over the life-

course. Sampson and Laub's age-graded theory of informal social control suggests that









deviance is natural. People must be controlled from following their natural feelings;

otherwise they'll participate in anti-social deviant behavior.

Over the life-course, people experience different types of social control. In

childhood, social bonds with parents and family are primary. Social bonds between

parent and child are important sources of control. Children who are bonded well to

parents and report strong attachment to school are less likely to commit delinquent acts

than those who have weak social bonds (Hawkins et al. 1992). In adolescence, peers

appear to have a greater influence affecting social controls Hawkins et al. 1992).

Adulthood offers marriage and employment as primary sources of control. Sampson and

Laub (1997) suggest that change can occur at any stage in the life-course, as long as

strong conventional bonds are developed in the individual.

Life-course research suggests that if crime prevention is the goal, intervention

should start early and focus on fostering social bonds between children and their families.

Since late adolescents/early adults are more willing to seek conventional behavior, timing

is crucial in knowing what strategies to employ when targeting this group. Within each

developmental stage, priority must be given to building and strengthening positive social

bonds between the appropriate community members. Each developmental stage requires

unique support systems that may be useful only during that stage.

Community-Based Coalitions

Community-based coalitions are vehicles for creating cohesion among its members.

Bonnie and O'Connell (2004:216) advocate, "in a democratic society, the mobilization of

communities in civic life is in and of itself of significant value. Democratic life relies on

civic participation and an active informed citizenry." Through open dialogue, community

members are able to set acceptable standards of its people, and work to encourage the









rehabilitation of those who need it most, in order to ensure the health of its citizenry.

Bogenschneider (1996:132) states, "consistent with the notion that development occurs in

context, consensus seems to be emerging that the most appropriate place for solving

problems is where they occur in communities." Lerner and Miller (1992) suggest the

increase in local collaborative efforts has led some to call the 1990's the 'decade of

community coalitions for children'.

Many agree with the current research showing that local residents are capable of

bringing about change in areas important to them (Bellah, Madsen, Sullivan, Swidler, and

Tipton 1985; Gardner 1989; Lofquist 1983; McKnight and Kretzman 1992). Also, "in

some large states, such as California, local coalitions have sometimes had greater success

than statewide efforts" (Bonnie and O'Connell:218). A more localized approach makes

the strategy more personal and allows it to take a shape that is more tailored to the

problems present in the community it hopes to address. The effort needs to be

community-wide to make a lasting impact on it residents. Research shows, "that even

when school programs change behavior, this success is short-lived in the absence of

community norms that support the program goals" (Bogenschneider 1996:133).

Effectiveness Of Community-Based Coalitions

We have previously addressed the strength community coalitions have in

mobilizing community efforts. Now it is important to suggest their effectiveness in

dealing with issues relating to youth. Solutions to youth problem behaviors are too

complex to be dealt with by any one single organization (Albee 1983). Community-based

coalitions involving varied agencies and organizations throughout the community are

necessary in dealing with the issues more comprehensively.









Community coalitions have broad goals of changing the infrastructure to the social

issue being addressed. Bonnie and O'Connell (2004:217) further explain, "community-

based prevention research points to the importance of broad efforts to reshape the

physical, social, economic, and legal environment affecting alcoholism." Also, they

attempt to generate public awareness, knowledge and concern for the issue to ensure

long-term efforts. Gwaltney (2005:8) explains, "despite 'truth' campaigns, Surgeon

General warnings, multiple treatments, and other important advances, too many

adolescents still start smoking annually and relapse is still the norm following a quit

attempt." Unlike one-shot educational approaches like the American Legacy

Foundation's "Truth" campaign or Philip Morris's "Think. Don't Smoke" campaign, or

extended programs like the D.A.R.E. program, which have been suggested to be

ineffective, the PIPSA coalition is aiming to change the physical, social, economic, and

political climate of drinking in Alachua County, particularly within underage youth

populations in the hopes of making long-term changes in the community relating to

alcohol use. The General Accounting Office (2003:3) pulled together a literature review

on the D.A.R.E. program, in which they cited six long-term evaluations done during the

1990's that found no significant difference between students who received the D.A.R.E.

program and those who did not.

Community-based coalitions have been effective in dealing with substance abuse

issues, more specifically, alcohol-related problems. As Bonnie and O'Connell (2004:216)

note:

Although most community coalitions have not been rigorously evaluated, several
community trials provide evidence that community coalitions can affect alcohol-
related outcomes and also document the elements that make community initiatives









successful. In addition, numerous case studies and substantial qualitative research
attest to the effectiveness of community coalitions.

Pentz, Dwyer, MacKinnon, Flay, Hansen, Wang, and Johnson (1989) further note,

comprehensive community collaborations have proven to be an effective method for

preventing such youth problems as alcohol and drug abuse. In more specific ways, a

community-based coalition can contribute to reductions in underage drinking. Bonnie and

O'Connell (2004:217) suggest:

It can help to create the political will and organizational support for developing and
implementing proven strategies for decreasing underage drinking (such as
minimum age drinking laws, zero tolerance laws, and measures to reduce physical
availability and outlet concentration). It can help change the normative climate
surrounding the acceptability of underage drinking, and create greater awareness of,
and publicity about, enforcement activities, such as random breath testing and sting
operations. It also helps to establish the idea that alcohol and other drugs are a
community problem that local people can solve, thereby increasing the likelihood
that people will support and sustain efforts they help create.

Community-based coalitions clearly have credibility in addressing substance abuse

issues like underage drinking. Research suggests that certain strategies are more effective

than others though.

Suggested Strategies Employing Community-Based Coalitions

Research has suggested many successful strategies in employing community-based

coalitions. Hingson and Howard (2002) suggest that if community coalitions are to be

successful, they must employ a variety of techniques such as educational programs,

community organization, environmental policy changes, use of media, and law

enforcement practices that correspond to the policies in place. It is in the combination of

the strategies that success is gained. As discussed, there is no one way to reduce underage

drinking. Successful community-based groups should include various techniques from a

variety of sources in the community.









It is important for communities to collaborate with neighboring colleges and

universities, such as in Gainesville where a college affects drinking behavior, to

effectively impact the community at large. Bonnie and O'Connell (2004:226) note:

Effective restrictions on underage access to alcohol in a community may be
severely undermined by the ease of alcohol in the campus living communities. The
reverse is also true: even a substantial campus-based alcohol prevention strategy
cannot succeed if it is surrounded by a community with easy access to alcohol.

Also, college-community partnerships may save time and money by developing

joint grant proposals, giving further credence to the initiative by showing its overlapping

support by both the college and community. It is for these reasons collaboration with

neighboring institutions is strongly suggested. Research shows that consistency of policy

between campus and community contributes to success. As Bonnie and O'Connell

(2004:227) state, "colleges working with local police can enhance the consistency of

enforcement efforts by notifying one another of alcohol-related incidents and by seeking

timely and meaningful sanctions." This communication is small in terms of cost, but has

been known to improve the drinking scene dramatically and reinforce the collective

efforts both the local police and campus police are working towards. There has also been

success in employing media to target underage drinking. Bonnie and O'Connell

(2004:217) note:

Case studies have documented how communities have organized and used the news
media to support changes in alcohol availability, reductions in outdoor advertising
of alcohol, increased compliance checks on retailers regarding service and sales of
alcohol to minors, keg registration laws....

The media can be a wonderful vehicle for getting important details out regarding

upcoming activities as well. In addition, they may broadcast or recap important efforts by

community-based coalitions, like town hall meetings.









School-based initiatives have had a long history in targeting underage drinking.

Bonnie and O'Connell (2004:193) suggest, "delivery of such programming through

schools offers the benefits of reaching a wide (and captive) audience, as most young

people (especially elementary and middle-school-aged children) are enrolled in school."

Also, school-based initiatives allow programs to be disseminated at specific

developmental intervals. Some would argue this is essential considering the life-course

perspective (Steinberg 1991). Since youth are reporting initial drinking between the ages

12 to 14, programs need to begin reaching them prior to this age. Bonnie and O'Connell

(2004:193) state what does not seem to work in school-based initiatives:

Many early drug education curricula that relied on factual information about
alcohol and other drugs, including information on the negative consequences of
use, or fear arousal were based on the theory that adolescents who used alcohol and
drugs had insufficient knowledge about the consequences of use and that increased
information would make them more likely to decide not to use drugs.

These programs have not been shown to affect behavior, for cognitive reasons

previously mentioned for adolescents beginning to use initially. "School-based initiatives

that use normative education to undermine youth beliefs that alcohol use is prevalent

among their peers and that peers universally approve of this behavior appear to have

promise" (Bonnie and O'Connell 2004:194). Also, programs that take a critical look at

the cultural messages the media is sending and the targeting tactics used to capitalize,

monetarily, on a wider audience may even work. Regardless of the content, it has been

suggested that "educational programs demonstrated to reduce alcohol use and abuse have

all been highly interactive" (Bonnie and O'Connell 2004:197). Dryfoos (1990) suggests

intervention needs to be early, and continuous for it to facilitate long-term change. Also,

Empowerment theory offers that youth should be involved in the decision-making

process in order to get them invested (Lofquist 1983).









Federal and state governments may also be instrumental in decreasing underage

drinking. Community-based coalitions may suggest they do a variety of tasks to improve

the well-being of the people they serve. Bonnie and O'Connell (2004:232) note:

Federal and state governments should coordinate and monitor the various
components, including providing the data and research needed to assess and
improve the strategy. The third role is to increase alcohol excise taxes to both
reduce consumption and provide funds to support the strategy. There is strong and
well-documented evidence of the effects of raising taxes on consumption,
particularly among youth.

The federal government oversees three national surveys, reporting the prevalence

of underage drinking: the National Survey on Drug Use and Health (NSDUH), Youth

Risk Behavior Survey (YRBS), and Monitoring the Future (MTF). Overall trends seem

generally consistent across surveys. Bonnie and O'Connell (2004:236) further note,

"currently the federal government does not report regularly on activities across the

various agencies that fund targeted underage drinking activities, and evaluating the effect

of those activities, as it does for illegal drugs." Efforts from the government to report

findings, especially discrepancies between agencies, would provide a clearer picture of

what the underage drinking scene is like. With this knowledge, programs can more

effectively plan strategies.

Within a community coalition, a broad range of organizations may be acceptable,

or a focused selection may work best together, depending on the needs of the community.

Bonnie and O'Connell (2004:218) explain, "there is some evidence that coalition partners

with strong ties to alcohol producers may not support effective environmental

interventions." Sometimes it is counterproductive to have members who have vested

interests in alcohol production or sales, since they may be given the power to veto

alternative intervention strategies that might affect their productivity. Bonnie and









O'Connell (2004:217) further note, "having the flexibility to choose one's partners has

been an important ingredient in the success of many effective coalitions." Also, "work-

based interventions may also serve to reach a population of young people who are not

exposed to school-based interventions" (Bonnie and O'Connell 2004:210). It is the

employer's duty to the community to provide work-place alcohol prevention programs to

warn against the dangers and repercussions it might have on job productivity and

possibly job security. The employer knows, "a full-or part-time job provides

discretionary money that young people may choose to spend on alcohol" (Bonnie and

O'Connell 2004:210). The business segment of a community has many resources and

should be considered when developing community coalitions.

Although not much research has been conducted with faith-based approaches,

"family involvement in faith-based institutions, religiosity, and spirituality all have been

shown in research to reduce the risk for adolescent substance use" (Bonnie and

O'Connell 2004:196). Also, parents have shown to be a positive source of socialization.

Community-based programs "can provide parents with skills and motivation for actively

monitoring and supervising their children" (Bonnie and O'Connell 2004:196). Both faith-

based approaches and parental involvement have been shown to be successful in

decreasing underage drinking.

Strategies employing healthcare staff and facilities are suggested to be successful as

well. Healthcare staff may come across to adolescents as impartial, possibly allowing

them to hear the dangers of alcohol use and abuse in a more sincere manner. As noted by

Bonnie and O'Connell (2004:209), "emerging research suggests that physician rates of

screening adolescents for alcohol use can be improved (from an average of 59 percent to









76 percent) by training physicians on knowledge, attitudes, and skills that are necessary

to create behavior change." This is another area of community-based initiatives that has

only recently been addressed.

Scientifically-based strategies are strongly recommended when implementing

alcohol prevention programs. "It is important for communities to rely on scientifically-

based strategies to reduce underage drinking," combining environmental and social

change with theory-based approaches (Bonnie and O'Connell 2004:217). Employing

strategies that have been proven ineffective could lead to an exhaustion of resources and

wasted time, without any real social change.

Attention to irresponsible sale, promotion, and marketing of alcohol are essential to

eliminating the culture of underage drinking, in addition to controlling the alcohol

availability to youth. As suggested by Bonnie and O'Connell (2004:218), "recent cross-

sectional research has shown a correlation between outlet density and underage

drinking." Decreasing the number of bars may lessen market competition, resulting in

fewer alcohol specials trying to attract underage drinkers to their establishment over

another.

Key leaders in the community are important to include. Some may not be able to

participate regularly, but just by their affiliation they give the coalition credence. Key

leaders who are active participants can increase support and awareness in ways other

coalition members may not have the contacts to do.

This chapter laid out the implications of alcohol use and abuse among underage

populations. It also described the drinking scene in Alachua County, the target population

of the PIPSA coalition. PIPSA's suggested theoretical framework expressed the









foundations the coalition was based on, as well how the coalition generally intends to

approach its community members. Literature describing the effectiveness of community

coalitions in response to social issues such as underage drinking was provided to show

the worth of PIPSA efforts and to express what this coalition aims to accomplish.

Suggestions for strengthening the coalition, based on prior literature, were presented.

These will be addressed in later chapters to highlight the PIPSA program's strengths and

weaknesses. Before this can be done, a deeper insight into the PIPSA program is

necessary. The following chapter expresses PIPSA's immediate priority and the goal of

the study in more detail.














CHAPTER 3
PARTNERS IN PREVENTION OF SUBSTANCE ABUSE (PIPSA) COALITION

The following chapter provides a more in-depth look at the PIPSA coalition. The

program history is outlined and a description of the Alachua County setting is detailed.

Also, attention is called to PIPSA's program theory, both in the form of its program

impact theory and its program process theory. Their new focus on underage drinking is

explained as well as PIPSA's immediate priority, program evaluation. A formative

evaluation in the form of this study is offered as a necessary step in moving towards an

evaluative program.

Program History

Partners in Prevention of Substance Abuse (PIPSA) was established in 1999 by

founding partners Corner Drug Store, Inc., UF Center for Cooperative Learning and

Department of Psychiatry, and the School Board of Alachua County. Originally, it

received funding through an Office of Juvenile Justice and Delinquency Prevention

(OJJDP) Drug Free Communities Grant, which was part of a five-year project that aimed

to create a coalition in every county by the year 2004 that dealt with local problems

specific to that community. The grant was matched dollar for dollar by the Ounce of

Prevention Fund of Florida. PIPSA is "a combination of several local agencies,

businesses and community members in the Alachua County area that meet to discuss and

plan ways to make our community drug free" (Corner Drug Store Incorporated 2006). It

is a level one prevention program that is non-client specific, meaning they do not track

individual client outcomes.









PIPSA's original mission was to reduce the prevalence of problem behaviors (such

as alcohol, tobacco, and other drug use) among the community's youth and to strengthen

PIPSA and develop a long-term (over the life-course) anti-drug initiative with citizen

involvement. The term "prevalence" refers to the total number of existing cases of

problem behaviors in Alachua County (Rossi et al. 2004). PIPSA hoped to focus

primarily on the youth of Alachua County, with program activities geared to them, but

also welcomed all residents of Alachua County to make a life-long commitment to this

community initiative. The program is currently not funded and is hoping to procure future

funding once evaluation pieces may be done to show the program's merit.

Alachua County

First I will describe the setting. Next, I will discuss PIPSA's program theory.

Alachua County includes the cities of Alachua, Archer, Gainesville, Hawthorne, High

Springs, La Crosse, Melrose, Micanopy, Newberry, Waldo and significant non urban

areas. In Table 4 the total estimated population in 2004 was 223, 090, with 20.2% making

up the under 18 population (Department of Children and Families 2003). Considering the

underage drinking level is twenty-one, PIPSA's target population is a slightly larger

percentage than 20.2% (Department of Children and Families 2003). This means slightly

more than 20 out of every one hundred people PIPSA hopes to reach in order to intervene

or prevent their use of alcohol. In terms of income, the median household income of

Alachua County residents is approximately seven thousand less than the Florida average.

Roughly twenty-three percent of the Alachua County population is below the poverty

level, as compared to Florida's state average of 12 percent (Department of Children and

Families 2003). Considering transportation and participation costs, free and easily

accessible prevention programs should be especially available in Alachua County. Age,









gender and race categories for Alachua County all have similar rates when compared to

the Florida average. Therefore, there are no notable considerations that need to be made

for Alachua County in regard to changing the current allocation of funding resources

based on these categories. Focus group participants suggested Alachua County to be

currently the highest funded county within its surrounding 11 counties, due to its

population. Attention should be focused on the patterns found in juvenile offenses in

Alachua County. Most crimes are committed during the week and in the daytime

(Department of Children and Families 2003). Successful prevention activities need to

accommodate youth at times they are most vulnerable to participate in crime. With 11

percent of drug offenses being committed by youth in Alachua County, it may be

suggested that prevention activities from the PIPSA coalition could be more successful in

reaching its target audience.

Table 4: Alachua County Statistics
Alachua County Florida
LAND AREA
Square miles (2000 est.) 874 53, 927
Persons per square mile (2000 est.) 249.3 296.4
POPULATION Alachua County Florida
Population (2004 est.) 223, 090 17,019,068
Population, percent change (2000- 2004) 2.4%+ 8.8%+
Households (2000 est.) 87,509 6,337,929
Persons per household 2.34 2.46
AGE
Under 5 years old (2000 est.) 5.1% 5.9%
Under 18 years old (2000 est.) 20.2% 22.8%
19-64, percent (2000 est.) 70.2% 59.6%
65 years old and over (2000 est.) 9.6% 17.6%
GENDER
Female (2000 est.) 51.2% 51.2%
Male (2000 est.) 48.8% 48.8%
RACE
%White (2000 est.) 73.5% 78%
% Black/African American (2000 est.) 19.3% 14.6%
% of Hispanic or Latino origin (2000 est.) 5.7% 16.8%









Table 4. Continued
Alachua County Florida
Persons reporting two or more races (2000 est.) 2% 2.4%
INCOME
Median household income (1999 est.) $31, 426 $38, 819
EDUCATION
High school graduates, % 25+ (2000 est.) 88.1% 79.9%
Bachelor's degree or higher, %25+ (2000 est.) 38.7% 22.3%
POVERTY PREVALENCE
Persons below poverty, percent (1999 est.) 22.8% 12.5%
Children below poverty, percent (1997 est.) 23% 21.8%
JUVENILE OFFENSES (2004 est.) 2,180 (2% ^)
Two most common days of the week to Thursday (16.6%)
commit Offense (2004 est.) Friday (16.7%)
Three most common time of day to commit 3-6pm freq. 399
Offense (18.3%)
12-3pm freq. 393
(18%)
9-12n freq. 320
(14.7%)
Drug offense (2004 est.) 240 (11% of offenses
committed by
juveniles)
(Department of Children and Families 2003). 2004 Alachua County Statistics.

Program Theory

In this section, I outline PIPSA's program theory. This explains why the program

does what it does and provides the rationale for expecting that doing so will achieve the

desired results (Rossi et al. 2004). PIPSA follows Catalano and Hawkins's Social

Development Theory (see Figure 3). The strategy is to begin with a goal of healthy

behaviors for all children and youth. In order for young people to develop healthy

behaviors, adults must communicate healthy behaviors and clear standards for behavior

to young people. Bonding (an attached, committed relationship) between a child and an

adult who communicates healthy beliefs and clear standards motivates the child to follow

healthy beliefs and clear standards. A child who creates this bond with an adult is less

likely to threaten the relationship by violating the beliefs and standards held by the adult









(Catalano and Hawkins 1996). Hawkins and Catalano suggest that bonding is dependent

on three conditions (Catalano and Hawkins 1996). Children need appropriate

opportunities for meaningful involvement with a positive social group, such as their

community, family, and school. Children need the emotional, cognitive, social and

behavioral skills to successfully take advantage of opportunities. Lastly, children must be

recognized for their involvement.


The Goal:
Healthy Behaviors* for
all children and youth

Start with (strong support system*):
Healthy Beliefs and Clear Standards
(in families, schools, communities and
peer groups)

Build:
Bonding*
(Attachment & Commitment to
families, schools, communities and
peer groups)


By providing: By providing: By providing:
Opportunities in Skills in families, Recognition in families,
families, schools, schools, communities schools, communities and
communities and and peer groups peer groups
peer groups
(Ex. workshops, (Ex. Certification in
(Ex. jobs, social counseling, good community programs
situations, etc...) parenting skills from Informed Families, Knight
community agencies) Vision)


And by nurturing:
Individual Characteristics (Protective factors based on cultural values)
Figure 3: Program Theory: Social Development Strategy









Healthy Behaviors include being totally free from substance abuse, promoting the

same in others, raising drug-free children. (Since social norms encourage the escalation

of substance abuse, it is ideal to curb initiation of these behaviors.)

Theory of affecting social norms: It may take years to change the ideas in the

population, but the community must start with a strong support system that provides clear

standards and healthy beliefs. (Ex. of values that are not healthy or clear standards -

Collecting keys at a party, so children may stay and drink all evening encourages binge

drinking and lack of responsibility).

Bonding is created among community members. When clear messages (as opposed

to "mixed messages") are conveyed, a sense of safety is maintained (Catalano and

Hawkins 1996).

Program impact theory

In this section, I explain PIPSA's impact theory (see Figure 4). An impact theory

consists of assumptions about the change process actuated by the program and the

improved conditions that are expected to result (Rossi et al. 2004). PIPSA's stated impact

theory is that by providing information to community members (through community

agencies) it will build strong "protective factors" (possibly changing attitudes/motivation

regarding substances) as barriers to "risk factors" to prevent initial or continued drug

abuse (see Appendix A).









Alachua County Community
Agencies Recruit Participants to
Attend PIPSA Events (by word-of-
mouth, flyers, posters, etc...)


J.L

Attendance and Participation at
Educational Events (workshops,
drug summits, red ribbon week)




Builds Pro-social Environment


Builds "Protective Factors" or "Assets" (encouraging
opportunity/skills/recognition for activities not
involving substance abuse)

J,--


Figure 4: Impact Theory

Catalano and Hawkins' Social Development Strategy seems to emphasize focusing

on "protective factors," in order to prevent initial or continued drug abuse. In practice,

PIPSA activities actually focus both on "protective factors" and "risk factors."

Educational workshops and Drug Summits include information regarding examples from









both categories. CADCA suggests focusing on both, with the goal of prevention to be

changing the balance so "protective factors" outweigh "risk factors" (National

Community Anti-Drug Coalition Institute 2006).

Alachua County community agencies recruit youth to attend PIPSA events by

interagency, e-mails, word-of-mouth, flyers, and posters. In theory, attendance and

participation at these educational events (workshops, drug summits, Red Ribbon

Awareness activities) lead to a pro-social environment for the individual with "protective

factors" being built. These strong "protective factors" guard against "risk factors" and

prevent the initial or continued use of substances. Without substance abuse, the individual

is more capable of being physically and emotionally healthy, both individually and for

his/her community.

Measurable outcomes showing the individual's "healthy" lifestyle may be either

proximal or distal. Proximal outcomes would be the attitudes, knowledge, skills, and

behavioral intentions. For example, youth may model their mentor's values and behavior,

or youth may use their leisure time more constructively (i.e. hanging out with family,

going to church, doing homework) strengthening the "protective factors" even more.

Distal outcomes might be a decrease in problem behaviors (alcohol, tobacco and drug

use) over an extended period of time.

Program process theory

In order for any outcome to occur, the services must be delivered to the target

populations. The service utilization plan is constituted by the program's assumptions and

expectations about how to reach the target population, provide and sequence service

contacts, and conclude the relationship when services are no longer needed or appropriate

(Rossi et al. 2004). Currently, participants are recruited by local advertising in ways









discussed below. These are considered the best ways (considering the resources

available) to reach PIPSA's large target population. Alachua County residents (both

youth and adults) are offered the same types of educational training and awareness

activities. This should lead to the strengthening of the individual's pro-social

environment (building "protective factors" as barriers to "risk factors"), since there is a

clear message being broadcast to all who may come in contact with the individual. The

process does not conclude, but is cyclical. Each year the same activities are offered, with

the idea in mind that, the more an individual participates, the stronger their pro-social

environment will become.

Examples of educational training include bi-monthly educational workshops and

the Annual Regional Drug Summit, advertised through flyers, posters, and list-serve e-

mails to community agencies (that they post and announce as well). Adults are always

able to become members of the coalition, as are youth, but youth also have a special

invite offered to them at the Annual Regional Drug Summit that encourages them to

become peer leaders and to join the Youth Advisory Committee (a sub-committee within

PIPSA). If they join this, they are expected to: attend bi-weekly meetings to discuss youth

problems in the community; help the committee develop/revise youth goals for their

peers in Alachua County; and implement activities that will achieve these goals.

Currently, the sub-committee is being formed, so goals and activities have not been

established. Adults and youth are also encouraged to participate in substance abuse

community awareness activities.

Examples of awareness activities include legislative activities, "Family Day", and

"Red Ribbon Week". Legislative activities encourage community members to take action









to combat substance abuse in forms of letter campaigns (highlighting the irresponsibility

of print and radio ads that advocate binge drinking), Op Ed pieces, Letters to the Editor,

and trips to Washington, D.C. (Day at the Capital). Family Day encourages families to

make dinner time a family affair. The goal of the project is to have 5,000 families pledge

to eat together on Family Day (last year, it was Monday, September 26, 2005) and to

make eating together a family a priority throughout the year. Increasing time spent

strengthening a pro-social environment builds "protective factors" as barriers to "risk

factors." Red Ribbon Week is a campaign honoring Enrique Camarena, a DEA agent

who lost his life while working undercover in Mexico investigating a major drug cartel.

The belief behind this campaign is that even one person can make a difference. Activities

include youth poster and essay contests that encourage and reward creative ways to get

out the message of substance abuse. A luncheon is held at the end of the week to

acknowledge and applaud the efforts of those participating, in an effort to recognize

community members (further strengthening their pro-social environment).

PIPSA's New Focus: Underage Drinking

PIPSA would like to specifically focus activities on combating underage drinking,

since this is their new primary concern. This study will aid PIPSA in brainstorming for

new activities, as well as connecting these activities with the organizational plan. The

organizational plan relates to program resources, personnel, administration, and the

general organization of the program (Rossi et al. 2004). Factors that are important for

PIPSA to maintain this service delivery system are interagency collaboration and citizen

involvement. It is crucial for PIPSA to have each sector (law enforcement, education,

social services, health, parents, government, civic, faith-based, and business) of the

community represented in the coalition. Their efforts need to be coordinated by a









governing body the executive board of PIPSA. This board organizes educational

training and awareness activities and encourages the sectors to disseminate this

information to community members they have contact with. Monthly meetings (at an

Executive Board member's place of work- presently The Corner Drug Store) are

important for this transaction of information to take place. They then can go back to their

respective agencies (with no additional facilities required) and broadcast the importance

of the upcoming events in the community, encourage participation and offer these

opportunities for community members to seek information regarding a prevalent social

issue that may exist as close as their very home.

Formative Evaluation

PIPSA is currently in the process of revising their organizational plan in order to

more effectively reach their target population and to develop a plan that can eventually be

evaluated in terms of its process and impact. Evaluation is essential to ensure future

funding, since most grants are now awarded to evidence-based programs. The program is

not capable of being evaluated based on its current program structure. Even though this

program has been in Alachua County for seven years, it is still in need of a more refined

program design. The past two years the program has been completely unfunded and

PIPSA is going through changes still, adopting CADCA's Strategic Prevention

Framework. Also, a Youth Advisory Committee was just newly appointed as a PIPSA

sub-committee and has yet to draft goals and objectives. These changes in goals and

objectives no doubt will affect the service utilization and organization aspects of the

PIPSA program. It is necessary to speak with coalition members to coordinate feedback

on the changes of the coalition and the resources and possible activities PIPSA could

offer the community, centered on the new primary concern of underage drinking.









Most often evaluations provide a singular focus on program improvement,

accountability or knowledge generation. Scriven (1991) notes, a formative evaluation is

intended to furnish information for guiding program improvement and its purpose is to

help form or shape the program to perform better. A formative evaluation is best suited

for PIPSA to help clarify the needs of the target population, improve program operations,

and enhance the quality of service delivery (Rossi et al. 2004) since impact assessments

are most appropriate for mature, stable programs with a well-defined program model and

a clear use for the results that justify the effort required (Rossi et al. 2004).

Rossi et al. (2004:34) explain, "the audiences for formative evaluations typically

are program planners, administrators, oversight boards, or funders with an intent in

optimizing the program's effectiveness." Following the idea of a formative evaluation,

this study will explore the needs of the target population, improvements in program

operations, and service delivery possibilities through the eyes of the coalition members. It

will incorporate feedback from them regarding program operations and service delivery

in order to create a comprehensive list of current as well as newly suggested activities

that are directly related to the program's process and impact theories concerning to

underage drinking. At this point, the PIPSA program does not coordinate the available

resources from participating coalition members and their respective agencies in a

comprehensive effort to reduce problem behaviors in Alachua County, let alone their new

goal. Following CADCA's Strategic Prevention Framework, it is first necessary to

identify the resources available to PIPSA through its coalition members, and their

participating agencies. The goal of the study is to develop a comprehensive response to

the problem behavior addressed (currently underage drinking). The duty of the coalition









will be to use this formative evaluation to create a feasible organizational plan including

only the activities they agree to include in the program, and monitor the process and

impact of these activities over periods of time to evaluate the programs strengths and

weaknesses. With feedback from all sectors, PIPSA can offer a more community-based

approach and increase the awareness and involvement of the program in Alachua County,

further strengthening its impact.

This chapter expressed the PIPSA coalition's efforts in more detail, allowing for a

better understanding of its history and its desired future. The next chapter will present the

ontological, epistemological and methodological approaches that will be employed in this

study, as well as any accompanying limitations that may be associated.














CHAPTER 4
STUDY DESIGN

This chapter gives the ontological, epistemological, and methodological

background of the study. Since focus groups were the primary method in this study, time

is dedicated to explaining the benefits and limitations of this method. More specific

details regarding the focus group design employed in this study are offered as well, such

as focus group questions and materials used in the study. Following this, analysis

procedures in applying Strauss and Corbin's Grounded Theory are described. Lastly,

overall limitations of the study design are addressed.

Ontology

The principal investigator approached this study within a constructivist paradigm.

As Schwandt (1994:118) notes:

Proponents of these persuasions share the goal of understanding the complex world
of lived experience from the point of view of those who live it. This goal is
variously spoken of as an abiding concern for the life world, for the emic point of
view, for understanding meaning, for grasping the actor's definition of a situation,
for Verstehen. The world of lived reality and situation-specific meanings that
constitute the general object of investigation is thought to be constructed by social
actors. That is, particular actors, in particular places, at particular times, fashion
meaning out of events and phenomena through prolonged, complex processes of
social interaction involving history, language, and action.

This constructivist paradigm assumes a relativist ontology, suggesting multiple

realities do exist. Hazelrigg (1989) stresses the importance in keeping this mindset by

focusing on the practice of the researcher: who we are, what we do, what world we make.

By distancing research from the God's eye point of view, we accept the logic that

research is dependent on both the social and historical setting. More importantly,









whatever results researchers produce because of this should be dealt with in a considerate

manner. Denzin and Lincoln (2003:441) note, "the problem is that to continue to employ

the language of a 'discovered world' is to continue a passivity in regard to responsibility

for the world." This is not to say that research is unproductive, but that a multiplicity of

realities exists and all studies, especially within the social sciences, should approach

knowledge with this notion, since it is a result of perspective.

Epistemology

A subjectivist epistemology was employed, understanding that the researcher and

respondent co-created meanings throughout the focus groups. As mentioned previously,

"these constructions are influenced by specific historical, geopolitical, and cultural

practices and discourses, and by the intentions noble and otherwise- of those doing the

constructing" (Denzin and Lincoln 2003:598). It is the researcher's responsibility to

understand people's construction of meanings in the context being studied. This

constructivist (or interpretivist) approach is undeniably subjectivist "the inquirer's

worldview becomes part of the construction and representation of meaning in any

particular context," with "inquirer bias, experience, expertise, and insight all part of the

meanings constructed and inscribed" (Denzin and Lincoln 2003:598). With this in mind,

a different researcher would most likely yield different results, with interpretation

stemming from individual beliefs and values.

Methodology

Natural settings are considered the best context for researchers employing

constructivism, "with the human inquirer as the primary gatherer and interpreter of

meaning, with qualitative methods, with emergent inquiry designs, and with contextual,

holistic understanding, in contrast to interventionist prediction and control, as the overall









goal of inquiry" (Denzin and Lincoln 2003:598). The focus is on quality and

understanding, with questions of purpose and role, rather than technique and

implementation. Since this study has an evaluative shadow to it, and "evaluators are

particularly concerned about criteria and methods of warranting their evaluative

knowledge claims as empirically based representations of program experiences and not as

biased inquirer opinions", constructivist evaluation techniques will be highlighted in the

Analysis section and the Formative Evaluation chapter (Denzin and Lincoln 2003:599).

Qualitative Design

Dewey (1934:2) comments on the importance of keeping an open mind during the

research process, "if the artist does not perfect a new vision in his process of doing, he

acts mechanically and repeats some old model fixed like a blueprint in his mind." It is

important to explain the methodology, or ways to study the social reality of substance

abuse used in this research study. As noted by Strauss and Corbin (1998:11), "qualitative

research is a type of research that produces findings not arrived at by statistical

procedures or other means of quantification." This does not mean that statistically

gathered sources of information were not referred to, but that the bulk of the analyses

were interpretative, with focus groups interpreted by the principal investigator. These

rich, thick descriptions were necessary to understand more fully coalition members'

views regarding the topic of substance abuse. Secondary sources of information, such as

the 2004 Florida Youth Substance Abuse Survey were incorporated to further strengthen

interpreted results of focus groups and to see if coalition members had differing accounts

in terms of what is occurring in Alachua County, according to statistical measures.

The purpose of qualitative research is to discover concepts and relationships in raw

data that preplanned quantitative analysis might not allow for, and organize them into a









theoretical explanatory scheme that offers new insight into the area under study. It not

only allows for but stresses the socially constructed nature of reality. Strauss and Corbin

(1998) suggest that qualitative research be used in research that attempts to understand

the meaning or nature of experience of persons with problems such as chronic illness,

addiction, divorce... to get out into the field and find out what people are doing and

thinking. The purpose of these focus groups is to get inside the minds of the PIPSA

coalition members to understand more clearly how they envision the coalition's

contribution to the community. The ideal way to encourage this is to approach the

individuals with no preconceived notions of underage drinking in Alachua County, and

learn from what they are willing to share, while also noting relevant topics they are not

addressing.

Qualitative research allows the researcher to glimpse an individual's feelings and

thought processes that may not be possible to uncover within stricter, more quantitative

research methods. Patton (1987:11) notes, "the narrative comments from open-ended

questions are typically meant to provide a forum for elaborations, explanations,

meanings, and new ideas." Not only do open-ended questions allow for closed-ended

responses, but they also offer the opportunity for fresh new ways of conceptualizing the

topic by giving the respondent ability to express them in a more detailed and fuller

manner.

Methods

Focus groups comprised of coalition members accounted for the bulk of the data

gathered. In addition, fieldnotes were documented during the focus groups, as well as

PIPSA events, noting physical gestures and reactions of coalition members that may have

been useful in understanding emphasis in later analysis of verbal dialogue.









Focus Group As A Method

Denzin and Lincoln speak of the significance the structure of a method has on the

outcome of the dialogue. They explain when choosing the method of research, "in a

culture that highlights individualism and separation, shifting the research agenda in the

direction of commonality and togetherness is, in itself, subversive" (Denzin and Lincoln

2003:373). They appear to suggest an importance of getting people to think in terms of

commonality and togetherness. I believe this strategy would only strengthen the support

of coalition members in the focus groups of this study.

Historical and contemporary uses of focus groups

The focus group has seen changes in its implementation throughout its history.

Initially, focus groups were used by social scientists to develop survey questionnaires in

the 1920's, with the final result being a purely quantitative response to the social issue at

hand. It wasn't until the 1970's that market researchers began to find value in focus

groups, hoping to find people's wants and needs in an effort to capitalize on them. The

1980's to present day has seen an increase in focus group usage across disciplines to

research varied social issues. Denzin and Lincoln (2003:367) explain, "in the social

sciences, group interviews developed as reservations concerning the effectiveness of

individual information gathering techniques grew. Such reservations focused on the

influence of the interviewer on research participants and the limitations imposed by

closed-ended questions." It is evident that social scientists have begun to consider the

focus group to be an important qualitative research technique.

Benefits of using focus groups

Focus groups have many benefits to their approach as a method. Arguably the most

important aspect of their nature is that they make it possible for the researcher to observe









the interactive processes occurring within the group, and among the participants. Morgan

(1997:2) clearly states, "the hallmark of focus groups is their explicit use of group

interaction to produce data and insights that would be less accessible without the

interaction found in a group." Krueger (1988:44) argues that, "focus groups place people

in natural, real-life situations as opposed to the controlled experimental situations typical

of quantitative studies." He suggests that hierarchy within the organization, that may

present itself in various forms throughout the interactions taking place in the focus

groups, may even be lessened by employing an outsider to the organization to conduct

the focus groups.

In addition to producing large amounts of information during a relatively short

period of time (compared to individual interviewing), focus groups produce concentrated

amounts of information on the topic of interest to the researcher in highly focused (by

sector) groups. Morgan (1997:10) offers, "group discussions provide direct evidence

about similarities and differences in the participants' opinions and experiences as

opposed to reaching such conclusions from post hoc analyses of separate statements from

each interviewee." An open discussion of the research topic is available to the

participants. As discussed previously, the researcher as an outsider has the ability to

appear less knowledgeable about the subject and is forgiven for probes intended for

clarification purposes. This flexibility in the focus group allows for unanticipated topics

to be explored more fully that might not have been addressed using other research

techniques.

Since it is unreasonable to get all coalition members to meet at one locale to

productively discuss these issues in such a focused manner, focus groups provide a









technique that is not only efficient, but productive as well including many viewpoints in

a relatively short period of time. Focus groups are traditionally considered a less

expensive research technique as well. If the researcher already has access to a room to

conduct the groups in, only a tape recorder is needed. No additional materials, such as

questionnaire copies are necessary, since the recorded dialogue is the main source of

data.

Focus groups are exploratory in nature. Morgan (1997:11) notes, "this ability to

give the group control over the direction of the interview is especially useful in

exploratory research in which the researcher may not initially even know what questions

to ask." Rather than testing hypotheses, focus groups offer the participants, those closest

to the issue, to tell the researcher what the important aspects are. It is a way to allow for

marginalized voices to be heard without forcing the researcher's agenda upon the

participants and possibly affecting social policy in the process. Although the researcher

may not escape influencing the discussion, by providing power to the group, focus groups

minimize researcher bias (such as preconceived notions, opinions, words, and concepts)

that could ultimately affect results. They allow the researcher to know the language

participants employ and encourage the researcher to conceptualize the issue within the

framework they provide. Denzin and Lincoln (2003:372) explain, "language is of

particular importance because a sensitive understanding of people's lives requires shared

symbols, meanings, and vocabularies."

When all this is taken into consideration, "focus groups can improve the planning

and design of new programs and provide means of evaluating existing programs"

(Krueger 1988:15), allowing for future evaluations of the program to accurately measure









the intentions of the program. Also, an unintended benefit of focus groups might be in

getting participants newly excited and informed about the issue, with the participants

encouraged to sit and think critically about the issue being addressed. They might not

have this luxury throughout the course of their average work day, and may not be

challenged to consider others' (possibly opposing) viewpoints.

Multiple viewpoints allow for contradictions to be dealt with throughout the data

collection period and not relegated to the researcher sorting it out in analyses, as is the

case in individual interviewing. Also, what Morgan calls "member checking" may take

place in a group environment, allowing the researcher to comment on the implementation

(or lack) of program activities as a way to hold participants accountable for what they are

supposed to be doing within the program, compared to what is actually done. Unlike

surveys and telephone interviews, focus groups allow the researcher to note the degree of

irregular participation from certain participants as well as nonverbal cues, body language

and patterns of turn taking, which may provide valuable insight into the content and style

of responses the participants offer. Since patterns were only able to be noted on a limited

basis because the researcher did not have an assistant at her disposal, no notable patterns

worthy of mention were found in the focus groups.

As a final note on the benefits of focus groups, they are typically considered as

having high face validity. As Krueger (1988:42) explains,

Fred Reynolds and Deborah Johnson (1978) reported on a comparison of focus
group discussions with a large-scale mail-out survey. The two studies were both
nationwide in scope-a mail survey of 2000 females with a 90% response rate
compared to a series of 20 focus groups in 10 cities. When these two market
research studies were compared, there was a 97% level of agreement, and, in the
area of discrepancy, the focus group results proved to have greater predictive
validity when compared to later sales data.









The high face validity may be attributable to the comments from participants

appearing more believable, since people provide more detail and open up more,

suggesting many possibilities.

As outlined, focus groups have many benefits as a research technique. Coupled

with these benefits also comes limitations. These are important to note as well, in an

attempt to be reflexive about the problems related to the research design of the study.

Limitations in using focus groups

Focus groups are difficult to assemble. Even careful planning in terms of location,

time, and date will not guard against nonparticipation. People may even confirm their

attendance, but are unable to show up due to unexpected work responsibilities, home

responsibilities, or personal illness. When the researcher expects a certain number of

participants but, in actuality gathers far less, it poses a dilemma to the researcher. Should

the researcher cancel, in the hopes that more people will show up at a rescheduled time,

or should s/he conduct the focus group knowing that this could mean compromising the

data? The size of the focus group is extremely important to its success. The more people

attending the focus group the greater the opportunity for a diverse amount of ideas shared

- and included in analyses. Due to the study needing to be accomplished in a reasonable

amount of time, it is unlikely that the researcher has the flexibility to continue to

reschedule focus groups until all participants are in attendance. The larger problem with

continuing on with small focus groups is the possibility of saturation not being reached.

Strauss and Corbin (1998) state this is the point at which data collection no longer

generates a new understanding of the issue. The data collection phase is considered

complete.









As mentioned earlier, focus groups are generally considered to occur in a natural

setting, unlike in experimental studies. It should also be noted that groups like a coalition,

where a group of people representing other organizations gather together, may be viewed

as being in an unnatural social setting. In actuality they are not being observed or

questioned in their own work environment but a mutually agreed upon location. This

location may not be where they regularly interact with program participants. Also, the

conversation is managed by the researcher and is not conducted as a regular coalition

meeting. Inexperience of the researcher may further jeopardize the results and the

comfort level of the participants further distancing participants from the natural

environment they are used to and affecting their behavior, ultimately affecting results.

Another major limitation to focus groups is that the group may influence the data it

produces. Krueger (1988:23) notes, "evidence from focus group interviews suggests that

people do influence each other with their comments, and, in the course of a discussion,

the opinions of an individual might shift." It is strongly suggested that the researcher pay

close attention when this happens in order to document what the influencing factors were

in creating the shift of opinion. They may even reverse their opinion after interacting

within the focus group. Also, it is suggested that people tend to report more extreme

views in focus groups than they actually hold, in an attempt to convince others or

conform to their stance. Morgan (1997:15) states:

The concerns for focus groups include both a tendency toward conformity, in
which some participants withhold things that they might say in private, and a
tendency toward polarization, in which some participants express more extreme
views in a group than in private.

Krueger highlights the dangers of researching existing groups, suggesting people

with more years of experience in the field may tend to dominate the discussion (Krueger









1988). Those who are less experienced may defer to them for a response, assuming they

know the issue in more nuanced ways. Power issues relating to experience orjob title

may influence participants' level of involvement. People holding higher offices may be

accustomed to controlling the group, while those in less senior positions are accustomed

to listening. The purpose of the focus group is to get everyone's input, but power issues

may pose a threat to this task. Individuals may have their own agenda within the focus

group, such as lobbying for a certain outcome. If the researcher allows for a less

structured format and allows individuals to manipulate the focus, this makes analyses

more difficult when attempting to compare across groups.

All of these aforementioned problems foreshadow difficulties with validity and

generalizability. Validity is the degree to which the procedure actually measures what it

intends to measure. Krueger (1988:41) suggests, "people are not always truthful, and

sometimes they give answers that seem best for the situation. Other times, people hold

back important information because of apprehensions or social pressure." Because data

are group dependent, it is difficult to comment on the validity of the data derived from

focus groups. Focus groups are generally thought to lack generalizability for this same

reason. This is not to say they do not offer valuable insight into the issue studied, but that

the results should not be used to generalize to other populations outside of the one under

study. These are all limitations that influence the results and implications of focus groups.

More limitations of focus groups include their reliance on verbal communication.

Certain questions may not be asked that would encourage respondents to respond in an

accurate and thorough way (Krueger 1988). Reasons for this may be due to a

misunderstanding of the questions posed. A limitation related to relying on verbal









communication is the quality of data they produce. As mentioned earlier, self-report data,

as is gathered in focus groups, may not be accurate whether intentional or unintentional

(Fallon and Schwab-Stone 1994).

Focus Group Design

The data collected for this study were gathered through semi-structured focus

groups. A guide was used to focus group discussion. Morgan (1997:47) suggests, "the

structure that a guide imposes on discussions is valuable both in channeling the group

interaction and in making comparisons across groups in the analysis phase of the

research." Considering the philosophical underpinnings previously suggested, moderator

involvement should be somewhat limited, in order to lessen researcher values framing the

discussion. A semi-structured guide allows for a somewhat focused, yet unconstrained

discussion.

The study consisted of nine focus groups, each one representing a sector within

PIPSA. This was in an attempt to allow each sector to collectively explain their

contributions to the coalition. Although there should be a difference of opinion among the

sector participants, the idea is that they will be more similar than across sectors.

Categorization of members into professional sectors was done by PIPSA executive

members prior to the study. Each coalition member was listed as having their current

professional experience lying within one sector. As Krueger (1988:26) explains, "focus

groups are best conducted with participants who are similar to each other, and this

homogeneity is reinforced in the introduction to the group discussion." An ice breaker at

the beginning of each focus group, allowing for participants to introduce themselves and

their affiliation with PIPSA, was a chance for them to relate on an occupational level.

Also, an announcement from the researcher regarding the purpose of the project, their






61


commitment to the social issue of substance abuse, reinforced homogeneity on a more

personal level.

The focus groups were conducted at the Corner Drug Store conference room, at

scheduled meeting times that were convenient for coalition members (see Table 5). The

Corner Drug Store is where PIPSA's bi-monthly meetings are held and access of the

room was granted by PIPSA's executive chairperson, an employee of the Corer Drug

Store.









Table 5: Focus Group Characteristics
Focus Group Members Total Members
By Sector within Sector Participating


Members
Participating
from Sector


Members
Participating
outside Sector


Organizations
Represented


Date Length
(minutes)


Law
Enforcement


Youth
Services

Schools


Gainesville Police Dept. 04/19/06
Alachua Sheriff s Office
Corner Drug Store, Inc.

Corner Drug Store, Inc. 04/24/06
Alachua Sheriffs Office

Corner Drug Store, Inc. 05/02/06
UF Student Health Care Center
Parent
School Board of Alachua
UF College Advocacy Initiative


Family/
Community


Parent
Corner Drug Store, Inc.


05/02/06 45


Religious 2


Act of Faith Production 05/03/06
Mt. Pleasant United Methodist
Church
Meridian Behavioral Healthcare
Corner Drug Store, Inc.

University of Florida 05/11/06
UF/Area Health Education
Center
Corner Drug Store, Inc.


Healthcare









Table 5. Continued
Focus Group Members Total Members Members Members
By Sector within Sector Participating Participating Participating
from Sector outside Sector


Organizations
Represented


Date Length
(minutes)


Gainesville Hospitality
Group
Corner Drug Store, Inc.

Dept. of Children &
Families

None


Federal/State/ 16
Local Agency


05/25/06 35



05/25/06 70


05/25/06


Totals


*All focus groups were conducted at the Corner Drug Store in Gainesville, Florida.


Business/
Media


Civic/
Volunteer
Group










Table 6: Focus Group Participation

Focus Group by Sector

Law Enforcement

Youth Services

Schools

Family/Community

Religious

Healthcare

Business/Media

Federal/State/Local Agency

Civic/Volunteer Group


1st Time Participants


Additional Sector Participants


Total 19 16

Note: Some participants contributed in more than the focus group they were invited to. This table indicates how many in each focus
group were participating in a focus group for the first time and how many were providing feedback for additional times.









Focus group questions

Since a grounded theory approach was to be used in analysis, the interview

questions were adapted to include topics that arose during earlier focus groups and to

follow-up unanticipated issues. The basic questions were placed in a logical order, with

the coalition members being asked about their approach to Alachua County residents,

followed by a more in-depth look at what their needs are, what resources are available to

aid them, and what activities could be planned for them. Five broad questions were asked

in each focus group to begin the dialogue, with secondary follow-up questions to guide

discussion. Question one was asked in order to determine how coalition members

actually reach Alachua County residents and what problems they seem to encounter. This

question generated suggestions for improving program process. Question two was asked

in order to determine if the coalition was in agreement regarding their new direction. This

allowed coalition members to express what PIPSA should focus on. Questions two and

three allowed them to brainstorm how PIPSA should go about reducing underage

drinking in Alachua County, if they deemed it a necessary direction for the coalition to

take. Question five encouraged the coalition members to think about the feasibility of the

brainstormed activities and reflect on the importance of each coalition members'

involvement in implementing them. Overall, these five questions allowed coalition

members an opportunity to express the new direction the coalition should take and what

the coalition's priorities should be in implementing the activities relating to reducing

underage drinking in Alachua County.










1 How does your sector attempt to reach Alachua County residents?
How do you broadcast PIPSA's meaning and activities?
What difficulties arise when reaching residents?
How do you combat these difficulties?

2 Is underage drinking a problem in Alachua County?
If so, why is it a problem here?

3 What resources (from your respective agencies) are available to PIPSA to reduce
underage drinking in Alachua County?

4 What activities (from your respective agencies) are available to PIPSA to reduce
underage drinking in Alachua County?

5 Are the activities feasible based on your sectors' resources?

Morgan suggests this to be an appropriate number of questions for a semi-

structured focus group, "in a more structured group, the limit should probably be four or

five distinct topics or questions, with preplanned probes under each major topic"

(Morgan 1997:47). It is important to note that consensus within the focus group is not the

goal. In understanding the thought processes, deeper meaning is possible. As Krueger

(1988:30) explains:

One of the unique elements of focus groups is that there is no pressure on the
moderator to have the group reach consensus. Instead attention is placed on
understanding the thought processes used by participants as they consider the issues
of discussion.

All focus groups were audio-taped. They lasted approximately 1 hour, but

continued until all five questions had been addressed. After all questions from the guide

were asked and all "serendipitous questions" were acknowledged, the researcher offered

the opportunity for any final comments regarding the discussion. As a final step,

respondents were thanked and the tape recorder was turned off to indicate the data

collection period was over.









Materials used in focus groups

Two documents were provided to the focus group participants. Both were

constructed by the researcher with information derived from executive PIPSA staff prior

to the focus groups being conducted. The first document was PIPSA's service utilization

plan, which diagrammed PIPSA activities throughout the course of a one-year period.

This was shown to focus group participants to refresh their memories of PIPSA activities.

The second document declared and explained PIPSA's new focus on underage drinking.

PIPSA executive coalition members came to consensus on this new priority at the

Community Anti-Drug Coalitions of America (CADCA) coalition training in January

2006. The document suggested that both the social and physical environments in Alachua

County contributed to underage drinking (Appendix C). It is important to note that

instruments did not affect focus group discussion. It was observed that coalition members

did not rely on them or even refer to them.

In addition to the two documents guiding focus group discussion, every coalition

member was provided an informed consent form to sign prior to their participation in the

focus group. This form explained the purpose of the research study, the time required to

participate, potential risks and benefits to participating, the voluntary nature of the study,

the right to withdraw from the study at any time, and contact information of the principal

investigator and her supervisors if they had any further questions following the focus

group. One copy was retained by the researcher and one copy was provided to the

participant for their personal records.

Sampling design

The executive members of the PIPSA coalition encouraged involvement in the

study. They provided contact information for all coalition members to allow the principal









investigator to contact them and schedule meeting times. Since there are only 70

members total in the PIPSA coalition, it was feasible to invite all of them to participate

(Appendix D). Originally, there were nine scheduled focus groups, with each

representing a different sector within the PIPSA coalition: Youth Services, Alachua

County School Board, Law Enforcement, Business/Media, Federal/State/Local Agencies,

Civic/Volunteer, Religious, Healthcare, and Parents. Representatives from each sector

were contacted and focus groups were scheduled and rescheduled based on their

availability.

Gathering a wide range of coalition members is important to get a comprehensive

view of what resources are available and to get input that might not have been

represented when the original goals and objectives were developed, eight years ago. Also,

within individual sectors, it was easier to focus the discussion on particular issues

involving specific issues, rather than discussing underage drinking in Alachua County as

a broad issue. Since this approach was more organized than regularly scheduled

meetings, it seemed to be more productive to the ultimate goal of understanding what

resources their individual sector could contribute, what activities they could plan, what

impact this will have on the youth, and if PIPSA is employing a comprehensive approach,

from their perspective. They hinted at PIPSA's program theory at various times

throughout the focus group in discussing what new activities could be introduced by the

coalition.

The study comprised data from 35 participants from the PIPSA coalition focus

groups, with only 19 different individuals, since some participated in more than one focus

group. It should be noted that some key leaders from within the community and outside









the community are listed as PIPSA members, but are rarely available to attend coalition

meetings (i.e. Senator Rod Smith). They are important to the coalition because of the

support and endorsement they give to PIPSA, but are not involved in the workings of the

coalition on a regular basis. They may attend PIPSA activities as guest speakers, but are

more or less honorary members. Another thing limiting participation was that some

members were representing more than just themselves when they attended the focus

groups. Even though all coalition members were strongly encouraged to participate, some

organizations that had multiple members on the coalition most often sent only one to

represent the entire organization. Also, some were unable to attend focus groups due to

family obligations, personal illnesses, and conflicting work schedules. So, in reality the

coalition has more active members than are included in the study. Therefore, it is

important not to solely consider its strength as a coalition based on participation in the

focus groups. Limitations regarding this will be addressed in the discussion chapter.

Eight focus groups were conducted throughout the course of the study, instead of

the original design of nine focus groups. The civic and volunteering agency sector is

comprised of five coalition members. Due to low participation from these members, their

focus group was combined with federal, state, and local agencies. Unfortunately, no

members from the civic and volunteering agency sector were able to participate in the

combined focus group. This limitation will be discussed in fuller detail in the Discussion

chapter. All other sectors were conducted separately, consistent with the original design

of the study. Some coalition members participated in more than the focus group they

were originally scheduled for, if they felt their experience could contribute to additional

focus groups (see Table 5 and 6). The principal investigator approved of this, since they









could possibly offer insight that might improve dialogue within the focus group.

Limitations regarding this will be discussed in the discussion section.

Patton (1987:15) explains, "within programs an inductive approach begins with

questions about the individual experiences of participants. Between programs [or

sectors], the inductive approach looks for unique institutional characteristics that make

each setting a case unto itself." As stated in the introduction, the goal for PIPSA was to

conceptualize underage drinking in terms of the contributing agencies, determine

untapped resources that are available to the coalition, and brainstorm innovative activities

to be offered by the coalition.

Analysis Procedures

Grounded Theory: background considerations

Barney Glaser and Anselm Strauss originally introduced this methodology as an

alternative strategy to more traditional approaches which relied heavily on hypothesis

testing and more quantitative forms of analysis. Babchuk (1996:2) suggests, "Grounded

Theory is a qualitative methodology which derives its name from the practice of

generating theory from research which is 'grounded' in data." Epistemological debates

between Glaser and Strauss have introduced different ways of utilizing grounded theory

as it was originally intended. There are 3 major differences between Glaser and Strauss

and Corbin's understandings of Grounded Theory. Since they are still recognized today

as the leading researchers of this approach, it is important to distinguish between the two,

and explain why Strauss and Corbin's approach is more suitable to this study design.

Glaser critiques Strauss and Corbin's approach to addressing the initial research

problem. Strauss and Corbin believe that "the research question in a Grounded Theory

study is a statement that identifies the phenomenon to be studied," while Glaser stresses









that "the research problem itself is discovered through emergence as a natural byproduct

of open coding, theoretical sampling, and constant comparison" (Babchuk 1996:4).

Glaser's approach seems rather idealistic, with the research question stemming from only

a basic "wonderment" of the phenomena under study.

Strauss and Corbin stress that theory should inform the coding process, and the

previous literature of the social phenomena should not be ignored. Glaser argues that

"Strauss and Corbin's overemphasis on extracting detail from the data by means of a pre-

structured paradigm yields full conceptual description at the expense of theory

development or generation" (Babchuk 1996:4). Since PIPSA had declared the life course

perspective as its theoretical underpinnings, it seemed more appropriate and informative

to primarily use theories relevant to this type of literature to guide analysis. Glaser

suggests that Strauss and Corbin have a strong emphasis on verification and validation of

theory. Babchuk (1996:4) notes, "in Glaser's opinion, verification falls outside the

parameters of grounded theory, which instead should be directed at the discovery of

hypotheses or theory." This highlights Strauss and Corbin's priority of including the

literature of the phenomena under study and referring back to it throughout the analysis

process. Strauss and Corbin do not offer a rigid structure with verification and validation

of theory at the core of the research, as suggested by Glaser. They allow for the

opportunity of relevant literature to provide for a deeper understanding of the important

issues the phenomena may be related to, and offer important linkages experts in the field

have suggested exist.

Denzin and Lincoln (2003:279) explain, "Grounded Theory is an iterative process

by which the analyst becomes more and more "grounded" in the data and develops









increasingly richer concepts and models of how the phenomenon being studied really

works." Categories and terms are defined by the participants under study, while the

researcher begins to link them together in theoretical models. Denzin and Lincoln

(2003:280) further note, "the end results of Grounded Theory are often displayed through

the presentation of segments of text verbatim quotes from informants as exemplars of

concepts and theories." Also, visual mappings of the concepts and their connections

allow for a clear presentation of final results. Strauss and Corbin's approach seems most

relevant to the research design after considering the epistemological differences that exist

in the field of Grounded Theory. The next section will provide further detail into ways

their methodology will guide the analysis of this research project.

Application of Strauss and Corbin's Grounded Theory

While this study was not a formal exercise in grounded theory (Glaser and Strauss

1967), it did follow the grounded theory method in some important respect. The goal was

neither to test logically deduced hypotheses nor to provide statistical verification. This

study represents an exploratory investigation into the problem behavior of underage

drinking in Alachua County, with coalition members contributing their current working

knowledge of the issue as it related to their professional experience, and highlighting the

important themes that were necessary to address. Elements of Strauss and Corbin's

grounded theory were utilized to analyze this data and create an explanatory scheme of

PIPSA's approach to the community.

Because this study employs a grounded theory method, data analysis was

conducted simultaneously with data collection, with coding following individual focus

groups. The constant comparative method was used for data analysis which allowed for

comparing incidents and their categories (Strauss and Corbin 1998). This allowed for any









changes in coding to be made throughout the data collection periods, as new information

presented itself. The grounded theory method proposed by Strauss and Corbin (1998) was

used to guide the coding process. Final coding analyses were presented to the principal

investigator's committee members as a form of"inter-coder reliability", and to allow for

modifications in the interpretations of the data (Miles and Huberman 1994).

Open coding. The coding process involved three stages: open coding, axial coding

and selective coding. The goal of open coding was to capture emergent categories and

organize substantive themes that were found in the focus groups. These categories were

abstractions from the raw data and were initially relatively specific concepts that underlie

the concrete examples and experiences that made up the data. "They depict the problems,

issues, concerns, and matters that are important to those being studied" (Strauss and

Corbin 1998:114). The point at this stage was to distinguish between the possible themes

considering the possible relevance to theoretical frameworks. Open coding can take on

many forms. Strauss and Corbin suggest open coding may be done line-by-line,

paragraph-by-paragraph, or document-by-document. The important concept is to begin to

separate groups of data into more manageable pieces between units of analysis.

Axial coding. Axial coding occurred simultaneously with open coding and helped

to refine categories, revealing how they were associated with sub-categories. The various

dimensions and properties of a category were explored and detailed in this stage. Analytic

tools such as the flip-flop technique and the comparative technique of systematic

comparison were used to further refine categories. The flip-flop technique "indicates that

a concept is turned inside out or upside down to obtain different perspective on the event,

object, or action/interaction" (Strauss and Corbin 1998:94). In other words, the researcher









focuses on opposites and extremes to understand connections between different ways of

looking at the same topic. The systematic comparison means, "comparing an incident in

the data to one recalled from experience or from the literature" (Strauss and Corbin

1998:95). Theories discussed previously in the literature chapter were used to help

distinguish among coalition members' theoretical underpinnings and deconstruct their

thought processes.

Selective coding. Selective coding was used to identify core themes that were

consistent with the study's primary focus on coalition members' approach to reducing

underage drinking in Alachua County. Upon completion of all focus groups and all three

stages of coding, themes emerged that guided the principal investigator in developing a

theoretical framework of PIPSA's approach to the community, based on the raw data

(recorded words of coalition members) collected in the focus groups.

Limitations Of Study Design

A major limitation of the study is that some sectors are more represented than

others in the PIPSA coalition. The Youth Services sector is comprised of 19 coalition

members, while the religious sector has only 2 active members. This either suggests that

PIPSA considers some sectors as more important than others, or that participation in

some sectors is harder to achieve. This was looked at during the focus groups and will be

addressed in detail in the discussion section. Also, time constraints only allowed for one

focus group from each sector. More focus groups would have allowed the principal

investigator to revisit topics that needed more clarification. Since this was not feasible,

the data may be organized in ways that may not have been intended by the coalition

members. Detail will be provided in the results chapter regarding topics that coalition

members need to discuss at future coalition meetings, such as program process and









impact measurements and what newly suggested activities should be adopted by the

program. It is important to note that additional focus groups would have allowed more

discussions that most likely would have generated new suggestions.

As mentioned earlier, the qualitative design to this study suggests the constructivist

nature it follows. While this can be considered a major strength to the data gathered, it

can also be regarded as a major limitation of the results produced. Only emergent patterns

and themes, or those that are addressed in the focus groups, will be discussed. Patterns

that may seem more relevant but do not appear in the data will not be emphasized in this

study. Also, Krueger (1988) suggests predictive validity and generalizability, usual

sources of a study's strength, are not appropriate for this research design. While Krueger

(1988) maintains focus groups are generally thought to have high face validity,

researchers should be cautioned as to the results having predictive validity. Readers who

insist on the importance of a study having predictive validity and generalizability may

have difficulty seeing the inherent value in the data gathered with this approach.

This chapter offered the design in greater detail and drew attention to possible

ontological, epistemological, and methodological limitations of the study. The following

chapter outlines thematic patterns found throughout the focus groups after following

Strauss and Corbin's open, axial, and selective coding.














CHAPTER 5
RESULTS

This chapter outlines four broad patterns that emerged throughout the focus groups.

Participants tended to center conversation around the coalition's theory of change, the

culture of drinking in Alachua County, the difficulty in reaching community members,

and new strategies for decreasing underage drinking. These patterns will be discussed in

further detail in the following sections.

In terms of the results, "facts do not merely embody reality, but must be

interpreted" (Vega and Murphy 1990:146). The principal investigator interpreted these

results as indicated in previous sections, and patterns within topics were analyzed. As for

the presentation of the topics, Morgan (1997:63) explains:

There are three basic factors that influence how much emphasis a given topic
should receive: how many groups mentioned the topic, how many people within
each of these groups mentioned the topic, and how much energy and enthusiasm
the topic generated among the participants. The best evidence that a topic is worth
emphasizing comes from a combination of all three of these factors that is known
as "group-to-group validation.

These factors will be considered and results will be presented in order of coalition

emphasis in this section. Four broad thematic patterns were stressed by participants in the

focus groups.

Theory Of Change

There were variations in how coalition members described their approaches to

youth. Some viewed underage drinking as a natural act the youth was drawn to, while

others saw it as a learned behavior, drawing heavily on social learning theory. It was









suggested that it was "important to separate adults and children" to better target their

needs. Certain strategies influence adults and children differently at different points in

their lives. The prevalent feeling was that adolescence, and maybe even the pre-teen

years, is a critical point in an individual's life-course where alcohol should not be

available. The individual is at a point in their lives where s/he does not understand the

consequences of their behavior and how it may affect his or her future. In terms of

adolescents, coalition members felt that if programs were in place that changed their

social norms and provided activities substituting drinking, rates would decrease.

Some coalition members stated "altering consciousness is part of the human

experience" while some felt that drinking is "healthy in moderation," possibly at any age.

Others agreed, stating "sensation seeking is natural," and activities that satisfy this innate

need must be presented to the adolescent if drinking is to be avoided. Echoing this same

idea, one participant stated, "they have access to everything in their house while their

parents work", stressing the "need for summer programs" and suggesting that the

community currently has "inadequate resources to keep them busy." The use of churches

and youth groups were suggested as a way to "get the message out that fun can be

without substances". A natural "curiosity leads to use," with "drinking used as an

expression in us", "an expression of being free". An attitude of drinking as a "rite of

passage" was often stated. One participant stated a "genetic predisposition" guiding

behavior, stating that someone is "3 times more likely to become an addict if their parent

was an addict." Also, some coalition members faulted parents today "pushing kids faster

socially," stating not only a "human desire to mature faster," but a parental pressure as

well.









Mention was made in a few focus groups whether "repression breeds" a drinking

problem, with repression encouraging youth. Participants pointed to Europe as an

example of a healthy environment, unlike the United States, that does not enforce

consequences that repress youth for substance use. Others pointed out that it was a myth

that Europe does not have problems similar to the United States in regard to substance

use, and "consequences don't repress youth," but help guide them to healthy behaviors.

Europe's "great transportation system" was highlighted as being a factor contributing to

fewer alcohol-related accidents than the United States. Another participant stated

Poland's low acceptable Blood Alcohol Concentration (BAC) of .02 was a reason for

fewer alcohol-related incidents, stating "harsher consequences lead to awareness of

acceptable amounts of alcohol and more responsible drinking behavior." This theme of

consequences correcting deviant behavior was found often in focus groups.

Many coalition members emphasized the need for "consequences" and "strict"

enforcement of them. A "need to supervise juveniles" was mentioned as well as a "lack

of consequences" in our culture. Some suggested the enforcement of consequences as a

way to identify those in need to resources and treatment and educate them of the

problems related to underage drinking. Also, some participants emphasized the need to

get out the "dangerous message" of the "evils of' drinking suggesting its deviant nature.

One participant mentioned the need, although seemingly impossible, for a "curfew,"

stating "they need to know they don't have total freedom and liberty to do whatever."

Year-round schooling for adolescents was also suggested as a way to decrease free time

for adolescents and monitor them on a continuous basis.









Reasons for preventing underage drinking were varied throughout the focus groups

as well. A wide range of feelings were shared, with some coalition members suggesting it

was a moral duty to protect the community members, stating "Am I not my brother's

keeper"? Others seemed to highlight the financial benefit the community would receive

in protecting its members from underage drinking, with future incarceration and health

costs being lessened. Drawing on current research, it was suggested that funding go to

underage drinking programs since federal agencies "already know a certain percentage

will surely grow up to be alcoholics." Community members representing local businesses

originally faulted individuals for substance abuse problems, but have recently retracted

from this notion because of pressures from the University of Florida threatening to attack

marketing strategies employed by the owners. Alachua County business owners are

currently recognizing underage drinking as a community problem and have recently

developed the Gainesville Hospitality Group, which works to monitor responsible

business practices relating to the issue throughout the community.

Hints of Catalano and Hawkins' social learning theory were scattered throughout

the focus groups, with some participants stating the necessity for "rewards for those not

using" and the impact of the Hippodrome's HITT program, which "provides protective

factors" to youth in the form of a prevention program. Those suggesting a change in the

normative structure of underage drinking explained its lengthy process. The Stages of

Change Model, employed by health professionals of the University of Florida, states that,

"change happens gradually." This was discussed by coalition members representing the

education and health care sectors of PIPSA. "It is unrealistic to have one talk and make a

change," but you "need to develop skills." The Stages of Change Model teaches students









skills to be able to "approach in a nonjudgmental manner, to get the underlying meaning

regarding personal feelings" involving patients with substance abuse problems.

Culture Of Drinking In Alachua County

Many coalition members felt it very important to address the current attitude

surrounding drinking in Alachua County. A "more blatant attitude" regarding underage

drinking and a "not me attitude" regarding addiction further complicates the issue.

"Young people are more talkative about their behavior," almost proud of it. Also,

"younger people are declaring substance abuse issues."

With the message of drinking normalized on a continuous basis, through video

games, pharmaceutical advertisements, music lyrics, and television shows like the

Sopranos, mixed messages are sent to youth at risk. One participant talked of the reality

show where parents go back to college, stating how parents are practicing misuse of

alcohol because "the peer pressure is too great," even for them. Some emphasized the

"new parenting styles" that are contributing to this "privileged generation" that gets what

they ask for on a regular basis. Alcohol is readily available, and youth may take alcohol

from home to "pharming parties," where adults are not monitoring their children.

Alachua County is host to Gainesville's downtown scene, with its density of bars.

The leniency of local bars was mentioned repeatedly, with allowing "fake arm bands,"

"bouncers letting anyone in" and the fact that "there are just too many people" to monitor

on a consistent basis. Some suggested that "kids look and dress older" also, complicating

the job of "carding" underage youth. Many cited the "University's influence" and that

students feel "it's cool" when hanging from street lights (see Appendix B), never

realizing the influence this behavior may have on people witnessing it. The college

culture is advertised through these pictures. Some explained the university's "transient









population," hinting that college kids don't care about the town because they are only

here for a short while (see Appendix B). A few mentioned the City Commissioner's

recent DUI citation and the acceptability "skybox drinking" of notable community

members contributing to even more mixed messages regarding drinking.

It was stressed that you "rarely hear of people dying or suffering" from alcohol

abuse. Unlike the tobacco campaign, alcohol is not demonized but often glamorized, with

"ads equivalent to Joe Camel," marketing wine coolers as tasting like Kool-aid. Also, it

was suggested that beer is too cheap these days, allowing for easy access to minors.

Difficulties Reaching Community Members

Coalition members often pointed out some difficulties they have had in reaching

the community. "Apathy" from parents and youth, "transportation difficulties," and a

"chaperone shortage" make it difficult to plan activities. Also, increased emphasis on

FCAT scores makes it difficult to get into the schools to educate or encourage

participation in PIPSA activities. A basic "unawareness of what can be done together"

influences the degree of participation.

It was suggested that the public is not present at important events, like town hall

meetings. This might suggest poorly advertised events or possible status differentials,

which will be discussed in more detail later, do not encourage attendance rates. Ways to

address these issues should be looked into further by the coalition. Low attendance at

parenting classes may be a result of this as well. Targeting of these populations should be

done more effectively. A major problem affecting long-term treatment is the absence of

youth residential treatment centers in the area. This makes it difficult for them to receive

intensive, focused treatment away from the environment they are using in.









Strategies For Decreasing Underage Drinking

Mirroring current research, the PIPSA coalition places a strong emphasis on

education, family-based interventions, and community-college partnerships, since these

initiatives have been successful over the years. Funding sources encourage activities to be

scientifically-based strategies, further pressuring the coalition to advocate these strategies

as well.

The literature, as well as the coalition, suggests that education alone is not enough,

but it needs to be interactive. Youth are knowledgeable about drinking but need to feel

personal relevance if their behavior is to be affected. "Kids get bored hearing the same

thing every year." One coalition member explains she has students raise their hands,

"asking them who has drunk to the point of feeling sick?" She then tells those with their

hands up that they have poisoned their bodies.

The coalition also emphasized the need to impact youth through education, done in

a variety of ways. Examples such as Mock car crashes and impaired-vision goggles were

mentioned as being effective. It was stressed that these messages should be infused in all

classes, not just one health class, that the student may or may not remember. Also,

graduate health students from the University of Florida have explained the drawbacks of

drinking in other ways, such as the caloric content of alcohol and the expenses related to

its use. These "in your face consequences" are necessary for impact. The coalition

repeatedly stressed the importance of educating earlier age groups. One member

explained "patterns of behavior are established at a young age." Prevention programs

should be in place prior to these patterns of behavior becoming set in order to prevent

certain behaviors. Another coalition member explained underage drinking prevention

needs to be a "generational approach," with an entire cohort in a twelve year program,









not a 5-year program, which is currently done. "Prevention needs to start earlier," with

5th and 6th grade youth falling in the middle of the prevention efforts, not the beginning.

Family-based prevention has consistently been cited as effective in decreasing

underage drinking. Coalition members explained that in addition to starting early,

prevention needs to focus on children and families, building social norms and fostering

them throughout the life-course. An affiliate of the PIPSA coalition, The Corner Drug

Store, offers these family-based prevention programs. The coalition could work to create

a greater awareness of this resource. It was suggested that all people should research their

personal history and have the knowledge of what they may be predisposed to. The church

was suggested as a great resource for reaching families.

Throughout the focus groups coalition members pointed to the college and

community relationship. Several participants strongly felt that underage drinking was due

to the University's influence on the community. Recently the University's President has

put forth initiatives to decrease underage drinking in the community. Many coalition

members felt that the community could benefit from a stronger partnership with the

University in these efforts. A University Police Department representative on the

coalition was strongly recommended, to foster communication with the Gainesville

Police Department and maintain consistency throughout the community in relation to

enforcement practices. The University has made it a priority to present to neighborhood

associations in an effort to affect community attitudes towards the college community,

further encouraging a partnership. No mention was made regarding neighboring

community colleges, but these should be considered as well.






84


This chapter outlined themes coalition members stressed throughout the focus

groups. The following chapter will provide more specific activities and resources

coalition members addressed throughout the focus groups, as well as priorities the

coalition should note when attempting to monitor the process and impact of the program

for future evaluations.














CHAPTER 6
FORMATIVE EVALUATION

Considering the data gathered throughout the focus groups, the following chapter

outlines ten overall suggestions for improving program process and program impact, in

hopes of strengthening the coalition for future stages of evaluation. All of these

suggestions should be discussed at upcoming PIPSA meetings. PIPSA's main priority

should be to vote on what activities the program will continue to implement, considering

its new focus on underage drinking. They should consider and vote on new suggestions

raised in the focus group. Lastly, they should develop a comprehensive strategic plan,

with the help of a researcher, much like the example listed in Appendix F. This should

list every PIPSA activity, how the activity relates to decreasing underage drinking in

measurable terms, and what the coalition would consider a success or failure based on the

measured outcomes. The example in the Appendix is based on PIPSA's most recent goals

and should be revised once new goals have been declared by the coalition. At the end of

this chapter will be a summary of the overall suggestions offered in this formative

evaluation to PIPSA. They will be listed in order of priority, so attention should be paid

to each in the order they are suggested.

Suggestions For Evaluating PIPSA Process

Before future evaluations may be conducted with PIPSA, coalition members should

make it a priority to document its process, since it currently does not have any baseline

data to project goals from. In terms of process, it is necessary for PIPSA to document

every event and activity in terms of its content, attendance, and length. The coalition









should come to a consensus on what they consider "successful" from each event, after

baseline data have been collected. This should be monitored over the course of the

program to chart progress in terms of program implementation. Also, activity

announcement methods should be documented and analyzed after baseline data have

been collected to evaluate who was invited to the event, how they were told, and when

they were told. Over time, the coalition should be able to detect what methods work best

for Alachua County, making it a more tailored approach to the community it hopes to

address. These methods then may be used to increase participation at events. Some

examples of process measures can be found in the appendix in Appendix D.

Suggestions For Evaluating PIPSA Impact

Appropriate impact assessments should be made in addition to monitoring PIPSA's

process, to evaluate the performance or impact the program has on the community. Based

on data from the three national surveys on substance use, local school-based surveys

conducted by PIPSA, and relevant local statistics (arrest rates, DUI rates, and hospital in-

take rates for alcohol-related incidences), consensus within PIPSA should be reached in

regards to "success." Specific rates and percentages considered successful should be

declared yearly to have clear and manageable goals that monitor the progress of the

program. Some example impact measures can be found in Appendix E.

Suggestions For PIPSA Program Improvement

Suggestions, from both current research and feedback from coalition members, for

implementing these goals are provided in this formative evaluation. These range from

ways to implement the program to get better attendance to ways to get the coalition to

work together in a more collaborative way.









Implement Scientifically-Based Strategies

It is suggested that programs should not employ strategies previously proven

ineffective, like school-based initiatives mentioned earlier that are information-only, or

those using scare tactics about the dangers of alcohol. While most of the literature

relating to underage drinking suggests using scientific-based strategies that have been

proven effective, some researchers suggest not limiting strategies to this. Vega and

Murphy (1990:145) note:

Yet essential to the success of community-based interventions are novel plans.
Practitioners who are community-based should be innovative and willing to try
untested strategies. Gaining access to communities and creating sensitive
methodologies sometimes requires that unorthodox practices be adopted. Those
who are reluctant to take risks and explore novel suggestions-question the
prevailing status quo-will not likely be successful at this type of intervention.

This is worthy of note, since focus group participants created new strategies not

currently being used by PIPSA. With this in mind, hopefully these ideas will be

considered by the coalition as possible alternatives to decreasing underage drinking.

Improve PIPSA Attendance And Dialogue

Ways to improve attendance and dialogue at PIPSA events should also be

considered. Significant effort should be made in trying to reach underage youth. Most

likely there are community members that would attend activities and meetings if they

were aware of them and if it was convenient for them to get to. Vega and Murphy

(1990:134) note:

The time and location of board meetings are supposed to be advertised before these
sessions are convened. But most often this requirement has not been taken
seriously. One notice may be placed in a newspaper that is marginal to a
community's key sources of information. As a result, attendance at these gatherings
has been generally low, thereby indicating further to bureaucrats that community
members are not interested in public affairs. When those who are not employed by
an agency do attend, their presence has been given nominal attention. Surely the









status differentials that are visible at these meetings do not encourage citizens to
participate in discussions.

These status differentials that may present themselves at town hall meetings or

other PIPSA events are important to consider as well. Underage youth should be given a

voice at these events also. This may be done in panel discussions with community

members following a PIPSA event. Underage youth can offer valuable insight and further

participation if these status differentials are recognized and dealt with in a responsible

fashion.

Encourage Collaboration Within PIPSA

The "linking-pin strategy," as suggested by Vega and Murphy (1990) links

departments of an organization, or in this case sectors of a coalition, who were formerly

indirectly related and directly join them together. Since the PIPSA coalition is "project

driven," it could utilize this strategy in linking coalition members from varying sectors in

an attempt to merge different knowledge bases together. Coalition members mixing

together to coordinate activities provides the opportunity for different approaches to be

incorporated. PIPSA should not rely on just one sector to organize an activity.

Extend PIPSA Membership

The coalition emphasized its priority of extending membership to segments of the

community that are not currently involved, but should be included to strengthen the

coalition in number and resources. It is important to note that PIPSA has a large

membership, but is missing necessary segments of the population. As mentioned

previously, key leaders in the community can generate support and awareness for the

coalition.









Foster community-school partnerships

Community-college partnerships. The President of the University of Florida

should be invited to join the coalition. Key leaders like, President Bernie Machen would

bring great publicity and strength to PIPSA. In addition, collaboration with University of

Florida's new alcohol programs could prove beneficial to the coalition. Community

colleges in the area have large numbers of underage students. They should also be

represented in the coalition. An added benefit would be the possible use of their facilities.

Also, representatives from the University Police Department should be included in the

coalition to allow for communication with the Gainesville Police Department, in an effort

to maintain enforcement consistency across the community.

Elementary and middle school personnel. Requests to have school nurses join

the coalition was met with enthusiasm by coalition members. School nurses were

explained to have valuable insight into what happens to adolescents over the course of the

school day. In addition, they are in positions to educate adolescents about alcohol.

Having a few on the coalition could provide yet another perspective regarding underage

people's practices. Also, any other elementary and middle school personnel who could

contribute to the coalition should be invited to join.

Include business community

The PIPSA coalition has been unfunded for the past two years, relying on

donations to coordinate program activities. Including more community businesses could

result in more money for the coalition and better public relations. A few focus groups

suggested participation from the banking community, Shand's Hospital and Domino's

Pizza would benefit the coalition, as well as encouraging current coalition members to

invite their spouses, broadening the resource pool even more. As for the Gainesville









Hospitality Group, coalition members suggested speaking with them regarding the

training of bouncers to effective target underage drinking. They recently declared local

businesses involved in the group would make it a priority to train wait staff. A push to

train bouncers as well is strongly recommended since these employees may serve as a

buffer between underage youth and alcohol.

Involve media

Involving the media is a necessary step as well. The coalition currently has

members representing local news and print media. According to the literature, PIPSA's

affiliations with these members should be strengthened. Also, PIPSA receives discounted

prices for advertisements preceding movie trailers. This should be utilized for upcoming

events as much as possible, with donations from local businesses going towards this

resource.

Form youth advisory committee

The Youth Advisory Committee should be strengthened considering the coalition's

new focus. The "Truth campaign" is evidence of how effective youth can be in changing

norms relating to substances. Insight from the Youth Advisory Committee should provide

excellent feedback for ways to reach youth, and messages they need to hear if behavior

change is to occur long-term. The committee may be more productive if it is comprised

of students who participate in few extracurricular activities, to ensure they will be able to

hold meetings on a regular basis. Also, it may be more effective if it draws from pools of

youth who have histories of alcohol use, so they make speak from experience. Local

S.A.D.D. groups may offer assistance to the committee by offering suggestions for

getting youth involved and by participating in program activities to draw greater

community support.