Literature Reviews: Effectiveness of Environmental Strategies on the Prevention of Prescription Drug, Marijuana, Alcohol and Tobacco Use

Literature Reviews:  Effectiveness of Environmental Strategies on the Prevention of Prescription Drug, Marijuana, Alcohol and Tobacco Use

The Full Document in .PDF Form may be downloaded at the bottom of this page.

Prepared by:

Wake Forest School of Medicine
Kimberly Wagoner, DrPH, MPH
Melinda Pankratz, PhD
Mark Wolfson, PhD

East Carolina University
Kathleen Egan, PhD

Global Evaluation Solutions
William Geary, PhD
Andrea de la Flor, MA

INTRODUCTION
Environmentally focused prevention strategies shift the focus on solving substance use-related problems from the individual to the settings in which the substance is used or obtained. These approaches have the capacity to change attitudes, behaviors, community norms, and consequences.

In an effort to assist the North Carolina Department of Health and Human Services, Division of Mental Health, Developmental Disabilities and Substance Abuse Services in identifying effective and/or promising environmental strategies to support in future initiatives, we conducted literature reviews to assess the evidence for environmental strategy implementation for four substances: prescription drugs, marijuana, alcohol, and tobacco. Findings from literature reviews can be extremely valuable for informing practice because they assess the body of research on a specific topic instead of focusing the outcomes of one or two single studies. We hope that the findings presented in this document provide valuable and timely information to inform future prevention efforts across the state of North Carolina.

METHODS
We conducted separate literature searches for each substance using PubMed. The focus of the literature reviews was limited to primary prevention outcomes; therefore, harm reduction strategies were not included in these reviews. Due to the existing evidence for the effectiveness of environmental strategies on alcohol and tobacco use, the searches used existing documents as the foundation for the review and conducted searches of peer-reviewed articles from 2008 to present to update the existing evidence (please see the sections of Alcohol and Tobacco for more information on the search details). Because no such documentation existed for prescription drugs or illicit drugs, a more extensive search was conducted of peer-reviewed articles from 2000 to present. Search terms were identified for each literature review and exclusion criteria were applied to identify the articles for the final list of articles. Specifically, articles were included if they 1) described the strategy used; 2) identified output measures to evaluate the strategy; 3) evaluated the effectiveness of the strategy at reducing substance use; and 4) used a strategy that could be implemented or supported by prevention providers in North Carolina. More detail about each literature review is included in the respective section.

Each article included was reviewed to abstract the following information:

• Title, authors, date published
• Type of literature reviewed
• Brief description
• Study design
• Sample size
• Strategy used (Availability; Price; Marketing/Advertising, Mass Communication Campaigns; Other)
• Population studied
• Standardization of Intervention
• Dose measurements
• Use of reliable and valid instruments
• Setting
• Replication study
• Outcomes and findings 

After the reviews were completed, the team completed a collective review of the evidence for each substance, using the abstracted data (listed above). We adapted the North Carolina Practice Improvement Collaborative’s (PIC) Application for an Evidence Based Practice Review to develop a matrix of Levels of Evidence (see Table 1). Using the operational criteria definitions listed on page 3, the team determined if the strategy was 1) evidenced-based; 2) promising; or an 3) insufficient / non evidence-based practice.