When alcohol, marijuana, and other drugs are more available in a community, youth are at higher risk of substance use and violence. If youth think that substances could be easy to access, the risk increases for substance use and violence.
Community norms are shaped by social values, beliefs, attitudes, and behaviors held by members of the community. When community norms are favorable toward substance use, the risk increases for substance use, violence, and delinquency.
Research on substance use across the lifespan shows that federal, state, and community-level policies that address the price, place, and promotion of substances can result in positive benefits including a reduction in general use and related harms. Such policies specifically target and reduce youth substance use by addressing two risk factors: the availability of substances in the community and community norms favorable to substance use.,,
Many of the suggested activities presented below are grounded in research involving youth tobacco, alcohol, and prescription use, however it is important to note that the same activities may be effective in reducing youth marijuana use. There is a growing body of research on what works to reduce youth consumption of marijuana products. It is recommended that the evidence on alcohol and tobacco prevention efforts guide efforts targeting youth marijuana use.
Understand the severity of substance use in your community. In order to select the best implementation activities for your community, you first need to understand youth use of substances within your community. Collecting and analyzing data on youth substance use will help you select targeted activities that will address the current needs within your community. To guide these efforts, communities should ensure they are using an effective assessment process that identifies relevant data, as well as indicates resources and gaps within their communities.
Resources:
Colorado communities should use Healthy Kids Colorado Survey (HKCS) data, which can be accessed via the HKCS Interactive Data Dashboard, as well as the CDPHE Community Health Equity Map.
The Colorado Consortium for Prescription Drug Abuse Prevention maintains a listing of various data dashboards which provide data on mortality, emergency department visits, treatment admissions for substance abuse, etc. at the county or region level.
The Colorado Consortium for Prescription Drug Abuse Prevention also created the Prescription Drug Abuse Prevention: A Colorado Community Reference as a resource and reference guide for communities and organizations working to address prescription drug use in Colorado. It contains information and resources that can help guide local efforts.
Analyze existing policies that impact the availability and price of substances in your community, as well as those that impact community norms surrounding substance use. Many of the evidence-based implementation activities outlined below first require an understanding of what ordinances, regulations, and requirements currently exist for establishments selling or promoting substances in your community.
Resources:
Local Policy Scan - Contact Policy Technical Assistance for support with reviewing municipal code in your communities (pscnetwork@cuanschutz.edu)
Identify and connect with other organizations and individuals working or interested in this area, as well as those that hold decision-making power. Working with other organizations and/or individuals is the best way to maximize your coalition’s power and allows for a greater influence. Before selecting implementation activities, your coalition should take time to understand who is already working in this space, who has power to influence decision making, and what efforts are already underway. Reaching out to these organizations and individuals can help you form partnerships and learn from current and/or previous systems-level work in this area.
Resources:
The National Academy of Community Organizers offers A Guide to Power Analysis in Community Organizing, which can help coalitions understand where power sits within a community around a particular issue.
Understand the inequities that are related to this strategy and consider the systemic and structural causes of disparities. By understanding the factors that contribute to this strategy, your coalition will be better able to identify the action that needs to be taken. Additionally, new and/or existing policies and systems-level approaches have the potential to exacerbate existing inequities, making it important for your coalition to critically examine your action plan for signs of negative consequences.
Resources:
As a part of their ‘Five Building Blocks for Racial Equity’, the Race Matters Institute of JustPartners, Inc. offers a free guide on conducting
a Racial Equity Backmap, which helps groups and individuals consider and identify the various drivers of a given inequity.
Consider using an Equity Impact Assessment to better explore and understand such consequences. Both the Center for the Study of Social Policy and Race Forward offer free resources.
The Government Alliance on Race and Equity offers Racial Equity Toolkit An Opportunity to Operationalize Equity.
The Public Health Institute offers several resources on the Principles for a Public Health & Equity Approach to Marijuana Regulation.
It is important to note that the uniqueness of your community, its resources, and its needs will ultimately determine what implementation of this strategy will look like. Additionally, it is important for your coalition to approach this strategy in a way that is aligned with your overarching goal(s).The list below offers suggestions and ideas of evidence-informed actions your coalition can consider taking as part of your implementation of this strategy.
Influencing Outlet Density
Foundation Building Activities:
Analyze existing policies that impact the availability and price of substances in your community, as well as those that impact community norms surrounding substance use. Many of the evidence-based implementation activities outlined below first require an understanding of what ordinances, regulations, and requirements currently exist for establishments selling or promoting substances in your community.
Resources:
Local Policy Scan - Contact Policy Technical Assistance for support with reviewing municipal code in your communities (pscnetwork@cuanschutz.edu)
Measure and understand your community’s substance outlet density. Information about substance outlet density can be used to guide the development of new regulations that limit the availability of substances in communities and/or to understand the relationship between exposure to substance retail locations and specific outcomes (e.g., interpersonal violence, property damage).
Resources:
Colorado Department of Public Health and Environment: Colorado-Focused Alcohol Outlet Density Story Map.
The CDC also has Measuring Alcohol Outlet Density: A Toolkit for State and Local Surveillance for communities that are ready to use outlet density indicators for surveillance.
Colorado coalitions can use the the Tobacco Retail Access Colorado (TRAC) system to specifically identify tobacco sale outlets in their community.
Policy Activities:
Strengthen local licensing, density and zoning regulations to impact youth use and access: restricting the number and location of establishments selling and promoting substances. Laws that limit the number and location of businesses that can sell, serve, or promote substances have been shown to reduce consumption and decrease related harms.
Resources:
PSCN Density + Proximity Fact Sheet for an overview of approaches
Use the Licensing & Zoning: Local Tools for Managing Alcohol Outlet Density in Colorado to understand alcohol licensing and zoning in Colorado.
The Tobacco Retailer Licensing Playbook offers guidance to develop, implement, and enforce tobacco retailer licensing policies.
This resource from Counter Tobacco discusses licensing and zoning impacts on tobacco retailer density.
To learn more about the relationship between retailer density and health equity, access this resource from The Ohio State University.
Coloradans can access the marijuana Hospitality Establishments in Colorado resource to better understand recent legislative changes and opportunities to protect community health.
Substance Availability
Caution: Policies that involve individual approaches such as penalties and fines can have inequitable applications and consequences. If considering policy interventions such as social host or other policies that penalize individuals vs. interventions at the system level, conduct an Unintended Consequences Analysis before proceeding with care.
Resources:
Unintended Consequences Analysis - Jefferson County’s (Jeffco) CTC coalition has conducted an unintended consequence analysis as a part of their policy change work. Some of the resources linked below are specific to Jeffco CTC and would need to be created for a different coalition.
Unintended Consequences of Policy Changes Assessment Process Tool is a great place to start when looking at what the process looks like to conduct this type of analysis.
The Individual Reflection document includes an in-depth look at what questions could be reflected on and discussed as a part of this analysis.
The Action Steps document is a planning tool that can be used during this analysis to start action planning around unintended consequences.
Policy Activities:
Social host ordinances can reduce alcohol use among youth. Social host ordinances target the locations in which underage consumption may take place by holding private individuals responsible for underage drinking events on property they own or lease. Such ordinances emphasize that allowing and enabling underage drinking is unacceptable, and reinforce community norms against youth substance abuse.
Resources:
The National Institute on Alcohol Abuse and Alcoholism’s Alcohol Policy Information System provides an overview of social host ordinances and compiles research supporting their effectiveness.
Commercial host liability or “dram shop liability” can reduce alcohol use among youth. Dram shop liability holds alcohol retailers (e.g., owner of a bar or liquor store) legally liable for any harm resulting from service to underage customers. These laws have been linked to reductions in youth alcohol abuse and related harms.
Resources:
Learn more about dram shop liability laws here.
Strengthen local licensing provisions by implementing responsible vendor practices through vendor education.
Resources:
The Colorado Marijuana Enforcement Division (MED) and Colorado Department of Public Health and Environment’s (CDPHE) certified Responsible Vendor Training is TenderWise. This class educates marijuana industry employees on Colorado marijuana laws, policies, and procedures and promotes responsible retail practices, public health principles, and reducing youth access. These trainings are provided by local chapters of the Responsible Association of Retailers (RAR).
The Colorado MED maintains a list of approved Responsible Vendor Training Program providers throughout the state.
Access and Exposure to Substances for Both Community and Youth
Policy Activities:
Strengthen place-based policies to prevent public substance use where youth may be exposed to the behavior(s). The modeling of substance use by adults can increase the likelihood that young people participate in the same behavior(s), so strengthening policies to reduce the likelihood youth will be exposed to substance use can reduce their use. Common examples of this are “smoke-free” policies for tobacco (e.g., Smoke-Free Housing, Smoke-Free Parks), however similar policies for other substances can be reviewed, developed, and/or strengthened.
Resources:
Learn more about the benefits of smoke-free policies here.
In Colorado, municipalities are responsible for defining “smoke-free housing” and “open and public smoking” in their marijuana ordinances. CDPHE’s resource, Effective Policies & Programs to Restrict Youth Access & Exposure to Drugs/Alcohol: Applications for Marijuana, covers smoke-free policies that are proven effective for tobacco that can also be used to reduce youth access to marijuana.
Additionally, CDPHE’s Colorado Retail Marijuana: Education & Prevention Resource Guide contains a case study on how Ouray County Schools Community Resource Consortium worked with the Mayor of Ridgway to reduce public use of marijuana at family events.
Educate stakeholders on how developing and maintaining limitations on the days and hours of sales can reduce substance use. Research shows that limitations on the days and hours of substance sales can reduce alcohol use in communities, as well as reduce related harms.
Resources:
A common example of this are bans on off-premises Sunday sales for alcohol, which is discussed in depth here.
Program Activities:
Expand and promote permanent medication and vape product take back sites. Medication take back sites can reduce community access to prescription drugs and reduce their non-medical use. Additionally, these sites can be used to also promote community disposal of vaping products, other for tobacco and THC.
Resources:
Colorado communities can locate current disposal locations and options in your community using The Colorado Consortium for Prescription Drug Abuse Prevention’s safe disposal resource.
For more information on establishing a vape disposal program locally, visit the Public Health Law Center’s disposing of e-cigarette waste resource for schools and other institutions.
Promote safe prescribing practices among local healthcare workers. Since prescription drugs are not distributed in retail settings, the healthcare workers that prescribe them are an important stakeholder in combating prescription drug use. Research shows that safe prescribing behaviors can reduce use by limiting the availability of prescription drugs in a community. To encourage safe prescribing behaviors, coalitions should help disseminate research-informed guidelines among their local healthcare community.
Resources:
Read about the CDC’s Opioid Prescribing Guidelines for 2022 to understand how to reduce unsafe prescribing practices.
The CDC offers additional resources on overdose prevention for health care providers including training and toolkits here.
Note: Often activities within price and promotion can influence each other.
Advertising and Marketing
Policy Activity:
Restrict marketing tactics and merchandising for alcohol, tobacco, and marijuana. Reducing the likelihood that youth will be exposed to product marketing can result in decreases in youth substance use. Restrictions can include bans on substance marketing at family and youth-focused events, as well as restrictions on on point of sale (POS) advertising and promotions. POS advertising and promotions can include advertisements displayed on the interior and exterior of retail stores, coupons, and placement of products in specific store locations. These tactics encourage use, and can increase the chances that youth will begin using substances.
Resources:
CDPHE’s Colorado Retail Marijuana: Education & Prevention Resource Guide discusses FAQs regarding the advertisement of marijuana products.
Policy Activities:
Increase the price of substances to reduce underage initiation and use of substances. Public policies at the federal, state, and local level that increase the purchase price per unit of sale of substances such as tobacco, marijuana, and alcohol include increasing excise taxes on these products and/or instituting higher taxes at the point of sale.
Resources:
The Community Guide outlines interventions to increase the unit price for tobacco products.
Dedicate sales tax funds to local prevention efforts. In Colorado local jurisdictions may choose to levy additional taxes on substances, such as marijuana, if they are sold in the community. Delegation of these so-called “sin taxes,” can support youth substance abuse prevention and treatment efforts. Fees for licensing of outlets can also be applied to youth prevention programs.It’s important that the funding that comes from the increased taxes of substances should be funneled into specific programs that further decrease the use of those substances.
Resources:
CDPHE’s Colorado Retail Marijuana: Education & Prevention Resource Guide contains a case study on Boulder County Public Health’s efforts to create a local tax proposal on marijuana products to reduce use and create a revenue stream to fund local youth substance abuse prevention activities.
The Public Health Institute provides a Model Local Ordinance for Marijuana Taxation in California as a resource.
Conduct a retail scan in the community to understand emerging and popular products.
Resources
APRC Environmental Scan Toolkit - This toolkit outlines considerations for conducting community environmental scans. Environmental scanning aims to identify your community’s risk factors that can contribute to underage or excessive alcohol consumption. From that picture, you can then identify strategies to reduce underage and excessive use of alcohol.
This could also include visiting stores in the community to get a feel for what products are sold, what is popular, and understand the layout of different product retail environments (e.g. dispensaries or liquor stores).
Policy Activities:
Address In-store access and exposure to substances through product placement. Limit where products can be placed in stores, or limit substance product displays to adult-only stores or to adult-only portions of the store to address product normalization and access. Product placement is a key factor in how products are sold. You’ll notice that in general attractive and highly visible product placement generates more sales. For example, alcohol is sometimes placed below three feet from the floor which is generally seen as marketing to youth. Sometimes products are next to toys or candy – again, items that are highly attractive to youth.
Resources:
CounterTobacco provides more information on Restricting Product Placement.
Ban products that appeal to youth. Example: flavored Tobacco Product Restrictions. Prohibit the sale of flavored tobacco products locally - all products, all places, all flavors.
Resource:
The Campaign for Tobacco Free Kids on Ending the Sale of Flavored Tobacco Products has more information on this policy approach.
Read about Colorado communities that have implemented this strategy here.