Communities Mobilizing for Change on Alcohol (CMCA): Implementation within the Cherokee Nation

Introduction: As progress has been made in attenuating commercial access of alcohol to teens (though much remains to be done in most communities), the role of informal social sources is gaining increased attention. Significant challenges remain in understanding how best to reduce availability of alcohol through social sources, particularly from (often slightly older) peers. Importantly, progress has been less in environments characterized by high alcohol use, other risk factors, and socioeconomic disadvantage. Direct-action community organizing, documented as effective in multiple previous trials, was used to address community identified issues related to alcohol use and access to alcohol among youth.

Methods: The Communities Mobilizing for Change on Alcohol (CMCA) model was developed using traditional community organizing tactics targeting underage access to alcohol. Rather than directing preventive interventions toward young people, CMCA organizes the adults in the community to take actions to reduce youth social and commercial access to alcohol. Community organizers were citizens hired from within the communities in which they served. They developed relationships with other everyday citizens in their community, formed local Action Teams, and implemented evidenced-based actions related to implementation and enforcement of existing laws. Organizers additionally provided technical assistance to the Action Teams so they—the community members—could leverage their collective resources and educate their communities about new strategies, policies and procedures to protect minors from underage alcohol access. Weekly, each community organizer documented one-on-ones, action team meetings, and action team actions and outcomes using a standardized web-based information management system.

Results: The process of making contact with community members and conducting one-on-ones was a large and important undertaking in each community with between 137 and 310 one-on-ones conducted by the CMCA organizers during the first few months of organizing. Based on the one-on-ones, each organizer successfully developed a core group of active community members (e.g., the Action Team) in addition to identifying larger groups of supporters within the community. Overall, the Action Teams conducted 193 actions (e.g., donating breathalyzers to local law enforcement, increasing compliance checks of alcohol outlets) resulting in outcomes such as increased enforcement, changed police procedures, and reduced social access to alcohol through parental interventions.

Conclusions: Direct-action community organizing is an effective strategy to advance evidence-based community policies and practices aimed at preventing alcohol use among adolescents.