Abstract of Distinction: Communities Mobilizing for Change on Alcohol (CMCA): Effects of Direct Action Community Organizing on Alcohol Sales to Youth in the Cherokee Nation

Introduction:

Commercial access to alcohol among youth continues to be a public health problem in rural communities (Landsman et al, 2016). Given that alcohol sales to those under the age of 21 is illegal nationwide, sales of alcohol to teens is clearly preventable. Direct-action community organizing, documented as effective in multiple previous trials, is a promising intervention to reduce commercial access to alcohol among youth by galvanizing community support for increased enforcement of minimum legal drinking age laws. We present results from the Prevention Trial in the Cherokee Nation, a randomized community trial which confirms the effectiveness of the direct-action community organizing intervention known as CMCA--Communities Mobilizing for Change on Alcohol.

Methods:

We evaluated commercial access to alcohol by underage-appearing female confederates in 5 rural communities within the jurisdictional service boundaries of the Cherokee Nation. Three communities were randomly assigned the CMCA intervention, with two communities as controls. Alcohol purchase attempts were made on average every four weeks at every off-premise alcohol retail outlet within a 20 minute drive-time from each town center, for a total of 3,447 alcohol purchase attempts in 31 repeated observations over a 29 month period. Confederates were required to be at least 21 years of age but judged to look under 20 years of age by panels of 10-20 community members.

We estimated changes in the probability of an alcohol purchase over time using a linear binomial mixed model. All models accounted for baseline differences in alcohol purchase completion rates, store type, and seller/clerk age. Additionally, we calculated per store rates of alcohol purchase completion.

Results:

Over 31 repeated purchase attempts, only 6% of stores never sold alcohol to the young-appearing confederates; 83% of stores sold less than half the time, and 11% of stores sold at more than half of the attempts. We found statistically significant differences in the change in probability of a completed alcohol purchase attempt over time in our CMCA communities relative to control communities (t=-3.46, p<0.001). Retail outlets within CMCA intervention communities had a reduction in the probability of an alcohol purchase of 0.61% per wave relative to outlets within the control communities, resulting in an overall 55% reduction (19% percentage-points) in completed alcohol purchases in CMCA affected outlets relative to outlets in the control communities.

Conclusion:

Results show that CMCA is an effective intervention leading to sizable reductions in alcohol outlets’ sales to youth.