CMCA: Communities Mobilizing for Change on Alcohol

About This Program

Target Population: Structures, institutions, and existing leaders in communities that desire to reduce underage drinking by youth who are 13-20 years of age

For organizations that serve children ages: 13 – 20

Program Overview

CMCA is a community-organizing intervention designed to reduce teens' access to alcohol by changing community policies and practices. CMCA seeks both to limit youths' access to alcohol and to communicate a clear message by the community that underage drinking is inappropriate and unacceptable. CMCA employs a specified process of community-organizing to address legal, institutional, and local cultural practices that facilitate underage drinking.

Program Goals

The goals of CMCA: Communities Mobilizing for Change on Alcohol are:

  • Reduce illegal commercial sales of alcoholic beverages to teens
  • Reduce noncommercial, social sources of alcohol to teens
  • Reduce structural and cultural community tolerance/acceptance of drinking by teens
  • Reduce drinking by teens

Essential Components

The essential components of CMCA: Communities Mobilizing for Change on Alcohol include:

  • CMCA involves and activates community citizens in seeking and achieving changes in local public policies and the practices of community institutions that affect youth access to alcohol.
  • Over a 3-or-more-year intervention period, CMCA follows a structured implementation process. Starting with a hundred or more one-on-one conversations, trained community organizers develop relationships with local citizens and form local citizen-led Action Teams.
  • Citizen-led Action Teams then initiate activities from a wide range of options, focusing on reducing youth access to alcohol from both commercial and social sources.
  • Organizers provide technical assistance to the Action Teams and help community members use resources and educate their communities.
  • CMCA does not follow a coalition model where efforts are focused on building a coalition of organizations, with representatives of those organizations forming the core group. In contrast, CMCA uses community organizing methods to activate local citizens to pressure local structures, institutions, and leaders to enforce the law, prevent youth alcohol access, and ensure a healthy and safe community for youth.
  • CMCA is based on research that has demonstrated the importance of the social and policy environment in facilitating or impeding drinking among youth.
  • CMCA’s community-organizing methods draw on a range of organizing traditions.
  • CMCA is not a service delivery program; it is a primary prevention community-organizing intervention that targets:
    • Structures and institutions (for example city, county, and other law enforcement agencies; commercial retail establishments, various city and county government departments; school systems, church/synagogue/mosque hierarchies and organizations)
    • Existing manifest community-level leaders (for example school principals, school district superintendents, mayors, city and county councilors, public sector department heads, sheriffs, police chiefs, prosecutors, judges, CEOs of local businesses, pastors/priests/imams, directors and heads of non-profit organizations)
    • People who perpetuate community-level norms and practices that tolerate or facilitate teen drinking

Program Delivery

Recommended Intensity:

Since the message it delivered by the community organizer and the Action Team, there is not a consistent number of times per week or month that the community hears the message of the program.

Recommended Duration:

Minimum of 3 years is necessary, and duration of 5 years is strongly recommended to achieve institutionalization of changes in community policies, procedures and practices.

Delivery Setting

This program is typically conducted in a(n):

  • Community Daily Living Setting

Homework

This program does not include a homework component.

Resources Needed to Run Program

The typical resources for implementing the program are:

Each organizer/Action Team needs a smartphone, a laptop computer and a modest expense budget of, say, $200/month for mileage, meals/snacks for one-on-one or group meetings, photocopying/printing, etc. Most organizers work “on the move” in the community, and do not require office space. Some meeting spaces are needed (usually at libraries, schools, community centers, etc.) It is important that each Action Team remain independent of existing agencies, so they have the freedom of citizen action to address power structures in the community that contribute to the acceptance of underage drinking.

Education and Training

Prerequisite/Minimum Provider Qualifications

The community organizers need training, experience, and continual “coaching” supervision/support. There is no set educational degree required—more important are organizing skills and qualities such as passion for the issue, spoken communication skills, extroversion, courage, careful strategic focus on a string of specific actions that logically build one on the next. The organizer then mentors the citizen Action Team members in those same skills.

Education and Training Resources

There is a manual that describes how to implement this program , and there is training available for this program.

Kennedy, K., Pettigrew, D., Komro, K., and Wagenaar, A. Communities Mobilizing for Change on Alcohol: A Guide for Implementation.

Training Contact:
  • Leah Barrett
    yli.org/training-consulting-services/communities-mobilizing-for-change-cmca-training/

    phone: (707) 714-1790
Training is obtained:

Trainings can take place in various locations and are negotiated with the Youth Leadership Institute based on the requester’s needs, resources, etc.

Number of days/hours:

Varying durations, typically 2 days or 6 days. Follow-up technical assistance is also available.

Implementation Information

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for CMCA: Communities Mobilizing for Change on Alcohol.

Formal Support for Implementation

There is formal support available for implementation of CMCA: Communities Mobilizing for Change on Alcohol as listed below:

Follow-up technical assistance is negotiated with the Youth Leadership Institute based on the requester’s needs, resources, etc. The training is recommended but not required, and focuses on intervention implementation, including intervention implementation monitoring, but not on effectiveness evaluation.

Fidelity Measures

There are no fidelity measures for CMCA: Communities Mobilizing for Change on Alcohol.

Implementation Guides or Manuals

There are implementation guides or manuals for CMCA: Communities Mobilizing for Change on Alcohol as listed below:

28-page guide for implementation:

Kennedy, K., Pettigrew, D., Komro, K., & Wagenaar, A. Communities Mobilizing for Change on Alcohol: A guide for implementation. http://web1.sph.emory.edu/eprc/docs/CMCA%20Handbook%2003-02-17.pdf

Research on How to Implement the Program

Research has not been conducted on how to implement CMCA: Communities Mobilizing for Change on Alcohol.

Relevant Published, Peer-Reviewed Research

Child Welfare Outcome: Child/Family Well-Being

Wagenaar, A. C., Gehan, J. P., Jones-Webb, R., Toomey, T. L., & Forster, J. L. (1999). Communities Mobilizing for Change on Alcohol: Lessons and results from a 15-community randomized trial. Journal of Community Psychology, 27(3), 315-326. doi:10.1002/(SICI)1520-6629(199905)27:33.0.CO;2-1

Type of Study: Randomized controlled trial
Number of Participants: Mean population of the study communities=20,836 (Range=8,029-64,797)

Population:

  • Age — 15-20 years
  • Race/Ethnicity — Not apecified
  • Gender — Not apecified
  • Status — Participants were 9thand 12th grade students and 18-20 year olds.

Location/Institution: 15 school districts in Minnesota and Wisconsin

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study aims to test the efficacy of Communities Mobilizing for Change on Alcohol (CMCA) [now called CMCA: Communities Mobilizing for Change on Alcohol] designed to reduce the accessibility of alcoholic beverages to youths under the legal drinking age. Seven communities were randomized to receive the community organizing Intervention (CMCA) and the remaining eight were assigned to the control group. Measures utilized include school surveys and surveys of alcohol outlet owners and managers. Results indicate that the CMCA project successfully mobilized randomly selected communities, initiated a number of changes in institutional policies and practices, improved the sales practices of alcohol merchants, and significantly changed the behavior of 18- to 20-year-olds in the communities. Limitations include prevalence of traffic crashes among teenagers is low when looking at community-specific counts, the short 2.5-year intervention period, and evidence of some spill-over of intervention activities from intervention communities to other communities in the upper Midwest region, including control communities.

Length of postintervention follow-up: None.

Wagenaar, A. C., Murray, D. M., Gehan, J. P., Wolfson, M., Forster, J. L., Toomey, T. L., … Jones-Webb, R. (2000). Communities Mobilizing for Change on Alcohol: Outcomes from a randomized community trial. Journal of Study of Alcohol, 61, 85–94. doi:10.15288/jsa.2000.61.85

Type of Study: Randomized controlled trial (secondary data analysis)
Number of Participants: Mean population of the study communities=20,836 (Range=8,029-64,797)

Population:

  • Age — 15-21 years
  • Race/Ethnicity — Not specified
  • Gender — Not specified
  • Status — Participants were 9thand 12th grade students and 18-20 year olds.

Location/Institution: 15 school districts in Minnesota and Wisconsin

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study utilizes the same sample as Wagenaar, Gehan, Jones-Webb, Toomey, & Forster (1999). This study aims to test the efficacy of Communities Mobilizing for Change on Alcohol (CMCA) [now called CMCA: Communities Mobilizing for Change on Alcohol] designed to reduce the accessibility of alcoholic beverages to youths under the legal drinking age. Seven communities were randomized to receive the community organizing Intervention and the remaining eight were assigned to the control group. Measures utilized include school surveys and surveys of alcohol outlet owners and managers. Results indicate that the CMCA intervention significantly and favorably affected both the behavior of 18- to 20-year-olds and the practices of on-sale alcohol establishments, may have favorably affected the practices of off-sale alcohol establishments, but had little effect on younger adolescents. Limitations include prevalence of traffic crashes among teenagers is low when looking at community-specific counts, the short 2.5-year intervention period, and evidence of some spill-over of intervention activities from intervention communities to other communities in the upper Midwest region, including control communities.

Length of postintervention follow-up: None.

Wagenaar, A. C., Murray, D. M., & Toomey, T. L. (2000). Communities Mobilizing for Change on Alcohol (CMCA): Effects of a randomized trial on arrests and traffic crashes. Addiction, 95(2), 209–217. doi:10.1046/j.1360-0443.2000.9522097.x

Type of Study: Randomized controlled trial (secondary data analysis)
Number of Participants: Mean population of the study communities=20,836 (Range=8,029-64,797)

Population:

  • Age — 15-21 years
  • Race/Ethnicity — Not specified
  • Gender — Not specified
  • Status — Participants were 9th and 12th grade students and 18-20 year olds.

Location/Institution: 15 school districts in Minnesota and Wisconsin

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study uses participants from Wagenaar et al. (1999). This study aims to test the efficacy of Communities Mobilizing for Change on Alcohol (CMCA) [now called CMCA: Communities Mobilizing for Change on Alcohol] on arrests and car crashes. Seven communities were randomized to receive the community organizing intervention and the remaining eight were assigned to the control group. Measures utilized administrative data of the annual arrest counts for the specific intervention and control cities in the study were obtained from the Minnesota Department of Public Safety and the Wisconsin Office of Justice Assistance. Results indicate overall net declines in the intervention communities for all arrest and traffic crash indicators. The decline was statistically significant for DUI arrests among 18- to 20-year-olds and approached significance for DUI arrests and disorderly conduct violations among 15- to 17-year-olds. Limitations include prevalence of traffic crashes among teenagers is low when looking at community-specific counts, the short 2.5-year intervention period, and evidence of some spillover of intervention activities from intervention communities to other communities in the upper Midwest region, including control communities.

Length of postintervention follow-up: None.

Komro, K. A., Livingston, M. D., Wagenaar, A. C., Kominsky, T. K., Pettigrew, D. W., Garrett, B. A., & The Cherokee Nation Prevention Trial Team. (2017). Multilevel prevention trial of alcohol use among American Indian and white high school students in the Cherokee Nation. American Journal of Public Health, 107(3), 1-32. doi:10.2105/AJPH.2016.303603

Type of Study: Randomized controlled trial
Number of Participants: 1,623

Population:

  • Age — 14-15 years
  • Race/Ethnicity — 43.5% White, 21.5% American Indian and White, 24.5% American Indian; 1.8% American Indian and Other, and 8.3% Other
  • Gender — 49% Female
  • Status — Participants were students in 9th-12th grades.

Location/Institution: 14-county jurisdictional service area of the Cherokee Nation in Oklahoma

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The purpose of this study was to evaluate the effectiveness of Communities Mobilizing for Change on Alcohol (CMCA) [now called CMCA: Communities Mobilizing for Change on Alcohol] and CONNECT to prevent underage alcohol use among youths living in the Cherokee Nation. Six communities were randomly assigned to a control, CMCA, CONNECT, or a combined condition. Measures utilized include the Youth Risk Behavior Surveillance System. Results indicate students exposed to CMCA, CONNECT, and the combined condition showed a significant reduction in the probability over time of 30-day alcohol use and heavy episodic drinking compared with students in the control condition, with variation in magnitude of effects over the 2.5-year intervention period. Limitations include small number of communities, only used 4 of the 6 communities that were randomized, could not blind school leadership to study condition, outcomes were on the basis of student self-report, and lack of follow-up.

Length of postintervention follow-up: None.

Livingston, M. D., Komro, K. A., Wagenaar, A. C., Kominsky, T. K., Pettigrew, D. W. & Garrett, B. A. (2018). Effects of alcohol interventions on other drug use in the Cherokee Nation. American Journal of Public Health, 108 (2), 259-261. doi:10.2105/AJPH.2017.304188

Type of Study: Randomized controlled trial
Number of Participants: 1,623 (secondary data analysis)

Population:

  • Age — 14-15 years
  • Race/Ethnicity — Youth: 43.5% White, 21.5% American Indian and White, 24.5% American Indian; 1.8% American Indian and Other, and 8.3% Other
  • Gender — 49% Female
  • Status — Participants were students in 9th -12th grades.

Location/Institution: 14-county jurisdictional service area of the Cherokee Nation in Oklahoma

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study use participants from Komro et al. (2017). The purpose of this study was to evaluate the effectiveness of Communities Mobilizing for Change on Alcohol (CMCA) [now called CMCA: Communities Mobilizing for Change on Alcohol] and CONNECT on other drug use outcomes. Six communities were randomly assigned to a control, CMCA, CONNECT, or a combined condition. Measures utilized include the Youth Risk Behavior Surveillance System. Results indicate significant reductions in drug use other than alcohol attributable to CMCA and CONNECT. CMCA was associated with a reduction in chewing tobacco use, a reduction in marijuana use, and a reduction in prescription drug misuse. CONNECT was associated with a reduction in marijuana use and a reduction in prescription drug misuse. Limitations include small number of communities, measures of nonalcohol substance use were limited, and lack of follow-up.

Length of postintervention follow-up: None.

Wagenaar, A. C., Livingston, M. D., Pettigrew, D. W., Kominsky, T. K., & Komro, K. A. (2018). Communities Mobilizing for Change on Alcohol (CMCA): Secondary analyses of a randomized controlled trial showing effects of community organizing on alcohol acquisition by youth in the Cherokee nation. Addiction, 113(4), 647-655. doi:10.1111/add.14113.

Type of Study: Randomized controlled trial (secondary analysis)
Number of Participants: 1399

Population:

  • Age — Mean=15.4 years
  • Race/Ethnicity — 45.5% White, 21% American Indian and White, 23.4% American Indian; 10% Other
  • Gender — 50.2% Female
  • Status — Participants were students in 9th and 10th grades

Location/Institution: 14-county jurisdictional service area of the Cherokee Nation in Oklahoma

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study uses participants from Komro et al. (2017). The purpose of this study was to evaluate the effectiveness of Communities Mobilizing for Change on Alcohol (CMCA) [now called CMCA: Communities Mobilizing for Change on Alcohol] on the propensity of retail alcohol outlets to sell alcohol to young buyers without age identification and on alcohol acquisition behaviors of underage youth. Random assignment of community to treatment (n = 3 communities) or control (n = 2 communities). Measures utilized include the Youth Risk Behavior Surveillance System. Results indicate alcohol purchases by young-appearing buyers declined significantly. Student survey results show statistically significant differences in the trajectory of perceived police enforcement, alcohol acquisition from parents, acquisition from 21+ adults, and acquisition from stores. Limitations include small number of communities, could not blind school leadership to study condition, outcomes were on the basis of student self-report, and lack of follow-up.

Length of postintervention follow-up: None.

Additional References

No reference materials are currently available for CMCA: Communities Mobilizing for Change on Alcohol.

Contact Information

April Hoogasian
Agency/Affiliation: Youth Leadership Institute
Website: yli.org/training-consulting-services/communities-mobilizing-for-change-cmca-training
Email:
Phone: (559) 492-8255

Date Research Evidence Last Reviewed by CEBC: April 2019

Date Program Content Last Reviewed by Program Staff: June 2019

Date Program Originally Loaded onto CEBC: July 2019