Focusing on the environmental influences that shape drinking behavior seems to lead naturally to the possibility of alcohol rehab centers or strategies to reduce alcohol problems with alcohol rehab. Several large-scale programs have been developed for other aspects of health behavior, and their implementation has included an evaluation component. These approaches and their potential relevance to alcohol problems are discussed below.

Community Approaches and Perspectives
from Other Health Fields

As a result of several alcohol rehab and drug prevention programs that incorporated sound research designs, significant changes have been made in the health behavior of program participants. Although the studies were conducted to alter unhealthful behaviors other than alcohol abuse, the lessons learned from these efforts and the strategies used may be applicable to the prevention of alcohol-related problems.

Two studies have attempted to alter community risk factor profiles for cardiovascular disease (CVD). The Stanford Three-Community Study conducted during the 1970s provided evidence that community-wide health education involving mass media and supplemental face-to-face instruction can be effective in changing behavior and thus reducing CVD risk factors. The study, which was conducted over three years, used the three communities as different experimental conditions: in the first town, the program was carried out through the mass media alone; in the second, mass media techniques were supplemented with intensive face-to-face instruction; and in the third, no program was instituted at all. The results of the educational program components were assessed over time by using a multiple logistic function that incorporated age, sex, plasma cholesterol, systolic blood pressure, relative weight, and smoking. During a two-year period, in those towns in which the program was presented, a statistically significant reduction was achieved in the community's composite risk score for CVD as a result of significant declines in blood pressure, smoking, and cholesterol levels. Even greater reductions were seen in the town in which face-to-face instruction was used.

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