How the “Housing Theory of Everything” Can Help Explain Alcohol and Other Drug Problems

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Up until the 1980s, common knowledge held that preventing addiction to substances, be they narcotic drugs, tobacco, or alcohol, were issues to be dealt with at the individual level through education and grounded in a moralistic knowledge of what is right and wrong.

Since then, attitudes about how to prevent drug and alcohol misuse have been scaled up, no longer focusing on the individual, but instead, on the community, in what has come to be known as “upstream prevention.”

This strategy seeks solutions that address a plurality of root causes that lead to alcohol and drug disorders. A great example of such a pluralistic root cause for substance use disorders is an unfortunately common issue throughout the U.S.: housing insecurity.

The “housing theory of everything” is a phenomenon that implies the U.S.’ housing shortage contributes to a broad range of societal problems such as inequality, climate change, disease, and stagnant population growth. A case can also be made for throwing substance use disorders into the mix as a consequence of the nation’s housing shortage.

Housing as a basic need

Housing is a fundamental necessity of human health, fulfilling both physiological and safety needs. However, the U.S. is experiencing an unprecedented housing crisis, in large part because housing development hasn’t kept up at the same pace as population and job growth.

This is especially true in the nation’s largest metropolitan areas. Last year, approximately 20% of the U.S. population reported they were very likely facing foreclosure, and 14% likely facing eviction.

When individuals become unsheltered or are facing some type of housing insecurity, stress and anxiety can be dramatically exacerbated. This is due in part to the ripple effects of not having a stable and secure place to eat or sleep.

For example, individuals experiencing homelessness may find it difficult or near impossible to secure a job, as employers often require a stable address for employment. Similarly, things like physical and mental hygiene become difficult, if not impossible, to attend to when housing is not immediately available.

These compounding issues have a cascading effect on health and well-being and can lead to self-medication with drugs and alcohol.

“The Housing Theory of Everything”

Are substance use disorders a cause or an effect of housing insecurity? On this, experts disagree. But what we do know is that there is a strong association between housing insecurity and poor mental health, thus supporting the theory that one’s housing situation is determinative of a range of health outcomes.

Whether it is struggling with the anxiety of rising housing costs, an inability to pay rent, or uncertainty about where the next meal and place to sleep will be, many Americans are turning to common coping mechanisms: drugs and alcohol.

And as consumption of these substances increases, so do poor health outcomes as suggested by increases in healthcare costs to treat substance-related diseases, emergency department costs, alcohol-related traffic fatalities, and domestic violence.

This last fallout from alcohol and drugs – domestic violence – concerns many housing advocates. Approximately 80% of homeless mothers with children are victims of domestic violence. Many victims flee their abuser with scant economic resources, little family support, or no solid place to land.

Housing as a stabilizing factor toward mental health

Providing housing that is safe, clean, affordable, and accessible doesn’t completely solve the entire homelessness crisis, but is a good first start. When a basic need like housing is met, we can start to see a general decrease in self-medicating habits, as well as a greater community impact through less burdensome social services.

The State of California has enacted legislation that commits over half a billion dollars to housing and services for individuals struggling with mental health and substance use disorders. This effort is a fundamental starting point for addressing the link between housing and substance use, providing treatment beds for over 1,000 Californians experiencing homelessness.

However, programs like this fall short by treating housing insecurity as the result, rather than the cause, of substance misuse. Instead, we need to focus efforts toward programs aiming to thwart housing insecurity at its root. By providing stability and security, we can eliminate many of the anxieties that contribute to substance use disorders, and we can make a meaningful difference.

Author:

Michael Pesavento
Media Advocacy Specialist

Michael Pesavento is a Media Advocacy Specialist in the San Diego County office. He serves on the Binge and Underage Drinking Initiative that aims to reduce harms and responsibly regulate drug and alcohol usage in the San Diego area.

Group of community advocates banning together

Creating a Prevention Campaign That Works

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Lessons learned from tobacco control hold value for future efforts

In 1880, James Albert Bonsack filed a patent on an invention that would eventually pit industrial growth against public health.

Bonstack’s invention could roll hundreds of cigarettes a minute, revolutionizing the tobacco industry and creating a product that would see thousands of percentages of increases in use over just a few short decades.

Tobacco industrialists saw tremendous potential for profit in this new, portable and cheap cigarette. This signaled the beginning of what would become almost a century-long campaign to sell consumers a highly addictive, highly carcinogenic product. And it worked!

Over 100 years since Bonsack filed his original patent, communities everywhere are still subjected to the fallout of the “smoking boom” of the 1900s, and new smokers are created every day through products like flavored tobacco and e-cigarettes/vaporizers.

But all hope is not lost. In the decades since, public health professionals have advanced policy and enforcement measures around tobacco, and have learned important lessons in the process.

Many early attempts to create tobacco prevention campaigns framed much of the issue as one of personal choice. Most of those campaigns regarded the individual smoker as the important unit of change, believing that if you can change the thinking of an individual through education and appeals to reason, then you can halt a behavior in an entire population. However, we have since learned this narrow focus has a very limited effect.

Instead, modern prevention strategies have shifted the focus from individual knowledge, behavior and attitudes as the “unit of change” to acknowledging the role of policy, systems and “environmental factors” in shaping individual behavior. In this context, environmental factors include factors like the way a neighborhood is built, the types of businesses that exist there, the amenities and spaces available to residents and even transportation. In tobacco prevention, it also includes the devious marketing tactics of Big Tobacco.

When focusing on these environmental factors, modern prevention campaigns focus on influencing policy to produce community-level change. Democracy at any level, from the local city council all the way to state and federal jurisdictions, plays a role. Focusing on policy, rather than individuals, provides resources for enforcement and maintenance of policies.

Despite the understanding that smoking was already a population-level health hazard, smoking prevention in the 1970’s and 80’s approached it as an individual choice; something for people to stop doing on their own.

It wasn’t until studies began showing the effects of second and even thirdhand smoke exposure (especially on children) that conversations about prevention began to elevate on a national level. In 1990 the federal government instituted its ban on smoking in airplanes for U.S. domestic flights, a policy which expanded worldwide thereafter. In the early 2000s, many cities and local jurisdictions in the U.S. began implementing indoor smoking bans, and as of 2018 nearly 30 states had totally banned the smoking of cigarettes indoors. These broad policy changes reflect efforts at the federal, state and local levels by public health professionals and advocates to create evidence-informed changes that promote healthy decisions and reduce access and exposure to harmful substances like tobacco.

Even now, initiatives like IPS’ Smoke-Free Multi-Unit Housing (MUH) project aim to implement smoking restrictions in residential spaces where secondhand tobacco exposure can impact people’s health, with a goal to implement transformative, equitable policy strategies that keep residences free of harmful tobacco smoke and other carcinogens.

As prevention efforts continue to hone in on effective strategies, one element remains consistent: community. Involving community members and welcoming their input instantly elevates any campaign, and is absolutely vital to creating sustainable change after a campaign’s conclusion. Prevention professionals have learned that it is important to work with community members to develop a plan that meets them where they are, to create a shared language with residents that embraces policy and systems change, and to invest in the capacity of the communities so that residents can continue this important work.

Efforts to reduce smoking-related problems are far from over. Despite successes like California’s recent successful ballot measure that will ban flavored tobacco products, issues with nicotine and tobacco will persist. Youth access and second-hand exposure are likely issues that will take decades of work to address. However, through the efforts of dedicated public health professionals—and with a lot of patience—we can learn from our successes and failures to bring strong, coherent campaigns that truly influence population-level change.

Let’s not let those lessons go up in smoke.

 

Tobacco Prevention 2.0: Integrating Equity into Smoke-Free Multi-Unit Housing

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Protecting the health and safety of everyone requires a new approach to policy

When it comes to housing vulnerable populations, tobacco prevention is essential. Tens of millions of Americans live in multi-unit housing (apartment buildings, condominiums, and other tightly-clustered living arrangements). A significant percentage of this housing is subsidized by the government.

Smoke-free building policies, which cover roughly one-third of multi-unit housing residences in the U.S., are intended to protect tenants from exposure to secondhand smoke, which can travel through open windows and under doors, seep in between shared walls, and blow through shared ventilation systems. Owners and managers of smoke-free housing also benefit from reduced fire risk and legal liability safeguards, lower maintenance costs, and maintenance of property value.

Research shows there is no level of safe exposure to secondhand smoke. In adults, health impacts range from mild nasal irritation to more severe health risks to the coronary, pulmonary, and reproductive systems.

In children, secondhand smoke can cause middle ear disease, compromise respiratory function, and even result in sudden infant death syndrome (SIDS). Secondhand smoke is also responsible for triggering asthma. About 1 in 20 children suffer from asthma, and of those, about 1 in 6 are treated at emergency departments or hospitalized, resulting in high medical bills, missed school (and work) days, and decreased quality of life.

The lack of policy around secondhand smoke is particularly harmful to children, people with lower income, people with less education, residents of rental and multi-unit housing, people who live with someone who smokes inside the home, and people in traditionally “blue collar” occupations. The Black population, in particular, is exposed to more secondhand smoke than other racial and ethnic groups. According to the Centers for Disease Control and Prevention:

As of June 2021, of the ten U.S. states with the highest proportion of Black residents, only three of those states have comprehensive smoke-free laws that prohibit smoking in all workplaces and public places. Of the seven states that do not have comprehensive laws, two also prevent local communities from adopting comprehensive smoke-free laws.

Smoke-free multi-unit housing policies have therefore been well-intentioned efforts to protect tenants from unwanted tobacco smoke. They have also, however, forced building managers to grapple with serious issues of equity: While it is not fair or right to expose tenants to someone else’s tobacco smoke, it is also ethically unsound to evict smokers with no other housing options available, particularly considering the U.S.’s current housing crisis.

Demand for housing that is in short supply for both homeowners and renters is sharply driving up the cost of homeownership and rent. The consequences are dire: billions of dollars in lost earnings, increased debt, overcrowded homeless shelters, more people living in their car or on the streets, and physical and emotional distress. It is neither a prudent public health nor ethical policy to force people out of their homes.

These dynamics have recently inspired a new take on smoke-free building policies. Cities in California, for example, have created equity-forward solutions that are less punitive toward the tenant while holding the HOA and/or landlord accountable for enforcing the policy before more extreme measures like tenant fines and eviction are implemented.

Berkeley’s Municipal Code 12.70 is one such example. Importantly, Berkeley’s policy is specifically framed to protect smokers, and eviction is not the preferred form of regulation and enforcement. Tenants who smoke are provided with adequate notice, education, access to comprehensive cessation resources, and reasonable accommodations.

Community groups advocating for smoke-free MUH policies, too, are adopting an equity-forward approach, ensuring affected tenants, and even smokers themselves, are involved in the process by sharing lived experiences, advising on policy details, and meeting with elected officials.

Solutions like the Smoke-Free Multi-Unit Housing Initiative are vital to preserving the health and well-being of tenants, property managers/owners, and community members without contributing to the housing insecurity crisis. The project advocates for eliminating extreme remedial measures such as massive fines or eviction in favor of a graduated, multi-step process that doesn’t shame or further threaten the health and well-being of smokers while also protecting non-smokers.

The tension between the needs and wants of smokers and non-smokers has plagued housing units for decades, and there are no easy solutions. These new, equity-forward approaches recognize the complexity of the problem and attempt to do a better job ensuring everybody – smokers and non-smokers alike – can live in housing that is healthy and safe.

California’s New Composting Law Takes on Climate Change

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It’s no secret that the first to be impacted by the devastating effects of climate change are those who are already the most vulnerable. The startling and unprecedented changes to the natural world—caused, at least in part, by human activity—individuals that are already struggling are likely to bear the burden of environmental collapse. Already, researchers indicate that the impacts faced by these communities can be far more widespread and immediate than many might expect.

For example, an obvious impact of climate change is rising average temperatures; we feel it, summer after summer as the thermometer ticks ever upward. However, less expected are the secondary effects these changes might have—things like fewer opportunities for healthy outdoor time and worse mental health outcomes. These effects are exacerbated in communities where inequalities are most pronounced. For low-income communities where amenities like air-conditioning and insulation are fewer and further between, the effects of increased global warming will be felt most severely. 

That’s why it is important to look for “upstream” solutions to environmental issues. By addressing the root causes of a problem rather than its symptoms we can prevent harm, such as increased global temperatures, as well as its trickle-down effects, like impacted mental and physical health.

In that vein, California has recently begun to implement SB 1383—dubbed “California’s Short-Lived Climate Pollutant Reduction Strategy”—in earnest. This legislation was introduced in 2016 by then-Governor Jerry Brown, and broadly sets goals for the reduction of methane emissions in the state. 

Methane (CH4) is a leading contributor to atmospheric insulation, 25 times as potent a contributor as carbon dioxide (CO2). That ratio makes methane a major target for emission reductions, as pound-for-pound, methane accounts for much more atmospheric insulation—and thus, temperature increase—than do even pollutants from fossil fuels. That’s why bills like SB 1383 are working to reduce the amount of methane we release in California. 

One way to reduce methane emissions is by lowering the amount of organic waste being decomposed in municipal landfills. This entails creating proper composting sites for the separation of food and yard waste and redirecting organic matter that would otherwise end up creating methane into more productive areas. One such redirection is the distribution of the created compost to local farms, parks, and gardens.  

But what would this look like in practice?

We can look to state and local municipalities for examples of success in creating a buffer between vulnerable communities and climate effects. Often, these localities can address the specific needs of their community members more acutely than broad strokes approaches by other governing bodies.

For example, in 2018 the Institute for Public Strategies (IPS) partnered with San Bernardino County residents who were advocating for the City of Pomona to allow them to use a vacant city-owned property to create Pomona’s first urban farming project. The project—titled ECOFARM—focuses on composting to support climate change mitigation and alleviate environmental justice burdens on the immediate community. The city could not deny the efforts of the residents and voted unanimously in favor to allow the use of the vacant lot for the ECOFARM free of cost.  The ECOFARM was funded by a grant secured by residents from the California Environmental Protection Agency. Residents used the funds for basic infrastructure development, acquisition of tools and supplies, soil, irrigation, essential farm labor, as well as a variety of educational programming around nutrition and environmental justice. 

But the options for addressing both community and environmental issues at once are not limited to farming and gardening projects. Outside of SB 1383, California agencies are providing some direct assistance to local jurisdictions. Just this year the California Natural Resources Agency released millions in grants to local jurisdictions to use in environmental projects. Highlights from these grant releases include the agency’s Youth Community Access and Environmental Enhancement and Mitigation programs, each of which awarded over $10M for everything from greenspace cleanups to park improvements and youth outdoor programs.

Obviously, these programs are not the ultimate solution to climate change; that responsibility lies at the highest levels of government and industry and should be prosecuted with all the vigor we can muster. However, state and local level programs are an important push toward improving both environmental wellbeing and mental and physical health outcomes, especially for youth. Moreso, the push to reduce methane emissions—a high-level upstream initiative—made way for materially impactful local changes.

As the global climate faces significant changes in the immediate future, our adaptation to these new conditions must strategize prevention efforts that prioritize the health and safety of marginalized communities. Future regulations and policies can learn from this upstream approach to designing solutions. A world with less food waste is a world with fewer methane emissions; a world with working public transport is a world with fewer polluting cars; a world with more available, livable housing is a world with fewer children sleeping on our streets.

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Author:

Michael Pesavento
Media Advocacy Specialist, IPS

Michael Pesavento is a Media Advocacy Specialist in the San Diego County office.

This Election Cycle, Vote with Redistricting in Mind

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California received a facelift this year in the form of a dramatic new redistricting plan that leaves the state’s political landscape barely recognizable, yet full of opportunities for new representatives to lead their regions. The changes have come at all levels of government, from city councils to Congress. They provide new opportunities for some communities to address neglected public health issues, but may also prevent other communities from strengthening their quality of life.

The politically independent California Citizens Redistricting Commission conducted the state’s redistricting process following the 2020 census data. The commission was tasked with considering census population data, complying with the federal Voting Rights Act to prevent discrimination against minority groups, and incorporating public opinion into the redistricting process. Now, the commission is being scrutinized for its map-drawing processes and potential biases.

The drama behind the scenes is spilling over into public conversations about Congressional and statewide representation as new districts have significantly shifted population density and demographics. For example, California will be losing a Congressional seat for the first time in state history. In a legislative process where every vote counts, losing a seat can shift party lines and tip the power balance dramatically. These reallocations of power may be one of the reasons why 48 members of Congress have decided to not run for reelection. Of the 23 Democrat Representatives not seeking reelection, three are from California.

For other California incumbents whose terms end in 2022, such as State Senator Patricia Bates of District 36 in San Diego, the new district lines could lead to shifting party power and favor new candidates of the previous minority party. Senator Bates’ Republican-leaning District 36 is now being replaced by District 38, which possesses a Democratic majority voter base. This change will require an entire reassessment of the party powers in districts throughout California, as new voter bases demand different priorities from their representatives.

Redistricting has also given more power to historically marginalized communities. The Public Policy Institute of California reported that the new district maps have 16 majority Latinx districts compared to the previous 10. With a population located in low-income communities, leaving them more vulnerable to less healthy environments, having greater representation for marginalized groups at the state legislative level is key in meeting the public health priorities for these communities.

What does this all mean for the future of public health policy in California and our nation as a whole? While redistricting may sometimes feel disruptive to the democratic system, it also has the opportunity to empower diverse groups to influence the health outcomes they want. Local and state government programs and community-based organizations have a responsibility to make a conscious effort to fill in the gaps of support created by redistricting, which has affected vulnerable communities throughout the state.

For example, former Assembly member Lorena Gonzalez recently resigned to become CEO of the California Labor Federation. Her 80th District assembly district was redrawn, which would have put her in competition with Assemblymember Dr. Akilah Weber for the 79th District seat. Her seemingly innocent career transition left community members to deal with problems like air pollution and high ozone levels without the help of their elected representative. Assembly District 80 encompasses the southern region of San Diego County including San Ysidro and Chula Vista, which suffer from air pollution and high ozone levels, leading to adverse health impacts like high asthma rates.

One of the most effective means of creating healthy community change is through the voters themselves. Constituents have significant power to engage in the legislative process by contacting their representatives, working with legislators to address public health issues, and voting for politicians that will address relevant problems in the most vulnerable communities.

While the moving pieces of California’s political landscape take time to fit into their new places, residents can influence what candidates and issues will be the focus of their attention. The power to address harmful environmental factors and public health disparities lie with community members. There is no need to wait for change to happen. We can influence how our communities take shape, by prioritizing the health and well-being of those around us.

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Author:

Maxwell Johnson
Prevention Specialist

Maxwell Johnson is a resident of downtown San Diego and a prevention specialist for the Binge and Underage Drinking Initiative at the Institute for Public Strategies. He graduated from SDSU with a degree in Political Science and Communication.

Juneteenth at IPS: Historical Oppression and Upstream Prevention

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On June 19, 1865, U.S. General Gordon Granger led federal troops to Galveston, Texas — one of the few remaining areas of the deep south that had held resistance late into the Civil War. As General Granger stepped foot on that arid soil, he brought with him orders which stated that all slaves were to be set free. These words, stated over two years after the Emancipation Proclamation, marked what many consider to be the “official” end of slavery in the United States, as those freed in Texas that day were many of the last slaves to be informed of their liberation.

This year, on June 19, 2022, the United States will be recognizing Juneteenth as a holiday following its enshrinement at the federal level in 2021. The Institute for Public Strategies will also be recognizing Juneteenth as a paid company holiday. IPS’ formal recognition of Juneteenth as an important date represents our organizational commitment to serving and elevating the voices of African American communities to address their unique needs and visions.

As practitioners of population-level prevention programs, IPS initiatives address the root causes of health disparities, which are frequently the result of inequitable community conditions and social injustice.  To prevent harm and improve public health and safety, IPS focuses on policy and systems change to achieve healthy, safe environments and provide for equal opportunity so that everyone in a community can thrive—this elevates the health of entire communities, rather than focusing on the health of select individuals. That’s why, when discussing the issues relevant to African American communities, context is key. Issues that have plagued neighborhoods for decades—nearly centuries—did not crop up overnight. In fact, quite the opposite: history shows that many of the persistent issues faced by African American communities are rooted in systemic and institutional inequities.

In areas like San Diego County, IPS initiatives encounter these structural injustices across programs. For example, IPS San Diego’s Binge and Underage Drinking Initiative (BUDI) often sees evidence of systemic inequity in things like the concentration of liquor outlets in neighborhoods of color—areas that were often formerly “redlined” by racist housing practices. Moreso, despite African Americans often drinking less on average than other demographic groups, predatory marketing practices by alcohol manufacturers are often targeted toward young Black people.

These are only a few instances of unequal and unfair treatment toward African Americans by just one industry—Big Alcohol. However, they represent just a few blips along a spectrum of injustice leveled against Black communities stretching all the way back to before that historic date on June 19, 1865.

In fact, many slaves brought from West Africa to the Americas during the early slave trade were bought for gallons worth of rum—a product of the very same sugar cane from plantations already employing slave labor. Thus, the history of African slavery in the Americas is also inextricably linked to its production of alcohol. This metaphor can be extended even further to describe how alcohol was historically used to control enslaved peoples; drunkenness was discouraged, except around the holidays when alcohol was liberally distributed to keep slaves from thoughts of revolt or insubordination. This mentality then informed later laws like Black Codes and Jim Crow which would enforce strict penalties for drunkenness in public—if you were Black.

Despite the long and storied history of the use of alcohol as an oppressive tool toward Black communities, this topic represents just one way in which a single IPS initiative encounters the deep history of injustice toward communities of color.

For example, in 2020 after the City of Adelanto passed legislation that proclaimed racism as a public health crisis, staff at IPS San Bernardino affirmed our organizational commitment to the value of Black lives and communities. This effort presents several opportunities for staff collaboration with the City of Adelanto, including educating BIPOC youth about engaging with local government and working with high-risk businesses to develop ways they can contribute more positively and equitably to the community. Along with other partnerships—like The St. Joseph Foundation’s Heart & Soul initiative and the Reimagine Our Communities Coalition (ROC)—IPS San Bernardino continues to exemplify allyship for Black health and safety.

Despite the hurdles IPS encounters working on our projects, we believe in creating equity and fairness in health and safety. This means learning from, engaging with, and elevating the voices of the communities we serve. Reverend Bolivar Flores, IPS’ newest member of its Board of Directors, summed up this mission:

“IPS wants to create a healthy community by creating economic opportunity, keeping residents safe by preventing crime, and focusing on equality for all. […] They have partnered with community groups throughout the nation to advance policies on issues related to public health, safety, equity and social justice. I believe the best way to create change is by defining the underlying issues and devising plans to resolve them, and IPS’ work on policy and systems change exemplifies that. […] Seeing that ambition to help a community rebuild into a safer city and create a brighter future for its residents is very inspirational.”

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Author:

Michael Pesavento
Media Advocacy Specialist

Michael Pesavento is a Media Advocacy Specialist in the San Diego County office.

Tackling the Alcohol Culture on College Campuses: Do Late Night Programming Alternatives Work?

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Imagine thousands of college students, gathered in a carnival atmosphere, some playing inflatable games, others climbing a rock wall, many dancing under the moonlight to a live band. Here and there, small groups are huddled together, with smiling faces, taking selfies. But wait… something is missing. None of them are holding those ubiquitous red plastic cups, the ones young people always have when they’re partying, the ones that hold their alcoholic drinks.

Why? Because this is a special kind of event, part of San Diego State University’s Aztec Nights, a series of late-night activities organized to meet students’ social needs. Held during the beginning of the school year, it’s where new and returning students get a chance to mix and mingle in a healthy atmosphere, grab free cookies, stickers, water bottles, get their caricatures drawn, or participate in a dozen other fun activities – all free of charge, and all free of alcohol.

It should be noted that these events are not promoted as alcohol-free, just as a way to have fun. However, they are specifically designed to draw students away from alcohol-based activities at bars, clubs, and house parties, especially during the beginning of the school year when students are establishing new attitudes and behaviors. And research has shown that this approach works, reducing substance misuse and associated harms.

Such problems have long plagued colleges and universities. In addition to declines in academic performance, excessive drinking has been associated with personal injuries from fights, vandalism, property damage, sexual harassment and assault. Many deaths have also resulted from alcohol poisoning occurring during house parties where heavy drinking is the norm. And with binge drinking rates hovering around 40% for decades, college-based prevention programs have been unable to stem the tide.

The reason, according to an article published by The Chronicle of Higher Education, is that efforts have been focused mostly on education, providing information about the hazards of drinking and the benefits of a healthy lifestyle. What is needed, is to focus directly on the drinking culture, which is based on the idea that excessive drinking is not only normal, but an essential part of the college experience. However, because it has become so very entrenched on college campuses, this culture is highly resistant to change.

This is where alcohol-free late-night programming comes in. By offering multiple opportunities for socializing in lower-risk settings, such programs provide another way – besides alcohol-based activities – to facilitate peer bonding and establish social networks. Students need these two functions in their formative years, which they have traditionally acquired through the drinking culture. But no longer, not where LNP has been implemented.

So, how does it work? The key is to hold events on campus on Thursday, Friday, and Saturday nights, during the young-adult prime social times of 9 p.m. to 2 a.m. To compete with the alcohol scene, the events need to be of high quality and designed to appeal to young people. Examples include free movies, carnivals, dances, live music, comedy, casino nights, magic shows, video games, or arts and crafts. Such activities are also scheduled for the first six weeks of the school year, when students are at the greatest risk, according to research.

Recognizing the value of LNP, many universities have adopted them as part of their overall prevention strategy. In addition to SDSU, these have included Stanford, Penn State, Ohio State, and several others. But these programs can be expensive, costing from $200,000 – $300,000 per year, and complex to implement. So, it’s difficult to get them up and running. However, data reflect it’s worth the effort as alcohol-related problems typically cost more than $1 million a year for an average size university.

For those working with colleges on such an effort, the following guidelines are offered to help overcome the challenges and achieve a successful outcome.

  1. Administrative Support is Crucial
    Most LNPs have been helped along by administrative staff within the Division of Student Affairs who acted as a champion for the program. Often this included the formation of a task group to assess the problem and investigate possible solutions. Involvement of student government and other key stakeholders is also important. So, conducting outreach to raise awareness about the value of LNP among appropriate administrative personnel is a good way to get started.
  2. Goals & Objectives
    Changing the campus culture is an appropriate goal. Objectives include organizing numerous large-scale events on campus and promoting them with branding designed to establish a new ethos of health and safety for the university. This is what SDSU has done with its Aztec Nights program. However, for a new program, starting with a goal of just diverting students away from alcohol-based activities is more advisable. Transferring one or more already-popular events to late-night hours would be a reasonable first step.
  3. Infrastructure
    Planning and organizing of events are usually done by an office within Student Affairs. Implementation is carried out by in-house staff with support from students clubs and organizations. Funded by mini-grants, such groups submit a proposal specifying the theme of the event, its cost, and expected attendance. Program staff provide support with event setup and breakdown as well as promotional activities.
  4. Funding
    Funding is dependent on administrative support. During its initial years, a program may have to rely on soft money, such as contributions by various donors on a year-to-year basis. With a more established program, such as SDSU, funding has been institutionalized as a part line item in the general budget. It should be noted that SDSU’s program was started with strong administrative support secured through research showing the program’s effectiveness.
  5. Evaluation
    Evaluation should at least include surveys of event participants to obtain data about attendance, student satisfaction, and any drinking on the night of the event. A more thorough evaluation would also measure the impact of LNP on rates of binge drinking and its consequences over time. Learnings should be used to improve the program’s operation as well as program success in reducing alcohol-related problems, which would be helpful in securing additional funding.

The establishment of an LNP, whatever form it takes, is not expected to eliminate all alcohol-related problems. Instead, it should be part of a comprehensive program that includes education, policies that are consistently enforced, and referrals for treatment for students in need. But despite such limits, LNP has shown to be an effective tool to address what has been for years an intractable problem, a tool that should be considered by all institutions of higher education.

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Author:

Dan Skiles
Consultant, IPS

Dan Skiles is a consultant and former Executive Director at the Institute for Public Strategies, a Southern California-based nonprofit that works alongside communities to build power, challenge systems of inequity, protect health, and improve quality of life.

Do Harm Reduction Practices Help People Stop Using Drugs?

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Drug overdose deaths reached a record high during the pandemic. By April 2021, more than 100,000 people died from an overdose, a 30% increase over the prior year, according to government statistics. The trend has some public health and elected officials looking toward a solution that some would consider radical: harm reduction. For the first time, the Substance Abuse and Mental Health Services Administration (SAMHSA) is targeting more than $30 million in grants for harm reduction efforts. The Centers for Disease Control and Prevention (CDC) is partnering with SAMHSA to establish a Harm Reduction Technical Assistance program to support syringe service programs. In California, health officials and some legislators are looking at harm reduction as they consider realistic ways to decrease the harmful effects of drug use.

Harm reduction is a set of practical strategies and ideas aimed at reducing the negative consequences associated with drug use, according to the Harm Reduction Coalition. Harm reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.

Perhaps the best known harm reduction strategy is syringe exchange, where workers give people who use drugs clean needles in exchange for their dirty ones. Additional harm reduction methods include:

  • Medically assisted treatment for opioid use disorder
  • Medication to reverse opioid overdoses (Naloxone)
  • Safe smoking supplies to help injection users find a less harmful method of use
  • Supervised injection sites, which have shown promise as a solution in European countries
  • Overdose prevention education
  • Fentanyl test strips (strips that test drugs for cross-contamination with fentanyl)
  • Education, therapy, and discussion groups aimed at helping active drug users minimize harms to their health through managed, reduced, or safer drug use

Harm reduction practices are not new. Europe has had harm reduction programs for many years. In the U.S., a few syringe exchange programs were started during the AIDS crisis in the 80’s and 90’s to prevent the sharing of needles and to slow the rapid rise in disease among injection drug users. According to the CDC, there has been a decrease in HIV diagnoses attributable to those early syringe exchange programs.

Declines in HIV and Hepatitis C infections have also dramatically reduced healthcare spending. The estimated lifetime cost of treating one person living with HIV is almost $450,000. Hospitalization in the U.S. due to substance use related infections alone costs over $700 million annually.

Harm reduction strategies are intended to keep users alive and healthy, without judgment or pressure to stop, until they are ready to seek treatment or quit. Syringe services programs (SSPs), for example, can reduce overdose deaths by teaching people who inject drugs how to prevent and respond to a drug overdose, providing them training on how to use naloxone (a medication used to reverse overdose), and providing naloxone to them. Importantly, SSPs facilitate entry into treatment for substance use disorders by people who inject drugs. People who use SSPs show high readiness to reduce or stop their drug use. There is evidence that people who inject drugs and work with a nurse at an SSP or other community-based venue are more likely to access primary care than those who don’t. SSPs have also partnered with law enforcement, providing naloxone to local police departments to distribute it more broadly in populations that need it.

Despite its demonstrated successes, there are concerns that harm reduction is giving people a license to freely use drugs. Former California Governor Jerry Brown vetoed a bill to create syringe service sites in San Francisco three years ago, calling it “enabling drug use.” This kind of stigma has prevented many communities from even considering harm reduction programs. Stigma is based on a perception, long-standing in the U.S., that substance users are bad and immoral rather than suffering with a chronic condition requiring care and treatment. Those who argue for harm reduction say it doesn’t enable drug use, rather, it encourages safer methods of use until abstinence is possible. Still, intense stigma persists. According to the Harm Reduction Journal, it is this intense stigmatization that aggravates, rather than ameliorates, the ability to engage people struggling with drugs into an abstinence model.

In the past year alone, the climate around harm reduction has dramatically shifted. Most states are expanding access to fentanyl test strips and Narcan and increasing funding for harm reduction programs. New York state just began its first safe injection site pilot program, opening two locations in Manhattan in November of 2021. A bill is also now winding through the California legislature. SB57 proposes hygienic spaces where trained staff will provide sterile supplies and connections to health resources and treatment. If more states and communities adopt harm reduction strategies, we’ll continue to get a better picture of whether or not it can impact the crisis of overdose deaths we’re facing.

Authors:

Dean Ambrosini
Prevention Coordinator, IPS

Dean Ambrosini is a Prevention Coordinator at the Institute for Public Strategies for the West Hollywood Project, based out of IPS’s LA office.

Cynthia Nickerson
Media Advocacy Specialist, IPS

Cynthia Brooks Nickerson is a Media Advocacy Specialist at the Institute for Public strategies, supporting IPS’s prevention projects across Southern California.

Looking to Empower Staff in 2022? Four Steps to Implementing a Peer Mentoring Program

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Traditional mentorship in the workplace has focused on connecting an expert with someone new to the workforce. Workplace mentoring programs have been shown to benefit staff. They increase engagement, improve retention, and provide opportunities to develop skills.

In the last decade, technological advancements and the influx of a younger labor force have tipped workplace mentoring toward an upward mentoring approach. As the name suggests, upward mentoring involves a junior staff member acting as a mentor to senior leaders or executives. Upward mentoring has been shown to create innovative spaces and deeper work connections that would traditionally take years to foster.

Lily Benjamin, a diversity & inclusion and organization development strategist consultant, sums up peer mentoring programs well: “Regardless of our title or years of experience we can learn from each other. Through mentoring and being open to learn we can reach our ultimate potential.”

In preparing for our own peer mentoring launch, IPS’ research identified four important steps necessary for successful peer mentoring programs:

STEP 1: Define what mentoring looks like for your organization

Mentorship programs in the workplace are more than just a feel-good exchange. Defining your goals will inform your program design and also provide expectations for your mentors/mentees.

Consider the following questions:

  • Will your program be integrated into your onboarding process to help new staff acclimate or is your goal to create a leadership pipeline for prospective managers?
  • How will the program help the organization achieve its mission?
  • What are the tangible and intangible benefits to those who participate (mentor/mentee)?
  • What are the qualities of an effective mentor?

STEP 2: Ensure your mentoring program revolves around diversity & inclusion

The difference between diversity and inclusion is important. The Society for Human Resource Management defines diversity as “the collective mixture of differences and similarities that includes, for example, individual and organizational characteristics, values, beliefs, experiences, backgrounds, preferences, and behaviors.”

The SHRM defines inclusion as “the achievement of a work environment in which all individuals are treated fairly and respectfully, have equal access to opportunities and resources, and can contribute fully to the organization’s success.”

All too often, diversity and inclusion are used interchangeably, however each would require a unique approach in creating a mentoring program.

The program should support diversity and empower staff from underrepresented groups by developing their skills and expanding their network while also supporting a culture of inclusion. This creates an environment that fosters the sharing of knowledge and leadership among all staff, which directly contributes to a thriving workplace.

STEP 3: Support a growth mindset for both mentors and mentees

Dr. Carol S. Dweck, Ph.D. is a leading expert on the benefits of a growth mindset. She proposes that skills, talents, and intelligence are not fixed, but in fact can be developed with supported and continued effort.

Embracing a growth mindset is the first good step for mentors. It focuses on the process rather than the results. A few indicators might be the ability to:

  • Face challenges and recover from setbacks
  • Learn from errors and failure
  • Take risks to reach beyond your own comfort level
  • Cope more effectively with conflict and negative experiences

Modeling a growth mindset also has benefits for mentees, providing the space to discuss:

  • Challenges experienced learning a new skill or mastering a task
  • Approaches to problem solving
  • Relevant narratives that led to improving a growth mindset

The growth mindset allows for the focus to be on mentees and their strong points and to find ways to encourage the process toward improvement.

STEP 4: Measure, track and evaluate your mentoring program

If the program can’t prove to be successful, there is a risk that it will not continue. How it is measured, tracked and evaluated will depend on the program goals and objectives that were set in Step 1. Identify how to manage this important step, whether through surveys, focus groups or interviews conducted by someone outside of the mentor/mentee relationship.

For monitoring purposes, include the number of staff that signed up for the program. And, a listening or feedback session will help to identify program aspects that may not have been obvious during the program design.

Whether implementing a traditional or upward mentorship program, evaluation can include tracking the compatibility between mentors’ and mentees’ skills and experiences to adequately match and pair staff and also to gauge progress. Examples of skills to track may include effective communication, creativity, adaptability and tools/techniques.

An effective mentorship program in the workplace is not always easy. It takes time, resources, and energy to make it work. When done well, it can provide opportunities for each staff member to feel supported and valued.

Author:
Dr. Frecia Gonzalez, PhD
Regional Director, IPS

Dr. Gonzalez is a Regional Director at the Institute for Public Strategies, a Southern California-based nonprofit that works alongside communities to build power, challenge systems of inequity, protect health, and improve quality of life.

Unleashing the Power of Prevention: Looking Forward, Public Policy is the Answer to High Health Care Costs

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An ounce of prevention is worth a pound of cure. That statement, submitted by Benjamin Franklin to the citizens of Philadelphia in 1736, was originally a warning to be vigilant about fire prevention. Still relevant after almost 300 years, that timeless phrase has become an American proverb. And its wisdom, it’s fair to say, has been almost universally accepted. Whether it’s speed bumps in a residential neighborhood, routine maintenance on the family car, or the annual medical checkup, prevention has become incorporated into our daily lives.

Another example would be the household fire extinguisher, of which, we can be sure, Ben Franklin would be proud. But Franklin had more than that on his mind when he drafted his essay on prevention for the Pennsylvania Gazette. To be sure, he urged the citizens of Philadelphia to take precautions that would ensure safety in their homes. But he also recommended the adoption of several public policies, measures enacted into law that would protect the entire community. In addition to regulations about the design of hearths, these included the organization of volunteer fire brigades and the licensing of chimney sweeps.

This forward-thinking approach, using public policy to circumvent potential hazards, is still one of our most effective tools to ensure public health and safety. Known as population-level prevention today, it has been successfully applied to many of our most pressing problems. For example, laws making workplaces, restaurants, and bars smoke-free can reduce heart attack hospitalizations by 8–17% according to the Center for Disease Control. And traffic-related fatalities have been significantly reduced over the years though the mandatory use of seat belts along with .08 alcohol consumption laws and DUI enforcement operations.

Controls on alcohol and tobacco products have always been a priority for prevention because they are associated with so many health-related problems.  In fact, data show that each of them, along with unhealthy diet and physical inactivity, plays a role in one or more of the top five causes of death in America: cancer, heart disease, stroke, diabetes, and injuries and violence. Of course, in a free society, we can’t compel people to do what’s good for themselves. But we can structure the environment in such a way that there are incentives for adopting healthy behaviors and disincentives for unhealthy ones.

The essence of population-level prevention is going upstream to address the root causes of illness and injury. Such initiatives are usually spurred by the work of nonprofit agencies, mostly with support from state agencies and private foundations. However, despite their success, resources to expand their use, such as funding from the federal government, have been limited. For example, even though 75% of our healthcare costs in America is attributable to preventable conditions, only about 3% of funds is spent on prevention, and most of it comes from states and local municipalities.

The costs involved here are enormous. In 2019, U.S. spending on healthcare – both mental and physical – reached $3.8 trillion, or $11,582 per person. That would amount to about 18% of the nation’s gross domestic product. What’s more, while these expenses have been growing for decades, the percentage spent on prevention has been declining. As such, the reason for the escalating cost of healthcare is not an increase in disease, but our reliance on treatment.

Access to treatment is important, especially for racial and ethnic minorities who have been historically underserved. But we can never expect to hold down the cost of healthcare unless we change our priorities and provide more funding for population-level prevention. More than three-quarters of Americans (76%) support this approach to healthcare reform, according to the Robert Wood Johnson Foundation. Overall, they found that prevention rates higher than providing tax credits to small businesses and prohibiting health insurers from denying coverage based on health status.

But we need to do more than just provide more money. In our work to address the root causes of illness and injury, we need to go even further upstream and consider the context in which they occur. It’s not enough to attribute our problems to the irresponsible behavior of certain individuals. Nor should we rely on singling out the bad actors in the business world who perpetuate them for profit.

 

These are systemic problems, all of which are interrelated and each of which depends on the others. We may not realize it, but they spring mostly from community conditions like poverty, inadequate housing, availability of healthy foods, racism, crime, and violence. That’s why the status of a person’s health depends largely on their zip code, which makes it clear where our prevention dollars should be spent.

In the final analysis, we’ve only scratched the surface in our prevention efforts. It’s time we go deeper and make the investment that’s required to meet the challenges we face.

Author:
Dan Skiles
Consultant, IPS

Dan Skiles is a consultant and former Executive Director at the Institute for Public Strategies, a Southern California-based nonprofit that works alongside communities to build power, challenge systems of inequity, protect health, and improve quality of life.