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Communities Mobilizing for Change on Alcohol (CMCA)
A citizen-driven effort to reduce underage access to alcohol via changes in local policy, law enforcement, media, and parental involvement.
Communities Mobilizing for Change on Alcohol (CMCA) is a community environmental change approach that employs community organizing techniques to galvanize everyday citizens (as opposed to civil leaders) to take action to reduce youth access to alcohol. It is implemented in six stages with the support of and coaching by a community organizer. Citizen-driven action teams conducted 38 to 85 actions per community, resulting in 23 to 43 sustained outcomes in media, policing, policy, and parental intervention. Both primary alcohol use outcomes and secondary analysis of perceived and actual alcohol availability are reported for this study.
Outcomes
CMCA reduced current use of alcohol, episodes of heavy drinking, and alcohol-related consequences among American Indian and non-Native American youth.
CMCA was tested in a clustered randomized trial in which communities were assigned to one of four groups: CONNECT, CMCA, both, or a delayed intervention control. Compared to controls, the CMCA-only condition was associated with 22% to 25% reductions in current use, heavy episodic drinking, and alcohol-related consequences. The effect peaked at year 2 of the 3-year intervention. Statistical tests by race found the intervention was effective for both American Indian and non-Native participants. Analyses of secondary outcome data found a 7% increase in perceptions of police enforcement and 4% to 8% reported reduction in acquisition of alcohol from parents, other adults, peers, and commercial outlets. There was an 18% reduction in successful alcohol purchases by young-appearing buyers attempting to purchase alcohol without proper identification.
Costs
Medium-level costs due to hiring, training, and supervision of community organizer plus resources necessary to implement environment intervention.
CMCA start-up costs involve hiring at least one full-time organizer from each community to establish action teams. Each organizer receives 3 days of training with conference and supervision calls at least three or four times per month. All are issued a laptop fully loaded with a management system and a binder on implementation of a menu of various organizing strategies. Ongoing costs may remain somewhat high, as community organizers continue to organize action teams and policy interventions throughout implementation. However, community organizers do not need to be highly educated professionals, and the action teams they recruit appear to be volunteer community members.
Cultural Engagment
Although no cultural elements were reported, the research included Cherokee Nation Behavioral Health as an equal partner.
No specific cultural adaptations were described and are likely low. Community members adapted the intervention in each location. The goal was to design culturally safe content but inclusive (to non-AI students). The research was an equal partnership between university-based and Cherokee Nation Behavioral Health staff; the Tribal institutional review board approved consents, presentations, and manuscripts.
Participants
Adolescent, Young Adult; Native, Non-Native; Female, Male
Setting
Community Wide, Rural
Delivery
Multi-level
Participants were American Indian and non-Native American students attending high school on the Cherokee Nation.
The CMCA only (n = 208), combined CONNECT and CMCA (n = 603), and control (n = 558) participants were male and female high school students in rural schools on the Cherokee Nation (not a reservation setting). The average age was 15 years old, and nearly half were Native. Survey data employed for the secondary outcomes analysis included 1,399 high school students and 113 stores licensed to sell alcohol. CMCA was delivered community-wide in two rural Cherokee Nation communities.
Staffing Needs
Community Member
No information was specified on the background of the community organizer or community activity team leaders.
The background of the three community organizers was not specified. Community organizers recruited action team members from each community. These team members were “everyday citizens.”
Research Design
Randomized controlled experimental design
Developmental stage of research
Mature research builds on an extensive body of evidence from mostly non-Native communities.
The developmental stage of CMCA research is deemed to be mature; the present report builds on other successful CMCA projects. The robust research design and collection of data on factors that may have influenced outcomes lend support to the positive outcome findings. A longer follow-up time is needed to evaluate how long the energy of the action teams and the effects of the interventions can be maintained. Generalization is limited by the small number of communities—all within the Cherokee Nation—that participated.
Potential
Community involvement has potential to be effective and long-lasting but lacks cultural components.
The bottom-up approach CMCA takes to enact community-wide changes to norms of accessibility appears to have the potential to be both powerful and long-lasting by enacting change in youths' social environments. A limitation to this intervention, as it currently stands, is that it lacks any cultural component, and thus may present transportability challenges across different AI communities. Nevertheless, the intervention appears flexible enough for adaptation to specific community needs.
References
Komro KA, Livingston MD, Wagenaar AC, et al. Multilevel prevention trial of alcohol use among American Indian and White high school students in the Cherokee Nation. Am J Public Health. 2017;107(3):453-459. https://pubmed.ncbi.nlm.nih.gov/28103073. https://doi.org/10.2105/ajph.2016.303603.
Wagenaar AC, Livingston MD, Pettigrew DW, Kominsky TK, Komro KA. 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. 2018;113(4):647-655. https://pubmed.ncbi.nlm.nih.gov/29178239. https://doi.org/10.1111/add.14113.
Komro KA, Wagenaar AC, Boyd M, et al. Prevention trial in the Cherokee Nation: Design of a randomized community trial. Prev Sci. 2015;16(2):291-300. https://pubmed.ncbi.nlm.nih.gov/24615546. https://doi.org/10.1007/s11121-014-0478-y.
Kennedy K, Pettigrew D, Komro KA, Wagenaar A. Communities Mobilizing for Change on Alcohol: A Guide for Implementation. No date. https://web1.sph.emory.edu/eprc/docs/CMCA%20Handbook%2003-02-17.pdf.
Related Intervention Webpages
National Institute on Alcohol Abuse and Alcoholism. Combined CONNECT and CMCA. October 2024.
National Institute on Alcohol Abuse and Alcoholism. CONNECT. October 2024.
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