The field of substance misuse prevention continues to evolve. There is increasing interest in environmental prevention and the role it can play in this field, although to date it has remained ill-defined and tends to be poorly understood. In February 2018, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) set out to address this deficit and published their first significant report on the topic: Environmental substance use prevention interventions in Europe.1 The report is made up of two sections: the first provides an operational definition of environmental preventions (see Box 1 on the right) and a short overview of how it has evolved; the second presents the findings of a survey of prevention experts that explores the current availability in Europe of environmental prevention measures for substance use.

What is environmental prevention?
While there has been growing recognition of the importance of environmental factors in the context of the wider determinants of health, the authors identify the prevention field as having been ‘slow to adapt to this broader focus’ (p. 8). The report outlines the established prevention traditions and explains what environmental prevention can add to this field. Traditionally, substance use prevention has been based on two broad approaches. First, interventions provide warnings about the risks and consequences of substance use and offer information on safer ways to use substances. Second, they develop young people’s social skills and competencies to avoid substance use. Both of these approaches focus on the individual as the main driver of change. In contrast, environmental prevention interventions aim to limit the individual’s exposure to unhealthy or risky behaviour opportunities, or to promote the availability of healthy options. The focus therefore is on changing the environment so that it supports the prevention of drug use.

Environmental prevention interventions in Ireland are focused around increasingly restrictive alcohol and tobacco controls; for example, the standardised packaging provisions of the Public Health (Standardised Packaging of Tobacco) Act 2015, which came into force in September 2017. Illustrations of typical interventions in Europe are outlined in Box 1.

Environmental prevention in Europe
The authors surveyed prevention experts across Europe. They were interested in assessing what environmental prevention interventions exist for illicit drug, alcohol and tobacco use, and the extent to which they were being implemented. Overall, regulatory and economic measures (see Box 1 for definitions) were more prevalent than physical environment measures. For example, 83% reported national level regulatory measures for illicit drugs, 54% for alcohol, and 58% for tobacco. Physical measures were not reported for illicit drugs alone, and only 2% reported them for alcohol; however, they were reported by 47% for tobacco. When looking at the extent to which any measures were enforced, regulatory and economic measures were perceived to have been strongly enforced in only limited cases, especially in relation to illicit drugs and alcohol. Enforcement was strong for measures related to tobacco. While these findings may be affected by some of the study’s limitations, which are explicitly acknowledged by the authors, they provide valuable insights into this growing field.

Box 1: Environmental prevention:
EMCDDA’s definition and scope
The purpose of environmental prevention policies and interventions is to limit the availability of unhealthy or risky behaviour opportunities (or promote the availability of healthy ones).
Environmental prevention operates by changing the physical, economic, or regulatory contexts for behaviour. It involves low individual ‘agency’; i.e. individual personal resources such as conscious decision making, motivation and intent do not need to be used to benefit from the specific intervention. Therefore, environmental prevention typically works without using persuasive messaging, although information can sometimes be provided alongside an environmental intervention.
In our definition and scope of environmental prevention we have grouped our examples according to the aspect of the environment they primarily modify: regulatory, economic or physical. These are meant to help organise the examples of environmental prevention that we provide, but we accept that there may be some overlaps between the areas. Nevertheless, we find it a useful way to cluster our examples.
The first type is regulatory environmental prevention interventions/measures. These are interventions that directly control what is allowable or accessible using legislation, regulations, restrictions, policing, institutional rules, bans and exclusions.
The second type is economic environmental prevention interventions/measures. These measures influence the costs of the healthy/unhealthy options through taxes, pricing policies and subsidies.
The third type is physical environmental interventions/measures. These are interventions that alter properties or placement of objects, stimuli or any built element within micro-environments (i.e. offices, bars, etc.) or macro-environments (i.e. cityscape, landscape, etc.) to foster certain health-related behaviour changes.
Source: Environmental substance use prevention interventions in Europe, p. 48

Concluding comment
In a context where there is little evidence of the effectiveness of traditional prevention approaches to bring about behavioural change in substance use, alternative or complementary approaches should be welcomed. This report suggests that environmental prevention measures offer a complementary approach to the prevention field. This report provides ‘a useful starting point’ (p. 6) for creating a greater understanding of these measures and a way to assess them.

1 Oncioiu SI, Burkhart G, Calafat A, Duch M, Perman-Howe P
and Foxcroft DR (2018) Environmental substance use prevention interventions in Europe. Technical Report. Lisbon:
European Monitoring Centre for Drugs and Drug Addiction. https://www.drugsandalcohol.ie/28613/