The Journal of Primary Prevention, Vol. 14, No. 4, 1994

A Social Marketing Approach to Involving Afghans in Community-Level Alcohol Problem Prevention Linda Cherry ~,3and Sonjla Parker Redmond 2

A program for preventing alcohol-related problems at the community level using environmentally-focused, public health approaches sought to involve a new segment of the community. That segment consisted of recently-immigrated Afghans from a traditionally abstinent culture. Social marketing research was employed to elicit value-based benefits to be used in promoting the product (involvement with environmental change efforts) to the target audience. While the channels of distribution for promotional messages were easily identified, special attention was required relative to effective spokespersons. Much was also learned about the immigration experience of Afghans in a San Francisco Bay Area community that has significance for other fields. KEY WORDS: marketing prevention; Afghan immigrants.

CommPre is one of the growing number of community-based alcohol problem prevention programs grounded in public health theory and focusing on changing environmental factors to reduce alcohol-related risks. Sponsored by Horizon Services, Inc., in the northern California community of Hayward, CommPre's model since it began in early 1989 has been to transfer the technology of prevention to key institutions and reference groups in its target community. Resources are then provided to assist participating ILinda Cherry is a social marketing and communications consultant who works with a variety of alcohol and other drug problem prevention efforts in California. 2Sonjia Parker Redmond is an associate professor of sociology and social services at California State University, Hayward where she is also affiliated with the Center for Study of Intercultural Relations. 3Address correspondence and reprint requests to Linda Cherry, M.A., Social Marketing and Communications Consultant, 27998 Fallbrook Drive, Hayward, California 94542. 289 O 1994 Human Sciences Press,

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institutions and groups in identifying the specific alcohol-related problems of their constituencies and in developing and implementing environmental change prevention initiatives. CommPre has facilitated problem assessment and prevention projects through churches, an independent living center for people with disabilities, high schools, women's services, civic and social clubs, youth athletic leagues, the police department, a family homeless shelter, and the chamber of commerce. A community-involved planning process in the summer of 1991 identified certain population groups that had not been represented in the work of CommPre, leaving gaps in its community-wide approach. Among the obvious absences were recent Southeast Asian and Afghan immigrants residing in the greater Hayward area. A decision was made to focus on the latter group first. Since Afghans are predominantly Muslims whose Islamic laws restrict the use of alcohol, there was interest in whether those traditional cultural protective factors against alcohol problems were still intact. If so, how had that been achieved within a dominant culture that places high value on alcohol consumption? If the protective factors were wearing away, would Afghans be concerned enough to become involved with community prevention efforts? There was recognition that involving such a recently immigrated and virtually unknown group would require a more intense learning and data-gathering process than had been necessary with other populations participating in the program. A social marketing approach was chosen for this process, the goal of which was to determine what benefits to the Afghan community could be identified that would encourage their buying involvement in the prevention program, if traditional protective factors were indeed disappearing.

SOCIAL MARKETING FOR PREVENTION Kolter (1989) describes social marketing as "a social-change management technology involving the design, implementation, and control of programs aimed at increasing the acceptability of a social idea or practice in one or more groups of target adopters. It utilizes concepts of market segmentation, consumer research, product concept development and testing, directed communication, facilitation, incentives, and exchange theory to maximize the target adopters' response." Unlike health education strategies which tend to focus on achieving behavioral change by individuals, social marketing ~ as with all marketing - - addresses broad categories of people, groups known as target audiences. When the target audience consists of political or social decision-makers, social marketing can be used to sell the social changes that are usually essential to resolving public health issues. i

Marketing Prevention to Afghan Immigrants High Involvement

Thinking Feeling

Provide information. Use long copy formats and reflective media vehicles. Touch emotions to change attitudes. Use imagery and large spaces to evoke sensual responses.

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Low Involvement Reinforce established habits. Use small, short, repetitive reminders. Emphasize self-satisfaction. Use media that encourage impulsive responses.

Fig. 1. Guidelines for developing promotional messages as suggested by Ihe FCB grid.

With respect to Afghans, CommPre was interested in selling involvement with its community-level prevention program. In social marketing lingo, involvement was the product and Afghans were the target audience. Understanding how to approach the segments within that target audience was the goal of a qualitative research project to reveal values among Afghan immigrants. Benefits to buying involvement with CommPre would be crafted from those values and used to promote purchase of the product. In developing promotional strategies, marketers often call upon the FCB Grid (Ratchford, 1987). This matrix (modified as Figure 1) suggests how promotions should look based upon where the product being promoted falls on the Think-Feel and High Involvement-Low Involvement axes of consumer decision-making. High Involvement/Thinking decisions are characterized by rational criteria while High Involvement/Feeling decisions are characterized by affective criteria. Low Involvement/Thinking decisions tend to be routine ones while Low Involvement/Feeling decisions relate to "life's little pleasures" and impulsivity. Fine (1981) indicates that issues generally draw greater involvement than ordinary products. Although alcohol-related problems evoke strong feelings, decisions to become involved in prevention work are likely to require considerable thinking on the part of Afghans. Thus CommPre could expect its promotions to be informative using long copy formats and reflective vehicles. However, tapping emotions to change attitudes would not be inappropriate. Promotions should educate Afghans to the issues so they become empowered to respond (think-feel-do) by buying the product. Research would also reveal the most appropriate communication distribution channels through which to promote the product. Indication of the price or cost to the Afghan community to become involved with CommPre would also be sought so as to ameliorate it to the extent possible.

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REVIEW OF THE LITERATURE The Islamic faith permeates all aspects of Muslim life. A true believer, according to Haneff (1985) will accept responsibility for changing what is wrong or evil; will be self-disciplined and exercise self-control; will be pure, modest and chaste; will practice cooperation not competition; and will shun overindulgence and injustice. Over time, various sects of Islam have modified how they interpret the lessons of the Prophet Mohammed as recorded in the Koran and Hadith. While many schools believe that the teachings of Islam provide the only way to know God, others such as the Sufi of Iran have cultivated a "broad humanism and latitudinarianism" and help all humans regardless of their creeds. They have accepted that all religious beliefs and human creeds are relative, an interpretation that is anathema to orthodox Muslims. According to Rahman (1987), the three most fundamental religious concepts in Islam mean "safety, wholeness and integrality as opposed to danger, fragmentation and destruction through disintegration." This results in a value toward human well-being. Although controversy may arise over whether to take control and seek treatment in the case of illness or to rely on God, the Koran (5, 90-91) denounces, without outfight and explicit prohibition, the use of alcohol. All schools of islamic law except the Hanafi do prohibit the use of alcohol although some allow for medicinal use. The Hanafi hold that it is intoxication and not consumption that is prohibited. Like many of their neighbors in this host country, immigrant Muslims are struggling with issues around family values. Traditionally accepted as a patriarchal culture, Islam's laws of gender inequality are increasingly criticized by religious and feminist scholars. Feminists (Mernissi, 1990) claim the Koran records that the Prophet actually taught non-violence and gender equality, but that manipulations in the Hadith (lessons from the Prophet interpreted by others) have occurred to create domination and exclusion of women from power. Although they reach the same conclusion, male scholars of the holy writings refer to the changes as reinterpretation for expediency and to accommodate reality. Values relating to children are less controversial. While children are cherished, young people are accountable for their own actions by the time of puberty so adolescence is seen as the time for taking on the values of adulthood and God, not a time for rebellion or deviation. According to Sheler (1990), a major fear of Muslims in America is that their children will be seduced by the practices of sectflar American culture. They express great concern about the use of alcohol and other drugs and about premarital (and extramarital) sex. They wonder how they can adopt the technologies of modernization without being consumed by Westernization (Hassan, 1990).

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Globally, Muslims number one billion people in 44 nations with an annual growth rate of three percent. In 1986, some 4.7 million Muslims lived in the United States, including one million Black Muslims. Adherents to the Islamic faith living in the United States outnumber Episcopalians and within the decade are likely to outnumber Jews (Sheler, 1990). Some 100,000 Muslims live in the Bay Area including first generation immigrants and their children, many of whom are now young adults, and U.S.-born African- and Euro-Americans who have adopted Islam (Hermansen, 1991). In general, according to Lipson and Meleis (1985), Middle Easterners acculturate in outward behavior more rapidly than other immigrant groups, but some individuals view their expatriation as temporary and are unwilling to assimilate. Although 20 ethnic groups live in Afghanistan, virtually all of them are Muslim so most Afghans in the United States can comfortably be assumed to be Islamic. Almost all of them are here because they were "displaced by force by a group who sold their souls to the enemy," said Roashan (1992) referring to the 1979 invasion of Afghanistan by the Soviet Union. According to Ali Mardanzai (1992), director of the Afghan Support Agency in Hayward, half of the Afghans now living in this country reside in California, and 64 percent of those live in the Bay Area. The highest concentration of Afghans live in Hayward, followed by Fremont, Union City, Newark, the rest of Northern California, and San Jose. Population data specific to Afghans is difficult to unearth because they get lost in demographic terminology. Although located on the Asian continent, Afghanistan is not home to Asians. Afghans generally classify themselves as Caucasian or undifferentiated Other on demographic forms. Hayward Unified School District reports that two percent or approximately 400 of its students speak Farsi (or related Dari) as their first language (Davis, 1992). Again according to Mardanzai, Afghans fall into three categories relative to their assimilation goals. A very small percentage of families came from Afghan villages and greatly desire to return to them. Another small percentage never cared for life in Afghanistan and intend to settle permanently in the United States. The third and largest group includes parents who would like to return to their homeland when it is safe to do so, but their children were born or grew up in this country and are not planning to leave. Therefore, until peace and security return to their homeland, the great majority of Afghans can be considered fairly homogeneous in their goal which is, according to Roashan, to contribute to making the host culture a pluralistic one. "Assimilation is slow and rough and needs exchange and contact with hosts to succeed," he said.

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In reporting on health and adjustment among Middle Eastern refugees, Lipson (1992) identified several key stressors: culture shock since their abrupt departure left little time for a marginal episode of transition, language, perceived loss of status from that enjoyed in the homeland, difficulty finding work comparable to that in the homeland, worries about children absorbing American norms and values, reduced social supports, and ethnic bias now due primarily to language barriers. Living in exile means loss of identity~ difficulty translating one's personality into the new culture, and the pain of losing the world of one's youth (Afkhami, 1990). For those Middle Easterne~ who are strongly attached to the Islamic faith, maintaining their cultural identity has been the most significant issue in living in the ho~t country.

~ESEAI~CH METHODS With this as background on Afghan immigrants, four research objectives and attendant questions were identified for a qualitative study utilizing depth interviews with key community sources and focus groups. 1. To determine the extent to which alcohol may be creating problems for Afghans who are now living in the greater Hayward area and who have a traditionally abstinent h~tage. Are the protections provided by the cultural and religious restrictions against the consumption of alcohol breaking down in this country? If so, for whom: adults, women, teenagers, children? 2. To identify the kinds of alcohol-related problems that Afghans may be experiencing in this country. Has alcoholism become a problem? Is drinking and driving a problem? Teenage drinking? Sales of alcohol to minors? Disruptions at social and cultural events? What other problematic situations raay Afghans attribute to alcohol consumption? 3. To better understand how Afghans view causation of alcohol-related problems, particularly alcoholism. Although this research was primarily concerned about the prevention of alcohol-related problems, it was recognized that prevention activities often uncover the need for intervention and/or treatment. Mainstream treatment and recovery services must have a basic understanding of Afghan perspectives and assumptions about alcoholism in order to effectively respond to the need for those services. 4. To elicit from the Afghan community itself viable prevention responses. If a loss of cultural protections is contributing to alcohol-related problems, how can they be restored, strengthened, and maintained? If dominant culture institutions and activities contribute to such problems, how can that be addressed? Will the community as a whole respond to this issue? Who will lead? What resources will be needed?

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Qualitative research methodology was used to collect data for this study for several reasons. Almost no information exists related to alcohol problem prevention and Afghans. Secondly, as confirmed by the literature, it was thought that more would be learned because the community would be more receptive to face-to-face contact than to written questionnaires (Lipson and Meleis, 1989). A variety of sources was tapped to identify key community sources with differing roles and perspectives and focus groups members from a cross-section of socioeconomic strata. These included the Afghan Support Agency, Afghan student clubs at California State University, Hayward and Chabot College, the Afghan Cultural Society, Hayward Unified School District, Hayward Public Library, and the Afghan Health Project conducted through the University of California, San Francisco. Key sources included the director of a culturallyrelevant social service agency, an officer of an Afghan cultural group, an instructional aide at a local elementary school, a community college student, a leader from a local mosque, a pre-med college student, the manager of a local banquet hall, and a college administrator. Six focus groups met including students from a local university, parents of students at a local elementary school, community leaders identified by a social service agency, participants in an Afghan health study, students at a local high school, and a mixed group of concerned citizens of various ages and walks of life. Approximately 75 individuals participated in interviews and focus groups. This study was conducted for CommPre by a social marketing consultant who has been involved with the prevention program since its inception. Consultation on specific aspects of the research was also provided by the Center for Study of Intercultural Relations at California State University, Hayward. The researcher is not Afghan so limitations that may have influenced the collection, and hence the completeness of the data, resulted from the cross-cultural nature of the process. However, others who have studied Afghan immigrants indicated to her that being a woman not of the Afghan culture would be a plus. She could interview both men and women and fears of her gossiping within the community would be few. That certainly seemed to be the case during the interviews, but there is the possibility that undetected cultural biases about male-female interactions did exist. There is also the potential that having both males and females participate in all focus groups had some impact on the information shared. The most obvious impact, however, seemed to be positive by providing perspectives from both men and women. This was the case even within the focus group of parents that included the most traditional individuals interviewed.

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Language barriers were likely to produce greater limitations. Although translators participated in the focus groups with parents, community leaders, and the mixed group, it was impossible to capture all of the conversations that took place during the sessions. It is a cultural custom for small side conversations to occur within group meetings and that happened during all focus groups. However, when there was concern about having missed significant information, the researcher spent extra time debriefing with the translator after the session. Although none of the interviews with key community sources required translation, it is possible that nuances of meaning were missed by both the respondents and the researcher. However, crosscultural situations were not new to her, and she remained alert to the potential risks. The most significant limitation to the research may have come from the topic itself. Since Islamic law restricts the use of alcohol almost completely, acknowledging either personal or community problems related to its consumption could be difficult. Fortunately, that did not seem to be the case. This issue is of such concern to the Afghans who participated in this study that they apparently overcame any uneasiness and contributed to the extent possible within the barriers created by language differences,

FINDINGS For a more complete understanding of the relationship between Afghans and alcohol than could be gleaned from the literature review, a leader from a local mosque was interviewed. A summary of that information is presented first. According to the Holy Koran, drinking alcohol is a sin equal to g a m bling, idolatry, murder, and other felonies. Koran 2:18 says that alcohol is a great sin. Even though it has some benefits, its harmfulness is greater than those benefits. However, the presence of alcohol in many medications is an example of its benefits, and its use in this instance is permissible. Koran 7:89 says that liquor, gambling, and idolatry are the works of Satan. Muslims must rid themselves of these activities which are Satan's tools for deceiving people away from God and prayers. Alcohol is considered haram, meaning it is prohibited by God. Those who engage in haram will be punished by God. Alcohol, like urine, is considered nigess, meaning that any contact with it is spiritually dirty. Getting even a drop on clothing is bad, and it must be cleaned away immediately.

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The restrictions on alcohol consumption are based on considerations of health and the loss of self-control. An Afghan pharmacology textbook is reported to use a religious fable to illustrate this concern over loss of control. As related by one source, that fable tells: The Prophet Noah was known to be a heavy drinker: When his ark struck ground at the end of the 40 days and 40 nights of rain, his first action was to plant a vineyard. However, the vines did not produce grapes. Noah complained to God, asking what good were vines if they didn't produce grapes. He was told to kill one of his two lions and pour the blood onto the roots of the vines. Grapes grew as a result, but they were not sweet. Noah again complained to God who told him to kill one of his two foxes and pour the blood on the roots. But still Noah was not pleased with the yield, and he complained again to God. This time he was told to kill one of his two donkeys and pour the blood on the roots. Finally, the grapes were to Noah's satisfaction, and he fermented a very sweet wine. Just as he was about to take his first drink, a hand reached down to stop him. "Take one drink, Noah," he was told, "and you will feel like the lion, full of bravery. Take a second drink, and you will act like the fox, deceitful even of yourself. Take a third drink, and you will be like the donkey, an ass."

In the time of the Prophet, breaking laws restricting the use of alcohol resulted in corporal punishment including 40 to 80 lashes to the bottoms of bare feet. Current law in Afghanistan calls for five to 15 years imprisonment if the police discover the drinking. This prevents virtually all public drinking. Private homes can also be invaded, and neighbors will inform on neighbors about drinking in homes. While alcohol addicts were often hospitalized for treatment, some were also put in jail. Opium addicts, on the other hand, often received allotments of the drug until they could get into treatment facilities. One source reported that the laws around alcohol were always applied inconsistently in Afghanistan. Rich and powerful people could find alcohol, and it was generally served at their social functions. It was acknowledged by many community sources and focus groups members that some Afghans drank in the homeland, occasionally in front of their children, and that those people continue to drink in this country. However, alcohol became much more visible in Afghanistan when the invading Soviets brought in vodka, many believe as a strategy to turn Afghans into alcoholics and thus less resistant to the invasion. But the unanimous opinion of focus group members and key sources was that alcohol is much more available and accessible in this country than in Afghanistan. One source exclaimed, "There are more liquor stores in this country than there are schools! Young Afghans see alcohol everywhere, and they think it is the American thing to do."

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A 25-year-old woman who came to this country at age 18 said young Afghans are not only emulating their American friends, but they are also taking cues from beer commercials on television that tell them to drink beer to have a good time. "Young people might have tried to drink in Afghanistan," she said, "but alcohol is too hard to get. Here it is easily available to them." A cousin of hers came to this country at the age of 14. He was very confused about rules for behavior at school and "in the streets." She also told of an older relative who drank in Afghanistan, but he had to rely on his Indian friend to provide the alcohol or else purchase it from the continental hotels in major cities where alcohol was available for tourists. Now he is able to easily purchase it himself whenever he chooses. She was disturbed by alcohol being in all the stores and wondered why it could not be sold only in special stores where it would be less accessible. Yet another source reiterated, "So many people can be seen drinking in so many situations that some Afghans believe this is the appropriate thing to do to adjust and fit in. During transition times, people don't understand the basis of new laws and customs. They just jump in and mimic without knowing their limits." Even some Afghans find themselves contributing to the availability of alcohol. Because he does not believe in drinking, an Afghan restaurant manager did not include a bar in his facility when he renovated a banquet hall. Shortly after opening, however, he was pressured into installing a bar if he expected to serve Ar~erican customers as well as Afghans. Now when Afghans use his establishment, the elders will ask him to close the bar which he gladly does. However, members of the younger generation who attend events at his facility simply go to the other bar in the same shopping center or to the grocery or drug stores and buy alcohol. He reported, "They will use coffee cups on the patio, and they think no one will know what they are drinking."

Effects of Alcohol Availability Many, many consequences of the abundant availability of alcohol on their children, families and community were identified. The staggering statistic that 50 percent of those Afghans who did not drink in their homeland do so in this country was offered. Typically, Afghan women do not drink although there were some reports of young women beginning to do so in secret. Those involved with an Afghan health study were concerned that drinking will exacerbate existing or potential health problems that Afghans already risk due to unhealthy diets, smoking, and a tendency toward undiagnosed diabetes and hypertension. 'Many are also suffering from posttraumatic stress disorder due to the situations that forced their immigration. They may be self-medicating with alcohol and worsening their conditions.

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Two groups of people seem to be drinking in ways that concern members of the Afghan community. One group consists of those who are not adjusting well to the immigration experience. They drink due to sadness and the stresses of living in a different culture, not being able to make a living, always worrying about money, and not understanding what is happening with their children who are no longer respectful of their cultural norms and values. This group includes alcoholic drinkers who range in age from 35 to 70. The second group of problems drinkers consists of, as one focus group described them, those who are adjusting too well to the immigration experience. These tend to be young people although the exact age of this population could not be established. Older adults said this group consists of 20-35-year-olds "who are young and careless and don't care about religion and don't listen to anyone." The adults are concerned about how living in the American culture is, and will continue to, weaken cultural protections against drinking problems in this younger generation. College students believed that Afghan teenagers are drinking particularly heavily with peer pressure to do so as strong or stronger from within the Afghan community as from outside it. One college-age source reported that in addition to drinking beer and using marijuana which is readily available to them, Afghan teens have formed the Four Horseman gang which attracts naive high school freshmen and sophomores. This gang was formed not to protect Afghan students from other ethnic gangs, but to be cool and attract attention. He suggested that since few high school students remember Afghanistan even if they were born there, their ties to the culture are not as strong as with young people who are now college age. High school students, on the other hand, did not believe that a significant number of their Afghan peers drink. When a group of 12 Afghan teenagers were asked to each think of five of their Afghan friends and report how many of them drink, the response was none. However, they were quick to respond that it is easy for teenagers to obtain alcoholic beverages. All they have to do is hang around outside a near-by convenience store and ask an adult who is going in to make the purchase for them. They also reported that Afghan teens drink at their friends' homes and when they cut classes at school. A third group of alcohol consumers was also identified, those who drank in the homeland and continue to do so here. However, their drinking does not seem to create problems for t h e m - - o t h e r than to be in violation of Islamic l a w - nor are community leaders particularly concerned about it.

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Regardless of the exact age of young drinkers, the reported effects of the drinking on families were similar. High school students suggested that one reason Afghan teens drink is in retaliation against restrictive parents. Even though parents may not recognize the symptoms of their children's drinking, adolescents may start drinking out of defiance. Then they discover they like the feeling and continue to do so. An adult source who works closely with students reported that drinking and possible drug use and/or dealing are ways that teenagers cope with tensions within their families. She said, for instance, that Afghans do not support romantic relationships between teenagers. When families say, "No, you cannot go out with a girl. You don't have any money to do that. We don't have any money to give you, and school is more important than getting a job," a young man is likely to drink to deal with the stress and be tempted to sell drugs for the money. That some parents may be unaware of these reactions was reinforced by the focus group of parents, who tended to represent the more traditional members of the community. They reported that only 10 percent of older Afghans drink and that "teenagers do not drink because their parents have taught them ant to." They indicated that Afghans do not start drinking until they are about 25 years old. Members of the high school focus group were very frustrated by the dual lives they must lead. They feel that Islamic laws control every aspect of their lives for reasons they do not understand. They recognize that only about 10 percent of Afghans couples divorce, which they believe is good. But they also believe it is a good idea to get to know someone before martying them. They want the freedom to get to know different people in social situations and to not be forced into marrying someone they do not like. Many spoke of parents not trusting their children, but most also recognized that it is often the environments that students want to involve themselves with that concern parents, rather than a lack of confidence in their children. If Afghan parents know that other Afghans are allowing their children to attend social events, they will often agree as well. Members of the focus group of college students indicated that young adults are caught in the middle. They are enough products of their culture that they respect traditional customs and practices and are proud to be Afghans. However, they have lived in this country long enough to have adopted more western social practices as well. This creates tension within families when, for instance, young women insist on their rights to choose their own husbands. This means being friends with a variety of young men first which is still strongly opposed by many of their parents. This group also reported that parents are usually unaware of the differences in their own educational experiences (if they had any since these students suggested that half of parents are illiterate even in Farsi) and those now encountered

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by their children. Parents do not understand the pressures on students nor the expectations that the educational system and other students have of them. An adult source who works with college students reported that "rigidity" is creating enormous problems within families as youngsters try to balance the demand of their parents to abide by cultural expectations with what it takes to survive in their new environments. She stated, "The self-esteem of Afghan teenagers is being crushed by their parents' and the community's disrespect for their struggles to exist in two cultures. They are shamed and humiliated for engaging in behaviors that they see their schoolmates engaging in without repercussions. This is already damaging these teenagers and will affect them in the future as well." A young Afghan source said that parents are having a difficult time understanding their children's behavior even if it may not seem so outrageous by American standards. However, she was not sure how involved parents get in trying to change either the behaviors or the situations that lead to them. Mostly, they are concerned about survival issues. She said, "Afghans who come here as teenagers are not prepared for the amount of freedom they have here, and parents are surprised that schools do not insist on appropriate behavior." Indeed, a source who works in an elementary school frequently finds herself the intermediary between parents and their children who are students and between parents and the school system which often does not understand the cultural differences either. She further reported that young Afghans often interpret living in a free country to mean there are no rules or behavioral expectations, Islamic or otherwise. She confirmed the confusion experienced by a previous source's cousin over acceptable behavior. These young Afghans frequently learn the responsibilities of living in a free country only when they are punished for violation of the rules and expectations that do, indeed, exist around school attendance and respect for teachers. Parents, this source said, have expectations that schools will exert even greater control over the students, and they do not understand the limitations set by law and custom. A college student m who understands that members of his culture drink "to get the ups" but himself believes the "downs" are so much worse than "regular life" that they are not worth enduring just to get the fleeting "ups" m drew a succinct conclusion. He explained that communication is very poor within Afghan families. Husbands don't communicate well with their wives, and young children are virtually ignored by their fathers. Men, he said, often use drinking as a way of telling their wives that they are unhappy. Then, since Afghans are volatile people with few restrictions against physical punishment within the family, alcohol contributes to an escalation into violence.

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Problematic Environments

The situations that were identified most frequently as the places where alcohol causes problems for Afghans are social gatherings, particularly weddings. One source indicated that alcohol is now expected at all social events even if the host does not drink. If hosts do not provide alcohol, they are shamed and become the subjects of gossip, a dreaded consequence for Afghans. Members of the focus group of community leaders suggested that up to 20 percent of the guests at a wedding will bring their own alcohol and go outside to get drunk. "They disrespect the hosts and the bride and groom by spending the entire time drinking." With people drinking at these gatherings, fights break o u t - - e v e n among friends over minor transgressions that would been overlooked if not for being under the influence. The restauranteur-source told of an incident that occurred just a few days prior to the interview. People were gathered for a small party at his establishment, and no alcohol was being served. However, several young men went to a nearby bar and drank. It was probably the first time one of them had had alcohol, and when he returned he harassed the young women at the party, stumbled around and fell, and got into arguments. The source was prompted to share this story because the young man's mother-in-law called during the interview to apologize for his behavior and to report that she had "divorced" her daughter because of her son-in-law's drinking. Several members of the mixed focus group recalled hearing a story about a recent concert in Los Angeles that targeted Afghan youth. The hall for the event was to rent for $5,000, but the managers told the planning group that if alcohol sales were high enough, there would be no rental charge. When the planners went to the facility managers after the event to pay the rent, they were told that $7,000 worth of alcohol had been sold to the predominately Afghan crowd so there would be no rental charge. From this instance, members of the group realized the power of the alcoholic beverage industry and its relationship to entertainment and sports. In addition to fights that erupt at social events, people who drink are reported to be involved in automobile crashes as well as creating dangerous situations in factories and on their jobs. Drivers are losing their licenses. Some Afghans who work in convenience stores sell alcohol as part of their jobs, and it is accepted that they have to do that to make a living. There are reports, however, of Afghans who have tried not to sell to certain people and have been injured for their efforts.

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Changing Environments for Prevention Given the nature of the CommPre program, there was interest in how these problematic environments might be changed to reduce the risks of alcohol-related problems developing. Such changes often involve modifications in social and cultural norms and values around the use of alcohol so probing questions sought to elicit information about culturally-specific changes that might work for prevention. Reflecting that there is no distinction between church and state for the Muslim, and government is good when its principle function is to enable the individual Muslim to lead a good Islamic life (Lewis, 1988), several changes in the ways that alcohol is available in this country were suggested: • • • •

Sell alcohol only in special stores where it would be harder to get. Sell alcohol only on weekends. Allow alcohol to be drunk only in homes and restaurants. Put alcohol manufacturers and sellers out of business or at least restrict the number of hours they can sell. • Government should intervene to raise prices; if alcohol were more expensive, fewer people could drink so much. One source used an analogy of their being too many uncovered wells (i.e., alcohol outlets) around for people to fall into, and he told about an experience when he was working with the government in Afghanistan. According to this source, cinemas in Afghanistan are much like alcohol and drugs in this country; they are used as temporary escapes from severe poverty and inadequate education. Young people will steal from families and friends to get money to go to the movies. When a businessman came to the source to discuss opening a cinema in an Afghan town, the source discouraged him from doing so. "But," the man said, "I have a family to support. I have to make a living. What else can I do?" The source recalled that he looked around and saw a pencil on his desk. He encouraged the businessman to open a pencil factory, to provide a product that was needed by the country. Although the source reported losing contact with the businessman when the Soviet invasions began soon thereafter, his story illustrated an understanding of how certain kinds of businesses can contribute to problems. Adult sources and focus group members recognized that convincing individuals to change their behaviors is very difficult. The restaurateur reported that although Afghan party hosts almost never serve alcohol, they are reluctant to confront their guests who leave and come back after drinking. They are often told by the drinkers that it is none of their business, and fights can start that way. Adults were split on how they would approach

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prevention with teenagers, Some believed that the approaches should be the same as with American teenagers. "For those who came to this country when they were very young or were born here, it is hard to tell them from American teenagers in many situations." Others believe that the best hope for preventing young Afghans from adopting unhealthy and dangerous western habits is through programs that strengthen ties to the Islamic culture and its protective factors. Helping Americans better understand that culture might also reduce pressures on Afghans to violate its norms and values. College-age sources and focus group members were also split on how to address alcohol-related problems among teenagers. One view supported working with high schoo| students to explain the effects and dangers of alcohol. They believe that many Afghan teenagers do not have this information, and some of them have witnessed teenagers stop drinking and smoking when they were educated about the dangers. To an extent, they supported the adults' belief in reinforcing cultural and religious prohibitions which many of the students do not believe are understood by adolescents. However, they indicated it will be hard for youngsters to accept these prohibitions when they see their elders violating them. The students felt that since many parents are illiterate, their children have not been taught the reasons behind the laws, and they do not get that information in American ~chools. They felt that the relevant teachings of the Koran should be explained to young people, but they should not simply be told that Islamic !aw prohibits drinking. College students believe that people their age are usually more effective in providing this information to teenagers because ~hey can help adolescents feel less alone. "Most Afghan kids are scared of feeling weird and being isolated:," said one source. Another view among college students was that parents needed educating about the need for communication within families. One source explained that while friends can communicate well, that does not happen in families. By the time children are nine or ten, they are expected to understand their culture, including the requirement of obedience to parents. But since Afghan children are not learning about their culture in American schools, this source believed it is essential that parents learn how to explain it to their children. Members of the college students focus group, especially the young women, longed to be able to talk to their parents about such issues as sex, drugs and alcohol that they encounter in their daily lives. Adopting the vernacular of the dominant culture, one student was particularly disturbed and stated that many Afghan families are dysfunctional. Although some of the students doubt that parents could be educated into changing their own drinking behaviors, they might listen to prevention information they felt would protect their children. On the other hand, some

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members of the group believed that parents are in serious denial about many of their children's activities and would simply respond, "My child would never do that. I taught them better."

COMMUNITY INVOLVEMENT WITH PREVENTION CommPre's approach to alcohol problem prevention is based on community organizing and empowerment principles through which special populations of various definitions are supported in identifying and responding to their unique situations. Therefore, determination of the readiness of members of a community to undertake prevention efforts is essential. Although there was definite concern among key sources and focus group members about the problems that alcohol is creating in the Afghan immigrant community, serious caveats to prevention were expressed. Some respondents voiced skepticism about successfully changing behaviors. One source wondered, "If the government is so concerned about these problems, why doesn't it stop them. How can this country spend the money to go to Somalia and not pay attention to the problems it has right here?" He understood that alcohol manufacturers and the U.S. government are closely related which makes making some changes very difficult. However, he also agreed to be part of a larger community effort to encourage those changes. Other sources were particularly interested in CommPre's efforts to limit the number of alcohol sales outlets through a conditional use permit process in the City of Hayward. Another dilemma could be the lack of a comprehensive social service agency that can attract and address the issues of Afghans from the many ethnic groups that have immigrated to the Bay Area. Islamic mosques do not traditionally serve as community centers. And, as members of the focus group of parents reported, "We talk about this problem in mosque. The mullah tells us that drinking is wrong because it affects the way we think and our health, but unfortunately those who drink do not come to mosque." All focus groups and key community sources agreed that the key to successful community involvement with prevention lies with parents. However, a concern expressed by two sources was that, while parents are likely to worry about alcohol use among their children, they may be too overwhelmed by survival issues to devote much attention or energy to prevention efforts. If parents do not exert their influence, the community as a whole will not respond, according to the focus group of community leaders.

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Outreach, Information and Education How to issue the invitation to members of the Afghan community to become involved with CommPre and how to disseminate any prevention initiatives that result from that involvement were issues of vital concern to this research. Members of the college student focus group suggested that since Afghans are very private about their family matters, they will respond better to such information and education from people outside of the community than from someone of the culture. This suggestion from college students was echoed by other key sources as well in recurring themes that could be summarized as follows: Afghans do not ter~d to take the word of other Afghans for much of anything. They are more willing to listen and learn from almost any outsider than from someone of their own culture. Support or discussion groups could be useful but must include outside influences to be credible. • Even though Afghan elders were respected in the home country, young Afghans may not respond positively to them now. • Parents often need someone to talk with, but the fear of gossip within the Afghan community often keeps them from going to friends or family members or even such places as the Afghan Support Agency or Afghan Center. Although they would prefer going to an American for assistance~ few Americans understand the culture or the language. Translators often confuse or interfere with the situations. One source addressed the issue of using role models as spokespeople through a story. According to the tale, a man once asked the Prophet how he should handle a situation of having eaten garlic before going to mosque. The Prophet told the man he would have an answer for him the next day. At that time, the Prophet said that in such a situation, he would first clean his teeth and then chew mint to freshen his breath before going in among the congregation. The man thanked the Prophet for his wisdom but asked why he had to wait a day for the answer. The Prophet responded that it was because he, himself, had just eaten garlic when the question was asked. The source seemed to suggest that those who drink may not be good role models for talking with the Afghan community about prevention. Two promotional media were recommended with equal enthusiasm: the use of television and convening community gatherings. Television programs in Farsi are cablecast from a few channels across the country and are popular with local Afghans, most of whom have cablevision in their homes to receive these programs. Presentations that combine dramatic enactments with discussions by a variety of physicians, social workers, religious leaders, and other erperts were suggested. Community gatherings also seem to be popular with

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Afghans. Concerts and dramas would attract Afghans to such events that would also focus on alcohol problem prevention.

MARKETING PLAN As a social marketing effort, the purpose of this study was to discover benefits to being involved with community alcohol problem prevention that could be used in promoting such involvement to Afghans in the greater Hayward area. Problems with alcohol were minimal in Afghanistan due to well-defined social values, norms, customs, and practices. The lack of such standards (the creation of which is a major goal for CommPre) in the dominant society within which Afghans live in this country is having a seriously negative impact on these immigrants. Two benefits to being involved in CommPre emerged from this research: 1) an enhanced future for Afghan children by helping them successfully adapt to bi-cultural lives and 2) more enjoyable social events when community standards for behavior are defined and enforced. (See Figure 2 for an application of marketing concepts to this study.) Television and community gatherings are the recommended media for promoting involvement with CommPre, supplemented by notices in locallypublished Afghan periodicals. Since CommPre has neither the resources nor technical expertise to produce MTV-type videos that would attract Afghan youth (who should be targets for all youth-oriented prevention messages), adults were identified as the segment of Afghans to target. Through its monthly cablevision program, CommPre has the capability of creating presentations m infomercials, if you will m that appeal to an audience starved for media in its native language. The most unexpected finding of this study with respect to promotion had to do with the messenger. Contrary to current thinking about working with virtually all other special populations --ethnic minorities, people with disabilities, women - - w h e r e being of the culture is seen as critical to delivering credible information, many community sources indicated that Afghans respond more positively to those outside of their culture. Three videotape productions are being produced to promote the valuebased benefits identified in this study. One will educate parents about the social expectations and educational environments of their children growing up in this country. One will discuss the anxiety and unease created within the community when social gatherings are disrupted by alcohol consumption. One will address the misconceptions and confusions reported among many young Afghans that living in a free country means no rules or behavioral expectations. These videotapes will be bilingual in response to the issue of

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Cherry and Redmond Target Audience

Afghan adults, especially parents

Product

Involvement in community-level prevention activities

Promotion

Based on benefits of enhancement of childrens' futures and having more enjoyable social events

Place

Message distribution channels of bilingual cablevision programs and community workshops

Price

Realization that life is different for their children and that preserving essential elements of their culture may mean accommodating those differences.

Fig. 2. Marketing concepts as applied to Afghans and alcohol problem prevention.

effective spokespeople to the Afghan community. Topics of concern will be addressed by English speaking experts such as educators, social workers and prevention specialists through discussions with leaders of the local Afghan community. Translations will be made during the programs so that the information is delivered by both Afghans and non-Afghans. These videotapes can be used as educational media when shown over cablevision channels viewed by Afghans. However, that passive medium will not adequately address the significant price to Afghans for being involved with prevention. That cost has to do with accepting the realities of their new lives. Time and again young sources sent a message to their elders: For whatever reasons, you have brought us to this country. We have to adapt to its ways to survive. We cannot live the lives you lived in Afghanistan. But we are also proud to be Afghans, to be Muslims. Please help us find a balance. Do not force us to choose. Reduction of this psychic cost will require more interactive use of the video productions. For that reason, the tapes will be used as centerpieces for community gatherings convened to discuss the very benefits--enhanced future for Afghan children and more enjoyable community social events m that were identified through this study. The goal is for these gatherings to also launch community organizing for wider dissemination of the information and for the initiation of changes for prevention. The specific change initiatives for prevention, of course, will grow out of the empowerment of that community organizing. CommPre makes copies of the tapes available to carriers of Afghan cablevision programming and to communities with Afghan residents.

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I M P L I C A T I O N S F O R O T H E R FIELDS This study was conducted to involve Afghans in community-level alcohol problem prevention efforts. However, many of its findings have relevance to other fields as well. • The related discipline of alcoholism treatment should be aware that, according to an Afghan psychologist in the health project focus group, alcoholism is an absolutely new phenomenon to Afghans. They have no philosophy of addiction nor understanding of it as a disease. Those who drink see it as a fun way to reduce the stress of immigration including isolation and depression, particularly among the elderly. Those who object to drinking see it as a violation of cultural or religious principle. T h e psychologist s u g g e s t e d that only the well-educated are likely to understand or recognize the physiological aspects • Law enforcement should find food for thought in this story told by a n o t h e r source: If a young boy comes home with cigarettes, his father will tell him that smoking is bad for his health and that he should not do it. If the child insists, the father will make him leave the house. Then the boy calls the police and tells them that his father has thrown him out of the house. The police come and arrest the father. The next time the boy brings cigarettes into the home and the father tells him to stop, the boy laughs at his father and tells him he cannot stop him; he will call the police, and they will arrest the father. When the father does what he believes is best for his son, the law takes away his authority and respect. • Immigration assistance agencies would be well-advised to respond to the concern about how young Afghans interpret living in a free country. T h e y and adult education p r o g r a m s could also m a k e significant contributions by heeding the pleas of young Afghans that their parents be helped to develop better family communication skills.

ACKNOWLEDGMENTS This study was conducted in conjunction with Ms. Cherry's graduate work in social marketing and was partially funded by C o m m P r e of Horizon Services, Inc. in A l a m e d a County, California.

REFERENCES Afkhami, Mahnaz. (1990). Iran: Exiles in their Own Land, Ms. 1:2:10.

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