Transcript A Global Perspective on Drinking ages and Alcohol use
FROM GLOBAL TO LOCAL: AN INTRODUCTION TO THE SYMPOSIUM
David Jernigan, PhD Johns Hopkins Bloomberg School of Public Health
GLOBAL BACKGROUND
Harmful use of alcohol is increasingly recognized as a global public health problem Alcohol use was responsible for 3.8% of global deaths and 4.6% of global disability in 2004 (Rehm et al., The Lancet, 29 July 2009) This is nearly equivalent to the harm from tobacco use, even when allowing for potential health benefits of alcohol use Global strategy on alcohol under development at WHO Areas of greatest concern: Alcohol and mortality in Russia Alcohol and young people
The U.S.A. in global context
Source: WHO GISAH, as cited in Rehm et al. 2009
Death and Disability Attributable to Alcohol Use Among Youth Ages 15-29, 2000
Males 15-29 Females 15-29 REGION Deaths (000s) % total Deaths DALYs (000s) % total DALYs Deaths (000s) % total Deaths DALYs (000s) % total DALYs
Afr D Afr E 10 28 5.90% 7.90% 560 1,469 5.30% 8.00% 2 5 1.10% 0.90% 129 257 1.00% 1.00% Amr A Amr B Amr D Emr B Emr D Eur A Eur B Eur C Sear B Sear D Wpr A Wpr B WORLD 9 52 5 2 1 9 9 42 14 26 2 39 249 23.00% 35.50% 17.20% 4.80% 1.20% 25.60% 24.30% 41.00% 11.70% 5.70% 18.40% 13.70% 12.90% 1,388 3,995 369 69 123 1,098 662 2,293 839 1,699 214 3,665 18,444 28.40% 30.80% 16.80% 2.40% 1.60% 24.40% 16.90% 35.00% 11.30% 5.30% 15.60% 14.60% 13.10% 1 4 1 0 0 1 1 5 2 6 0 7 36 9.50% 7.90% 3.30% 1.20% 0.20% 10.20% 7.20% 19.90% 2.40% 1.30% 7.00% 4.90% 2.20% 401 637 69 10 16 237 103 391 116 328 110 630 9.80% 7.80% 3.70% 0.40% 0.20% 6.10% 3.10% 11.20% 1.80% 0.90% 8.70% 3.10% 3,434 2.50%
Source: Rehm et al. 2003
Death and Disability Attributable to Alcohol Use Among Youth Ages 15-29, 2000
Males 15-29 Females 15-29 REGION Deaths (000s) % total Deaths DALYs (000s) % total DALYs Deaths (000s) % total Deaths DALYs (000s) % total DALYs
Afr D Afr E 10 28 5.90% 7.90% 560 1,469 5.30% 8.00% 2 5 1.10% 0.90% 129 257 1.00% 1.00% Amr A Amr B Amr D Emr B Emr D Eur A Eur B Eur C Sear B Sear D Wpr A Wpr B WORLD 9 52 5 2 1 9 9 42 14 26 2 39 249 23.00% 35.50% 17.20% 4.80% 1.20% 25.60% 24.30% 41.00% 11.70% 5.70% 18.40% 13.70% 12.90% 1,388 3,995 369 69 123 1,098 662 2,293 839 1,699 214 3,665 18,444 28.40% 30.80% 16.80% 2.40% 1.60% 24.40% 16.90% 35.00% 11.30% 5.30% 15.60% 14.60% 13.10% 1 4 1 0 0 1 1 5 2 6 0 7 36 9.50% 7.90% 3.30% 1.20% 0.20% 10.20% 7.20% 19.90% 2.40% 1.30% 7.00% 4.90% 2.20% 401 637 69 10 16 237 103 391 116 328 110 630 9.80% 7.80% 3.70% 0.40% 0.20% 6.10% 3.10% 11.20% 1.80% 0.90% 8.70% 3.10% 3,434 2.50%
Source: Rehm et al. 2003
Death and Disability Attributable to Alcohol Use Among Youth Ages 15-29, 2000
Males 15-29 Females 15-29 REGION Deaths (000s) % total Deaths DALYs (000s) % total DALYs Deaths (000s) % total Deaths DALYs (000s) % total DALYs
Afr D Afr E 10 28 5.90% 7.90% 560 1,469 5.30% 8.00% 2 5 1.10% 0.90% 129 257 1.00% 1.00% Amr A Amr B Amr D Emr B Emr D Eur A Eur B Eur C Sear B Sear D Wpr A Wpr B WORLD 9 52 5 2 1 9 9 42 14 26 2 39 249 23.00% 35.50% 17.20% 4.80% 1.20% 25.60% 24.30% 41.00% 11.70% 5.70% 18.40% 13.70% 12.90% 1,388 3,995 369 69 123 1,098 662 2,293 839 1,699 214 3,665 18,444 28.40% 30.80% 16.80% 2.40% 1.60% 24.40% 16.90% 35.00% 11.30% 5.30% 15.60% 14.60% 13.10% 1 4 1 0 0 1 1 5 2 6 0 7 36 9.50% 7.90% 3.30% 1.20% 0.20% 10.20% 7.20% 19.90% 2.40% 1.30% 7.00% 4.90% 2.20% 401 637 69 10 16 237 103 391 116 328 110 630 9.80% 7.80% 3.70% 0.40% 0.20% 6.10% 3.10% 11.20% 1.80% 0.90% 8.70% 3.10% 3,434 2.50%
Source: Rehm et al. 2003
Death and Disability Attributable to Alcohol Use Among Youth Ages 15-29, 2000
Males 15-29 Females 15-29 REGION Deaths (000s) % total Deaths DALYs (000s) % total DALYs Deaths (000s) % total Deaths DALYs (000s) % total DALYs
Afr D Afr E 10 28 5.90% 7.90% 560 1,469 5.30% 8.00% 2 5 1.10% 0.90% 129 257 1.00% 1.00% Amr A Amr B Amr D Emr B Emr D Eur A Eur B Eur C Sear B Sear D Wpr A Wpr B WORLD 9 52 5 2 1 9 9 42 14 26 2 39 249 23.00% 35.50% 17.20% 4.80% 1.20% 25.60% 24.30% 41.00% 11.70% 5.70% 18.40% 13.70% 12.90% 1,388 3,995 369 69 123 1,098 662 2,293 839 1,699 214 3,665 18,444 28.40% 30.80% 16.80% 2.40% 1.60% 24.40% 16.90% 35.00% 11.30% 5.30% 15.60% 14.60% 13.10% 1 4 1 0 0 1 1 5 2 6 0 7 36 9.50% 7.90% 3.30% 1.20% 0.20% 10.20% 7.20% 19.90% 2.40% 1.30% 7.00% 4.90% 2.20% 401 637 69 10 16 237 103 391 116 328 110 630 9.80% 7.80% 3.70% 0.40% 0.20% 6.10% 3.10% 11.20% 1.80% 0.90% 8.70% 3.10% 3,434 2.50%
Source: Rehm et al. 2003
Review of public health findings
The earlier young people start to drink, the worse the alcohol-related consequences: Alcohol dependence Traffic crashes Physical violence after drinking Other unintentional injuries after drinking (e.g. drowning, falls) Potential damage to still-developing adolescent brain Lower chances of success in school Age of alcohol initiation has long-term influence on health Bottom line: strong public health interest in delaying onset of drinking
Minimum drinking age laws
One of many steps taken by societies to limit alcohol-related harm EVERY society must take on question of how to control intoxicants and their effects Minimum drinking age laws only one strategy – cannot be expected to do the whole job International experience reflects U.S. experience: minimum age laws do affect onset of drinking
Age requirement for on- and off premise purchase of beer and spirits
90 80 70 60 50 40 30 20 10 0 2 1 2 2 15 15 10 11 7 16 2 2 1 1 17 74 78 68 72 18 3 3 3 3 19 2 3 3 5 20 4 5 4 4 21 16 15 24 22 None 9 9 8 10 No response Beer Off Beer On Spirits Off Spirits On
Countries greater than 18
19 Canada (all but Alberta, Manitoba and Quebec) Republic of Korea Nicaragua 20 Iceland Japan Norway Sweden 21 Egypt Indonesia Micronesia Palau USA Source: WHO GAD 2006
Recent changes
France: Moves to increase minimum purchase for alcohol and tobacco from 16 to 18 in 2009 New Zealand (AJPH 2006;96:126–131) Reduced from 20 to 18 in 1999 Comparing four years before and after the change from 20 to 18, compared to crashes among 20 to 24 year-olds (comparison group), alcohol-involved traffic crashes grew: 14% among 15-17 year-old males 24% among 15-17 year-old females 12% among 18 and 19 year-old males 51% among 18 and 19 year-old females
Drinking Ages in Europe
15 – Slovenia 16 – Italy, Malta, Portugal 17 – Greece 18 – Austria, Belgium, Bulgaria, Croatia, Czech Republic, Denmark, Estonia, France, Germany, Hungary, Ireland, Latvia, Lithuania, Netherlands, Poland, Romania, Russia, Slovakia, Spain, Switzerland, Ukraine, United Kingdom 20 – Iceland, Norway, Sweden
Drinking Among 15-16 year-olds: U.S. and Europe, 2007
40 30 20 10 0 100 90 80
92 83 83 84 79 93 94 87 77 81 91 87 84
70 Percent Drank in Past Twelve Months
78 81 89 87 87 84 66 78 79 74 77 88 87 77 71 85 83 88
60
56 56
50
Drinking Among 15-16 year-olds: U.S. and Europe, 2007
Percent Drank in Past 30 Days 90 80
80
70
70 66 64 62 76 80
60
60
50 40 30 20
48 64 75 71 59 31 56 63 65 65 73 69 42 57 60 52 52 63 65 57 44 67 61 70 33
10 0
Drinking Among 15-16 year-olds: U.S. and Europe, 2007
Percent Drunk in Past 30 Days 15 10 5 0 50 45 40 35 30
31
25 20
10 21 21 9 20 49 12 21 18 22 12 19 26 12 18 20 19 16 20 13 11 11 19 25 20 25 17 20 12 33 18
“Extreme drinking worse in U.S.”
Actually, looking at indicator “drunk in past 30 days” 21 countries worse off than U.S., 14 countries better off Extreme drunkenness worse in U.S.?
15-16 year-olds reporting 10-19 incidents of drunkenness in past 30 days 1 percent of U.S. 10 th graders report this Same percentage as in 14 European countries, including Austria, Italy and Spain
Background for this syposium
“Amethyst Initiative” – signed by 130 college presidents and asking for a re-opening of the debate over the federal law withholding 10% of highway funds if states did not implement age 21 alcohol purchase laws “Rush to judgment” on 21 largely uninformed by public health research What light can public health research and experience shed on this debate?
“Eyeball analyses”
Many shortcomings – much more going on in each country than this cursory analysis can capture More important to review literature in its entirety – never rely on any single study Single studies may mis-specify variables to “wash out” effects, e.g.
Using 15-24 year-olds as focus of analysis Using all traffic crashes instead of alcohol-related traffic crashes as outcome variable Diluting statistical power by performing state-by-state analyses which increase range of error, involve fitting linear analysis to trends that are by no means linear
Goals of this symposium
Key questions: What can research tell us about drinking among college-aged persons?
What does the research literature suggest are the most effective approaches for reducing alcohol-related harm among college students?
What is our specific situation here in Baltimore?
What can we, as campus and community, do in this city to reduce alcohol-related harm among college students?
Structure of the evening
PRESENTATIONS: What is the situation regarding college drinking in the U.S.A.?
What has public health research told us to date about what will be most effective in reducing alcohol-related harm in college campuses and communities?
What can we learn from experience nearby about reducing alcohol related harm in campus communities?
What special challenges do we face here in Baltimore?
DISCUSSION: How can Baltimore benefit from the findings of research literature and experience?
How do we go forward from here?
What partnerships exist and what are needed?
What concrete next steps could be proposed?