Transcript Document

Prevention of Alcohol Harm
in the Community--I
What Can International Research Teach Us?
Harold D. Holder
Prevention Research Center
Berkeley, California USA
Associação Brasileira de Estudos de Álcool e Outras Drogas,
Sao Paulo
September 4, 2003
Underage Drinking
 11% of 6th grade students reported
binge drinking (Kelder, Murray, et al., 2001)
 21% of 8th graders reported having
been drunk at least once (Johnson, 2002b)
 About 30% of 12th graders engaged in
binge drinking (Johnson, 2002a)
Prevalence of Lifetime Alcohol Dependence
by Age at Drinking Onset
60
% Prevalence
50
40
30
20
10
0
13
14
15
16
17
18
19
Age of First Use of Alcohol
20
21
Binge Drinking Across the Life Span
 50% of students who drink engage in binge
drinking; 20% do so frequently (twice or
more every 3 weeks)
 More than 2/3 of binge drinking episodes in
the U.S. occur among adults age 26 and
older (Naimi, 2003)
 Half of all binge drinking episodes occur
among otherwise moderate drinkers (White et
al., 2002)
Public Health Model of Alcohol
Problem Prevention
Individual
(Drinker)
Environment
Agent
(Drinking Context)
(Alcohol)
Environmental Influence & Youth Drinking
(1)Physical -
Proximity of alcohol outlets,
places of public drinking
(2) Social -
Family, peers and larger
social networks
(3) Economic - Cost of alcohol; economic
geography of availability
For Example, Youth Drinking
Availability of
alcohol to &
from peers
Physical
Cost &
availability
to youth
Alcohol
Availability
Social
Drinking
By Peers
Retail
Price
Economic
Alcohol purchases by other youth
Community System of Alcohol Use and Abuse
Legal Action
about Drinking
Social Control and
Communication
Alcohol-involved
Mortality & Morbidity
CONSUMPTION
Formal Regulation
and Control of
Alcohol Sales
Retail Sales by
Average Type
Social, Health,
and Economic
Consequences
Social and Health
Services
Alcohol Production,
Marketing and
Distribution
Community
Economic Sector
Environmental Approaches
1.
Retail Access to Alcoholic Beverages,
e.g., price, outlet locations, minimum
drinking laws.
2.
Restrictions or Constraints on
the Drinker’s Behavior, e.g.,
drinking locations, drink drive
3.
Reduce Risk or Problem Severity
Agent Approaches
1.
Low or No Alcohol Beverages
2.
Container Size
3.
Restrictions on Advertising
Youth Alcohol Problem Prevention
Strategies: Solid Evidence
¤ Retail price of alcohol
¤ Minimum drinking age
¤ “Zero tolerance” for Youth
¤ Drinking/driving deterrence
¤ Lower BAC limits for driving
¤ Graduated Licenses
Youth Alcohol Problem Prevention
Strategies: Promising –Replication needed

Tort Liability for sales/service of alcohol to youth
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Genetics, alcohol dependency risk, & treatment
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Third Party alcohol sales/”Shoulder Taps”
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Auto ignition controls
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Curfew laws/Party Patrols

Parent training and mobilization

Restrictions on drinking location & outlet density

Low or no alcoholic beverages

Alcohol container sizes & keg registration
Latest Advance:
Mix of evidence-based prevention
strategies at local level
Community Action Trials which use
complimentary interventions
LOCATIONS OF COMMUNITY ACTION
PROJECTS FROM AROUND THE WORLD
Stockholm, Sweden
..
Malmo,
Malmo, Sweden
Aarhus,
Aarhus, Denmark
Lahti, Finland
Minnesota, USA
Ontario, Canada
Florence, Italy
California, USA
Massachusetts, USA
Israel
South Carolina, USA
Paulinia, Brazil
Western Australia
New Zealand
Examples of International Community Action
Projects for Alcohol Prevention
COUNTRY
GOALS
STRATEGIES
RESULTS
Canada
Ontario
(6 Projects)
Reduce alcohol • Alcohol serving
practices & policies
problems
• Municipal policies
• DUI enforcement
Finland
Lathi
 Reduced public
drinking
 Lower heavy
drinking in bars
and restaurants
 Modest effects on
overall drinking
Reduce heavy
drinking
 Reductions in
• Primary health care
heavy drinking
• Community education
• News
 Greater news
coverage
Reduce heavy
drinking and
youth drinking
• School education
 Modest effect on
•Public education
heavy drinking
Sweden
Stockholm-Kungsholmen
Examples of International Community Action
Projects for Alcohol Prevention
COUNTRY
GOALS
Australia
Reduce alcohol
injury and death
COMPARI
Project
Australia
Surfers
Paradise
Safety
Action
Project
Lower
alcohol
involved
violence
STRATEGIES
• Local coalitions
• Health education
• Local alcohol
policy concerning
public alcohol sale
• Community Forum &
alcohol safety audit
RESULTS
 Modest effect
on injury
 Violent events:
--original site
• Model House Policies
from 9.8 to 4.7
• Increased
enforcement of alcohol
licensed premises
--replication
sites from 12.2
to 3.0
Examples of International Community Action
Projects for Alcohol Prevention
COUNTRY
New Zealand
Waikata Rural
Drink/ Drive
Project
GOALS
Reduce
drink/drive
problems
STRATEGIES
• Public awareness
using local news
 Fatal alcohol
• Highly visible
drink/drive
enforcement
 Public perception
•Investigation of onlicense premises
based upon “place of
last drink” data
New Zealand
Six City Project
Increase local
alcohol policy
RESULTS
• Local coordinating
committee
• Review of alcohol
availability
• Local alcohol
advertising limits
crashes reduced
from 22 to 14%
of risk of being
caught increased
 Alcohol positive
breath checks
decreased by 600%
 Greater news
coverage
 Increased public
support of local
policy
Examples of International Community Action
Projects for Alcohol Prevention
COUNTRY
GOALS
STRATEGIES
RESULTS
Sweden
Stockholm
City--STAD
Reduce alcohol •Youth Program
and drug
problems
• Secondary
prevention in health
care
•Responsible
Beverage Service
Stockholm City
(18 Districts) &
Stockholm
County Targets
 Modest effect in
medium strength
beer sales to youth
 Reduction in sales
to intoxicated
patrons (5% to 47%)

Violent crime
down by 29%
 Reduced Sales to
Increase
local
alcohol
policy
• Local work committees
Youth in 2 target
sites (81% to 25%
• Develop Alcohol Plan
& 48% to 42%)
• Decrease sales of folk
beer to youth
 Increased interest
in local policy
Examples of International Community Action
Projects for Alcohol Prevention
COUNTRY
GOALS
STRATEGIES
RESULTS
Sweden
Malmö
Reduce alcohol • Public education
• Primary health care
problems
screening
• Reduce alcohol
access
 Low effects on
problem indicators
 Reduced male
consumption and
problems in (a)
screening program
and (b) general
population
 Program adopted
by city
Examples of International Community Action
Projects for Alcohol Prevention
COUNTRY
GOALS
STRATEGIES
RESULTS
United States
California/
South Carolina
Reduce alcohol • DUI enforcement
injury and death • Alcohol service
• News coverage
• Underage sales
• Alcohol outlets
 10% reduction in
alcohol crashes
 43% reduction in
violence
 Lower alcohol
sales to youth
 Lower alcohol
Minnesota
Reduce youth
drinking
• Local sales policies
sales to youth
and enforcement
 Reduced traffic
crashes
Massachusetts
Reduce alcohol
crashes
• News coverage
• DUI enforcement
• Alcohol outlet
surveillance
 25% reduction in
fatal crashes
Community Action and Prevention
Lessons from International Projects
 Community Mobilization
Community Mobilization
Community Organizing
Local News
(Media Advocacy)
Goal: Community
Awareness
of Alcohol Problems
and
Support for Local
Policy Actions
Community Action and Prevention
Lessons from International Projects
 Community Mobilization
 Science-based interventions are essential
 Utilize Local News
Friday, December 10, 1993
Newspaper Factor Score - Local Stories
44
Organizational
Organizational Development
Development and
and
Planning
Planning
33
Training,
Training, Additional
Additional
Planning
Planning Training
Training
and
and 1st
1st
Media
Media
Events
Events
Ongoing
Ongoing Advocacy
Advocacy Efforts
Efforts
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Experimental
Experimental Sites
Sites
Comparison
Comparison Sites
Sites
Community Action and Prevention
Lessons from International Projects
 Community Mobilization
 Science-based interventions are essential
 Utilize local news media
 Value of Evaluation—determine effects
 Environmental strategies are most effective
Elements in Effective Local Alcohol
Prevention: The top 10
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Local
9. Community as a System
Cultural
0. Local
8. Media Advocacy (local news)
Cultural Values
10. Cultural Values
7. Enforcement in local action
6. Partnership of local & nation/state
5. Community Leadership and Responsibility
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4. Central government supporting local action
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3. Local information (evaluation)
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2. Evidence based strategies
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1. Courage & Passion