policy approaches to reduce binge drinking and impaired driving toben f nelson, scd division of...
TRANSCRIPT
![Page 1: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/1.jpg)
Policy Approaches to Reduce Binge Drinking and Impaired
Driving
Toben F Nelson, ScDDivision of Epidemiology and Community HealthUniversity of Minnesota
![Page 2: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/2.jpg)
Learning Objectives:• Describe the problem of underage
drinking within a public health perspective• Describe the value of adopting a public
health perspective to combat underage drinking
• Identify the ways that a public health perspective is unique
• Identify a menu of public health / policy options to reduce underage drinking
![Page 3: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/3.jpg)
Alcohol Misuse
Injuries
Liver disease
Violence, Sexual Assault
Unintended Pregnancies
Cardiovascular disease
Alcohol Use Disorders
RISK FACTOR OUTCOME
Child Neglect
GI cancers, GI disorders
Crime, legal costs
Lost productivity, absenteeism
![Page 4: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/4.jpg)
PERSON
CONSUMPTION
CONSEQUENCE(S)
Consequences of Alcohol
Probabilistic relationship
By drinking event
By drinker
PREVENTION
HARM REDUCTION
![Page 5: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/5.jpg)
Underage drinking is part of a larger societal problem
with alcohol• 3rd leading cause of preventable death
in the US– 4,500 under 21– 79,000 adults
• Youth tend to drink like the adults around them
• The causes are the same• The solutions the same too…
![Page 6: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/6.jpg)
Binge Drinking amongCurrent Drinkers
0
10
20
30
40
50
60
70
18-20 21-25 26-34 35-54 55+
Age Group (years)
Bin
ge
Pre
vale
nce
(%
)
Male Female
Naimi et al., JAMA, (2003)
![Page 7: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/7.jpg)
![Page 8: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/8.jpg)
Percentage of High School Students Who Reported Binge Drinking
* Had five or more drinks of alcohol in a row within a couple of hours on at least 1 day during the 30 days before the survey.
11.5% - 21.8%
21.9% - 23.9%
24.0% - 25.1%
25.2% - 30.7%
No Data
State Youth Risk Behavior Surveys, 2009
![Page 9: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/9.jpg)
Minnesota has a problem
Underage>60 alcohol-attributable deaths annually
• Mostly acute conditions– Motor vehicle crash – Homicide / Suicide
General population>1,100 alcohol-attributable deaths annually
• Both acute and chronic conditions– Abuse/Dependence– Liver disease
Source: Alcohol-Related Disease Impact (ARDI) CDC
![Page 10: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/10.jpg)
Ronald Reagan signs national minimum legal drinking age bill,
July 1984“…raising that drinking age is not a fad or an experiment. It's a proven success. Nearly every State that has raised the drinking age to 21 has produced a significant drop in the teenage driving fatalities.”
-President Ronald Reagan
Policy Success
![Page 11: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/11.jpg)
Effects of Minimum DrinkingAge Laws
Review of 241 published analyses 1960-2000
135 were of high quality• Outcomes
– Alcohol consumption (n=33)– Traffic crashes (n=79)– Other (n=23)
Wagenaar & Toomey, 2002
![Page 12: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/12.jpg)
Effects of Minimum DrinkingAge Laws
Alcohol consumption (n=33)• Higher MDLA – Lower Consumption (n=11; 33%)• Higher MDLA – Higher Consumption (n=1; 3%)
Traffic crashes (n=79)• Higher MDLA – Fewer Traffic Crashes (n=46; 58%) • Higher MDLA – More Traffic Crashes (n=0; 0%)
Other (n=23)• Higher MDLA – Fewer Alcohol-related problems (n=8; 35%)• Higher MDLA – More Alcohol-related problems (n=0; 0%)
Wagenaar & Toomey, 2002
![Page 13: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/13.jpg)
Annual lives saved by 21 MLDA• Based on an average decline in deaths of
13% when individual states raised the MLDA• 890 lives saved in 2006• Total lives saved - more than 25,000
![Page 14: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/14.jpg)
Source: The Monitoring the Future Study, the University of Michigan
![Page 15: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/15.jpg)
Underage Drinking in the U.S.
• 10.8 million youth ages 12-20 years in the U.S. reported past-month drinking in 2004, and 7.4 million reported past-month binge drinking.
• 5,400 children under 16 years start drinking every day in the U.S.
• On average, 12-17 year olds report they began drinking at age 14 years.
Source: Substance Abuse Mental Health Services Administration, National Survey on Drug Use and Health, 2005
![Page 16: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/16.jpg)
Deaths and YPLL among Youth <21 due to Exposure to
Excessive Drinking• 4,500 alcohol-attributable deaths • 274,000 YPLL (60 yrs lost/death)• >95% of deaths and YPLL involved binge
drinking.• 1 of 4 deaths among males and 1 of 6 deaths
among females age 15 to 20 years.• Three-fourths of the deaths involved young
men.
CDC: ARDI Web Site (www.cdc.gov/alcohol), 2007
![Page 17: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/17.jpg)
Onset of drinking
Early start (before age
15) associated with:– Alcohol use – Other substance use– Alcohol-related health and social
consequences– Abuse, Dependence, Alcoholism
…in adulthood
![Page 18: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/18.jpg)
Grant J Stud Alcohol (1997)
![Page 19: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/19.jpg)
Long‐Term Effects of Minimum Drinking Age Laws on Past‐Year Alcohol and Drug Use Disorders
Alcoholism: Clinical and Experimental ResearchVolume 33, Issue 12, pages 2180-2190, 23 SEP 2009 DOI: 10.1111/j.1530-0277.2009.01056.xhttp://onlinelibrary.wiley.com/doi/10.1111/j.1530-0277.2009.01056.x/full#f2
![Page 20: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/20.jpg)
Surgeon General’s Recommendations
• Enforce all policies and laws against underage drinking and publicize these efforts
• Gain public support for enforcing underage drinking laws
Source: Office of the US Surgeon General (2007)
![Page 21: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/21.jpg)
Some Distinctions between Public Health and Medicine
Public Health Medicine
Focus Populations Individuals
Ethic Public Service Personal Service
Emphasis Prevention, Community Health Promotion
Diagnosis & Treatment, Patient Care
Interventions Environment, Behavior, Medical Care
Medical Care
H Fineberg, Harvard School of Public Health, 1990 http://www.hsph.harvard.edu/about.html
![Page 22: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/22.jpg)
The Strategy of Prevention
An example
![Page 23: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/23.jpg)
The Prevention Paradox
• Greatest risk health harms among extreme drinkers.
• HOWEVER, few extreme - many “moderate” drinkers.
• “Moderate” drinking also carries risks• Vast majority of health harms in a community
arise from moderate or low consumption. • Greatest health gains from incrementally
moving majority.
Rose (1985); Rose (1992)
![Page 24: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/24.jpg)
0
5
10
15
20
25
0 1 2 3 4 5 6 7 8 9 ormore
Usual Number of Drinks
Po
pu
lati
on
Per
cen
t
0.00
0.10
0.20
0.30
0.40
0.50
0.60
Ris
k o
f B
ein
g H
urt
or
Inju
redPopulation Percent Risk ofHarm
Risk of injury, by usual number of drinks (past 30 days)
Weitzman & Nelson (2004)
![Page 25: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/25.jpg)
Evidence for findings regardless of:• consumption measure
– Usual drinks– Drinking frequency– Frequency of drunkenness
• Negative social/health consequence– 14 different outcomes– Only the risk trajectory varied
The Prevention Paradox
Weitzman & Nelson (2004); Wechsler & Nelson (2006)
![Page 26: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/26.jpg)
The Prevention Paradox
“A prevention measure that brings large benefits to the community affords little to each participating individual”
Geoffrey Rose , 1998
![Page 27: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/27.jpg)
High-risk & Population Approaches
• High-risk: change extreme, high-risk individuals, treatment
• Population: change majority, the conditions that shape everyone’s behavior.
![Page 28: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/28.jpg)
High-Risk Approach
Advantages• Intervention
tailored/targeted to the individual
• Clear benefits (when achieved) to the individual
• Intuitive
Disadvantages• Difficult & costly to ID “at-
risk”
• Effects palliative, temporary
• Low odds success
• Modest benefit to the population
![Page 29: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/29.jpg)
Population Approach
Advantages• Large population benefits
• Broad target audience
• Longer lasting effects
Disadvantages• May limit personal
freedoms
• Resistance from invested parties
• Counter-intuitive
![Page 30: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/30.jpg)
High-Risk & Population Approaches Not
Mutually Exclusive
You Can Do Both
![Page 31: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/31.jpg)
Social Ecology of Drinking
What are some mutable factors that can shift the population
distribution?
![Page 32: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/32.jpg)
![Page 33: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/33.jpg)
Underage drinking
Adult drinking
EnvironmentalConditions
![Page 34: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/34.jpg)
Integrated theory of drinking behavior
Public Policy & Institutional
Policies/Structures
Legal Availability
Formal Social Controls
Economic Availability
Physical Availability
Individual Risk Factors
Drinking Behavior
Alcohol-related Problems
Adapted from Wagenaar & Perry, 1994
Problems that stem from alcohol use are primarily a function of
availability
![Page 35: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/35.jpg)
Public Health Triad
AgentHost
Environment
![Page 36: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/36.jpg)
Knowledge
Attitudes
Intentions
Skills
Pricing
Composition
Labeling
Packaging
Person Drug
Advertising/Promotion
Physical Context
Availability
SocioculturalContext
Institutions
Legal Sanctions
KeyInfluencers
Drug-Related Problems
Environment
Torjman (1986)
![Page 37: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/37.jpg)
Intervening to Reduce Alcohol-related Motor Vehicle Crashes
Alcohol-
Related
MV
Death
DWI
Arrest/
Conviction
Alcohol-
Related
MV
Injury
Alcohol-
Related
MV
Crash
Alcohol-
Impaired
Driving
Binge
Drinking
Any
Drinking
Regulating price
Regulating access
Altering the drinking context
Advertising content control
Education and persuasion
Drinking driver countermeasures
Treatment and early intervention
![Page 38: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/38.jpg)
Assessing the State Alcohol Policy
Environment in the United States
![Page 39: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/39.jpg)
![Page 40: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/40.jpg)
Percentage of High School Students Who Reported Binge Drinking
* Had five or more drinks of alcohol in a row within a couple of hours on at least 1 day during the 30 days before the survey.
11.5% - 21.8%
21.9% - 23.9%
24.0% - 25.1%
25.2% - 30.7%
No Data
State Youth Risk Behavior Surveys, 2009
![Page 41: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/41.jpg)
Policy Environment
Youth Alcohol Pattern
- 5+ (binge) drinking- Freq. 5+ drinking- Current drinking- Freq. current drinking- Drinking/Driving
Youth-Specific Policies
Adult Alcohol Pattern- 5+ (binge) drinking- Freq. 5+ drinking- Heavy drinking- Total drinks- Current drinking
Adult-Oriented (i.e., population-based)
Policies
![Page 42: Policy Approaches to Reduce Binge Drinking and Impaired Driving Toben F Nelson, ScD Division of Epidemiology and Community Health University of Minnesota](https://reader036.vdocuments.us/reader036/viewer/2022081519/56649dd15503460f94ac76a9/html5/thumbnails/42.jpg)
http://www.epi.umn.edu/alcohol