prevention of alcohol harm in the community--i harold d. holder prevention research center berkeley,...
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Prevention of Alcohol Prevention of Alcohol Harm in the Harm in the
Community--ICommunity--I
Prevention of Alcohol Prevention of Alcohol Harm in the Harm in the
Community--ICommunity--I
Harold D. HolderHarold D. HolderPrevention Research CenterPrevention Research Center
Berkeley, California USABerkeley, California USA
What Can International Research Teach Us?What Can International Research Teach Us?
Associação Brasileira de Estudos de Álcool e Outras Drogas,Associação Brasileira de Estudos de Álcool e Outras Drogas, Sao PauloSao 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
0
10
20
30
40
50
60
13 14 15 16 17 18 19 20 21
Age of First Use of Alcohol
% P
reva
lenc
e
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 Public Health Model of Alcohol Problem PreventionProblem Prevention
IndividualIndividual(Drinker)(Drinker)
EnvironmentEnvironment(Drinking Context)(Drinking Context)
AgentAgent(Alcohol)(Alcohol)
Environmental Influence & Youth DrinkingEnvironmental Influence & Youth Drinking
(3) Economic - (3) Economic - Cost of alcohol; economic Cost of alcohol; economic geography of availability geography of availability
(3) Economic - (3) Economic - Cost of alcohol; economic Cost of alcohol; economic geography of availability geography of availability
(1)(1)Physical - Physical - Proximity of alcohol outlets, Proximity of alcohol outlets, places of public drinkingplaces of public drinking
(1)(1)Physical - Physical - Proximity of alcohol outlets, Proximity of alcohol outlets, places of public drinkingplaces of public drinking
(2) Social - (2) Social - Family, peers and larger Family, peers and larger social networkssocial networks
(2) Social - (2) Social - Family, peers and larger Family, peers and larger social networkssocial networks
For Example, Youth DrinkingFor Example, Youth DrinkingFor Example, Youth DrinkingFor Example, Youth Drinking
AlcoholAlcoholAvailabilityAvailability
DrinkingDrinkingBy PeersBy Peers
RetailRetailPricePrice
Alcohol purchases by other youthAlcohol purchases by other youth
EconomicEconomicSocialSocial
Cost &Cost &availabilityavailability to youthto youth
Availability of Availability of alcohol to & alcohol to & from peersfrom peers
PhysicalPhysical
Formal Regulationand Control of Alcohol Sales
CONSUMPTION
Alcohol Production, Marketing and
Distribution
Social, Health, and Economic Consequences
Retail Sales by Average Type
Alcohol-involved Mortality & Morbidity
Community Economic Sector
Social and Health Services
Legal Action about DrinkingSocial Control and
Communication
Community System of Alcohol Use and Abuse
Environmental ApproachesEnvironmental Approaches
1.1.
2.2.
3.3.
Retail Access to Alcoholic Beverages, Retail Access to Alcoholic Beverages, e.g., price, outlet locations, minimum e.g., price, outlet locations, minimum drinking laws.drinking laws.
Restrictions or Constraints on Restrictions or Constraints on the Drinker’s Behavior, the Drinker’s Behavior, e.g., e.g., drinking locations, drink drivedrinking locations, drink drive
Reduce Risk or Problem SeverityReduce Risk or Problem Severity
Agent ApproachesAgent Approaches
1.1.
2.2.
3.3.
Low or No Alcohol BeveragesLow or No Alcohol Beverages
Container SizeContainer Size
Restrictions on AdvertisingRestrictions on Advertising
Youth Alcohol Problem Prevention Youth Alcohol Problem Prevention Strategies: Strategies: Solid EvidenceSolid Evidence
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Retail price of alcoholRetail price of alcohol
Graduated LicensesGraduated Licenses
Lower BAC limits for drivingLower BAC limits for driving
Drinking/driving deterrenceDrinking/driving deterrence
Minimum drinking ageMinimum drinking age
““Zero tolerance” for YouthZero tolerance” for Youth
Youth Alcohol Problem Prevention Youth Alcohol Problem Prevention Strategies: Strategies: PPromising –Replication neededromising –Replication needed
Tort Liability for sales/service of alcohol to youthTort Liability for sales/service of alcohol to youth
Genetics, alcohol dependency risk, & treatmentGenetics, alcohol dependency risk, & treatment
Auto ignition controlsAuto ignition controls
Curfew laws/Party PatrolsCurfew laws/Party Patrols
Parent training and mobilizationParent training and mobilization
Restrictions on drinking location & outlet densityRestrictions on drinking location & outlet density
Low or no alcoholic beveragesLow or no alcoholic beverages
Alcohol container sizes & keg registrationAlcohol container sizes & keg registration
Third Party alcohol sales/”Shoulder Third Party alcohol sales/”Shoulder Taps”Taps”
Latest Advance:Latest Advance: Mix of evidence-based Mix of evidence-based
prevention strategies at local prevention strategies at local levellevel
Community Action Trials which use Community Action Trials which use complimentary interventionscomplimentary interventions
LOCATIONS OF COMMUNITY ACTIONLOCATIONS OF COMMUNITY ACTIONPROJECTS FROM AROUND THE WORLD PROJECTS FROM AROUND THE WORLD
Western AustraliaWestern Australia
IsraelIsrael
Florence, ItalyFlorence, Italy
LahtiLahti, Finland, Finland
Stockholm, SwedenStockholm, Sweden
AarhusAarhus, Denmark, Denmark
Ontario, CanadaOntario, Canada
Massachusetts, USAMassachusetts, USA
South Carolina, USASouth Carolina, USA
Minnesota, USAMinnesota, USA
California, USACalifornia, USA
MalmoMalmo, Sweden, Sweden....
New ZealandNew ZealandWestern AustraliaWestern AustraliaWestern Australia
IsraelIsraelIsrael
Florence, ItalyFlorence, ItalyFlorence, Italy
LahtiLahtiLahti, Finland,, FinlandFinland
Stockholm, SwedenStockholm, SwedenStockholm, Sweden
AarhusAarhusAarhus, Denmark, Denmark, Denmark
Ontario, CanadaOntario, CanadaOntario, Canada
Massachusetts, USAMassachusetts, USAMassachusetts, USA
South Carolina, USASouth Carolina, USASouth Carolina, USA
Minnesota, USAMinnesota, USAMinnesota, USA
California, USACalifornia, USACalifornia, USA
MalmoMalmoMalmo, Sweden, SwedenSweden....
New ZealandNew ZealandNew ZealandPaulinia, BrazilPaulinia, Brazil
Examples of International Community Action Examples of International Community Action Projects for Alcohol PreventionProjects for Alcohol Prevention
COUNTRYCOUNTRY GOALSGOALS STRATEGIESSTRATEGIES RESULTSRESULTS
• • Alcohol servingAlcohol servingpractices & policiespractices & policies
•• Municipal policiesMunicipal policies
•• DUI enforcementDUI enforcement
CanadaCanada
Ontario Ontario (6 Projects)(6 Projects)
Reduce alcohol Reduce alcohol problemsproblems
Reduced public Reduced public drinkingdrinking
Lower heavy Lower heavy drinking in bars drinking in bars and restaurantsand restaurants
Modest effects on Modest effects on overall drinkingoverall drinking
• • School educationSchool educationStockholm--Stockholm--KungsholmenKungsholmen
Reduce heavy Reduce heavy drinking and drinking and youth drinkingyouth drinking
Greater news Greater news coveragecoverage
• • Primary health carePrimary health care •• Community education Community education •• News News
FinlandFinland
LathiLathi
Reduce heavy Reduce heavy drinkingdrinking
Reductions in Reductions in heavy drinkingheavy drinking
SwedenSwedenModest effect on Modest effect on heavy drinkingheavy drinking
••Public educationPublic education
Examples of International Community Action Examples of International Community Action Projects for Alcohol PreventionProjects for Alcohol Prevention
COUNTRYCOUNTRY GOALSGOALS STRATEGIESSTRATEGIES RESULTSRESULTS
• • Local coalitionsLocal coalitions •• Health education Health education •• Local alcohol Local alcohol policy concerning policy concerning public alcohol salepublic alcohol sale
AustraliaAustralia
COMPARI COMPARI ProjectProject
Reduce alcohol Reduce alcohol injury and deathinjury and death
Modest effect Modest effect on injuryon injury
AustraliaAustralia
Surfers Surfers Paradise Paradise Safety Safety Action Action ProjectProject
Lower Lower alcohol alcohol involved involved violenceviolence
• • Community Forum & Community Forum & alcohol safety alcohol safety auditaudit
• • Model House PoliciesModel House Policies
•• Increased Increased enforcement of alcohol enforcement of alcohol licensed premiseslicensed premises
Violent events: Violent events:
----original siteoriginal site from 9.8 to 4.7from 9.8 to 4.7
----replication replication
sitessites from 12.2 from 12.2 to 3.0to 3.0
Examples of International Community Action Examples of International Community Action Projects for Alcohol PreventionProjects for Alcohol Prevention
COUNTRYCOUNTRY GOALSGOALS STRATEGIESSTRATEGIES RESULTSRESULTS
• • Public awareness Public awareness using local newsusing local news
•• Highly visible Highly visible drink/drive drink/drive enforcementenforcement
••Investigation of on-Investigation of on-license premises license premises based upon “place of based upon “place of last drink” datalast drink” data
Reduce Reduce drink/drive drink/drive problemsproblems
Fatal alcohol Fatal alcohol crashes reduced crashes reduced from 22 to 14% from 22 to 14%
Public perception Public perception of risk of being of risk of being caught increasedcaught increased
• • Local coordinatingLocal coordinating committee committee•• Review of alcohol Review of alcohol availability availability•• Local alcohol Local alcohol advertising limits advertising limits
New ZealandNew Zealand
Six City ProjectSix City Project
Increase local Increase local alcohol policyalcohol policy
Greater news Greater news coveragecoverage
Alcohol positive Alcohol positive breath checks breath checks decreased by 600%decreased by 600%
Increased public Increased public support of local support of local policypolicy
New ZealandNew ZealandWaikata RuralDrink/ Drive
Project
Examples of International Community Action Examples of International Community Action Projects for Alcohol PreventionProjects for Alcohol Prevention
COUNTRYCOUNTRY GOALSGOALS STRATEGIESSTRATEGIES RESULTSRESULTS
••Youth ProgramYouth Program
•• Secondary Secondary prevention in health prevention in health carecare
••Responsible Responsible Beverage Service Beverage Service
SwedenSwedenStockholm Stockholm City--STADCity--STAD
Reduce alcohol Reduce alcohol and drug and drug problemsproblems
Modest effect in Modest effect in medium strength medium strength beer sales to youthbeer sales to youth
• • Local work committeesLocal work committees•• Develop Alcohol Plan Develop Alcohol Plan• Decrease sales of folk • Decrease sales of folk beer to youthbeer to youth
Stockholm City Stockholm City (18 Districts) & (18 Districts) & Stockholm Stockholm County TargetsCounty Targets
Increase Increase local local alcohol alcohol policypolicy
Reduced Sales to Reduced Sales to Youth in 2 target Youth in 2 target sites (81% to 25% & sites (81% to 25% & 48% to 42%) 48% to 42%)
Increased interest Increased interest in local policyin local policy
Reduction in sales to intoxicatedpatrons (5% to 47%)
Violent crime down by 29%
Examples of International Community Action Examples of International Community Action Projects for Alcohol PreventionProjects for Alcohol Prevention
COUNTRYCOUNTRY GOALSGOALS STRATEGIESSTRATEGIES RESULTSRESULTS
• • Public educationPublic education •• Primary health care Primary health care screening screening •• Reduce alcohol Reduce alcohol access access
SwedenSweden
MalmMalmöö Reduce alcohol Reduce alcohol problemsproblems
Low effects on Low effects on problem indicatorsproblem indicators
Reduced male Reduced male consumption and consumption and problems in (a) problems in (a) screening program screening program and (b) general and (b) general populationpopulation
Program adopted Program adopted by cityby city
Examples of International Community Action Examples of International Community Action Projects for Alcohol PreventionProjects for Alcohol Prevention
COUNTRYCOUNTRY GOALSGOALS STRATEGIESSTRATEGIES RESULTSRESULTS
• • DUI enforcementDUI enforcement •• Alcohol service Alcohol service •• News coverage News coverage •• Underage sales Underage sales •• Alcohol outlets Alcohol outlets
United StatesUnited States
California/California/South CarolinaSouth Carolina
Reduce alcohol Reduce alcohol injury and deathinjury and death
10% reduction in 10% reduction in alcohol crashesalcohol crashes
43% reduction in 43% reduction in violenceviolence
Lower alcohol Lower alcohol sales to youthsales to youth
• • News coverageNews coverage•• DUI enforcement DUI enforcement•• Alcohol outlet Alcohol outlet surveillance surveillance
MassachusettsMassachusetts Reduce alcohol Reduce alcohol crashescrashes 25% reduction in 25% reduction in
fatal crashesfatal crashes
•• Local sales policies Local sales policies and enforcement and enforcement
MinnesotaMinnesota Reduce youth Reduce youth drinkingdrinking
Lower alcohol Lower alcohol sales to youthsales to youth
Reduced traffic Reduced traffic crashescrashes
Community Action and PreventionCommunity Action and PreventionLessons from International ProjectsLessons from International Projects
Community MobilizationCommunity Mobilization
Community MobilizationCommunity Mobilization
Community OrganizingCommunity Organizing Goal:Goal: Community Community AwarenessAwarenessof Alcohol Problemsof Alcohol ProblemsandandSupport for LocalSupport for LocalPolicy ActionsPolicy Actions
Local NewsLocal News(Media Advocacy)(Media Advocacy)
Community Action and PreventionCommunity Action and PreventionLessons from International ProjectsLessons from International Projects
Science-based interventions are essentialScience-based interventions are essential
Utilize Local News Utilize Local News
Community MobilizationCommunity Mobilization
Friday, December 10, 1993Friday, December 10, 1993
Community Action and Prevention Community Action and Prevention Lessons from International ProjectsLessons from International Projects
Science-based interventions are essentialScience-based interventions are essential
Utilize local news mediaUtilize local news media
Community MobilizationCommunity Mobilization
Environmental strategies are most effectiveEnvironmental strategies are most effective
Value of Evaluation—Value of Evaluation—determine effectsdetermine effects
Elements in Effective Local Alcohol Elements in Effective Local Alcohol Prevention: The top 10Prevention: The top 10
10. Cultural Values Local Cultural 0. Local Cultural Values
9. Community as a System
8. Media Advocacy (local news)
7. Enforcement in local 7. Enforcement in local actionaction6. Partnership of local & nation/state6. Partnership of local & nation/state
4. Central government supporting local action4. Central government supporting local action
3. Local information (evaluation)3. Local information (evaluation)
2. Evidence based strategies2. Evidence based strategies
1. Courage & Passion1. Courage & Passion
5. Community Leadership and Responsibility