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Prevention of Alcohol Harm in the Community--I Harold D. Holder Prevention Research Center Berkeley, California USA What Can International Research Teach.

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Presentation on theme: "Prevention of Alcohol Harm in the Community--I Harold D. Holder Prevention Research Center Berkeley, California USA What Can International Research Teach."— Presentation transcript:

1 Prevention of Alcohol Harm in the Community--I Harold D. Holder Prevention Research Center Berkeley, California USA What Can International Research Teach Us? Associação Brasileira de Estudos de Álcool e Outras Drogas, Sao Paulo Sao Paulo September 4, 2003

2 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)

3 Prevalence of Lifetime Alcohol Dependence by Age at Drinking Onset

4 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)

5 Public Health Model of Alcohol Problem Prevention Individual (Drinker) Environment (Drinking Context) Agent (Alcohol)

6 Environmental Influence & Youth Drinking (3) Economic - Cost of alcohol; economic geography of availability (3) Economic - Cost of alcohol; economic geography of availability (1)Physical - Proximity of alcohol outlets, places of public drinking (2) Social - Family, peers and larger social networks

7 For Example, Youth Drinking AlcoholAvailability Drinking By Peers RetailPrice Alcohol purchases by other youth EconomicSocial Cost & availability to youth to youth Availability of alcohol to & from peers Physical

8 Formal Regulation and 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 Drinking Social Control and Communication Community System of Alcohol Use and Abuse

9 Environmental Approaches Retail Access to Alcoholic Beverages, e.g., price, outlet locations, minimum drinking laws. Restrictions or Constraints on the Drinkers Behavior, e.g., drinking locations, drink drive Reduce Risk or Problem Severity

10 Agent Approaches Low or No Alcohol Beverages Container Size Restrictions on Advertising

11 Youth Alcohol Problem Prevention Strategies: Solid Evidence ¤ ¤ ¤ ¤ ¤ ¤ Retail price of alcohol Graduated Licenses Lower BAC limits for driving Drinking/driving deterrence Minimum drinking age Zero tolerance for Youth

12 Youth Alcohol Problem Prevention Strategies: P romising –Replication needed Tort Liability for sales/service of alcohol to youth Genetics, alcohol dependency risk, & treatment Auto ignition controls Curfew laws/Party Patrols Parent training and mobilization Restrictions on drinking location & outlet density Low or no alcoholic beverages Alcohol container sizes & keg registration Third Party alcohol sales/Shoulder Taps

13 Latest Advance: Mix of evidence-based prevention strategies at local level Community Action Trials which use complimentary interventions

14 Paulinia, Brazil

15 Examples of International Community Action Projects for Alcohol Prevention COUNTRYGOALSSTRATEGIESRESULTS Alcohol serving practices & policies Municipal policies DUI enforcement Canada Ontario (6 Projects) Reduce alcohol problems Reduced public drinking Lower heavy drinking in bars and restaurants Modest effects on overall drinking School education Stockholm-- Kungsholmen Reduce heavy drinking and youth drinking Greater news coverage Primary health care Community education News FinlandLathi Reduce heavy drinking Reductions in heavy drinking Sweden Modest effect on heavy drinking Public education

16 Examples of International Community Action Projects for Alcohol Prevention COUNTRYGOALSSTRATEGIESRESULTS Local coalitions Health education Local alcohol policy concerning public alcohol sale Australia COMPARI Project Reduce alcohol injury and death Modest effect on injury Australia Surfers Paradise Safety Action Project Lower alcohol involved violence Community Forum & alcohol safety audit Model House Policies Increased enforcement of alcohol licensed premises Violent events: --original --original site from 9.8 to replication sites sites from 12.2 to 3.0

17 Examples of International Community Action Projects for Alcohol Prevention COUNTRYGOALSSTRATEGIESRESULTS Public awareness using local news Highly visible drink/drive enforcement Investigation of on- license premises based upon place of last drink data Reduce drink/drive problems Fatal alcohol crashes reduced from 22 to 14% Public perception of risk of being caught increased Local coordinating committee Review of alcohol availability Local alcohol advertising limits New Zealand Six City Project Increase local alcohol policy Greater news coverage Alcohol positive breath checks decreased by 600% Increased public support of local policy New Zealand Waikata Rural Drink/ Drive Project

18 Examples of International Community Action Projects for Alcohol Prevention COUNTRYGOALSSTRATEGIESRESULTSYouth Program Secondary prevention in health care Responsible Beverage Service Sweden Stockholm City--STAD Reduce alcohol and drug problems Modest effect in medium strength beer sales to youth Local work committees Develop Alcohol Plan Decrease sales of folk beer to youth Stockholm City (18 Districts) & Stockholm County Targets Increase local alcohol policy Reduced Sales to Youth in 2 target sites (81% to 25% & 48% to 42%) Increased interest in local policy Reduction in sales to intoxicated patrons (5% to 47%) Violent crime down by 29%

19 Examples of International Community Action Projects for Alcohol Prevention COUNTRYGOALSSTRATEGIESRESULTS Public education Primary health care screening Reduce alcohol access Sweden Malmö Reduce alcohol problems Low effects on problem indicators Reduced male consumption and problems in (a) screening program and (b) general population Program adopted by city

20 Examples of International Community Action Projects for Alcohol Prevention COUNTRYGOALSSTRATEGIESRESULTS DUI enforcement Alcohol service News coverage Underage sales Alcohol outlets United States California/ South Carolina Reduce alcohol injury and death 10% reduction in alcohol crashes 43% reduction in violence Lower alcohol sales to youth News coverage DUI enforcement Alcohol outlet surveillance Massachusetts Reduce alcohol crashes 25% reduction in fatal crashes Local sales policies and enforcement Minnesota Reduce youth drinking Lower alcohol sales to youth Reduced traffic crashes

21 Community Action and Prevention Lessons from International Projects Community Mobilization

22 Community Organizing Goal: Community Awareness of Alcohol Problems and Support for Local Policy Actions Local News (Media Advocacy)

23 Community Action and Prevention Lessons from International Projects Science-based interventions are essential Utilize Local News Community Mobilization

24 Friday, December 10, 1993

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26 Community Action and Prevention Lessons from International Projects Science-based interventions are essential Utilize local news media Community Mobilization Environmental strategies are most effective Value of Evaluationdetermine effects

27 Elements in Effective Local Alcohol Prevention: The top Cultural Values Local Cultural 0. Local Cultural Values 9. Community as a System 8. Media Advocacy (local news) 7. Enforcement in local action 6. Partnership of local & nation/state 4. Central government supporting local action 3. Local information (evaluation) 2. Evidence based strategies 1. Courage & Passion 5. Community Leadership and Responsibility

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