Alcohol As a Risk Factor For Injury Intermediate Injury Prevention Course Indian Health Service Billings, Montana August 2011

Alcohol As a Risk Factor for Injury Goal:To understand the role that alcohol plays as a risk factor for injury, and it’s impact nationally as well as among American Indians and Alaska Natives.

Alcohol As a Risk Factor for Injury Objectives:  Describe What We Know  Review Injury Data and Trends  Understand factors which place American Indians and Alaska Natives at increased risk of alcohol-related injury

Alcohol, Injury, and American Indians Common Belief: Alcohol is the cause of all problems in Indian country. True or False:  Alcohol is the leading risk factor for injuries.  The solution to injury is to abolish alcohol  Males have the greatest injury problem  The solution to injury is to eliminate males

Public Health Approach Define the Problem Identify Risk Factors Find what Prevents the Problem Implement & Evaluate Programs Surveillance Who, What? What Works? Prevention Source: National Center for Injury Prevention and Control, CDC

Alcohol and Injury vWhat Percent of American Indian and Alaska Native Deaths Are Alcohol-Related? Sources: May P, The Epidemiology of Alcohol Abuse Among American Indians: the Mythical and Real Properties. The Primary Care Provider, Volume 20, March 1995, Indian Health Service;. Ethnicity and Alcohol-Related Fatalities, , by Voas RB and Tipetts AS, National Highway Traffic Safety Administration, vHomicide vSuicide vMotor Vehicle vPedestrian — 85% — 75% — 73-65% — 84%

American Indian Youth Risk Behavior Survey, BIA/CDC Youth Risk Behavior Survey, students in grades 9-12: v48% Rode with Drinking Drivers v21% Drove after Drinking v37% Rarely/Never used Seat Belts v15% Attempted Suicide

Among American Indian/Alaska Natives adolescents aged 19 years and younger, motor vehicle crashes are the leading cause of injury-related death. Motor Vehicle Fatality

Odds of Causing a Motor Vehicle Crash by BAC RF Borkenstein, The Role of the Drinking Driver in Traffic Accidents. Alcohol, Drugs and Behavior 1974; 2 (suppl) 8-32.

Motor Vehicle Fatality In 2006, American Indian/Alaska Natives had the highest percentage (48%) of alcohol-impaired driving fatalities among all racial/ethnic populations.

Alcohol-Related Traffic Fatalities, , U.S. Source: NHTSA, Fatality Analysis Reporting System 0 5,000 10,000 15,000 20,000 25,000 30, Number of Fatalities Year

Impact of Alcohol-impaired Driving, U.S. 115 million episodes Each DUI arrest: not arrested 16,000 deaths 310,000 injuries Each Year:

Source: NHTSA FARS Query system 2002: and Ethnicity and Alcohol-Related Fatalities, , by Voas RB and Tipetts AS, National Highway Traffic Safety Administration, Are We Making a Difference? Percent of Alcohol-Related Motor Vehicle Deaths, Native Americans and All US Races

Seat belt usage ranges from a low of 28% to a high of 88% on reservations. Source: NHTSA. FARS data, 2006.

Risky Alcohol Use Means Costly Health Problems

Predictors of seatbelt use in American Indian motor vehicle crash trauma victims on and off the reservation. Accid Anal Prev.Accid Anal Prev Sep;39(5): Epub 2007 Mar 28. “…alcohol, rather than race or location, is the overriding predictor of seatbelt use. This study compared patients that were in crashes, and only those triaged to a level one trauma facility.”

Alcohol and American Indians vIn groups of 2-3, discuss what you know are factors that place American Indians/Alaska Natives at high risk for alcohol-related injury death. Take into consideration age, drinking style, environment, and gender.

Alcohol and American Indians vAmerican Indians Overall are Younger vMedian age of 24 vs. 33 for all US Races. vAll Youth Engage More in Risky Behaviors vThe large proportion of young AI/AN places a large segment of the population at risk Risk Factor: Age

Alcohol and American Indians vIn some Tribes, fewer adults drink than in the general US population, and a substantial proportion of Indian people do not drink, especially older adults. vAmong AI/AN Who Do Drink—2-3 times Greater Prevalence of Problem Drinking Risk Factor: Drinking Style

Alcohol and American Indians vIndian Males Often “Binge” Drink with High BACs. vHigh BACs Often Lead to Severe Injury Risk Factor: Drinking Style

Alcohol and American Indians vAbout Half of All American Indians Live in Rural Environments vLong Distances to Advanced Trauma Care Risk Factor: Environment

Alcohol and American Indians vRisky Environments Such as Driving Long Distances at Night, Walking, and Boating Combined with High BACs Often Lead to Fatal Outcomes Risk Factor: Environment

Alcohol and American Indians vMore Indian Men Drink Than Women vYoung Indian Men More Likely to Engage in Excessive Binge Drinking With High BACs Risk Factor: Gender

Alcohol and American Indians vIndian Male Injury Death Rates are 2 to 5 Times Greater Than Female Rates vIndian Females Are at Higher Risk of Alcohol- Related Death than Non-Indian Women. Risk Factor: Gender

Intervening in the Presence of Alcohol vGallup Protective Custody Program vHighway Lighting Projects: Whiteriver, Gallup, Sells, others vFloat coat programs in Alaska vReduce Alcohol Availability--Policy vLegislation and Enforcement of Laws

Intervening in the Presence of Alcohol vProtective Custody Program, Gallup, NM vIntoxicated people picked up off streets and housed up to 3 days vReduces potential pedestrian injuries, hypothermia deaths, and violence vAlcohol detoxification and treatment provided Na’nizhoozhi Center

Intervening in the Presence of Alcohol vSuccessful street lighting projects in Whiteriver, AZ, Gallup, NM, Sells, AZ, and others Pedestrian Lighting Projects vAllow drivers to see pedestrians at night, even if intoxicated and walking in roadway vWhich of the Three “Es” is this approach?

Intervening in the Presence of Alcohol Alaska’s rivers are the “highways” of Native village life. The use of float coats and life jackets can save lives even in alcohol- related boating incidents. Photo Source: Ryan Hill Float Coat Programs

Who Controls Alcohol Policy? v Bootleggers  Border Towns v Tribal Council

Alcohol Policy Considerations vLong history of prohibition of American Indians and alcohol. American Indians could not legally buy alcohol until vMany tribes today are still “Dry” and don’t allow alcohol on the reservation.

Alcohol Policy Considerations Buzz Group Discussion (5-7 min) List policy considerations (pros and cons) of tribes legalizing the sale of alcohol - ”Wet” and “Dry”. Half the class take the Wet policy and other half Dry. WetDry Pro Con

Alcohol and Injury Summary vThere are ways to be involved in reducing alcohol-related injuries in your community vAlcohol is a complex problem requiring multi-disciplined approach and community empowerment vNot just a police and court system problem

Alcohol Resources The Epidemiology of Alcohol Abuse Among American Indians: The Mythical and Real Properties by Dr. Philip May was published in the IHS Primary Care Provider, March, 1995, and can be found at: lthprovider/issues/IHSProMar2.asp#alcohol