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

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

Page 2: Prevention of Alcohol Harm in the Community--I Harold D. Holder Prevention Research Center Berkeley, California USA What Can International Research Teach.

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)

Page 3: Prevention of Alcohol Harm in the Community--I Harold D. Holder Prevention Research Center Berkeley, California USA What Can International Research Teach.

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

Page 4: Prevention of Alcohol Harm in the Community--I Harold D. Holder Prevention Research Center Berkeley, California USA What Can International Research Teach.

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)

Page 5: Prevention of Alcohol Harm in the Community--I Harold D. Holder Prevention Research Center Berkeley, California USA What Can International Research Teach.

Public Health Model of Alcohol Public Health Model of Alcohol Problem PreventionProblem Prevention

IndividualIndividual(Drinker)(Drinker)

EnvironmentEnvironment(Drinking Context)(Drinking Context)

AgentAgent(Alcohol)(Alcohol)

Page 6: Prevention of Alcohol Harm in the Community--I Harold D. Holder Prevention Research Center Berkeley, California USA What Can International Research Teach.

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

Page 7: Prevention of Alcohol Harm in the Community--I Harold D. Holder Prevention Research Center Berkeley, California USA What Can International Research Teach.

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

Page 8: Prevention of Alcohol Harm in the Community--I Harold D. Holder Prevention Research Center Berkeley, California USA What Can International Research Teach.

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

Page 9: Prevention of Alcohol Harm in the Community--I Harold D. Holder Prevention Research Center Berkeley, California USA What Can International Research Teach.

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

Page 10: Prevention of Alcohol Harm in the Community--I Harold D. Holder Prevention Research Center Berkeley, California USA What Can International Research Teach.

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

Page 11: Prevention of Alcohol Harm in the Community--I Harold D. Holder Prevention Research Center Berkeley, California USA What Can International Research Teach.

Youth Alcohol Problem Prevention Youth Alcohol Problem Prevention Strategies: Strategies: Solid EvidenceSolid Evidence

¤¤

¤¤

¤¤

¤¤

¤¤

¤¤

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

Page 12: Prevention of Alcohol Harm in the Community--I Harold D. Holder Prevention Research Center Berkeley, California USA What Can International Research Teach.

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”

Page 13: Prevention of Alcohol Harm in the Community--I Harold D. Holder Prevention Research Center Berkeley, California USA What Can International Research Teach.

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

Page 14: Prevention of Alcohol Harm in the Community--I Harold D. Holder Prevention Research Center Berkeley, California USA What Can International Research Teach.

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

Page 15: Prevention of Alcohol Harm in the Community--I Harold D. Holder Prevention Research Center Berkeley, California USA What Can International Research Teach.

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

Page 16: Prevention of Alcohol Harm in the Community--I Harold D. Holder Prevention Research Center Berkeley, California USA What Can International Research Teach.

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

Page 17: Prevention of Alcohol Harm in the Community--I Harold D. Holder Prevention Research Center Berkeley, California USA What Can International Research Teach.

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

Page 18: Prevention of Alcohol Harm in the Community--I Harold D. Holder Prevention Research Center Berkeley, California USA What Can International Research Teach.

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%

Page 19: Prevention of Alcohol Harm in the Community--I Harold D. Holder Prevention Research Center Berkeley, California USA What Can International Research Teach.

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

Page 20: Prevention of Alcohol Harm in the Community--I Harold D. Holder Prevention Research Center Berkeley, California USA What Can International Research Teach.

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

Page 21: Prevention of Alcohol Harm in the Community--I Harold D. Holder Prevention Research Center Berkeley, California USA What Can International Research Teach.

Community Action and PreventionCommunity Action and PreventionLessons from International ProjectsLessons from International Projects

Community MobilizationCommunity Mobilization

Page 22: Prevention of Alcohol Harm in the Community--I Harold D. Holder Prevention Research Center Berkeley, California USA What Can International Research Teach.

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)

Page 23: Prevention of Alcohol Harm in the Community--I Harold D. Holder Prevention Research Center Berkeley, California USA What Can International Research Teach.

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

Page 24: Prevention of Alcohol Harm in the Community--I Harold D. Holder Prevention Research Center Berkeley, California USA What Can International Research Teach.

Friday, December 10, 1993Friday, December 10, 1993

Page 25: Prevention of Alcohol Harm in the Community--I Harold D. Holder Prevention Research Center Berkeley, California USA What Can International Research Teach.
Page 26: Prevention of Alcohol Harm in the Community--I Harold D. Holder Prevention Research Center Berkeley, California USA What Can International Research Teach.

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

Page 27: Prevention of Alcohol Harm in the Community--I Harold D. Holder Prevention Research Center Berkeley, California USA What Can International Research Teach.

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

Page 28: Prevention of Alcohol Harm in the Community--I Harold D. Holder Prevention Research Center Berkeley, California USA What Can International Research Teach.