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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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
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
• • 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
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
•• 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
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
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