1 / 21

From Global to Local: An Introduction to the SYmposium

From Global to Local: An Introduction to the SYmposium. David Jernigan, PhD Johns Hopkins Bloomberg School of Public Health. GLOBAL BACKGROUND . Harmful use of alcohol is increasingly recognized as a global public health problem

cora-vinson
Download Presentation

From Global to Local: An Introduction to the SYmposium

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. From Global to Local: An Introduction to the SYmposium David Jernigan, PhD Johns Hopkins Bloomberg School of Public Health

  2. GLOBAL BACKGROUND • Harmful use of alcohol is increasingly recognized as a global public health problem • Alcohol use was responsible for 3.8% of global deaths and 4.6% of global disability in 2004 (Rehm et al., The Lancet, 29 July 2009) • This is nearly equivalent to the harm from tobacco use, even when allowing for potential health benefits of alcohol use • Global strategy on alcohol under development at WHO • Areas of greatest concern: • Alcohol and mortality in Russia • Alcohol and young people

  3. The U.S.A. in global context Source: WHO GISAH, as cited in Rehm et al. 2009

  4. Males 15-29 Females 15-29 REGION Deaths (000s) % total Deaths DALYs (000s) % total DALYs Deaths (000s) % total Deaths DALYs (000s) % total DALYs Afr D 10 5.90% 560 5.30% 2 1.10% 129 1.00% Afr E 28 7.90% 1,469 8.00% 5 0.90% 257 1.00% Amr A 9 23.00% 1,388 28.40% 1 9.50% 401 9.80% Amr B 52 35.50% 3,995 30.80% 4 7.90% 637 7.80% Amr D 5 17.20% 369 16.80% 1 3.30% 69 3.70% Emr B 2 4.80% 69 2.40% 0 1.20% 10 0.40% Emr D 1 1.20% 123 1.60% 0 0.20% 16 0.20% Eur A 9 25.60% 1,098 24.40% 1 10.20% 237 6.10% Eur B 9 24.30% 662 16.90% 1 7.20% 103 3.10% Eur C 42 41.00% 2,293 35.00% 5 19.90% 391 11.20% Sear B 14 11.70% 839 11.30% 2 2.40% 116 1.80% Sear D 26 5.70% 1,699 5.30% 6 1.30% 328 0.90% Wpr A 2 18.40% 214 15.60% 0 7.00% 110 8.70% Wpr B 39 13.70% 3,665 14.60% 7 4.90% 630 3.10% WORLD 249 12.90% 18,444 13.10% 36 2.20% 3,434 2.50% Death and Disability Attributable to Alcohol Use Among Youth Ages 15-29, 2000 Source: Rehm et al. 2003

  5. Males 15-29 Females 15-29 REGION Deaths (000s) % total Deaths DALYs (000s) % total DALYs Deaths (000s) % total Deaths DALYs (000s) % total DALYs Afr D 10 5.90% 560 5.30% 2 1.10% 129 1.00% Afr E 28 7.90% 1,469 8.00% 5 0.90% 257 1.00% Amr A 9 23.00% 1,388 28.40% 1 9.50% 401 9.80% Amr B 52 35.50% 3,995 30.80% 4 7.90% 637 7.80% Amr D 5 17.20% 369 16.80% 1 3.30% 69 3.70% Emr B 2 4.80% 69 2.40% 0 1.20% 10 0.40% Emr D 1 1.20% 123 1.60% 0 0.20% 16 0.20% Eur A 9 25.60% 1,098 24.40% 1 10.20% 237 6.10% Eur B 9 24.30% 662 16.90% 1 7.20% 103 3.10% Eur C 42 41.00% 2,293 35.00% 5 19.90% 391 11.20% Sear B 14 11.70% 839 11.30% 2 2.40% 116 1.80% Sear D 26 5.70% 1,699 5.30% 6 1.30% 328 0.90% Wpr A 2 18.40% 214 15.60% 0 7.00% 110 8.70% Wpr B 39 13.70% 3,665 14.60% 7 4.90% 630 3.10% WORLD 249 12.90% 18,444 13.10% 36 2.20% 3,434 2.50% Death and Disability Attributable to Alcohol Use Among Youth Ages 15-29, 2000 Source: Rehm et al. 2003

  6. Males 15-29 Females 15-29 REGION Deaths (000s) % total Deaths DALYs (000s) % total DALYs Deaths (000s) % total Deaths DALYs (000s) % total DALYs Afr D 10 5.90% 560 5.30% 2 1.10% 129 1.00% Afr E 28 7.90% 1,469 8.00% 5 0.90% 257 1.00% Amr A 9 23.00% 1,388 28.40% 1 9.50% 401 9.80% Amr B 52 35.50% 3,995 30.80% 4 7.90% 637 7.80% Amr D 5 17.20% 369 16.80% 1 3.30% 69 3.70% Emr B 2 4.80% 69 2.40% 0 1.20% 10 0.40% Emr D 1 1.20% 123 1.60% 0 0.20% 16 0.20% Eur A 9 25.60% 1,098 24.40% 1 10.20% 237 6.10% Eur B 9 24.30% 662 16.90% 1 7.20% 103 3.10% Eur C 42 41.00% 2,293 35.00% 5 19.90% 391 11.20% Sear B 14 11.70% 839 11.30% 2 2.40% 116 1.80% Sear D 26 5.70% 1,699 5.30% 6 1.30% 328 0.90% Wpr A 2 18.40% 214 15.60% 0 7.00% 110 8.70% Wpr B 39 13.70% 3,665 14.60% 7 4.90% 630 3.10% WORLD 249 12.90% 18,444 13.10% 36 2.20% 3,434 2.50% Death and Disability Attributable to Alcohol Use Among Youth Ages 15-29, 2000 Source: Rehm et al. 2003

  7. Males 15-29 Females 15-29 REGION Deaths (000s) % total Deaths DALYs (000s) % total DALYs Deaths (000s) % total Deaths DALYs (000s) % total DALYs Afr D 10 5.90% 560 5.30% 2 1.10% 129 1.00% Afr E 28 7.90% 1,469 8.00% 5 0.90% 257 1.00% Amr A 9 23.00% 1,388 28.40% 1 9.50% 401 9.80% Amr B 52 35.50% 3,995 30.80% 4 7.90% 637 7.80% Amr D 5 17.20% 369 16.80% 1 3.30% 69 3.70% Emr B 2 4.80% 69 2.40% 0 1.20% 10 0.40% Emr D 1 1.20% 123 1.60% 0 0.20% 16 0.20% Eur A 9 25.60% 1,098 24.40% 1 10.20% 237 6.10% Eur B 9 24.30% 662 16.90% 1 7.20% 103 3.10% Eur C 42 41.00% 2,293 35.00% 5 19.90% 391 11.20% Sear B 14 11.70% 839 11.30% 2 2.40% 116 1.80% Sear D 26 5.70% 1,699 5.30% 6 1.30% 328 0.90% Wpr A 2 18.40% 214 15.60% 0 7.00% 110 8.70% Wpr B 39 13.70% 3,665 14.60% 7 4.90% 630 3.10% WORLD 249 12.90% 18,444 13.10% 36 2.20% 3,434 2.50% Death and Disability Attributable to Alcohol Use Among Youth Ages 15-29, 2000 Source: Rehm et al. 2003

  8. Review of public health findings • The earlier young people start to drink, the worse the alcohol-related consequences: • Alcohol dependence • Traffic crashes • Physical violence after drinking • Other unintentional injuries after drinking (e.g. drowning, falls) • Potential damage to still-developing adolescent brain • Lower chances of success in school • Age of alcohol initiation has long-term influence on health • Bottom line: strong public health interest in delaying onset of drinking

  9. Minimum drinking age laws • One of many steps taken by societies to limit alcohol-related harm • EVERY society must take on question of how to control intoxicants and their effects • Minimum drinking age laws only one strategy – cannot be expected to do the whole job • International experience reflects U.S. experience: minimum age laws do affect onset of drinking

  10. Age requirement for on- and off-premise purchase of beer and spirits

  11. Countries greater than 18 • 19 • Canada (all but Alberta, Manitoba and Quebec) • Republic of Korea • Nicaragua • 20 • Iceland • Japan • Norway • Sweden • 21 • Egypt • Indonesia • Micronesia • Palau • USA Source: WHO GAD 2006

  12. Recent changes • France: • Moves to increase minimum purchase for alcohol and tobacco from 16 to 18 in 2009 • New Zealand (AJPH 2006;96:126–131) • Reduced from 20 to 18 in 1999 • Comparing four years before and after the change from 20 to 18, compared to crashes among 20 to 24 year-olds (comparison group), alcohol-involved traffic crashes grew: • 14% among 15-17 year-old males • 24% among 15-17 year-old females • 12% among 18 and 19 year-old males • 51% among 18 and 19 year-old females

  13. Drinking Ages in Europe • 15 – Slovenia • 16 – Italy, Malta, Portugal • 17 – Greece • 18 – Austria, Belgium, Bulgaria, Croatia, Czech Republic, Denmark, Estonia, France, Germany, Hungary, Ireland, Latvia, Lithuania, Netherlands, Poland, Romania, Russia, Slovakia, Spain, Switzerland, Ukraine, United Kingdom • 20 – Iceland, Norway, Sweden

  14. Drinking Among 15-16 year-olds:U.S. and Europe, 2007

  15. Drinking Among 15-16 year-olds:U.S. and Europe, 2007

  16. Drinking Among 15-16 year-olds:U.S. and Europe, 2007

  17. “Extreme drinking worse in U.S.” • Actually, looking at indicator “drunk in past 30 days” 21 countries worse off than U.S., 14 countries better off • Extreme drunkenness worse in U.S.? • 15-16 year-olds reporting 10-19 incidents of drunkenness in past 30 days • 1 percent of U.S. 10th graders report this • Same percentage as in 14 European countries, including Austria, Italy and Spain

  18. Background for this syposium • “Amethyst Initiative” – signed by 130 college presidents and asking for a re-opening of the debate over the federal law withholding 10% of highway funds if states did not implement age 21 alcohol purchase laws • “Rush to judgment” on 21 largely uninformed by public health research • What light can public health research and experience shed on this debate?

  19. “Eyeball analyses” • Many shortcomings – much more going on in each country than this cursory analysis can capture • More important to review literature in its entirety – never rely on any single study • Single studies may mis-specify variables to “wash out” effects, e.g. • Using 15-24 year-olds as focus of analysis • Using all traffic crashes instead of alcohol-related traffic crashes as outcome variable • Diluting statistical power by performing state-by-state analyses which increase range of error, involve fitting linear analysis to trends that are by no means linear

  20. Goals of this symposium • Key questions: • What can research tell us about drinking among college-aged persons? • What does the research literature suggest are the most effective approaches for reducing alcohol-related harm among college students? • What is our specific situation here in Baltimore? • What can we, as campus and community, do in this city to reduce alcohol-related harm among college students?

  21. Structure of the evening • PRESENTATIONS: • What is the situation regarding college drinking in the U.S.A.? • What has public health research told us to date about what will be most effective in reducing alcohol-related harm in college campuses and communities? • What can we learn from experience nearby about reducing alcohol-related harm in campus communities? • What special challenges do we face here in Baltimore? • DISCUSSION: • How can Baltimore benefit from the findings of research literature and experience? • How do we go forward from here? • What partnerships exist and what are needed? • What concrete next steps could be proposed?

More Related