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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

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From Global to Local: An Introduction to the SYmposium

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  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?

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