Measuring the second-hand effects of drinking: Moving the alcohol policy agenda forward

1. Measuring the second-hand effects of drinking: Moving the alcohol policy agenda forward 1Samantha CukierMBA, MA, 2Norman Giesbrecht, PhD & 3Dan Steeves, MAEd(c) 1Johns Hopkins Bloomberg School of Public Health, 2Centre for Addiction and Mental Health, 3APTS Capital Health, Nova Scotia Alcohol Policy 15 | Washington, D.C. | December 7, 2010

2. Second-hand effects of drinking • “The damage from alcohol to persons other than the drinker” (Giesbrecht et al., 2010) Examples: • Drinking and driving or boating • Alcohol-fuelled physical violence • Alcohol-fuelled family violence (emotional) • Unplanned sexual behaviour • Workplace incidents • Public transportation crashes • Chronic disease or disability due to alcohol – burden to others

3. The Concept: Terminology • Second-hand drinking • Second-hand effects of drinking • Other terminology used: • Collateral damage • Negative externalities (economic) • Passive drinking (Burgess: A ‘good lie’ too far) • Alcohol’s harm to others

4. Why second-hand drinking? • MANY Health effects of ‘first-hand’ drinking are not influential in stimulating societal change • Call to action necessary with relevant ‘hook’ and significant impact • Effective response necessary: Implications for policy (like second-hand smoke)

5. Causation vs. Association • Resistance? • Would the event have occurred without the alcohol? • May take blame away from individual

6. Parallels • Second-hand effects of drinking //’s • Smoking • Obesity (physical infrastructure changes, emotional toll on family) • Gun control • Second-hand alcohol //’s Second-hand smoke

7. Currently: Measuring Second-Hand Drinking Harm experienced by respondent in the past year from drinking by others (%) (Giesbrecht et al., 2010)

8. Measuring Second-Hand Drinking (Cont’d) • New Zealand: 62,000+ physical assaults, 10,000 sexual assaults involve alcohol by perpetrator / yr. (Connor, You & Casswell, 2009) • Australia: heavy drinkers cost others $13b+ lost productivity & wages (Laslett et al., 2010)

9. Currently: Measuring Second-Hand Drinking (Cont’d)

10. Currently: Measuring Second-Hand Drinking (Cont’d) • Population surveys • Info from drinker • Info from ‘other’ re: drinker • Cost of alcohol studies • Review health records • Direct • Indirect • Intangible (Laslett et al., 2010)

11. Limitations to Current Measures • Population surveys • Less serious cases • Asking drinker: indirect reporting • Asking ‘other’: unclear relationship to drinker • Cost of alcohol studies • Inaccurate measures • Who is hurt • Who is paying (Laslett et al., 2010)

12. Moving Forward: New Ways of Measurement • Laslett et al., 2010: • Population survey asking questions to ‘specific others’

13. New Ways of Measurement • Second-hand effects measured by: • Age • Gender • Ethnicity • Drinking Context (structured vs. non-structured) • Drinking level • Drink type

14. e.g. Second-hand effects by age Second-hand effects Age (yrs) & dominant type varies by age

15. e.g. Second-hand effects by gender ? Second-hand effects Male Female

16. e.g. Second-hand effects by context ? Second-hand effects Structured (eg. Workplace) Unstructured (eg. Backyard drinking)

17. e.g. Second-hand effects by drinking level Second-hand effects Low Medium High Drinking Level

18. e.g. Second-hand effects by drinking level Second-hand effects Non-binger Occasional Binger Heavy Binger Drinking Level (Srivastava and Zhao, 2010)

19. e.g. Second-hand effects by drink type Second-hand effects Regular Strength Beer Wine RTD (Spirits) Drink type (Srivastava and Zhao, 2010)

20. Other ways of measurement • Do we need to find other ways? • Currently: • Quantitative measures of • #s of people physically harmed by others • #s of people died via drinking driver • What are the options? • Other quantitative measures but different categories? • Qualitative: the power of stories • Challenges if the results from different measures are divergent

21. Challenges to Measurement • Qualitative • E.g. “Two Nova Scotia schools are banning dances, blaming out-of-control boozers, brawlers and girls in short skirts.” http://www.cbc.ca/canada/nova-scotia/story/2010/10/19/ns-school-dances-cancelled.html#ixzz16UvwXtYX • E.g. “On September 12, 2003, Eric climbed through the casement window of his seventh-floor room and stepped onto the eyebrow ledge to smoke a cigarette. He fell off the ledge, resulting in his death. A medical examiner determined Eric's blood-alcohol level at the time of his death was .16, significantly impairing his motor coordination and judgment.” http://www.kscourts.org/Cases-and-Opinions/opinions/ctapp/2008/20080808/98663.htm

22. Other Research • College Drinking • Connor, You & Casswell (2009): “Alcohol-related harm to others: a survey of physical and sexual assault in New Zealand” • Burgess (2009): “Passive drinking” • Klingemann & Gmel (2001): “Mapping the social consequences of alcohol consumption”

23. Contact Information Samantha Cukier, MBA, MA Johns Hopkins Bloomberg School of Public Health Baltimore, MD scukier@jhsph.edu Norman Giesbrecht, PhD Centre for Addiction and Mental Health Toronto, Ontario norman_giesbrecht@camh.net Dan Steeves, MAEd (c) Addiction Prevention and Treatment Services Capital District Health Authority Dartmouth, Nova Scotia dan.steeves@cdha.nshealth.ca

24. References • Connor, J., You, R., & Casswell, S. (2009). Alcohol-related harm to others: a survey of physical and sexual assault in New Zealand. Journal of the NZ Med Assoc, 122(1303). • Giesbrecht, N., Cukier, S., & Steeves, D. (2010). Collateral damage from alcohol: implications of ‘second-hand effects of drinking’ for populations and health priorities. Addiction, 105(8), 1323-1325. • Laslett, A., Catalano, P., Chikritzhs et al., (2010). The range and magnitude of alcohol’s harm to others. Alcohol Education and Rehabilitation Foundation: Australia. • Srivastava & Zhao. (2010). What do the bingers drink? Micro-unit evidence on negative externalities and drinker characteristics of alcohol consumption by beverage types. Economic Papers, 29(2), 229-250.)