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Prevention of Underage Drinking Problems

Prevention of Underage Drinking Problems. Ralph Hingson, ScD Director, Division of Epidemiology and Prevention Research National Institute on Alcohol Abuse and Alcoholism Preventing Underage Alcohol Use: A National Meeting of the States Sponsored by the Interagency Coordinating

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Prevention of Underage Drinking Problems

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  1. Prevention of Underage Drinking Problems Ralph Hingson, ScD Director, Division of Epidemiology and Prevention Research National Institute on Alcohol Abuse and Alcoholism Preventing Underage Alcohol Use: A National Meeting of the States Sponsored by the Interagency Coordinating Committee for the Prevention of Underage Drinking October 31, 2005

  2. Magnitude of Alcohol Problems on U.S. College Campuses Dr. Margaret Jonathan Travis Moore Levy Stedman Hingson et al. (2002) J. Studies on Alcohol

  3. Interventions • Individually oriented • Family • School • Environmental • Comprehensive Community Interventions

  4. Brief Motivational Alcohol Intervention in a Trauma Center • 46% of injured trauma center patients age 18 and older screened positive for alcohol problems. • Half (N=336) randomly allocated to receive 30 minute brief intervention to reduce risky drinking and offers links to alcohol treatment Source: Gentilello Annals of Surgery, 1999

  5. Brief Motivational Alcohol Intervention in a Trauma Center Results: • Reduced alcohol consumption by an average 21 drinks per week at 1 year follow up • 47% reduction in new injuries requiring treatment in ED • 48% reduction in hospital admissions for injury over 3 years • 23% fewer drunk driving arrests Source: Gentilello Annals of Surgery, 1999

  6. Brief Alcohol Intervention for Older Adolescents • 94 ED patients, mean age 18.4, injured after drinking • Half randomly allocated to a 35-40 minute motivational intervention to reduce drinking and related risky behaviors such as DWI Results at six months: • Brief intervention group had • ¼ drinking and driving occasions • Fewer moving violations 3% vs. 23% • ¼ alcohol related injuries Source: Monti et al. J. Consulting and Clinical Psychology (1999)

  7. Fifteen Studies Provide Strong Support for the Efficacy of This Approach Among College Students • Marlatt, 1998 • Anderson et. Al., 1998 • Larimer, 2000 • D’Amico & Fromme 2000 • Dimeff, 1997 • Aubrey, 1998 • Monti, 1999 • Baer, 2001 • Barnett et al. 2004 • Borsari and Carey (in press) • Labrie 2002 • Gregory 2001 • LaChance 2004 • Murphy et al. 2001 • Murphy et al. 2004 Source: Larimer and Cronce (2002, 2005 In Review)

  8. Implementation Gap • Fewer than • ½ of pediatricians screen all adolescents for use of alcohol and drugs • ¼ screen for drinking and driving. • Pediatric Medical Care Providers considerably underdiagnose alcohol use, abuse, and dependence among patients ages 14-18. • 1.5 million 12-17 year olds need alcohol treatment • Only 216,000 14% received treatment Sources: American Academy of Pediatrics, 1997; Wilson, Sheritt, Gates, Knight Pediatrics, 2004; National Household Survey on Drug Use and Health, 2003

  9. Insurers’ Liability for Losses Due to IntoxicationAs of January 1, 2004 28 States and DC allow with holding of medical reimbursement if injured under the influence

  10. Family Interventions Iowa Strengthening Families Program Goals: • Improve parent/child relations • Strengthen family communication skills • Increase child coping skills Implementation: • 7 sessions at school • 13 hours total • Parent and child separately and together

  11. Family Interventions A randomized controlled trial with families of 6th graders: • Iowa Strengthening Families Program (ISFP) (206 families) • Preparing for Drug Free Years Program (PDFYP) (221 families) • Control (221 families) Lifetime Drunkenness Through 6 Years Past Baseline: Logistic Growth Curve Trajectory for ISFP Condition Trajectory for Control Condition 72 0 6 18 30 48 Months Source: Spoth, Redmond, Shin J Consulting Clinical Psychology (2001, 2004)

  12. School Based Programs • Programs that rely primarily on increasing knowledge about consequences of drinking are not effective. • Effective Programs : • Are based on social influence models • Include norm setting • Address social pressures to drink and teach resistance skills • Include developmentally appropriate information • Include peer-led components • Provide teacher training • Are interactive • School only program effects are generally small • Less effective with students who initiate drinking prior to grades 5 or 6 Source: NIAAA, Alcohol and Development in Youth: A Multidisciplinary Overview

  13. School Based Life Skills Program Junior High- 30 sessions, most in Year 1 Curricula: Drug Information Alcohol/Drug Resistance Skills Self Management Skills General Social Skills Results: Beneficial Effects Alcohol & Tobacco Use Through High School, Not After Sources: Botvin et al. J. Consulting and Clinical Psychology (1990); JAMA (1995); Addictive Behaviors (2000)

  14. Combined Family Interventions& School Based Life skills Program Randomized controlled trial of 7th graders from 36 rural schools: • ISFP Plus Life Skills Training (n=549) • Life Skills Training Only (n=517) • Control (n=453) • Results: 2 ½ Years Later • Weekly drunkenness rate among intervention students 1/3 lower • Strengthening Family plus Life Skills (p=.03) • Life Skills Training (p=.08) Conclusion: Family and school interventions combined are more effective than school interventions only Source: Spoth, et al Psychology of Addictive Behaviors (In Press)

  15. Environmental Approaches

  16. Drinking Trends AmongHigh School Seniors, 1975-2003 Federal 21 drinking age Drinking age 21 in all States Source: Monitoring the Future, 2004

  17. Trends in Alcohol Related and Non Alcohol Related Traffic Fatalities persons 16-20 U.S. - 1982-2004 US MLDA Age 21 Law MLDA 21 in All 50 States 5,244 Non Alcohol Related Fatalities ↑38% 3,781 2,738 2,115 Alcohol Related Fatalities ↓60% Source: U.S. Fatality Analysis Reporting System

  18. Legal Drinking Age Changes • CDC reviewed 49 studies published in scientific journals • Alcohol-Related Traffic Crashes: - Increased 10% when the drinking age was lowered - Decreased 16% when the drinking age was raised Source: Shults et al., American Journal of Preventive Medicine, 2001

  19. Cumulative Estimated Number of Lives Saved by the Minimum Drinking Age Laws 1975-2003 Source: National Highway Traffic Safety Administration

  20. Alcohol-related traffic fatalities and injuries Other unintentional injuries (falls, drownings, burns) Homicide and assault Sexual assault Suicide STDs, HIV/AIDS Unplanned pregnancy Alcohol dependence Teen drug use Poor academic performance 10 Reasons for Legal Drinking Age of 21

  21. Source: Grant and Dawson J. Substance Abuse (1997)

  22. Purpose To assess whether an earlier drinking onset is related to: • Unintentional injuries under the influence of alcohol • Motor vehicle crashes because of drinking • Physical fights after drinking - ever in the respondent’s life - during the year prior to the survey

  23. Micheal Timothy Wilder

  24. Ever in a Physical Fight While or After Drinking According to Age of Drinking Onset, National Longitudinal Alcohol Epidemiologic Survey Odds Ratio and Confidence Intervals Age Started Drinking P<.001 Controlling for age, gender, black, non hispanic, Hispanic, other, education, marital status, current, past, never smoke current, past, never use drugs, family history of alcoholism, current, past, never alcohol dependent, frequency drank 5+ during respondent’s period of heaviest drinking

  25. Why Are These Findings Important? Injuries are the leading cause of death among youth 1-44 • Unintentional injuries #1 1-44 • Intentional injuries #2 8-34 Source: Centers for Disease Control and Prevention

  26. Why Are These Findings Important? Alcohol is involved over 50,000 injury deaths annually* * Over half under age 44 Source G. Smith et. al 1999

  27. BAC and Impairment Concentrated Attention, Speed Control, Braking, Steering, Gear Changing, Lane Tracking, Judgement Tracking, Divided Attention, Coordination, Comprehension, Eye Movement Simple Reaction Time, Emergency Response Choice Reaction Time • Key driving functions are impaired at levels as low as .02-.04%. Source: National Highway Traffic Safety Administration

  28. Relative Risk of Fatal CrashDrivers Age 16-19 and 20+ as a function of BAC 16-19 y.o. 20+ y.o. The risk of fatal crash increases more with each drink among young drivers than drivers age 20 and older. Source: Simpson, H. 1989

  29. Proportion of Teen Fatal Crashes Involving Single Vehicles at Night Before and After Zero Tolerance Laws for Youth Comparison ZeroTolerance Percent Before After Before After 1% 21% SVNF 143910791150 717 Fatal Crashes 4597 3400 3637 2851 Source: Hingson, Heeren, Winter, 1994

  30. States with Primary Safety Belt Laws • Primary Law As of July 2004, 21 states, DC and Puerto Rico have primary safety belt laws. New Hampshire is the only state that has no adult safety belt law

  31. Increase Price of Alcohol • Younger heavier drinkers more affected than older heavier drinkers Kenkel, 1993 Godfrey, 1997 Chaloupka & Wechsler, 1996 Sutton & Godfrey, 1995 • Higher prices reduce alcohol related problems • Motor vehicle fatalities (Kenkel, 1993) • Robberies • Rapes • Liver cirrhosis mortality See: Cook & Moore, 1993; Cook & Tauchen, 1982; Ruhm, 1996

  32. Restricting Alcohol Licenses Density of alcohol outlets is associated with - Higher alcohol consumption - Violence - Other crime - Health problems • Sources: Ornstein & Hanssens, 1985; Gliksman & Rush, 1986; Gruenewald et.al, 1993; Scribner et.al., 1995; Stitt and Giacopassi, 1992; Chaloupka & Wechsler, 1996

  33. Is Passing Laws Enough?

  34. Potential Process of Change After a Drinking Age Increase Police and Enforcement General Legal Deterrence Legal Drinking Age Increase Reduction In Drinking & Driving After Drinking Court Enforcement Fatal and Night Fatal Crash Reductions Public Education Who - Minors - Alcohol Outlets What - Reasons for Law - Enforcement Changes in Public Perception about Alcohol

  35. Comprehensive Community Interventions • Involve multiple departments of city government and private citizens • Use multiple program strategies • Education • Media advocacy • Community organizing and mobilization • Environment policy change • Heightened enforcement

  36. Successful Comprehensive Community Interventions • Project Northland Perry (1996) • Communities Mobilizing for Change Wagenaar (2002) • Community Trials Holder (2000) • A Matter of Degree Weitzman (2004) • Fighting Back Hingson (2005) • Saving Lives Program Hingson (1996) • Clapp et al. (2005)

  37. Project Northland • Intervention to prevent or reduce alcohol use among 6, 7, and 8th grade students • School Education Programs (general program each grade) • Parent Involvement • Peer Participation • Community task forces to engage citizens • Compliance Checks • Server Training • Ordinances Source: Perry C. et al. American Journal of Public Health, 1996; Perry C. et al. Health Education Research, 2002.

  38. Project Northland Results: 3 Years Later • Drinking 50% lower among baseline non-drinkers (5% vs 10%) • Lower rates of cigarette and marijuana use • Monthly and weekly drinking 20-30% lower among entire sample Grades 11 & 12 • Fewer Northland students drink 5+ • 80% reduction in youth ability to purchase alcohol (Off Sale)

  39. Communities Mobilizing for Change • Interventions to Reduce Availability: • Merchants record underage buy attempts • Beer kegs prohibited at University Homecoming • Policies to discourage motels from permitting underage drinking parties • Security at high school dances • Model local ordinances to restrict underage access to alcohol • Compliance checks Source: Wagenaar et al., J. Studies on Alcohol, 2000

  40. Communities Mobilizing for Change Results: -17% increase in outlets checking age ID -24% decline in bar and restaurant sales -25% decrease in the proportion of 18-20 year olds attempting alcohol purchase -17% decline in the proportion of older teens providing alcohol to younger teens -7% decrease in the percent under 21 who drank -14% decline in alcohol traffic injuries, drivers 18-20 Source: Wagenaar et al., J. Studies on Alcohol, 2000

  41. Community Trials Intervention: • Reduce youth alcohol availability • Drinking and driving enforcement • Alcohol outlet density reduction • Community mobilization & media • Advocacy • Responsible alcohol service Results: • Self reported DWI cut in half • 10%-11% decrease in single vehicle night crashes • 43% decrease in emergency department alcohol related assault admissions “Mountain of Beer” Source: Holder et al., JAMA (2000)

  42. A Matter of Degree • Intervention Components: • College/ Community Partnerships • Environmental strategies to reduce drinking problems: • Keg registration • Mandatory responsible beverage service • Police wild party enforcement • Substance free residence halls • Advertising bans Source: Weitzman et al. American Journal of Preventive Medicine. 2004

  43. A Matter of Degree Results: • Achieved reductions among college students in • Binge drinking • Driving after drinking • Alcohol related injuries • Being assaulted by other drinking college students Source: Weitzman et al. American Journal of Preventive Medicine 2004

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