Alcohol as a Risk Factor for Injury Prevention Course

1. Alcohol As a Risk Factor For Injury Intermediate Injury Prevention Course Indian Health Service Billings, Montana August 2011

2. Alcohol As a Risk Factor for Injury Goal: To understand the role that alcohol plays as a risk factor for injury, and it’s impact nationally as well as among American Indians and Alaska Natives.

3. Alcohol As a Risk Factor for Injury • Objectives: • Describe What We Know • Review Injury Data and Trends • Understand factors which place American Indians and Alaska Natives at increased risk of alcohol-related injury

4. Alcohol, Injury, and American Indians Common Belief: Alcohol is the cause of all problems in Indian country. True or False: • Alcohol is the leading risk factor for injuries. • The solution to injury is to abolish alcohol • Males have the greatest injury problem • The solution to injury is to eliminate males

5. PublicHealth Approach • Prevention Implement & Evaluate Programs • What Works? Find what Prevents the Problem • Who, What? Identify Risk Factors • Surveillance Define the Problem Source: National Center for Injury Prevention and Control, CDC

6. Alcohol and Injury • What Percent of American Indian and Alaska Native Deaths Are Alcohol-Related? • Homicide — 85% • Suicide — 75% • Motor Vehicle — 73-65% • Pedestrian — 84% Sources: May P, The Epidemiology of Alcohol Abuse Among American Indians: the Mythical and Real Properties. The Primary Care Provider, Volume 20, March 1995, Indian Health Service; . Ethnicity and Alcohol-Related Fatalities, 1990-1994, by Voas RB and Tipetts AS, National Highway Traffic Safety Administration, 1999.

7. American Indian Youth Risk Behavior Survey, 1997 1997 BIA/CDC Youth Risk Behavior Survey, students in grades 9-12: • 48% Rode with Drinking Drivers • 21% Drove after Drinking • 37% Rarely/Never used Seat Belts • 15% Attempted Suicide

8. Among American Indian/Alaska Natives adolescents aged 19 years and younger, motor vehicle crashes are the leading cause of injury-related death. Motor Vehicle Fatality

9. Odds of Causing a Motor Vehicle Crash by BAC RF Borkenstein, The Role of the Drinking Driver in Traffic Accidents. Alcohol, Drugs and Behavior 1974; 2 (suppl) 8-32.

10. Motor Vehicle Fatality In 2006, American Indian/Alaska Natives had the highest percentage (48%) of alcohol-impaired driving fatalities among all racial/ethnic populations.

11. Alcohol-Related Traffic Fatalities, 1982-2000, U.S. 30,000 25,000 20,000 Number of Fatalities 15,000 10,000 5,000 0 2005 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 Year Source: NHTSA, Fatality Analysis Reporting System

12. Impact of Alcohol-impaired Driving, U.S. Each Year: • 115 million episodes • Each DUI arrest: 1000-2000 not arrested • 16,000 deaths • 310,000 injuries

13. Are We Making a Difference? Percent of Alcohol-Related Motor Vehicle Deaths, Native Americans and All US Races Source: NHTSA FARS Query system 2002: http://www-fars.nhtsa.dot.gov/; and Ethnicity and Alcohol-Related Fatalities, 1990-1994, by Voas RB and Tipetts AS, National Highway Traffic Safety Administration, 1999.

14. Seat belt usage ranges from a low of 28% to a high of 88% on reservations. Source: NHTSA. FARS data, 2006.

15. Risky Alcohol UseMeans Costly Health Problems

16. Predictors of seatbelt use in American Indian motor vehicle crash trauma victims on and off the reservation. “…alcohol, rather than race or location, is the overriding predictor of seatbelt use. This study compared patients that were in crashes, and only those triaged to a level one trauma facility.” Accid Anal Prev. 2007 Sep;39(5):1001-5. Epub 2007 Mar 28.

17. Alcohol and American Indians • In groups of 2-3, discuss what you know are factors that place American Indians/Alaska Natives at high risk for alcohol-related injury death. Take into consideration age, drinking style, environment, and gender.

18. Alcohol and American Indians Risk Factor: Age • American Indians Overall are Younger • Median age of 24 vs. 33 for all US Races. • All Youth Engage More in Risky Behaviors • The large proportion of young AI/AN places a large segment of the population at risk

19. Alcohol and American Indians Risk Factor: Drinking Style • In some Tribes, fewer adults drink than in the general US population, and a substantial proportion of Indian people do not drink, especially older adults. • Among AI/AN Who Do Drink—2-3 times Greater Prevalence of Problem Drinking

20. Alcohol and American Indians Risk Factor: Drinking Style • Indian Males 15-35 Often “Binge” Drink with High BACs. • High BACs Often Lead to Severe Injury

23. Alcohol and American Indians Risk Factor: Environment • About Half of All American Indians Live in Rural Environments • Long Distances to Advanced Trauma Care

24. Alcohol and American Indians Risk Factor: Environment • Risky Environments Such as Driving Long Distances at Night, Walking, and Boating Combined with High BACs Often Lead to Fatal Outcomes

25. Alcohol and American Indians Risk Factor: Gender • More Indian Men Drink Than Women • Young Indian Men More Likely to Engage in Excessive Binge Drinking With High BACs

26. Alcohol and American Indians Risk Factor: Gender • Indian Male Injury Death Rates are 2 to 5 Times Greater Than Female Rates • Indian Females Are at Higher Risk of Alcohol-Related Death than Non-Indian Women.

28. Intervening in the Presence of Alcohol • Gallup Protective Custody Program • Highway Lighting Projects: Whiteriver, Gallup, Sells, others • Float coat programs in Alaska • Reduce Alcohol Availability--Policy • Legislation and Enforcement of Laws

29. Intervening in the Presence of Alcohol Na’nizhoozhi Center • Protective Custody Program, Gallup, NM • Intoxicated people picked up off streets and housed up to 3 days • Reduces potential pedestrian injuries, hypothermia deaths, and violence • Alcohol detoxification and treatment provided

30. Intervening in the Presence of Alcohol Pedestrian Lighting Projects • Successful street lighting projects in Whiteriver, AZ, Gallup, NM, Sells, AZ, and others • Allow drivers to see pedestrians at night, even if intoxicated and walking in roadway • Which of the Three “Es” is this approach?

31. Intervening in the Presence of Alcohol Float Coat Programs • Alaska’s rivers are the “highways” of Native village life. • The use of float coats and life jackets can save lives even in alcohol-related boating incidents. Photo Source: Ryan Hill

32. Who Controls Alcohol Policy? • Bootleggers • Border Towns • Tribal Council

33. Alcohol Policy Considerations • Long history of prohibition of American Indians and alcohol. American Indians could not legally buy alcohol until 1953. • Many tribes today are still “Dry” and don’t allow alcohol on the reservation.

34. Alcohol Policy Considerations Buzz Group Discussion (5-7 min) List policy considerations (pros and cons) of tribes legalizing the sale of alcohol - ”Wet” and “Dry”. Half the class take the Wet policy and other half Dry.

35. Alcohol and InjurySummary • There are ways to be involved in reducing alcohol-related injuries in your community • Alcohol is a complex problem requiring multi-disciplined approach and community empowerment • Not just a police and court system problem

36. Alcohol Resources • The Epidemiology of Alcohol Abuse Among American Indians: The Mythical and Real Properties by Dr. Philip May was published in the IHS Primary Care Provider, March, 1995, and can be found at: • http://www.ihs.gov/publicinfo/publications/healthprovider/issues/IHSProMar2.asp#alcohol