Effective Interventions for Reducing Alcohol-relatedHarms

Transcription

1 Effective Interventions for Reducing Alcohol-relatedHarms Walter Farke German Centre for Addiction Issues(DHS) Hamm, Germany or

2 Presentation Outline Alcohol consumption and its consequences What is effective to reduce alcohol related harm?

3 Adult per capita consumption in litre pure alcohol Adult per capita consumption to to to to to to 19.30

4 Alcohol Consumption (15+) in EU Member States

5 Changes between 2003 and 2007 in the proportion reporting in binge drinking in the last 30 days Hibell et al. 2007; The 2007 ESPAD report

6 Proportion reporting having had 5+ drinks on one occasion during the last 30 days (averages for 17 countries) Hibell et al. 2007; The 2007 ESPAD report

7 Burden of disease attributable to alcohol (% DALYs in each subregion) Proportion of DALYs attributableto selected risk factor < % % 1-1.9% 2-3.9% 4-7.9% %

8 Top 10 risk factors for DALYs (world)

9 Top 10 risk factors for DALYs (high income countries)

10 Top 10 risk factors for DALYs (middle income countries)

11 Share of alcohol injuries in all injuries 2002 Zatonski et al (2008)

12 The share of deaths attributable to alcohol in the EU % of all deaths attributable to alcohol in the EU % of all male deaths at age years are due to alcohol Age group 11% of all female deaths at age years are due to alcohol Males Females Source: Rehm 2005

13 The tangible costs of alcohol in the EU, 2003 Source: Anderson & Baumberg 2006

14 Effectiveness of Measures to reduce alcohol related harm 1. Information and education 2. Health-sector response 3. Community action 4. Drink-driving policies and countermeasures 5. Availability of alcohol 6. Marketing of alcoholic beverages 7. Pricing policies 8. Drinking environments 9. Reducing illegally and informally produced alcohol

15 Education and Information School-based education Parenting programmes Social marketing programmes Public information campaigns Counteradvertising Drinking guidelines Health warnings

16 Proportion of risky drinkers by intervention and comparison groups

17 Impact of school education: synthesis of 14 systematic reviews 6/59 3/19 0/19 1/9 2/12 Source: Jones et al 2007

18 Evidence of education & information campaigns There is extensive & consistent evidence that school-based programmes do not lead to sustained changes in behaviour; Although poorly researched, there is no consistent evidence that public education campaigns lead to sustained changes in behaviour; There are no rigorous evaluations to demonstrate whether or not campaigns based on drinking guidelines lead to sustained changes in behaviour; Although there is limited research, there is some evidence that campaigns funded by the alcohol industry can have negative effects; There are some evidence to show that consumer labelling & warning messages do not lead to sustained changes in behaviour

19 Effectiveness of Measures 1. Information and education 2. Health-sector response 3. Community Programmes 4. Drink-driving policies 5. Availability of alcohol 6. Marketing of alcoholic beverages 7. Pricing policies 8. Drinking environments 9. Reducing illegally and informally produced alcohol

20 Evidence of the health sector s reponse There is extensive and consistent evidence that brief advice in health care settings reduces alcohol-related harm Evidence has been identified for the positive impact of brief interventions on alcohol consumption, mortality, morbidity, alcohol-related injuries, alcohol-related social consequences, and healthcare resource use There is consistent evidence that brief interventions are cost-effective There is consistent evidence that behavioural and pharmacological therapies are effective in treating alcohol use disorders

21 Effectiveness of Measures 1. Information and education 2. Health-sector response 3. Community Programmes 4. Drink-driving policies 5. Availability of alcohol 6. Marketing of alcoholic beverages 7. Pricing policies 8. Drinking environment 9. Reducing illegally and informally produced alcohol

22 Community Programmes Control of sale & consumption of alcohol Law enforcement education and information campaigns Media advocacy Counter advertising Health promotion Workplace-based interventions

23 Evidence of community programmes There is some evidence that multi-component community-based programmes including community mobilization, responsible beverage service and stricter enforcement of existing alcohol laws can lead to reductions in alcohol related traffic fatalities and injuries from assault There is limited evidence that such community-based programmes can be cost-effective There is some limited evidence that interventions at the workplace, including peer support & brief advice, can reduce alcohol-related harm

24 Effectiveness of Measures 1. Information and education 2. Health-sector response 3. Community Programmes 4. Drink-driving policies 5. Availability of alcohol 6. Marketing of alcoholic beverages 7. Pricing policies 8. Drinking environments 9. Reducing illegally and informally produced alcohol

25 Drink-driving policies Alcohol policy and drink-driving Unrestricted breath-testing Licence suspension Alcohol locks Training for servers of alcohol & civil liability Designated driver & safe ride programmes Educational programmes & mass media campaigns

26 Lower blood alcohol levels Sweden: impact of reduction of BAC level from 0.5g/l to 0.2g/l in 1990 Source:Sporre2001

27 Evidence drink-driving measures The introduction and/or reduction of legal BAC levels for driving reduces motor vehicles accidents & fatalities, when these are enforced; The introduction of sobriety checkpoints & random breath-testing reduces accidents & fatalities; Alcohol locks can reduce motor vehicle accidents; Mass media campaigns enhance the effectiveness of drink-driving policies; There are studies that find no evidence for any impact from designated driver & safe ride programmes in reducing accidents & fatalities

28 Effectiveness of Measures 1. Information and education 2. Health-sector response 3. Community Programmes 4. Drink-driving policies 5. Availability of alcohol 6. Marketing of alcoholic beverages 7. Pricing policies 8. Drinking Environment 9. Reducing illegally and informally produced alcohol

29 Availability of Alcohol Minimum age for purchase of alcohol Number of outlets and outlet density Days of hours of sale

30 Iceland: Impact of 24 hour opening of bars and restaurants Source: Ragnarsdottir et al. 2002

31 Impact of 2002 licensing law that prohibited on-premises alcohol sales after 2300h

32 Evidence Availability of Alcohol Maintaining and raising minimum purchasing ages for alcohol can reduce alcohol-related harm; Government monopolies on the retail sale of alcohol can reduce alcohol related harm; Regulating and limiting outlet densities can reduce alcohol related harm; Regulating and limiting the days and hours of sale can reduce alcohol related harm.

33 Effectiveness of Measures 1. Information and education 2. Health-sector response 3. Community Programmes 4. Drink-driving policies 5. Availability of alcohol 6. Marketing of alcoholic beverages 7. Pricing policies 8. Drinking Environment 9. Reducing illegally and informally produced alcohol

34 Alcohol Marketing

35 Experimental study: Alcohol portrayal & drinking behaviour Characters consumed alcohol 3 times and alcoholic beverages were portrayed an additional 15 times

36 Experimental Study: Alcohol portrayal & drinking behaviour Characters consumed alcohol 18 times and alcoholic beverages were portrayed an additional 23 times

37 Results III Number of drinks consumed Alcohol movie and commercial Non-alcohol movie and commercial Engels et al 2009

38 Evidence of Marketing of Alcoholic Beverages The content of commercial marketing of alcohol has an impact on the risk of young people consuming alcohol; The volume of commercial marketing of alcohol increases the risk of young people consuming alcohol, also in a risky way There is some evidence and experience that self-regulation of commercial marketing of alcohol does not prevent the kind of marketing that has an impact on younger people, particularly when it is not backed up by a legal framework and effective sanctions

39 Effectiveness of Measures 1. Information and education 2. Health-sector response 3. Community Programmes 4. Drink-driving policies 5. Availability of alcohol 6. Marketing of alcoholic beverages 7. Pricing policies 8. Drinking environment 9. Reducing illegally and informally produced alcohol

40 Germany: Impact of spirit alcohol tax 30 g alcohol/week Spirit alcopops Wine/Beer alcopops Beer Wine Spirits year olds weekly alcohol consumption

41 Alcohol tax cuts and alcohol-positive sudden deaths, Finland On 1/3/04, tax reduced by 33% retail price decreased by 22% 7.7 additional deaths/week, 17% increase Government alcohol tax revenue went down by 17%

42 Evidence of pricing policies Raising the price of alcohol reduces alcoholrelated harm Rises in the price of alcohol need to account for changes in income and the prices of other commodities Raising in the price has an impact on younger and heavier drinkers Price increases and setting a minimum price affect the consumption and expenditure of heavier drinkers to a much greater extent than lighter drinkers Lowering taxes to reduce cross-border trade can lead to increased alcohol-related harm

43 Effectiveness of Measures 1. Information and education 2. Health-sector response 3. Community Programmes 4. Drink-driving policies 5. Availability of alcohol 6. Marketing of alcoholic beverages 7. Pricing policies 8. Drinking environments 9. Reducing illegally and informally produced alcohol

44 Drinking environments Design of premises Training of alcohol servers Active enforcement

45 Physical Factors Alcohol use Overserving Aggressio n Poor ventilation Crime Poor cleanliness Crowding Noisy, loud music High temperature Lighting Seating Shabby Hughes et al, Addiction supplement, AMPHORA

46 Social factors Alcohol use Overserving Aggression Cheap drinks Crime Permissive Games Dancing, bands.. Illegal activity (drugs) Drunk customers Non-alcohol drinks Food available Hughes et al, Addiction supplement, AMPHORA

47 Younger staff Staff factors Alcohol use Overserving Aggression Crime Poor staff practice Over-serving Door supervisors Friendly staff All female staff Warnings/staff policies Hughes et al, Addiction supplement, AMPHORA

48 Evidence of drinking environments Increased enforcement on sales to intoxicated and underage drinkers can reduce alcoholrelated harm Responsible serving practices do not on their own consistently reduce alcohol-related harm Interventions delivered in drinking environments do not consistenly reduce alcohol-related harm Interventions aimed at reducing underage access to alcohol do not on their own consistently reduce alcohol-related harm

49 Effectiveness of Measures 1. Information and education 2. Health-sector response 3. Community Programmes 4. Drink-driving policies 5. Availability of alcohol 6. Marketing of alcoholic beverages 7. Pricing policies 8. Drinking environments 9. Reducing illegally and informally produced alcohol

50 Evidence of reducing illegally & informally produced alcohol There are very limited studies that have been undertaken suggest that the chemical composition of unrecorded alcohol is unlikely to pose; the exeption to this is surrogate alcohols

51 Evidence of Infrastructures for alcohol policy An alcohol policy supported by adequate resources is a pre-requisite for government action; Alcohol policies need to be supported by an adequate research base, ensuring that the knowledge of research is widely available; Alcohol policies need to be supported by effective information systems that allow monitoring of the implementation of policy

52 Cost effectiveness of policy measures (cost/daly saved ) Anderson et al. 2009

53 Some references

54 Thank you for your attention!