Prevention of Alcohol- and Tobacco-Related Harms

Based on a definition of comprehensive prevention, the author submits prevention actions in alcohol and tobacco related problems to the question: “Education or control, must we choose?” After reviewing the history, the author describes the current panorama of health education actions and control before discussing some methodological and ethical questions concerning the methods and the actors of prevention. He tries to define “prevention ideal” – which must be distinguished from “ideal prevention” and its totalitarian abuse – to introduce the second part of his text which deals with the question of evaluation of the effectiveness of alcohol- and tobacco-related problems prevention.

The author confirms the efficacy of control measures, but also shows that education has a certain degree of efficacy, despite the dominant trends in Anglo-Saxons countries. He also shows that education is necessary in the context of many European countries. After discussing the issue of cost-effectiveness ratio, the author emphasise the need for global prevention taking into account cultural and political elements to ensure efficient as well as effective prevention and social acceptance of this prevention.

Off-premise alcohol outlets on and around tribal land: risks for rural California Indian youth

Investigating the alcohol environment for rural American Indian youth, we conducted 70 interviews with leading members and youth representatives of nine Southern California tribes. We also conducted brief observations in all 13 stores licensed to sell alcohol on and close to the reservation lands of the nine tribes. Underage youth may obtain alcoholic beverages at stores either directly through illegal sales to minors or indirectly through social sources. Stores are also environments within which alcoholic beverages and heavy drinking may become normalized for youth. Limitations and implications for convenience store-based prevention research on alcohol retail environment for youth in rural populations areas are discussed.

Wahrgenommene Verfügbarkeit und Alkoholkonsum Jugendlicher im Längsschnitt

Zielsetzung: Untersuchung des Einflusses der wahrgenommenen Verfügbarkeit von Alkohol auf die Initiierung des Rauschtrinkens im Kindes- und Jugendalter Methodik: Es handelt sich um eine längsschnittliche Beobachtungsstudie mit drei Erhebungszeitpunkten über einen Zeitraum von 30 Monaten. Die Daten wurden an 1167 Schüler/innen mittels Fragebögen erhoben. Ergebnisse: Die Wahrscheinlichkeit für die Initiierung des Rauschtrinkens im Beobachtungszeitraum war bei Kindern und Jugendliche, die die Verfügbarkeit von Bier/Wein als hoch einschätzten, im Vergleich zu denen, die sie für gering erachteten, mit einem Chancenverhältnis (Adjustiertes Odds Ratio: AOR) von 1,54 (95 % Konfidenzintervall (KI): 1,14 – 2,09; p = 0,005) signifikant erhöht. Auch die wahrgenommene Verfügbarkeit von Spirituosen stellte sich als signifikanter Prädiktor heraus (AOR = 1,59; 95 % KI: 1,10 – 2,32; p = 0,014). Hier ergab sich weiterhin ein signifikanter Interaktionseffekt mit dem Alter der Kinder und Jugendlichen (AOR = 3,01; 95 % KI: 1,35 – 6,74; p = 0,007). Ein signifikanter Einfluss der wahrgenommenen Verfügbarkeit von Spirituosen konnte lediglich bei älteren Jugendlichen gefunden werden. Schlussfolgerungen: Neben politischen Maßnahmen zur Regulation der objektiven Verfügbarkeit von Alkohol (Mindestbezugsalter, Öffnungszeiten und Dichte von Verkaufsstellen) erscheint im Hinblick auf die subjektive Verfügbarkeit auch die Berücksichtigung des unmittelbaren sozialen Umfeldes für präventive Maßnahmen von Bedeutung zu sein.

Reducing youth access to alcohol: findings from a community-based randomized trial

Underage drinking continues to be an important public health problem and a challenge to the substance abuse prevention field. Community-based interventions designed to more rigorously control underage access to alcohol through retailer education and greater enforcement of underage drinking laws have been advocated as potentially effective strategies to help address this problem, but studies designed to evaluate such interventions are sparse. To address this issue we conducted a randomized trial involving 36 communities to test the combined effectiveness of five interrelated intervention components designed to reduce underage access to alcohol. The intervention was found to be effective in reducing the likelihood that retail clerks would sell alcohol to underage-looking buyers, but did not reduce underage drinking or the perceived availability of alcohol among high school students. Post hoc analyses, however, revealed significant associations between the level of underage drinking law enforcement in the intervention communities and reductions in both 30-day use of alcohol and binge drinking. The findings highlight the difficulty in reducing youth drinking even when efforts to curtail retail access are successful. Study findings also suggest that high intensity implementation of underage drinking law enforcement can reduce underage drinking. Any such effects of enhanced enforcement on underage drinking appear to be more directly attributable to an increase in perceived likelihood of enforcement and the resultant perceived inconveniences and/or sanctions to potential drinkers, than to a reduction in access to alcohol per se.

Implementing a reward and reminder underage drinking prevention program in convenience stores near Southern California American Indian reservations

BACKGROUND

Underage drinking is associated with a number of social and public health consequences. Preventing access to alcohol is one approach to reducing underage drinking.

OBJECTIVES

This study assesses the efficacy of a culturally tailored "reward and reminder" program aimed at reducing convenience store alcohol sales to youth living on or near nine American Indian reservations.

METHODS

First, tribal council proclamations were sought to support underage drinking prevention, including reward and reminder efforts. Then, decoys (volunteers over 21 years of age but judged to look younger) attempted to purchase alcohol without identification. Clerks who asked for identification were given "rewards" (gift cards and congratulatory letters), whereas clerks who did not were given "reminders" of the law regarding sales to minors. Following an initial baseline of 12 purchase attempts, three repeated reward and reminder visits were made to 13 convenience stores selling alcohol within 10 miles of the reservations (n = 51 total attempts).

RESULTS

Five of nine tribal councils passed resolutions in support of the program. The baseline sales rate without requesting ID was 33%. Similarly, 38% of stores in the first reward and reminder visit round failed to request identification. However, in the following two reward and reminder rounds, 0% of the stores failed to request identification.

CONCLUSIONS

These results indicate that environmental community-level underage drinking prevention strategies to reduce alcohol sales near rural reservations are feasible and can be effective.

SCIENTIFIC SIGNIFICANCE

Environmental prevention strategies within reservation communities support integrated supply and demand reduction models for reducing underage drinking.

Alcohol Retailing in Canadian and Nordic Contexts: Challenges and Opportunities in Balancing Trade and Prevention Agendas

This article involves a comparison of the Nordic alcohol-monopoly countries with Canadian provinces that have a tradition of off-premise alcohol retail monopolies. The aim of the article is to shed light on recent developments in Canadian and Nordic alcohol-retailing systems, and to propose a way forward for alcohol-control policy that involves balancing alcohol trade and damage-reduction agendas. The article first considers developments over the past three decades in alcohol production, marketing, and retailing involving a concentration of production, and an expansion and increased sophistication of alcohol marketing and retailing, and the underlying international and national pressures. Next, it examines examples of recent alcohol policy making in Canada and the Nordic countries, noting the challenges of controlling total alcohol consumption and high-risk drinking in a market-oriented environment. Third, it offers several steps forward that will facilitate a better balance of alcohol trade and problem-prevention agendas in the context of off-premise alcohol-retail-control systems.

The impact of retail practices on violence: the case of single serve alcohol beverage containers

INTRODUCTION AND AIMS

This paper examines the role that sales of single serve alcoholic beverages plays in violent crime in surrounding areas. Increasingly a target of regulatory measures, this is the first study to systematically assess the impact of single serve containers on neighbourhood violence.

DESIGN AND METHODS

The relative proportion of shelf space in each liquor establishment in San Bernardino, CA devoted to single serve alcohol containers was surveyed. Assuming that this is a rough indicator of the amount of sales derived from single serve containers, we use this indicator as a measure of the impact of specific retail practice on violence around the outlet.

RESULTS

Results show that the average proportion of shelf space devoted to single serve containers in the unit of analysis, the US Census Bureau block group, was positively related to violent crime, net of overall retail availability of alcohol and relevant social and economic indicators often used to predict violent crime rates in such units.

DISCUSSION AND CONCLUSIONS

These findings suggest that if the city were to make the voluntary ban on single serve container sales mandatory, violence in the surrounding areas would decline, all other things being equal. This study provides a much more grounded and specific justification for enacting such policy changes and once again shows the utility of alcohol policy for the reduction of crime and violence.

Legislating for health: locating the evidence

This article examines the timorous courtship between public health law and evidence-based policy. Legislation, in the form of direct prescriptions or proscriptions on behaviour, is perhaps the most powerful tool available to the public health policymaker. Increasingly, the same policymakers have striven to ensure that interventions are based soundly on a secure evidence base. The modern mantra is that the policies to follow are the ones that have been demonstrated to work. Legislative interventions, involving trade-offs between public benefit and private interests, present formidable challenges for the evaluator. Systematic reviews of their overall efficacy, the main tool of evidence-based policy, are in their infancy. The article presents a design for such reviews using the example of a forthcoming synthesis on the effectiveness of banning smoking in cars carrying children.

Community alcohol outlet density and underage drinking

AIM

This study examined how community alcohol outlet density may be associated with drinking among youths.

METHODS

Longitudinal data were collected from 1091 adolescents (aged 14-16 at baseline) recruited from 50 zip codes in California with varying levels of alcohol outlet density and median household income. Hierarchical linear models were used to examine the associations between zip code alcohol outlet density and frequency rates of general alcohol use and excessive drinking, taking into account zip code median household income and individual-level variables (age, gender, race/ethnicity, personal income, mobility and perceived drinking by parents and peers).

FINDINGS

When all other factors were controlled, higher initial levels of drinking and excessive drinking were observed among youths residing in zip codes with higher alcohol outlet densities. Growth in drinking and excessive drinking was, on average, more rapid in zip codes with lower alcohol outlet densities. The relation of zip code alcohol outlet density with drinking appeared to be mitigated by having friends with access to a car.

CONCLUSION

Alcohol outlet density may play a significant role in initiation of underage drinking during early teenage, especially when youths have limited mobility. Youth who reside in areas with low alcohol outlet density may overcome geographic constraints through social networks that increase their mobility and the ability to seek alcohol and drinking opportunities beyond the local community.

Why do we Need to Control Alcohol Use Through Legislative Measures? A South East Asia Perspective?

BACKGROUND

Even though prevalence of alcohol use in the world is very high, it has not been brought under legal control in several countries, contrary to other controlled substances like opium, cocaine, cannabis, and so on.

AIM

To demonstrate the similarities in both alcohol and opioid dependence by comparing and contrasting the course of clinical dependence for both substances.

PATIENTS AND METHODS

Consecutively admitted patients during the period August 2005 to May 2006, in the Center for Addiction Psychiatry, Central Institute of Psychiatry, Ranchi, India, with ICD-10 (DCR) diagnosis of alcohol dependence syndrome or opioid dependence syndrome were recruited for the study and administered the alcohol or other drug (opioid) section of SSAGA-II, respectively, and the data was entered in the corresponding tally sheet.

RESULTS

The total sample size was 150, of which 112 consented to participate. Eighty-one (72%) were alcohol-dependent and 31 (28%) were opioid-dependent. Mean ages of the patients of alcohol dependence for opioid dependence was 35.16 +/- 10.2 compared to 26.09 +/- 5.65. Mean age of onset of alcohol and opioid use were similar (18.72 +/- 6.84 and 20.73 +/- 3.93 years, respectively). Patterns of dependence were also similar for both substances, from the first criteria to dependence (0.49 years for alcohol versus 0.64 years for opioids), and from the appearance of the second criteria to dependence (0.24 years versus 0.28 years).

CONCLUSION

This study recommends alcohol to be treated on par with opioids and calls for legislations for the control of alcohol, uniformly, across the world, as a public health policy, on the lines of the Framework Convention for Tobacco Control.

Cross-national comparison of adolescent drinking and cannabis use in the United States, Canada, and the Netherlands

BACKGROUND

This research examined the prevalence of drinking and cannabis use among adolescents in the United States, Canada, and the Netherlands, countries with substantially different laws and policies relating to these substances.

METHODS

Laws regarding drinking and cannabis use were rated for each country. Substance use prevalence data among 10th graders from the Health Behaviour in School-Aged Children Survey conducted in each country in 2005-2006 were examined.

RESULTS

Laws regarding alcohol and cannabis were found to be strictest in the United States, somewhat less strict in Canada, and least strict in the Netherlands. On most measures of drinking, rates were lower in the United States than in Canada or the Netherlands. With United States as the referent, relative risks (RR) for monthly drinking were 1.30 (1.11-1.53) for Canadian boys and 1.55 (1.31-1.83) for girls, and 2.0 (1.73-2.31) for Dutch boys and 1.92 (1.62-2.27) for Dutch girls. Drunkenness was also higher among Canadian boys and girls and Dutch boys. However, rates of cannabis use did not differ between the countries, except that Dutch girls were less likely to use cannabis in the past year (RR=.67; .46-.96).

CONCLUSIONS

The lower prevalence of adolescent drinking and drunkenness (except among Dutch girls) in the United States is consistent with the contention that strict drinking policies may limit drinking among 10th graders. However, the finding that cannabis use rates did not differ across countries is not consistent with the contention that prohibition-oriented policies deter use or that liberal cannabis policies are associated with elevated adolescent use. Based on these findings, the case for strict laws and policies is considerably weaker for cannabis than for alcohol.

Alcohol policy and harm reduction in Australia

With consultations having been held across Australia this year as part of the process of developing a new National Alcohol Strategy, it seemed timely to invite my colleagues from the National Drug Research Institute who are experts in the alcohol field to write this Harm Reduction Digest. The authors have canvassed a range of alcohol policy options and discussed their effectiveness in reducing harm for what is arguably Australia's number one drug problem. Australia's response to alcohol and other drug problems has, historically, been based on 'harm minimization--incorporating supply reduction, demand reduction and harm reduction'. At this time where the policy options for alcohol are being set for the next 5 years in a climate of 'small government', removing restrictions of 'fair competition' in business and a belief in the free market, what does the research have to say about recommended policies and strategies to reduce alcohol-related harm?

Preventing impaired driving using alcohol policy

Considerable progress has been made in the reduction of impaired driving crashes during the last two decades. Much of this progress is attributable to strengthening laws against impaired driving along with vigorous enforcement efforts aimed at deterring impaired driving. In addition, many useful strategies can also be applied that focus on the control of alcohol availability, use, and promotion. Alcohol policies include controls on the price of alcohol, the location, density, and opening hours of sales outlets, controls on the social availability of alcohol, and on the promotion and advertising of alcohol. Enforcement of these policies is an important aspect of their effectiveness. These strategies have been shown to be effective or promising in reducing impaired driving as well as other consequences related to alcohol use and misuse.

Alcohol availability as a predictor of youth drinking and driving: a hierarchical analysis of survey and archival data

BACKGROUND

Much attention has recently been directed toward developing preventive interventions to reduce drinking and driving through efforts to limit the numbers and locations of alcohol outlets at the community level. Although evaluations of these efforts have suggested linkages between alcohol outlets and problem outcomes, they have not addressed the linkage between outlets and drinking and driving among youth. The analysis reported here investigates the relationship between alcohol outlet densities and underage drinking and driving as self-reported on two telephone surveys conducted in California.

METHODS

These analyses were based on data obtained from two telephone surveys conducted by the Prevention Research Center and archival data collected by the California Department of Alcoholic Beverage Control and the US Census Bureau. The sample for the first survey consisted of 15- to 20-year-old adolescents and young adults contacted by telephone, using a random digit dialing of exchanges in the greater San Francisco Bay Area. A second set of survey data was similarly collected by a random sample of households throughout California, and the Bay Area subset was also used for this analysis.

RESULTS

At the individual level, older respondents were more likely to report drinking and driving and riding with drinking drivers, whereas females and Asians were less so. At the aggregate or city-level, alcohol outlet density, as measured by the number of on- and off-premises establishments licensed to sell alcohol, was associated with both drinking and driving and riding with drinking drivers. These effects were moderated by a number of individual level effects, with younger respondents and females more likely to be affected by outlet densities.

CONCLUSIONS

The findings here provide support for the implementation of policies targeting alcohol outlet density reductions. Areas with large numbers of such outlets provide ample opportunities to youth for alcohol purchases.