PHP 1540 Alcohol Use and Misuse Part III

PHP 1540: Alcohol Use and Misuse Part III: the public health response Prevention & Treatment

Public. Health Approach Public Approach Downstream efforts • Upstream = health • Mid-stream efforts • Upstream efforts policy Midstream = prevention Downstream = treatment

Public Health = All organized measures (whether public or private) to prevent disease, promote health, and prolong life among the population as a whole

Prevention = actions directed to preventing illness and promoting health Ultimate goal = reduce incidence or prevalence Proximal goals = risk factors protective factors Just as causes of health behaviors have multiple determinants, prevention usually requires a multidimensional approach

Over the life course, there is a continuum of alcohol involvement Initiation Regular use Heavy use Problem use

Traditional approach: 3 types of prevention (Commission on Chronic Illness, 1957) • Primary prevention : goal is to decrease the number of new cases of a disease or illness (incidence) • Secondary prevention : goal is to lower the rate of established cases in a population (prevalence) • Tertiary prevention : goal is to decrease the amount of disability associated with existing conditions

Spectrum of drinkers and consequences

3 targets of prevention used by the Institute of Medicine (Mrazek & Haggerty, 1994) • Universal prevention – Target: everyone • Selective prevention – Target: at-risk groups Reducing risk factors; increasingly enhancing strengths as well, as in health promotion More efficient use of resources; allows for tailoring messages/approaches to a particular risk group • Indicated prevention – Target: people showing early signs of problems

Universal: nondrinkers & nonproblem drinkers Indicated: drinkers showing early signs of problems Selective: drinkers in at-risk groups

Two sides to prevention: Reducing Supply and Demand • Demand reduction = reduces demand for alcohol via prevention & treatment – High demand keeps prices high and supply flowing – Prevention aims to motivate users to consume less • Supply reduction = makes alcohol harder to get, more expensive, or less socially tolerated, via policy and law enforcement – When alcohol cost more and is difficult to get, fewer people drink and demand goes down – Prevention aims to reduce physical availability/access

social ecological model Society National, state, local laws & policies, national/cultural mores Community Norms, standards, social organizations Interpersonal Family, friends, social networks Individual Attitudes, beliefs, motives, physiology

Complementary approaches to prevention: EXAMPLES Supply reduction = Demand reduction = • Increasing price • Restricting sales by hours or location (restricting outlets) • Server training • Minimum legal drinking age • Use education and mass media to reduce acceptability of irresponsible use • Challenge exaggerated norms • Use warning labels • Empower people to resist pressure • Develop alternate ways of coping/socializing + Enforcement of restrictions

PRICE = base price + taxes BIGGEST IMPACT on 16 -21 year olds & females clear and consistent evidence that increasing alcohol price or taxation reduces overall consumption and related harm (Booth et al. , 2008; Elder et al. , 2010; Wagenaar et al. , 2010) • Morbidity and mortality • Traffic crashes • Crime, violence • STI rates Elder et al. (2010): 10% increase in alcohol prices 310% decrease in consumption

• Promotions, specials, large volume options (e. g. , kegs, cases) • Aggressive marketing associated with higher binge rates ⇒ The lower the price of beer in the community, the higher the binge drinking rate at the college • Number of alcohol outlets on and near campus predicted consumption • Self-selection or socialization? • Students who were non-bingers in high school also drank more in “wet” environments What is a campus to do?