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Section D
Collecting Alcohol Data and Planning Interventions
Russia




Injury mortality increasing
Alcohol one of the reasons given
What is the evidence?
Poor injury and alcohol data
3
Development of Better Data


Violent deaths involve legal investigation in many countries
Ideal opportunity to establish alcohol data system
4
Development of Better Data



Pilot project in Yekaterinburg, the capital city of Siberia
Work to computerize records
Used drownings to monitor alcohol involvement
5
Mortality: Drowning

Age-specific mortality per 100,000 males per year for nonboating drownings,* Russia and U.S.
35
Death rate/100,000
30
25
20
15
10
Russia
U.S.
5
0
>1
1–4
5–14
Age in years
Source: Brass, Smith, Baker, and Mohan. (1998).
15–24 25–54
55–64
65–74
75+
*Does not include drownings related
to boating, land, or air transport
6
Alcohol Survey of Recreational Boaters in Maryland





Respondents at least 18 years old
Breath sample is requested at the end of their
participation
Intoxilyzer 400 used to measure BACs
Individual BAC results are stored internally
Results were not known by interviewer and respondents
7
BAC by Operator vs. Passenger
16
14
Percent positive
12
1 to 49
50 to 99
100 +
10
8
6
4
2
0
Operator (n = 857)
Passenger (n = 732)
Role on boat
8
BAC by Gender

Do women drink less than men when out on the water?
9
BAC by Gender
16
Percent positive
14
12
1 to 49
50 to 99
100 +
10
8
6
4
2
0
Male (n = 1138)
Female (N = 399)
10
Variation by Chesapeake Regions with OVERALL
Region of Chesapeake Bay
11
Respondent BAC and BACs of Boating Fatalities
Respondent BAC and BACs of boating fatalities, Maryland
80
70
Percent positive

60
Respondents (n = 1589)
50
Fatalities (n = 255)
40
30
20
10
0
0
1 to 49
50 to 99
100 +
BAC (mg/dl)
12
Interventions to Reduce Alcohol Problems


See: NIAAA. (October 1996). Preventing alcohol problems.
Alcohol Alert No. 34 PH 370. http://www.niaaa.nih.gov/.
Most work done with motor vehicle injuries and drinking-anddriving laws
13
Interventions to Reduce Alcohol Problems




Policy interventions
Community interventions
Educational interventions
Screening and brief interventions
14
Policy Interventions



Other BAC laws
Reduce permissible BAC to .08
-  16% decline in fatal crashes with drivers over the limit
Illegal per se (without proving intoxication)
-  0.08 (all U.S. states)
15
Alcohol Is Cheap and Becoming Cheaper
16
Alcohol Tax and Price Policies



Effects of alcohol tax and price policies on morbidity and
mortality: A systematic review
Conclusions:
-  Public policies affecting the price of alcoholic beverages
have significant effects on alcohol-related disease and
injury rates
Our results suggest that doubling the alcohol tax would
reduce alcohol-related mortality by an average of 35%, traffic
crash deaths by 11%, sexually transmitted disease by 6%,
violence by 2%, and crime by 1.4%
Source: Wagenaar, A. C., Tobler, A. L., and Komro, K. A. (2010). Am J Public Health.
Policy Interventions


Administrative license revocation
-  Does not require court action
-  5% decline in nighttime fatal crashes
Server liability
18
BAC and Driver Age
70
Percent of fatally injured passenger vehicle drivers
with BACs 0.10 percent or higher, by driver age
50
30
16–20 years
21–30 years
>30 years
1980
82
84
86
88
90
92
94
96
98
19
Legally Intoxicated US Drivers Involved in Fatal
Crashes
Proportion of all US drivers involved in fatal crashes estimated to have been legally
intoxicated (BAC => .08), 1982-2008
43% reduction
No reduction
20
Community Intervention


Enforcement of drunk driving laws
-  Random breath testing
Restriction of sales to minors
21
Factors Contributing to Decline





Deterrence, including enforcement practices, administrative
license revocation, and lower BAC limits
Raising the drinking age to 21
Increased public awareness and activism
Reduction in per capita alcohol consumption
Socioeconomic factors
22
Educational Interventions



Promote awareness of injury risks associated with alcohol use
-  For example, drinking and boating in New Zealand
Little recognition of the risks of alcohol use on the water
Public awareness campaign around the America’s Cup yacht
races
23
Advice
Don’t go overboard with the booze.
24
Alcoholism Diagnosis


Screening for alcohol problems in trauma patients
Brief interventions to reduce hazardous drinking
25
Psychoactive Substance Use: Serious Injured Trauma
Center Patients


Psychoactive substance use disorders among serious injured
trauma center patients
Soderstrom, C. A., Smith, G. S., Dischinger, P. C., et al. (1997). JAMA
227: 1769-1774
18-20
21-39
40-59
≥ 60
Alcohol dependence
Lifetime
Current
16%
13%
38%
27%
43%
28%
25%
13%
26
Mandated Alcohol Screening and Intervention for Trauma Center Patients


Level I and II—essential
-  “Have a mechanism to
identify patients who are
problem drinkers”
Level I—essential
-  “Must have the capability
to provide an intervention
for patients identified as
problem drinkers.”
Source: 2006 ACS Frequently Asked Questions (FAQ) website in development as of Jan 15, 2007. facs.org/trauma/
faq_answers.htm.
Injury Control Strategies


Many injury control strategies also reduce alcohol-related
injuries
Protect all people regardless of whether or not they have
been drinking
28