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From Global to Local: An Introduction to the SYmposium. David Jernigan, PhD Johns Hopkins Bloomberg School of Public Health. GLOBAL BACKGROUND . Harmful use of alcohol is increasingly recognized as a global public health problem

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From global to local an introduction to the symposium

From Global to Local: An Introduction to the SYmposium

David Jernigan, PhD

Johns Hopkins Bloomberg School of Public Health


Global background
GLOBAL BACKGROUND

  • Harmful use of alcohol is increasingly recognized as a global public health problem

  • Alcohol use was responsible for 3.8% of global deaths and 4.6% of global disability in 2004 (Rehm et al., The Lancet, 29 July 2009)

  • This is nearly equivalent to the harm from tobacco use, even when allowing for potential health benefits of alcohol use

  • Global strategy on alcohol under development at WHO

  • Areas of greatest concern:

    • Alcohol and mortality in Russia

    • Alcohol and young people


The u s a in global context
The U.S.A. in global context

Source: WHO GISAH, as cited in Rehm et al. 2009


Death and disability attributable to alcohol use among youth ages 15 29 2000

Males 15-29

Females 15-29

REGION

Deaths (000s)

% total Deaths

DALYs (000s)

% total DALYs

Deaths (000s)

% total Deaths

DALYs (000s)

% total DALYs

Afr D

10

5.90%

560

5.30%

2

1.10%

129

1.00%

Afr E

28

7.90%

1,469

8.00%

5

0.90%

257

1.00%

Amr A

9

23.00%

1,388

28.40%

1

9.50%

401

9.80%

Amr B

52

35.50%

3,995

30.80%

4

7.90%

637

7.80%

Amr D

5

17.20%

369

16.80%

1

3.30%

69

3.70%

Emr B

2

4.80%

69

2.40%

0

1.20%

10

0.40%

Emr D

1

1.20%

123

1.60%

0

0.20%

16

0.20%

Eur A

9

25.60%

1,098

24.40%

1

10.20%

237

6.10%

Eur B

9

24.30%

662

16.90%

1

7.20%

103

3.10%

Eur C

42

41.00%

2,293

35.00%

5

19.90%

391

11.20%

Sear B

14

11.70%

839

11.30%

2

2.40%

116

1.80%

Sear D

26

5.70%

1,699

5.30%

6

1.30%

328

0.90%

Wpr A

2

18.40%

214

15.60%

0

7.00%

110

8.70%

Wpr B

39

13.70%

3,665

14.60%

7

4.90%

630

3.10%

WORLD

249

12.90%

18,444

13.10%

36

2.20%

3,434

2.50%

Death and Disability Attributable to Alcohol Use Among Youth Ages 15-29, 2000

Source: Rehm et al. 2003


Death and disability attributable to alcohol use among youth ages 15 29 20001

Males 15-29

Females 15-29

REGION

Deaths (000s)

% total Deaths

DALYs (000s)

% total DALYs

Deaths (000s)

% total Deaths

DALYs (000s)

% total DALYs

Afr D

10

5.90%

560

5.30%

2

1.10%

129

1.00%

Afr E

28

7.90%

1,469

8.00%

5

0.90%

257

1.00%

Amr A

9

23.00%

1,388

28.40%

1

9.50%

401

9.80%

Amr B

52

35.50%

3,995

30.80%

4

7.90%

637

7.80%

Amr D

5

17.20%

369

16.80%

1

3.30%

69

3.70%

Emr B

2

4.80%

69

2.40%

0

1.20%

10

0.40%

Emr D

1

1.20%

123

1.60%

0

0.20%

16

0.20%

Eur A

9

25.60%

1,098

24.40%

1

10.20%

237

6.10%

Eur B

9

24.30%

662

16.90%

1

7.20%

103

3.10%

Eur C

42

41.00%

2,293

35.00%

5

19.90%

391

11.20%

Sear B

14

11.70%

839

11.30%

2

2.40%

116

1.80%

Sear D

26

5.70%

1,699

5.30%

6

1.30%

328

0.90%

Wpr A

2

18.40%

214

15.60%

0

7.00%

110

8.70%

Wpr B

39

13.70%

3,665

14.60%

7

4.90%

630

3.10%

WORLD

249

12.90%

18,444

13.10%

36

2.20%

3,434

2.50%

Death and Disability Attributable to Alcohol Use Among Youth Ages 15-29, 2000

Source: Rehm et al. 2003


Death and disability attributable to alcohol use among youth ages 15 29 20002

Males 15-29

Females 15-29

REGION

Deaths (000s)

% total Deaths

DALYs (000s)

% total DALYs

Deaths (000s)

% total Deaths

DALYs (000s)

% total DALYs

Afr D

10

5.90%

560

5.30%

2

1.10%

129

1.00%

Afr E

28

7.90%

1,469

8.00%

5

0.90%

257

1.00%

Amr A

9

23.00%

1,388

28.40%

1

9.50%

401

9.80%

Amr B

52

35.50%

3,995

30.80%

4

7.90%

637

7.80%

Amr D

5

17.20%

369

16.80%

1

3.30%

69

3.70%

Emr B

2

4.80%

69

2.40%

0

1.20%

10

0.40%

Emr D

1

1.20%

123

1.60%

0

0.20%

16

0.20%

Eur A

9

25.60%

1,098

24.40%

1

10.20%

237

6.10%

Eur B

9

24.30%

662

16.90%

1

7.20%

103

3.10%

Eur C

42

41.00%

2,293

35.00%

5

19.90%

391

11.20%

Sear B

14

11.70%

839

11.30%

2

2.40%

116

1.80%

Sear D

26

5.70%

1,699

5.30%

6

1.30%

328

0.90%

Wpr A

2

18.40%

214

15.60%

0

7.00%

110

8.70%

Wpr B

39

13.70%

3,665

14.60%

7

4.90%

630

3.10%

WORLD

249

12.90%

18,444

13.10%

36

2.20%

3,434

2.50%

Death and Disability Attributable to Alcohol Use Among Youth Ages 15-29, 2000

Source: Rehm et al. 2003


Death and disability attributable to alcohol use among youth ages 15 29 20003

Males 15-29

Females 15-29

REGION

Deaths (000s)

% total Deaths

DALYs (000s)

% total DALYs

Deaths (000s)

% total Deaths

DALYs (000s)

% total DALYs

Afr D

10

5.90%

560

5.30%

2

1.10%

129

1.00%

Afr E

28

7.90%

1,469

8.00%

5

0.90%

257

1.00%

Amr A

9

23.00%

1,388

28.40%

1

9.50%

401

9.80%

Amr B

52

35.50%

3,995

30.80%

4

7.90%

637

7.80%

Amr D

5

17.20%

369

16.80%

1

3.30%

69

3.70%

Emr B

2

4.80%

69

2.40%

0

1.20%

10

0.40%

Emr D

1

1.20%

123

1.60%

0

0.20%

16

0.20%

Eur A

9

25.60%

1,098

24.40%

1

10.20%

237

6.10%

Eur B

9

24.30%

662

16.90%

1

7.20%

103

3.10%

Eur C

42

41.00%

2,293

35.00%

5

19.90%

391

11.20%

Sear B

14

11.70%

839

11.30%

2

2.40%

116

1.80%

Sear D

26

5.70%

1,699

5.30%

6

1.30%

328

0.90%

Wpr A

2

18.40%

214

15.60%

0

7.00%

110

8.70%

Wpr B

39

13.70%

3,665

14.60%

7

4.90%

630

3.10%

WORLD

249

12.90%

18,444

13.10%

36

2.20%

3,434

2.50%

Death and Disability Attributable to Alcohol Use Among Youth Ages 15-29, 2000

Source: Rehm et al. 2003


Review of public health findings
Review of public health findings

  • The earlier young people start to drink, the worse the alcohol-related consequences:

    • Alcohol dependence

    • Traffic crashes

    • Physical violence after drinking

    • Other unintentional injuries after drinking (e.g. drowning, falls)

    • Potential damage to still-developing adolescent brain

    • Lower chances of success in school

    • Age of alcohol initiation has long-term influence on health

  • Bottom line: strong public health interest in delaying onset of drinking


Minimum drinking age laws
Minimum drinking age laws

  • One of many steps taken by societies to limit alcohol-related harm

  • EVERY society must take on question of how to control intoxicants and their effects

  • Minimum drinking age laws only one strategy – cannot be expected to do the whole job

  • International experience reflects U.S. experience: minimum age laws do affect onset of drinking



Countries greater than 18
Countries greater than 18 spirits

  • 19

    • Canada (all but Alberta, Manitoba and Quebec)

    • Republic of Korea

    • Nicaragua

  • 20

    • Iceland

    • Japan

    • Norway

    • Sweden

  • 21

    • Egypt

    • Indonesia

    • Micronesia

    • Palau

    • USA

Source: WHO GAD 2006


Recent changes
Recent changes spirits

  • France:

    • Moves to increase minimum purchase for alcohol and tobacco from 16 to 18 in 2009

  • New Zealand (AJPH 2006;96:126–131)

    • Reduced from 20 to 18 in 1999

    • Comparing four years before and after the change from 20 to 18, compared to crashes among 20 to 24 year-olds (comparison group), alcohol-involved traffic crashes grew:

      • 14% among 15-17 year-old males

      • 24% among 15-17 year-old females

      • 12% among 18 and 19 year-old males

      • 51% among 18 and 19 year-old females


Drinking ages in europe
Drinking Ages in Europe spirits

  • 15 – Slovenia

  • 16 – Italy, Malta, Portugal

  • 17 – Greece

  • 18 – Austria, Belgium, Bulgaria, Croatia, Czech Republic, Denmark, Estonia, France, Germany, Hungary, Ireland, Latvia, Lithuania, Netherlands, Poland, Romania, Russia, Slovakia, Spain, Switzerland, Ukraine, United Kingdom

  • 20 – Iceland, Norway, Sweden


Drinking among 15 16 year olds u s and europe 2007
Drinking Among 15-16 year-olds: spiritsU.S. and Europe, 2007


Drinking among 15 16 year olds u s and europe 20071
Drinking Among 15-16 year-olds: spiritsU.S. and Europe, 2007


Drinking among 15 16 year olds u s and europe 20072
Drinking Among 15-16 year-olds: spiritsU.S. and Europe, 2007


Extreme drinking worse in u s
“Extreme drinking worse in U.S.” spirits

  • Actually, looking at indicator “drunk in past 30 days” 21 countries worse off than U.S., 14 countries better off

  • Extreme drunkenness worse in U.S.?

    • 15-16 year-olds reporting 10-19 incidents of drunkenness in past 30 days

      • 1 percent of U.S. 10th graders report this

      • Same percentage as in 14 European countries, including Austria, Italy and Spain


Background for this syposium
Background for this syposium spirits

  • “Amethyst Initiative” – signed by 130 college presidents and asking for a re-opening of the debate over the federal law withholding 10% of highway funds if states did not implement age 21 alcohol purchase laws

  • “Rush to judgment” on 21 largely uninformed by public health research

  • What light can public health research and experience shed on this debate?


Eyeball analyses
“Eyeball analyses” spirits

  • Many shortcomings – much more going on in each country than this cursory analysis can capture

  • More important to review literature in its entirety – never rely on any single study

    • Single studies may mis-specify variables to “wash out” effects, e.g.

      • Using 15-24 year-olds as focus of analysis

      • Using all traffic crashes instead of alcohol-related traffic crashes as outcome variable

      • Diluting statistical power by performing state-by-state analyses which increase range of error, involve fitting linear analysis to trends that are by no means linear


Goals of this symposium
Goals of this symposium spirits

  • Key questions:

    • What can research tell us about drinking among college-aged persons?

    • What does the research literature suggest are the most effective approaches for reducing alcohol-related harm among college students?

    • What is our specific situation here in Baltimore?

    • What can we, as campus and community, do in this city to reduce alcohol-related harm among college students?


Structure of the evening
Structure of the evening spirits

  • PRESENTATIONS:

    • What is the situation regarding college drinking in the U.S.A.?

    • What has public health research told us to date about what will be most effective in reducing alcohol-related harm in college campuses and communities?

    • What can we learn from experience nearby about reducing alcohol-related harm in campus communities?

    • What special challenges do we face here in Baltimore?

  • DISCUSSION:

    • How can Baltimore benefit from the findings of research literature and experience?

    • How do we go forward from here?

    • What partnerships exist and what are needed?

    • What concrete next steps could be proposed?


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