Second-hand drinking: Public health s response to harm caused to others from alcohol

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2 Second-hand drinking: Public health s response to harm caused to others from alcohol Ashley Wettlaufer and Norman Giesbrecht Centre for Addiction and Mental Health Public Health Ontario Webinar, April 29,

3 Overview Harms and costs from alcohol use Harms to others from alcohol use Emerging evidence International Canadian Harm to others and alcohol policy The role of public health 2

4 A Quick Audience Poll How many of you do work on alcohol issues? My organization s main focus is on alcohol related-issues. My organization focuses somewhat on alcohol-related issues. Alcohol related issues is an area my organization is yet to focus on. 3

5 Alcohol-related Harms & Social Costs in Canada Alcohol is a leading risk factor for death, disease and disability (Lim et al., 2012). A major risk factor for cancers and other types of chronic disease Associated injuries, trauma, violence and social disruptions Interacts with other risk factors to substantially increase health risks Contributes to health inequities Involves significant economic costs 4

6 Alcohol and Acute Harms to the Drinker Acute harms (Mann et al., 2006; 2008; Bond et al., 2010) Injury Violence Homicide & suicide Drinking and driving incidents Alcohol poisoning 5

7 Alcohol and Chronic Harms to the Drinker Chronic harms (Lim et al, 2012; Rehm et al., 2010) Chronic disease Cancers Gastrointestinal conditions (liver cirrhosis) Cardiovascular conditions On-going social harms Family Friends Workplace 6

8 Alcohol-Related Costs Costs (Rehm et al., 2006; CCSA, 2012) Health care Law enforcement (policing and enforcement) Loss of productivity and wages Provincial deficits from alcohol billion dollars Illegal Alcohol Tobacco Total Costs attributable to substance abuse in Canada, 2002 Total: $39.8 billion; Alcohol: $14.6 billion Source: CCSA, Rehm, et al

9 Harms to the Drinker & Harms to Others (Babor et al., 2010, p.49) Major Alcohol-related Health Conditions Cancers: liver cancer, colorectal cancers, female breast cancer. Neuropsychiatric conditions: alcohol-dependence, depression Diabetes: protective and adverse effects Cardiovascular conditions: protective and adverse effects Gastrointestinal conditions: liver cirrhosis, pancreatitis Maternal and perinatal conditions: low birth weight, FASD Infectious diseases: tuberculosis, pneumonia Acute toxic effects: alcohol poisoning Self-inflicted injuries: suicide Accidents: transport injuries, falls, workplace injuries Violent deaths: assault injuries 8

10 Harms to the Drinker & Harms to Others (Babor et al., 2010, p.49) Harms to Others associated with these Alcohol related Health Conditions Burden to care givers and support systems Emotional trauma and loss Injuries, violence and drinking and driving harms Reduced productivity and unfulfilled roles and responsibilities 9

11 Harms to others from alcohol use Terminology Alcohol s harm to others Collateral damage Externalities (economic) Social consequences Passive drinking Second-hand effects (Cukier, Giesbrecht & Steeves, 2010) 10

12 Range of Harms to Others Family Emotional trauma Spousal or child abuse Loss of income Social Disruption or confrontation Property damage Violence & other crime Unwanted sexual behaviour Workplace Safety or health risks to others Reduced productivity impacting others Transportation Drinking and driving or boating Transportation crashes Alcohol-related disease & disability Burden to care givers Strain on support systems 11

13 A Quick Audience Poll Does your organization work with or service individuals who may have been impacted by the drinking of others? Yes No Don t know 12

14 Harms to Others Research Four research traditions: 1. Specific context or population 2. Extrapolation of harms to others from research focused on harms to the drinker 3. Short survey research 4. Economic impact 13

15 Emerging Research Australia (Laslett et al. 2010; Livingston, 2009) Canada (Giesbrecht et al. 2010; Adlaf et al. 2005; Demers & Poulin, 2005) New Zealand (Connor et al., 2009; Casswell et al. 2011; Connor & Casswell, 2011) Norway (Rossow & Hauge, 2004) United Kingdom (Leontardi, 2006) United States (Greenfield et al. 2009) Europe (Anderson & Baumberg, 2006) 14

16 Australia: Laslett et al Australian study (N= 2,649) Prevalence rates (last 12 months) from 30-70% depending on the specific harm and relationship. Range of harms: social, leisure and neighbourhood disruptions, family problems, workplace incidents, reported harms to children and financial costs. Information collected on well-being, service use, drinking patterns and relevant demographic variables. High-risk groups: Younger Heavy drinkers Higher income Gender? 15

17 Harms experienced by respondents who identified a known drinker (Laslett et al., 2010) 28.8% (329 men and 434 women) identified at least one known drinker from their familial and social networks whose drinking had negatively affected them in the past year male female emotionally hurt serious argument physically hurt put at risk in a car 16

18 United States: Greenfield et al., 2009 US data from 2005 National Alcohol Survey N=6,919 About 60% of the US population reported ever having at least one problem from another s drinking and 34% reported two or more problems in lifetime. Women were almost twice as likely as men to have reported family or marital problems (24% vs. 13%) Men had more physical assaults by other drinkers (35% vs. 26%) 17

19 Lifetime Prevalence of Harms from Other Drinkers (Greenfield et al., 2009) Greenfield TK, Ye Y, Kerr WC, Bond J, Rehm J, Giesbrecht N (2009) Externalities Int J Environ Res Public Health 6(12):

20 Canada: Giesbrecht et al., 2010 Canada 2004 (N=13,328), Ontario 2006 (N= 937) Nova Scotia 2008 (N=1,200) Almost 33% of adults said that in the past year they had experienced one or more types of harm resulting from others drinking. ~11% of respondents indicating problems in their marriage. ~11% of respondents indicating they have been pushed or shoved. 19

21 % Harm due to drinking by others (Past Yr., Aged 18+, Ontario, Nova Scotia, Canada) Insult Humiliated Family Marriage Pushed shoved Serious Arguments Verbal Abuse Hit or Assault 1 or more harms Ontario Nova Scotia Canada Source : CCSA, 2004; Adlaf et al. 2005; Demers & Poulin, 2005; Giesbrecht et al

22 Canadian Research: A recent proposal Giesbrecht et al. 2013; CIHR proposal Feasibility study, inform main study (N= 75 from BC, SK, ON, QC, NS; total N=375) Research Questions 1) Forms of harm to others (contexts & gender) 2) Extent of the harm (prevalence, impact and costs) Based on Laslett et al., minute interviews Draw comparisons across international research 21

23 Questions? Are there any questions so far? If so, feel free to enter them into the chat box on the right hand side of the screen. 22

24 A Quick Audience Poll Are there initiatives in your region that aim to reduce harm to others from alcohol use? If so, what types of initiatives exist? No, I am not aware of such initiatives in my region Yes, policies to control the density of alcohol outlets Yes, screening and brief intervention initiatives Yes, initiatives to reduce alcohol marketing Yes, education based initiatives Yes, other initiatives Yes, several types of initiatives 23

25 Why focus on harms to others from alcohol use? Why is this an important area? Public knowledge is limited Innocent victims (FASD and D&D) Harms to others drives policy change The tobacco experience Major developments: Surgeon general report linking smoking with cancer Second hand smoke (innocent victims) 24

26 Trends and Drinking Patterns Level of drinking is associated with level of harm from alcohol. Per capita adult alcohol consumption increased by 13% ( ). Concurrently, national and provincial surveys indicate that approximately 20% of drinkers drink above the low-risk drinking guidelines. There was a significant increase among women overall, and among men aged and in heavy episodic drinking ( ). 25

27 How to control risky drinking & alcohol problems 1. Population level strategies: Precautionary pricing Min. pricing, pricing on alcohol content, indexation Marketing controls Limits on content and quantity Public alcohol control & retailing system Maintain government monopolies (all channels) Controls on density of alcohol outlets Avoid high density entertainment districts 26

28 How to control risky drinking & alcohol problems (cont.) 2. Focused interventions evidence based Server interventions Mandatory, evidence based training Drinking & driving policies Graduated licensing, suspensions & remedial programs Education/information Warning labels/signs, social responsibility messaging Screening, brief intervention & referral primary care setting, for general population 3. Comprehensive strategy & system to deliver it (Giesbrecht et al., CMAJ, 2011) 27

29 The assessment of alcohol policies in Canada Giesbrecht et al., years, CIHR funded 17 team members 10 policy dimensions 10 provinces Aim: comparisons to bring about policy change Implementation of effective policies that reduce alcohol consumption and related harms 28

30 Project Team Norman Giesbrecht, Senior Scientist, Centre for Addiction & Mental Health, Toronto Ashley Wettlaufer, Research Coordinator, Centre for Addiction & Mental Health, Toronto Nicole April, Médecin-conseil, Institut national de santé publique du Québec, Québec City Mark Asbridge, Associate Professor, Dalhousie University, Halifax Samantha Cukier, Doctoral student and Research Fellow, Johns Hopkins University, Baltimore Robert Mann, Senior Scientist, Centre for Addiction & Mental Health, Toronto Janet McAllister, Health Promoter, Centre for Addiction & Mental Health, London Andrew Murie, Chief Executive Officer, Mothers Against Drunk Driving, Oakville Chris Pauley, Research Coordinator, Dalhousie University, Halifax Laurie Plamondon, Research Assistant, Institut national de santé publique du Québec, Québec City Tim Stockwell, Director, Centre for Addictions Research of BC, Victoria Gerald Thomas, Policy Analyst, Gerald Thomas & Associates, Summerland, BC Kara Thompson, Research Associate, Centre for Addictions Research of BC, Victoria Kate Vallance, Research Associate, Centre for Addictions Research of BC, Victoria 29

31 A Policy Focus: WHO (2010) and Giesbrecht et al. (2013) World Health Organization 1. Pricing 1. Pricing 2. Reducing the public health impact of Illicit/informally produced alcohol CIHR Alcohol Policy Project 2. Control System 3. Availability of Alcohol 3. Physical Availability 4. Drinking and Driving 4. Drinking and Driving 5. Marketing 5. Marketing and Advertising 6. Community Action 6. Legal Drinking Age 7. Health Services response 7. SBIR 8. Reduce consequences of drinking and intoxication 9. leadership, awareness & commitment 8. Server interventions and Challenge and refusal 9. Provincial Alcohol Strategy 10. Monitoring and surveillance 10. Warning labels and Signs 30

32 Total Weighted Score (% of ideal) The assessment of alcohol policies in Canada Comparing the provinces on all 10 policy dimensions Top ranking provinces Middle ranking provinces Bottom ranking provinces Average score BC (2) AB (5) SK (4) MB (7) ON (1) QC (10) NB (6) Province NS (3) PEI (9) NL (8) Mean Score 31

33 Alcohol policy and harms to others from alcohol How are alcohol policy and the issue of harms to others linked? Alcohol policies reduce consumption and harms, including harms to others. Understanding harms to others to mobilize policy change (tobacco experience) Baseline measure of harms and costs Tailor interventions and prevention initiatives Strengthen health services response and resources 32

34 Addressing the Issue of Harms to Others from Alcohol Use Type of harm to others Education Pop. level policies Type of intervention Focused policies Drinking & driving Violence Public disruption Work place Health Service response Family FASD Care giving (e.g. chronic disease or to children) 33

35 Public health: Addressing harms to others from alcohol use Public health units address alcohol issues from a variety of angles 1. Alcohol as a risk factor for chronic disease Caregiver burden, strain on the systems 2. Alcohol as a risk factor for injury Injury to others 3. Prevention of substance misuse Social, workplace and family problems 4. Supporting good child and maternal health FASD 34

36 The Role of Public Health Increase public awareness of the issue Highlight harms to others as part of communications strategies around alcohol (e.g. incorporate into LRDGs communications) Influence the development and implementation of healthy policies Conduct a needs assessment Monitoring and surveillance of alcohol related trends Share best practices and evidence for the prevention of substance misuse Conduct program evaluations and disseminate the results widely. 35

37 The Role of Public Health (cont.) Mobilize and promote access to community resource Provide access/referral to resources, programs and services for individuals experiencing harm from others drinking as well as for the drinker Training and capacity building Make use of the resources available to you and your organization i.e. PHO capacity building services 36

38 References Anderson, P., & Baumberg, B. (2006). Alcohol in Europe: A public health perspective. A Report for the European Commision. Institute of Alcohol Studies, UK. Babor, T., Caetano, R., Casswell, S., Edwards, G., Giesbrecht, N., Graham, K., Grube, J., Hill, L. Holder, H., Livingston, M., Romel, R., Österberg. E., Rehm, J., Room, R. & Rossow, R. (2010) Alcohol, No Ordinary Commodity: Research and Public Policy. Second Edition. Oxford: Oxford University Press. Bond, J., Ye, Y., Cherpitel, C., Room, R., Rehm, J., et al., (2006). The relationship between self-reported drinking and BAC level in Emergency room injury cases: Is it a straight line? Alcoholism: Clinical and Experimental Research. 34(6), Casswell, S., & Thamarangsi, T. (2009). Alcohol and Global Health 3: Reducing harm from alcohol: call to action. Lancet; 373: Connor J. & Casswell S. (2011). Alcohol related harm to others in New Zealand: Evidence of the burden and gaps in knowledge. Presentation at the Kettil Bruun Society Annual Meeting, Melbourne, Australia. Cukier, S., Giesbrecht, N., Steeves, D. (2010). Measuring the second-hand effects of drinking: Moving the alcohol policy agenda forward. Presented at Alcohol Policy 15, Washington, D.C., December Giesbrecht, N., Cukier, S., Steeves, D. (2010) Collateral damage from alcohol: implications of secondhand effects of drinking for population and health priorities. Addiction, 105, Giesbrecht, N., Stockwell, T., Kendall, P, Strang, R., Thomas G. (2011) Alcohol: reducing the toll through focused interventions and public health policies. Canadian Medical Association Journal Feb 7,

39 References (cont.) Giesbrecht, N., Wettlaufer, A., April, N., Asbridge, M., Cukier, S., Mann, R., McAllister, J., Murie, A., Pauley, C., Plamondon, L., Stockwell, T., Thomas, G., Thompson, K., & Vallance, K. (2013). Strategies to Reduce Alcohol-Related Harms and Costs in Canada: A Comparison of Provincial Policies. Toronto: Centre for Addiction and Mental Health. Greenfield, T. K., Ye, Y., Kerr, W., Bond, J., Rehm, J., & Giesbrecht, N. (2009). Externalities from alcohol consumption in the 2005 US national alcohol survey: Implications for policy. International Journal of Environmental Research and Public Health, 6(12), Laslett, A-M., Catalano, P., Chikritzhs, T., Dale, C., Doran, C., et al. (2010). The range and magnitude of alcohol s harm to others. Australia: Alcohol Education and Rehabilitation Foundation. Deakin West, Australia. Lim, S. et al (2012) A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, : A systematic analysis for the Global Burden of Disease Study Lancet, 380, Livingston, M. (2009). Effects of alcohol consumption in spousal relationships on healthrelated quality of life and life satisfaction. J Stud Alcohol Drugs; 70(3): Mann R., Rootman, B., Shuggi, R., Adlaf, E. (2006) Assessing consequences of alcohol and drug abuse in a drinking driving population. Drugs: Education, Prevention and Policy. 13, Rehm, J., Baliunas, D., & Guilherme, L. G., et al. (2010) The relation between different dimensions of alcohol consumption and burden of disease: an overview. Addiction, 105:

40 References (cont.) Rehm, J., Baliunas, D., Brochu, S., Fischer, B., Gnam, W., Patra, J., Popova, S., Sarnocinska-Hart, A., & Taylor, B. (2006). The costs of substance abuse in Canada Ottawa:Canadian Centre on Substance Abuse. Thomas, G. (2012). Price policies to reduce alcohol-related harm in Canada. (Alcohol Price Policy Series: Report 3) Ottawa, ON: Canadian Centre on Substance Abuse. Wettlaufer, A., & Giesbrecht, N. (2013). Harms to others from alcohol: Examining the types and extent of the harms associated with alcohol use in Canada. The Ontario Public Health Conference. April, World Health Organization [WHO] (2010). Global Strategy to Reduce the Harmful Use of Alcohol. Geneva: World Health Organization. 39

41 Contact information Norman Giesbrecht Social and Epidemiological Research Department, CAMH Phone: (416) ext Ashley Wettlaufer Social and Epidemiological Research Department, CAMH Phone: (416) ext

42 Questions and Discussion 41

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