The Epidemiology and Prevention of Excessive Alcohol Use

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1 The Epidemiology and Prevention of Excessive Alcohol Use Bob Brewer, MD, MSPH Alcohol Program Leader National Center for Chronic Disease Prevention and Health Promotion/CDC Alcohol Policy 17 April 6, 2016 National Center for Chronic Disease Prevention and Health Promotion Division of Population Health

2 As required by the Alcohol Policy 17 Conference, I have signed a disclosure statement and note the following conflict(s) of interest: None

3 CDC Alcohol Program Established in July Public Health Surveillance on excessive alcohol use and related harms. Applied research on health impacts and intervention effectiveness. State capacity building & technical assistance. National leadership & collaboration

4 Public Health Impact of Excessive Drinking in the U.S. 88,000 deaths every year 1 in 10 deaths among working-age adults (20-64 years) 30 years of life lost per death (2.5 million in total) 4 th leading preventable cause of death $249 billion in economic costs (2010) or ~$2.05/drink 2 in 5 dollars paid by government 9 in 10 excessive drinkers are not alcohol dependent Alcohol-Related Disease Impact (ARDI); available at: ;Mokdad A, et al JAMA 2004; 291(10): ; Sacks, et al Am J Prev Med 2015; 49(5):e73 e79; Esser et al. Prev Chronic Dis 2014;11:

5 Binge Drinking is the Most Deadly, Costly, & Common Pattern of Excessive Drinking in the U.S. 4 drinks per occasion for women and 5 for men 54% of the deaths due to excessive drinking Binge Drinking 66% of the Years of Potential Life Lost (YPLL) 77% of the economic costs CDC. Vital Signs: Binge Drinking Prevalence, Frequency and Intensity Among Adults United States, NIAAA. NIAAA Scientific Advisory Council Approves Binge Drinking Definition Newsletter. 2004;3(3) 5

6 RISK FACTOR POTENTIAL CONDITION High Blood Pressure Various Cancers Binge Drinking Unintended Pregnancy HIV/STDs Motor Vehicle Crashes Alcohol Poisoning

7 Percent Binge Drinking is Common Across the Lifespan High School Students Youth Online: High School YRBS; Kanny D, et al. Binge Drinking United States, MMWR 2013; 62 (Suppl):77-80.

8 Most Alcohol Poisoning Deaths in the U.S. Involve Middle Aged Adults Kanny D, et al. Vital Signs: Alcohol Poisoning Deaths United States, MMWR 2015;63:

9 Percent Binge Drinking Increases with Household Income <$25,000 $25,000<$50,000 $50,000<$75,000 $75,000 Kanny D, et al. Binge Drinking United States, MMWR 2013;62 (Suppl):77-80.

10 Episodes per Month Binge Drinkers Do So Frequently Kanny D, et al. Binge Drinking United States, MMWR 2013;62 (Suppl):77-80.

11 Binge Drinkers Drink a Lot Per Binge * Average largest number of drinks consumed on occasion among binge drinkers. Kanny D, et al. Binge Drinking United States, MMWR 2013;62 (Suppl):77-80.

12 Binge Drinking Prevalence and Intensity Varies by State Prevalence Intensity Kanny D, et al. Binge Drinking United States, MMWR 2013;62 (Suppl):77-80.

13 Factors that Affect Health Smallest Impact Largest Impact Counseling & Education Clinical Interventions Long-lasting Protective Interventions Changing the Context to make individuals default decisions healthy Socioeconomic Factors Examples Eat healthy, be physically active Rx for high blood pressure, high cholesterol, diabetes Immunizations, brief intervention, cessation treatment, colonoscopy Fluoridation, 0g trans fat, iodization, smokefree laws, tobacco tax Poverty, education, housing, inequality

14 Guide to Community Preventive Services Community Guide recommends several prevention strategies for excessive drinking Based on systematic reviews of the scientific literature Interventions selected based on potential public health impact Most are directed toward the general population Recommendations made by the Community Preventive Services Task Force Independent, nonfederal, volunteer body of experts in public health and prevention research, practice, and policy Based on strength of scientific evidence 14

15 Community Guide Recommendations for Preventing Excessive Drinking, Increase alcohol taxes Regulate alcohol outlet density Dram shop (commercial host) liability Avoid further privatization of alcohol sales Maintain limits on days of sale Maintain limits on hours of sale Enhance enforcement of laws prohibiting alcohol sales to minors Electronic screening and brief intervention (e-sbi) 15

16 Guide Findings on Increasing Alcohol Excise Taxes Strong and consistent evidence of intervention effectiveness. Increasing price by 10% would reduce overall alcohol consumption by about 7%. Tax increases are efficiently reflected in the retail price. Impact is proportional to the size of the tax increase. Elder RW, et al. Am J Prev Med (2)

17 Commercial Host (Dram Shop) Liability Allows alcohol retailers to be held liable for harms caused by illegal alcohol sales to minors or intoxicated patrons Shown to reduce alcohol-related harms, particularly deaths in alcohol-related motor vehicle crashes State laws vary in scope and evidence requirements Rammohan et al. Am J Prev Med,

18 Regulating Alcohol Outlet Density Refers to the concentration of retail alcohol outlets within a small geographic area Higher alcohol outlet density is associated with increased alcohol consumption and related harms (e.g., violent crime) Most studies assessed the impact of relaxing controls on outlet density (e.g., privatization of retail sales) Local control over alcohol licensing varies by state Campbell, et al. Am J Prev Med 2009 ;37(6):

19 Privatizing Alcohol Sales Relaxing of government controls over the retail sales of alcoholic beverages in off-premise locations Can significantly increase the number of retail alcohol outlets and alcohol outlet density in states Median 44.4% increase in per capita sales of privatized alcoholic beverages Per capita sales are a strong proxy for excessive alcohol use Hahn, et al. Am J Prev Med, 2012

20 2015 Prevention Status Reports (PSRs) Developed by CDC Office for State, Tribal, Local and Territorial Support (OSTLTS) with input from CDC programs Individual reports for all 50 states and D.C. 10 topics: Structure: Alcohol-Related Harms Food Safety Healthcare-Associated Infections Heart Disease and Stroke HIV Problem: Brief overview of the public health burden Solutions: Identification of evidence-based and/or expert recommended policies and practices intended to prevent or reduce public health problems Status: Status of policies and practices using a simple three-level rating scale (green, yellow, red) Available at Motor Vehicle Injuries Nutrition, Physical Activity, and Obesity Prescription Drug Overdose Teen Pregnancy Tobacco Use

21 2015 State PSRs on Excessive Alcohol Use Public Health Problem Indicators: Binge drinking among adults Binge drinking intensity (drinks per occasion) Binge drinking among women of childbearing age Binge drinking among high school students Policy and Practice Indicators: State beer tax State distilled spirits tax State wine tax Commercial host (dram shop) liability laws 21

22 Status of State Beer Taxes in the U.S., January 1, 2014 Green: $1.00 per gallon 4 Yellow: $ $0.99 per gallon 4 Red: $ $0.49 per gallon 42 N/A: Data were not available State Count includes the District of Columbia

23 Status of State Distilled Spirits Taxes in the U.S., January 1, 2014 Green: $8.00 per gallon 3 Yellow: $ $7.99 per gallon 11 Red: $ $3.99 per gallon 20 N/A: Data were not available State Count includes the District of Columbia

24 Status of State Wine Taxes in the U.S., January 1, 2014 Green: $2.00 per gallon 2 Yellow: $ $1.99 per gallon 8 Red: $ $0.99 per gallon 29 N/A: Data were not available State Count includes the District of Columbia

25 Status of commercial host (dram shop) liability laws, United States (as of January 1, 2015) Green: Commercial host liability with no major limitations 20 Yellow: Commercial host liability with major limitations 25 Red: No commercial host liability State Count includes the District of Columbia

26 In Conclusion. Excessive alcohol use, particularly binge drinking, is a leading cause of preventable death in the U.S. Evidence-based policy strategies for preventing excessive drinking are available but underused. Public health agencies can help define the problem and support the implementation of effective prevention strategies to reduce excessive alcohol use and related harms.

27 Acknowledgments Jessica Mesnick Dafna Kanny Marissa Esser Tim Naimi Jeff Sacks Randy Elder Mandy Stahre Jim Mosher Sabrina Adler Aysha Pamucku Community Preventive Services Task Force BRFSS Staff & Coordinators YRBS Staff & Coordinators Office for State, Tribal, Local and Territorial Support CDC Foundation Robert Wood Johnson Foundation

28 Contact Information: Bob Brewer, MD, MSPH For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA Telephone: CDC-INFO ( )/TTY: Web: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion Division of Population Health

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