Cancer What s Alcohol Use Got to Do With It?
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1 Cancer What s Alcohol Use Got to Do With It? Tuesday, July 7 th, 2015 Ena Wanliss, MS Dafna Kanny, PhD S. Jane Henley, MSPH Amy Ann Moore
2 Welcome! Shelina D. Foderingham MPH MSW Director of Practice Improvement Project Director, National Behavioral Health Network for Tobacco & Cancer Control National Council for Behavioral Health Margaret A. Jaco MSSW Policy Associate Project Manager, National Behavioral Health Network for Tobacco & Cancer Control National Council for Behavioral Health
3 Housekeeping The best way to ask a question is to type it into the Questions box in your GoToWebinar window. To access handouts and a copy of the presentation slides, click on and download them from the Handouts pane. Technical Difficulties? Call Citrix Tech Support at
4 Jointly funded by CDC s Office on Smoking & Health & Division of Cancer Prevention & Control Provides resources and tools to help organizations reduce tobacco use and cancer among people with mental illness and addictions 1 of 8 CDC National Networks to eliminate cancer and tobacco disparities in priority populations Visit and Join Today! Free Access to Toolkits, training opportunities, virtual communities and other resources Webinars & Presentations State Strategy Sessions Community of Practice #BHtheChange
5 Webinar Agenda Overview: Centers for Disease Control and Prevention s (CDC) Cancer Prevention & Control Efforts Alcohol Use & Cancer Risk: Impact & Reducing Excessive Alcohol Use Lessons Learned from the Field: Interventions that Work in Integrated Care Settings to Address Alcohol Concerns
6 Guest Speaker #1 Ena Wanliss, MS Project Lead, National Partnerships Comprehensive Cancer Control Branch, CDC Division of Cancer Prevention & Control
7 Cancer - What's Alcohol Use Got to Do With It? Ena Wanliss, MS National Partnership Project Lead Comprehensive Cancer Control Branch Webinar July 7, 2015 National Center for Chronic Disease Prevention and Health Promotion Division of Cancer Prevention and Control
8 Division of Cancer Prevention and Control
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10 Collect and Analyze Data about Policies & Practices Use the CDC Prevention Status Reports to learn the status of Community Guide strategies for preventing excessive alcohol use in your state Conduct an environmental scan to identify any additional alcohol-related laws in your area
11 Collect and Analyze Data about Policies & Practices Use cancer registry data to examine incidence and death rates for alcohol-related cancers in your state, including cancers of the breast, liver, colon, rectum, mouth, pharynx, larynx, and esophagus Monitor changes in these indicators over time
12 Collect and Analyze Data about Policies & Practices Use these CDC websites for statistics on excessive alcohol use in your state and compare them to national statistics CDC Chronic Disease Indicators website: CDC s Prevention Status Report: BRRSS Prevalence and Trends Data: YRBS Youth Online: Monitor changes in these indicators over time Consider developing a special survey to examine a topic specific to your prevention efforts
13 Identify and Engage with Potential Partners Educate cancer coalition members on the public health impact of excessive alcohol use and related harms, particularly alcohol-related cancer rates, in your area Identify potential partners at local and national levels and ask them to help you educate key stakeholders on cancer risks linked with alcohol use and strategies to reduce excessive alcohol use Collect information about alcohol use and alcohol-related cancer rates that you can give to partners and stakeholders
14 Identify and Engage with Potential Partners cont Disseminate guidance that is evidence-based and reflects the most current science available Survey key partners to identify their needs and what resources they can add to your efforts Ensure that health promotion activities throughout the state are congruent with and supportive of alcohol control
15 Potential Partners: Professional and Non-Profit Organizations Substance abuse prevention programs Public health programs with an interest in reducing excessive alcohol use Media outlets and retailers Law enforcement Schools, state and local education agencies, and parentteacher associations
16 Potential Partners: Professional and Non-Profit Organizations Healthcare providers, clinics, and medical associations State and local health departments Community mental health centers Colleges and universities City planners, urban developers, city and county officials
17 Potential Partners: Professional and Non-Profit Organizations Center on Alcohol Marketing and Youth (CAMY): Community Anti-Drug Coalitions of America (CADCA): Leadership to Keep Children Alcohol Free: National Association of Chronic Disease Directors:
18 Potential Partners: Professional and Non-Profit Organizations The National Association of State Alcohol and Drug Abuse Directors: National Liquor Law Enforcement Association: The Robert Wood Johnson Foundation: National Behavioral Health Network for Tobacco and Cancer Control:
19 Library of Indicators (LIDS) Measure Your Effects Database for CDC s National Comprehensive Cancer Control Programs. Includes indicators that can be used to develop objectives and to plan evaluations within cancer plans and action plans Comprehensive Cancer Control Branch Program Evaluation Toolkit Provides guidance on how to plan and conduct evaluations Behavioral surveillance systems Existing systems such as YRBS and BRFSS can be used to monitor changes in key excessive alcohol use indicators
20 Cancer - What's Alcohol Use Got to Do With It? Thank You! Ena Wanliss EWanliss@cdc.gov For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA Telephone: CDC-INFO ( )/TTY: Visit: Contact CDC at: CDC-INFO or 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 Cancer Prevention and Control
21 Guest Speakers #2 Dafna Kanny, PhD Senior Scientist Alcohol Program, CDC s National Center for Chronic Disease Prevention and Health Promotion dkk3@cdc.gov S. Jane Henley, MSPH Epidemiologist Cancer Surveillance Branch, CDC s Division of Cancer Prevention and Control skh3@cdc.gov
22 Cancer: What s Alcohol Got to Do With It? Dafna Kanny, PhD, Senior Scientist, Alcohol Program, Division of Population Health Jane Henley, MSPH, Epidemiologist, Cancer Surveillance Branch, Division of Cancer Prevention and Control National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention July 7, 2015 National Center for Chronic Disease Prevention and Health Promotion
23 Outline 1. Public health impact of excessive alcohol use 2. Cancer risk associated with alcohol use 3. Alcohol use among adults and youth 4. Summary of Alcohol Control Efforts in Comprehensive Cancer Control Plans and Alcohol Use Among Adults in the USA 5. What works to reduce excessive alcohol use
24 Focus on reducing cancer risk I want to reduce my risk for cancer. What can I do? Well, did you know that scientists say reducing your alcohol use could reduce your risk for cancer?
25 Focus on reducing alcohol use I m concerned about your alcohol use. Did you know that alcohol is a risk factor for cancer? Really? That s another good reason to drink less.
26 PUBLIC HEALTH IMPACT OF EXCESSIVE ALCOHOL USE
27 How is Excessive Alcohol Use Defined? Excessive alcohol use Binge drinking Heavy drinking Underage drinking Pregnant drinking Source:
28 What Counts as a Drink? Source:
29 Overall Public Health Impact of Excessive Alcohol Use in the United States 88,000 deaths every year (from ) 2.5 million Years of Potential Life Lost (YPLL) every year Shortens each life lost by 30 years Cost (in 2006) $223.5 billion in economic costs or ~$1.90/drink $94.2 billion (42%) paid by government or ~$0.80/drink Most excessive drinkers are not alcohol dependent Sources: Alcohol-Related Disease Impact (ARDI) available at: ; Bouchery, et al Am J Prev Med 2011;41(5): Stahre et al Prev Chronic Dis 2014;11: Esser et al. Prev Chronic Dis 2014;11:
30 Excessive Alcohol Use is Associated with Many Health and Social Outcomes
31 CANCER RISK ASSOCIATED WITH ALCOHOL USE
32 Alcohol Use and Cancer Risk The International Agency on Research on Cancer considers alcohol a carcinogen Alcohol use increases the risk of cancer: Mouth, throat & voice box Esophagus Breast Liver Colon & rectum Alcohol use was estimated to cause 20,000 deaths from cancer in the United States in 2009 Sources: IARC monographs on the evaluation of carcinogenic risks to humans: Volume 96: Alcohol consumption and ethyl carbamate. Lyon, France: International Agency for Research on Cancer Nelson DE et al. (2013) Alcohol-attributable cancer deaths and years of potential life lost in the United States. Am J Public Health 103:
33 Cancer Risk Goes up with Each Drink Adapted from Table 1, Parkin DM. Br J Cancer 2011;105:514-8
34 Even One Drink a Day Can Increase Cancer Risk Sources: IARC monographs on the evaluation of carcinogenic risks to humans: Volume 96: Alcohol consumption and ethyl carbamate. Lyon, France: International Agency for Research on Cancer World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective. Washington, DC: AICR
35 ALCOHOL USE AMONG U.S. ADULTS AND YOUTH
36 Alcohol Use among US Adults Drinking alcohol is one of the most common avoidable risk factors for cancer 55% of adults drink alcohol 17% of adults are binge drinkers 6% of adults are heavy drinkers Source: Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System survey data. 2013
37 Alcohol Use among US Youth While the legal age for drinking alcohol is 21 years, drinking alcohol is common among youth: 35% of high school youth drink alcohol 21% of high school youth reported binge drinking Source: Centers for Disease Control and Prevention. Youth Risk Behavior Survey data. 2013
38 Guidelines for Alcohol Use Source: U.S. Department of Agriculture and U.S. Department of Health and Human Services, 2010
39 Alcohol Control Efforts in Comprehensive Cancer Control Plans and Alcohol Use Among Adults in the USA Source: Henley SJ, Kanny D, et al. Alcohol and Alcoholism 2014;49(6):661-7.
40 Study Objectives Assess the prevalence of current alcohol use among U.S. adults, categorized by adherence to U.S. Dietary Guidelines. Assess the extent to which alcohol control efforts, in the context of cancer prevention, are being implemented in comprehensive cancer control plans. Source: Henley SJ, Kanny D, et al. Alcohol and Alcoholism 2014;49(6):661-7.
41 Study Methods 2011 Behavioral Risk Factor Surveillance System prevalence of current alcohol use ( 1 drink in past 30 days) Alcohol use exceeding Dietary Guidelines for moderate drinking (women: 1 drink/day; men: 2 drinks/day) Restricted to adults of legal drinking age ( 21 years) 447,505 respondents Comprehensive Cancer Control Plans 69 states, tribes, and jurisdictions Cancer Control P.L.A.N.E.T. website Source: Henley SJ, Kanny D, et al. Alcohol and Alcoholism 2014;49(6):661-7.
42 Comprehensive Cancer Control Programs CDC s National Comprehensive Cancer Control Program helps prevent and control cancer in the United States by supporting community efforts to Set up and convene cancer coalitions Develop data-driven cancer control plans Implement and evaluate cancer control plans Source:
43 A third of US adults exceed guidelines for moderate alcohol use Half of adults did not drink alcohol in the past 30 days Half of adults had at least one alcoholic drink in the past 30 days 1 in 3 drinkers drank within guidelines 2 of 3 drinkers exceeded guidelines Source: Henley SJ, Kanny D, et al. Alcohol and Alcoholism 2014;49(6):661-7.
44 Percentage of drinkers who exceeded moderate drinking guidelines was fairly consistent across most demographic characteristics Overall Sex Age Race/Ethnicity Education Household Income Source: Henley SJ, Kanny D, et al. Alcohol and Alcoholism 2014;49(6):661-7.
45 Current Drinkers who Exceed Guidelines for Moderate Alcohol Use by State Source: Henley SJ, Kanny D, et al. Alcohol and Alcoholism 2014;49(6):661-7.
46 Comprehensive Cancer Control Plans Content # % Plan acknowledges alcohol use as a cancer risk factor At least one goal, objective, or strategy addresses alcohol use as a cancer risk factor (including any of the below) Raise public awareness of cancer risk associated with alcohol use Educate individuals about cancer risk associated with alcohol use Reduce prevalence of excessive alcohol use: Measurable Non-measurable Partner with health care providers to promote awareness among their patients Collaborate with other organizations Source: Henley SJ, Kanny D, et al. Alcohol and Alcoholism 2014;49(6):661-7.
47 How Comprehensive Cancer Control Plans Addressed Alcohol Control Source: Henley SJ, Kanny D, et al. Alcohol and Alcoholism 2014;49(6):661-7.
48 Summary of paper by Henley, Kanny et al. Two in three legal-aged drinkers in the U.S. reported alcohol use that exceeded moderate drinking guidelines at least once in the past 30 days. While most comprehensive cancer control plans acknowledged that alcohol use was a cause of cancer, fewer than half included an objective, goal, or strategy to address alcohol as a cancer risk factor. Source: Henley SJ, Kanny D, et al. Alcohol and Alcoholism 2014;49(6):661-7.
49 Individual Behavior Change
50 Health Impact Pyramid Counseling & Education Clinical Interventions Long-Lasting Protective Interventions Changing the Context to Make Individuals Default Decision Making Socioeconomic Factors Source: Frieden TR. A Framework for Public Health Action: The Health Impact Pyramid. Am J Public Health 2010; 100:590-5.
51 WHAT WORKS TO REDUCE EXCESSIVE ALCOHOL USE
52 Community and Clinical Strategies Work Together to Reduce Excessive Alcohol Use Community Preventive Services Task Force U.S. Preventive Services Task Force National Prevention Strategy World Health Organization
53 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) Source:
54 Community Guide Recommendation Increase Alcohol Taxes Federal, state or local level Different for each beverage type (beer, wine, distilled spirits) 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 Source:
55 Community Guide Recommendation Regulate Alcohol Outlet Density Alcohol outlet density is the number and concentration of places that sell alcohol, such as bars, restaurants, and liquor stores, in an area City, county or state governments can regulate alcohol outlet density through licensing or zoning processes The higher the alcohol outlet density, the higher the harms related to alcohol use Source:
56 Community Guide Recommendation Commercial Host ( Dram Shop ) Liability Laws Laws that hold alcohol retail establishments liable (at fault) for injuries or harms caused by illegal sales or service to intoxicated or underage (<21 years) customers Most states have dram shop liability laws although they vary in scope and evidence required Areas with dram shop liability laws have reduced alcoholrelated harms (such as motor vehicle deaths) Source:
57 US Preventive Services Task Force (USPSTF) Recommendation Related to Excessive Alcohol Use Screening and Brief Intervention Health care providers (eg, doctors, nurses, PAs) Source:
58 Screening and Brief Intervention Provided through Electronic Devices (e-sbi) Source:
59 Cancer: What s Alcohol Got to Do With It? Conclusions Alcohol use is a common cancer risk factor Community and clinical strategies can reduce excessive alcohol use Community programs can identify and engage with partners to promote awareness of the cancer risk associated with alcohol use support widespread implementation of evidence-based strategies to reduce excessive alcohol use
60 Thank you! 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
61 Guest Speaker #3 Amy Ann Moore Certified Prevention Specialist Ingham County Health Department
62 The Burden of Disease Attributable to Alcohol World Health Organization Global distribution of all alcohol-attributable deaths by disease or injury,
63 63
64 Framing the Issue: What to say NIAAA: National Institute on Alcohol Abuse and Alcoholism American Cancer Society: Alcohol and Cancer (attached) World Health Organization: 1988 Alcohol as a Carcinogen Centers for Disease Control and Prevention SAMHSA: Local Treatment Options for highest 10% who cannot make behavioral changes 64
65 65
66 Clinical Interventions: SBIRT -NIAAA Patient Education Materials AUDIT-C: Clinical Measure in Electronic Medical Record Alcohol Use Disorders Identifications Test (AUDIT) What is a Standard Drink: NIAAA U.S. Adult Drinking Patterns: NIAAA Strategies for Cutting Down: NIAAA Cancer and Alcohol Use: State of Michigan Alcohol Epidemiology Program (attached) 66
67 67
68 Identify Alcohol Concerns Based on Symptoms Depression Anxiety Sleep Disorders Tobacco Use: including electronic smoking devices Frequent Expression of Negative Emotion in the Home Neglectful of Medications Cancer: Concern, History, Treatment Fidelity 68
69 Model Appropriate Messaging There is new science that shows Alcohol is a Carcinogen and contains 15 carcinogenic compounds, including ethanol. Do you know of anyone that should cut down their alcohol use? Most people do not drink, or rarely drink alcohol. Here are some good ideas if you want to improve your health in small ways every day. I am asking about alcohol use, because I know you want good health as you age. Most people don t know that using alcohol raises cancer risk. Would you help me share that news with your friends and family? 69
70 Comments & Questions?
71 Jointly funded by CDC s Office on Smoking & Health & Division of Cancer Prevention & Control Provides resources and tools to help organizations reduce tobacco use and cancer among people with mental illness and addictions 1 of 8 CDC National Networks to eliminate cancer and tobacco disparities in priority populations Visit and Join Today! Free Access to Toolkits, training opportunities, virtual communities and other resources Webinars & Presentations State Strategy Sessions Community of Practice #BHtheChange
72 Thank you for joining us for the Cancer What s Alcohol Use Got to Do With It? Webinar!
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