greenfield

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Alcohol Consumption, Problems and Policy Tom K. Greenfield Alcohol Research Group Public Health Institute Berkeley, California ARG A talk at the Marin Institute, March3, 2004

The National Alcohol Surveys : 

The National Alcohol Surveys The Alcohol Research Group is in 24th year, 1 of 15 NIAAA ARCs National series began 1964; standardized measurement by 1979 ARG’s national surveys have been fielded at about 5-year intervals, with N6 through N10 Surveys in 1979, 1984, 1990, 1995, and 2000 (N11 is now being finalized for data collection in 2004 and 2005) Among the variables in the Year 2000 National Alcohol Survey are: Demographics like age, sex, ethnic self identification, birthplace, income. Alcohol Use Patterns: specific beverages, drinking amount “profile”, history. Drinking contexts: location frequencies & amounts and where drank most. Norms, Attitudes, Opinions: acceptance of drunkenness; policy opinions. Alcohol-related problems: DSM-IV Dependence, Social and Health Consequences, Harms to self or other, and many others . . .

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Wine Spirits Beer Total ?

Concentration of U.S. Alcohol Consumption : 

Concentration of U.S. Alcohol Consumption Greenfield & Rogers, 1999

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0 20 40 60 80 100 Percentage of Total Consumption 0 2 4 6 8 10 Average Drinks/Day 0 20 40 60 80 100 Percentile Group Average Drinks/Day Unsafe FDA Occasion Volume Total Volume Unsafe FDA Volume Overall and FDA Guideline Drinking Distributions

Hazardous U.S. Alcohol Consumption : 

Hazardous U.S. Alcohol Consumption Rogers & Greenfield, 1999

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Overall and 5+ Drinking Distributions from the 2000 NAS 0 20 40 60 80 100 Percentage of Total Consumption 0 2 4 6 8 10 Average Drinks/Day 0 20 40 60 80 100 Percentile Group Average Drinks/Day 5+ Occasion Volume Total Volume Pure 5+ Volume

Hazardous Drinking: Percentage : 

Hazardous Drinking: Percentage OF TOTAL OF BEVERAGE Rogers & Greenfield, 1999

Drinking Volume Partitioned by 6 Contexts : 

Drinking Volume Partitioned by 6 Contexts TOTAL 37% HAZARDOUS 1984 & 1995 National Alcohol Surveys; Clark, 1988; Greenfield et al, 2000

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Drinking Patterns & Problems by Ethnic Group and Gender

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DSM-IV Dependence Prevalence by Age and Ethnic Group for Males

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Proportion of Intake from Quantity Range at Eight Volumes: All Drinkers

Controversy in Optimal Policy Approaches : 

Controversy in Optimal Policy Approaches Single Distribution Theory (Ledermann-Refined by Skog) Argues that a substantial decrease in a population’s mean (or per capita) consumption is accompanied by a decrease in the prevalence of heavy drinkers; so targets overall consumption Harm Reduction: Abates Hazardous Drinking Patterns Attention is less on trying to modify everyone’s drinking, be it light or heavy, and more on policy measures aimed at reducing drinking of hazardous quantities (per occasion) Sources: Skog, 1985; Edwards et al, 1994; Rehm et al, 1996; Stockwell et al, 1997

Relative Price of Beverages, 1970–1997 : 

Relative Price of Beverages, 1970–1997 Sources: Mosher, 1997; Mosher & Cowan, 1985; Bureau of Labor Statistics, 1996 Relative Price, 1970 $

Price and Taxation Policies : 

Price and Taxation Policies Studies at both federal and state levels show: significant price effects on consumption effects for heavier drinkers as well as for lighter ones effects on population-level problem indicators: cirrhosis mortality, vehicular crashes only modest regressive tax measure compared to other commodity taxes—there is a lower burden on the poor supported by public health experts, anathema to industry Sources: Coate & Grossman, 1988; Babor et al, 1978; Cook & Tauchen, 1982; Edwards et al, 1994

U.S. Support for Stronger Alcohol Policies : 

U.S. Support for Stronger Alcohol Policies Room et al, 1995; Giesbrecht & Greenfield, 1999; 2000 NAS %

Summary, Conclusions & Questions : 

Summary, Conclusions & Questions Assembling data can help focus policy effort and mobilize communities; policy opinions show erosion of support (excepting support for warning label policy). Has advocacy - abated? - failed? In the last 20 years, policy analyses have demonstrated efficacy of many model programs/policy strategies; implementation and effectiveness studies are accelerating. These might help persuade public/politicians. What steps might aid this transfer? We need both policies that affect all drinkers and targeted harm reduction measures aimed at heavy drinkers and settings in where large quantities are the norm. But should second be emphasized? Policy development studies reveal opportunities; might identify ways to help enact evidence-based policies. What has been learned?

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