Use of several mutually reinforcing strategies is key
CHICAGO -- A coordinated, comprehensive, community-based intervention can reduce high-risk alcohol consumption and alcohol-related injuries from motor vehicle crashes and assaults, according to an article in the November 8 issue of The Journal of the American Medical Association.
Harold D. Holder, Ph.D., of the Pacific Institute for Research and Evaluation, Berkeley, Calif., and colleagues conducted a community alcohol trauma prevention trial from April 1992 to December 1996 to determine the effect of environmental intervention programs in three communities in northern California, southern California, and South Carolina. Interventions included mobilizing communities through community coalitions and media advocacy, encouraging responsible beverage service in bars and restaurants, limiting access to alcohol for underage drinkers, increasing local enforcement of drinking and driving laws, and limiting access to alcohol through the use of local zoning authority. Intervention communities were matched with comparison sites to evaluate the effectiveness of the programs in reducing high-risk drinking and alcohol-related motor vehicle injuries and assaults. High-risk drinking includes binge drinking, underage drinking, and driving after drinking.
According to background information cited in the study, there is increasing evidence of a causal link between the availability of alcohol and traffic crashes and assaults in community settings. Previous evaluations of community-based programs to prevent alcohol-related injuries have focused specifically on fatal motor vehicle crashes or special populations, such as youth.
The authors used telephone surveys to assess alcohol consumption and driving after drinking. They analyzed traffic data on alcohol-related motor vehicle crashes, and collected data on assault injuries treated in emergency departments and admitted to hospitals.
"Population surveys revealed that the self-reported amount of alcohol consumed per drinking occasion declined 6 percent from 1.37 to 1.29 drinks," the authors write. "Self-reported rate of 'having had too much to drink' declined 49 percent from 0.43 to 0.22 times per 6-month period. Self-reported driving when 'over the legal limit' was 51 percent lower (0.77 vs. 0.38 times) per 6-month period in the intervention communities relative to the comparison communities."
"Traffic data revealed that, in the intervention communities vs. comparison communities, nighttime injury crashes declined by 10 percent and crashes in which the driver had been drinking declined by 6 percent," they continue. Nighttime crashes have consistently been shown to be alcohol-related.
Emergency department (ED) surveys were conducted in one intervention-comparison matched pair in northern California, and in one separate intervention site in South Carolina. Permission to conduct ED surveys at hospitals in other sites could not be obtained. "Assault injuries observed in emergency departments declined by 43 percent in the intervention communities vs. the comparison communities, and all hospitalized assault injuries declined by 2 percent," the authors write.
The authors believe this large prevention trial demonstrates that communities do not need to remain passive recipients of trauma caused by heavy drinking. "Whereas education and public awareness campaigns alone are unlikely to reduce alcohol-related injury and death in communities, when they are combined with the environmental strategies tested in this trial, mutually reinforcing preventive interventions can succeed," they write.
"We believe the key is to use several mutually reinforcing strategies: media attention to alcohol problems, changes in alcohol serving practices in local bars and restaurants, reductions in retail sale of alcohol to young people, increased enforcement of drinking and driving laws, and reductions in the concentration of alcohol retail outlets," they conclude.
(JAMA. 2000; 284:2341-2347)
Editor's Note: Research for and preparation of this article were supported by a grant from the National Institute on Alcohol Abuse and Alcoholism and the Center for Substance Abuse Prevention.
Media Advisory: To contact Harold D. Holder, Ph.D., call Barbara Nygaard at 510/486-1111.
This release is reproduced verbatim and with permission from the American Medical Association as a service to reporters interested in health and behavioral change. For more information about The Journal of the American Medical Association or to obtain a copy of the study, please contact the American Medical Association's Science News Department at (312) 464-5374.
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