1. Prevention of Alcohol Harm in the Community--I
What Can International Research Teach Us?
Harold D. Holder
Prevention Research Center
Berkeley, California USA
Associação Brasileira de Estudos de Álcool e Outras Drogas,
Sao Paulo
September 4, 2003

2. Underage Drinking
11% of 6th grade students reported binge drinking (Kelder, Murray, et al., 2001)
21% of 8th graders reported having been drunk at least once (Johnson, 2002b)
About 30% of 12th graders engaged in binge drinking (Johnson, 2002a)

3. Prevalence of Lifetime Alcohol Dependence by Age at Drinking Onset

4. Binge Drinking Across the Life Span
50% of students who drink engage in binge drinking; 20% do so frequently (twice or more every 3 weeks)
More than 2/3 of binge drinking episodes in the U.S. occur among adults age 26 and older (Naimi, 2003)
Half of all binge drinking episodes occur among otherwise moderate drinkers (White et al., 2002)

5. Public Health Model of Alcohol Problem Prevention
Individual(Drinker)
Environment (Drinking Context)
Agent (Alcohol)

6. Environmental Influence & Youth Drinking
Physical - Proximity of alcohol outlets, places of public drinking
(2) Social - Family, peers and larger social networks
(3) Economic - Cost of alcohol; economic
geography of availability

7. For Example, Youth Drinking
Physical
Cost &
availability
to youth
Availability of alcohol to & from peers
Alcohol
Availability
Drinking
By Peers
Retail
Price
Social
Economic
Alcohol purchases by other youth

8. Community System of Alcohol Use and Abuse
Legal Action about Drinking
Social Control and Communication
Alcohol-involved Mortality & Morbidity
CONSUMPTION
Social, Health, and Economic Consequences
Formal Regulation and Control of Alcohol Sales
Retail Sales by Average Type
Social and Health Services
Alcohol Production, Marketing and Distribution
Community Economic Sector

9. Environmental Approaches1.
Retail Access to Alcoholic Beverages, e.g., price, outlet locations, minimum drinking laws. 2.
Restrictions or Constraints on the Drinker’s Behavior, e.g., drinking locations, drink drive 3.
Reduce Risk or Problem Severity

10. Agent Approaches 1. Low or No Alcohol Beverages 2. Container Size 3.
Restrictions on Advertising

11. Youth Alcohol Problem Prevention Strategies: Solid Evidence
Retail price of alcohol
Minimum drinking age
“Zero tolerance” for Youth
Drinking/driving deterrence
Lower BAC limits for driving
Graduated Licenses

12. Third Party alcohol sales/”Shoulder Taps”
Youth Alcohol Problem Prevention Strategies: Promising –Replication needed 
Tort Liability for sales/service of alcohol to youth 
Genetics, alcohol dependency risk, & treatment 
Third Party alcohol sales/”Shoulder Taps” 
Auto ignition controls 
Curfew laws/Party Patrols 
Parent training and mobilization 
Restrictions on drinking location & outlet density 
Low or no alcoholic beverages 
Alcohol container sizes & keg registration

13. Community Action Trials which use complimentary interventions
Latest Advance: Mix of evidence-based prevention strategies at local level
Community Action Trials which use complimentary interventions

14. LOCATIONS OF COMMUNITY ACTION PROJECTS FROM AROUND THE WORLD
Western Australia
Israel
Florence, Italy
Lahti
, Finland
Stockholm, Sweden
Aarhus
, Denmark
Ontario, Canada
Massachusetts, USA
South Carolina, USA
Minnesota, USA
California, USA
Malmo
, Sweden ..
New Zealand
Paulinia, Brazil

15. Examples of International Community Action Projects for Alcohol Prevention
COUNTRY
GOALS
STRATEGIES
RESULTS
Canada
Ontario (6 Projects)
Reduce alcohol problems
• Alcohol serving practices & policies
• Municipal policies
• DUI enforcement 
Reduced public drinking 
Lower heavy drinking in bars and restaurants 
Modest effects on overall drinking
Finland
Lathi
Reduce heavy drinking
• Primary health care • Community education • News 
Reductions in heavy drinking 
Greater news coverage
Sweden
Reduce heavy drinking and youth drinking
• School education 
Modest effect on heavy drinking
Stockholm--Kungsholmen
•Public education

16. Examples of International Community Action Projects for Alcohol Prevention
COUNTRY
GOALS
STRATEGIES
RESULTS
Australia
COMPARI Project
Reduce alcohol injury and death
• Local coalitions • Health education • Local alcohol policy concerning public alcohol sale 
Modest effect on injury
Australia
Surfers Paradise Safety Action Project
• Community Forum & alcohol safety audit
• Model House Policies
• Increased enforcement of alcohol licensed premises 
Violent events: --original site from 9.8 to 4.7
--replication sites from 12.2 to 3.0
Lower alcohol involved violence

17. Examples of International Community Action Projects for Alcohol Prevention
COUNTRY
GOALS
STRATEGIES
RESULTS
New Zealand
Reduce drink/drive problems
• Public awareness using local news
• Highly visible drink/drive enforcement
•Investigation of on-license premises based upon “place of last drink” data 
Fatal alcohol crashes reduced from 22 to 14%
Waikata Rural
Drink/ Drive
Project 
Public perception of risk of being caught increased 
Alcohol positive breath checks decreased by 600%
• Local coordinating committee • Review of alcohol availability • Local alcohol advertising limits
New Zealand
Six City Project
Increase local alcohol policy 
Greater news coverage 
Increased public support of local policy

18. Examples of International Community Action Projects for Alcohol Prevention
COUNTRY
GOALS
STRATEGIES
RESULTS
Sweden
Stockholm City--STAD
Reduce alcohol and drug problems
•Youth Program
• Secondary prevention in health care
•Responsible Beverage Service 
Modest effect in medium strength beer sales to youth 
Reduction in sales
to intoxicated
patrons (5% to 47%)
Violent crime
down by 29%  
Reduced Sales to Youth in 2 target sites (81% to 25% & 48% to 42%)
Stockholm City (18 Districts) & Stockholm County Targets
• Local work committees • Develop Alcohol Plan • Decrease sales of folk beer to youth
Increase local alcohol policy 
Increased interest in local policy

19. Examples of International Community Action Projects for Alcohol Prevention
COUNTRY
GOALS
STRATEGIES
RESULTS
Sweden
Low effects on problem indicators
• Public education • Primary health care screening • Reduce alcohol access 
Reduce alcohol problems
Malmö 
Reduced male consumption and problems in (a) screening program and (b) general population 
Program adopted by city

20. Examples of International Community Action Projects for Alcohol Prevention
COUNTRY
GOALS
STRATEGIES
RESULTS
United States
California/ South Carolina
Reduce alcohol injury and death
• DUI enforcement • Alcohol service • News coverage • Underage sales • Alcohol outlets 
10% reduction in alcohol crashes 
43% reduction in violence 
Lower alcohol sales to youth
Lower alcohol sales to youth
Reduced traffic crashes 
Minnesota
Reduce youth drinking
• Local sales policies and enforcement 
Massachusetts
Reduce alcohol crashes
• News coverage • DUI enforcement • Alcohol outlet surveillance 
25% reduction in fatal crashes

21. Community Action and Prevention Lessons from International Projects
Community Mobilization

22. Community Mobilization
Goal: Community Awareness
of Alcohol Problems
and
Support for Local
Policy Actions
Community Organizing
Local News
(Media Advocacy)

23. Community Action and Prevention Lessons from International Projects
Community Mobilization  
Science-based interventions are essential 
Utilize Local News

24. Friday, December 10, 1993

26. Community Action and Prevention Lessons from International Projects
Science-based interventions are essential
Utilize local news media
Community Mobilization  
Value of Evaluation—determine effects 
Environmental strategies are most effective

27. Elements in Effective Local Alcohol Prevention: The top 10
10. Cultural Values Local Cultural 0. Local Cultural Values  
9. Community as a System 
8. Media Advocacy (local news) 
7. Enforcement in local action 
6. Partnership of local & nation/state 
5. Community Leadership and Responsibility 
4. Central government supporting local action 
3. Local information (evaluation) 
2. Evidence based strategies 
1. Courage & Passion