>>> good afternoon. i'm dr. john iskander. it's my pleasure to welcome youto this month's edition of cdc's grand rounds. for those of you who are regularground rounds viewers, you're not seeing dr. popovic on aparticularly bad hair day. just wanted to remind all of ourviewers that grand rounds is available for continuingeducation credit. the information is listed onyour screen.
over the past two years, we haveprovided continuing education credits to more than 2,000individuals through the grand rounds forum. we're pleased to have thecollaboration of the outstanding cdc library and informationcenter as we always do featuring science clips for those of youinterested in more information from the medical literature. dafna kahni has served as ourinformation expert. that's at cdc.gov/science.
we're continuing to featuregrand rounds topics in the mmwr and those are available atcdc.gov/mmwr. over the next several months,we're pleased to feature for you a variety of interesting topicsin chronic disease prevention and control, infectious diseasecontrol and injury prevention. and there's one place to go tofind everything about grand rounds. the grand rounds website, whichis listed on your screen. so we have an outstanding panelfor you today.
i was looking on public pubmed abit earlier. our panel has well over 100publications in alcohol aspects of public health and prevention. i have one article to my creditas an academic editor. but what you don't see here isthat i could not have achieved even that very small featwithout the cdc alcohol program team pictured here who served aspeer reviewers and served as my subject matter experts. so some of you may have noticedsomething that i noticed.
captain brewer, and so with thatname, you may be wondering how committed is he, really, to thisprogram? so i think this picture prettymuch speaks for itself. and with that, i'm very pleasedto introduce cdc director dr. thomas frieden. >> as you'll hear today,excessive alcohol use is an underrecognized andunderaddressed public health problem. in fact, some ongoing work inour surveillance at the lab
services unit has taken all ofthe community guide recommendations and looked atwhich are the ones for which there's a the largest gapbetween what we recommend and what the world does. and alcohol control policyalcohol prevention is right up there with the top. now, jeffrey rose in his book onpreventive medicine said the following. of all the threats to humanhealth, it is alcohol which
causes the widest range ofinjuries. it shortens life, shrinks thebrain and impairs the intellect. causes failure of liver, heartand peripheral nerves, contributes to depression,violence, and the break-up of social life and has been blamedfor a quarter of all deaths on the road. of course, there are otherhealth and social impacts, as well, ranging from myocardialinfarction, sudden infant death syndrome and importantly, hiv.
although difficult to quantitate, risky sex following alcohol use is a major driver ofthe hiv epidemic both in this country and globally. that's particularly timely tomention because we have here at cdc this week our global aidsprogram, several hundred cdc employees, including locallyengaged staff from around the world work on peptar and otherpriority public health programs here for a week and many of themare listening into this session. so think about the importance ofaddressing problem alcohol use
to address many, many of thepublic health problems that we wish to make progress on,ranging from the injury to the infectious disease to thenoncommunicable disease. in the u.s., alcohol is thecause of about 80,000 deaths a year and over 2 $00 billion ayear in lost productivity, an estimate of $1.90 for everydrink consumed. this is a dangerous problem butone for which we have made limited progress. this session is going to explorethe impact of alcohol use and
the factors that contribute toit, particularly marketing to youth. speakers will discuss some ofthe evidence, the strategies to prevent harmful use of alcoholand look at the state and local levels where, as is often thecase, the most rapid and inobitive means of makingprogress may first be manifested. i want to thank the speakers forbeing part of the session and i look forward to hearing fromyou.
>> it is now my pleasure tointroduce the cdc alcohol program lead, captain bobbrewer. >> good afternoon. its my pleasure to be withyou this afternoon and yes, that really is the license plate onmy car. i lead the cdc alcohol programand i will be talking to you today about the public healthimpact of excessive drinking. present a few key points aboutthe epidemiology of bing drinking and briefly discussrecommendations for the
prevention of excessive alcoholuse. as dr. frieden said, excessivedrinking has a huge public impact. we estimate it killsapproximately 80,000 people each year and shortens those who dieby an average of 30 years resulting in about 2.3 millionyears of potential life lost each year. this makes excessive drinkingthe third leading cause of preventable death in the unitedstates.
it is also very expensive. as dr. frieden noted, weestimate that excessive drinking cost the u.s. $223 billion in2006 or about $1.90 per drink and about 80 cents of that drinkwas paid by government. so, in effect, we are allsubsidizing the cost of excessive drinking. bing drinking is responsible forover half the deaths of two-thirds of potential lifelost and three quarters of the economic cost.
bing drinking is defined as theconsumption of four or more dripgs by a woman, fire or moredrinks on occasion by a man. it leads to acute impairment, itis by far the most common pattern of excessive drinking inthe west. bing drinking is associated withmany serious health and social problems. dr. frieden mentioned some ofthese. they include motor vehiclecrashes, interpersonal violence, hiv and other stds andunintended pregnancies.
this slide shows information onbing drinking among u.s. adults in 1993, 2001 and 2009. and it's based on data from thesurveillance factors. there was a slight increase toproblems with bing drinking in 2009, but it has changed verylittle over all the time period. in contrast, bing drinkingepisodes increased 29% from 1.2 billion to 1.5 billion during1990 and it stayed at our above this level since then. annual per capita episodes ofbing drinking increased about
17% from 6.3 to 7.4 episodes perperson per year during the 1990s and has changed very littlesince then. while many people think thatbing drinking is predominantly a problem for underage youth andcollege students, it is a major public health problem across thelife span. about one in four high schoolstudents and adults, age 18 to 34 years reported bing drinkingin the past month during 2009. youth who bing drink maycontinue to engage into this behavior in adulthood and adultswho bing drink may encourage
youth to do so by the examplethey set. in contrast to some otherleading health risk behaviors, the problems with bing drinkingincrease significantly with household income. in short, people with more moneyhave to drink more. this could reflect the fact thatbing drinking has not been the focus and is, therefore, notwidely recognized by some who others would seek doctors forearly health behaviors. binge drinkers reported engagingin this behavior about four
times a month. however, the frequency of bingdrinking is higher among bing drinkers age 65 and older thanamong those age 18 to 34. the average intensity is abouteight drinks per occasion and is well above the cut point used todefine that for men and women and among adults of all ages. this is particularly concerningbecause the risk of alcohol and harm increases with the numberof drinks consumed per occasion. given the high frequently andintensity of bing drinking among
adults, it may be surprisingthat most of these drinksers are not alcohol dependent. this slide is based on a studydone in new mexico by a copanelest here today andcolleague. note that over 90% of bingdrinkers did not meet criteria for alcohol dependency. while alcohol dependance is animportant public health problem, these findings show theexcessive problems with bing drinking.
the problems and intensities ofbinge drinking varies across the state. the dark colored states have thehighest prevalence of bing they were generally clustered inthe midwest and new england and included d.c., alaska andhawaii. in contrast, the intensity washighest in the southern mountain states and midwest and includedsome states such as louisiana, new mexico and utah that had alower prevalence of bing this shows that the problem ofbinge drinking is broadly
distributed geographical in theu.s. while we have been talking aboutdrinking by adults, uths tend to model their behavior afteradults and adults are often the source of the alcohol consumedby youth. furthermore, most alcoholcontrol policies in states affect the drinking behavior ofadults and youth. still, youth and adults who bingdrink differ somewhat in the types of beverages they consume. half of the high school studentswho bing drink usually consume
liquor. in contrast, 74% of adults whobing drink drink beer exclusively or predominantly astheir beverage of choice. there are several interventionstrategies for providing excessive binge drinking by theguide. there are based on reviews doneby community guide scientists in consultation with subject matterexperts, both inside and outside the cdc. recommendations on interventioneffectiveness are then made by
the independent, nonfederalcommunity preventive services task force based on the strengthof intervention effectiveness. here are the strategiescurrently recommended by the community services task force. in general, these interventionsdeal with increasing the price and limiting the available ofalcoholic beverages. i will highlight the findingsfor the first three interventions. jan moeser will discuss legalissues related to their
implications and the status andtax of policies for states. overall, a 10% increase in theprice of alcoholic beverages would be expected to reducealcohol consumption by about 7%. tax increases result in priceincreases and subsequent reductions in excessive drinkingwould be expected to be proportional to the side of thetax increase. alcohol outlet density referenceto the concentration of alcohol retailers in a particulargeographic area. a higher concentration of retailalcohol outlets is associated
with increased alcoholconsumption and relative harm. it is also worth noting thatmost of the studies we reviewed assess the impact of relaxingcontrol on alcohol outlet densities, reflecting thegeneral trend toward the deregulation of alcohol sales. commercial host or dramshotliability allows alcohol retailers to be held libel forharm caused by underage patrons. it varies substantially acrossstates, but these laws can help reduce alcohol related harms.
motor vehicle crashes werereduced about 6% in locations with these laws compared tothose that did not have them. despite the public health impactof excessive drinking and the availability of many evidencebased strategies to address it, there remains numerouschallenges to mobilizing an adequate public health response. these include the misperceptionthat excessive drinking is only a problem among youth. the lack of attention to policyand environmental factors
significantly influence drinkingbehavior and the limited public health capacity at the federal,state and local level to inform community prevention activities. it is now my pleasure tointroduce dr. david jernigan. >> thank you and good afternoon. my name is david jernigan. i'm an associate professor atthe johns hopkins blackberg school of public health and thedirector of the markets youth. let me reinforce some of thedata about youth and drinking.
alcohol is the most commonlyused drug in young people. in 2010, there wereapproximately 10 million underage drinkers between theages of 12 and 20 in the u.s. alcohol is also a key factor inthe leading causes of death among 12 to 20-year-olds. unintentional injuries, homicideand suicide. every day, 4500 young people inthe u.s. start drinking and every year we lose 4700 youngpeople because of alcohol use. the prevalence of bing drinkingamong male high school students
has declined since 1991 but hasremained largely unchanged among females. as a result, about 1 in 4 highschool students report bing drinking in the past 30 days. and this is likely to be asubstantial underestimate of actual alcohol consumption inthis population. a growing body of studies hasfollowed groups of young people over time. these study ves generally foundthe more young people are
exposed to alcohol advertising,the more likely they are to start drinking or if alreadydrinking to drink more. various forms of alcoholadvertising and marketing that predict drinking onset amongyouth are listed here. and i will discuss youthexposure to magazine, television and radio advertising shortly. the key problem is that thealcohol industry's own self-regulatory codes are theprincipal way that young people are protected from alcoholadvertising.
these codes cover both content,what's in the ads and placement, what age audiences will see,here or read them. regulating content is verydifficult. content is subjective. it raises first amendment issuesand it disappears quickly, particularly in digital media. one example of a self-regulatoryprovision is from the distilled spirit code. these ads are not supposed tohave indecent images, but they
frequently use sex appeal tomarket alcohol. unlike content, ad placement. what audiences see, hear or readthe advertising can be measured, at least in traditional media. by 200, the wine, beer anddistilled spirits industries had all agreed to advertise onlywhere people under 21 come prize less than 30% of the audience. the national research counciland institute of medicine in 2003 and 24 state attorneysgeneral in 2011 called for a
stricter standard because 12 to20-year-olds are the group most at risk of underage drinking. they are less than 15% of thepopulation. so the industry's 30% standardallows them to be exposed at more than double the rate of therest of the population. a 15% standard based on personsage 12 to 20 in the audience would more effectively preventoverexposure of this vulnerable group. self-regulation requires anindependent monitor.
since 2002, the center ofmarketing and youth or cami has been that monitor. it uses media industry standarddata sources to monitor compliance with industryplacement standards and to compare youth to adult exposure. we found, for example, that in2008, youth ages 12 to 20 compared to adults 21 and oversaw 10% more beer ads, 16% more ads for alcohol pops likesmirnov ice. most, 79% of youth exposureoccurred in magazines with
disproportionate youthaudiences. in 2009, there were 315,581alcohol product commercials on u.s. television. and youth much more likely percapita than adults to see more than 67,000 of these ads. the average tv watching youthsaw 366 alcohol ads on television alone, an average ofabout an ad a day. nearly 24,000 of these ads wereplaced in violation of the industry's voluntary 30%threshold.
and youth exposure to alcoholads on television is growing more rapidly than adult or youngadult exposure. on radio, we were able to getdata for 75 local markets for 2009, covering about 42.5% ofthe u.s. population ages 12% and above. 9% of ad placement violated thatand generated more than half of youth exposure. this slide shows a tool on thecamy website where users can put in their media market and seethe local results.
monitoring must occur at thebrand let me because different alcohol brands pursue differentadvertising strategies. a small number of beer anddistilled spirits brands, less than 10%, is responsible for atleast half of all youth exposure by media. monitoring across media is alsocritical. for instance, while youthexposure has been falling in magazines, it's been rising ontelevision. the adoption of the on 30%standard in 2003 had little
there are limitations to ourmonitoring activities. the survey data we use is basedon consumer self-reports of exposure which may be inaccuratebut which helped form the basis for alcohol company decisionsabout where and when they advertise. we cannot link brand specific adexposure with youth alcohol consumption because data are notavailable on youth alcohol consumption by brand. and alcohol companies are movingaway from traditional towards
digital media which cannot beassessed using the traditional methods we've used. for example, while companieslike nielsen can provide demographic information forfacebook as a whole, such information is not available forfacebook pages hosted by individual alcohol brands. much of digital alcoholmonitoring is created by users and has spread virally making itdifficult to control. young people and the alcoholcompanies are both early
adopters of these newtechnologies. our center has found thatalcohol brands have amassed millions of likes or fans onfacebook and their pages have tens of thousands of photos andvideos posted by both the brands and users. facebook illustrates many of theproblems posed by alcohol, marketing and digital media. assessing the age of users ofthe site is imperfect. facebook requires alcoholcompanies to register as such
and to block access to theirpages by users with a facebook page below 2. but appear estimated third ofminors are there with false ages and persons between the ages of18 and 20 can change that in a few clicks. we know young people are on thealcohol brands facebook pages because we can see the photos ofthemselves that they have posted there. what can be done to reduce youthexposure to alcohol marketing?
we need to maintain themonitoring of industry activities in traditional media. exposure standards need to becomplied with and strengthened. the 30% standard permitsdisproportionate exposure of underage youth. the federal trade commission hasasked for a 25% standard and one company, beam incorporated, hasadopted it. the national research council'sinstitute of medicine and 24 state attorneys general havecalled for the 15% today and our
modeling of 15% found it wouldreduce youth exposure, save the industry money and havevirtually no effect on the industry's ability to reachyoung adults. it's often stated target forthis advertising. the federal trade commission cancollect and report annually on alcohol industry spending onmarketing just as it does for tobacco marketing. companies and media outletsshould tighten their age data and companies should, as the ftcrecommended in 1999, establish
no bylifts, committing not toadvertise on programs and venues where youth overexposure islikely. public health has an importantrole to play and can restrict alcohol advertising nearschools, churches and on public transit where young people arelikely to be present. restricting alcohol ads onretail outlet windows and banning alcohol advertising onstate-owned property including institutions of highereducation. our next speaker is jim mosher.
my name is jim mosher. i am the president of alcoholpolicy consultation, a private consulting firm as well as asenior policy adviser of the cdm group inc. i will describe the structure ofthe alcohol regulation in the united states, provide examplesof policies that have been shown to be effective and discussedthe challenges and opportunities associated with theirimplementation. alcoholic beverages are the onlyconsumer products specifically
mentioned in the u.s. constitution. the 21st amendment, whichrepealed prohibiton grants state a substantial role in regulatingthe alcohol trade with greater authorities than apply to otherconsumer products. in practice, while not required,states generally defer to the federal government regardingregulations of alcohol manufacturing and marketing. states have concurrent authorityin these areas.
alcohol taxes are an exceptionas all states as well as the federal government imposealcohol taxes. states focus primarily on theretail sector of the industry. all states require commercialretailers to obtain a license who are operated by the statesthemselves. there are two kinds ofregulations. for new alcohol outlets, where,how many and what kinds of retail outlets are permitted inthe states. for retail operations generally,many areas are covered such as
prohibitions on sales ofintoxicated an underage person and restrictions on hours anddays of sale. aus heard from dr. brewer, manyof the community guide recommendations address thesetwo categories. states may delegate some or mostof their authority to local governments, allowing localitiesto impose regulations stricter than required by the state law. state preemption is the legalterm for describing the extent to which the state limits thislocal authority.
there are four categories ofstate preemption. some states, including new yorkand texas have exclusive or nearly exclusive preemptionrelegating local governments to the olympicsing process. many states have sclousivelicensing but allow local governments to regulate retailzout lets. many states, including georgiaand colorado with joint licensing. a retail outlet must obtain bothstate and local government
a small number of states,including wisconsin, nevada and hawaii, turn the licensingauthority over to landlord government. new york has strong statepreemption, not allowing cities to use either licensing orzoning authority to regulate alcohol outlets. in a 22-year period, the statelicensing authority issued 358 new licenses in new york city'slower east side. this area is now experiencingwidespread alcohol problems
related to this high concentrateof alcohol outlets. the state preemption do you meandoctrine has a critical challenge to enacting and ebbforcing effective alcohol policy measures. in general, the policyinterventions endorsed by the community guide as well asmarketing controls so potentially adverse effects onmushl interest who often have considerable influence withcongress andgislatelegislators. however, they are less influenceon local communities because of
the increased access that localcitizens in public and private health officials have topolicymakers. all states as well as thefederal government impose alcohol packages. both states preempt the localauthorities to impose alcohol patterns. there's strong evidence showingthe effectiveness of increasing alcohol taxes for reducingexcessive alcohol consumption and related harms.
yet alcohol taxes have beensteadily and substantially decan increasing over the last fourdecades. here you can see the decline infederal alcohol taxes since 1970 for distilled spirits, beer andwine. this decline is caused by thefact that alcohol taxes are most often imposed based on volumes,such as a dollar per gallon. as such, alcohol tax rates seemto decline over time to at least keep up with the pace ofinflation. state taxes are also decreasingover time for the same reason as
shown here for the average beertax rate. these decreases have come inspite of public support for increasing alcohol taxes, atopic i will discuss later. case studies demonstrate thatthe primary barrier to alcohol tax increases is the powerfulcommercial lobbies that oppose such factions. in general, controls of alcoholretail outlets are eroding over time. for example, last year, georgiaenacted legislation that allows
municipalities to repeal thestate anticipates alcohol sunday sales ban. restrictions on the number,types and location of alcohol outlets are also being repealedor loosens. unfortunately, public health andlaw enforcement groups do not consider alcohol regulation tobe a high priority. as a result, many deregulationproposals would face little or no opposition for public healthconstituencies. an added challenge is the racheteffect that particularly that
occurs with deregulation. once instituted, changes instate regulations are very hard to reverse because new economicstakeholders are established. at the end of prohibition, 18states created control systems where the state owned andoperated wholesale and retail alcohol business. these systems havebeenderegulated, turning parts of theiroperations over to private licensees.
as this map shows, of the 18control states, six states have privatized most of all of thestate retail system and five states have active privatizationproposals. commercial hosts or dram shopliability proposes another example of this deregulatorytrend. courts began imposing commercialhost liability in the 1970s and 1980s. in response, the concerns raisedby commercial interests, many state legislators enacted lawsto limit the court rulings by
imposing significant barriersthat make bringing commercial host cases more difficult. this slide documents theincreasing number of legislative barriers in place in the 50states in 1989 and 2011. nevertheless, progress is beingmade in implementing community guide recommended alcohol policypolicies. illinois is one of the fewstates that does not preempt local alcohol taxation. both the city of chicago andcook county where chicago is
located impose alcohol taxes. cook county doubled its alcoholtaxes effective the first of this year. chicago and cook countymunicipal government ves enacted four alcohol tax increases since2005. chicago residents paid bothtaxes as shown here. clearly, if public healthconstituencyies organize effective alcohol controlpolicies, positive changes can be made particularly at thelocal level.
in response to a broad basedcoalition campaign, maryland enacted a special 3% alcoholsales tax in 2011 and the raised revenue has been dedicated tosocial services programs. this campaign may provide amodel for similar efforts in other states. opinion works, a public interestresearch and communications firm conducted a poll to determinepublic support for the maryland tax proposal. the results were disseminated tolegislators to demonstrate that
voters strongly supportedincreasing alcohol taxes particularly if the funds wereused for health initiatives. these findings are consistentwith the findings of polls down in other locations and show thatthere's often strong support for evidence based alcohol controlpolicies such as increasing excise taxes. there are many state and localcampaigns across the country attempt to go regulate alcoholoutlet densities, another one of the community guide recommendedstrategies.
in conclusion, implementingalcohol policy forums is feasible and has potential forsignificant public health gains. public health constituentsiesplay an instrumental role in disseminating findings,educating decisionmakers and providing expertise to state andlocal coalition and conducting evaluations to determineeffectiveness of intervention. our next speaker will be jimroeber. my name is jim roeber and i'mthe alcohol epidemiology gist with the new mexico departmentof health.
today i'll talk about theepidemiology of alcohol contributed problems in newmexico and some of the steps taken in recent years to reduceexcessive drinking and related harms. i will end with some lessonslearned that could be useful to the public health authoritiesand other states and localities. this slide shows trends inalcohol attributable death rates in new mexico and the u.s. from1990 through 2007. throughout this period, newmexico's aad rate has ranged
from 1.5 to 179 times the u.s. rate and has been among thehighest in the country. new mexico's aad rate increasedabout 11% during this time while the u.s. rate actually fellslightly. much of this increase has beendue to an increase in deaths due to alcohol attributable injuriesdue to bing drinking. there are substantialdisparities in aad rates in new mexico. american indians come prizeabout 0% of new mexico's
population and have had highestalcohol attributable death rate. while their rates are somewhatlower than the rates for american indians, white hispanics and white nonhis panics, each of whom complies newmexico's population also have high rates of alcoholattributable deaths. they're at graefter risk foralcohol attributable injuries. white hispanics and white nonhispanics have a prevalence for consumer over 10 drinks perepisode placing them at attributable risks ofattributable harms.
to learn more about bingdrinking in new mexico, the state implemented a six-questionbing drinking mod you'll and the 2004 state brfss survey. here are the findings on bingdrinking by location for 2004. roughly 170 tlous new mexicoadults reported bing drinking during the past months. of these, about 24,000 reporteddrinking in a bar or a club during their most recent bingdrinking episode. of those who drank in bars orclubs, one in four or about
6,000 bing drinkers per monthdrove during their most recent bing drinking episode. furthermore, about one-third ofthe bing drinkers who drove after drinking in a bar or aclub, roughly 2,000 per month, reported consuming ten or moredrinks before driving. this suggests that some barswere serving alcohol to persons who were intoxicated, which isillegal in new mexico as it is in most states in the u.s. these findings were used tosupport the implementation of an
aggressive campaign against bingdrinking and alcohol impaired driving, including changes innew mexico's liquor control regulations. i will now briefly describe thiscampaign. new mexico's campaign to reducebing drinking alcohol impaired driving and alcohol impairedmotor vehicle crash depths began in 2005. one component of the campaignfocused on reducing alcohol service to underage youth and topersons who were already
intoxed, also known asoverservice. in alcohol licensedestablishments were persons who were able to drink on-site suchas bars and restaurants. before start of the preventioncampaign, new mexico had established a clear legaldefinition of overservice. if the patron of a retailalcohol establishment such as a bar is found to have a bloodalcohol content of bac of 0.4 graems per deciliter or higher,almost twice the legal alcohol for driving, within 90 minutesof consuming their last drink at
a retail alcohol establishment,this bac can be used as productive evidence ofintoxication at the time of sale and the licensee can be sitedfor overservice. however, before the campaign,new mexico languages were allowed to have five violationsper year before losing their liquor license. to address this problem, thestate's alcohol beverage control agency proposed to reduce thenumber of legal service and sales violations from servicerevocation from five to three
violations a year. this came to be known in newmexico as the three strikes regulation. new mexico also implementedcommunity guided strategies for reducing alcohol im paceddriving including sobriety checkpointes and a mediacampaign that warned drivers about the enforcement of lawsagainst alcohol impaired driving. the three strikes regulation wasapproved in the summer of 2006
and went into effect in october2006. this was followed by a period ofenhanced liquor control license which led to a substantialincrease in citations for illegal sales to intoxicatedpersons and minors. citations increased by more than260%. citations for illegal sales tominors increased by 43%. this enhanced liquor control lawenforcement led in 2008 to the first license revocations forillegal sales and service in new mexico history.
in addition to implementingxhoount community guide strategies, new mexico implementimplemented strategies for reducing alcohol impaireddriving, including increased dwi law enforcement which employedsobriety check points around the state and a comprehensive mediacampaign warning drivers about this increased dwi lawenforcement. this media campaign includedboth media, tv spots, radio psas and billboards and news reports. both super blitz dwi lawenforcement and supporting media
activity are ongoing priertds innew mexico. as shown in this slide, therewere some important changes in bing drinking and alcoholimpaired driving during the two-year period before theseinterventions took full effect. that is 2004 to 20 a 05 and thetwo-year period after these interventions were fullyimplemented in 2007 to 2008. first, the intensity of bingdrinking decreased 16% among bing drinkers who drank in barsand clubs from 8.3 drinks to 7.0 drinks on their last bingoccasion.
second, the intensity of bingdrinking decreased 19% among bing drinkers who drove aftertheir most recent bing drinking episode. third, the overall previous helens of alcohol impaired driving decreased among males. furthermore, after a decade oflittle to no change, the death rate from alcohol impaired motorvehicle crashes decreased 39% from 2004 to 2008. this moved new mexico's deathrate from among the highest in
the country to near the nationalmedian which we see as important progress. although other factors may havecontributed to this decline, we believe these findings arestrong productive evidence that the implementation of communityguide recommendations for preventing excessive drinkingand alcohol impaired driving in new mexico helped produce bingdrinking, alcohol impaired driving and harms related tothem. in closing, i'd like to share afew lessons learned.
policy challenges can beaddressed and progress can be made in reducing excessivedrinking in states. comprehensive preventionprograms can reduce excessive drinking, related risk behaviorsand downstream consequences 367 and, finally, well designed andwell managed prevention efforts that focus on community guiderecommendations can reduce alcohol related problems instates. thanks for the opportunity toshare new mexico's recent experience and we look forwardto your comments and questions.
>> all right. well, and we do look forward toyour comments and questions. we would ask, though, that ifyou have questions, please step up to the microphone or those ofyou that have microphones in front of you, please use thoseand we would ask that you please limit your questions to one perperson. and we would encourage you tokeep them kind of brief. any questions from the audience? please.
>> thank you, doctor. i thank you for thepresentation. has there been any studies inthe hard to reach population or population -- that speaksenglish and has there been any data showing the previousleaptsy of drinking there and if any programs have been tailoredto this hard to reach population to reduce their rate of, youknow, bing drinking? thank you. >> i'm going to maybe summarizethat a little bit as asking a
question about studies donelooking at disparities, difference in bing drinkingacross different populations and targeting interventions acrosssome of those high rate groups. i'll give a brief response andinvite others on the pam to respond, as well. jim roeber might not to respondin particular. the short answer is yes, therehave been a lot of studies that have been done looking at riskfactors across various racial and ethnic groups.
one of the findings that ipresented is that in contrast to other risk behaviors, the issuesof disparities is different for excessive drinking in that wedon't find the usual high risk groups that we would for tobaccoor increasingly now for obesity. the highest prevalence is onpeople that have higher household incomes. we find higher bing drinkingamong people that are white. that is by no means to say it isnot a huge public health problem for our high riske groups.
we know, for example, hispanicstend to have high rates of bing drinkbinge drinking. we highlighted this in ourreport earlier this year. when you start to drill down andlook at other measures of binge drinking, you start to seedifferent patterns emerging. for example, you starts to seeafrican-americans having higher intensity binge drinking,hispanics having higher intensity binge drinking andthat you say that's one of the reasons we emphasized from aprevalence not just about
surveillance and drilling down. would other members of the panellike to comment on that? jim, do you want to comment alittle bit from the standpoint on your findings in new mexico? >> well, i think the most recentfindings we're interested in is the intensity of binge drinkingwhich show dramatic differences across racial groups that mirrorthe disparities that we find in alcohol attributable outcomes. so i think certainly if one ofour challenges is to find
interventions that address thosedisparities, i think ooef i'll leave it at that. >> in terms of interventions,the one that i'd like to highlight is alcohol outletdensities. what we find in the research isracial communities, ethnic communities tend to have higherconcentrations of outlets. it tends to be a much biggerproblem in low income areas. but the low rate, it's bothethnic and income. in other words, low incomeneighborhoods that are primarily
white have lower alcohol outletdensities in general than ethnic communities including asian andpacific islanders out in california. and it demonstrates that some ofthese problems interact with economic issues because in lowincome communities, there tepdz to be less money available toinvest in other types of retail outlets. and so alcohol outlet res a lowcapital business. you don't need a whole lot ofmoney to open an alcohol store.
and that is one of the reasonsbecause of the red lining by insurance industries and banksmakes the money less available so you end up having more liquorstores serves not just as atlanticer stores but theneighborhood bank and the neighborhood groerp grocerystore. and this is in spite of the factthat as bob said, the excessive drinking rates of that'spopulations are lower than the higher income areas. >> dr. frieden.
>> perhaps dr. jernigan orothers on the panel could comment on the prevalence ofharmful drinking globally, what the patterns are and what someof the potential interventions may be as this may the relate toour audience which is weighted to the global area at thispoint. >> sure. globally, alcohol worldwide isthe number three cause of the -- the third largest preventablerisk factor in the global burden of disease.
and it is in the middle incomecountries. it's actually number one andthis relates to the income effect that bob talked about. poverty is actually a protectivefactor against excessive alcohol use, but it's also rapidlyrising in the low income companies. and the interventions, we'rereally pleased that the world health organization in 2010adopted a global strategy to reduce alcohol related harm andit's got ten areas, but the
three best buys identified inthat strategy line up very well with the community guidestrategies. they are reducing physicalavailability, increasing the price of alcohol and restrictingor reducing the marketing of alcohol. >> if i can also add on oneother point, you're talking about the economic developmentand a connection between economic development. one of the horrible tragedies ofexcessive tragedies are the
years of potential loss figurethat i highlighted is the extent to which excessive drinking issnuffing people out in a large proportion of their life. the large proportion of alcoholrelated deaths are in the 20 to 64 age groups. >> when you look at it in a lessresourced society perspective, this is a major threat to humancapital development because it does tend to strike harder inthe more educated and wealthier segment of the population.
the population that's rising interms of ability to move development forward is the oneat highest risk. >> yes. >> i have, i guess, a follow-upcomment. i'm peter kelmarks. the company director in cdczimbabwe. and we've been working togetherwith a college from samsah supporting, providing a tacticalassistance for the alcohol policy in zimbabwe that'scurrently under review and
hosted an implementationplanning meeting for that policy. i would know that w.h.o. hasidentified eastern and southern africa as the region with the --among drinkers the highest proportion of dangerousdrinksers. and we're very interested fromour perspective in the division of global har/aids because ofthe drink linkses with risky sex, with alcohol use and pooradherence to hiv treatment. so i'm wondering just infollow-up to ask captain brewer
is there plans for more supportfor our global programs for alcohol policy or alcoholactivities? >> well, we would love to domore globally. i must say at this point, we'rea little bit stretched for resources to reach out globallyas much as we would like. we have been involved in some ofthe discussions around the noncommunicable diseasenecessary strategies in particular. we have been in touch with thedivision of hav aids
particularly in efts to try toimprove public health surveillance to look at bingedrinking, drinking to the point of intoexcation, risky sexualbehavior and hiv risk. but would love to have moreconversations with you in ways about which we can help. david, did you want to talkabout the work in africa? i'm on the board of the alcoholalliance policy. that's a coalition ofnongovernmental groups around the world working on theseissues.
we're hoping to be doing thoseon a two-year -- every two years. and i'm also an adviser to aproject in africa that's looking at alcohol marketing in africa. i did my dissertation work inpart in zimbabwe so there was a lot to study. but one of the things -- i mean,the questioner's question is so well taken because the resourcesissue in the u.s. is a problem but globally it's even more andfar too often, the alcoholic
beverage industry is filling thevacuum left by a lack of public health resources, sending theirown public health experts in to advise countries on theirnational alcohol policies and, as i wrote in an article in theamerican journal of public health in january, the list ofpolicies that the industry promotes for national alcoholpolicies conspicuously excludes the three best buys that imentioned, taxes, marketing restrictions and physicalavailability restrictions. >> yes?
>> first of all, thanks for agreat session. it was really good. i wonder if any of you couldspeak to biology, biological plausibility, mechanisms,anything like that. because you're presenting veryinteresting epidemiology that's different from some of the otherbehavior risk entities we have. so biology, i wonder if youcould mention anything about that. >> maybe you can tell me moreabout what you have in mind.
are you talking about therelationship between excessive consumption and impairment? >> right. in mechanisms. it seems to me that alcohol useis prevalent, obviously. but excessive alcohol use thatyou're addressing here, is there a biological mechanism that'sdriving this in certain types of people and certain groups ofpeople? >> so you're talking about abiological predecision position
to abuse alcohol? yes. >> i think there are differencesin the way that different segments of the population mayrespond to alcohol. and there have been a lot ofstudies looking at the relationship between genetics,for example, family history of alcohol dependents and that'sspecifically talking about the disease of alcohol dependance oraddiction. but honestly, i think perhapswhat public health can bring to
the table is a recognition onpeople's drinking behavior. and that's very similar to whatwe've learned over the years about smoking, what we, ofcourse, with learning with diet and sfl activity. and it matters whether alcoholis cheap and readily available and heavily advertised. so, yes, you got individualdifferences in drinking behavior and perhaps vulnerability. but those vulnerabilities aregoing to be included
substantially by the environmentin which people are making their positions. from a public health standpoint,i think that's why we can make the greatest difference. most of the industries are goingin the wrong direction. so even if there are differencesin vulnerability, i would argue that that ought to say we oughtto do everything we can to protect those who are mostvulnerable to using alcohol. >> bob, we have a question froma remote viewer.
and that may be for jim mosher. what would be the expectedimpact of privatizing alcohol sales in states that currentlyoperate state stores? >> well, what happened is thecommunity -- it happens that the community guide just issued itsfindings on the impact of privatization. i don't have those figures in myhead, but it's available on the web now, their report, and it'sa substantial increase in consumption and problems can beanticipated.
washington state passed aninitiative just last year. they're in the process ofprivatizing all of their stores right now. and so we'll have yet anothercase study of the impact of we've had, unfortunately, muchof the research we do is studying what happens when we gothe wrong way. and we can expect in washingtonthat this will have a pretty negative effect in terms ofpublic health outcomes. >> the paper actually just cameout.
we just put a number on this. it's a 43% in per capita alcoholincome following privatization. you're going to from a situationwhere you have government run retail stores and you'reprivatizing that. so in some of the states that welooked at, privatization around, for example, wine sales and i'mthinking of the state of iowa. they went from having 200locations where you could purchase wine to 800 locationsvirtually overnight. you have to expect it has aenimpact on people's alcohol
consumption. >> cindy whitney from ncrd. i thought it was great how youtalked about the broad societal i'm sure the most effectiveoverall, but i was curious if there are smaller scale things,things that schools and parents and hospitals can do to preventbinge drinking. >> thanks for the question. the short answer is, theredefinitely is. similar to what we've learnedabout tobacco control,
comprehensive programs are theway to go. we put a lot of emphasize onpolicy and environmental work, but there are absolutely thingsthat can be done in the home and certainly in health caresettings. and i would mention inparticular screening and brief interventions. there's a strong body ofliterature showing that having a physician or other healthprofessional ask a patient about their drinking behavior andspecifically screening for
excessive drinking, screeningfor binge drinking in particular and following that by brief whatare called motivational interviewing techniques can havequite a significant impact on changing a patient's drinkingbehavior. the unfortunate reality is basedon the most recent statistics we have about the extent to whichthose conversations take place, the reality is a lot of timesphysicians and other health professionals are reluctant toengage in those conversations with their patients.
so i think there is there's alot more that we need to do to get the health care systemengaged. as i think dr. frieden would beimportant to remind us, we have opportunities to scale up thisintervention because of insurance coverage for screeningand counseling. so there would be theopportunity for providers to be reimbursed. in terms of parents, the onepoint i would make there is it's critically important for parentsto model responsible use of
alcohol and for all the reasonswe talked about in the presentation. >> are we out of time? >> thanks very much. >> thanks very much to ourspeakers and to the excellent questions posed. our next session of grand roundswill be april 17th at 1:00 p.m., lymphatic psoriasis elimination. for those of you interested inglobal tobacco control, that
will be featured in grand roundsthis july. thank you all,very much.
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