18th Alcohol Policy Conference April 11-13, 2018 Washington, DC - USA

April 7th

April 5th
4:00 - 7:00pm Registration open
April 6th
8:30am – 6:00pm Registration open
9:00am – noon Pre-Conference Session
Room TBD
Presenters:

Thomas F. Babor, Ph.D., MPH
University of Connecticut

David Jernigan, PhD
Johns Hopkins Bloomberg School of Public Health

Katherine Brown, MSc
Institute of Alcohol Studies in London 

Michael Sparks, MA
Sparks Initiatives


Description:

ALCOHOL POLICY AND ADOLESCENT DRINKING: USING SCIENCE IN THE PUBLIC INTEREST
(Pre-registration required and limited. Please send requests to ap17@alcoholpolicy.org)

This workshop provides training for alcohol policy advocates interested in translating scientific evidence into effective alcohol policies that are focused on underage drinking at the local and national levels.  The workshop material is based on a policy advocate’s User’s Manual which demonstrates how to implement the most effective policies identified in the book, Alcohol: No Ordinary Commodity (Babor et al., 2010).  The issues and skills to be addressed by the workshop are: a) the science base for the most effective policy options, b) key policy advocacy messages, and c) ways to minimize inertia or even opposition to evidence-based policies. Special attention will be given to the implementation of policies dealing with the affordability, accessibility and attractiveness of alcohol to underage drinkers.  A key advocacy skill to be discussed is how best to frame the policy issue from a public health perspective.  Other issues are forming a community coalition to conduct a policy campaign and how best to influence policy makers.  The workshop facilitators will help participants to identify internet resources that show how to conduct a local situation assessment.  

This workshop should be of interest to anyone interested in implementing effective alcohol policies at the local or national levels. 

1:00 – 2:30pm Opening Session - Alcohol Policies: Who Needs Them and Why
Salon 4
Presenters:

Diane Riibe
U.S. Alcohol Policy Alliance

Robert Brewer, MD, MSPH
Centers for Disease Control and Prevention

Dr. Tim Naimi, MD, MPH
Boston Medical Center

Linda Bauld, PhD
Stirling University and Cancer Research UK

David Jernigan, PhD
Johns Hopkins Bloomberg School of Public Health

2:45 – 4:15pm Concurrent Sessions (C 1-5)

C-1 TRANSLATING EFFECTIVE ALCOHOL POLICIES INTO PUBLIC HEALTH PRACTICE

Studio B
Presenters:

Sabrina Adler, JD 
ChangeLab Solutions

Robert Brewer, MD, MSPH , Moderator
Centers for Disease Control and Prevention

Marissa Esser, PhD, MPH
Centers for Disease Control and Prevention

Laura Tomedi, PhD, MPH
New Mexico Department of Health

Description:

Excessive alcohol consumption is responsible for an average of 88,000 deaths and 2.5 million years of potential life lost in the United States each year and costs the U.S. almost $250 billion in 2010, yet evidence-based policies for reducing excessive alcohol use are underutilized. The purpose of this session is to discuss CDC tools for supporting the translation of effective alcohol policies into public health practice (e.g., State Prevention Status Reports), legal research on effective alcohol policies, and the role of state alcohol epidemiologists in preventing excessive drinking at the state and local levels.

C-2 ALCOHOL AND CANCER: POLICY AND RESEARCH IMPLICATIONS

Studio D
Presenters:

Moderator: Robert Pezzolesi, MPH
New York Alcohol Policy Alliance 

Linda Bauld, PhD
Stirling University and Cancer Research UK

Noelle LoConte, MD
University of Wisconsin Carbone Cancer Center

Niyati Parekh, PhD
New York University.

Description:

A robust and rapidly growing body of research has established that alcohol is a leading preventable cause of cancer. Despite this, there remains a relative lack of awareness, among the general public and even many health professionals, about the role of alcohol consumption in cancer. This session will review the latest research on alcohol-related cancers, pointing to the need for population-level policy solutions to reduce those cancers and implications for diverse communities.

C-3 HOW TO USE PUBLIC HEALTH SURVEILLANCE METHODS TO EVALUATE THE GLOBAL ALCOHOL PRODUCERS’ CORPORATE SOCIAL RESPONSIBILITY ACTIVITIES

Salon 1
Presenters:

Thomas F. Babor, PhD, MPH
University of Connecticut

Katherine Brown, MSc
Institute of Alcohol Studies in London 

Daniela Pantani, MSoc
Ilana Pinsky, PhD
Federal University of São Paulo, Brazil 

Katherine Robaina, MPH
University of Connecticut

Description:

Public health surveillance has an important role to play in monitoring the Corporate Social Responsibility (CSR) activities of the alcohol industry. More than 3,500 “Industry Actions” have been posted on alcohol industry websites to demonstrate CSR activities the alcohol industry (e.g., producers, trade organizations) is conducting in support of the World Health Organization’s (WHO) Global Strategy to Reduce the Harmful Use of Alcohol. This panel will describe surveillance methods that can be used to evaluate the extent to which industry CSR activities are likely to reduce alcohol consumption by underage youth and alcohol-related problems in the adult population, using as an example a content analysis of over 1,100 Industry Actions conducted in the United Kingdom, the United States, and Latin America. Results from the three regions suggest that most of the Actions do not fit the recommended WHO Global Strategy target areas, and few are evidence-based. Examples will be discussed in terms of how systematic surveillance of industry activities can be used to identify and counteract “stakeholder marketing,” that is, the strategic CSR activities of the alcohol industry designed to promote stakeholder value. Workshop participants will be asked to help plan a dissemination strategy that makes maximum use of surveillance methods in the interests of public health, including press releases, petitions, and meetings with industry representatives to correct inaccurate information. 

C-4 PLANNING FOR NATIONAL AND REGIONAL CHANGE

Studio E
Presenters:

Norman Giesbrecht, PhD
Emeritus, CAMH, Toronto

Amanda Kroger
Durham Region Health Department 

Description:

Effective vs. Popular: Moving Community Action Forward Using the Most Effective Local Strategies—An Analysis of Local Alcohol Policies and Prevention Initiatives

Several scholars have posited that effective alcohol policies tend to be unpopular, and those that are largely ineffective are more popular. This presentation will examine this theme by assessing locally driven alcohol policies in the 36 Ontario health units while considering implications in other contexts. Three methods will be discussed: the assessment of 18 systematic reviews on alcohol prevention, a survey of 36 public health units (PHU), and key informant interviews (KII) conducted with nine experts from alcohol or tobacco. Seven policy interventions were assessed: pricing/taxation controls, regulating physical availability, advertising restrictions, modifying the drinking environment, drinking- driving countermeasures, education/awareness-raising strategies, and treatment/early intervention. The PHU survey and KII pointed to the importance of all seven interventions with a contrast between evidence and PHU activities. Lack of public support for effective alcohol policies can provide limitations on local action. The panel will discuss the need for building capacity through training on comprehensive approaches as well as demonstrating how effectiveness and scope of impact are important in strategic decisions regarding resources and priorities. The panel will discuss (1) facilitating regular communication across communities to provide a model for exemplary initiatives to others; (2) engaging NGOs, including chronic disease, injury, and trauma charities, to take up alcohol as an issue worthy of attention; and (3) involving authentic voices of those victimized by harm to others from alcohol in campaigns for effective local alcohol controls.

 

PAHO Regional Plan of Action to Reduce the Harmful Use of Alcohol: Progress and Challenges after Five Years

Blake Smith
Pan American Health Organization (PAHO) 

In 2011, the Pan American Health Organization (PAHO)’s Member States approved the Regional Plan of Action to Reduce the Harmful Use of Alcohol. The plan centered around five objectives and ten policy areas. While progress has been made in some areas, much work remains. This session will highlight some of the achievements, including the creation of an information system containing epidemiological and policy data for each country; the formation of a network of country-level officials and experts working on alcohol-related topics; and the production of various tools to help policymakers, service providers, and others address the harmful use of alcohol. The discussion will also address some of the challenges faced at the national and international levels toward promoting policies that can reduce alcohol consumption and harm, including the lack of advocacy, low political priority given to alcohol, and influence of the alcohol industry. The session will conclude with suggestions for actions that can be taken by researchers, civil society organizations, service providers, policymakers, and others. 

 

Perceptions and Recommendations Regarding Alcohol Marketing: Findings from NGO Leaders in Eastern Africa

Rogers Kasirye
Uganda Youth Development Link

Charles Chandia
Twekembe Slum Project, Uganda

Monica Swahn, PhD
Georgia State University 

Alcohol misuse in Eastern Africa is highly prevalent but remains a largely unaddressed public health burden. Because of fragmented infrastructure and limited alcohol policies, much of the prevention efforts in this region are operated by non-governmental organizations (NGOs). However, few studies if any, examine the strategies that NGOs use to address alcohol problems and how they integrate prevention programs and policies in their communities. The panel conducted a survey to determine the approaches used by NGOs and also to identify their needs. A cross-sectional survey was conducted with 55 NGO leaders in 2014 to assess their organizational structure, their operational and strategic priorities, target population, and perceptions of best practices and alcohol-related concerns in their local communities. Early alcohol use and heavy drinking were reported by the large majority of NGOs as specific problems in their communities. Additionally, laws in their country that regulate either production or drinking of alcohol and lack of strong enforcement of the minimum legal drinking age were identified as lacking. While NGOs in Eastern Africa are heavily engaged in alcohol prevention and policy development, fragmented support and infrastructure serve as key barriers for progress and proactive implementation of more strict alcohol policies and enforcement of existing laws. Strategies for how to provide additional support to NGOs to implement evidence-based alcohol prevention strategies and to push for stricter policies are urgently needed in Eastern Africa. 

 

Focusing on Alcohol Availability to Minors: California Indian Reservation Communication Plan

Roland Moore, PhD
Pacific Institute for Research and Evaluation (PIRE)

Jennifer A. Geisler, BA, RN
Indian Health Clinic  

Documented effective interventions to reduce underage drinking among rural American Indian and Alaska Natives (AIAN) are scarce. A collaborative prevention effort targeting underage drinking in rural California Indian reservations incorporated both community- and individual-level prevention strategies. The individual-level strategy used brief motivational interviewing to reduce drinking among tribal youth. The community-level strategy focused on enforcing alcohol sales to minors laws and community mobilization to increase tribal awareness and support of the program, including extensive outreach programs in community gatherings, afterschool programs, and local media. Project impact was assessed with multi-level regression models comparing anonymous in-school, self-administered California Healthy Kids Survey data for 9th and 11th grade AIAN and non-AIAN students in the intervention area and an additional comparison group of rural AIAN students from outside the area. The study commenced in 2008 and the pre- and post-intervention survey data points include 2003, 2005, 2007, 2009, and 2011. Over the course of the intervention project, significant and substantial declines in the intervention group’s frequency of past 30-day drinking (p < .02) and heavy episodic drinking (p < .003) were found relative to both comparison groups. The intervention group moved from drinking frequencies similar to those of non-intervention AIAN students to lower drinking frequencies similar to those of non-AIAN students in the study project area. This presentation elaborates on elements of the community outreach that supported norm change and support for policy interventions in the intervention reservations. 

C-5 CONSTITUENCIES AND CAMPAIGNS

Studio C
Presenters:

Cynthia Abrams, MDiv
Kristin Kumpf
General Board of Church and Society – United Methodist Church

Description:

Organizing Faith Communities for Effective Alcohol Policy

[Description to come]

 

Exploring Alcohol Outlet Density Around Military Installations

Alicia Sparks, MPH
Abt Associates  

Reducing alcohol outlet density has been endorsed by the CDC as an effective strategy for reducing alcohol-related harms as it can be a determinant of high alcohol consumption patterns, particularly surrounding college campuses, communities with a similar age group, and “work hard, play hard” mentality as the military. For this paper, the alcohol outlet density around military bases was analyzed at one-, two-, and five-mile radii around military installations to determine if there is a difference in the number of outlets as one gets closer to a military installation. To analyze the density, addresses of licensed alcohol establishments were obtained from state licensing agencies for eight states: Arizona, California, Florida, North Carolina, Nebraska, Texas, Virginia, and Washington. These states were selected based on responses to requests for licensing data and the presence of one or more military installations. Military installation and 2010 Census data were obtained from the U.S. Census Bureau and mapped using ArcGIS. Initial results suggest a clustering of alcohol outlets around military installations with additional analyses being conducted to determine the number of alcohol outlets per 1,000 people per mile surrounding the base. This is the first study to look at the alcohol environment surrounding military installations by mapping the alcohol outlet density around a random selection of installations across the country and has important implications for evidence-based interventions for this high-risk military population. 

 

Alcohol Taxes Save Lives and Money: Legislative Analysis

Marie Claire Voorhees, MA
Santa Fe Prevention Alliance 

“Alcohol Taxes Save Lives and Money” is a grassroots coalition whose purpose is to raise the alcohol excise tax in New Mexico by 25 cents a drink. Currently, New Mexico has the highest national rate of alcohol-related deaths annually and the fourth highest rate nationally of early initiate drinking. The Centers for Disease Control and Prevention indicates in its Community Guide that the most effective strategy to reduce excessive drinking, alcohol-related health harms, and underage drinking is to raise the price of alcohol. The alcohol excise tax has not been raised in New Mexico since 1993. The annual costs of alcohol-related health harms in New Mexico is over $2.2 billion. The funds generated from this excise tax increase could be used for prevention, treatment, and Medicaid state match. Due to the current sales and licensing system in New Mexico, the only means to raise the excise tax is through the state legislative process. Therefore, it is imperative to have an understanding of the alcohol policy and public health policy landscape of the state legislature. This analysis considers current power conditions of each chamber of the legislature, the referral pathways of alcohol policy related bills, voting patterns of standing committees, as well as chambers as a whole. The report findings are currently being utilized in the messaging and greater education campaign for the “Alcohol Taxes Saves Lives and Money” coalition effort. 

4:30 – 6:00pm Concurrent Sessions (C 6-10)

C-6 OUT OF CONTROL? PRIVATIZATION AND THE MERITS OF STATE CONTROL SYSTEMS

Salon 1
Presenters:

Judy Cushing
Emerita, Lines for Life

Julia Dilley, PhD, MES
Multnomah County Health Department/Oregon Public Health Division 

Description:

Impact Study of Change in Alcohol Laws in Washington State (I-1183)

In November 2011, Washington voters passed initiative 1183, which closed state-owned and contracted liquor stores, allowed stores in the private sector to begin selling spirits (hard liquor, e.g., vodka, rum, whisky), removed bans on spirits advertising in stores, and removed uniform pricing and a ban on quantity discounts. Researchers in Washington and Oregon collaborated on studying the impacts of this change in law. The purpose of this study was to document the benefits and costs of the change in law, including health and social consequences. The study results are based on data collected between 5 and 16 months after the change in law. The workshop will include data and observed changes such as (1) changes in the alcohol/spirits distribution environment and (2) changes in consumption, sales, tax revenue, emergency department visits, car crashes, and retail theft. States or other entities considering dismantling an alcohol regulation system will learn how taking the broad view of potential benefits and costs is valuable beyond simply focusing only on projected tax revenue.

 

Benefits of the U.S. Three-Tier System of Alcohol Control

Pam Erickson
Public Action Management 

The workshop’s objective is to explain the benefits of the U.S. three-tier system of alcohol control and how it works to foster public health and safety. The objectives are to describe how and why this system was developed; explain how it works to enhance basic control strategies designed to reduce social problems with alcohol; and indicate some of the unique benefits of the system in terms of efficient tax collection and product safety. The workshop will build off a webinar conducted on this subject for the National Alcohol Beverage Control Association (NABCA).

 

Product Bans: Why and How States Can Ban Problematic Alcohol Products

Elyse Grossman, PhD
Johns Hopkins Bloomberg School of Public Health 

High alcohol content grain alcohol, powdered alcohol, Jell-O shots, alcohol in test tubes—alcohol companies innovate rapidly and produce new products, some of which prove highly popular among young people. Alcohol is responsible for 4,300 deaths a year in the United States among persons under 21. The primary responsibility for regulation of alcohol in the United States lies at the state level, and states vary greatly in their regulatory structures and thus in their ability to govern which products become available within their borders. The 17 control states and local control jurisdictions, because they exercise monopoly control over some aspect of alcohol distribution, have used their regulatory powers to block particular products from sale. The remaining license states have at times enacted statutes or regulations to ban or restrict specific products. This workshop presents case studies on two products: high alcohol content grain alcohol and powdered alcohol. Data will be shared from a survey conducted by the National Alcohol Beverage Control Association (NABCA), the professional association for control states, and from legal research examining actions by license states to explore how different states have regulated problematic products. Overall, while it is easier for control states to limit access to problematic alcohol products than license states, where such a ban usually requires legislative action, even control states vary in the degree to which they use these powers. All states could benefit from greater awareness of state and local powers to restrict youth access to these problematic products.

C-7 ENGAGING CHRONIC DISEASE AND CANCER CHARITIES IN EFFECTIVE COLLABORATIVE ACTIONS ON ALCOHOL POLICY

Studio D
Presenters:

Beverly Canin
Breast Cancer Action 

Norman Giesbrecht, PhD
Emeritus, CAMH, Toronto

Shelia Nesbitt
Partnership for Change 

Donald Zeigler, PhD
University of Chicago at Illinois

Description:

Alcohol is a major risk factor for many chronic diseases, including several cancers. The planning, implementation, and promotion of effective policy change requires participation of many stakeholders dedicated to reducing the harm from alcohol. This panel will focus on successful and ongoing efforts from chronic disease charities and NGOs, especially those focused on cancer, drawing from experiences in the United States, Canada, and elsewhere. Panelists have expertise in alcohol policy research and evaluation, working in NGOs to develop alcohol positions, and mobilizing communities to advocate for “best buys” of alcohol policy to reduce alcohol-related harm. The panel will (1) discuss challenges to educating chronic disease charities of the importance of including alcohol risks in their efforts, (2) provide examples of exemplary initiatives, (3) highlight lessons from tobacco advocacy efforts and successes, (4) describe chronic illnesses other than cancer where similar advocacy on alcohol is needed, and (5) work with participants during this session to draft recommendations and next steps designed to enhance engagement with charities and NGOs. Participants are encouraged to reflect on their experiences working with NGOs on alcohol or related issues and bring their insights and recommendations for discussion during the session.

C-8 COMMUNITIES MOBILIZING FOR CHANGE ON ALCOHOL (CMCA): IMPLEMENTATION WITHIN THE CHEROKEE NATION

Studio C
Presenters:

Kathleen Kennedy, MS
CMCA, Oklahoma

Kelli Komro, PhD
Emory University

Dallas Pettigrew, MSW
Eastern Band of Cherokee Indians

Alex Wagenaar, PhD
University of Florida

Description:

The Prevention Trial in the Cherokee Nation is a partnership between prevention scientists and Cherokee Nation Behavioral Health. Research design elements included purposive selection of towns, random assignment to study condition, an intensive longitudinal design, a factorial design crossing two conceptually distinct interventions, and multiple comparison groups. The study involved six rural communities and their high school populations located within the 14-county tribal jurisdictional service area of the Cherokee Nation. Communities Mobilizing for Change on Alcohol (CMCA) was found to be effective in a previous trial, and chosen because it is based on traditional community organizing tactics that empower local citizens to participate and create change in their own communities. Community organizers, hired from within the communities in which they served, developed relationships with other everyday citizens in their community, formed local Action Teams, and implemented evidenced-based actions related to implementation and enforcement of policies and laws to reduce high school students’ social and commercial access to alcohol. Based on quarterly surveys over a three-year period, high school students exposed to the CMCA intervention showed a significant reduction in the probability over time of both 30-day alcohol use and 30-day heavy drinking compared to students in the control condition, with some variation over the 2.5-year intervention period. Our results suggest that CMCA can be an effective intervention for the reduction of alcohol use in rural communities within Indian Country.

C-9 SAMHSA’s APPROACH TO UNDERAGE DRINKING PREVENTION

Studio B
Presenters:
Frances Harding and Jorielle Brown, PhD
SAMHSA's Center for Substance Abuse Prevention
Description:

The Center for Substance Abuse Prevention (CSAP), part of the federal Substance Abuse and Mental Health Services Administration (SAMHSA), engages in multiple efforts, including federal interagency collaboration, town hall meetings, media campaigns, grant-making, and training and technical assistance to states and communities to promote health and safety among Americans, including youth and young adults. SAMHSA promotes a structured approach to prevent alcohol and drug misuse through its Strategic Prevention Framework, which aims to promote youth development, reduce risk-taking behaviors, build assets and resilience, and prevent problem behaviors across the individual’s lifespan. This interactive session, led by CSAP’s director, Frances Harding, will elaborate on SAMHSA’s mission, its Strategic Initiative to Prevent Substance Abuse and Mental Illness, and its work with states and communities to prevent underage drinking. Successful efforts to prevent underage drinking at the state and community levels and currently available federal resources will be highlighted.

C-10 HEALTH EFFECTS OF MODERATE ALCOHOL CONSUMPTION: IMPLICATIONS FOR POLICY DEVELOPMENT AND HEALTH GUIDELINES

Studio E
Presenters:

Robert D. Brewer, MD, MSPH 
Centers for Disease Prevention and Health Promotion

Tim Naimi, MD
Boston Medical Center

Timothy Stockwell, PhD
University of British Columbia

Description:

This workshop will discuss current scientific evidence on the health effects of “moderate” (i.e., low volume) alcohol consumption, including epidemiological studies and Mendelian randomization studies evaluating the impact of moderate alcohol consumption on heart disease and related biomarkers. The limitations of observational studies on moderate drinking will be discussed in light of two meta-analyses assessing the relationship between alcohol consumption and all-cause mortality and prostate cancer, respectively. The workshop will also include an overview of the 2015 U.S. Dietary Guidelines for Americans, including a discussion of its current definition of moderate drinking, size of a standard drink, and the framing of public health messages for non-drinkers.

6:30 – 8:30pm Documentary Showing: Sober Indian - Dangerous Indian
Salon 4
Presenters:

Frank LaMere
Winnebago Tribe

John Maisch, JD
University of Central Oklahoma

Description:

A Story of Empowerment through Sobriety

Sober Indian | Dangerous Indian is both a story of brave men and women on the Pine Ridge Indian Reservation who have found empowerment through sobriety and those still struggling to overcome their alcohol addiction. Set in the weeks leading up to the Oglala Sioux Tribe’s historic vote to repeal its ban on alcohol on August 13,  

2013, the documentary follows the journey of four alcoholics living on the streets of Whiteclay, Nebraska, less than 300 yards from their homes in Pine Ridge, South Dakota. A must-see film for anyone interested in stories about beating the odds in one of the poorest places in the country, Sober Indian | Dangerous Indian explores the harmful effects of alcohol abuse on tribal reservations including high rates of fetal alcohol syndrome, cirrhosis, teen suicide, and high-risk sexual behavior.


April 7th
7:30 – 9:00am Registration Open
7:30 – 9:00am Poster Presentations/Continental Breakfast
Pre-function Area
Description:

P-1 Advocacy Against Alcopops – New Science and New Approaches

Bruce Livingston, MPP
Alcohol Justice

This presentation will focus on the state of the market and products and on current advocacy efforts to limit the product line. Since Mike's Hard Lemonade and Smirnoff Ice debuted in 1999, the market share for alcopops (flavored malt beverages) in the United States has grown to exceed 3.5 percent of market share of the beer market and still expands in size and influence on other sweetened, fruity products. Alcopops are often the first drink for underage youth, especially girls. Advocacy at the local, state, and national levels has had peeks and valleys. The presentation will share the relevant research on price and availability and trends in container size, ABV, and market share (now led by 38 percent AB InBev with the Lime-a-Rita brands). A December 2015 report by Alcohol Justice, "Alcopops, Sweet, Fizzy Threats to Youth and Public Health," will be shared and available.  A range of advocacy efforts has taken place with mostly limited effectiveness. Attorneys Generals have effectively questioned specific products and marketing, assisting in the elimination of caffeine infusion, targeting Four Loko's marketing, packaging and alcohol levels, and challenging Blast by Colt 45's marketing to impacted communities. Alcohol Justice has been involved in national press and reports on all of these, but is excited to present very local coalition and youth efforts. The most exciting activity is around alcopop-free zones and single can bans proposed in numerous areas.    Much like fortified wine and malt liquor, alcopops are not going away. A coordinated local, state and national strategy is needed and encouraged.

P-2 Alcohol Outlets and Pedestrian Injury in Baltimore City: A Spatial Analysis

Elizabeth Nesoff, MPH, CHES
Johns Hopkins University Bloomberg School of Public Health

The aim of this study was to explore the extent of overlap between areas of concentrated pedestrian injuries and alcohol outlet density in Baltimore City. Pedestrian injury prevention and alcohol outlet zoning are currently topics of important debate in Baltimore. This study incorporated methods from Geographic Information Systems (GIS) and spatial statics for integrating, visualizing and analyzing data with location information. Pedestrian injury incidence data were gathered in real-time through EMS records collected from January 1, 2014, to April 15, 2015 (n=848). Alcohol outlet locations licensed for off-premise consumption in 2014 were obtained through the Baltimore Board of Liquor License Commissioners (n=693). The researchers hypothesized that pedestrian injuries occur more frequently in areas of greater alcohol outlet density than in areas of lower density. All outlet locations and injury locations were geocoded and mapped using ArcGIS. The spatial intensity of both outlet density and injuries were estimated and compared statistically, and the Cross K function was estimated using R. Socio-economic factors were also explored using aggregated data from the 2010 US Census. Study findings point to the built and social environment as possible mechanisms by which alcohol outlet density impacts injury risk.  Future research will incorporate observational measures of the built and social environment to investigate possible mediators of the relationship between density and injury risk. Study findings have implications for understanding the impact of alcohol outlet density on unintentional injury, as well as increasing the evidence base to inform health policy on liquor store licensing, zoning and enforcement.

P-3 Binge Drinking and Associated Health Risks Among Underage Youth

Raimee Eck, MPA, MPH, CPH, PA-C
Johns Hopkins University Bloomberg School of Public Health

Alcohol is the most commonly used drug by youth and contributes to an estimated 4,300 deaths every year among persons under age 21. The Centers for Disease Control and Prevention’s 2013 Youth Risk Behavior Survey (YRBS) reported 34.9% of high school students currently drink and 20.8% binge drink. Prior research has demonstrated that alcohol use by youth is associated with increased risk for engaging in other health risk behaviors, such as sexual risk behaviors and driving after drinking. This poster will present the analyzed data from the 2013 YRBS, updating estimates on the association between various drinking patterns by youth and health risk behaviors. The presenter will discuss the results of the study, including that current drinking, especially binge drinking, is strongly associated with many health risk behaviors among youth. Evidence-based policy interventions to reduce alcohol consumption by youth may help in reducing the prevalence of several health risk behaviors.

P-4 College Student Likelihood of Calling 911 Before and After Enactment of a Medical Amnesty Law

Julia Sanem, MPH
University of Minnesota

College student alcohol use is a major public health problem. In response to the perceived risk of death resulting from excessive alcohol use, colleges and states are increasingly implementing medical amnesty policies and laws. Medical amnesty policies and laws aim to encourage individuals under the age of 21 to seek help in situations where an individual needs medical assistance by providing amnesty for college alcohol policy or state alcohol law violations. Research on the effect of medical amnesty policies and laws on student behavior is limited. Minnesota enacted a medical amnesty law in 2013. Students at a sample of 17 Minnesota colleges participated in a student health survey one or more times before enactment of Minnesota’s medical amnesty law and again in 2015, after enactment of Minnesota’s medical amnesty law. Students were asked: If a person has "passed out" from alcohol/drug use and you cannot wake him/her up, how likely is it you would call 911?    Prior to the medical amnesty law, 61.9% of students reported they would be very likely to call 911 in this situation (school range: 48.7%-75.4%). We will discuss whether college students are more likely to call 911 in a drug- or alcohol-related situation after enactment of a state medical amnesty law and the demographic characteristics and alcohol use behaviors associated with college students’ likelihood of calling 911. This presentation will provide important insight into whether medical amnesty policies and laws should be a recommended strategy for reducing the negative consequences of college student alcohol use.  

P-5 Effects of a Responsible Beverage Service Training and Enforcement Program

Jim Fell, MS
National Opinion Research Center (NORC)

Studies of risk factors associated with a wide range of harmful alcohol-related incidents (violence, injury, motor vehicle crashes, illness) suggest that the most significant risk factors are the amount of alcohol consumed and whether obviously intoxicated customers continue to be served. Two communities—Monroe County, New York and Cleveland, Ohio—participated in a demonstration program and evaluation. The intervention integrated responsible beverage service (RBS) training, targeted enforcement, and, as necessary, implementation of corrective actions by the enforcement agency to a random sample of identified problem bars. The immediate goal of the RBS/enforcement program was to reduce the practice of over-serving and serving to obviously intoxicated individuals.   Overall, there were indications in both intervention communities that RBS training plus enforcement reduced the incidence of bar patron intoxication (and potential impaired driving). In Monroe County, New York, the percent of intervention bar patrons who were intoxicated decreased from 44% to 27% and the average blood alcohol concentration (BAC) of patrons decreased from .097 g/dL to .059 g/dL. In Cleveland, Ohio, the percent of pseudo-intoxicated patrons who were denied service in the intervention bars increased from 6% to 29%. It appears that when bar managers and owners are aware of the program and the enforcement of it, and servers are properly trained in RBS, fewer patrons become highly intoxicated (i.e., over-served) and an effort is made to deny service to obviously intoxicated patrons. RBS training, followed up with visible and sustained enforcement, may be an important strategy to combat impaired driving and other injuries associated with excessive drinking.

P-6 Eliminate the Most Dangerous Beverage on the Market for Youth – Alcopops

Thania Balcorta
Eden Youth and Family Center

Alcopops are the most dangerous beverage on the market for youth. Alcopops are flavored malt beverages that are soda-like with strong appeal to young people while high in alcohol content. It is time to stand up to the alcohol industry and eliminate alcopops from our community. We will discuss how several communities have implemented an alcopop campaign. These communities have worked with local merchants to persuade them to voluntarily eliminate alcopops from their shelves, passed local resolutions and revised local legislation all in hopes of eliminating alcopops. Youth have been instrumental in implementing the campaign and ensuring that the community is being included in the process. Strategies to be discussed will include how to engage peers, educate the public and gain tools on how to make this happen in other communities. The presenter will share ways in which community advocates can be at the forefront of alcohol policy and partner with young people for a healthier tomorrow.

P-7 Environmental Scanning to Engage Community Members in Alcohol Policy Advocacy: Lessons Learned from Recent Efforts in a U.S. – Mexico Border Community

Daniela Marquez
YMCA of El Paso

Alicia Sparks, MPH
Johns Hopkins Bloomberg School of Public Health

Holly Mata, PhD, CHES
YMCA of El Paso

This project highlights how a team of alcohol policy advocates engaged community members in an extensive environmental scanning process to examine risk factors in the retail alcohol environment. As part of a 14-month alcohol policy advocacy training program in the U.S. – Mexico border region, participants were trained in scanning their local environments to identify risk factors that may contribute to underage drinking and binge drinking. With the guidance of the training team, participants have had extensive training in the “4 P’s” of Environmental Prevention (Place, Product, Price, and Promotion), which provided context for the current project. Using an environmental scanning tool developed by the training team to assess the retail alcohol environment, community members and public health sciences students in our alcohol policy internship program completed approximately 100 scans at on- and off-premise establishments in El Paso, Texas. Data include price of wine, beer, and liquor; the number of alcohol advertisements in and outside of each establishment, including those targeting specific groups such as college students, military personnel, and women; the promotions and deals that occur at each establishment; the placement of alcohol products in relation to non-alcohol beverages such as soda or tea; and the types of products available at each establishment. Through descriptive data from the scans and evaluation feedback from scan participants, we discuss how gathering and sharing these data with a wide range of stakeholders facilitates collaborative efforts to reduce high-risk alcohol use and related consequences.

P-8 Gender Differences in Binge Drinking in Brazil

Isis Machado, MN
Pan American Health Organization

Gender differences in alcohol consumption are mediated by the ways each culture distinguishes male from female roles. To know these differences may direct cost-effective prevention and intervention policies. The aim of this study was to analyze factors associated with binge drinking between men and women in Brazil. We used cross-sectional secondary data from the National Health Survey in Brazil, a household-based nationwide survey and the analyses were conducted based on 60,225 individuals living in 26 states and the Federal District in the year of 2013. Binge drinking was considered when reported an intake of four or more alcoholic drinks on at least one occasion in the last 30 days for women and five or more drinks for men. The target covariates were: age, skin color, schooling, marital status, region of the country and urban or rural area. Logistic regression was used to estimate the associated factors with abuse of alcohol. The analyses were performed separately for each gender. The rate of binge drinking Brazilian in 2013 was 13.7%. Among women, the rate was 6.6% vs. 21.6% among men (p>0,001). The logistic regression analysis shows that women and men differ in relation to drinking behavior. The risk factors for binge drinking for women were: younger age, brown or black skin color, high educational level, single or divorced, live in the Northeast , Southeast and Midwest and live in urban area (p <0.05). For men: younger age, single or divorced, live in the Northeast and South and live in urban area (p <0.05). Skin color and schooling were not associated with binge drinking among men. The results indicate that gender had significant effects on Brazilian drinking patterns.

P-9 Influence of Using Sportsmen/Actors/Singers/Musicians as Products Presenters on Youth Drinking Behavior of Beer in Bangkok, Thailand

Nitha Sirichotiratana, PhD
Mahidol University, Thailand

Research on using celebrity as presenter for consumer’s products indicates that it has many dimensions: consumer’s perception, product endorsement by the presenter, and a strategic model for presenter’s endorsement. The alcohol industry spends significant dollars on activities to advertise beer products via sponsorship of activities, such as concerts, popular sports, and variety shows on television. Using celebrity as products presenter is a form of advertisement to communicate directly to target young adult consumers.  Celebrity endorsement is a very popular marketing communication technique. This poster will demonstrate the research used to collect data from 500 young adults, age 18-25 years old, who attended alcohol industry-sponsored activities in the Bangkok metropolitan area. The research was conducted between August 2014 – April 2015.   Results indicat that using celebrities as beer presenters had influence on low-level alcoholic drinking youths to drink more (over 10%) than heavy or binge drinking youths.  Various reasons were given as followed: 45.4% because of advertisement in concerts, 42.6% due to advertisement in sports program, and 22% because of idol presenters of that particular alcoholic product.  Using celebrities or idols as presenters of alcoholic product is a violation of Alcohol Control Act, 2551 B.E., article 26 (Labeling) and article 32 (Advertisement) in Thailand.  Therefore, total alcohol advertising ban is a necessary measure, as it is effective and efficient to prevent young, new drinkers in Bangkok metropolitan area.

P-10 Mapping the Unknown: A Conceptual Framework for Alcohol’s Harms to Others Among United States College Students

Pamela Trangenstein, MPH
Johns Hopkins Bloomberg School of Public Health

Alcohol-related harms research traditionally focuses on harms or costs borne by the drinker. However, drinkers necessarily impact their surroundings because alcohol consumption is inherently social. Therefore, estimates of alcohol-related harms are overly conservative because they exclude the morbidity, mortality, and cost of persons around the drinker. Alcohol-related harms to others are changes attributable to alcohol that occur in an individual’s social behavior, interactions, or environment. International research suggests young adults in higher education institutions are at increased risk of experiencing harms to others. Building on this research base, this poster presents a conceptual framework of harms to others experienced by United States college students. The framework is grounded in Bronfenbrenner’s Ecological Systems Theory and structured around two key proximal determinants of alcohol's harms to others: the victim’s relationships with heavy drinkers and the victim’s drinking pattern.  The framework suggests social network interventions and campus or national policies are potential solutions to prevent alcohol’s harms to others.

P-11 Monitoring Alcohol Advertising to Reduce Youth Exposure: A Public Health Strategy

Craig Ross, PhD
Fiorente Media

Alcohol contributes to 4,300 deaths per year among young people In the United States. Numerous longitudinal studies have found an association between youth exposure to alcohol advertising and both initiation and quantity of drinking among youth. The alcohol industry regulates its own advertising placements using a set of advertising guidelines, but over an eight-year period an underage youth was exposed to a non-compliant alcohol advertisement on television more than 15 billion times. To reduce youth exposure to alcohol advertising under current industry guidelines, we developed a “no-buy list” strategy that relies on three methods for identifying programs to avoid placing alcohol advertisements. We estimate that if companies applied these methods, the majority of non-compliant youth exposure could be eliminated. This poster presentation will describe the key elements of the no-buy list approach. We will also describe an annual national overview report and a quarterly reporting strategy, which involves the monitoring of non-compliant advertising as a step towards reducing youth exposure to alcohol advertising.

P-12 More than a Hangover: Consequences of Alcohol Use by Student Athletes

Georgia Marks
Texans Standing Tall

Student athletes are a population at higher risk for risky drinking behavior.  Literature suggests that athletes perceive alcohol consumption to be a social norm and think that college is synonymous with alcohol consumption.  Athletes also tend to use alcohol as an escape or coping mechanism to manage increased stress. Additional influences include overestimation of peer consumption and where a student athlete resides.  According to the National Collegiate Athletic Association’s (NCAA) “Best of Choices” report (2008), athletes engage in riskier behaviors than the average college student, which may be a result of greater access to alcohol, peer approval, and direct offers from other athletes. The 2013 NCAA Student-Athlete Substance Use Study indicates that 81% of college student-athletes used alcohol in the past year, and 62% used alcohol in the past month (NCAA, 2014). Of these, 44% of male student-athletes reported binge drinking and 33% of female student-athletes reported binge drinking. Approximately 12% of student athletes reported typically drinking 10 or more drinks in one sitting.  Student-athletes are in a unique position of having special ties to and support from additional campus staff. As a result, there is an existing opportunity to decrease use among student athletes through educating coaches and support staff on the impact alcohol use has on athletes. This presentation will reveal the lesser-known mental and physical consequences of alcohol use as they pertain to the student athlete. It will also explore avenues for educating these effects in order to deter alcohol use among the student athlete population.    

P-13 The 24/7 Sobriety Monitoring Program in South Dakota

Jim Fell, MS
National Opinion Research Center (NORC)

Of special interest regarding impaired driving offender sanctions is the intensive supervision 24/7 program, which has been implemented in South Dakota, North Dakota and Montana. In these programs, DWI offenders appear at the local sheriff’s office each morning (between 7 AM and 9 AM) and evening (between 7 PM and 9 PM) for breath testing. Among the key features of a 24/7 sobriety-monitoring program are the following:  1. It makes use of existing police facilities and standard police equipment—handheld preliminary breath test devices. No expensive computer or testing equipment is needed.  2. It is low cost ($1 per test; $2 per day) compared to $12 for the SCRAM®, and the cost is paid by the offender.   3. It replaces some or all of the jail time for multiple DWI offenders, thereby reducing jail costs.  4. It is applicable to all types of alcohol offenders, not just DWI offenders.   5. It can be imposed as a condition of setting bail or bond, so it can be applied close to the time of arrest rather than months later when the trial occurs.

P-14 The Role of Acculturation on Alcohol Use Disorders Among Mexican Origin Adults On and Off the U.S. – Mexico Border

Miguel Pinedo, PhD
UC Berkeley/Alcohol Research Group

Overall, Latinos disproportionally report higher rates of alcohol problems (i.e., alcohol abuse, alcohol dependence) than other ethnic groups. Notably, the US-Mexico border is a ‘hot spot’ for alcohol problems. Higher rates of alcohol problems are consistently documented at the border (vs. off) among Mexican-origin adults. This is true despite Mexicans at the border reporting lower alcohol use than their non-border counterparts. Acculturation (i.e., adapting to US culture) is a critical factor for predicting drinking patterns and alcohol outcomes among Latinos. However, there is clearer evidence indicating a link between acculturation and increased alcohol use and alcohol problems among Latina women than among Latino men. This poster will describe: (1) alcohol use disorders (AUD; alcohol abuse or alcohol dependence) among a sample of Latinos living on and off the US-Mexico border, (2) causal mechanisms underlying how and why acculturation shapes risk to AUD, (3) and differential impacts of acculturation on AUD by environmental contexts (i.e., border vs. off border) and gender. We will discuss important implications of these findings to inform policy and prevention strategies among Latinos, particularly in high-risk environments such as the border region

P-15 Using the Community Health Improvement Process to Adopt Community Alcohol Policy

Julia Sherman
University of Wisconsin Law School

Excessive alcohol use by Wisconsin residents is well documented. Over half (54 of 92) of Wisconsin’s Community Health Improvement Plans (CHIPs) indicate reducing excessive alcohol use is a priority. Alcohol control is a municipal responsibility in Wisconsin creating the potential for significant changes through local CHIPs.  Twenty public health agencies participate in the Community Health in Action (CHIA) project receiving support & technical assistance to demonstrate it is possible to adopt and implement evidence-based policies addressing specific alcohol-related problems identified in the CHIP. This project tests the efficacy of the CHIP policy model but also tests the ability of local health agencies to improve the local alcohol environment through evidence-based alcohol policy when technical support is provided.  The Wisconsin Alcohol Policy Project (WAPP) collaborated with Wisconsin Association of Local Health Departments and Boards to create tools & training to support municipal evidence-based policies, using language & references familiar to public health departments supported with monitoring and technical assistance.  This session will discuss how alcohol-related issues identified in the CHIP became alcohol policy advocacy goals, the skills and tools that supported these goals, how the CHIP supports a comprehensive approach to alcohol policy, the barriers encountered and how they were addressed. 

P-16 What Do I See?

Wanda Boone
Together for Resilient Youth

What do I see? It starts with what we see in order to counter and combat the series of cultural shifts that have made alcohol so accessible and appealing. Young people are strategically lured and targeted by the placement of alcohol, the packaging of alcohol in larger and more kid-friendly forms, the glamorization of alcohol by musicians, the media and billboards for example.  “Holding young people soley responsible for underage drinking is like holding fish responsible for dying in a polluted stream.” – FACE project. The community at large is at risk. There is a link. Poor health, cancer, chronic disease, crime, injury and death can now be traced to alcohol misuse. I will present the various ways that Together for Resilient Youth (TRY) uses environmental strategies to address the changing alcohol infused landscapes where we all live, work and play.  

9:15 – 10:45am Plenary Sessions

PLENARY 1—BRIDGING THE GAP: RESEARCH TO ACTION ON ALCOHOL TAXES

Salon 5 - 7
Presenters:

Alex Wagenaar, PhD
University of Florida

Nicole Holt
Texans Standing Tall

Peter DeBenedittis
Alcohol Taxes Save Lives and Money

Vinny DeMarco – Session Chair
Maryland Healthcare for All

PLENARY 2—FROM PRIVATIZED SYSTEMS TO PUBLIC NUISANCES: RECKONING WITH ALCOHOL AVAILABILITY

Salon 4
Presenters:

William Kerr, PhD
Alcohol Research Group

Nicole Carritt, MPH
Project Extra Mile

Tom Mumgaard, JD
Omaha City Attorney’s Office

Cassandra Greisen, MPA
Johns Hopkins Bloomberg School of Public Health

Debra Furr-Holden, PhD
Johns Hopkins University

Steve Schmidt – Session Chair
National Association of Beverage Control Agencies

11am - 12:30pm Concurrent Sessions (C 11-15)

C-11 ENHANCING LOCAL CONTROL OF ALCOHOL OUTLETS: EMERGING BEST PRACTICES

Studio A
Description:

1992–2016: Addressing alcohol outlet density—A historical look at deemed approved ordinances 

Mike Bates, BBM/MIT
Rohnert Park Department of Public Safety

Nicole Carritt, MPH
Project Extra Mile

Cassandra Greisen, MPA
Johns Hopkins Bloomberg School of Public Health

Michael Sparks, MA
Sparks Initiatives 

Recently the independent, non-federal Task Force for Community Preventive Services recommended that one of the most effective approaches for reducing excessive drinking and its many health and social consequences is to limit the physical availability of alcohol through local zoning and planning provisions, commonly known as deemed approved ordinances. Since the first “deemed approved” ordinance was adopted in Oakland, California, in 1992, more than 250 localities in California have followed suit, adopting local regulatory structures that establish new operational and nuisance standards for alcohol outlets, providing new avenues for community input, and reducing alcohol-related police calls for service. More recently, the City of Omaha, Nebraska, used its zoning powers to pass an alcohol outlet-focused nuisance abatement ordinance in 2012. In Baltimore, Maryland, the city is pursuing a similar ordinance to more effectively regulate and control its 1,300 alcohol outlets. This interactive panel will draw on experiences in California, Nebraska, and Maryland to provide the history and lessons learned from using zoning as a tool to address the physical availability of alcohol over the past 30 years. Participants will learn the necessary steps a community must take to develop a deemed approved ordinance and identify how to sustain a deemed approved ordinance over time, ensuring the implementation and enforcement provisions remain a priority. 

 

Halfway There: Local Control for Retail Alcohol Outlets in California Cities

Friedner Wittman, PhD, M.Arch
CLEW Associates 

Compared to other states, California’s 482 cities and 58 counties have enormous power to control retail alcohol outlets through local planning and zoning ordinances. Local jurisdictions have authority through conditional use-permits (CUPs) and deemed-approved ordinances (DAOs) to regulate alcohol outlet location, density, types of settings, hours of operation, design, and operations. Localities also have authority to stop outlets from applying for ABC licenses and to shut down troublesome licenses by revoking permits in violation of CUP conditions. How do local jurisdictions use their powers to prevent health and safety problems associated with retail alcohol outlets? How effective are they, and how can they be strengthened? This presentation describes how the “alcohol outlet CUP” has evolved through four developmental phases from 1980 (when few cities knew about alcohol outlet CUPs) to today when an estimated 80% of cities require alcohol outlet CUPs far more powerful than early versions. The panelist will describe processes to enact local control ordinances (including help from state/county alcohol/drug program agencies and the alcohol research and advocacy community), and report how they are being implemented (or not) to prevent and reduce community alcohol problems. The panelist will review planning research on considerable (but untapped) potential to reduce and mitigate health and safety problems associated with the outlets. Finally, the panelist will review why the 30-year development process plateaued and will explore prospects for resuming a policy journey that is just half complete. 

C-12 EFFECTIVE ALCOHOL POLICIES: SCANNING THE LANDSCAPE (SECTION 1)

Studio B
Description:

Alcohol Policies and Leading Causes of Alcohol-Related Mortality

Tim Naimi, MD, MPH
Boston Medical Center

Monica Swahn,PhD

Ziming Xuan, ScD, SM, MA
Boston University School of Public Health 

Excessive alcohol consumption is a leading preventable cause of death in the United States and is related to a variety of mortality outcomes including fatal motor vehicle crashes, suicide, homicide, and alcoholic cirrhosis. This workshop will examine alcohol involvement in each of these four outcome areas. For each mortality outcome, we will present descriptive statistics on the number and/or proportion of deaths that are alcohol-involved (BAC > 0.01%) and alcohol-related (BAC > 0.08%), overall and on the basis of age, sex, race/ethnicity, and geographic region. In addition, the panelists will examine the relationship between state-level alcohol policies and each of these mortality outcomes, including the independent effects of policy subgroups (e.g., driving-oriented policies vs. drinking-oriented policies). The state-level alcohol policy “environment” will be characterized using the Alcohol Policy Scale (APS). The APS is based on summing the presence of 29 alcohol policies in each state-year after weighting each policy by its relative efficacy and level of implementation. Modified scores for policy subgroups are derived using identical methods but include fewer policies. The panelists’ previous research finds that stronger state policies (reflected in higher APS scores) are associated with reduced odds of adult binge drinking, youth drinking, and alcohol-impaired driving, and increased odds of remission from prior lifetime alcohol dependence. Analyses of fatal motor vehicle crashes use data from the Fatality Analysis Reporting System, those for suicide and homicide use data from the National Violent Death Reporting System, and those for alcoholic cirrhosis use data from the National Vital Statistics System. 

 

The Landscape of State and Local Alcohol Policy on Underage Drinking

Mark Wolfson, PhD
Wake Forest School of Medicine

Policy has long been recognized as a critical tool in preventing underage drinking. While the Minimum Legal Drinking Age (MLDA) has been instrumental in reducing rates of underage drinking and negative consequences in the United States, there are many other state and local policies that can enhance the effectiveness of this overarching federal regulation. These policies include (1) prohibition of youth in on-sale alcohol outlets, (2) restrictions on alcohol outlet density, (3) limits on days and hours of sale, (4) regulation of alcohol at local events, and (5) social host ordinances, among others. Relatively little is known about this patchwork of state and local policies. The panelist and his colleagues conducted a systematic effort, using online municipal codes and other sources, to identify and code these policies in 272 local communities across 22 states. They also coded relevant state policies in these 22 states, and compared the existence, strength, and specific provisions of policies at the state and local levels for each of the 272 communities in the sample. This presentation will provide key findings from this study. While there is substantial variation across the five policy areas, the panelist offers observations on four patterns of findings: (1) coincidence of state and local policies, (2) absence of both state and local policies, (3) existence of a state policy but no local policy, and (4) existence of a local policy but no state policy. This “patchwork” of regulation offers important opportunities for advocates and for future research.

C-13 SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION: OVERVIEW OF NATIONAL UNDERAGE DRINKING PROGRAMS AND REPORTS

Studio C
Description:

Town Hall Meetings to Prevent Underage Drinking: A Catalyst for Change for Campus Communities

Marion Pierce 
Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention 

According to a report of the National Institute on Alcohol Abuse and Alcoholism, “the tradition of drinking has developed into a kind of culture—beliefs and customs—entrenched in every level of college students’ environments.” The consequences of this cultural development have been pervasively and extraordinarily negative for students and campus communities. Changing the college drinking culture requires systemic change as well as evidence-based environmental and individual interventions sustained over time. Town Hall Meetings—which provide a constructive venue for multiple stakeholders to assess both problems and solutions—can be the catalyst for effective change. This workshop will review success stories and outcomes from campus communities that have used Town Hall Meetings sponsored by the Substance Abuse and Mental Health Services Administration to initiate and sustain interventions to prevent and reduce underage and high-risk drinking among college students.

 

Sober Truth on Preventing Underage Drinking Act (the STOP Act) 2015 Report to Congress

Robert Vincent
Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention 

Congress enacted the Sober Truth on Preventing Underage Drinking Act (the STOP Act) in 2006. The STOP Act created the Interagency Coordinating Committee on the Prevention of Underage Drinking (ICCPUD), which includes 15 federal agencies that play a role in underage drinking prevention. The STOP Act requires the ICCPUD to submit an annual Report to Congress on the Prevention and Reduction of Underage Drinking. The Report describes and characterizes the most recent data available from federal surveys on the nature and extent of the problem, and summarizes current federal prevention activities. The Report also provides detailed information on 25 state underage-drinking-prevention policies in all 50 states and the District of Columbia and summarizes an annual state survey on underage drinking enforcement practices, prevention programs, and state expenditures. As described in the Report, national epidemiologic data demonstrate that federal and state governmental prevention efforts may be having positive effects. For example, since 2004, past-month alcohol use by underage drinkers has declined by 15%, and past-month binge drinking has decreased by 22%. However, alcohol continues to be a factor in 4,300 youth deaths annually, and binge-drinking rates, particularly among college students, are troubling. This presentation will place the Report in the context of current trends in underage drinking, highlight available data in the Report, and identify ways in which the Report’s content can be useful to the prevention community, including federal, state, and local government agencies, law enforcement, nonprofit organizations, schools, parents, and others. 

C-14 GETTING TO GRADUATION: ADDRESSING COLLEGE DRINKING

Studio D
Description:

College Alcohol Prevention: A Policy Agenda

John Clapp, PhD
The Ohio State University

This presentation will discuss the current state of college alcohol prevention in the United States. The presentation will offer the historical context of the problem and detail science-based approaches related to policy and environmental alcohol problem prevention targeting college students. Barriers related to implementation of sound alcohol policies including (1) governmental fragmentation, (2) a disconnect between science and practice, (3) inadequate higher education responses and competing interests, and (4) the complex etiology of the problems associated with heavy drinking will be discussed. A policy agenda will be offered to address these factors. 

Using Social Host Laws to Reduce College Drinking at Off-Campus House Parties

Doug Gibson
Baltimore City Police Department 

Molly Mitchell, JD
Maryland Collaborative to Reduce College Drinking and Related Problems

Off-campus house parties are a challenge for many campuses trying to reduce high-risk drinking among their students. Several campus communities in Maryland have begun exploring local social host ordinances to reduce the problem of large, unruly off-campus house parties where students often access cheap alcohol and drink to excess, leading to injuries, alcohol poisoning, sexual assaults, and more. This paper presentation will describe the process these communities are using to educate key stakeholders and build support, make their case to decision makers, and, in one case to date, pass a local social host ordinance. The panelists will discuss the literature on the effectiveness of these ordinances, the obstacles communities have faced in passing and implementing them, and how they have addressed these obstacles. The panelists will also discuss how the new social host ordinance in Baltimore City is being enforced and preliminary evidence of its effectiveness. 

Alcohol Policies on Campus: What Do We Know and Where Do We Go?

Molly Mitchell, JD
Gabrielle Nichols
Johns Hopkins Bloomberg School of Public Health

Excessive drinking on college campuses is a serious and persistent public health problem. Colleges have attempted numerous strategies for addressing it, including individual and environmental approaches as well as actions on- and off-campus. There have been few attempts to analyze and assess on-campus policies and how they can contribute to an overall effective strategy for reducing college drinking and related problems. A comprehensive review of the literature identified existing taxonomies of college alcohol policies as well as methods of ranking them in terms of effectiveness. From this literature review, the panelists developed an instrument for categorizing and assessing existing college alcohol policies at 14 mid-Atlantic institutions of higher education. Colleges have a wide range of on-campus alcohol policies. Alcohol policies are often spread throughout college websites and comprehending them as a coherent approach to a significant problem can be difficult. Some of the most common policies have little support from the research literature; however, this is at least in part a function of few efforts thus far to systematically evaluate the effects of individual alcohol policies on college campuses. Campus alcohol policies have potential as a first line of defense and education in protecting students against excessive drinking and related harms. Colleges need to develop comprehensive and integrated policies that are readily visible to students, parents, and other members of college communities. Further research is needed to identify more clearly the essential policies campuses should adopt in order to shape effective responses to excessive college drinking. 

Addressing the Needs of College Campuses on a Shoestring Budget

Nicole Holt
Nancy Pryor
Texans Standing Tall 

When faced with limited funding and the litany of problems related to excessive alcohol use, it is easy to put Institutes of Higher Education (IHEs) on the backburner when addressing the problem. Often it is assumed that colleges and universities have the resources and capacity to address the issue on their own, but many campuses, especially smaller ones, may not have the funding or staff to devote to prevention efforts. Research shows that 18–25 year olds, particularly those in college, are not only major contributors to the problem, they suffer greatly from the consequences of risky alcohol use. With limited resources, Texans Standing Tall’s strategic approach is to illuminate the nature of the problem and identify cost effective and sustainable options to address issues related to underage and risky alcohol use among students at IHEs. The approach includes Texans Standing Tall’s:

  1. Report Card on Higher Education that assesses the state of the problem; identifies gaps in research, programs, and services; and helps generate resources to address the issues. 
  2. Database of Campus Prevention Professionals that requires upfront costs with regard to time, but low monetary cost. Once developed, the database is easy to maintain and serves as an ongoing resource that connects campus prevention professionals across the state. Additionally, it helped identify high rates of turnover among these positions on campuses.
  3. Screening and Brief Intervention Program that serves as a primary prevention tool and allows smaller campuses without counselors or prevention specialists to offer students support resources.

C-15 ADDRESSING THE GAP BETWEEN RESEARCH AND PRACTICE

Studio E
Description:

Measurement as a Driver of Policy Change: The Role of the Maryland College Alcohol Survey in Reducing College Alcohol Use and Problems

Amelia Arria, PhD
University of Maryland School of Public Health 

Excessive drinking among college students is a serious and persistent public health problem. The Maryland Collaborative began in 2012 as an initiative to strengthen the ability of colleges in Maryland to implement multi-level, multi-component evidence-based approaches to reduce high-risk drinking. Consistent measurement of progress is a key element of this data-driven initiative. This presentation will describe the design and implementation of the Maryland College Alcohol Survey, an online survey for students attending colleges involved in the Maryland Collaborative. The survey assesses alcohol use, high-risk drinking, alcohol-related harms to others, and direct alcohol-related consequences, as well as several suspected “drivers” of alcohol-related problems. Particular attention to measuring malleable risk factors that could be targets of interventions—including alcohol availability and access, injunctive norms, false ID use, attitudes about policy enforcement, and parental attitudes—has served as a guide and basis for policy change as well as a feedback tool for colleges who are engaged in implementing evidence-based environmental and individual-level approaches to reduce high-risk drinking. Specific examples of how the measurement system has supported alcohol policy change campaigns will be provided.

 

Building the Alcohol Story—Even When Government Is Not Ready to Listen

Jyotsna Vohra, PhD 
Cancer Research UK 

Alcohol consumption is increasing globally and is the cause of large burden from a disease, social, and economic perspective. In 2012 the WHO reported that it was responsible for 5.9% of deaths globally. Between 1990 and 2011, alcohol consumption in the UK has doubled and it is now a well-established and modifiable cause of cancer, with clear evidence that drinking even small amounts of alcohol can raise the risk and is responsible for 12,800 cases annually (4% of total cancers diagnosed) in the UK. The current UK government has to date failed to implement many of its core recommendations in their 2012 strategy, including Minimum Unit Pricing, and has either frozen or reduced existing tax levies. This makes the probability of new policies to support the reduction of harms from alcohol unlikely. The Policy Research Centre for Cancer Prevention, Cancer Research UK believes that by providing key evidence it can ensure the conversation around alcohol still exists, and that the public are more aware of the risks associated. We have embarked on studies that will examine the effects of raising the awareness of links between cancer and alcohol and acceptance of policy interventions, and a modeling study to look at the economic impact of alcohol policies. In addition, the panelist will look at the parity of primary care advice on alcohol and impact of awareness on young people and will discuss some of the key findings from these studies. 

 

Framing Data for Maximum Policy Impact

David Jernigan, PhD
Johns Hopkins Bloomberg School of Public Health

Sue Thau
Community Anti-Drug Coalitions for America  

This session will teach participants how to take facts and data and reduce the information to its essence for use in educating elected officials and other key influential stakeholders. Participants will also learn how to connect alcohol and underage drinking issues to other public policy issues that are of utmost concern to policy makers. Finally, participants will be updated on federal legislation and funding proposals related to underage drinking. 

12:30 – 2:00pm Luncheon
Salons 4 - 7
Presenters:

Cynthia Abrams, MDiv
General Board of Church and Society - United Methodist Church 

2:15 – 3:45pm Concurrent Sessions (C 16-20)

C-16 BAR EXAMS: CONTROLLING ALCOHOL PROBLEMS AT BARS AND LARGE EVENTS

Studio E
Description:

Community Alcohol Problems Related to Bars: Results of a Six-city Study of Barroom and Bar Area Characteristics

Juliet Lee, PhD
Prevention Research Center

Christina F. Mair, PhD
University of Pittsburgh School of Public Health

Christopher Morrison, MPH
University of Pennsylvania 

An assessment was conducted to determine whether and how barroom characteristics, operating conditions, and neighborhood characteristics contributed to community alcohol-related problems. From six mid-sized California cities, premise assessments were conducted of all licensed barrooms (N = 165 bars), ethnographic observations inside and Systematic Social Observations (SSO) outside a subset of bars (n = 112 bars); and interviews with staff and patrons (n = 36 bars). Data was combined from ethnographic observations of barrooms and from SSO of the local areas around these bars together with police-reported assault data in the associated cities. Statistical relationships were assessed between barroom and neighborhood characteristics and police-reported assaults around bars within the four cities (assault events nested within buffered areas around bars). Observation field notes were analyzed and interview data for recurring and salient themes. More patrons, more dancing, and louder music within bars, and higher density of bars in an area, correlated with increased risks for bar-area assaults. Specific bar practices contributed to these risks. Some bars deliberately altered their operating conditions in the late night hours to increase patronage. In some bars, managers were said to tolerate and even encourage heavy drinking but then move alcohol-related problems outside. Problems associated with bars may devolve from the ecological settings within which bars develop as businesses. A high density of bars encourages competition for patrons. Bar practices may offload risks and costs from bar managers to city officials. Local alcohol control policies that clearly define bar operating conditions and restrict and reduce density may reduce the risk and burden of alcohol-related problems on communities.

 

Alcohol Risk Management (ARM) Programs: Implementation of Alcohol Service Policy Training for Multiple High-risk Settings 

Traci Toomey, PhD
University of Minnesota, Alcohol Epidemiology Program

Toben Nelson, ScD
University of Minnesota School of Public Health

Kathleen Lenk, MPH
University of Minnesota School of Public Health 

In the 1990s, we identified a need for a training program designed to help managers of alcohol establishments (e.g., bars, restaurants) adopt establishment-specific alcohol policies that promote risk management and responsible alcohol service practices. To address this need, the Alcohol Risk Management (ARM) program was created, a four-session, one-on-one training program for key decision-makers within alcohol establishments. In a randomized controlled trial evaluating the effect of the ARM program, a 23% reduction was found in the likelihood of sales to obviously intoxicated patrons one month following the training; however, these effects were not sustained beyond three months. In response, a new version of the ARM program called the Enhanced Alcohol Risk Management (eARM) was created and incorporated online components designed to sustain effects of the original program. This program also incorporates increased training on how to implement establishment policies. Two other versions of ARM were created: one for bars and restaurants that cater to military personnel (ARM-M) and another targeting social events hosted by college fraternities (gARM). In this workshop, the panelists will describe the four ARM programs and identify key and newly developed components of the programs, including understanding the self-interest of the target audience, facilitating the policy implementation process, use of motivational interviewing techniques, and partnerships with local law enforcement. The panelists will discuss future steps and implications for both researchers and practitioners regarding risk management practices, responsible beverage service training, and policy implementation.

 

Fiesta “Daze”: Managing Alcohol at Large Community Events

Friedner Wittman, PhD, M.Arch
CLEW Associates 

Fiesta Days is an annual three-day fair founded in 1968 that is a well-loved institution with a history of excessive drinking as part of its “pioneer spirit.” This vital event attracts more than a thousand fair-goers among 12,000 people living in close-knit small towns perched on a mountain ridge between Los Angeles and Kern Counties. By the late 1990s excessive drinking had become such a regular part of the fair that it became known as Fiesta “Daze.” In 2007, the local Family Resource Center sought help from Kern County Alcohol and Drug Program to establish preventive alcohol policies with the fair’s self-perpetuating board of directors (Mountain Memories). This presentation describes actions to create a local community prevention coalition (MCCASA, funded by a Drug Free Communities grant in 2009) that successfully engaged the fair board in a five-year process to redesign the Fiesta Days alcohol environment through a participatory planning process. Redesign eliminated day-time excessive drinking (measured by grid-based field observations of “tipsy” and “drunk” fair-goers) and reduced excessive drinking during evening hours by 72%. The redesign was formalized in a Fiesta Days Alcohol Management Plan (AMP) that can be replicated and generalized. This presentation reviews uses of data to reconfigure the fair’s alcohol environment; reports on methods for constructive engagement (and several setbacks) for community stakeholders to jointly shape the fair’s alcohol environment; and discusses the novel integration of the AMP into the sheriff’s standard operations plan for such events as county-wide policy. 

C-17 ALCOHOL POLICY ADVOCACY IN THE U.S.–MEXICO BORDER REGION: BUILDING REGIONAL CAPACITY TO SUPPORT LOCAL AND STATE-LEVEL WORK

Studio C
Presenters:

Jessica Jara
Luna County, New Mexico 

Cambri Johnson 
Otero County, New Mexico 

Holly Mata, PhD, CHES
YMCA of El Paso

Jana Renner, MPA
Paso del Norte Health Foundation

Michael Sparks, MA
Sparks Initiatives

Description:

In this interactive session, panelists discuss how alcohol policy advocates in several U.S.–Mexico border communities collaborate as a regional entity supporting local and state-specific policy efforts in New Mexico and Texas. Shift+ is an alcohol prevention initiative funded by a regional health foundation and designed to reduce excessive and underage drinking. The moderator, panelists, and session participants will discuss state-level preemption issues and solutions that have impacted alcohol policy efforts at the governmental level. Panelists and participants will then discuss state-level policy efforts including excise tax campaigns and local level Social Host Ordinance campaigns with an emphasis on key ordinance characteristics within the preemption context. As a backdrop to the campaigns, panelists will provide an overview of our 14-month alcohol policy advocacy training program, which has been essential in building regional capacity to implement evidence-based environmental alcohol prevention strategies. Training cohort participants included representatives from law enforcement, school districts and universities, state and local health departments, community coalitions, and a variety of nonprofit organizations. Key to the success of the program from the perspective of all stakeholders was the use of local data and evidence-based strategies to guide work in each community, as well as the transition from more general training to training to support specific strategy implementation consistent with the needs and progress of participating communities. This session provides a forum for panel members and participants to discuss replicable strategies relevant for communities committed to alcohol policy and environmental change at local and state levels.

C-18 TOOLS FOR ADVOCACY AND FRAMING

Studio D
Description:

Development and Use of an Issue Brief as a Tool for Public Policy Change

Cassandra Greisen, MPA
Johns Hopkins Bloomberg School of Public Health 

Excessive drinking among U.S. college students continues to be a significant public health problem, and 75% of college students report obtaining their alcohol through social, rather than commercial, sources. College students report frequent excessive drinking in social settings, such as house parties. In Maryland, communities are looking to implement social host ordinances to address availability of alcohol in social settings. Social host laws hold individuals who control the property accountable for drinking that occurs there. NIAAA’s college Alcohol Interventions Matrix (AIM) rates social host laws as being of moderate effectiveness with a research basis. The concept of an issue brief is part of a 10-step model of how communities can understand and influence policy. The issue brief is a translational research tool for public policy change in the interest of public health. It includes the results of informal discussions and interviews with students, campus administrators, community members, and local law enforcement officials, and data gathered through the use of surveys and other assessments. This research is used to communicate the current problem and the need to adopt the social host ordinance outlined, serving as a catalyst for public policy change. Barriers and challenges to the development of an issue brief will be discussed.

 

Using Social Media to Break Up the Party: Reducing Underage Drinking with a Comprehensive Approach

Brian Lemons
Texans Standing Tall 

Texans Standing Tall (TST) is using innovative technology to work with coalitions and law enforcement to advance local efforts to reduce underage drinking. Data show that youth obtain alcohol primarily through social settings such as parties, friends, and adult providers. In an effort to decrease social access, TST partners with SnapTrends to identify and collect social media posts about underage drinking parties in target communities. By identifying these posts, coalitions and law enforcement can locate where underage drinking parties are occurring and better target resources. Additionally, by monitoring social media posts for certain keywords, qualitative and quantitative data can be collected about the issue in each community. This data can then be used in conjunction with traditional data sources to create a local issue brief on the community problem, which is instrumental in creating local policy change. TST is currently utilizing SnapTrends data to enhance the issue briefs of several coalitions pursuing a social host ordinance, which has yet to be enacted in a community in Texas. Participants will learn the value of using social media and other technology to identify and share community attitudes about underage drinking. In addition, participants will see examples of successful partnerships between community coalitions and their local law enforcement made possible by the collaborative use of SnapTrends. Ideas for further opportunities for collaboration among prevention partners will be discussed. 

 

Environmental Scans as Tools for Reducing Excessive Drinking

Jeff Graham, PhD
Frostburg State University

Pamela Trangenstein, MPH
Johns Hopkins Bloomberg School of Public Health 

Numerous analyses of college drinking, including NIAAA’s new Alcohol Intervention Matrix as well as peer-reviewed and independently published books and reports, have recommended environmental strategies as among the most effective interventions. Translating these recommendations into practice requires efficient tools for environmental assessment and identification of appropriate strategies. Through a literature review and key informant interviews, existing environmental scanning instruments were identified, collected, and analyzed on two key criteria: environmental elements that research has indicated are significant points of intervention, and for which there are strategies reasonably within reach of campus-community partnerships. From existing scans and college surveys, nine environmental scanning tools were developed and implemented on mobile platforms. Teams from individual campuses were trained in the use of the scans and chose at least two to implement on each campus. Scans encompassed on-campus environments as well as on- and off-sale environments off-campus; they also included tailgating, off-campus parties, and other locations where research has found high-risk college drinking occurs. Analysis of scanning data informed the identification of next steps in environmental interventions on and off campus. Community-based data collection, in the form of environmental scans, can play a significant role in calling attention to and developing strategies for influencing environmental risk factors for excessive drinking on college campuses.

 

Alcohol in All Policies: The Case of Mainstreaming Alcohol Policy in Global Women’s Rights and Gender Equality Political Processes

Kristina Sperkova, MA
IOGT International 

One of the main focus areas of global political processes to advance women’s rights and promote gender equality is the need to reduce and prevent gender-based violence. This presentation starts with a comprehensive review of the political discussions within the women’s rights community. The 1995 Beijing Declaration and Platform for Action have provided momentum and consensus among the global community over the last 20 years. The Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) forms the bedrock for these processes, as it is an international treaty adopted in 1979 by the United Nations General Assembly. CEDAW can be regarded as the international bill of rights for women. The presentation will provide a comprehensive and concise overview of the alcohol-related harm burdening women and girls, especially gender-based violence, and will provide an outline of the latest state-of-play with regard to independent evidence on how alcohol policy measures impact the prevalence of gender-based violence. The hypothesis is that there are numerous entry points and relevant windows of opportunity to mainstream alcohol policy into the political processes for the advancement of women’s rights. To explore the validity of the hypothesis, we will analyze the aforementioned processes and documents and assess the viability of effectively mainstreaming alcohol policy measures for promoting gender equality. 

C-19 BRANDED: KIDS IN THE CROSSHAIRS

Studio B
Description:

Kids Drink Brands: Understanding the Association Between the Branded Advertising Kids See and Underage Drinking

Craig Ross, PhD
Fiorente Media, Inc. 

This workshop session will review the history of published research examining the influence of alcohol advertising on underage drinking and present new insights derived from studies that use data on advertising placements for specific brands and consumption of those same brands by underage drinkers. We will present models that examine individual youth exposure to brand-specific alcohol advertising and individual consumption of alcohol brands; multiple models of population-level brand advertising exposure and brand consumption prevalences among the population of underage drinkers; models of factors that influence underage drinkers’ brand choices; and sex-specific models of branded alcoholic beverage consumption. The implications of these research insights for alcohol policy will be discussed.

 

Brands Matter: The Contribution of Brand-Specific Alcohol Research to Alcohol Epidemiology and Prevention

Michael Siegel, PhD
Boston University School of Public Health

This workshop session will explore the development, implementation, results, and implications of an initiative to create a new field of brand-specific alcohol research. The panelist will describe the methodology and results from the Alcohol Brand Research among Underage Drinkers (ABRAND) project, a four-year NIAAA-funded investigation of patterns of alcohol brand use among underage drinkers in the United States and the relationship between brand-specific advertising exposure and brand-specific alcohol consumption among youth drinkers. Data for the project came from two sources: (1) a national internet-based survey of 1,031 underage drinkers, which ascertained the past 30-day consumption of 898 different alcohol brands; and (2) Nielsen data on brand-specific youth advertising exposure on national television programs and in magazines. The session will summarize findings in four areas: (a) the descriptive epidemiology of youth alcohol brand use; (b) factors that influence youth brand choices; (c) the relationship between youth brand preferences and brand promotion in social media; and (d) the relationship between youth exposure to brand-specific alcohol advertising and brand preferences as well as quantity of alcohol consumption. The implications of these findings for future alcohol research, practice, and policy will be discussed. 

C-20 POPULATION-LEVEL APPROACHES TO PREVENTING FETAL ALCOHOL SPECTRUM DISORDER

Studio A
Presenters:

Robert Pezzolesi, Moderator

Description:

Fetal Alcohol Spectrum Disorders: Piloting Strategies for Policy Change

Jamie McCarville
Wisconsin Bureau of Prevention, Treatment and Recovery 

Lindsey Peterson
University of Wisconsin 

The adverse effects of alcohol consumption during pregnancy have been widely reported and represent a leading preventable cause of physical and cognitive birth defects in the United States. Fetal alcohol spectrum disorders (FASD) represent the range of lifelong effects that can occur including cognitive, behavioral, and/or social deficits. Despite continuing awareness and education, a significant number of women continue to drink alcohol during pregnancy. Total rates of FASD in the United States have been estimated at 24 to 48 per 1,000 children, or 2.4% to 4.8% (May et al., 2014). Within the juvenile justice system, the prevalence is estimated at 23% for all fetal alcohol spectrum disorders (Fast et al., 1999). This workshop will provide an overview of fetal alcohol spectrum disorders, and present an innovative pilot program that is implementing screening for FASD at the point of intake, evidence-based interventions, and modified treatment programs for youth at risk of an FASD. The collaboration is building on relationships being developed between local jurisdictions, state agencies, and the University of Wisconsin. Recommendations for community-level public policies and prevention initiatives to reduce alcohol-related risk will be discussed.

 

Fetal Alcohol Spectrum Disorders: Prospects for Population-Level Prevention

Jennifer Faringer 
DePaul’s NCADD-Rochester Area 

Prenatal alcohol exposure (PAE) is the leading preventable cause of birth defects and intellectual and neurocognitive disabilities, and alcohol is the most damaging drug of abuse with respect to neurobehavioral developmental consequences.

These consequences—and the reality that 7% of women of childbearing age are at risk of an alcohol-exposed pregnancy (with 3 in 4 women trying to get pregnant reporting drinking alcohol) —points to the need for what the CDC has termed a preconceptional approach to FASD prevention. Such an approach includes the reduction of binge drinking among women of child-bearing age. 

Accordingly, this session will examine the need for—and prospects of—integrating the population-level, universal prevention of alcohol problems with selective and indicated FASD prevention efforts.

4:00 – 5:30pm Plenary Sessions

PLENARY 3—CODES, KIDS AND COUNTER-ADS: BATTLING ALCOHOL MARKETING’S CULTURE OF ILL HEALTH

Salon 4
Presenters:

Tom Babor, PhD
University of Connecticut

Vicki Hebert
Haley Demers
Hannah Martuscello
Dover Youth to Youth

David Jernigan, PhD – Session Chair
Johns Hopkins Bloomberg School of Public Health

PLENARY 4—ALCOHOL’S HARMS: TACKLING THE “INTRACTABLE"

Salon 5-7
Presenters:

Dallas Pettigrew, MSW
Eastern Band of Cherokee Indians

Amelia Arria, PhD
University of Maryland

Justin Nordhorn
Washington State Liquor and Cannabis Board

Rebecca Ramirez, MPH – Session Chair
National Liquor Law Enforcement Association

April 8th
7:30 – 9:00am Poster Presentations/Continental Breakfast
Pre-Function Area
Description:

P-17 Alcohol Consumption and Increased Risk of Violent Injury for Older Adults

Priscilla Martinez, PhD
UC Berkeley/Alcohol Research Group

Alcohol use is a well-known risk factor for injury. However, information is needed about alcohol drinking patterns and injury among older adults in emerging economies as this population continues to grow. This poster will present and discuss findings from a study to examine the influence of drinking patterns on injury among older adults. We used data from Wave I of the Study on Global AGEing and Adult Health (SAGE) conducted in six emerging economies: China, Ghana, India, Mexico, Russia and South Africa. SAGE contains data from more than 37,000 adults aged 50 and older. We investigated past year reported injuries from falls, traffic accidents, and being hit or stabbed. We defined drinking patterns as lifetime abstinence, ever but not past week use, past-week low risk and past-week high-risk use. For women, being a high-risk drinker increased the odds of being hit or stabbed, whereas for men, all levels of drinking (vs. lifetime abstinence) were associated with an increased risk of being hit or stabbed. Associations of high-risk drinking with being hit or stabbed were stronger among women than among men. There were no associations of drinking with falls or traffic accidents in this sample. We will discuss these findings in light of the growing presence of alcohol advertising in low and middle income countries, and the potential for policy initiatives to develop interventions to reduce the risk of violence among heavy drinking older adults, especially women.

P-18 Alcohol Policies and Youth Marijuana Use in the United States

Ziming Xuan, ScD, SM, MA
Boston University School of Public Health

Tim Naimi, MD, MPH
Boston Medical Center

Alcohol and marijuana are the most commonly used substances among youth in the U.S.  Studies are mixed about whether alcohol and marijuana are complements or substitutes, and the relationship between alcohol policies and marijuana use is unclear.  The Alcohol Policy Scale (APS), developed by our research team, was used to characterize the alcohol policy environment. Stronger alcohol policy environments (i.e., higher APS scores) are associated with less youth drinking.  Youth drinking and marijuana outcomes were assessed using state-level biennial YRBS surveys from 1999-2013.  We controlled for marijuana policies using a new measure that incorporated multiple policies and provisions related to decriminalization and medical use, and compared this to a binary measure (0/1) based on the presence of medical marijuana policies. A 10 percentage point increase of the Marijuana Policy Score in 2011 was associated with reduced odds of youth marijuana use in 2013 (AOR=0.93, 95% CI: 0.90, 0.97); the r-square for the comprehensive measure was larger than that for the binary measure.  Overall, 21.6% of high school youth had past-30 day marijuana use, including 7.1% of non-drinkers and 43.0% of current drinkers.  Among alcohol drinkers, a 10% absolute increase in the APS score was associated with a 5% increase in the odds of marijuana use (AOR = 1.05, 95% CI 1.01, 1.09); among non-drinkers there was no significant association.  For drinkers the associations between APS and marijuana use were significant among males, non-Hispanic whites, and non-smokers. Among drinkers, stronger alcohol policies are associated with increased marijuana use.

P-19 Can Regulating Malt Liquor Sales Reduce Crime?

Patricia McKee, MPP
University of Minnesota

We investigated retail malt liquor sales restrictions to improve our understanding of the role that local government alcohol policies play in reducing alcohol-related crime in urban neighborhoods in the United States.  We used a rigorous interrupted time series design with comparison areas to examine monthly crime rates in the three years before and after malt liquor policy adoption. The policies prohibited the sale of large (16 to 70 ounce), single containers of high-alcohol malt liquor in off-premise outlets (e.g., liquor stores, grocery stores, and convenience stores). The policies included operating restrictions placed on individual liquor stores in Minneapolis, Minnesota (n=6), and city ordinances targeting all stores within full or partial wards in Washington, D.C. (n=6). We controlled for crime rates in similar areas without policies. We selected comparison areas in Minneapolis based on alcohol outlet density, demographics, store type, and neighborhood characteristics. We measured neighborhood characteristics by conducting virtual audits using Google Street View.  Adoption of malt liquor sales restrictions was associated with patterns of reduced crime around liquor stores in Minneapolis and in Washington, D.C. study areas. Although not always statistically significant, pre- to post differences in assaults, disorderly conduct, and vandalism were generally in the hypothesized direction. Evidence of the effectiveness of local alcohol-control efforts can inform future community efforts to protect local residents from alcohol-related harms. Our results provide evidence that malt liquor sales restrictions, even relatively weak ones, may have an effect on a range of crimes.                                                                                                                                                                            

P-20 Catching Problems Upstream: Earlier Screening and Brief Motivational Interviewing

Nancy Pryor
Texans Standing Tall

This poster presentation will introduce a new innovative way of understanding how Screening and Brief Intervention (SBI) can be used as a primary prevention tool to proactively reduce underage drinking, binge drinking, and negative consequences on college campuses outside of a healthcare or judicial settings before an alcohol-related injury or violation has occurred. SBI for risky alcohol use is an evidence-based approach to deliver early intervention to individuals at risk for alcohol-related problems. Texans Standing Tall has partnered with colleges and universities to implement SBI as a primary prevention tool for all students. The presentation will describe how campuses can implement SBI proactively outside of the campus judicial or healthcare setting. By implementing SBI in this way, all students participating have an opportunity to discuss their alcohol consumption, potential risks associated with their drinking habits, and opportunities for change.    Implementing SBI as a prevention tool requires minimal resources and does not require trained counselors or a large existing prevention infrastructure, making it a low-cost, high-return option for campuses. The presenters will describe Texans Standing Tall’s process for implementing and evaluating this approach to SBI at four-year and two-year colleges and universities. After this session, participants will understand how this NIAAA Tier 1 strategy can be implemented simply and successfully.  

P-21 Changes in Alcohol and Spirits Consumption in Washington following the 2012 Spirits Privatization

Edwina Williams, MPH
Alcohol Research Group

Washington Initiative 1183 ended the state monopoly on spirit sales in June 2012 resulting in the removal of several distribution and pricing regulations, and allowed the sale of spirits at stores with 10,000 square feet or more. This has resulted in a nearly five times increase in off-premise outlet density for spirits.  Changes in individual drinking patterns were evaluated through repeated representative cross-sectional surveys. Using random-digit dialing, past month alcohol and spirits consumption (quantity and frequency) was assessed among Washington residents; consumption before privatization was retrospectively assessed. Statistical analyses utilized t-test to compare mean consumption before and after privatization; and multiple multivariable regression models were developed to predict characteristics associated with increases or decreases in consumption. Results revealed a non-significant increase in alcohol consumption of 10.8 drinks pre-privatization to 11.0 drinks post-privatization; and a significant (P < .05) decrease in spirits consumption of 5.3 drinks pre-privatization and 3.8 drinks post-privatization. Among current drinkers, men were significantly (P< .05) more likely to consume more alcohol post-privatization compared to women. These findings indicate there has been a decline in spirits consumption, and men are consuming more alcohol products such as beer since privatization.

P-22 Early Life Adversity and Marijuana Use among Caregivers are Associated with Children’s Exposure to Alcohol Harms in the 2015 National Alcohol Survey

Lauren Kaplan, PhD
UC Berkeley/Alcohol Research Group

Despite recent United States attention to alcohol’s harms to others, little is known about children’s exposure to such harms. We examined associations of caregiver’s early life adversity (ELA) (family alcohol history, socioeconomic disadvantage and physical/sexual abuse by age 18) and past year marijuana use with children’s harm exposure. We expected that ELA and marijuana use would increase likelihood of children’s exposure to alcohol harms. Using the 2015 National Alcohol Survey (N~5,600), we assessed potential exposure of children to alcohol harm defined by (a) family/marital and financial harms attributed to partners/spouses drinking, (b) caregiver’s own heavy drinking, and (c) harms due to caregiver’s drinking (heated argument, fight, angering spouse, spouse threatened to leave, interference with taking care of home/family). A composite measure of children’s alcohol harm exposure demonstrated good reliability (alpha=0.70). Weighted linear regression models tested hypotheses, adjusting for numerous personal characteristics among caregivers of at least one child. ELA was positively associated with children’s harm exposure (p<.001). When demographic controls were added, ELA retained its significance (p<.001). Additionally, caregivers’ children showed elevated exposure when caregivers were younger, lacking high school education and indicated early drinking onset. When marijuana use was included, both marijuana and ELA were associated with children’s alcohol exposure. New data indicate that family histories of alcohol problems and violence can perpetuate such harms across generations. Interventions adding focus on coping with ELA could help reduce alcohol’s harm to children. Regulatory policies and prevention strategies for marijuana should consider parental patterns of use involving alcohol.

P-23 Effects of the 2011 Maryland Alcohol Tax Increase on Alcohol-Impaired Drivers Involved in Fatal Crashes

Marie-Claude LaVoie, MPH
University of Maryland

Traffic crashes claim the lives of 500 persons annually in Maryland (MD). Approximately 30% of these fatalities are associated with alcohol-impaired driving. A variety of alcohol control policies have been shown to reduce alcohol-impaired driving, including increasing alcohol taxes. In 2011, policy makers in MD raised the alcohol sales tax. This study evaluated the effects of the 2011 increase MD alcohol sales tax on the rate of alcohol-impaired drivers who were involved in a fatal motor vehicle crash between 2001 and 2013. We obtained data on all MD fatal motor vehicle crashes from the Fatality Analysis Reporting System. We used generalized estimating equations with a negative binomial distribution. Variables were retained in the final multivariable model if they were significant at the p<0.05 level, and/or if they had been identified as important predictors. In MD between January 2001 and December 2013, a total of 6,967 crashes involving 10,777 drivers occurred. In our unadjusted analysis, there was a significant 15% reduction in the rate of alcohol-impaired drivers after the introduction of the alcohol tax in comparison to the pre-intervention. This reduction did not remain once we adjusted for linear trend, seasonality, and unemployment. There was a non-significant 3% increase in the rate of alcohol-impaired drivers (RR: 1.03, 95%CI: 0.95-1.11) after the introduction of the alcohol tax in comparison to before. There was a significant downward trend across the study period for three outcomes. The price increase might have been insufficient to lead to a significant reduction in alcohol-impaired driving.

P-24 Enhanced Enforcement of the Minimum Legal Drinking Age in New York City

Hillary Kunins, MD, MPH
New York City Department of Health and Mental Hygiene

Enforcement of laws that prohibit sales to minors reduces underage drinking.  The New York State Liquor Authority (SLA) conducts approximately 1,000, mostly complaint driven, compliance checks annually, statewide. In NYC, 27% of 12-20 year olds report past-30 day alcohol consumption and 21% of New York City high schools students reporting purchasing alcohol in stores. To determine the prevalence of underage sales in NYC and the feasibility of a geographic approach, the NYC Department of Health and Mental Hygiene (DOHMH) collaborated with the SLA to enhance compliance checks.  SLA staff generated lists of off-premise licensed premises within each of the 76 police precincts in NYC and selected target areas for compliance checks by concentration of licensed establishments. At each store, an undercover investigator entered first, to witness the transaction. Then, the decoy entered the store and attempted to purchase an alcoholic beverage. The SLA reported to DOHMH the disposition of each compliance check, including whether ID was checked and sale completed. Between April and September 2014, the SLA conducted 1039 compliance checks, reaching approximately 10% of off-premises licensees throughout NYC. 58% of stores sold to underage decoys, including 60% of wine/liquor stores and 56% of grocery stores.  Stores with recent citations for selling to minors were less likely to sell to minors (43%) than stores with no recent citations (60%).  Alcohol sales to underage New Yorkers are frequent. Evaluation of the impact of these efforts on underage alcohol sales and prevalence of underage alcohol consumption is needed. 

P-25 Impact of Marketing Restrictions on the Prevalence of Youth Drinking, Adult Drinking, and Alcohol Consequences

Jonathan Noel, MPH
University of Connecticut School of Medicine

Alcohol marketing activities have been linked with increased alcohol consumption and increased alcohol initiation among youth.  To counteract these effects, countries have instituted marketing restrictions, ranging from complete bans to self-regulation.  The aim of this study is to determine if increased marketing restrictions were associated with decreased alcohol use and alcohol consequences.  Methods: Country-level data on marketing restrictions, other alcohol-related policies, alcohol use, and alcohol consequences was collected from the World Health Organization’s Global Health Observatory Database.  Country development was controlled for using the United Nation’s Human Development Index (HDI).  Data was analyzed using structural equation modeling.  The final model utilized seven latent variables: alcohol consequences, adult drinking, youth drinking, marketing restrictions, taxes, alcohol legal purchase age, and HDI. Preliminary analysis indicates that there are significant negative correlations between marketing restrictions and alcohol consequences (Ψ=-0.321, p<0.001), adult drinking (Ψ =-0.244; p<0.001), and youth drinking (Ψ =-0.24; p=0.001).  Model fit was considered acceptable (χ2(153,,136)=358.43; CFI=0.940; NNFI=0.926; SRMR=0.084; RMSEA[90%CI]=0.106 [0.092-0.119]).  Strong country-level marketing restrictions, principally through complete bans, may significantly reduce the prevalence of youth drinking, adult drinking, and alcohol consequences.  Conversely, minimal marketing restrictions, such as self-regulation or weak co-regulation may lead to greater alcohol use and result in a higher prevalence of alcohol-related consequences.  However, these results must be interpreted cautiously until confounders, such as country religious preferences, are included.  Muslim countries, in particular, may have very low rates of alcohol use while also promulgating few to no alcohol regulations.    

P-26 Just One More Drink Can Hurt: Development and Implementation of a Citywide Media Campaign to Reduce Binge Drinking in New York City

Hillary Kunins, MD, MPH
New York City Department of Health and Mental Hygiene

While prominent media campaigns contributed to reductions in drunk driving, the impact of media campaigns on alcohol consumption is not well documented.  A 2010 NYC Department of Health and Mental Hygiene (DOHMH) public awareness campaign produced high recall (52%) but only 35% of viewers reported taking action as a result. DOHMH developed the “Just One More Drink Can Hurt” campaign in 2014 emphasizing preventing a friend’s excessive drinking.  Campaign development included ideas generated within DOHMH, pitches from media firms, and two rounds of focus groups. The final ads included the call to action: “Keep your friends from hurting themselves or others. Cut them off before they’ve had too much.”  The campaign ran in subways, alcohol outlets, in periodicals, and on radio and digital platforms. The campaign was evaluated using an online survey completed by a convenience sample selected to be representative of NYC adults.  The survey included respondents’ demographic characteristics, drinking patterns, recall of the campaign and actions taken or anticipated as a result of exposure to the campaign.  Half of the 808 respondents recognized the campaign, most often online ads (31%) or the subway (18%).  Seventy-five percent reported taking action as a result of this campaign: 37% taking a taxi or car service and 26% cutting off a friend who was drinking too much. Younger respondents and binge drinkers were most likely to recall the campaign.  Findings indicate that delivering a clear call to action to bystanders can prompt action and inform future binge-drinking campaigns.

P-27 New Opportunities for Prevention: SBIRT Across Diverse Settings

Mary Gonzalez, BS, RN
South Carolina Department of Alcohol and Other Drug Abuse Services

Beatrice Koon, LMSW
South Carolina Department of Alcohol and Other Drug Abuse Services

As healthcare reform and other policy changes occur throughout the country, prevention professionals may find themselves considering how their skills and expertise can be integrated into various sectors and systems (e.g., primary health care, schools).  Two states will describe how they collaborate with community partners to plan, implement, and evaluate SBIRT practices across adult and youth populations.  Successful SBIRT processes require knowledge of implementation science including the importance of fidelity to the process, high-quality services, and adequate dosage and reach to various types of populations. Certainly, prevention practitioners have expertise in models of adoption and dissemination in their work to successfully integrate prevention initiatives into schools and community settings.   A model for how SBIRT addresses a critical system and infrastructure gap will be discussed with ideas presented for how prevention practitioners may take a more active role in this practice. This is particularly relevant in all health care systems as SBIRT can normalize the conversation about alcohol and drug use and reduce stigma so it can be prevented and treated like any other health condition.   The session will highlight how SBIRT can prevent and reduce a variety of substance-use related consequences as well as some ideas as to how prevention science can best inform implementation of new practices such as SBIRT and other selected and indicated prevention programs.  The session will conclude with an audience discussion of how prevention may become more closely aligned wit SBIRT including roles for screening, and developing brief interventions with populations across the lifespan.    

P-28 New Mexico Alcohol Excise Tax Campaign

Peter DeBenedittis, PhD
New Mexico Alcohol Taxes Save Lives and Money Coalition

Maire Claire Voorhees, MA
Santa Fe Prevention Alliance

New Mexicans are working to raise alcohol excise taxes 25¢ per drink. This workshop will describe how we adapted the DeMarco Plan to work in a rural state that suffers the highest alcohol-related death rate in America. We'll explain how we built our coalition and funded its efforts. Our volunteer coalition is now garnering the attention of both the media and politicians. This case study will be useful for activists to learn how they can have an impact even when unfunded and understaffed. We'll address the challenges we've faced in building the coalition and the creative solutions we've employed to overcome them. 

P-29 Opinions on the Privatization of Liquor Sales in Washington State: Did Voters Change Their Minds?

Meenakshi Subbaraman, PhD
Alcohol Research Group

In November 2011, voters in Washington state approved Initiative 1183 (I-1183), which ended the government monopoly on spirits sales. The goal of this study was to examine the relationship between demographics, spirits use, and voting outcomes, as well as how these variables relate to wanting to change one’s vote. Method: The sample consists of 1,202 adults recruited through Random Digit Dial (RDD) methods and reached via telephone between January and April 2014.  Bivariate tests and multivariable regressions were used for statistical analyses. Results: Most notably, those who voted Yes on I-1183 had almost eight times the odds of wanting to change their votes compared to those who voted No. Older age, higher education, and being a spirits buyer/drinker were significantly associated with voting (vs. not voting). A larger proportion of those who reported that I-1183 has been a success (vs. not) were spirits drinkers/non-buyers. Those who reported that I-1183 has not been a success were more likely to report that the number of liquor stores should be decreased. Opinions on taxes were not related to wanting to change one’s vote or thinking that I-1183 has been a success. Conclusions: The result of the I-1183 election likely would have been different if voters could know their future opinions of the actual situation resulting from privatization. This finding is particularly important for states considering privatization. Results also indicate that spirits drinkers/buyers may be more invested in privatization than non-buyers, and that the increased availability of liquor may affect opinions regarding privatization.

P-30 SIMDWI – Predicting the Impact of Laws on Alcohol-Related Crashes Among Underage Drinkers

Michael Scherer, PhD
Pacific Institute for Research and Evaluation

Supported by a grant from the Office of Juvenile Justice and Delinquency Prevention (OJJDP), and developed as a tool for researchers, advocates, and policy makers, Simulated Driving While Intoxicated (SIMDWI) is a model aimed at predicting the impact of implementing and/or altering alcohol-related community and state laws, policies, and programs targeting underage drinking and driving.   Based on historical data, the model allows users to see how their modified laws may impact projected rates of fatal and non-fatal alcohol-related crashes impact males and females both in total or broken down by age groups.  SIMDWI is a no-cost Excel-based modeling tool that allows users to simulate how changing existing laws or implementing new laws, policies, and programs in their jurisdiction may impact underage alcohol-related crashes (fatal and non-fatal) among teens aged 15 to 20 years old over the next 10 years. The idea behind SIMDWI is that it will serve as a tool for decision makers in large or small communities to estimate the impact that the adoption of alternative policies would have on underage drinking and driving crashes, given the current status of the problem in their community.  Though anyone may find SIMDWI to be informative, the program was designed specifically as a tool for researchers, advocates, and policy makers to aid in determining what laws and policies may be most beneficial in their jurisdiction. 

P-31 The Merits of Adopting Administrative Penalties for Impaired Drivers with BACs from .05 to .07 g/dL

Jim Fell, MS
National Opinion Research Center

In May, 2013, the National Transportation Safety Board (NTSB), an independent federal agency dedicated to investigating transportation safety issues, publicized a report recommending among other measures that states lower the illegal blood alcohol concentration (BAC) for driving from 0.08 to 0.05 grams per deciliter (g/dL). There is sound rationale and strong evidence that this measure will reduce alcohol-impaired driving and save lives. Most industrialized countries around the world have enacted a .05 BAC limit. To date, no state has adopted this criminal per se statute in the United States.  However, in Canada, except for Quebec, all Canadian provinces have enacted administrative laws that provide penalties for drivers with BACs ranging from .05 to .07 g/dL. Canada has a federal criminal per se law set at .08 g/dL similar to the United States. These administrative laws vary by province, but the penalties for driving at .05-.07 BAC are loss of the offender’s drivers’ license, a fine and possibly impoundment of the vehicle. In British Columbia this administrative law is called “Immediate Roadside Prohibition” and calls for a 3-day license suspension, a $200 fine and possibly a 3-day vehicle impoundment for a first offense. Studies show that this administrative .05 BAC limit is effective.  Take-away information:  (1) The risk of a crash is significant at .05 BAC, (2) adopting administrative .05 laws has been very effective in Canada., (3) many countries in Europe have administrative penalties for offenders with BACs=.05 to .07, not criminal penalties, and (4) further progress is needed in reducing alcohol-impaired driving fatalities and .05 administrative laws have substantial potential to be effective. 

P-32 Trends of Mortality Due to Alcohol Use in Brazil, 2000-2013

Isis Machado, MN
Pan American Health Organization

The aim of this study was to describe the evolution of mortality due to diseases and damage fully attributable to alcohol in Brazil. Specific and standardized mortality rates due to underlying or associated causes fully attributable to alcohol use were described by sex, age group, ethnicity/skin color, region of the country and Federative Unit of residence between 2000 and 2013. Data on deaths was obtained from the Ministry of Health’s Mortality Information System. Deaths with underlying and/or associated causes fully attributable to alcohol accounted for 2.5% of total deaths in the period. There were more deaths among men (3.8%) than women (0.7%). In both sexes there was a higher proportion of deaths in the 40-49 age group (27.9%) and Black/Brown skin color (48.8%). Alcoholic liver disease accounted for 54.6% of deaths with underlying cause fully attributable to alcohol. There has been an upward trend in specific mortality rates due to underlying and/or associated causes fully attributable to alcohol in age groups above 50-59 years, especially in people with brown skin color. Rates increased most in Brazil’s Northeast region in the period 2000-2013. Therefore, alcohol is a significant cause of premature death in Brazil, especially among men and people of Black/Brown skin color.

P-33 State-level Policies, Enforcement, and Alcohol Use in the United States

Kathleen Lenk, MPH
University of Minnesota

We examined the relationships between U.S. state-level alcohol policies, enforcement of those policies, and alcohol consumption. To measure alcohol policies, we developed strength measures for multiple alcohol policies from the Alcohol Policy Information System. We then grouped policies into four domains (underage use, underage provision, alcohol serving, availability) and used a clustering statistical approach to assign states to one of four classes based on the configuration of alcohol policies—weak except serving policies (6 states), average (29 states), strong for underage use (11 states), and strong overall (4 states). To measure enforcement we surveyed 1,082 local enforcement agencies regarding alcohol enforcement practices and used the same clustering technique to assign states to classes in five domains (underage use, underage provision, underage sales, drinking-driving, overservice). Based on these classes, we assigned states to an overall low (15 states), moderate (19 states), or high (16 states) enforcement group. Finally, we assessed how policy classes and enforcement groups were associated with state-levels of alcohol use (from the Behavioral Risk Factor Surveillance Survey), and whether enforcement affected the policy-consumption relationships. We found the strong underage use policy class was consistently associated with the lowest consumption, and states with low enforcement had consistently higher alcohol use than states with high enforcement. Enforcement group did not, however, affect the policy class and consumption associations. Results suggest strong alcohol policies, particularly underage use policies, may help to reduce alcohol consumption and related consequences. Implications for practice and research will be presented.

P-34 Which Underage Drinking Laws Have Been Effective in Reducing Underage Drinking Drivers in Fatal Crashes in the United States?

Jim Fell, MS
National Opinion Research Center

It is a widely maintained misperception that the minimum legal drinking age of 21 (MLDA-21) in the United States (US) is embodied in a single law and, therefore, all states have essentially the same law. In actuality, the MLDA-21 has multiple provisions targeting outlets that sell alcohol to minors; adults who provide alcohol to minors; and underage persons who purchase or attempt to purchase, possess, or consume alcohol. The Federal Government adopted legislation in 1984 that provided strong incentives—the risk of losing substantial highway construction funds—for the states to adopt a uniform minimum drinking age of 21. By 1988, each of the 50 states and the District of Columbia (DC) had passed laws that made it illegal for persons under the age of 21 to possess or purchase alcohol. In addition, all states and DC enacted laws prohibiting the furnishing or selling of alcohol to individuals under the age of 21 years. To support the core MLDA-21 laws, states have also expanded MLDA-21 laws that target youth, for example, zero tolerance (ZT) laws that provide for lower blood alcohol concentration (BAC) limits for drivers under the age of 21 years, graduated driver licensing (GDL) with nighttime driving restrictions intended to limit underage drivers’ alcohol availability and drinking and driving, and making it illegal for youth to use fake identification in order to purchase alcohol. Other MLDA-21 laws focus on affecting the behavior of those who may sell or furnish alcohol and include beer keg registration (or regulation), prohibitions on hosting underage drinking parties, and civil liability laws targeting commercial and non-commercial providers of alcohol to underage youth, among others. These laws vary considerably from state to state, and only one state has all of the 20 law components or regulations that we have documented (i.e. Utah). 

9:15 – 10:45am Concurrent Sessions (C 21-25)

C-21 Enforcement Matters

Studio C
Description:

Effects of Enforcement Intensity Measures on Drinking and Driving

Jim Fell, MS
National Opinion Research Center (NORC) 

Research measuring levels of enforcement has investigated whether increases in police activities (e.g., checkpoints, driving-while-intoxicated [DWI] special patrols) above some baseline level are associated with reduced crashes and fatalities. Little research, however, has attempted to quantitatively measure enforcement efforts and relate different enforcement levels to specific levels of the prevalence of alcohol-impaired driving. This session will report on a study that investigated the effects of law-enforcement intensity in a sample of 30 communities on the rate of drinking and driving on the roadways and on crashes involving a drinking driver. The panelist and colleagues analyzed the influence of six different enforcement measures: (1) specific deterrence—annual number of driving-under-the-influence (DUI) arrests per capita; (2) specific deterrence—annual number of saturation patrols per capita; (3) general deterrence—frequency of sobriety checkpoint operations; (4) highly visible traffic enforcement—annual number of traffic stops per capita; (5) enforcement presence—number of sworn officers per capita; and (6) overall traffic enforcement—the number of other traffic enforcement citations per capita (i.e., seat belt citations, speeding tickets, and other moving violations and warnings) in each community. Results indicated that a 10% increase in the DUI arrest rate is associated with a 1% reduction in the drinking driver crash rate. Similar results were obtained for an increase in the number of sworn officers per 10,000 driving-age population. The overall findings in this study may help law enforcement agencies around the country adjust their traffic enforcement intensity in order to reduce impaired driving in their community. 

 

Source Investigation, Underage Drinking, and High Visibility Enforcement: Denying Alcohol Access in Greenville County, South Carolina

Michael George
Pacific Institute for Research and Evaluation (PIRE)

Matt Smith
Greenville County Sheriff’s Office 

The purpose of the presentation is to discuss community efforts during a NHTSA demonstration grant led by the Greenville County (SC) EUDL Coalition. High visibility enforcement (HVE) campaigns have demonstrated effectiveness in the areas of increased seat belt usage and decreased alcohol-related crashes. The HVE approach combines multiple waves of strict enforcement with strong media messages occurring at each enforcement wave. HVE shows promise to the issues of underage drinking and adult provision of alcohol to youth. Source investigation is an effective enforcement strategy in decreasing alcohol access to underage drinkers. The research plan merged source investigation with HVE; the six enforcement and education waves occurred during the 2012–2013 project period. Pre- and post-surveys conducted at community locations gained information about underage drinking patterns. The project evaluation consultant utilized a pre-post evaluation design; however, coalition members performed further evaluation utilizing community-specific monthly time-series measures after additional data became available in 2014. The speakers will discuss evaluation designs and outcomes during the presentation, affording a more robust conversation concerning the lessons learned during the project. The project results suggest the merged HVE/source investigation approach holds significant promise to reducing underage drinking harms found in communities.


Place of Last Drink: Identifying and Addressing Over-service of Alcohol

Chief Shane Mikkelson
Osseo Police Department

Sheila Nesbitt
Partnership for Change 

Place of Last Drink (POLD) is an initiative to efficiently identify patterns of alcohol use and allows departments to concentrate education and enforcement efforts toward areas of concern. Over-service of alcohol to bar patrons and the challenges of addressing it have been well documented by Lenk et al. (2006 and 2014) and Toomey et al. (2004 and 2013). To address this problem, the POLD Task Force created systems change and policies among law enforcement departments to identify the location where a person last consumed alcohol when he or she was involved in an alcohol-related incident such as DWI, assault, or other offense. This award-winning initiative has been recognized nationally as an innovative policy strategy that includes the development of an online data collection system. The effort involves sharing information between participating departments and collects last drink information at the time of the incident rather than later in the adjudication process. The system launched in February 2014, and as of early November 2015, there were 2,912 incident entries from 20 participating departments. Several retailers have been notified about problematic trends with law enforcement departments and city councils requiring changes to serving practices. Through identifying problem trends, law enforcement has been able to direct patrols and work with retailers to address serving practices and eventually reduce alcohol-related incidents in the community. The routine collection of last drink information also aids victims of impaired crashes to more easily pursue civil remedies through dram shop liability. This workshop will present an overview of POLD, its history, and outcomes.

C-22 GLOBAL REACH: FRAMING INITIATIVES ON ALCOHOL MARKETING

Studio D
Description:
Questionable Company: Big Alcohol and the Corporate Consumption Complex
Maik Duennbier

IOGT International

The 21st century is so far the era of the radical consumerist society, driven by an ideology of personal choice as liberty and the hyper-reality created by corporate communication. The first hypothesis to be explored is that the corporate consumption complex, including the alcohol industry, is playing a decisive role in this development. The discussion will analyze the corporate consumption complex in terms of its web of relations and networks between and among the six industries that form it while tracing how and to what extent the corporate consumption complex is fueling this radical, individualistic, and often infantile consumerist society. This analysis sets the stage for an in-depth exploration of the role of the alcohol industry within the corporate consumption complex, addressing the leading research question: Just how dominant is the alcohol industry in setting the agenda, determining the tactics and tools, and in shaping the world we live in? To answer this question, research will be presented on the alcohol industry’s ties with other industries of the corporate consumption complex including senior leadership relationships, board representation, and cooperation with PR agencies and research institutions. Additionally, the panelist will look at the tactics of the alcohol industry, from targeted marketing, aggressive lobbying, tax evasion schemes, corporate social responsibility, and self-regulation efforts. These considerations serve to provide evidence for discussing the main hypothesis: that the alcohol industry is the most destructive industry that is, at the same time, the least scrutinized.

Alcohol Cheaper than Water: Engaging the Ministry of Trade to Reduce Alcohol Use and Related Harm among Youth Using Evidence-Based Strategies

Rogers Kasirye
Uganda Youth Development Link

Monica Swahn, PhD
Georgia State University

In March 2013, a CNN study ranked Uganda eighth in the world and first on the African continent in liquor intake. Research with Georgia State University in the urban slums of Kampala demonstrates high levels of alcohol use among youth. A key issue for Uganda in addressing the problem is that the alcohol industry has targeted children and young people through the proliferation and packaging of alcohol tot packs/sachets in lowest quantities and cheap pricing. This distribution strategy makes alcohol very cheap, easy to conceal, and accessible to minors. Consequently, young people (10-24 years old) are increasingly getting hooked on alcohol, hindering their ability to attend school and to be employed. This result calls for regulations that protect children and youth from unethical advertising and marketing of alcohol as well as enforcement of the minimum legal drinking age of 18 years. Proposed areas for regulation and enforcement of alcohol production, sale, and consumption in Uganda include:

(1) short-term measures—regulating alcohol packaged in sachets and advertisements; prohibiting public sales; and regulating time of sale and selling places; and

(2) long-term measures—reviewing the law to make it more compliant with modern times and operationalizing the Alcohol Licensing Board to enforce the law; fast tracking the development of the alcohol policy in cooperation with the relevant sectors; and establishing an endowment fund (5% tax) from alcohol beverages; and engagement meetings, development of policy briefs, sharing research, development of bylaws, and public lectures. A multi- pronged strategy is key in generating political will.

Alcohol Ads on Public Transit: Can They Be Stopped?                                                                    

Bruce Livingston, MPP
Alcohol Justice

Robert Pezzolesi, MPH
New York Alcohol Policy Alliance

Diane Riibe, Moderator
U.S. Alcohol Policy Alliance

Michael Siegel, PhD
Boston University School of Public Health 

Model laws exist in San Francisco, Seattle, and Philadelphia to ban advertising on public transit. Currently 19 major transit agencies in the nation don’t allow alcohol advertising. New York City’s Public Transit and the City of Chicago still allow alcohol advertising that is viewed by millions of children every school day. Other transit agencies continually backslide, for example, a recent attempt at the DC Metro system. Success is much more difficult where state governments have primary authority, such as in New York and Massachusetts. This panel includes the researchers and advocates from throughout the country to compare notes and share strategies. A sustained effort from 2006 to 2010 in the San Francisco Bay Area drove alcohol ads off of BART and MUNI. An effort in Los Angeles from 2010 to 2015 ended with a City of Los Angeles ordinance that ends alcohol ads on city buses, benches, and bus stops. (See NoAlcoholAds.org.) Boston advocates have been mostly successful through long-term efforts, while a New York City effort has begun, highlighted at BAAFT.org. The panelists will look at the national research in Alcohol Justice’s 2013 report, “These Bus Ads Don’t Stop for Children.” Can local efforts be coordinated nationally? Are there state or federal transportation funding handles for organizing? How is the cost-benefit for the public integrated into the transit agency calculations, if at all? How can the agencies be better tracked? Can communities control alcohol ads on other public property, such as airports, train stations, and sports venues?

C-23 OUT OF THE MOUTHS OF YOUNG PEOPLE: POLICY CHANGE AND CAMPAIGNS

Studio B
Description:

Engaging Youth in Policy Change

Sarah Daniels
Ava Dobson
Izabelle Wensely
Dover Youth to Youth 

This workshop is designed as an in-depth illustration of the process of involving youth in policy change efforts. Policy change is treated broadly to include state and local legislative activities, as well as non-legislative policy change efforts aimed at schools, retailers, and other organizations. The session will provide descriptions of the procedures used to develop the knowledge base of youth advocates and the core skills youth need to participate meaningfully in policy change. A variety of examples of policy change initiatives will be used to illustrate the process. In addition, participants will be provided with resources and tools used to prepare youth to engage in these activities. Also described will be counter-advertising efforts aimed at making the public more skeptical of industry practices, creating an environment open to regulatory efforts and challenging the industry to modify advertising and promotional practices. Dover Youth to Youth is a nationally recognized youth empowerment program based in New Hampshire that uses media, education, community initiatives, and policy change to challenge the alcohol industry and promote environmental change in the community.

 

Oliver Youth Counter Ad Workshops

Becky Slogeris
MICA Center for Social Design

Miles Haley
St. Francis Academy

Rita Mattison
Behavioral Health System Baltimore 

Nia Vic
Institute of Notre Dame 

Since 2012, MICA’s Center for Social Design has partnered with Behavioral Health System Baltimore to facilitate a series of design workshops exposing Baltimore City youth to design and media literacy through first-hand experiences, relationship building, and a transfer of knowledge and skills. Collaboratively, Maryland Institute College of Art (MICA) students and Baltimore City youth have created a series of counter-ad campaigns to encourage their peers to think twice before participating in underage drinking. This workshop will showcase the Oliver Youth Counter-Ad Workshops model and will engage participants in creating their own counter-ad using the approach.

C-24 ALCOHOL'S HARMS TO OTHERS: FROM RESEARCH TO LEGISLATIVE ACTION

Studio E
Description:

Tom Greenfield, PhD
Alcohol Research Group

Norm Giesbrecht, PhD
Emeritus, CAMH, Toronto

Katherine Karriker-Jaffe, PhD
Alcohol Research Group

Robin Room, PhD
Centre for Alcohol Policy Research

In many countries, including Canada and the United States, studies are documenting the prevalence of alcohol’s harms to others (AHTO) and the impacts of particular harms to communities and families (spousal abuse and childhood neglect and trauma), including victimization by physical and sexual assaults (notably on campuses), vandalism, property damage, and workplace absenteeism/accidents. Studied longer is the role of others’ drinking in injuries and vehicular accidents, as well as fetal alcohol spectrum disorders. Victimization by other heavy drinkers cuts across ages, genders, socioeconomic status, and types of community and neighborhood. Recently, the toll of the broader range of AHTOs in terms of mental health, wellbeing, and financial costs (and even mortality) to individuals, organizations, and society is being better documented. The WHO has elevated the AHTO issue by incorporating it in the goals of the global strategy on alcohol. In this panel, the presenters will take up the implication of these AHTO findings for community mobilization, and municipal, county, state and federal legislative agenda setting and action. While the literature indicates that those victimized by other drinkers favor effective alcohol policies more than others, this is only a start. What the panel organizers envisage is a vigorous discussion among panelists and AP17 attendees to consider viable, specific steps needed to translate AHTO findings into action. What are the best strategies to heighten awareness and build electoral momentum to address alcohol’s second-hand effects? The tobacco case will be drawn upon where relevant lessons learned from related campaigns will be discussed (e.g., to confront drunk driving and more recently reduce NCDs). 

C-25 EFFECTIVE ALCOHOL POLICIES: SCANNING THE LANDSCAPE (SECTION 2)

Studio A
Description:

State Alcohol Policies and High-Risk Drinking Behaviors: Does Gender Matter?

Diana Silver, PhD, MPH
New York University, College of Global Public Health

The relationship between state laws and drinking behaviors by gender has been underexplored. The panelists will examine the relationship between state alcohol policies and two high-risk drinking behaviors (binge and heavy drinking) among adult women and men, using 2011–2013 Behavioral Risk Factor Surveillance System data. Using data from the Alcohol Policy Information System and original legal research, the panelists created an index of 12 alcohol-related evidence-based policies for each state and year, weighted for comprehensiveness. Lagged policy scores for each state/year were used as independent variables in Poisson regression models to calculate adjusted prevalence ratios for heavy drinking and binge drinking among current drinkers by gender. The panelists decompose[JD2] d gender groups by age, education level, and race to explore the relationship between state-level alcohol policies and high-risk drinking behaviors. They found a significant inverse relationship between state policy scores and both binge and heavy drinking for men, as expected. However, for women, the panelists found a significant direct relationship between policy scores and heavy drinking, and no relationship for binge drinking, controlling for state and individual level covariates, region, and year. In subgroup analyses, this direct relationship remained significant among white women, women aged 35 to 44, and women who are college-educated. In further analyses, the observed relationships between policy scores and heavy drinking persisted in states with alcohol consumption below the median for all states. In contrast, an inverse relationship between the state alcohol policy score and binge drinking was found for both sexes in states with alcohol consumption above the median.

 

Results of an Assessment Study from Ten Countries in the Americas

Blake Smith, MPH
Pan American Health Organization

While many countries have implemented policies related to alcohol consumption, these policies are not always designed to produce the most effective public health benefit. There is a need for a reliable and valid tool to measure alcohol policies, identify weak policies requiring strengthening and revision, and compare alcohol policy frameworks between countries. This session covers a Pan American Health Organization funded project to apply one such tool (Carragher et. al., Toolkit for Evaluating Alcohol Policy Stringency and Enforcement) to countries in the Americas.

11am - 12:30pm Closing Session - Alcohol Policy: The Way Forward
Salon 4
Presenters:

Maristela Monteiro, MD, PhD
Pan American Health Organization

Michael Thorn, PhD
Foundation for Alcohol Research and Education, Australia

Alex Wagenaar, PhD
University of Florida 

12:30 - 1:00pm Final Comments
Presenters:

David Jernigan, PhD
Johns Hopkins Bloomberg School of Public Health

Diane Riibe
US Alcohol Policy Alliance