Evidence-Based Prevention of Underage Drinking: An Overview

Scott CaldwellPresentation to the Dane Co. Coalition to

Reduce Alcohol Abuse

March 31, 2009

Outline for overview:

• Definitions

• Levels of focus

• Strategies

• Measures

Cultural basis for drinking (model)

Knowledge and perceptions about alcohol benefits and

consequences

Expectations for alcohol effects

General values and values related to alcohol

Drinking behavior

Decision and intention to drink or to avoid alcohol

Evaluation of importance of benefits and consequences

Source: Komo et al. (2006)

“Cultural environment” of drinking includes:

• Messages, behavior from adults

• Family, peer values

• Availability

• Social normative beliefs

• Media exposure

• Public policies

Source: Komo et al. (2006)

“Evidence-based” prevention strategies are…

• Based on a specific set of activities, the results of which can be detected and measured

• Driven by independent, replicated research• Resource intensive to develop and typically

requires a great deal of resources and coordination to implement

• Must be implemented with fidelity

Source: Schinke et al. (2002)

Levels of focus

• Policy

• Community

• Individual/families

Evidence of effectiveness, here, is based on number of studies

showing positive results.

Three levels:

1.Strong evidence

2.Moderate evidence

3.Minimal evidence

Caveat: minimal evidence does not necessary mean the strategy would not be effective

Strategies with strong evidence:

• Raising the minimum drinking age

• Alcohol taxes/prices– Over 100 studies

– 85% showed inverse correlation for tax/price and consumption (general population)

– Measures: car accidents, crime, sexual assault, medical mortality

– 10 of 13 studies with youth showed a similar correlation

Source: Wagenaar et al. (2006)

Strategies with moderate evidence:

• Server/manager training

• Advertising restrictions

• Individual level: alcohol SBIRT: Screening, Brief Intervention, and Referral for Treatment in “opportunistic” settings (e.g., primary care, schools, detention)

Source: Saltz (2006); Wagenaar et al. (2006)

Strategies with minimal evidence:

• Compliance checks• Seller/server liability• Community/public event restrictions• Happy hour restrictions• Social host liability• Marketing campaigns to correct misperceptions

(“social norms marketing”)• Increasing law enforcement• Increasing publicity about law enforcement• Student orientation (w/ parents) about alcohol policies

Source: Saltz (2006); Wagenaar et al. (2006)

What do these strategies have in common? – Two themes:

• Supply reduction – reducing availability and supply, monitoring access

• Demand reduction – increasing perception of risk for drinking; decreasing social desirability

What does not work:

• Scare tactics• Confrontational interventions• Knowledge-based education about

alcohol effects• Messages to “drink responsibly”• Self BAL administration (college

students)

Potential measures from the Dane Co. Youth Assessment:

• Alcohol consumption: past year, past month, at least one drink, and binge

• Age of initiation

• Perception of risk for alcohol

• Prevalence of related risk behavior

• Parent messages about drinking

Summary

• Several evidence-based policy, community, and person level strategies exist that can impact the cultural environment of drinking

• Some strategies have more evidence than others

• The goal is to most powerfully impact supply and demand

Presentation References:• Komro, K. A., Stigler, M. H., & Perry, C. L. (2006). Comprehensive

approaches to prevent adolescent drinking and related problems. In M. Galanter (Ed.), Alcohol problems in adolescents and young adults (pp. 207-224). New York: Spinger.

• Schinke, S., Brounstein, P., & Gardner, S. (2002). Science-based prevention programs and principles, 2002. DHHS Publication No. (SMA) 03-3764. Rockville, MD: Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration.

• Staltz, R. F. (2006). Prevention of college student drinking problems: A brief summary of strategies and degree of empirical support for them. In M. Galanter (Ed.), Alcohol problems in adolescents and young adults (pp. 255-274). New York: Spinger.

• Wagenaar, A. C., Lenk, K. M., & Toomey, T. L. (2006). Policies to reduce underage drinking: A review of recent literature. In M. Galanter (Ed.), Alcohol problems in adolescents and young adults (pp. 275-297). New York: Spinger.