1 epidemiology update spf-sig advisory council july 2013 elizabeth eustis turf, ph.d
TRANSCRIPT
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Epidemiology UpdateSPF-SIG Advisory Council
July 2013
Elizabeth Eustis Turf, Ph.D.
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Outcomes-Based Prevention
Use of data to identify high levels of a substance-related consequence – AKA Outcome
Our outcome is MVCs with drinking drivers within the 15-24 year age range
All locations identified18-24 year olds as target Change in level of outcome over time
determines success of prevention activities
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Distribution of MVCs & $$$
Baseline MVC rates were 3-year rates - 2006-2008*
Funding considered two thingsJurisdiction rates higher then state rateProportion of crashes >1%
13 Jurisdictions funded 11 Jurisdictions implementing Phase II
*Data acquired from Virginia DMV
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Virginia Updates Since 2008
Number / rate of all MVCs downward trend Rate of alcohol-related MVCs down
Dropped one-third (33%) since 2004From 19.2 to 12.9 alcohol-related MVCs per 10,000
persons 15 years of age and olderWith BAC => 0.08
Alcohol is consistently involved in 7-8% of all MVCs Any alcohol involved in >35% of fatal crashes
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Eligible Jurisdictions
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Funded Jurisdictions
13 cities/counties funded to conduct local needs assessment - determine why so many MVCs
• Albemarle
• Arlington
• Augusta
• Campbell
• Chesterfield
• Fairfax County
• Franklin County
• Hanover
• Lynchburg
• Rockingham
• Roanoke City
• Roanoke County
• Washington County
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Funded Jurisdictions - Phase I
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Strategic Prevention Framework
Step 1: Assessment Step 2: Capacity Step 3: Planning Step 4: Implementation Step 5: Evaluation
Sustainability and inclusion of cultural competency important throughout
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Phase II
11 jurisdictions completed Steps 1-3AssessmentCapacityPlanning
Working on Steps 4 & 5Implementation andEvaluation
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Assessment Identified Causes
Intervening Variables
and Contributing
Factors
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IVs & CFs - Strategy Targets
Intervening Variables (IVs)Made up of specific Contributing FactorsCommunity / population level – describe characteristics that influence alcohol-related outcomesFactors that influence the level of a behavior and then the outcome in populations Target of Environmental Strategies – most effective
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IVs & CFs - Strategy Targets
Risk and Protective Factors Individual level IVs -- influencing individuals
directly rather than indirectly thru environment Individual-focused strategies work best in
conjunction with Environmental Strategies Once local assessment done - select the IVs to
target and appropriate strategies
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Jurisdiction Prevention
All prevention activities evidence-based and approved by SPF-SIG Evidence-Based Workgroup (EBW)
All jurisdictions implementing environmental strategies
One jurisdiction has included an individually-focused strategyHigh risk college studentsBrief intervention
Several strategies selected for ~3 prioritized factors (IVs)
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Alcohol-Specific IVs
Based on research – shown on Holder model Seven (7) key community IVs
1. Retail Availability2. Social Availability3. Enforcement4. Community Norms 5. Promotion 6. Price7. Perceived Risk
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15Harold Holder, Environmental Prevention: Achieving High Quality Implementation to Best Outcomes, SAMHSA, November 2011
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Examples of Targeted EBS
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Virginia Examples - IV/CF Targets
Law enforcement Greater presence – check points and saturation patrols Social media awareness
Retail availability Sales to intoxicated App for taxi rides home / estimate BAC
Community norms Not okay to drink and drive / binge All friends don’t Targeted internet / social media messages
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Trend in Alcohol-Related Crashes
BAC 0.08 or higherhttp://www.dmvnow.com/safety/#crash_data/index.asp
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Persons Killed in Crashes
Any BAC>0http://www-fars.nhtsa.dot.gov/States/StatesAlcohol.aspx
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Trend – 15 to 24 Year Olds
Decreased even more since 2004 15-20 year olds – down 44% from 2004-2011
From 21.7 to 12.1 per 10,000 persons 15-20 15-20 year olds – rates similar to all drivers 21-24 year olds – down 36%
From 56.2 to 36.0 per 10,000 persons 21-24 21-24 year olds – rate remains 2-3 times then
either 15-20 year olds or all drivers
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Trend – 15 to 24 Year Olds
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Where Do Crashes Occur
Baseline was 3 years – to get more stable rates Since then, looked at individual years and
variations seen With some locations remaining high each year
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2006-08 Baseline Data
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2009 Data
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2010 Data
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2011 Data
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2011 Data – 18-24 only
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Statewide -- Who is the Driver?
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Statewide -- Who is the Driver?
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Statewide -- Who’s At Risk?
Overall, males ~ 3 times more likely to be the driver32 MVCs/10,000 males vs 11 MVCs/10,000 femalesFor 15-17 year group – 2 times more likely
21-24 year olds - highest rate 52 MVCs/ 10,000 males 21-24 vs 18/ 10,000 females 31 MVCs/ 10,000 males 18-20 vs 11/ 10,000 females 4 MVCs/10,000 males 15-17 vs 2/ 10,000 females
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When Do MVCs Occur?
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When Do MVCs Occur?
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Statewide Updates in Usage
Past month use of substances decreased overall from 2006-2010 in both 12-17 year olds and 18-25 year olds
Exception --- alcohol use and binge drinking for 18-25 year olds
Data – National Survey on Drug Use and Health (NSDUH), 2004-2011
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Illicit Drug Use 12-17
NSDUH, 2004-2011
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Illicit Drug Use 18-25
NSDUH, 2004-2011
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Past Month Alcohol Use, 12-17
NSDUH, 2004-2011
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Past Month Alcohol Use, 18-25
NSDUH, 2004-2011
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Specifics -- Fundees
Change in rate over time Consider percent of change in funded localities
versus unfunded localities statewide Goal - decrease of at least 10% from baseline Country-wide seeing decrease in rates Since all localities are decreasing – hope to see
a 10% greater decrease in funded localities
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Specifics -- Fundees
Assessment activities began in 2012 Interventions began early 2013 Local data will be collected in late 2013
Change in usage-related behaviorsAwareness of prevention activities
MVC data -- 2006-08 baseline thru 2013
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43Virginia DMV
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Trend in Rates – Funded Localities
Virginia DMV
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18-24 Year Old Survey Data
Survey data from 10 fundees merged 2,137 responses Responses per locality ranged from
49 in Augusta County626 in Lynchburg City
Merged data Cannot be generalized to entire state Suggests interesting findings
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18-24 Year Old Survey Data
Overall – 59% (1,263) were 18-2041% (874) were 21-24
Augusta and Chesterfield – more 21-24 year olds then 18-20 year olds
44% males, 56% females, 4% missing 77% white, 23% non-white 4% Hispanic, 8% missing
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18-24 Year Old Survey Data
18-20 year olds42% lived w/parents, 32% dorm, 19% w/ friends
21-24 year olds35% in w/ friends, 28% w/ parents, 13% with SO
66% full-time college students 47% worked part-time / 20% worked full-time
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18-24 Year Old Usage Data
Virginia’s Young Adult Survey data – similar to NSDUH results for drinking and bingeing
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18-24 Year Old Usage
Most who drank alcohol did so on few days only
More males then females
~5% males, 3% females drank most days
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18-24 Year Old Usage
Differed by age
51% 18-20 drank 1+ days
77% 21-24 drank 1+ days
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18-24 Year Old Survey Data
Those not in school were most likely to drink
21-24 – full time students similar
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18-24 Year Old Binge Drinking
45% drank 5+ (males) / 4+ (females)
52% of males
36% of females
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18-24 Year Old Binge Drinking
52% 21-24 year olds binge drank in past month
37% 18-24 year olds binge drank in past month
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18-24 Year Old Drinking & Driving
BAC >= 0.04 – significant impairment~4 beers, 2 hours, 180 lbs
Impairments may be present at very low levels - equivalent to 1 standard drink and BACs as low as 0.01 (Taylor et al., 2010).
Fujita and Shibata (2006) found BAC = 0.05+ resulted in 4X the risk of fatality in traffic accidents
Taylor, et al. (2010). The more you drink, the harder you fall: A systematic review and meta-analysis of how alcohol consumption and injury or collision risk increase together. Drug and Alcohol Dependence, 110(1-2), 108-116).
Fujita, Y. & Shibata, A. (2006). Relationship between traffic fatalities and drunk driving in Japan. Traffic Injury Prevention, 7(4), 325-327.
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18-24 Year Old Drinking & Driving
Only 18% said drove after drinking 2+ drinks
Most few days only
26% males 13% females
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18-24 Year Old Drinking & Driving
More 21-24 year olds
24% 21-24 year olds
15% of 18-20 year olds
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18-24: Rode With Drinking Driver
Most claimed to not ride with someone who’d been drinking
21-24 year olds more likely to ride -- 30% versus 21% of 18-24
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18-24: Rode With Drinking Driver
Males more likely to ride with someone who was drinking
30% males 22% females
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18-24 Year Old Risk Perceptions
Survey asked – “risk” of binge drinking and drink-driving*
Driving after drinking 1-2 drinks – results differed by age group
Others similar
*World Health Organization promotes this term globally
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18-24: Risk – Binge Drinking
No difference between age groups
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18-24: Risk – Driving After Drinking
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18-24: Risk – Driving After Drinking
No difference between age groups
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18-24: Perception of DUI Risk
Only 13-24% thought it ‘Not very likely / Not at all likely’ that someone driving under the influence would be stopped or arrested
70% thought it ‘Very likely/Somewhat likely’ drunk adults would be served or sold alcohol
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18-24 Year Old Attitudes
20% said ‘Somewhat acceptable’ to provide alcohol for people <21 26% said ‘Somewhat unacceptable’ 44% said ‘Unacceptable’
52% said ‘Acceptable/Somewhat’ for 18-20 year olds to have 1-2 drinks
34% said ‘Acceptable/Somewhat’ for 18-20 year olds to get drunk
84% said ‘Unacceptable/Somewhat’ for 15-17 year olds to have 1-2 drinks
92% said ‘Unacceptable/Somewhat’ for 15-17 to get drunk
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18-24: Top Reasons to Drink
Of those who drank, the top reason was celebration (62%).
48% just like the taste
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18-24: Top Reasons to Drink by Age
Older more apt to like taste and use alcohol for stress relief
Younger use it to fit in and flirt
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18-24: How Hard to Get Alcohol
57% said sort of / very easy to get alcohol if underage
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18-24: Where Do They Get Alcohol
18-20 primarily got alcohol from friends (77%)
32% said from parents
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18-24: Where Do They Get Alcohol
29% of respondents said they were NOT asked to show an ID last time they bought alcohol
24% said they had provided alcohol to someone under 21
9% said they’d used a fake ID
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18-24: Drinking Games
Less then 50% localities included questions about drinking games
Of those that did – 97% respondents said somewhat / very popular92% said rapid consumption somewhat / very
popular48% said drink specials influence the number they
consume47% said drink specials influence where they go
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18-24 Year Old Survey
To be repeated late this year To include evaluation questions regarding
environmental strategies Hope to see decreases in risky behaviors
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Next Year – Complete Profile
Usage alcohol and other drugs Substance-related harms
DUI / Drug-related arrestsCirrhosis / Drug-related / overdose deathsAlcohol / Illicit drug abuse/dependence
Co-morbidity – mental health / SANeed to explore data sources – nothing currently
available statewide Returning military
Need to explore data sources