Lecture 17: Alcohol and Injury Flashcards
What is this?
It is the pattern of drinking.
All these things are interrelated.
the toxic and beneficial biochemical effects, intoxication and dependence depend on how you drink it and how much you drink it.
Intoxication can lead to injuries (acute disease) or have acute social impacts!
what does this show about the pattern of drinking?
Person A has 2 glasses of wine every night
Person B has 2 bottles of wine every Friday night
- volume is the same, but the pattern is different so the effects will be different too
what is meant by a heavy drinking episode?
- drinking large amounts
- binge drinking
- this is more than 6 standard drinks for men
- more the 4 standard drinks for women
how much is a standard drink?
10g of pure alcohol
what does this show about the progressive effects of blood alcohol concentration?
- up to 0.05, people get the effect of relaxation and sense of well-being, this is the feeling most people aim to get when drinking
above 0.05 (shown by red line which is legal BAC limit, effects are also relatively good with things like pleasure, numbing of feelings and emotional arousal happen, but impairments start to get worse
- after the 0.1, effects and impairment can start to be harmful
what are the psychological and psychomotor effect of intoxication?
- impairment: reaction time, physical coordination
- disinhibition: poor judgement
- emotional changes: euphoria, depression, can be related to violence, self harm and aggression
- sedative: sleepiness
what can some of the effects of intoxication be modified by?
- personal characterisitcs
- previous experience of alcohol
- the setting
- expectation
also:
- interactions with drugs, fatigue, peers and mood
what does this tell us?
the level of intoxication is determined by how much and how quickly you drink
- the harm depends in the context and the situation
- how often you drink heavily is the most important determinant of health risks in the long term
what is the most recent data on the burden of alcohol in NZ?
2007 data:
- 802 deaths under 80 years old are attributable to alcohol
- 5.4% of all premature deaths
- nearly 14,000 years of life lost
- 6% of male deaths
- 4% of female deaths
- Maori: 8% of deaths of men, 6% of women
- Non Maori: 6% of men, 4% of women
clear disparity for maori is shown
what does this tell us?
alcohol-attributable deaths in NZ, 2007
- injury makes a large proportion of alcohol-related deaths
- burden varies by age, sex and ethnicity
what does this show?
- Maori contributed to most YLL compared to non-Maori
- Younger age group has more YLL
- More pronounced for males than females in both Maori and non Maori
what does this show?
- prevalence of regular intoxication is higher in younger people, especially males
- the amount we drink and the frequency of heavy drinking influences risk of injury
what does this show?
- this is fatal injury data (mainly because data is poor for non-fatal injuries)
- most kinds of injury are related to alcohol use
- shows that 40% of deaths by injuries were positive for alcohol
what does this show?
- risk estimate increases as BAC increases
what does this show?
30% of hospital admissions due to car crashes were alcohol related
what does this show?
- exponential curve for fatal crashes by blood alcohol level
blue = 30+ green = 20-39 orange = 15-19
- alcohol affects us differently depending on age
- the change of BAC aligns well with the risk profile for adults and young people. This reduces the risk by quite a lot.
- effect of low levels of alcohol consumption doesn’t affect too much. The curve starts to take of after 0.05 BAC
- things like fatigue and sleepiness impact the risk of low BAC levels
what does this show?
Risk of fatal crashes is much higher for younger people compared to older people with similar BAC
what does this show?
BAC doesnt only impact MVTC
- shows similar curves for boating fatalities
who gets injured from MVTC? Is it just the drinker?
- the drinker
- the drinker’s partner
- the drinker’s children
- the drinker’s drinking mates
- people met in the pub or party
- the others in the car
- the people in the other car/the pedestrian/the cyclist
- the police
- helpful members of public
- bystanders
how is alcohol policy used as an injury prevention strategy?
- if alcohol appears in almost every Haddon matrix for injury, effective countermeasures will be very useful!
- having an upstream approach to alcohol is important
- most interventions tend to reduce one type of injury. there is a lot of focus on the context and situation
what are the main focuses of healthy alcohol policies?
- prohibition neither necessary or desirable
- Harm reduction
reduce episodes and severity of intoxication
target dangerous contexts - Epidemiologists go looking for what has been shown to work by using evidence-based policies
what does this show about legal drinking age changes?
- each state had its own laws in terms of drinking age
- drinking ages were changed in different states at different times
- studies found that if the drinking age was lowered, increase in traffic crashes and when the drinking age was raised, there was a decrease in traffic crashes
- NZ studies have found that an increase in young drivers crashing was linked to the decrease in purchase age
- in the US, they used this data to show the states that they wouldn’t get a lot of their funding if they kept the drinking age to 18 or 19, which is why it is now up to 21
what sorts of things are in place for education and persuasion of healthy alcohol policies?
evaluation have been conducted of:
- alcohol education in schools
- college student education
- public service messages
- warning labels
what does this show about the effectiveness of the education and persuasion strategies?
- none of these programmes are effective!
- a lot of them have been heavily researched which comes with a high cost
- they target high-risk groups and the general population
- these strategies may raise awareness and knowledge, but don’t have any sustained effect on drinking behaviour
- resources shouldn’t be diverted into these ineffective campaigns as they wont reduce harm
- health promotion can be really effective, but only if it has the policies in place to support that kind of promotion
what are some evidence-based policies that would be effective and cost-effective countermeasures?
- regulating physical availability
- pricing and taxation
- reducing advertising and promotion
- drinking-driving countermeasures
- treatment and early intervention
what is the effectiveness/impact of these evidence-based policies?
- they are effectiveness in reducing alcohol-related injury
- they have little impact on moderate drinkers
- they protect families and the public from injury due to hazardous drinkers
- they can also reduce chronic diseases caused by alcohol
