Levels and perceptions of support for alcohol Levels and perceptions of support for alcohol control policies among local public health leaders.control policies among local public health leaders.

Mandy Stahre, MPHMandy Stahre, MPHSchool of Public HealthSchool of Public Health

Alcohol Epidemiology ProgramAlcohol Epidemiology Program

2007 Summer Pre-doctoral Fellowship in Clinical & Translational Research

Public Health Impact of Alcohol UsePublic Health Impact of Alcohol Use

Approximately 75,000 alcoholApproximately 75,000 alcohol--related (AR) related (AR) deaths/ yeardeaths/ year33rdrd leading lifeleading life--style related cause of deathstyle related cause of deathImpact largely related to abuse not dependenceImpact largely related to abuse not dependence

Specific AR Health EffectsSpecific AR Health Effects

Chronic conditions (e.g., cirrhosis, stroke, and Chronic conditions (e.g., cirrhosis, stroke, and various cancers)various cancers)Acute conditions (e.g., MV crash deaths and Acute conditions (e.g., MV crash deaths and interpersonal violence)interpersonal violence)Other health problems (unintended pregnancy, Other health problems (unintended pregnancy, STDs, and FAS) STDs, and FAS)

Successful Policies and programs to Successful Policies and programs to reduce impact of alcohol usereduce impact of alcohol use

Regulation of marketingRegulation of marketingDrinking and driving policiesDrinking and driving policiesReduce demandReduce demandEnvironmental controls to reduce availability Environmental controls to reduce availability Treatment servicesTreatment services

Levels of policy and program Levels of policy and program implementationimplementation

Federal levelFederal levelCDC, NIAAA, SAMHSACDC, NIAAA, SAMHSA

State health departmentsState health departmentsState Substance Abuse AgenciesState Substance Abuse Agencies

County or local levelCounty or local levelLocal Public Health Agencies (LPHA)Local Public Health Agencies (LPHA)Governing BoardsGoverning Boards

Potential Facilitators of Potential Facilitators of Policies/ProgramsPolicies/Programs

Local Public Health Agencies (LPHA)Local Public Health Agencies (LPHA)Approx 3,000 USApprox 3,000 USComplexComplexJurisdictions varyJurisdictions vary

Governing boardsGoverning boardsCounty CommissionersCounty CommissionersFundingFunding

Local Public Health AgenciesLocal Public Health Agencies

DirectorDirector’’s roles roleDivision or Agency LeadDivision or Agency LeadPhD or MD levelPhD or MD level

ManagerManager’’s roles roleTopic specificTopic specificProgram specificProgram specific

StaffStaff

County commissionersCounty commissioners

Elected to staggered 4Elected to staggered 4--year termsyear termsOver 400 in MNOver 400 in MNAdministrative arm of state Administrative arm of state Policies and programs are presented to themPolicies and programs are presented to themSet budget prioritiesSet budget priorities

Provide funding for public health servicesProvide funding for public health services

Purpose of studyPurpose of study

No research: No research: County commissioner attitudes towards alcohol County commissioner attitudes towards alcohol policies and programspolicies and programsWhether directors and managers of Whether directors and managers of LPHAsLPHAs know know the level of support of their own county the level of support of their own county commissioners toward alcoholcommissioners toward alcohol--related policies and related policies and programs programs

Public Health Impact:Public Health Impact:Missed opportunities to implement successful Missed opportunities to implement successful programsprograms

Study objectiveStudy objective

Identify the levels and perceptions of support for Identify the levels and perceptions of support for alcohol control policies among local public alcohol control policies among local public health leaders.health leaders.

Research QuestionsResearch Questions

What is level of support among county What is level of support among county commissioners for alcohol policies and commissioners for alcohol policies and programs?programs?

What level of support do directors and managers What level of support do directors and managers of of LPHAsLPHAs perceive their county commissioners perceive their county commissioners to have towards alcohol policies and programs?to have towards alcohol policies and programs?

MethodsMethods

Census of all MN Census of all MN LPHAsLPHAs76 76 LPHAsLPHAs (county or multi(county or multi--county)county)

Paper and Web survey:Paper and Web survey:DirectorsDirectorsManagersManagersCounty CommissionersCounty Commissioners

Variety of questionsVariety of questionsAlcoholAlcohol--related program/policy activitiesrelated program/policy activitiesAwareness and attitudes toward alcohol useAwareness and attitudes toward alcohol useAccess of researchAccess of researchDemographicsDemographics

Response ratesResponse rates

Paper survey Paper survey –– 82%82%Overall 60%Overall 60%

Directors 83% (N=66)Directors 83% (N=66)Managers 67% (N=43)Managers 67% (N=43)County commissioners 56% (N=248)County commissioners 56% (N=248)

DemographicsDemographics

59%59%26%26%15%15%

2%2%59%59%40%40%

0058%58%43%43%

EducationEducation

HS/AssocHS/AssocBachelorBachelor’’ssMasterMaster’’s +s +

84%84%11%11%9%9%GenderGender

MalesMales

County County commissionerscommissioners

ManagersManagersDirectorsDirectors

Survey itemsSurvey items

6 specific policies6 specific policies2 Areas2 Areas

Increasing taxesIncreasing taxesReducing youth accessReducing youth access

DirectorDirector’’s and Managers and Manager’’s questionss questions

How likely is your governing board to:How likely is your governing board to:Support this program or policySupport this program or policyDesignate funds or other resourcesDesignate funds or other resources

Research proposal for feasibility in local areaResearch proposal for feasibility in local areaEstablishing infrastructureEstablishing infrastructure

Response options were:Response options were:Very likely, somewhat likely, not very likelyVery likely, somewhat likely, not very likely

County CommissionerCounty Commissioner’’s questionss questions

How strongly do you favor or oppose the How strongly do you favor or oppose the suggested policy or program?suggested policy or program?

Response options were:Response options were:Strongly favor, somewhat favor, somewhat oppose, Strongly favor, somewhat favor, somewhat oppose, strongly opposestrongly oppose

How likely is it that you would vote to designate How likely is it that you would vote to designate funds or resources to support the establishment funds or resources to support the establishment of the policy or program?of the policy or program?

Response options were:Response options were:Very likely, somewhat likely, not very likelyVery likely, somewhat likely, not very likely

Increasing taxes Increasing taxes

How likely would How likely would you/county commissioneryou/county commissioner support support increasing alcohol excise taxes to pay for:increasing alcohol excise taxes to pay for:

youth alcohol treatment and prevention?youth alcohol treatment and prevention?alcohol treatment and prevention for general public?alcohol treatment and prevention for general public?

How likely would How likely would you/county commissioneryou/county commissioner designate designate funds or resources to work with coalitions to help funds or resources to work with coalitions to help increase taxes to pay for:increase taxes to pay for:

youth alcohol treatment and prevention?youth alcohol treatment and prevention?alcohol treatment and prevention for general public?alcohol treatment and prevention for general public?

Results for support for increasing Results for support for increasing taxes*taxes*

27%27%37%37%40%40%General General publicpublic

80%80%66%66%61%61%Youth Youth programsprograms

County County commissionerscommissioners

ManagersManagersDirectorsDirectors

*Percent responding very likely or somewhat likely, strongly favor or somewhat favor

Results for designating funds to work Results for designating funds to work on tax initiative*on tax initiative*

43%43%20%20%13%13%General General publicpublic

57%57%27%27%16%16%Youth Youth programsprograms

County County commissionerscommissioners

ManagersManagersDirectorsDirectors

*Percent responding very likely or somewhat likely

Youth AccessYouth Access

How likely would How likely would you/county commissionersyou/county commissionerssupport:support:

EnforcementEnforcementCompliance checksCompliance checksShoulder tap methodShoulder tap method

Laws and fines for:Laws and fines for:Older adults purchasing alcohol for youthOlder adults purchasing alcohol for youthParents holding alcohol parties in the homeParents holding alcohol parties in the home

Results for supportResults for support

83%83%65%65%77%77%Adults buy Adults buy for youth for youth

80%80%38%38%49%49%House House partiesparties

61%61%28%28%49%49%Shoulder tapShoulder tap

80%80%79%79%89%89%Compliance Compliance checkcheck

County County Comm.Comm.

ManagersManagersDirectorsDirectors

*Percent responding very likely or somewhat likely, strongly favor or somewhat favor

Results for designating fundsResults for designating funds

64%64%25%25%24%24%Adults buy Adults buy for youth for youth

61%61%11%11%19%19%House House partiesparties

50%50%26%26%32%32%Shoulder tapShoulder tap

70%70%48%48%55%55%Compliance Compliance checkcheck

County County Comm.Comm.

ManagersManagersDirectorsDirectors

*Percent responding very likely or somewhat likely.

IndicesIndices

Further analysisFurther analysis4 indices for:4 indices for:

2 Support indices2 Support indicesAlcohol excise taxesAlcohol excise taxesYouth AccessYouth Access

2 Designation of funds2 Designation of fundsAlcohol excise taxesAlcohol excise taxesYouth accessYouth access

Results (Means)Results (Means)

2.52.5

1.91.9

2.82.82.32.3

DirectorsDirectors

2.52.5

1.91.9

2.72.72.22.2

ManagersManagers

2.12.1

1.91.9

2.32.32.52.5

County* County* CommissionersCommissioners

Support for youth Support for youth accessaccessDesignate funds for Designate funds for youth accessyouth access

Designate funds for Designate funds for taxestaxes

Support for taxesSupport for taxes

IndexIndex

*Different scale

Results (Results (αα))

.87.87

.72.72

.59.59

.67.67

DirectorsDirectors

.87.87

.72.72

.78.78

.47.47

ManagersManagers

0.830.83

0.730.73

0.710.710.380.38

County County CommissionersCommissioners

Support for youth Support for youth accessaccessDesignate funds Designate funds for youth accessfor youth access

Designate funds Designate funds for taxesfor taxes

Support for taxesSupport for taxes

IndexIndex

Data linkingData linking

How do LPHA leaders perceive county How do LPHA leaders perceive county commissioner support for specific alcohol commissioner support for specific alcohol policies?policies?

Specific county informationSpecific county informationLink: Director, Manager and County commissioner Link: Director, Manager and County commissioner datadata

Issues with data:Issues with data:Multiple countiesMultiple countiesDirectors and managers differDirectors and managers differ

Future analysesFuture analyses

Frequency:Frequency:Likeliness of taking action on specific issues related Likeliness of taking action on specific issues related to alcohol use.to alcohol use.

Regression:Regression:Predict county commissioner support and Predict county commissioner support and designation of funds based on manager and director designation of funds based on manager and director responsesresponses

SubSub--analyses based on demographicsanalyses based on demographics

Future plansFuture plans

Present findings at APHA, November 2007Present findings at APHA, November 2007Publish results in peerPublish results in peer--reviewed journalreviewed journalSubmit to Alcohol Policy 14 conferenceSubmit to Alcohol Policy 14 conference

AcknowledgementsAcknowledgements

Alcohol Epidemiology ProgramAlcohol Epidemiology ProgramDr. Traci ToomeyDr. Traci ToomeyDr. Darin EricksonDr. Darin EricksonLindsey FabianLindsey FabianGudrun KillianGudrun KillianKathleen LenkKathleen Lenk

Questions?Questions?