Measuring the second-hand effects of drinking: Moving the alcohol

policy agenda forward1Samantha Cukier MBA, MA, 2Norman Giesbrecht, PhD

& 3Dan Steeves, MAEd(c)1Johns Hopkins Bloomberg School of Public Health, 2Centre for Addiction

and Mental Health, 3APTS Capital Health, Nova Scotia

Alcohol Policy 15 | Washington, D.C. | December 7, 2010

Second-hand effects of drinking

• “The damage from alcohol to persons other than the drinker” (Giesbrecht et al., 2010)

Examples:– Drinking and driving or boating– Alcohol-fuelled physical violence– Alcohol-fuelled family violence (emotional)– Unplanned sexual behaviour– Workplace incidents– Public transportation crashes– Chronic disease or disability due to alcohol – burden to

others

The Concept: Terminology

• Second-hand drinking

• Second-hand effects of drinking

• Other terminology used:– Collateral damage– Negative externalities (economic)

– Passive drinking (Burgess: A ‘good lie’ too far)

– Alcohol’s harm to others

Why second-hand drinking?

• MANY Health effects of ‘first-hand’ drinking are not influential in stimulating societal change

• Call to action necessary with relevant ‘hook’ and significant impact

• Effective response necessary: Implications for policy (like second-hand smoke)

Causation vs. Association

• Resistance?

– Would the event have occurred without the alcohol?

– May take blame away from individual

Parallels

• Second-hand effects of drinking //’s – Smoking– Obesity (physical infrastructure changes,

emotional toll on family)– Gun control

• Second-hand alcohol //’s Second-hand smoke

Currently: Measuring Second-Hand Drinking

Type of disruption or harm Canada (2004)

N= 13,328Aged 18 +

Nova Scotia (2008)

N= 1,200Aged 18+

Ontario (2006)

N= 937Aged 18+

Insulted or humiliated 22.1 19.3 21.1

Family or marriage problems 10.5 8.8 11.2

Pushed or shoved 10.8 12.0 10.8

Serious arguments or quarrels 15.5 15.0 17.3

Verbal abuse 15.8 14.1 15.0

Hit or physically assaulted 3.2 4.4 3.1

One or more types of harm 32.7 30.4 31.3

Harm experienced by respondent in the past year from drinking by others (%)

(Giesbrecht et al., 2010)

Measuring Second-Hand Drinking (Cont’d)

• New Zealand: 62,000+ physical assaults, 10,000 sexual assaults involve alcohol by perpetrator / yr. (Connor, You & Casswell, 2009)

• Australia: heavy drinkers cost others $13b+ lost productivity & wages (Laslett et al., 2010)

Currently: Measuring Second-Hand Drinking (Cont’d)

Currently: Measuring Second-Hand Drinking (Cont’d)

• Population surveys– Info from drinker– Info from ‘other’ re: drinker

• Cost of alcohol studies– Review health records

• Direct• Indirect• Intangible

(Laslett et al., 2010)

Limitations to Current Measures

• Population surveys– Less serious cases– Asking drinker: indirect reporting– Asking ‘other’: unclear relationship to drinker

• Cost of alcohol studies– Inaccurate measures– Who is hurt – Who is paying

(Laslett et al., 2010)

Moving Forward: New Ways of Measurement

• Laslett et al., 2010: – Population survey asking questions to ‘specific

others’

New Ways of Measurement

• Second-hand effects measured by:– Age– Gender– Ethnicity– Drinking Context (structured vs. non-structured)– Drinking level– Drink type

e.g. Second-hand effects by age

Second-hand effects

Age (yrs) & dominant type varies by age

e.g. Second-hand effects by gender

Second-hand effects

Male Female

?

e.g. Second-hand effects by context

Second-hand effects

Structured (eg. Workplace)

Unstructured (eg. Backyard drinking)

?

e.g. Second-hand effects by drinking level

Second-hand effects

Drinking Level

Low Medium High

e.g. Second-hand effects by drinking level

Second-hand effects

Drinking Level

Non-binger Occasional Binger

Heavy Binger

(Srivastava and Zhao, 2010)

e.g. Second-hand effects by drink type

Second-hand effects

Drink type

Regular Strength Beer

Wine RTD (Spirits)

(Srivastava and Zhao, 2010)

Other ways of measurement

• Do we need to find other ways?• Currently:

– Quantitative measures of• #s of people physically harmed by others• #s of people died via drinking driver

• What are the options?– Other quantitative measures but different

categories? – Qualitative: the power of stories– Challenges if the results from different measures are

divergent

Challenges to Measurement

• Qualitative• E.g. “Two Nova Scotia schools are banning dances,

blaming out-of-control boozers, brawlers and girls in short skirts.” http://www.cbc.ca/canada/nova-scotia/story/2010/10/19/ns-school-dances-cancelled.html#ixzz16UvwXtYX

• E.g. “On September 12, 2003, Eric climbed through the casement window of his seventh-floor room and stepped onto the eyebrow ledge to smoke a cigarette. He fell off the ledge, resulting in his death. A medical examiner determined Eric's blood-alcohol level at the time of his death was .16, significantly impairing his motor coordination and judgment.” http://www.kscourts.org/Cases-and-Opinions/opinions/ctapp/2008/20080808/98663.htm

Other Research

• College Drinking

• Connor, You & Casswell (2009): “Alcohol-related harm to others: a survey of physical and sexual assault in New Zealand”

• Burgess (2009): “Passive drinking”

• Klingemann & Gmel (2001): “Mapping the social consequences of alcohol consumption”

Contact InformationSamantha Cukier, MBA, MAJohns Hopkins Bloomberg School of Public HealthBaltimore, MDscukier@jhsph.edu

Norman Giesbrecht, PhDCentre for Addiction and Mental HealthToronto, Ontarionorman_giesbrecht@camh.net

Dan Steeves, MAEd (c)Addiction Prevention and Treatment ServicesCapital District Health AuthorityDartmouth, Nova Scotiadan.steeves@cdha.nshealth.ca

References• Connor, J., You, R., & Casswell, S. (2009). Alcohol-related harm to others: a

survey of physical and sexual assault in New Zealand. Journal of the NZ Med Assoc, 122(1303).

• Giesbrecht, N., Cukier, S., & Steeves, D. (2010). Collateral damage from alcohol: implications of ‘second-hand effects of drinking’ for populations and health priorities. Addiction, 105(8), 1323-1325.

• Laslett, A., Catalano, P., Chikritzhs et al., (2010). The range and magnitude of alcohol’s harm to others. Alcohol Education and Rehabilitation Foundation: Australia.

• Srivastava & Zhao. (2010). What do the bingers drink? Micro-unit evidence on negative externalities and drinker characteristics of alcohol consumption by beverage types. Economic Papers, 29(2), 229-250.)