|Prevention Project Reduces
High Risk Drinking, Alcohol-related Crashes, and Trauma
-- Environmental strategies,
plus public education and awareness prove effective --
November 7, 2000
A study reported in the November 8 issue of
the Journal of the American Medical Association (Volume 284, Number
18) shows that communities that undertake comprehensive prevention
strategies can effectively reduce alcohol-related traffic crashes and
injuries from crashes and assaults. Relative to matched comparison sites,
intervention communities (two in California and one in South Carolina)
experienced marked reductions in alcohol-related crashes, nighttime injury
crashes, injuries due to assault, and assaults that required
hospitalization, as well as in self-reported alcohol consumption, heavy
drinking, and drinking and driving.
First author Harold D. Holder, Ph.D., and
his colleagues at the Prevention Research Center, Berkeley, California,
and the Pacific Institute for Research and Evaluation reported the gains
at the conclusion of the April 1992-December 1996 Community Prevention
Trial (CPT). The National Institute on Alcohol Abuse and Alcoholism
supported the study.
"Dr. Holder and his colleagues
demonstrate that complex community systems can be studied rigorously—a
formidable achievement given the complexity of the environment," said
NIAAA Director Enoch Gordis, M.D. AThe CPT provides powerful new evidence
that comprehensive, coordinated environmental prevention programs can be
effective in reducing alcohol-related injuries and accidents in the
a comprehensive public health approach, the CPT involved local city
councils, the police, the media, alcohol sales and service
institutions, and others in an array of interventions designed to
communities through coalition-building and media advocacy,
responsible beverage service,
underage drinking by limiting access to alcohol,
local enforcement of drinking and driving laws, and
alcohol access through zoning measures.
Earlier studies had shown each intervention
to be independently effective but they had never before been combined in a
Rather than drinking per se the CPT
targeted environmental conditions and drinking patterns that are likely to
be antecedents to trauma. While the proportion of respondents who reported
drinking remained essentially unchanged across the five-year study, the
intervention communities experienced substantial reductions in the
quantity of alcohol consumed per occasion.
The researchers implemented the
interventions in successive stages tied to specific effectiveness indices.
For example, phase 1 and phase 2, which focused in large part on drunk
driving prevention, were indexed by police use of breath-testing devices
and roadside checkpoints, respectively. The date of onset for each phase
provided an intervention "pulse" that enabled the researchers to
track intervention effects on drinking behavior and alcohol-related
Outcome measures included self-reported and
objective measures. To obtain the self-reports, the investigators placed
120 random general population telephone calls each month for 66 months in
both the intervention and control communities. For the objective outcomes,
they relied on routinely collected traffic and hospital discharge data.
They found that, at five years, nighttime car crashes with injuries had
declined by 10 percent, crashes involving drunk drivers had declined by 6
percent, injuries due to assault had fallen by 43 percent and hospitalized
assaults by 2 percent. Self-reported alcohol consumption per drinking
occasion declined by 6 percent, having "too much to drink"
declined by 49 percent, and driving while "over the legal limit"
declined by 51 percent in the intervention relative to the control
The study has several limitations, the
authors point out: The intervention communities were not randomly
selected, and the interventions may have introduced a bias that influenced
self-reports. Even so, Athe CPT shows that the public need not remain
passive recipients of trauma caused by heavy drinking,@ said Dr. Holder.
Research interest in community-based
prevention programs is based in part on the successes from the study of
cardiovascular disease, which began more than 20 years ago. The heart
disease interventions were helpful in changing behaviors by reducing
smoking and dietary fat intake and by controlling blood pressure, and have
led to a lower incidence of acute coronary syndromes such as heart attack
and unstable angina. During recent years, alcohol researchers have adapted
these approaches in community interventions to prevent and reduce youth
alcohol use and drinking and driving (see News
Releases at http://www.niaaa.nih.gov).
AWhile education and public awareness
campaigns alone are unlikely to prove effective in reducing the rate of
alcohol-related injury and death, a combination of those programs with
some of the environmental strategies is mutually reinforcing and thus can
be successful,@ Dr. Holder writes.
For interviews with Dr. Holder, telephone
the Pacific Institute for Research and Evaluation and Prevention Research
Center in Berkeley, California (510/486-1111). For interviews with
Dr.Gordis, telephone NIAAA Press (301/443-0595). For additional
information on alcohol research, please visit http://www.niaaa.nih.gov.