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Alcohol Policy 101

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... 8% 6.2% 2.0% 1.3% % of GBD alc.-related 1,445,169 96,911 115,863 409,688 364,117 458,601 Total DALYS 58,323 11,742 7897 25,519 7199 5966 Total alc.-rel. DALYs ... – PowerPoint PPT presentation

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Title: Alcohol Policy 101


1
Alcohol Policy 101
  • Norman Giesbrecht
  • Senior Scientist
  • Research Division
  • Centre for Addiction and Mental Health
  • norman_giesbrecht_at_camh.net
  • Janet McAllister
  • Project Consultant
  • Education Health Promotion Division
  • Centre for Addiction and Mental Health
  • janet_mcallister_at_camh.net

2
Topics
  • What is alcohol policy?
  • What is the relationship between health promotion
    alcohol policy?
  • Why have alcohol policies?
  • Who makes alcohol policies and implements them?
  • Which policies have been shown to be effective?
  • What are recent examples from Ontario
  • What are public views on alcohol policy?
  • What are some challenges and conclusions?

3
1. What are alcohol policies?
  • Authoritative decisions made by governments and
    other leaders through laws, rules and
    regulations.
  • Alcohol policies can be directed at
  • individuals
  • populations (such as underage drinkers or
    pregnant women)
  • organizations and health care systems.  

4
What are alcohol policies?
  • Policies may involve the implementation of a
    specific strategy with regard to alcohol problems
    (e.g., increase alcohol taxes).
  • Policies may involve the allocation of resources
    that reflect priorities with regard to prevention
    or treatment efforts.
  • Policies that unintentionally increase harm
    should also be examined, in order to provide
    insight into the public health risks associated
    with ill-advised policy decisions.

5
Setting the Policy Agenda
  • Alcohol policies have been implemented throughout
    history to minimize the effects of alcohol on the
    health and safety of the population.
  • All policies begin with a perceived problem. How
    that problem is defined, its social and political
    importance relative to other pressing issues and
    competing interests determines the policy
    response.

6
A Definition of Alcohol Policy
  • What governments institutions choose to do or
    not to do about alcohol the conditions that
    contribute to its misuse.

7
2. Health Promotion and Policy
  • Definition The process of enabling people (and
  • communities) to increase control over and
    (thereby)
  • to improve, their health (The Ottawa Charter
    for
  • Health Promotion (WHO, 1986)
  • Domains of determinants of health (CIHR)
  • Social economic environment
  • Physical environment
  • Personal health practices
  • Individual capacity coping skills
  • Health services

8
Health Promotion Actions(Ottawa Charter)
  • Build Healthy Public Policy
  • Strengthening community action
  • Create supportive environments
  • Advocate
  • Mediate
  • Enable
  • Reorient

9
Alcohol Policy and Health Promotion
  • Alcohol Policy primarily affects
  • social environment (social norms)
  • physical environment (accessibility, safety)
  • economic environment (alcohol sales)

10
3. Why Have Alcohol Policies?
  • Damage, disease, social disruption and death
    associated with alcohol
  • Population level damage requires population level
    interventions

11
(Babor et al. 2003)
12
Evidence of the damage from alcohol
  • Drinking-related events and conditions have been
    linked with trauma, chronic conditions, social,
    workplace and family disruption and associated
    with other social problems.
  • The evidence is well established for liver
    cirrhosis and drinking and driving, but in other
    areas, such as cancer, it is not widely known.

13
Evidence of the damage from alcohol
  • WHO international projects, provide recent
    evidence of the risks and damage associated with
    alcohol consumption
  • Alcohol Public Policy Project (Babor et al.
    2003) and
  • Global Burden of Disease Project (e.g. Rehm et a.
    2003).

14
Major alcohol-related health conditions
contributing to morbidity and mortality
  • Cancers head and neck, gastrointestinal tract,
    liver cancer, and female breast cancer.
  • Neuropsychiatric conditions alcohol-dependence
    syndrome, alcohol abuse, depression, anxiety
    disorder, organic brain disease.
  • Cardiovascular conditions ischaemic heart
    disease, cerebrovascular disease.

15
Major alcohol-related health conditions
contributing to morbidity and mortality
continued
  • Gastrointestinal conditions alcoholic liver
    cirrhosis, cholelithiasis, pancreatitis.
  • Maternal and perinatal conditions low birth
    weight, intrauterine growth retardation.
  • Acute toxic effects alcohol poisoning.
  • Accidents road and other transport injuries,
    fall, drowning and burning injuries, occupational
    and machine injuries.
  • Self-inflicted injuries suicide.
  • Violent deaths assault injuries.

Source Babor et al. (2003, p. 64) and Gutjahr et
al. (2001)
16
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17
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18
Burden of disease in 2000 attributable to alcohol
by development status of region and sex
High mortality developing region High mortality developing region High mortality developing region Low mortality developing regions Low mortality developing regions Low mortality developing regions Developed regions Developed regions Developed regions World World World
(AFR-D, AFR-E, AMR-D, EMR-D, SEAR-D) (AFR-D, AFR-E, AMR-D, EMR-D, SEAR-D) (AFR-D, AFR-E, AMR-D, EMR-D, SEAR-D) (AMR-B, EMR-B, SEAR-B, WPR-B) (AMR-B, EMR-B, SEAR-B, WPR-B) (AMR-B, EMR-B, SEAR-B, WPR-B) (AMR-A, EUR-A, EUR-B, EUR-C, WPR-A) (AMR-A, EUR-A, EUR-B, EUR-C, WPR-A) (AMR-A, EUR-A, EUR-B, EUR-C, WPR-A) World World World
M F Both M F Both M F Both M F Both
Total DALYs (000s) 420711 412052 832763 223181 185316 408497 117670 96543 214213 761562 693911 1455373

Alcohol 2.6 0.5 1.6 9.8 2.0 6.2 14.0 3.3 9.2 6.5 1.3 4.0

19
Global mortality burden (deaths in 1000s)
attributable to alcohol by major disease
categories - 2000
20
Global burden of disease (DALYs in 1000s)
attributable to alcohol by major disease
categories - 2000
21
Development status patterns of
alcohol-attributable disorder ( of total in 1000
DALYs)
develop ing coun tries developed countries world
EMR-D, SEAR-D AFR-DE, AMR-D AMR-B, EMR.B, DEAR-B, WPR-B AMR-A, EUR-A, WPR-A EUR-BC
Perinatal conditions 0.5 0.7 0.1 0.1 0.1 0.2
Cancers 2.6 7.0 9.1 10.5 3.4 7.2
Mental disorders 29.8 23.5 39.7 72.1 22.1 37.6
Cardiovascular dis. 15.1 6.1 8.9 -19.6 16.4 6.8
Other non-communic-able diseases 5.1 8.3 7.3 10.0 8.6 7.8
Unintentional injuries 38.4 38.1 23.4 19.9 33.5 28.3
Intentional injuries 8.5 16.4 11.5 7.1 16.0 12.1
Total alc.-rel. DALYs 5966 7199 25,519 7897 11,742 58,323
Total DALYS 458,601 364,117 409,688 115,863 96,911 1,445,169
of GBD alc.-related 1.3 2.0 6.2 6.8 12.1 4.0
22
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23
Impact of Alcohol in Ontario
  • 29 of major injury hospitalisations in 2000/01
    were alcohol-related (CIHI)
  • 39 of preventable water-related deaths involved
    alcohol 1996-2000 (Lifesaving Society)
  • 31 of suicide deaths involved alcohol / other
    drugs (SmartRisk)

24
Alcohol Our Society
  • Costs
  • 7.5 billion annually in Canada (CCSA, 1992)
  • Lost productivity, law enforcement costs and
    health care services.


25
Interim Conclusions
  • Alcohol is associated with a number of acute
    events and chronic conditions
  • Current international estimates are likely low
    because they do not take into account social
    consequences
  • Nevertheless the estimated global burden of
    death, disease and disability from alcohol is
    just about equal to tobacco
  • In some countries is the highest of 25 risk
    factors examined
  • It is expected that this burden will increase if
    our interventions and policies do not become more
    effective

Sources Room Rehm (2004) Rehm et al. 2003
26
4. Who makes alcohol policy?
  • Federal and provincial laws often establish the
    legislative framework regarding alcohol
  • Alcohol issues have increasingly become the
    concern of health professionals
  • The mass media can have a significant influence
    on the policy debate
  • The alcoholic beverage industry and related
    groups involved in for-profit production are
    often key players (e.g., self-regulation)

27
Regulating Alcohol Promotion in Ontario
  • Internationally,
  • e.g. Trade agreements GATT add full
  • Federally,
  • e.g. Canadian Code of Advertising Standards
  • Provincially
  • e.g., Liquor Licence Control Act Liquor Control
    Board of Ontario Alcohol Gaming Commission of
    Ontario

28
Alcohol Policy in Ontario
  • Key Groups (Ontario)
  • - Alcohol Gaming Commission of Ontario
    Liquor Control Board of Ontario
  • - The Beer Store Wine Council of Ontario
  • - Hospitality Associations
  • - Ministries of Consumer Business
    Services Economic Development and Trade
    Finance Health Long-Term Care
    Transportation

29
Alcohol Policy in Ontario
  • Key groups ( Canada)
  • CRTC
  • ASC, Consumer Response Council
  • Canadian Heritage
  • Department of Justice Canada
  • Health Canada

30
Local Policy Development
  • MUNICIPALITIES
  • Municipal Alcohol Policies
  • Zoning
  • Enforcement

31
Local Policy Development
  • INSTITUTIONS/GROUP
  • Workplaces
  • School / campus
  • Community halls centres
  • Charity Groups
  • Sports Associations

32
Tools for Action
  • Research
  • Lobbying
  • Community mobilization
  • Media advocacy

33
Opportunities for Action
  • Local policy development
  • New partnerships
  • Broader policy focus

34
Opportunities for Action
  • NEW PARTNERSHIPS
  • Injury prevention community
  • Community/safety/ratepayers groups
  • Ethno-racial communities
  • Progressive corporations/institutions
  • National international groups

35

Part 5 What are alcohol policy options? Which
have been shown to be most effective in either
reducing alcohol consumption or
drinking-related harm?

36
Evidence of Effective Alcohol Policies
  • In controlling the damage from alcohol, the most
    effective health promotion interventions are
    alcohol policies that focus on population-level
    interventions e.g. access to alcohol, drinking
    contexts and drinking-related behaviours.
  • This evidence has been recently been summarized
    by Babor et al. (2003)

37
Alcohol, No Ordinary CommodityResearch and
Public Policy
  • Thomas Babor Linda Hill
  • Raul Caetano Harold Holder
  • Sally Casswell Ross Homel
  • Griffith Edwards Esa Österberg
  • Norman Giesbrecht Jürgen Rehm
  • Kathryn Graham Robin Room
  • Joel Grube Ingeborg Rossow
  • Paul Gruenewald
  • Assisted by
  • Cees Coos, Maristela Monteiro, Shakar Saxena,
    Maggie Brady, Therese Reitan, Jacek Moskoliwicz

Published by Oxford University Press in 2003
38
Prevention and Intervention Strategies Evaluated
  • Hundreds of studies were reviewed by the
  • project team of 15 persons and the
  • 31 interventions -- grouped as follows --
  • were examined and evaluated

39
Prevention and Intervention Strategies Evaluated
  • Regulating Physical Availability - e.g. days,
    hours of sale, legal drinking age
  • Pricing and Taxation
  • Altering the Drinking Context e.g. server
    intervention, training, bar policies, etc.
  • Education and Persuasion e.g. mass media
    counter-advertising campaigns, warning labels
    and signs, school-based education programs

40
Prevention and Intervention Strategies
Evaluatedcontinued
  • Regulating Alcohol Promotion e.g. controls on
    alcohol advertising, advertising guidelines, bans
  • Drinking-Driving Countermeasures e.g. lower
    blood alcohol levels, random road-side spot
    checks
  • Treatment and Early Intervention

41
Ratings of 31 Policy-relevant Prevention
Strategies and Interventions
  • Evidence of Effectivenessa the quality of
    scientific information
  • Breadth of Research Supporta quantity and
    consistency of the evidence
  • Tested Across Culturesa, e.,g. countries,
    regions, subgroups
  • Cost to Implement and Sustainb monetary and
    other costs
  • aRating Scale 0, , , , (?)
  • b Rating Scale Low, Moderate, High

42
Results of Evaluation
  • Based on extensive review of the evidence and
    scoring of the 31 interventions on each of the 4
    criteria noted above, the following 10 best
    practices were identified by the research team

43
Best Practices
  • Minimum legal purchase age
  • Government monopoly of retail sales
  • Restriction on hours or days of sale
  • Outlet density restrictions
  • Alcohol taxes
  • Sobriety check points
  • Lowered BAC limits
  • Administrative license suspension
  • Graduated licensing for novice drivers
  • Brief interventions for hazardous drinkers

44
Pricing and Taxation
  • People increase their drinking when prices are
    lowered, and decrease their consumption when
    prices rise.
  • Heavy or problem drinkers are no exception to
    this rule.
  • Economic studies demonstrate that increased
    alcoholic beverage taxes and prices are related
    to reductions in alcohol-related problems.
  • Alcohol taxes are thus an attractive instrument
    of alcohol policy because they can be used both
    to generate direct revenue and to reduce
    alcohol-related harm.
  • The most important downside to raising alcohol
    taxes is smuggling and illegal in-country alcohol
    production.

45
Pricing and Taxation in Ontario
  • Complex structure
  • Federally
  • Excise Act Adds excise duty to spirits, wine
    and beer at set rates.
  • Provincially
  • PST on manufactured goods services is 8, 10
    for beverage alcohol in licenced establishments,
    12 in retail stores
  • 2004 budget added volume levies/wine levies /
    brewers basic fees

46
Regulating Physical Availability
  • Reductions in the hours and days of sale, numbers
    of alcohol outlets, and restrictions on access to
    alcohol are associated with reductions in both
    alcohol use and alcohol-related problems.
  • Laws that raise the minimum legal purchasing age
    reduce alcohol sales and problems among young
    drinkers.
  • Government-owned alcohol outlets (i.e.,
    off-premise monopoly systems) can limit alcohol
    consumption and alcohol-related problems
  • Extreme restrictions (e.g., total prohibition)
    can lower drinking and reduce alcohol problems,
    but often have adverse side effects, such as the
    criminality associated with illicit markets

47
Regulating Physical Availability in Ontario
  • Liquor Licence Act
  • Hours of Service 11 a.m. to 2 a.m. (New Years
    Eve 3 a.m.)
  • Legal Drinking Age 19
  • Liquor Control Board of Ontario
  • Alcohol Gaming Commission of Ontario

48
Modifying the Drinking Context
  • Enforcement of serving regulations can be highly
    effective in reducing serving to intoxication
  • Community mobilization can be extremely powerful
    but is costly to implement and typically not
    sustained over time
  • Well-delivered training programs for bar staff
    have been shown to have immediate effects both on
    serving and aggression but require policy
    enforcement for continuing effects

49
Drinking-Driving Countermeasures
  • Consistently produce long-term problem reductions
    of between 5 and 30
  • Deterrence-based approaches, using innovations
    such as Random Breath Testing, yield few arrests
    but substantial accident reductions
  • The persistent delinquency of some impaired
    drivers should not detract from the enormous
    achievements of recent decades

50
Drinking-Driving Countermeasures in Ontario
  • Federally
  • -Criminal Code of Canada Blood Alcohol Level
    .05
  • Provincially
  • - Zero BAC for first (minimum) 20 months
    (graduated licencing)
  • - Licence suspension ignition interlock

51
Education and Persuasion
  • School-based alcohol education programs have been
    found to increase knowledge and change attitudes
    toward alcohol and other substances, but do not
    change actual use
  • Approaches that address values clarification,
    self-esteem, general social skills, and
    alternatives approaches that provide activities
    inconsistent with alcohol use (e.g., sports) are
    equally ineffective
  • Programs that include both resistance skills
    training and normative education (which attempts
    to correct adolescents tendency to overestimate
    the number of their peers who drink) have modest
    effects that are short-lived unless accompanied
    by ongoing booster sessions

52
Education and Persuasion
  • Programs that include both individual-level
    education and family- or community-level
    interventions may not be sufficient to delay the
    initiation of drinking, or to sustain a small
    reduction in drinking beyond the operation of the
    program
  • Despite their good intentions, Public Service
    Announcements are an ineffective antidote to the
    high-quality pro-drinking messages that appear
    much more frequently as paid advertisements in
    the mass media
  • Although a significant proportion of the
    population reports seeing counter-advertising
    warning labels, research indicates that exposure
    produces no change in drinking behavior

53
Summary Education and Persuasion Strategies
  • The impact of education and persuasion programs
    tends to be small at best
  • When positive effects are found, they do not
    persist
  • Among the hundreds of studies, only two show
    significant lasting effects (after 3 years), and
    the significance of these is questionable when
    reanalyzed
  • If educational approaches are to be used, they
    should be implemented within the framework of
    broader environmental interventions that address
    availability of alcohol

54
Regulating Alcohol Promotion
  • Findings suggest that while the restrictions have
    not achieved a major reduction in drinking and
    related harms in the short-term, countries with
    greater restrictions on advertising have less
    drinking and fewer alcohol-related problems
  • Self-regulation on advertising by the beverage
    alcohol industry tends to be fragile and largely
    ineffective

55
Regulating Alcohol Promotion in Ontario
  • Federally
  • Canadian Code of Advertising Standards
  • Provincially
  • Liquor Licence Control Act

56
Treatment and Early Intervention
  • Exposure to any treatment is associated with
    significant reductions in alcohol use and related
    problems
  • Behavioural treatments are likely to be more
    effective than insight-oriented therapies
  • There is no consistent evidence that intensive
    inpatient treatment provides more benefit than
    less intensive outpatient treatment, but
    inpatient treatment is indicated for persons with
    certain problem profiles
  • Brief interventions have shown the strongest
    evidence of effectiveness as general prevention
    strategies

57
6. Examples of Provincial Alcohol Policy
  • Taxes on alcohol
  • Mandatory Server Training
  • Closing Hours of Bars
  • Density of Licensed Establishments
  • Reduction of BAC
  • Driving and Drinking for young drivers
  • Standardized regulations related to alcohol
  • workplace issues
  • Advertising guidelines and controls

58
Examples of Municipal Alcohol-Related Policies
  • Licensing
  • Zoning
  • Transportation
  • Patios
  • Street Vendors
  • Noise by-law
  • Littering and public annoyance

59
Other Avenues for Alcohol Policy Development
  • Community Organisations (snowmobile association,
  • church, sports group)
  • Post secondary institutions residence etc.
  • Workplace- social functions, fit to work
  • Bars/Licensed Restaurants- internal policies
  • Retail Stores- marketing and selling practices

60
Environmental Supports
  • Coalition building
  • Media advocacy
  • Alcohol accords
  • Cleanliness and appearance
  • Lighting
  • Physical set up of licensed establishments
  • Police scheduling and coverage
  • RIDE programs
  • Enforcement

61
Part 7.What are public views on alcohol policies?
62
Per Adult Rate of Official Sales in Litres of
Absolute Alcohol
Statistics Canada Control Sale of Alcoholic
Beverages
63
Per Adult Rate of Official Sales Litres of
Absolute Alcohol by Beverage
Statistics Canada Control Sale of Alcoholic
Beverages
64
Percent aged 15 supporting alcohol controls,
Canada, 1989 1994
Ns 11,634 in 89 12,155 in 1994
65
Percent aged 15 supporting alcohol controlsby
gender, Canada, 1989 1994
Ns 11,634 in 89 12,155 in 94
66
Percent aged 15 supporting alcohol controlsby
region of Canada, 1994
N 12,144
67
Canada, 1989 and 1994Surveys
  • Based on 11,634 respondents in 1989 and 12, 155
    in 1994
  • Sampled by province, respondents aged 15 and
    older
  • The next table shows odds ratios for logistic
    regressions on alcohol policy measures by year,
    gender, age and drinking pattern

68
Policy Item Taxes increase Hours decreased Age raised No Corner Sales Govt ads increased Warning labels Prevent service to drunks
Yr 94 vs 89 0.76 0.84 0.58 0.67 0.55 0.74 0.60
Female vs male 1.35 1.49 1.35 2.58 1.58 1.77 1.48
Age 15-19 vs 35-44 0.74 0.77 0.32 1.12 0.90 1.31 0.50
20-34 vs 35-44 0.73 0.73 1.10 1.10 0.95 0.97 0.81
55 vs 35-44 0.88 0.98 1.66 1.12 0.74 1.07 0.83
Abstain. vs other drinkers 3.60 3.40 1.63 2.49 1.45 1.81 0.86
Freq. High-max vs other drinker 0.32 0.40 0.67 0.48 0.56 0.62 0.61
Source Giesbrecht Kavanagh, 1999, p.12, Table 2
69
National Surveys 1989 1994 Main Findings
  • Support declined for all policies over 5 yr
    interval
  • Support more likely among women than among men
  • Variation by age but not a consistent general
    pattern
  • Abstainers more likely to support controls
    compared to other drinkers
  • Frequent/high maximum drinkers less likely to
    support controls compared to other drinkers

70
Ontario Surveys
  • Sources Ontario sample of National Alcohol and
    Drug Survey Ontario samples of U.S. Warning
    Label Project provincial surveys sponsored by
    the Addiction Research Foundation the Centre
    for Addiction Mental Health
  • Representative samples of adults selected by
    random digit dialing
  • Ns varied by year from 1,034 to 2,721
  • Results based on adults aged 20 and older

71
Percent aged 20 supporting increased taxes on
alcohol, Ontario, 1989-2000
72
Percent aged 20 supporting shorter store hours
or opposed to corner store sales, Ontario,
1989-2003
73
Percent aged 20 supporting a ban on alcohol ads
on TV or ban on sponsorship by alcohol producers,
Ontario, 1989 - 2001
74
Percent aged 20 supporting warning labels or
increased counter-advertising, Ontario, 1989-2001
75
Percent aged 20 supporting an increase in
preventing service to drunken customers, Ontario,
1989-2001
76
Percent against privatizationby total sample and
gender, Ontario,1999 2002
Ns 1,288 in99 1,206 in 02
77
Percent against privatization of government
stores,by age, Ontario, 1999 2002
Ns 1,288 in 99 1,206 in 02
78
Percent against privatizationby drinking
pattern, Ontario, 1999 2002
Ns 1,288 in 99 2,002 in 02
79
Conclusions
  • There is support for a number of control
    measures, but it has declined
  • Majority of respondents support interventions
    with low impact (e.g.warning labels) and also
    modest potential (e.g.server intervention)
  • However a minority support interventions with
    demonstrated potential in reducing damage e.g.,
    higher taxes on alcohol and fewer outlets
  • Less support among males and frequent/heavier
    drinkers

80
Questions
  • Is there an interaction between increased
    marketing and extensive retailing of alcohol and
    declining support for controls?
  • What is the basis for the strong support for
    government liquor stores and opposition to corner
    store sales
  • Prevention agenda?
  • Fear of losing current modernized and customer
    friendly government retailing system?
  • Both?
  • Why have per adult sales increased in recent
    years?

81
Part 8.What are challenges and conclusions?
82
Challenges
  • Much of government alcohol policy-making is still
    based mainly on commercial agendas
  • The associations between increasing alcohol
    distribution and promotion and alcohol-related
    damage are typically not considered when policy
    decisions are made.
  • Ongoing challenge is that of having research and
    epidemiological findings provide a stronger basis
    for priorities in service and practice

83
Challengescontinued
  • Higher priority needs to be given to the more
    effective interventions alcohol policies.
  • Opportunities for synergistic combinations of
    interventions and effective partnerships need to
    be further explored and effective partnerships
    developed.
  • A current challenge is that of getting alcohol on
    the agenda e.g. governments see alcohol as a
    risk factor re chronic disease prevention.
  • The relevant lessons from other arenas, e.g. the
    tobacco control experiences, provide a useful
    guide for developing and implementing effective
    alcohol policies.

84
Conclusions
  • Alcohol policies can be effective at both the
    community level and the national level.
  • Policies can be targeted at the general
    population, at high-risk drinkers, and at people
    already experiencing alcohol-related problems.
  • Alcohol policies rarely operate independently or
    in isolation from other measures. Complementary
    system strategies that seek to restructure the
    total drinking environment are more likely to be
    effective than single strategies.
  • Full-spectrum interventions are needed to achieve
    the greatest population impact.

85
References Resource Material
  • Babor, T. et al. (2003) Alcohol No Ordinary
    Commodity. Research and Public Policy. Oxford
    Oxford University Press.
  • Centre for Addiction Mental Health (2004)
    Alcohol Policy Framework for Reducing
    Alcohol-Related Problems.
  • Centre for Addiction Mental Health (2004)
    Position Paper Retail Alcohol Monopolies and
    Regulation Preserving the Public Interest.
  • Centre for Addiction Mental Health (2004)
    Strategies to Prevent Community Alcohol-Related
    Problems Bar Areas
  • Giesbrecht, N. et al. (2001) Trends in public
    opinion on alcohol policy measures Ontario
    1989-1998. Journal of Studies on Alcohol vol 62
    142-149.
  • Gutjahr E. et al. (2001) The relation between
    average alcohol consumption and disease an
    overview. European Addiction Research 7 117-127.
  • Rehm, J. et al. Alcohol as a risk factor for
    global burden of disease. European Addiction
    Research, vol. 9, no. 4 157-164.
  • Room R. J. Rehm (2004) Alcohol-related global
    burden of disease. Presentation at the Research
    Society on Alcoholism, Vancouver 26-30 June 2004.

86
Contact Information
  • Norman Giesbrecht
  • Senior Scientist
  • Research Division
  • Centre for Addiction Mental Health
  • 33 Russell Street
  • Toronto, Ontario, Canada M5S 2S1
  • 416 535-8501 ext. 6895
  • Fax 416 595-6899
  • Email norman_giesbrecht_at_camh.net

87
Contact Information
  • Janet McAllister
  • Project Consultant
  • Education and Health Promotion Division
  • 171 Queens Avenue, Suite 330
  • London, Ontario N6A 5J7
  • 519 433-3171
  • Fax 519 433-2722
  • Email janet_mcallister_at_camh.net
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