Transcript The scientific basis for alcohol policy

Resources for finding
additional information
needed to support
advocacy campaigns
Part B: Module II
Good evidence makes good advocacy
• Minimum legal
purchase age
• Government
monopoly
• Restriction on hours
or days of sale, outlet
density
• Alcohol taxes
• Lower alcohol
strength
• Random Breath
Testing
• Lowered BAC limits
• Administrative license
suspension
• Graduated licensing
for novice drivers
• Brief interventions for
hazardous drinkers
• Treatment and detox
Data on young people and alcohol
• Rates of harm:
– Mortality rates associated with
alcohol
– Accident and injury rates
– Rates of crime associated with
alcohol
– Number of drink driving offences/
road traffic crashes related to
alcohol
– Morbidity rates (e.g. liver disease,
heart disease, cancer, FASD)
– Suicide rates
– Poor performance at school
– Sexual health problems and
unwanted pregnancies
• Consumption levels and
attitudes towards
drinking:
– Prevalence of drinking for
different age groups
– Average age of onset of
regular drinking
– Rates of ‘heavy episodic’
or ‘binge’ drinking
• Current regulations and
alcohol controls – e.g.
age/licensing
restrictions in individual
countries.
Useful databases
• The World Health Organization Global School-based
Student Health Survey (WHO GSHS)
• WHO Global Status Report on Alcohol Policy
• The European Schools Survey Project on Alcohol
and Other Drugs report (ESPAD)
• The Health Behaviour in School Children study
(HBSC)
• European Monitoring Centre for Drugs & Addiction
(EMCDDA)
• Youth Risk Behavioral Surveillance System (YRBSS)
• Behavioural Risk Factor Surveillance System (BRFSS)
Tips and Suggestions
• Use the most recent statistics available
• Report trends over periods of time to help put
the data into perspective
• Relate to the geographical area most relevant
to your target audience
*Remember, when referencing data,
the source must always be credited.
Conducting surveys/opinion polls
• Available national and regional opinion polls
• Add questions to existing surveys
• Collect data from general public and key
stakeholders
• Coordinate school surveys with advocacy
campaigns
• Use online tools
– www.surveymonkey.com
– www.dotsurvey.com
– www.freeonlinesurveys.com
Designing survey questionnaires
• Begin with an explanation of who’s leading the
research, why the data is being collected, and
what is going to happen to the data after it has
been submitted
• Adhere to ethical principles
• Consult a survey expert
• Keep it as short as possible
• Use incentives
• Word questions carefully (short and direct)
• Use open-ended questions sparingly
• Pilot the survey
Needs Assessment Exercise:
Establishing the Need for Alcohol Policy
• Consult local and national resources such as school surveys,
morbidity and mortality statistics, drinking-driving arrest data,
alcohol-related emergency department admissions, etc.
• Use the Global Burden of Disease data base as well as WHO
national statistics
• Review current concerns, existing policies, and the extent to
which policy is evidence-based.
• Conduct interviews and focus groups with policymakers
• Conduct attitude surveys of public support for alcohol
policies.
Part C: Dealing with “Junk
Science:”
How to deal with the alcohol
industry’s research and prevention
programs
Corporation-induced Diseases
(+Disorders, Disability and Social Harm)
• A generic concept applied to diseases and other
health conditions attributed to consumption of
hazardous industrial products such as tobacco,
alcohol, food, guns, and gambling machines
• Harm caused to consumers, workers, or
community residents who have been exposed in
the marketplace, work site or community, to
disease agents that are part of the products of
corporate activity
• Jahiel, R. (2008) Corporation-induced diseases, upstream epidemiologic
surveillance, and urban health. Journal of Urban Health. 85, 4, 517-531.
Case Study- Finland
Alcohol industry pressures; partnerships; lobbying
Government
Limited alcohol control policies
In 2004, a dramatic cut in prices via taxes led within a year to an increase of 9%
in consumption
By 2005 alcohol-related problems were the most common cause of death
among Finns of working age
Cumulative Growth in Alcohol Industry
Social Aspect/Public Relations Organizations
Sources: Witheridge (2003), Anderson (2005), ICAP (2006)
Social Aspect Organizations:
Ostensible Role
•Support youth prevention activities
•Support scientific research
•Promote road safety and crime
reduction
Actual Role of Social Aspect
Organizations
•Public relations
•Lobbying for industry-favorable policies
•Neutralize opposing views and criticism
•Promote industry-favored scientists
•Oppose unpopular but effective policies
•Support ineffective but popular policies
Corporate Practices that Influence Alcohol and
Tobacco Use and Misuse
• Product design -- modifications of product
increase sales,
profits or market share
• Marketing -- advertising and product promotions increase sales
and market share, attract new customers and retain customer
loyalty
• Retail distribution -- activities such as convenience make
alcohol and tobacco more accessible to consumers
• Pricing -- product costs increase sales, profits, and market share
• Political influence – lobbying, political contributions, and
public relations activities can affect the policy environment
Areas where industry interests interact
with addiction science
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industry sponsorship of research funding organizations
direct financing of university-based scientists and centers
research conducted through contract research organizations
research conducted by trade organizations and SAPROs
publication of scientific documents and support of scientific
journals
• sponsorship of scientific conferences and presentations at
scientific conferences
• efforts to influence public perceptions of research, research
findings and alcohol/tobacco policies
Areas where industry interests interact
with practice and policy
• Industry sponsorship of prevention programs,
especially alcohol and tobacco education
• Industry self-regulation of advertising
• Industry “social responsibility” advertising messages
• Industry positions on effective alcohol and tobacco
policies
• Industry involvement in writing national alcohol
policies
History of the tobacco industry in relation
to scientific research
• Misuse of science and scientific information to
market their products to vulnerable
populations and to make cigarettes more
addictive
• Internal documents show that the tobacco
industry has used university-based scientists
to oppose health policies designed to prevent
diseases caused by cigarette smoking
Questions for Discussion
• What is the impact of corporate practices on population
health?
• Is industry collaboration (“partnerships”) with the scientific
community, public health advocates and prevention
professionals mainly designed to achieve their business
objectives?
• What should be done about corporate intrusions into science
and practice?
• Is there an opportunity to channel corporate responsibility
into needed funding for research, prevention and treatment?
ICAP Survey of Health Authorities
• An international survey of 114 national health
authorities
• Solicited views about alcohol policies and
partnerships with the alcohol industry
• 42% response rate
• Concluded that alcohol education was a
priority areas for partnerships, especially in
developing countries
Efforts to influence public perceptions of
research
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California Wine Institute publications and its website: 1) made exaggerated claims
about the health benefits of alcohol and wine; 2) regularly omitted the cautionary
statements made by scientists whose studies it cited; and 3) failed to mention the
health risks of alcohol consumption (Steinhardt and Hacker, 1997).
Representatives of Portman Group nominated to sit on governmental advisory
counsels charged with research funding and policy (Alcohol Education and
Research Council)
Portman Group invited criticism of the book, Alcohol Policy and the Public Good
(Edwards et al., 1994)
Representatives of Portman Group contribute to drafting of "A Harm Reduction
Strategy for England"
Critique of Swiss tax study (Gmel, et al., 2005) by economist paid by Groupement
Suise des Spirituex de Marque
Distilled Spirits Council of United States supports letters to the editor questioning
the methodology of an NIH study concluding that alcohol advertising is associated
with increased alcohol use by youth
Does industry funding affect alcohol policy
and program effectiveness?
• One study reported that industry funding of programs to
prevent underage drinking was associated with an
abandonment of a less expensive compliance check program
• Alcohol industry opposition to advertising bans in favour of
self-regulation exposes millions of youth to alcohol marketing
• Industry opposition to alcohol taxes and availability
restrictions leads to the adoption of less effective or
ineffective policies (e.g., alcohol education campaigns,
designated driver programs) in many countries.
Can industry funding
bias research findings?
• In a comparison of the conclusions of 24 published review papers,
Jorgensen et al. (2008) found that industry supported reviews of drug
medications had more favourable conclusions than corresponding
Cochrane reviews of the same drugs, and were also rated as being of
lower methodological quality.
• Studies of anti-hypertensive drugs funded by a single drug company have
a 55% rate of favourable results, compared with 18% if they are not
funded by an industry source (Yank et al. (2008).
• In a review of breast cancer clinical trials, it was found that
pharmaceutical industry involvement may affect study design, focus and
results (Peppercorn et al., 2007). Studies that reported drug company
sponsorship were more likely to be positive than non-sponsored studies
(Bekelman et al., 2003).
Can industry funding
bias research findings?
• A growing number of studies have shown that conflicts of
interests in health research are associated with biased
research findings that favor commercial interests at the
expense of patient health
• It is 3.5 times more likely a study will yield a positive result
about a product if that study is funded by industry (DeAngelis,
2007)
• In several integrative reviews of the evidence it has been
argued that not only does this compromise scientific integrity,
it also decreases public trust in research. (FASED, 2007;
Brennen et al., 2007; Kassirer, 2005; Krimsky, 2003).
What is the extent of industry involvement in alcohol
research and prevention?
• Despite claims that the industry devotes
millions to health-related alcohol research and
prevention, the evidence suggests a rather
small direct contribution, one that is unlikely
to contribute to alcohol science, lead to
prevention breakthroughs, or reduce the
burden of alcohol-related illness.
What is the proper role of scientists and
prevention professionals?
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Alcohol scientists should be very wary about accepting research funding directly
from the industry, its trade associations or SAPROs.
Consulting arrangements wherein scientists are paid to critique the work of other
scientists constitute a serious financial conflict of interest
Acceptance of fees for book chapters, background reports, attending conferences
and prevention activities should be prefaced by the following questions: 1) To
what extent is the activity designed to promote the commercial interests of the
alcohol or tobacco industries? 2) Will the funding source be acknowledged?
Funding from independent organizations (e.g., ABMRF and ERAB) may be
consistent with scientific and public health aims if the grant review process is
independent, transparent and peer reviewed. But scientists and prevention
professionals need to be careful that their objectivity and independence are not
compromised by fraternizing with industry executives, paid travel to meeting sites,
and consulting fees.
What about industry-sponsored dialogues
and "partnerships" in relation to public
health issues?
• The “hands-off” position: refuse to engage in
communication or collaboration with industry
representatives, based on the assumption that
the industry’s commercial interests are
incompatible with the values and aims of public
health and with scientific research.
• The “hands-on” approach: engage in dialogue
with industry representatives, accept industry
funding, and participate as “partners” in industryfunded scientific activities as long as independent
judgment is maintained
A third way – Engage with the industry only
when it promotes the interests of science
and public health
• Insist on industry support for evidence-based policies, and cessation
of anti-scientific lobbying activities, as a precondition for dialogue
about partnerships with scientists and prevention professionals
• Encourage monitoring of industry activities using advanced social
science methods
• Be attentive to organizational legitimacy issues
• Conduct ethical hazard inventories before engaging in any
partnerships, prevention initiatives, or mutual scientific activities
• Engage professional scientific organizations and NGOs in a critical
review of industry-science relationships
• Insist on rigorous adherence to Conflict of Interest principles
Should the alcohol and tobacco
industries pay for the societal costs of
research, prevention and policy?
• The attributable burden can be estimated
• The costs can be estimated
• It is agreed that alcohol and tobacco are no
ordinary commodities
• General and dedicated taxation are
accepted by governments and industry