Upload
thomasine-richards
View
215
Download
0
Tags:
Embed Size (px)
Citation preview
Alcohol As a Risk Factor For Injury
Intermediate Injury Prevention Course
Indian Health Service
Billings, Montana
August 2011
Alcohol As a Risk Factor for Injury
Goal: To understand the role that alcohol plays as a risk factor for injury, and it’s impact nationally as well as among American Indians and Alaska Natives.
Alcohol As a Risk Factor for Injury
Objectives:
Describe What We Know
Review Injury Data and Trends
Understand factors which place American
Indians and Alaska Natives at increased risk of alcohol-related injury
Alcohol, Injury, and American Indians
Common Belief: Alcohol is the cause of all problems in Indian country.
True or False:Alcohol is the leading risk factor for injuries.
The solution to injury is to abolish alcohol
Males have the greatest injury problem
The solution to injury is to eliminate males
PublicHealth Approach
Define the Problem
IdentifyRisk Factors
Find what Prevents
the Problem
Implement &Evaluate Programs
•Surveillance
•Who, What?
•What Works?
•Prevention
Source: National Center for Injury Prevention and Control, CDC
Alcohol and Injury
What Percent of American Indian and Alaska Native Deaths Are Alcohol-Related?
Sources: May P, The Epidemiology of Alcohol Abuse Among American Indians: the Mythical and Real Properties .
The Primary Care Provider, Volume 20, March 1995, Indian Health Service; . Ethnicity and Alcohol-Related Fatalities,
1990-1994, by Voas RB and Tipetts AS, National Highway Traffic Safety Administration, 1999.
Homicide
Suicide
Motor Vehicle
Pedestrian
— 85%
— 75%
— 73-65%
— 84%
American Indian Youth Risk Behavior Survey, 1997
1997 BIA/CDC Youth Risk Behavior Survey, students in grades 9-12:
48% Rode with Drinking Drivers 21% Drove after Drinking 37% Rarely/Never used Seat Belts 15% Attempted Suicide
Among American Indian/Alaska Natives adolescents aged 19 years and younger, motor vehicle crashes are the leading cause of injury-related death.
Motor Vehicle Fatality
Odds of Causing a Motor Vehicle Crash by BAC
05
10152025303540
0 .06 .08 0.1 0.12 0.14 0.16
BAC Percent
Rel
ativ
e R
isk
RF Borkenstein, The Role of the Drinking Driver in Traffic Accidents. Alcohol, Drugs and Behavior 1974; 2 (suppl) 8-32.
Motor Vehicle Fatality
In 2006, American Indian/Alaska Natives had the highest percentage (48%) of alcohol-impaired driving fatalities among all racial/ethnic populations.
Alcohol-Related Traffic Fatalities, 1982-2000, U.S.
Source: NHTSA, Fatality Analysis Reporting System
0
5,000
10,000
15,000
20,000
25,000
30,000
1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2005
Nu
mb
er o
f F
atal
itie
s
Year
Impact of Alcohol-impaired Driving, U.S.
• 115 million episodes
• Each DUI arrest: 1000-2000 not arrested
• 16,000 deaths
• 310,000 injuries
Each Year:
75
65
50
40
0
1020
3040
50
6070
8090
100
1990 2000
IndianAll U.S.
Source: NHTSA FARS Query system 2002: http://www-fars.nhtsa.dot.gov/; and Ethnicity and Alcohol-Related Fatalities, 1990-1994, by Voas RB and Tipetts AS, National Highway Traffic Safety Administration, 1999.
Are We Making a Difference?
Percent of Alcohol-Related Motor Vehicle Deaths, Native Americans and All US Races
Seat belt usage ranges from a low of 28% to a high of 88% on reservations.
Source: NHTSA. FARS data, 2006.
Risky Alcohol UseMeans Costly Health Problems
Predictors of seatbelt use in American Indian motor vehicle crash trauma victims on and off the
reservation.
Accid Anal Prev. 2007 Sep;39(5):1001-5. Epub 2007 Mar 28.
“…alcohol, rather than race or location, is the overriding predictor of seatbelt use. This study compared patients that were in crashes, and only those triaged to a level one trauma facility.”
Alcohol and American Indians
In groups of 2-3, discuss what you know are
factors that place American Indians/Alaska Natives at high risk for alcohol-related injury death. Take into consideration age, drinking style, environment, and gender.
Alcohol and American Indians
American Indians Overall are Younger
Median age of 24 vs. 33 for all US Races.
All Youth Engage More in Risky Behaviors
The large proportion of young AI/AN places a large segment of the population at risk
Risk Factor: Age
Alcohol and American Indians
In some Tribes, fewer adults drink than in the general US population, and a substantial proportion of Indian people do not drink, especially older adults.
Among AI/AN Who Do Drink—2-3 times Greater Prevalence of Problem Drinking
Risk Factor: Drinking Style
Alcohol and American Indians
Indian Males 15-35 Often “Binge” Drink with High BACs.
High BACs Often Lead to Severe Injury
Risk Factor: Drinking Style
Alcohol and American Indians
About Half of All American Indians Live in Rural Environments
Long Distances to Advanced Trauma Care
Risk Factor: Environment
Alcohol and American Indians
Risky Environments Such as Driving Long Distances at Night, Walking, and Boating Combined with High BACs Often Lead to Fatal Outcomes
Risk Factor: Environment
Alcohol and American Indians
More Indian Men Drink Than Women
Young Indian Men More Likely to Engage in Excessive Binge Drinking With High BACs
Risk Factor: Gender
Alcohol and American Indians
Indian Male Injury Death Rates are 2 to 5 Times Greater Than Female Rates
Indian Females Are at Higher Risk of Alcohol-Related Death than Non-Indian Women.
Risk Factor: Gender
Intervening in the Presence of Alcohol
Gallup Protective Custody Program Highway Lighting Projects: Whiteriver,
Gallup, Sells, others Float coat programs in Alaska Reduce Alcohol Availability--Policy Legislation and Enforcement of Laws
Intervening in the Presence of Alcohol
Protective Custody Program, Gallup, NM Intoxicated people picked up off streets and
housed up to 3 days Reduces potential pedestrian injuries,
hypothermia deaths, and violence Alcohol detoxification and treatment provided
Na’nizhoozhi Center
Intervening in the Presence of Alcohol
Successful street lighting projects in Whiteriver, AZ, Gallup, NM, Sells, AZ, and others
Pedestrian Lighting Projects
Allow drivers to see pedestrians at night, even if intoxicated and walking in roadway
Which of the Three “Es” is this approach?
Intervening in the Presence of Alcohol
• Alaska’s rivers are the “highways” of Native village life.
•The use of float coats and life jackets can save lives even in alcohol-related boating incidents.
Photo Source: Ryan Hill
Float Coat Programs
Who Controls Alcohol Policy?
Bootleggers
Border Towns
Tribal Council
Alcohol Policy Considerations
Long history of prohibition of American Indians and alcohol. American Indians could not legally buy alcohol until 1953.
Many tribes today are still “Dry” and don’t allow alcohol on the reservation.
Alcohol Policy Considerations
Buzz Group Discussion(5-7 min) List policy considerations (pros and cons) of tribes legalizing the sale of alcohol - ”Wet” and “Dry”. Half the class take the Wet policy and other half Dry.
Wet Dry
Pro
Con
Alcohol and Injury Summary
There are ways to be involved in reducing alcohol-related injuries in your community
Alcohol is a complex problem requiring multi-disciplined approach and community empowerment
Not just a police and court system problem
Alcohol Resources
• The Epidemiology of Alcohol Abuse Among American Indians: The Mythical and Real Properties by Dr. Philip May was published in the IHS Primary Care Provider, March, 1995, and can be found at:
• http://www.ihs.gov/publicinfo/publications/healthprovider/issues/IHSProMar2.asp#alcohol