Technical Paper 3:
Preventing Alcohol-related harm in Australia: a window of opportunity
International reviews of education and persuasion strategies suggest that even with adequate resources, such approaches have limited potential for success on their own. Part of the reason for this is the counter effect of powerful forces that underpin unsafe and unhealthy drinking cultures, such as the price, availability and promotion of alcohol products. Recent Australian research for the development of a national alcohol social marketing initiative reports that ‘the challenge for communication is that intoxication is closely linked to alcohol per se. When we simply asked participants about their earliest memories in relation to alcohol there was an overwhelming tendency to leap to their first drunk experience. Further, these experiences were recalled with a sense of pride and nostalgia, even though the stories inevitably involved some embarrassment.’ A key element to the success of social marketing in the public health area is effective integration with and reinforcement by other complementary strategies. For instance, the success of social marketing in promoting quitting smoking and road safety, including anti-drink-driving campaigns, is indicative that education and persuasion strategies can be effective when coupled with other measures such as support services, changes to the environment, regulation and enforcement.
Throughout the world, alcohol education in schools is an enormously popular approach to addressing the issue of harmful consumption of alcohol among young people. The traditional alcohol education programs that are based on an informational approach, while still very common, have not been shown to prevent or reduce the harmful consumption of alcohol by young people, and in some cases have actually been counterproductive by stimulating an interest in drinking among young people. In recent years, there has been a shift towards normative education, which aims to correct young people’s perceptions about their peers’ drinking and thus de-normalise the harmful consumption of alcohol. While this makes intuitive sense, it has been found that such school-based educational interventions, in general, produce only modest results that are short-lived unless accompanied by ongoing booster sessions. Importantly, given there are considerable risks involved in school-based education, it has been recommended that investment in such programs be accompanied by a proportionate investment in evaluation. There are some examples of sound outcomes but these are relatively unusual. These generally involve whole-of-community efforts and they are usually associated with a close evaluation that ensures they are implemented (with modifications through feedback) as planned. In Australia, these include the School Health and Harm Reduction Project (SHAHRP) in Western Australia and the Gatehouse Project in Victoria, whose primary target was reduced school bullying but where the side benefit was a comparative reduction in the use of tobacco and alcohol. Related to alcohol education programs for school students are parent education programs. While some reviews cite promising signs of effectiveness, in general there remains a lack of research to fully determine the value of such programs.
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Low-risk drinking guidelines have been adopted in many countries, including Australia, to provide advice on the health risks and benefits of drinking at various levels for the general adult population, and for particular sub-groups. Despite their popularity, there is very little research that demonstrates the effectiveness of guidelines.
However, guidelines do potentially fulfil an important function as supporting information for other measures known to be effective, such as brief interventions in primary care, and as the basis for health promotion messages and social marketing campaigns. In Australia, the current alcohol guidelines. are under review. New draft guidelines prepared for public consultation are due to be finalised and released in late 2008. The new draft guidelines have been informed by updated modelling on the health risks of drinking, which have produced new estimates of the lifetime risks of alcohol-related harm. Emerging evidence also indicates that previous studies claiming the significant health benefits of alcohol consumption have tended to overestimate the effects. The consultation draft indicates the main changes are expected to include a new simplified, universal guideline level for alcohol intake for both short-term and long-term risks, a new guideline with special precautions for children and adolescents, and a new guideline for pregnant or breastfeeding women.
Warning labels on alcohol products, while not required in Australia, have a high level of public support. Evaluations of alcohol warning labels are generally limited to the US experience, where labels were implemented in 1989. While there is some evidence of effects on knowledge and attitudes, there is no evidence that warning labels influence drinking behaviour. By contrast, the tobacco labelling experience offers strong evidence that warning labels can be effective, not only in increasing information and changing attitudes but also in changing behaviour. These successes of tobacco warning labels suggest that alcohol warning labels should be graphic and attention-getting, should occupy a considerable portion of the package surface, and should involve rotating and changing messages. Perhaps most importantly, they should complement and be complemented by a wider range of strategies aimed at changing drinking behaviour.