Can a criminal justice alcohol abstention programme with swift, certain, and modest sanctions (24/7 Sobriety) reduce population mortality? A retrospective observational study
Can a criminal justice alcohol abstention programme with swift, certain, and modest sanctions (24/7 Sobriety) reduce population mortality? A retrospective observational study
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DOI：
10.1016/s2215-0366(15)00416-2
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发表时间：
2016-03-01
影响因子：
64.3
通讯作者：
Heaton, Paul
中科院分区：
文献类型：
--
作者：
Nicosia, Nancy;Kilmer, Beau;Heaton, Paul
背景在英国和美国，不同的司法管辖区已经推出了新的方法来管理可能对公共卫生产生影响的酒精相关的提供者。这些方案要求参与者戒酒，并经常接受酒精测试，对违规行为给予迅速、确定和适度的制裁，目的是减少犯罪，使酗酒者留在社区。在这项研究中，我们检查了美国南达科他州的24/7清醒计划（迄今为止最大的此类计划）是否与死亡率的降低有关。方法采用差异中差异设计，我们利用2005年至2011年间南达科他州各县24/7清醒实施时间的变化来估计计划引入与县级死亡率之间的关联。我们使用2000年1月至2011年6月的月度县级死亡率汇总计数。我们评估了总死亡人数，以及由于外伤，循环系统疾病，消化系统疾病和癌症（作为一个潜在的安慰剂）导致的死亡。结果在2005年1月至2011年6月期间，16932人（约占成年人口的3%）参加了24/7清醒计划。该分析基于样本量（108个县-月观察结果，即66个县x 12个月x 11.5年）。实施24/7清醒与全因成人死亡率降低4.2%（95%CI 1.5-6.9）相关，其中女性（8.0%，95%CI 3.9-11.8）和40岁以上个体（4.3%，95%CI 1.4-7.0）的相关性最大。解释24/7清醒可能具有公共健康益处，这可能超出直接参加该计划的个人。然而，需要进一步的研究，包括随机对照试验和个人水平数据的分析，以证实这些发现，重新评估这些关联的大小，并深入了解因果机制。如果一个负面的关联被复制，它可能代表着我们在理解刑事司法干预如何帮助塑造公共卫生方面的一个重大进步。
Background In the UK and USA, various jurisdictions have launched new approaches for managing alcohol-involved off enders that might have public health implications. These programmes require participants to abstain from alcohol and submit to frequent alcohol testing with swift, certain, and modest sanctions for violations, with the aim to reduce crime and keep alcohol-involved off enders in the community. In this study we examine whether the 24/7 Sobriety programme in South Dakota, USA-the largest such programme to date-is associated with reductions in mortality.Methods With a differences-in-differences design, we used variation in the timing of 24/7 Sobriety implementation across South Dakota counties between 2005 and 2011 to estimate the association between programme introduction and county-level mortality. We used monthly, county-level, aggregate counts for mortality from January, 2000, to June, 2011. We assessed total deaths, and deaths due to external injuries, circulatory disorders, digestive disorders, and cancer (as a potential placebo).Findings Between January, 2005, and June, 2011, 16 932 people (about 3% of the adult population) participated in the 24/7 Sobriety programme. The analysis was based on a sample size of (108 county-month observations (ie, 66 counties x 12 months x 11.5 years). Implementation of 24/7 Sobriety was associated with a 4.2% (95% CI 1.5-6.9) reduction in all-cause adult mortality, with the largest associations among women (8.0%, 95% CI 3.9-11.8) and individuals older than 40 years (4.3%, 95% CI 1.4-7.0). Associations were most evident among circulatory disorders.Interpretation 24/7 Sobriety might have public health benefi ts, which could extend beyond individuals directly enrolled in the programme. However, further research, including randomised controlled trials and analyses of individual-level data, is needed to corroborate the fi nding, reassess the size of these associations, and gain insight into causal mechanisms. Should a negative association be replicated, it might represent a substantial advance in our understanding of how criminal justice interventions could help shape public health.