Public Health Consequences of the 24/7 Sobriety Program: A Focus on Mortality

 描述(由申请人提供)：过量饮酒最具破坏性和代价最高的后果之一是死亡。酒精对死亡的影响似乎在酒精相关的罪犯中最严重，但据我们所知，还没有基于美国样本的研究。确定有效减少酒精相关危害的社区策略的研究结果喜忧参半，关于死亡率的证据很少。这种不同程度的成功可能部分是因为这些干预措施针对的是那些最有可能造成伤害的饮酒者。这项研究解决了文献中的两个重要空白。首先，我们提供了美国第一份关于酗酒罪犯死亡率过高的严格文件。其次，我们评估了南达科他州的全天候戒酒计划(以下简称全天候戒酒计划)是否对死亡率有影响，该计划在减少酗酒和刑事司法后果方面一直有效。酒精使用在刑事司法人群中尤其成问题。在传统的社区监督模式中，对违规行为的制裁--如果真的实施了的话--通常只在相当严重的违规行为之后发生，可能要到突如其来的违规行为发生数周或数月后才会实施。但是，越来越多的证据表明，惩罚的确定性和快捷性对非法活动的威慑作用强于严重性，特别是在酗酒人群中。南达科他州的24/7全天候将频繁测试的概念与对酒精违规行为的迅速和一定(但轻微)的制裁结合在一起，适用于居住在社区的涉及酒精的罪犯。兰德的NIAAA资助的评估发表在《美国公共卫生杂志》上，它提供的证据表明，该项目减少了酗酒，将县级因重复酒后驾车被捕的比例降低了12%，因家庭暴力被捕的人数减少了9%，年轻男性的交通事故减少了4%。鉴于该计划在减少酗酒事件和刑事司法后果方面取得的成功，人们自然会考虑它的好处是否会延伸到公共卫生结果--其中死亡是最昂贵的。利用一个独特的个人级别的数据集，将罪犯队列的犯罪记录、全天候参与和死亡记录联系起来，我们将首先记录这一高危人群的死亡率，然后考虑是否/如何影响他们的死亡率。虽然24/7正在几个较小的州和司法管辖区被采用或考虑，但它尚未被较大的司法管辖区广泛接受，尽管它最近被添加到符合资格或美国交通部资金的受损驾驶反措施名单(MAP-21；P.L.112-141)。负责母亲反对酒驾公共政策的副总裁最近发表的评论以及刑事司法学者之间的辩论表明，尽管有新的证据表明，酗酒和刑事司法后果有所减少，但该方案的做法受到了抵制。因此，这项研究的结果将为关于全天候是否是保障公共安全和健康的有效手段的辩论提供进一步的证据。

 DESCRIPTION (provided by applicant): One of the most devastating and costly consequences of excessive alcohol use is mortality. The mortality effects of alcohol appear to be most severe among alcohol-involved offenders, but to our knowledge there are no studies based on US samples. Research to identify community-level strategies that effectively reduce alcohol-related harms has produced mixed results and very little evidence on mortality. The varying degrees of success may be explained, in part, by the extent to which these interventions target those drinkers most likely to impose harms. The study addresses two important gaps in the literature. First, we provide the first rigorous documentation of excess mortality among alcohol-involved offenders in the US. Second, we evaluate whether South Dakota's 24/7 Sobriety Program (hereafter 24/7), which has been effective in reducing heavy drinking and criminal justice consequences, has implications for mortality. Alcohol use is particularly problematic among criminal justice populations. In traditional community supervision models, sanctions for violations-if applied at all-often occur only after fairly serious offenses and may not be imposed until weeks or months after the precipitating offense. But, a growing body of evidence suggests that punishment certainty and celerity create a stronger deterrent to illegal activity than severity, especially among alcohol-abusing populations. South Dakota's 24/7 applied the concept of frequent testing in combination with swift and certain (but mild) sanctions for alcohol violations to alcohol-involved offenders living in the community. RAND's NIAAA-funded evaluation, published in the American Journal of Public Health, provides evidence that the program reduced heavy drinking and reduced the prevalence of arrests for repeat drunk driving by 12%, arrests for domestic violence by 9%, and traffic crashes among young males by 4% at the county-level. Given the program's success in reducing heavy drinking episodes and criminal justice consequences, it is natural to consider whether its benefits extend to public health outcomes - among which mortality is the most costly. Exploiting a unique individual-level dataset linking criminal records, 24/7 participation and mortality records for a cohort of offenders, we will first document mortality among this high- risk population and then consider whether/how 24/7 influenced their mortality. While 24/7 is being adopted or considered in several smaller states and jurisdictions, it has not yet been widely accepted by larger jurisdictions despite its recent addition to the list of impaired driving countermeasures eligible or U.S. Department of Transportation funds ("MAP-21"; P.L. 112-141). Recent comments from the Vice President of Public Policy for Mothers Against Drunk Driving and debates among criminal justice scholars demonstrate a resistance to the program's approach despite emerging evidence of reductions in heavy drinking and criminal justice consequences. Thus, findings from this study will provide further evidence to inform the debate on whether 24/7 is an effective means of safeguarding public safety and health.