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

24/7 清醒计划的公共卫生后果：关注死亡率

基本信息

批准号：
9332302
负责人：
Nancy Nicosia
金额：
$ 37.06万
依托单位：
RAND CORPORATION
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-08-15 至 2019-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9332302
关键词：
Accidental Injury Accidents Address Adopted Alcohol abuse Alcohol consumption Alcohols American Biological Breathalyzer Tests Cessation of life Communities County Crime Criminal Justice Data Data Set Documentation Domestic Violence Drunk driving Effectiveness Eligibility Determination Evaluation Excess Mortality Face Funding Goals Health Health Benefit Heavy Drinking Incidence Individual Intervention Jail Journals Justice Lawyers Letters Link Literature Methods Modeling Montana Mothers National Institute on Alcohol Abuse and Alcoholism Outcome Participant Peer Review Policies Population Premature Mortality Prevalence Prisoner Privatization Process Public Health Public Policy Published Comment Publishing Punishment Recording of previous events Records Research Resistance Risk Safety Sampling Severities South Dakota Statutes and Laws Suicide Supervision Testing Transportation Violence aged alcohol effect alcohol monitoring alcohol violation base cohort cost high risk population impaired driving performance innovation male mortality offender premature prevent programs public health relevance sobriety social success

项目摘要

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.

描述（由申请人提供）：过度饮酒的最具破坏性和代价最高的后果之一是死亡。酒精对死亡率的影响似乎在酗酒的罪犯中最为严重，但据我们所知，还没有基于美国样本的研究。旨在确定有效减少酒精相关危害的社区一级战略的研究产生了喜忧参半的结果，而且几乎没有关于死亡率的证据。不同程度的成功可以部分地解释为，这些干预措施针对那些最有可能造成伤害的饮酒者的程度。这项研究解决了文献中的两个重要空白。首先，我们提供了第一个严格的文件过量死亡率在酒精参与罪犯在美国。其次，我们评估是否南达科他州的24/7清醒计划（以下简称24/7），这是有效地减少酗酒和刑事司法的后果，有影响的死亡率。酗酒在刑事司法人员中尤其成问题。在传统的社区监督模式中，对违法行为的制裁（如果适用的话）通常只发生在相当严重的违法行为之后，而且可能要在突发性违法行为发生后数周或数月才能实施。但是，越来越多的证据表明，惩罚的确定性和绝对性比严厉性对非法活动产生了更强的威慑力，特别是在酗酒人群中。南达科他州的24/7适用的概念，经常测试结合迅速和某些（但温和）的制裁酒精违反酒精涉及罪犯生活在社区。兰德的NIAAA资助的评估，发表在美国公共卫生杂志，提供的证据表明，该计划减少了大量饮酒，并减少了12%的重复酒后驾车逮捕的流行率，家庭暴力逮捕了9%，年轻男性交通事故减少了4%。鉴于该计划在减少酗酒事件和刑事司法后果方面取得了成功，人们自然会考虑其好处是否会延伸到公共卫生结果--其中死亡率是最昂贵的。利用一个独特的个人层面的数据集链接犯罪记录，24/7参与和死亡率记录的罪犯队列，我们将首先记录死亡率在这个高风险人群，然后考虑是否/如何24/7影响他们的死亡率。虽然24/7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条件的受损驾驶对策或美国运输部基金（“MAP-21”; P.L. 112-141）。母亲反对酒后驾车公共政策副总裁最近的评论和刑事司法学者之间的辩论表明，尽管有新的证据表明大量饮酒和刑事司法后果减少，但对该计划的方法存在阻力。因此，这项研究的结果将提供进一步的证据，为24/7是否是保障公共安全和健康的有效手段的辩论提供信息。