Reducing alcohol-related harm in rural communities

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In 1992 in Australia, there were an estimated 3,660 alcohol-related deaths and 71,593 alcohol-related hospital episodes, resulting in a total economic cost of $4,031.9 million, 84% of which was avoidable. In 1998, about half of all males and a third of all females drank at least once a month at levels that placed them at risk of harm. In NSW, alcohol was estimated as being a causal factor in about one-quarter of all road traffic deaths in 1995 and was associated with a 58% increase in hospital utilistion rates between 1988-89 and 1990-91. The burden of suffering appears disproportionately higher in rural areas of NSW: per capita rate of convictions associated with a prescribed alcohol concentration in rural towns was approximately double that in metropolitan areas in 2000. The rate of attendances at hospital accident and emergency departments was also higher in rural areas. These data suggest a need for additional effort to reduce alcohol-related harm in rural, relative to metropolitan, areas. In Australia, there have been no well-controlled, community-based, attempts to reduce alcohol-related harm by simultaneously implementing a range of interventions. The conduct of a large-scale randomised controlled trial (RCT) to investigate the effectiveness of this approach is difficult to justify, due to the substantial costs associated with such a rigorous design. However, a less rigorus, though equally valid, design, such as a stepped wedged approach, would likely provide good evidence to justify the subsequent conduct of an RCT. If the expected outcomes are not achieved, the conduct of an RCT can be postponed until reasonable preliminary evidence regarding the types of community-based interventions most likely to be effective is obtained. In either case, this study will provide valuable information as to which community-based interventions, and in what combination, are most likely to reduce the occurrence of alcohol-related harm in rural communities in Australia.