Reducing alcohol-related harm in rural communities

1992年，澳大利亚估计有3，660例与酒精有关的死亡和71，593例与酒精有关的住院事件，导致总经济成本为40.319亿美元，其中84%是可以避免的。1998年，大约一半的男性和三分之一的女性每月至少饮酒一次，饮酒量使他们处于危险之中。在新南威尔士州，据估计，酒精是1995年约四分之一的道路交通死亡的原因，并与1988-89年和1990-91年之间医院使用率增加58%有关。新南威尔士州农村地区的痛苦负担似乎高得不成比例：2000年，农村城镇与规定的酒精浓度有关的人均定罪率大约是大都市地区的两倍。在农村地区，医院事故和急诊部门的就诊率也较高。这些数据表明，相对于大都市地区，需要进一步努力减少农村地区与酒精有关的伤害。在澳大利亚，还没有一种控制良好的、以社区为基础的尝试，通过同时实施一系列干预措施来减少与酒精有关的伤害。进行大规模随机对照试验（RCT）来研究这种方法的有效性是很难证明的，因为这种严格的设计会产生大量的成本。然而，虽然同样有效，但不太严格的设计，如阶梯楔形入路，可能会提供良好的证据来证明随后进行RCT的合理性。如果没有达到预期的结果，可以推迟进行随机对照试验，直到获得关于最有可能有效的社区干预类型的合理初步证据。在任何一种情况下，这项研究将提供有价值的信息，以社区为基础的干预措施，以及在什么样的组合，最有可能减少发生在澳大利亚农村社区与酒精有关的伤害。

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.