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Montero-Zamora P, Brown EC, Ringwalt CL, Schwartz SJ, Prado G, Ortiz-García J. Etiologic mechanisms in an adapted family-based preventive intervention for underage alcohol use in Mexico: Results of an exploratory pilot study. FAMILY PROCESS 2023; 62:609-623. [PMID: 35876057 DOI: 10.1111/famp.12800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 05/12/2022] [Accepted: 05/26/2022] [Indexed: 06/08/2023]
Abstract
Alcohol use represents a global health problem, especially for Latin American youth. As part of the Global Smart Drinking Goals campaign, a family-based preventive intervention was adapted and piloted in Mexico based on an existing evidence-based program, Guiding Good Choices. In this study, we explored the malleability and session-specific mean-level changes in protective and risk factors targeted by the adapted family intervention as related to the prevention of underage alcohol use and abuse. The sample consisted of 177 parents working at four private local companies who had children between the ages of 8 and 16. Data were collected before and after each program session. Linear mixed-effects models were used to examine growth trajectories and session-specific mean differences for selected etiologic factors. Significant effects on protective and risk factors were found. Among protective factors, positive family involvement showed the most considerable linear growth over time, while clear standards for youth showed the largest within-session increase. The greatest linear decrease in risk was observed for family conflict, which also showed the greatest pre-, and post-session reduction. Our findings suggest that the adapted program helped families develop protection against, and reduce risk of, alcohol use in their adolescent children. Results from this exploratory pilot study provide support for further rigorous evaluation and dissemination of the adapted intervention for Hispanic families.
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Affiliation(s)
- Pablo Montero-Zamora
- Departments of Kinesiology, Health Education, and Educational Psychology, University of Texas at Austin, Austin, Texas, USA
| | - Eric C Brown
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | | | - Seth J Schwartz
- Departments of Kinesiology, Health Education, and Educational Psychology, University of Texas at Austin, Austin, Texas, USA
| | - Guillermo Prado
- School of Nursing and Health Studies, University of Miami, Miami, Florida, USA
| | - Jorge Ortiz-García
- Academic Unit of Psychology, Autonomous University of Zacatecas, Zacatecas, Mexico
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Paschall MJ, Ringwalt CL, Fisher DA, Grube JW, Achoki T, Miller TR. Screening and brief intervention for alcohol use disorder risk in three middle-income countries. BMC Public Health 2022; 22:1967. [PMID: 36289538 PMCID: PMC9609268 DOI: 10.1186/s12889-022-14358-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/09/2022] [Accepted: 10/14/2022] [Indexed: 11/11/2022] Open
Abstract
Background This study examined the prevalence of screening and brief intervention (SBI) for alcohol use disorder (AUD) risk in samples of adult drinkers in three middle-income countries (Brazil, China, South Africa), and the extent to which meeting criteria for AUD risk was associated with SBI. Methods Cross-sectional survey data were collected from adult samples in two cities in each country in 2018. Survey measures included past-year alcohol use, the CAGE assessment for AUD risk, talking to a health care professional in the past year, alcohol use screening by a health care professional, receiving advice about drinking from a health care professional, and sociodemographic characteristics. The prevalence of SBI was determined for past-year drinkers in each country and for drinkers who had talked to a health care professional. Logistic regression analyses were conducted to examine whether meeting criteria for AUD risk was associated with SBI when adjusting for sociodemographic characteristics. Results Among drinkers at risk for AUD, alcohol use screening rates ranged from 6.7% in South Africa to 14.3% in Brazil, and brief intervention rates ranged from 4.6% in South Africa to 8.2% in China. SBI rates were higher among drinkers who talked to a health care professional in the past year. In regression analyses, AUD risk was positively associated with SBI in China and South Africa, and with brief intervention in Brazil. Conclusion Although the prevalence of SBI among drinkers at risk for AUD in Brazil, China, and South Africa appears to be low, it is encouraging that these drinkers were more likely to receive SBI. Supplementary information The online version contains supplementary material available at 10.1186/s12889-022-14358-4.
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Affiliation(s)
- Mallie J. Paschall
- grid.280247.b0000 0000 9994 4271PIRE Programs NF, Pacific Institute for Research and Evaluation, 2030 Addiston St., Suite 410, 94704 Berkeley, CA United States
| | - Christopher L. Ringwalt
- grid.280247.b0000 0000 9994 4271PIRE Programs NF, Pacific Institute for Research and Evaluation, 2030 Addiston St., Suite 410, 94704 Berkeley, CA United States
| | - Deborah A. Fisher
- grid.280247.b0000 0000 9994 4271PIRE Programs NF, Pacific Institute for Research and Evaluation, 101 Conner Drive, Suite 200, 27514 Chapel Hill, NC United States ,grid.280247.b0000 0000 9994 4271PIRE Programs NF, Pacific Institute for Research and Evaluation, 4061 Powder Mill Road, Suite 350, 20705 Beltsville, MD United States
| | - Joel W. Grube
- grid.280247.b0000 0000 9994 4271PIRE Programs NF, Pacific Institute for Research and Evaluation, 2030 Addiston St., Suite 410, 94704 Berkeley, CA United States
| | - Tom Achoki
- grid.431216.3AB InBev Foundation, 1440 G Street NW, 20005 Washington, DC United States
| | - Ted R. Miller
- grid.280247.b0000 0000 9994 4271PIRE Programs NF, Pacific Institute for Research and Evaluation, 4061 Powder Mill Road, Suite 350, 20705 Beltsville, MD United States ,grid.1032.00000 0004 0375 4078Curtin University School of Public Health, 6845 Perth, WA Australia
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Fisher DA, Miller TR, Grube JW, Ringwalt CL, Achoki T, Ngwato TP, Shilakoe L, Mkhondo P. Locked Down: Economic and Health Effects of COVID-19 Response on Residents of a South African Township. GLOBAL SOCIAL WELFARE : RESEARCH, POLICY & PRACTICE 2022:1-13. [PMID: 35967248 PMCID: PMC9361952 DOI: 10.1007/s40609-022-00230-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 06/15/2023]
Abstract
Background Little research has examined how pandemics affect residents in under-resourced communities. This study investigated how COVID-19 and lockdown policies affected residents of Alexandra, one of Johannesburg, South Africa's lowest-income townships. Methods We conducted a telephone survey May 11-22, 2020, while the lockdown and alcohol ban were in effect, of a spatially stratified sample of 353 adult Alexandra residents drawn randomly from voter registration, credit card application, and prior studies' sampling frames. We examined economic consequences; health experiences, including COVID-19 exposure and mental health symptoms; alcohol use; and personal experiences with violence. Results Respondents were aged 18 to 89 and 47% female. About 70% of those employed before the lockdown were no longer working. Over half of households lost at least one source of income. About 50% of respondents reported stockpiling food. A majority reported price rises and declines in availability of food. Smaller percentages reported such changes for other items. Over 80% reported stress or anxiety, or depression due to the pandemic. The prevalence of past-week alcohol use fell from over 50% before the lockdown to less than 10% during the lockdown. Self-reported physical violence victimization increased. Discussion COVID-19 and the lockdown disrupted Alexandra residents' lives through unemployment, lost income, mental health problems, and increased violence. The differences between these outcomes and those in more advantaged communities deserve investigation. Research should also seek to identify tailored responses to effectively address the challenges of marginalized communities that often have limited resources to deal with pandemics and policies to contain them.
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Affiliation(s)
- Deborah A. Fisher
- Pacific Institute for Research and Evaluation, 4061 Powder Mill Road, Suite 350, Beltsville, MD 20705-3113 USA
| | - Ted R. Miller
- Pacific Institute for Research and Evaluation, 4061 Powder Mill Road, Suite 350, Beltsville, MD 20705-3113 USA
- Curtin University School of Public Health, Curtin University, Kent St, Bentley, WA 400 Australia
| | - Joel W. Grube
- Pacific Institute for Research and Evaluation, 2150 Shattuck Ave., Suite 601, Berkeley, CA 94704 USA
| | - Christopher L. Ringwalt
- Pacific Institute for Research and Evaluation, 101 Conner Drive, Suite 200, Chapel Hill, NC 27514-7038 USA
| | - Tom Achoki
- AB InBev Foundation, 1440 G Street NW, DC Washington, DC, 20005 United States
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Tara Polzer Ngwato
- Social Surveys Africa, 2 Upper Park Drive, Forest Town, Johannesburg, 2193 South Africa
| | - Lebogang Shilakoe
- Social Surveys Africa, 2 Upper Park Drive, Forest Town, Johannesburg, 2193 South Africa
| | - Penelope Mkhondo
- Social Surveys Africa, 2 Upper Park Drive, Forest Town, Johannesburg, 2193 South Africa
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Montero-Zamora P, Brown EC, Ringwalt CL, Schwartz SJ, Prado G, Ortiz-García J. Predictors of Engagement and Attendance of a Family-Based Prevention Program for Underage Drinking in Mexico. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 23:237-247. [PMID: 34626326 DOI: 10.1007/s11121-021-01301-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2021] [Indexed: 11/29/2022]
Abstract
Underage drinking represents a major global health problem. Given the crisis that underage drinking represents, Tomando Buenas Decisiones, a family-based prevention program, was adapted and piloted in Mexico based on the existing Guiding Good Choices program. Although family-based interventions in the USA are promising for preventing underage drinking, little is known about how adapted versions of these interventions may work in low-middle income countries, such as in Latin America. The present study examined whether baseline individual, familial, and cultural factors predict participants' engagement and attendance in an adapted program for preventing underage drinking in Zacatecas, Mexico. The study was conducted with a sample of 178 parents who participated in the adapted program and were employed at local private companies. Latent growth curve modeling was used to analyze (a) change in engagement, (b) predictors of engagement, and (c) predictors of attendance. Results indicated that perceived engagement evidenced a significant linear increase throughout the intervention. Participants' familism values, such as perceived family as referents and family support, at baseline predicted both initial levels of and change in engagement. Perceived familial obligation also predicted change in engagement. Attendance was negatively predicted by male gender, by perceived stress, and by perceived familial obligations among women only. Poor family management, and perceived familial obligations among men, positively predicted attendance. Our findings have important implications for the conceptualization of engagement and attendance in family-based preventive interventions for underage drinking among Hispanics. Researchers interested in implementing interventions in Latin America can use these findings to better comprehend how and for whom adapted family-based preventive interventions work.
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Affiliation(s)
- Pablo Montero-Zamora
- Departments of Kinesiology and Health Education, College of Education, University of Texas at Austin, 2109 San Jacinto Blvd, Bellmont HallAustin, TX, 78712, USA. .,Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, FL, 33136, USA.
| | - Eric C Brown
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Christopher L Ringwalt
- Pacific Institute for Research and Evaluation, 1229 E Franklin St, Chapel Hill, Chatham, NC, 27514, USA
| | - Seth J Schwartz
- Departments of Kinesiology and Health Education, College of Education, University of Texas at Austin, 2109 San Jacinto Blvd, Bellmont HallAustin, TX, 78712, USA
| | - Guillermo Prado
- School of Nursing and Health Studies, University of Miami, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Jorge Ortiz-García
- Academic Unit of Psychology, Autonomous University of Zacatecas, Zacatecas, Mexico
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Paschall MJ, Miller TR, Grube JW, Fisher DA, Ringwalt CL, Kaner E, Lilliott E, Watson S, Gordon M. Compliance with a law to reduce alcoholic beverage sales and service in Zacatecas, Mexico. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 97:103352. [PMID: 34252789 DOI: 10.1016/j.drugpo.2021.103352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 06/03/2021] [Accepted: 06/15/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Research on the effects of restricting bar opening hours and alcohol sales in middle-income countries is very limited. We assessed compliance with and possible effects of a law enacted in Zacatecas, Mexico on December 30, 2017 and implemented in 2018 and 2019 that established a 2 AM bar closing time and 10 PM cut-off for alcohol sales by off-premises stores. METHODS Monthly observations of bars and off-premises stores and alcohol mystery shopping visits from 2018 to early 2020 were conducted to assess compliance with the law. Breath tests were conducted in 2018 and 2019 with samples of pedestrians in the nighttime entertainment districts of Zacatecas and a comparison city (Aguascalientes). Surveys of bar owners/managers and staff, emergency medical personnel (EMP), and police officers were conducted in Zacatecas in 2018 and 2019 to assess awareness and support of the law and possible effects of the law on alcohol-related problems such as violence and injuries. RESULTS Monthly observations indicated that a substantial percentage of bars and off-premises package stores did not comply with the law. Pedestrian breath tests in 2018 and 2019 indicated significant reductions in blood alcohol concentration and heavy drinking among pedestrians in Zacatecas from 11 PM to 2 AM compared to Aguascalientes, but not after 2 AM. Surveys of bar owners/managers indicated that most were aware and supportive of the law. EMP surveys indicated reductions in incidents of physical fighting and drunk or injured customers during the annual September fair in Zacatecas. CONCLUSIONS This study suggests that restricting bar opening hours and alcohol sales may not result in full compliance by bars and off-premises stores, but may help to reduce excessive alcohol use and related harms in a middle-income country. A more rigorous evaluation with pre-intervention data is needed, however, to fully address this latter question.
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Affiliation(s)
- Mallie J Paschall
- HBSA, Pacific Institute for Research and Evaluation, 2150 Shattuck Ave., Suite 601, Berkeley, CA 94704, United States.
| | - Ted R Miller
- HBSA, Pacific Institute for Research and Evaluation, 11720 Beltsville Drive, Suite 900, Calverton, Maryland 20705, United States; Curtin University School of Public Health, Nedlands, Australia
| | - Joel W Grube
- HBSA, Pacific Institute for Research and Evaluation, 2150 Shattuck Ave., Suite 601, Berkeley, CA 94704, United States
| | - Deborah A Fisher
- HBSA, Pacific Institute for Research and Evaluation, 11720 Beltsville Drive, Suite 900, Calverton, Maryland 20705, United States
| | - Christopher L Ringwalt
- HBSA, Pacific Institute for Research and Evaluation, 101 Conner Drive, Suite 200, Chapel Hill, North Carolina 27514, United States
| | - Emily Kaner
- HBSA, Pacific Institute for Research and Evaluation, 2150 Shattuck Ave., Suite 601, Berkeley, CA 94704, United States
| | - Elizabeth Lilliott
- HBSA, Pacific Institute for Research and Evaluation, 851 University Blvd SE #101, Albuquerque, NM 87106, Mexico
| | - Sonia Watson
- HBSA, Pacific Institute for Research and Evaluation, 11720 Beltsville Drive, Suite 900, Calverton, Maryland 20705, United States
| | - Mary Gordon
- HBSA, Pacific Institute for Research and Evaluation, 11720 Beltsville Drive, Suite 900, Calverton, Maryland 20705, United States
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Montero-Zamora P, St Fleur RG, Mejía-Trujillo J, Brown EC. Contextual Fit of a Family Evidence-Based Intervention for Preventing Youth Alcohol Use in Mexico. J Prim Prev 2021; 42:441-457. [PMID: 34189718 DOI: 10.1007/s10935-021-00640-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 12/12/2022]
Abstract
Reducing youth alcohol use is a public health priority that can be addressed by implementing evidence-based preventive interventions (EBPIs) with high fidelity. However, when EBPIs are delivered in a new geographical setting, lack of contextual fit might interfere with expected effects. The purpose of our study was to understand the contextual fit of the family preventive program, Guiding Good Choices (GGC), to inform its future adaptation in Zacatecas, Mexico. Four focus groups were conducted with parents of children aged 9-14 years (N = 43) from four private companies. After transcribing audiotaped sessions, we used a general inductive approach to obtain codes and derive themes. Parents expressed a high level of interest in program content, highlighting its potential to decrease underage drinking in Mexico. Surface-structure modifications of program audiovisual materials (e.g., new videos with Mexican actors and locations) and delivery methods were recommended by parents to maximize participant acceptability and engagement. Participant definitions of family and perception of family dynamics both support the cultural relevance of the program modules and activities related to this content. Underage drinking was acknowledged by parents as a major problem in Zacatecas. Our findings suggest a need for incorporating an extra session that focuses on addressing low alcohol literacy levels and parents' positive alcohol expectancies. Machismo was not considered a cultural factor that could affect attendance and program activities. In fact, we observed an opportunity to use local masculinity to ensure practice of parental skills at home. Due to the needs expressed by participants and the apparent compatibility and fit of the curriculum contents with the new context, we conclude that GGC could be an adequate EBPI for preventing underage drinking in Mexico.
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Affiliation(s)
- Pablo Montero-Zamora
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, 33136, USA.
| | - Ruth G St Fleur
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, 33136, USA
| | | | - Eric C Brown
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, 33136, USA
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Miller TR, Paschall MJ, Ringwalt CL, Kaner E, Grube JW, Yao J, Fisher DA, Lau J. A Comparison of Chinese Adults Who Consume Homemade versus Commercial Alcohol. Subst Use Misuse 2021; 56:787-792. [PMID: 33757403 DOI: 10.1080/10826084.2021.1899221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Little is known about adults in China who drink homemade alcohol, and whether they are at elevated risk of harms relative to those who drink alcohol from commercial sources. Purpose: We describe and contrast adults in China who regularly consume either homemade or commercially available alcohol, or both. Methods: Household-based in-person interviews were conducted in 2018 with adults in Jiangshan and Lanxi. We examined the characteristics of 833 adults who had consumed alcohol within the previous 30 days, comparing those who drank commercial alcohol only with those who drank homemade alcohol only and alcohol from both sources. Results: Regression analyses revealed that drinkers of both homemade and commercial alcohol consumed more drinks and were more likely to report heavy drinking than did drinkers of commercial or homemade alcohol only and were also more likely to meet criteria for alcohol use disorder. We also found that homemade-only alcohol drinkers were at elevated risk for this disorder. Conclusions: Drinkers of both homemade and commercial alcohol in China may be at risk for alcohol-related problems and constitute a little understood population for whom further research is needed. The AB InBev Foundation supported this study.
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Affiliation(s)
- Ted R Miller
- HBSA & Curtin University School Of Public Health, Perth, Australia
| | | | | | - Emily Kaner
- HBSA & Curtin University School Of Public Health, Perth, Australia
| | - Joel W Grube
- HBSA & Curtin University School Of Public Health, Perth, Australia
| | - Julie Yao
- HBSA & Curtin University School Of Public Health, Perth, Australia.,College of Humanities and Social Sciences, Harbin Institute of Technology, Shenzhen, Guangdong, China
| | - Deborah A Fisher
- HBSA & Curtin University School Of Public Health, Perth, Australia
| | - Joseph Lau
- Division of Behavioral Health and Health Promotion, Centre for Health Behaviours Research, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.,Community Research Program on AIDS; The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
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Miller TR, Courser M, Shamblen SR, Lange JE, Tippetts AS, Ringwalt C. Efficacy and cost-effectiveness of subsidized ridesharing as a drunk driving intervention in Columbus, OH. ACCIDENT; ANALYSIS AND PREVENTION 2020; 146:105740. [PMID: 32866769 DOI: 10.1016/j.aap.2020.105740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 08/15/2020] [Accepted: 08/18/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND No economic evaluations exist of free or subsidized ridesharing services designed to reduce impaired driving. OBJECTIVES To evaluate the effects and economics of a 17-weekend program that provided rideshare coupons good for free one-way or round trips to/from the hospitality zones in Columbus, Ohio, coupled with a modest increase in enforcement and a media campaign that used messaging about enforcement to promote usage. METHODS Web surveys of riders and intercept surveys of foot traffic in the hospitality zones yielded data on the reduction in driving after drinking and the change in alcohol consumption associated with coupon use. We estimated crash changes from trip data using national studies, then confirmed with an ARIMA analysis of monthly police crash reports. Costs and output data came from program and rideshare company records. RESULTS 70.8% of 19,649 responding coupon redeemers said coupon use reduced the chance they would drive after drinking. An estimated 1 in 4,310 drink-driving trips results in an alcohol-attributable crash, so the coupons prevented an estimated 3.2 crashes. Consistent with that minimal change, the ARIMA analysis did not detect a drunk-driving crash reduction. Self-reports indicated alcohol consumption rose by an average of 0.4 drinks per coupon redeemer, possibly with an equal rise among people who rode with the redeemer. The program cost almost $650,000 and saved an estimated 1.8 years of healthy life. Across a range of discount rates and values for a year of healthy life, it cost $366,000 to $791,000 per year of healthy life saved. Its estimated benefit-cost ratio was between 0.31 and 0.59, meaning it cost far more than it saved. CONCLUSIONS Ridesharing, coupled with a media campaign and increased enforcement, was not a cost-effective drunk-driving intervention. Although it reduced drink-driving crashes and saved years of healthy life, those savings were modest and expensive. Moreover, the self-reported increase in participant drinking imposed countervailing risks. Even sensitivity analyses that potentially overestimate the benefits and underestimate the costs indicate a significant imbalance between program costs and savings. Any funding devoted to ridesharing would divert scarce resources from interventions with benefit-cost ratios above 1. Thus, our evaluation suggests that governments should not devote energy or resources to ridesharing programs if their primary objective is to reduce drink-driving or harmful alcohol use.
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Affiliation(s)
- Ted R Miller
- HBSA, 11720 Beltsville Drive, Suite 900, Calverton, MD, 20705, USA; Curtin University School of Public Health, Kent St, Bentley, WA, 6102, Australia.
| | - Matthew Courser
- HBSA, 11720 Beltsville Drive, Suite 900, Calverton, MD, 20705, USA
| | | | - James E Lange
- San Diego State University, Well-being & Health Promotion Department, 5500 Campanile Dr, San Diego, CA, 92182-4705, USA
| | - A Scott Tippetts
- HBSA, 11720 Beltsville Drive, Suite 900, Calverton, MD, 20705, USA
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