Revising the preventive paradox: the Swiss case

Gmel, Gerhard; Klingemann, Sven; Müller, Richard; Brenner, Daniel S.

doi:10.1046/j.1360-0443.2001.96227311.x

Cited by 67 publications

(104 citation statements)

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“…When they defi ned high-risk using per occasion thresholds, 87% of those 67 individuals reported hazardous drinking on the day the event occurred. Gmel et al 7 and even Kreitman 5 reported similar fi ndings. Assessment of per-occasion alcohol consumption, however, has been limited.…”

Section: Introductionmentioning

confidence: 71%

Alcohol-Related Injuries: Evidence for the Prevention Paradox

Spurling

Vinson²

2005

The Annals of Family Medicine

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PURPOSEThe risk of an injury increases exponentially with alcohol consumption on a given occasion, but the conclusion that alcohol-related injuries are attributable primarily to heavy drinking may or may not be correct. The prevention paradox states that a large number of people at small risk may contribute more cases of a particular condition than a smaller number of people who are individually at greater risk. We sought to determine the extent to which the prevention paradox applies in the relationship between alcohol consumption and injury. METHODSWe conducted a population-based case-control and case-crossover study in all 3 emergency departments in Boone County, Mo. Data were collected from 2,517 patients with an acute injury and 1,856 age-and sex-matched controls selected by random digit dialing. RESULTSThe population attributable fraction (PAF) associated with drinking in the 6 hours before injury-the proportion of injuries that would not have occurred in the absence of drinking-was 10.6% in case-crossover analysis and 8.5% in casecontrol analysis. The PAF that was due to what is usually considered nonhazardous alcohol consumption (fewer than 5 drinks for men, fewer than 4 for women) was 4.5% in case-crossover analysis and 3.1% in case-control analysis. The PAF that was due to alcohol dependence was 4.0%.CONCLUSIONS Injury is associated more with an occasion of alcohol consumption than with alcohol dependence. A substantial proportion of the PAF that is due to an occasion of alcohol consumption is from what are usually considered low-risk quantities.

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Section: Introductionmentioning

confidence: 71%

Alcohol-Related Injuries: Evidence for the Prevention Paradox

Spurling

Vinson²

2005

The Annals of Family Medicine

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“…It is observed when a large number of people at small risk contribute more cases of a disease or negative health outcome in a population than do a small number of people at large risk. Researchers in the United States and internationally have demonstrated the importance of this perspective for alcohol using large representative data sets for a variety of negative alcohol related outcomes [27][28][29][30][31].…”

Section: Introductionmentioning

confidence: 99%

College Student Binge Drinking and the “Prevention Paradox”: Implications for Prevention and Harm Reduction

Weitzman

Nelson

2004

J Drug Educ

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Considerable attention has been paid to heavy episodic or "binge" drinking among college youth in the United States. Despite widespread use, the binge measure is perceived by some as a low intervention threshold. We use data from the Harvard School of Public Health College Alcohol Study (n = 49,163) to describe patterns of consumption and harms along a continuum including the binge measure to demonstrate the validity of the binge threshold and prevention paradox in college. While the heaviest drinkers are at greatest risk for harm, they are relatively few and generate proportionately small amounts of all drinking-harms. The risk of harms is not zero among lower level drinkers in college. Because they are numerous, they account for the majority of harms. This paradoxical pattern suggests we moderate consumption among the majority using environmental approaches, the efficacy of which are described using case study data from a national prevention demonstration. Implications for prevention policy, programming, and media advocacy are discussed.

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“…It is showed, too, that the probabilities of being a victim of predatory crime for females who are weekly or more frequent drinkers are higher than those for males, which could reflect the fact that females, especially those who drink frequently, are more likely to be victims of various crimes [22]. Analyses have shown that the majority of problems may occur in relation to heavy drinking occasions, and that the number of people with heavy drinking occasions is larger among low-moderate consumers than among heavy consumers [28,29,30,144].…”

Section: Discussionmentioning

confidence: 99%