If the Prime Minister really wants to make an impact on binge drinking, he might suggest his advisors speak to those running an unusual program at the University of Nebraska-Lincoln in the US.

It’s unusual for a number of reasons, including that it’s worked. Not only has it achieved a big drop in binge drinking among students, this has been associated with an increase in student retention rates.

The program is also unusual because it’s been funded for the long-haul – it started in 1998 – and has evolved in response to ongoing evaluation of its work.

It’s involved a coalition of diverse groups who’ve implemented a raft of strategies to create a culture that supports responsible low-risk drinking. These have included legislative reform to reduce the concentration of liquor outlets, media campaigns, training for hospitality and retail workers, and projects focusing on high risk groups of students.

The program’s director, Linda Major, says a key reason for its success is the strong coalition that has been built between the many stakeholders – including community leaders, officials from different levels of government, police officers, hospitality owners, prevention specialists, educators, students, and parents.

With the project involving dozens of different strategies, Major says it is difficult to know which were the most effective, and she expects it is the “totality” of the approach, with synergistic effects, that counts. But she has no doubt that a critical element was bringing on board a communications professional to engage the media.

One of the other notable lessons, Major adds, is that such campaigns take years of consistent work and require patience.

Toben Nelson, a researcher at the Harvard School of Public Health who has helped evaluate the program, says there is great potential for policymakers to make better use of research evidence when examining options for reducing alcohol-related harm.

Effective interventions include enforcing the minimum legal drinking age, zoning restrictions to reduce alcohol outlet density, mandatory responsible beverage service training, and increased excise taxes.

In other words, the lesson from Nebraska is that if the PM really wants to make a difference to binge drinking, his government will have to work a lot harder than simply mounting a one-off public education campaign.

He may also wish to note the British Medical Association’s warm welcome today for the British budget announcement of tax hikes for alcohol.

“These tax increases may be unpopular with some members of the public but we hope that they will look at the wider issue and recognise that the UK has a real problem on its hands regarding alcohol misuse,” a BMA spokeswoman said. “Tough action is needed.”

The PM may also wish to talk to the Alcohol Education and Rehabilitation Foundation, which has funded a number of innovative projects along the lines of the Nebraska approach, including one in the WA mining town of Kalgoorlie.

Declaration: the Nebraska program is featured in a report by Melissa Sweet and Ray Moynihan investigating the use of evidence in US public health policy. It is published by the Milbank Memorial Fund in collaboration with the Centers for Disease Control and Prevention, and called “Improving Population Health: The Uses of Systematic Reviews“.

Peter Fray

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