Babor Thomas F, Caetano Raul
University of Connecticut School of Medicine, Farmington, Connecticut 06030-6325, USA.
Rev Panam Salud Publica. 2005 Oct-Nov;18(4-5):327-37. doi: 10.1590/s1020-49892005000900013.
The objectives of this article are to describe the evidence base for alcohol policy in the Americas, to evaluate the extent to which national policies are likely to have an impact on public health, and to identify areas where alcohol policies could be improved. The paper begins with a brief review of epidemiological surveys of the prevalence of alcohol problems in the Americas. This is followed by an analysis of 32 prevention strategies and interventions in terms of the evidence for their effectiveness, amount of research support, cost to implement, and other feasibility issues. Overall, the strategies and interventions with the greatest amount of empirical support are low blood alcohol concentration levels for driving while intoxicated, controls on alcohol availability, age limits on alcohol purchases, and relatively high alcohol prices. The implications of the evidence are next discussed in relation to alcohol policy initiatives in the Americas, based on an analysis of the extent to which strategies and interventions currently used in 25 countries of the Americas are likely to have a public health impact on alcohol-related problems. The countries that have adopted the policies with the highest expected impact overall are Colombia, Costa Rica, Venezuela, and El Salvador. Nevertheless, the analysis indicates that almost all the countries of the Americas could improve the likelihood of preventing alcohol-related problems. Policy efforts in the developing countries of Latin America should focus on improving countermeasures against driving while intoxicated, measures that alter the drinking context, and limits on physical availability. For the developed, high-income countries of North America the goal should be to prevent deterioration of current drinking patterns and to reduce the overall volume of drinking. Given the low to moderate cost of many of the policies reviewed in this article, it now seems possible for communities and nations to substantially reduce the alcohol-related burden of illness in the Americas.
本文的目的是描述美洲酒精政策的证据基础，评估国家政策对公众健康可能产生影响的程度，并确定酒精政策可以改进的领域。本文开篇简要回顾了美洲酒精问题患病率的流行病学调查。接下来分析了32种预防策略和干预措施，涉及它们的有效性证据、研究支持量、实施成本以及其他可行性问题。总体而言，获得最多实证支持的策略和干预措施是对醉酒驾车设定低血液酒精浓度水平、控制酒精供应、设定酒精购买年龄限制以及维持相对较高的酒精价格。接下来，基于对美洲25个国家目前使用的策略和干预措施对与酒精相关问题可能产生的公共卫生影响程度的分析，讨论了这些证据对美洲酒精政策倡议的影响。总体而言，采用的政策预计影响最大的国家是哥伦比亚、哥斯达黎加、委内瑞拉和萨尔瓦多。然而，分析表明，美洲几乎所有国家都可以提高预防与酒精相关问题的可能性。拉丁美洲发展中国家的政策努力应侧重于改进针对醉酒驾车的应对措施、改变饮酒环境的措施以及对实际供应的限制。对于北美洲发达的高收入国家来说，目标应该是防止当前饮酒模式恶化并减少总体饮酒量。鉴于本文所审查的许多政策成本较低至中等，现在看来社区和国家有可能大幅减轻美洲与酒精相关的疾病负担。
