Giesbrecht Norman, Haydon Emma
Social, Prevention and Health Policy Research Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada M5S 2S1.
Drug Alcohol Rev. 2006 Nov;25(6):633-46. doi: 10.1080/09595230600944594.
The social, health and economic burdens from alcohol, tobacco and other drugs have impacts globally, national and locally. Effective interventions are needed at each level in order to reduce the extensive harm and attendant costs. This paper examines four topics: options available to the local community, evidence of effectiveness, links between local experiences and national and regional initiatives and implications for future research and intervention. It appears that there are a substantial number of options available at the local level. However, evaluation of them is not standard practice, and the results of the higher quality evaluations indicate that many, but not all, interventions have modest or equivocal impact. There is also not a consistent relationship between local and national interventions, although some themes are apparent: in tobacco control there may be good synergy across jurisdictional levels, for alcohol there is evidence that as national control measures are eroded local communities are encouraged or required to take up these agendas, and with regard to illicit drugs there may be tension between law enforcement priorities at the national level and harm reduction orientations locally. Future initiatives need to have appropriate evaluations as a standardised part of prevention initiatives, and include the development of national databases of what is going on locally. These initiatives should promote national policies that include setting parameters and guidelines, but nevertheless do not dictate specific steps and strategies how to achieve local goals in reducing risk and harm.
酒精、烟草及其他毒品带来的社会、健康和经济负担在全球、国家和地方层面均有影响。为减少广泛的危害及相关成本，各级都需要有效的干预措施。本文探讨四个主题：当地社区可采用的选项、有效性证据、地方经验与国家及区域举措之间的联系以及对未来研究和干预的影响。似乎在地方层面有大量可采用的选项。然而，对这些选项的评估并非标准做法，且更高质量评估的结果表明，许多（但并非全部）干预措施的影响不大或不明确。地方和国家干预措施之间也不存在一致的关系，不过一些主题较为明显：在烟草控制方面，不同管辖层面之间可能存在良好的协同作用；对于酒精，有证据表明随着国家控制措施的削弱，地方社区会受到鼓励或被要求承担这些议程；而对于非法药物，国家层面的执法重点与地方层面的减少危害导向之间可能存在矛盾。未来的举措需要将适当的评估作为预防举措的标准组成部分，并包括建立关于地方情况的国家数据库。这些举措应推动国家政策的制定，包括设定参数和指导方针，但不规定实现地方减少风险和危害目标的具体步骤和策略。
