Cancer Whats Alcohol Use Got to Do With It? Tuesday, July 7 th , - - PowerPoint PPT Presentation

Cancer – What’s Alcohol Use Got to Do With It?

Tuesday, July 7th, 2015

Ena Wanliss, MS Dafna Kanny, PhD

• S. Jane Henley, MSPH

Amy Ann Moore

Shelina D. Foderingham MPH MSW

• Director of Practice Improvement
• Project Director, National Behavioral Health

Network for Tobacco & Cancer Control

• National Council for Behavioral Health
• ShelinaF@thenationalcouncil.org

Welcome!

Margaret A. Jaco MSSW

• Policy Associate
• Project Manager, National Behavioral Health

Network for Tobacco & Cancer Control

• National Council for Behavioral Health
• MargaretJ2@thenationalcouncil.org

Housekeeping

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• Jointly funded by CDC’s Office on Smoking &

Health & Division of Cancer Prevention & Control

• Provides resources and tools to help
• rganizations reduce tobacco use and

cancer among people with mental illness and addictions

• 1 of 8 CDC National Networks to eliminate

cancer and tobacco disparities in priority populations

Free Access to…

Toolkits, training opportunities, virtual communities and other resources Webinars & Presentations State Strategy Sessions Community of Practice

#BHtheChange Visit www.BHtheChange.org and Join Today!

• Overview: Centers for Disease Control and Prevention’s

(CDC) Cancer Prevention & Control Efforts

• Alcohol Use & Cancer Risk: Impact & Reducing Excessive

Alcohol Use

• Lessons Learned from the Field: Interventions that Work

in Integrated Care Settings to Address Alcohol Concerns

Webinar Agenda

Guest Speaker #1

Ena Wanliss, MS

• Project Lead, National Partnerships
• Comprehensive Cancer Control Branch,

CDC Division of Cancer Prevention & Control

• Ewanliss@cdc.gov

Cancer - What's Alcohol Use Got to Do With It?

Ena Wanliss, MS

National Partnership Project Lead Comprehensive Cancer Control Branch Webinar July 7, 2015

National Center for Chronic Disease Prevention and Health Promotion Division of Cancer Prevention and Control

Division of Cancer Prevention and Control

Collect and Analyze Data about Policies & Practices

• Use the CDC Prevention Status Reports to learn the status of

Community Guide strategies for preventing excessive alcohol use in your state

• www.cdc.gov/psr/alcohol/
• Conduct an environmental scan to identify any additional

alcohol-related laws in your area

Collect and Analyze Data about Policies & Practices

• Use cancer registry data to examine incidence and death

rates for alcohol-related cancers in your state, including cancers of the breast, liver, colon, rectum, mouth, pharynx, larynx, and esophagus

• Monitor changes in these indicators over time

Collect and Analyze Data about Policies & Practices

• Use these CDC websites for statistics on excessive alcohol use in your

state and compare them to national statistics

• CDC Chronic Disease Indicators website:

http://www.cdc.gov/cdi/

• CDC’s Prevention Status Report: www.cdc.gov/psr/alcohol/
• BRRSS Prevalence and Trends Data:

http://apps.nccd.cdc.gov/brfss/

• YRBS Youth Online:

http://nccd.cdc.gov/youthonline/App/Default.aspx

• Monitor changes in these indicators over time
• Consider developing a special survey to examine a topic specific to your

prevention efforts

Identify and Engage with Potential Partners

• Educate cancer coalition members on the public health

impact of excessive alcohol use and related harms, particularly alcohol-related cancer rates, in your area

• Identify potential partners at local and national levels and

ask them to help you educate key stakeholders on cancer risks linked with alcohol use and strategies to reduce excessive alcohol use

• Collect information about alcohol use and alcohol-related

cancer rates that you can give to partners and stakeholders

Identify and Engage with Potential Partners cont…

• Disseminate guidance that is evidence-based and reflects

the most current science available

• Survey key partners to identify their needs and what

resources they can add to your efforts

• Ensure that health promotion activities throughout the state

are congruent with and supportive of alcohol control

Potential Partners: Professional and Non-Profit Organizations

• Substance abuse prevention programs
• Public health programs with an interest in reducing excessive

alcohol use

• Media outlets and retailers
• Law enforcement
• Schools, state and local education agencies, and parent-

teacher associations

Potential Partners: Professional and Non-Profit Organizations

• Healthcare providers, clinics, and medical associations
• State and local health departments
• Community mental health centers
• Colleges and universities
• City planners, urban developers, city and county officials

Potential Partners: Professional and Non-Profit Organizations

• Center on Alcohol Marketing and Youth (CAMY):

http://camy.org/

• Community Anti-Drug Coalitions of America (CADCA):

http://www.cadca.org/

• Leadership to Keep Children Alcohol Free:

http://www.alcoholfreechildren.org/

• National Association of Chronic Disease Directors:

http://www.nasadad.org/

Potential Partners: Professional and Non-Profit Organizations

• The National Association of State Alcohol and Drug Abuse

Directors: http://www.nasadad.org/

• National Liquor Law Enforcement Association:

http://www.nllea.org/

• The Robert Wood Johnson Foundation:

http://www.rwjf.org/

• National Behavioral Health Network for Tobacco and Cancer

Control: http://bhthechange.org

Measure Your Effects

• Library of Indicators (LIDS)
• Database for CDC’s National Comprehensive Cancer Control

Programs.

• Includes indicators that can be used to develop objectives and to

plan evaluations within cancer plans and action plans

• Comprehensive Cancer Control Branch Program Evaluation Toolkit
• Provides guidance on how to plan and conduct evaluations
• Behavioral surveillance systems
• Existing systems such as YRBS and BRFSS can be used to

monitor changes in key excessive alcohol use indicators

Thank You!

Ena Wanliss EWanliss@cdc.gov

For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 Visit: www.cdc.gov | Contact CDC at: 1-800-CDC-INFO or www.cdc.gov/info

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

National Center for Chronic Disease Prevention and Health Promotion Division of Cancer Prevention and Control

Cancer - What's Alcohol Use Got to Do With It?

• S. Jane Henley, MSPH
• Epidemiologist
• Cancer Surveillance Branch, CDC’s Division of

Cancer Prevention and Control

• skh3@cdc.gov

Guest Speakers #2

Dafna Kanny, PhD

• Senior Scientist
• Alcohol Program, CDC’s National Center for

Chronic Disease Prevention and Health Promotion

• dkk3@cdc.gov

Cancer: What’s Alcohol Got to Do With It?

Dafna Kanny, PhD, Senior Scientist, Alcohol Program, Division of Population Health Jane Henley, MSPH, Epidemiologist, Cancer Surveillance Branch, Division of Cancer Prevention and Control National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention July 7, 2015

National Center for Chronic Disease Prevention and Health Promotion

Outline

1.

Public health impact of excessive alcohol use

2.

Cancer risk associated with alcohol use

3.

Alcohol use among adults and youth

4.

Summary of Alcohol Control Efforts in Comprehensive Cancer Control Plans and Alcohol Use Among Adults in the USA

5.

What works to reduce excessive alcohol use

Well, did you know that scientists say reducing your alcohol use could reduce your risk for cancer? I want to reduce my risk for cancer. What can I do?

Focus on reducing cancer risk

Really? That’s another good reason to drink less. I’m concerned about your alcohol use. Did you know that alcohol is a risk factor for cancer?

Focus on reducing alcohol use

PUBLIC HEALTH IMPACT OF EXCESSIVE ALCOHOL USE

How is Excessive Alcohol Use Defined?

• Excessive alcohol use
• Binge drinking
• Heavy drinking
• Underage drinking
• Pregnant drinking

Source: http://www.cdc.gov/alcohol/pdfs/excessive_alcohol_use.pdf

What Counts as a Drink?

Source: http://www.cdc.gov/alcohol/pdfs/excessive_alcohol_use.pdf

Overall Public Health Impact of Excessive Alcohol Use in the United States

• 88,000 deaths every year (from 2006 – 2010)
• 2.5 million Years of Potential Life Lost (YPLL) every year
• Shortens each life lost by 30 years
• Cost (in 2006)
• $223.5 billion in economic costs or ~$1.90/drink
• $94.2 billion (42%) paid by government or ~$0.80/drink
• Most excessive drinkers are not alcohol dependent

Sources: Alcohol-Related Disease Impact (ARDI) available at: www.cdc.gov/alcohol ; Bouchery, et al Am J Prev Med 2011;41(5):516-24. Stahre et al Prev Chronic Dis 2014;11:130293. Esser et al. Prev Chronic Dis 2014;11:140329.

Excessive Alcohol Use is Associated with Many Health and Social Outcomes

CANCER RISK ASSOCIATED WITH ALCOHOL USE

Alcohol Use and Cancer Risk

• The International Agency on Research on

Cancer considers alcohol a carcinogen

• Alcohol use increases the risk of cancer:
• Mouth, throat & voice box
• Esophagus
• Breast
• Liver
• Colon & rectum
• Alcohol use was estimated to cause

20,000 deaths from cancer in the United States in 2009

Sources: IARC monographs on the evaluation of carcinogenic risks to humans: Volume 96: Alcohol consumption and ethyl carbamate. Lyon, France: International Agency for Research on Cancer. 2010. Nelson DE et al. (2013) Alcohol-attributable cancer deaths and years of potential life lost in the United States. Am J Public Health 103:641-648.

Cancer Risk Goes up with Each Drink

Adapted from Table 1, Parkin DM. Br J Cancer 2011;105:514-8

Even One Drink a Day Can Increase Cancer Risk

Sources: IARC monographs on the evaluation of carcinogenic risks to humans: Volume 96: Alcohol consumption and ethyl carbamate. Lyon, France: International Agency for Research on Cancer. 2010. World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective. Washington, DC: AICR. 2007.

ALCOHOL USE AMONG U.S. ADULTS AND YOUTH

Alcohol Use among US Adults

• Drinking alcohol is one of the most common

avoidable risk factors for cancer

• 55% of adults drink alcohol
• 17% of adults are binge drinkers
• 6% of adults are heavy drinkers

Source: Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System survey data. 2013

Alcohol Use among US Youth

• While the legal age for drinking alcohol is 21 years,

drinking alcohol is common among youth:

• 35% of high school youth drink alcohol
• 21% of high school youth reported binge drinking

Source: Centers for Disease Control and Prevention. Youth Risk Behavior Survey data. 2013

Guidelines for Alcohol Use

Source: U.S. Department of Agriculture and U.S. Department of Health and Human Services, 2010

Alcohol Control Efforts in Comprehensive Cancer Control Plans and Alcohol Use Among Adults in the USA

Source: Henley SJ, Kanny D, et al. Alcohol and Alcoholism 2014;49(6):661-7.

Study Objectives

 Assess the prevalence of current alcohol use among

U.S. adults, categorized by adherence to U.S. Dietary Guidelines.

 Assess the extent to which alcohol control efforts,

in the context of cancer prevention, are being implemented in comprehensive cancer control plans.

Source: Henley SJ, Kanny D, et al. Alcohol and Alcoholism 2014;49(6):661-7.

Study Methods

 2011 Behavioral Risk Factor Surveillance System

• prevalence of current alcohol use (≥1 drink in past 30 days)
• Alcohol use exceeding Dietary Guidelines for moderate drinking

(women: ≤1 drink/day; men: ≤2 drinks/day)

• Restricted to adults of legal drinking age (≥21 years)
• 447,505 respondents

 Comprehensive Cancer Control Plans

• 69 states, tribes, and jurisdictions
• Cancer Control P.L.A.N.E.T. website

Source: Henley SJ, Kanny D, et al. Alcohol and Alcoholism 2014;49(6):661-7.

Comprehensive Cancer Control Programs

CDC’s National Comprehensive Cancer Control Program helps prevent and control cancer in the United States by supporting community efforts to—

• Set up and convene cancer coalitions
• Develop data-driven cancer control plans
• Implement and evaluate cancer control plans

Source: http://www.cdc.gov/cancer/ncccp/

A third of US adults exceed guidelines for moderate alcohol use

Half of adults did not drink alcohol in the past 30 days Half of adults had at least one alcoholic drink in the past 30 days 1 in 3 drinkers drank within guidelines 2 of 3 drinkers exceeded guidelines

Source: Henley SJ, Kanny D, et al. Alcohol and Alcoholism 2014;49(6):661-7.

Percentage of drinkers who exceeded moderate drinking guidelines was fairly consistent across most demographic characteristics

10 20 30 40 50 60 70 80 90 100 Sex Age Race/Ethnicity Education Household Income

Source: Henley SJ, Kanny D, et al. Alcohol and Alcoholism 2014;49(6):661-7.

Overall

Current Drinkers who Exceed Guidelines for Moderate Alcohol Use by State

Source: Henley SJ, Kanny D, et al. Alcohol and Alcoholism 2014;49(6):661-7.

Comprehensive Cancer Control Plans

Content # %

Plan acknowledges alcohol use as a cancer risk factor 50 72 At least one goal, objective, or strategy addresses alcohol use as a cancer risk factor (including any of the below) 31 45 Raise public awareness of cancer risk associated with alcohol use 19 28 Educate individuals about cancer risk associated with alcohol use 10 14 Reduce prevalence of excessive alcohol use: Measurable Non-measurable 16 7 23 10 Partner with health care providers to promote awareness among their patients 12 17 Collaborate with other organizations 12 17

Source: Henley SJ, Kanny D, et al. Alcohol and Alcoholism 2014;49(6):661-7.

How Comprehensive Cancer Control Plans Addressed Alcohol Control

Source: Henley SJ, Kanny D, et al. Alcohol and Alcoholism 2014;49(6):661-7.

Summary of paper by Henley, Kanny et al.

• Two in three legal-aged drinkers in the U.S. reported alcohol

use that exceeded moderate drinking guidelines at least

• nce in the past 30 days.
• While most comprehensive cancer control plans

acknowledged that alcohol use was a cause of cancer, fewer than half included an objective, goal, or strategy to address alcohol as a cancer risk factor.

Source: Henley SJ, Kanny D, et al. Alcohol and Alcoholism 2014;49(6):661-7.

Individual Behavior Change

Health Impact Pyramid

Counseling & Education

Clinical Interventions Long-Lasting Protective Interventions Changing the Context to Make Individuals’ Default Decision Making Socioeconomic Factors

Source: Frieden TR. A Framework for Public Health Action: The Health Impact Pyramid. Am J Public Health 2010; 100:590-5.

WHAT WORKS TO REDUCE EXCESSIVE ALCOHOL USE

Community and Clinical Strategies Work Together to Reduce Excessive Alcohol Use

Community Preventive Services Task Force U.S. Preventive Services Task Force National Prevention Strategy World Health Organization

Community Guide Recommendations for Preventing Excessive Drinking, 2005-2012

Source: www.thecommunityguide.org/alcohol

• Increase alcohol taxes
• Regulate alcohol outlet density
• Dram shop (commercial host) liability
• Avoid further privatization of alcohol sales
• Maintain limits on days of sale
• Maintain limits on hours of sale
• Enhance enforcement of laws prohibiting alcohol sales to

minors

• Electronic screening and brief intervention (e-SBI)

Community Guide Recommendation Increase Alcohol Taxes

• Federal, state or local level
• Different for each beverage type (beer, wine, distilled

spirits)

• Strong and consistent evidence of intervention

effectiveness

• Increasing price by 10% would reduce overall alcohol

consumption by about 7%

• Tax increases are efficiently reflected in the retail price
• Impact is proportional to the size of the tax increase

Source: www.thecommunityguide.org/alcohol

Community Guide Recommendation Regulate Alcohol Outlet Density

Alcohol outlet density is the number and concentration

• f places that sell alcohol, such as bars, restaurants,

and liquor stores, in an area

• City, county or state governments can regulate alcohol
• utlet density through licensing or zoning processes
• The higher the alcohol outlet density, the higher the harms

related to alcohol use

Source: www.thecommunityguide.org/alcohol

Community Guide Recommendation Commercial Host (“Dram Shop”) Liability Laws

• Laws that hold alcohol retail establishments liable (at fault)

for injuries or harms caused by illegal sales or service to intoxicated or underage (<21 years) customers

• Most states have dram shop liability laws although they

vary in scope and evidence required

• Areas with dram shop liability laws have reduced alcohol-

related harms (such as motor vehicle deaths)

Source: www.thecommunityguide.org/alcohol

US Preventive Services Task Force (USPSTF) Recommendation Related to Excessive Alcohol Use Screening and Brief Intervention

Health care providers (eg, doctors, nurses, PAs)

Source: http://www.uspreventiveservicestaskforce.org/uspstf12/alcmisuse/alcmisusefinalrs.htm

Screening and Brief Intervention Provided through Electronic Devices (e-SBI)

Source: http://www.thecommunityguide.org/news/2013/e-SBI.html

Cancer: What’s Alcohol Got to Do With It?

Conclusions

• Alcohol use is a common cancer risk factor
• Community and clinical strategies can reduce excessive

alcohol use

• Community programs can identify and engage with partners

to

• promote awareness of the cancer risk associated with alcohol use
• support widespread implementation of evidence-based strategies to

reduce excessive alcohol use

For more information please contact Centers for Disease Control and Prevention

1600 Clifton Road NE, Atlanta, GA 30333 Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: cdcinfo@cdc.gov Web: www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Thank you!

National Center for Chronic Disease Prevention and Health Promotion

Amy Ann Moore

• Certified Prevention Specialist
• Ingham County Health Department
• AMoore@ingham.org

Guest Speaker #3

The Burden of Disease Attributable to Alcohol

–World Health Organization

62

Global distribution of all alcohol-attributable deaths by disease or injury, 2004

63

Framing the Issue: What to say…

• NIAAA: National Institute on Alcohol Abuse and Alcoholism
• American Cancer Society: Alcohol and Cancer (attached)
• World Health Organization: 1988 Alcohol as a Carcinogen
• Centers for Disease Control and Prevention
• SAMHSA: Local Treatment Options for highest 10% who

cannot make behavioral changes

64

65

Clinical Interventions: SBIRT

• NIAAA Patient Education Materials
• AUDIT-C: Clinical Measure in Electronic Medical Record
• Alcohol Use Disorders Identifications Test (AUDIT)
• What is a Standard Drink: NIAAA
• U.S. Adult Drinking Patterns: NIAAA
• Strategies for Cutting Down: NIAAA
• Cancer and Alcohol Use: State of Michigan Alcohol

Epidemiology Program (attached)

66

67

Identify Alcohol Concerns Based on Symptoms

• Depression
• Anxiety
• Sleep Disorders
• Tobacco Use: including electronic smoking devices
• Frequent Expression of Negative Emotion in the Home
• Neglectful of Medications
• Cancer: Concern, History, Treatment Fidelity

68

Model Appropriate Messaging

• “There is new science that shows Alcohol is a Carcinogen and

contains 15 carcinogenic compounds, including ethanol. Do you know of anyone that should cut down their alcohol use?”

• “Most people do not drink, or rarely drink alcohol. Here are

some good ideas if you want to improve your health in small ways every day.”

• “I am asking about alcohol use, because I know you want

good health as you age. Most people don’t know that using alcohol raises cancer risk. Would you help me share that news with your friends and family?”

69

Comments & Questions?

• Jointly funded by CDC’s Office on Smoking &

Health & Division of Cancer Prevention & Control

• Provides resources and tools to help
• rganizations reduce tobacco use and

cancer among people with mental illness and addictions

• 1 of 8 CDC National Networks to eliminate

cancer and tobacco disparities in priority populations

Free Access to…

Toolkits, training opportunities, virtual communities and other resources Webinars & Presentations State Strategy Sessions Community of Practice

#BHtheChange Visit www.BHtheChange.org and Join Today!

Thank you for joining us for the Cancer – What’s Alcohol Use Got to Do With It? Webinar!