You can get garden variety health advice from the daily newspaper, the "health" section of most book stores, and of course thousands of web sites. I'm hoping to present thought provoking and maybe change provoking thoughts about individual and community health. This blog is not just what to do about health, but how to think about it. I'm looking forward to an exchange of ideas with readers. July, 2010


Thursday, November 18, 2010

Secondhand Drinking?

Once it was recognized that tobacco smoke was harmful, it wasn't long before people connected the dots and began to worry that if a smoker was doing something harmful, then maybe it was harmful to breathe in smoke from someone else's cigarette.  The suspicion eventually was declared fact, and now it is thought that so-called "secondhand smoke" kills about 38,000 per year in the U.S.  Usually those hurt by secondhand or environmental tobacco smoke either live with one or more smokers or work where there is a lot of smoking going on.  Substantial harm doesn't come from fleeting occasional exposure, but risk goes up when exposure is prolonged and intense.

Ironically, the establishment of the reality of secondhand smoke damage may have been more powerful than public knowledge about the health effects of primary smoking.  Many smokers enjoyed smoking, even though they became aware of the damage done, but were willing to continue and take their chances.  There was an attitude that you have to die from something, so why not take a chance with something that fills a need in the smoker's life.

The social dynamics of secondhand smoke were entirely different.  Once it became common understanding that secondhand smoke was damaging to the health of others, that made smoking socially unacceptable  Whereas in the past, smoking was thought to be sophisticated and chic, the secondhand smoke awareness made smoking seem akin to belching in public; socially unacceptable.  Whereas no one used to ask "Do you mind if I smoke?" that was the question smokers always had to ask.  This developing social stigma was a powerful incentive for millions of smokers to make quit attempts.

This brings us to alcohol.   We have known for quite some time that for most people, the hazards of alcohol drinking can be portrayed with a U-shaped curve (see below).  For overall mortality, total abstainers have elevated risk compared to moderate drinkers, whereas drinking beyond a moderate level quickly drives mortality risk to rise dramatically.  While alcohol in small amounts has some protective value for heart disease, stroke and diabetes, rising consumption brings increased risk for liver disease, highway injury, neurological damage and seizures, alcohol-related violence and suicide and damage to unborn children.  There is a huge array of other social and personal problems that come to the individual drinking alcohol excessively.
In general, we have not seen the concept of "secondhand" applied to alcohol.  Remember in this context, secondhand would mean consequences harming third parties, incidental to their being in the presence of drinkers.  It is clear that the analogy is useful and legitimate.  People are harmed by abusive drinking by others.  Binge and heavy drinkers are responsible for injury and death to other drivers and pedestrians.  Many acts of violence and suicide, if not caused by alcohol, are committed under the influence of alcohol, which is clearly a contributing factor.  There is a lot of vandalism and property damage done by intoxicated drinkers; this includes damage related to motor vehicle accidents as well as intentional vandalism of private and public property.  Alcohol abuse on university campuses makes the living circumstances such that most people in middle class neighborhoods would not tolerate.  This includes vomiting in people's cars and in public places, rowdy behavior disturbing sleep and study time,  Finally, there is a substantial amount of sexual assaults committed by alcohol impaired persons.

Up until now, these secondhand alcohol effects have not generated a social stigma.  Especially on college campuses, this behavior is accepted as normal and acceptable.  It is possible to recognize this acceptance as a contributing factor making campuses a toxic social environment for alcohol abuse.  People drink this way because the consequences don't lead to social condemnation.

Secondhand alcohol effects are real, and effect millions of bystanders.  It remains a challenge for health promotion to design ways to martial the power of social support and social shame to mold people away from destructive alcohol drinking.  Failing that, we continue to rely on education campaigns and policies to limit the harm.  While educational programs have not shown much success, there are many policy solutions that could make a dent in primary and secondary alcohol exposure.  Examples include making alcohol more expensive with tax increases, putting limits on where alcohol may be purchased, registering the names of keg purchasers, to hold them accountable for abusive drinking which may occur after the purchase.  It will take time to build a social consensus to accept and establish policy solutions. Attitudes which accept secondhand alcohol effects as normal are the same ones which are barriers to policy solutions.

Alcohol is America's number one drug problem, perhaps because a lot of people really don't think it is a problem.


snore stop said...

Smocking is harmful to our health.In recent years the number of smoking people is increased.

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There was an attitude that you have to die from something, so why not take a chance with something that fills a need in the smoker's life.

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I am currently reading From Binge to Black Out. Our country was founded by people who abuse alcohol, perhaps that's why it's so widely accepted. Only recently has drinking become a problem on college campuses to the 50% who do not drink. You left out a group of people that alcoholism affects the most tho, families of alcoholics. Where do you think alcoholics learn to drink in the first place? Until non drinkers out number drinkers, we will always be at their mercy.

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