Effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol

Surveying Alcohol Outlet Density in Four Neighborhoods of Beirut Lebanon: Implications for Future Research and National Policy

Underage drinking among youth in Lebanon is increasing. Regulating availability is one of the best buy policies recommended by the World Health Organization. To quantitatively document the current status of alcohol availability to youth in Lebanon, we used GPS technology to survey alcohol outlet density in four highly populated neighborhoods in Beirut, Lebanon, and to estimate their proximity to educational institutions. The density of alcohol outlets ranged from 18.30 to 80.95 per km² (average of 39.6 alcohol outlets/km²). The highest number of total alcohol outlets was in the “Hamra & Jamiaa” area, which includes one of the largest private universities in the country. Thirteen out of 109 (12%) alcohol outlets (on and off-premise) were located less 100 m away from educational institutions, in violation of the current licensing law. None of the off-premise and the majority (94%) of on-premise alcohol outlets displayed the “no sale for <18” sign. Findings were indicative of an environment conducive to increased access and availability of alcohol among youth in Lebanon probably attributed to the prevailing weak alcohol policies and their enforcement. Systematic collection and reporting of alcohol outlet densities is critical to understand the alcogenic environment and guide local harm reduction policies.

Police documentation of drug use in injured drivers: Implications for monitoring and preventing drug-impaired driving

INTRODUCTION

Most countries have laws against driving while impaired by drugs. However, in many countries, including Canada and the United States, police must have individualized suspicion that the driver has recently used an impairing substance before they can gather the evidence required for laying a criminal charge. This report studies police documentation of drug involvement among drivers who had a motor-vehicle crash after using an impairing substance.

METHODS

We obtained blood samples and police reports on injured drivers treated in participating British Columbia trauma centres following a crash. Blood was analyzed for alcohol, cannabinoids, other recreational drugs, and impairing medications. Corresponding police reports were examined to determine whether police recorded that the driver's ability was impaired by alcohol, drug or medication, or that one of these substances was a possible contributory factor in the crash.

RESULTS

We obtained blood samples and corresponding police reports on 1816 injured drivers. Mean driver age was 44 years, 63.2% were male, and 25.8% were admitted to hospital. Alcohol was detected in 272 drivers (15.0%), THC (tetrahydrocannabinol - the principal psychoactive ingredient in cannabis) in 136 (7.5%), other recreational drugs in 166 (9.1%), and potentially impairing medications in 363 (20.0%). Police reported that the driver's ability was impaired by alcohol or that alcohol was a possible contributory factor in 64.1% of the crashes involving alcohol-positive drivers. Drug impairment or drugs as a possible contributory factor was reported in 5.9% of the crashes involving THC-positive drivers, and in 16.9% of the crashes involving drivers who tested positive for other recreational drugs. Medication impairment was reported in only 2.2% of the crashes involving medication-positive drivers.

CONCLUSION

Police seldom document drug involvement in drivers who were in a crash after using cannabis, other recreational drugs or potentially impairing medications. This finding raises serious concerns about the ability of the police to effectively enforce current drug-impaired driving laws and public health officials' continued reliance on police crash reports to monitor the prevalence of drug-impaired driving.

Burden of liver disease in Europe: Epidemiology and analysis of risk factors to identify prevention policies

The burden of liver disease in Europe continues to grow. We aimed to describe the epidemiology of liver diseases and their risk factors in European countries, identifying public health interventions that could impact on these risk factors to reduce the burden of liver disease. As part of the HEPAHEALTH project we extracted information on historical and current prevalence and mortality from national and international literature and databases on liver disease in 35 countries in the World Health Organization European region, as well as historical and recent prevalence data on their main determinants; alcohol consumption, obesity and hepatitis B and C virus infections. We extracted information from peer-reviewed and grey literature to identify public health interventions targeting these risk factors. The epidemiology of liver disease is diverse, with variations in the exact composition of diseases and the trends in risk factors which drive them. Prevalence and mortality data indicate that increasing cirrhosis and liver cancer may be linked to dramatic increases in harmful alcohol consumption in Northern European countries, and viral hepatitis epidemics in Eastern and Southern European countries. Countries with historically low levels of liver disease may experience an increase in non-alcoholic fatty liver disease in the future, given the rise of obesity across most European countries. Liver disease in Europe is a serious issue, with increasing cirrhosis and liver cancer. The public health and hepatology communities are uniquely placed to implement measures aimed at reducing their causes: harmful alcohol consumption, child and adult obesity, and chronic infection with hepatitis viruses, which will in turn reduce the burden of liver disease.

Evaluating moderators of beneficial effects of severity-based assignment to substance use treatments in impaired drivers

Remedial programs for impaired driving offenders have proved valuable in reducing subsequent alcohol and other drug use and preventing recidivism in this population. Many of these programs are based on a severity-based assignment scheme, where individuals assessed to have greater problems or be at higher risk are assigned to longer, more intensive interventions. Recent research, using regression discontinuity analyses, provided support for severity-based assignment schemes in demonstrating that those with higher problem or risk levels assigned to longer and more intensive programming showed a significant reduction in drinking days over a follow-up interval, attributable to program assignment. Regression discontinuity analyses can also be used to assess moderators of this assignment benefit. We report an assessment of the impact of eight potential moderators of assignment benefit, derived from a factor analysis of the Research on Addictions Self-Inventory screening instrument. Five of the eight factors were found to moderate the assignment benefit: Negative Affect, Sensation Seeking, High Risk Lifestyle, Alcohol Problems, and Family History. The significance of these results for developing more effective program assignment procedures is discussed.

Comparisons between context-specific and beverage-specific quantity frequency instruments to assess alcohol consumption indices: Individual and sample level analysis

There are many survey instruments to determine drinking patterns and alcohol consumption levels in the general population. This study aims to compare the context-specific quantity-frequency (CSQF) and beverage-specific quantity-frequency (BSQF) methods to estimate alcohol consumption indices at individual and sample levels. A community-based cross-sectional study was conducted among a population aged 15 years and older in Songkhla Province, Thailand. The BSQF and CSQF questionnaires with a 3-month retrospective time frame and in random order were applied to each participant. The CSQF was developed to ask more about the drinking contexts. The questions elicited information on location, partner, beverage, quantity, and frequency for five common drinking situations. Among 804 participants, 183 drank alcohol in the last three months. At the individual level, total alcohol consumption of almost all types of beverage by the CSQF was higher than the BSQF in approximately 50% of current drinkers and was mainly accounted for by the higher report of average quantity. At the sample level, there were no significant differences in the average daily intake, 3-month intake per drinker or per capita consumption between instruments. The interview duration and burden of answering the questions by the participants for the CSQF were not significantly higher than those for the BSQF. In summary, the fuller picture of drinking behaviors from the CSQF has several valuable methodological advantages and provides information allowing alcohol policies to be more directly specific to certain target populations or situations. The CSQF is a prototype questionnaire and forms the basis for a contextual approach. However, additional methodological studies need to be explored.

Alcoholic liver disease

Alcoholic liver disease (ALD) is the most prevalent type of chronic liver disease worldwide. ALD can progress from alcoholic fatty liver (AFL) to alcoholic steatohepatitis (ASH), which is characterized by hepatic inflammation. Chronic ASH can eventually lead to fibrosis and cirrhosis and in some cases hepatocellular cancer (HCC). In addition, severe ASH (with or without cirrhosis) can lead to alcoholic hepatitis, which is an acute clinical presentation of ALD that is associated with liver failure and high mortality. Most individuals consuming >40 g of alcohol per day develop AFL; however, only a subset of individuals will develop more advanced disease. Genetic, epigenetic and non-genetic factors might explain the considerable interindividual variation in ALD phenotype. The pathogenesis of ALD includes hepatic steatosis, oxidative stress, acetaldehyde-mediated toxicity and cytokine and chemokine-induced inflammation. Diagnosis of ALD involves assessing patients for alcohol use disorder and signs of advanced liver disease. The degree of AFL and liver fibrosis can be determined by ultrasonography, transient elastography, MRI, measurement of serum biomarkers and liver biopsy histology. Alcohol abstinence achieved by psychosomatic intervention is the best treatment for all stages of ALD. In the case of advanced disease such as cirrhosis or HCC, liver transplantation may be required. Thus, new therapies are urgently needed.

Impact of exposure to alcohol marketing and subsequent drinking patterns among youth and young adults

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the impact of exposure to any form of alcohol marketing, compared to less exposure or no exposure, on alcohol consumption patterns among youth and young adults up to and including the age of 25 years (we want to be able to look at potential dose response relationships at different levels of exposure).

A Comparison of International Drunk-Driving Policies and the Role of Drinking Patterns

INTRODUCTION

Effective drunk-driving policies are not adopted consistently in many countries. To understand how drinking behaviors influence national drunk-driving policymaking, the associations between drunk-driving policies and country-level drinking volumes and patterns were examined.

METHODS

Data for 194 countries were obtained from the WHO 2012 Global Information System on Alcohol and Health. Country-level drinking behaviors were measured using average drinking volumes and patterns of drinking scores based on six attributes of risky drinking. Drunk-driving policies were categorized into preemptive measures (random breath testing, breath alcohol concentration limits for driving a vehicle, and sobriety checkpoints), penalties (community service, short- or long-term detention, fines, suspension or revocation of license, and vehicle impoundment), mandatory treatment, and ignition interlock. Data analysis was conducted in 2017. The percentages of each policy adoption were examined in countries with different drinking behaviors. The internal consistencies of preemptive measures were calculated using Cronbach's α. A structural equation model was established to examine the associations between drinking behaviors and drunk-driving policy categories, after adjusting for national income levels and general alcohol policies.

RESULTS

Mandatory treatment and preemptive measures were less commonly adopted than penalties were. The adoption of preemptive measures had a low consistency level, and the consistency level decreased with drinking pattern riskiness. Risky drinking patterns were negatively associated with mandatory treatment policy.

CONCLUSIONS

Drinking patterns are associated with national drunk-driving policymaking. Accessible medical treatment and comprehensive preemptive measures should be advocated in countries with risky drinking patterns.

Alcohol policy and fatal alcohol-related crashes in Finland 2000-2016

OBJECTIVE

The purpose of this study was to explore the relationship between annual alcohol consumption per capita/alcohol price index and the number of alcohol-related fatal motor vehicle accidents (AFMVAs). We were particularly interested in whether a tax reduction in 2004 increased the number of alcohol-related accidents.

METHOD

The data consisted of all fatal motor vehicle accidents (FMVAs) during the years 2000-2016 obtained from a database maintained by the Finnish Crash Data Institute (OTI). The data included all fatally injured drivers. We compared the OTI data to official statistics on annual alcohol consumption and the alcohol price index.

RESULTS

There were 3,447 fatally injured drivers, of which 25% (n = 869) were intoxicated (blood alcohol concentration [BAC] ≥ 0.05%). After the reduction of the alcohol tax in 2004, the alcohol consumption rose 12.4% from 2003 to 2005 and AFMVAs rose 38%. There was a strong correlation (r = 0.7000, P < .018) between the recorded consumption of alcohol and the number of AFMVAs. There was a strong negative correlation between AFMVAs and the combined (retail + restaurant sales) alcohol price index (r = -0.7863, P = .0005). A linear mixed-effects model showed that a 1-L increase in total alcohol consumption per capita per year increases AFMVAs by 10.6 and a one-unit increase in the price index decreases AFMVAs by 1.8 per year.

CONCLUSIONS

The correlation between alcohol consumption and alcohol-related crashes should be considered when making political decisions regarding alcohol price and availability. Any further liberalization of the alcohol policy would likely lead to an increase in alcohol-related fatal motor vehicle accidents. Similar consequences are likely to occur with drugs. Alcohol price policy is an effective way to improve road safety, but other measures taken to prevent FMVAs also seem to reduce the prevalence of AFMVAs.

Childhood Adversity and Hazardous Drinking: The Mediating Role of Attachment Insecurity

BACKGROUND

Harmful alcohol use is associated with disease and mortality. Identifying new determinants of harmful drinking may aid the 16.3 million adults who have alcohol use disorders. Childhood adversity is associated with alcohol use, but is not amenable to change. Attachment insecurity (anxiety and avoidance) may be associated with alcohol use and may be a target for modification or used to personalize interventions.

OBJECTIVES

This study aims to (a) identify the association between attachment insecurity and harmful drinking, (b) determine if attachment insecurity may mediate between childhood adversity and harmful drinking, and (c) test sex as a moderator between attachment insecurity and harmful drinking in the mediation relationship.

METHODS

Adult primary care patients (N = 348, 60% women) completed a cross-sectional survey study using validated measures in 2012. Statistical analyses were performed using Hayes's PROCESS macro in SPSS.

RESULTS

Childhood adversity was reported by 61% of the cohort and 18% endorsed harmful drinking. Attachment anxiety was associated with harmful drinking (p >.001), but attachment avoidance was not (p =.11). Attachment anxiety may mediate between childhood adversity and harmful drinking (95% CI:.03-.14). Sex did not moderate the relationships between attachment anxiety and harmful drinking in the mediation relationship (women: 95% CI:.031-.179; men: 95% CI:.003.-.182). Conclusions/Importance: Attachment anxiety may mediate between childhood adversity and harmful drinking in both men and women. Attachment anxiety may be a potential therapeutic target for people with a history of childhood adversity.

Self-Reported Knowledge, Correct Knowledge and use of UK Drinking Guidelines Among a Representative Sample of the English Population

AIMS

Promotion of lower risk drinking guidelines is a commonly used public health intervention with various purposes, including communicating alcohol consumption risks, informing drinkers' decision-making and, potentially, changing behaviour. UK drinking guidelines were revised in 2016. To inform potential promotion of the new guidelines, we aimed to examine public knowledge and use of the previous drinking guidelines, including by population subgroup.

METHODS

A demographically representative, cross-sectional online survey of 2100 adults living in England in July 2015 (i.e. two decades after adoption of previous guidelines and prior to introduction of new guidelines). Univariate and multivariate logistic regressions examined associations between demographic variables, alcohol consumption (AUDIT-C), smoking, and knowledge of health conditions and self-reported knowledge and use of drinking guidelines. Multinomial logistic regression examined the same set of variables in relation to accurate knowledge of drinking guidelines (underestimation, accurate-estimation, overestimation).

RESULTS

In total, 37.8% of drinkers self-reported knowing their own-gender drinking guideline, of whom 66.2% gave an accurate estimate. Compared to accurate estimation, underestimation was associated with male gender, lower education and AUDIT-C score, while overestimation was associated with smoking. Few (20.8%) reported using guidelines to monitor drinking at least sometimes. Drinking guideline use was associated with higher education, overestimating guidelines and lower AUDIT-C. Correctly endorsing a greater number of health conditions as alcohol-related was associated with self-reported knowledge of guidelines, but was not consistently associated with accurate estimation or use to monitor drinking.

CONCLUSIONS

Two decades after their introduction, previous UK drinking guidelines were not well known or used by current drinkers. Those who reported using them tended to overestimate recommended daily limits.

SHORT SUMMARY

We examined public knowledge and use of UK drinking guidelines just before new guidelines were released (2016). Despite previous guidelines being in place for two decades, only one in four drinkers accurately estimated these, with even fewer using guidelines to monitor drinking. Approximately 8% of drinkers overestimated maximum daily limits.

Unrecorded alcohol use: a global modelling study based on nominal group assessments and survey data

BACKGROUND AND AIMS

Alcohol use is among the most important risk factors for burden of disease globally. An estimated quarter of the total alcohol consumed globally is unrecorded. However, due partly to the challenges associated with its assessment, evidence concerning the magnitude of unrecorded alcohol use is sparse. This study estimated country-specific proportions of unrecorded alcohol used in 2015.

DESIGN

A statistical model was developed for data prediction using data on the country-specific proportion of unrecorded alcohol use from nominal group expert assessments and secondary, nationally representative survey data and country-level covariates.

SETTING

Estimates were calculated for the country level, for four income groups and globally.

PARTICIPANTS

A total of 129 participants from 49 countries were included in the nominal group expert assessments. The survey data comprised 66 538 participants from 16 countries.

MEASUREMENTS

Experts completed a standardized questionnaire assessing the country-specific proportion of unrecorded alcohol. In the national surveys, the number of standard drinks of total and unrecorded alcohol use was assessed for the past 7 days.

FINDINGS

Based on predictions for 167 countries, a population-weighted average of 27.9% [95% confidence interval (CI) = 10.4-44.9%] of the total alcohol consumed in 2015 was unrecorded. The proportion of unrecorded alcohol was lower in high (9.4%, 95% CI = 2.4-16.4%) and upper middle-income countries (18.3%, 95% CI = 9.0-27.6%) and higher in low (43.1%, 95% CI = 26.5-59.7%) and lower middle-income countries (54.4%, 95% CI = 38.1-70.8%). This corresponded to 0.9 (high-income), 1.2 (upper middle-income), 3.2 (lower middle-income) and 1.8 (low-income) litres of unrecorded alcohol per capita.

CONCLUSIONS

A new method for modelling the country-level proportion of unrecorded alcohol use globally showed strong variation among geographical regions and income groups. Lower-income countries were associated with a higher proportion of unrecorded alcohol than higher-income countries.

The socioeconomic profile of alcohol-attributable mortality in South Africa: a modelling study

BACKGROUND

Globally, illness and life expectancy follow a social gradient that puts people of lower socioeconomic status (SES) at higher risk of dying prematurely. Alcohol consumption has been shown to be a factor contributing to socioeconomic differences in mortality. However, little evidence is available from low- and middle-income countries. The objective of this study was to quantify mortality attributable to alcohol consumption in the adult (15+ years) general population of South Africa in 2015 by SES, age, and sex.

METHODS

A comparative risk assessment was performed using individual and aggregate data from South Africa and risk relations reported in the literature. Alcohol-attributable fractions (AAFs) and alcohol-attributable mortality rates were estimated for cause-specific mortality by SES, sex, and age. Monte Carlo simulation techniques were used to calculate 95% uncertainty intervals (UI).

RESULTS

Overall, approximately 62,300 (95% UI 27,000-103,000) adults died from alcohol-attributable causes in South Africa in 2015, with 60% of deaths occurring in people in the low and 15% in the high SES groups. Age-standardized, alcohol-attributable mortality rates per 100,000 adults were highest for the low SES group (727 deaths, 95% UI 354-1208 deaths) followed by the middle (377 deaths, 95% UI 165-687 deaths) and high SES groups (163 deaths, 95% UI 71-289 deaths). The socioeconomic differences were highest for mortality from infectious diseases. People of low SES had a lower prevalence of current alcohol use but heavier drinking patterns among current drinkers. Among men, AAFs were elevated at low and middle SES, particularly for the middle and higher age groups (35+). Among women, AAFs differed less across SES groups and, in the youngest age group (15-34), women of high SES had elevated AAFs.

CONCLUSIONS

Alcohol use contributed to vast socioeconomic differences in mortality. Where observed, elevated AAFs for people of low and middle SES arose from higher levels of consumption among current drinkers and not from the prevalence of current alcohol use per se. The findings can direct preventive measures and interventions on those at highest risk. Future research is needed to investigate socioeconomic differences in the risk functions relating alcohol use to cause-specific mortality.

A Commentary on the Limits of Alcoholic Beverage Policies

Providing one set of policy measures for all countries as if they were a single, homogeneous entity does not appear to be evidence-based, according to recent research on the effectiveness of alcoholic beverage control policies. Contextual and cultural determinants-social, economic, demographic, cultural and political-appear to be major factors of influencing change in drinking trends, drinking patterns and drinking-related harms. The variable interplay between contextual determinants and alcohol control policy measures implies diverse impacts on consumption and harm according to time, and to the different countries and groups of countries. In addition, epidemiology research manifests some limitations when applied to alcohol drinking and results are transferred from one culture to another. The conditions of individual cultures and countries should be considered when planning and evaluating alcohol control policies.

DIAMOND (DIgital Alcohol Management ON Demand): a feasibility RCT and embedded process evaluation of a digital health intervention to reduce hazardous and harmful alcohol use recruiting in hospital emergency departments and online

BACKGROUND

The harmful use of alcohol is a causal factor in more than 200 disease and injury conditions and leads to over 3 million deaths every year worldwide. Relatively few problem alcohol users access treatment due to stigma and lack of services. Alcohol-specific digital health interventions (DHI) may help them, but trial data comparing DHI with face-to-face treatment are lacking.

METHODS

We conducted a feasibility RCT of an alcohol DHI, testing recruitment, online data-collection and randomisation processes, with an embedded process evaluation. Recruitment ran from October 2015 for 12 months. Participants were adults, drinking at hazardous and harmful levels, recruited from hospital emergency departments (ED) in London or recruited online. Participants were randomised to HeLP-Alcohol, a six module DHI with weekly reminder prompts (phone, email or text message), or to face-to-face treatment as usual (TAU). Participants were invited to take part in qualitative interviews after the trial.

RESULTS

The trial website was accessed 1074 times: 420 people completed online eligibility questionnaires; 350 did not meet eligibility criteria, 51 declined to participate, and 19 were recruited and randomised. Follow-up data were collected from three participants (retention 3/19), and four agreed to be interviewed for the process evaluation. The main themes of the interviews were:Participants were not at equipoise. They wanted to try the website and were disappointed to be randomised to face-to-face, so they were less engaged and dropped out.Other reasons for drop out included not accepting that they had a drink problem; problem drinking interfering with their ability to take part in a trial or forgetting appointments; having a busy life and being randomised to TAU made it difficult to attend appointments.

CONCLUSIONS

This feasibility RCT aimed to test recruitment, randomisation, retention, and data collection methods, but recruited only 19 participants. This illustrates the importance of undertaking feasibility studies prior to fully powered RCTs. From the qualitative interviews we found that potential recruits were not at equipoise for recruitment. An alternative methodology, for example a preference RCT recruiting from multiple locations, needs to be explored in future trials.

TRIAL REGISTRATION

International Standard Randomized Controlled Trial Number: ISRCTN31789096.

"[Drinking is] Like a Rule That You Can't Break": Perceived Barriers and Facilitators to Reduce Alcohol Use and Improve Antiretroviral Treatment Adherence among People Living with HIV and Alcohol Use Disorder in Vietnam

BACKGROUND

Alcohol use, a highly normative behavior in Vietnam that is associated with high rates of HIV infection and lower antiretroviral treatment (ART) adherence, has been largely overlooked by HIV prevention efforts.

OBJECTIVES

Using the risk environment framework, this qualitative study aims to explore the perceived microenvironmental (community-level) and endogenous (individual-level) barriers and facilitators to alcohol reduction among people living with HIV (PLHIV) with alcohol use disorders (AUDs) in Vietnam.

METHODS

From June-July 2014, semi-structured interviews were conducted with thirty PLHIV (18 men; 12 women) recruited from an outpatient ART clinic in Thai Nguyen province, Vietnam. All participants had scores of ≥8 on the Alcohol Use Disorders Identification Test and ten of the 30 participants were currently using injection drugs. Interviews were transcribed, translated, and analyzed to identify perceived barriers and facilitators to alcohol reduction.

RESULTS

Most participants reported a spike in alcohol consumption at the time of HIV diagnosis. Most perceived barriers existed at the microenvironmental level, including perceived inability to refuse alcohol in the context of community-level social norms and lack of alcohol treatment programs. Two commonly mentioned endogenous barriers were compensatory behaviors when reducing injection drug use and using alcohol as a coping strategy for HIV-related sadness. Those who were able to successfully reduce alcohol use and adhere to ART reported having social support to buffer community-level social pressure and cope with sadness.

CONCLUSIONS

It may be effective to introduce targeted alcohol reduction interventions in health care centers to address individual risk practices and microenvironmental social norms.

Awareness of alcohol as a risk factor for cancer is associated with public support for alcohol policies

BACKGROUND

Globally, alcohol is causally related to 2.5 million deaths per year and 12.5% of these are due to cancer. Previous research has indicated that public awareness of alcohol as a risk factor for cancer is low and this may contribute to a lack of public support for alcohol policies. The aim of this study was to investigate the relationship between awareness of the alcohol-cancer link and support for a range of alcohol policies in an English sample and policy context.

METHODS

A cross-sectional survey of 2100 adult residents in England was conducted in which respondents answered questions regarding awareness of the link between alcohol and cancer and support for 21 policy proposals. Principal component analysis (PCA) was used to reduce the 21 policy proposals down to a set of underlying factors. Multiple regression analyses were conducted to estimate the relationship between awareness of the alcohol-cancer link and each of these policy factors.

RESULTS

Thirteen per cent of the sample were aware of the alcohol-cancer link unprompted, a further 34% were aware when prompted and 53% were not aware of the link. PCA reduced the policy items to four policy factors, which were named price and availability, marketing and information, harm reduction and drink driving. Awareness of the alcohol-cancer link unprompted was associated with increased support for each of four underlying policy factors: price and availability (Beta: 0.06, 95% CI: 0.01, 0.10), marketing and information (Beta: 0.05, 95% CI: 0.00, 0.09), harm reduction (Beta: 0.09, 95% CI: 0.05, 0.14), and drink driving (Beta: 0.16, 95% CI: 0.11, 0.20).

CONCLUSIONS

Support for alcohol policies is greater among individuals who are aware of the link between alcohol and cancer. At the same time, a large proportion of people are unaware of the alcohol-cancer link and so increasing awareness may be an effective approach to increasing support for alcohol policies.

Cost of Intensive Care Treatment for Liver Disorders at Tertiary Care Level in India

BACKGROUND

Liver diseases contribute significantly to the health and economic burden globally. We undertook this study to assess the health system costs, out-of-pocket (OOP) expenditure and extent of financial risk protection associated with treatment of liver disorders in a tertiary care public sector hospital in India.

METHODOLOGY

The present study was undertaken in an intensive care unit (ICU) of a tertiary care hospital in North India. It comprised an ICU and an HDU (high dependency unit). Bottom-up micro-costing was undertaken to assess the health system costs. Data on OOP expenditure and indirect costs were collected for 150 liver disorder patients admitted to the ICU or HDU from December 2013 to October 2014. Per-patient and per-bed-day costs of treatment were estimated from both health system and patient perspectives. Financial risk protection was assessed by computing prevalence of catastrophic health expenditure as a result of OOP expenditure.

RESULTS

In 2013-2014, health system costs per patient treated in the ICU and HDU were US$2728 [Indian National Rupee (INR) 1,63,664] and US$1966 (INR 1,17,985), respectively. The mean OOP expenditures for treatment in the ICU and HDU were US$2372 (INR 1,42,297) and US$1752 (INR 1,05,093), respectively. Indirect costs of hospitalization in ICU and HDU patients were US$166 (INR 9952) and US$182 (INR 10,903), respectively.

CONCLUSION

Treatment of chronic liver disorders poses an economic challenge for both the health system and patients. There is a need to focus on prevention of liver disorders, and finding ways to treat patients without exposing their households to the catastrophic effect of OOP expenditure.

Aligning the ICD-11 classification of disorders due to substance use with global service needs

The use of psychoactive, potentially dependence-producing substances is highly prevalent around the world, and contributes substantially to global disease burden. There is a major gap between the need for treatment for substance use disorders. Changes proposed for the classification of substance use disorders in the Eleventh Revision of the International Classification of Diseases and Related Health Problems, based on a public health approach, have important implications for the conceptualisation, structure and availability of services. These include: (1) an updated and expanded range of substance classes; (2) greater specification of different harmful patterns of substance use, which may be continuous or episodic and recurrent; (3) a new category to denote single episodes of harmful use; (4) a category describing hazardous use of substances; and (5) simplification of diagnostic guidelines for substance dependence. This paper describes these changes and the opportunities they present for improved prevention, treatment, monitoring and health policy.

Contrasting staff and student views on alcohol education provision in a UK university

Alcohol education and awareness aims to teach individuals the risks of excess consumption. It is common in UK universities, despite limited evidence of success with student cohorts. This research explored the development and delivery of such alcohol activities at one UK university. In-depth, one-to-one interviews were carried out with non-academic staff and with first-year students. These aimed to understand the development of alcohol awareness messages and staff involvement in delivery, as well as exploring student responses to key alcohol educational activities. Results indicate that alcohol is a normalized aspect of UK student identity and is accepted as such by students and staff. Despite this, there is a widely held view that the university has a responsibility to provide alcohol education and awareness, which forms the basis of current practice on campus. This reflects perception of education interventions as non-coercive and acceptable within the staff-student relationship, with limited support for more interventionist approaches with a group engaging in a legal behavior with strong cultural associations. However, staff approval of education as appropriate for this audience is contradicted by students, who reject these same approaches as reminiscent of school, instead favoring self-directed learning or peer-led programs.

Barriers to implement screening for alcohol consumption in Spanish hypertensive patients

BACKGROUND

Alcohol intake and hypertension (HT) are interrelated public health problems with cost-effective interventions at the primary care level that, to date, are poorly implemented.

OBJECTIVE

This study aims to explore the barriers to implementing alcohol interventions for people with HT in primary care.

METHODS

As part of the project BASIS (Baseline Alcohol Screening and Intervention Survey), an internet survey from five European countries was developed to determine the role of alcohol in the management of HT in primary care practice. The survey contained 28 core items and 7 country-specific items. We present answers from Spanish general practitioners (GPs), who were reached through the main professional and scientific societies via e-mail and asked to take the online survey.

RESULTS

In total, 867 GPs answered the survey (65.1% women, 70.4% > 30 years old). As indicated by the Alcohol Use Disorders Identification Test-C scores, 12.4% of GPs who responded were risky drinkers (21.3% of men versus 7.1% of women). GPs reported considering alcohol relatively unimportant in HT treatment, as well as a difficult condition to deal with. The three main barriers to implement screening for alcohol consumption in HT patients were the lack of time (50.0%), considering alcohol unimportant for HT (28.4%) and stigma (16.5%).

CONCLUSIONS

GPs did not consider alcohol consumption a relevant factor for HT and, additionally, found it difficult to deal with alcohol problems. Some of the barriers for alcohol screening could be overcome through structural changes in the health system, such as empowering GPs to treat alcohol use disorders (rather than a single focus on implementing preventive strategies) by enhancing training in alcohol diagnosis and treatment.

Behavior Change Techniques Used in Digital Behavior Change Interventions to Reduce Excessive Alcohol Consumption: A Meta-regression

Background

Digital behavior change interventions (DBCIs) appear to reduce alcohol consumption, but greater understanding is needed of their mechanisms of action.

Purpose

To describe the behavior change techniques (BCTs) used in DBCIs and examine whether individual BCTs, the inclusion of more BCTs or more Control Theory congruent BCTs is associated with increased effectiveness.

Methods

Forty-one randomized control trials were extracted from a Cochrane review of alcohol reduction DBCIs and coded for up to 93 BCTs using an established and reliable method. Random effects unadjusted and adjusted meta-regression models were performed to assess associations between BCTs and intervention effectiveness.

Results

Interventions used a mean of 9.1 BCTs (range 1-22), 23 different BCTs were used in four or more trials. Trials that used "Behavior substitution" (-95.112 grams per week [gpw], 95% CI: -162.90, -27.34), "Problem solving" (-45.92 gpw, 95% CI: -90.97, -0.87) and "Credible source" (-32.09 gpw, 95% CI: -60.64, -3.55) were significantly associated with greater alcohol reduction than trials without these BCTs. The "Behavior substitution" result should be treated as preliminary because it was reported in only four trials, three of which were conducted by the same research group. "Feedback" was used in 98% of trials (n = 41); other Control Theory congruent BCTs were used less frequently: for example, "Goal setting" 43% (n = 18) and "Self-monitoring" 29%, (n = 12).

Conclusions

"Behavior substitution," "Problem solving," and "Credible source" were associated with greater alcohol reduction. Many BCTs were used infrequently in DBCIs, including BCTs with evidence of effectiveness in other domains, such as "Self-monitoring" and "Goal setting."

Responding to excessive alcohol consumption in third-level (REACT): a study protocol

BACKGROUND

Problem alcohol use is an ongoing, worldwide phenomenon of considerable concern. Throughout the past 20 years, national policies have noted the importance of students when tackling alcohol consumption. Considering alcohol is a multifaceted issue, a multi-component response is required to combat its excessive use. This protocol sets out the approach used for developing, implementing and evaluating the REACT (Responding to Excessive Alcohol Consumption in Third-level) Programme.

METHODS/DESIGN

This evaluation will provide the evidence base for programme development, implementation and improvement. Stage one involved defining the multi-component intervention. This was developed following a systematic review of existing literature and a Delphi-consensus workshop involving university students, staff and relevant stakeholders. Following this, the programme is being implemented across the Higher Education sector in Ireland. A number of Higher Education Institutes have declined the invitation to participate in the programme. These institutions will act as control sites. Each intervention site will have a steering committee whose membership will include a mix of students and academic and student service staff. This steering committee will report to the REACT research team on the implementation of mandatory and optional action points at local sites. An online cross-sectional study at baseline and two-years post intervention will be utilised to determine the impact of the REACT programme. The impact assessment will focus on (1) whether the intervention has reduced alcohol consumption among third-level students (2); whether the programme altered students attitudes toward alcohol and (3) whether the programme has decreased the second-hand effects associated with excessive consumption. Finally, qualitative research will focus on factors influencing the take-up and implementation of this programme as well as students' views on the initiative.

DISCUSSION

Alcohol consumption has remained on the policy agenda at both national and international level over recent decades. Students are regularly among the highest alcohol consumers, yet university management and public policymakers struggle to tackle this burgeoning issue. The REACT Programme provides a structure to translate policy into practice for those seeking to reduce hazardous alcohol consumption and related harms among third-level students.

Measuring and preventing alcohol use and related harm among young people in Asian countries: a thematic review

Background

The paper reviews alcohol consumption patterns and alcohol-related social and health issues among 15–29-year old young people in Asian countries, and discusses strategies for preventing and controlling alcohol use and related harms.

Methods

We searched Google Scholar, PubMed, and Web of Science for reports, reviews and journal articles published in English between 1st Jan 1990 and 31st August 2016.

Results

Forty-one reports, reviews and journal papers were identified and included in the final review. The current drinking levels and prevalence among young people are markedly different between eight included Asian countries, ranging from 4.2% in Malaysia to 49.3% in China. In a majority of the selected Asian countries, over 15% of total deaths among young men and 6% among young women aged 15–29 years are attributable to alcohol use. Alcohol use among young people is associated with a number of harms, including stress, family violence, injuries, suicide, and sexual and other risky behaviours. Alcohol policies, such as controlling sales, social supply and marketing, setting up/raising a legal drinking age, adding health warning labels on alcohol containers, and developing a surveillance system to monitor drinking pattern and risky drinking behaviour, could be potential means to reduce harmful use of alcohol and related harm among young people in Asia.

Conclusions

The review reveals that drinking patterns and behaviours vary across eight selected Asian countries due to culture, policies and regional variations. The research evidence holds substantial policy implications for harm reduction on alcohol drinking among young people in Asian countries -- especially for China, which has almost no alcohol control policies at present.

Effect of a text message intervention to reduce hazardous drinking among injured patients discharged from a trauma ward: a randomized controlled trial

Screening and brief intervention for hazardous alcohol use in trauma care settings is known to reduce alcohol intake and injury recidivism, but is often not implemented due to resource constraints. Brief interventions delivered by mobile phone could overcome this challenge. This study aimed to evaluate the effect of a mobile phone text message intervention (YourCall^TM) on hazardous drinkers admitted for an injury. The parallel two-group, single-blind, randomised controlled trial enrolled 598 injured patients aged 16–69 years identified as medium-risk drinkers at recruitment. The intervention group (n = 299) received 16 text messages incorporating brief intervention principles in the 4 weeks following discharge from hospital. Controls (n = 299) received usual care and one text message acknowledging participation in the trial. The primary outcome was the difference in hazardous alcohol use (assessed using AUDIT-C) between study groups at 3 months, with the maintenance of effect examined at 6 and 12 months’ follow-up. Data were analysed using a mixed-effects model for repeated measures. Both groups had similar baseline features. Compared to controls, hazardous drinking was significantly lower in the intervention group at 3 months and maintained over the 12-month follow-up period (least squares mean difference in AUDIT-C scores: −0.322; 95% CI: −0.636, −0.008; p = 0.04). The intervention effect was similar among Māori (New Zealand’s indigenous population) and non-Māori (interaction p = 0.59), and among younger (16–29 years) and older (30–69 years) patients (p = 0.77). The effectiveness of this intervention reflects the potential of low cost, scalable mobile health technologies to overcome common barriers in implementing alcohol harm reduction strategies following injury.

Mobile phone text messages reduce dangerous patterns of alcohol consumption and could help prevent alcohol-related injuries. A trial carried out in New Zealand led by Sarah Sharpe at the University of Auckland examined the effect of sending 16 automated text messages over a four-week period to 299 adults discharged from hospital following an injury and identified as moderate risk hazardous drinkers. The messages, which encouraged patients to reduce their alcohol consumption and offered information on how to do so in an easy-to-understand and non-judgemental manner, reduced hazardous drinking throughout the 12-month follow-up period compared with a control group that received usual care. These findings suggest that text message interventions are an effective, low cost and easily scalable solution to curb harmful alcohol consumption.

Effectiveness of Mass Media Campaigns to Reduce Alcohol Consumption and Harm: A Systematic Review

AIMS

To assess the effectiveness of mass media messages to reduce alcohol consumption and related harms using a systematic literature review.

METHODS

Eight databases were searched along with reference lists of eligible studies. Studies of any design in any country were included, provided that they evaluated a mass media intervention targeting alcohol consumption or related behavioural, social cognitive or clinical outcomes. Drink driving interventions and college campus campaigns were ineligible. Studies quality were assessed, data were extracted and a narrative synthesis conducted.

RESULTS

Searches produced 10,212 results and 24 studies were included in the review. Most campaigns used TV or radio in combination with other media channels were conducted in developed countries and were of weak quality. There was little evidence of reductions in alcohol consumption associated with exposure to campaigns based on 13 studies which measured consumption, although most did not state this as a specific aim of the campaign. There were some increases in treatment seeking and information seeking and mixed evidence of changes in intentions, motivation, beliefs and attitudes about alcohol. Campaigns were associated with increases in knowledge about alcohol consumption, especially where levels had initially been low. Recall of campaigns was high.

CONCLUSION

Mass media health campaigns about alcohol are often recalled by individuals, have achieved changes in knowledge, attitudes and beliefs about alcohol but there is little evidence of reductions in alcohol consumption.

SHORT SUMMARY

There is little evidence that mass media campaigns have reduced alcohol consumption although most did not state that they aimed to do so. Studies show recall of campaigns is high and that they can have an impact on knowledge, attitudes and beliefs about alcohol consumption.

Is It More Feeling or Thinking? The Influence of Affective and Cognitive Attitude on Adolescents' Intention to Engage in Binge Drinking

Previous work has revealed that interventions aiming to reduce adolescent binge drinking commonly focus on cognitive attitudes, but are insufficiently effective in changing binge-drinking intentions. The focus on these cognitive attitudes might be the reason for this insufficient success. That is, other work has revealed that affective attitudes have a stronger influence on binge-drinking intention than cognitive attitudes. However, this relation has so far only been found among traditional college students and pre-vocational school students, therewith neglecting another important population at risk, namely vocational community college students. This study examines whether affective attitudes are also significantly stronger influencers of binge-drinking intentions among vocational community college students. Using a sample of 298 vocational community college students (M_age = 17.63), the current study shows that affective attitudes were more strongly related to vocational community college students' intention to engage in binge drinking than cognitive attitudes. This finding indicates that the effectiveness of interventions targeting adolescent binge drinking can be improved by incorporating content elements concerning affective attitudes.

Evaluation of a public education campaign to support parents to reduce adolescent alcohol use

INTRODUCTION AND AIMS

Mass media education campaigns targeting parents may influence parent factors that reduce adolescent drinking; however few such campaigns have been evaluated.

DESIGN AND METHODS

The Parents, Young People and Alcohol campaign included two phases of mass media advertising, Cogs and I See, to deliver consistent messages across multiple media channels. The campaign targeted Western Australian parents of 12-17 year olds with messages describing alcohol's effect on the developing brain and adolescent physical and mental health. The campaign reinforced the National Health and Medical Research Council (NHMRC) Guideline that for under 18s, not drinking is the safest option. Parent knowledge, attitudes and behaviours were assessed via cross-sectional surveys administered before the campaign (Time 1) and at two post-tests (Time 2; Time 3). Post-test campaign awareness and perceptions were also assessed.

RESULTS

Campaign awareness was high (48% Time 2; 80% Time 3) and over 86% of parents found the campaign believable and relevant at both post-tests. Increased knowledge of the NHMRC guideline and lower belief in alcohol myths were found at both post-tests compared to Time 1. Less positive attitudes to parental supply were found at Time 2, but were not sustained at Time 3. Parents were more likely to have discussed alcohol risks and limiting drinking with their child at Time 3, but parent-to-child alcohol supply did not change significantly.

DISCUSSION AND CONCLUSIONS

The campaign achieved high awareness and positively influenced parental outcomes. Longer term campaign implementation supported by policy and environmental measures may be required to change parental supply.

Industry interests in gambling research: Lessons learned from other forms of hazardous consumption

Research indicates that the evidential bases for many harm reduction policies targeting hazardous consumptions (including tobacco, alcohol and gambling) have been distorted by commercial industries that derive revenue from such commodities. These distortions are best illustrated by research on tobacco and alcohol, which indicates similar tactics used by industries to determine favourable policy environments through engineering of evidence, among other approaches. Although there is concern that gambling research is similarly vulnerable to commercial interests, the relevant literature lags far behind other fields and the aim of this paper is to increase familiarity with tactics used by industries for influencing research. It summarises the conceptual and empirical bases for expecting conflicts between goals of public health and companies that profit from hazardous consumptions. It also summarises evidence describing practices deployed by tobacco corporations, which include third-party techniques and the selective funding of research to manufacture doubt and deflect attention away from the consequences of smoking. It then reviews both early and emerging evidence indicating similar strategies used by alcohol industry, and uses this literature to view practices of the gambling industry. It argues that parallels regarding selective funding of research and third-party techniques provide grounds for strong concern about commercial influences on gambling research, and implementation of precautionary approaches to management of vested interests.

Effects on Alcohol Consumption and Alcohol Related Harm of a Community-Based Prevention Intervention With National Support in Sweden

BACKGROUND

In order to strengthen local alcohol prevention work in Sweden the Swedish government has for the past almost 15 years commissioned the Public Health Agency of Sweden to initiate a series of community-based alcohol prevention projects. The latest of these, labeled local development with ambitions (LUMA), included 25 municipalities in Sweden.

OBJECTIVES

Aim of this study is to examine if LUMA municipalities that received financial support, with requirements, increased local alcohol prevention and if alcohol consumption and harm declined.

METHODS

Twenty-five Swedish municipalities that received financial support aiming to strengthen local alcohol preventing activities (intervention group) were compared to municipalities that did not receive such support (control group, N = 224), before, during, and after the intervention period. Two composite measures of policy and activity were created and used. The composite activity measure includes seven activity indicators and the composite policy measure includes six policy indicators. Harm measures have been selected based on several recommended indicators for monitoring alcohol, tobacco, and other drugs in Sweden. A fixed effects model was used to analyze data.

RESULTS

The results reveal that prevention activities increased and several alcohol-related harm indicators were reduced in intervention municipalities (LUMA) compared with in control municipalities.

CONCLUSIONS

It seems as if financial support, combined with specific requirements and support from the regional and national level, can stimulate local alcohol prevention activities and have a significant effect on alcohol consumption and alcohol-related harm. Similar evaluations in other countries would be of great value for assessing the generalizability of findings.

Contribution of alcohol use disorders to the burden of dementia in France 2008-13: a nationwide retrospective cohort study

BACKGROUND

Dementia is a prevalent condition, affecting 5-7% of people aged 60 years and older, and a leading cause of disability in people aged 60 years and older globally. We aimed to examine the association between alcohol use disorders and dementia risk, with an emphasis on early-onset dementia (<65 years).

METHODS

We analysed a nationwide retrospective cohort of all adult (≥20 years) patients admitted to hospital in metropolitan France between 2008 and 2013. The primary exposure was alcohol use disorders and the main outcome was dementia, both defined by International Classification of Diseases, tenth revision discharge diagnosis codes. Characteristics of early-onset dementia were studied among prevalent cases in 2008-13. Associations of alcohol use disorders and other risk factors with dementia onset were analysed in multivariate Cox models among patients admitted to hospital in 2011-13 with no record of dementia in 2008-10.

FINDINGS

Of 31 624 156 adults discharged from French hospitals between 2008 and 2013, 1 109 343 were diagnosed with dementia and were included in the analyses. Of the 57 353 (5·2%) cases of early-onset dementia, most were either alcohol-related by definition (22 338 [38·9%]) or had an additional diagnosis of alcohol use disorders (10 115 [17·6%]). Alcohol use disorders were the strongest modifiable risk factor for dementia onset, with an adjusted hazard ratio of 3·34 (95% CI 3·28-3·41) for women and 3·36 (3·31-3·41) for men. Alcohol use disorders remained associated with dementia onset for both sexes (adjusted hazard ratios >1·7) in sensitivity analyses on dementia case definition (including Alzheimer's disease) or older study populations. Also, alcohol use disorders were significantly associated with all other risk factors for dementia onset (all p<0·0001).

INTERPRETATION

Alcohol use disorders were a major risk factor for onset of all types of dementia, and especially early-onset dementia. Thus, screening for heavy drinking should be part of regular medical care, with intervention or treatment being offered when necessary. Additionally, other alcohol policies should be considered to reduce heavy drinking in the general population.

FUNDING

None.

All drinking is not equal: how a social practice theory lens could enhance public health research on alcohol and other health behaviours

BACKGROUND

The social meanings, settings and habitual nature of health-related activities and their integration into our daily lives are often overlooked in quantitative public health research. This reflects an overly individualized approach to epidemiological surveillance and evaluations of public health interventions, based on models of behaviour that are rooted in social cognition and rational choice theories. This paper calls for a new approach to alcohol epidemiology and intervention research informed by theories of practice.

ARGUMENT

Practices are conceptualized as routinized types of human activity that are made up of, and can be recognized by, the coming together of several interwoven elements in the same situation (e.g. materials, meanings, skills, locations, timings). Different practices are interconnected-they can occur simultaneously (e.g. drinking and eating), hold each other in place (e.g. after-work drinks) or compete for time (e.g. parenting versus socializing). Applying these principles to alcohol research means shifting attention away from individuals and their behaviours and instead making drinking practices an important unit of analysis. Studying how drinking practices emerge, persist and decay over time, how they spread through populations and local or social networks and how they relate to other activities of everyday life promises new insights into how, why, where, when and with whom drinking and getting drunk occur.

CONCLUSIONS

Theories of practice provide a framework for generating new explanations of stability and change in alcohol consumption and other health behaviours. This framework offers potential for novel insights into the persistence of health inequalities, unanticipated consequences of policies and interventions and new interventions targets through understanding which elements of problematic practices are likely to be most modifiable. We hope this will generate novel insights into the emergence and decay of drinking practices over time and into the geographical and socio-demographic patterning of drinking. Theories of practice-informed research would consider how alcohol policies and population-level interventions might differentially affect different drinking practices.

New cancer cases in France in 2015 attributable to different levels of alcohol consumption

BACKGROUND AND AIMS

Alcohol consumption increases the risk of cancer. Thus, to inform policy decisions, this study estimated the number of new cancer cases in France in 2015 attributable to alcohol consumption generally and to light (< 20 g per day (g/day) among women; < 40 g/day among men), moderate (20 to < 40 g/day among women; 40 to < 60 g/day among men) and heavy drinking (≥ 40 g/day among women; ≥ 60 g/day among men), and the number of cancer cases that would have been prevented assuming a previous 10% decrease in alcohol consumption.

DESIGN

New cancer cases attributable to alcohol were estimated using a population-attributable fraction methodology, assuming a 10-year latency period between exposure and diagnosis.

SETTING AND PARTICIPANTS

Population of France, 2015.

MEASUREMENTS

Alcohol consumption was estimated by coordinating data from the Baromètre santé 2005, a national representative survey (n = 30 455), with data from the Global Information System on Alcohol and Health. Relative risks were obtained from meta-analyses. Cancer data were estimated based on data from the French Cancer Registries Network. Uncertainty intervals (UI) were estimated using a Monte Carlo procedure.

FINDINGS

In France in 2015, an estimated 27 894 (95% UI = 24 287-30 996) or 7.9% of all new cancer cases were attributable to alcohol. The number of alcohol-attributable new cancer cases was similar for both men and women, with oesophageal squamous cell carcinomas having the largest attributable fraction (57.7%). Light, moderate, heavy and former alcohol drinking were responsible for 1.5, 1.3, 4.4 and 0.6% of all new cancer cases, respectively. Lastly, if there had been a previous 10% reduction in alcohol consumption, 2178 (95% UI = 1687-2601) new cancer cases would have been prevented.

CONCLUSIONS

Alcohol consumption in France appears to cause almost 8% of new cancer cases, with light and moderate drinking contributing appreciably to this burden. A 10% drop in drinking in France would have prevented more than 2000 (estimated) new cancer cases in 2015.

City-based action to reduce harmful alcohol use: review of reviews

Background: The World Health Organization global strategy on alcohol called for municipal policies to reduce the harmful use of alcohol. Yet, there is limited evidence that documents the impact of city-level alcohol policies. Methods: Review of reviews for all years to July 2017. Searches on OVID Medline, Healthstar, Embase, PsycINFO, AMED, Social Work Abstracts, CAB Abstracts, Mental Measurements Yearbook, Health and Psychosocial Instruments, International Pharmaceutical Abstracts, International Political Science Abstracts, NASW Clinical Register, and Epub Ahead of Print databases. All reviews that address adults, without language or date restrictions resulting from combining the terms ("review" or "literature review" or "review literature" or "data pooling" or "comparative study" or "systematic review" or "meta-analysis" or "pooled analysis"), and "alcohol", and "intervention" and ("municipal" or "city" or "community"). Results: Five relevant reviews were identified. Studies in the reviews were all from high income countries and focussed on the acute consequences of drinking, usually with one target intervention, commonly bars, media, or drink-driving. No studies in the reviews reported the impact of comprehensive city-based action. One community cluster randomized controlled trial in Australia, published after the reviews, failed to find convincing evidence of an impact of community-based interventions in reducing adult harmful use of alcohol.     Conclusions: To date, with one exception, the impact of adult-oriented comprehensive community and municipal action to reduce the harmful use of alcohol has not been studied. The one exception failed to find a convincing effect. We conclude with recommendations for closing this evidence gap.

City-based action to reduce harmful alcohol use: review of reviews

Background: The World Health Organization global strategy on alcohol called for municipal policies to reduce the harmful use of alcohol. Yet, there is limited evidence that documents the impact of city-level alcohol policies. Methods: Review of reviews for all years to July 2017. Searches on OVID Medline, Healthstar, Embase, PsycINFO, AMED, Social Work Abstracts, CAB Abstracts, Mental Measurements Yearbook, Health and Psychosocial Instruments, International Pharmaceutical Abstracts, International Political Science Abstracts, NASW Clinical Register, and Epub Ahead of Print databases. All reviews that address adults, without language or date restrictions resulting from combining the terms ("review" or "literature review" or "review literature" or "data pooling" or "comparative study" or "systematic review" or "meta-analysis" or "pooled analysis"), and "alcohol", and "intervention" and ("municipal" or "city" or "community"). Results: Five relevant reviews were identified. Studies in the reviews were all from high income countries and focussed on the acute consequences of drinking, usually with one target intervention, commonly bars, media, or drink-driving. No studies in the reviews reported the impact of comprehensive city-based action. One community cluster randomized controlled trial in Australia, published after the reviews, failed to find convincing evidence of an impact of community-based interventions in reducing adult harmful use of alcohol.     Conclusions: To date, with one exception, the impact of adult-oriented comprehensive community and municipal action to reduce the harmful use of alcohol has not been studied. The one exception failed to find a convincing effect. We conclude with recommendations for closing this evidence gap.

Alcohol consumption, masculinity, and alcohol-related violence and anti-social behaviour in sportspeople

OBJECTIVES

There is no research examining alcohol-related aggression and anti-social behaviour in UK or European sportspeople (athletes), and no research has examined relationships between masculinity, alcohol consumption, and alcohol-related aggression and antisocial behaviour in sportspeople (athletes). This study addresses this gap.

DESIGN

Cross-sectional.

METHODS

A sample (N=2048; women=892, 44%) of in season sportspeople enrolled at UK universities (response 83%), completed measures of masculinity, alcohol consumption, within-sport (on-field) violence, and having been the perpetrator and/or victim of alcohol-related violent/aggressive and antisocial behaviour (e.g., hit/assaulted, vandalism, sexual assault). Logistic regressions examined predictors of alcohol-related violence/aggression and anti-social behaviours.

RESULTS

Significant bivariate relationships between masculinity, within-sport violence, alcohol consumption, and alcohol-related aggression and anti-social behaviour were found for both men and women (p's<.001). Logistic regression adjusting for all variables showed that higher levels of masculinity and alcohol consumption in men and women were related to an increased odds of having conducted an aggressive, violent and/or anti-social act in the past 12 months when intoxicated. Odds ratios were largest for relationships between masculinity, alcohol consumption, within-sport violence, and interpersonal violence/aggression (p's<.001). A similar pattern of results was found for having been the victim of aggression and anti-social behaviour.

CONCLUSIONS

Alcohol-related aggression and anti-social behaviour appear to be problematic in UK university sportspeople, and is related to masculinity and excessive drinking. Interventions that reduce excessive alcohol consumption, masculine norms and associated within-sport violence, could be effective in reducing alcohol-related aggression and antisocial behaviour in UK sportspeople.

When are they old enough to drink? Outcomes of an Australian social marketing intervention targeting alcohol initiation

INTRODUCTION AND AIMS

This paper reports on the evaluation of an Australian whole-of-community social marketing intervention targeting social norms, which aimed to reduce inflated perceptions of the prevalence of underage drinking and increase the age at which alcohol initiation is considered acceptable.

DESIGN AND METHODS

A community-wide intervention was delivered in a single community over a period of 2 years, targeting adolescents, parents and community members. Pre-and post-intervention computer-assisted telephone interview surveys were conducted in the intervention and a matched comparison (control) community. A total of 417 respondents completed both surveys (215 in the intervention community and 202 in the control community).

RESULTS

The intervention community saw an increase of 6 months in the average age at which it is perceived to be acceptable for young people to have a sip/taste of alcohol and 5 months in the average age at which it is perceived to be acceptable to have weak/watered down alcohol. Furthermore, there was a reduction in the perception of the prevalence of alcohol consumption by young people to a level consistent with actual underage drinking rates. In comparison, the control community saw no change in any of these variables.

DISCUSSION AND CONCLUSIONS

This study provides preliminary evidence that a whole-of-community social marketing intervention can change perceptions of the prevalence, and acceptability, of underage drinking. Given the central role of social norms in decisions regarding alcohol consumption, these changes have the potential to reduce parental supply and thus underage drinking.

Alcohol policy and public health

Alcohol is the most commonly used recreational drug in the world and the third leading cause of preventable death. Alcohol consumption and alcohol problems have increased steadily over the past six decades. Methods likely to reduce alcohol problems (e.g. minimum pricing, restricting licensing hours and increasing the availability of alcohol treatment) tend not to be supported by the drinks industry. Methods favoured by the industry (e.g. public education, industry self-regulation and product warning labelling) are less effective or do not work. The recent history of alcohol policy clearly demonstrates how the financial power of industry can influence governments and undermine effective public health measures, for instance by lobbying, political donations, confusion marketing and creating fnancial vested interests by grants from industry-sponsored 'social aspect organisations'.

Hypothetical interventions to prevent stroke: an application of the parametric g-formula to a healthy middle-aged population

The effects of interventions on multiple lifestyle and metabolic risk factors, initiated in midlife or later in a healthy population, on the long-term risk of first-ever stroke is not known. A particular methodological challenge in observational studies is to estimate the unbiased effect of a time-varying exposure in presence of time-varying confounders, if those confounders are affected by prior exposure. In such cases, the parametric g-formula can be applied to estimate an unbiased effect. We applied the parametric g-formula to estimate the 18-years (1994-2012) cumulative stroke risk under different scenarios of hypothetical interventions on levels of blood pressure, cholesterol, weight, physical activity, smoking and alcohol intake; and compared these to the observed scenario, to calculate the population risk ratios and risk differences. Among 14,796 eligible participants in the prospective, population-based Tromsø study (baseline mean age 46.1 years, 51% women), the observed 18-years stroke risk was 5.9%. A feasible joint hypothetical intervention on six lifestyle and metabolic risk factors would reduce the 18-year stroke risk by 32% (95% confidence interval 16, 44). A combination of more intensive interventions reduced the estimated 18-years stroke risk by 64% (95% confidence interval 40, 80). Blood pressure reduction and quitting smoking significantly reduced the risk when applied separately.

A Review of Personality-Targeted Interventions for Prevention of Substance Misuse and Related Harm in Community Samples of Adolescents

Several school-based prevention programmes have been developed and used to prevent, delay, or reduce substance misuse, and related problems among community samples of adolescents. However, findings indicate that many of these interventions are associated with null, small, or mixed effects in reducing adolescent substance misuse, in particular for those mostly at risk of transitioning to substance use disorders. These findings highlight the need to shift the focus of substance use prevention efforts toward intervention strategies which directly target high-risk adolescents. The Preventure programme was designed to target four personality risk factors for substance misuse: hopelessness, anxiety sensitivity, impulsivity, and sensation seeking. This article reviews findings from the previous trials of personality-targeted interventions (i.e., Preventure programme) with adolescents and discuss the promises and benefits of these interventions for targeting community samples of high-risk adolescents at school level for reducing substance misuse and related mental health problems. Findings indicated that this programme has been successful in reducing the rates of alcohol and illicit drug use and substance-related harms by ~50% in high-risk adolescents with the effects last for up to 3 years. These interventions were also associated with a 25% reduction in likelihood of transitioning to mental health problems, such as anxiety, depression, suicidal ideation, and conduct problems. The programme is particularly beneficial for youth with more significant risk profiles, such as youth reporting clinically significant levels of externalizing problems, and victimized adolescents. A key strength of the Preventure programme is that it is embedded in the community and provides substance use intervention at school level to the general samples of high-risk adolescents who might not otherwise have access to those programmes.

Perceptions About Alcohol Harm and Alcohol-control Strategies Among People With High Risk of Alcohol Consumption in Alberta, Canada and Queensland, Australia

OBJECTIVES

To explore alcohol perceptions and their association hazardous alcohol use in the populations of Alberta, Canada and Queensland, Australia.

METHODS

Data from 2500 participants of the 2013 Alberta Survey and the 2013 Queensland Social Survey was analyzed. Regression analyses were used to explore the association between alcohol perceptions and its association with hazardous alcohol use.

RESULTS

Greater hazardous alcohol use was found in Queenslanders than Albertans (p<0.001). Overall, people with hazardous alcohol were less likely to believe that alcohol use contributes to health problems (odds ratio [OR], 0.46; 95% confidence interval [CI], 0.27 to 0.78; p<0.01) and to a higher risk of injuries (OR, 0.54; 95% CI, 0.33 to 0.90; p<0.05). Albertans with hazardous alcohol use were less likely to believe that alcohol contributes to health problems (OR, 0.48; 95% CI, 0.26 to 0.92; p<0.05) and were also less likely to choose a highly effective strategy as the best way for the government to reduce alcohol problems (OR, 0.63; 95% CI, 0.43 to 0.91; p=0.01). Queenslanders with hazardous alcohol use were less likely to believe that alcohol was a major contributor to injury (OR, 0.39; 95% CI, 0.20 to 0.77; p<0.01).

CONCLUSIONS

Our results suggest that people with hazardous alcohol use tend to underestimate the negative effect of alcohol consumption on health and its contribution to injuries. In addition, Albertans with hazardous alcohol use were less in favor of strategies considered highly effective to reduce alcohol harm, probably because they perceive them as a potential threat to their own alcohol consumption. These findings represent valuable sources of information for local health authorities and policymakers when designing suitable strategies to target alcohol-related problems.

Alcohol and Cancer: A Statement of the American Society of Clinical Oncology

Alcohol drinking is an established risk factor for several malignancies, and it is a potentially modifiable risk factor for cancer. The Cancer Prevention Committee of the American Society of Clinical Oncology (ASCO) believes that a proactive stance by the Society to minimize excessive exposure to alcohol has important implications for cancer prevention. In addition, the role of alcohol drinking on outcomes in patients with cancer is in its formative stages, and ASCO can play a key role by generating a research agenda. Also, ASCO could provide needed leadership in the cancer community on this issue. In the issuance of this statement, ASCO joins a growing number of international organizations by establishing a platform to support effective public health strategies in this area. The goals of this statement are to:

• Promote public education about the risks between alcohol abuse and certain types of cancer;

• Support policy efforts to reduce the risk of cancer through evidence-based strategies that prevent excessive use of alcohol;

• Provide education to oncology providers about the influence of excessive alcohol use and cancer risks and treatment complications, including clarification of conflicting evidence; and

• Identify areas of needed research regarding the relationship between alcohol use and cancer risk and outcomes.

Systematic review of dietary trans-fat reduction interventions

OBJECTIVE

To systematically review published studies of interventions to reduce people's intake of dietary trans-fatty acids (TFAs).

METHODS

We searched online databases (CINAHL, the CRD Wider Public Health database, Cochrane Database of Systematic Reviews, Ovid®, MEDLINE®, Science Citation Index and Scopus) for studies evaluating TFA interventions between 1986 and 2017. Absolute decrease in TFA consumption (g/day) was the main outcome measure. We excluded studies reporting only on the TFA content in food products without a link to intake. We included trials, observational studies, meta-analyses and modelling studies. We conducted a narrative synthesis to interpret the data, grouping studies on a continuum ranging from interventions targeting individuals to population-wide, structural changes.

RESULTS

After screening 1084 candidate papers, we included 23 papers: 12 empirical and 11 modelling studies. Multiple interventions in Denmark achieved a reduction in TFA consumption from 4.5 g/day in 1976 to 1.5 g/day in 1995 and then virtual elimination after legislation banning TFAs in manufactured food in 2004. Elsewhere, regulations mandating reformulation of food reduced TFA content by about 2.4 g/day. Worksite interventions achieved reductions averaging 1.2 g/day. Food labelling and individual dietary counselling both showed reductions of around 0.8 g/day.

CONCLUSION

Multicomponent interventions including legislation to eliminate TFAs from food products were the most effective strategy. Reformulation of food products and other multicomponent interventions also achieved useful reductions in TFA intake. By contrast, interventions targeted at individuals consistently achieved smaller reductions. Future prevention strategies should consider this effectiveness hierarchy to achieve the largest reductions in TFA consumption.