Perception of intoxication in a field study of the night-time economy: Blood alcohol concentration, patron characteristics, and event-level predictors

Characteristics of high- and low-risk drinkers who use online alcohol home delivery in Western Australia

INTRODUCTION

Variation in alcohol availability is an important driver of levels of consumption and harm, with recent increases in online alcohol home delivery use expanding availability. There is limited research on the impacts of these changes and the characteristics of consumers who use alcohol home delivery.

METHODS

This study presents findings from an online survey (n = 465) of Western Australian adults who had purchased alcohol for home delivery within the past 6 months. Analyses compared high-risk and low-risk drinkers on use of, and exposure to, alcohol home delivery.

RESULTS

Compared to low-risk drinkers, high-risk drinkers were significantly more likely to make more frequent online purchases (odds ratio 5.42), utilise same day delivery (odds ratio 2.91) and purchase through specialised online-only retailers (odds ratio 2.69). High-risk drinkers also reported receiving deliveries while intoxicated more often (odds ratio 11.62), and ordering alcohol for delivery to continue a current drinking session (odds ratio 7.47). High-risk drinkers also received advertising for alcohol home delivery more frequently (odds ratio 1.60) than low-risk drinkers. High-risk drinkers also ordered larger quantities of alcohol than low-risk drinkers (M = 49 vs. 32 standard drinks).

DISCUSSION AND CONCLUSIONS

Findings from this study indicate that these services are popular with high-risk drinkers and potentially undermine other policy efforts to reduce drinking. Within Australia, stronger legislation (such as mandatory delay between order and delivery) and monitoring (e.g., test purchasing for compliance) are recommended.

Investigating the relationship between inaccurate blood alcohol concentration estimates, harm and other negative consequences

INTRODUCTION

Alcohol-related harms place a significant burden on the Australian economy and health-care system. The current study aims to: (i) explore the relationship between blood alcohol concentration (BAC) and self-estimated blood alcohol concentration (EBAC); and (ii) determine whether BAC underestimation is related to an increased risk of experiencing physical aggression, verbal aggression, drink driving, ejection from a venue or refusal of service.

METHODS

Patron street surveys were conducted in four night-time entertainment precincts (NEP) across Queensland, Australia, between June 2016 and November 2018. Participants (N = 2144) reported on their EBAC and recent negative or harmful experiences in NEPs. BAC was measured via a breathalyser. Paired samples t tests were conducted to determine if patrons' BAC and EBAC were significantly different. Logistic regressions were conducted to examine whether BAC underestimation is a significant predictor of harm and negative outcomes.

RESULTS

Analyses identified a small, significant difference between patron's BAC and EBAC. Patrons with a low BAC were more likely to overestimate their BAC, while patrons with higher BACs were more likely to underestimate their BAC. Moderately intoxicated patrons had the most precise BAC estimations. Patrons with a high BAC and who underestimated their intoxication level were more likely to have been recently ejected from licensed venues, compared to accurate estimators or over-estimators.

DISCUSSION AND CONCLUSIONS

Overall, patrons are poor evaluators of their own intoxication level, which may have implications for their experiences in NEPs. The findings highlight the need for improved BAC education for patrons.

Energy drinks at adolescence: Awareness or unawareness?

Energy drinks (EDs) are beverages similar to soft drinks, characterized by high caffeine concentrations with additional ingredients like taurine and vitamins, marketed for boosting energy, reducing tiredness, increasing concentration, and for their ergogenic effect. The majority of consumers are children, adolescents, and young athletes. Although EDs companies claim about the ergogenic and remineralizing properties of their products, there is a serious lack of evidence at preclinical as well as clinical level to validate their benefits. The regular intake and long-term consequences of these caffeinated drinks are not well documented, especially the possible negative effects in adolescents whose brain is still developing. EDs combined with alcohol are also gaining popularity among adolescents and different publications indicate that this combined consumption might increase the risk to develop an alcohol use disorder, as well as produce serious adverse cardiovascular effects. There is an increasing need to disseminate knowledge on EDs damage on health, so that adolescents can be aware about the potential harmful outcomes of consuming these drinks.

The hazardous (mis)perception of Self-estimated Alcohol intoxication and Fitness to drivE-an avoidable health risk: the SAFE randomised trial

BACKGROUND

Worldwide, alcohol-related road traffic accidents represent a major avoidable health risk. The aim of this study was to evaluate the accuracy of self-estimating the degree of acute alcohol intoxication regarding the legal driving limit, and to identify risk factors for misjudgement.

METHODS

In this prospective randomised controlled crossover trial, 90 social drinkers (mean age 23.9 ± 3.5 years, 50% female) consumed either beer or wine. Study group subjects were made aware when exceeding the legal driving limit (BrAC = 0.05%). Controls received no information about their BrAC. For crossover, beer or wine were consumed in the opposite order.

RESULTS

39-53% of all participants exceeded the legal driving limit whilst under the impression to be still permitted to drive. Self-estimation was significantly more accurate on study day 2 (p = 0.009). Increasing BrAC positively correlated with self-estimation inaccuracy, which was reproducible during crossover. Multiple regression analysis revealed fast drinking and higher alcohol levels as independent risk factors for inaccurate self-estimation.

CONCLUSIONS

Social drinkers are commonly unaware of exceeding the legal driving limit when consuming alcohol. Self-estimating alcohol intoxication can be improved through awareness. Dedicated awareness programs, social media campaigns and government advice communications should be utilised to address this avoidable hazard. Trial registration The trial was registered prospectively at the Witten/Herdecke University Ethics Committee (trial registration number 140/2016 on 04/11/2016) and at the DRKS-German Clinical Trials Register (trial registration number DRKS00015285 on 08/22/2018-Retrospectively registered). Trial protocol can be accessed online.

Care of women and girls after sexual assault in Geneva: A descriptive study between 2005 and 2014

BACKGROUND AND PURPOSE

We aimed to examine epidemiological data and identify risk factors for sexual assault. This study included women seeking care at the Geneva University Hospitals emergency obstetrics and gynaecological unit.

METHOD

Retrospective, sociodemographic, and clinical data were collected from the medical reports.

RESULTS

We reviewed 836 medical charts and registered 92.8 women and girls per year who consulted the emergency department after sexual assault. The average age was 26 (±12) years, with a median of 23 years. Body lesions were reported in 525 patients (63%) and genital traumatic lesions were reported in 230 (28%) patients. Sexual assault by a stranger was reported in 436 cases (52%). Thirty percent of patients knew their aggressor. Aggressions were predominantly committed on the weekend, accounting for 367 cases (46%), with nearly two-thirds (65%, n = 474) occurring between 10 pm and 6 am. In total, 399 (48%) patients who were sexually assaulted reported having consumed alcohol and 102 (12%) reported having taken drugs prior to the aggression; 80 (10%) patients had consumed both and 286 (34%) had amnesia. Half of the sample sought and received medical care within 24 h from the time the aggression took place.

CONCLUSION

Sexual assault risk factors in our study population in Geneva included use of drugs and alcohol, with amnesia. Future prevention and education interventions should target these areas.

Interaction of Energy Drinks with Prescription Medication and Drugs of Abuse

In recent years, the consumption of energy drinks (EDs) has become increasingly popular, especially among adolescents. Caffeine, a psychostimulant, is the main compound of EDs which also contain other substances with pharmacological effects. This review aims to compile current evidence concerning the potential interactions between EDs, medicines, and drugs of abuse as they are frequently consumed in combination. The substances involved are mainly substrates, inductors or inhibitors of CYP1A2, psychostimulants, alcohol and other depressant drugs. Furthermore, intoxications reported with EDs and other substances have also been screened to describe acute toxicity. The results of our review show that the consumption of both EDs alone and in combination is not as safe as previously thought. Health professionals and consumers need to be aware of the potential interactions of these drinks as well as the absence of long-term safety data.

Alcohol Hangover Across the Lifespan: Impact Of Sex and Age

AIM

To investigate the relationship between age and hangover frequency and severity.

METHOD

An online survey, generated through Facebook, collected self-report data relating to alcohol consumption from 761 Dutch alcohol consumers aged 18-94 years (61.6% female).

RESULTS

Overall, young individuals consumed more alcohol than older drinkers, and men more than women. Significant interactions between age group and sex were found for both subjective intoxication and hangover severity, indicating that the sex differences in these variables were greatest in the younger age groups but became significantly smaller or absent in the older age groups. Partial correlations, correcting for estimated blood alcohol concentration (eBAC), revealed significant and negative partial correlations between age and subjective intoxication (r = -0.444, P < 0.0001), age and hangover severity (r = -0.327, P < 0.0001) and between age and hangover frequency (r = -0.195, P < 0.0001), i.e. subjective intoxication, hangover severity and hangover frequency decline with age. With regard to sex differences, the observed correlations with age for the past month heaviest drinking occasion were stronger in men for subjective intoxication, (z = -2.25, P = 0.024), hangover severity (z = -3.36, P = 0.0008) and hangover frequency (z = -3.63, P = 0.0003).

CONCLUSIONS

Hangover severity declines with age, even after controlling for eBAC or the amount of alcohol consumed. Sex differences were greatest in the younger age groups but became significantly smaller or absent in the older age groups. The relationship between age and hangover severity is strongly mediated by subjective intoxication. Pain sensitivity, lower with aging, might be a mediator.

Personal Assessment of Ability to Drive Under the Influence of Alcohol vs. Objective Measurement

BACKGROUND

Alcohol intoxication often affects patient management in the emergency department.

OBJECTIVE

This study evaluates participants' subjective sense of impairment using ability to drive as a reference compared with measured breath alcohol concentrations (BrAC) and evaluate whether there is a gender difference.

METHODS

In this prospective study, 55 volunteers consumed one beer and estimated their BrAC and their ability to drive. BrAC was measured objectively and participants were blinded to the value until they reached a BrAC of 0.1 g/dL. Then they stopped drinking and estimated their BrAC and ability to drive every 30 min until objective BrAC reached 0.08 g/dL.

RESULTS

As BrAC increased, the association between estimated and perceived ability to drive was significantly different (p < 0.0001). At BrAC levels > 0.08 g/dL, 20.3% affirmed the ability to drive. At BrAC levels < 0.08 g/dL, 35.5% denied ability to drive. As BrAC decreased, the association between estimated and actual ability to drive was significantly different (p = 0.001). At BrAC values > 0.08 g/dL, 59.7% affirmed the ability to drive. At BrAC < 0.08 g/dL, 49.1% denied ability to drive. As BrAC increased, the correlations for men and women were strong and statistically significant (r = 0.80, p < 0.0001 and r = 0.79, p < 0.0001, respectively). As men's and women's BrAC decreased, the women's correlation was higher (r = 0.061 and r = 0.74, respectively; p < 0.0001).

CONCLUSIONS

Both genders can estimate their impaired ability to drive while drinking, but women are better at assessing their capacity to drive after drinking cessation.

How intoxicated are you? Investigating self and observer intoxication ratings in relation to blood alcohol concentration

INTRODUCTION

The ability to accurately detect alcohol intoxication is an important skill for people who use these substances and for a variety of professions (e.g. policing, responsible service of alcohol). Previous studies have found that intoxicated people are generally poor at estimating their own intoxication (particularly at high blood alcohol concentration; BAC) and the relationship between perceived intoxication and BAC appears to flatten at higher BAC levels. Studies of observer ratings of other's intoxication have yielded mixed results. The aim of this study was to investigate both self- and observer-ratings of intoxication against BAC levels to determine whether we observe a similar flattening in intoxication for both self- and observer-rated intoxication.

METHODS

Participants were 388 students interviewed outside three university events. Participants provided demographics, a rating of how intoxicated they felt (0 = not at all, 10 = very) and provided an alcohol breath test. Interviewers recorded a rating of how intoxicated the participant appeared to be.

RESULTS

A significant correlation was observed between self- and observer-ratings of intoxication (r = 0.802). We fitted our data with both linear and polynomial regressions. Polynomial regression accounted for more variance when predicting both self-rated intoxication (R²  = 0.50 vs. R²  = 0.40) and observer-rated intoxication from BAC (R²  = 0.58 vs. R²  = 0.52), suggesting a flattening for both intoxication ratings.

DISCUSSION AND CONCLUSIONS

Both self-rated and observer-rated intoxication appeared to flatten at higher levels of BAC. This may be due to either tolerance or a 'ceiling effect' for observable signs of intoxication.

Why are caffeinated alcoholic beverages especially risky?

PURPOSE

Evidence suggests that people drink more alcohol and experience more adverse alcohol-related consequences (ARCs) on occasions when they also consume caffeine. The current study examined whether this increase in risk is a result of caffeine attenuating the subjective effects of alcohol intoxication (i.e., the masking hypothesis).

METHODS

Undergraduate students (n = 148) reported their drinking patterns using a modified Timeline Followback approach. For each recalled drinking occasion, alcohol consumption, caffeine consumption, perceived blood alcohol concentration, and ARCs were assessed. Generalized linear mixed models were used to examine the influence that alcohol and caffeine consumption had on perceived intoxication and the experience of ARCs.

RESULTS

At the occasion level, greater caffeine consumption was associated with increased consumption of alcohol and increased ARCs. There was also a significant curvilinear relationship between the amount of alcohol consumed and perceived intoxication, such that the more alcohol was consumed on each occasion the less each additional drink increased perceived intoxication. Increased caffeine consumption weakened the association between alcohol consumption and perceived intoxication and it also weakened the association between alcohol consumption and ARCs. Specifically, the weakest relationship between ARCs and alcohol consumption existed at the highest level of caffeine consumption (240+ mg). Caffeine increased subjective intoxication.

CONCLUSIONS

These findings do not support the masking hypothesis. Caffeine was strongly associated with ARCs when consumed at high doses and this effect does not appear to be the result of drinking more alcohol or underestimating one's blood alcohol content. Efforts to reduce caffeinated alcohol beverage use are greatly needed.

A Control-Theoretic Assessment of Interventions During Drinking Events

This paper employs control-theoretic tools to provide guidelines for in-situ interventions aimed at reducing high-risk alcohol consumption at drinking events. A dynamical directed network model of a drinking event with external intervention, suitable for mathematical analysis and parameter estimation using field data is proposed, with insights from pharmacokinetics and psychology. Later, a characterization of a bound on blood alcohol content (BAC) trajectories is obtained via Lyapunov stability analysis, and structural controllability guarantees are obtained via a graph-theoretic method. We use the degree of controllability, given to be the trace of the system's controllability Gramian, as a metric to compare the viability of network nodes for intervention based on theoretic and heuristic centrality measures. Results of numerical examples of bars and parties, informed by field data, and the stability and controllability results, suggest that intervening in the environment in wet bars, while targeting influential individuals with high alcohol consumption motivations in private parties efficiently yield lower peak BAC levels in individuals at the drinking events.

Road safety implications of the blood alcohol concentrations among alcohol users exiting bars in northern Ghana

OBJECTIVE

The main objective of this study was to establish the blood alcohol concentrations (BACs) of bar patrons relative to the legal (BAC) limit for Ghana and the international guideline on alcohol consumption.

METHOD

A cross-sectional study design and a convenience sampling technique were used to collect data at selected bars in 2 cities, namely; Bolgatanga and Wa, in northern Ghana. A breathalyzer was used to measure the breath alcohol concentrations of participants exiting bars and face-to-face questionnaires were administered to participants to capture their accident histories, alcohol consumption patterns, and modes of transport they usually use to travel to their next destination after alcohol consumption.

RESULTS

The mean BAC of bar patrons was 0.143 ± 0.096% (95% confidence interval, 0.127 to 0.160%). The mean BAC of males (0.156%) was significantly higher than the mean BAC of females (0.103%; p = 0.004). Sixty-two percent of participants were exiting the bars with BACs of more than the legal BAC limit and 44% of this proportion was at 0.150% or more. Fifty-one percent of participants indicated that they usually consume a mixture of alcoholic beverages consisting of homemade and factory-made drinks. Fifty-seven percent of participants who usually consume a mixture of drinks had BACs of 0.150% or above. Only 22% of females and 6% of males consume alcohol within their respective recommended low risk of 1 to 2 units and 1 to 4 units, respectively. A vast majority of participants (96%) reported that they usually engage in risky behaviors such as riding, walking, or driving to their next destination after consuming alcohol.

CONCLUSION

Motorists were more likely to exit the bars with very high BACs. It is recommended that police should enforce the BAC law. In addition, in order to prevent harmful use of alcohol, the introduction of an alcohol consumption guideline in Ghana is recommended. Because alcohol consumption is increasing currently with motorization, it is also necessary to educate alcohol users about the number of drinks required to stay below the legal limit if they are motorists as well as other road users or to prevent long-term illnesses associated with excessive alcohol use.

Examining the social ecology of a bar-crawl: An exploratory pilot study

Many of the problems associated with alcohol occur after a single drinking event (e.g. drink driving, assault). These acute alcohol problems have a huge global impact and account for a large percentage of unintentional and intentional injuries in the world. Nonetheless, alcohol research and preventive interventions rarely focus on drinking at the event-level since drinking events are complex, dynamic, and methodologically challenging to observe. This exploratory study provides an example of how event-level data may be collected, analyzed, and interpreted. The drinking behavior of twenty undergraduate students enrolled at a large Midwestern public university was observed during a single bar crawl event that is organized by students annually. Alcohol use was monitored with transdermal alcohol devices coupled with ecological momentary assessments and geospatial data. “Small N, Big Data” studies have the potential to advance health behavior theory and to guide real-time interventions. However, such studies generate large amounts of within subject data that can be challenging to analyze and present. This study examined how to visually display event-level data and also explored the relationship between some basic indicators and alcohol consumption.