Alcohol policy and harm reduction in Australia

Alcohol-related harm minimization practices among university students: Does the type of residence have an impact?

BACKGROUND

The culture of 'risk-related alcohol use' has been identified as an intrinsic part of university life for many students, especially those in residential colleges in English-speaking countries. While the prevailing approach to managing drinking in these countries is harm minimization, little is known about students' uptake of these practices or the relationship of them to students' type of residence.

OBJECTIVE

To examine the ways in which type of residence may impact alcohol-related harm minimization practices among university students.

DESIGN

A qualitative research design using focus group methodology informed all aspects of the study.

METHODS

University students (N = 70) aged 18-24 years and differentiated by their type of residence were recruited from universities in Australia. Nineteen audio-recorded focus groups were conducted. Systematic qualitative analysis was used to identify the main themes.

RESULTS

Students reported risk-related alcohol use and alcohol-related harms as either consumers or having witnessed others' consumption through three main themes: (1) The pervasiveness of alcohol use and harms; (2) Perceived safety and physical spaces; and (3) Gender-based alcohol-related harms. Harm minimization practices were talked about in terms of four themes: (1) Policy ineffectiveness; (2) Pre-drinking planning; (3) Friends look after friends; and (4) Help-seeking as a covert activity.

CONCLUSIONS

Alcohol use by university students occurs with limited knowledge of harm minimization policies or practices. Students do engage in ad hoc harm minimization practices usually developed during their first year at university through specific 'drinking cultures' that are constituted by various factors including their type of residence. Statement of contribution What is already known on this subject? Previous research has strongly indicated that university students' heavy alcohol consumption is linked with social and environmental factors such as marketing alcohol, low cost, availability, 'wet' environments, and shared accommodation. However, little is known about what, if any, alcohol-related harm minimization practices students employ and if type of residence has an impact on these practices. What does this study add? This study is one of the first to examine alcohol-related harm minimization practices among university students and type of residence demonstrating the impact of social environments on drinking and related practices. Regardless of type of residence, university students were either not aware of university and residential college alcohol policies or found them unclear. Students do engage in ad hoc harm minimization practices usually developed during their first year at university through specific 'drinking cultures' that are constituted by various factors including the type of residence. Two practical recommendations are made in this study to develop alcohol-related harm minimization related to university students.

Prevalence of hepatitis C virus infection among prisoners in Iran: a systematic review and meta-analysis

Background

Hepatitis C virus (HCV) is one of the major public health problems both in developed and developing countries. Prison represents a high-risk environment for prisoners, in that it is characterized by high-risk behaviors such as injecting drug use (IDU), tattooing, unprotected sexual intercourses, or sharing syringes. The aim of this study was to quantitatively evaluate the prevalence of HCV among Iranian prisoners conducting a systematic review and meta-analysis.

Methods

We searched different scholarly databases including Embase, PubMed/MEDLINE, ISI/Web of Sciences, the Cochrane library, Scopus, CINAHL, and PsycINFO as well as Iranian bibliographic thesauri (namely, Barakatns, MagIran, and SID) up to December 2017. The Newcastle Ottawa Scale (NOS) was used to assess the quality of the studies included. HCV prevalence rate with its 95% confidence interval (CI) was estimated using the DerSimonian-Laird random-effects model, with Freeman-Tukey double arcsine transformation. Egger’s regression test was used to evaluate publication bias.

Results

Finally, 17 articles were selected based on inclusion and exclusion criteria. Overall, 18,693 prisoners were tested. Based on the random-effects model, the prevalence of HCV among Iranian prisoners was 28% (CI 95% 21–36) with heterogeneity of I² = 99.3% (p = 0.00). All studies used an ELISA test for the evaluation of HCV antibodies. The findings of this study showed that the highest prevalence rate (53%) was among prisoners who inject drugs.

Conclusion

The findings of our study showed that the prevalence of HCV among Iranian prisoners is dramatically high. Managing this issue in Iran’s prisons requires careful attention to the availability of health facilities and instruments, such as screening, and harm reduction policies, such as giving sterile syringes and needles to prisoners. An integrated program of training for prisoners, prison personnel and medical staff is also needed to improve the level of health condition in prisons.

An exploration of adolescents' decisions to abstain or refrain from alcohol consumption in Australian social settings: a qualitative systematic review

BACKGROUND

A significant number of Australian adolescents consume alcohol, with almost two thirds of them doing so at risky levels. This is continuing to increase despite recent National Health and Medical Research Council (NHMRC) guidelines stipulating that no alcohol is the safest option. Measures initiated to reduce and prevent alcohol consumption by adolescents have limited effectiveness. Consumption of alcohol by Australian adolescents is a national concern because of the deleterious effects of alcohol consumption on adolescents' social, physical and neurological development, as well as other short- and long-term health risks, and the negative impact of alcohol-related violence and injury on the community. Understanding adolescents' decisions to abstain or refrain from alcohol consumption may provide valuable insights to assist in dealing with this significant social and health issue, more particularly about the mechanisms used by adolescents or their ability to make decisions about resisting or abstaining from alcohol consumption when exposed to alcohol in their social setting(s).

OBJECTIVES

The review aimed to synthesize the best available qualitative evidence on the decisions made or mechanisms used by adolescents who abstain or refrain from consuming alcohol in any social setting where alcohol is available.

INCLUSION CRITERIA

Adolescents aged between 14 and 19 years who reside in Australia.The phenomenon of interest was abstinence from or resistance to alcohol consumption when exposed to alcohol in social situations.This review considered studies that focused on qualitative data, including, but not limited to,designs such as phenomenology, grounded theory, action research and exploratory studies.

SEARCH STRATEGY

A three-step search strategy was used. An initial search to identify keywords only was undertaken in Medline and CINAHL. This was followed by an expanded search using all identified keywords and index terms specific to each included database. The reference lists of included papers were then searched for any other relevant studies.

METHODOLOGICAL QUALITY

No studies met the inclusion criteria sufficiently to progress to critical appraisal.

DATA EXTRACTION

No studies progressed to data extraction.

DATA SYNTHESIS

Data synthesis was not undertaken as no study met the inclusion criteria.

RESULTS

Although a number of studies retrieved indicated they had qualitative elements to their studies, the qualitative data was not reported.

CONCLUSIONS

Although a number of studies met some aspects of the inclusion criteria there was insufficient reporting of the phenomenon of interest. Due to the lack of studies meeting the inclusion criteria, no conclusions can be drawn for clinical practice. A lack of qualitative data on this topic has been identified. Thus there is a great need for qualitative research to understand and know more about what enables an adolescent to abstain or refrain from consumption in order to inform or formulate effective interventions, policies or plans to prevent or reduce the volume of alcohol consumed by Australian adolescents.

“Drinking Cultures” in University Residential Colleges

Young people’s heavy alcohol use has been widely linked to their “drinking cultures.” Recent scholarly commentary, however, suggests that prevailing conceptualizations of drinking culture, including those in “public health-oriented” research, tend to oversimplify the complexities involved. This article contributes to the conceptual clarification and development of young people’s “drinking cultures.” We provide a case study of a highly publicized example—that of Australian university residential college students. The case study focuses on the role of residential college policy and management in students’ alcohol use, examining how they represent, understand, and address it. Adopting a qualitative approach, we identify and analyze key themes from college policy documents and minimally structured interviews with college management related to students’ alcohol use. Our analysis is informed by two key existing works on the subject. The first is a sociological framework theorizing young people’s heavy drinking as a “culture of intoxication,” which is embedded in and shaped by broader social forces, especially those linked to a “neoliberal social order.” The second draws on findings from a previously published study on student drinking in university residential colleges that identified the significant role of institutional “micro-processes” for shaping alcohol use in university residential colleges. In understanding the specific character of students’ drinking in Australian university residential colleges, however, we also draw on sociological—specifically neo-institutionalist—approaches to organizations, proposing that Australian college policy and management related to students’ drinking do not operate simply as regulatory influences. Rather, they are organizational processes integral to residential college students’ drinking cultures and their making. Accordingly, college alcohol policy and management of students’ drinking, as they have prevailed in this Australian context, offer limited opportunities for minimizing harmful drinking.

Problematizations in Alcohol Policy

This article examines how the issue of alcohol use has been problematized using past and current World Health Organization reports and associated publications as illustrations. The 2010 Global Strategy to Reduce the Harmful Use of Alcohol serves as a salient example. Applying an approach to policy analysis called “What’s the Problem Represented to be?” this article highlights grounding presuppositions in selected alcohol policies and policy proposals. Particular attention is directed to the genesis and continually evolving and changing key concept “alcohol problems” (or “alcohol-related problems” and other variations). The objective is to raise questions about the implications of public health frameworks of meaning around alcohol policy for how governing takes place and for governed subjects. On the basis of this analysis, this article signals the importance of interrogating the meaning and role of taken-for-granted categories of analysis.

Improving the implementation of responsible alcohol management practices by community sporting clubs: A randomised controlled trial

INTRODUCTION AND AIMS

Despite an increased prevalence of risky alcohol consumption and alcohol-related harm among members of sporting groups and at sporting venues, sporting clubs frequently fail to implement alcohol management practices consistent with liquor legislation and best practice guidelines. The aim of this study was to assess the impact of a multi-strategy intervention in improving the implementation of responsible alcohol management practices by sports clubs.

DESIGN AND METHODS

A randomised controlled trial was conducted with 87 football clubs, with half randomised to receive a multi-strategy intervention to support clubs to implement responsible alcohol management practices. The 2-year intervention, which was based on implementation and capacity building theory and frameworks, included project officer support, funding, accreditation rewards, printed resources, observational audit feedback, newsletters, training and support from state sporting organisations. Interviews were undertaken with club presidents at baseline and post-intervention to assess alcohol management practice implementation.

RESULTS

Post-intervention, 88% of intervention clubs reported implementing '13 or more' of 16 responsible alcohol management practices, which was significantly greater than the proportion of control groups reporting this level of implementation (65%) [odds ratio: 3.7 (95% confidence interval: 1.1-13.2); P = 0.04]. All intervention components were considered highly useful and three-quarters or more of clubs rated the amount of implementation support to be sufficient.

DISCUSSION AND CONCLUSIONS

The multi-strategy intervention was successful in improving alcohol management practices in community sports clubs. Further research is required to better understand implementation barriers and to assess the long-term sustainability of the change in club alcohol management practices.

Alcohol, University Students, and Harm-Minimization Campaigns: “A Fine Line between a Good Night Out and a Nightmare”

Trends in alcohol consumption in Australia suggest that university and college students engage in heavy drinking. However, while media and policy representations of young drinkers are frequently negative, the academic literature suggests that young people are not unaware or unconcerned about the harms linked to alcohol use. In this study, we conducted in-depth, semistructured interviews with six university students aged 18–21 years. We examined the concerns they raised about alcohol use, including their views on two harm-minimization campaigns that were distributed in Australia at the time of the study. Our data suggest that, although there are some significant contradictions in attitudes and views about what constitutes “harm” in relation to alcohol use, university students nonetheless do reflect on the risks associated with intoxication. Furthermore, we found that the messages embedded in the campaigns resonate with this cohort's concerns and fears about drinking, as well as their values and future ambitions.

Local government alcohol policy development: case studies in three New Zealand communities

AIMS

Local alcohol policies can be effective in reducing alcohol-related harm. The aim of this study was to examine local government responses to alcohol-related problems and identify factors influencing their development and adoption of alcohol policy. DESIGNSETTINGS AND PARTICIPANTS: Case studies were used to examine local government responses to alcohol problems in three New Zealand communities: a rural town, a provincial city and a metropolitan city. Newspaper reports, local government documents and key informant interviews were used to collect data which were analysed using two conceptual frameworks: Kingdon's Streams model and the Stakeholder model of policy development.

MEASUREMENTS

Key informant narratives were categorized according to the concepts of the Streams and Stakeholder models.

FINDINGS

Kingdon's theoretical concepts associated with increased likelihood of policy change seemed to apply in the rural and metropolitan communities. The political environment in the provincial city, however, was not favourable to the adoption of alcohol restrictions. The Stakeholder model highlighted differences between the communities in terms of power over agenda-setting and conflict between politicians and bureaucrats over policy solutions to alcohol-related harm. These differences were reflected in the ratio of policies considered versus adopted in each location. Decisions on local alcohol policies lie ultimately with local politicians, although the policies that can be adopted by local government are restricted by central government legislation.

CONCLUSIONS

The adoption of policies and strategies to reduce alcohol-related harm may be better facilitated by an agenda-setting process where no 'gate-keepers' determine what is included into the agenda, and community mobilization efforts to create competitive local government elections around alcohol issues. Policy adoption would also be facilitated by more enabling central government legislation.

The gendered trouble with alcohol: young people managing alcohol related violence

BACKGROUND

Alcohol related violence is a troubling backdrop to the social lives and relationships of many young people in post-industrial societies. The development of the night-time economy where young people are encouraged to drink heavily in entertainment precincts has increased the risk of violence.

METHODS

This paper reports on 60 individual structured in-depth interviews about the drinking biographies of young people (aged 20-24) living in Victoria, Australia. Twenty-six males and 34 females participated in the research. The participants discussed their experiences with alcohol over their life course to date. The material on alcohol related violence is analysed in this paper.

RESULTS

Just over half of the participants (33/60) recounted negative experiences with alcohol related violence. The findings demonstrate the continuing gendered nature of experiences of perpetration and victimization. Participants reported that aggression and violence perpetrated by some men was fuelled by alcohol consumption and required ongoing management. Experiences of violence were also spatialized. Men were more likely to report managing and avoiding violence in particular public settings whilst more women than men discussed managing violence in domestic settings.

CONCLUSION

The central argument of this paper is that incidents of alcohol related violence and reactions to it are specific gender performances that occur in specific socio-cultural contexts. In contrast to research which has found some young people enjoy the adventure and excitement of alcohol related violence the mainstream participants in this study saw violence as a negative force to be managed and preferably avoided. Understanding violence as a dynamic gender performance complicates the development of policy measures designed to minimize harm but also offers a more holistic approach to developing effective policy in this domain. There is a need for greater acknowledgement that alcohol related violence in public venues and in families is primarily about particular performances of masculinity and this is where policy should be targeted in addition to venue based interventions.

Alcohol policy and taxation in South Africa: an examination of the economic burden of alcohol tax

BACKGROUND

Alcohol consumption accounts for over 4% of the global burden of disease and an even higher figure in developing countries. Several policies have been proposed to curb the negative impact of alcohol misuse. Apart from South Africa, which has witnessed a rapid development in alcohol policy, such policies are poorly developed in most African countries. South Africa uses taxation as a policy lever, in line with international evidence, to reduce alcohol consumption. However, the problem of alcohol abuse still exists.

OBJECTIVE

The objective of this article is to present an analysis of alcohol tax incidence for the first time in South Africa. This was done for each category of alcohol tax (wines, spirits, beer and traditional brew [sorghum beer]) and for alcohol tax as a whole. The paper also uses the results to point to the areas where a greater understanding of the issues surrounding alcohol abuse needs to be developed.

METHODS

Data were drawn from the 2005/06 South African Income and Expenditure Survey. Reported expenditures on alcohol beverages were used to obtain the tax component paid by households. This was done under certain assumptions relating to alcohol content and the price per litre of alcohol. Per adult equivalent consumption expenditure was used as the measure of relative living standards and concentration curves and Kakwani indices to assess relative progressivity of alcohol taxes. Statistical dominance tests were also performed.

RESULTS

Most sorghum beer and malt beer drinkers were in the poorer quintiles. The reverse was the case for wines and spirits. Overall, alcohol tax in South Africa was regressive (Kakwani index -0.353). The individual categories were found to be regressive. The most regressive tax was that on sorghum beer (Kakwani index -1.01); the least regressive was that on spirits (Kakwani index -0.09), although this was not statistically significant at conventional levels. These results were confirmed by the test of dominance.

CONCLUSION

In South Africa, there has been a renewed interest in addressing the problem of rising alcohol abuse, but the extent to which this will translate into meaningful policies is unclear. The use of an excise tax is increasingly being recognized by economists as a way to get around some of the negative effects of abusive alcohol consumption. However, this study indicates that alcohol taxes are regressive in South Africa.

Regulation of alcohol-seeking by orexin (hypocretin) neurons

Orexins (hypocretins) are found primarily within a restricted portion of neurons within the hypothalamus, but provide innervation across the neuraxis. Orexin A (hypocretin 1) has been implicated in drug and food reward. Not surprisingly therefore, interest has come to bear on whether orexins are implicated in aspects of alcohol consumption and/or seeking. This mini-review provides a concise, but timely, discussion on this issue. The evidence to date would suggest a role for orexins in alcohol use, and integration of orexin-containing neurons in reward-seeking circuitry. There are however still many unanswered questions, some of which are canvassed herein.