Older Australians' perceptions of alcohol-related harms and low-risk alcohol guidelines

Review and Call for Improved Cannabis Measurement and the Potential for Leveraging Cannabis Seed-To-Sale Systems

International consensus has emerged, which proposes that the measurement and standardization of the quantity of THC potency, or dose (mgTHC), is a requisite for identifying consistent relationships between patterns of cannabis use and the risk for negative health outcomes, especially critical given the increasing number of U.S. states and European countries considering legalizing cannabis for recreational use. Despite the lack of measurement approaches that provide accurate, real-time data on THC dosage, the number of states that have implemented legal adult use cannabis markets has coincided with the use of regulatory seed-to-sale or track-and-trace systems. Seed-to-sale tracking systems are designed to track the amount of cannabis cultivated, and typically leverage biochemical testing contractors to label the THC potencies and amounts on a diverse array of cannabis products. We propose leveraging seed-to-sale tracking systems to facilitate a more objective measure of THC potency. In the current review, we will: 1) summarize the complexities of accurately measuring the multidimensional aspects of cannabis use patterns; 2) review recent advancements in quantifying THC and the importance of standardizing THC dose in measuring cannabis use; and 3) discuss the potential value of future research efforts examining how state-level seed-to-sale tracking data can inform the standard THC dose.

Perceived Risk of Binge Drinking among Older Alcohol Users: Associations with Alcohol Use Frequency, Binge Drinking, Alcohol Use Disorder, and Alcohol Treatment Use

Despite the high prevalence of alcohol use and binge drinking among older adults, little research has been conducted on the association between their alcohol risk perception and alcohol use patterns. Using data on past-year alcohol users aged 50 and older (N = 6693) in the 2022 National Survey on Drug Use and Health, we examined the (1) associations between risk perception of binge alcohol use 1-2 times a week and alcohol use frequency, binge use frequency, and alcohol use disorder (AUD), and (2) the association between alcohol treatment use and risk perception. About 40% of past-year alcohol users perceived great risk of binge alcohol use 1-2 times a week, and 27% of past-year users had binge drinking in the past month. Multivariable analyses showed the negative association between great risk perception and alcohol use frequency (IRR = 0.60, 95%CI = 0.48-0.74 for daily use) and past-month binge alcohol use (IRR = 0.33, 95%CI = 0.19-0.57 for 6-19 days of binge use). The odds of great risk perception were also lower among those with mild AUD. Risk perception was not significantly associated with alcohol treatment. The lower likelihood of risk perception among problematic alcohol users and low treatment use is concerning. Education and interventions to reduce harm from alcohol are needed.

Smartphone-delivered approach bias modification for reducing harmful drinking amongst middle-older age adults: Secondary analyses of a single-arm pilot study

INTRODUCTION

Novel, scalable, low-cost interventions are needed to reduce harmful drinking amongst middle-older adults. Approach bias modification (ApBM) is a promising form of cognitive training for preventing/reducing alcohol use that can be delivered via smartphone. This study explored the acceptability and preliminary effectiveness of smartphone delivered and personalised ApBM amongst Australians ≥55 years, an age cohort at risk of alcohol-related harms.

METHODS

Secondary analyses in a middle-older adult subsample (≥55 years, n = 289) of an open-label pilot study using a retrospective, repeated measures design. We explored acceptability (adherence, user mobile acceptability ratings, free-text responses) and preliminary effectiveness (changes in drinking quantity and frequency, craving, dependence and proportion drinking within government-recommended guidelines) of two sessions/week over 4 weeks of evidence-based ApBM training, adapted to include personalisation and smartphone delivery amongst Australians ≥55 years.

RESULTS

Although minor adaptations to training were suggested, the intervention was acceptable amongst survey completers, with 72% training adherence. Relative to baseline, there was a significant increase in the proportion of drinking within recommended single-session and weekly guidelines post-training (from 25% to 41% and 6% to 28%, respectively, p < 0.001), with past-week standard drinks significantly decreasing by 18% (p < 0.001) and significant reductions in drinking days, mean craving and dependence scores (p < 0.001).

DISCUSSION AND CONCLUSIONS

Findings suggest smartphone ApBM is acceptable amongst middle-to-older aged Australians and may support this 'at risk' cohort to remain within government-recommended alcohol consumption guidelines to optimise healthy aging, although, in the context of a single-arm study, preliminary results should be interpreted cautiously.

Health risk factors in Australian Stroke Survivors: A latent class analysis

ISSUES ADDRESSED

To (i) determine the prevalence of health risk factors (physical activity, diet, alcohol, smoking, blood pressure medication use and mental health) in community-dwelling stroke survivors; and (ii) examine how these health risk factors cluster, and identify associations with physical functioning, independent living, or sociodemographic factors.

METHODS

A secondary analysis of data obtained during a national randomised controlled trial. Participants had experienced stroke and completed a baseline telephone survey on demographic and stroke characteristics, health risk factors, physical functioning and independence in activities of daily living. A latent class analysis was performed to determine health risk profiles. Univariate logistic regressions were performed to identify if participant characteristics were associated with resulting classes.

RESULTS

Data analysed from 399 participants. Two classes of health risk factors were identified: Low Mood, Food & Moves Risk (16% of participants) and Alcohol Use Risk (84% of participants). The Low Mood, Food & Moves Risk group had poorer diet quality, lower physical activity levels and higher levels of depression and anxiety. Lower levels of independence and physical functioning were predictor variables for this group. In contrast, the Alcohol Use Risk group had better physical activity and diet scores, significantly lower probability of depression and anxiety, but a higher probability of risky drinking.

CONCLUSIONS

We identified two distinct health risk factor groups in our population. SO WHAT?: Future interventions may benefit from targeting the specific needs and requirements of people who have experienced stroke based on their distinct risk group. Alcohol consumption in poststroke populations requires further attention.

Knowledge, Attitudes, and Behaviours Concerning the Mediterranean Diet Among Older Adults in Australia

Despite the growing body of evidence demonstrating the positive health effects of the Mediterranean diet, it is not routinely recommended in practice and adherence is low in the general population in Australia. The knowledge-attitude-behaviour model explains how health behaviours are supported through a process of acquiring knowledge, developing attitudes, and forming behaviours. Evidence has suggested that having a high level of nutrition-related knowledge is associated with more positive attitudes, which is directly linked to positive dietary behaviours. However, reports of knowledge and attitudes towards the Mediterranean diet, and how these directly relate to behaviours in older adults, are lacking. This study explored Mediterranean diet-related knowledge, attitudes, and behaviours among community-dwelling older adults in Australia. Participants were adults aged 55 years and older who completed an online survey that contained three parts: (a) knowledge - Mediterranean Diet Nutrition Knowledge Questionnaire (Med-NKQ); (b) nutrition-related attitudes and behaviours, and barriers and enablers to dietary change; (c) demographics. The sample included 61 adults who ranged in age from 55 to 89 years. The overall knowledge score was 30.5 out of a possible 40 points, with 60.7% classified as having a high level of knowledge. Knowledge was lowest for nutrient content and label reading. Attitudes and behaviours were generally positive and were not associated with level of knowledge. The most common barriers to dietary change were perceived cost and lack of knowledge, and motivational factors. There are a number of key gaps in knowledge that should be addressed through targeted educational programs. Strategies and tools to overcome perceived barriers and improve self-efficacy are needed to facilitate positive dietary behaviours.

'I'd be willing to take that risk for the enjoyment of the time that I have': a COM-B influenced analysis of older people's perspectives on their alcohol consumption

Objectives: To explore how older people understand, perceive, and evaluate the various factors which drive their alcohol consumption behaviours.Methods: Semi-structured interviews were conducted with 33 Australian community-dwelling older adults (aged 65+ years) who drank alcohol at least once a month. Thematic analyses identified common themes which were then mapped onto the COM-B theoretical framework.Results: Drinking behaviours were driven by a lack of capability in the form of poor knowledge regarding safe drinking behaviours and guidelines; high opportunity for consumption due to ease of accessing alcohol and its prominence in social routines; and high motivation to drink due to perceived benefits outweighing perceived risks.Conclusion: Increasing older peoples' knowledge of the risks associated with consumption and safe drinking behaviours represents a key health promotion priority in order to reduce the burden of alcohol-related harms among this group.

Extending the sociology of candidacy: Bourdieu's relational social class and mid-life women's perceptions of alcohol-related breast cancer risk

Alcohol is a modifiable breast cancer risk, increasing risk in a dose-dependent manner. Mid-life women (aged 45-64 years) consume alcohol at higher rates than younger women and this, combined with age, make them a high-risk group for breast cancer. This critical public health problem has a seemingly obvious solution (reduce drinking); however, women do not necessarily know alcohol causes breast cancer, and if they do, reducing consumption is not always possible, or desirable. To innovate public health responses, we employ an interpretative sociological framework 'candidacy' to understand women's perspectives on breast cancer risk relative to alcohol consumption and their social class. Drawing on 50 interviews with Australian mid-life women, our findings reveal the socio-structural determinants of 'candidacy', that mean modifying alcohol consumption for breast cancer prevention is impacted by social class. Utilising Bourdieu's relational capitals, our interpretations show how social class shapes women's ascriptions and enactments of breast cancer candidacy. We offer an important theoretical extension to 'candidacy' by demonstrating more or less fluidity in women's assessment of breast cancer risk according to their agency to adopt breast cancer prevention messages. Understanding the social class possibilities and limitations in women's perceptions of breast cancer risk provides a new opportunity to reduce inequities in breast cancer incidence.

Which drinkers have changed their alcohol consumption due to energy content concerns? An Australian survey

Background

Alcohol is a discretionary, energy dense, dietary component. Compared to non-drinkers, people who consume alcohol report higher total energy intake and may be at increased risk of weight gain, overweight, and obesity, which are key preventable risk factors for illness. However, accurate consumer knowledge of the energy content in alcohol is low. To inform future behaviour change interventions among drinkers, this study investigated individual characteristics associated with changing alcohol consumption due to energy-related concerns.

Methods

An online survey was undertaken with 801 Australian adult drinkers (18–59 years, 50.2% female), i.e. who consumed alcohol at least monthly. In addition to demographic and health-related characteristics, participants reported past-year alcohol consumption, past-year reductions in alcohol consumption, frequency of harm minimisation strategy use (when consuming alcohol), and frequency of changing alcohol consumption behaviours because of energy-related concerns.

Results

When prompted, 62.5% of participants reported changing alcohol consumption for energy-related reasons at least ‘sometimes’. Women, those aged 30–44 years, metropolitan residents, those with household income $80,001–120,000, and risky/more frequent drinkers had increased odds of changing consumption because of energy-related concerns, and unemployed respondents had reduced odds.

Conclusions

Results indicate that some sociodemographic groups are changing alcohol consumption for energy-related reasons, but others are not, representing an underutilised opportunity for health promotion communication. Further research should investigate whether messaging to increase awareness of alcohol energy content, including through systems-based policy actions such as nutritional/energy product labelling, would motivate reduced consumption across a broader range of drinkers.

Identifying the Assumptions and Bias That Affect Screening and Brief Interventions for Harmful Alcohol Use

BACKGROUND

Screening for harmful alcohol use (HAU) is standard in clinical settings; however, self-reports of the quantity/frequency of use are often inconsistent with population survey data and objective assessment. Inaccuracies of self-reported alcohol use prompt exploration of patients' reluctance to share this information with their health care providers.

OBJECTIVES

The purpose of this article is to identify the assumptions and biases that affect screening and brief interventions for HAU.

METHOD

A total of 22 research articles were selected for a systematic review of the literature. The studies included prospective and retrospective studies, randomized controlled trials, case studies, and quantitative and qualitative research from 2015 to 2021.

RESULTS

This systematic review identified alcohol health literacy, the inherent bias of surveys and screening tools, stigma, avoidance bias, and the normalization/villainization of alcohol use as contributors to the assumptions and biases that affect screening and brief interventions for HAU.

CONCLUSIONS

Exploring these assumptions and biases presents opportunities to develop strategies that promote positive change.

Understanding and Overcoming Barriers to Drink Counting

Objectives: Drink counting has been found to be an effective protective behavioral strategy (PBS) to reduce alcohol consumption. However, little is known about attitudes to this strategy and barriers and facilitators to its use. The aim of this study was to explicate these factors and draw comparisons with less efficacious PBSs. Method: In Stage 1, 1,703 Australian drinkers were surveyed about their perceptions of five PBSs ("Count the number of drinks you have," "Drink slowly rather than gulping or sculling," "Refuse an alcoholic drink you are offered because you don't really want it," "Avoid trying to 'keep up' or 'outdrink' others," and "Decide not to exceed a certain number of drinks"). Respondents reported perceived believability, relevance, ease of use, effectiveness, barriers, and facilitators. In Stage 2, 10 focus groups were conducted with drinkers to identify potential methods of effectively promoting drink counting. Results: Overall, drink counting was rated less favorably than the less-efficacious PBSs, indicating a need to inform drinkers of the importance and feasibility of this strategy to encourage its use. The main identified barriers were a lack of awareness of the long-term harms associated with alcohol use, social factors (e.g., peer pressure), and difficulty counting when intoxicated. Participants suggested improving drinkers' understanding of alcohol-related harms and developing mechanisms to assist with counting. Conclusion: To encourage drink counting, information campaigns are needed to educate the community about the long-term risks of alcohol use. Evidenced-based mechanisms to facilitate drink counting may be welcomed by drinkers.

Alcohol consumption, drinking patterns and cancer incidence in an Australian cohort of 226,162 participants aged 45 years and over

BACKGROUND

Although overall alcohol consumption is known to increase the risk of a number of cancers internationally, evidence for Australia and evidence regarding the pattern of drinking and cancer risk is limited.

METHODS

Adjusted hazard ratios (HR) and 95% confidence intervals (CI) for cancer risk in relation to overall alcohol consumption (drinks/week) and pattern of drinking were calculated using Cox proportional hazard regressions for 226,162 participants aged ≥45 years (2006-2009) in the 45 and Up Study, an Australian prospective cohort study. Incident primary cancer cases were ascertained by linkage to the New South Wales Cancer Registry to 2013 by the Centre for Health Record Linkage.

RESULTS

Over a median of 5.4 years, 17,332 cancers were diagnosed. Increasing levels of alcohol intake were associated with increased risk of cancers of the upper aerodigestive tract (1.19; 1.10-1.29), mouth and pharynx (1.18; 1.08-1.29), oesophagus (1.22; 1.04-1.43), colorectum (1.09; 1.04-1.15), colon (1.13; 1.06-1.20), liver (1.22; 1.04-1.44) and breast (1.11; 1.02-1.21). Breast cancer risk was marginally associated with drinking pattern, with higher risk when intake was concentrated on 1-3 days/week compared to the same amount spread over 4-7 days (P_interaction = 0.049).

CONCLUSIONS

Alcohol consumption confers a significant risk of cancer, and drinking pattern may be independently related to breast cancer risk.

Ageing and Alcohol: Drinking Typologies among Older Adults

Objectives: Alcohol consumption and harms among older people are increasing. We examined different demographic characteristics and drinking patterns among an older population. Methods: Secondary analyses of nationally representative Australian data; subjects aged 50+ years (N = 10,856). Two-step cluster analysis was performed to identify demographic groups and alcohol consumption behaviours. Results: Three groups were identified: Group 1 (older, unmarried, and lived alone): >65 years, moderate drinkers, poorest health, psychological distress, social disadvantage, smokers, illicit drug users, and more frequent previous alcohol treatment. Group 3 (older married): >65 years, good health, low psychological distress, less likely to drink at risky levels, and one in five drank daily. Group 2 (younger married): 50-64 years, mostly employed, highest proportion of risky drinkers and of 5+ standard drinks per session, and liberal drinking attitudes with most concern from others about their drinking. Discussion: These demographic typologies can inform targeted prevention efforts for an estimated 1.3 million adults older than 50 years drinking at risky levels.