1
|
Forbes SM, Schwartz N, Fu SH, Hobin E, Smith BT. The association between off- and on-premise alcohol outlet density and 100% alcohol-attributable emergency department visits by neighbourhood-level socioeconomic status in Ontario, Canada. Health Place 2024; 89:103284. [PMID: 38875963 DOI: 10.1016/j.healthplace.2024.103284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 05/17/2024] [Accepted: 05/31/2024] [Indexed: 06/16/2024]
Abstract
Alcohol availability is positively associated with alcohol use and harms, but the influence of socioeconomic status (SES) on these associations is not well established. This population-based cross-sectional study examined neighbourhood-level associations between physical alcohol availability (measured as off- and on-premise alcohol outlet density) and 100% alcohol-attributable emergency department (ED) visits by neighbourhood SES in Ontario, Canada from 2017 to 2019 (n = 19,740). A Bayesian spatial modelling approach was used to assess associations and account for spatial autocorrelation, which produced risk ratios (RRs) and 95% credible intervals (95% CrI). Each additional off-premise alcohol outlet in a neighbourhood was associated with a 3% increased risk of alcohol-attributable ED visits in both men (RR = 1.03, 95%CrI: 1.02-1.04) and women (RR = 1.03, 95% CrI: 1.02-1.04). Positive associations were also observed between on-premise alcohol outlet density and alcohol-attributable ED visits, although effect sizes were small. A disproportionately greater association with ED visits was observed with increasing alcohol outlet density in the lowest compared to higher SES neighbourhoods. Reducing physical alcohol availability may be an important policy lever for reducing alcohol harm and alcohol-attributable health inequities.
Collapse
Affiliation(s)
- Samantha M Forbes
- Public Health Ontario, 661 University Ave, Toronto, Ontario, Canada, M5G 1M1.
| | - Naomi Schwartz
- Public Health Ontario, 661 University Ave, Toronto, Ontario, Canada, M5G 1M1.
| | - Sze Hang Fu
- Public Health Ontario, 661 University Ave, Toronto, Ontario, Canada, M5G 1M1.
| | - Erin Hobin
- Public Health Ontario, 661 University Ave, Toronto, Ontario, Canada, M5G 1M1; Dalla Lana School of Public Health, University of Toronto, 1 55 College St, Toronto, Canada, M5T 3M7.
| | - Brendan T Smith
- Public Health Ontario, 661 University Ave, Toronto, Ontario, Canada, M5G 1M1; Dalla Lana School of Public Health, University of Toronto, 1 55 College St, Toronto, Canada, M5T 3M7.
| |
Collapse
|
2
|
Benny C, Hobin E, Andreacchi AT, Schwartz N, Smith BT. Socio-economic inequities in emergency department visits for wholly alcohol-attributable acute and chronic harms in Canada, 2003-2017. Drug Alcohol Rev 2024; 43:927-936. [PMID: 38388158 DOI: 10.1111/dar.13821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/24/2024] [Accepted: 01/24/2024] [Indexed: 02/24/2024]
Abstract
INTRODUCTION Individuals with low socio-economic position (SEP) experience disproportionate alcohol-attributable harm. Limited research has investigated whether these inequities are driven by alcohol-attributable conditions that are acute or chronic. The study aimed to estimate the sex-specific associations between SEP and incident wholly alcohol-attributable emergency department (ED) visits for acute and chronic harms, respectively. METHODS A cohort study was conducted using the Canadian Community Health Survey (2003-2008) linked to the National Ambulatory Care Reporting System (2002-2017) in Alberta and Ontario. SEP was measured using educational attainment. Acute and chronic ED visits were captured in the National Ambulatory Care Reporting System follow-up data. Hazard models were fit to estimate the association between SEP and acute and chronic wholly alcohol-attributable ED visits. RESULTS The analytical sample included 88,865 respondents. In men and women, individuals with lower SEP had increased hazard of acute ED visits (women hazard ratio [HR] 1.75, 95% confidence interval [CI] 1.07-2.87; men HR 3.47, 95% CI 2.29-5.25) and chronic ED visits (women HR 2.24, 95% CI 1.04-4.80; men HR 5.02, 95% CI 2.88-8.75). Acute and chronic wholly alcohol-attributable ED visit rates were higher in men than women. DISCUSSION AND CONCLUSIONS The findings indicated lower SEP was associated with greater harms for both acute and chronic wholly alcohol-attributable ED visits when compared to their higher SEP counterparts. We conclude that gradients in SEP are associated with acute and chronic harms. These results highlight a need for equitable interventions that reduce the absolute burden of inequities in both acute and chronic wholly alcohol-attributable ED visits.
Collapse
Affiliation(s)
| | - Erin Hobin
- Public Heath Ontario, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Alessandra T Andreacchi
- Public Heath Ontario, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Brendan T Smith
- Public Heath Ontario, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| |
Collapse
|
3
|
Anderson P, Stockwell T, Natera G, Kaner E. Minimum unit pricing for alcohol saves lives, so why is it not implemented more widely? BMJ 2024; 384:e077550. [PMID: 38471733 DOI: 10.1136/bmj-2023-077550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Affiliation(s)
| | - Tim Stockwell
- Canadian Institute for Substance Use Research, University of Victoria, Canada
- Department of Psychology, University of Victoria, Canada
| | - Guillermina Natera
- WHO Collaborating Center for Research and Training in Mental Health and Substance Abuse, Ramón de la Fuente Muñiz National Institute of Psychiatry, Ciudad de México, Mexico
| | - Eileen Kaner
- Population Health Sciences Institute, University of Newcastle upon Tyne, UK
| |
Collapse
|
4
|
Hughes J, Livingston W, Buykx P, Johnston A, Little S, McCarthy T, McLean A, Perkins A, Wright A, Holmes J. Views on minimum unit pricing for alcohol before its introduction among people with alcohol dependence in Scotland: A qualitative interview study. Drug Alcohol Rev 2023; 42:1338-1348. [PMID: 37380168 DOI: 10.1111/dar.13704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/04/2023] [Accepted: 05/29/2023] [Indexed: 06/30/2023]
Abstract
INTRODUCTION Scotland implemented a minimum price per unit of alcohol (MUP) of £0.50 in May 2018 (1 UK unit = 10 mL/8 g ethanol). Some stakeholders expressed concerns about the policy having potential negative consequences for people with alcohol dependence. This study aimed to investigate anticipated impacts of MUP on people presenting to alcohol treatment services in Scotland before policy implementation. METHODS Qualitative interviews were conducted with 21 people with alcohol dependence accessing alcohol treatment services in Scotland between November 2017 and April 2018. Interviews examined respondents' current and anticipated patterns of drinking and spending, effects on their personal life, and their views on potential policy impact. Interview data were thematically analysed using a constant comparison method. RESULTS Three key themes were identified: (i) strategies used to manage the cost of alcohol and anticipated responses to MUP; (ii) broader effects of MUP; and (iii) awareness and preparedness for MUP. Respondents expected to be impacted by MUP, particularly those on low incomes and those with more severe dependence symptoms. They anticipated using familiar strategies including borrowing and reprioritising spending to keep alcohol affordable. Some respondents anticipated negative consequences. Respondents were sceptical about the short-term benefits of MUP for current drinkers but felt it might prevent harm for future generations. Respondents had concerns about the capacity of treatment services to meet support needs. DISCUSSION AND CONCLUSIONS People with alcohol dependence identified immediate concerns alongside potential long-term benefits of MUP before its introduction. They also had concerns over the preparedness of service providers.
Collapse
Affiliation(s)
- Jane Hughes
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Wulf Livingston
- Faculty of Social and Life Sciences, Glyndwr University, Wrexham, UK
| | - Penny Buykx
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- College of Human and Social Futures, University of Newcastle, Newcastle, Australia
| | | | | | | | - Alex McLean
- Gartnaval Hopsital Mental Health Unit, NHS Greater Glasgow & Clyde, Glasgow, UK
| | | | - Alex Wright
- Global Health Policy Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - John Holmes
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| |
Collapse
|
5
|
Sherk A, Stockwell T, Sorge J, Churchill S, Angus C, Chikritzhs T, Holmes J, Meier P, Naimi TS, Norström T, Ramstedt M, Simpura J. The public-private decision for alcohol retail systems: Examining the economic, health, and social impacts of alternative systems in Finland. NORDIC STUDIES ON ALCOHOL AND DRUGS 2023; 40:218-232. [PMID: 37255607 PMCID: PMC10225965 DOI: 10.1177/14550725231160335] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/13/2023] [Indexed: 09/20/2023] Open
Abstract
Background: Organising alcohol retail systems with more or less public ownership has implications for health and the economy. The aim of the present study was to estimate the economic, health, and social impacts of alcohol use in Finland in 2018 (baseline), and in two alternative scenarios in which current partial public ownership of alcohol retail sales is either increased or fully privatised. Methods: Baseline alcohol-attributable harms and costs were estimated across five categories of death, disability, and criminal justice. Two alternate alcohol retail systems were defined as privately owned stores selling: (1) only low strength alcoholic beverages (public ownership scenario, similar to Sweden); or (2) all beverages (private ownership scenario). Policy analyses were conducted to estimate changes in alcohol use per capita. Health and economic impacts were modelled using administrative data and epidemiological modelling. Results: In Finland in 2018, alcohol use was estimated to be responsible for €1.51 billion (95% Uncertainty Estimates: €1.43 billion, €1.58 billion) in social cost, 3,846 deaths, and 270,652 criminal justice events. In the public ownership scenario, it was estimated that alcohol use would decline by 15.8% (11.8%, 19.7%) and social cost by €384.3 million (€189.5 million, €559.2 million). Full privatisation was associated with an increase in alcohol use of 9.0% (6.2%, 11.8%) and an increase in social cost of €289.7 million (€140.8 million, €439.5 million). Conclusion: The outcome from applying a novel analytical approach suggests that more public ownership of the alcohol retail system may lead to significant decreases in alcohol-caused death, disability, crime, and social costs. Conversely, full privatisation of the ownership model would lead to increased harm and costs.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Mats Ramstedt
- The Swedish Council for Information on Alcohol and Other Drugs, Sweden
| | | |
Collapse
|
6
|
Stevely AK, Mackay D, Alava MH, Brennan A, Meier PS, Sasso A, Holmes J. Evaluating the effects of minimum unit pricing in Scotland on the prevalence of harmful drinking: a controlled interrupted time series analysis. Public Health 2023; 220:43-49. [PMID: 37263177 DOI: 10.1016/j.puhe.2023.04.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/06/2023] [Accepted: 04/21/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVES In May 2018, the Scottish Government introduced a minimum unit price (MUP) for alcohol of £0.50 (1 UK unit = 8 g ethanol) to reduce alcohol consumption, particularly among people drinking at harmful levels. This study aimed to evaluate MUP's impact on the prevalence of harmful drinking among adults in Scotland. STUDY DESIGN This was a controlled interrupted monthly time series analysis of repeat cross-sectional data collected via 1-week drinking diaries from adult drinkers in Scotland (N = 38,674) and Northern England (N = 71,687) between January 2009 and February 2020. METHODS The primary outcome was the proportion of drinkers consuming at harmful levels (>50 [men] or >35 [women] units in diary week). The secondary outcomes included the proportion of drinkers consuming at hazardous (≥14-50 [men] or ≥14-35 [women] units) and moderate (<14 units) levels and measures of beverage preferences and drinking patterns. Analyses also examined the prevalence of harmful drinking in key subgroups. RESULTS There was no significant change in the proportion of drinkers consuming at harmful levels (β = +0.6 percentage points; 95% confidence interval [CI] = -1.1, +2.3) or moderate levels (β = +1.4 percentage points; 95% confidence interval = -1.1, +3.8) after the introduction of MUP. The proportion consuming at hazardous levels fell significantly by 3.5 percentage points (95% CI = -5.4, -1.7). There were no significant changes in other secondary outcomes or in the subgroup analyses after correction for multiple testing. CONCLUSIONS Introducing MUP in Scotland was not associated with reductions in the proportion of drinkers consuming at harmful levels but did reduce the prevalence of hazardous drinking. This adds to previous evidence that MUP reduced overall alcohol consumption in Scotland and consumption among those drinking above moderate levels.
Collapse
Affiliation(s)
- A K Stevely
- Sheffield Alcohol Research Group, School of Health and Related Research (ScHARR), University of Sheffield, UK.
| | - D Mackay
- School of Health and Wellbeing, University of Glasgow, UK
| | - M H Alava
- Health Economics and Decision Science, School of Health and Related Research (ScHARR), University of Sheffield, UK
| | - A Brennan
- Health Economics and Decision Science, School of Health and Related Research (ScHARR), University of Sheffield, UK
| | - P S Meier
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - A Sasso
- Sheffield Alcohol Research Group, School of Health and Related Research (ScHARR), University of Sheffield, UK; European Commission, Joint Research Center (JRC), Ispra, Italy
| | - J Holmes
- Sheffield Alcohol Research Group, School of Health and Related Research (ScHARR), University of Sheffield, UK
| |
Collapse
|
7
|
Wyper GMA, Mackay DF, Fraser C, Lewsey J, Robinson M, Beeston C, Giles L. Evaluating the impact of alcohol minimum unit pricing on deaths and hospitalisations in Scotland: a controlled interrupted time series study. Lancet 2023; 401:1361-1370. [PMID: 36963415 PMCID: PMC10154457 DOI: 10.1016/s0140-6736(23)00497-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND Since May 1, 2018, every alcoholic drink sold in Scotland has had minimum unit pricing (MUP) of £0·50 per unit. Previous studies have indicated that the introduction of this policy reduced alcohol sales by 3%. We aimed to assess whether this has led to reductions in alcohol-attributable deaths and hospitalisations. METHODS Study outcomes, wholly attributable to alcohol consumption, were defined using routinely collected data on deaths and hospitalisations. Controlled interrupted time series regression was used to assess the legislation's impact in Scotland, and any effect modification across demographic and socioeconomic deprivation groups. The pre-intervention time series ran from Jan 1, 2012, to April 30, 2018, and for 32 months after the policy was implemented (until Dec 31, 2020). Data from England, a part of the UK where the intervention was not implemented, were used to form a control group. FINDINGS MUP in Scotland was associated with a significant 13·4% reduction (95% CI -18·4 to -8·3; p=0·0004) in deaths wholly attributable to alcohol consumption. Hospitalisations wholly attributable to alcohol consumption decreased by 4·1% (-8·3 to 0·3; p=0·064). Effects were driven by significant improvements in chronic outcomes, particularly alcoholic liver disease. Furthermore, MUP legislation was associated with a reduction in deaths and hospitalisations wholly attributable to alcohol consumption in the four most socioeconomically deprived deciles in Scotland. INTERPRETATION The implementation of MUP legislation was associated with significant reductions in deaths, and reductions in hospitalisations, wholly attributable to alcohol consumption. The greatest improvements were in the four most socioeconomically deprived deciles, indicating that the policy is positively tackling deprivation-based inequalities in alcohol-attributable health harm. FUNDING Scottish Government.
Collapse
Affiliation(s)
- Grant M A Wyper
- Place and Wellbeing Directorate, Public Health Scotland, Glasgow, UK; School of Health and Wellbeing, University of Glasgow, Glasgow, UK.
| | - Daniel F Mackay
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Catriona Fraser
- Place and Wellbeing Directorate, Public Health Scotland, Glasgow, UK
| | - Jim Lewsey
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Mark Robinson
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK; Institute for Social Science Research, University of Queensland, Brisbane, QLD, Australia
| | - Clare Beeston
- Place and Wellbeing Directorate, Public Health Scotland, Glasgow, UK
| | - Lucie Giles
- Place and Wellbeing Directorate, Public Health Scotland, Glasgow, UK
| |
Collapse
|
8
|
Friesen EL, Staykov E, Myran DT. Understanding the association between neighbourhood socioeconomic status and grocery store alcohol sales following market liberalization in Ontario, Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023; 114:254-263. [PMID: 36214995 PMCID: PMC10036712 DOI: 10.17269/s41997-022-00694-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 08/31/2022] [Indexed: 03/24/2023]
Abstract
OBJECTIVES In 2015, Ontario partially deregulated alcohol sales by allowing grocery stores to sell alcohol. The purpose of this study was to evaluate (1) whether neighbourhood-level socioeconomic status (SES) impacted the likelihood that a grocery store began selling alcohol, and (2) whether increases in alcohol retail availability following deregulation differed between neighbourhoods based on SES. METHODS This was a repeated cross-sectional analysis of 1062 grocery stores in 17,096 neighbourhoods in urban Ontario. The association between neighbourhood-level SES and whether a grocery store began selling alcohol was modeled using mixed effect logistic regression. The annual change in drive-distance from a neighbourhood to the closest off-premise alcohol outlet between 2015 and 2020 was modeled using mixed effect linear regression. An interaction between time and SES was included to evaluate whether this change differed between neighbourhoods based on SES. RESULTS Grocery stores in neighbourhoods in the lowest SES quintile were 39% less likely to start selling alcohol than grocery stores in neighbourhoods in the highest SES quintile (odds ratio (OR): 0.61, 95% confidence interval (CI): 0.39-0.94). As grocery store sales expanded, the distance to the closest off-premise alcohol outlet decreased by 51.8 m annually (95% CI: 48.8-54.9, p < 0.01). A significant interaction between year and SES was observed whereby this trend was more pronounced in high- versus low-SES neighbourhoods. CONCLUSION The expansion of grocery store alcohol sales increased alcohol availability, but this increase was proportionately larger in high- versus low-SES neighbourhoods. This reduced historic disparities in alcohol availability between low- and high-SES neighbourhoods.
Collapse
Affiliation(s)
- Erik Loewen Friesen
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Emiliyan Staykov
- Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
| | - Daniel Thomas Myran
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
9
|
Maharaj T, Angus C, Fitzgerald N, Allen K, Stewart S, MacHale S, Ryan JD. Impact of minimum unit pricing on alcohol-related hospital outcomes: systematic review. BMJ Open 2023; 13:e065220. [PMID: 36737089 PMCID: PMC9900069 DOI: 10.1136/bmjopen-2022-065220] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To determine the impact of minimum unit pricing (MUP) on the primary outcome of alcohol-related hospitalisation, and secondary outcomes of length of stay, hospital mortality and alcohol-related liver disease in hospital. DESIGN Databases MEDLINE, Embase, Scopus, APA Psycinfo, CINAHL Plus and Cochrane Reviews were searched from 1 January 2011 to 11 November 2022. Inclusion criteria were studies evaluating the impact of minimum pricing policies, and we excluded non-minimum pricing policies or studies without alcohol-related hospital outcomes. The Effective Public Health Practice Project tool was used to assess risk of bias, and the Bradford Hill Criteria were used to infer causality for outcome measures. SETTING MUP sets a legally required floor price per unit of alcohol and is estimated to reduce alcohol-attributable healthcare burden. PARTICIPANT All studies meeting inclusion criteria from any country INTERVENTION: Minimum pricing policy of alcohol PRIMARY AND SECONDARY OUTCOME MEASURES: RESULTS: 22 studies met inclusion criteria; 6 natural experiments and 16 modelling studies. Countries included Australia, Canada, England, Northern Ireland, Ireland, Scotland, South Africa and Wales. Modelling studies estimated that MUP could reduce alcohol-related admissions by 3%-10% annually and the majority of real-world studies demonstrated that acute alcohol-related admissions responded immediately and reduced by 2%-9%, and chronic alcohol-related admissions lagged by 2-3 years and reduced by 4%-9% annually. Minimum pricing could target the heaviest consumers from the most deprived groups who tend to be at greatest risk of alcohol harms, and in so doing has the potential to reduce health inequalities. Using the Bradford Hill Criteria, we inferred a 'moderate-to-strong' causal link that MUP could reduce alcohol-related hospitalisation. CONCLUSIONS Natural studies were consistent with minimum pricing modelling studies and showed that this policy could reduce alcohol-related hospitalisation and health inequalities. PROSPERO REGISTRATION NUMBER CRD42021274023.
Collapse
Affiliation(s)
- Tobias Maharaj
- Royal College of Surgeons in Ireland, Dublin, Ireland
- Hepatology Unit, Beaumont Hospital, Dublin, Ireland
| | - Colin Angus
- Sheffield Alcohol Research Group, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Niamh Fitzgerald
- Institute for Social Marketing, UK Centre for Tobacco and Alcohol Studies, School of Health Sciences, University of Stirling, Stirling, UK
| | | | - Stephen Stewart
- Centre for Liver Disease, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Siobhan MacHale
- Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Liaison Psychiatry, Beaumont Hospital, Dublin, Ireland
| | - John D Ryan
- Royal College of Surgeons in Ireland, Dublin, Ireland
- Hepatology Unit, Beaumont Hospital, Dublin, Ireland
| |
Collapse
|
10
|
Babor TF, Casswell S, Graham K, Huckle T, Livingston M, Rehm J, Room R, Rossow I, Sornpaisarn B. Alcohol: No Ordinary Commodity-a summary of the third edition. Addiction 2022; 117:3024-3036. [PMID: 36321607 DOI: 10.1111/add.16003] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/29/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND AIMS This article summarizes the findings and conclusions of the third edition of Alcohol: No Ordinary Commodity. The latest revision of this book is part of a series of monographs designed to provide a critical review of the scientific evidence related to alcohol control policy from a public health perspective. DESIGN A narrative summary of the contents of the book according to five major issues. FINDINGS An extensive amount of epidemiological evidence shows that alcohol is a major contributor to the global burden of disease, disability and death in high-, middle- and low-income countries. Trends in alcohol products and marketing are described, indicating that a large part of the global industry has been consolidated into a small number of transnational corporations that are expanding their operations in Asia, Africa and Latin America. The main part of the book is devoted to a review of strategies and interventions designed to prevent or minimize alcohol-related harm. Overall, the most effective strategies to protect public health are taxation that decreases affordability and restrictions on the physical availability of alcohol. A total ban on alcohol marketing is also an effective strategy to reduce consumption. In addition, drink-driving counter-measures, brief interventions with at-risk drinkers and treatment of drinkers with alcohol dependence are effective in preventing harm in high-risk contexts and groups of hazardous drinkers. CONCLUSION Alcohol policy is often the product of competing interests, values and ideologies, with the evidence suggesting that the conflicting interests between profit and health mean that working in partnership with the alcohol industry is likely to lead to ineffective policy. Opportunities for implementation of evidence-based alcohol policies that better serve the public good are clearer than ever before as a result of accumulating knowledge on which strategies work best.
Collapse
Affiliation(s)
- Thomas F Babor
- Department of Public Health Sciences, University of Connecticut School of Medicine, CT, USA
| | - Sally Casswell
- College of Health, SHORE & Whariki Research Centre, Massey University, Auckland, New Zealand
| | - Kathryn Graham
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto/London, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Taisia Huckle
- College of Health, SHORE & Whariki Research Centre, Massey University, Auckland, New Zealand
| | - Michael Livingston
- National Drug Research Institute, Curtin University, Melbourne, Australia.,Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jürgen Rehm
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research & Campbell Family Mental Health Research Institute, Toronto, Canada.,Institute of Clinical Psychology and Psychotherapy & Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität, Dresden, Germany.,Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Psychiatry & Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Robin Room
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Victoria, Australia.,Centre for Social Research on Alcohol and Drugs, Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Ingeborg Rossow
- Department of Alcohol, Tobacco, and Drugs, Norwegian Institute of Public Health, Oslo, Norway
| | - Bundit Sornpaisarn
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, Toronto, Canada.,Faculty of Public Health, Mahidol University, Thailand
| |
Collapse
|
11
|
Vandoros S, Kawachi I. Minimum Alcohol Pricing and Motor Vehicle Collisions in Scotland. Am J Epidemiol 2022; 191:867-873. [PMID: 34849531 DOI: 10.1093/aje/kwab283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 10/24/2021] [Accepted: 11/23/2021] [Indexed: 11/14/2022] Open
Abstract
On May 1, 2018, Scotland introduced a minimum price of 50 pence per unit of alcohol, which led to a reduction in alcohol consumption. As drink-driving is an important risk factor for motor vehicle collisions, we examined whether the minimum alcohol pricing was followed by a decrease in collisions. We took advantage of a case where the minimum price was introduced to 1 population during the study period (Scotland) and another population that served as the control group did not experience this intervention (England and Wales). We used data on the daily number of motor vehicle collisions resulting in death or injury in 2018 and used a differences-in-differences econometric approach, comparing trends before and after the introduction of the minimum price. Controlling for seasonality, we found a small relative decrease in collisions in Scotland compared with England and Wales (difference-in-difference interaction coefficient, -0.35; 95% confidence interval: -0.65, -0.04; P = 0.03). Our results suggest that there was a relative decrease in motor vehicle collisions in Scotland of between 1.52 and 1.90, on average, in the first months after the introduction of the policy. More research is needed to understand any long-term impacts of minimum alcohol pricing.
Collapse
|
12
|
Karlsen TH, Sheron N, Zelber-Sagi S, Carrieri P, Dusheiko G, Bugianesi E, Pryke R, Hutchinson SJ, Sangro B, Martin NK, Cecchini M, Dirac MA, Belloni A, Serra-Burriel M, Ponsioen CY, Sheena B, Lerouge A, Devaux M, Scott N, Hellard M, Verkade HJ, Sturm E, Marchesini G, Yki-Järvinen H, Byrne CD, Targher G, Tur-Sinai A, Barrett D, Ninburg M, Reic T, Taylor A, Rhodes T, Treloar C, Petersen C, Schramm C, Flisiak R, Simonova MY, Pares A, Johnson P, Cucchetti A, Graupera I, Lionis C, Pose E, Fabrellas N, Ma AT, Mendive JM, Mazzaferro V, Rutter H, Cortez-Pinto H, Kelly D, Burton R, Lazarus JV, Ginès P, Buti M, Newsome PN, Burra P, Manns MP. The EASL-Lancet Liver Commission: protecting the next generation of Europeans against liver disease complications and premature mortality. Lancet 2022; 399:61-116. [PMID: 34863359 DOI: 10.1016/s0140-6736(21)01701-3] [Citation(s) in RCA: 245] [Impact Index Per Article: 122.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/10/2021] [Accepted: 07/15/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Tom H Karlsen
- Department of Transplantation Medicine and Research Institute for Internal Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital Rikshospitalet and University of Oslo, Oslo, Norway.
| | - Nick Sheron
- Institute of Hepatology, Foundation for Liver Research, Kings College London, London, UK
| | - Shira Zelber-Sagi
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel; Department of Gastroenterology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Patrizia Carrieri
- Aix-Marseille University, Inserm, Institut de recherche pour le développement, Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale (SESSTIM), ISSPAM, Marseille, France
| | - Geoffrey Dusheiko
- School of Medicine, University College London, London, UK; Kings College Hospital, London, UK
| | - Elisabetta Bugianesi
- Department of Medical Sciences, Division of Gastroenterology, University of Torino, Torino, Italy
| | | | - Sharon J Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Clinical and Protecting Health Directorate, Public Health Scotland, Glasgow, UK
| | - Bruno Sangro
- Liver Unit, Clinica Universidad de Navarra-IDISNA and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Pamplona, Spain
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA; Population Health Sciences, University of Bristol, Bristol, UK
| | - Michele Cecchini
- Health Division, Organisation for Economic Co-operation and Development, Paris, France
| | - Mae Ashworth Dirac
- Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA; Department of Family Medicine, University of Washington, Seattle, WA, USA; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Annalisa Belloni
- Health Economics and Modelling Division, Public Health England, London, UK
| | - Miquel Serra-Burriel
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Cyriel Y Ponsioen
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Brittney Sheena
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Alienor Lerouge
- Health Division, Organisation for Economic Co-operation and Development, Paris, France
| | - Marion Devaux
- Health Division, Organisation for Economic Co-operation and Development, Paris, France
| | - Nick Scott
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
| | - Margaret Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia; Department of Infectious Diseases, Alfred Hospital, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Doherty Institute and School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Henkjan J Verkade
- Paediatric Gastroenterology and Hepatology, Department of Paediatrics, University Medical Centre Groningen, University of Groningen, Netherlands; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Ekkehard Sturm
- Division of Paediatric Gastroenterology and Hepatology, University Children's Hospital Tübingen, Tübingen, Germany; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | | | | | - Chris D Byrne
- Department of Nutrition and Metabolism, Faculty of Medicine, University of Southampton, Southampton, UK; Southampton National Institute for Health Research, Biomedical Research Centre, University Hospital Southampton and Southampton General Hospital, Southampton, UK
| | - Giovanni Targher
- Department of Medicine, Section of Endocrinology, Diabetes, and Metabolism, University of Verona, Verona, Italy
| | - Aviad Tur-Sinai
- Department of Health Systems Management, The Max Stern Yezreel Valley College, Yezreel Valley, Israel
| | - Damon Barrett
- School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Tatjana Reic
- European Liver Patients Organization, Brussels, Belgium; Croatian Society for Liver Diseases-Hepatos, Split, Croatia
| | | | - Tim Rhodes
- London School of Hygiene & Tropical Medicine, London, UK
| | - Carla Treloar
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Claus Petersen
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Christoph Schramm
- Martin Zeitz Center for Rare Diseases, Hamburg Center for Translational Immunology (HCTI), and First Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Robert Flisiak
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, Poland
| | - Marieta Y Simonova
- Department of Gastroenterology, HPB Surgery and Transplantation, Clinic of Gastroentrology, Military Medical Academy, Sofia, Bulgaria
| | - Albert Pares
- Liver Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; CIBEREHD, Madrid, Spain
| | - Philip Johnson
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Alessandro Cucchetti
- Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Isabel Graupera
- Liver Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; CIBEREHD, Madrid, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Spain
| | - Christos Lionis
- Clinic of Social and Family Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Elisa Pose
- Liver Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Spain
| | - Núria Fabrellas
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; CIBEREHD, Madrid, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Spain
| | - Ann T Ma
- Liver Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Juan M Mendive
- Prevention and Health Promotion Research Network (redIAPP), Institute of Health Carlos III, Madrid, Spain; La Mina Health Centre, Catalan Institute of Health (ICS), Barcelona, Spain
| | - Vincenzo Mazzaferro
- HPB Surgery and Liver Transplantation, Istituto Nazionale Tumori IRCCS Foundation (INT), Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Helena Cortez-Pinto
- Clínica Universitária de Gastrenterologia and Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Deirdre Kelly
- Liver Unit, Birmingham Women's and Children's Hospital and University of Birmingham, UK
| | - Robyn Burton
- Alcohol, Drugs, Tobacco and Justice Division, Public Health England, London, UK
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, Barcelona, Spain
| | - Pere Ginès
- Liver Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; CIBEREHD, Madrid, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Spain
| | - Maria Buti
- CIBEREHD del Instituto de Salud Carlos III, Madrid, Spain; Liver Unit, Hospital Universitario Valle Hebron, Barcelona, Spain
| | - Philip N Newsome
- National Institute for Health Research Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, UK
| | - Patrizia Burra
- Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | | |
Collapse
|
13
|
Anderson P, Kokole D, Jané Llopis E. Impact of minimum unit pricing on shifting purchases from higher to lower strength beers in Scotland: Controlled interrupted time series analyses, 2015-2020. Drug Alcohol Rev 2021; 41:646-656. [PMID: 34791729 DOI: 10.1111/dar.13408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/21/2021] [Accepted: 10/21/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION On 1 May 2018 Scotland introduced a minimum unit price (MUP) of GB50 pence per unit of alcohol (8 g) sold. We analysed household purchase data to assess the impact of MUP in shifting purchases from higher to lower strength beers. METHODS Data from Kantar Worldpanel's household shopping panel, with 75 376 households and 4.76 million alcohol purchases, 2015-2020. We undertook interrupted time series analyses of the impact of introducing MUP in Scotland on changes in the proportion of the volume of purchased beer with an alcohol by volume (ABV) ≤3.5% using purchases in England as control. We analysed the moderating impact of the volume of purchased beer with an ABV ≤3.5% on the size of the associated impact of MUP in reducing purchases of grams of alcohol within beer. RESULTS MUP was associated with a relative increase in the proportion of the volume of beer purchased with an ABV ≤3.5%, Scotland minus England, of 10.9% (95% CI 10.6-11.1), following a 43.6% (95% CI 40.1-47.1) increase in the volume of beer purchased with an ABV ≤3.5%, and a 9.6% (95% CI 9.4-9.8) decrease in the volume of beer purchased with an ABV >3.5%. MUP was associated with reduced purchases of grams of alcohol within beer by 8% (95% CI 7.8-8.3), increasing to 9.6% (95% CI 9.3-9.9), when accounting for the moderating impact of shifts to lower strength beer. DISCUSSION AND CONCLUSIONS MUP seems an effective policy to reduce off-trade purchases of alcohol and encourage shifts to lower strength beers.
Collapse
Affiliation(s)
- Peter Anderson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.,Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Daša Kokole
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Eva Jané Llopis
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.,ESADE Business School, Ramon Llull University, Barcelona, Spain
| |
Collapse
|
14
|
LeClercq J, Bernard S, Mucciaccio F, Esser MB. Prospective Analysis of Minimum Pricing Policies to Reduce Excessive Alcohol Use and Related Harms in U.S. States. J Stud Alcohol Drugs 2021; 82:710-719. [PMID: 34762030 PMCID: PMC8819621 DOI: 10.15288/jsad.2021.82.710] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 06/08/2021] [Indexed: 12/14/2023] Open
Abstract
OBJECTIVE Increasing the price of alcohol is an effective strategy for reducing excessive consumption and alcohol-related harms. Limited research is available on how the establishment of a minimum price for alcoholic beverages might be an effective strategy to reduce this health risk behavior and what impact that might have in the United States. This study describes alcohol minimum pricing (MP) policy options for consideration in the United States, assesses implementation feasibility and effectiveness, and discusses implications for implementation. METHOD Three alcohol pricing policy options for reducing excessive drinking were compared in this prospective analysis: alcohol taxation (status quo in states), minimum unit pricing (MUP) by unit of alcohol (e.g., 0.6 oz. [14 g] of pure alcohol), and MP by specified amount of an alcoholic beverage type (e.g., liter of beer). For each policy, five implementation-related domains were analyzed: political feasibility, public acceptability, implementation cost, health equity, and legal feasibility. Effectiveness was also evaluated based on literature. RESULTS Alcohol MP policies, particularly MUP, could be feasible to implement and cost-efficient for reducing excessive alcohol consumption and related harms in the United States. MP policies are likely to have modest public acceptability in the United States. Although the political feasibility of MP policies is uncertain and would likely vary across states, international research suggests that MP might be a feasible pricing strategy that can be used in conjunction with alcohol taxes. CONCLUSIONS Alcohol MP can be part of a comprehensive approach for reducing excessive drinking and related harms; however, factors such as state-level differences in alcohol control regulation may influence policy implementation.
Collapse
Affiliation(s)
- Jennifer LeClercq
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephanie Bernard
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Francesca Mucciaccio
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Marissa B. Esser
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
15
|
So V, Millard AD, Katikireddi SV, Forsyth R, Allstaff S, Deluca P, Drummond C, Ford A, Eadie D, Fitzgerald N, Graham L, Hilton S, Ludbrook A, McCartney G, Molaodi O, Open M, Patterson C, Perry S, Phillips T, Schembri G, Stead M, Wilson J, Yap C, Bond L, Leyland AH. Intended and unintended consequences of the implementation of minimum unit pricing of alcohol in Scotland: a natural experiment. PUBLIC HEALTH RESEARCH 2021. [DOI: 10.3310/phr09110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Scotland was the first country to implement minimum unit pricing for alcohol nationally. Minimum unit pricing aims to reduce alcohol-related harms and to narrow health inequalities. Minimum unit pricing sets a minimum retail price based on alcohol content, targeting products preferentially consumed by high-risk drinkers. This study comprised three components.
Objectives
This study comprised three components assessing alcohol consumption and alcohol-related attendances in emergency departments, investigating potential unintended effects of minimum unit pricing on alcohol source and drug use, and exploring changes in public attitudes, experiences and norms towards minimum unit pricing and alcohol use.
Design
We conducted a natural experiment study using repeated cross-sectional surveys comparing Scotland (intervention) and North England (control) areas. This involved comparing changes in Scotland following the introduction of minimum unit pricing with changes seen in the north of England over the same period. Difference-in-difference analyses compared intervention and control areas. Focus groups with young people and heavy drinkers, and interviews with professional stakeholders before and after minimum unit pricing implementation in Scotland allowed exploration of attitudes, experiences and behaviours, stakeholder perceptions and potential mechanisms of effect.
Setting
Four emergency departments in Scotland and North England (component 1), six sexual health clinics in Scotland and North England (component 2), and focus groups and interviews in Scotland (component 3).
Participants
Research nurses interviewed 23,455 adults in emergency departments, and 15,218 participants self-completed questionnaires in sexual health clinics. We interviewed 30 stakeholders and 105 individuals participated in focus groups.
Intervention
Minimum unit pricing sets a minimum retail price based on alcohol content, targeting products preferentially consumed by high-risk drinkers.
Results
The odds ratio for an alcohol-related emergency department attendance following minimum unit pricing was 1.14 (95% confidence interval 0.90 to 1.44; p = 0.272). In absolute terms, we estimated that minimum unit pricing was associated with 258 more alcohol-related emergency department visits (95% confidence interval –191 to 707) across Scotland than would have been the case had minimum unit pricing not been implemented. The odds ratio for illicit drug consumption following minimum unit pricing was 1.04 (95% confidence interval 0.88 to 1.24; p = 0.612). Concerns about harms, including crime and the use of other sources of alcohol, were generally not realised. Stakeholders and the public generally did not perceive price increases or changed consumption. A lack of understanding of the policy may have caused concerns about harms to dependent drinkers among participants from more deprived areas.
Limitations
The short interval between policy announcement and implementation left limited time for pre-intervention data collection.
Conclusions
Within the emergency departments, there was no evidence of a beneficial impact of minimum unit pricing. Implementation appeared to have been successful and there was no evidence of substitution from alcohol consumption to other drugs. Drinkers and stakeholders largely reported not noticing any change in price or consumption. The lack of effect observed in these settings in the short term, and the problem-free implementation, suggests that the price per unit set (£0.50) was acceptable, but may be too low. Our evaluation, which itself contains multiple components, is part of a wider programme co-ordinated by Public Health Scotland and the results should be understood in this wider context.
Future work
Repeated evaluation of similar policies in different contexts with varying prices would enable a fuller picture of the relationship between price and impacts.
Trial registration
Current Controlled Trials ISRCTN16039407.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 11. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Vivian So
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
| | - Andrew D Millard
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - S Vittal Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
- Place and Wellbeing Directorate, Public Health Scotland, Glasgow, UK
| | - Ross Forsyth
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Sarah Allstaff
- Tayside Sexual and Reproductive Health Service, Ninewells Hospital and Medical School, Dundee, UK
| | - Paolo Deluca
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Colin Drummond
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Allison Ford
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Douglas Eadie
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Niamh Fitzgerald
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
- SPECTRUM Consortium, University of Edinburgh, Edinburgh, UK
| | - Lesley Graham
- Place and Wellbeing Directorate, Public Health Scotland, Glasgow, UK
| | - Shona Hilton
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Anne Ludbrook
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Gerry McCartney
- Place and Wellbeing Directorate, Public Health Scotland, Glasgow, UK
| | - Oarabile Molaodi
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Michele Open
- NHS Lothian, Emergency Department, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Chris Patterson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Samantha Perry
- NHS Greater Glasgow and Clyde, Emergency Department, Glasgow Royal Infirmary, Glasgow, UK
| | - Thomas Phillips
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Institute for Clinical and Applied Health Research (ICAHR), University of Hull, Hull, UK
| | | | - Martine Stead
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | | | - Chris Yap
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Lyndal Bond
- Mitchell Institute, Victoria University, VIC, Australia
| | - Alastair H Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| |
Collapse
|
16
|
Robinson M, Mackay D, Giles L, Lewsey J, Richardson E, Beeston C. Evaluating the impact of minimum unit pricing (MUP) on off-trade alcohol sales in Scotland: an interrupted time-series study. Addiction 2021; 116:2697-2707. [PMID: 33723866 DOI: 10.1111/add.15478] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/02/2020] [Accepted: 03/04/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS On 1 May 2018, Scotland became the first country in the world to introduce minimum unit pricing (MUP), a strength-based floor price below which alcohol cannot be sold, across all alcoholic beverages. The legislation contains a sunset clause meaning a comprehensive mixed-methods evaluation of its impact across a range of outcomes will inform whether it will continue beyond its sixth year. In this study, we assessed the impact of MUP on off-trade alcohol sales (as a proxy for consumption) after its first year. DESIGN, SETTING AND PARTICIPANTS Controlled interrupted time-series regression was used to assess the impact of MUP on alcohol sales among off-trade retailers in Scotland in the year after it was introduced, with England and Wales (EW) being the control group. In adjusted analyses, we included household disposable income, on-trade alcohol sales and substitution between beverage categories as covariates. MEASUREMENTS Weekly data on the volume of pure alcohol sold by off-trade retailers in Scotland and EW between January 2013 and May 2019, expressed as litres of pure alcohol per adult. FINDINGS The introduction of MUP in Scotland was associated with a 3.5% [95% confidence interval (CI) = 2.2-4.9%] reduction in off-trade alcohol sales per adult after adjustment for the best available geographical control, disposable income and substitution. In unadjusted analysis, the introduction of MUP was associated with a 2.0% (95% CI = 0.4-3.6%) reduction in off-trade alcohol sales per adult in Scotland. In EW, there was a 2.4% (95% CI = 0.8-4.0%) increase during the same time-period. The reduction in off-trade alcohol sales in Scotland was driven by reduced sales of spirits, cider and perry beverage categories. CONCLUSION The implementation of minimum unit pricing for alcohol in Scotland in 2018 appears to have been associated with a reduction in off-trade alcohol sales after its first year.
Collapse
Affiliation(s)
- Mark Robinson
- Institute for Social Science Research, University of Queensland, Indooroopilly, Queensland, Australia.,Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Daniel Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Jim Lewsey
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | | |
Collapse
|
17
|
Secombe P, Campbell L, Brown A, Bailey M, Pilcher D. Hazardous and harmful alcohol use in the Northern Territory, Australia: the impact of alcohol policy on critical care admissions using an extended sampling period. Addiction 2021; 116:2653-2662. [PMID: 33891373 DOI: 10.1111/add.15432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/29/2020] [Accepted: 01/20/2021] [Indexed: 11/30/2022]
Abstract
AIMS To describe the effect of alcohol policy on the incidence of intensive care unit (ICU) admissions associated with hazardous and harmful alcohol use in the Northern Territory (NT) of Australia DESIGN, SETTING AND PARTICIPANTS: Before and after analysis of admissions to NT ICUs between April 2018 and September 2019, extending on both a descriptive study describing hazardous and harmful alcohol use and single-centre analyses of harm minimization policies. After exclusions, 2281 (83%) admissions were analysed, 20.3% of which were associated with hazardous and harmful alcohol use. MEASUREMENTS Primary outcome was the incidence of admissions associated with hazardous and harmful alcohol use in the 5 months preceding (baseline period) the introduction of new alcohol policies [full-time stationing of Police Auxiliary Liquor Inspectors (PALIs) and minimum unit price (MUP)] compared with 12 months (post-intervention) following. Secondary outcomes included measures of resource use [length of stay (LoS), need for mechanical ventilation] and mortality, stratified by site. FINDINGS Overall, there was a 4.5% [95% confidence interval (CI) = 0.8-8.2%] absolute risk reduction between the time-periods (95% CI = 23.4 versus 18.9% for baseline and post-intervention, respectively, P = 0.01), predominantly due to a reduction in admissions associated with acute misuse (2.3%, 95% CI = -0.2 to 4.9% risk reduction, P = 0.06). There were regional differences, with a more marked relative risk reduction observed in Central Australia compared with the city of Darwin (27.0 versus 16.7% relative risk reduction, respectively). CONCLUSIONS Introduction of new alcohol harm minimization policies in the Northern Territory of Australia appears to have reduced the number of intensive care unit admissions associated with hazardous and harmful alcohol use. Strength of effect varies by geographical region and chronicity of hazardous and harmful alcohol use.
Collapse
Affiliation(s)
- Paul Secombe
- Intensive Care Unit Alice Springs Hospital, Alice Springs, NT, Australia.,School of Medicine, Flinders University, Bedford Park, SA, Australia.,Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation, Camberwell, VIC, Australia
| | - Lewis Campbell
- School of Medicine, Flinders University, Bedford Park, SA, Australia.,Intensive Care Unit, Royal Darwin Hospital, Darwin, NT, Australia
| | - Alex Brown
- Aboriginal Health Equity, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia.,Faculty of Health and Medical Sciences, University of Adelaide, Australia
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - David Pilcher
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation, Camberwell, VIC, Australia.,Department of Intensive Care, The Alfred Hospital, Prahran, Melbourne, VIC, Australia
| |
Collapse
|
18
|
Chaudhary S, MacKey W, Duncan K, Forrest EH. Changes in Hospital Discharges with Alcohol-Related Liver Disease in a Gastroenterology and General Medical Unit Following the Introduction of Minimum Unit Pricing of Alcohol: The GRI Q4 Study. Alcohol Alcohol 2021; 57:477-482. [PMID: 34343256 DOI: 10.1093/alcalc/agab051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/11/2021] [Accepted: 07/09/2021] [Indexed: 11/12/2022] Open
Abstract
AIMS Minimum unit price (MUP) of 50 pence per unit of alcohol was introduced in Scotland on the 1 May 2018. We assessed alcohol-related liver disease (ArLD) discharges from Glasgow Royal Infirmary (GRI) before and after the introduction of MUP. METHODS Medical records of all patients discharged from Gastroenterology wards at GRI in the fourth quarter (Q4) of the years 2015-2019 were reviewed. All patients with ArLD were identified, and detailed hospitalization data were collected retrospectively. Active drinking, severity scores, presence of alcoholic hepatitis (AH) and 90-day mortality and readmission rates were assessed. RESULTS There were fewer ArLD discharges per quarter after MUP than before (mean 80.3 pre-MUP; mean 68 post-MUP), and the proportion of active drinkers was lower post-MUP (64.7 vs. 70.5%). There was a significant fall in the mean number of weekly discharges of individual patients who were actively drinking (4.0 ± 2.0 pre-MUP, 2.8 ± 1.5 post-MUP, P = 0.01). There were no differences in the proportion of patients presenting with ascites, encephalopathy or AH; however, there was a reduction in presentations with acute upper gastrointestinal bleeding from 15.8% pre-MUP to 7.4% post-MUP (P = 0.02; odds ratio 0.42). Severity of liver disease remained unchanged. The 90-day mortality and readmission rates were not significantly different. CONCLUSION Since the introduction of MUP there has been a reduction in the absolute numbers of patients discharged with ArLD and the number of individual patients involved at GRI. The pattern of clinical presentation was largely unaffected with overall ArLD severity, readmission rates and 90-day mortality similar pre- and post-MUP.
Collapse
Affiliation(s)
- Sardar Chaudhary
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow G4 0SF, UK
| | - William MacKey
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow G4 0SF, UK
| | - Katherine Duncan
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow G4 0SF, UK
| | - Ewan H Forrest
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow G4 0SF, UK.,College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| |
Collapse
|
19
|
de Oliveira CWL, Mendes CV, Kiepper A, Monteiro MG, Wagner GA, Sanchez ZM. Analysis of gaps in alcohol policies in Brazil using the Pan American Health Organization's Alcohol Policy Scoring. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 97:103322. [PMID: 34271251 DOI: 10.1016/j.drugpo.2021.103322] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 05/14/2021] [Accepted: 05/21/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND National alcohol policies need to be systematized and evaluated to identify the gaps that should be filled by future laws. This study aims to search for and classify Brazilian public alcohol policies at the federal and state levels, based on the ten Alcohol Policy Scoring (APS) domains used by the Pan American Health Organization (PAHO), to identify any gaps METHODS: Documental research was carried out in two phases: document identification and content analysis. The search included laws, decrees, and ordinances for alcohol referred to in this text as regulatory documents (RD), enacted until December 31, 2019, in Brazil and its 26 states and the Federal District. The APS was used to classify and score the RD, which consists of ten policy domains (including pricing, availability, marketing, and health services), weighted according to the level of scientific evidence of each strategy RESULTS: We identified and categorized 435 valid RD (21 national laws and 414 state laws). Overall, Brazilian alcohol policies account for 51.6% (255/494) of the APS score. In the pricing policy domain, the second most robust indicator of the APS, the policy gap reached 87% in 25 states, demonstrating a weakness. Only the federal laws against drink-driving include all the recommended dimensions. There are important legislative contradictions in the definition of an alcoholic beverage and in the content of the policies to control marketing CONCLUSION: At the national level, the federal government adopted alcohol policies in several of the PAHO policy domains but enacted RD with little practical effect. At the subnational level, despite the autonomy to complement federal laws, the states have not yet addressed the most important gaps.
Collapse
Affiliation(s)
- Camila W Lopes de Oliveira
- Departamento de Psiquiatria e Psicologia Médica. Universidade Federal de São Paulo, São Paulo, Brazil. Rua Borges Lagoa, 570 - 1º Andar - São Paulo, SP, Brazil
| | - Camila Vieira Mendes
- Departamento de Medicina Preventiva, Universidade Federal de São Paulo, São Paulo, Brazil. Rua Botucatu, 740, 4° andar, São Paulo, SP, Brazil
| | | | - Maristela G Monteiro
- Noncommunicable Diseases and Mental Health Department, Pan American Health Organization (PAHO), 525 Twenty-third Street, N.W., Washington, DC 20037, United States
| | - Gabriela Arantes Wagner
- Departamento de Medicina Preventiva, Universidade Federal de São Paulo, São Paulo, Brazil. Rua Botucatu, 740, 4° andar, São Paulo, SP, Brazil
| | - Zila M Sanchez
- Departamento de Medicina Preventiva, Universidade Federal de São Paulo, São Paulo, Brazil. Rua Botucatu, 740, 4° andar, São Paulo, SP, Brazil.
| |
Collapse
|
20
|
Phillips AZ, Rodriguez HP, Kerr WC, Ahern JA. Washington's liquor license system and alcohol-related adverse health outcomes. Addiction 2021; 116:1043-1053. [PMID: 33058384 PMCID: PMC8043979 DOI: 10.1111/add.15234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/08/2020] [Accepted: 08/18/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS In June 2012, Washington state (USA) implemented Initiative 1183, privatizing liquor sales. As a result, off-premises outlets increased from 330 to over 1400 and trading hours lengthened. Increased availability of liquor may lead to increased consumption. This study examines the impact of Initiative 1183 on alcohol-related adverse health outcomes, measured by inpatient hospitalizations for alcohol-related disorders and accidental injuries. It further assesses heterogeneity by urbanicity, because outlets increased most in metropolitan-urban areas. DESIGN County-by-quarter difference-in-difference linear regression models, estimated statewide and within metropolitan/rural strata. SETTING AND PARTICIPANTS Data are from AHRQ Healthcare Cost and Utilization State Inpatient Database 2010-2014 and HHS Area Health Resource File 2010-2014. Changes in the rates of hospitalizations in the 2.5 years following Initiative 1183 in Washington (n = 39 counties) are compared with changes in Oregon (n = 36 counties). MEASUREMENTS County rates of hospitalizations per 1000 residents, including all records with any-listed ICD-9 Clinical Classification Software code denoting an alcohol-related disorder, and all records with any-listed external cause of injury code denoting an accidental injury. FINDINGS The increase in the rate of accidental injury hospitalizations in Washington's metropolitan-urban counties was on average 0.289 hospitalizations per 1000 county residents per quarter greater than the simultaneous increase observed in Oregon (P = 0.017). This result was robust to alternative specifications using a propensity score matched sample and synthetic control methods with data from other comparison states. The evidence did not suggest that Initiative 1183 was associated with differential changes in the rate of hospitalizations for alcohol-related disorders in metropolitan-urban (P = 0.941), non-metropolitan-urban (P = 0.162), or rural counties (P = 0.876). CONCLUSIONS Implementing Washington's Initiative 1183 (privatizing liquor sales) appears to have been associated with a significant increase in the rate of accidental injury hospitalizations in urban counties in that state but does not appear to be significantly associated with changes in the rate of hospitalizations specifically for alcohol-related disorders within 2.5 years.
Collapse
Affiliation(s)
- Aryn Z. Phillips
- Center for Healthcare Organizational and Innovation Research, University of California, Berkeley, Berkeley, CA, USA,Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Hector P. Rodriguez
- Center for Healthcare Organizational and Innovation Research, University of California, Berkeley, Berkeley, CA, USA,University of California, Berkeley, School of Public Health, Berkeley, CA, USA
| | | | - Jennifer A. Ahern
- University of California, Berkeley, School of Public Health, Berkeley, CA, USA
| |
Collapse
|
21
|
Trefan L, Akbari A, Morgan JS, Farewell DM, Fone D, Lyons RA, Jones Hywel M, Moore SC. Visualisation and optimisation of alcohol-related hospital admissions ICD-10 codes in Welsh e-cohort data. Int J Popul Data Sci 2021; 6:1373. [PMID: 34007894 PMCID: PMC8103565 DOI: 10.23889/ijpds.v6i1.1373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction The excessive consumption of alcohol is detrimental to long term health and increases the likelihood of hospital admission. However, definitions of alcohol-related hospital admission vary, giving rise to uncertainty in the effect of alcohol on alcohol-related health care utilization. Objectives To compare diagnostic codes on hospital admission and discharge and to determine the ideal combination of codes necessary for an accurate determination of alcohol-related hospital admission. Methods Routine population-linked e-cohort data were extracted from the Secure Anonymised Information Linkage (SAIL) Databank containing all alcohol-related hospital admissions (n,= 92,553) from 2006 to 2011 in Wales, United Kingdom. The distributions of the diagnostic codes recorded at admission and discharge were compared. By calculating a misclassification rate (sensitivity-like measure) the appropriate number of coding fields to examine for alcohol-codes was established. Results There was agreement between admission and discharge codes. When more than ten coding fields were used the misclassification rate was less than 1%. Conclusion With the data at present and alcohol-related codes used, codes recorded at admission and discharge can be used equivalently to identify alcohol-related admissions. The appropriate number of coding fields to examine was established: fewer than ten is likely to lead to under-reporting of alcohol-related admissions. The methods developed here can be applied to other medical conditions that can be described using a certain set of diagnostic codes, each of which can be a known sole cause of the condition and recorded in multiple positions in e-cohort data.
Collapse
Affiliation(s)
- Laszl Trefan
- Honorary Research Associate, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff CF14 4YS
| | - Ashley Akbari
- Senior Research Manager and Data Scientist, Health Data Research UK Wales and Northern Ireland, Swansea University Medical School, Institute of Life Science 2, Sketty, Swansea SA2 8QA
| | - Jennifer Siân Morgan
- Performance Analysis Manager, NHS Wales Delivery Unit, Pencoed, Bridgend CF35 5LJ
| | - Daniel Mark Farewell
- Senior Lecturer, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff CF14 4YS
| | - David Fone
- Retired professor, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff CF14 4YS
| | - Ronan A Lyons
- Professor, Health Data Research UK Wales and Northern Ireland, Swansea University Medical School, Institute of Life Science 2, Sketty, Swansea SA2 8QA
| | - Merfyn Jones Hywel
- Research Associate / Statistician, Division of Population Medicine, Cardiff University, Cardiff CF14 4YS
| | - Simon C Moore
- Professor of Public Health Research, Crime and Security Research Institute and School of Dentistry, Cardiff University, Cardiff CF14 4XY
| |
Collapse
|
22
|
Brennan A, Angus C, Pryce R, Buykx P, Henney M, Gillespie D, Holmes J, Meier PS. Potential effects of minimum unit pricing at local authority level on alcohol-attributed harms in North West and North East England: a modelling study. PUBLIC HEALTH RESEARCH 2021. [DOI: 10.3310/phr09040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
In 2018, Scotland implemented a 50p-per-unit minimum unit price for alcohol. Previous modelling estimated the impact of minimum unit pricing for England, Scotland, Wales and Northern Ireland. Decision-makers want to know the potential effects of minimum unit pricing for local authorities in England; the premise of this study is that estimated effects of minimum unit pricing would vary by locality.
Objective
The objective was to estimate the potential effects on mortality, hospitalisations and crime of the implementation of minimum unit pricing for alcohol at local authority level in England.
Design
This was an evidence synthesis, and used computer modelling using the Sheffield Alcohol Policy Model (local authority version 4.0). This study gathered evidence on local consumption of alcohol from the Health Survey for England, and gathered data on local prices paid from the Living Costs and Food Survey and from market research companies’ actual sales data. These data were linked with local harms in terms of both alcohol-attributable mortality (from the Office for National Statistics) and alcohol-attributable hospitalisations (from Hospital Episode Statistics) for 45 conditions defined by the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. These data were examined for eight age–sex groups split by five Index of Multiple Deprivation quintiles. Alcohol-attributable crime data (Office for National Statistics police-recorded crimes and uplifts for unrecorded offences) were also analysed.
Setting
This study was set in 23 upper-tier local authorities in North West England, 12 upper-tier local authorities in the North East region and nine government office regions, and a national summary was conducted.
Participants
The participants were the population of England aged ≥ 18 years.
Intervention
The intervention was setting a local minimum unit price. The base case is 50p per unit of alcohol. Sensitivity analyses were undertaken using minimum unit prices of 30p, 40p, 60p and 70p per unit of alcohol.
Main outcome measures
The main outcome measures were changes in alcohol-attributable deaths, hospitalisations and crime. Savings in NHS costs, changes in alcohol purchasing and consumption, changes in revenue to off-trade and on-trade retailers and changes in the slope index of inequality between most and least deprived areas were also examined.
Results
The modelling has proved feasible at the upper-tier local authority level. The resulting estimates suggest that minimum unit pricing for alcohol at local authority level could be effective in reducing alcohol-attributable deaths, hospitalisations, NHS costs and crime. A 50p minimum unit price for alcohol at local authority level is estimated to reduce annual alcohol-related deaths in the North West region by 205, hospitalisations by 5956 (–5.5%) and crimes by 8528 (–2.5%). These estimated reductions are mostly due to the 5% of people drinking at high-risk levels (e.g. men drinking > 25 pints of beer or five bottles of wine per week, women drinking > 17 pints of beer or 3.5 bottles of wine per week, and who spend around £2500 per year currently on alcohol). Model estimates of impact are bigger in the North West and North East regions than nationally because, currently, more cheap alcohol is consumed in these regions and because there are more alcohol-related deaths and hospitalisations in these areas. A 30p minimum unit price has estimated effects that are ≈ 90% lower than those of a 50p minimum unit price, and a 40p minimum unit price has estimated effects that are ≈ 50% lower. Health inequalities are estimated to reduce with greater health gains in the deprived areas, where more cheap alcohol is purchased and where there are higher baseline harms.
Limitations
The approach requires synthesis of evidence from multiple sources on alcohol consumption; prices paid; and incidence of diseases, mortality and crime. Price elasticities used are from previous UK analysis of price responsiveness rather than specific to local areas. The study has not estimated ‘cross-border effects’, namely travelling to shops outside the region.
Conclusions
The modelling estimates suggest that minimum unit pricing for alcohol at local authority level would be an effective and well-targeted policy, reducing inequalities.
Future work
The Sheffield Alcohol Policy Model for Local Authorities framework could be further utilised to examine the local impact of national policies (e.g. tax changes) or local policies (e.g. licensing or identification and brief advice). As evidence emerges from the Scottish minimum unit price implementation, this will further inform estimates of impact in English localities. The methods used to estimate drinking and purchasing patterns in each local authority could also be used for other topics involving unhealthy products affecting public health, for example to estimate local smoking or high-fat, high-salt food consumption patterns.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 4. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Alan Brennan
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Colin Angus
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Robert Pryce
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Penny Buykx
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- School of Humanities and Social Science, University of Newcastle, Newcastle, NSW, Australia
| | - Madeleine Henney
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Duncan Gillespie
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - John Holmes
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Petra S Meier
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| |
Collapse
|
23
|
Giesbrecht N, Wettlaufer A, Stockwell T, Vallance K, Chow C, April N, Asbridge M, Callaghan R, Cukier S, Hynes G, Mann RE, Solomon R, Thomas G, Thompson K. Alcohol retail privatisation in Canadian provinces between 2012 and 2017. Is decision making oriented to harm reduction? Drug Alcohol Rev 2020; 40:459-467. [PMID: 33319402 DOI: 10.1111/dar.13229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/16/2020] [Accepted: 11/16/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Policy changes may contribute to increased alcohol-related risks to populations. These include privatisation of alcohol retailing, which influences density of alcohol outlets, location of outlets, hours of sale and prevention of alcohol sales to minors or intoxicated customers. Meta-analyses, reviews and original research indicate enhanced access to alcohol is associated with elevated risk of and actual harm. We assess the 10 Canadian provinces on two alcohol policy domains-type of alcohol control system and physical availability of alcohol-in order to track changes over time, and document shifting changes in alcohol policy. METHODS Our information was based on government documents and websites, archival statistics and key informant interviews. Policy domains were selected and weighted for their degree of effectiveness and population reach based on systematic reviews and epidemiological evidence. Government representatives were asked to validate all the information for their jurisdiction. RESULTS The province-specific reports based on the 2012 results showed that 9 of 10 provinces had mixed retail systems-a combination of government-run and privately owned alcohol outlets. Recommendations in each provincial report were to not increase privatisation. However, by 2017 the percentage of off-premise private outlets had increased in four of these nine provinces, with new private outlet systems introduced in several. DISCUSSION AND CONCLUSIONS Decision-making protocols are oriented to commercial interests and perceived consumer convenience. If public health and safety considerations are not meaningfully included in decision-making protocols on alcohol policy, then it will be challenging to curtail or reduce harms.
Collapse
Affiliation(s)
- Norman Giesbrecht
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Ashley Wettlaufer
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Tim Stockwell
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - Kate Vallance
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - Clifton Chow
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - Nicole April
- Direction du développement des individus et des communautés, Institut National de Santé Publique du Québec, Québec City, Canada
| | - Mark Asbridge
- Departments of Community Health and Epidemiology and Emergency Medicine, Dalhousie University, Halifax, Canada
| | - Russell Callaghan
- Northern Medical Program, University of Northern British Columbia, Prince George, Canada
| | - Samantha Cukier
- Centre for Journalogy, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Geoff Hynes
- Population Health, Canadian Institute for Health Information, Ottawa, Canada
| | - Robert E Mann
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | | | - Gerald Thomas
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - Kara Thompson
- Department of Psychology, St. Francis Xavier University, Antigonish, Canada
| |
Collapse
|
24
|
Xhurxhi IP. The early impact of Scotland's minimum unit pricing policy on alcohol prices and sales. HEALTH ECONOMICS 2020; 29:1637-1656. [PMID: 32929848 DOI: 10.1002/hec.4156] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 07/03/2020] [Accepted: 09/02/2020] [Indexed: 06/11/2023]
Abstract
In May 2018, Scotland became the first country in the world to enforce a minimum unit pricing (MUP) of 50 pence ($0.65; €0.55) on alcoholic beverages as a measure to control alcohol consumption and alcohol-related harms. This study presents early estimates of the impact of MUP on three outcomes: average price per unit (8 gr/10 ml) of alcohol, liters of alcohol sold per adult, and liters of alcohol sold per adult drinker, in three different settings: off-premise, on-premise, and both combined. Using yearly alcohol price and sales data from 2011 to 2019, I find that the average price per unit of alcohol has significantly risen post-MUP across all beverage categories (beer, spirits, wine, cider, and alcohol-all types), whereas liters of alcohol sold per adult and per adult drinker have significantly reduced for beer, spirits, cider, and alcohol-all types. For all outcomes, the impact of MUP on off-premise alcohol prices and sales is more pronounced than under the combined case, while no significant effects are found on-premise. These results are robust to model specification and to the addition of various control variables. Falsification tests changing the timing of the policy were performed and no significant results were found.
Collapse
Affiliation(s)
- Irena Palamani Xhurxhi
- Department of Economics, Trinity College, Hartford, Connecticut, USA
- Economics Program, The Graduate Center, CUNY, New York, New York, USA
| |
Collapse
|
25
|
Myrzamatova AO, Kontsevaya AV, Gorny BE, Drapkina OM. Population-based preventive measures aimed at reducing alcohol consumption: international practice and prospects for escalating measures in the Russian Federation. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2020. [DOI: 10.15829/1728-8800-2020-2566] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aim. To conduct a review of international studies and guidelines on the implementation of population-based preventive measures aimed at reducing alcohol consumption, and identify measures recommended by the World Health Organization, which have the potential for use in the Russian Federation.Material and methods. We used the following databases: PubMed, Science Citation Index, Scopus, The Campbell Collaboration Library of Systematic Reviews. The review includes systematic and non-systematic studies of measures related to alcohol consumption. The effectiveness of the identified measures was assessed according to the following criteria: behavioral changes (consumption/sales/level); incidence changes; mortality changes.Results. According to international practice of population-based prevention, effective measures that can be implemented in the Russian Federation include reducing the blood alcohol concentration legal driving limit, increasing the minimum legal drinking age, a complete ban on alcohol advertising, and a further increase in excise taxes.Conclusion. In the Russian Federation, significant progress has been achieved in implementing alcohol restriction measures, which has led to a reduction in its consumption and related consequences. Despite this, levels of alcohol consumption remain high and the potential for introducing population-based measures to reduce it has not been exhausted.
Collapse
Affiliation(s)
- A. O. Myrzamatova
- National Medical Research Center for Therapy and Preventive Medicine
| | - A. V. Kontsevaya
- National Medical Research Center for Therapy and Preventive Medicine
| | - B. E. Gorny
- National Medical Research Center for Therapy and Preventive Medicine
| | - O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine
| |
Collapse
|
26
|
Cook M, Livingston M, Wilkinson C, Shanthosh J, Morrison CN. Alcohol Industry vs. Public Health Presentations at Judicial Reviews of Liquor Licence Applications in Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 82:102808. [PMID: 32531514 DOI: 10.1016/j.drugpo.2020.102808] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/21/2020] [Accepted: 05/25/2020] [Indexed: 11/18/2022]
Abstract
Greater densities of alcohol outlets are associated with greater incidence of alcohol-related harms. In Australia, public health advocates aiming to limit alcohol availability expend significant energy objecting to new outlets in licensing and planning hearings. This study identifies and reviews the key scientific arguments put forward by industry and public health representatives in liquor and planning hearings to determine the factors that contribute to decisions by the presiding authority and to identify ways forward for researchers wishing to facilitate harm minimisation through these regulatory forums. Scientific evidence presented in 23 cases from Victoria, New South Wales and Western Australia between 2010 and 2018 were assessed using directed content analysis. Cases were identified through the AustLii and Westlaw online databases. The full transcripts of two cases that were identified as representative of the scientific arguments presented in other included cases were also reviewed. Four main arguments that industry used during hearings were identified-causal inference, non-linearities, differentiation and risk mitigation. These arguments were used across many included hearings and raised fundamental questions that public health evidence was often ill-equipped to respond to. The overall success of industry arguments in liquor and planning hearings highlighted the challenges of applying epidemiological evidence to individual case studies. These findings have particular implications and will be of use for researchers and public health experts participating in future licensing hearings, especially those wishing to prevent alcohol-related harm through regulatory mechanisms such as state licensing authorities (i.e. courts).
Collapse
Affiliation(s)
- M Cook
- Centre for Alcohol Policy Research, La Trobe University, Melbourne.
| | - M Livingston
- Centre for Alcohol Policy Research, La Trobe University, Melbourne
| | - C Wilkinson
- Centre for Alcohol Policy Research, La Trobe University, Melbourne; Drug Policy Modelling Program (DPMP) at the Social Policy Research Centre (SPRC), University of New South Wales
| | - J Shanthosh
- The George Institute for Global Health, Newtown, New South Wales; The Australian Prevention Partnership Centre, New South Wales
| | - C N Morrison
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria
| |
Collapse
|
27
|
Stockwell T, Churchill S, Sherk A, Sorge J, Gruenewald P. How many alcohol-attributable deaths and hospital admissions could be prevented by alternative pricing and taxation policies? Modelling impacts on alcohol consumption, revenues and related harms in Canada. Health Promot Chronic Dis Prev Can 2020; 40:153-164. [PMID: 32529975 PMCID: PMC7367427 DOI: 10.24095/hpcdp.40.5/6.04] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
INTRODUCTION In 2017, Canada increased alcohol excise taxes for the first time in over three decades. In this article, we describe a model to estimate various effects of additional tax and price policies that are predicted to improve health outcomes. METHODS We obtained alcohol sales and taxation data for 2016/17 for all Canadian jurisdictions from Statistics Canada and product-level sales data for British Columbia. We modelled effects of alternative price and tax policies - revenue-neutral taxes, inflation-adjusted taxes and minimum unit prices (MUPs) - on consumption, revenues and harms. We used published price elasticities to estimate impacts on consumption and revenue and the International Model for Alcohol Harms and Policies (InterMAHP) to estimate impacts on alcohol-attributable mortality and morbidity. RESULTS Other things being equal, revenue-neutral alcohol volumetric taxes (AVT) would have minimal influence on overall alcohol consumption and related harms. Inflation-adjusted AVT would result in 3.83% less consumption, 329 fewer deaths and 3762 fewer hospital admissions. A MUP of $1.75 per standard drink (equal to 17.05mL ethanol) would have reduced consumption by 8.68% in 2016, which in turn would have reduced the number of deaths by 732 and the number of hospitalizations by 8329 that year. Indexing alcohol excise taxes between 1991/92 and 2016/17 would have resulted in the federal government gaining approximately $10.97 billion. We estimated this could have prevented 4000-5400 deaths and 43 000-56 000 hospitalizations. CONCLUSION Improved public health outcomes would be made possible by (1) increasing alcohol excise tax rates across all beverages to compensate for past failures to index rates, and (2) setting a MUP of at least $1.75 per standard drink. While reducing alcohol-caused harms, these tax policies would have the added benefit of increasing federal government revenues.
Collapse
Affiliation(s)
- Tim Stockwell
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | - Samuel Churchill
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | - Adam Sherk
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | - Justin Sorge
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | - Paul Gruenewald
- Prevention Research Center, Berkeley, California, United States of America
| |
Collapse
|
28
|
Beeston C, Robinson M, Giles L, Dickie E, Ford J, MacPherson M, McAdams R, Mellor R, Shipton D, Craig N. Evaluation of Minimum Unit Pricing of Alcohol: A Mixed Method Natural Experiment in Scotland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3394. [PMID: 32414068 PMCID: PMC7277813 DOI: 10.3390/ijerph17103394] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/07/2020] [Accepted: 05/09/2020] [Indexed: 12/31/2022]
Abstract
In May 2018, Scotland became the first country in the world to implement minimum unit pricing (MUP) for all alcoholic drinks sold in licensed premises in Scotland. The use of a Sunset Clause in the MUP legislation was a factor in successfully resisting legal challenges by indicating that the final decision on a novel policy would depend on its impact. An overarching evaluation has been designed and the results will provide important evidence to inform the parliamentary vote on the future of MUP in Scotland. The evaluation uses a mixed methods portfolio of in-house, commissioned, and separately funded studies to assess the impact of MUP across multiple intended and unintended outcomes related to compliance, the alcoholic drinks industry, consumption, and health and social harms. Quantitative studies to measure impact use a suitable control where feasible. Qualitative studies assess impact and provide an understanding of the lived experience and mechanism of change for key sub-groups. As well as providing important evidence to inform the parliamentary vote, adding to the international evidence on impact and experience of alcohol pricing policy across a broad range of outcomes, this approach to evaluating novel policy interventions may provide guidance for future policy innovations.
Collapse
Affiliation(s)
- Clare Beeston
- Place and Wellbeing Directorate Public Health Scotland, Glasgow G2 6QP, UK; (L.G.); (E.D.); (J.F.); (R.M.); (D.S.); (N.C.)
| | - Mark Robinson
- Institute for Social Science Research, University of Queensland, Brisbane, QLD 4068, Australia;
| | - Lucie Giles
- Place and Wellbeing Directorate Public Health Scotland, Glasgow G2 6QP, UK; (L.G.); (E.D.); (J.F.); (R.M.); (D.S.); (N.C.)
| | - Elinor Dickie
- Place and Wellbeing Directorate Public Health Scotland, Glasgow G2 6QP, UK; (L.G.); (E.D.); (J.F.); (R.M.); (D.S.); (N.C.)
| | - Jane Ford
- Place and Wellbeing Directorate Public Health Scotland, Glasgow G2 6QP, UK; (L.G.); (E.D.); (J.F.); (R.M.); (D.S.); (N.C.)
| | | | - Rachel McAdams
- Place and Wellbeing Directorate Public Health Scotland, Glasgow G2 6QP, UK; (L.G.); (E.D.); (J.F.); (R.M.); (D.S.); (N.C.)
| | - Ruth Mellor
- Public Health, NHS Lanarkshire, Glasgow G71 8BB, UK;
| | - Deborah Shipton
- Place and Wellbeing Directorate Public Health Scotland, Glasgow G2 6QP, UK; (L.G.); (E.D.); (J.F.); (R.M.); (D.S.); (N.C.)
| | - Neil Craig
- Place and Wellbeing Directorate Public Health Scotland, Glasgow G2 6QP, UK; (L.G.); (E.D.); (J.F.); (R.M.); (D.S.); (N.C.)
| |
Collapse
|
29
|
Myran DT, Hsu AT, Smith G, Tanuseputro P. Rates of emergency department visits attributable to alcohol use in Ontario from 2003 to 2016: a retrospective population-level study. CMAJ 2020; 191:E804-E810. [PMID: 31332048 DOI: 10.1503/cmaj.181575] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2019] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Alcohol use causes a large burden on the health of Canadians, and alcohol-related harms appear to be increasing in many high-income countries. We sought to analyze changes in emergency department visits attributable to alcohol use, by sex, age and neighbourhood income over time. METHODS All individuals aged 10 to 105 years living in Ontario, Canada, between 2003 and 2016 were included in this study. The primary outcome was age-standardized rates of emergency department visits attributable to alcohol use, defined using diagnostic codes from the Canadian Institute for Health Information Health Indicator "hospitalizations entirely caused by alcohol." We compared rates of these visits using a retrospective population-level design. RESULTS Among 15 121 639 individuals, there were 765 346 emergency department visits attributable to alcohol use over the study period. Between 2003 and 2016, the age-standardized rates of these visits increased more in women (86.5%) than in men (53.2%), and the increase in rates of emergency department visits attributable to alcohol use was 4.4 times greater than the increases in the rates of overall emergency department visits. Individuals aged 25-29 years experienced the largest change in the rate of emergency department visits attributable to alcohol use (175%). We found evidence of age-cohort effects, whereby the rate of emergency department visits attributable to alcohol use at age 19 years increased on average by 4.07% (95% confidence interval [CI] 3.71%-4.44%) per year for each cohort born between 1986 and 1999. Individuals in the lowest neighbourhood income quintile had 2.37 (95% CI 2.27-2.49) times the rate of emergency department visits attributable to alcohol use than those in the highest income quintile. This disparity increased slightly over the study period. INTERPRETATION Although men and lower-income individuals have the highest burden of emergency department visits attributable to alcohol use, the largest increases in visits have been in women and younger adults. Further research should focus on potential causes of these trends to provide guidance on how to reduce alcohol-related harms.
Collapse
Affiliation(s)
- Daniel T Myran
- School of Epidemiology and Public Health (Myran), Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program (Hsu, Smith), The Ottawa Hospital, Ottawa Hospital Research Institute; ICES uOttawa (Smith); Bruyère Research Institute (Hsu, Tanuseputro); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont.
| | - Amy T Hsu
- School of Epidemiology and Public Health (Myran), Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program (Hsu, Smith), The Ottawa Hospital, Ottawa Hospital Research Institute; ICES uOttawa (Smith); Bruyère Research Institute (Hsu, Tanuseputro); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont
| | - Glenys Smith
- School of Epidemiology and Public Health (Myran), Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program (Hsu, Smith), The Ottawa Hospital, Ottawa Hospital Research Institute; ICES uOttawa (Smith); Bruyère Research Institute (Hsu, Tanuseputro); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont
| | - Peter Tanuseputro
- School of Epidemiology and Public Health (Myran), Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program (Hsu, Smith), The Ottawa Hospital, Ottawa Hospital Research Institute; ICES uOttawa (Smith); Bruyère Research Institute (Hsu, Tanuseputro); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont
| |
Collapse
|
30
|
Weerasinghe A, Schoueri-Mychasiw N, Vallance K, Stockwell T, Hammond D, McGavock J, Greenfield TK, Paradis C, Hobin E. Improving Knowledge that Alcohol Can Cause Cancer is Associated with Consumer Support for Alcohol Policies: Findings from a Real-World Alcohol Labelling Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E398. [PMID: 31936173 PMCID: PMC7014334 DOI: 10.3390/ijerph17020398] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 12/25/2022]
Abstract
Knowledge that alcohol can cause cancer is low in Canada. Alcohol labels are one strategy for communicating alcohol-related harms, including cancer. Extending existing research observing an association between knowledge of the alcohol-cancer link and support for alcohol policies, this study examined whether increases in individual-level knowledge that alcohol is a carcinogen following an alcohol labelling intervention are associated with support for alcohol polices. Cancer warning labels were applied to alcohol containers at the intervention site, and the comparison site did not apply cancer labels. Pre-post surveys were conducted among liquor store patrons at both sites before and two-and six-months after the intervention was stopped due to alcohol industry interference. Limiting the data to participants that completed surveys both before and two-months after the cancer label stopped, logistic regression was used to examine the association between increases in knowledge and support for policies. Support for pricing and availability policies was low overall; however, increases in individual-level knowledge of the alcohol-cancer link was associated with higher levels of support for pricing policies, specifically, setting a minimum unit price per standard drink of alcohol (OR = 1.86, 95% CI: 1.11-3.12). Improving knowledge that alcohol can cause cancer using labels may increase support for alcohol policies. International Registered Report Identifier (IRRID): RR2-10.2196/16320.
Collapse
Affiliation(s)
| | | | - Kate Vallance
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC V8P 2Y2, Canada; (K.V.); (T.S.)
| | - Tim Stockwell
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC V8P 2Y2, Canada; (K.V.); (T.S.)
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada;
| | - Jonathan McGavock
- Children’s Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB R3E 3P4, Canada;
| | | | - Catherine Paradis
- Canadian Centre for Substance Use and Addiction, Ottawa, ON K1P 5E7, Canada;
| | - Erin Hobin
- Public Health Ontario, Toronto, ON M5G 1V2, Canada; (A.W.); (N.S.-M.)
| |
Collapse
|
31
|
Heterogenous wealth effects of minimum unit price on purchase of alcohol: Evidence using scanner data. PLoS One 2019; 14:e0225538. [PMID: 31805079 PMCID: PMC6894865 DOI: 10.1371/journal.pone.0225538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 11/06/2019] [Indexed: 11/19/2022] Open
Abstract
One of the key arguments given to oppose the "sin taxes" is that they are regressive in nature and place disproportionately higher cost on the poor thereby reducing their net wealth. The response to a reduction in net wealth attributed to tax can potentially have significant effects through an increase in alcohol purchase by heavy drinkers reinforcing or even offsetting the direct price or substitution effect of these taxes in reducing alcohol consumption. Comparatively little is known empirically about the net wealth effect associated with changes in alcohol tax policy, and this study aims to help fill this gap in the literature. In this study we aim to estimate how the wealth effects of introducing a minimum unit price (MUP) of A$2.00 per standard drink vary over the distribution (quantiles) of alcohol consumers. The data used in this study is a longitudinal panel of 1,395 households' daily alcohol purchases (scanner data) recorded over a full year. Our analysis involves (i) quantile regression to estimate income elasticity over the distribution of consumption, and (ii) using these elasticities to estimate the potential wealth effects of a hypothetical change in alcohol prices from introducing an MUP policy. We control for consumer demographic characteristics, alcohol product prices and prices of close substitutes, and quarterly seasonal effects. We find that the estimated wealth effect from increasing the price of alcohol under a MUP policy is not significant at any point over the distribution of alcohol consumers. The policy increases per capita tax impact by less than A$5.00 per week for light/moderate consumers (50th-80th quantile) and decreases their daily per capita alcohol consumption by less than 0.02 standard drinks. Wealth effects attributable to an MUP policy are likely to be negligible. Substitution effects of the policy dominate the wealth effects in generating key health related outcomes such as reductions in alcohol consumption.
Collapse
|
32
|
Room R, Cisneros Örnberg J. Government monopoly as an instrument for public health and welfare: Lessons for cannabis from experience with alcohol monopolies. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 74:223-228. [DOI: 10.1016/j.drugpo.2019.10.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/11/2019] [Accepted: 10/16/2019] [Indexed: 12/01/2022]
|
33
|
Alcohol policies and alcohol-attributable cancer mortality in U.S. States. Chem Biol Interact 2019; 315:108885. [PMID: 31678112 DOI: 10.1016/j.cbi.2019.108885] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/26/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although more restrictive alcohol control policies (e.g., higher alcohol taxes) are related to lower levels of alcohol consumption, little is known about the relationship between alcohol policies and rates of alcohol-attributable cancer. METHODS State alcohol policy restrictiveness, as measured by a validated policy scale, were related to state rates of six alcohol attributable cancers in the U.S. from 2006 to 2010 in a lagged, cross-sectional linear regression that controlled for a variety of state-level factors. Cancer mortality rates were from the Center for Disease Control and Prevention's Alcohol-Related Disease Impact application, which uses population-attributable fraction methodology to calculate mortality from cancers of the esophagus, larynx, liver, oropharynx, prostate (male only) and breast (female only). RESULTS More restrictive state alcohol policies were associated with lower cancer mortality rates for the six cancer types overall (beta [β] -0.33; 95% confidence interval [CI] -0.59, -0.07), and among men (β -0.45; 95% CI -0.81, -0.10) and women (β -0.21; 95% CI -0.40, -0.02). A 10% increase in the restrictiveness of alcohol policies (based on the mean APS among states) was associated with an 8.5% decrease in rates of combined alcohol-attributable cancers. In all analyses stratified by cancer subtype and sex, the associations were in the hypothesized direction (i.e., more restrictive state policy environments were associated with lower rates of alcohol-attributable cancers), with the exception of laryngeal cancer among women. CONCLUSION Strengthening alcohol policies is a promising prevention strategy for alcohol-related cancer.
Collapse
|
34
|
Graham CJ. Minimum unit pricing for alcohol: Scotland the brave. BMJ 2019; 367:l6105. [PMID: 31649027 DOI: 10.1136/bmj.l6105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Christopher J Graham
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Royal College of Physicians of Edinburgh, Edinburgh EH2 1JQ, UK
| |
Collapse
|
35
|
Zhang CQ, Wong MCY, Zhang R, Hamilton K, Hagger MS. Adolescent sugar-sweetened beverage consumption: An extended Health Action Process Approach. Appetite 2019; 141:104332. [DOI: 10.1016/j.appet.2019.104332] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 06/22/2019] [Accepted: 06/25/2019] [Indexed: 11/28/2022]
|
36
|
O'Donnell A, Anderson P, Jané-Llopis E, Manthey J, Kaner E, Rehm J. Immediate impact of minimum unit pricing on alcohol purchases in Scotland: controlled interrupted time series analysis for 2015-18. BMJ 2019; 366:l5274. [PMID: 31554617 PMCID: PMC6759563 DOI: 10.1136/bmj.l5274] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess the immediate impact of the introduction of minimum unit pricing in Scotland on household alcohol purchases. DESIGN Controlled interrupted time series analysis. SETTING Purchase data from Kantar Worldpanel's household shopping panel for 2015-18. PARTICIPANTS 5325 Scottish households, 54 807 English households as controls, and 10 040 households in northern England to control for potential cross border effects. INTERVENTIONS Introduction of a minimum price of 50p (€0.55; $0.61) per UK unit (6.25p per gram) for the sale of alcohol in Scotland on 1 May 2018. MAIN OUTCOME MEASURES Price per gram of alcohol, number of grams of alcohol purchased from off-trade by households, and weekly household expenditure on alcohol. RESULTS The introduction of minimum unit pricing in Scotland was associated with an increase in purchase price of 0.64p per gram of alcohol (95% confidence interval 0.54 to 0.75), a reduction in weekly purchases of 9.5 g of alcohol per adult per household (5.1 to 13.9), and a non-significant increase in weekly expenditure on alcohol per household of 61p (-5 to 127). The increase in purchase price was higher in lower income households and in households that purchased the largest amount of alcohol. The reduction in purchased grams of alcohol was greater in lower income households and only occurred in the top fifth of households by income that purchased the greatest amount of alcohol, where the reduction was 15 g of alcohol per week (6 to 24). Changes in weekly expenditure were not systematically related to household income but increased with increasing household purchases. CONCLUSIONS In terms of immediate impact, the introduction of minimum unit pricing appears to have been successful in reducing the amount of alcohol purchased by households in Scotland. The action was targeted, in that reductions of purchased alcohol only occurred in the households that bought the most alcohol.
Collapse
Affiliation(s)
- Amy O'Donnell
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne NE2 4AX, UK
| | - Peter Anderson
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne NE2 4AX, UK
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Eva Jané-Llopis
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- ESADE Business School, Ramon Llull University, Barcelona, Spain
| | - Jakob Manthey
- Institute of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne NE2 4AX, UK
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of International Health Projects, Institute for Leadership and Health Management, IM Sechenov First Moscow State Medical University, Moscow, Russian Federation
| |
Collapse
|
37
|
Ventura-Cots M, Ballester-Ferré MP, Ravi S, Bataller R. Public health policies and alcohol-related liver disease. JHEP Rep 2019; 1:403-413. [PMID: 32039391 PMCID: PMC7005647 DOI: 10.1016/j.jhepr.2019.07.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/23/2019] [Accepted: 07/30/2019] [Indexed: 12/11/2022] Open
Abstract
Alcohol-related liver disease (ALD) represents a major public health problem worldwide. According to the World Health Organization, the highest levels of per capita alcohol consumption are observed in countries of the European Region. Alcohol consumption is also alarmingly increasing in developing countries. ALD is one of the main contributors to the burden of alcohol-attributable deaths and disability. In the United States, severe forms of ALD such alcoholic hepatitis have increased in the last decade and in the United Kingdom, three-quarters of liver-related mortality results from alcohol consumption. Besides genetic factors, there is strong evidence that the amount of alcohol consumed plays a major role in the development of advanced ALD. Establishing effective public health policies is therefore mandatory to reduce the burden of ALD. Since the 90s, major public health institutions and governments have developed a variety of policies in order to reduce the harm caused by excessive drinking. These policies encompass multiple factors, from pricing and taxation to advertising regulation. Measures focused on taxation and price regulation have been shown to be the most effective at reducing alcohol-related mortality. However, there are few studies focused on the effect of public policies on ALD. This review article summarises the factors influencing ALD burden and the role of different public health policies.
Collapse
Affiliation(s)
- Meritxell Ventura-Cots
- Center for Liver Diseases, Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Samhita Ravi
- Center for Liver Diseases, Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ramon Bataller
- Center for Liver Diseases, Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
38
|
Katikireddi SV, Beeston C, Millard A, Forsyth R, Deluca P, Drummond C, Eadie D, Graham L, Hilton S, Ludbrook A, McCartney G, Phillips T, Stead M, Ford A, Bond L, Leyland AH. Evaluating possible intended and unintended consequences of the implementation of alcohol minimum unit pricing (MUP) in Scotland: a natural experiment protocol. BMJ Open 2019; 9:e028482. [PMID: 31221890 PMCID: PMC6596978 DOI: 10.1136/bmjopen-2018-028482] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/27/2019] [Accepted: 05/30/2019] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Scotland is the first country to carry out a national implementation of minimum unit pricing (MUP) for alcohol. MUP aims to reduce alcohol-related harms, which are high in Scotland compared with Western Europe, and to improve health equalities. MUP is a minimum retail price per unit of alcohol. That approach targets high-risk alcohol users. This work is key to a wider evaluation that will determine whether MUP continues. There are three study components. METHODS AND ANALYSIS Component 1 sampled an estimated 2800 interviewees at a baseline and each of two follow-ups from four Emergency Departments in Scotland and Northern England. Research nurses administered a standardised survey to assess alcohol consumption and the proportion of attendances that were alcohol-related.Component 2 covered six Sexual Health Clinics with similar timings and country allocation. A self-completion survey gathered information on potential unintended effects of MUP on alcohol source and drug use.Using a natural experiment design and repeated cross-sectional audit, difference between Scotland (intervention) and North England (control) will be tested for outcomes using regression adjusting for differences at baseline. Differential impacts by age, gender and socioeconomic position will be investigated.Component 3 used focus groups with young people and heavy drinkers and interviews with stakeholders before and after MUP implementation. The focus groups will allow exploration of attitudes, experiences and behaviours and the potential mechanisms by which impacts arise. The interviews will help characterise the implementation process. ETHICS AND DISSEMINATION Study components 1 and 2 have been ethically approved by the NHS, and component 3 by the University of Stirling. Dissemination plans include peer-reviewed journal articles, presentations, policy maker briefings and, in view of high public interest and the high political profile of this flagship policy, communication with the public via media engagement and plain language summaries. TRIAL REGISTRATION NUMBER ISRCTN16039407; Pre-results.
Collapse
Affiliation(s)
| | - Clare Beeston
- Scottish Public Health Observatory, NHS Health Scotland, Glasgow, UK
| | - Andrew Millard
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow School of Life Sciences, Glasgow, UK
| | - Ross Forsyth
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow School of Life Sciences, Glasgow, UK
| | | | - Colin Drummond
- Institute of Psychiatry, Kings College London, London, UK
| | - Douglas Eadie
- School of Health Sciences, Institute for Social Marketing, Stirling, UK
| | | | - Shona Hilton
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow School of Life Sciences, Glasgow, UK
| | - Anne Ludbrook
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Gerry McCartney
- Scottish Public Health Observatory, NHS Health Scotland, Glasgow, UK
| | - Thomas Phillips
- Faculty of Health Sciences Institute for Clinical and Applied Health Research (ICAHR), University of Hull, Hull, UK
| | - Martine Stead
- Institute for Social Marketing, University of Stirling and the Open University, Stirling, UK
| | - Allison Ford
- Institute for Social Marketing, University of Stirling, Stirling, UK
| | - Lyndal Bond
- Australian Health Policy Collaboration, Victoria University, Victoria, Australia
| | - Alastair H Leyland
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow School of Life Sciences, Glasgow, UK
| |
Collapse
|
39
|
Myran DT, Chen JT, Bearnot B, Ip M, Giesbrecht N, Rees VW. Alcohol Availability Across Neighborhoods in Ontario Following Alcohol Sales Deregulation, 2013-2017. Am J Public Health 2019; 109:899-905. [PMID: 30998409 DOI: 10.2105/ajph.2019.305014] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objectives. To examine the association between neighborhood socioeconomic status (SES) and alcohol availability before and after deregulation in 2015 of the alcohol market in Ontario, Canada. Methods. We quantified alcohol access by number of alcohol outlets and hours of retail for all 19 964 neighborhoods in Ontario. We used mixed effects regression models to examine the associations between alcohol access and a validated SES index between 2013 and 2017. Results. Following deregulation, the number of alcohol outlets in Ontario increased by 15.0%. Low neighborhood SES was positively associated with increased alcohol access: lower-SES neighborhoods had more alcohol outlets within 1000 meters and were closer to the nearest alcohol outlets. Outlets located in low-SES neighborhoods kept longer hours of operation. Conclusions. We observed a substantial increase in alcohol access in Ontario following deregulation. Access to alcohol was greatest in low-SES neighborhoods and may contribute to established inequities in alcohol harms. Public Health Implications. Placing limits on number of alcohol outlets and the hours of operation in low-SES neighborhoods offers an opportunity to reduce alcohol-related health inequities.
Collapse
Affiliation(s)
- Daniel T Myran
- Daniel T. Myran is with the School of Epidemiology and Public Health, University of Ottawa, Faculty of Medicine, Ottawa, ON. Jarvis T. Chen and Vaughan W. Rees are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Benjamin Bearnot is with the Division of General Internal Medicine, Massachusetts General Hospital, Boston. Michael Ip is with the School of Epidemiology and Public Health, University of Ottawa, Faculty of Medicine. Norman Giesbrecht is with the Institute for Mental Health Policy Research, Center for Addiction and Mental Health, Toronto, ON
| | - Jarvis T Chen
- Daniel T. Myran is with the School of Epidemiology and Public Health, University of Ottawa, Faculty of Medicine, Ottawa, ON. Jarvis T. Chen and Vaughan W. Rees are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Benjamin Bearnot is with the Division of General Internal Medicine, Massachusetts General Hospital, Boston. Michael Ip is with the School of Epidemiology and Public Health, University of Ottawa, Faculty of Medicine. Norman Giesbrecht is with the Institute for Mental Health Policy Research, Center for Addiction and Mental Health, Toronto, ON
| | - Benjamin Bearnot
- Daniel T. Myran is with the School of Epidemiology and Public Health, University of Ottawa, Faculty of Medicine, Ottawa, ON. Jarvis T. Chen and Vaughan W. Rees are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Benjamin Bearnot is with the Division of General Internal Medicine, Massachusetts General Hospital, Boston. Michael Ip is with the School of Epidemiology and Public Health, University of Ottawa, Faculty of Medicine. Norman Giesbrecht is with the Institute for Mental Health Policy Research, Center for Addiction and Mental Health, Toronto, ON
| | - Michael Ip
- Daniel T. Myran is with the School of Epidemiology and Public Health, University of Ottawa, Faculty of Medicine, Ottawa, ON. Jarvis T. Chen and Vaughan W. Rees are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Benjamin Bearnot is with the Division of General Internal Medicine, Massachusetts General Hospital, Boston. Michael Ip is with the School of Epidemiology and Public Health, University of Ottawa, Faculty of Medicine. Norman Giesbrecht is with the Institute for Mental Health Policy Research, Center for Addiction and Mental Health, Toronto, ON
| | - Norman Giesbrecht
- Daniel T. Myran is with the School of Epidemiology and Public Health, University of Ottawa, Faculty of Medicine, Ottawa, ON. Jarvis T. Chen and Vaughan W. Rees are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Benjamin Bearnot is with the Division of General Internal Medicine, Massachusetts General Hospital, Boston. Michael Ip is with the School of Epidemiology and Public Health, University of Ottawa, Faculty of Medicine. Norman Giesbrecht is with the Institute for Mental Health Policy Research, Center for Addiction and Mental Health, Toronto, ON
| | - Vaughan W Rees
- Daniel T. Myran is with the School of Epidemiology and Public Health, University of Ottawa, Faculty of Medicine, Ottawa, ON. Jarvis T. Chen and Vaughan W. Rees are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Benjamin Bearnot is with the Division of General Internal Medicine, Massachusetts General Hospital, Boston. Michael Ip is with the School of Epidemiology and Public Health, University of Ottawa, Faculty of Medicine. Norman Giesbrecht is with the Institute for Mental Health Policy Research, Center for Addiction and Mental Health, Toronto, ON
| |
Collapse
|
40
|
Castillo-Carniglia A, Pear VA, Tracy M, Keyes KM, Cerdá M. Limiting Alcohol Outlet Density to Prevent Alcohol Use and Violence: Estimating Policy Interventions Through Agent-Based Modeling. Am J Epidemiol 2019; 188:694-702. [PMID: 30608509 DOI: 10.1093/aje/kwy289] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 12/12/2018] [Accepted: 12/12/2018] [Indexed: 12/27/2022] Open
Abstract
Increasing alcohol outlet density is well-documented to be associated with increased alcohol use and problems, leading to the policy recommendation that limiting outlet density will decrease alcohol problems. Yet few studies of decreasing problematic outlets and outlet density have been conducted. We estimated the association between closing alcohol outlets and alcohol use and alcohol-related violence, using an agent-based model of the adult population in New York City. The model was calibrated according to the empirical distribution of the parameters across the city's population, including the density of on- and off-premise alcohol outlets. Interventions capped the alcohol outlet distribution at the 90th to the 50th percentiles of the New York City density, and closed 5% to 25% of outlets with the highest levels of violence. Capping density led to a lower population of light drinkers (42.2% at baseline vs. 38.1% at the 50th percentile), while heavy drinking increased slightly (12.0% at baseline vs. 12.5% at the 50th percentile). Alcohol-related homicides and nonfatal violence remained unchanged. Closing the most violent outlets was not associated with changes in alcohol use or related problems. Results suggest that focusing solely on closing alcohol outlets might not be an effective strategy to reduce alcohol-related problems.
Collapse
Affiliation(s)
- Alvaro Castillo-Carniglia
- Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Chile, Santiago, Chile
- Violence Prevention Research Program, Department of Emergency Medicine, University of California, Davis, Sacramento, California
| | - Veronica A Pear
- Violence Prevention Research Program, Department of Emergency Medicine, University of California, Davis, Sacramento, California
| | - Melissa Tracy
- Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, Albany, New York
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Magdalena Cerdá
- Violence Prevention Research Program, Department of Emergency Medicine, University of California, Davis, Sacramento, California
- Department of Population Health, New York University School of Medicine, New York, New York
| |
Collapse
|
41
|
Fergie G, Leifeld P, Hawkins B, Hilton S. Mapping discourse coalitions in the minimum unit pricing for alcohol debate: a discourse network analysis of UK newspaper coverage. Addiction 2019; 114:741-753. [PMID: 30475418 PMCID: PMC6492293 DOI: 10.1111/add.14514] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 06/07/2018] [Accepted: 11/02/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Minimum unit pricing (MUP) for alcohol was introduced in Scotland on 1 May 2018, and is now on the policy agenda in other devolved administrations and at Westminster. Previous research has explored the arguments deployed for and against MUP, but the congruence between actors in the MUP debate has not been sufficiently examined. This study identified and mapped the discourse coalitions that emerged in the UK MUP debate through an analysis of actors' use of arguments in media coverage of the policy debates. DESIGN A sample of print media coverage of MUP was obtained from the LexisNexis newspaper database. The resulting sample was imported into discourse network analysis (DNA) software for coding and subsequent visualization of actor networks. SETTING United Kingdom. OBSERVATIONS A total of 348 articles from eight UK-wide and three Scottish newspapers from an 18-month period, ending in November 2012, were analysed. MEASUREMENTS Actors' arguments were coded to generate structured data for conversion into a weighted actor network where ties represent similarities among actors in terms of arguments in support of or opposition to MUP. FINDINGS Two polarized discourse coalitions, Opponents and Proponents of MUP, emerged in media coverage. The Proponents coalition consisted mainly of health advocacy groups, charities, political parties and academic institutions. In the Opponents coalition, the networks were formed of key alcohol manufacturers and economic think-tanks. While producer organizations were central to the Opponents coalition, some commercial actors were more favourable to MUP, highlighting divisions within the industry overall. CONCLUSIONS Media coverage of minimum unit pricing (MUP) in Scotland from June 2011 to November 2012 showed alignment between the policy positions of (1) alcohol producers and think-tanks opposed to MUP; and (2) public health advocates and health charities in favour of the policy. Some alcohol industry actors were supportive of MUP indicating divisions among the industry. Discourse network analysis may be usefully applied to study other highly contested policy issues in health and beyond.
Collapse
Affiliation(s)
- Gillian Fergie
- MRC/CSO Social and Public Health Sciences UnitUniversity of GlasgowGlasgowUK
| | - Philip Leifeld
- Department of Government, University of Essex; and School of Social and Political SciencesUniversity of GlasgowGlasgowUK
| | - Ben Hawkins
- Faculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Shona Hilton
- MRC/CSO Social and Public Health Sciences UnitUniversity of GlasgowGlasgowUK
| |
Collapse
|
42
|
Ludbrook A. Fiscal measures to promote healthier choices: an economic perspective on price-based interventions. Public Health 2019; 169:180-187. [PMID: 30904321 DOI: 10.1016/j.puhe.2019.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 11/21/2018] [Accepted: 02/04/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Non-communicable diseases strongly linked to lifestyle factors create an increasing burden of disease. Fiscal interventions (tax and subsidy) are one approach to improving lifestyles, but their effective design might be improved. ECONOMIC FRAMEWORK Conventional economic theory suggests that fiscal interventions are only used to correct prices for externalities (costs or benefits imposed on others). These can be difficult to calculate accurately. Fiscal interventions operate by altering the prices that consumers face. Price increases are predicted to reduce demand, and the size of the effect is measured by the price elasticity. Tax changes may not translate directly into price changes, however. EVIDENCE FOR THE EFFECT OF TAXES, SUBSIDIES AND PRICES There is strong evidence for the effectiveness of taxation in relation to reducing tobacco and alcohol consumption and resulting harms. There has been less evaluation of taxation in relation to other unhealthy behaviors or of subsidies to promote healthy behaviors. DISCUSSION Fiscal levers have been used as interventions to improve health rather than for market correction. Taking account of behavioral insights may improve the design of fiscal interventions and combining interventions may increase effectiveness. CONCLUSION Both types of intervention have a role in improving health, but there may be challenges in promoting uptake of healthy behaviors.
Collapse
Affiliation(s)
- A Ludbrook
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK.
| |
Collapse
|
43
|
Stockwell T, Sherk A, Norström T, Angus C, Ramstedt M, Andréasson S, Chikritzhs T, Gripenberg J, Holder H, Holmes J, Mäkelä P. Estimating the public health impact of disbanding a government alcohol monopoly: application of new methods to the case of Sweden. BMC Public Health 2018; 18:1400. [PMID: 30577827 PMCID: PMC6303908 DOI: 10.1186/s12889-018-6312-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 12/07/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Government alcohol monopolies were created in North America and Scandinavia to limit health and social problems. The Swedish monopoly, Systembolaget, reports to a health ministry and controls the sale of all alcoholic beverages with > 3.5% alcohol/volume for off-premise consumption, within a public health mandate. Elsewhere, alcohol monopolies are being dismantled with evidence of increased consumption and harms. We describe innovative modelling techniques to estimate health outcomes in scenarios involving Systembolaget being replaced by 1) privately owned liquor stores, or 2) alcohol sales in grocery stores. The methods employed can be applied in other jurisdictions and for other policy changes. METHODS Impacts of the privatisation scenarios on pricing, outlet density, trading hours, advertising and marketing were estimated based on Swedish expert opinion and published evidence. Systematic reviews were conducted to estimate impacts on alcohol consumption in each scenario. Two methods were applied to estimate harm impacts: (i) alcohol attributable morbidity and mortality were estimated utilising the International Model of Alcohol Harms and Policies (InterMAHP); (ii) ARIMA methods to estimate the relationship between per capita alcohol consumption and specific types of alcohol-related mortality and crime. RESULTS Replacing government stores with private liquor stores (Scenario 1) led to a 20.0% (95% CI, 15.3-24.7) increase in per capita consumption. Replacement with grocery stores (Scenario 2) led to a 31.2% (25.1-37.3%) increase. With InterMAHP there were 763 or + 47% (35-59%) and 1234 or + 76% (60-92%) more deaths per year, for Scenarios 1 and 2 respectively. With ARIMA, there were 850 (334-1444) more deaths per year in Scenario 1 and 1418 more in Scenario 2 (543-2505). InterMAHP also estimated 10,859 or + 29% (22-34%) and 16,118 or + 42% (35-49%) additional hospital stays per year respectively. CONCLUSIONS There would be substantial adverse consequences for public health and safety were Systembolaget to be privatised. We demonstrate a new combined approach for estimating the impact of alcohol policies on consumption and, using two alternative methods, alcohol-attributable harm. This approach could be readily adapted to other policies and settings. We note the limitation that some significant sources of uncertainty in the estimates of harm impacts were not modelled.
Collapse
Affiliation(s)
- Tim Stockwell
- Canadian Institute for Substance Use Research (CISUR), Department of Psychology, University of Victoria, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2 Canada
| | - Adam Sherk
- Canadian Institute for Substance Use Research (CISUR), Social Dimensions of Health Program, University of Victoria, Victoria, BC Canada
| | - Thor Norström
- Swedish Institute for Social Research, Stockholm University, Stockholm, Sweden
| | | | - Mats Ramstedt
- The Swedish Council for Information on Alcohol and Other Drugs (CAN), Stockholm, Sweden
| | - Sven Andréasson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Tanya Chikritzhs
- Health Sciences, National Drug Research Institute, Curtin University, Perth, Australia
| | - Johanna Gripenberg
- Department of Clinical Neuroscience, Stockholm Prevents Alcohol and Drug Problems (STAD), Karolinska Institutet, Stockholm, Sweden
| | - Harold Holder
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA USA
| | | | - Pia Mäkelä
- National Institute for Health and Welfare, Helsinki, Finland
| |
Collapse
|
44
|
Williams R, Alexander G, Aspinall R, Batterham R, Bhala N, Bosanquet N, Severi K, Burton A, Burton R, Cramp ME, Day N, Dhawan A, Dillon J, Drummond C, Dyson J, Ferguson J, Foster GR, Gilmore I, Greenberg J, Henn C, Hudson M, Jarvis H, Kelly D, Mann J, McDougall N, McKee M, Moriarty K, Morling J, Newsome P, O'Grady J, Rolfe L, Rice P, Rutter H, Sheron N, Thorburn D, Verne J, Vohra J, Wass J, Yeoman A. Gathering momentum for the way ahead: fifth report of the Lancet Standing Commission on Liver Disease in the UK. Lancet 2018; 392:2398-2412. [PMID: 30473364 DOI: 10.1016/s0140-6736(18)32561-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/04/2018] [Accepted: 10/10/2018] [Indexed: 02/06/2023]
Abstract
This report presents further evidence on the escalating alcohol consumption in the UK and the burden of liver disease associated with this major risk factor, as well as the effects on hospital and primary care. We reiterate the need for fiscal regulation by the UK Government if overall alcohol consumption is to be reduced sufficiently to improve health outcomes. We also draw attention to the effects of drastic cuts in public services for alcohol treatment, the repeated failures of voluntary agreements with the drinks industry, and the influence of the industry through its lobbying activities. We continue to press for reintroduction of the alcohol duty escalator, which was highly effective during the 5 years it was in place, and the introduction of minimum unit pricing in England, targeted at the heaviest drinkers. Results from the introduction of minimum unit pricing in Scotland, with results from Wales to follow, are likely to seriously expose the weakness of England's position. The increasing prevalence of obesity-related liver disease, the rising number of people diagnosed with type 2 diabetes and its complications, and increasing number of cases of end-stage liver disease and primary liver cancers from non-alcoholic fatty liver disease make apparent the need for an obesity strategy for adults. We also discuss the important effects of obesity and alcohol on disease progression, and the increased risk of the ten most common cancers (including breast and colon cancers). A new in-depth analysis of the UK National Health Service (NHS) and total societal costs shows the extraordinarily large expenditures that could be saved or redeployed elsewhere in the NHS. Excellent results have been reported for new antiviral drugs for hepatitis C virus infection, making elimination of chronic infection a real possibility ahead of the WHO 2030 target. However, the extent of unidentified cases remains a problem, and will also apply when new curative drugs for hepatitis B virus become available. We also describe efforts to improve standards of hospital care for liver disease with better understanding of current service deficiencies and a new accreditation process for hospitals providing liver services. New commissioning arrangements for primary and community care represent progress, in terms of effective screening of high-risk subjects and the early detection of liver disease.
Collapse
Affiliation(s)
| | | | | | - Rachel Batterham
- National Institute of Health Research, UCLH Biomedical Research Centre, London, UK
| | - Neeraj Bhala
- Queen Elizabeth Hospital Birmingham and University of Birmingham, Edgbaston, Birmingham, UK
| | - Nick Bosanquet
- Department of Bioengineering, Imperial College London, London, UK
| | | | - Anya Burton
- Hepatocellular Carcinoma UK and National Cancer Registration and Analysis Service, Public Health England, Bristol, UK
| | | | - Matthew E Cramp
- Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | | | | | - John Dillon
- Medical Research Institute, University of Dundee, Dundee, UK
| | - Colin Drummond
- Institute of Psychiatry, Psychology & Neuroscience, King's College London and South London and Maudsley NHS Foundation Trust, London, UK
| | | | - James Ferguson
- National Institute for Health Research Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Graham R Foster
- Barts Liver Centre, Queen Mary University of London, London, UK
| | | | | | | | | | - Helen Jarvis
- Institute of Health and Society, Newcastle University, Newcastle, UK; The Royal College of General Practitioners, London, UK
| | - Deirdre Kelly
- Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Jake Mann
- Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | | | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Joanne Morling
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK; Nottingham Digestive Diseases Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Philip Newsome
- National Institute for Health Research, Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | | | | | - Peter Rice
- Scottish Health Action on Alcohol Problems (SHAAP), Bath, UK
| | | | - Nick Sheron
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton, Southampton, UK
| | | | | | - Jyotsna Vohra
- Cancer Policy Research Centre, Cancer Research UK, London
| | - John Wass
- Department of Endocrinology, Churchill Hospital, Oxford, UK
| | | |
Collapse
|
45
|
Maheswaran R, Green MA, Strong M, Brindley P, Angus C, Holmes J. Alcohol outlet density and alcohol related hospital admissions in England: a national small-area level ecological study. Addiction 2018; 113:2051-2059. [PMID: 30125420 PMCID: PMC6220934 DOI: 10.1111/add.14285] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 03/06/2018] [Accepted: 05/29/2018] [Indexed: 12/02/2022]
Abstract
BACKGROUND AND AIMS Excessive alcohol consumption has a substantial impact on public health services. A key element determining alcohol availability is alcohol outlet density. This study investigated the relationship between on-trade and off-trade outlets and hospital admission rates in local neighbourhoods. DESIGN National small-area level ecological study. SETTING AND PARTICIPANTS All 32 482 lower layer super output census areas (LSOAs) in England (42 227 108 million people aged 15+ years). Densities for six outlet categories (outlets within a 1-km radius of residential postcode centroids, averaged for all postcodes within each LSOA) were calculated. MEASUREMENTS Main outcome measures were admissions due to acute or chronic conditions wholly or partially attributable to alcohol consumption from 2002/03 to 2013/14. FINDINGS There were 1 007 137 admissions wholly, and 2 153 874 admissions partially, attributable to alcohol over 12 years. After adjustment for confounding, higher densities of on-trade outlets (pubs, bars and nightclubs; restaurants licensed to sell alcohol; other on-trade outlets) and convenience stores were associated with higher admission rate ratios for acute and chronic wholly attributable conditions. For acute wholly attributable conditions, admission rate ratios were 13% (95% confidence interval = 11-15%), 9% (7-10%), 12% (10-14%) and 10% (9-12%) higher, respectively, in the highest relative to the lowest density categories by quartile. For chronic wholly attributable conditions, rate ratios were 22% (21-24%), 9% (7-11%), 19% (17-21%) and 7% (6-9%) higher, respectively. Supermarket density was associated with modestly higher acute and chronic admissions but other off-trade outlet density was associated only with higher admissions for chronic wholly attributable conditions. For partially attributable conditions, there were no strong patterns of association with outlet densities. CONCLUSIONS In England, higher densities of several categories of alcohol outlets appear to be associated with higher hospital admission rates for conditions wholly attributable to alcohol consumption.
Collapse
Affiliation(s)
- Ravi Maheswaran
- Public Health GIS Unit, School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - Mark A. Green
- Department of Geography and PlanningUniversity of LiverpoolLiverpoolUK
| | - Mark Strong
- Public Health GIS Unit, School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - Paul Brindley
- Department of LandscapeUniversity of SheffieldSheffieldUK
| | - Colin Angus
- Sheffield Alcohol Research Group, School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - John Holmes
- Sheffield Alcohol Research Group, School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| |
Collapse
|
46
|
EASL Clinical Practice Guidelines: Management of alcohol-related liver disease. J Hepatol 2018; 69:154-181. [PMID: 29628280 DOI: 10.1016/j.jhep.2018.03.018] [Citation(s) in RCA: 477] [Impact Index Per Article: 79.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 03/20/2018] [Indexed: 12/12/2022]
|
47
|
Gill J, Black H, Rush R, O'May F, Chick J. Heavy Drinkers and the Potential Impact of Minimum Unit Pricing-No Single or Simple Effect? Alcohol Alcohol 2018; 52:722-729. [PMID: 29016713 DOI: 10.1093/alcalc/agx060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 08/09/2017] [Indexed: 12/15/2022] Open
Abstract
Aims To explore the potential impact of a minimum unit price (MUP: 50 pence per UK unit) on the alcohol consumption of ill Scottish heavy drinkers. Methods Participants were 639 patients attending alcohol treatment services or admitted to hospital with an alcohol-related condition. From their reported expenditure on alcohol in their index week, and assuming this remained unchanged, we estimated the impact of a MUP (50 ppu) on future consumption. (Around 15% purchased from both the more expensive on-sale outlets (hotels, pubs, bars) and from off-sales (shops and supermarkets). For them we estimated the change in consumption that might follow MUP if (i) they continued this proportion of 'on-sales' purchasing or (ii) their reported expenditure was moved entirely to off-sale purchasing (to maintain consumption levels)). Results Around 69% of drinkers purchased exclusively off-sale alcohol at <50 ppu. Their drinking, post MUP, may reduce by a mean of 33%. For this group, from a population of very heavy, ill consumers, we were unable to show a differential effect across multiple deprivation quintiles. For other drinkers there might be no reduction, especially if after MUP there were many products priced close to 50 ppu. Moving away from on-sales purchases could support, for some, an increase in consumption. Conclusions While a proportion of our harmed, heavy drinkers might be able to mitigate the impact of MUP by changing purchasing habits, the majority are predicted to reduce purchasing. This analysis, focusing specifically on harmed drinkers, adds a unique dimension to the evidence base informing current pricing policy. Short Summary From drink purchasing data of heavy drinkers, we estimated the impact of legislating £0.50 minimum unit price. Over two thirds of drinkers, representing all multiple deprivation quintiles, were predicted to decrease alcohol purchasing; remainder, hypothetically, could maintain consumption. Our data address an important gap within the evidence base informing policy.
Collapse
Affiliation(s)
- J Gill
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, EH11 4BN, Scotland, UK
| | - H Black
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, EH11 4BN, Scotland, UK
| | - R Rush
- School of Health Sciences, Queen Margaret University Edinburgh, EH21 6UU, Scotland, UK
| | - F O'May
- School of Health Sciences, Queen Margaret University Edinburgh, EH21 6UU, Scotland, UK
| | - J Chick
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, EH11 4BN, Scotland, UK
| |
Collapse
|
48
|
Keatley DA, Hardcastle SJ, Carragher N, Chikritzhs TN, Daube M, Lonsdale A, Hagger MS. Attitudes and beliefs towards alcohol minimum pricing in Western Australia. Health Promot Int 2018; 33:400-409. [PMID: 28011651 DOI: 10.1093/heapro/daw092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Modelling data have provided good evidence to support the efficacy of a minimum pricing policy for alcoholic beverages as a means to reduce alcohol consumption and risky and harmful drinking. The aim of the present study was to investigate attitudes and beliefs towards a minimum price policy for alcohol among members of the general public in Western Australia (WA). The study also explored what factors might promote acceptance of the policy. Eleven focus groups, comprising participants from a broad range of backgrounds in WA, were conducted. Using a facilitator-administered semi-structured interview schedule participants discussed their beliefs about the policy and how its acceptability might be promoted. Transcriptions of discussions were analysed using qualitative inductive content analysis for emergent themes. Three major themes emerged: attitudes towards the policy, beliefs about effectiveness and strategies to increase acceptability. Participants expressed negative attitudes towards the policy and thought that it would lead to increased crime, drug use and financial strain. Participants identified the policy as unfair on disadvantaged groups, and suggested that individuals would find a way to procure alcohol regardless of minimum pricing policies. Suggestions to make the policy more acceptable included increasing alcohol education and directing the revenue towards alcohol reduction initiatives. Participants' negative views and perceived lack of effectiveness corroborate research conducted in the UK. Information and education campaigns aimed at reducing misunderstanding of the policy and highlighting its effectiveness may help to promote greater acceptability.
Collapse
Affiliation(s)
- David A Keatley
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Sarah J Hardcastle
- Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Natacha Carragher
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | | | - Mike Daube
- Public Health Advocacy Institute, Curtin University, Perth, Australia
| | - Adam Lonsdale
- Department of Psychology, Oxford Brookes University, Oxford, UK
| | - Martin S Hagger
- Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Faculty of Health Sciences, Curtin University, Perth, Australia.,Department of Sports Sciences, University of Jyväskylä, Jyväskylä, Finland.,School of Applied Psychology, Menzies Health Institute, Griffith University, Nathan, Australia.,School of Human, Health, and Social Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| |
Collapse
|
49
|
Sassi F, Belloni A, Mirelman AJ, Suhrcke M, Thomas A, Salti N, Vellakkal S, Visaruthvong C, Popkin BM, Nugent R. Equity impacts of price policies to promote healthy behaviours. Lancet 2018; 391:2059-2070. [PMID: 29627166 PMCID: PMC6642722 DOI: 10.1016/s0140-6736(18)30531-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 01/28/2018] [Accepted: 01/31/2018] [Indexed: 12/21/2022]
Abstract
Governments can use fiscal policies to regulate the prices and consumption of potentially unhealthy products. However, policies aimed at reducing consumption by increasing prices, for example by taxation, might impose an unfair financial burden on low-income households. We used data from household expenditure surveys to estimate patterns of expenditure on potentially unhealthy products by socioeconomic status, with a primary focus on low-income and middle-income countries. Price policies affect the consumption and expenditure of a larger number of high-income households than low-income households, and any resulting price increases tend to be financed disproportionately by high-income households. As a share of all household consumption, however, price increases are often a larger financial burden for low-income households than for high-income households, most consistently in the case of tobacco, depending on how much consumption decreases in response to increased prices. Large health benefits often accrue to individual low-income consumers because of their strong response to price changes. The potentially larger financial burden on low-income households created by taxation could be mitigated by a pro-poor use of the generated tax revenues.
Collapse
Affiliation(s)
- Franco Sassi
- Centre for Health Economics and Policy Innovation, Imperial College Business School, London, UK.
| | | | | | - Marc Suhrcke
- University of York, York, UK; Luxembourg Institute of Socio-Economic Research, Esch-sur-Alzette, Luxembourg
| | - Alastair Thomas
- Organisation for Economic Co-operation and Development, Paris, France
| | | | | | | | - Barry M Popkin
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rachel Nugent
- Research Triangle Institute International, Seattle, WA, USA
| |
Collapse
|
50
|
Robinson M, Bouttell J, Lewsey J, Mackay D, McCartney G, Beeston C. The short-term impact of the alcohol act on alcohol-related deaths and hospital admissions in Scotland: a natural experiment. Addiction 2018; 113:429-439. [PMID: 28876499 PMCID: PMC5836928 DOI: 10.1111/add.14019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 02/27/2017] [Accepted: 08/18/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIM The introduction of the Alcohol Act in Scotland on 1 October 2011, which included a ban on multi-buy promotions, was probably associated with a fall in off-trade alcohol sales in the year after its implementation. The aim of this study was to test if the same legislation was associated with reduced levels of alcohol-related deaths and hospital admissions in the 3-year period after its introduction. DESIGN A natural experiment design using time-series data to assess the impact of the Alcohol Act legislation in Scotland. Comparisons were made with unexposed populations in the rest of Great Britain. SETTING Scotland with comparable data obtained for geographical control groups in other parts of Great Britain. PARTICIPANTS For alcohol-related deaths, a total of 17 732 in Scotland and 88 001 in England and Wales throughout 169 4-week periods between January 2001 and December 2013 and for alcohol-related hospital admissions, a total of 121 314 in Scotland and 696 892 in England throughout 182 4-week periods between January 2001 and December 2014. MEASUREMENTS Deaths and hospital admissions in Scotland and control groups that were wholly attributable to alcohol for consecutive 4-week periods between January 2001 and December 2014. Data were obtained by age, sex and area-based socio-economic position. FINDINGS There was no evidence to suggest that the Alcohol Act was associated with changes in the overall rate of alcohol-related deaths [incidence rate ratio (IRR) = 0.99, 95% confidence interval (CI) = 0.91-1.07)] or hospital admissions (IRR = 0.98, 95% CI = 0.95-1.02) in Scotland. In control group analyses, the pseudo intervention variable was not associated with a change in alcohol-related death rates in England/Wales (IRR = 0.99, 95% CI = 0.95-1.02), but was associated with an increase in alcohol-related hospital admission rates in England (IRR = 1.05, 95% CI = 1.03-1.07). In combined models, the interaction analysis did not provide support for a 'net effect' of the legislation on alcohol-related deaths in Scotland compared with England/Wales (IRR 0.99, 95% CI = 0.95-1.04), but suggested a net reduction in hospital admissions for Scotland compared with England (IRR = 0.93, 95% CI = 0.87-0.98). CONCLUSION The implementation of the Alcohol Act in Scotland has not been associated clearly with a reduction in alcohol-related deaths or hospital admissions in the 3-year period after it was implemented in October 2011.
Collapse
Affiliation(s)
- Mark Robinson
- Public Health Science DirectorateNHS Health ScotlandGlasgowUK
| | - Janet Bouttell
- Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - James Lewsey
- Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - Daniel Mackay
- Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - Gerry McCartney
- Public Health Science DirectorateNHS Health ScotlandGlasgowUK
| | - Clare Beeston
- Public Health Science DirectorateNHS Health ScotlandGlasgowUK
| |
Collapse
|