The hidden impact of alcohol on young victims: an analysis of alcohol-related police offences resulting in hospitalisation

BACKGROUND

Alcohol-related harm (ARH) is a significant public health concern affecting young individuals, particularly those involved in alcohol-related police incidents resulting in hospitalisation. However, the impact of alcohol on young victims remains under researched. This study aimed to identify the characteristics of offenders and victims involved in these incidents, analyse the types of offences, and understand the under-ascertainment of ARH in hospital records.

METHODS

A retrospective longitudinal study of 12-24-year-olds born between 1980 and 2005 was conducted using linked data from hospital admissions, emergency department presentations, and police incident records. Alcohol-related incidents were identified based on the attending officers' opinions in the Western Australia Police's Incident Management System (IMS). Logistic and log-binomial regression were utilised to analyse the factors associated with victimisation and under-ascertainment of ARH.

RESULTS

Our study included 22,747 individuals (11,433 victims and 11,314 offenders) involved in alcohol-related police incidents, with a small majority of victims being female (53%, n = 6,074) and a large majority of offenders being male (84.3%, n = 9,532). Most victims did not receive a diagnosis of ARH (71%, n = 760). Women were 10 times more likely to have been a victim in ARH police incidents and 2 times more likely to have an undiagnosed alcohol-related hospital admission than men. Victims and offenders predominantly came from disadvantaged areas and major cities. Aboriginal individuals were overrepresented as both offenders and victims. A significant proportion of individuals experienced emergency department presentations or hospital admissions, with head injuries being the most common. Assault causing bodily harm was the most prevalent offence resulting in hospitalisation (66%, n = 2,018).

CONCLUSIONS

There is a noteworthy disparity between the quantity of hospital admissions attributed to alcohol-related incidents and the number of cases that are formally classified as ARH in the hospital system. This disparity highlights a more profound issue of substantial under-ascertainment or inadequate identification of ARH than previously acknowledged. Our findings justify the prioritisation of prevention strategies, beyond improvement in the documentation of alcohol-related hospitalisation. Considering the scale of the problem, and the underestimation of the burden of alcohol-related hospitalisation, a proportional increase in investment is necessary to achieve population-level reductions in ARH.

How effective are health messages/warnings in improving knowledge and awareness of alcohol-related harm? The Slovenian case on using a mobile app

BACKGROUND

Consumers generally lack access to information on alcoholic beverages, in spite of it being readily available for food and non-alcoholic beverages. Given the rights of consumers, and as with other products harmful to the population, there have been increasing calls for health warnings to be placed on alcoholic beverages, similar to those implemented on tobacco products. The aim of our research was to assess whether knowledge and awareness of the risks and harms associated with alcohol can be improved with a mobile app.

METHODS

Intervention was conducted using VKJ mobile app, which enables users to scan the barcode of an alcoholic beverage and receive feedback on its labelled alcohol content and estimated energy value. At each search, eleven different health messages/warnings about the risks and harms of alcohol are also displayed randomly, rotating on the screen. A survey was conducted before and after the intervention, to assess the knowledge and awareness of the risks and harms associated with drinking alcohol.

RESULTS

Significant differences were found for eight of the twelve tested statements. The improvement was seen to a greater extent in the group of high-risk drinkers. The results also showed that the vast majority of participants (78%) who were exposed to the health messages supported mandatory labelling of alcoholic beverages with information on ingredient listing and energy value, and 72% would like to have health warnings on alcohol products.

CONCLUSIONS

The use of a mobile app can be an option to improve knowledge and raise awareness of the risks and harms related to alcohol.

"It's like a safety net for when things go wrong": key stakeholder and program user perspectives on a peer-led safe space program in Sydney, Australia

BACKGROUND

Safe Spaces are a harm reduction approach commonly utilised in nightlife and festival settings to address alcohol and other drug-related harms. Despite increasing use, there has been little independent evaluation of safe space programs. This study aimed to explore (1) program user satisfaction with and use of a safe space program implemented in Sydney, Australia (The Take Kare Safe Space (TKSS)), and (2) the strengths and weaknesses of TKSS from the perspective of key stakeholders.

METHODS

Semi-structured, in-depth, interviews lasting between 30 min to 1 h were conducted with 38 key program stakeholders, including staff from police (n = 4), ambulance (n = 4), a local hospital accident and emergency room (n = 4), local council (n = 2), city 'rangers' (n = 2), the TKSS program (n = 4), licensed venues and other nightlife service providers (n = 4), and program users (n = 14). Purposive sampling was used to identify key stakeholders to participate in interviews.

RESULTS

Stakeholders stated that the TKSS program had a number of core benefits, including that it filled a service gap in nightlife settings; improved the efficiency and effectiveness of emergency services and other stakeholders operating in nightlife precincts; provided welfare services through proactive and non-judgmental interventions; and facilitated a means to de-escalate conflict without engaging police. Perceived weaknesses of the program included a lack of public awareness about the program; staff and volunteer levels; and misunderstandings regarding the scope and function of the TKSS program by some stakeholders.

CONCLUSION

This study demonstrates the complex relationships that exist around the delivery of harm reduction in nightlife settings. In particular, it highlights the relative lack of servicing of public nightlife settings and the value of safe spaces/peer-to-peer safety ambassador programs in linking up care and filling this service gap. Further, it documents the extended benefit across key stakeholder groups of delivering proactive and non-judgemental harm reduction services and, in doing so, provides critical evidence around their efficacy in reducing AOD-related harms in the night-time economy.

Socioeconomic inequalities in alcohol-related harm in adolescents: a prospective cohort study of 68,299 Danish 15-19-year-olds

Background

Evidence shows that similar levels of alcohol consumption lead to greater harm in adults with low socioeconomic position (SEP) compared to high SEP. We investigated if SEP is associated with alcohol-related hospital contacts in adolescents, and whether differences in risk can be explained by differences in levels of alcohol consumption, drinking pattern, and substance use.

Methods

This is a prospective cohort study of 68,299 participants aged 15-19 years old from the Danish National Youth Cohort 2014. SEP was operationalised as parent educational level, family income and perceived financial strain in the family. Data were linked to national registers and participants were followed up for five years from 2014 to 2019. Outcomes were hospital contacts due to alcohol. Multilevel Poisson regression was used to estimate incidence rates (IR) and incidence rate ratios (IRR).

Findings

During 280,010 person years of follow-up, 872 participants had an alcohol-attributable hospital contact; intoxications (n = 778, 89%) were the most common diagnosis. Low as compared to high SEP was associated with higher IRR of alcohol-attributable hospital contacts for all three SEP measures. The adjusted IRR of harm was 1.73 (95% CI: 1.29-2.33) for elementary school as the highest parent education compared to longer parent education and 1.57 (95% CI: 1.30-1.89) for family financial strain compared to those without financial strain. Adjustment for weekly alcohol intake, drinking pattern and substance use did not substantially change results. Cubic spline analysis of the association between family income and alcohol-attributable hospital contacts revealed a dose-response relationship with decreasing risk of alcohol-related harm with higher income.

Interpretation

Our findings suggested that alcohol-related harm is more common in socioeconomically disadvantaged adolescents despite similar levels of alcohol consumption, regardless of differences in drinking pattern or substance use. Future preventive strategies should prioritise young adolescents, including those who are most disadvantaged.

Funding

Tryg Foundation (ID: 153539).

Externalizing and internalizing problems as predictors of alcohol-related harm and binge drinking in early adolescence: The role of gender

BACKGROUND

Externalizing problems are commonly associated with alcohol outcomes in adolescence. Nevertheless, findings regarding internalizing problems are mixed, and fewer longitudinal studies have considered the both problems concomitantly and the role of gender. We examined the role of externalizing and internalizing problems in predicting adolescent alcohol-related harm and binge drinking, taking into account the gender differences. We also evaluated if externalizing problems could moderate the association between internalizing problems and alcohol outcomes.

METHOD

We used longitudinal data from 2368 8th grade students across 37 public schools in three Brazilian cities. Linear and logistic regressions were performed to analyze the association between alcohol outcomes and the independent variables (externalization and internalization scores, and sociodemographic variables) according to gender. We also tested the same model with an interaction term between externalizing*internalizing.

RESULTS

Our results suggest that externalizing problems predict adolescents' binge drinking in both genders; it also may predict adolescents' alcohol-related harms, but only in boys. Internalizing problems seem to be a gender-specific risk factor for binge drinking among girls. All findings are independent of comorbid problems and sociodemographic variables.

LIMITATION

The findings should be considered taking into account the short follow-up period from risk factors to the outcomes.

CONCLUSION

Our results highlight the contribution of internalizing and externalizing problems to the development of alcohol-related harm and binge drinking in early adolescence and the need for interventions to prevent early behavioral problems that consider the role played by gender.

Decline in youth drinking in high-income settings: Implications for public health in low-income countries

Declining drinking among youth in many high-income countries has attracted scholarly attention and debates. Still, researchers are yet to globalize such research or examine its public health implications for low-resource settings. This commentary has two interrelated purposes. First, using evidence from Nigeria, it highlights how declining youth drinking in high-income countries may impact public health in low-income countries. Second, it highlights the necessity for research to examine youth drinking behaviours simultaneously worldwide. The declining drinking trends among young people in high-income countries have occurred simultaneously with global alcohol corporations being more aggressive in low-income countries like Nigeria. Relatedly, alcohol corporations may employ evidence regarding declines in drinking to argue against implementing stringent policies or other effective interventions in Nigeria (and other low-income settings), claiming their apparent success in the falling drinking trends in high-income settings. The article argues that research on the drinking decline among young people should be globalized because without commensurate attempts to examine their drinking behaviours/trends worldwide simultaneously, public and/or global health may be harmed for the reasons explored in this article.

Yi ethnic minority households in Yunnan Province, China

China is a multi-ethnic country, but inter-ethnic disparities in alcohol-related harm to children have not been described. In this study, we assessed differences in prevalence of self-reported alcohol-related harm to children in Yi and Han households in Chuxiong Yi Prefecture, Yunnan Province, China. We conducted a cross-sectional study among caregivers in households with a child age less than 18 years using structured questionnaire interview. Participants included 241 Yi caregivers and 610 Han caregivers (overall refusal rate = 1.1%). Heavy drinking was more common in Yi households than Han households (41.9% vs. 30.8%, respectively), but there was no difference in alcohol-related harm to children (21.2% vs. 17.9%; Adjusted OR = 0.98; 95% CI = 0.65, 1.46). Caveats such as social desirability in reporting sensitive issues and the cross-sectional study design should be considered in the interpretation of the study findings.

Evaluation of the national sobriety checkpoints program in Mexico: a difference-in-difference approach with variation in timing of program adoption

BACKGROUND

Up to a third of global road traffic deaths, and one in five in Mexico, are attributable to alcohol. In 2013, Mexico launched a national sobriety checkpoints program designed to reduce drink-driving in municipalities with high rates of alcohol-related collisions. Our study measured the association between the sobriety checkpoints program and road traffic mortality rates in 106 urban municipalities.

METHODS

We leveraged data from the Salud Urbana en America Latina (SALURBAL), which compiles health and environmental data from cities with over 100,000 residents. Death data from 2005 to 2019 (i.e., outcome) were from official vital statistics. Among 106 Mexican municipalities defined as priority areas for intervention, 54 adopted the program (i.e., treatment) in 2013, 16 municipalities did so in 2014, 16 in 2015, 10 in 2016, 7 in 2017, and 2 in 2019. We used a difference-in-difference approach with inverse probability weighting adapted to a context where program adoption is staggered over time.

RESULTS

There was a 12.3% reduction in road traffic fatalities per 10,000 passenger vehicles in the post-treatment period compared to the pre-treatment period (95% Confidence Interval, - 17.8; - 6,5). There was a clear trend of decline in mortality in municipalities that adopted the program (vs. comparison) particularly after year 2 of the program.

CONCLUSIONS

In this study of 106 municipalities in Mexico, we found a 12.3% reduction in traffic fatalities associated with the adoption of sobriety checkpoints. There was a clear trend indicating that this association increased over time, which is consistent with sustained changes in drink-driving behavior. These findings provide support and insight for efforts to implement and evaluate the impact of sobriety checkpoint policies across Latin America.

Unmet financial obligations and alcohol-related mortality: A nationwide register-based follow-up study

This study sets out to explore whether experiencing financial indebtedness is related to alcohol-related mortality. For this purpose, people aged between 20 and 64 having a registration date for a debt in the Swedish Enforcement Authority's register during 2015 (n = 48,541) were followed up for a five-year period for alcohol-related mortality and were compared with a sample from the general Swedish population (n = 261,148). On the basis of logistic regression analysis, it is shown that people who had experienced financial indebtedness were almost two and a half times more likely to suffer from alcohol-related death than those who had not lived through this experience (OR = 2.43), controlling for several demographic, socio-economic, and health conditions prior to the date of the registration at the Enforcement Authority. The results provide support for the notion that debt repayment problems may, in itself, be an important indicator to consider in the study of alcohol-related harm. Consequently, debt counselling and other programs directed toward mitigating debt-related stress may play an important role in alleviating the adverse effects of indebtedness.

Fathers' alcohol consumption and risk of substance-related disorders in offspring

BACKGROUND

Few studies have assessed how children are affected by parental alcohol consumption without clinically diagnosed alcohol problems, especially in relation to more long-term and severe consequences. The aim is to investigate how fathers' alcohol use is related to the risk for substance-related disorders in offspring.

METHOD

A prospective cohort study of 64 710 Swedish citizens whose fathers were conscripted for compulsory military training at ages 18-20 in 1969/70. Information on fathers' alcohol consumption, frequency of intoxication and apprehended for drunkenness, was collected during conscription. Offspring was followed for substance-related disorders from age 12 to end of follow up in 2009.

RESULTS

All measures of fathers' alcohol use were significantly and positively associated with risk for substance-related disorders in offspring. The associations were to a large extent explained by other risk factors in childhood. In the fully adjusted model, those with fathers in the highest alcohol consumption quintile still had a 63% higher risk (HR=1.63 CI 1.26-2.12) of substance-related disorders compared to those whose fathers' reported abstinence. The highest risk was found among offspring to fathers with alcohol-related disorders or that had been apprehended for drunkenness, with a more than two-fold increased risk for substance-related disorders.

CONCLUSIONS

Despite the lower risk found among offspring to fathers with sub-clinical drinking when compared to those with alcohol-related disorders, the former group accounts for a much larger proportion of all cases of substance-related disorders in the population, prompting universal prevention efforts targeting the level of total alcohol consumption in society.

Alcohol-related harm in emergency departments: linking to subsequent hospitalizations to quantify under-reporting of presentations

TITLE

Alcohol-related harm in emergency departments: linking to subsequent hospitalizations to quantify under-reporting of presentations.

AIMS

To quantify the proportion of emergency department (ED) presentations that could be identified as alcohol-related when linking to a patient's subsequent hospitalization, compared with using ED data alone, and to assess that comparison according to the change in alcohol harm rates over time and potential variations within subpopulations.

DESIGN

A retrospective study using linked hospital administrative data to identify ED patients who had subsequent alcohol-related hospitalizations.

SETTING

Western Australia.

PARTICIPANTS

A total of 533 816 Western Australian young people (246 866 females and 286 950 males), aged 12-24 years.

MEASUREMENTS

Whether or not presentations of young people to ED could be identified as alcohol-related, and for those that were not, how many had a subsequent alcohol-related hospitalization. Rates and proportions of alcohol-related harm for both methods of ascertainment were estimated by sex and Aboriginality across different age groups.

FINDINGS

Alcohol-related hospitalizations that followed an initial presentation at ED allowed the identification of an additional 19 994 alcohol-related presentations (95% increase). Linking to additional hospitalization information also resulted in significant variation in alcohol-related harm trends. In particular, trends in alcohol-related ED presentations for 21-24-year-old males were stable to slightly increasing using only ED data, but decreased after linking with hospitalization data (P < 0.05). Similarly, trends among Aboriginal persons aged 21-24 shifted from increasing using only ED data to being stable in comparison to presentations using subsequent hospitalizations (P < 0.05).

CONCLUSIONS

Among young people in Western Australia, twice as many emergency department presentations could be identified as being alcohol-related using diagnosis information from subsequent hospitalizations compared with emergency department data alone. When supplemented with hospitalization data, trends in alcohol-related harm presentations become significantly different within some subpopulations compared with using emergency department presentation data alone.

Changes over time in young adults' harmful alcohol consumption: A cross-temporal meta-analysis using the AUDIT

BACKGROUND

Recent studies suggest that young adult participation in, and volume of, alcohol consumption has decreased. However, the evidence on trends in harmful alcohol consumption in this age group is limited. The current paper aims to examine changes over time in harmful alcohol consumption using a robust, widely employed measure.

METHODS

The literature was systematically searched for articles reporting on Alcohol Use Disorders Identification Test (AUDIT) scores in young adults aged 18-24 years. The key data extracted were year of measurement and mean AUDIT score (proportion above clinical cut-off was not relevant for these analyses). Cross-temporal meta-analysis was applied to the extracted data.

RESULTS

A decrease was found in young adults' AUDIT scores measured between 1989 and 2015 (b=-0.13, β=-0.38, p = 0.015, 95 % CI=-0.24, -0.03), representing a 0.63 standard deviation change over this period. Variance did not change over this time, suggesting scores decreased equally over the distribution.

CONCLUSIONS

Results indicate that harmful alcohol consumption in young adults may have declined between 1989 and 2015. Despite the continued problems posed by dependence and short and long-term harms, these promising findings offer hope that the considerable alcohol-related disease burden in this age group may be reduced. Ongoing data collection is required to evaluate whether these declines in young adulthood persist into later life, and future research should explore the reasons for declining harmful alcohol consumption in young adults.

Trends in inequalities of alcohol-related harms among Thai households: 2007-2017

BACKGROUND

To estimate and compare the socio-economic inequities in alcohol-related harms among households in Thailand between 2007 and 2017 adjusted for socioeconomic status with the proportions of current and binge drinkers in each household.

METHODS

A secondary data analysis of the 2007 and 2017 National Cigarette and Alcohol Consumption Survey was conducted. The unit of analysis was household-level. Concentration index (CI) was used to measure household income-based inequalities in alcohol-related harms (i.e., workplace, domestic, non-domestic, financial, and drinking-and-driving) in the previous 12 months.

RESULTS

Based on data from two waves of survey (n = 66,776 in 2007 and 39,630 in 2017), the prevalence of households that had at least one member who had an alcohol-related harm event was 21.8% and 26.2% in 2007 and 2017, respectively. The highest prevalence was the drinking-and-driving domain (about 20%). The prevalence increased between 2007 and 2017 with an annual rate of change ranged from 1.2 to 4.4%. All of the CI values were negative for both survey waves, except the drink-and-driving domain in 2007. The CI values for all domains in 2017 had a larger magnitude than in 2007, except the domestic domain. For any alcohol-related harm, the CI value was not significant at +0.002 (Standard error [SE] 0.004) in 2007, but significant at -0.014 (SE 0.004) in 2017. So, the index changed around -0.016.

CONCLUSIONS

The poor households had a slightly greater tendency to incur harms from alcohol and there existed more inequality in the prevalence of harms in 2017 compared with 2007.

Risk-based licensing of alcohol venues and emergency department injury presentations in two Australian states

BACKGROUND

Risk-based licensing (RBL) is among the more recent policy interventions to reduce alcohol-related harm in and around licensed venues. RBL sets licence fees to reflect the venue's propensity to cause harm as a means of encouraging operators to improve their practices. We assessed whether the introduction of RBL in the Australian states of Queensland and Victoria was associated with a reduction in the incidence of emergency department (ED) injury presentations.

METHODS

We employed an interrupted time series design using Prais-Winsten and Cochrane-Orcutt regression modelling to estimate step and slope parameters in injury incidence rates in each state. We defined the population as residents of the state, aged 15-54 years, the age group we considered most likely to be exposed to the night-time economy. To reduce noise, we confined cases to presentations during times previously identified as correlated with a high probability of alcohol involvement, namely 'high alcohol hours' (HAH). We adjusted our models for the alcopops tax, implemented shortly before RBL, and for assaults during low alcohol hours (LAH) as a proxy for other risk factors for assault.

RESULTS

RBL was not associated with an overall reduction in the incidence of ED injury presentations during HAH in Queensland (β = 0.003; 95% CI: -0.010, 0.003, p = 0.318) or Victoria (β=-0.010; 95% CI: -0.021, 0.001, p = 0.087). Post-hoc subgroup analyses showed a reduction in ED injury presentations among men aged 20-39 years in Victoria (β=-0.026; 95% CI:-0.012, -0.040, p-0.0003) but this was not replicated in Queensland.

CONCLUSION

There was little evidence that RBL affected the incidence of ED presentations for injury. This may be due to weak financial penalties being applied to venues assessed as high-risk.

Randomized controlled trial of harm reduction treatment for alcohol (HaRT-A) for people experiencing homelessness and alcohol use disorder

BACKGROUND

People experiencing homelessness are disproportionately affected by alcohol use disorder (AUD). Abstinence-based treatment, however, does not optimally engage or treat this population. Thus, harm reduction treatment for alcohol (HaRT-A) was developed together with people with lived experience of homelessness and AUD and community-based agencies that serve them. HaRT-A is a compassionate and pragmatic approach that aims to help people reduce alcohol-related harm and improve quality of life (QoL) without requiring abstinence or use reduction. A three-month, two-arm randomized controlled trial was conducted to test the initial efficacy of HaRT-A compared to a services-as-usual control condition.

METHODS

People experiencing homelessness and AUD (N = 168; 24% women) were recruited in community-based clinical and social services settings. Self-reported alcohol use, alcohol-related harm, motivation, and QoL as well as urinary ethyl glucuronide were assessed over a 3-month follow-up. Participants were randomized to receive HaRT-A or services as usual. Over four sessions, HaRT-A interventionists delivered three components: a) collaborative tracking of participant-preferred alcohol metrics, b) elicitation of harm-reduction and QoL goals, and c) discussion of safer-drinking strategies.

RESULTS

Compared to control participants, HaRT-A participants reported significantly greater increases in confidence to engage in harm reduction and decreases in peak alcohol use, alcohol-related harm, AUD symptoms, and positive urinary ethyl glucuronide tests (ps < .05). Findings were inconclusive regarding group differences on QoL (ps > .12).

CONCLUSION

A low-barrier, low-intensity, patient-driven, harm-reduction approach has at least short-term efficacy in improving AUD outcomes in this population. Future studies are needed to establish its longer-term efficacy.

Evaluation of a local government "shelter and van" intervention to improve safety and reduce alcohol-related harm

Background

The entertainment precincts of cities, while contributing to local economies, need to be carefully managed to mitigate harms. Individual behaviours and government regulation have typically been the foci of interventions aimed at reducing alcohol-related harm. Little is known about how changes to the built environment might influence alcohol-related harms in these settings. The aim of this study was to explore how a public shelter and a volunteer-funded and staffed mobile van in a regional city influenced perceptions of safety and reduction in alcohol-related harm.

Methods

An intrinsic case-study approach was used. Document reviews, qualitative interviews with 16 key informants (volunteers, licensees, police, local business owners, patrons, community members and security guards), observation, and secondary data analysis were conducted in 2016. A conceptual framework of the causative pathways linking the drivers of alcohol consumption with social and health outcomes was used to inform the analysis.

Results

The shelter and van were frequently utilised but there was no significant association with a reduction in the proportion of alcohol-related hospital emergency department presentations or police incident reports. Occupational health and safety risks were identified for the volunteers which had no management plan.

Conclusions

The findings highlight the challenge faced by local governments/authorities wanting to provide community-based interventions to complement other evidence-based approaches to reduce alcohol-related harm. Local governments/authorities with restricted regulatory oversight need to collaborate with key agencies for targeted upstream and evidence-based alcohol prevention and management interventions before investing resources. Such approaches are critical for improving community safety as well as health and social outcomes in communities at greatest risk of alcohol-related harm.

Harms from a partner's drinking: an international study on adverse effects and reduced quality of life for women

BACKGROUND

Partners of heavy drinking individuals can be detrimentally affected as a result of their partner's drinking.

OBJECTIVES

The aim of this study was to identify the proportion of heterosexual intimate partner relationships with a heavy drinking male that resulted in reported alcohol-related harm and to investigate the impact of this on well-being in 9 countries.

METHODS

This study used survey data from the Gender and Alcohol's Harm to Others (GENAHTO) Project on Alcohol's Harm to Others in 9 countries (10,613 female respondents, 7,091 with intimate live-in partners). Respondents were asked if their partners drinking had negatively affected them as well as questions on depression, anxiety, and satisfaction with life.

RESULTS

The proportion of partnered respondents that reported having a harmful heavy drinking partner varied across countries, from 4% in Nigeria and the US to 33% in Vietnam. The most consistent correlate of experiencing harm was being oneself a heavy episodic drinker, most likely as a proxy measure for the acceptability of alcohol consumption in social circles. Women with a harmful heavy drinking partner reported significantly lower mean satisfaction with life than those with a partner that did not drink heavily.

CONCLUSIONS

Harms to women from heavy drinking intimate partners appear across a range of subgroups and impact on a wide range of women, at least demographically speaking. Women living with a heavy drinking spouse experience higher levels of anxiety and depression symptoms and lower satisfaction with life.

Harnessing advances in computer simulation to inform policy and planning to reduce alcohol-related harms

OBJECTIVES

Alcohol misuse is a complex systemic problem. The aim of this study was to explore the feasibility of using a transparent and participatory agent-based modelling approach to develop a robust decision support tool to test alcohol policy scenarios before they are implemented in the real world.

METHODS

A consortium of Australia's leading alcohol experts was engaged to collaboratively develop an agent-based model of alcohol consumption behaviour and related harms. As a case study, four policy scenarios were examined.

RESULTS

A 19.5 ± 2.5% reduction in acute alcohol-related harms was estimated with the implementation of a 3 a.m. licensed venue closing time plus 1 a.m. lockout; and a 9 ± 2.6% reduction in incidence was estimated with expansion of treatment services to reach 20% of heavy drinkers. Combining the two scenarios produced a 33.3 ± 2.7% reduction in the incidence of acute alcohol-related harms, suggesting a synergistic effect.

CONCLUSIONS

This study demonstrates the feasibility of participatory development of a contextually relevant computer simulation model of alcohol-related harms and highlights the value of the approach in identifying potential policy responses that best leverage limited resources.

When parents supply alcohol to their children: Exploring associations with drinking frequency, alcohol-related harms, and the role of parental monitoring

BACKGROUND

Youth obtain alcohol from many sources, including friends, siblings, parents and other adults. Whether parental supply, relative to other sources, is associated with experiencing a negative alcohol-related outcome is an area of considerable debate. Less well understood is whether the observed association is further contextualized by level of parental monitoring of the child.

OBJECTIVES

This study has two main objectives: 1) determine if there is a relationship between parental supply, drinking frequency, and alcohol-related harms among youth; and 2) assess whether parental monitoring moderates this relationship.

METHODS

Participants were drawn from the 2012 Student Drug Use Survey in Canada's Atlantic Provinces, an anonymous cross-sectional survey of high school students (ages 15-19 years). Adjusted regression models assessed the association between drinking frequency, experiencing alcohol-related harms, and four different sources of supply. Additional analyses stratified on levels of parental monitoring.

RESULTS

Relative to receiving alcohol from friends, parental supply was associated with lower odds of experiencing any alcohol-related harm (AOR 0.42; 95% CI 0.28-0.61) and loss of control (AOR = 0.42; 95% CI 0.29-0.62). Drinking frequency did not differ by source of supply. Associations between parental supply and harm were absent among youth reporting low levels of parental monitoring.

CONCLUSIONS

Youth who receive alcohol from parents' report fewer alcohol-related harms relative to those who obtain their alcohol from friends, despite no observed differences in drinking frequency. Understanding how parents may help to minimize experiences of alcohol-related harm among youth beyond the simple promotion of abstinence from drinking is warranted.

Provincial alcohol index and its relationship to alcohol-related harm in Thailand: implications for subnational alcohol policy development

BACKGROUND

The Provincial Alcohol Index (PAI) is one of the efforts to develop a composite measurement to operationalize the situation of alcohol consumption and related risk behaviors. The index offers a means for national and subnational alcohol control committees to address alcohol-related problems in their responsible jurisdiction areas. The objective of this study is to assess the relationship between PAI scores and alcohol-related problems using Thailand as an example.

METHODS

Cross-sectional analyses of PAI scores based on the 2007 National Cigarette Smoking and Alcohol Drinking Behavior Survey (CSAD) and the National Statistical Office data were conducted. CSAD data were collected from 168,285 Thai residents aged 15 years and above in 76 provinces of Thailand (population range 180,787 to 5,716,248). The PAI scores were generated using three different methods based on five indicators: 1) prevalence of adult (≥15 years) drinkers, 2) prevalence of underage drinkers, 3) proportion of regular drinkers, 4) proportion of binge drinkers and 5) proportion of drink-drivers. Alcohol-related injuries and violent events together with provincial level covariates (age, gender, income and region) were assessed. Correlational and linear regression analyses were performed to examine the relationship between PAI scores and alcohol-related problems.

RESULTS

The PAI scores generated from the three methods were significantly correlated with one another (r > 0.7, p < 0.05) and significantly related to alcohol-related problems after adjusting for the provincial level covariates. Based on the normalized method, PAI scores had a significant and positive relationship with prevalence of alcohol-related injuries (beta = 562 cases per million population, p = 0.027) and violence (beta = 451 events per million population, p = 0.013). PAI scores were highest in the north and lowest in the south of the country.

CONCLUSIONS

The findings of this study illustrate the relationship between the PAI and alcohol-related problems. The PAI scores can be used to benchmark the alcohol situation across jurisdiction areas. Future studies are suggested to develop a scale to measure subnational alcohol policy performances.

Impulsive Personality, Parental Monitoring, and Alcohol Outcomes From Adolescence Through Young Adulthood

PURPOSE

We examined the time-varying effects of sensation seeking, lack of perseverance, and parental monitoring on heavy drinking and alcohol-related harms from ages 16 to 28 years.

METHODS

Participants were from the Victoria Healthy Youth Survey, followed six times, biennially, between 2003 and 2013 (N = 662; mean age at Time 1 = 15.52, range = 12-18). Analyses used time-varying effect models, which estimate how the association between a predictor and an outcome differs over time without assuming the association follows a parametric function of time.

RESULTS

Sensation seeking was a stable risk factor for heavy drinking, and lack of perseverance was stable risk factor for alcohol-related harms at each age. Parental monitoring was associated with lower rates of heavy drinking in adolescence and lower rates of alcohol harm until the age of 24 years. Moreover, high levels of parental monitoring moderated the association between personality traits and rates of harm at ages 17-20 years but only for youth high on lack of perseverance and low on sensation seeking.

CONCLUSIONS

The results provide a better understanding of age-related changes in risk and protective factors of alcohol use across the transition to adulthood. Impulsive personality traits are stable risk factors for alcohol outcomes until the late-20s despite typical age-related declines in these traits and drinking. Moreover, parental monitoring buffers the association between personality traits and alcohol harm for specific youth during the transition to adulthood. Personality-targeted interventions may be effective beyond adolescence, and parenting interventions may help reduce harm among low perseverance, low sensation-seeking youth.