An evaluation of the evidence submitted to Australian alcohol advertising policy consultations

BACKGROUND

Industry self-regulation is the dominant approach to managing alcohol advertising in Australia and many other countries. There is a need to explore the barriers to government adoption of more effective regulatory approaches. This study examined relevance and quality features of evidence cited by industry and non-industry actors in their submissions to Australian alcohol advertising policy consultations.

METHODS

Submissions to two public consultations with a primary focus on alcohol advertising policy were analysed. Submissions (n = 71) were classified into their actor type (industry or non-industry) and according to their expressed support for, or opposition to, increased regulation of alcohol advertising. Details of cited evidence were extracted and coded against a framework adapted from previous research (primary codes: subject matter relevance, type of publication, time since publication, and independence from industry). Evidence was also classified as featuring indicators of higher quality if it was either published in a peer-reviewed journal or academic source, published within 10 years of the consultation, and/or had no apparent industry connection.

RESULTS

Almost two-thirds of submissions were from industry actors (n = 45 submissions from alcohol, advertising, or sporting industries). With few exceptions, industry actor submissions opposed increased regulation of alcohol advertising and non-industry actor submissions supported increased regulation. Industry actors cited substantially less evidence than non-industry actors, both per submission and in total. Only 27% of evidence cited by industry actors was highly relevant and featured at least two indicators of higher quality compared to 58% of evidence cited by non-industry actors.

CONCLUSIONS

Evaluation of the value of the evidentiary contribution of industry actors to consultations on alcohol advertising policy appears to be limited. Modifications to consultation processes, such as exclusion of industry actors, quality requirements for submitted evidence, minimum standards for referencing evidence, and requirements to declare potential conflicts, may improve the public health outcomes of policy consultations.

Nature and Potential Impact of Alcohol Health Warning Labels: A Scoping Review

Alcohol is toxic to human health. In addition to providing nutritional information, labels on alcohol products can be used to communicate warnings on alcohol-related harms to consumers. This scoping review examined novel or enhanced health warning labels to assess the current state of the research and the key studied characteristics of labels, along with their impact on the studied outcomes. Four databases (Web of Science, MEDLINE, PsycInfo, CINAHL) were searched between January 2010 and April 2021, and 27 papers were included in the review. The results found that most studies were undertaken in English-speaking populations, with the majority conducted online or in the laboratory setting as opposed to the real world. Seventy percent of the papers included at least one cancer-related message, in most instances referring either to cancer in general or to bowel cancer. Evidence from the only real-world long-term labelling intervention demonstrated that alcohol health warning labels designed to be visible and contain novel and specific information have the potential to be part of an effective labelling strategy. Alcohol health warning labels should be seen as tools to raise awareness on alcohol-related risks, being part of wider alcohol policy approaches.

Government Options to Reduce the Impact of Alcohol on Human Health: Obstacles to Effective Policy Implementation

Evidence for effective government policies to reduce exposure to alcohol's carcinogenic and hepatoxic effects has strengthened in recent decades. Policies with the strongest evidence involve reducing the affordability, availability and cultural acceptability of alcohol. However, policies that reduce population consumption compete with powerful commercial vested interests. This paper draws on the Canadian Alcohol Policy Evaluation (CAPE), a formal assessment of effective government action on alcohol across Canadian jurisdictions. It also draws on alcohol policy case studies elsewhere involving attempts to introduce minimum unit pricing and cancer warning labels on alcohol containers. Canadian governments collectively received a failing grade (F) for alcohol policy implementation during the most recent CAPE assessment in 2017. However, had the best practices observed in any one jurisdiction been implemented consistently, Canada would have received an A grade. Resistance to effective alcohol policies is due to (1) lack of public awareness of both need and effectiveness, (2) a lack of government regulatory mechanisms to implement effective policies, (3) alcohol industry lobbying, and (4) a failure from the public health community to promote specific and feasible actions as opposed to general principles, e.g., 'increased prices' or 'reduced affordability'. There is enormous untapped potential in most countries for the implementation of proven strategies to reduce alcohol-related harm. While alcohol policies have weakened in many countries during the COVID-19 pandemic, societies may now also be more accepting of public health-inspired policies with proven effectiveness and potential economic benefits.

Alcohol-Related Deaths in Poland During a Period of Weakening Alcohol Control Measures

This population epidemiology study describes trends in overall and age- and sex-specific alcohol-related deaths in Poland between 2002 and 2017, following the weakening in 2001 of policy measures designed to reduce alchohol consumption.

Alcohol Industry Arguments for Liberalizing Alcohol Policy in Finland: Analysis of Twitter Data

OBJECTIVE

The aim of this study was to investigate the arguments used by the alcohol industry and actors aligning with it as a lobbying strategy on Twitter to influence the reform of the Finnish alcohol law during its preparation phase between 2014 and 2017, when the original purpose of the law reform was changed from reducing alcohol-related harm to liberalizing alcohol policy.

METHOD

Primary data were collected on Twitter between 2014 and 2017 from six alcohol industry actors (n = 1,085 tweets). The Twitter data were analyzed by coding using Microsoft Excel and by content and thematic analyses using a modified version of the European Centre for Monitoring Alcohol Marketing's (2011) seven key messages of the alcohol industry.

RESULTS

The findings identified three main arguments used on Twitter by the alcohol industry and actors aligning with it, namely: (1) application of liberal alcohol policies generates more revenue, (2) liberties should be generally prioritized above bureaucracy and control, and (3) education about responsibility is the best solution to alcohol-related problems.

CONCLUSIONS

Social media applications such as Twitter offer the alcohol industry unlimited opportunities for promoting its traditional public relations arguments.

Evaluating the causal impact of individual alcohol licensing decisions on local health and crime using natural experiments with synthetic controls

BACKGROUND AND AIMS

Given the costs of alcohol to society, it is important to evaluate whether local alcohol licensing decisions can mitigate the effects of alcohol misuse. Robust natural experiment evaluations of the impact of individual licensing decisions could potentially inform and improve local decision-making. We aimed to assess whether alcohol licensing decisions could be evaluated at small spatial scale by using a causal inference framework.

DESIGN

Three natural experiments.

SETTING AND PARTICIPANTS

Three English local areas of 1000-15 000 people each.

INTERVENTION AND COMPARATOR

The case study interventions were (i) the closure of a nightclub following reviews; (ii) closure of a restaurant/nightclub following reviews and (iii) implementation of new local licensing guidance (LLG). Trends in outcomes were compared with synthetic counterfactuals created using Bayesian structural time-series.

MEASUREMENTS

Time-series data were obtained on emergency department admissions, ambulance call-outs and alcohol-related crime at the Lower or Middle Super Output geographical aggregation level.

FINDINGS

Closure of the nightclub led to temporary 4-month reductions in antisocial behaviour (-18%; 95% credible interval - 37%, -4%), with no change in other outcomes. Closure of the restaurant/nightclub did not lead to measurable changes in outcomes. The new licensing guidance led to small reductions in drunk and disorderly behaviour (nine of a predicted 21 events averted), and the unplanned end of the LLG coincided with an increase in domestic violence of two incidents per month.

CONCLUSIONS

The impact of local alcohol policy, even at the level of individual premises, can be evaluated using a causal inference framework. Local government actions such as closure or restriction of alcohol venues and alcohol licensing may have a positive impact on health and crime in the immediate surrounding area.

Industry Actor Use of Research Evidence: Critical Analysis of Australian Alcohol Policy Submissions

OBJECTIVE

Governments' limited adoption of evidence-based policies to reduce alcohol-related harm has been partly attributed to alcohol industry influence. A better understanding of industry political strategy may help protect public policy against vested interests. We examined how industry actors used scientific evidence in their submissions to government alcohol policy consultations.

METHOD

We conducted a content analysis of 214 submissions from industry actors in 21 Australian public consultations between 2013 and 2017. Represented industry actors included alcohol producers and retailers, trade associations, licensees, and associated entities that derive commercial benefit from alcohol (e.g., advertising companies). Adapting an existing framework, we classified industry practices into two categories: (a) misuse of evidence and (b) denial of the effectiveness of evidence-based strategies.

RESULTS

Almost all submissions (91%) denied the effectiveness of evidence-based strategies; the most common denial practices were making unsubstantiated claims about adverse effects of policies (76%) and promoting alternatives without evidence (71%). The misuse of scientific evidence was apparent in 66% of submissions. Trade associations, producers, and retailers were most likely to use such practices.

CONCLUSIONS

The extent to which the examined industry actors misused scientific evidence in their submissions to a wide range of alcohol policy consultations in Australia suggests the need for governments to consider excluding the industry from consultation on the regulation of alcohol.

The Right Time and Place: A New Approach for Prioritizing Alcohol Enforcement and Prevention Efforts by Combining the Prevalence and the Success Rate for Minors Purchasing Alcohol Themselves

OBJECTIVE

In the Netherlands, enforcement of the alcohol age limit is low and inconsistent because of limited resources. A solution is to optimize the efforts of enforcement officers by prioritizing ways in which they regulate commercial alcohol availability. This could increase compliance by sellers, curbing commercial availability. The objective of this study is to present the development of a commercial alcohol availability estimate (CAAE) for all vendor types selling alcohol and to propose a priority ranking.

METHOD

A multi-method design was used, combining data (collected in 2015) from national studies reporting behavior of minors purchasing alcohol themselves and the success rate (noncompliance) of alcohol vendors (interviewing 510 minors by telephone and conducting 1,373 purchase attempts of alcohol by minors, respectively). Descriptive data and the development of the CAAE are presented.

RESULTS

Compared with other vendor types (e.g., sports bars or supermarkets), bars/cafes/discos scored highest on the CAAE, indicating that 7.7% of 16- to 17-year-olds in the survey reported successfully purchasing their own alcohol at this vendor type.

CONCLUSIONS

To control commercial alcohol availability efficiently for minors in the Netherlands, our estimates suggest that enforcement and prevention efforts should prioritize bars/cafes/discos. However, local authorities should also consider local circumstances and maintain a base amount of attention for all vendor types. Ultimately, the CAAE has the potential to improve enforcer capacity and efficiency in policing commercial alcohol regulation, and prevention workers could align their interventions or campaigns to high-ranked vendor types.

Alcohol Advertising, Promotion, and Sponsorship: A Review of Regulatory Policies in the Association of Southeast Asian Nations

OBJECTIVE

The expansion of transnational alcohol corporations (TACs) in Southeast Asia has been suggested as a possible contributor to increased alcohol advertising, promotion, and sponsorship (AAPS), which in turn may have contributed to increasing rates of alcohol consumption and alcohol-related problems. The aim of this scoping review is to document the growth of TACs in the region and to critically evaluate the development of alcohol policies to regulate AAPS in 10 Southeast Asian nations.

METHOD

National policies related to AAPS were reviewed using data from the Global Information System on Alcohol and Health, following the framework of the WHO Global Strategy to reduce the harmful use of alcohol. The policy review was supplemented with data from corporate annual reports, press releases, four databases of academic literature, market research from Euromonitor International, and news articles.

RESULTS

Four TACs--Carlsberg, Diageo, Heineken, and San Miguel--have been expanding operations in Southeast Asia by setting up new breweries, acquiring local alcohol companies as subsidiaries, and entering into joint ventures. In contrast, policies for regulating AAPS vary across Southeast Asia and range from nonexistent to strong control of AAPS. There is strong control of AAPS in countries with existing legislation ranging from a complete ban (Brunei) to almost comprehensive bans (Indonesia, Myanmar, Laos) and partial bans (Thailand). Nonexistent to weak control of AAPS is observed in the Philippines, Singapore, Cambodia, Malaysia, and Vietnam, which mostly rely on voluntary regulation.

CONCLUSIONS

The study's findings point to the growing power of TACs in the region and call for the need for stronger measures based on scientific evidence of effectiveness that are implemented without interference from commercial interests.

Evaluation of a Mystery Shopper Intervention to Reduce Sales of Alcohol to Minors in Zacatecas and Guadalupe, Mexico

We report the results of a quasi-experimental evaluation of a mystery shopper intervention in Zacatecas and Guadalupe, Mexico. Underage youth attempted to purchase beer at 50 Modelorama stores and 32 Oxxo stores (intervention groups), and at 19 comparison convenience stores in March, July, and August 2018. After each attempt, intervention store operators were informed if a sale was made. Modelorama operators also received training and were warned that repeated sales to minors could jeopardize their franchise. Average sales rates to minors were 63.8% at Modeloramas, 86.5% at Oxxo stores, and 98.2% at comparison stores. The findings suggest that mystery shopper interventions with training, feedback to store operators, and sanctions after repeated sales to underage youth may reduce sales to minors in low- and middle-income countries.

Relationships between US state alcohol policies and alcohol outcomes: differences by gender and race/ethnicity

BACKGROUND AND AIMS

Alcohol taxation and availability restrictions are among the most effective methods for reducing alcohol use and problems, yet may affect demographic subgroups differently. Understanding who responds to specific policies can inform approaches for reducing disparities. We examined how state-level beverage-specific taxes and availability restrictions in the United States are associated with consumption and alcohol-related problems across subgroups defined by gender and race/ethnicity.

DESIGN, SETTING AND PARTICIPANTS

Data came from the 2000-15 National Alcohol Surveys (n = 28 251), computer-assisted telephone cross-sectional surveys of United States residents aged 18+. African Americans and Hispanics were oversampled.

MEASUREMENTS

Primary outcomes were beverage-specific (beer, wine, spirits and total) volume, DSM-IV alcohol dependence and alcohol-related consequences. Analyses entailed survey-weighted log-log and logistic regressions adjusting for state-level beer tax, spirits tax, government-controlled spirits sales and sales tax; respondent ZIP-code-level density of off-premise beer outlets, off-premise spirits outlets and on-premise bars; respondent individual-level age, marital status, education, employment and income; and fixed effects for wet/moderate/dry US region and year.

FINDINGS

Higher beer tax was significantly (P < 0.05) associated with lower odds of any drinking among white women [odds ratio (OR) = 0.98] and lower beer volume (price-elasticity = -0.40), total volume (price-elasticity = -0.50) and odds of alcohol-related consequences (OR = 0.84) among African American women. Higher spirits tax was significantly (P < 0.05) associated with both lower beer and total volume among Hispanic women (price-elasticities = -0.73 and - 1.04, respectively) and men (price-elasticities = -1.19 and - 0.92, respectively) and decreased wine volume among Hispanic women (price-elasticity = -0.62). Apparent protective effects of living in a state with government-controlled spirits sales or a neighborhood with lower bar density was greater among white men than other groups.

CONCLUSIONS

The effects of beverage-specific taxes and alcohol availability policies may vary across subgroups, highlighting the importance of considering differential policy impacts in future research and intervention.

"It's business as usual": adolescents perspectives on the ban of alcohol sachets towards reduction in under age alcohol use in Malawi

BACKGROUND

Alcohol contributes to poor health, social and economic outcomes among adolescents. In Malawi, alcohol consumption among young people significantly increased after the introduction of alcohol sachets. A government ban on the sale of alcohol sachets affected in 2012 aimed to reduce prevalence of alcohol among users. We explored adolescents perceptions regarding the effectiveness of the ban towards reducing alcohol consumption among the under aged in the country.

METHODS

Using a descriptive phenomenological school-based approach, we recruited 44 school-going adolescents, 15-17 year olds using snow ball sampling and conducted 12 individual semi-structured interviews and four group discussions differentiated by sex. We sought a waiver from College of Medicine Ethics Committee (COMREC) to obtain verbal consent from adolescents. All interviews and discussions were digitally recorded and simultaneously transcribed and translated verbatim into English. Data management and analysis was done manually using thematic approach.

RESULTS

Aggressive packaging, and marketing tendencies and lack of restrictive measures in Malawi have rendered the ban ineffective through increased affordability and availability to different income population groups and the underage. Results indicate that even though adolescents perceive the ban as a significant step towards reducing under age alcohol use, personality and drinking motives precede any interventions. Adolescents emphasized on strong personality as a significant factor for reduced alcohol intake or abstinence.

CONCLUSIONS

We recommend strict alcohol policy and enforcement regarding packaging, pricing, positive role modelling by parents and enhanced adolescent personality development through schools and families.

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

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.

Cancer Warning Labels on Alcohol Containers: A Consumer's Right to Know, a Government's Responsibility to Inform, and an Industry's Power to Thwart

Although the World Health Organization (WHO) declared alcohol a Class 1 carcinogen 30 years ago, few governments have communicated this fact to the public. We illustrate how alcohol industry groups seek to keep their customers in the dark about alcohol-related cancer risks. In Canada, a federally funded scientific study examining the introduction of cancer warning labels on containers was shut down following industry interference. We show that the industry complaints about the study had no legal merit. Of 47 WHO member countries with alcohol warning labels, only South Korea requires cancer warnings on alcohol containers. However, industry complaints, supported by sympathetic governments, helped weaken the warning labels' implementation. Ireland has legislated for cancer warnings but faces continuing legal opposition expressed through regional and global bodies. Cancer societies and the public health community have failed to counter industry pressures to minimize consumer awareness of alcohol's cancer risks. Placing cancer warnings on alcohol containers could make a pivotal difference in motivating both drinkers to consume less and regulators to introduce more effective policies to reduce the serious harms of alcohol consumption.

Science and Health Policies to Tackle Chronic Diseases in Chile

Chile has experienced rapid epidemiological transitions characterized by decreasing infant mortality, population aging, and a shift towards obesity with an increase in noncommunicable diseases (NCDs). Today, tobacco, alcohol, and ultraprocessed foods are the main risk factors for these diseases. Based on Chile's experience in tobacco control, we discuss paths to make progress in population evidence-based strategies to improve overall community health.

Alcohol Outlet Density and Deprivation in Six Towns in Bergrivier Municipality before and after Legislative Restrictions

Introduction. In 2016, after the Western Cape Liquor Act was enacted, alcohol outlets were mapped in the six towns from a previous 2008 study to determine: (1) alcohol outlet density; (2) the association between deprivation and alcohol outlet density; (3) geospatial trends of alcohol outlet densities; and (4) the impact of alcohol legislation. Methods. Latitude and longitude coordinates were collected of legal and illegal alcohol outlets, and alcohol outlet density was calculated for legal, illegal and total alcohol outlets by km2 and per 1000 persons. To determine the impact of legislation, t-tests and hot spot analyses were calculated for both 2008 and 2016 studies. Spearman coefficients estimated the relationship between alcohol outlet density and deprivation. Results. Although not statistically significant, the number of alcohol outlets and the density per 1000 population declined by about 12% and 34%, respectively. Illegal outlets were still more likely to be located in more deprived areas, and legal outlets in less deprived areas; and a reduction or addition of a few outlets can change a town’s hot spot status. Conclusions. Further studies with larger sample sizes might help to clarify the impacts of the Liquor Act, and the more recent 2017 Alcohol-Related Harms Reduction Policy on alcohol outlet density in the province.

Effects of a Risk-Based Licensing Scheme on the Incidence of Alcohol-Related Assault in Queensland, Australia: A Quasi-Experimental Evaluation

: Amid concerns about increasing alcohol-related violence in licensed premises, Queensland introduced a system of risk-based licensing (RBL) in 2009, the first of five Australian jurisdictions to do so. Under RBL, annual license fees are supposed to reflect the risk of harm associated with the outlet's trading hours and record of compliance with liquor laws. The objective is to improve service and management practices thereby reducing patron intoxication and related problems. Using police data, we defined cases as assaults that occurred during so-called 'high-alcohol hours', and compared a pre-intervention period of 2004-2008 with the post-intervention period 2009-2014. We employed segmented linear regression, adjusting for year and time of assault (high vs. low alcohol hours), to model the incidence of (1) all assaults and (2) a subset that police indicated were related to drinking in licensed premises. We found a small decrease in all assaults (β = -5 per 100,000 persons/year; 95% CI: 2, 9) but no significant change in the incidence of assault attributed to drinking in licensed premises (β = -8; 95% CI: -18, 2). Accordingly, we concluded that the results do not support a hypothesis that RBL is effective in the prevention of harm from licensed premises. There may be value in trialing regulatory schemes with meaningful contingencies for non-compliance, and, in the meantime, implementing demonstrably effective strategies, such as trading hour restrictions, if the aim is to reduce alcohol-related violence.

A proposal for an alcohol purchase license

Background: Recent advances in technology have allowed for innovative targeting of high-risk alcohol users.Objectives: We propose the implementation of an alcohol purchase license linked to a state agency managed database, or so-called Banned Drinker Register (BDR).Methods: Individuals who are unable to drink safely will be identified by a well-founded criterion and their ability to purchase alcohol proscribed. A state agency will be responsible for maintaining the BDR and compiling mandated reports from hospitals, courts, police and child protective agencies of alcohol-related dangerous behavior, adjudicating reports with the input of those involved in these events, and determining which individuals will not be allowed to purchase alcohol. Outlets of alcohol sales will then be required to assess customers for eligibility of alcohol purchase using an electronic card reader (as used for age verification). Individuals wanting to protect themselves from drinking may also self-request to be placed on the BDR.Results: Overall, the convenience/access for persons who injure themselves with alcohol and others with intoxicated behavior would be reduced. Opportunities for cost savings would come from a decrease in yearly incarcerations, a reduction in preventable traffic accidents and property damage requiring state municipal intervention, a decreased cost to offending individuals by preventing increased insurance rates, loss of jobs to incarceration and loss of potential future wages, and the possibility of preventing long term medical complications of chronic alcohol use and its toll on the health care system.Conclusions: Health benefits will include increased public safety and awareness about drinking consequences and reduced alcohol-related morbidity and mortality.

Alcohol policy in Iran: Policy content analysis

BACKGROUND

Muslim majority countries (MMCs) typically have limited alcohol policy development due to Islamic prohibition of alcohol consumption. In response to recent increases in alcohol consumption and related harms, MMCs have introduced civil alcohol policies, ranging from total prohibition to European-style regulations. Using Iran as a case study, we describe how alcohol prohibition is translated into policy in the face of influences from globalisation.

METHODS

We collected information from publicly available literature and policy documents, because of the sensitivity of the topic of alcohol in Iran. The search was conducted in English and Persian. We verified information through consultations with policy actors. We also reviewed newspapers over periods just before the 1979 Islamic revolution, and before and after the 2011 alcohol policy (2008-2010; 2014-2016) was introduced. We analysed policy content based on WHO policy recommendations and used the Walt & Gilson health framework to identify policy content, context, actors and process.

RESULTS

Despite its broad approach of civil prohibition with concessions for the non-Muslim population, Iran has developed approaches to reduce the harmful impacts of alcohol and adopted nine of ten policy interventions recommended by WHO. Pricing policy was the only intervention not used. We identified contextual challenges, such as resources, stigma and cultural offence that influence policy development.

CONCLUSION

MMCs face challenges in creating civil alcohol policies. Iran has taken steps, including a national alcohol strategy, to reduce alcohol-related harms. The socio-cultural, governance and historical context have shaped Iran's adaptation of policy interventions recommended by WHO.

Minimum unit prices for alcohol

Minimum unit prices (MUPs) have been proposed on the grounds that they can reduce alcohol consumption of the heaviest drinkers, without significantly burdening moderate drinkers. This paper examines the case for MUPs in an optimal tax framework. Such a policy can improve welfare when two conditions are both satisfied. First, beverage quality and quantity should be substitutes. Second, there should be more distortion to consumption of cheaper alcohol than to more expensive varieties. The consequences of a MUP for the optimal corrective tax are explored with a calibrated numerical example. This example illustrates how the optimal tax rate might be higher when used in isolation, than when a MUP is also being used.

Evaluating possible intended and unintended consequences of the implementation of alcohol minimum unit pricing (MUP) in Scotland: a natural experiment protocol

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.

Understanding public opinion to the introduction of minimum unit pricing in Scotland: a qualitative study using Twitter

OBJECTIVES

On 1 May 2018 minimum unit pricing (MUP) of alcohol was introduced in Scotland. This study used Twitter posts to quantify sentiment expressed online during the introduction of MUP, conducted a thematic analysis of these perceptions and analysed which Twitter users were associated with which particular sentiments.

DESIGN AND SETTING

This qualitative social media analysis captured all tweets relating to MUP during the 2 weeks after the introduction of the policy. These tweets were assessed using a mixture of human and machine coding for relevance, sentiment and source. A thematic analysis was conducted.

PARTICIPANTS

74 639 tweets were collected over 14 days. Of these 53 574 were relevant to MUP.

RESULTS

Study findings demonstrate that opinion on the introduction of MUP in Scotland was somewhat divided, as far as is discernible on Twitter, with a slightly higher proportion of positive posts (35%) than negative posts (28%), with positive sentiment stronger in Scotland itself. Furthermore, 55% of positive tweets/retweets were originally made by health or alcohol policy-related individuals or organisations. Thematic analysis of tweets showed some evidence of misunderstanding around policy issues.

CONCLUSIONS

It is possible to appreciate the divided nature of public opinion on the introduction of MUP in Scotland using Twitter, the nature of the sentiment around it and the key actors involved. It will be possible to later study how this changes when the policy becomes more established.

Driving under the influence of alcohol and the effects of alcohol prohibition-Case study in Serbia

Objective: The purpose of this study is to provide an overview of the prevalence of driving under the influence of alcohol (DUI) according to day of the week, specific roads (urban/rural), daytime or nighttime, and vehicle category. In addition, this study examines how the prohibition of selling alcoholic drinks in shops and supermarkets (not in restaurants) after 10 p.m. has affected the prevalence of DUI. Method: Breath alcohol concentration (BrAC) was collected from all drivers through police checkpoints at 54 locations in Serbia. In this study, 17,945 drivers were tested in urban areas and 19,507 in rural areas. The relationship between DUI during the prohibition on alcohol sales in Belgrade and other large cities in Serbia was determined using logistic regression. Results: On average, every 100th driver in traffic in Serbia was DUI (0.99%). This study shows that the 0 blood alcohol concentration (BAC) limit for motorcyclists does not have an influence on DUI. Moreover, motorcyclists represent the category with the highest share of DUI, with a statistically significantly larger difference compared to drivers of other vehicle categories. These results may be a consequence of the fact that a large number of drivers drive both motorcycles and other vehicle categories (cars or mopeds), so the different BAC limits for nonprofessional drivers may create confusion about the legal BAC limit. Conclusions: This study suggests that the required legal BAC limit for nonprofessional drivers should be the same. The prohibition of selling alcoholic drinks in Belgrade after 10 p.m. does not decrease the prevalence of DUI.

Public Health and the Four P's of Marketing: Alcohol as a Fundamental Example

This article examines how public health addresses alcohol use through marketing - place, product, promotion, and price. The article reviews current product trends and how restrictions on certain products designs may reduce youth consumption; how product availability may be restricted through zoning; and the current advertising landscape.