A time series analysis of presentations to Queensland health facilities for alcohol-related conditions, following the increase in ‘alcopops’ tax

Objective: In response to concerns about the health consequences of high-risk drinking by young people, the Australian Government increased the tax on pre-mixed alcoholic beverages ('alcopops') favoured by this demographic. We measured changes in admissions for alcohol-related harm to health throughout Queensland, before and after the tax increase in April 2008. Methods: We used data from the Queensland Trauma Register, Hospitals Admitted Patients Data Collection, and the Emergency Department Information System to calculate alcohol-related admission rates per 100,000 people, for 15 - 29 year-olds. We analysed data over 3 years (April 2006 - April 2009), using interrupted time-series analyses. This covered 2 years before, and 1 year after, the tax increase. We investigated both mental and behavioural consequences (via F10 codes), and intentional/unintentional injuries (S and T codes). Results: We fitted an auto-regressive integrated moving average (ARIMA) model, to test for any changes following the increased tax. There was no decrease in alcohol-related admissions in 15 - 29 year-olds. We found similar results for males and females, as well as definitions of alcohol-related harms that were narrow (F10 codes only) and broad (F10, S and T codes). Conclusions: The increased tax on 'alcopops' was not associated with any reduction in hospital admissions for alcohol-related harms in Queensland 15 - 29 year-olds

Availability of alcohol: Location, time and ease of purchase in high- and middle-income countries: Data from the International Alcohol Control study

INTRODUCTION AND AIMS: Cross-country studies on alcohol purchasing and access are rare. We examined where and when people access alcohol to understand patterns of availability across a range of middle- and high-income countries. DESIGN AND METHODS: Surveys of drinkers in the International Alcohol Control study in high-income countries (Australia, England, Scotland, New Zealand and St Kitts and Nevis) and middle-income countries (Mongolia, South Africa, Peru, Thailand and Vietnam) were analysed. Measures were: location of purchase from on-premise and take-away outlets, proportion of alcohol consumed on-premise versus take-away outlets, hours of purchase, access among underage drinkers and time to access alcohol. RESULTS: On-premise purchasing was prevalent in the high-income countries. However, the vast majority of alcohol consumed in all countries, except St Kitts and Nevis (high-income), was take-away. Percentages of drinkers purchasing from different types of on-premise and take-away outlets varied between countries. Late purchasing was common in Peru and less common in Thailand and Vietnam. Alcohol was easily accessed by drinkers in all countries, including underage drinkers in the middle-income countries. DISCUSSION AND CONCLUSIONS: In nine out of 10 countries the vast majority of alcohol consumed was take-away. Alcohol was readily available and relatively easy for underage drinkers to access, particularly in the middle-income countries. Research is needed to assess the harms associated with take-away consumption including late at night. Attention is needed to address the easy access by underage drinkers in the middle-income countries which has been less of a focus than in high-income countries

The short-term impact of the alcohol act on alcohol-related deaths and hospital admissions in Scotland: a natural experiment

Background and aim: The introduction of the Alcohol Act in Scotland on 1 October 2011, which included a ban on multi-buy promotions, was likely 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/Wales across 169 four-week periods between January 2001 and December 2013. For alcohol-related hospital admissions, a total of 121,314 in Scotland and 696,892 in England across 182 four-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 four-week periods between January 2001 and December 2014. Data were obtained by age, sex and area-based socioeconomic 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 (0.91 to 1.07)] or hospital admissions [IRR 0.98 (0.95 to 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 (0.95 to 1.02)], but was associated with an increase in alcohol-related hospital admission rates in England [IRR 1.05 (1.03 to 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 (0.95 to 1.04)], but suggested a net reduction in hospital admissions for Scotland compared with England [IRR 0.93 (0.87 to 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

Tools for policy and prevention: The Australian National Alcohol Indicators Project (NAIP)

Alcohol is a leading cause of preventable death, disease, and disability in Australia. The National Alcohol Indicators Project (NAIP) is funded by the Commonwealth Government of Australia to monitor and report on trends in alcohol consumption and related harms across states and communities with special emphasis on the wide dissemination of information and evaluation of policy change. Using aetiologic fraction and surrogate methods, the NAIP has established a minimum set of reliable indictors of alcohol-related harms for monitoring and evaluation purposes, including: alcohol-attributable deaths and hospitalizations; police-reported road crash and violent offences related to alcohol intoxication; alcohol sales data, and national alcohol consumption surveys. The NAIP uses a range of strategies for maintaining policy-relevant outputs that are both scientifically rigorous and readily accessible by non-researchers, including: a range of dissemination modes which potentially appeal to diverse audiences (e.g. bulletins, submissions, journal articles); proactive communication of outputs to potential audiences; timely response to key stake-holder information needs; and a strong commitment to capitalizing on opportunities for alcohol policy evaluation at local, state, and national levels. </jats:p

Patron offending and intoxication in night time entertainment districts (POINTED) : a study protocol

Risky alcohol consumption is the subject of considerable community concern in Australia and internationally, particularly the risky drinking practices of young people consuming alcohol in the night-time economy. This study will determine some of the factors and correlates associated with alcohol-related risk-taking, offending and harm in and around licensed venues and night-time entertainment precincts across five Australian cities (three metropolitan and two regional). The primary aim of the study is to measure levels of pre-drinking, drinking in venues, intoxication, illicit drug use and potentially harmful drinking practices (such as mixing with energy drinks) of patrons in entertainment areas, and relating this to offending, risky behaviour and harms experienced. The study will also investigate the effects of license type, trading hours, duration of drinking episodes and geographical location on intoxication, offending, risk-taking and experience of harm. Data collection involves patron interviews (incorporating breathalysing and drug testing) with 7500 people attending licensed venues. Intensive venue observations (n=112) will also be undertaken in a range of venues, including pubs, bars and nightclubs. The information gathered through this study will inform prevention and enforcement approaches of policy makers, police and venue staff.<br /

Age at first use of alcohol and risk of heavy alcohol use: A population-based study

Aim: To examine the association between age at first alcohol use and risk of heavy alcohol use among the adult US general drinking population.Methods: This population-based study used the 2010 National Survey on Drug Use and Health (NSDUH) from United States. Multivariate Poisson regression was employed to predict the frequency of heavy alcohol use (five or more drinks per occasion) in the last 30 days with age at first use of alcohol controlling for potential confounding factors.Results: Younger age at first use of alcohol was associated with increased likelihood of heavy alcohol use in the last 30 days in this population-based sample. This association remained significant when analysis was reperformed for the subgroup of participants who were with desired good health status and Kessler score lower than 12.Conclusion: Younger age at first use of alcohol was associated with increased likelihood of heavy alcohol use

Age at first use of alcohol predicts the risk of heavy alcohol use in early adulthood: A longitudinal study in the United States

Background: Two ecological cross-sectional studies which relied on national survey data (U.S. and Australia) have shown that starting drinking at a younger age increases the frequency of heavy drinking in the general population, including those with good mental and physical health status. This study further investigates the hypothesis that age at first use of alcohol increases the risk of heavy alcohol use by applying data from a longitudinal study. Method: This study used public-use data collected from Wave I, Wave III and Wave IV of the National Longitudinal Study of Adolescent Health in the United States. The association between age at first use of alcohol and heavy alcohol use (5+ drinks per occasion) was examined with two different multivariate analysis approaches with data from 2316 participants: ordered logistic regression models and Poisson regression models with longitudinal data settings. In addition, the newly developed proxy outcome approach was further used to estimate and adjust for unmeasured/unobserved confounding factors. Results: Age at first use of alcohol before 18 years was associated significantly higher risk of heavy alcohol use at follow-up. Conclusion: After adjusting for known and residual confounders, younger age at first use of alcohol was associated with significantly higher risk of heavy alcohol use, moreover, we posit that the association observed from this longitudinal study is probably causal. Abstinence from alcohol until the age of 18 years will likely reduce individual risk of alcohol-related problems in adulthood. In the longer term, delayed onset of exposure with widespread abstinence among this age group is also likely to reduce the overall prevalence of alcohol-related problems in the general population

Brief report: marital status and alcohol consumption behaviours

Introduction and aims: Divorced people have been found to be more likely to consume alcohol at higher levels than those who are married, with the association varying somewhat by country. However,the effect that remaining unmarried has on alcohol consumption is less clear. This study investigated the association between marital status and alcohol consumption among young and middle-aged Australian adults. Methods: Using a cross-sectional study design, the association between marital status and alcohol consumption behaviour was assessed using data from the Australian 2007 National Drug Strategy Household Survey. Results: Young and middle-aged people who were never married, divorced or separated were more likely to consume alcohol at levels associated with increased risk for both long-term and short-term harm when compared to married people. Discussion: It may be possible that mental health status is one of the factors mediating the association between marital status and alcohol consumption. Conclusions: Being never married, divorced or separated was a strong indicator of hazardous alcohol consumption behaviours. The marital status of young and middle-aged people might serve as a useful screening tool for health professionals wishing to identify patients at elevated risk of alcohol-related problems

Examining the relationship between heavy alcohol use and assaults: With adjustment for the effects of unmeasured confounders

Background. Experimental studies suggest that alcohol can lead to aggression in laboratory settings; however, it is impossible to test the causal relationship between alcohol use and real-life violence among humans in randomized clinical trials. Objectives. (i) To examine the relationship between heavy alcohol use and assaults in a population based study; (ii) to demonstrate the proxy outcome method, as a means of controlling the effects of unknown/unmeasured confounders in observational studies. Methods. This study used data collected from three waves of the National Survey on Drug Use and Health (NSDUH). The effects of heavy alcohol use on assault were measured using multivariable logistic regressions in conjunction with the proxy outcome method. Results. Application of the proxy outcome method indicated that effect sizes of heavy alcohol use on the risk of assault were overestimated in the standard models. After adjusting for the effects of unknown/unmeasured confounders, the risk of assault remained 43% and 63% higher P &lt; 0.05 among participants who consumed 5+ drinks/day for 5-8 days/month and 9-30 days/month, respectively. Conclusions. Even after adjustment for unknown/unmeasured confounders the association between heavy alcohol use and risk of violence remained significant. These findings support the hypothesis that heavy alcohol use can cause violence

Asthma history predicts the risk of affective disorders and anxiety disorders

Background: Positive associations between asthma and a range of mental disorders have been increasingly reported in cross-sectional studies. It is important to determine whether the association between asthma and mental disorders may be causal. Objectives: We conducted a retrospective cohort study using data collected from the 2007 Australia Mental Health and Wellbeing survey (MHW) to examine whether preexisting asthma may predict the likelihood of various types of anxiety disorders and affective disorders. Design, Settings and Subjects: The 2007 MHW survey was a nationally representative household survey. Its data included 8841 Australian adults aged 18 - 85 yrs. Age at first onset of asthma and mental disorders were used to reveal the order of occurrence of asthma and mental disorders, and to define time at risk and asthma exposure. Kaplan-Meier failure function and multivariate Poisson regression models were employed in analysis. Results: Participants who had a history of asthma that lasted six months or more were at higher risk of panic disorder, obsessive compulsive disorder, posttraumatic stress disorder, bipolar disorder, mania and hypomania. The association between asthma history and risk of mental disorder subtypes differed by gender. Conclusion: The findings of this study support the hypothesis that pre-existing asthma increases the risk of a number of anxiety disorders and affective disorders. Predisposition to carbon dioxide hypersensitivity and corticosteroid therapy may partly explain the observed associations