Patterns in Reduction or Cessation of Drinking in Australia (2001-2013) and Motivation for Change

Have declines in the prevalence of young adult drinking in English-speaking high-income countries followed declines in youth drinking? A systematic review

Background

Alcohol use in early adulthood is a significant public health concern. The prevalence of adolescent alcohol consumption has been declining in high-income English-speaking countries since the early 2000s. This review aims to examine whether this trend continues in young adulthood.

Methods

We systematically searched Medline, PsycInfo and CINAHL and the grey literature. Eligible records reported the prevalence of alcohol consumption amongst 18-25-year-olds over a minimum three-year time frame in the United States (US), Canada, the United Kingdom, the Republic of Ireland, Australia and New Zealand. Results were described using narrative synthesis. Quality assessment was undertaken using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies.

Results and conclusion

Thirty-two records from 22 different surveys were included. The prevalence of consumption amongst young adults fell in Australia, Ireland, and the United Kingdom and was stable in New Zealand and Canada. In the US, there was evidence of a decline in the prevalence of drinking among under-21s, but results for adults over the minimum purchase age were mixed. The prevalence of alcohol consumption in young adults appears to be broadly declining. This could lead to reduced rates of alcohol-related harms in the future. Further high-quality multinational surveys may help to confirm this trend.

Drinker's own drinking, experience of alcohol-related harms, and concern for drinking predict drinker's attitudes towards non-drinkers

OBJECTIVE

While the stigma experienced by non-drinkers is well-documented, little is known about the factors that influence it. This study aims to test a sequential mediation model in which the amount of alcohol consumed by a drinker, predicts their experienced alcohol-related harm, which in turn predicts the concern they have for drinking and their negative attitudes towards non-drinkers.

METHODS

A sample of 787 Australian drinkers (Mage = 38.4 years, SD = 11.4) completed online measures of alcohol consumption, alcohol-related harms, concern for drinking and the Cheers Attitudes towards Non-drinker Scale (CANS): a scale that measures the negative attitudes toward non-drinkers via three threats non-drinkers are perceived to pose to drinkers (Threat to Fun, Connection, and Self).

RESULTS

The model was shown to be a good fit and demonstrated a sequential mediation with significant indirect effects from alcohol consumption via experienced alcohol-related harms and concern, to each CANS subscale: Threat to Self (β = 0.402, p < 0.001), Fun (β = 0.096, p = 0.006) and Connection (β = 0.165, p < 0.001).

CONCLUSION

The findings suggest that the stigma directed at non-drinkers may be enacted as a defence against an unwanted self-reflection from a drinker's concern for their own drinking.

Student drinking cultures in tertiary education residential accommodation: A contextual research study

Background: In Australia, harmful drinking among students aged 18-24 years in tertiary education residential accommodation (TRA) remains high, placing students at higher risk of harms than non-TRA and university peers. Aim: The aim of this study was to identify the context-specific factors distinctive to TRAs that supported a heavy drinking culture among students. Conducted across three sites in Melbourne, Australia, the purpose of the study was to inform the development of context-specific harm reduction interventions for these sites. Methods: Five focus groups were conducted with 32 students to examine their lived experience of drinking within the distinctive environments of their TRAs. The data were examined using thematic data analysis. Results: Three themes were identified: (1) routine drinking in TRAs; (2) drinking for social inclusion in the TRA; and (3) TRA alcohol governance and students' self-regulation. The data show that factors contributing to these TRA drinking cultures included: liberty to store alcohol and drink on campus; freshers' belief that admission to the TRA was conditional on "partying hard"; students' belief that staff supported the TRA drinking culture; and poor dissemination and operationalisation of TRA alcohol policy. Collectively, these factors fostered an environment that enabled frequent and heavy alcohol consumption among residents. Conclusions: The TRA drinking cultures were supported by social and regulatory factors specific to these institutions and, in particular, by a liberal approach to TRA alcohol governance and poorly disseminated alcohol policy that made widespread heavy drinking possible. Drinking cultures in TRAs can be changed through appropriate interventions that include nuanced policy and effective governance.

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

Background

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

Methods

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

Results

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

Conclusions

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

Protocol for the Data-Linkage Alcohol Cohort Study (DACS): investigating mortality, morbidity and offending among people with an alcohol-related problem using linked administrative data

INTRODUCTION

The aims of this program of research are to use linked health and law enforcement data to describe individuals presenting to emergency and inpatient healthcare services with an acute alcohol harm or problematic alcohol use; measure their health service utilisation and law enforcement engagement; and quantify morbidity, mortality, offending and incarceration.

METHODS AND ANALYSIS

We will assemble a retrospective cohort of people presenting to emergency departments and/or admitted to hospitals between 1 January 2005 and 31 December 2014 in New South Wales, Australia with a diagnosis denoting an acute alcohol harm or problematic alcohol use. We will link these data with records from other healthcare services (eg, community-based mental healthcare data, cancer registry), mortality, offending and incarceration data sets. The four overarching areas for analysis comprise: (1) describing the characteristics of the cohort at their first point of contact with emergency and inpatient hospital services in the study period with a diagnosis indicating an acute alcohol harm and/or problematic alcohol use; (2) quantifying health service utilisation and law enforcement engagement; (3) quantifying rates of mortality, morbidity, offending and incarceration; and (4) assessing predictors (eg, age, sex) of mortality, morbidity, offending and incarceration among this cohort.

ETHICS AND DISSEMINATION

Ethics approval has been provided by the New South Wales Population and Health Services Research Ethics Committee. We will report our findings in accordance with the REporting of studies Conducted using Observational Routinely collected health Data (RECORD) statement and Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) where appropriate. We will publish data in tabular, aggregate forms only. We will not disclose individual results. We will disseminate project findings at scientific conferences and in peer-reviewed journals. We will aim to present findings to relevant stakeholders (eg, addiction medicine and emergency medicine specialists, policy makers) to maximise translational impact of research findings.