Alcohol Sales and Alcohol-Related Emergencies During the COVID-19 Pandemic

Summer alcohol-related emergency department workload and occupancy in Australasia 2019-2022

OBJECTIVE

Alcohol is a major public health issue and the ACEM funds regular 'snapshot' surveys of the prevalence of alcohol-related presentations in EDs. The present study uses these data to investigate ED occupancy and alcohol- and methamphetamine-related presentations at the time of the COVID-19 pandemic.

METHODS

Survey-based point prevalence study of EDs in Australia and New Zealand conducted at 02:00 hours local time on the Saturday of the weekend before Christmas in 2019-2022. Primary outcomes were ED occupancy, the number of alcohol-related presentations and methamphetamine-related presentations in each ED at the time of survey.

RESULTS

Seventy eight of a possible 152 hospitals answered all four surveys (51%, 95% confidence interval 43-59, individual yearly response rates ranged from 70.5% to 83.3%). The mean number of alcohol-related presentations in EDs at the snapshot time was 4.2 (95% confidence interval 3.2-5.2) in the 2019 survey and 3.8 (3.1-4.6) in 2022 with no significant variation over time. There was also no change in methamphetamine-related presentations which occurred at a lower level. There was a major increase in reported total ED occupancy - from 31.4 to 43.5 in Australia (P < 0.0001, paired t test) and from 22.8 to 38.7 in New Zealand (P = 0.0001). Subgroup analysis showed that both the number being treated and the number waiting to be seen increased, with little change in the number in observation units.

CONCLUSIONS

The present study demonstrates that the COVID-19 pandemic did not affect summer alcohol-related ED presentations in Australasia but was associated with an unsustainable increase in ED crowding.

Reevaluating Sleep Quality During COVID-19 and Associations With Quarantine, Mental Health, Stress, and Screen Time in Young Adults: Results From a Cross-Sectional Online Survey

The COVID-19 pandemic affected individual sleep quality, especially with high-stress levels. We assessed sleep quality in young adults during COVID-19, and mental health, stress, and screen time (ST) use. An international cross-sectional study was conducted from September 2020 to January 2021. The surveys assessed sleep quality (PSQI), ST use, and mental health. 183 participants were eligible for analysis. The average global PSQI score was 7.29 (sd = 3.58, n = 99). Associations were found between global PSQI scores and Fear of COVID-19 (r (98) = .223, P = .027), anxiety scores (r (99) = -.541, P < .001), increased total stress scores (r (88) = .486, P < .001), and depression (r (97) = .628, P < .001). Those currently quarantining had statistically higher PSQI scores than those who quarantined in the past (F (2,175) = 3.397, P = .036), but not for those who did not quarantine. Differences were found between genders for global PSQI (F (4,94) = 2.865, P < .027) and poor vs good sleep (X2 (1,98) = 3.982, P = .046). There was also a relationship between ethnicity and poor vs good sleep quality (X2 (2,94) = 6.538, P = .038). We did not find associations between ST and sleep quality but found poor sleep quality significantly related to mental health during COVID-19. We found no direct evidence that quarantining itself results in poor sleep quality. Interventions need to maximize sleep quality in certain groups, like females and ethnic minorities.

Alcohol-related liver disease: A global perspective

Alcohol-associated liver disease (ALD) represents one of the deadliest yet preventable consequences of excessive alcohol use. It represents 5.1 % of the global burden of disease, mainly involving the productive-age population (15-44 years) and leading to an increased mortality risk from traffic road injuries, suicide, violence, cardiovascular disease, neoplasms, and liver disease, among others, accounting for 5.3 % of global deaths. Daily alcohol consumption, binge drinking (BD), and heavy episodic drinking (HED) are the patterns associated with a higher risk of developing ALD. The escalating global burden of ALD, even exceeding what was predicted, is the result of a complex interaction between the lack of public policies that regulate alcohol consumption, low awareness of the scope of the disease, late referral to specialists, underuse of available medications, insufficient funds allocated to ALD research, and non-predictable events such as the COVID-19 pandemic, where increases of up to 477 % in online alcohol sales were registered in the United States. Early diagnosis, referral, and treatment are pivotal to achieving the therapeutic goal in patients with alcohol use disorder (AUD) and ALD, where complete alcohol abstinence and prevention of alcohol relapse are expected to enhance overall survival. This can be achieved through a combination of cognitive behavioral, motivational enhancement and pharmacological therapy. Furthermore, the appropriate use of available pharmacological therapy and implementation of public policies that comprehensively address this disease will make a real difference.

Intersection of Coronavirus Disease 2019 and Alcohol-associated Liver Disease: A Review of Emerging Trends and Implications

PURPOSE

This review will provide an overview of alcohol use and alcohol associated liver disease (ALD) prior to the coronavirus disease 2019 (COVID-19) pandemic and the impact of the pandemic on alcohol use and ALD. Furthermore, this review will explore strategies to mitigate the growing disease burden of AUD and ALD.

METHODS

A search using PubMed was performed for articles on topics related to alcohol use, ALD, and COVID-19. The literature was reviewed and pertinent sources were used for this narrative review.

FINDINGS

In the United States (US), excessive alcohol use is the third leading cause of preventable death. Prior to the COVID-19 pandemic, the increasing prevalence of alcohol use disorder (AUD) and ALD in the US had already constituted a public health crisis given the association between alcohol misuse, AUD, and ALD with significant medical, economic, and societal burdens. The COVID-19 pandemic led to increased alcohol consumption and downstream consequences, including increased prevalence of AUD, ALD, ALD-related hospitalization and death, and liver transplantation for ALD.

IMPLICATIONS

There is a critical need for additional, multi-pronged interventions to mitigate the mortality and morbidity linked to ALD.

Alcohol-Associated Liver Disease: Evolving Concepts and Treatments

Alcohol is a prominent cause of liver disease worldwide with higher prevalence in developed nations. The spectrum of alcohol-associated liver disease (ALD) encompasses a diverse range of clinical entities, from asymptomatic isolated steatosis to decompensated cirrhosis, and in some cases, acute or chronic liver failure. Consequently, it is important for healthcare practitioners to maintain awareness and systematically screen for ALD. The optimal evaluation and management of ALD necessitates a collaborative approach, incorporating a multidisciplinary team and accounting for concurrent medical conditions. A repertoire of therapeutic interventions exists to support patients in achieving alcohol cessation and sustaining remission, with complete abstinence being the ultimate objective. This review explores the existing therapeutic options for ALD acknowledging geographical discrepancies in accessibility. Recent innovations, including the inclusion of alcohol consumption biomarkers into clinical protocols and the expansion of liver transplantation eligibility to encompass severe alcohol-associated hepatitis, are explored.

Impact of COVID-19 on hospital visits for non-traumatic dental conditions in Ontario, Canada

BACKGROUND AND RATIONALE

As general health care is publicly funded in Canada and oral health care is not, many people seek care from hospitals for their dental problems. This study assessed if the unprecedented times of Coronavirus disease (COVID-19) affected the hospital visits for dental emergencies, making disadvantaged populations further vulnerable for attendance of their dental problems.

METHODS

Data from IntelliHealth Ontario for emergency department (ED) visits, day surgery visits, and hospitalizations associated with non-traumatic dental conditions (NTDCs) were retrieved for years 2016 to 2020 to assess trends before COVID-19 and changes, if any, for the year 2020. Trends by month, for the years 2019 and 2020, to make straight comparisons and understand the effects of lockdown in Ontario, was also analyzed.

RESULTS

In the year 2020, there was a reduction of 40% in day surgeries, 21% in ED visits and 8% in hospitalizations compared to 2019. Stratified by month, largest reductions were observed in April 2020: 96% in day surgeries; 50% in ED visits; and 38% reductions in hospitalizations when compared to the same month of 2019. In May 2020, day surgeries and ED visits though remained reduced, hospitalization rates increased by 31%.

CONCLUSION

Hospital EDs are inefficient avenues for handling dental emergencies. Nevertheless, they do remain a care setting that is sought by many for dental problems, and if the need for hospitalization and day surgery is there, this care setting is an important avenue for dentally related medical care. Perhaps unsurprisingly, COVID-19 has lessened the opportunity and capacity for such care.

PRACTICAL IMPLICATIONS

Administrators and policy makers can utilize this information to strategize on augmenting community infrastructure for building more effective, and cost-efficient avenues of care for timely management of dental problems.

The COVID-19 impact and characterization on substance use-related emergency department visits for adolescents and young adults in Canada: Practical implications

RATIONALE

Coronavirus (COVID-19)-related stressors precipitated the mental health crisis and increased substance use in Canada and worldwide. As the pandemic continues to evolve, monitoring and updating substance use-related ED visit trends is essential to ensure the stability and quality of ED services under the prolonged pandemic timeline.

AIMS AND OBJECTIVES

This study examined the trends and characterization of substance use-related ED visits during the pandemic among adolescents and young adults (aged 13-25 years) in Ontario, Canada.

METHODS

Descriptive statistics and binary logistic regression analyses were conducted using population-based, repeated cross-sectional data. The volume, patient characteristics (age and sex) and hospital/ED visit features (triage to end time, timing of the visit, triage level and referral source) were compared before (2019) and during COVID-19 (2020 and 2021) by each substance type (alcohol, opioid, cannabis, sedatives, cocaine, stimulants and multiple psychoactive substances).

RESULTS

Substance use-related ED visits decreased by 1.5 times during the pandemic compared to the prepandemic level. However, opioid-related ED visits continued to show an increasing trend and did not recover to the prepandemic level in 2021. Moreover, a significant increase in emergent/life-threatening triage levels (Canadian Triage and Acuity Scales 1 and 2) in substance-related ED visits is alarming (2019 = 36.8%, 2020 = 38.7% and 2021 = 38.4%). We also found a general decrease in weekend visits, overnight visits and visits on statutory holidays, and substance use-related ED patients tended to stay longer (over 6 h) in the ED during the pandemic.

CONCLUSION

Our findings indicate unmet substance use treatment needs due to the limited accessibility and heightened threshold for ED visits during the pandemic. Providing access to substance treatment/programs outside ED is critical to reducing substance use-related complications presenting in the ED. Also, policies addressing the pandemic-related complexities in the ED and Health Human Resource challenges are warranted.

Changes in health service use due to alcohol during the COVID-19 pandemic among individuals with and individuals without pre-existing alcohol-related medical diagnoses

OBJECTIVE

To compare changes in outpatient and acute care visits due to alcohol during the COVID-19 pandemic between individuals with and those without a history of alcohol-related health service use (AHSU).

METHODS

We conducted a cross-sectional analysis of health administrative data in Ontario, Canada. The Ontario population was stratified into those with and those without 1+ health service encounter(s) due to alcohol in the past 2 years. We compared age- and sex-standardized rates of alcohol-related outpatient visits, emergency department (ED) visits, and hospitalizations during the first 15 months of the pandemic (March 2020-May 2021) to those during the same 15-month period prior to the pandemic (March 2018-May 2019).

RESULTS

Of 13,450,750 eligible Ontarians on March 11, 2022, 129,434 (1.0%) had AHSU in the previous 2 years. Overall, rates of alcohol-related outpatient visits and hospitalizations increased, while rates of alcohol-related ED visits decreased during the pandemic. There was a similar relative increase in rates of alcohol-related outpatient visits and hospitalizations between those with and those without prior AHSU. However, the absolute increase in rates of alcohol-related outpatient visits and hospitalizations was higher among those with prior AHSU (outpatient rate difference (RD) per 10,000 population: 852.3, 95% confidence interval (CI): 792.7, 911.9; inpatient RD: 26.0, 95% CI: -2.3, 54.2) than among those without (outpatient RD: 6.5, 95% CI: 6.0, 6.9; inpatient RD: 0.4, 95% CI: 0.2, 0.7).

CONCLUSION

Rates of alcohol-related outpatient and inpatient care increased during the COVID-19 pandemic, and high rate of recurrent harm among individuals with pre-pandemic AHSU was an important contributor to this trend.

The Fallacy of a Single Diagnosis

BACKGROUND

Diagnostic reasoning requires clinicians to think through complex uncertainties. We tested the possibility of a bias toward an available single diagnosis in uncertain cases.

DESIGN

We developed 5 different surveys providing a succinct description of a hypothetical individual patient scenaric. Each scenario was formulated in 2 versions randomized to participants, with the versions differing only in whether an alternative diagnosis was present or absent. The 5 scenarios were designed as separate tests of robustness using diverse cases, including a cautious scenario, a risky scenario, a sophisticated scenario, a validation scenario, and a comparative scenario (each survey containing only 1 version of 1 scenario). Participants included community members (n = 1104) and health care professionals (n = 200) who judged the chances of COVID infection in an individual patient.

RESULTS

The first scenario described a cautious patient and found a 47% reduction in the estimated odds of COVID when a flu diagnosis was present compared with absent (odds ratio = 0.53, 95% confidence interval 0.30 to 0.94, P = 0.003). The second scenario described a less cautious patient and found a 70% reduction in the estimated odds of COVID in the presence of a flu diagnosis (odds ratio = 0.30, 95% confidence interval 0.13 to 0.70, P < 0.001). The third was a more sophisticated scenario presented to medical professionals and found a 73% reduction in the estimated odds of COVID in the presence of a mononucleosis diagnosis (odds ratio = 0.27, 95% confidence interval 0.10 to 0.75, P < 0.001). Two further scenarios-avoiding mention of population norms-replicated the results.

LIMITATIONS

Brief hypothetical scenarios may overestimate the extent of bias in more complicated medical situations.

CONCLUSIONS

These results demonstrate that an available simple diagnosis can lead individuals toward premature closure and a failure to fully consider additional severe diseases.

HIGHLIGHTS

Occum's razor has been debated for centuries yet rarely subjected to experimental testing for evidence-based medicine.This article offers direct evidence that people favor an available simple diagnosis, thereby neglecting to consider additional serious diseases.The bias can lead individuals to mistakenly lower their judged likelihood of COVID or another disease when an alternate diagnosis is present.This misconception over the laws of probability appears in judgments by community members and by health care workers.The pitfall in reasoning extends to high-risk cases and is not easily attributed to information, incentives, or random chance.

Epidemiology and Disease Burden of Alcohol Associated Liver Disease

Consumption of alcohol in excess leads to substantial medical, economic, and societal burdens. Approximately 5.3% of all global deaths may be attributed to alcohol consumption. Moreover, the burden of alcohol associated liver disease (ALD) accounts for 5.1% of all disease and injury worldwide. Alcohol use disorder (AUD) affects men more than women globally with significant years of life loss to disability in low, middle and well-developed countries. Precise data on global estimates of alcohol related steatosis, alcohol related hepatitis, and alcohol related cirrhosis have been challenging to obtain. In the United States (US), alcohol related steatosis has been estimated at 4.3% based on NHANES data which has remained stable over 14 years. However, alcohol-related fibrotic liver disease has increased over the same period. In those with AUD, the prevalence of alcohol related hepatitis has been estimated at 10-35%. Globally, the prevalence of alcohol-associated cirrhosis has been estimated at 23.6 million individuals for compensated cirrhosis and 2.46 million for those with decompensated cirrhosis. The contribution of ALD to global mortality and disease burden of liver related deaths is substantial. In 2016 liver disease related to AUD contributed to 50% of the estimated liver disease deaths for age groups 15 years and above. Data from the US report high cost burdens associated with those admitted with alcohol-related liver complications. Finally, the recent COVID-19 pandemic has been associated with marked increase in alcohol consumption worldwide and will likely increase the burden of ALD.

Alcohol Withdrawal and the Associated Mood Disorders-A Review

Recreational use of alcohol is a social norm in many communities worldwide. Alcohol use in moderation brings pleasure and may protect the cardiovascular system. However, excessive alcohol consumption or alcohol abuse are detrimental to one's health. Three million deaths due to excessive alcohol consumption were reported by the World Health Organization. Emerging evidence also revealed the danger of moderate consumption, which includes the increased risk to cancer. Alcohol abuse and periods of withdrawal have been linked to depression and anxiety. Here, we present the effects of alcohol consumption (acute and chronic) on important brain structures-the frontal lobe, the temporal lobe, the limbic system, and the cerebellum. Apart from this, we also present the link between alcohol abuse and withdrawal and mood disorders in this review, thus drawing a link to oxidative stress. In addition, we also discuss the positive impacts of some pharmacotherapies used. Due to the ever-rising demands of life, the cycle between alcohol abuse, withdrawal, and mood disorders may be a never-ending cycle of destruction. Hence, through this review, we hope that we can emphasise the importance and urgency of managing this issue with the appropriate approaches.

Investigating the early impacts of the COVID-19 pandemic on modifiable risk factors for cancer and chronic disease: a repeated cross-sectional study in Alberta, Canada

OBJECTIVES

This study contributes to empirical evidence by examining the impact of the first and second waves of the COVID-19 pandemic on modifiable risk factors (MRF) and whether these patterns differ according to level of material deprivation among people living in Alberta.

METHODS

Using data from a repeated cross-sectional provincial health survey (Alberta Community Health Survey (ACHS): 2018-2021), we conducted logistic regression analyses examining the impacts of the COVID-19 pandemic on meeting national guidelines on four MRFs (tobacco use, physical activity, fruit and vegetable consumption, alcohol use) (n=11,249). We compared population-level changes in MRFs from one year before the COVID-19 pandemic (March 2019-February 2020) to one year during the pandemic (March 2020-February 2021) in Alberta. We also assessed whether these trends differed by a measure of material deprivation.

RESULTS

Compared to the pre-COVID-19 period, the fully adjusted odds of meeting recommended guidelines for fruit and vegetable consumption (OR=0.42) decreased during the pandemic. Individuals experiencing high material deprivation had lower odds of meeting recommended guidelines for physical activity (OR=0.65) and higher odds of not being current tobacco users (OR=1.36) during the pandemic versus during the pre-pandemic period.

CONCLUSION

At a population level, analyses from the ACHS showed minimal impacts of the first year of the COVID-19 pandemic on MRFs, besides fruit and vegetable consumption. Yet, stratifying results showed statistically significant differences in pandemic impacts on MRFs by level of material deprivation. Therefore, understanding the influence of material deprivation on MRFs during the pandemic is key to tailoring future public health interventions promoting health and preventing cancer and chronic disease.

Disputes between neighbors in Mexican cities during the COVID‐19 pandemic

We estimate the effect of the COVID‐19 pandemic lockdown on disputes between neighbors using a panel of 70 cities from across Mexico and a difference‐in‐difference strategy. Our results show that the lockdown exacerbated disputes related to pets as nuisances by 45%, noise by 31%, unruly children by 23%, and garbage by 22%. We do not find any effect of the COVID‐19 lockdown on disputes related to gossip. We also estimate heterogeneous effects of the alcohol sales ban across Mexican municipalities. Our findings suggest that this public policy helped to reduce the likelihood of disputes related to noise and garbage.

Hospitalizations During the COVID-19 Pandemic Among Recently Homeless Individuals: a Retrospective Population-Based Matched Cohort Study

BACKGROUND

Hospitalizations fell precipitously among the general population during the COVID-19 pandemic. It remains unclear whether individuals experiencing homelessness experienced similar reductions.

OBJECTIVE

To examine how overall and cause-specific hospitalizations changed among individuals with a recent history of homelessness (IRHH) and their housed counterparts during the first wave of the COVID-19 pandemic, using corresponding weeks in 2019 as a historical control.

DESIGN

Population-based cohort study conducted in Ontario, Canada, between September 30, 2018, and September 26, 2020.

PARTICIPANTS

In total, 38,617 IRHH, 15,022,368 housed individuals, and 186,858 low-income housed individuals matched on age, sex, rurality, and comorbidity burden.

MAIN MEASURES

Primary outcomes included medical-surgical, non-elective (overall and cause-specific), elective surgical, and psychiatric hospital admissions.

KEY RESULTS

Average rates of medical-surgical (rate ratio: 3.8, 95% CI: 3.7-3.8), non-elective (10.3, 95% CI: 10.1-10.4), and psychiatric admissions (128.1, 95% CI: 126.1-130.1) between January and September 2020 were substantially higher among IRHH compared to housed individuals. During the peak period (March 17 to June 16, 2020), rates of medical-surgical (0.47, 95% CI: 0.47-0.47), non-elective (0.80, 95% CI: 0.79-0.80), and psychiatric admissions (0.86, 95% CI: 0.84-0.88) were significantly lower among housed individuals relative to equivalent weeks in 2019. No significant changes were observed among IRHH. During the re-opening period (June 17-September 26, 2020), rates of non-elective hospitalizations for liver disease (1.41, 95% CI: 1.23-1.69), kidney disease (1.29, 95% CI: 1.14-1.47), and trauma (1.19, 95% CI: 1.07-1.32) increased substantially among IRHH but not housed individuals. Distinct hospitalization patterns were observed among IRHH even in comparison with more medically and socially vulnerable matched housed individuals.

CONCLUSIONS

Persistence in overall hospital admissions and increases in non-elective hospitalizations for liver disease, kidney disease, and trauma indicate that the COVID-19 pandemic presented unique challenges for recently homeless individuals. Health systems must better address the needs of this population during public health crises.

Women's Substance Use and Mental Health During the COVID-19 Pandemic

Purpose

Women are experiencing greater unemployment and increased stress from childcare responsibilities than men during the COVID-19 pandemic. Women with these experiences may be at particular risk for mental illness and increased substance use during the COVID-19 pandemic. The purpose of the study was to assess women's substance use, mental health, and experiences of COVID-19 pandemic impacts.

Methods

A national online survey was administered to adult women from September to November 2020. The survey included questionnaires assessing mental health, loneliness, intolerance for uncertainty, social support, substance use, and intimate partner violence (IPV).

Results

A total of 499 women responded; most were White, college educated, and in their mid-30s. Of the 20.24% who acknowledged at least one IPV problem, 29.7% stated that their IPV problems have gotten worse since the pandemic began, and 16.83% said that they have increased their drug or alcohol use to cope with their relationship problems. Anxiety, perceived daily impact of COVID-19, and lower self-efficacy were significant predictors of COVID-19 anxiety. Those with risky alcohol use had significantly higher anxiety (p = .028) and depression (p = .032) than those with low-risk alcohol use.

Conclusions

Greater anxiety about COVID-19, greater reported changes in daily life due to the pandemic, and high-risk alcohol use are related to greater mental health–related distress among women. For some, IPV has gotten worse during the pandemic and drug or alcohol use is a coping mechanism.

A longitudinal study of change in substance use from before to during the COVID-19 pandemic in young adults

Introduction

We assessed change in substance use from before to during the COVID-19 pandemic in young adults and identified factors associated with initiation/increase in use.

Methods

The sample comprised young adults from a longitudinal investigation of 1294 youth recruited at ages 12-13 (1999-2000) in 10 Montréal-area high schools. Pre-pandemic data on use of cannabis, alcohol, combustible cigarette, e-cigarette and binge drinking were collected at ages 20.4, 24.0 and 30.6. During COVID-19, data were collected from December 2020 to June 2021 (age 33.6). We studied the prevalence of any and weekly/daily use from age 20.4 to 33.6. Individual-level change in substance use during the pandemic was estimated as differences in the frequency of use from age 30.6 to 33.6 versus from age 24.0 to 30.6. Heterogeneity in the risk of initiated/increased substance use during COVID-19 across sociodemographic subgroups was assessed using modified Poisson regression.

Results

The prevalence of cannabis use increased from 17.5% to 23.1% from before to during the pandemic; e-cigarette use increased from 3.8% to 5.4%. In individual change analyses, the proportion of participants whose substance use did not change ranged from 48.9% (alcohol) to 84.0% (e-cigarettes). The incidence of initiated/increased cannabis use (22.4%), and quit/decreased alcohol (35.2%) and binge drinking (53.5%) were higher during the pandemic than between ages 24.0 to 30.6. Low education and living alone were associated with higher risks of initiated/increased use of most substances.

Discussion

Most participants reported stable patterns in substance use from before to during the COVID-19 pandemic.

Funding

The NDIT study was supported by the Canadian Cancer Society (grant numbers 010271, 017435, 704031) and the Canadian Institutes of Health Research (grant number 451832).

Barriers to recruiting primary care practices for implementation research during COVID-19: A qualitative study of practice coaches from the Stop Unhealthy (STUN) Alcohol Use Now trial

Background: The COVID-19 pandemic has brought widespread change to health care practice and research. With heightened stress in the general population, increased unhealthy alcohol use, and added pressures on primary care practices, comes the need to better understand how we can continue practice-based research and address public health priorities amid the ongoing pandemic. The current study considers barriers and facilitators to conducting such research, especially during the COVID-19 pandemic, within the context of recruiting practices for the STop UNhealthy (STUN) Alcohol Use Now trial. The STUN trial uses practice facilitation to implement screening and interventions for unhealthy alcohol use in primary care practices across the state of North Carolina. Methods: Semistructured interviews were conducted with a purposive sample of 15 practice coaches to discuss their recruitment experiences before and after recruitment was paused due to the pandemic. An inductive thematic analysis was used to identify themes and subthemes. Results: Pandemic-related barriers, including challenges in staffing, finances, and new COVID-19-related workflows, were most prominent. Competing priorities, such as quality improvement measures, North Carolina's implementation of Medicaid managed care, and organizational structures hampered recruitment efforts. Coaches also described barriers specific to the project and to the topic of alcohol. Several facilitators were identified, including the rising importance of behavioral health due to the pandemic, as well as existing relationships between practice coaches and practices. Conclusions: Difficulty managing competing priorities and obstacles within existing practice infrastructure inhibit the ability to participate in practice-based research and implementation of evidence-based practices. Lessons learned from this trial may inform strategies to recruit practices into research and to gain buy-in from practices in adopting evidence-based practices more generally.

Plain Language Summary

What is known: Unhealthy alcohol use is a significant public health issue, which has been exacerbated during the COVID-19 pandemic. Screening and brief intervention for unhealthy alcohol use is an evidence-based practice shown to help reduce drinking-related behaviors, yet it remains rare in practice. What this study adds: Using a qualitative approach, we identify barriers and facilitators to recruiting primary care practices into a funded trial that uses practice facilitation to address unhealthy alcohol use. We identify general insights as well as those specific to the COVID-19 pandemic. Barriers are primarily related to competing priorities, incentives, and lack of infrastructure. Facilitators are related to framing of the project and the anticipated level and type of resources needed to address unhealthy alcohol use especially as the pandemic wanes. Implications: Our findings provide information on barriers and facilitators to recruiting primary care practices for behavioral health projects and to implementing these activities. Using our findings, we provide a discussion of suggestions for conducting these types of projects in the future which may be of interest to researchers, practice managers, and providers.

High-Risk Alcohol Use and Disordered Eating Behavior Before and 1 Year After Sleeve Gastrectomy

Background

Evidence suggests a rise in alcohol misuse after some bariatric procedures. Whether undergoing sleeve gastrectomy raises the risk of high-risk alcohol use is unclear.

Objective

To characterize the risk of high-risk alcohol use 1 year after sleeve gastrectomy and collect preliminary data on potential associations between disordered eating and high-risk drinking post-surgery.

Methods

We interviewed 97 patients before and 1 year after sleeve gastrectomy and assessed for high-risk alcohol use via a modified version of the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C). Eating behavior was assessed using the Three Factor Eating Questionnaire Revised-18 (TFEQ-R18).

Results

The prevalence of high-risk drinking increased from 13.4% prior to surgery to 22.7% 1 year after sleeve gastrectomy; 16.5% of our sample reported new high-risk drinking equivalent to an incidence of 19.0%. New high-risk drinkers appeared more likely to report lower cognitive restraint scores and higher scores for emotional and uncontrolled eating at baseline and had larger improvements in disordered eating scores post-surgery although these differences approached, but did not reach, statistical significance.

Conclusion

One in five non-high-risk drinkers developed new high-risk alcohol intake 1 year after sleeve gastrectomy. New high-risk drinkers appear to have greater disordered eating at baseline and reported greater improvement in eating behavior than those who did not develop new high-risk drinking. These results are consistent with the addiction transfer hypothesis postulating that some patients may replace disordered eating with alcohol misuse after sleeve gastrectomy.

Graphical abstract

Supplementary Information

The online version contains supplementary material available at 10.1007/s11695-021-05847-3.

Trends in alcohol consumption in relation to the COVID-19 pandemic: A cross-country analysis

During the first sequence of lockdowns implemented in many countries around the world in early 2020 as a result of the emerging COVID-19 pandemic, there was widespread concern amongst many health professionals regarding a predicted rise in alcohol consumption. However, studies have reported diverse findings, with some consumer groups exhibiting an increase and others a decrease in their alcohol purchase and consumption patterns. Although the long-lasting changes in alcohol consumption, if any, are still unknown, the current situation has effectively accelerated a number of pre-existing trends which will likely continue in the future. E-commerce is growing steadily, mainly because of the restrictions within the on-trade channel and concerns around catching COVID-19 amongst consumers, thus lifting traditional barriers to the adoption of digital channels. Premiumization has also grown significantly during the pandemic, especially in the spirits category, due, in part, to the fact that consumers have been increasingly trying to recreate bar and restaurant quality gastronomic experiences in the privacy of their own homes. The trend toward homemade experiences is multi-stakeholder as consumers, retailers, restaurateurs, bar owners, and brands all try to help facilitate at-home consumption experiences. Larger size purchases seem to reflect not only the stockpiling phenomena that occurred during the initial phases of the pandemic but also convenience for consumers (e.g., avoiding queues). Additionally, the growing home mixology movement has been observed to result in consumers buying larger amounts of alcohol in order to facilitate cocktail making experimentation at home. It is important to stress, though, that this review was specially focused on available data from the first three quarters of 2020, as an effort to identify and understand the initial impacts the COVID-19 was creating amongst alcohol consumers. It currently remains uncertain how these trends will evolve, and whether or not they will continue post COVID-19 (whenever that might be). Key similarities and differences across national markets are highlighted.

Exploring the Linkages between Substance Use, Natural Disasters, Pandemics, and Intimate Partner Violence against Women: A Rapid Review in the Context of COVID-19

Rates of intimate partner violence (IPV) and substance use have risen during the COVID-19 pandemic, with potentially enduring effects on women’s health. A rapid review was conducted on IPV and women’s substance use in the context of the COVID-19 pandemic. The rapid review explored two separate research questions with a view to integrate the literature related to: (1) containment, social isolation, pandemics, disasters, lockdowns, and IPV; and (2) the relationships between substance use and IPV. Two different searches for each question were conducted between May and October 2020 and n = 47 articles were included. Women experience multiple physical and mental health consequences related to IPV that can be exacerbated by public health crises such as pandemics and disasters. Perpetrators may use these events as a tactic to threaten, isolate, or use coercive control. Similar tactics are reported in the complex relationship between IPV and substance use, where substance use can accompany IPV and/or be used as a coping mechanism for survivors. The findings highlight long standing women’s health concerns made further visible during the COVID-19 pandemic. Additional research is needed to identify actions required to reduce gender inequities and harms associated with IPV and substance use, and to adequately tailor and prepare effective responses in the context of future public health crises.

Lockdown and licensed premises: COVID-19 lessons for alcohol policy

Introduction

The COVID‐19 pandemic necessitated unprecedented changes in alcohol availability, including closures, curfews and restrictions. We draw on new data from three UK studies exploring these issues to identify implications for premises licensing and wider policy.

Methods

(i) Semi‐structured interviews (n = 17) with licensing stakeholders in Scotland and England reporting how COVID‐19 has reshaped local licensing and alcohol‐related harms; (ii) semi‐structured interviews (n = 15) with ambulance clinicians reporting experiences with alcohol during the pandemic; and (iii) descriptive and time series analyses of alcohol‐related ambulance callouts in Scotland before and during the first UK lockdown (1 January 2019 to 30 June 2020).

Results

COVID‐19 restrictions (closures, curfews) affected on‐trade premises only and licensing stakeholders highlighted the relaxation of some laws (e.g. on takeaway alcohol) and a rise in home drinking as having long‐term risks for public health. Ambulance clinicians described a welcome break from pre‐pandemic mass public intoxication and huge reductions in alcohol‐related callouts at night‐time. They also highlighted potential long‐term risks of increased home drinking. The national lockdown was associated with an absolute fall of 2.14 percentage points [95% confidence interval (CI) −3.54, −0.74; P = 0.003] in alcohol‐related callouts as a percentage of total callouts, followed by a daily increase of +0.03% (95% CI 0.010, 0.05; P = 0.004).

Discussion and Conclusions

COVID‐19 gave rise to both restrictions on premises and relaxations of licensing, with initial reductions in alcohol‐related ambulance callouts, a rise in home drinking and diverse impacts on businesses. Policies which may protect on‐trade businesses, while reshaping the night‐time economy away from alcohol‐related harms, could offer a ‘win–win’ for policymakers and health advocates.

NAFLD and Alcohol-Associated Liver Disease Will Be Responsible for Almost All New Diagnoses of Cirrhosis in Canada by 2040

BACKGROUND AND AIMS

Mortality secondary to cirrhosis in North America is increasing. We describe the incidence of cirrhosis stratified by birth cohort and cirrhosis etiology and project disease burden to 2040.

APPROACH AND RESULTS

This is a retrospective cohort study in Ontario, Canada, using population-based administrative health care data. Individuals with incident cirrhosis (2000-2017) were identified, and etiology was defined as HCV, HBV, NAFLD, alcohol-associated liver disease (ALD), or autoimmune liver disease/other using validated case definitions. Annual age/sex-adjusted cirrhosis incidence rate per 100,000 person-years was calculated with incidence projection to 2040 using age-period-cohort modeling along with average annual percent change (AAPC) in cirrhosis incidence stratified by birth cohort and etiology. In total, 159,549 incident cases of cirrhosis were identified. Incidence increased by 26% with an AAPC of 2%/year (95% CI, 1.6-2.4; P < 0.001). The largest increases were for HCV (AAPC, 4.1%/year; 95% CI, 2.6-5.7; P < 0.001) and NAFLD (AAPC, 3.3%/year; 95% CI, 2.6-4.1%; P < 0.001). ALD and HCV cirrhosis in those born >1980 increased by 11.6%/year (95% CI, 9.3-13.9; P < 0.001) and 9.5%/year (95% CI, 6.2-13.0; P < 0.001), respectively. However, by 2040, cirrhosis incidence is projected to continue to increase, driven mostly by NAFLD, especially in postmenopausal women, and ALD in individuals born >1980.

CONCLUSIONS

Cirrhosis incidence will continue to increase over the next two decades secondary to NAFLD with a worrisome rapid rise in ALD cirrhosis among young adults. Public education, policy, and intervention targeting NAFLD risk factors and alcohol use in young adults are urgently needed.

Changes in the dollar value of per capita alcohol, essential, and non-essential retail sales in Canada during COVID-19

Background

Multiple survey reports suggest that alcohol use has increased in Canada during the COVID-19 pandemic. However, less is known about how per capita alcohol sales, which predict population-level alcohol use, have changed and whether changes in alcohol sales differ from changes in sales of other products due to pandemic factors.

Methods

We obtained monthly retail sales data by industry from Statistics Canada, for the six largest provinces in Canada (containing 93% of the national population), between January 2010 and November 2020, representing time before and 9 months after the start of the pandemic in Canada. We used an interrupted time series analysis to estimate pandemic impacts on the dollar value of monthly per capita (per individuals 15+ years) alcohol, essential and non-essential retail sales. We adjusted our analyses for pre-pandemic sales trends, inflation, seasonality and changing population demographics over time.

Results

During the first 9 months of the pandemic, the values of per capita alcohol, essential and non-essential sales were, respectively, 13.2% higher, 3.6% higher and 13.1% lower than the average values during the same period in the prior 3 years. Interrupted time series models showed significant level change for the value of monthly per capita alcohol sales (+$4.86, 95% CIs: 2.88, 6.83), essential sales (−$59.80, 95% CIs: − 78.47, − 41.03) and non-essential sales (−$308.70, 95% CIs: − $326.60, − 290.79) during the pandemic. Alcohol sales were consistently elevated during the pandemic, and the pre- and post-pandemic slopes were comparable. In contrast, essential and non-essential retail sales declined in the early months of the pandemic before returning to regular spending levels.

Conclusion

During the first 9 months of the pandemic, per capita alcohol sales were moderately elevated in Canada. In contrast, non-essential sales were lower than prior years, driven by large decreases during the initial months of the pandemic. These findings suggest that the pandemic was associated with increased population-level alcohol consumption, which may lead to increased alcohol-related harms. Ongoing research is needed to examine how factors, including pandemic-related stressors and specific alcohol sales-related policies, may have influenced changes in alcohol use and harms.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12226-1.

The impact of the COVID-19 pandemic on alcohol-related emergency department visits in the Netherlands: The ALCOVID study

INTRODUCTION

The ongoing COVID-19 pandemic has a profound impact on society and healthcare utilisation. Some studies found that alcohol consumption increased. While declines in non-COVID emergency department (ED) visits have been observed worldwide, little is known about the impact of the COVID-19 pandemic on the number of alcohol-related ED visits. We aimed to examine the changes in alcohol-related ED utilisation during the first year of the pandemic in the Netherlands. We assessed whether lockdowns, closure of the catering industry and alcohol bans were associated with changes in ED utilisation for alcohol-related emergencies.

METHODS

We performed a retrospective analysis of alcohol-related ED visits in a Dutch trauma level 2 centre, comparing the pandemic year 2020 and using the year 2019 as a reference. Alcohol-related ED visits were categorised as alcohol intoxication, alcohol-related trauma or a combination of both.

RESULTS

There was an absolute decline of 23.3% in alcohol-related ED visits during 2020 compared to 2019. The decline was most distinct during the second lockdown period (-60%, P ≤ 0.001), which included an alcohol ban. No significant differences were found in the type of alcohol-related ED visits. The proportion of alcohol-related ED visits remained similar (2.2% vs. 2%).

DISCUSSION AND CONCLUSIONS

Despite reports of higher alcohol consumption, we observed a reduction of alcohol-related ED visits during the COVID-19 pandemic. The decline was most distinct during the second lockdown period, which included an alcohol ban. Further prospective studies are warranted to examine this possible association.

Changes in alcohol consumption during the COVID-19 pandemic: exploring gender differences and the role of emotional distress

INTRODUCTION

Restrictions to do with the COVID-19 pandemic have had substantial unintended consequences on Canadians' alcohol consumption patterns, including increased emotional distress and its potential impact on alcohol use. This study examines 1) changes in adults' alcohol consumption during the COVID-19 pandemic in New Brunswick and Nova Scotia; 2) whether drinking more frequently during the pandemic is associated with increased feelings of stress, loneliness and hopelessness; and 3) whether gender moderates this relationship.

METHODS

Participants were drawn from a cross-sectional survey of 2000 adults. Adjusted multinomial regression models were used to assess the association between drinking frequency and increased feelings of stress, loneliness and hopelessness. Additional analyses were stratified by gender.

RESULTS

About 12% of respondents reported drinking more frequently after the start of the COVID-19 pandemic, and 25%-40% reported increased emotional distress. Increased feelings of stress (odds ratio [OR] = 1.99; 95% confidence interval [CI]: 1.35-2.93), loneliness (OR = 1.79; 95% CI: 1.22-2.61) and hopelessness (OR = 1.98; 95% CI: 1.21-3.23) were all associated with drinking more frequently during the pandemic. While women respondents reported higher rates of emotional distress, significant associations with increased drinking frequency were only observed among men in gender-stratified analyses.

CONCLUSION

Individuals who report increased feelings of stress, loneliness and hopelessness during the COVID-19 pandemic were more likely to report increased drinking frequency; however, these associations were only significant for men in stratified analyses. Understanding how the pandemic is associated with mental health and drinking may inform alcohol control policies and public health interventions to minimize alcohol-related harm.

Alcohol-Associated Liver Disease Before and After COVID-19-An Overview and Call for Ongoing Investigation

The Coronavirus Disease 2019 (COVID-19) pandemic has exacted a heavy toll on patients with alcohol-associated liver disease (ALD) and alcohol use disorder (AUD). The collective burden of ALD and AUD was large and growing, even before the COVID-19 pandemic. There is accumulating evidence that this pandemic has had a large direct effect on these patients and is likely to produce indirect effects through delays in care, psychological strain, and increased alcohol use. Now a year into the pandemic, it is important that clinicians fully understand the effects of the COVID-19 pandemic on patients with ALD and AUD. To fill existing gaps in knowledge, the scientific community must set research priorities for patients with ALD regarding their risk of COVID-19, prevention/treatment of COVID-19, changes in alcohol use during the pandemic, best use of AUD treatments in the COVID-19 era, and downstream effects of this pandemic on ALD. Conclusion: The COVID-19 pandemic has already inflicted disproportionate harms on patients with ALD, and ongoing, focused research efforts will be critical to better understand the direct and collateral effects of this pandemic on ALD.

Sociodemographic changes in emergency department visits due to alcohol during COVID-19

INTRODUCTION

Little detailed sociodemographic information is available about how alcohol use and associated health care visits have changed during COVID-19. Therefore, we assessed how rates of emergency department (ED) visits due to alcohol have changed during COVID-19 by age and sex and for individuals living in urban and rural settings and low and high-income neighborhoods.

METHODS

Our cohort included 13,660,516 unique Ontario residents between the ages of 10-105. We compared rates and characteristics of ED visits due to alcohol, identified using ICD-10 codes, from March 11-August 31 2020 to the same period in the prior 3 years. We used negative binomial regressions to examine to examine changes is visits during COVID-19 after accounting for temporal and seasonal trends.

RESULTS

During COVID-19, the average monthly rate of ED visits due to alcohol decreased by 17.2 % (95 % CI -22.7, -11.3) from 50.5-40.9 visits per 100,000 individuals. In contrast, the proportion of all-cause ED visits due to alcohol increased by 11.4 % (95 % CI 7.7, 15.3) from 15.0 visits to 16.3 visits per 1000 all cause ED visits. Changes in ED visits due to alcohol were similar for men in women. Decreases in visits were larger for younger adults compared to older adults and pre-COVID-19 disparities in rates of ED visits due to alcohol between urban and rural settings and low and high-income neighborhoods widened. ED visits related to harms from acute intoxication showed the largest declines during COVID-19, particularly in younger adults and urban and high-income neighborhoods.

CONCLUSION

ED visits due to alcohol decreased during the first six months of COVID-19, but to a lesser extent than decreases in all-cause ED visits. Our data suggest a widening of geographic and income-based disparities in alcohol harms in Ontario during COVID-19 which may require immediate and long-term interventions to mitigate.

Delivering the Multisensory Experience of Dining-Out, for Those Dining-In, During the Covid Pandemic

In many parts of the world, restaurants have been forced to close in unprecedented numbers during the various Covid-19 pandemic lockdowns that have paralyzed the hospitality industry globally. This highly-challenging operating environment has led to a rapid expansion in the number of high-end restaurants offering take-away food, or home-delivery meal kits, simply in order to survive. While the market for the home delivery of food was already expanding rapidly prior to the emergence of the Covid pandemic, the explosive recent growth seen in this sector has thrown up some intriguing issues and challenges. For instance, concerns have been raised over where many of the meals that are being delivered are being prepared, given the rise of so-called "dark kitchens." Furthermore, figuring out which elements of the high-end, fine-dining experience, and of the increasingly-popular multisensory experiential dining, can be captured by those diners who may be eating and drinking in the comfort of their own homes represents an intriguing challenge for the emerging field of gastrophysics research; one that the chefs, restaurateurs, restaurant groups, and even the food delivery companies concerned are only just beginning to get to grips with. By analyzing a number of the high-end fine-dining home food delivery options that have been offered (in the UK and in the US) in this narrative review, we highlight a number of promising directions for those wanting to optimize the at-home multisensory dining experience, wherever in the world they might be.