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.

Is Alcohol Consumption Associated With Risk of Early Menopause?

Earlier age at menopause is associated with increased long-term health risks. Moderate alcohol intake has been suggested to delay menopause onset, but it is unknown whether alcohol subtypes are associated with early menopause onset at age 45 years. Therefore, we aimed to evaluate risk of early natural menopause among 107,817 members of the Nurses' Health Study II who were followed from 1989 to 2011. Alcohol consumption overall and by subtypes, including beer, red wine, white wine, and liquor, was assessed throughout follow-up. We estimated hazard ratios in multivariable models that were adjusted for age, body mass index, parity, smoking, and other potential confounders. Women who reported moderate current alcohol consumption had lower risks of early menopause than did nondrinkers. Those who reported consuming 10.0-14.9 g/day had a lower risk of early menopause than did nondrinkers (hazard ratio = 0.81, 95% confidence interval: 0.68, 0.97). Among specific beverages, evidence of lower early menopause risk was confined to consumption of white wine and potentially red wine and liquor, but not to beer. Data from this large prospective study suggest a weak association of moderate alcohol intake with lower risk of early menopause, which was most pronounced for consumption of white and red wine and liquor. High consumption was not related to lower risk of early menopause.

Long-Term Trends (1994-2011) and Predictors of Total Alcohol and Alcoholic Beverages Consumption: The EPIC Greece Cohort

The aim of this study was to evaluate the longitudinal changes in alcohol consumption (total alcohol and types of alcoholic beverages) of the Greek EPIC cohort participants (28,572) during a 17-year period (1994-2011), with alcohol information being recorded repeatedly over time. Descriptive statistics were used to show crude trends in drinking behavior. Mixed-effects models were used to study the consumption of total alcohol, wine, beer and spirits/other alcoholic beverages in relation to birth cohort, socio-demographic, lifestyle and health factors. We observed a decreasing trend of alcohol intake as age increased, consistent for total alcohol consumption and the three types of beverages. Older birth cohorts had lower initial total alcohol consumption (8 vs. 10 g/day) and steeper decline in wine, spirits/other alcoholic beverages and total alcohol consumption compared to younger cohorts. Higher education and smoking at baseline had a positive association with longitudinal total alcohol consumption, up to +30% (vs. low education) and more than +25% (vs. non-smoking) respectively, whereas female gender, obesity, history of heart attack, diabetes, peptic ulcer and high blood pressure at baseline had a negative association of -85%, -25%, -16%, -37%, -22% and -24% respectively. Alcohol consumption changed over age with different trends among the studied subgroups and types of alcohol, suggesting targeted monitoring of alcohol consumption.

Alcohol excise taxes as a percentage of retail alcohol prices in 26 OECD countries

BACKGROUND

Many countries have implemented alcohol excise taxes. However, measures of excise taxes as a percentage of alcohol prices have not been systematically studied.

METHODS

Data on the retail prices of alcoholic beverages sold in stores and excise taxes in 26 countries during 2003-2018 was from the Economist Intelligence Unit price city data and the Organization for Economic Co-operation and Development (OECD) tax database. The percentages of excise taxes in off-premise retail prices were derived as the ratio of taxes to prices at different price levels. Changes of excise taxes over time were assessed using negative binominal regressions.

RESULTS

The percentage of excise taxes in average off-premise alcohol prices was from 5 % in Luxembourg to 59 % in Iceland for beer, and from 0 % in France to 26 % in Iceland for wine. Excise taxes accounted for 5% of discount liquor prices in Czech Republic to 41 % in Sweden for Cognac, for 19 % in the United States (US) to 67 % in Sweden for Gin, for 13 % in the US to 63 % in Australia for Scotch Whisky six years old, and for 6 % in Iceland to 76 % in Sweden for Liqueur Cointreau. There were no significant changes in the percentage of excise taxes in alcohol prices over time in most countries except for Nordic countries. While wine had the lowest excise taxes, liquors had the highest tax burden.

CONCLUSION

Tax burden on alcoholic beverages is low in OECD countries, indicating ample room for increasing alcohol excise taxes, particularly for beer and wine in those countries.

Nonalcoholic and Alcoholic Beverage Intakes by Adults across 5 Upper-Middle- and High-Income Countries

BACKGROUND

Despite considerable public health interest in sugary drink consumption, there has been little comparison of intake across countries.

OBJECTIVES

This study aimed to compare the consumption frequency and amounts of commonly consumed beverages among adults in 5 upper-middle- and high-income countries, and examine differences in consumption between population subgroups.

METHODS

Adults aged 18-65 y completed online surveys in December 2017 in Australia (n = 3264), Canada (n = 2745), Mexico (n = 3152), the United Kingdom (n = 3221), and the USA (n = 4015) as part of the International Food Policy Study. The frequency of consuming beverages from 22 categories in the past 7 d was estimated using the Beverage Frequency Questionnaire. Regression models were used to examine differences in the likelihood of any consumption and in the amounts consumed of sugar-sweetened beverages (SSBs), sugary drinks (SSBs and 100% juice), diet, and alcoholic beverages between countries and across sociodemographic subgroups.

RESULTS

The prevalence of reported SSB consumption in the past 7 d ranged from 47% (United Kingdom) to 81% (Mexico), and that of sugary drinks ranged from 62% (United Kingdom) to 87% (Mexico). Rates of consumption of diet drinks ranged from 26% (Mexico) to 37% (United Kingdom), whereas alcoholic drink consumption rates ranged from 45% (USA) to 52% (Canada). Respondents in Mexico were more likely to consume SSBs and sugary drinks, and in greater amounts, than those in other countries. Respondents in the United Kingdom were more likely to consume diet drinks than those in Australia, Canada, and Mexico, and greater amounts of diet drinks were consumed in the United Kingdom and the USA. Across countries, younger respondents and males were more likely to consume greater amounts of SSBs and sugary drinks.

CONCLUSIONS

Most adult respondents across all countries consumed SSBs and sugary drinks, with greater consumption in Mexico and the USA. Consumption varied greatly across countries, but patterns of association among subpopulations were relatively similar.

The pass-through of alcohol excise taxes to prices in OECD countries

Tax pass-through rates to prices measure how much prices increase when taxes are increased by one unit, which will in turn determine the effectiveness of taxation policies in reducing substance use. Using longitudinal data of alcohol prices and excise taxes from 27 Organization for Economic Cooperation and Development (OECD) countries from 2003 to 2016, we estimate the tax pass-through rates to prices for a variety of alcoholic beverages-beer (1.24; 95% CIs: [0.67, 1.81]), wine (2.4; 95% CIs: [1.7, 3.11]), Cognac (1.71; 95% CIs: [1.07, 2.35]), Gin (0.85; 95% CIs: [0.34, 1.35]), Scotch whisky (1.14; 95% CIs: [0.52, 1.75]), and Liqueur Cointreau (1.98; 95% CIs: [1.21, 2.76]). While excise taxes on wine, Cognac, and Liqueur Cointreau are over-shifted to prices, taxes on Gin are exact- or under-shifted. Excise taxes on beer and Scotch whisky are likely over-shifted to prices, but the tax pass-through rates for these beverages are not significantly different from 1 and we cannot completely rule out exact pass-through of taxes to prices. The tax pass-through to prices for most beverage types is also higher for higher-priced products. Dynamic model further shows a lagged impact of wine and beer taxes on prices, indicating pricing strategies that may target lower-priced beer and wine.

The Rise and Fall of Alcohol Excise Taxes in U.S. States, 1933-2018

OBJECTIVE

Higher alcohol taxation is protective against alcohol-related morbidity and mortality. All states have specific (volume-based) excise taxes for alcohol that decrease if not adjusted for inflation. These taxes have diminished substantially in real terms since their inception after National Prohibition in the United States. The purpose of this study was to examine trends in the magnitude and frequency of changes in state specific excise taxes to document their erosion.

METHOD

Alcohol excise tax data were examined for all 50 states from 1933 to 2018. Tax data were obtained from the Alcohol Policy Information System, Pacific Institute for Research and Evaluation, Wine Institute, and HeinOnline. Linear and logistic regression analyses were conducted for beer, wine, and distilled spirits taxes to examine trends in the frequency and inflation-adjusted magnitude of changes in taxes from the year of alcohol tax inception.

RESULTS

From 1933 until 1970, beer, wine, and distilled spirits tax rates increased in value compared with inception rates, but by 2018 alcohol taxes had declined 66%, 71%, and 70%, respectively, compared with their inception values. The erosion of taxes after 1970 was driven primarily by declines in the magnitude of tax increases through the 1970s and 1980s, followed by declines in the frequency of tax increases in subsequent decades.

CONCLUSIONS

The value of alcohol excise taxes has declined since 1970 from both insufficient tax increases and later infrequent tax increases. Laws that index rates to inflation could sustain the public health benefit of reduced morbidity and mortality resulting from higher alcohol tax rates.

Alcohol Availability, Use, and Harms Among Adolescents in Three Mexican Cities

Alcohol remains readily available to youth in most countries. We examined the associations between both the on- and off-premises commercial availability of alcohol to youth and their alcohol use, heavy episodic drinking, and alcohol-related harms. We conducted the study using data from a survey of a sample of 594 students in central Mexico between 12 and 17 years of age in 2016. Both the perceived availability of alcohol and the purchasing of alcohol at an off-premises establishment were positively related to past-30-day alcohol use and heavy episodic drinking, as well as to alcohol-related harms in the past year. Consumption at on-premises establishments was also positively associated with alcohol-related harms. Preventive efforts to reduce the availability of alcohol at off- and on-premises establishments, by such strategies as mystery shopper and responsible beverage service programs, are imperative.

Alcohol Outlet Clusters and Population Disparities

Alcohol outlet clusters are an important social determinant of health in cities, but little is known about the populations exposed to them. If outlets cluster in neighborhoods comprised of specific racial/ethnic or economic groups, then they may function as a root cause of urban health disparities. This study used 2016 liquor license data (n = 1204) from Baltimore City, Maryland, and demographic data from the American Community Survey. We defined alcohol outlet clusters by combining SaTScan moving window methods and distances between outlets. We used multiple logistic regression to compare census block groups (CBGs) (n = 537) inside and outside of four types of outlet clusters: total, on-premise, off-premise, and LBD-7 (combined on-/off-premise). The most robust predictor of alcohol outlet cluster membership was a history of redlining, i.e., racially discriminatory lending policies. CBGs that were redlined had 7.32 times the odds of being in an off-premise cluster, 8.07 times the odds of being in an on-premise cluster, and 8.60 times the odds of being in a LBD-7 cluster. In addition, level of economic investment (marked by vacant properties) appears to be a key characteristic that separates CBGs in on- and off-premise outlet clusters. CBGs with racial/ethnic or socioeconomic advantage had higher odds of being in on-premise clusters and CBGs marked by disinvestment had higher odds of being in off-premise clusters. Off-premise clusters deserve closer examination from a policy perspective, to mitigate their potential role in creating and perpetuating social and health disparities. In addition to addressing redlining and disinvestment, the current negative effects of alcohol outlet clusters that have grown up in redlined and disinvested areas must be addressed if inequities in these neighborhoods are to be reversed.

Effects of Extensions and Restrictions in Alcohol Trading Hours on the Incidence of Assault and Unintentional Injury: Systematic Review

OBJECTIVE

We undertook a systematic review to assess the effects of extensions and restrictions in trading hours of on- and off-license alcohol outlets. We included new primary studies that help address limitations in previous reviews.

METHOD

We systematically searched electronic databases and reference lists, up to December 2018, and contacted the authors of eligible studies. Studies were eligible if (a) the design was randomized, or nonrandomized with at least one control site/series; (b) the intervention evaluated extensions or restrictions in trading hours at on- or off-license premises; and (c) the outcome measures were assault, unintentional injury, traffic crash, drink-driving offenses, or hospitalization. Two reviewers independently extracted data using a standard form that included study quality indicators.

RESULTS

After screening 3,857 records, we selected 22 studies for the systematic review, all of which used an interrupted time series design. In the included studies, extension of trading hours concerned on-license premises only, whereas restriction concerned both on- and off-license premises. Extending trading hours at on-license premises was typically followed by increases in the incidence of assault, unintentional injury, or drink-driving offenses. Conversely, restricting trading hours at on- and off-license premises was typically followed by decreases in the incidence of assault and hospitalization.

CONCLUSIONS

On balance, this review augments existing evidence that harm typically increases after extensions in on-license alcohol trading hours. It provides new evidence that alcohol-related harm decreases when on- and off-license trading hours are restricted.

Changes in alcohol and cigarette consumption in response to medical and recreational cannabis legalization: Evidence from U.S. state tax receipt data

BACKGROUND

Whether medical or recreational cannabis legalization impacts alcohol or cigarette consumption is a key question as cannabis policy evolves, given the adverse health effects of these substances. Relatively little research has examined this question. The objective of this study was to examine whether medical or recreational cannabis legalization was associated with any change in state-level per capita alcohol or cigarette consumption.

METHODS

Dependent variables included per capita consumption of alcohol and cigarettes from all 50 U.S. states, estimated from state tax receipts and maintained by the Centers for Disease Control and National Institute for Alcohol Abuse and Alcoholism, respectively. Independent variables included indicators for medical and recreational legalization policies. Three different types of indicators were separately used to model medical cannabis policies. Indicators for the primary model were based on the presence of active medical cannabis dispensaries. Secondary models used indicators based on either the presence of a more liberal medical cannabis policy ("non-medicalized") or the presence of any medical cannabis policy. Difference-in-difference regression models were applied to estimate associations for each type of policy.

RESULTS

Primary models found no statistically significant associations between medical or recreational cannabis legalization policies and either alcohol or cigarette sales per capita. In a secondary model, both medical and recreational policies were associated with significantly decreased per capita cigarette sales compared to states with no medical cannabis policy. However, post hoc analyses demonstrated that these reductions were apparent at least two years prior to policy adoption, indicating that they likely result from other time-varying characteristics of legalization states, rather than cannabis policy.

CONCLUSION

We found no evidence of a causal association between medical or recreational cannabis legalization and changes in either alcohol or cigarette sales per capita.

Drinking beer, wine or spirits - does it matter for inequalities in alcohol-related hospital admission? A record-linked longitudinal study in Wales

BACKGROUND

Alcohol-related harm has been found to be higher in disadvantaged groups, despite similar alcohol consumption to advantaged groups. This is known as the alcohol harm paradox. Beverage type is reportedly socioeconomically patterned but has not been included in longitudinal studies investigating record-linked alcohol consumption and harm. We aimed to investigate whether and to what extent consumption by beverage type, BMI, smoking and other factors explain inequalities in alcohol-related harm.

METHODS

11,038 respondents to the Welsh Health Survey answered questions on their health and lifestyle. Responses were record-linked to wholly attributable alcohol-related hospital admissions (ARHA) eight years before the survey month and until the end of 2016 within the Secure Anonymised Information Linkage (SAIL) Databank. We used survival analysis, specifically multi-level and multi-failure Cox mixed effects models, to calculate the hazard ratios of ARHA. In adjusted models we included the number of units consumed by beverage type and other factors, censoring for death or moving out of Wales.

RESULTS

People living in more deprived areas had a higher risk of admission (HR 1.75; 95% CI 1.23-2.48) compared to less deprived. Adjustment for the number of units by type of alcohol consumed only reduced the risk of ARHA for more deprived areas by 4% (HR 1.72; 95% CI 1.21-2.44), whilst adding smoking and BMI reduced these inequalities by 35.7% (HR 1.48; 95% CI 1.01-2.17). These social patterns were similar for individual-level social class, employment, housing tenure and highest qualification. Inequalities were further reduced by including either health status (16.6%) or mental health condition (5%). Unit increases of spirits drunk were positively associated with increasing risk of ARHA (HR 1.06; 95% CI 1.01-1.12), higher than for other drink types.

CONCLUSIONS

Although consumption by beverage type was socioeconomically patterned, it did not help explain inequalities in alcohol-related harm. Smoking and BMI explained around a third of inequalities, but lower socioeconomic groups had a persistently higher risk of (multiple) ARHA. Comorbidities also explained a further proportion of inequalities and need further investigation, including the contribution of specific conditions. The increased harms from consumption of stronger alcoholic beverages may inform public health policy.

Neighborhood Alcohol Environment: Differential Effects on Hazardous Drinking and Mental Health by Sex in Persons Living with HIV (PLWH)

Despite greater mental health co-morbidities and heavier alcohol use among PLWH, few studies have examined the role of the neighborhood alcohol environment on either alcohol consumption or mental health. Utilizing cross-sectional data from a cohort study in a southern U.S. metropolitan area, we examine the association between neighborhood alcohol environments on hazardous drinking and mental health among 358 in-care PLWH (84% African American, 31% female). Multilevel models were utilized to quantify associations between neighborhood alcohol exposure on hazardous drinking and effect modification by sex. Neighborhood alcohol density was associated with hazardous drinking among men but not women. Women living in alcohol dense neighborhoods were nearly two-fold likely to report depression compared to those in less dense neighborhoods, with no association between neighborhood alcohol density and depression among men. Neighborhood alcohol environments may be an important contextual factor to consider in reducing heavy alcohol consumption and improving mental health among PLWH.

Why are caffeinated alcoholic beverages especially risky?

PURPOSE

Evidence suggests that people drink more alcohol and experience more adverse alcohol-related consequences (ARCs) on occasions when they also consume caffeine. The current study examined whether this increase in risk is a result of caffeine attenuating the subjective effects of alcohol intoxication (i.e., the masking hypothesis).

METHODS

Undergraduate students (n = 148) reported their drinking patterns using a modified Timeline Followback approach. For each recalled drinking occasion, alcohol consumption, caffeine consumption, perceived blood alcohol concentration, and ARCs were assessed. Generalized linear mixed models were used to examine the influence that alcohol and caffeine consumption had on perceived intoxication and the experience of ARCs.

RESULTS

At the occasion level, greater caffeine consumption was associated with increased consumption of alcohol and increased ARCs. There was also a significant curvilinear relationship between the amount of alcohol consumed and perceived intoxication, such that the more alcohol was consumed on each occasion the less each additional drink increased perceived intoxication. Increased caffeine consumption weakened the association between alcohol consumption and perceived intoxication and it also weakened the association between alcohol consumption and ARCs. Specifically, the weakest relationship between ARCs and alcohol consumption existed at the highest level of caffeine consumption (240+ mg). Caffeine increased subjective intoxication.

CONCLUSIONS

These findings do not support the masking hypothesis. Caffeine was strongly associated with ARCs when consumed at high doses and this effect does not appear to be the result of drinking more alcohol or underestimating one's blood alcohol content. Efforts to reduce caffeinated alcohol beverage use are greatly needed.

An observational study to examine how cumulative impact zones influence alcohol availability from different types of licensed outlets in an inner London Borough

OBJECTIVES

Cumulative impact zones (CIZs) are a widely implemented local policy intended to restrict alcohol availability in areas proliferated with licensed outlets. Limited previous research has questioned their effectiveness and suggested they may play a more nuanced role in shaping local alcohol environments. This study evaluates the association between CIZ implementation and the number of licence applications made, and the number issued, relative to a control region.

DESIGN

A quantitative observational study.

SETTING

The inner London Borough of Southwark, which currently enforces three CIZs.

POPULATION

Licence applications received by Southwark Council's Licensing Authority between 1 April 2006 and 31 March 2017 (n=1254).

INTERVENTIONS

CIZ implementation.

PRIMARY OUTCOME MEASURES

Five outlet types were categorised and evaluated: drinking establishments, eateries, takeaways, off sales and other outlets. Primary outcome measures were the number of applications received and the number of licences issued. These were analysed using Poisson regression of counts over time.

RESULTS

Across all CIZs, implementation was associated with greater increases in the number of eateries in CIZ regions (incidence rate ratio (IRR)=1.58, 95% CI: 1.02-2.45, p=0.04) and number of takeaway venues (IRR=3.89, 95% CI: 1.32-11.49, p=0.01), relative to the control area. No discernible association was found for the remaining outlet types. Disaggregating by area indicated a 10-fold relative increase in the number of new eateries in Peckham CIZ (IRR=10.38, 95% CI: 1.39-77.66, p=0.02) and a fourfold relative increase in the number of newly licensed takeaways in Bankside CIZ (IRR=4.38, 95% CI: 1.20-15.91, p=0.03).

CONCLUSIONS

CIZs may be useful as policy levers to shape local alcohol environments to support the licensing goals of specific geographical areas and diversify the night-time economy.

Beverage intake during alternate-day fasting: Relationship to energy intake and body weight

BACKGROUND

Alternate-day fasting (ADF) involves a 'famine day' (25% energy intake) and a 'feast day' (ad libitum intake). This secondary analysis examined changes in beverage intake in relation to energy intake and body weight during 12 months of ADF versus daily calorie restriction (CR).

METHODS

Obese subjects (n = 100 enrolled, n = 69 completers) were randomized to one of three groups for 12 months: (a) ADF; (b) CR; or (c) control.

RESULTS

At baseline, intakes of diet soda, caffeinated beverages, sugar-sweetened soda, alcohol, juice, and milk were similar between groups. There were no statistically significant changes in the intake of these beverages by month 6 or 12 between ADF (feast or famine day), CR, or control groups. Beverage intake was not related to energy intake or body weight at month 6 or 12 in any group.

CONCLUSION

These pilot findings suggest that intermittent fasting does not impact beverage intake in a way that affects energy intake or body weight.

Exploring violence: The role of neighborhood characteristics, alcohol outlets, and other micro-places

This study explores the association between neighborhood characteristics, alcohol outlets, other micro-places, and neighborhood violence rates. Prior studies that examined the alcohol availability and violence associations suggested that alcohol outlets play an important role in violent outcomes, yet we know less about the larger environment in which alcohol outlets are located, including how the availability of other types of places that exist side by side with alcohol outlets in neighborhoods could influence the alcohol-violence relationships. I collected publicly available data on simple and aggravated assaults, neighborhood characteristics (concentrated disadvantage, concentrated immigration, residential stability, and ethnic heterogeneity), on- and off-premise outlets, and other micro-places (colleges and universities, primary and secondary schools, financial services, gas stations, hotels and motels, laundromats, parks and playgrounds, and rooming houses) and subsequently aggregated the data to Milwaukee, Wisconsin census block groups. I estimated spatially lagged regression models to test these associations and compared the results across the models. The findings show that some neighborhood characteristics and some micro-places are important predictors of neighborhood violence. Importantly, off-premise alcohol outlets have a consistently significant positive relationship with simple and aggravated assaults, even when the influence of the neighborhood characteristics and micro-places is accounted for in the models. This study contributes to the environmental criminology theories and alcohol availability theory by highlighting the importance of off-premise outlets as crime attractors and crime generators to explain violence.

(Unintended) Consequences of initiating an alcohol sales policy at college football stadiums: A case study

University officials are increasingly considering selling alcoholic beverages at campus football stadiums. To inform this decision, we report on offenses occurring at a campus football stadium and surrounding community on game day weekends between 2009 and 2013. Campus police log data for 35 home football weekends were examined, accounting for 1,940 distinct incidents. There was a general upward trend in crime incidents. On average, 330 total crime incidents occurred when alcohol was not sold (2009-2011) compared to 475 annually when alcohol was sold (2012-2013). Liquor law violations and alcohol consumption by a minor were the two most frequently cited offenses. Liquor law violations (317) was highest after alcohol sales initiated. Police incidents were markedly higher when playing a traditional football rival at home. College administrators, health officials, athletic departments, and local law enforcement must work together to weigh the potential benefit of enhanced financial profit against the risk of increased alcohol-related crime.

Alcohol sale status and homicide victimization in Kentucky, 2005-2012: Is there a spatial association?

To date, the association between the alcohol sale status of decedents' residence and alcohol-related homicide victimization have not been studied as far as we know. The current study aims to: i) determine whether homicide victims who were residents of wet counties had higher odds of testing positive for alcohol than their counterparts in moist or dry counties after adjusting for confounders; ii) determine whether homicides and alcohol-related homicides tend to cluster spatially; iii) determine whether the aforementioned associations exist only in highly-populated counties. A multilevel logistic regression analysis was used to analyze the data on homicide victims in the Kentucky Violent Death Reporting System from 2005 to 2012. Spatial statistics were used to determine the spatial autocorrelation in rates of homicides and alcohol-related homicides. Overall, 944 homicide victims were included. The male to female ratio was 3:1. About 32.8% of homicide victims tested positive for alcohol. About 33.0% of homicide decedents who were residents in wet counties tested positive for alcohol compared to 32.5% of their counterparts in moist/dry counties. Residence in wet counties was associated with a statistically insignificant increase in the unadjusted odds ratio (OR) of alcohol-related homicide victimization (OR=1.20, 95% CI=0.81-1.77) as well as the adjusted odds (aOR=1.33, 95% CI=0.83-2.12). There was no association between population size and alcohol-related homicide rate.

Spirits purchasing and marijuana use behaviors of risky drinkers in the state of Washington from 2014 to 2016

BACKGROUND

Few studies have evaluated alcoholic beverage purchasing behaviors, which are relevant to the design and effectiveness of alcoholic beverage control policies. Focusing on spirits purchasing among spirits drinkers, this study compares purchasing behaviors between risky and non-risky drinkers and across drinking patterns among those observed drinking at both levels.

METHODS

A rolling panel of 794 spirits drinkers in the state of Washington were surveyed between two and five times at 6-month intervals during 2014, 2015 and 2016 regarding their alcohol use, spirits purchasing and marijuana use frequency. Purchasing behaviors assessed for spirits were the frequency of purchasing and the travel time, unit cost, bottle size and store type from the respondents most recent purchase. Alcohol use was categorized at each measurement as risky or not using US NIAAA guidelines.

RESULTS

Risky drinkers were more likely to purchase spirits, purchase spirits more frequently, purchase larger spirits containers and use marijuana occasionally, but not frequently. Among drinkers who were risky only in some survey waves, during risky waves they were more likely to purchase more frequently, pay less per liter for spirits purchased, buy larger sized containers of spirits and use marijuana occasionally.

CONCLUSIONS

Drinkers chose to purchase lower cost spirits in larger containers when they were drinking more heavily compared to times when they were drinking within US low-risk guidelines. Findings also support complementarity between heavier drinking and marijuana use among spirits drinkers in a state with legal recreational marijuana sales.

Association of food groups with depression and anxiety disorders

PURPOSE

Adherence to the Mediterranean diet has been associated with fewer depressive symptoms, however, it is unknown whether this is attributed to some or to all components. We examined the association between the individual food groups of the Mediterranean Diet Score (MDS), in isolation and in combination, with depression and anxiety (symptom severity and diagnosis).

METHODS

Data from 1634 adults were available from the Netherlands Study of Depression and Anxiety. Eleven energy-adjusted food groups were created from a 238-item food frequency questionnaire. In regression analysis, these were associated in isolation and combination with (1) depressive and anxiety disorders (established with the Composite International Diagnostic Interview) (current disorder n = 414), and (2) depression and anxiety severity [measured with the Inventory of Depressive Symptomatology (IDS), the Beck Anxiety Inventory (BAI) and the Fear Questionnaire (FEAR)].

RESULTS

Overall, the MDS score shows the strongest relationships with depression/anxiety [Diagnosis: odds ratio (OR) 0.77 per SD, 95% confidence interval (95% CI) 0.66-0.90, IDS: standardised betas (β) - 0.13, 95% CI - 0.18, - 0.08] and anxiety (BAI: β - 0.11, 95% CI - 0.16, - 0.06, FEAR: β - 0.08, 95% CI - 0.13, - 0.03). Greater consumption of non-refined grains and vegetables was associated with lower depression and anxiety severity, whilst being a non-drinker was associated with higher symptom severity. Higher fruit and vegetable intake was associated with lower fear severity. Non-refined grain consumption was associated with lower odds and being a non-drinker with greater odds of current depression/anxiety disorders compared to healthy controls, these associations persisted after adjustment for other food groups (OR 0.82 per SD, 95% CI 0.71-0.96, OR 1.26 per SD 95% CI 1.08-1.46).

CONCLUSION

We can conclude that non-refined grains, vegetables and alcohol intake appeared to be the driving variables for the associated the total MDS score and depression/anxiety. However, the combined effect of the whole diet remains important for mental health. It should be explored whether an increase consumption of non-refined grains and vegetables may help to prevent or reduce depression and anxiety.

Alcohol quantity and quality price elasticities: quantile regression estimates

Many people drink more than the recommended level of alcohol, with some drinking substantially more. There is evidence that suggests that this leads to large health and social costs, and price is often proposed as a tool for reducing consumption. This paper uses quantile regression methods to estimate the differential price (and income) elasticities across the drinking distribution. This is also done for on-premise (pubs, bars and clubs) and off-premise (supermarkets and shops) alcohol separately. In addition, we examine the extent to which drinkers respond to price changes by varying the 'quality' of the alcohol that they consume. We find that heavy drinkers are much less responsive to price in terms of quantity, but that they are more likely to substitute with cheaper products when the price of alcohol increases. The implication is that price-based policies may have little effect in reducing consumption amongst the heaviest drinkers, provided they can switch to lower quality alternatives.

Trends in Alcohol Intake and the Association between Socio-Demographic Factors and Volume of Alcohol Intake amongst Adult Male Drinkers in China

Background: The volume of alcohol intake and type of alcohol affect Chinese men’s health. This study investigated changes of alcohol type between 2004 and 2011, explored the trend of change in alcohol type with age and determined the social demographic factors influencing the alcohol intake of Chinese men. Methods: Research data originated from the public database, China Health and Nutrition Survey (CHNS). Three chi-square tests were used to determine the prevalence of different alcohol types (beer, wine and liqueur) and the trend with age among male drinkers from 2004 to 2011. An ordered logistic regression model was established with alcohol intake as the dependent variable and social demography as the independent variable to analyze the influence of these factors on male alcohol intake. Results: This study confirmed that from 2004 to 2011, 70.1% of Chinese men consumed alcohol less than 168 g/w. The popularity of beer was on the rise, while the liqueur alcohol consumption decreased from 2004 to 2011 and the consumption of wine began to rise rapidly after 2006 (p < 0.05 for all). The prevalence of liqueur drinking increased with age and the prevalence of beer drinking decreased with age among Chinese male drinkers (p < 0.05 for all). From 2004 to 2011, a positive correlation appeared between age and male alcohol intake (p < 0.05 for all). In 2004 (OR = 1.22, 95% CI: 1.03–1.44), 2006 (OR = 1.21, 95% CI: 1.02–1.42) and 2011 (OR = 1.51, 95% CI: 1.31–1.75), Chinese men living in rural areas had a high volume of alcohol intake. From 2004 to 2011, the participants had married consumed more alcohol (p < 0.05 for all). In 2004 (OR = 0.61, 95% CI: 0.43–0.88) and 2011 (OR = 0.80, 95% CI: 0.68–0.94), higher education levels were negatively correlated with male alcohol intake. In 2006 (OR = 1.29, 95% CI: 1.07–1.56), 2009 (OR = 1.76, 95% CI: 1.45–2.14) and 2011 (OR = 1.35, 95% CI: 1.13–1.61), male drinkers who were working consumed more alcohol. From 2004 to 2011, a significant positive correlation appeared between tobacco consumption and alcohol intake (p < 0.05 for all). Conclusion: Consumption of three types of alcohol (beer, wine and liqueur) varies with the year. Beer consumption decreases with age, whereas liqueur consumption increases with age. Social demographic factors, such as residence, age, highest education level, working status and tobacco consumption, are related to alcohol intake. Our study affirms the effect of age on the choice of different types of alcohol.

The association between excise tax structures and the price variability of alcoholic beverages in the United States

Recent tobacco taxation research suggests that excise tax structure plays an important role in the effectiveness of increasing taxes in reducing consumption. However, evidence on excise tax structures of alcoholic beverages is scarce. We linked price variability measures for beer, wine, and liquor in the US derived using Economist Intelligence Unit city data from 2003 to 2016 with state-level excise tax structures from the Alcohol Policy Information System. Ordinary least squares (OLS) regressions were performed to assess the associations between excise tax structures and price variability, for beer, wine, and liquor (spirits), respectively. Results suggest that, compared with a specific excise beer tax structure based on volumes, a mixed structure with both specific and ad valorem components was associated with 38% (p≤0.01) greater beer price variability. In addition, a mixed excise tax structure for liquor was associated with 60–77% (p≤0.01) greater liquor price variability. However, these associations do not imply a causal link between tax structures and price variability. In summary, a mixed excise tax structure is associated with greater variability in beer and liquor prices, an indicator for tax avoidance opportunities. Future research is needed to identify the causal impact of tax structures on price variability.

Surveying Alcohol Outlet Density in Four Neighborhoods of Beirut Lebanon: Implications for Future Research and National Policy

Underage drinking among youth in Lebanon is increasing. Regulating availability is one of the best buy policies recommended by the World Health Organization. To quantitatively document the current status of alcohol availability to youth in Lebanon, we used GPS technology to survey alcohol outlet density in four highly populated neighborhoods in Beirut, Lebanon, and to estimate their proximity to educational institutions. The density of alcohol outlets ranged from 18.30 to 80.95 per km² (average of 39.6 alcohol outlets/km²). The highest number of total alcohol outlets was in the “Hamra & Jamiaa” area, which includes one of the largest private universities in the country. Thirteen out of 109 (12%) alcohol outlets (on and off-premise) were located less 100 m away from educational institutions, in violation of the current licensing law. None of the off-premise and the majority (94%) of on-premise alcohol outlets displayed the “no sale for <18” sign. Findings were indicative of an environment conducive to increased access and availability of alcohol among youth in Lebanon probably attributed to the prevailing weak alcohol policies and their enforcement. Systematic collection and reporting of alcohol outlet densities is critical to understand the alcogenic environment and guide local harm reduction policies.

Survey Estimates of Changes in Alcohol Use Patterns Following the 2012 Privatization of the Washington Liquor Monopoly

AIMS

The US state of Washington's 333 state-run liquor stores were privatized on 1 June 2012 and purchases began in ~1500 licensed stores of a variety of types. A regime of taxes and fees was implemented to replace the revenues generated by the state stores and, 1 year later, the beer tax was reduced by two thirds. This study evaluates the impact of these changes on total alcohol and spirits consumption in a retrospective pre-test design.

METHODS

The study sample consists of 2289 adults recruited in three cross-sectional surveys during 2014 and 2015. Retrospective typical past month quantity-frequency measures for before privatization drinking and current past month quantity-frequency measures were compared within subjects, for all alcohol and for spirits only.

RESULTS

No change in alcohol volume was seen across privatization while spirits volume was found to decrease, suggesting a shift from spirits to beer. This decline in spirits volume came from a reduction in drinking days while overall drinking days were found to increase. This was offset by a reduction in drinks per drinking day and in heavy occasions.

CONCLUSIONS

These findings accurately mirror the overall flat trend in per capita alcohol sales but seem to exaggerate the very small shift towards beer seen in sales data. Effects of increased spirits availability appear to have been countered by increased spirits prices and a decreased beer tax, leading to a shift to beer consumption.

SHORT SUMMARY

Survey-based analyses of alcohol use across Washington's spirits privatization, beer tax reduction and marijuana legalization found no change in alcohol volume, a reduction in spirits volume and a shift to more moderate drinking patterns. Reductions in drinking occurred among marijuana users and those with lower educational attainment reduced spirits volume.

The association between exposure to social media alcohol marketing and youth alcohol use behaviors in India and Australia

BACKGROUND

Alcohol marketing on social networking sites (SNS) is associated with alcohol use among young people. Alcohol companies adapt their online marketing content to specific national contexts and responses to such content differ by national settings. However, there exists very little academic work comparing the association between alcohol marketing on SNS and alcohol use among young people in different national settings and across different SNS. Therefore, we aimed to extend the limited existing work by investigating and comparing the association between self-reported exposure to alcohol marketing on three leading SNS (Facebook, YouTube, and Twitter) and alcohol use among young people in diverse national contexts (India and Australia).

METHODS

Cross-sectional, self-report data were obtained from a convenience sample of 631 respondents (330 in India; 301 in Australia) aged 13-25 years via online surveys. Respondents answered questions on their drinking behaviors and involvement with alcohol marketing on SNS.

RESULTS

Many respondents from both countries reported interacting with alcohol content online, predominantly on Facebook, followed by YouTube and then Twitter. The interaction was primarily in the forms of posting/liking/sharing/commenting on items posted on alcohol companies' social media accounts, viewing the event page/attending the event advertised by an alcohol company via social media, and/or accessing an alcohol website. Multivariate analyses demonstrated significant associations between respondents' interaction with alcohol content and drinking levels, with effects differing by SNS, demographic group, and country. For example, having friends who shared alcohol-related content was an important predictor of usual alcohol consumption for Indian respondents (p < .001), whereas posting alcohol-related information themselves was a stronger predictor among Australians (p < .001).

CONCLUSIONS

The results suggest that interaction with alcohol-related content on SNS is associated with young people's alcohol use behaviors and that these behaviors vary by national settings. This study extends previous work by demonstrating this connection across varying social media platforms and national contexts. The results highlight the need to formulate and implement strategies to effectively regulate the SNS alcohol marketing, especially among younger SNS users.

[Features of a drinking regimen and signs of deficiency of magnesium at elderly patients with removable stomatologic orthopedic constructions.]

The purpose was to study features of a drinking regimen and signs of deficiency of magnesium at elderly patients with removable stomatologic orthopedic constructions. Questioning of 1 388 elderly patients who coming for the dentistry office. Patients were divided into three groups: the 1st was characterized by existence only of fixed stomatologic orthopedic constructions (n=419); the 2nd group was characterized by existence of partially removable constructions (n=512); the 3rd group was characterized by existence of full-removable constructions (n=457). We defined symptoms of the central obesity as rising of BMI and a circle of a waist. Patients were tested for possible deficiency of magnesium. At patients of the 3rd group have more often symptoms of the central obesity, than at the 1st and 2nd groups (52,5% against 21,5 and 41,8%, p<0.05). Patients of the 3rd group have more often signs of deficiency of magnesium, than other patients (62,3% against 11,7 and 22,3%, p<0.05). Patients of the 3rd group more often than others intake cocoa (54,1% against 5,7 and 10,4%, p<0.05), carbonated drinks (24,5% against 7,6 and 4,3%, p<0,05), hard alcoholic beverages (23% against 10 and 10,2%, p<0,05). All elderly patients extremely seldom use bottled water.

Do emotions related to alcohol consumption differ by alcohol type? An international cross-sectional survey of emotions associated with alcohol consumption and influence on drink choice in different settings

OBJECTIVES

To examine the emotions associated with drinking different types of alcohol, explore whether these emotions differ by sociodemographics and alcohol dependency and whether the emotions associated with different drink types influence people's choice of drinks in different settings.

DESIGN

International cross-sectional opportunistic survey (Global Drug Survey) using an online anonymous questionnaire in 11 languages promoted through newspapers, magazines and social media from November 2015 to January 2016.

STUDY POPULATION

Individuals aged 18-34 years who reported consumption of beer, spirits, red and white wine in the previous 12 months and were resident in countries with more than 200 respondents (n=21 countries; 29 836 respondents).

MAIN OUTCOME MEASURES

Positive and negative emotions associated with consumption of different alcoholic beverages (energised, relaxed, sexy, confident, tired, aggressive, ill, restless and tearful) over the past 12 months in different settings.

RESULTS

Alcoholic beverages vary in the types of emotions individuals report they elicit, with spirits more frequently eliciting emotional changes of all types. Overall 29.8% of respondents reported feeling aggressive when drinking spirits, compared with only 7.1% when drinking red wine (p<0.001). Women more frequently reported feeling all emotions when drinking alcohol, apart from feelings of aggression. Respondents' level of alcohol dependency was strongly associated with feeling all emotions, with the likelihood of aggression being significantly higher in possible dependent versus low risk drinkers (adjusted OR 6.4; 95% CI 5.79 to 7.09; p<0.001). The odds of feeling the majority of positive and negative emotions also remained highest among dependent drinkers irrespective of setting.

CONCLUSION

Understanding emotions associated with alcohol consumption is imperative to addressing alcohol misuse, providing insight into what emotions influence drink choice between different groups in the population. The differences identified between sociodemographic groups and influences on drink choice within different settings will aid future public health practice to further comprehend individuals' drinking patterns and influence behaviour change.

Assessment of alcoholic standard drinks using the Munich composite international diagnostic interview (M-CIDI): An evaluation and subsequent revision

The quantity and frequency of alcohol consumption are crucial both in risk assessment as well as epidemiological and clinical research. Using the Munich Composite International Diagnostic Interview (M-CIDI), drinking amounts have been assessed in numerous large-scale studies. However, the accuracy of this assessment has rarely been evaluated. This study evaluates the relevance of drink categories and pouring sizes, and the factors used to convert actual drinks into standard drinks. We compare the M-CIDI to alternative drink assessment instruments and empirically validate drink categories using a general population sample (n = 3165 from Germany), primary care samples (n = 322 from Italy, n = 1189 from Germany), and a non-representative set of k = 22503 alcoholic beverages sold in Germany in 2010-2016. The M-CIDI supplement sheet displays more categories than other instruments (AUDIT, TLFB, WHO-CIDI). Beer, wine, and spirits represent the most prevalent categories in the samples. The suggested standard drink conversion factors were inconsistent for different pouring sizes of the same drink and, to a smaller extent, across drink categories. For the use in Germany and Italy, we propose the limiting of drink categories and pouring sizes, and a revision of the proposed standard drinks. We further suggest corresponding examinations and revisions in other cultures.

Characteristics of university students who mix alcohol and energy drinks

OBJECTIVE

Research has identified correlates (eg, drug use, risky sex, smoking) of using alcohol mixed with energy drinks (AMEDs). Few studies have investigated common mental health-related concerns (eg, depression, sleep).

PARTICIPANTS

Alcohol-using college students (n = 380 never used AMEDs, n = 180 used AMEDs) were recruited in the study during the fall 2011 semester.

METHODS

The study examined demographics, substance use, depressive symptoms, and sleep problems in association with AMED use.

RESULTS

Multivariable logistic regression indicated that alcohol use severity (AOR = 1.24; 95% CI = 1.14+1.34), drug use severity (AOR = 1.20; 95% CI = 1.04-1.39), depressive symptoms (AOR = 1.06; 95% CI = 1.01-1.12), and smoking (AOR = 2.12; 95% CI = 1.22-3.68) were independently associated with AMED use; sleep problems were non-significant.

CONCLUSIONS

Administrators may consider policies regarding energy drink availability on campus, and campus health personnel may increase screening and education surrounding AMED use to reduce risks among students.

Typology and Dynamics of Heavier Drinking Styles in Great Britain: 1978-2010

AIMS

To identify a typology of heavier drinking styles in Great Britain and to identify socio-demographic trends in the typology over the period 1978-2010.

METHODS

We applied multiple correspondence analysis and agglomerative hierarchical clustering to beverage-specific quantity-frequency measures of alcohol consumption in the repeated cross-sectional General Lifestyle Survey of Great Britain, 1978-2010. The cluster analysis focuses on the 60,043 adult respondents over this period reporting average drinking levels above the UK Government guidelines. We projected sex, age, income, education, socio-economic status and tobacco consumption variables onto the clusters to inspect socio-demographic trends in heavier drinking.

RESULTS

We identified four stable clusters of heavier drinking: (a) high volume beer; (b) beer and spirit combination; (c) all beverage and (d) wine and spirit only. The socio-demographic characteristics of the clusters were distinct from both each other and the general population. However, all clusters had higher median incomes and higher smoking rates than the population. Increases in the prevalence of heavier drinking were driven by a 5-fold increase in the contribution of the female-dominated, wine and spirit only cluster.

CONCLUSIONS

Recent changes in per capita alcohol consumption in Great Britain occurred within the context of a stable typology of heavier drinking styles and shifting socio-demographics. Identifying these trends is essential to better understand how drinking cultures develop over time and where potentially problematic drinking styles may emerge. Our findings suggest that careful attention to patterns and cultures of consumption is more important than relying on headline consumption data, for both understanding drinking behaviours and targeting interventions.

SHORT SUMMARY

This analysis of alcohol consumption survey data identifies four styles of heavier drinking in Great Britain, which remain unchanged over the period 1978-2010. The socio-demographic characteristics of the drinking styles are distinct from both each other and the general population, with increased participation of female and older drinkers over time.

Effects of posted point-of-sale warnings on alcohol consumption during pregnancy and on birth outcomes

In 23 states and Washington D.C., alcohol retailers are required by law to post alcohol warning signs (AWS) that warn against the risks of drinking during pregnancy. Using the variation in the adoption of these laws across states and within states over time, I find a statistically significant reduction in prenatal alcohol use associated with AWS. I then use this plausibly exogenous change in drinking behavior to establish a causal link between prenatal alcohol exposure and birth outcomes. I find that AWS laws are associated with decreases in the odds of very low birth weight and very pre-term birth.

Between a rock and a hard place: Economic expansion and social responsibility in UK media discourses on the global alcohol industry

CONTEXT

Transnational alcohol corporations (TACs) employ a range of strategies to achieve their business objectives, including attempts to frame perceptions of their activities in media debates. TACs aim to achieve a favourable regulatory environment by presenting themselves as socially responsible actors. However, the need to secure financial investment means they must also emphasise their potential for growth. This article investigates tensions between these objectives in coverage of the global alcohol industry in the UK print media.

METHODS

This article examines coverage of the world's four largest TACs in five British daily newspapers and one industry publication between March 2012 and February 2013. 477 articles were identified for analysis through keyword searches of the LexisNexis database. Thematic coding of articles was conducted using Nvivo software.

FINDINGS

Two conflicting framings of the alcohol industry emerge from our analysis. The first presents TACs as socially responsible actors; key partners to government in reducing alcohol-related harms. This is targeted at policy-makers and the public in an attempt to shape policy debates. The second framing highlights TACs' potential for economic growth by establishing new markets and identifying new customer bases. This is targeted at an audience of potential investors.

CONCLUSIONS

A fundamental contradiction lies at the heart of these framings, reflecting the tensions that exist between TACs' political and financial strategies. Alcohol industry involvement in policy-making thus involves a fundamental conflict of interests. Consequently, the UK government should reassess the prominence it currently affords to the industry in the development and delivery of alcohol policy.

Parental supply of alcohol and alcohol consumption in adolescence: prospective cohort study

BACKGROUND

Parents are a major supplier of alcohol to adolescents, yet there is limited research examining the impact of this on adolescent alcohol use. This study investigates associations between parental supply of alcohol, supply from other sources, and adolescent drinking, adjusting for child, parent, family and peer variables.

METHOD

A cohort of 1927 adolescents was surveyed annually from 2010 to 2014. Measures include: consumption of whole drinks; binge drinking (>4 standard drinks on any occasion); parental supply of alcohol; supply from other sources; child, parent, family and peer covariates.

RESULTS

After adjustment, adolescents supplied alcohol by parents had higher odds of drinking whole beverages [odds ratio (OR) 1.80, 95% confidence interval (CI) 1.33-2.45] than those not supplied by parents. However, parental supply was not associated with bingeing, and those supplied alcohol by parents typically consumed fewer drinks per occasion (incidence rate ratio 0.86, 95% CI 0.77-0.96) than adolescents supplied only from other sources. Adolescents obtaining alcohol from non-parental sources had increased odds of drinking whole beverages (OR 2.53, 95% CI 1.86-3.45) and bingeing (OR 3.51, 95% CI 2.53-4.87).

CONCLUSIONS

Parental supply of alcohol to adolescents was associated with increased risk of drinking, but not bingeing. These parentally-supplied children also consumed fewer drinks on a typical drinking occasion. Adolescents supplied alcohol from non-parental sources had greater odds of drinking and bingeing. Further follow-up is necessary to determine whether these patterns continue, and to examine alcohol-related harm trajectories. Parents should be advised that supply of alcohol may increase children's drinking.

Measuring Alcohol Marketing Engagement: The Development and Psychometric Properties of the Alcohol Marketing Engagement Scale

Ample evidence exists in support of the influence of media, both traditional and electronic, on perceptions and engagement with alcohol marketing. We describe the development, calibration, and evidence for technical quality and utility for a new measure, the Alcohol Marketing Engagement Scale. Using two samples of college undergraduates (n1 = 199, n2 = 732), we collected field test responses to a total of 13 items. Initial support for scale validity is presented via correlations with attributes previously shown to be related to alcohol engagement. While the joint map of estimated scale locations of items and respondents indicates the need for further scale development, the results of the present analyses are promising. Implications for use in research are discussed.

Mixing alcohol with artificially sweetened beverages: Prevalence and correlates among college students

Mixing alcohol with diet beverages, as compared to mixing the same amount of alcohol with a regular beverage, is associated with greater intoxication. This may occur because diet mixers increase alcohol absorption rates. Thus, it is plausible that the use of diet mixers may increase the risk of alcohol-related harms. The current study sought to (1) determine the rate/frequency of use in among college students, (2) examine the relationship between mixing alcohol with diet beverages and alcohol-related problems, above typical alcohol use and sensation seeking, and (3) explore key traits (gender, restricting food while drinking, and body mass index [BMI]) that may characterize users. Participants were 686 (73% female) undergraduate students who completed self-reports of alcohol use (including diet mixer use), alcohol-related problems, eating behaviors while drinking, sensation seeking, and demographic information. Results revealed that about 36% of the sample reported consuming alcohol with diet mixers, and users typically consumed this beverage at least once a month. Students who reported mixing alcohol with diet beverages experienced more alcohol-related problems. And, the more frequently one consumed this beverage, the more problems were reported. These associations were found after controlling for typical level of alcohol use and sensation seeking. No differences were observed between user-status on gender, eating behaviors while drinking, and BMI. Our findings suggest that mixing alcohol with diet beverages could be a risk factor for experiencing more alcohol-related harms. Further research is needed to understand this relationship, as it may help guide intervening efforts aimed to reduce alcohol-related risks.

Estimated increase in cross-border purchases by Washington residents following liquor privatization and implications for alcohol consumption trends

AIMS

To estimate changes in liquor sales occurring in Washington, USA and bordering states following the privatization of government controlled liquor stores.

DESIGN

Trend analyses of data from January 2009 to October 2014 of a natural experiment beginning 1 June 2012, when liquor prices increased and the number of stores selling liquor increased in the state of Washington. Difference-in-differences (DID) models and interrupted time-series methods were used.

SETTING

Washington and bordering counties in Oregon and Idaho.

MEASUREMENTS

Monthly liquor sales in 9-l cases.

FINDINGS

DID model estimates of adjusted change in liquor sales as a result of privatization produced a cross-model average increase of 10.1% in Oregon and 8.2% in Idaho (both P < 0.001). Similar results were found using interrupted time-series. This represents a total loss to Washington of 89 865 l of liquor, 0.226% of total Washington sales, for June 2012 to May 2013. Adding these sales to Washington totals for fiscal years 2013 and 2014, we find that per-capita spirits sales were 5.80 l in both 2012 and 2013, declining slightly to 5.76 l in 2014.

CONCLUSIONS

The privatization of liquor sales in the state of Washington, USA in 2012 and the price increases associated with this resulted in a significant increase in sales in bordering counties in the states of Oregon and Idaho. However, the amount of alcohol sales and revenue lost by Washington was relatively small. Per-capita liquor sales in Washington appear to have remained flat after privatization.

[Economic issues and public alcohol abuse prevention policies in France]

Objective: To analyse the impact of the alcohol market on the implementation of strong-willed public alcohol abuse prevention policies based on a critical review of the literature. Method: Documentary research and analysis of the alcohol market economic data were performed. An overview of public alcohol abuse prevention policies was conducted from a historical perspective by distinguishing drunkenness control policies, protection of vulnerable populations, and the fight against drink driving and drinking in the workplace. Results: Public alcohol abuse prevention policies are primarily designed to reduce the harmful consequences of alcohol occurring as a result of a drinking episode (motor vehicle accident, highway accidents, etc.), while neglecting the long-term consequences (cancer, cirrhosis, etc.). Moreover, while taxation is one of the major public health tools used to reduce the costs of alcohol-related damage on society, the State exercises legislative and tax protection for alcoholic beverages produced in France. In particular, wine benefits from a lower tax rate than other stronger forms of alcohol (spirits, liquors, etc.). The economic weight of the alcohol market can provide an explanation for these public alcohol abuse prevention policies. Conclusion: In view of the mortality caused by alcohol abuse, France must implement a proactive public policy. An alcohol taxation policy based on the alcohol content, a minimum unit pricing for alcohol, or higher taxes on alcohol are public policies that could be considered in order to reduce alcohol-related mortality.

A Behavioral Economic Model of Alcohol Advertising and Price

This paper presents a new empirical study of the effects of televised alcohol advertising and alcohol price on alcohol consumption. A novel feature of this study is that the empirical work is guided by insights from behavioral economic theory. Unlike the theory used in most prior studies, this theory predicts that restriction on alcohol advertising on TV would be more effective in reducing consumption for individuals with high consumption levels but less effective for individuals with low consumption levels. The estimation work employs data from the National Longitudinal Survey of Youth, and the empirical model is estimated with quantile regressions. The results show that advertising has a small positive effect on consumption and that this effect is relatively larger at high consumption levels. The continuing importance of alcohol taxes is also supported. Education is employed as a proxy for self-regulation, and the results are consistent with this assumption. The key conclusion is that restrictions on alcohol advertising on TV would have a small negative effect on drinking, and this effect would be larger for heavy drinkers. Copyright © 2015 John Wiley & Sons, Ltd.

Targeting gender: A content analysis of alcohol advertising in magazines

Creating target specific advertising is fundamental to maximizing advertising effectiveness. When crafting an advertisement, message and creative strategies are considered important because they affect target audiences' attitudes toward advertised products. This study endeavored to find advertising strategies that are likely to have special appeal for men or women by examining alcohol advertising in magazines. The results show that the substance of the messages is the same for men and women, but they only differ in terms of presentation. However, regardless of gender group, the most commonly used strategies in alcohol advertising are appeals to the target audience's emotions.

Alcohol and Tobacco Sales to Underage Buyers in Dutch Supermarkets: Can the Use of Age Verification Systems Increase Seller's Compliance?

PURPOSE

Age limits are effective in reducing alcohol- and tobacco-related harm, however, their effectiveness depends on the extent to which they are complied with. This study aimed to investigate the effectiveness of different age verification systems (AVSs) implemented by 400 Dutch supermarkets on requesting a valid age verification (ID) and on sellers' compliance.

METHODS

A mixed method design was used. Compliance was measured by 800 alcohol and tobacco purchase attempts by 17-year-old mystery shoppers. To analyze the effectiveness of AVSs, logistic regression analyses were performed. Insight into facilitating and hindering factors in the purchase process was obtained by 13 interviews with supermarket managers.

RESULTS

Only a tendency toward a positive effect of the presence of the keying-on-date-of-birth AVS or ID swiper/checker was found on ID request for both alcohol and tobacco purchase attempts. The use of the keying-on-date-of-birth AVS or ID swiper/checker significantly increased the odds for compliance after an ID was requested, for both alcohol and tobacco purchase attempts. Managers indicated that ID requests and compliance could be facilitated by providing cashiers with sufficient managerial support, technical support, and regular training about the purchase process and use of the AVS.

CONCLUSIONS

The usage of AVSs calculating and confirming whether the customer reached the legal purchase age for cashiers significantly increases the odds for cashiers to comply with age limits of alcohol and tobacco. Future research should gain insight into how usage of effective AVSs can be improved and explore the feasibility of implementation and effectiveness in other outlets.

Alcohol mixed with energy drink: Use may be a consequence of heavy drinking

AIMS

In recent years, studies have indicated that consumers of alcohol mixed with energy drink (AmED) are more likely to drink heavily and experience more negative consequences than consumers who avoid these beverages. Although researchers have identified a number of plausible hypotheses that explain how alcohol-energy drink co-ingestion could cause greater alcohol consumption, there has been no postulation about reverse causal relations. This paper identifies several plausible hypotheses for the observed associations between AmED consumption and greater alcohol consumption, and provides initial evidence for one such hypothesis suggesting that heavy drinking may be a determinant of AmED use.

METHOD

Data collected from 511bar patrons were used to examine the plausibility of one of the proposed hypotheses, i.e., AmED is an artifact of heavy drinking. Associations between the consumption of an assortment of alcoholic beverage types and total alcohol consumption were examined at the event-level, to assess whether AmED is uniquely related with greater alcohol consumption.

RESULTS

Increased alcohol consumption was associated with greater odds of consuming most alcoholic beverage types; this association was not unique to AmED.

CONCLUSIONS

Results support the overlooked hypothesis that AmED use is an artifact of heavy drinking. Thus, AmED consumption may be a consequence or marker of heavier drinking. Much of the existing research on alcoholic beverage types is limited in its ability to implicate any specific type of drink, including AmED, as a cause of increased alcohol consumption and related harm. More rigorous study designs are needed to examine causal relationships.

The Effect of a Sunday Liquor-Sales Ban Repeal on Crime: A Triple-Difference Analysis

BACKGROUND

This study investigates whether alcohol availability in state-run liquor stores affects crime nearby. In 2003, Pennsylvania repealed its Sunday alcohol-sales ban for a portion of its state-run liquor stores. We capitalize on this change in alcohol policy to assess the effect of alcohol availability on crime occurring within the vicinity of liquor stores that opened on Sundays in Philadelphia.

METHODS

We employed a difference-in-difference-in-differences model that compared reported crime before versus after the change in alcohol policy, Sundays versus other days of the week, and the fraction of liquor stores affected versus not affected by the repeal. We used crime incident data in Philadelphia between 1998 and 2011.

RESULTS

The repeal was associated with a significant increase in total and property-crime incidents occurring around Sunday-open state liquor stores in low-socioeconomic-status neighborhoods. We found no evidence of the displacement of crime to nearby areas.

CONCLUSIONS

This is the first triple-difference alcohol study that attempts to isolate the micro-spatial effects of a shift in alcohol availability on local crime patterns, and shows that the repeal of Sunday alcohol-sales restrictions may increase crime in poor urban areas.

Portrayals of Eating and Drinking in Popular American TV Programs: A Comparison of Scripted and Unscripted Shows

This study investigated portrayals of eating and drinking behaviors in popular American TV programs and compared scripted and unscripted (i.e., reality) shows. Through a content analysis of 95 episodes, the prevalence and nature of food/alcohol consumption that accompanied depictions of eating and drinking behaviors in 461 scenes were measured. Various foods were portrayed, but only 9% of foods portrayed were healthy (e.g., low in calories/fat content, such as fruits, vegetables, etc.). Approximately half of eating or drinking scenes either were accompanied by alcohol or contained solely alcoholic beverages. Significant differences between the scripted and unscripted shows were also found.

ERICA: patterns of alcohol consumption in Brazilian adolescents

OBJECTIVE To describe the patterns of alcohol consumption in Brazilian adolescents. METHODS We investigated adolescents who participated in the Study of Cardiovascular Risks in Adolescents (ERICA). This is a cross-sectional, national and school-based study, which surveyed adolescents of 1,247 schools from 124 Brazilian municipalities. Participants answered a self-administered questionnaire with a section on alcoholic beverages consumption. Measures of relative frequency (prevalence), and their 95% confidence intervals, were estimated for the following variables: use of alcohol beverages in the last 30 days, frequency of use, number of glasses or doses consumed in the period, age of the first use of alcohol, and most consumed type of drink. Data were estimated for country and macro-region, sex, and age group. The module survey of the Stata program was used for data analysis of complex sample. RESULTS We evaluated 74,589 adolescents, who accounted for 72.9% of eligible students. About 1/5 of adolescents consumed alcohol at least once in the last 30 days and about 2/3 in one or two occasions during this period. Among the adolescents who consumed alcoholic beverages, 24.1% drank it for the first time before being 12 years old, and the most common type of alcoholic beverages consumed by them were drinks based on vodka, rum or tequila, and beer. CONCLUSIONS There is a high prevalence of alcohol consumption among adolescents, as well as their early onset of alcohol use. We also identified a possible change in the preferred type of alcoholic beverages compared with previous research.

Who uses alcohol mixed with energy drinks? Characteristics of college student users

OBJECTIVE

To examine characteristics associated with alcohol mixed with energy drink (AmED) use in a sample of college students.

PARTICIPANTS

College students (N = 614, 53% female) in their second year of college participated during the fall of 2008.

METHODS

Students completed a cross-sectional survey with questions regarding AmED use.

RESULTS

AmED use in the last 30 days was reported by 27% of participants. Logistic regression analyses found that risk factors for AmED included participating in a fraternity/sorority; participating in athletics; living off-campus; having greater fun/social, relax, and image motives for alcohol consumption; and binge drinking. Protective factors included early morning classes, honors program participation, and greater physical/behavioral motives for not drinking.

CONCLUSIONS

Risk factors for AmED use can identify college students most likely to consume AmEDs and thereby inform screening and intervention efforts to reduce negative AmED-related consequences.

Selected personality - related determinants of alcohol beverage consumption among Polish elite team sport athletes

BACKGROUND

Many studies documented an increase in the alcohol consumption among athletes, particularly among representatives of some disciplines, such as team sports.

OBJECTIVE

The aim of the study was to analyse the consumption of alcohol beverages among Polish elite team sport athletes, depending on their sex, age and selected personality traits (general self-efficacy and health locus of control).

MATERIAL AND METHODS

The study included 517 Polish team sport athletes (251 women an 266 men). The subjects were examined with an original alcoholic beverage intake survey, General Self-Efficacy Scale (GSES) and Multidimensional Health Locus of Control Scales (MHLC). Relationship between the intake of alcoholic beverages and explanatory variables (sex, age, psychological traits) was determined on multivariate analysis of variance and analysis of regression.

RESULTS

Beer turned out to be an alcoholic beverage which the surveyed athletes consumed most often (a few times per month on average). Wine, spirits and alcoholic cocktails were consumed less often (once a month on average). Multivariate analysis showed that consumption of wine, including dry wine, increased significantly with age of the study subjects (p<0.001). Women significantly less frequently considered beer and vodka (p<0.001), whereas men significantly less often preferred wine (p<0.05). The level of general self-efficacy did not influence the intake of alcoholic beverages (p>0.05). Lower levels of Internality were associated with less frequent consumption of beer (p<0.001), and lower scores for Powerful Others with lower intakes of dry wine (p<0.001) and vodka (p<0.01). Lower scores for Chance showed a significant association with lesser preference for alcoholic cocktails (p<0.05).

CONCLUSIONS

The frequency and structure of otherwise relatively limited intake of alcoholic beverages among elite team sport athletes were influenced by their sex, age and health locus of control.

KEY WORDS

athletes, team sports, alcoholic beverages, personality traits, self-efficacy, health locus of control.

Are Barroom and Neighborhood Characteristics Independently Related to Local-Area Assaults?

BACKGROUND

Two separate but complementary literatures examine bar-related violence: one has focused on barroom features, and the other has focused on features of neighborhoods near bars. This study unifies these 2 perspectives using a microenvironmental approach.

METHODS

In a purposive sample of 65 bars in 4 California cities, we used premise assessments to characterize the physical, social, and economic environments of barrooms (e.g., patron count, average pace of drinking, and restaurant service); and a combination of systematic social observation, census, and alcohol license data to characterize the neighborhoods in which they were located (e.g., physical disorder, alcohol outlet density, and median household income). Hierarchical Poisson models then assessed relationships between these features and counts of police-reported assaults within buffer areas around bars.

RESULTS

Aspects of both barroom environments (more patrons, more dancing, and louder music) and neighborhood environments (greater bar density, greater physical disorder, lower population density, and lower income) were independently related to increased incidence of assaults.

CONCLUSIONS

Preventive intervention to reduce bar-area violence may be directed at both bar environments (e.g., limiting the number of patrons) and neighborhood environments (e.g., limiting outlet density).

Comparison of tobacco and alcohol use in films produced in Europe, Latin America, and the United States

BACKGROUND

Studies that have evaluated tobacco and alcohol portrayals in films have mainly focused on US films. Our aim is to describe tobacco and alcohol portrayals in nationally produced films from six European and two Latin American countries, and compare them with US produced films.

METHODS

A sample of 337 nationally produced and 502 US produced films, consisting of top grossing films from 2004 to 2009 in each country, was content coded for presence of tobacco or alcohol and seconds of tobacco or alcohol use. Logistic and linear regression models were estimated for all films and youth-rated films (Ages 0-14) to assess cross country differences in tobacco and alcohol content, with US films as the reference category.

RESULTS

Domestically produced films from several countries were more likely than US films to contain any tobacco use both overall (Iceland (OR = 9.29, CI: 1.22-70.89), Italy (OR = 3.58, CI: 1.72-7.43), Argentina (OR = 5.06, CI: 2.13-12.03), Mexico (OR = 4.87, CI: 2.17-10.90)) and for youth-rated films (Germany (OR = 2.24, CI: 1.21-4.16), Iceland (OR = 13.79, CI: 1.80-105.5), Italy (OR = 5.31, CI: 2.54-11.1), and Argentina (OR = 6.9, CI: 0.88-1.34)). Models for alcohol showed few differences compared to US, regardless of rating. Linear regression models for seconds of use in films with tobacco indicated that only Argentine films had more seconds of smoking than US films, regardless of the rating category. For films with alcohol use, Mexican films had higher seconds of alcohol use than US films.

CONCLUSIONS

Smoking was more commonly depicted in films produced outside the US, however there were few differences in the means for smoking screen time in films that contained smoking. This may be partly explained by the prohibition of tobacco product placement in the US. Countries should consider banning paid placement of both products and eliminating subsidies for films with content that promotes tobacco and alcohol use.