Alcohol Purchase Research Articles

Acculturation and alcohol: Exploring experiences of alcohol for Asian international students in Australia

Acculturation can be a challenging experience for Asian international students moving to Western countries for study. The majority of international students are young adults, a population that has recently entered the legal alcohol purchase age, and who might not be familiar with new regulatory contexts and socio-cultural environments where drinking is common. Informed by theories of acculturative stress, ethno-identity conflict and adaptation, we explored 15 Asian international students’ lived experiences of alcohol in Australia, and the social, cultural and religious contexts within which these experiences were situated. Semi-structured interviews were undertaken, with an Interpretative Phenomenological Analysis exploring subjective experiences of alcohol and acculturation processes. Participants articulated numerous and varied experiences of their transitions, however, did not draw connections between stressful transition experiences and subsequent drinking. Most participants reported having increased their drinking since arrival in Australia, and although many participants had adapted to Australian patterns of drinking and socialising, they also reported it was challenging to navigate different cultural and social expectations and values around alcohol that were strongly rooted as a part of their ethnic heritage. Our participants’ experiences may be useful to inform future research on this much under-studied topic, as well as being used by universities to consider appropriate strategies for addressing alcohol-related acculturation processes as part of orientation curriculum with international students.

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.

INCREASED VALUE OF SUBSTANCES OR DECREASING ALTERNATIVES? BEHAVIORAL ECONOMICS IN THE TIME OF COVID-19

COVID-19 offers a chance to test the Reinforcer Pathology (RP) model through the effects of social constraints on the motivation to use drugs. Aims. This study aimed to empirically assess the RP model in the context of a cross-sectional online survey in Spain. Method. During the strictest period of confinement (14th March-12th April 2020), 203 participants provided measures on past 30-day use of legal and illegal substances and responded to hypothetical alcohol and cigarette purchase tasks. Univariate and bivariate analyses were conducted to inform on pre- and intra-pandemic substance use patterns. Breakpoint (i.e., price at which consumption ceases), elasticity (i.e., sensitivity of demand to rises in costs) and intensity (i.e., unrestricted consumption) were used as indicators of substance use demand. Results. Past 30-day alcohol use decreased from 71.4% (145/203) to 50.7% (103/203), tobacco from 14.3% (30/203) to 12.8% (26/203), and cannabis from 8.9% (18/203) to 4.4% (9/203). Predictably, illegal substance use went from 1% (2/203) to 0%. Conclusions. Despite reductions in substance use, alcohol and tobacco reinforcement, as measured by intensity and breakpoint, slightly increased within the first month of confinement. Potentially beneficial nudges and intervention strategies are discussed from the preventive and treatment standpoint.

An evaluation of fixed and randomized price sequence on the alcohol purchase task.

Factors influencing drug consumption can be effectively evaluated in the context of behavioral economic demand. Specifically, hypothetical purchase tasks (HPTs) allow for estimated drug consumption at a range of prices in which drug administration is not ethically or feasibly possible. With the marked increase of HPTs in behavioral research, understanding methodological influences on responding is paramount. One such methodological consideration is the price sequence, which can be presented in a fixed, ascending order or a randomized sequence. This study compared fixed and fully randomized sequence order with college student drinkers using a within-subjects design. Self-reported consumption revealed that despite some small differences between the fixed and random sequences, consumption preferences were highly similar, regardless of presentation order. These results suggest participants are likely not anchoring their responses to the prior price on a fixed-order sequence. We conclude with a discussion on how these findings provide implications for HPTs and future research. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Changes in alcohol intoxication-related ambulance attendances during COVID-19: How have government announcements and policies affected ambulance call outs?

BackgroundIn response to COVID-19, government-mandated health directives including widespread lockdowns were implemented. Changes in alcohol purchasing were reported, with growing concern that alcohol may be consumed as a way to cope with pandemic-associated stressors. Hitherto, there have been limited studies examining alcohol-related harms, including acute harms requiring an ambulance, and their relationship to government announcements or policies related to COVID-19.MethodsAnalyses were conducted between January and September 2020, with matched months in 2019, using Victorian data from the National Ambulance Surveillance System in Australia. Interrupted time series (ITS) models with odds ratios (OR) were used to map alcohol-related harms as a function of government policies for both metropolitan and regional areas.FindingsA total of 43,003 alcohol intoxication-related ambulance attendances occurred between January 2019 and September 2020. Attendances in the home increased in 2020 by 9% compared to matched 2019 months. The most socioeconomically advantaged cases showed the highest percentage change. ITS models showed decreased odds of alcohol-related attendances at the beginning of each COVID-19 wave in metropolitan (OR:0•77; 95%CI: 0•71-0•83; p<0•001) and regional Victoria (OR: 0•72; 95%CI: 0•67-0•79, p<0•001) separately, and increased odds following the introduction of harsher restrictions in metropolitan Melbourne (OR:1•07; 95%CI:1•01-1•11, p=0•005). A 19% increase in odds of alcohol-related harms was observed at the end of the second wave lockdown period in regional Victoria (OR:1•19; 95%CI: 1•01-1•41, p=0•004).InterpretationAlcohol-related attendances during COVID-19 restrictions showed a displacement to home settings. Changes in patterns of harms were evident in specific sociodemographic groups, and geographic regions when mapped to government health directives. This study is one of the first to investigate alcohol-related harms at the population level in response to a global pandemic.FundingCommonwealth Department of Health and Victorian Department of Health.

Extending alcohol retailers’ opening hours: Evidence from Sweden

Excessive alcohol use is associated with a wide range of adverse outcomes that inflict large societal costs. This paper investigates the impacts of increases in regulated opening hours of Swedish alcohol retailers on alcohol purchases, health and crime outcomes by relating changes in these outcomes in municipalities that increased their retail opening hours to those in municipalities whose opening hours remained unchanged. We show that extended opening hours led to statistically and economically significant increases in alcohol purchases by around two percent per weekly opening hour, but find no corresponding increases in adverse outcomes related to the consumption of alcohol. We study potential mechanisms, such as consumption spillovers and on and off-premise substitution, and we discuss policy implications of our findings.

Recreational cannabis legalization and alcohol purchasing: a difference-in-differences analysis

BackgroundWhether recreational cannabis legalization is associated with changes in alcohol consumption (suggesting a potential substitution or complementary relationship) is a key question as cannabis policy evolves, particularly given the adverse health and social effects of alcohol use. Relatively little research has explored this question.MethodsThis study examined the association between recreational cannabis legalization and alcohol purchasing in the USA using an interrupted time series design. We used data from the Nielsen Consumer Panel (2004–2017) from 69,761 households in all 50 states to calculate monthly milliliters of pure ethanol purchased for four beverage categories (beer, wine, spirits, and all alcohol products). We used difference-in-differences models and robust cluster standard errors to compare changes in milliliters of pure ethanol purchased. We fit models for each beverage category, comparing three “policy” states that have legalized recreational cannabis (Colorado, Oregon, and Washington) to states that had not legalized recreational cannabis. In one set of models, a single control state was selected that matched pre-policy purchasing trends in the policy states. In another set, policy states were compared to all states that had not legalized recreational cannabis.ResultsCompared to all other states that did not legalize recreational cannabis, Colorado households showed a 13% average monthly decrease in purchases of all alcoholic products combined (estimate, 0.87; CI, 0.77, 0.98) and a 6% decrease in wine (0.94; CI, 0.89, 0.99). Estimates in Washington were suggestive of an increase in spirits purchased in both the unrestricted (1.24; CI, 1.12, 1.37) and restricted sample (1.18; CI, 1.02, 1.36). Oregon showed a significant decrease in monthly spirits purchased when compared to its selected comparator state (0.87; CI, 0.77, 0.99) and to all other states without legalized recreational cannabis (0.85; CI, 0.77, 0.95).ConclusionsResults suggest that alcohol and cannabis are not clearly substitutes nor complements to one-another. Future studies should examine additional states as more time passes and more post-legalization data becomes available, use cannabis purchase data and consider additional methods for control selection in quasi-experimental studies.

Recreational Cannabis Legalization and Alcohol Purchasing: A Difference-in-Differences Analysis

Background: Whether recreational cannabis legalization is associated with changes in alcohol consumption (suggesting a potential substitution or complementary relationship) is a key question as cannabis policy evolves, particularly given the adverse health and social effects of alcohol use. Relatively little research has explored this question. Methods: This study examined the association between recreational cannabis legalization and alcohol purchasing in the U.S. using an interrupted time series design. We used data from the Nielsen Consumer Panel (2004-2017) from 69,761 households in all 50 states to calculate monthly milliliters of pure ethanol purchased for four beverage categories (beer, wine, spirits, and all alcohol products). We used difference-in-differences models and robust cluster standard errors to compare changes in milliliters of pure ethanol purchased. We fit models for each beverage category, comparing three “policy” states that have legalized recreational cannabis (Colorado, Oregon, and Washington) to states that had not legalized recreational cannabis. In one set of models, a single control state was selected that matched pre-policy purchasing trends in the policy states. In another set, policy states were compared to all states that had not legalized recreational cannabis. Results: Compared to all other states that did not legalize recreational cannabis, Colorado households showed a 13% average monthly decrease in purchases of all alcoholic products combined (estimate: 0.87; CI: 0.77, 0.98) and a 6% decrease in wine (0.94; CI: 0.89, 0.99). Estimates in Washington were suggestive of an increase in spirits purchased in both the unrestricted (1.24; CI: 1.12, 1.37) and restricted sample (1.18; CI: 1.02, 1.36). Oregon showed a significant decrease in monthly spirits purchased when compared to its selected comparator state (0.87; CI: 0.77, 0.99) and to all other states without legalized recreational cannabis (0.85; CI: 0.77, 0.95). Conclusions: Results suggest that alcohol and cannabis are not clearly substitutes nor complements to one-another. Future studies should examine additional states as more time passes and more post-legalization data becomes available, use cannabis purchase data and consider additional methods for control selection in quasi-experimental studies.

Impact of minimum unit pricing on alcohol purchases in Scotland and Wales: controlled interrupted time series analyses

As a policy option to reduce consumption of alcohol and the harm it does, on May 1, 2018, Scotland introduced a minimum price of 50 British pence (p) per unit of alcohol (8 g) sold; Wales followed suit on March 2, 2020, with the same minimum unit price (MUP). We analysed household purchase data based on bar codes to assess the impact of these policy options in the medium term for Scotland and in the immediate term for Wales. For these location-controlled, interrupted time series regression analyses, the data source was Kantar WorldPanel's household shopping panel, which, at the time of our analysis, included 35 242 British households providing detailed information on 1·24 million separate alcohol purchases in 2015-18 and the first half of 2020. With no data exclusions, we analysed the impact of introducing MUP in Scotland, using purchases in northern England as control, and in Wales, using western England as control. The studied changes associated with MUP were price paid per gram of alcohol purchased, grams of alcohol purchased, and amount of money spent on alcohol. In Scotland, price increases and purchase decreases following the introduction of MUP in 2018 were maintained during the first half of 2020. The difference between Scotland and northern England in 2020 was a price increase of 0·741 p per gram (95% CI 0·724-0·759), a 7·6% increase, and a purchase decrease of 7·063 g per adult per household per day that an alcohol purchase was made (6·656-7·470), a 7·7% decrease. In Wales, the introduction of MUP led to similar results. The difference between Wales and western England was a price increase 0·841 of 0·841 p per gram (0·732-0·951), an 8·2% increase, and a purchase decrease of 7·052 g per adult per household per day that an alcohol purchase was made (6·463-7·640), an 8·6% decrease. For both Scotland and Wales, reductions in overall purchases of alcohol were largely restricted to households that bought the most alcohol. The introduction of MUP was not associated with an increased expenditure on alcohol by households that generally bought small amounts of alcohol and, in particular, those with low incomes. The changes were not affected by the introduction of COVID-19 confinement in the UK on March 26, 2020. The evidence base supporting the positive, targeted impact of MUP is strengthened by the comparable results for Scotland and Wales. The short-term impact of MUP in Scotland during 2018 is maintained during the first half of 2020. MUP is an effective alcohol policy option to reduce off-trade purchases of alcohol and should be widely considered. None.

Minimum unit price deters heaviest alcohol purchasers

Alcohol use is one of the leading risk factors for non-communicable diseases and intentional and unintentional injuries, contributing to an estimated 3 million deaths each year.1,2 Setting a floor price on alcohol is considered by WHO to be one of the most cost-effective means to prevent and reduce the harmful use of alcohol and associated health issues.3 By use of large-scale panel data on alcohol purchasing obtained through product barcodes, Anderson and colleagues4 provide strong evidence that the introduction of a minimum unit price (MUP) might reduce off-trade alcohol purchases (eg, from shops or online) and consumption, seemingly despite COVID-19-associated changes, and that the effect is considerably concentrated in households that generally purchase the most alcohol.

The behaviour of alcohol-dependent drinkers of spirits during level 4 COVID-19 lockdown in Auckland, New Zealand.

IntroductionBehaviour of alcohol drinkers during previous major public health or economic crises has varied, with reductions in use generally occurring during periods of reduced availability. This study aimed to discover the behaviour of a group of dependent drinkers of spirits during a 33‐day period of complete closure of physical stores selling spirits during COVID‐19 lockdown in Auckland, New Zealand, March 2020.MethodsElectronic clinical records of drinkers waitlisted to complete an alcohol detox at the in‐patient service were followed from day 1 of lockdown and outcomes at the end of the period analysed.ResultsDrinkers of spirits were statistically more successful in stopping drinking (P = 0.002) than those of wine or beer. Only 26% chose to switch to an alternate alcohol type initially.Discussion and ConclusionA sudden reduction in availability of spirits resulted in positive behaviour change in spirits drinkers compared to those of other alcohol types, aided by the support of detox services. Internet alcohol purchasing, while not used by this group, deserves close future scrutiny due to its potential to increase alcohol availability in dependent drinkers.

Insights from behavioral economics to characterize substance use involvement in adolescents: a cluster analysis

Reinforcement pathology (RP), a framework rooted in behavioral economics, has contributed to advances in the etiology and treatment of substance use. Drug demand and delay discounting (DD) have gained considerable interest, as they inform on the risk for escalation to substance use as well as treatment-specific targets. No prior study conducted in Spain has explored the interplay of demand and DD in adolescents. This study was aimed to: 1) identify whether DD and alcohol demand can yield empirically driven subgroups, and 2) examine differences in substance use involvement. The sample comprised 107 (% females = 54.2) adolescents (M=15.46, SD=1.25) from a high school in Asturias (Spain). Participants filled out an ad-hoc survey on substance use over the prior 30 days and one year. A 20-item alcohol purchase task (APT) was used to assess the reinforcing value of alcohol. The 21-item Monetary Choice Questionnaire evaluated impulsive choice. Two subgroups emerged: Cluster 1 (n = 72) and Cluster 2 (n = 35). Participants in C2 consistently showed higher impulsivity and demand for alcohol, signifying lower responsiveness to alcohol pricing. As compared to C1, those in C2 had a higher prevalence of past-month substance use [C1: 26/72 (36.1%) vs. C2: 33/35 (94.3%), p &lt;.001], and a greater frequency of drunkenness [p &lt;.001] and binge drinking episodes [p &lt;.001]. RP differentiate between subgroups of adolescent substance users with patterns of more versus less substance use involvement. The existence of specific drug use subpopulations should be considered when designing environmental preventive policies

Working memory and alcohol demand relationships differ according to PTSD symptom severity among veterans with AUD.

Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) are highly comorbid with complex and often unclear associations. Working memory deficits may represent a shared mechanism implicated in emotion regulation and control over impulsive alcohol use. Here we test whether PTSD symptoms and working memory correlated with performance on a behavioral economic assessment of alcohol demand. 113 veterans (mean age 51 years; 89% male) completed an Alcohol Purchase Task (APT) and were assessed for PTSD, alcohol use, and working memory. We examined the interaction of PTSD symptoms and working memory on four indices of alcohol demand measured from the APT; specifically, we used separate models to test whether associations between working memory and intensity (consumption at $0), Omax (maximum expenditure), Pmax (price at maximum expenditure), and elasticity (price sensitivity), differed as a function of PTSD symptoms. In a model controlling for hazardous drinking, average drinking levels, age, sex, marital status, occupation, and education, we observed a significant interaction between PTSD symptoms and working memory on elasticity, whereby greater working memory capacity was associated with greater elasticity for veterans with lower PTSD symptoms. Follow-up analyses regarding specific PTSD symptom domains indicated that this effect was strongest for avoidance symptoms. Taken together, working memory abilities correlated with subjective valuations of alcohol in a laboratory setting for veterans with less severe PTSD symptoms. This work highlights the conditions under which working memory may be a potential target for interventions geared toward reducing alcohol use in veterans with co-occurring PTSD and AUD. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Commentary on Martínez‐Loredo et al.: Where do we go from here? Increasing the clinical utility of alcohol purchase tasks by expanding our definition of constraint

Alcohol purchase tasks provide clinically meaningful indices of motivation to consume alcohol by measuring decisions to consume alcohol across price constraints. The convergent validity of these tasks could be enhanced by extending the definition of constraints to include clinically relevant contextual factors that could help to inform ideographic treatment approaches. Imagine a Friday night pre-pandemic. You are attending a concert with your closest companions. Before the show starts, you meander to the bar to buy a drink. While you review the menu, you overhear the bartender say that drinks will cost $10 each. How many would you purchase? What if drinks only cost $5? $2? Many of us have experienced these moments. We might be willing to buy three drinks when they are $5, but only one at the $10 price. Of course, we all know of someone who refuses to pay more for a single beer than what it would cost in a six-pack (those hyper-rational agents). What about those infrequent, but remarkable circumstances where drinks are free, such as at a wedding, or a university party? Now, imagine you are home alone and have an important event the next morning—how many drinks would you have under these circumstances? These real-life scenarios demonstrate a fundamental concept in behavioral theory: as the costs of alcohol increase, choices to purchase and consume alcohol decrease, and both the amount of consumption in the absence of constraints and the degree to which constraints influence choice can serve as markers of alcohol value. Borrowing from economic theory, behavioral scientists have developed alcohol purchase tasks (APTs) modeled after laboratory progressive ratio tasks (and real-life choices) to measure this alcohol value, or alcohol demand. Demand indices incorporate data across constraints and should theoretically serve as robust predictors of extended periods of observable real-life behavior. Martínez-Loredo and colleagues [1] update previous meta-analytical effect sizes [2], demonstrating a robust association between alcohol demand indices and alcohol consumption, problems, and heavy drinking. Intensity (consumption under no constraints) demonstrated uniquely robust utility in predicating alcohol problems. Opportunities for unconstrained drinking may be relatively infrequent (e.g. parties, weddings) and thus may be difficult to predict based on standard assessments of drinking. However, these ‘high-intensity’ drinking episodes can be extremely risky and are thus important to account for in models of alcohol problem severity used to inform alcohol interventions. Intensity may be a useful index in predicting risk for these high-intensity drinking events over time, and should be examined in future research. An additional unique utility of APTs may lie in their dynamic measurement of fluctuations in alcohol valuation due to intentional modeling of behavior across constraints. Although there are numerous valid indices of alcohol use severity (e.g. quantity/frequency, heavy drinking, alcohol use disorder symptoms), these are often ‘slices’ of past behavior which took place within a set of environmental constraints, and do not account for possible fluctuations in these constraints under future conditions. In other words, an individual who drank four drinks last week may have drunk more if drinks were more available or if they had seen their friends. Although standard APTs define constraints as increasing price, a substantial literature has demonstrated that alcohol demand changes under a variety of other constraints [3], such as when one has to drive after drinking [4], when there is a next-day responsibility (opportunity cost [5]) and when friends are no longer present [6]. In other words, demand elasticity might be better conceptualized more broadly as the change in consumption as a function of constraint, with monetary price being just one important and easily quantified type of constraint [3]. Thus, one future direction to increase the convergent validity of APTs might be to quantify the effect of other clinically relevant constraints. The present review provides an excellent starting-point for what we hope is the next stage of APT research, which carefully models relative utility as a dynamic indicator of motivation to consume alcohol in any given moment. Purchase tasks exploring novel constraints could identify idiographic high-risk situations and protective factors for informing person-centered treatment and intervention. This research may be facilitated specifically with brief APTs administered through ecological momentary assessment to determine dynamic contextual influences on demand. This could greatly enhance the clinical utility of the APT. For example, an individual may report low drinking while alone but heavy drinking at low drink prices when with friends. These tasks would provide nuanced contextual data that could help clinicians to identify vulnerable moments to target through intervention. None. Samuel F. Acuff: Conceptualization, Writing, Editing. James G. Murphy: Conceptualization, Editing.

Effects of a multi-component alcohol prevention intervention at sporting events: a quasi-experimental control group study.

Alcohol intoxication among spectators and related problems are common at sporting events. This study estimated the impact a multi-component community-based alcohol prevention intervention, implemented at Swedish Premier Football (soccer) League matches, had on intoxication levels among spectators and refusal rates of alcohol service to, and arena entry of, obviously intoxicated spectators. A quasi-experimental controlled study using a repeated cross-sectional design. Spectators and sport arenas in Stockholm and Gothenburg, Sweden. The intervention was implemented in Stockholm and consisted of community mobilisation and collaboration, training of staff and improved enforcement and policy work. Gothenburg was the comparison area and received usual care. Primary outcomes were spectators' mean breath alcohol concentration (BrAC), proportion of spectators with high intoxication levels, (defined as BrAC ≥0.1%), overserving at licensed premises inside arenas and refused arena entry of obviously intoxicated spectators. Baseline data were collected during 2015 and follow-up during 2016 and 2017. BrAC assessments (n=10 188), arena entry attempts (n=201) and alcohol purchase attempts at premises inside arenas (n=495) were collected. There was evidence that the refusal rates of alcohol purchase at premises inside arenas improved differently between study areas and over time (adjusted odds ratio [aOR]=0.28, 95% CI=0.07, 1.06, P=0.060, Bayes factor [BF]=8.60). In both study areas, the arena entry refusal rates improved over time (aOR=5.87, 95% CI=1.16, 29.83, P=0.033, BF=17.7), but evidence that the rates improved differently between study areas and over time was equivocal (aOR=0.57, 95% CI=0.09, 3.56, P=0.543, BF=1.2). Mean BrAC levels decreased over time in both study areas (β=-0.032, 95% CI=-0.050, -0.015, P<0.001), and differently (β=0.104, 95% CI=0.061, 0.146, P<0.001), but evidence for an interaction effect was equivocal (β=-0.002, 95% CI=-0.022, 0.018, P=0.868, BF=1.0). Evidence was equivocal regarding whether the proportion of spectators with high intoxication levels decreased differently between study areas and over time (aOR=1.17, 95% CI=0.91, 1.50, P=0.220, BF=2.2). A multi-component community-based alcohol prevention intervention at sporting events may have increased staff intervention toward obviously intoxicated spectators. It was not clear whether this translated into a reduction in intoxication, which can be explained by improvements in the comparison area.

Understanding the secondary supply of alcohol as a wicked policy problem: The unique case of the Banned Drinker Register in the Northern Territory

AbstractIn an effort to tackle the exceptionally high level of alcohol consumption in the Northern Territory (NT) of Australia, there are a suite of alcohol policies and new legislation that have been introduced. These include restricted purchasing and consumption for certain individuals. In 2017, the Banned Drinker Register (BDR) was (re)introduced – a policy that involves placing persons who consume alcohol at harmful levels to themselves or others onto a register which prohibits the purchase of alcohol from take‐away liquor outlets. As a result, there is an incentive for banned drinkers to obtain alcohol through friends, family, and through the black market – referred to as secondary supply. Though the phenomenon of secondary supply is not new, the recent evaluation of the BDR highlighted a number of challenges of tackling the secondary supply of alcohol. Informed by Head's framework for assessing ‘wicked’ policy problems, this policy analysis uses data from interviews with stakeholders undertaken as part of two studies on alcohol policy and services. The findings present the limitations of the policy design and implementation context in preventing secondary supply of alcohol to banned drinkers. The paper concludes with implications for policy and research that better recognise the implementation context.

Using social media comments to reduce alcohol purchase intentions: An online experiment.

Alcohol advertising is prevalent on social media. The current study sought to identify effective message types to pair with social media alcohol ads to minimise purchase intentions associated with exposure. A 6 (within) × 5 (between) randomised controlled experiment was conducted with n=723 US participants. Participants viewed six unique social media alcohol ads and were randomised to view one of four message types (i.e. pro-drinking comments, anti-drinking comments, industry responsibility messages and health warning labels) associated with the ads or the control (i.e. no messages). Purchase intentions were measured after each ad exposure. Significant main and interactive effects were determined by two-level, random intercept hierarchical linear models. Purchase intentions were significantly lower among participants who viewed anti-drinking comments relative to the control (P=0.022) and warning labels (P=0.016). Purchase intentions were significantly greater among participants who viewed pro-drinking comments and had a family history of alcohol use (P=0.032) and among those who viewed warning labels and were previously exposed to alcohol depictions through family and friends' social media posts (P=0.033). Anti-drinking messages, written by social media users, may be effective at reducing alcohol purchase intentions when posted as social media comments. Current industry responsibility messages had no effect, and caution may be needed if warning labels are applied to ads in this medium.

Retail Alcohol and Tobacco Sales During COVID-19

Retail Alcohol and Tobacco Sales During COVID-19

Potential effects of minimum unit pricing at local authority level on alcohol-attributed harms in North West and North East England: a modelling study

Background In 2018, Scotland implemented a 50p-per-unit minimum unit price for alcohol. Previous modelling estimated the impact of minimum unit pricing for England, Scotland, Wales and Northern Ireland. Decision-makers want to know the potential effects of minimum unit pricing for local authorities in England; the premise of this study is that estimated effects of minimum unit pricing would vary by locality. Objective The objective was to estimate the potential effects on mortality, hospitalisations and crime of the implementation of minimum unit pricing for alcohol at local authority level in England. Design This was an evidence synthesis, and used computer modelling using the Sheffield Alcohol Policy Model (local authority version 4.0). This study gathered evidence on local consumption of alcohol from the Health Survey for England, and gathered data on local prices paid from the Living Costs and Food Survey and from market research companies’ actual sales data. These data were linked with local harms in terms of both alcohol-attributable mortality (from the Office for National Statistics) and alcohol-attributable hospitalisations (from Hospital Episode Statistics) for 45 conditions defined by the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. These data were examined for eight age–sex groups split by five Index of Multiple Deprivation quintiles. Alcohol-attributable crime data (Office for National Statistics police-recorded crimes and uplifts for unrecorded offences) were also analysed. Setting This study was set in 23 upper-tier local authorities in North West England, 12 upper-tier local authorities in the North East region and nine government office regions, and a national summary was conducted. Participants The participants were the population of England aged ≥ 18 years. Intervention The intervention was setting a local minimum unit price. The base case is 50p per unit of alcohol. Sensitivity analyses were undertaken using minimum unit prices of 30p, 40p, 60p and 70p per unit of alcohol. Main outcome measures The main outcome measures were changes in alcohol-attributable deaths, hospitalisations and crime. Savings in NHS costs, changes in alcohol purchasing and consumption, changes in revenue to off-trade and on-trade retailers and changes in the slope index of inequality between most and least deprived areas were also examined. Results The modelling has proved feasible at the upper-tier local authority level. The resulting estimates suggest that minimum unit pricing for alcohol at local authority level could be effective in reducing alcohol-attributable deaths, hospitalisations, NHS costs and crime. A 50p minimum unit price for alcohol at local authority level is estimated to reduce annual alcohol-related deaths in the North West region by 205, hospitalisations by 5956 (–5.5%) and crimes by 8528 (–2.5%). These estimated reductions are mostly due to the 5% of people drinking at high-risk levels (e.g. men drinking &gt; 25 pints of beer or five bottles of wine per week, women drinking &gt; 17 pints of beer or 3.5 bottles of wine per week, and who spend around £2500 per year currently on alcohol). Model estimates of impact are bigger in the North West and North East regions than nationally because, currently, more cheap alcohol is consumed in these regions and because there are more alcohol-related deaths and hospitalisations in these areas. A 30p minimum unit price has estimated effects that are ≈ 90% lower than those of a 50p minimum unit price, and a 40p minimum unit price has estimated effects that are ≈ 50% lower. Health inequalities are estimated to reduce with greater health gains in the deprived areas, where more cheap alcohol is purchased and where there are higher baseline harms. Limitations The approach requires synthesis of evidence from multiple sources on alcohol consumption; prices paid; and incidence of diseases, mortality and crime. Price elasticities used are from previous UK analysis of price responsiveness rather than specific to local areas. The study has not estimated ‘cross-border effects’, namely travelling to shops outside the region. Conclusions The modelling estimates suggest that minimum unit pricing for alcohol at local authority level would be an effective and well-targeted policy, reducing inequalities. Future work The Sheffield Alcohol Policy Model for Local Authorities framework could be further utilised to examine the local impact of national policies (e.g. tax changes) or local policies (e.g. licensing or identification and brief advice). As evidence emerges from the Scottish minimum unit price implementation, this will further inform estimates of impact in English localities. The methods used to estimate drinking and purchasing patterns in each local authority could also be used for other topics involving unhealthy products affecting public health, for example to estimate local smoking or high-fat, high-salt food consumption patterns. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 4. See the NIHR Journals Library website for further project information.

Changes in alcohol use during the COVID-19 pandemic among a sample of cannabis users

ABSTRACT Background: The Coronavirus (COVID-19) pandemic has infiltrated all aspects of life in the U.S, including how consumers purchase and use alcohol. Given these changes and the use of alcohol to cope with states of distress, the primary objective of this study is to examine the association between alcohol use and the COVID-19 pandemic. Methods: In this one-group longitudinal study, we administered a self-report online survey to cannabis users in December 2019 and June 2020. This survey included the AUDIT and was amended at Wave 2 for the inclusion of COVID-10 impacts, beliefs, and behaviors. Results: Most (68.6%) of the sample reported little to no change in alcohol use. Our results showed an overall decline in AUDIT scores from Wave 1 to Wave 2 (p < .001, d = .40). However, those who reported greater amounts of change in alcohol use had statistically significant differences in AUDIT scores compared to those reporting no change. Conclusion: This study highlights the initial effects of COVID-19 on alcohol use and provides direction for research and clinical practice. The decline in consumption aligns with predictive literature and the group differences warrant investigation into changes for alcohol education through in-person or socially distant modes.