Alcohol-related Harm Research Articles

The Roles of Alcohol Availability, Overserving, and Enforcement in Recreational and Social Settings on Alcohol Misuse and Harms: A Comparison of Australia and the United States.

To examine how alcohol availability, overserving, and enforcement in recreational and social settings are related to alcohol misuse and alcohol-impaired driving among young adults in Victoria, Australia and Washington State, United States. Longitudinal data came from 1,430 participants in Victoria (n = 757; 52% female) and Washington (n = 673; 53% female), surveyed in 2014 (age 25) and 2018 (age 29) from the International Youth Development Study, a population-based, cross-national study to examine factors influencing substance use. Path modeling tested associations between age 25 perceptions of the alcohol environment, age 25 social alcohol consumption, and age 31 alcohol-related harms. Multiple-group modeling examined differences in parameter estimates across both states. Age 25 perceptions of the alcohol environment (alcohol availability, overservice in evening social venues, legal enforcement) and alcohol consumption in evening social settings were similar between the two states. Higher alcohol availability and perceived tendency of evening social venues to overserve were associated with higher alcohol consumption in these contexts. In turn, higher alcohol consumption in these settings was associated with more problematic alcohol use and an increased likelihood of alcohol-impaired driving 4 years later. Perceived likelihood of legal enforcement in evening social settings was not related to alcohol consumption in these contexts. The recreational and social settings commonly frequented by young adults can influence drinking behaviors and alcohol-related harms. Reducing alcohol availability and over-servicing in settings where young adults often congregate and socialize could reduce problematic alcohol use and alcohol-impaired driving.

Community awareness and engagement to prevent alcohol related harm: Stakeholder priorities in West Africa

Community awareness and engagement to prevent alcohol related harm: Stakeholder priorities in West Africa

Assessing the implementation of evidence-based alcohol policies on Atlantic Canadian post-secondary campuses: A comparative analysis

ObjectiveThis study assessed the quality of campus alcohol policies against best practice to assist campus decision-makers in strengthening their campus alcohol policies and reducing student alcohol use and harm.MethodsDrawing on empirical literature and expert opinion, we developed an evidence-based scoring rubric to assess the quality of campus alcohol policies across 10 alcohol policy domains. Campus alcohol policy data were collected from 12 Atlantic Canadian universities. All extracted data were verified by the institutions and then scored.ResultsOn average, post-secondary institutions are implementing only a third of the evidence-based alcohol policies captured by the 10 domains assessed. The average campus policy score was 33% (range 15‒49%). Of the 10 domains examined, only enforcement achieved an average score above 50%, followed closely by leadership and surveillance at 48%. The two heaviest-weighted domains—availability and access, and advertising and sponsorship—had average scores of 27% and 24%, respectively. However, if post-secondary campuses adopted the highest scoring policies from across all 12 campuses, they could achieve a score of 74%, indicating improvement is possible.ConclusionAtlantic Canadian universities are collectively achieving less than half their potential to reduce student alcohol-related harm. However, this study identifies opportunities where policies can be enhanced or modified. The fact that most policies are present at one or more campuses highlights that policy recommendations are an achievable goal for campuses. Campuses are encouraged to look to each other as models for improving their own policies.

Alcohol control policy and alcohol-attributable disease burden in Finland and the Baltic countries: A longitudinal study 1995-2019.

Alcohol remains a significant contributor to mortality and morbidity in Finland and the Baltic countries, particularly among men. This study aimed to assess alcohol policy restrictiveness in this region from 1995 to 2019 using a modified version of the Bridging the Gap (BtG-M) policy scale and examine its association with alcohol-related disease burden. The study utilised national laws to score policy restrictiveness (higher BtG-M scores mean stricter policies) and age-standardised rates of disability-adjusted life years (DALY), years of life lost, years lived with disability and deaths per 100,000 from the 2019 Global Burden of Disease Study (GBD). Spearman correlation tests and panel data regression models were applied to assess the association between policy score and burden of disease. Finland maintained a high BtG-M score, while the Baltic countries experienced recent increases from initially lower scores. Alcohol-related disease burden showed an inverse association with policy changes in these countries. Strongest association was seen between the BtG-M score and DALY rates attributed to injuries. Premature mortality among men constituted the largest proportion of disease burden. Despite challenges in accessing and comparing policy data over time, we showed a strong association between alcohol policy and alcohol-related harm in Finland and the Baltic countries. This study is one of the first to use the BtG-M scale to monitor changes in alcohol policies over time and their relationship to alcohol-related harm using GBD methodology. The study highlights the effects of national alcohol policies on levels of alcohol-related harm.

Predictors of Alcohol Use, Alcohol-Related Problems, and Substance Use Following Adolescent Metabolic and Bariatric Surgery.

To identify factors associated with incident alcohol consumption, hazardous drinking, alcohol-related problems, and substance use up to 8 years following metabolic and bariatric surgery (MBS) during adolescence. In this cohort, nearly half of those who underwent MBS as adolescents screened positive for alcohol use disorder, symptoms of alcohol-related harm, or alcohol-related problems within 8 years post-surgery. Moreover, persistent or heavy marijuana use following MBS during adolescence is higher than national data. This study includes 217 adolescents (aged 13-19 years) enrolled in a 5-center prospective cohort study who underwent Roux-en-Y gastric bypass or vertical sleeve gastrectomy between 2007 and 2011 and were followed for up to 8 years. Participants self-reported alcohol use via the Alcohol Use Disorders Identification Test and substance use for up to 8 years. Female sex, pre-surgery lower body mass index, and pre-surgery substance use were independently associated with increased risk of incident post-surgery hazardous drinking. Pre-surgery psychiatric counseling was significantly associated with increased risk for new-onset substance use post-surgery. Starting substance use post-surgery or continuing pre- to post-surgery was independently associated with a higher risk of post-surgery hazardous drinking. Greater percent weight loss, starting post-surgery or continuing pre- to post-surgery psychiatric counseling, using alcohol, and hazardous drinking were independently associated with a higher risk of post-surgery substance use. Future research with a nonsurgical control group should be examined to further elucidate the relationships between MBS and alcohol and substance use following surgery during adolescence.

Enhancing Alcohol-Related Research in Africa: Possibility for a Continental-Wide Alliance.

Alcohol-related harms constitute a major public health concern in Africa, with high rates of alcohol consumption and associated negative health and social consequences. Despite this, there is a lack of comprehensive and coordinated research on alcohol use and related harms across the continent. This paper discusses common factors such as diverse traditions and cultures, prevailing low socioeconomic status, gendered approach, limited policy and weak regulation and compliance to existing alcohol control policies that contribute to alcohol-related problems, and the challenges facing alcohol-related research including limited research, isolated and uncoordinated research, and resource scarcity; it further proposes strategies for advancing a continental-wide alliance to enhance alcohol-related research in Africa. The alliance would bring together researchers, policymakers, and other stakeholders to collaborate on research projects, share data and resources, and develop evidence-based interventions to reduce alcohol-related harms. Furthermore, the paper outlines the potential benefits of such an alliance, including improved data collection and analysis, greater capacity building for researchers, and more effective policy and program development. The paper concludes that a continental-wide alliance on alcohol-related research in Africa has the potential to significantly enhance our understanding of alcohol use and related harms on the continent and to inform effective prevention and intervention strategies.

Understanding the challenges of identifying, supporting, and signposting patients with alcohol use disorder in secondary care hospitals, post COVID-19: a qualitative analysis from the North East and North Cumbria, England

BackgroundAlcohol-related mortality and morbidity increased during the COVID-19 pandemic in England, with people from lower-socioeconomic groups disproportionately affected. The North East and North Cumbria (NENC) region has high levels of deprivation and the highest rates of alcohol-related harm in England. Consequently, there is an urgent need for the implementation of evidence-based preventative approaches such as identifying people at risk of alcohol harm and providing them with appropriate support. Non-alcohol specialist secondary care clinicians could play a key role in delivering these interventions, but current implementation remains limited. In this study we aimed to explore current practices and challenges around identifying, supporting, and signposting patients with Alcohol Use Disorder (AUD) in secondary care hospitals in the NENC through the accounts of staff in the post COVID-19 context.MethodsSemi-structured qualitative interviews were conducted with 30 non-alcohol specialist staff (10 doctors, 20 nurses) in eight secondary care hospitals across the NENC between June and October 2021. Data were analysed inductively and deductively to identify key codes and themes, with Normalisation Process Theory (NPT) then used to structure the findings.ResultsFindings were grouped using the NPT domains ‘implementation contexts’ and ‘implementation mechanisms’. The following implementation contexts were identified as key factors limiting the implementation of alcohol prevention work: poverty which has been exacerbated by COVID-19 and the prioritisation of acute presentations (negotiating capacity); structural stigma (strategic intentions); and relational stigma (reframing organisational logics). Implementation mechanisms identified as barriers were: workforce knowledge and skills (cognitive participation); the perception that other departments and roles were better placed to deliver this preventative work than their own (collective action); and the perceived futility and negative feedback cycle (reflexive monitoring).ConclusionsCOVID-19, has generated additional challenges to identifying, supporting, and signposting patients with AUD in secondary care hospitals in the NENC. Our interpretation suggests that implementation contexts, in particular structural stigma and growing economic disparity, are the greatest barriers to implementation of evidence-based care in this area. Thus, while some implementation mechanisms can be addressed at a local policy and practice level via improved training and support, system-wide action is needed to enable sustained delivery of preventative alcohol work in these settings.

Modelling the impacts of volumetric and minimum unit pricing for alcohol on social harms in Australia

AimsAlcohol pricing policies may reduce alcohol-related harms, yet little work has been done to model their effectiveness beyond health outcomes especially in Australia. We aim to estimate the impacts of four taxation and minimum unit pricing (MUP) interventions on selected social harms across sex and age subgroups in Australia. MethodsWe used econometrics and epidemiologic simulations using demand elasticity and risk measures. We modelled four policies including (A) uniform excise rates (UER) (based on alcohol units) (B) MUP $1.30 on all alcoholic beverages (C) UER + 10 % (D) MUP$ 1.50. People who consumed alcohol were classified as (a) moderate (≤ 14 Australian standard drinks (SDs) per week) (b) Hazardous (15–42 SDs per week for men and 14–35 ASDs for women) and (c) Harmful (> 42 SDs per week for men and > 35 ASDs for women). Outcomes were sickness absence, sickness presenteeism, unemployment, antisocial behaviours, and police-reported crimes. We used relative risk functions from meta-analysis, cohort study, cross-sectional survey, or attributable fractions from routine criminal records. We applied the potential impact fraction to estimate the reduction in social harms by age group and sex after implementation of pricing policies. ResultsAll four modelled pricing policies resulted in a decrease in the overall mean baseline of current alcohol consumption, primarily due to fewer people drinking harmful amounts. These policies also reduced the total number of crimes and workplace harms compared to the current taxation system. These reductions were consistent across all age and sex subgroups. Specifically, sickness absence decreased by 0.2–0.4 %, alcohol-related sickness presenteeism by 7–9 %, unemployment by 0.5–0.7 %, alcohol-related antisocial behaviours by 7.3–11.1 %, and crimes by 4–6 %. Of all the policies, the implementation of a $1.50 MUP resulted in the largest reductions across most outcome measures. ConclusionOur results highlight that alcohol pricing policies can address the burden of social harms in Australia. However, pricing policies should just form part of a comprehensive alcohol policy approach along with other proven policy measures such as bans on aggressive marketing of alcoholic products and enforcing the restrictions on the availability of alcohol through outlet density regulation or reduced hours of sale to have a more impact on social harms.

A composite index of provincial alcohol control policy implementation capacity in Thailand

BackgroundThere is a well-published literature on the effectiveness and stringency of alcohol control policies, but not many studies focus on policy implementation, where policies transform into impact. The objective of this study is to create a composite index that measures the capacity for implementing effective alcohol control policies across all provinces in Thailand. MethodsBased on the international literature, we developed a list of key indicators for tracking the implementation of alcohol policies at the subnational level. To ensure these indicators were relevant to the Thai context, we obtained feedback from Thai experts. We collected primary data according to the developed indicators using questionnaires filled in by key informants at the implementing agencies and gathered secondary data at the provincial level. On this basis, we developed indices that reflect the status of alcohol control policy implementation. We then investigated the association between the indices and the prevalence and pattern of alcohol consumption and alcohol-related harms while adjusting for potential confounders using multiple linear regression and negative binomial regression, respectively. ResultsScores on the Provincial Alcohol Policy Implementation Capacity (PAPIC) Index ranged between 39 and 79. We found that each 1-point increase in PAPIC score was associated with a 1.98 % reduction in the quantity of alcohol consumed in grams per day (coefficient: −0.02; 95 %CI: −0.03, −0.00; p-value<0.05; e−0.02= 0.9802). We also found that for each 1-point increase in PAPIC score, the proportion of regular drinkers reduced by 0.30 per cent (coefficient: −0.30; 95 %CI: −0.55, −0.05; p-value<0.05). However, we did not find any association between the indices and alcohol-related harms. ConclusionThe level of implementation of alcohol control policy at the sub-national level is associated with alcohol consumption levels. The findings suggest the value of allocating resources to the implementation of alcohol control policy.

Alcohol Consumption Norms and the Favored Alcohol Consumption Policies of Citizens of Seoul.

The purpose of this study was to define the alcohol consumption norms and attitudes toward alcohol regulation policies among citizens of Seoul and the relationships between such norms and the favored regulatory policies. The study population consisted of 1001 adults aged 19-80 years living in Seoul. We collected demographic data and data on health behaviors, attitudes towards drinking, and preferred alcohol regulation policies. The correlations between drinking and the favored regulatory policies were analyzed. Male, as well as being employed, aged 19-39 years, single, a smoker, and a current or heavy episodic drinker were associated with more positive attitudes toward drinking (all p < 0.001) and less desire for alcohol regulation policies (all p < 0.001). We found a significant negative correlation between attitudes toward drinking and preferred alcohol regulation policies (p < 0.001). Participants who favored reduced or no alcohol consumption and a reduction in alcohol-related harm were more accepting of restrictive alcohol consumption policies. To establish alcohol control polices, differences in drinking norms within populations should be considered. Furthermore, for a successful alcohol control policy, efforts should be made to change drinking norms, as well as consider differences in regulatory policy preferences between population groups.

A pilot study of virtual Harm Reduction Talking Circles for American Indian and Alaska Native adults with alcohol use disorder.

Prior research suggests that culturally aligned, accessible and lower-barrier interventions are well-placed to align with the needs of American Indian and Alaska Native (AI/AN) people with alcohol use disorder (AUD). Taking into account community members' suggestions and the need for physical distancing during the COVID-19 pandemic, our team developed a protocol for virtual Harm Reduction Talking Circles (HaRTC) to incorporate these points. The aims of this 8-week, single-arm pilot were to initially document feasibility, acceptability, and outcomes associated with attendance at virtual HaRTC, which integrates the accessibility of virtual connection, a lower-barrier harm-reduction approach, and a culturally aligned intervention. Participants (N = 51) were AI/AN people with AUD (current or in remission) across 41 Tribal affiliations and 25 US states. After a baseline interview, participants were invited to attend 8, weekly virtual HaRTC sessions. At the baseline, midpoint and post-test assessments, we collected data on virtual HaRTC acceptability, cultural connectedness, quality of life, and alcohol outcomes. Of the 123 people approached, 63% were interested in and consented to participation. Participants attended an average of 2.1 (SD = 2.02) virtual HaRTC sessions, with 64% of participants attending at least one. On a scale from 1 to 10, participants rated the virtual HaRTC as highly acceptable (M = 9.3, SD = 1.9), effective (M = 8.4, SD = 2.9), culturally aligned (M = 9.2, SD = 1.5), helpful (M = 8.8, SD = 1.9), and conducted in a good way (M = 9.8, SD = 0.5). Although the single-arm study design precludes causal inferences, participants evinced statistically significant decreases in days of alcohol use and alcohol-related harm over the three timepoints. Additionally, both sense of spirituality, which is a factor of cultural connectedness, and health-related quality of life increased over time as a function of the number of HaRTC sessions attended. Virtual HaRTC shows initial feasibility and acceptability as a culturally aligned intervention for AI/AN people with AUD. Future randomized controlled trials will provide a test of the efficacy of this approach.

Effect of alcohol health warning labels on knowledge related to the ill effects of alcohol on cancer risk and their public perceptions in 14 European countries: an online survey experiment

Alcohol health-warning labels are a policy option that can contribute to the reduction of alcohol-related harms, but their effects and public perception depend on their content and format. Our study aimed to investigate the effect of health warnings on knowledge that alcohol causes cancer, the perceptions of three different message topics (responsible drinking, general health harm of alcohol, and alcohol causing cancer), and the role of images included with the cancer message. In this online survey experiment, distributed in 14 European countries and targeting adults of the legal alcohol-purchase age who consumed alcohol, participants were randomly allocated to one of six label conditions using a pseudorandom number generator stratified by survey language before completing a questionnaire with items measuring knowledge and label perceptions. Effect on knowledge was assessed as a primary outcome by comparing participants who had increased knowledge after exposure to labels with the rest of the sample, for the six label conditions. Label perceptions were compared between label conditions as secondary outcomes. 19 110 participants completed the survey and were eligible for analysis. Our results showed that a third of the participants exposed to the cancer message increased their knowledge of alcohol causing cancer (increase for 1131 [32·5%, 95% CI 29·8 to 35·2] of 3409 participants [weighted percentage] for text-only message; increase for 1096 [33·3%, 30·4 to 36·2] of 3198 [weighted percentage] for message inlcuding pictogram; and increase for 1030 [32·5%, 29·6 to 35·4] of 3242 [weighted percentage] for message including graphic image), compared with an increase for 76 (2·4%, -1·2 to 6·0) of 3018 participants who viewed the control message. Logistic regression showed that cancer messages increased knowledge compared with the control label (odds ratio [OR]text only 20·20, 95% CI 15·88 to 26·12; ORpictogram 21·16, 16·62 to 27·38; ORgraphic-image 20·61, 16·19 to 26·68). Cancer messages had the highest perceived impact and relevance, followed by general health harm and responsibility messages. Text-only and pictogram cancer messages were seen as clear, comprehensive, and acceptable, whereas those including an image of a patient with cancer had lower acceptability and the highest avoidance rating of all the labels. The only identified interaction between perceptions and experimental conditions (with gender) indicated higher comprehensibility and acceptability ratings of cancer labels than responsibility messages and control labels by women, with the results reversed in men. Health warnings are an effective policy option to increase knowledge of alcohol causing cancer, with a generalisable effect across several countries. Europeans consider alcohol health-warning labels to be comprehensible and acceptable, with cancer-specific health warnings having the highest perceived impact and relevance. EU4Health.

Is alcohol outlet availability associated with binge drinking in Canadian young adults? Findings from British Columbia and Quebec.

Alcohol availability is associated with alcohol consumption and related harms, but there is less evidence on associations with heavy episodic drinking (HED), a drinking pattern prevalent among young adults. This study aimed to assess the associations between alcohol availability and HED among young Canadians. We used a population-based sample of Canadian urban-dwelling young adult drinkers (18‒29years) from the cross-sectional Canadian Community Health Survey (CCHS; cycles 2015‒2019). We linked data from CCHS respondents in British Columbia and Quebec with two measures of alcohol availability for both offsite and onsite outlets: density (AOD) and accessibility (SAI) within dissemination areas (N = 1,067,747). We used logistic regression to estimate the associations between alcohol availability and monthly HED, adjusting for covariates. The associations between availability and HED differed by province, and availability measure. In British Columbia, offsite and onsite accessibility using SAI was inversely associated with HED. For example, living in neighbourhoods with medium alcohol accessibility (as compared to low) was significantly associated with reduced odds of HED (offsite OR = 0.33, 95% CI 0.17‒0.64; onsite OR = 0.49, 95% CI 0.27‒0.89). In Quebec, offsite availability was positively associated with HED using SAI (although not statistically significant) while no clear trend was seen for onsite availability. Results were consistent with previous evidence. Restricting spatial availability of alcohol remains an important public health strategy for decreasing the ease/convenience of access. Understanding why patterns of availability and drinking differ across regions could inform regionally tailored policies.

Classifying national drinking patterns in Europe between 2000 and 2019: A clustering approach using comparable exposure data.

Previously identified national drinking patterns in Europe lack comparability and might be no longer be valid due to changes in economic conditions and policy frameworks. We aimed to identify the most recent alcohol drinking patterns in Europe based on comparable alcohol exposure indicators using a data-driven approach, as well as identifying temporal changes and establishing empirical links between these patterns and indicators of alcohol-related harm. Data from the World Health Organization's monitoring system on alcohol exposure indicators were used. Repeated cross-sectional hierarchical cluster analyses were applied. Differences in alcohol-attributable harm between clusters of countries were analyzed via linear regression. European Union countries, plus Iceland, Norway and Ukraine, for 2000, 2010, 2015 and 2019. Observations consisted of annual country data, at four different time points for alcohol exposure. Harm indicators were only included for 2019. Alcohol exposure indicators included alcohol per capita consumption (APC), beverage-specific consumption and prevalence of drinking status indicators (lifetime abstainers, current drinkers, former drinkers and heavy episodic drinking). Alcohol-attributable harm was measured using age-standardized alcohol-attributable Disability-Adjusted Life Years (DALYs) lost and deaths per 100 000 people. The same six clusters were identified in 2019, 2015 and 2010, mainly characterized by type of alcoholic beverage and prevalence drinking status indicators, with geographical interpretation. Two-thirds of the countries remained in the same cluster over time, with one additional cluster identified in 2000, characterized by low APC. The most recent drinking patterns were shown to be significantly associated with alcohol-attributable deaths and DALY rates. Compared with wine-drinking countries, the mortality rate per 100 000 people was significantly higher in Eastern Europe with high spirits and 'other' beverage consumption [ = 90, 95% confidence interval (CI) = 55-126], and in Eastern Europe with high lifetime abstainers and high spirits consumption ( = 42, 95% CI = 4-78). European drinking patterns appear to be clustered by level of beverage-specific consumption, with heavy episodic drinkers, current drinkers and lifetime abstainers being distinguishing factors between clusters. Despite the overall stability of the clusters over time, some countries shifted between drinking patterns from 2000 to 2019. Overall, patterns of drinking in the European Union seem to be stable and partly determined by geographical proximity.

Safer-use strategies in the context of harm-reduction treatment for people experiencing homelessness and alcohol use disorder

BackgroundTwo, randomized controlled trials found harm-reduction treatment for AUD (HaRT-A) improves alcohol outcomes for adults experiencing homelessness. HaRT-A, which neither requires nor precludes abstinence, entails tracking alcohol-related harm, harm-reduction goals, and safer-use strategies. This secondary dual study qualitatively describes this last component, safer-use strategies, and their quantitative association with treatment outcomes. MethodsParticipants were people who experienced homelessness and AUD and were enrolled in the active HaRT-A treatment arms in 2 randomized control trials (Trial 1 N = 86; Trial 2 N = 208). Trial 1was a 2-arm study with randomization to HaRT-A or services as usual. Trial 2 was a 4-arm study combining HaRT-A and extended release naltrexone. In HaRT-A sessions, participants received a list of 3 categories of safer-use strategies (i.e., buffering alcohol's effects on the body, changing the manner of drinking to be safer and healthier, and reducing alcohol use). Mixed methods were used to qualitatively describe safer-use strategies implemented and quantitatively test their association with alcohol outcomes (i.e., peak quantity, frequency, alcohol-related harm). ResultsIn Trial 1, but not Trial 2, participants committed to more safer-use strategies across time, which was associated with reductions in alcohol frequency over the past 30 days. In both trials, participants committing to reducing alcohol consumption drank on a quarter fewer days overall, and in Trial 2, experienced 15 % less alcohol-related harm. In Trial 1, participants who committed to changing the manner of drinking were heavier drinkers overall, and although they showed significant reductions in alcohol-related harm, their reduction rate was slower than for participants who selected other strategies. In Trial 2, strategies to buffer alcohol's effects were associated with a monthly 14 % decrease of alcohol-related harm. ConclusionThis study replicated prior findings that people experiencing homelessness and AUD regularly adopt strategies to reduce alcohol-related harm. The implementation of safer-use strategies was favorably associated with alcohol outcomes, but specific associations differed by trial and outcome. Discussion of safer-use strategies appears helpful; however, further research is needed to firmly establish how this HaRT-A component works.

Protective effects of ethnic enclaves: Testing pathways to alcohol use and use disorders in Mexican American young adults.

Ethnic enclave residence is associated with decreased risk for drinking and related problems, but less is known about the mechanisms that explain this association. Informed by theories of social control, we used a multilevel framework to examine whether negative attitudes toward drinking mediated associations between ethnic enclave residence (i.e., neighborhood linguistic isolation) and alcohol outcomes among Mexican American young adults (N = 628) in Southern California. Model 1 assessed mediation effects in the pathways from linguistic isolation to current drinking and alcohol use disorder (AUD). Model 2 adjusted for parental drinking attitudes and neighborhood alcohol availability. There were differential associations by gender in direct effects of linguistic isolation and negative drinking attitudes on both drinking and AUD. Among women only, linguistic isolation was related to greater abstinence and decreased AUD after accounting for social control proxies of parent attitudes and alcohol availability. Young adults' own drinking attitudes did not mediate relationships between linguistic isolation and alcohol outcomes. This study offers evidence on the importance of disaggregating Hispanic national groups by gender to uncover social mechanisms within ethnic enclave settings for tailored supports in reducing risk of drinking and alcohol-related harms.

Overview of State Laws Restricting Alcohol Outlet Density in the United States.

Complementing the extensive research literature demonstrating that increased alcohol outlet density is associated with excessive alcohol consumption and related harms, this article synthesizes information on the types of alcohol outlet density restrictions in US state-level laws. Statutes and regulations related to alcohol outlet density in all 50 states and the District of Columbia in effect as of January 1, 2022, were collected using Westlaw. State-level density restrictions were coded according to 4 variables and overlaid with existing research on state-specific local authority to regulate outlet density. Alcohol outlet density laws in Michigan and Massachusetts were analyzed in detail as case studies. United States. US state-level licensing laws restricting alcohol outlet density. Thirty-three states and the District of Columbia have state-level licensing laws that limit alcohol outlet density. Of those, 25 have population-based restrictions, 8 have distance-based restrictions, 7 have quotas, and 6 require the licensing agency to consider density-related factors. Within the same group of 34 jurisdictions, 22 apply restrictions to both on- and off-premises outlets, 5 apply them only to on-premises outlets, and 7 apply them only to off-premises outlets. Among the 32 states where localities lack authority to license alcohol outlets, two-thirds have state-level laws restricting outlet density. State-level density restrictions also exist in approximately two-thirds of the states where localities have licensing authority. Case studies of Michigan and Massachusetts highlight how state-level density restrictions operate in practice. Two-thirds of jurisdictions have state-level alcohol outlet density restrictions, with population-based restrictions being the most common. In addition, outlet density restrictions may exist regardless of limits on local control and whether localities with authority to enact density restrictions have done so. Policymakers and others can reference this assessment to identify examples and opportunities to strengthen the alcohol policy environment in any given state.

Alcohol Interventions on Online Grocery Shopping Platforms

Introduction &amp; BackgroundThere is opportunity to engage light to moderate drinkers in alcohol reduction interventions as a preventative measure. In the space of online grocery shopping there is an added challenge in intervention development in the form of deceptive patterns, which influence consumer behaviour in unhealthy ways including automating behaviour and encouraging overconsumption. Objectives &amp; ApproachThe objectives of this study are to: 1) identify deceptive patterns in the online grocery shopping context, 2) develop interventions which support healthier decision making in this context, 3) apply those interventions to appropriate product categories. The method utilised in the first objective is heuristic analysis which was conducted across eleven major online grocery shopping platforms. The interventions were then developed using the Rapid Iterative Testing and Evaluation (RITE) method, which involved interviewing participants and iterating upon the inventions after every interview. Each interview was analysed using content analysis. When incorporating the interventions into the online grocery shopping environment, interviews were conducted to gain insight into drinking and purchasing habits of consumers. These final interviews were then analysed with inductive thematic analysis. Relevance to Digital FootprintsDigital Footprints underpin the entire intervention development space. The background of the project is built upon human shopping and interaction behaviour online when encountering deceptive patterns. These deceptive patterns have been established using mobile gaming micro-transaction data, online grocery shopping log-in and rewards data, among other data sources. Digital Footprints data can further support the findings from the thematic analysis by further showing cultural and social trends around drinking (e.g., increased purchasing of seasonal beers and ciders in the summer and during sporting tournaments). The purpose of the drinking identified through those social and cultural trends gauge the appropriateness of proposed alcohol interventions. Beyond this, digital footprints data around engagement with health and wellness promoting applications (e.g., active users and app downloads) provides greater insight into the types of health messaging that garner attention and can be used to further inform how to approach those currently outside the health-engaged group. Digital footprints serve to attach larger societal trends to the smaller-scaled interviews and thematic analysis conducted as part of the study. ResultsInitial findings have shown opportunities for nudging light to moderate drinkers who primarily consume beer, wine, or cider. Spirits have been identified as difficult to substitute due to a lack of substitution options in the low alcohol spirit category that are widely available on the consumer market via online grocery retailers. Conclusions &amp; ImplicationsWithout significant change, costs to the National Health Service (NHS) in alcohol related harm are set to rise by over 1 billion GBP. Alcohol consumption is a public health risk and there are opportunities to utilise digital footprint informed interventions to engage the public in preventative interventions.

Solitary drinkers in Great Britain: How do their sociodemographic characteristics, consumption patterns, and drinking occasions differ from those who drink with others?

Inequalities in alcohol-related harm may arise partly from differences in drinking practices between population groups. One under-researched practice associated with harm is consuming alcohol alone. We identify sociodemographic characteristics associated with drinking alone and the occasion-level characteristics associated with occasions when people drink alone. A cross-sectional analysis of one-week drinking diaries collected between 2015 and 2019 was conducted using event-level data on 271,738 drinking occasions reported by 83,952 adult drinkers in Great Britain. Our two dependent variables were a binary indicator of reporting at least one solitary drinking occasion in the diary-week at the individual-level and a binary indicator of drinking alone at the occasion-level (event-level). Individual-level characteristics associated with solitary drinking were being a man (OR 1.88, 95%CI [1.80,1.96]), aged over 50 (OR 2.60, 95%CI [2.40,2.81]), not in a relationship (OR 3.39, 95%CI [3.20, 3.59]), living alone (OR 2.51, 95%CI [2.37, 2.66]), and a high-risk drinker (OR 1.54, 95%CI [1.52,1.59]). Occasion-level characteristics associated with solitary drinking were that they were more likely to occur in the off-trade (OR 3.08, 95%CI [2.95,3.21]), Monday-Thursday (OR 1.36, 95%CI [1.27,1.47]), and after 10pm (OR 1.36, 95%CI [1.27,1.47]) controlling for geographic region and the month the interview took place. Characteristics of solitary drinking largely align with characteristics we associated with drinking problems. Those who partake in at least one solitary drinking occasion are overall more likely to consume alcohol at risky levels, however, the number of drinks consumed in each occasion was lower during a solitary drinking occasion.

Novel medications for problematic alcohol use.

Alcohol-related harm, a major cause of disease burden globally, affects people along a spectrum of use. When a harmful pattern of drinking is present in the absence of significant behavioral pathology, low-intensity brief interventions that provide information about health consequences of continued use provide large health benefits. At the other end of the spectrum, profound behavioral pathology, including continued use despite knowledge of potentially fatal consequences, warrants a medical diagnosis, and treatment is strongly indicated. Available behavioral and pharmacological treatments are supported by scientific evidence but are vastly underutilized. Discovery of additional medications, with a favorable balance of efficacy versus safety and tolerability can improve clinical uptake of treatment, allow personalized treatment, and improve outcomes. Here, we delineate the clinical conditions when pharmacotherapy should be considered in relation to the main diagnostic systems in use and discuss clinical endpoints that represent meaningful clinical benefits. We then review specific developments in three categories of targets that show promise for expanding the treatment toolkit. GPCRs remain the largest category of successful drug targets across contemporary medicine, and several GPCR targets are currently pursued for alcohol-related indications. Endocrine systems are another established category, and several promising targets have emerged for alcohol indications. Finally, immune modulators have revolutionized treatment of multiple medical conditions, and they may also hold potential to produce benefits in patients with alcohol problems.