Evidence-based Alcohol Policy Research Articles

Changes in alcohol-related emergency department presentations—a comparison of three waves in 2013, 2017 and 2022

aims: Emergency departments (EDs) around the world are increasingly overcrowded, which is associated with significant patient harm. Alcohol use is a known contributor to ED overcrowding. This study aimed to assess trends in the characteristics of alcohol-related ED presentations over time. methods: A cross-sectional observational study of Christchurch ED attendances during 3-week waves of data collection in November–December 2013, 2017 and 2022 was conducted. Potential participants were those patients attending the Christchurch Hospital ED who had ingested alcohol in the 4 hours prior to arrival, and/or the presentation was thought to be related to alcohol. Those who consented to take part were interviewed to examine amount and source of alcohol. results: There has been a change in the age profile towards a greater proportion of older patients attending the ED with alcohol-related issues. In 2022, a greater proportion of alcohol was purchased from on-licence venues compared to previous years, although off-licence alcohol purchase and consumption in private locations remained the most common. conclusion: Alcohol use and harm places a significant, yet preventable, burden on EDs and the wider healthcare system. Implementation of evidence-based alcohol policies is urgently needed to reduce the impact of alcohol in the ED and improve the health of communities.

Reducing Alcohol Use to Prevent Cancer Deaths: Estimated Effects Among U.S. Adults

The Dietary Guidelines for Americans, 2020-2025 recommends non-drinking or no more than 2 drinks for men or 1 drink for women in a day. However, even at lower levels, alcohol use increases the risk for certain cancers. This study estimated mean annual alcohol-attributable cancer deaths and the number of cancer deaths that could potentially be prevented if all U.S. adults who drank in excess of the Dietary Guidelines had instead consumed alcohol to correspond with typical consumption of those who drink within the recommended limits. Among U.S. residents aged ≥20 years, mean annual alcohol-attributable cancer deaths during 2020-2021 that could have been prevented with hypothetical reductions in alcohol use were estimated. Mean daily alcohol consumption prevalence estimates from the 2020-2021 Behavioral Risk Factor Surveillance System, adjusted to per capita alcohol sales to address underreporting of drinking, were applied to relative risks to calculate population-attributable fractions for cancers that can occur from drinking alcohol. Analyses were conducted during February-April 2023. In the U.S., an estimated 20,216 cancer deaths were alcohol-attributable/year during 2020-2021 (men: 14,562 [72.0%]; women: 5,654 [28.0%]). Approximately 16,800 deaths (83% of alcohol-attributable cancer deaths, 2.8% of all cancer deaths) could have been prevented/year if adults who drank alcohol in excess of the Dietary Guidelines had instead reduced their consumption to ≤2 drinks/day for men or ≤1 drink/day for women. Approximately 650 additional deaths could have been prevented annually if men consumed 1 drink/day, instead of 2. Implementing evidence-based alcohol policies (e.g., increasing alcohol taxes, regulating alcohol outlet density) to decrease drinking could reduce alcohol-attributable cancers, complementing clinical interventions.

Evidence-based alcohol policies are the answer.

Evidence-based alcohol policies are the answer.

Canada's Alcohol Deficit, 2007-2020: Social Cost, Public Revenue, Magnitudes of Alcohol Use, and the Per-Drink Net Deficit for a Fourteen-Year Period.

Governments generate substantial revenue from the distribution and sale of alcoholic beverages. However, the use of this alcohol results in considerable public costs for health care, criminal justice, and economic loss of production. Because comparisons of these two sides of the same coin are limited, this study aims to estimate this net alcohol surplus or deficit in Canada and each province/territory for a 14-year study period. Net government revenue from alcohol sales and net social costs of alcohol use were estimated for Canada and each province/territory for all years of study from 2007 to 2020, and all dollar figures were Consumer Price Index-adjusted to 2020 Canadian dollars (CAD). The net alcohol surplus/deficit was estimated as the difference. Per capita recorded alcohol sold was from administrative sources and used as proxy to calculate alcohol used by adding an estimate of unrecorded use and converting to Canadian standard drinks (CSDs). The per-drink net deficit was the net deficit divided by CSDs. In Canada in 2020, governments generated CAD $13.3 billion in revenue from alcohol sales, but this was offset by $19.7 billion in social costs attributable to alcohol use. This "alcohol deficit" increased by 122.0% in real-dollar terms over the study period and reached a high of $6.4 billion in 2020. In 2020, the magnitude of the alcohol used in Canada was 16.8 billion CSDs. Each of these drinks resulted in a public net deficit of $0.379. Both alcohol use and the resulting public alcohol deficit are high in Canada. To mitigate these losses to the well-being of Canadians and their economy, government planners, regulators, and policymakers must urgently deploy evidence-based alcohol policies toward reducing the magnitude of alcohol used in Canada.

Unpacking assertions made by the alcohol industry and how they make them: An analysis of submissions into Australia's National Alcohol Strategy.

Alcohol is a leading cause of morbidity and mortality globally. One significant barrier to the implementation of evidence-based alcohol policy is alcohol industry opposition. Making submissions to national policy processes is one way in which the industry exert influence. The aim of this study was to analyse alcohol industry submissions into Australia's National Alcohol Strategy to determine key assertions made by the alcohol industry and the ways in which they use evidence and refute the effectiveness of public health policies to make their claims. Submissions made by alcohol industry actors (n = 12) were analysed using content analysis to determine key industry assertions. A pre-existing framework on alcohol industry use of evidence was then applied to analyse the evidentiary practices used to make these assertions. Five common industry assertions were identified: 'Drinking alcohol in moderation has health benefits'; 'Alcohol isn't the cause of violence'; 'Targeted initiatives, not population level alcohol policies, are needed'; 'Strong alcohol advertising regulations are not necessary'; and 'Minimum unit price and pricing and taxation policies more broadly are not needed'. The industry systematically manipulated, misused and ignored evidence throughout their submissions. The alcohol industry is misusing evidence in their submissions to government consultations to make their assertions about alcohol policy. It is therefore essential that industry submissions are scrutinised and not accepted on face value. Additionally, it is suggested that the alcohol industry requires a distinct model of governance similarly to that which regulates the tobacco industry to prevent their attempts to undermine evidence-based public health policy.

Support for evidence-based alcohol policy in Ireland: results from a representative household survey.

Alcohol use is a leading risk factor for death and disability and there is a need for evidence-based policy measures to tackle excess alcohol consumption and related harms. The aim of this study was to examine attitudes towards alcohol control measures among the general public in the context of significant reforms undertaken in the Irish alcohol policymaking landscape. A representative household survey was conducted among individuals aged 18+ years in Ireland. Descriptive and univariate analyses were used. A total of 1069 participants took part (48% male) and there was broad support (>50%) for evidence-based alcohol policies. Support was strongest for a ban on alcohol advertising near schools and creches (85.1%) and for warning labels (81.9%). Women were more likely than men to support alcohol control policy measures while participants with harmful alcohol use patterns were significantly less likely to support these measures. Respondents with a greater awareness of the health risks of alcohol showed higher levels of support, while those who had experienced harms due to other people's drinking showed lower support compared with those who had not experienced such harms. This study provides evidence of support for alcohol control policies in Ireland. However, notable differences were found in levels of support according to sociodemographic characteristics, alcohol consumption patterns, knowledge of health risks and harms experienced. Further research on reasons behind public support towards alcohol control measures would be worthwhile, given the importance of public opinion in the development of alcohol policy.

Alcohol: No Ordinary Commodity-a summary of the third edition.

This article summarizes the findings and conclusions of the third edition of Alcohol: No Ordinary Commodity. The latest revision of this book is part of a series of monographs designed to provide a critical review of the scientific evidence related to alcohol control policy from a public health perspective. A narrative summary of the contents of the book according to five major issues. An extensive amount of epidemiological evidence shows that alcohol is a major contributor to the global burden of disease, disability and death in high-, middle- and low-income countries. Trends in alcohol products and marketing are described, indicating that a large part of the global industry has been consolidated into a small number of transnational corporations that are expanding their operations in Asia, Africa and Latin America. The main part of the book is devoted to a review of strategies and interventions designed to prevent or minimize alcohol-related harm. Overall, the most effective strategies to protect public health are taxation that decreases affordability and restrictions on the physical availability of alcohol. A total ban on alcohol marketing is also an effective strategy to reduce consumption. In addition, drink-driving counter-measures, brief interventions with at-risk drinkers and treatment of drinkers with alcohol dependence are effective in preventing harm in high-risk contexts and groups of hazardous drinkers. Alcohol policy is often the product of competing interests, values and ideologies, with the evidence suggesting that the conflicting interests between profit and health mean that working in partnership with the alcohol industry is likely to lead to ineffective policy. Opportunities for implementation of evidence-based alcohol policies that better serve the public good are clearer than ever before as a result of accumulating knowledge on which strategies work best.

Is Buying and Drinking Zero and Low Alcohol Beer a Higher Socio-Economic Phenomenon? Analysis of British Survey Data, 2015-2018 and Household Purchase Data 2015-2020.

Zero and low alcohol products, particularly beer, are gaining consideration as a method to reduce consumption of ethanol. We do not know if this approach is likely to increase or decrease health inequalities. The aim of the study was to determine if the purchase and consumption of zero and low alcohol beers differs by demographic and socio-economic characteristics of consumers. Based on British household purchase data from 79,411 households and on British survey data of more than 104,635 adult (18+) respondents, we estimated the likelihood of buying and drinking zero (ABV = 0.0%) and low alcohol (ABV > 0.0% and ≤ 3.5%) beer by a range of socio-demographic characteristics. We found that buying and consuming zero alcohol beer is much more likely to occur in younger age groups, in more affluent households, and in those with higher social grades, with gaps in buying zero alcohol beer between households in higher and lower social grades widening between 2015 and 2020. Buying and drinking low alcohol beer had less consistent relationships with socio-demographic characteristics, but was strongly driven by households that normally buy and drink the most alcohol. Common to many health-related behaviours, it seems that it is the more affluent that lead the way in choosing zero or low alcohol products. Whilst the increased availability of zero and low alcohol products might be a useful tool to reduce overall ethanol consumption in the more socially advantageous part of society, it may be less beneficial for the rest of the population. Other evidence-based alcohol policy measures that lessen health inequalities, need to go hand-in-hand with those promoting the uptake of zero and low alcohol beer.

국민건강증진종합계획에서의 알코올관련 정책변화와 함의

Objectives: Although Korean Health Plans are first and official alcohol policies of Korean government, changes and implications have not scrutinized from. So we followed those from wider view for new era. Methods: We compared the alcohol-related policies of first to fifth Korean Health Plan. The implication was deducted from wider view based on recent international and domestic evidences. Results: Major effective alcohol control policies have only slowly and incrementally introduced in Korea. Regulating the availability of alcohol and marketing restrictions have tried recently. Pricing policies were not apparent in official policies. Regarding to changes of governance bodies, the Ministry of Health and Welfare (1stHP), the Korea Institute for Health and Social Affairs (2nd and 3rd HPs), and the Korea Health Promotion and Development Institute (4th and 5th HPs) were governance bodies. About changes in contents, in the latest HP, 6 divisions, 29 tasks, 83 projects, and 400 performance indicators were made and these are more confirmed than the previous plans. The 1st Health Plan 2010 launched a campaign with alcohol prevention education, establishment of a healthy drinking culture, educational counseling. In the 2nd New Health Plan 2020, it was changed to a more comprehensive plan, including consumption restrictions. In the 3rd plan, performance indicators such as high-risk drinking rate indicators and the number of projects were further expanded. In the representative indicators by sector, the adult high-risk drinking rate indicator was selected as the representative indicator. In the 4th and 5th plans, detailed projects and indicators were revised without major changes in the framework. Conclusions: Korean Health Plans have been improve continuously toward evidence based alcohol policy. More progresses are expected. In the future, it is thought that a diverse interdisciplinary approach will be necessary, focusing on the business fields and performance indicators approached in the Comprehensive National Health Promotion Plan.

Strategies for engaging policy stakeholders to translate research knowledge into practice more effectively: Lessons learned from the Canadian Alcohol Policy Evaluation project.

Evidence-based alcohol policies have the potential to reduce a wide range of related harms. Yet, barriers to adoption and implementation within governments often exist. Engaging relevant stakeholders may be an effective way to identify and address potential challenges thereby increasing reach and uptake of policy evaluation research and strengthening jurisdictional responses to alcohol harms. As part of the 2019 Canadian Alcohol Policy Evaluation project, we conducted interviews with government stakeholders across alcohol-related sectors prior to a second round of researcher-led policy assessments in Canada's 13 provinces and territories. Stakeholders were asked for feedback on the design and impact of an earlier policy assessment in 2013 and for recommendations to improve the design and dissemination strategy for the next iteration. Content analysis was used to identify ways of improving stakeholder engagement. We interviewed 25 stakeholders across 12 of Canada's 13 jurisdictions, including representatives from government health ministries and from alcohol regulation, distribution and finance departments. In providing feedback on our stakeholder engagement strategy, participants highlighted the importance of maintaining ongoing contact; presenting results in accessible online formats; providing advance notice of results; and offering jurisdiction-specific webinars. This study offers important insight into the engagement preferences of government stakeholders involved in the health, regulation, distribution and financial aspects of alcohol control policy. Findings suggest that seeking input from stakeholders as part of conducting evaluation research is warranted; increasing the relevance, reach and uptake of results. Specific stakeholder engagement strategies are outlined.

The Canadian Alcohol Policy Evaluation project: Findings from a review of provincial and territorial alcohol policies.

Effective alcohol control measures can prevent and reduce alcohol-related harms at the population level. This study aims to evaluate implementation of alcohol policies across 11 evidence-based domains in Canada's 13 jurisdictions. The Canadian Alcohol Policy Evaluation project assessed all provinces and territories on 11 evidence-based domains weighted for scope and effectiveness. A scoring rubric was developed with policy and practice indicators and peer-reviewed by international experts. The 2017 data were collected from publicly-available regulatory documents, validated by government officials, and independently scored by team members. The average score for alcohol policy implementation across Canadian provinces and territories was 43.8%; Ontario had the highest (63.9%) and Northwest Territories the lowest (38.4%) jurisdictional scores. Only six of 11 policy domains had average scores above 50% with Monitoring and Reporting scoring the highest (62.8%) and Health and Safety Messaging the lowest (25.7%). A 2017 provincial/territorial current best practice score of 86.6% was calculated taking account of the highest scores for any individual policy indicators implemented in at least one jurisdiction across the country. Most of the evidence-based alcohol policies assessed by the Canadian Alcohol Policy Evaluation project were not implemented across Canadian provinces and territories as of 2017, and many provinces showed declining scores since 2012. However, the majority of policies assessed have been implemented in at least one jurisdiction. Improved alcohol policies to reduce related harm are therefore achievable and could be implemented consistently across Canada.

Alcohol control policies in Former Soviet Union countries: A narrative review of three decades of policy changes and their apparent effects.

Issues.The last Soviet anti-alcohol campaign of 1985 resulted in considerably reduced alcohol consumption and saved thousands of lives. But once the campaign’s policies were abandoned and the Soviet alcohol monopoly broken up, a steep rise in mortality was observed in many of the newly formed successor countries, although some kept their monopolies. Almost 30 years after the campaign’s end, the region faces diverse challenges in relation to alcohol.Approach.The present narrative review sheds light on recent drinking trends and alcohol policy developments in the 15 Former Soviet Union (FSU) countries, highlighting the most important setbacks, achievements and best practices. Vignettes of alcohol control policies in Belarus, Estonia, Kazakhstan, Lithuania and Uzbekistan are presented to illustrate the recent developments.Key Findings.Over the past decade, drinking levels have declined in almost all FSU countries, paralleled by the introduction of various alcohol-control measures. The so-called three ‘best buys’ put forward by the World Health Organization to reduce alcohol-attributable burden (taxation and other measures to increase price, restrictions on alcohol availability and marketing) are relatively well implemented across the countries.Implications.In recent years, evidence-based alcohol policies have been actively implemented as a response to the enormous alcohol-attributable burden in many of the countries, although there is big variance across and within different jurisdictions.Conclusion.Strong declines in alcohol consumption were observed in the 15 FSU countries, which have introduced various alcohol control measures in recent years, resulting in a reduction of alcohol consumption in the World Health Organization European region overall.

The Health Impact of Alcohol on American Cities: Modeling the Local Burden of Current Alcohol Use in One Jurisdiction.

Measurement of alcohol use and associated harms at the city level is often incomplete or non-existent even though such data are often critical to informing local prevention strategies. This paper models how to generate local estimates of the morbidity, mortality, and cost of current alcohol use instead of abstaining. Administrative data sources, including medical examiner records, hospital records, and police records, among others, were used to obtain local estimates of alcohol-attributable outcomes. In 2018, we used alcohol-attributable fractions and scaled national estimates to quantify the burden of current alcohol use in Baltimore, MD, in 2013. Fifty-two percent of Baltimore adults reported past 30-day drinking. There were 276 alcohol-attributable deaths in 2013, and 106 (38.4%) of these were persons other than the drinker. In 2013, current alcohol use cost $582.3 million in Baltimore City. This burden was distributed across drinkers (40.1%), persons other than the drinker (21.3%), and the government (38.6%). It is possible to quantify this burden at the local level, and these data could be used to inform evidence-based alcohol policy strategies at the local level.

Alcohol use and its consequences in the Czech Republic.

Alcohol consumption is associated with substantial public health burden. This article summarises available information on the patterns and prevalence of alcohol use in the Czech Republic with a focus on the heavy alcohol use and its health and social consequences. A non-systematic literature review was conducted. The data sources included primarily 3 series of surveys in the adult population, 2 series of surveys in the school population, routine monitoring system of per capita alcohol consumption, routine statistics on alcohol-related morbidity and mortality, and alcohol-related crime. In recent years the registered alcohol consumption in the Czech Republic has been very high; 9.8 litres of pure alcohol were consumed per capita in 2017. Recently, the prevalence of hazardous alcohol consumption in the adult population has reached 16.8-17.6% and harmful alcohol consumption 9.0-9.3%. From 12% to 17% of adult population and 12% of adolescent population were heavy episodic drinkers. Alcohol-related disorders are disproportionately higher (2-3 times) among men. Mortality for alcohol-related causes fully attributable to alcohol (AAF = 100%) and their proportion in overall mortality is on increase. Alcohol consumption as well as the prevalence of heavy episodic drinking in the Czech Republic belongs among the highest globally. On the other hand, declines in alcohol use have been recently observed among children and adolescents. Available data on alcohol-related morbidity indicate stable situation, though alcohol-related mortality is increasing. Alcohol-related burden is rather underestimated and evidence-based alcohol policy should be increasingly implemented.

Workshop: Alcohol policy reforms in European countries – challenges and solutions

Abstract Alcohol-related harm is a major public health concern in Europe, with levels of alcohol consumption and associated health harm among the highest worldwide. According to the European Commission, premature deaths linked to alcohol account for over 7% of all European morbidity, and alcohol is a major avoidable risk factor for neuropsychiatric disorders, cardiovascular diseases, cirrhosis of the liver, cancer and unintentional and intentional injuries. Even moderate use of alcohol raises long-term risks of certain heart conditions, liver disease and cancers, and frequent use can lead to dependence. There is extensive research on efficient strategies to reduce alcohol-related harm, alongside high-level policy recommendations. Examples are the WHO’s global strategy to reduce harmful use of alcohol and the WHO European office’s European action plan to reduce the harmful use of alcohol 2012-2020. The European Union (EU) strategy to support member states in reducing alcohol-related harm expired in 2012. Since then, the Committee on National Alcohol Policy and Action (CNAPA) has drawn up a non-binding Action Plan in relation to alcohol and EU countries have the main responsibility for their national alcohol policy. Despite strong evidence bases supporting alcohol policy, the implementation of potentially effective alcohol policy is often challenged by companies with commercial interests seeking to undermine evidence and advocate for less effective alternatives. These alternatives, such as education or voluntary industry action, are often favoured by politicians and the public. This opposition to evidence-based alcohol policy represents a challenge to public health. In this session, we will discuss recent developments in alcohol policy reform in Estonia, Finland and Scotland; reflecting on the outcomes of policies and the challenges faced in implementation. We invite commentaries from national experts and from the DG Sante and WHO Euro. Among these the French commentary will address the influence of the alcohol industry in circumventing effective public health policies, with discussions concerning the new strict French low-risk guidelines on alcohol use as one example. The objective of this workshop is to share experiences of the challenges faced in applying effective alcohol policies, to discuss ways to tackle those challenges, and to invite the EU and the WHO to share their views on ways to overcome these barriers in future policy advocacy. Key messages Commercial determinants of health are a powerful force in preventing effective public health policy on alcohol-related harm. The public health community need to work in a persistent and coordinated manner to bring in a suite of effective alcohol policy interventions across Europe.

Evaluating the relationship between binge drinking rates and a replicable measure of U.S. state alcohol policy environments.

Excessive alcohol consumption contributes significantly to premature mortality, injuries and morbidity, and a range of U.S. state policies have been shown to reduce these behaviors. Monitoring state alcohol policy environments is essential, but methodologically challenging given that new laws may be passed (or repealed) each year, resulting in considerable variation across states. Existing measures have not been made public or have only a single year available. We develop a new replicable measure, the state alcohol policy score, for each state and year 2004–2009, that captures the essential features of a state’s evidence-based alcohol policies. We evaluate its similarity to two existing alcohol policy measures and validate it by replicating findings from a previous study that used one of those measures to assess its relationship with several binge drinking outcomes. Estimates of the association between one-year lagged state alcohol policy scores and state binge drinking outcomes, obtained from the 2005–2010 Behavioral Risk Factor Surveillance System surveys (n = 440,951, 2010), were produced using Generalized Linear Models that controlled for state and individual-level co-variates, with fixed effects for year and region. We find a 10-percentage point increase in the state alcohol policy score was associated with a 9% lower odds of binge drinking (aOR = 0.91, 95% CI 0.89, 0.92; N = 1,992,086), a result consistent for men, women and for most age and race subgroups. We find that gender gaps in binge drinking behaviors narrowed in states with higher state alcohol policy scores. These results were nearly identical to those found in other studies using different scores obtained with the aid of expert opinions. We conclude that the score developed here is a valid measure that can be readily updated for monitoring and evaluating the variation and impact of state alcohol policies and make available our state scores for the years of the study.

Support for evidence-based alcohol policy in Ireland: results from the Community Action on Alcohol Pilot Project.

In Ireland, the Public Health (Alcohol) Bill proposes introducing minimum unit pricing, health labelling, and advertising restrictions to tackle excessive consumption. The aim of this research was to examine the level of support for evidence-based alcohol control policy among the Irish population. We conducted a household survey using quota sampling in three pilot sites in Southern Ireland. Consumption, attitude, and behaviour questions were taken from previously validated instruments. In total, 1075 individuals completed the questionnaire. Hazardous alcohol consumption was reported by 51.1% of the population, 31.5% of women, and 69.8% of men. The majority of individuals (> 50%) supported alcohol policy measures. These individuals are more likely to be low-risk drinkers, older individuals, and report alcohol-related issues in their local area. In the context of Ireland's Public Health (Alcohol) Bill, this research signals support for evidence-based strategies including minimum unit pricing and a reduction and separation of alcohol sales outlets.

Alcohol policies and programmes which reduced alcohol-related harm

This review is a critical reflection on the effectiveness of evidence-based alcohol policies and their implementation, based on studies and observations that have arisen in recent years. This article covers themes in recent literature of: the relationship between alcohol consumption and harm, the variability of country contextual factors and the interactions of both country contexts and alcohol policies on changes in alcohol consumption and harm. These recent observations imply that alcoholic beverage policies and programmes should focus on contextual determinants in each country and community, and address targeted problems (like problem drinking) and harm (such as liver cirrhosis, cancer and road accidents), rather than consumption per se.

Physical abuse, psychological abuse and neglect: Evidence of alcohol-related harm to children in five states of India.

In India, alcohol consumption per capita has increased in recent years, and child maltreatment is highly prevalent. We assess alcohol-related harms to children, including physical abuse, psychological abuse and neglect, and correlates for men reporting these harms. We analysed data from household interviews collected in a cross-sectional, case-control study in five Indian states (n = 5026). Data were collected from October 2011 to May 2012. Using multilevel mixed-effects logistic regression, we examined male adult's reports of five types of alcohol-related harm to children (respondents were not necessarily the perpetrators of the harms) and respondents' drinking patterns and socio-demographic characteristics associated with the reporting of these harms. In this sample, 43.2% of the men reported at least one alcohol-related harm to children in the past year; among them, 61.6% reported multiple. Among all men, 15.7% reported that a child experienced physical abuse from adults' drinking. Adjusting for respondents' drinking pattern and socio-demographics, multilevel mixed-effects logistic regression showed that living in a rural area was associated with greater odds of reporting alcohol-related physical abuse, psychological harm and neglect to children. Compared with past-year abstainers, both non-heavy episodic and heavy episodic drinkers had significantly greater odds of reporting these harms. We found significant differences in the reporting of harms by location. This study suggests that adults' drinking is associated with physical and psychological abuse and neglect to children. Greater use of evidence-based alcohol policy interventions may help reduce alcohol-related harms to children in India. [Esser MB, Rao GN, Gururaj G, Murthy P, Jayarajan D, Sethu L, Jernigan DH, Benegal V, Collaborators Group on Epidemiological Study of Patterns and Consequences of Alcohol Misuse in India. Physical abuse, psychological abuse and neglect: Evidence of alcohol-related harm to children in five states of India. Drug Alcohol Rev 2016;35:530-538].

Evidence-based research, epidemiology and alcohol policy: a critique

To demand ‘evidence-based medicine’ and ‘evidence-based research’ has become almost a dogma for researchers and policy-makers in Western cultures. A critical analysis shows that the original intention of the term ‘evidence-based’ was to aim to use the best existing evidence (emphasising that research should be planned and interpreted in a methodologically correct way), while recognising that, in some areas, experimental research would be neither sensible nor feasible. However, as the paradigm has become established, three dubious and commonly coexisting additional connotations have become prominent in practice: ‘proven beyond doubt’, ‘exclusively relying on experimental research’ and ‘any conclusions based on empirical data’. Drawing on examples from renowned publications that demand an ‘evidence-based alcohol policy’, this article argues that much of what is presented as ‘evidence-based policy’ should more appropriately be labelled ‘policy-based evidence’.