National Alcohol Policy Research Articles

Alcohol policy and alcohol-attributed disease burden in Finland and the Baltic countries 1995-2019

Abstract Introduction 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. Methods The study utilised national statutory laws to score policy restrictiveness (higher BtG-M scores mean stricter policies) and age-standardised rates of disability-adjusted life years (DALYs), years of life lost (YLLs), years lived with disability (YLDs) 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 scores and burden of disease. Results 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. Discussion and Conclusions 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. Key messages • This study stands out due to its longitudinal study design, which quantitatively compares the level of alcohol policy restrictiveness in Finland and the Baltic countries from 1995 to 2019. • Our study suggests that shifts towards more restrictive alcohol policies are linked to reduction in alcohol-related harm in Finland and the Baltic countries.

The macroeconomic overview of the alcohol industry: a perspective from the emerging market of Asia

Purpose This study aims to analyze the relationship between the alcohol brewing industry and the macroeconomic variables of the emerging market of Asia. Design/methodology/approach The study uses secondary data for the period of 32 years and applies the autoregressive distributed lag-error correction method (ARDL-ECM) approach to understand short- and long-run dynamics in the alcohol industry by considering macroeconomic variables. Findings The findings of the study confirm the existence of a long-run relationship between the alcohol brewing industry and the macroeconomic variables considered for this study. Research limitations/implications The authors present a few limitations of this study. First, this study uses secondary data originating from one of the emerging markets of Asia. Second, the study is solely conducted from an economic perspective rather than from a social or health perspective. Finally, the study considers the data originating from the organized sector of the alcohol industry of India. Practical implications The study will be helpful to the researchers in guiding the future course of research in the area of the alcohol industry. This study can be helpful to the policymakers in framing the National Alcohol and taxation Policy. This study also helps both the producers and exporters to strategize sustainable production and trade of alcoholic beverages. Originality/value To the best of the authors’ knowledge, this study is the first of its kind to analyze the alcohol industry from the macroeconomic perspective through the ARDL-ECM approach.

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.

Alcohol policy development in Sierra Leone: An assessment of the role of civil society

Objective: To assess the value addition of civil society collaboration with Government in the development of Sierra Leone’s National Alcohol Policy (NAP). Policy Development Process: We reviewed the entire process of lobby, advocacy, and support for the development of the NAP from 2015 when the Siera Leone Alcohol Policy Alliance (SLAPA) was formed to the launch of the NAP in 2023. It also assesses the level of collaboration between FoRUT, SLAPA and Ministry of Health of Health and Sanitation (MoHS). The MoHS coordinated the policy formulation process with substantive technical support from civil society. Results: The quality of the NAP was rated high as it reflected appropriate policy areas and interventions from the Global Strategy to Reduce the Harmful Use of Alcohol, the WHO SAFER initiative, and the Global Action Plan for Alcohol Control (202-2030). The NAP is a solid reference material for the development of a new alcohol bill. MoHS recognized FoRUT and SLAPA as the national champions for alcohol control in the country. FoRUT, directly and through SLAPA influenced the process of developing the NAP and its quality through advocacy, collaboration and technical and financial support. Conclusions: The development of the NAP in Sierra Leone truly reflects civil society-government collaboration, built on mutual trust and a common health and development agenda. Connecting national level lobby and advocacy with regional global advocacy actions to prioritize, influence, support, and monitor the alcohol control agenda is a critical catalyst for civil society to advancing the development of NAPs.

6.H. Round table: How can the public health community contribute to better alcohol policies through trade law?

Abstract Alcohol is a causal factor in more than 200 disorders, communicable and injuries. Harms results at even relatively low levels of consumption, and it is estimated that alcohol use causes 3 million deaths globally each year. In parallel to the ever-growing evidence on alcohol-related harm, evidence also continues to accumulate on the effectiveness of policy interventions which tackle the commercial determinants of alcohol consumption, not least on labelling, marketing, pricing and availability. While it is imperative that States introduce national measures to tackle alcohol harms, alcohol is not merely an issue of national policy as it is manufactured, marketed, bought and sold across borders. The WHO Global Alcohol Strategy illustrates the importance of regulation in contributing to the development of robust, comprehensive interventions to tackle alcohol use. However, what States can do at the national level is constrained by international rules. In particular, international trade law under the World Trade Organization is often invoked in opposing national rules. This litigation can result in expensive, time-consuming and distracting disputes with no certainty of winning. Even before policies are challenged, ‘regulatory chill’ often results in preventing, watering down and delaying policies. This is unfortunate not least because many policies, if framed correctly, could be defended successfully. The objectives of this roundtable workshop are to: 1. To understand the relationship which trade law has with national and regional alcohol policies. 2. To explore how various stakeholders can contribute to the development rules which are not constrained by international trade law. Five short 5-minute presentations will be mixed with discussions. The first presentation sets the scene through giving an overview of the existing developments of alcohol policies in Europe and the context States find themselves in. The second presentation explores the role of WHO and the work it is undertaking, as well as the interventions envisaged by the WHO Global strategy, Global action plan and the European framework. The third presentation will discuss the various policies which have been discussed in international trade law forums by States, and the roles some States have played in promoting or challenging proposals by other States. The fourth presentation will continue the discussions on trade law by showing how policies can progress through increased recognition on the right to know and efforts to grant this right through standardising alcohol labelling internationally. The fifth presentation will reflects on the work by civil society in promoting more effective policies and the barriers faced from the alcohol industry in particular. The workshop will be moderated by the chair, who will draw on links and common themes and facilitate discussions between panellists, and between the panel and members of the public health community in the audience. Key messages • Trade law has a significant impact on national alcohol policies. • Trade law barriers can be overcome through effective strategies.

Subtle industry interference in public health: the case of the alcohol industry

Abstract Upstream drivers of alcohol consumption forcing people to consume alcohol frequently and excessively and experience alcohol-related harms are in fact all industry-related factors: easy physical access to alcohol, cheap alcohol beverage pricing, and heavy alcohol advertising and promotion. Unequivocal evidence exists on how these visible industry tactics effectively allow the infiltration of alcohol products into the market, targeting specific subgroups (women, youth), increase total per capita consumption and subsequently alcohol-related morbidity and mortality. This presentation will highlight using country cases and various examples the more subtle mechanisms in which the industry has successfully been interfering with nations’ progress in alcohol policy (e.g., NoLo beverages, interfering with WHO definitions, using SDGs to foster partnerships). Using the whole-of-government whole-of-society approaches, the presentation will also present evidence-based multi-sectoral actions (their facilitators and barriers) for more effective national alcohol policy. Given that alcohol is no ordinary commodity, the presentation will end with implications for policy to counterbalance global alcohol industry interference and support national actions.

Toward a national policy on Alcohol: A complex public health issue in need of urgent action.

Alcohol use is a major public health issue. It is also associated with a range of family, social, and economic problems. This led multiple countries worldwide to adopt national policies for alcohol regulation. Over the years, alcohol use and related problems have increased in India. The existing regulatory framework on alcohol varies greatly across states in terms of government sanctions, pricing, and legal drinking age, resulting in variations in its availability and prevalence of alcohol use disorder and related harms. Despite alcohol use being mentioned in several national policies and plans, a comprehensive national policy addressing alcohol is lacking. In this manuscript, the need for a dedicated national alcohol policy is underscored, emphasizing its potential to mobilize resources, prioritize interventions, and guide various stakeholders. The timely implementation of such a policy is crucial to address the multifaceted challenge of alcohol use effectively.

Characteristics associated with buying alcohol to-go and for delivery during the first year of the COVID-19 pandemic among a national sample of US adults.

This study: (i) determined the population coverage of alcohol delivery and to-go/carryout policies (i.e., policies permitting bars/restaurants to sell individual drinks for off-site consumption) in 2019 and 2020; and (ii) identified characteristics associated with alcohol delivery and to-go purchases. Data are from the National Alcohol Survey and Alcohol Policy Information System (n = 1677 adults, 52.1% female). Population coverage models summed state populations across state-level bar/restaurant delivery and to-go/carryout policies by beverage. Regression outcomes were past-year alcohol delivery and to-go purchases. Independent variables included demographics, excessive drinking, COVID-19 impacts and state COVID-19 bar/restaurant alcohol laws. Chi-squared tests and logistic regression models tested associations between delivery/to-go purchases and independent variables. Overall, 7.5% of adults had alcohol delivered and 14.5% bought alcohol to-go. From December 2019 to December 2020, the number of people living in states allowing beer/wine/spirits delivery (284%) and to-go sales (627%) rose steeply. People who were Black (vs. White; adjusted odds ratio [aOR] 2.92, p < 0.001), excessive drinkers (vs. non-excessive drinkers; aOR 2.06, p < 0.001) or lived in states allowing beer/wine/spirits to-go sales (aOR 2.20, p = 0.01) had higher odds of buying alcohol to-go. Conversely, older people had lower odds of buying alcohol to-go (aOR 0.97, p < 0.001). People with some college or more (vs. high school degree or less, aOR 2.21, p < 0.001) and a higher economic burden (vs. fewer COVID-19 impacts, aOR 2.32, p = 0.05) had higher odds of alcohol delivery. A select sub-population defined by socioeconomic status, race, excessive drinking and state policies bought alcohol for delivery or to-go in the Unites States.

Alcohol's harm to others in 2021: Who bears the burden?

Alcohol's harm to others (AHTO) has become a key driver of national and international alcohol policy. This study aimed to produce a contemporary, comprehensive estimate of the correlates and harms from others' drinking in 2021 in Australia. Across Australia, 2574 adults (1380 women; 1172 men) were sampled via two cross-sectional survey modes: a random-digit dial mobile phone sample of 1000 people and 1574 people from the Life in Australia™ panel survey. In 2021 participants were asked about harms they had experienced from the drinking of family, friends, co-workers and the public in the past year. Applying combined sample weights from each mode, bivariable and adjusted multivariable logistic regressions were used to analyse differences in rates of AHTO by participant gender, age, residence in rural or metropolitan regions, country of birth, education and employment. In 2021, 23.6% reported being negatively affected by strangers' drinking and 21.3% by the drinking of someone they knew, with 34.3% reporting being negatively affected a lot or a little by either; 42.4% of respondents reported specific harms from strangers' drinking. Thus, 48.1% of respondents reported any harm (negative effects or specific harms) from others' drinking. Women, younger people, Australian-born and heavier episodic drinkers reported significantly higher rates of AHTO compared with other respondents. Smaller percentages (7.5%) of participants reported being harmed substantially by others' drinking, including by people they knew (5.8%) or strangers (2.3%). Stratified analyses showed that heavier drinking, furloughed, younger men who were born overseas in English-speaking countries were affected by others' drinking, whereas women were affected regardless of these factors (apart from age). More than one-third of Australian adults appear to have been negatively affected by others' drinking in 2021, with women, younger people and heavier drinkers at greater risk. Substantial harm appears to be more likely to arise from the drinking of people Australians know than from strangers' drinking.

WITHDRAWN: Extremely high sex disparities in adult premature mortality in Estonia 1995–2014: Is a stricter alcohol and tobacco policy needed?

To quantify relative sex disparities in cause-specific adult premature mortality in Estonia and to determine for which causes of death the inequalities are the highest; subsequently, to provide some guidance to public health policy-makers, considering the relatively liberal national alcohol policy. The analyses were based on individual death records of 1995–2014 and ages of 20–69 years, and involved the calculation of overall and cause-specific age-standardized mortality rates, average annual percentage changes of mortality, and cause-specific men to women mortality rate ratios. Overall adult premature mortality has decreased considerably during 1995–2014, but no reduction was observed with respect to the high relative sex disparities. In circulatory disease mortality the disparities widened significantly with time. Extremely high mortality rate ratios were observed for cancer of the upper aero-digestive tract and lung cancer. There was a stable, more than five-fold male excess mortality from external causes. A four-fold male disadvantage was evident for alcohol poisoning and mental disorders due to alcohol. Even though adult premature mortality has markedly decreased over time, there has been no success in diminishing high sex differences in mortality patterns, many of which were related to smoking and excessive drinking of alcohol, both more prevalent among men. Estonia needs a comprehensive and consistent alcohol policy while maintaining and further developing anti-tobacco measures.

Analysis of gaps in alcohol policies in Brazil using the Pan American Health Organization's Alcohol Policy Scoring.

National alcohol policies need to be systematized and evaluated to identify the gaps that should be filled by future laws. This study aims to search for and classify Brazilian public alcohol policies at the federal and state levels, based on the ten Alcohol Policy Scoring (APS) domains used by the Pan American Health Organization (PAHO), to identify any gaps METHODS: Documental research was carried out in two phases: document identification and content analysis. The search included laws, decrees, and ordinances for alcohol referred to in this text as regulatory documents (RD), enacted until December 31, 2019, in Brazil and its 26 states and the Federal District. The APS was used to classify and score the RD, which consists of ten policy domains (including pricing, availability, marketing, and health services), weighted according to the level of scientific evidence of each strategy RESULTS: We identified and categorized 435 valid RD (21 national laws and 414 state laws). Overall, Brazilian alcohol policies account for 51.6% (255/494) of the APS score. In the pricing policy domain, the second most robust indicator of the APS, the policy gap reached 87% in 25 states, demonstrating a weakness. Only the federal laws against drink-driving include all the recommended dimensions. There are important legislative contradictions in the definition of an alcoholic beverage and in the content of the policies to control marketing CONCLUSION: At the national level, the federal government adopted alcohol policies in several of the PAHO policy domains but enacted RD with little practical effect. At the subnational level, despite the autonomy to complement federal laws, the states have not yet addressed the most important gaps.

Are Countries' Drink-Driving Policies Associated With Harms Involving Another Driver's Impairment?

International drink-driving policy research generally focuses on aggregate outcomes (e.g., rates of crashes, fatalities) without emphasizing secondhand alcohol-related vehicular harms. In contrast, we investigate associations between drink-driving policies and harms involving another driver's impairment. Alcohol's harms to others (AHTO) survey data from 12 countries (analytic N=29,616) were linked to national alcohol policy data from the World Health Organization. We examined separately associations of two 12-month driving-related AHTOs (passenger with an impaired driver; vehicular crash involving someone else's drink driving) with 3 national drinking-driving policies-legal blood alcohol concentration (BAC) limits, use of random breath testing, use of sobriety checkpoints, and comprehensive penalties for drink-driving (community service, detention, fines, ignition interlocks, license suspension/revocation, mandatory alcohol treatment, vehicle impoundment, and penalty point system), plus 2 alcohol tax variables (having excise taxes and value-added tax [VAT] rate). Multilevel logistic regression addressed clustering of individuals within countries and subnational regions, while adjusting for individuals' gender, age, marital status, risky drinking, and regional drinking culture (% male risky drinkers in sub-national region). Controlling for national-, regional-, and individual-level covariates, comprehensive penalties were significantly and negatively associated with both outcomes; other vehicular policy variables were not significantly associated with either outcome. A society's VAT rate was negatively associated with riding with a drunk driver. Regional male drinking culture was positively associated with riding with an impaired driver, but was not significantly associated with being in a vehicular crash due to someone else's drinking. In both models, being male, being younger, and engaging in risky drinking oneself each were positively associated with vehicular harms due to someone else's drinking. Although results are associational and not causal, comprehensive penalties may be promising policies for mitigating driving-related harms due to another drinker. Higher VAT rate might reduce riding with a drunk driver.

Tackling NCDs: The Need to Address Alcohol Industry Interference and Policy Incoherence Across Sectors Comment on "Towards Preventing and Managing Conflict of Interest in Nutrition Policy? An Analysis of Submissions to a Consultation on a Draft WHO Tool".

Ralston et al highlight the ways that different actors in global nutrition governance conceptualise and frame the role of non-state actors in governance arrangements, including the potential for conflict of interest (COI) to undermine global health efforts. The authors argue that the World Health Organization (WHO) draft tool on managing COI in nutrition policy is an important innovation in global health, but that further research and refinement is needed for operationalising the management of COI with diverse actors in diverse contexts. In this commentary, reflecting on strategic framing and industry interference in policy-making, we argue for the urgent need for states and intergovernmental organisations to prevent alcohol industry interference in the development of national and global alcohol policy. We argue that policy incoherence remains a key barrier, where governments pursue health goals in the health sector while pursuing exports and market liberalisation of health harmful commodities in the trade sector.

Alcohol policy in Chile: a systematic review of policy developments and evaluations.

To comprehensively review enacted and proposed alcohol laws and existing impact evaluations of national alcohol policies in Chile. We searched enacted laws in the Chilean National Library of Congress, proposed laws in the websites of the House of Deputies and Senate and impact evaluations in PubMed, Web of Science, Scopus, Scielo, JSTOR, Epistemonikos and OpenGrey from inception to February 2019. Eligibility criteria included enacted laws and proposed laws on national alcohol policies and research studies evaluating the impact of national alcohol policies. One author screened enacted laws and proposed laws; two authors independently screened research records. We included any national alcohol policy intervention and classified policies according to 10 World Health Organization (WHO) alcohol policy domains. We used the Cochrane EPOC Review Group criteria to assess risk of bias of research records. We registered the review protocol in PROSPERO, registration record CRD42016050156. We identified and screened 229 enacted laws, 138 proposed laws and 1538 research records. Of these, 72 enacted laws, 118 proposed laws and three research articles were eligible for synthesis. We found enacted policies in all WHO alcohol policy domains. Regarding the most cost-effective policies, Chile has made limited use of taxation, has not regulated alcohol marketing and has weakened alcohol availability regulation. We found a large number of proposed laws, 79% of which would strengthen alcohol control. The few impact evaluation studies examined drink-driving policies and found a short-term reduction of alcohol-related injuries and deaths. Chile has enacted alcohol policies in all World Health Organization policy domains, but has not adopted policies with highest likely cost-effectiveness. Only the impact of drink-driving policies has been evaluated.

New approach for the measurement of long-term alcohol consumption trends: Application of wastewater-based epidemiology in an Australian regional city

BackgroundWastewater-based epidemiology (WBE) provides complementary information to traditional self-report methods for estimating substance use within a population. WBE was applied to estimate the consumption of alcohol in an Australian rural city (population estimated 100,000) over 6 years. MethodsA total of 352 wastewater samples were analysed from a wastewater treatment plant located in South-East Queensland, Australia, from 2012 to 2017. The concentration of an alcohol biomarker, ethyl sulphate, was quantified by liquid chromatography tandem mass spectrometry and used to estimate per-capita consumption. The WBE results were compared with alcohol consumption estimates based on national taxation data and self-reported national survey data in Australia. ResultsAverage daily alcohol consumption estimated by WBE was between 19 and 30 mL/person/day for the population aged 15 years and older during the six-year period. Alcohol consumption decreased 4 % per annum on average over the study period. Our data showed higher rates of consumption on weekends and public holidays when compared to consumption between Monday and Thursday. The comparative trend of WBE data was consistent with the national alcohol survey and taxation statistics on alcoholic beverages over the same period. ConclusionsA clear decline in alcohol consumption in the catchment was observed during the sampling period, which reflected similar changes in consumption from taxation statistics and self-report survey data. Expected variations in weekly consumption and public holidays were also identified. This study demonstrates the potential of WBE for long-term monitoring of alcohol consumption in evaluating the effectiveness of local and national alcohol policies and prevention programs.

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.

Predicting hazardous drinking in late adolescence/young adulthood from early and excessive adolescent drinking - a longitudinal cross-national study of Norwegian and Australian adolescents.

BackgroundResearch has consistently shown that early onset of drinking (EOD) is associated with alcohol-related problems in adulthood. However, recent reviews have identified several limitations in the early onset literature, including the use of retrospective reports, insufficient control for potential confounders, ambiguous definitions of the concept, and an assumption that early onset is independent of cultural norms and national alcohol policies. This study addresses these limitations by examining whether EOD, independent of early onset of excessive drinking (EOE), prospectively predicts hazardous drinking in late adolescence/young adulthood in Norway and Australia, two countries with different drinking cultures.MethodsData were drawn from two population-based longitudinal studies; the Norwegian Tracking Opportunities and Problems Study (n = 329) and the Australian International Youth Development Study (n = 786). Data were collected prospectively from mid adolescence (14–16 years) to late adolescence/young adulthood (18–25 years) and a modified Poisson regression approach was used to estimate prevalence ratios. Adolescent self-reports included measures of EOD and EOE. Young adults completed the Alcohol Use Disorders Identification Test (AUDIT). The results were adjusted for adolescent factors; age, gender, impulsivity, hyperactivity, conduct problems, smoking, early sexual intercourse and friends’ substance use, and family factors; alcohol and drug use in the family, maternal education, family management and monitoring.ResultsHazardous drinking was identified in 46.8 and 38.9% of young adults in Norway and Australia, respectively. Both EOD and EOE in adolescence were significantly related to an increased risk of alcohol-related problems in late adolescence/young adulthood in both studies, even when adjusting for possible confounders.ConclusionOur findings indicate that adolescent drinking behaviour is an indicator of alcohol-related problems in late adolescence/young adulthood, even when controlling for a variety of covariates. This finding is in contrast to previous research on older adults, where no association between adolescent drinking and later alcohol-related problems were found when controlling for covariates. The divergence in findings may suggest that the impact of EOD/EOE is limited to the late adolescent and young adult period. Preventing drinking in early adolescence may thus have some impact on the drinking patterns in late adolescence/young adulthood.

Has a national policy guideline influenced the practice of raising the topic of alcohol and breastfeeding by maternal healthcare practitioners?

Globally, the public health recommendation for exclusive breastfeeding to the first 6 months of life is not being achieved by many low- and middle-income countries. Many factors have been determined to affect the early cessation of breastfeeding; however, little attention has been paid to the role of alcohol, an increasingly favoured commodity, particularly in these Westernised nations. Maternal healthcare practitioners play a pivotal role in a woman's breastfeeding journey by providing timely advice that can help support continued breastfeeding. Maternal healthcare practitioners (MHP) from across Australia were invited to take part in a semi-structured telephone interview (n = 19) to elicit their knowledge of a national alcohol policy guideline on alcohol and breastfeeding, their confidence to provide information on this topic, and if they were routinely incorporating conversations on alcohol and breastfeeding into their practice. The results affirmed that the majority of MHP were not aware of the national policy providing direction for safely consuming alcohol during lactation and were not incorporating this information into their practice. This study suggests having a national policy guideline for safe alcohol consumption during lactation has not promoted awareness of this topic among MHP as a potential strategy to support long-term breastfeeding duration.

Alcohol policies in Malawi: inclusion of WHO \u201cbest buy\u201d interventions and use of multi-sectoral action

BackgroundHarmful use of alcohol is one of the most common risk factors for Non-Communicable Diseases and other health conditions such as injuries. World Health Organization has identified highly cost-effective interventions for reduction of alcohol consumption at population level, known as “best buy” interventions, which include tax increases, bans on alcohol advertising and restricted access to retailed alcohol. This paper describes the extent of inclusion of alcohol related “best buy” interventions in national policies and also describes the application of multi-sectoral action in the development of alcohol policies in Malawi.MethodsThe study was part of a multi-country research project on Analysis of Non-Communicable Disease Preventive Policies in Africa, which applied a qualitative case study design. Data were collected from thirty-two key informants through interviews. A review of twelve national policy documents that relate to control of harmful use of alcohol was also conducted. Transcripts were coded according to a predefined protocol followed by thematic content analysis.ResultsOnly three of the twelve national policy documents related to alcohol included at least one “best buy” intervention. Multi-Sectoral Action was only evident in the development process of the latest alcohol policy document, the National Alcohol Policy. Facilitators for multi-sectoral action for alcohol policy formulation included: structured leadership and collaboration, shared concern over the burden of harmful use of alcohol, advocacy efforts by local non-governmental organisations and availability of some dedicated funding. Perceived barriers included financial constraints, high personnel turnover in different government departments, role confusion between sectors and some interference from the alcohol industry.ConclusionsMalawi’s national legislations and policies have inadequate inclusion of the “best buy” interventions for control of harmful use of alcohol. Effective development and implementation of alcohol policies require structured organisation and collaboration of multi-sectoral actors. Sustainable financing mechanisms for the policy development and implementation processes should be considered; and the influence of the alcohol industry should be mitigated.

Alcohol consumption, mental health status, and treatment in Nigeria and Uganda

Background: The current level of alcohol consumption has placed Nigeria and Uganda in the group of high consumption countries, however little is known about how people with problematic alcohol use and related problems utilize treatment services. Aims: This study examined the relationship between alcohol consumption and mental health status in Nigeria and Uganda, and the relationship between heavy episodic drinking and treatment-seeking and treatment-receiving behavior. Data and methods: Analyses were based on cross-sectional survey data from Nigeria (N= 2018) and Uganda (N=1478) aged &gt; 18 years from the 2003 Gender, Alcohol, and Culture: An International Study (GENACIS). Results: In both countries, the level of alcohol consumption was comparatively high, however, associations between drinking status and mental health problems were found only in Nigeria. Heavy episodic drinkers were more likely to report having sought help in both countries, only in Nigeria was it also related to ever receiving help. Conclusion: National strategies in both countries must continue allocation of resources to treatment services, supporting treatment availability and early identification of alcohol and related mental health problems. Implementation of national alcohol policies should be followed up with assessment and adjustments.