Per-capita Alcohol Consumption Research Articles

Three years of minimum unit pricing in the Northern Territory, what does the evidence say?

Three years of minimum unit pricing in the Northern Territory, what does the evidence say?

Alcohol sales in Canadian liquor outlets as a predictor of subsequent COVID-19 infection rates: a time-series analysis.

AimsGovernment alcohol sales data were used to examine whether age 15+ per‐capita alcohol consumption (PCAC) (i) changed during COVID‐19 and (ii) predicted COVID‐19 infections 2–5 weeks later.DesignInterrupted time‐series analyses were applied to panels of data before and after COVID‐19 restrictions were introduced in Canada.Setting and participantsThe populations, aged 15+, of the provinces of Ontario (ON), British Columbia (BC) and Nova Scotia (NS), Canada.InterventionExpansion of home delivery options and hours of trading for liquor stores while restrictions on travel, social and economic activities were imposed by governments during COVID‐19 from 17 March 2020 until 29 March 2021.MeasurementsWeekly estimates of (i) age 15+ PCAC using sales data supplied by provincial government alcohol distributors for liquor stores, bars and restaurants, (ii) stringency of public health measures assessed by the Public Health Agency of Canada (PHAC) and (iii) new COVID‐19 infections reported by PHAC.FindingsPCAC increased by 7.10% (P = 0.013) during the pandemic versus previous years, with increased private liquor store sales partly offset by reduced bar/restaurant sales. Consumption was positively associated with stringency of public health measures. Weekly PCAC was positively associated with new COVID‐19 infections 2 weeks later (+6.34% for a one drink/week increase, P < 0.001). Lagged associations with COVID‐19 infections 2 or 3 weeks later were observed for PCAC from all sales channels, with larger effect sizes per standard drink/person/week increase for on‐premise outlets (+77.27% week 2, P = 0.009) than government liquor stores (+6.49%, week 2, P < 0.001) or private liquor stores (+7.13%, week 4, P < 0.001).ConclusionsAlcohol consumption increased in three Canadian provinces during COVID‐19 to degrees corresponding to the extent of the strictness of measures imposed to prevent viral spread. Increased consumption of alcohol was associated with increased COVID‐19 infection rates 2 weeks later.

The transition of alcohol control in China 1990-2019: Impacts and recommendations.

The harmful use of alcohol is a severe public health issue globally. Chinese per-capita alcohol consumption has increased sharply in recent decades, which has contributed to a rise in alcohol-related problems. In this article we present an analysis of Chinese alcohol policy, beginning with a characterization of alcohol consumption in China followed by an examination of how the nation's alcohol control policy has evolved over the past 30 years, identifying shortcomings and obstacles to improvement. Finally, we present several recommendations informed by the Global Strategy to Reduce the Harmful Use of Alcohol and the SAFER Technical Package-Five Areas of Intervention at National and Subnational Levels (SAFER initiative), to the areas of taxation, alcohol availability, alcohol marketing regulation, and treatment.

Domestication of drinking: a survey study of changes in types of drinking occasions during periods of increasing and decreasing alcohol consumption in the 2000s in Finland.

Background and AimsIn Finland, per‐capita alcohol consumption increased in the early 2000s and decreased after 2007. Our aim was to determine how these changes originated from changes in drinking practices.DesignRepeated cross‐sectional general‐population surveys.SettingFinland in 2000, 2008 and 2016.ParticipantsFinnish residents aged 15–69 years (n = 6703, response rate 59–78%).MeasurementsEvent‐level data on drinking occasions (n = 21 097). Types of drinking occasions (drinking practices) were identified with latent class analysis using occasion characteristics. The aggregated volume of consumption and intoxication occasions were decomposed into contributions from drinking practice classes and years.FindingsNine drinking occasion types were identified: three at home without company other than family (51% of occasions in 2016), three socializing occasions in different places and with different company (33%) and three party occasion types (16%). Both the frequency of drinking occasion types and the occasion type‐specific amounts of alcohol consumed contributed to aggregate‐level changes in alcohol use. Drinking at home without external company (with family only; for men, also alone) contributed most to the increase in alcohol use before 2008. Big parties in homes and bars became less common in the 2000s, contributing most to the decline in drinking after 2008.ConclusionsThe rise in per‐capita alcohol consumption in Finland in the early 2000s appears to have been linked mainly to an increase in lighter drinking occasions at home without external company. The fall in per‐capita drinking after 2007 was linked mainly to a decrease in big parties in homes and in licensed premises. Changes in drinking frequency and the amounts of alcohol consumed per occasion changed in the same direction as alcohol affordability.

Declines in alcohol consumption in Australia: some challenges to the theory of collectivity.

There is significant debate about whether or not changes in per-capita alcohol consumption occur collectively across the entire distribution of drinking. This study used data from a decade of declining drinking in Australia to test the collectivity of drinking trends. Repeated cross-sectional surveys (2010, 2013, 2016, 2019), analysed with quantile regression techniques assessing trends in drinking for 20 quantile groups. Australia. A general population sample (total n = 85 891; males = 39 182, females = 46 709) aged 14 years and over. Past-year volume of alcohol consumed was measured using standard graduated frequency survey questions. Models were stratified by sex and age group. Throughout the whole population, alcohol consumption had declined in all percentile groups, with the largest proportional declines evident for light and moderate drinkers [e.g. drinkers in the 25th percentile declined by 32.7%; 95% confidence interval (CI) = -41.6, -22.3% per wave]. Broadly collective declines were also found for younger men and women with significant declines in every percentile group, but older groups showed some evidence of polarization. For example, women aged 45-64 years significantly increased their consumption (2.9% per wave, 95% CI = 0.3-5.5%), while consumption for those in the 25th percentile fell significantly (-16.7%, 95% CI = -27.6, -4.2%). The declines in Australian drinking since 2010 have included important deviations from the collectivity predicted by Skog's influential theory of collectivity of drinking, with markedly different patterns evident among different demographic groups.

A time-series analysis of the association between alcohol and suicide in Australia

Introduction800,000 people die by suicide every year according to World Health Organisation data. Studies have shown associations between alcohol consumption and suicide, with most demonstrating that alcohol consumption increases suicide risk. However, some studies from high consumption countries show results in the opposite direction. This present study examines the association between per capita (PC) alcohol consumption and same year suicide mortality in Australia, and tests for lag effects, between 1910 and 2017. Materials and methodsAge and gender-specific autoregressive integrated moving average (ARIMA) models were used to examine associations between alcohol consumption PC and suicide mortality rates. Associations between unemployment, divorce, barbiturates access, and the Great Depression and World War II, and suicide were examined. ResultsA 10% increase in PC alcohol consumption was associated with a 5% and 5.1% decrease in overall and male suicide mortality respectively in the same year. However, a 10% increase in PC alcohol consumption was associated with an 5.1% and 5.4% increase in overall and male suicide mortality respectively 12 years later. This association differed among age groups and was significant in the male population only. Unemployment, divorce, the Great Depression and WW2, and barbiturates access were significantly associated with same year suicide mortality. DiscussionContemporaneous alcohol consumption was associated with decreased suicide mortality, but was also associated with an increased risk of suicide 12 years later. Unemployment and barbiturates access were associated with an increased risk of suicide. Interventions and policies that address chronic alcohol consumption and support the unemployed may reduce suicide mortality.

A wastewater-based assessment of the impact of a minimum unit price (MUP) on population alcohol consumption in the Northern Territory, Australia.

To test if there was a reduction in alcohol consumption in wastewater samples in the Northern Territory of Australia after the implementation of a minimum unit alcohol price policy (MUP) in October 2018. Between August 2016 and February 2020, wastewater samples were collected across 66 sites in the Northern Territory and all other states and territories in Australia. Samples were collected every 2months in capital cities and every 4months in regional places during this period. Overall, 4917 samples were taken (2816 before MUP and 2101 after). The number of standard drinks per 1000 people per day in the respective catchment areas was estimated based on the concentration of an alcohol-specific metabolite, ethyl sulphate in the samples (using the excretion factor of ethyl sulphate, the flow of wastewater entering the wastewater treatment plants and the population of each wastewater catchment). Results from a linear mixed model showed that there was a large drop in alcohol consumption immediately after the MUP in Northern Territory [estimated drop=1231, 99% confidence interval (CI)=830, 1633; 38.75%]. There was no significant drop in all other states/territories except for Queensland, which showed a significant but much smaller drop (estimated drop: 310; 99% CI=114, 550). One year after the MUP, the drop narrowed to 520 (99% CI=189, 851) and was no longer statistically significant in February 2020 (15months after MUP; estimated drop=283, 99% CI=-114, 681). Per-capita consumption of alcohol appears to have decreased substantially in the Northern Territory of Australia immediately after the implementation of a minimum unit price but consumption steadily recovered and almost returned to the pre-MUP consumption level after 15months.

Alcohol and Mortality: An Actuarial Issue

Despite some favorable global trends in the prevalence of heavy episodic drinking, alcohol-related mortality and morbidity since 2010, and the prevalence of youth drinking in certain developed countries, there has been limited progress in reducing total per-capita alcohol consumption. The burden of disease attributable to alcohol remains high, particularly at pre-retirement ages, and is increasing in some countries and for some causes of death. This article describes the status and trends in alcohol consumption, both worldwide and in the United States. It also describes the adverse consequences of heavy and binge drinking, which are significant to the individual, family and friends, and society. Although the overall effect on mortality of moderate alcohol drinking compared with no drinking at all has generally been viewed to be somewhat favorable due to the effect of certain cardiovascular risks, this view is not shared by all—the arguments involved are examined in this article. The recognition and need for active management of the adverse effects of heavy and binge alcohol consumption, remain essential to favorable health and longevity. Possible public interventions are also described. Actuaries involved in assessing mortality trends and product design need to assess trends in drivers and consequences of historical, current, and expected future alcohol-attributable mortality and morbidity patterns on a regular basis.

Alcohol consumption, harms and policy developments in sub-Saharan Africa: The case for stronger national and regional responses.

Sub-Saharan Africa (SSA) has long been characterised as a region with weak alcohol policies, high proportions of abstainers and heavy episodic drinkers (among drinkers), and as a target for market expansion by global alcohol producers. However, inter-regional analyses of these issues are seldom conducted. Focusing mainly on the period 2000-2016, we compare alcohol consumption and harms, alcohol policy developments and alcohol industry activities over time and across the four sub-regions of SSA. Per-capita consumption of alcohol and alcohol-related disease burden have increased in Central Africa but stabilised or reduced in other regions, although they are still high. Most countries have implemented tax policies, but they have seldom adopted other World Health Organization 'best buys' for cost-effective alcohol control policies. Countries range from having minimal alcohol controls to having total bans (e.g. some Muslim-majority countries); and some, such as Botswana, have attempted stringent tax policies to address alcohol harm. Alcohol producers have continued their aggressive marketing and policy interference activities, some of which have been highlighted and, in a few instances, resisted by civil society and public health advocates, particularly in southern Africa. Increased government support and commitment are needed to be able to adopt and implement effective alcohol policies and respond to pressures from alcohol companies to which SSA remains a target market. SSA needs effective alcohol control measures in order to reverse the trajectory of worsening alcohol harms observed in some countries and reinforce improvements in alcohol harms observed in others.

The impact of a minimum unit price on wholesale alcohol supply trends in the Northern Territory, Australia

ObjectiveThe Northern Territory (NT) Government introduced a minimum unit price (MUP) of $1.30 per standard drink (10g pure alcohol) explicitly aimed at reducing the consumption of cheap wine products from October 2018. We aimed to assess the impact of the NT MUP on estimates of beverage‐specific population‐adjusted alcohol consumption using wholesale alcohol supply data. MethodsInterrupted time series analyses were conducted to examine MUP effects on trends in estimated per capita alcohol consumption (PCAC) for cask wine, total wine and total alcohol, across the NT and in the Darwin/Palmerston region. ResultsSignificant step decreases were found for cask wine and total wine PCAC in Darwin/Palmerston and across the Northern Territory. PCAC of cask wine decreased by 50.6% in the NT, and by 48.8% in Darwin/Palmerston compared to the prior year. PCAC for other beverages (e.g. beer) were largely unaffected by MUP. Overall, PCAC across the Territory declined, but not in Darwin/Palmerston. ConclusionWith minimal implementation costs, the Northern Territory Government's MUP policy successfully targeted and reduced cask wine and total wine consumption. Cask wine, in particular, almost halved in Darwin/Palmerston where the impact of the MUP was able to be determined and considering other interventions. Implications for public healthImplementation of a minimum unit price for retail alcohol sales is a cost‐effective way to reduce the consumption of high alcohol content and high‐risk products, such as cheap cask wine.

Alcohol consumption in India: A rising burden and a fractured response.

To review the burden of alcohol use in India, examine current policy initiatives and programs specific to India and provide a roadmap for future actions. A literature search was undertaken to review available published research papers, unpublished reports and anecdotal media information in the period 2000-2020 to assess the burden and pattern of alcohol use and appraise alcohol control policies in India. The per-capita alcohol consumption among individuals aged 15+ years was 5.7 L, which increased over time. Prevalence of alcohol use varied across states with considerable impact on the nation. Regulatory policies and alcohol control programs vary across Indian states, with poor enforcement and implementation. Taxation and pricing policies are revenue oriented. Policies are needed to address the aggressive and innovative marketing strategies of the alcohol industry. The system for regular monitoring of alcohol burden and conducting alcohol policy analysis needs strengthening. Alcohol use and its public health impact would continue to increase in India in the absence of effective policy and programs; the country may not achieve its stated goal of relative reduction of alcohol use prevalence by 10% by 2025. The prevailing alcohol control policies and programs in India have been less than fully effective in controlling the burden of alcohol use and its associated impact. There is a need for comprehensive, evidence-based and consensus-driven national alcohol control policy to appropriately guide and support the Indian states in regulating alcohol and reducing the associated burden. Effective implementations of such policies are central to its success.

New Estimates of the Mean Ethanol Content of Beer, Wine, and Spirits Sold in the United States Show a Greater Increase in Per Capita Alcohol Consumption than Previous Estimates.

Recent increases in alcohol-related morbidity and mortality have not occurred alongside notable increases in per capita alcohol consumption (PCC). This discrepancy may be partially due to U.S. PCC estimates not including annual estimates of the percentage of alcohol by volume (%ABV) of beer, wine, and spirits, but rather relying on time-invariant %ABV values. Building on a prior study covering 1950 to 2002, estimates of the annual mean %ABV of beer, wine, and spirits sold in the United States were calculated using the %ABV of major brands and sales of each beverage type for each state and nationally for the period 2003 to 2016. We applied these estimates to the calculation of annual beverage-specific and total PCC, and made descriptive comparisons between our PCC estimates and those estimates using invariant %ABV values. For all beverage types, our mean %ABV estimates increased nationally and for all but 5 states. The PCC estimates from wine and spirits utilizing variable %ABV values were lower than estimates using invariant %ABV, and consumption from beer was higher. Our total PCC estimates were also lower than %ABV-invariant estimates; however, the percent change for %ABV-invariant estimates was 5.8% compared to a 7.9% change in our %ABV-variant estimates over the 2003 to 2016 period. Given the application of PCC estimates to understand changes in alcohol-related morbidity and mortality, the inclusion of annual estimates of the %ABV of alcoholic beverages sold in the United States is necessary to ensure the precision of PCC measures such that the conclusions drawn from these applications are accurate and valid.

An evaluation of the effects of lowering blood alcohol concentration limits for drivers on the rates of road traffic accidents and alcohol consumption: a natural experiment

SummaryBackgroundDrink driving is an important risk factor for road traffic accidents (RTAs), which cause high levels of morbidity and mortality globally. Lowering the permitted blood alcohol concentration (BAC) for drivers is a common public health intervention that is enacted in countries and jurisdictions across the world. In Scotland, on Dec 5, 2014, the BAC limit for drivers was reduced from 0·08 g/dL to 0·05 g/dL. We therefore aimed to evaluate the effects of this change on RTAs and alcohol consumption.MethodsIn this natural experiment, we used an observational, comparative interrupted time-series design by use of data on RTAs and alcohol consumption in Scotland (the interventional group) and England and Wales (the control group). We obtained weekly counts of RTAs from police accident records and we estimated weekly off-trade (eg, in supermarkets and convenience stores) and 4-weekly on-trade (eg, in bars and restaurants) alcohol consumption from market research data. We also used data from automated traffic counters as denominators to calculate RTA rates. We estimated the effect of the intervention on RTAs by use of negative binomial panel regression and on alcohol consumption outcomes by use of seasonal autoregressive integrated moving average models. Our primary outcome was weekly rates of RTAs in Scotland, England, and Wales. This study is registered with ISRCTN, number ISRCTN38602189.FindingsWe assessed the weekly rate of RTAs and alcohol consumption between Jan 1, 2013, and Dec 31, 2016, before and after the BAC limit came into effect on Dec 5, 2014. After the reduction in BAC limits for drivers in Scotland, we found no significant change in weekly RTA rates after adjustment for seasonality and underlying temporal trend (rate ratio 1·01, 95% CI 0·94–1·08; p=0.77) or after adjustment for seasonality, the underlying temporal trend, and the driver characteristics of age, sex, and socioeconomic deprivation (1·00, 0·96–1·06; p=0·73). Relative to RTAs in England and Wales, where the reduction in BAC limit for drivers did not occur, we found a 7% increase in weekly RTA rates in Scotland after this reduction in BAC limit for drivers (1·07, 1·02–1·13; p=0·007 in the fully-adjusted model). Similar findings were observed for serious or fatal RTAs and single-vehicle night-time RTAs. The change in legislation in Scotland was associated with no change in alcohol consumption, measured by per-capita off-trade sales (−0·3%, −1·7 to 1·1; p=0·71), but a 0·7% decrease in alcohol consumption measured by per-capita on-trade sales (−0·7%, −0·8 to −0·5; p<0·0001).InterpretationLowering the driving BAC limit to 0·05 g/dL from 0·08 g/dL in Scotland was not associated with a reduction in RTAs, but this change was associated with a small reduction in per-capita alcohol consumption from on-trade alcohol sales. One plausible explanation is that the legislative change was not suitably enforced—for example with random breath testing measures. Our findings suggest that changing the legal BAC limit for drivers in isolation does not improve RTA outcomes. These findings have significant policy implications internationally as several countries and jurisdictions consider a similar reduction in the BAC limit for drivers.FundingNational Institute for Health Research Public Health Research Programme.

Behavioral Health Risk Factors: the Interaction of Personal and Country Effects.

This study investigated the relationship between the individual's self-assessed health status (SAHS) and health-risk factors (smoking, alcohol consumption and obesity), in 16 European countries. The associations were studied for the individual and for the country measures-and in particular, for the unexplored aspect of interaction between individual and country levels of the three risk factors. Data for 47,114 adults, who participated in the Survey of Health Aging and Retirement Europe (SHARE), were analyzed using Multilevel Regression Analysis. The individual data were complemented by OECD data that provided country-specific risk measures: percentage of daily smokers, annual per-capita consumption of alcohol (liters), and percentage of obese individuals. We found that the individual's SAHS is negatively associated with smoking and with weight-risk factors and is positively associated with her/his alcohol consumption. The most pronounced associations relate to the weight variables, albeit they are attenuated in countries with higher percentages of obese individuals. Significant differences across countries were evidenced in the association between SAHS and smoking and between SAHS and alcohol consumption. Individual health levels are associated with individual risk factors and also with the behaviors in the country. Significant interactions might indicate that psychological factors are at work.

Child injury deaths linked with adult alcohol consumption: A time series analysis

ObjectiveThis paper aims to quantify the population-level associations between child injury deaths and adult (aged 15+ years) per capita alcohol consumption (PCC) and between child injury deaths and the impact of major alcohol and safety policy changes in Australia. MethodsAll child deaths due to external causes during 1910–2013, and child deaths due specifically to road crashes, assaults, suicide and other external causes, were obtained from the Australian Institute of Health and Welfare. Child (0–14 year) mortality rates were analysed in relation to PCC using an Autoregressive Integrated Moving Average model. ResultsA positive association between PCC and overall child external mortality was identified. The estimated coefficient was 0.326 (p = .002), indicating that a 10% decrease in PCC was associated with a 3.3% reduction in child injury mortality. A positive association was identified for road traffic and other child injury mortality, but not assault injuries. The introduction of compulsory seatbelt legislation in combination with random breath testing was associated with a reduction in overall injury and road traffic child mortality. Decreasing the legal drinking age was associated with an increase in the rate of other external-cause child mortality. ConclusionReducing PCC in Australia is likely to result in a small but significant reduction in the injury mortality rate of children aged 0–14 years.

Development of the International Alcohol Policy and Injury Index

ABSTRACTObjectiveTo develop a new index to measure the effectiveness of alcohol control policies on selected indicators of alcohol-related injuries.MethodsWe used the World Health Organization Global Information System on Alcohol and Health (GISAH) for cross-sectional data from 156 countries for this analysis. Five policy domains were selected: physical availability, drinking context, pricing, advertising, and vehicular. Injury mortality and alcohol-attributable fractions (AAFs) for vehicular deaths were also used for the same countries. We created a new composite indicator, the International Alcohol Policy Injury Index (IAPII), in order to assess the association between policy and deaths due to alcohol-related injury.ResultsAfter we controlled for per-capita alcohol consumption, we found that injury deaths and AAF deaths were inversely associated with four of the five policy domains. The domains were weighted according to effectiveness and used to construct the IAPII, which produced acceptable sensitivity and specificity. Regression results, controlling for consumption, demonstrated that the IAPII was significantly associated with AAF vehicular injury death for males, AAF vehicular injury death for females, and overall injury death at p < 0.01.ConclusionsOur findings support the IAPII as a reliable indicator of the relationship between alcohol policies and injury deaths: the stronger the policy, the less the likelihood of both overall and vehicular injury death. Future work should test the effectiveness of the IAPII in reducing alcohol-related injury morbidity, which accounts for a larger share of the global burden of disease than alcohol-related injury mortality does.

Changing Attitudes to Alcohol in Australia.

Per-capita alcohol consumption in Australia increased between 2001 and 2007 and has subsequently declined, particularly for young people over this period. We examine trends in general attitudes to alcohol and to perceptions of risk from alcohol consumption to assess whether consumption trends have been mirrored by changing ideas about alcohol. We also examine whether trends in attitudes vary across sociodemographic subgroups. Data are from the National Drug Strategy Household Survey (n = 127,916), 2001-2013. To examine trends in attitudes to alcohol and perceptions of risk related to alcohol, logistic regression was used to assess changes over time, with interaction analyses used to explore whether changing attitudes have been consistent across sociodemographic subgroups. There were statistically significant increases in the percentage of the population naming excessive alcohol consumption as the most serious drug problem in Australia (22.6% in 2001 to 43.6% in 2013, p < .001), naming alcohol as the drug that causes the most deaths (22.7% in 2001 to 34.2% in 2013, p < .001), and suggesting thresholds for low-risk drinking below two drinks per day for men (22.4% in 2001 to 33.0% in 2013, p < .001) and women (54.4% in 2001 to 64.8% in 2013, p < .001). These trends were consistent across all sociodemographic subgroups. Australian attitudes to alcohol became more conservative between 2001 and 2013. These trends may partly explain the decline in youth drinking observed over the same period, with young people's consumption potentially more likely to be affected by growing social concern about alcohol, although shifts in attitudes occurred even while consumption was increasing.

The prevalence of psychiatric co-morbidities and relapses in males treated for alcohol dependence syndrome – Prospective study from tertiary de-addiction care unit in Kerala, India

Kerala has high percapita consumption of alcohol among the other Indian states.ObjectivesPrevalence of psychiatric comorbidities in alcohol dependence syndrome and association of severity of alcohol dependence, personality dimensions, motivation and short delay relapses.MethodsA prospective study in 91 male alcoholic patients for 2 months.ResultsTwo groups not relapsed (NR = 48) and Relapsed (R = 43) were comparable in age, SADQ severity score, average units of alcohol consumption and years of alcohol use. Average consumption was 17 units/day (500 mL spirits), age of onset before 25 years 87%, mean age 40 and severe alcohol dependence was in 57% of study population. Co-morbid nicotine use was 80.2% and in equal numbers in the relapsers and non-relapsers group.ConclusionsBipolar disorder was the most prevalent (19.8%) in the study population. About 53.8% had alcohol dependence as the primary diagnosis with no associated psychiatric comorbidities. Anxiety disorders (12%) and personality disorders (19.7%) were found more in the relapsers group. Anxiety symptoms seemed to be a risk factor for relapsing compared to other comorbidities in bivariate analysis (Pearson Chi2 5.998, P = 0.014). Psychoticism among relapsers were high (Pearson Chi2 4.901, P value 0.027, OR: 3.782, 95% CI: 1.103–12.958). Co-morbidities were not statistically significant in multivariate (Pearson Chi2 1.765, P = 0.184, OR: 1.755, 95% CI: 0.763–4.037). Severity of alcohol dependence in relapsers was not significant (Pearson Chi2 0.650, P = 0.722). Motivation levels of 62.8% of relapsers were low, 32.6% medium and only 4.7% reported high motivation (Pearson Chi2 11.846, P = 0.003). Poor motivation proved to be a risk factor for future relapse (P = 0.008, 95% CI: 1.266–4.648, SE.332).Disclosure of interestThe authors have not supplied their declaration of competing interest.

The Alcohol Use Disorders Identification Test (AUDIT): Exploring the Factor Structure and Cutoff Thresholds in a Representative Post-Conflict Population in Northern Uganda.

Despite increased use of the Alcohol Use Disorders Identification Test (AUDIT) in sub-Saharan Africa, few studies have assessed its underlying conceptual framework, and none have done so in post-conflict settings. Further, significant inconsistencies exist between definitions used for problematic consumption. Such is the case in Uganda, facing one of the highest per-capita alcohol consumption levels regionally, which is thought to be hindering rebuilding in the North after two decades of civil war. This study explores the impact of varying designation cutoff thresholds in the AUDIT as well as its conceptual factor structure in a representative sample of the population. In all, 1720 Cango Lyec Project participants completed socio-economic and mental health questionnaires, provided blood samples and took the AUDIT. Participant characteristics and consumption designations were compared at AUDIT summary score thresholds of ≥3, ≥5 and ≥8. Confirmatory factor analyses (CFA) explored one-, two- and three-factor level models overall and by sex with relative and absolute fit indicators. There were no significant differences in participant demographic characteristics between thresholds. At higher cutoffs, the test increased in specificity to identify those with hazardous drinking, disordered drinking and suffering from alcohol-related harms. All conceptual models indicated good fit, with three-factor models superior overall and within both sexes. In Northern Uganda, a three-factor AUDIT model best explores alcohol use in the population and is appropriate for use in both sexes. Lower cutoff thresholds are recommended to identify those with potentially disordered drinking to best plan effective interventions and treatments. A CFA of the AUDIT showed good fit for one-, two, and three-factor models overall and by sex in a representative sample in post-conflict Northern Uganda. A three-plus total AUDIT cutoff score is suggested to screen for hazardous drinking in this or similar populations.

Coverage of alcohol consumption by national surveys in South Africa.

Evidence suggests that adult per-capita alcohol consumption, as estimated from self-reports of nationally representative surveys, underestimates 'true' consumption, as measured as the sum of recorded and unrecorded consumption. The proportion of total adult alcohol per capita reported in representative surveys is usually labelled 'coverage'. The aim of the present paper was to estimate coverage for South Africa under different scenarios of alcohol use assessment and 'true' consumption. Five nationally representative surveys from South Africa were used to estimate the prevalence of drinking and the grams per day among current drinkers. All surveys used a complex multi-stage sampling frame that was accounted for by using survey weights. The total (recorded and unrecorded), the recorded and the adjusted total adult per-capita alcohol consumption in South Africa served as different estimates of the 'true' consumption. South Africa. Alcohol use information was assessed on a total of 8115, 16 398 and 13 181 adults (15years or older) in surveys from the years 2003, 2005 and 2008, respectively. Two surveys in 2012 included 27 070 and 18 688 adults. Coverage of the alcohol use reported in the surveys was calculated, compared with the 'true' adult per-capita alcohol. The survey data covered between 11.8% [2005; 95% uncertainty interval (UI)=9.3-16.2%)] and 19.4% (2003; 95% UI=14.9-24.2%) of the total alcohol used per capita. The highest coverage of 27.9% (95% UI=22.4-36.8%) was observed when looking only at recorded alcohol in 2003. Evidence from five nationally representative surveys assessing alcohol use suggests that less than 20% of the total adult per-capita alcohol consumption in South Africa is reported in surveys.