Population-level Alcohol Consumption Research Articles

Assessing the impact of stricter drink driving policy on alcohol consumption in a population of Hanoi, Vietnam using wastewater analysis.

On 1 January 2020, Vietnam introduced a new law with harsher fines and penalties for driving under the influence of alcohol. Reports of empty beer restaurants following this implementation suggested the new law has the potential to reduce population-level alcohol consumption. This pilot study aims to quantify short-term changes in alcohol consumption levels after the implementation of the new law and assess whether it could lead to a reduction in total alcohol consumption in the population. Wastewater samples were collected from two sites along a sewage canal in Hanoi during two periods: Period 1 (15 December 2018 to 14 January 2019) and Period 2 (15 December 2019 to 14 January 2020). Ethyl sulfate, a specific metabolite of alcohol, was quantified to monitor the trend of alcohol consumption. Both interrupted time series and controlled interrupted time series approaches were utilised, with Period 1 and Period 2 serving as the control and intervention periods, respectively. Our analysis indicated that the implementation of the new law did not result in an immediate and significant reduction in alcohol consumption at the population level. Meanwhile, there was no significant difference in alcohol consumption between weekdays and weekends both before and after the implementation of the new law. Long-term monitoring is needed to assess the impact of stricter DUI policy on alcohol consumption in the urban areas of Vietnam.

The effect of an annual temporary abstinence campaign on population-level alcohol consumption in Thailand: a time-series analysis of 23 years

RationaleA small number of earlier studies have suggested an effect of temporary abstinence campaigns on alcohol consumption. However, all were based on self-reported consumption estimates.ObjectivesUsing a time series of 23-year...

Population-Level Alcohol Consumption and Homicide Rates in Latin America: A Fixed Effects Panel Analysis, 1961-2019

Population-Level Alcohol Consumption and Homicide Rates in Latin America: A Fixed Effects Panel Analysis, 1961-2019

Population-Level Alcohol Consumption and Homicide Rates in Latin America: A Fixed Effects Panel Analysis, 1961-2019

Population-Level Alcohol Consumption and Homicide Rates in Latin America: A Fixed Effects Panel Analysis, 1961-2019

Population-Level Alcohol Consumption and Homicide Rates in Latin America: A Fixed Effects Panel Analysis, 1961-2019.

Latin America and the Caribbean (LAC) possesses 8 per cent of the global population but approximately one-third of global homicides. The region also exhibits high per capita alcohol consumption, risky drinking patterns and a heterogeneous mix of beverage preferences. Despite this, LAC violence receives limited attention in the English-language literature and there are no studies of the population-level alcohol-homicide association in the region. We examined the effects on total, male and female homicide rates of total and beverage-specific alcohol consumption (22 nations, 1961-2019) and of risky drinking patterns (20 nations, 2005 and 2010). We collected homicide and alcohol data from the World Health Organization. Panel fixed effects models showed (1) per capita total and wine consumption were positively associated with total, male and female homicide rates, though effects were much stronger for males, (2) per capita beer consumption was positively associated with total and male homicide rates, (3) per capita spirits consumption was not associated with homicide rates, and (4) nations with riskier drinking patterns had higher total, male and female homicide rates than those with less risky drinking patterns.

Testing the effectiveness of alcohol health warning label formats: An online experimental study with Australian adult drinkers.

Health warning labels (HWLs) on alcohol containers may help reduce population-level alcohol consumption. However, few studies have examined the most effective formats for alcohol HWLs. This study tested the effects of three different types of alcohol HWLs. In an online experiment, N = 1,755 Australian adult drinkers were randomly assigned to one of five conditions: (a) No HWL control; (b) DrinkWise control (industry-developed labels currently on some containers); (c) Text-Only HWLs; (d) Text + Pictogram HWLs; or (e) Text + Photograph HWLs. In the three intervention conditions, participants were exposed to eight HWLs, each depicting a different long-term harm. Exposure occurred during an initial session, and repeatedly over the subsequent eight days. Differences between conditions were assessed immediately following initial exposure and at nine-day follow-up. Compared to participants in the No HWL control, participants exposed to Text + Pictogram HWLs were more likely to have intentions to avoid drinking alcohol completely in the next month (post-exposure) and intentions to drink less alcohol in the next week (follow-up), and participants in all three intervention conditions reported stronger negative emotional arousal (follow-up) and weaker positive emotional arousal (follow-up). Compared to participants in the DrinkWise control, those exposed to Text + Pictogram HWLs had stronger intentions to drink less alcohol in the next week and intentions to avoid drinking alcohol completely in the next month (follow-up), participants in the Text + Photograph condition reported significantly weaker positive emotional arousal, and all three intervention conditions resulted in stronger negative emotional arousal. There would likely be benefits to public health if any of the three types of intervention HWLs were implemented. However, there is some evidence that Text + Pictogram HWLs should be recommended over Text-Only or Text + Photograph HWLs, given they were the only HWLs to increase intentions to drink less.

Changes in the dollar value of per capita alcohol, essential, and non-essential retail sales in Canada during COVID-19

BackgroundMultiple survey reports suggest that alcohol use has increased in Canada during the COVID-19 pandemic. However, less is known about how per capita alcohol sales, which predict population-level alcohol use, have changed and whether changes in alcohol sales differ from changes in sales of other products due to pandemic factors.MethodsWe obtained monthly retail sales data by industry from Statistics Canada, for the six largest provinces in Canada (containing 93% of the national population), between January 2010 and November 2020, representing time before and 9 months after the start of the pandemic in Canada. We used an interrupted time series analysis to estimate pandemic impacts on the dollar value of monthly per capita (per individuals 15+ years) alcohol, essential and non-essential retail sales. We adjusted our analyses for pre-pandemic sales trends, inflation, seasonality and changing population demographics over time.ResultsDuring the first 9 months of the pandemic, the values of per capita alcohol, essential and non-essential sales were, respectively, 13.2% higher, 3.6% higher and 13.1% lower than the average values during the same period in the prior 3 years. Interrupted time series models showed significant level change for the value of monthly per capita alcohol sales (+$4.86, 95% CIs: 2.88, 6.83), essential sales (−$59.80, 95% CIs: − 78.47, − 41.03) and non-essential sales (−$308.70, 95% CIs: − $326.60, − 290.79) during the pandemic. Alcohol sales were consistently elevated during the pandemic, and the pre- and post-pandemic slopes were comparable. In contrast, essential and non-essential retail sales declined in the early months of the pandemic before returning to regular spending levels.ConclusionDuring the first 9 months of the pandemic, per capita alcohol sales were moderately elevated in Canada. In contrast, non-essential sales were lower than prior years, driven by large decreases during the initial months of the pandemic. These findings suggest that the pandemic was associated with increased population-level alcohol consumption, which may lead to increased alcohol-related harms. Ongoing research is needed to examine how factors, including pandemic-related stressors and specific alcohol sales-related policies, may have influenced changes in alcohol use and harms.

Can alcohol consumption in Germany be reduced by alcohol screening, brief intervention and referral to treatment in primary health care? Results of a simulation study.

Screening, brief intervention and referral to treatment (SBIRT) is a programme to reduce alcohol consumption for drinkers with high alcohol consumption levels. Only 2.9% of patients in primary health care (PHC) are screened for their alcohol use in Germany, despite high levels of alcohol consumption and attributable harm. We developed an open-access simulation model to estimate the impact of higher SBIRT delivery rates in German PHC settings on population-level alcohol consumption. A hypothetical population of drinkers and non-drinkers was simulated by sex, age, and educational status for the year 2009 based on survey and sales data. Risky drinking persons receiving BI or RT were sampled from this population based on screening coverage and other parameters. Running the simulation model for a ten-year period, drinking levels and heavy episodic drinking (HED) status were changed based on effect sizes from meta-analyses. In the baseline scenario of 2.9% screening coverage, 2.4% of the adult German population received a subsequent intervention between 2009 and 2018. If every second PHC patient would have been screened for alcohol use, 21% of adult residents in Germany would have received BI or RT by the end of the ten-year simulation period. In this scenario, population-level alcohol consumption would be 11% lower than it was in 2018, without any impact on HED prevalence. Screening coverage rates below 10% were not found to have a measurable effect on drinking levels. Large-scale implementation of SBIRT in PHC settings can yield substantial reductions of alcohol consumption in Germany. As high screening coverage rates may only be achievable in the long run, other effective alcohol policies are required to achieve short-term reduction of alcohol use and attributable harm in Germany. There is large potential to apply this open-access simulation model to other settings and for other alcohol interventions.

Interested constituents: identifying groups to mobilize in community organizing efforts to strengthen alcohol control policies

ABSTRACT Background: Policy support research identifies demographic profiles of those who support policies, but community organizers aim to mobilize groups with an existing structure. Thus, identifying established groups that support alcohol policies may aid organizing efforts. Objective: This paper calculates prevalence and odds of policy support among three potential constituency groups (i.e., religious affiliation, persons harmed by others’ drinking, and persons in recovery from alcohol) for three policies: alcohol tax increases, banning alcohol in corner stores, and universal coverage for alcohol treatment. Methods: Using the 2014–15 National Alcohol Survey (n = 3,444; 1,457 male, 1,987 female) and logistic regression, this study explores associations between constituency groups and policy support. Results: Support was higher for the individual-level strategy of alcohol treatment (80.8%) than raising taxes (27.5%) and banning sales in corner stores (52.2%). Support for taxes was higher among persons who valued religion highly (vs not; aOR = 1.46, p < .01), persons harmed by others’ drinking (vs not; aOR = 1.71, p < .001), and persons in recovery (vs. not; aOR = 1.76, p = .02); Catholics had lower odds of support for taxes (vs no denomination; aOR = 0.63, p = .01). Persons who valued religion highly (aOR = 1.53, p < .001), Protestants (aOR = 1.63, p < .01), Catholics (aOR = 1.46, p = .03), and persons with other religious denominations (aOR = 2.17, p = .02) had higher odds of supporting bans in corner stores. Only those in recovery showed greater support for treatment (aOR = 3.20, p < .001). Conclusion: Overall, support was lower for population-wide approaches, but results revealed constituency groups that supported these policies. These groups may be allies to organizers who seek to reduce population-level alcohol consumption and harms.

The link between per capita alcohol consumption and alcohol-related harm in educational groups.

Research based on individual-level data suggests that the same amount of alcohol yields more harm in low-socioeconomic status (SES) groups than in high-SES groups. Little is known whether the effect of changes in population-level alcohol consumption on harm rates differs by SES-groups. The aim of this study was to elucidate this issue by estimating the association between per capita alcohol consumption and SES-specific rates of alcohol-related mortality. Per capita alcohol consumption was proxied by Systembolaget's alcohol sales (litres 100% alcohol per capita 15+). Quarterly data on mortality and alcohol consumption spanned the period 1991Q1-2017Q4. We used two outcomes: (i) alcohol-specific mortality (deaths with an explicit alcohol diagnosis); and (ii) violent deaths. SES was measured by education. We used three educational groups: (i) low (<10 years); (ii): intermediate (10-12 years); and (iii) high (13+ years). We applied error correction modelling to estimate the association between alcohol and alcohol-specific mortality, and seasonal autoregressive integrated moving average-modelling to estimate the association between alcohol and violent deaths. The estimated associations between per capita consumption and the two outcomes were positive and statistically significant in the two groups with low and intermediate education, but not in the high education group. There was a significant gradient in the level of association between alcohol consumption and alcohol-related harm by educational group; the association was stronger the lower the educational group. Our findings suggest that the association between per capita consumption and alcohol-related harm was stronger the lower the educational group.

Testing the Effectiveness of Enhanced Alcohol Warning Labels and Modifications Resulting From Alcohol Industry Interference in Yukon, Canada: Protocol for a Quasi-Experimental Study.

BackgroundAlcohol warning labels are a promising, well-targeted strategy to increase public awareness of alcohol-related health risks and support more informed and safer use. However, evidence of their effectiveness in real-world settings remains limited and inconclusive.ObjectiveThis paper presents a protocol for a real-world study examining the population-level impact of enhanced alcohol warning labels with a cancer message; national drinking guidelines; and standard drink information on attention, processing, and alcohol-related behaviors among consumers in Canada. Postimplementation modifications to the original protocol due to interference by national alcohol industry representatives are also described.MethodsThis quasi-experimental study involved partnering with local governments in two northern Canadian territories already applying alcohol warning labels on alcohol containers for sale in liquor stores. The study tested an 8-month intervention consisting of three new enhanced, rotating alcohol warning labels in an intervention site (Whitehorse, Yukon) relative to a comparison site (Yellowknife, Northwest Territories) where labelling practices would remain unchanged. Pre-post surveys were conducted at both sites to measure changes in awareness and processing of label messages, alcohol-related knowledge, and behaviors. Liquor store transaction data were collected from both sites to assess changes in population-level alcohol consumption. The intervention was successfully implemented for 1 month before it was halted due to complaints from the alcohol industry. The government of the intervention site allowed the study to proceed after a 2-month pause, on the condition that the cancer warning label was removed from rotation. Modifications to the protocol included applying the two remaining enhanced labels for the balance of the intervention and adding a third wave of surveys during the 2-month pause to capture any impact of the cancer label.ResultsThis study protocol describes a real-world quasi-experimental study that aimed to test the effectiveness of new enhanced alcohol warning labels as a tool to support consumers in making more informed and safer alcohol choices. Alcohol industry interference shortly after implementation compromised both the intervention and the original study design; however, the study design was modified to enable completion of three waves of surveys with cohort participants (n=2049) and meet the study aims.ConclusionsFindings from this study will directly inform alcohol labelling policies in Canada and internationally and provide further insight into the alcohol industry’s attempts to disrupt research in this area. Additional unimpeded real-world evaluations of enhanced alcohol warning labels are recommended.International Registered Report Identifier (IRRID)RR1-10.2196/16320

Population-level alcohol consumption and suicide mortality rate in South Korea: An application of multivariable spatial regression model.

This research estimates the contextual effects of populationlevel alcohol consumption on the average suicide mortality rate (SMR) in South Korea from 2013 to 2015. The effect was estimated not only in relation to the risk factors of suicide, such as divorce and being elderly, but also protective factors, such as church attendance and educational attainment. Using a multivariable spatial regression model, results show that only excessive population-level alcohol consumption pattern had a positive effect on SMR by increasing 0.24 standardized units in the SMR; the moderate pattern, however, had no significant impact. These results imply that the excessive population-level alcohol consumption pattern is a risk factor with respect to SMR. This research suggests the implementation of policies to control population- level alcohol consumption, based on a concern for public health, to reduce the suicide risk in South Korea.

On the outside looking in: Finding a place for managed alcohol programs in the harm reduction movement

Alcohol policy in North America is dominated by moderation and abstinence-based modalities that focus on controlling population-level alcohol consumption and modifying individual consumption patterns to prevent and reduce alcohol-related harms. However, conventional alcohol policies and interventions do not adequately address harms associated with high-risk drinking among individuals experiencing severe alcohol use disorder (AUD) and structural vulnerability such as poverty and homelessness. In this commentary we address this gap in alcohol harm reduction, and highlight the lack of, and distinct need for, alcohol-specific harm reduction for people experiencing structural vulnerability and severe AUD. These individuals, doubly impacted by structural oppression and severe AUD, engage in various high-risk drinking practices that contribute to a unique set of harms that conventional abstinence-based treatments and interventions fail to adequately attend to. Managed alcohol programs (MAPs) have been established to address these multiple intersecting harms, and though gaining momentum across Canada, have had a hard time finding their place within the harm reduction movement. We illustrate how MAPs play a crucial role in the harm reduction movement in their ability to not only address high-risk drinking practices among structurally marginalized individuals, but to respond to harms associated with broader structural inequities such as poverty and homelessness.

Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

SummaryBackgroundAlcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older.MethodsUsing 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health.FindingsGlobally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2·2% (95% uncertainty interval [UI] 1·5–3·0) of age-standardised female deaths and 6·8% (5·8–8·0) of age-standardised male deaths. Among the population aged 15–49 years, alcohol use was the leading risk factor globally in 2016, with 3·8% (95% UI 3·2–4·3) of female deaths and 12·2% (10·8–13·6) of male deaths attributable to alcohol use. For the population aged 15–49 years, female attributable DALYs were 2·3% (95% UI 2·0–2·6) and male attributable DALYs were 8·9% (7·8–9·9). The three leading causes of attributable deaths in this age group were tuberculosis (1·4% [95% UI 1·0–1·7] of total deaths), road injuries (1·2% [0·7–1·9]), and self-harm (1·1% [0·6–1·5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27·1% (95% UI 21·2–33·3) of total alcohol-attributable female deaths and 18·9% (15·3–22·6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0·0–0·8) standard drinks per week.InterpretationAlcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption.FundingBill & Melinda Gates Foundation.

A cross-national study of the population-level association between alcohol consumption and suicide rates

IntroductionThe objective of this study was to explore the association between population-level alcohol consumption and cross-national suicide rates. Suicide mortality rates vary substantially by nation, as do the level and character of alcohol consumption. Only a few prior studies examined this association, however, and they used a small number of nations and failed to test for the multiple hypothesized pathways through which any association may operate. Material and methodsWe obtained data from the World Health Organization for a sample of 83 nations. Controlling for potential structural covariates, we tested four theoretical mechanisms through which population-level alcohol consumption may influence national suicide rates. ResultsResults showed no evidence of threshold effects, nor were risky national drinking patterns associated with higher suicide rates. We found evidence for the most common explanation that total per capita consumption is linearly associated with suicide rates. Our other findings, however, suggested this linear association masks more complex beverage-specific effects. Per capita wine consumption was not associated with male or female suicide rates, per capita spirits consumption was associated with both male and female suicide rates, per capita beer consumption was associated with male suicide rates, and per capita consumption of “other” alcohol types was associated with female suicide rates. Discussion and conclusionsTesting for only a linear association between total alcohol consumption and suicide rates fails to tell the whole story. Further research requires exploration of beverage-specific effects and other potential mechanisms, and consideration of national alcohol policies to reduce suicide rates.

Population-level alcohol consumption and national homicide rates

We explored the cross-national association between population-level alcohol consumption and homicide victimization rates. The very few prior studies of this association had small homogeneous sample...

Implementing a Public Health Objective for Alcohol Premises Licensing in Scotland: A Qualitative Study of Strategies, Values, and Perceptions of Evidence.

The public health objective for alcohol premises licensing, established in Scotland in 2005, is unique globally. We explored how public health practitioners engaged with the licensing system following this change, and what helped or hindered their efforts. Semi-structured interviews were conducted with 13 public health actors, audio-recorded, and analysed using an inductive framework approach. Many interviewees viewed the new objective as synonymous with reducing population-level alcohol consumption; however, this view was not always shared by licensing actors, some of whom did not accept public health as a legitimate goal of licensing, or prioritised economic development instead. Some interviewees were surprised that the public health evidence they presented to licensing boards did not result in their hoped-for outcomes; they reported that licensing officials did not always understand or value health data or statistical evidence. While some tried to give “impartial” advice to licensing boards, this was not always easy; others were clear that their role was one of “winning hearts and minds” through relationship-building with licensing actors over time. Notwithstanding the introduction of the public health objective, there remain significant, and political, challenges in orienting local premises licensing boards towards decisions to reduce the availability of alcohol in Scotland.

Decreasing prevalence of social drinkers in Australia

IntroductionThere has been a recent decrease in population level alcohol consumption in Australia, particularly in young people. Whether this is due to increasing abstinence or a shift in the way people think about alcohol is not known. The aim of this study is to investigate trends in self-identification of drinker types in Australia from 2001 to 2013 in light of shifting patterns of alcohol consumption in Australia. MethodsFive waves of the National Drug Strategy Household Survey from 2001 to 2013 (N=118,416) were used to assess trends in self-identification as a drinker type (non-, ex-, occasional, light, social, heavy and binge drinker). Consumption patterns and demographics of the self-identified groups were also examined. ResultsThe pattern of self-identification has mostly remained steady over time. The two exceptions to this are a decrease in identification as a social drinker (28% to 22%) and a corresponding increase in identification as a non-drinker (from 19% to 27%). There are few changes over time in the demographic make-up of, or consumption patterns in, the social drinker category with the exception of those over 50, who continue to identify as social drinkers at the same rate. ConclusionThe recent increase in abstinence in Australia seems to be matched by a corresponding decrease in self-identified social drinkers, particularly among those under 50. This indicates that the decrease in consumption is not occurring in those most likely to experience harms.

Health Impacts of the Great Recession: A Critical Review.

The severity, sudden onset, and multipronged nature of the Great Recession (2007-2009) provided a unique opportunity to examine the health impacts of macroeconomic downturn. We comprehensively review empirical literature examining the relationship between the Recession and mental and physical health outcomes in developed nations. Overall, studies reported detrimental impacts of the Recession on health, particularly mental health. Macro- and individual-level employment- and housing-related sequelae of the Recession were associated with declining fertility and self-rated health, and increasing morbidity, psychological distress, and suicide, although traffic fatalities and population-level alcohol consumption declined. Health impacts were stronger among men and racial/ethnic minorities. Importantly, strong social safety nets in some European countries appear to have buffered those populations from negative health effects. This literature, however, still faces multiple methodological challenges, and more time may be needed to observe the Recession's full health impact. We conclude with suggestions for future work in this field.

Alcohol and social media: drinking and drunkenness while online

Our New Zealand-based research provides new insights, drawn from focus group and interview data gathered from 18- to 25-year-olds, about how alcohol use and technology converge in drinking and drunkenness while online. Alcohol consumption is a key source of harm and damage to population health, particularly for young people whose engagement with web-based communications may be exacerbating problems. Participants’ talk around alcohol and SNS use is complex, with expressions of caution and regret, juxtaposed with accounts of fun, excitement and pleasure. Sharing, narration and elaboration of experiences of alcohol use online reinforce the social nature of risky drinking practices. The interface of social media and alcohol use is attracting novel forms of alcohol marketing that penetrates virtual and offline spaces, undermining conventional public health policies, approaches and tools for reducing population-level alcohol consumption.