Impact on alcohol-related mortality of a rapid rise in the density of private liquor outlets in British Columbia: a local area multi-level analysis

Aims To study relationships between rates of alcohol‐related deaths and (i) the density of liquor outlets and (ii) the proportion of liquor stores owned privately in British Columbia (BC) during a period of rapid increase in private stores. Design Multi‐level regression analyses assessed the relationship between population rates of private liquor stores and alcohol‐related mortality after adjusting for potential confounding. Setting The 89 local health areas of BC, Canada across a 6‐year period from 2003 to 2008, for a longitudinal sample with n = 534. Measurements Population rates of liquor store density, alcohol‐related death and socio‐economic variables obtained from government sources. Findings The total number of liquor stores per 1000 residents was associated significantly and positively with population rates of alcohol‐related death (P < 0.01). A conservative estimate is that rates of alcohol‐related death increased by 3.25% for each 20% increase in private store density. The percentage of liquor stores in private ownership was also associated independently with local rates of alcohol‐related death after controlling for overall liquor store density (P < 0.05). Alternative models confirmed significant relationships between changes in private store density and mortality over time. Conclusions The rapidly rising densities of private liquor stores in British Columbia from 2003 to 2008 was associated with a significant local‐area increase in rates of alcohol‐related death.     

An investigation of the effect of privatization of retail sales of alcohol on consumption and traffic accidents in Alberta, Canada

AIMS: Privatization of the retail sale of alcohol in Alberta took place primarily between the end of the 1980s and the beginning of the 1990s. The aim of this study was to evaluate the effects of this privatization on alcohol sales and on the incidence of fatal motor vehicle traffic accidents in the province. DATA AND METHOD: Interrupted time-series analysis (ARIMA) with a quasi-experimental control area design was used, and all series were differenced to remove long-term trends. Canada, with the exception of Alberta, was the control area. The effects of privatization were measured by means of created privatization variables. In the analyses of the effects of privatization on alcohol sales, the inhabitants' disposable income and alcohol prices were used as control variables. The study period was 1950-2000. When effects on the number of fatal motor vehicle traffic accidents were analysed the number of road motor vehicle registrations was used as a control variable, and the study period was 1950-98. FINDINGS: Privatization had a significant permanent effect on the sale of spirits, but the effect was not large enough to affect total sales. The effect on wine and beer sales was not significant. There was no significant effect on the number of fatal motor vehicle traffic accidents. CONCLUSION: The fact that sales on the wholesale level continued to be monopolized, along with the fact that alcohol sales were never allowed in ordinary grocery stores, may explain the lack of any larger effects of privatization on alcohol sales in Alberta.     

Weakening of one more alcohol control pillar: a review of the effects of the alcohol tax cuts in Finland in 2004

Aims   To review the consequences of the changes in Finnish alcohol policy in 2004, when quotas for travellers' tax-free imports of alcoholic beverages from other European Union (EU) countries were abolished, Estonia joined the EU and excise duties on alcoholic beverages were reduced in Finland by one-third, on average.
Design   A review of published research and routinely available data.
Setting   Finland.
Measurements   Prices of alcoholic beverages, recorded and unrecorded alcohol consumption, data on criminality and other police statistics, alcohol-related deaths and hospitalizations, service use.
Findings   Alcohol consumption increased 10% in 2004, clearly more than in the early 2000s. With few exceptions, alcohol-related harms increased. Alcohol-induced liver disease deaths increased the most, by 46% in 2004–06 compared to 2001–03, which indicates a strong effect on pre-2004 heavy drinkers. Consumption and harms increased most among middle-aged and older segments of the population, and harms in the worst-off parts of the population in particular.
Conclusions   Alcohol taxation and alcohol prices affect consumption and related harms, and heavy drinkers are responsive to price. In Finland in 2004, the worst-off parts of the population paid the highest price in terms of health for cuts in alcohol prices. The removal of travellers' import quotas, which was an inherent part of creating the single European market, had serious public health consequences in Finland.     

Fetus at risk: prevalence of alcohol consumption during pregnancy estimated with a simple screening method in Swedish antenatal clinics

Aims Maternal alcohol consumption is a major health hazard for the fetus. Sweden has an extensive system of public antenatal care clinics, whose mission is to detect and prevent this type of health hazards. However, very few cases of alcohol consumption during pregnancy are detected. The aim of this study was to examine the prevalence of hazardous or harmful alcohol consumption during pregnancy in a consecutive series of Swedish pregnant females. Design, setting, participants and measurements The Alcohol Use Disorders Identification Test (AUDIT) was used to collect anonymous data from consecutive pregnant subjects admitted during 1 year to an antenatal clinic in Stockholm, and signing up for parental education offered routinely (n = 1327). Data were obtained from 1101 subjects, typically in pregnancy week 30. A complete AUDIT form was filled out referring to alcohol use during the year prior to pregnancy. A separate form with the consumption items from AUDIT was filled out to report behaviour during pregnancy. Findings For the year preceding pregnancy, 17% of subjects reported AUDIT scores of 6 or higher, indicating hazardous or harmful alcohol use in women. Few individuals reported scores of 13 or higher (indicating abuse or dependence), but almost half the subjects (46%) reported binge drinking (six standard drinks on a single occasion) once/month or more often, and 6% reported binge drinking on every occasion of alcohol consumption. One‐third of the subjects (30%) continued regular alcohol use during pregnancy, and 6% reported consumption two to four times/month. In a logistic regression model, AUDIT scores for the year prior to pregnancy and subject age, but not education level were significant predictors of continued alcohol use during pregnancy. Conclusions Alcohol use during pregnancy is more extensive than has been presumed in Sweden. Simple, clinically useful screening methodology detects hazardous consumption during pregnancy in a manner which regular antenatal care does not. If this methodology can be shown to have similar sensitivity when administered under non‐anonymous conditions, it should be made part of routine antenatal care.     

The stability of baseline‐defined categories of alcohol consumption during the adult life‐course: a 28‐year prospective cohort study

Background and aims

Studies that report the relationship between alcohol consumption and disease risk have predominantly operationalized drinking according to a single baseline measure. The resulting assumption of longitudinal stability may be simplistic and complicate interpretation of risk estimates. This study aims to describe changes to the volume of consumption during the adult life‐course according to baseline categories of drinking.

Design

A prospective observational study.

Setting

United Kingdom.

Participants

A cohort of British civil servants totalling 6838 men and 3372 women aged 34–55 years at baseline, followed for a mean 19.1 (standard deviation = 9.5) years.

Measurements

The volume of weekly alcohol consumption was estimated from data concerning the frequency and number of drinks consumed. Baseline categories were defined: non‐current drinkers, infrequent drinkers, 0.1–50.0 g/week, 50.1–100.0 g/week, 100.1–150.0 g/week, 150.1–250.0 g/week and >250.0 g/week. For women, the highest category was defined as > 100.0 g/week. Baseline frequency was derived as ‘daily or almost daily’ and ‘not daily or almost daily’. Trajectories were estimated within baseline categories using growth curve models.

Findings

Trajectories differed between men and women, but were relatively stable within light‐to‐moderate categories of baseline consumption. Drinking was least stable within the highest categories of baseline consumption (men: > 250.0 g/week; women: > 100.0 g/week), declining by 47.0 [95% confidence interval (CI) = 40.7, 53.2] and 16.8 g/week (95% CI = 12.6, 21.0), respectively, per 10‐year increase in age. These declines were not a consequence of sudden transitions to complete abstention. Rates of decline appear greatest in older age, with trajectories converging toward moderate volumes.

Conclusion

Among UK civil servants, consumption within baseline drinking categories is generally stable during the life‐course, except among heavier baseline drinkers, for whom intakes decline with increasing age. This shift does not appear to be driven by transitions to non‐drinking. Cohorts of older people may be at particular risk of misclassifying former heavy drinkers as moderate consumers of alcohol.