Harms from alcohol consumption by strangers in five Indian states and policy implications

Introduction and Aims . India has a checkered history of alcohol prohibition; however, alcohol use is becoming more prevalent. We assessed the reporting of tangible and intangible harms from strangers' alcohol consumption by respondents' sex and how respondents' drinking and sociodemographic characteristics were associated with the reporting of these alcohol‐related harms by strangers. Design and Methods . We analysed cross‐sectional data from household interviews administered in five Indian states from October 2011 to May 2012. We analysed data among 7332 adults who responded to all 12 questions on alcohol‐related harms from strangers' drinking and for whom data were available on drinking status and sex. Result . In this sample, 63.2% reported experiences of one or more harms from strangers' drinking in the past year, with 47.4% reporting at least one tangible harm. Nearly one‐fifth reported being physically harmed from strangers' alcohol consumption. Drinking by women did not predict reports of alcohol‐related harms from strangers, while drinking by men was associated with at least 1.9 greater odds of reporting these harms compared with non‐drinkers. Living in rural areas was associated with reduced odds of reporting psychological harms from strangers' drinking among women but greater odds of reporting physical and sexual harms among men. Discussion and Conclusions . In five Indian states, both drinkers and non‐drinkers report being harmed by strangers' alcohol consumption. Greater implementation and enhanced enforcement of multilevel interventions may effectively reduce these alcohol‐related harms, such as regulating the density of alcohol outlets, screening and brief interventions in health settings and community empowerment initiatives. [Esser MB, Gururaj G, Rao GN, Jayarajan D, Sethu L, Murthy P, Jernigan DH, Benegal V. Harms from alcohol consumption by strangers in five Indian states and policy implications. Drug Alcohol Rev 2016;00:000‐000]     

Associations between alcohol outlet densities and adolescent alcohol consumption: A study in Australian students

Objective

To assess whether the density of alcohol sales outlets in specific geographic communities is associated with adolescent alcohol consumption.

Method

A cross-sectional representative sample of secondary school students from Victoria, Australia (N = 10,143), aged between 12 and 17 years, self-reported on alcohol use in the last 30 days in 2009. The density of alcohol outlets per local community area was merged with this information.

Results

After controlling for risk factors, multilevel modelling (MLM) revealed a statistical interaction between age and density on alcohol consumption. While older adolescents had higher alcohol consumption, increases in the density of alcohol outlets were only significantly associated with increased risk of alcohol consumption for adolescents between the ages of 12 and 14.

Conclusion

Increased alcohol availability was associated with an increased risk of alcohol consumption specifically for early adolescents (12 and 14 years). Potential mechanisms as to how density is associated with direct and indirect alcohol availability, such as through parents or older siblings, need to be explored in future research.     

Associations of Alcohol Availability and Neighborhood Socioeconomic Characteristics With Drinking: Cross-Sectional Results From the Multi-Ethnic Study of Atherosclerosis (MESA)

Background: Living in neighborhoods with a high density of alcohol outlets and socioeconomic disadvantage may increase residents’ alcohol use. Few researchers have studied these exposures in relation to multiple types of alcohol use, including beverage-specific consumption, and how individual demographic factors influence these relationships. Objective: To examine the relationships of alcohol outlet density and neighborhood disadvantage with alcohol consumption, and to investigate differences in these associations by race/ethnicity and income. Methods: Using cross-sectional data (N = 5,873) from the Multi-ethnic Study of Atherosclerosis in 2002, we examine associations of residential alcohol outlet density and neighborhood socioeconomic disadvantage with current, total weekly and heaviest daily alcohol use in gender-specific regression models, as well as moderation by race/ethnicity and income. Results: Drinking men living near high densities of alcohol outlets had 23%–29% more weekly alcohol use than men in low density areas. Among women who drank, those living near a moderate density of alcohol outlets consumed approximately 40% less liquor each week than those in low density areas, but higher outlet densities were associated with more wine consumption (35%–49%). Living in highly or moderately disadvantaged neighborhoods was associated with a lower probability of being a current drinker, but with higher rates of weekly beer consumption. Income moderated the relationship between neighborhood context and weekly alcohol use. Conclusions/Importance: Neighborhood disadvantage and alcohol outlet density may influence alcohol use with effects varying by gender and income. Results from this research may help target interventions and policy to groups most at risk for greater weekly consumption.     

The relationship between the density of alcohol outlets and parental supply of alcohol to adolescents

This study investigated whether the number of alcohol outlets per 10,000 population in a given area (density) influenced parental supply of alcohol to adolescents; differences in Australian born and acculturating parents were also examined. A state-representative student survey in Victoria identified that the majority of adolescents (55%) reported that they had used alcohol in the past 12 months; 34 % of those who had consumed alcohol reported that it had been supplied by their parents. Multilevel modelling identified that there were no overall effects of density, however there were different effects based on parent country of birth and type of license. Specifically, each unit increase in the density of takeaway liquor stores increased the likelihood by 2.03 that children with both Australian-born parents would be supplied alcohol. Adolescents with both migrant parents on the other hand, had a 1.36 increased risk of being supplied alcohol as the density of outlets requiring at-venue consumption increased. The findings of this study suggest that in Australia, alcohol outlet density is associated with parental supply of alcohol to children, with this effect moderated by the cultural background of the parent and type of outlet density. Future research should investigate the association between the density of alcohol outlets and public approval of parents supplying alcohol to adolescents.     

Distances to on- and off-premise alcohol outlets and experiences of alcohol-related amenity problems

Introduction and Aims. There are a number of studies in recent years that have examined the relationship of alcohol outlets to the incidence of alcohol‐related problems. Only a small number of these studies examine the types of alcohol‐related problems which may be considered amenity problems, such as neighbourhood disturbance, litter and noise. This paper examines the association between the proximity of someone's home to alcohol outlets and their experience of public amenity problems. Design and Methods. Data came from an Australian general population survey: the Alcohol's Harm to Others Survey (2008). Two thousand six hundred and forty‐nine Australians aged 18 years and over were asked about their experiences of a number of amenity‐type problems and the distance they lived to the nearest on‐ and off‐premise alcohol outlet. Results. Bivariate results showed that respondents living closer to on‐ and off‐premise outlets reported more problems, with minor differences by distance to on‐ and off‐premise outlet. In multivariate logistic regression analyses, controlling for possible confounding effects of the respondent and neighbourhood characteristics, living closer to on‐premise outlets was independently associated with reporting being kept awake or disturbed at night and living closer to an off‐premise outlet was independently associated with reporting property damage. Discussion and Conclusions. A possible interpretation of the results is that respondents living close to on‐ and off‐premise outlets experience more amenity problems than those living further away, but that these experiences are concentrated among demographic groups who live in these areas. Direction of influence cannot be inferred from these cross‐sectional findings.[Wilkinson C, Livingston M. Distances to on‐ and off‐premise alcohol outlets and experiences of alcohol‐related amenity problems. Drug Alcohol Rev 2012;31:394–401]     

Accessibility of ‘essential’ alcohol in the time of COVID‐19: Casting light on the blind spots of licensing?

Among the Australian and UK governments' responses to the COVID‐19 pandemic has been the designation of outlets selling alcohol for off‐premise consumption as ‘essential’ services, allowing them to remain open while pubs, hotels and restaurants have been forced to close. In a context of restrictions on movement outside the home in both countries, and where alcohol providers are trying to find new ways to reach their customers, this may lead to an intensification of the social and health harms associated with home drinking. By examining the current situation in both Australia and the UK, we argue that heightened risks from home drinking amid COVID‐19 bring into sharp focus long‐standing weaknesses within licensing systems in both countries: the regulation of off‐premise outlets to minimise harms from drinking at home. We call for critical conversations on how licensing systems should be revised to take more responsibility for protecting people from the health and social harms associated with home drinking, both under COVID‐19 and in the future.     

Alcohol outlets,drug paraphernalia sales,and neighborhood drug overdose

BackgroundAlcohol outlets have been associated with various forms of injury and may contribute to neighborhood disparities in drug overdose. Few studies have examined the associations between alcohol outlets and drug overdose. This study investigated whether alcohol outlets were associated with the neighborhood drug overdose rate and whether the sale of drug paraphernalia contributes to this association.MethodsA cross-sectional ecological spatial analysis was conducted within census block groups in Baltimore City (n = 653). Outcomes were counts of EMS calls for any drug overdose in 2015 (n = 3,856). Exposures of interest were counts of alcohol outlets licensed for off-premise and on-premise consumption and the proportion of off-premise outlets selling drug paraphernalia (e.g., blunt wrappers, baggies, pipes). Negative binomial regression was used to assess the relationship between outlet count and overdose rate, and if paraphernalia sales altered this relationship, controlling for other neighborhood factors. Spatial autocorrelation was assessed and regression inference adjusted accordingly.ResultsEach additional off-premise alcohol outlet was associated with a 16.6% increase in the neighborhood overdose rate (IRR=1.17, 95%CI=(1.11, 1.23)), adjusted for other neighborhood variables. On-premise alcohol outlets were not significantly associated with overdose rate when adjusting for off-premise alcohol outlets (IRR=1.01, 95% CI=(0.97, 1.06)). The proportion of off-premise outlets that sold drug paraphernalia was negatively associated with overdose rate (IRR=0.55, 95% CI=(0.41, 0.74)) and did not alter the relationship between off-premise outlets and overdose.ConclusionThis study provides preliminary public health evidence for informing policy decisions about alcohol outlet licensing and zoning. Alcohol outlets could be potential community partners for harm reduction strategies such as health communication in identifying overdose symptoms or Good Samaritan Laws.     

Alcohol policy and harm reduction in Australia

With consultations having been held across Australia this year as part of the process of developing a new National Alcohol Strategy, it seemed timely to invite my colleagues from the National Drug Research Institute who are experts in the alcohol field to write this Harm Reduction Digest. The authors have canvassed a range of alcohol policy options and discussed their effectiveness in reducing harm for what is arguably Australia's number one drug problem. Australia's response to alcohol and other drug problems has, historically, been based on ‘harm minimization‐incorporating supply reduction, demand reduction and harm reduction’. At this time where the policy options for alcohol are being set for the next 5 years in a climate of ‘small government’, removing restrictions of ‘fair competition’ in business and a belief in the free market, what does the research have to say about recommended policies and strategies to reduce alcohol‐related harm?     

Alcohol‐related mortality in Ukraine

Introduction and Aims. To substantiate public health policies aimed at diminishing alcohol‐related harm, the level of alcohol‐related deaths needs to be documented on a national level. The aim of this study was to explore the opportunities provided by the 1985–1988 anti‐alcohol campaign related data for estimation of alcohol‐related mortality in Ukraine. Design and Methods. Ecological study design based on the aggregate‐level data analysis regarding the natural experiment in Ukraine. All‐cause and cause‐specific observed mortality levels in 1986‐88 compared to the extrapolated 1980–84 trends. The number and proportion of ‘prevented’ deaths were calculated for those causes, for which were observed: (1) reduction of mortality levels during the campaign and (2) increase after 1988. Alcohol‐attributable fractions of mortality per one litre of per capita consumption were calculated for each death cause based on prevented deaths and consumption decrease estimates. The total number of alcohol‐related deaths for a specific year was also calculated. Results. Ukraine experienced a large mortality reduction during the campaign. The estimates of prevented deaths revealed that at least 76% of the mortality reduction was attributable to alcohol. Alcohol‐related mortality due to injuries is much higher for men, while coronary heart disease (CHD) alcohol‐attributable fractions were about 0.5 in middle age both for men and women. Discussion and Conclusions. While in Western countries alcohol is considered as a protective factor for CHD, in Ukraine alcohol‐related cardiovascular mortality is rather high. In 2004 in Ukraine total number of alcohol‐related deaths was about 119,000 or 251 per 100,000 of population.[Krasovsky K. Alcohol‐related mortality in Ukraine. Drug Alcohol Rev 2009;28:396–405]     

A spatial analysis of the moderating effects of land use on the association between alcohol outlet density and violence in urban areas

Aims. While there is substantial evidence of an association between alcohol outlet density and assault, it is unlikely this association is constant across the urban environment. This study tested the moderating influence of land use on the outlet–violence association. Design. Cross‐sectional ecological study that controlled for spatial autocorrelation. Setting, Participants and Measurements. Police‐recorded data on simple and aggravated assaults were obtained for all 302 block groups (mean population = 1038) in Cincinnati, Ohio, USA. Addresses of alcohol outlets for Cincinnati were obtained from the Ohio Division of Liquor Control, geocoded to the street level, and aggregated to census block groups. Data on eight categories of land use were obtained from the Cincinnati Area Geographic Information System, with location quotients computed for each block group. Findings. We found substantial evidence that the impact of total alcohol outlet density, bar density and carryout density on assault density was moderated by land use. Conclusions. By taking into account local characteristics, policy‐makers can make more informed decisions when regulating the placement and density of alcohol licenses in urban areas. Similarly, more systematic knowledge of how the association between alcohol outlet density and assault varies across the urban landscape should reduce harm and promote responsible retailing. Nevertheless, ours is one of the first studies to address the moderating effect of land use and we encourage further research to test the stability and generalisability of our results.[Pridemore WA, Grubesic TH. A spatial analysis of the moderating effects of land use on the association between alcohol outlet density and violence in urban areas. Drug Alcohol Rev 2012;31:385–393]     

Alcohol and economic development: Observations on the kingdom of Bhutan

Bhutan is a small country undergoing rapid social change arising from income growth, urbanisation and Western cultural influence. Markers of poverty, namely infectious disease and infant mortality, have improved dramatically. The attention of health authorities is now focused on the non‐communicable disease and injury burdens, to which alcohol consumption is a major contributor. The paper draws on official data to characterise the consumption of alcohol and related harm, and the nature of the alcohol market, with commentary on crucial aspects of availability policies and drink‐driving regulation that need reform. Kypri K, Dorji G, Dalton C. Alcohol and economic development: Observations on the kingdom of Bhutan. Drug Alcohol Rev 2017;36:333?336.]     

Pills and pints: risky drinking and alcohol-related harms among regular ecstasy users in Australia

Introduction and Aims. A significant proportion of young Australians engage in risky alcohol consumption, and an increasing minority are regular ecstasy (3,4‐methylenedioxymethamphetamine) users. Risky alcohol use, alone or in combination with ecstasy, is associated with a range of acute and chronic health risks. The aim of this study was to document the incidence and some health‐related correlates of alcohol use, and concurrent alcohol and ecstasy use, among a large, national sample of regular ecstasy users (REU) in Australia. Design and Methods. National, cross‐sectional surveys of REU in Australia 2003–2008. Among REU in 2008 (n = 678) usual alcohol use, psychological distress and health‐related quality of life were measured using the Alcohol Use Disorders Identification Test, Kessler Psychological Distress Scale and Short Form‐8 Survey respectively. Results. Among REU in 2008, 36% reported high‐risk patterns of usual alcohol consumption, 62% reported usually consuming more than five standard drinks with ecstasy, and 24% reported currently experiencing high or very high levels of psychological distress. Controlling for age and education, high‐risk drinking among REU was associated with higher levels of psychological distress and poorer health‐related functioning; however, the associations between concurrent alcohol and ecstasy use, and health outcomes, were not significant (P > 0.05). Discussion and Conclusions. A large and increasing proportion of REU in Australia engage in high‐risk patterns of alcohol consumption, including in combination with ecstasy. High‐risk alcohol consumption among this group is associated with adverse health‐related outcomes. Prevention and harm reduction interventions for REU should incorporate messages about the risks associated with alcohol use. There is an ongoing need for youth‐specific, coordinated alcohol and other drug and mental health services.[Kinner SA, George J, Johnston J, Dunn M, Degenhardt L. Pills and pints: Risky drinking and alcohol‐related harms among regular ecstasy users in Australia. Drug Alcohol Rev 2012;31:273–280]     

Alcohol availability and homicide in New Orleans: conceptual considerations for small area analysis of the effect of alcohol outlet density.

OBJECTIVE: To determine the geographic relation between homicide rate and two competing measures of exposure to alcohol outlets, alcohol outlets per square mile and alcohol outlets per person. METHOD: Homicides occurring in 1994 and 1995 and on-sale and off-sale alcohol outlets with active 1995 licenses were geocoded by address for aggregation at the census tract level. Ecologic analysis of the 155 urban residential census tracts in New Orleans was conducted with controls for potential sociodemographic confounders (% black, % adults unemployed, % unmarried households, and ratio males 15-24/males 35-44). RESULTS: After logarithmic transformation of all study variables, sociodemographic confounders alone accounted for 58% (R2 = .58) of the variance of homicide rates. Adding off-sale alcohol outlet density to the models, measured (beta +/- SE) either as outlets per square mile (beta = .211 +/- .062) or outlets per person (beta = .244 +/- .063), yielded strong geographic relations with homicide and increased the amount of variance explained (R2 = .62). A 10% higher off-sale outlet density accounted for a 2.4% higher homicide rate. CONCLUSIONS: Both off-sale alcohol outlets per square mile and off-sale outlets per person demonstrate strong geographic associations with homicide rates among urban residential census tracts in New Orleans. These findings suggest that communities faced with high rates of assaultive violence might consider policy interventions that address alcohol outlet related factors.     

Saturday opening of alcohol retail shops in Sweden: an impact analysis

OBJECTIVE: The objective of this study was to assess the impact of Saturday opening of alcohol retail shops in Sweden. METHOD: An experimental design was applied. Prior to February 2000, all alcohol monopoly outlets we closed on Saturdays. After this date, stores in an experimental area (six counties) were open on Saturdays. In the control area (seven counties) the shops remained closed. To prevent biases resulting from border trade, the experimental and control areas were separated by a border area (seven counties). The outcome measures included alcohol sales and indicators of assaults and drunken driving. The pre-intervention period covered January 1995-January 2000, and the post-intervention period February 2000-June 2001 (17 months). The data were analyzed on a monthly basis through ARIMA-modeling according to the Box-Jenkins technique. RESULTS: The analysis uncovered a statistically significant increase in alcohol sales of 3.3%. There were no significant changes in any of the assault indicators. There was a statistically significant increase in drunken driving (8.3%) on Saturdays-Sundays; however, further analyses suggested this increase was due mainly to a change in the surveillance strategy of the police. CONCLUSIONS: The Saturday opening of alcohol retail shops seems to have increased consumption but not alcohol-related harm. The absence of a significant effect on harm indicators could signify either that no such effect is present or that the design has insufficient power to uncover effects of the expected magnitude.     

Alcohol Marketing in the 21st Century: New Methods,Old Problems

Marketing and advertising for alcoholic beverages is abundant throughout the United States and the rest of the world. Despite the fact that alcohol advertising is related to earlier initiation of drinking, higher rates of consumption, and positive expectancies among youth populations, alcohol companies continue to design new products and related campaigns with youth-friendly attributes. Alcopops and caffeinated alcoholic beverages are two particularly dangerous types of products, and new social networking technologies make direct promotion easy and voluminous. In order to stop the harm from these alcohol products and promotion, advocacy from the research community is imperative.     

DUI pre-arrest alcohol purchases: a survey of Sonoma County drunk drivers.

Based on a sample of 1,052 drunk drivers in northern California, less than 1% (0.80%) of those arrested for DUI had purchased and consumed alcohol prior to arrest from a convenience/gas store (gasmart). Data from both "on-sale" (on-premises consumption) and "off-sale" (off-premises consumption) alcohol outlets were compared. When off-sale outlets were compared only 2% of the DUI offenders had purchased and consumed alcohol from gasmarts prior to the arrest event. Gasmarts were the least frequent source of DUI-offender alcohol purchases. This report also describes the distribution of alcohol outlets for Sonoma and San Diego counties with respect to type of license and activity. Convenience stores that sold gas and alcohol concurrently were not overrepresented in either county.     

Acute Alcohol Consumption,Alcohol Outlets,and Gun Suicide

A case–control study of 149 intentionally self-inflicted gun injury cases (including completed gun suicides) and 302 population-based controls was conducted from 2003 to 2006 in a major US city. Two focal independent variables, acute alcohol consumption and alcohol outlet availability, were measured. Conditional logistic regression was adjusted for confounding variables. Gun suicide risk to individuals in areas of high alcohol outlet availability was less than the gun suicide risk they incurred from acute alcohol consumption, especially to excess. This corroborates prior work but also uncovers new information about the relationships between acute alcohol consumption, alcohol outlets, and gun suicide. Study limitations and implications are discussed.     

The Drinking Expectancy Questionnaire for Men who have Sex with Men (DEQ-MSM): a measure of substance-related beliefs

Introduction and Aims. Alcohol expectancies are associated with drinking behaviour and post‐drinking use thoughts, feelings and behaviours. The expectancies held by specific cultural or sub‐cultural groups have rarely been investigated. This research maps expectancies specific to gay and other men who have sex with men (MSM) and their relationship with substance use. This study describes the specific development of a measure of such beliefs for alcohol, the Drinking Expectancy Questionnaire for Men who have Sex with Men (DEQ‐MSM). Design and Methods. Items selected through a focus group and interviews were piloted on 220 self‐identified gay or other MSM via an online questionnaire. Results. Factor analysis revealed three distinct substance reinforcement domains (‘Cognitive impairment’, ‘Sexual activity’ and ‘Social and emotional facilitation’). These factors were associated with consumption patterns of alcohol, and in a crucial test of discriminant validity were not associated with the consumption of cannabis or stimulants. Similarities and differences with existing measures will also be discussed. Discussion and Conclusions. The DEQ‐MSM represents a reliable and valid measure of outcome expectancies, related to alcohol use among MSM, and represents an important advance as no known existing alcohol expectancy measure, to date, has been developed and/or normed for use among this group. Future applications of the DEQ‐MSM in health promotion, clinical settings and research may contribute to reducing harm associated with alcohol use among MSM, including the development of alcohol use among young gay men.[Mullens AB, Young R McD, Dunne MP, Norton G. The Drinking Expectancy Questionnaire for Men who have Sex with Men (DEQ‐MSM): A measure of substance‐related beliefs. Drug Alcohol Rev 2011;30:372–380]     

Predictors of neurotic symptom severity among female drug users in Glasgow,Scotland

The current study tracks the drinking behaviour of new police recruits from their first day in the academy, after 6 months of training, through to one year into training ( n = 177). Drinking behaviour was assessed with the AUDIT, a well-researched instrument for assessing risk of harm from drinking behaviour. The results showed that recruits' risk of harm from alcohol consumption increased as their training progressed. These findings, based on a longitudinal methodology, suggest that the police service and training process introduces recruits into a culture of alcohol consumption which may impact on their individual consumption levels.     

Estimating alcohol‐attributable mortality among Indigenous Australians: Towards Indigenous‐specific alcohol aetiologic fractions

Introduction and Aims. Past estimates of Indigenous alcohol‐attributable health in Australia have been based on drinking prevalence estimates from the general population, rather than prevalence figures from the Indigenous population. The purpose of this paper is to demonstrate the efficacy of using Indigenous‐specific drinking prevalence to estimate alcohol‐attributable deaths among Indigenous Australians. Design and Methods. Estimates of Indigenous alcohol‐attributable deaths between 2000 and 2004 were obtained using both (i) national general‐population drinking prevalence estimates and (ii) national Indigenous‐specific drinking prevalence. Estimates were calculated using the ‘aetiologic fraction’ method. Results. By using national general‐population drinking prevalence figures, past reports on Indigenous health have underestimated alcohol‐attributable deaths for the national Indigenous population. Female deaths due to alcohol‐attributable haemorrhagic stroke were estimated to be approximately four times higher and alcohol‐attributable suicides among men were estimated to be 30% higher than was previously held, when Indigenous‐specific drinking prevalence figures were used. Discussion and Conclusions. By substituting Indigenous‐specific alcohol consumption prevalence estimates for general‐population drinking prevalence, the accuracy of estimates of alcohol‐related harm among Indigenous Australians can be significantly improved.[Pascal R, Chikritzhs T, Gray D. Estimating alcohol‐attributable mortality among Indigenous Australians: Towards Indigenous‐specific alcohol aetiologic fractions. Drug Alcohol Rev 2009;28:196–200]