The relationship between alcohol problems, perceived risks and attitudes toward alcohol policy in Canada

Introduction and Aims. Approval of alcohol policies by the public in democratic countries is critical for instituting social change. With respect to alcohol policies, mounting research indicates that a higher price per unit of ethanol is an effective approach for reducing alcohol‐related problems, yet surveys have found this approach is usually unpopular. The purpose of this paper is to assess the relationship between amount of drinking and support for various alcohol policies. Design and Methods. A secondary analysis was conducted on the Canadian Addictions Survey, a randomised telephone survey of over 10 000 Canadians. The relationship between the amounts of drinking reported by the respondents was examined in relation to the perceived seriousness of alcohol problems in their communities and the endorsement of several alcohol policies. Results. Increased amount of drinking was significantly related to lower perceptions of drinking‐related risks. Furthermore, heavier consumers had less favourable attitudes than lighter drinkers and abstainers toward alcohol policies, such as increased taxation. Aggregated data across the 10 Canadian provinces showed a strong effect size (r = ?0.515, P = 0.128) between endorsement of alcohol taxation and rates of hospital separations for alcohol. Discussion and Conclusions. Results from this study show that the more that people drink, the more they oppose taxation. The implications of these findings are that as alcohol problems in communities become worse, the population may become more resistant to effective alcohol policies. Strategies are suggested for implementing effective policies.[Macdonald S, Stockwell T, Luo J. The relationship between alcohol problems, perceived risks and attitudes toward alcohol policy in Canada. Drug Alcohol Rev 2010;30:652–658]     

A European union concerted action: Alcohol consumption and alcohol problems among women in European countries

Traditionally, less research has been conducted on women's drinking as compared to men's. But women's drinking has been shown to differ from men's in terms of consumption patterns and in factors determining heavy and problematic drinking. Thus, special efforts are needed to increase knowledge in this field. This article introduces a set of papers from the recently completed concerted action project “Alcohol Consumption and Alcohol Problems among Women in European Countries, “ supported by the European Commission. The aim of the study was to examine and compare the drinking patterns and problems of women in 9 European countries. This was done by comparing alcohol consumption and alcohol problem rates within and between countries and between men and women and among women. The project also developed recommendations for much needed standardized measures of alcohol consumption and alcohol problems for use in European alcohol epidemiological research.     

Public opinion and community-based prevention of alcohol-related harms

Aim: This article looks at alcohol policy opinions from the point of view of the possibilities and frames for creating local alcohol control policy. Local action against harms related to drinking is a compromise between different points of view, and the question of public support is important for community-based prevention. Data and analyses: The respondents of a postal questionnaire were asked if they supported different alcohol policy measures, and logistic regression analyses were carried out to examine the impact of the demographic characteristics, drinking measures and observations of alcohol-related harms in the community. Results: The wide majority of the population supported such measures suitable for community-based prevention as enforcement of the minimum legal age to purchase alcohol, surveillance of restaurants and shops, and the ban to sell alcohol to a drunken person. Decreasing numbers of outlets of restaurants or their opening hours were least popular. There was a relationship between drinking habits and alcohol policy opinions. Abstainers and moderate drinkers were most likely to support all alcohol policy measures examined, whilst heavier drinkers were least likely to support them. There was a connection between awareness of alcohol problems in one's locality, and favourable opinions on alcohol control measures. The result is similar with the ones found earlier in other countries. Conclusion: Potential members of local alcohol policy coalitions seem to have some similarities in different countries.     

Support for alcohol policies from drinkers in the City of Tshwane,South Africa: Data from the International Alcohol Control study

Introduction and Aims. South Africa is considering a range of alcohol policy reforms. This study aims to determine the magnitude of public support for 13 alcohol policies in the Tshwane Metropolitan Municipality and whether this varies by demographic factors and heavy drinking status. Design and Methods. Data are from the South African arm of the International Alcohol Control study, a household survey of adult drinkers using a multistage stratified cluster random sampling design. The sample included 1920 drinkers aged 18–65 years (62% men), with complete drinking data for 16 drinking locations on 955 persons (510 heavy and 445 not heavy drinkers). Results. Over half (53%) of the sample were found to be heavy drinkers. Support varied by alcohol policy, ranging from 31% to 77%, with support above 50% for 11 of the 13 policies. Policy support was higher for policies increasing the purchase age to 21 years (77%), addressing drink driving (58–76%) and restricting physical availability (60–66%). There was slightly less support for policies restricting alcohol marketing (59%) or for policies increasing the price of alcohol (34–58%), especially if no justification was given or the funds were not earmarked. Policy support differed by age, gender, heavy drinking status and income. Discussion and Conclusions. Public support from adult drinkers for a range of alcohol policies is extensive and, as found elsewhere, was strongest for raising the minimum drinking age and lowest for increasing prices. The support from drinkers to increasing controls on alcohol could be one lever to getting control measures implemented. [Parry CDH, Trangenstein P, Lombard C, Jernigan DH, Morojele NK. Support for alcohol policies from drinkers in the City of Tshwane, South Africa: Data from the International Alcohol Control study. Drug Alcohol Rev 2017;00:000‐000]     

Performance of Screening Instruments for Alcohol Use Disorders in Emergency Department Patients in Argentina

The performance of the Alcohol Use Disorders Identification Test (AUDIT), CAGE, Brief Michigan Alcohol Screening Test (Brief MAST), Rapid Alcohol Problems Screen (RAPS), Rapid Alcohol Problems Screen-Quantity and Frequency (RAPS4-QF), and TWEAK was evaluated against a diagnosis of alcohol dependence and harmful drinking or alcohol abuse from ICD-10 and DSM-IV criteria. Data were collected from a probability sample of 779 patients admitted to the emergency department of a public general hospital in Mar del Plata, Argentina, during the year 2001. The majority of the patients sampled were male. The age range was 18 to 89 years, with a mean value of 36 years and a median of 31 years. Almost half of the sample had an elementary school education or less. All instruments were more sensitive for alcohol dependence than for harmful drinking or abuse and more sensitive for men than for women. Findings suggest the RAPS4 and RAPS4-QF may be preferred when screening for alcohol use disorders in the emergency department in Argentina. The study's limitations are noted.     

Grasping the thistle: The role of alcohol brief interventions in Scottish alcohol policy

Issue. Scotland has experienced a substantial rise in alcohol‐related harm, which is now one of the biggest public health challenges it faces. Approach. Alcohol problems in Scotland are described along with national alcohol policy response in addressing them. The role of a program of Alcohol Brief Interventions is discussed therein. Key Findings. In Scotland, considerable proportions of the population are drinking hazardously or harmfully, common across different age and socioeconomic groups. Rising consumption has been set in wider environmental changes with alcohol becoming more available and affordable. Scotland has had one of the fastest growing chronic liver disease mortality rates in the world at a time when rates in most of Western Europe are falling. Scotland's alcohol policy has an explicit aim to reduce population consumption and includes legislative measures to tackle price and availability. A national program to deliver Alcohol Brief Interventions for hazardous drinkers is a key plank of this wider strategy. A portfolio of studies will monitor and evaluate national policy and, through contribution analysis, describe the role Alcohol Brief Interventions play in reducing alcohol misuse. Implications. Effective alcohol policy recognises that determinants of health not only lie at individual level, but include wider social, environmental and economic factors. Scotland's policy is addressing these determinants with both population‐based and population‐targeted interventions. Conclusion. Scotland has a serious problem with alcohol. A comprehensive, evidence‐based, resourced alcohol policy is being implemented, which will need continual review to ensure it remains anchored in evidence while maintaining its ambition.[Graham LJC, MacKinnon D. Grasping the thistle: The role of alcohol brief interventions in Scottish alcohol policy. Drug Alcohol Rev 2010;29;603–607]     

Performance of screening instruments for alcohol use disorders in emergency department patients in Argentina

The performance of the Alcohol Use Disorders Identification Test (AUDIT), CAGE, Brief Michigan Alcohol Screening Test (Brief MAST), Rapid Alcohol Problems Screen (RAPS), Rapid Alcohol Problems Screen-Quantity and Frequency (RAPS4-QF), and TWEAK was evaluated against a diagnosis of alcohol dependence and harmful drinking or alcohol abuse from ICD-10 and DSM-IV criteria. Data were collected from a probability sample of 779 patients admitted to the emergency department of a public general hospital in Mar del Plata, Argentina, during the year 2001. The majority of the patients sampled were male. The age range was 18 to 89 years, with a mean value of 36 years and a median of 31 years. Almost half of the sample had an elementary school education or less. All instruments were more sensitive for alcohol dependence than for harmful drinking or abuse and more sensitive for men than for women. Findings suggest the RAPS4 and RAPS4-QF may be preferred when screening for alcohol use disorders in the emergency department in Argentina. The study's limitations are noted.     

Public opinion and alcohol policy: comparisons of two Canadian general population surveys

In recent years increasing attention has been devoted to the association between public opinion and alcohol policy. This paper compares public opinion on alcohol policy questions in two national crosssectional surveys of representatives samples of the general population in Canada, with total Ns of 11 634 (1989) and 12 155 (1994). Views on the following topics are analysed: taxation of alcoholic beverages, the legal drinking age, beer and liquor store hours, government advertising against drinking, efforts to prevent drunken patrons from being served, adding warning labels on alcoholic beverage containers, selling alcohol in convenience (corner) stores, alcohol and drug education and treatment programs. Public support for current and potential alcohol policies is compared to actual changes in alcohol policy at the national level and to gradual or dramatic increases in access to alcohol in provincial contexts. Personal views on policies are placed into context by examining associations among support for policies, respondents' demographic characteristics and their drinking volumes and patterns. A decline in support for further or enhanced policy interventions is evident, although support remains high for several measures. In some instances public responses seemed to be a reaction to increased access, in others a confirmation of greater availability. \[Giesbrecht N, Kavanagh L. Public opinion and alcohol policy: comparisons of two Canadian general population surveys. Drug Alcohol Rev 1999;18:7-19]     

How the quality of peer relationships influences college alcohol use

Peer relationships are consistently linked to alcohol use in college students. However, this disparate literature often reveals contradictory findings regarding the precise mechanisms of peer influence. In this review, we use an organisational framework based on social learning theory (SLT) to demonstrate how the quality of peer relationships may influence personal alcohol use. We propose that the quality of peer relationships enhance the influence of social reinforcement, modelling and cognitive processes on personal alcohol use. Research indicates that the quality of peer relationships influences drinking via three pathways: the lack or breakdown of quality peer relationships, alcohol use being an integral part of peer interactions, and if peers disapprove of alcohol use or do not drink. This conceptualisation of peer influence informs the consistent finding of gender differences in college student drinking. Limitations of the reviewed research include reliance on cross-sectional surveys, self-report and homogeneous populations. Future directions for research on quality peer relationships involve detailed longitudinal assessment and the application of advanced statistical methods. [Borsari B, Carey KB. How the quality of peer relationships influences college alcohol use. Drug Alcohol Rev 2006;25:361 - 370]     

Effects of alcohol controls: Nordic research traditions

Drawing on a recent review of studies of the impact of alcohol control changes in the Nordic countries (particularly Finland, Norway and Sweden), this paper reviews the development of research traditions of such studies in the Nordic countries. From the Nordic experience, there is evidence of variation in the effects of policy changes by demographic segment, by type of problem and by drinking pattern and amount. Policy changes have often had their greatest effect on heavier drinkers. Big reductions in alcohol taxes in Denmark in 2003 and Finland in 2004 offer a new chance to study whose drinking changes how much, and in what contexts, in a collaborative study comparing northern Sweden with Finland, Denmark and southern Sweden. [Room R. Effects of alcohol controls: Nordic research traditions. Drug Alcohol Rev 2004;23:43-53]     

Caffeinated alcohol consumption profiles and associations with use severity and outcome expectancies

Growing evidence suggests that the consumption of caffeinated alcoholic beverages (CAB) may be riskier than alcohol alone. Efforts to identify patterns of CAB use and the correlates of such drinking patterns could further our conceptualization of and intervention for this health issue. Consequently, the current study aimed to (1) identify distinct classes of CAB users, (2) examine differences between classes on measures of alcohol and caffeine problems, and (3) compare distinct classes of CAB users on caffeine and alcohol outcome expectancies. Participants were 583 (31% men) undergraduate students from a psychology research pool. Latent profile analysis models were derived using four indicators: CAB use quantity, CAB use frequency, alcohol use quantity, and alcohol use frequency. Finding revealed four classes of drinkers: High Alcohol/High CAB (6.00%), High Alcohol/Moderate CAB (5.15%), High Alcohol/Low CAB (22.99%), and Low Alcohol/Low CAB (65.87%). The Low Alcohol/Low CAB class reported the lowest relative levels of caffeine dependence symptoms, caffeine withdrawal, alcohol use problems, and heavy episodic drinking frequency. Further, results indicated differential expectancy endorsement based on use profiles. CAB users in the High Alcohol/Low CAB class endorsed more positive alcohol expectancies than the Low Alcohol/Low CAB group. Those in the High Alcohol/High CAB class endorsed stronger withdrawal symptom caffeine expectancies than all other classes. Inclusion of substance-specific expectancies into larger theoretical frameworks in future work of CAB use may be beneficial. Findings may inform intervention efforts for those at greatest risk related to CAB consumption.     

Mapping Australian public opinion on alcohol policies in the new millennium

Introduction and Aims. Drawing on 16 items in the 2004 National Drug Strategy Household Survey (NDSHS), the paper explores the degree to which Australian public opinion towards different alcohol policies cohere or diverge, and the social location of support for and resistance to more restrictive alcohol controls. Variations in support for particular policies by demographic groups, across states and territories and among those with difference drinking patterns are explored. The extent and direction in which attitudes have changed over time was determined. Design and Methods. Sixteen items from the 2004 NDSHS were subjected to factor analysis. Both a single factor and a four‐factor solution were derived and became the dependent variables for state/territory comparisons and multiple regression analyses determining the predictive power of respondents demographics and drinking behaviour. Trends over time in alcohol policy attitudes used the 1993, 1995, 1998, 2001 and 2004 NDSHS. Results. More severe penalties against drink driving and stricter laws against serving customers who were drunk had the strongest support while policies that controlled accessibility to alcohol such as reducing trading hours received the least support. For all policies support was greater among females, older respondents and those drinking less. The individual's drinking pattern was as strong, and in some cases a stronger predictor of support than gender and age. Discussion and Conclusions. While support for the majority of the alcohol policies decreased over the 11‐year period since 1993, attitudes may be influenced and changed over a shorter period of time.[Wilkinson C, Room R, Livingston M. Mapping Australian public opinion on alcohol policies in the new millennium. Drug Alcohol Rev 2009]     

Alcohol Consumption and Alcohol Problems Among Women in European Countries

Traditionally, less research has been conducted on women's drinking as compared to men's. But women's drinking has been shown to differ from men's in terms of consumption patterns and in factors determining heavy and problematic drinking. Thus, special efforts are needed to increase knowledge in this field. This article introduces a set of papers from the recently completed concerted action project Alcohol Consumption and Alcohol Problems among Women in European Countries, supported by the European Commission. The aim of the study was to examine and compare the drinking patterns and problems of women in 9 European countries. This was done by comparing alcohol consumption and alcohol problem rates within and between countries and between men and women and among women. The project also developed recommendations for much needed standardized measures of alcohol consumption and alcohol problems for use in European alcohol epidemiological research.     

Anticipated and subjective sensitivities to alcohol

The development and maintenance of alcohol use patterns may depend, in part, on differences between how an individual anticipates he will respond to alcohol and how he appears to others when he is drinking. Such differences may introduce bias in decisions regarding which activities are safe while under the influence of an intoxicating amount of alcohol. This study of 387 participants of the Colorado Alcohol Research on Twins and Adoptees project examined the interrelationships of anticipated, subjective and observer-judged sensitivity to a blood alcohol concentrations of about 0.1 g/dl (approximated by breath alcohol concentration). Differences among the sensitivity measures were dependent upon recent alcohol drinking history and individual differences in actual sensitivity (as observer-rated). The results were consistent with hypotheses that people with little drinking experience may overestimate how intoxicated they will be, that heavier drinkers may develop chronic tolerance to the intoxicating effects and that denial may play a role in both subjective and anticipated sensitivity.     

A review of emergency room studies on alcohol and injuries conducted in Latin America and the Caribbean region

Issues. Alcohol-attributable burden of injury is one of the most serious public health problems in Latin America and the Caribbean region (LAC). Although knowledge on alcohol's involvement in injuries has progressed along with the implementation of evidenced-based alcohol policies in developed countries, this was not true for the most part of LAC countries for which reducing alcohol-related injuries is an urgent necessity. Approach. A systematic review was performed in order to identify the most up-to-date information on alcohol and injuries derived from emergency room (ER) studies conducted in LAC. Key Findings. Findings corroborate that alcohol has a high prevalence among injured patients in the ER setting in LAC, with violence-related injuries showing an increased association with alcohol use compared to unintentional injuries. However, a large number of studies did not include all types of injury and the measurement of injury risk associated with alcohol consumption. The amount of alcohol consumed in the event and hazardous drinking patterns seem to be strongly associated with injury occurrence, as well as drinking in public spaces, but a paucity of data relating to social-contextual factors limits the interpretation of the heterogeneity in the magnitude of the association of alcohol and injuries found across studies. Conclusions. There is a lack of ER studies able to support strategies to reduce alcohol-related injuries in a region where effective alcohol policies are scant. Future research should focus on understanding how drinking influenced by local contexts and drinking behaviours may affect the risk of injury within each LAC country.[Andreuccetti G, Carvalho HB, Korcha R, Ye Y, Bond J, Cherpitel CJ. A review of emergency room studies on alcohol and injuries conducted in Latin America and the Caribbean region. Drug Alcohol Rev 2012;31:737-746].     

Student Drinking at U.S. College Sports Events

Alcohol consumption control policies at U.S. intercollegiate sports events, and their association with student drinking, were assessed using data from a 2001 nationally representative survey of students and administrators (n = 7,261 students, N = 117 colleges). Alcohol was available to sports event attendees through in-stadium sales, tailgating parties, and allowing spectators to bring in alcohol. Policies varied by college, with fewer restrictions at large public schools with NCAA Division I athletics. Permitting alcohol at tailgate parties was associated with more students drinking at sports events. Future research should evaluate whether enacting policy restrictions can reduce drinking and related problems at intercollegiate sports events.     

Maternal alcohol consumption producing fetal alcohol spectrum disorders (FASD): Quantity,frequency, and timing of drinking

Background

Concise, accurate measures of maternal prenatal alcohol use are needed to better understand fetal alcohol spectrum disorders (FASD).

Methods

Measures of drinking by mothers of children with specific FASD diagnoses and mothers of randomly-selected controls are compared and also correlated with physical and cognitive/behavioral outcomes.

Results

Measures of maternal alcohol use can differentiate maternal drinking associated with FASD from that of controls and some from mothers of alcohol-exposed normals. Six variables that combine quantity and frequency concepts distinguish mothers of FASD children from normal controls. Alcohol use variables, when applied to each trimester and three months prior to pregnancy, provide insight on critical timing of exposure as well. Measures of drinking, especially bingeing, correlate significantly with increased child dysmorphology and negative cognitive/behavioral outcomes in children, especially low non-verbal IQ, poor attention, and behavioral problems. Logistic regression links (p < .001) first trimester drinking (vs. no drinking) with FASD, elevating FASD likelihood 12 times; first and second trimester drinking increases FASD outcomes 61 times; and drinking in all trimesters 65 times. Conversely, a similar regression (p = .008) indicates that drinking only in the first trimester makes the birth of a child with an FASD 5 times less likely than drinking in all trimesters.

Conclusions

There is significant variation in alcohol consumption both within and between diagnostic groupings of mothers bearing children diagnosed within the FASD continuum. Drinking measures are empirically identified and correlated with specific child outcomes. Alcohol use, especially heavy use, should be avoided throughout pregnancy.     

Association between concurrent alcohol and tobacco use and poverty

Introduction and Aims. The harm from alcohol and tobacco use in low‐ and middle‐income countries includes substantial economic cost to the individual. Our aim was to describe the expenditure on concurrent alcohol and tobacco use in relation to family income in two districts in Sri Lanka. Design and Methods. A community‐based cross‐sectional study was carried out in two districts in Sri Lanka. We sampled 2684 men over 18 years of age using multistage cluster sampling. Cost of alcohol and cigarettes was calculated using the retail price for each brand and multiplying by the amount consumed. Results. Among current alcohol users 63.1% were also smokers. Among current smokers 61.9% were also using alcohol. Prevalence of concurrent alcohol and tobacco use in urban areas was 20.1% and in rural areas 14%. The two lowest income categories (<$US76 per month) spent more than 40% of their income on concurrent use while the next category ($US76–143 per month) spent 34.8% of their income on concurrent use. Discussion and Conclusions. The poor spent less than those with higher income on alcohol and tobacco, but the expenditure constituted a much larger slice of their income thus compromising their ability to meet basic needs. In low‐income countries, damaging economic consequences start at lower levels of alcohol and tobacco consumption and affect a significant proportion of the population. Defining risk levels and guidelines on safe limits based purely on individual health harm has, at best, little meaning in such settings.[de Silva V, Samarasinghe D, Hanwella R. Association between concurrent alcohol and tobacco use and poverty. Drug Alcohol Rev 2011;30;69–73]     

Dose-response expectancies for alcohol: Validation and implications for brief interventions

Introduction and Aims. Brief interventions for alcohol problems are informed by elements of behavioural motivation theories and behaviour change models. However, motivations across drinking occasions have yet to be explored. This paper addresses this need and presents initial validity statistics for a new construct, Dose Response Expectancies for Alcohol Metrics (DREAM) that can be used to investigate expectancies across the drinking session and thus inform novel interventions. Design and Methods. Twenty‐seven participants completed a test–retest reliability assessment. Hypothesised systematic relationships between the hypothetical number of drinks consumed across a drinking session and anticipated affective responses were assessed. Results. The DREAM questionnaire yielded good test–retest statistics for anticipated happiness and nausea in the hours following drinking. Consistent with hypotheses, DREAM yielded a systematic relationship between anticipated alcohol dose and affective response. Discussion and Conclusions. DREAM offers a novel means to investigate alcohol dose–response expectancies across drinking sessions and to therefore provide a theoretical platform that can be used to inform effective brief interventions for young people.[Adey GE, Moore SC, Chestnutt IG. Dose–response expectancies for alcohol: Validation and implications for brief interventions. Drug Alcohol Rev 2010;29;662–668]     

Work-place screening of mine employees using the alcohol use disorders identification test (AUDIT) and alcohol breathalyzation

Although public health campaigns focusing on alcohol in the work-place are receiving increasing attention, there is little empirical evidence regarding the use of screening. In this work-place study, 152 mining personnel (67% of the work-force) completed a self report screen using the Alcohol Use Disorders Identification Test (AUDIT). One hundred and thirty-three of these (58.5% of the work-force) also consented to be breathalysed and one (0.75%) recorded a BAC just over threshold for detection. Forty-eight males (37.7% of the male work-force) recorded AUDIT scores of eight or more consistent with hazardous alcohol use and one female registered a cumulative score above the female cut-off level for hazardous alcohol use. Eighty males (67% of the work-force), recorded binge drinking at least monthly and 81 males recorded a cumulative AUDIT score of less than eight; however, on item analysis, 64 (83%) of these recorded binge drinking at least sometimes. There is substantial hazardous alcohol use in this sample work group and younger males had higher alcohol consumption, more adverse consequences and higher total AUDIT scores identifying them as particularly at risk. The Cronbach & AUDIT was 0.72, confirming adequate internal consistency.