High-alcohol-content flavored alcoholic beverages (supersized alcopops) should be reclassified to reduce public health hazard

In the US, underage drinkers often consume supersized alcopop – a high-alcohol-content, ready-to-drink flavored alcoholic beverage that is currently regulated as beer. However, calculations in this paper illustrate how the high alcohol by volume and low price of supersized alcopops suggest that they rely on a larger proportion of additives for their alcohol content than permitted to meet the legal definition for beer. From a public safety perspective, it is urgently important that the Alcohol and Tobacco Tax and Trade Bureau assess the formulation of supersized alcopops – specifically, the percent of alcohol in the finished product that is derived from additives. Appropriate reclassification of supersized alcopops as distilled spirits would reduce youth access by resulting in increased price and reduced availability at the retail locations where youth most often obtain alcohol.     

Tracking drinking behaviour from age 15-19 years

Aims The aim of this paper was to assess (1) changes in drinking behaviour over time among Danish adolescents and (2) use of which alcoholic beverages and what drinking patterns would have the strongest predictive effect on later alcohol consumption. Design, setting, participants The population was a random sample of 15‐year‐olds (baseline 1990, response rate 86%, n= 847) with a first follow‐up 4 years later (response rate 85%, n= 729). Measurements Alcohol intake was assessed by experience of drunkenness, quantity and frequency of consumption. Thresholds recommended by the Danish National Board of Health were used to discriminate high from low intake. Findings At 19 years of age at least 80% drank alcohol monthly, and 24% of the men and 11% of the women had an alcohol intake above the recommended national limits, i.e. 21 weekly units of alcohol for men and 14 for women. Consumption of alcoholic beverages at age 15 increased the risk of drinking alcohol weekly at the age of 19 [odds ratio (OR)‐values from 1.11 to 3.53]. Drunkenness among the 15‐year‐old boys and the use of spirits of the 15‐year‐old girls showed the strongest predictive relationship with excessive consumption at age 19 [OR = 2.44, confidence interval (CI): 1.38–4.29, respectively, OR = 1.97, CI: 1.15–3.38]. Conclusions Alcohol consumption as early as the age of 15 predicted weekly alcohol consumption and alcohol intake exceeding the recommended amount 4 years later. Young teenagers’ high alcohol consumption was not just a passing phenomenon. It was a behaviour that tracked into young adulthood, leaving the adolescents at increased risk of being long‐term, large‐scale consumers.     

How much alcohol do you buy? A comparison of self‐reported alcohol purchases with actual sales

Background Unrecorded alcohol has increased in the Nordic countries during recent years, above all in terms of cross‐border trade. This implies that trends and levels of per capita consumption would look different without estimates of this source of alcohol, estimates that in Sweden and other countries are made through surveys. Aim The overall aim is to analyse the validity of Swedish survey estimates of alcohol bought in the cross‐border trade and possibly to develop weights that can be applied to such estimates. Data and method The analysis consists of comparing self‐reported purchases of spirits, wine, cider/alcopops and beer at retail monopoly (Systembolaget) during 2008 (n = 18 000) with actual sales during the same period overall and monthly. Findings Of the recorded amount of purchases at Systembolaget, 87% was reported in the survey, compared with the 40–60% usually found for self‐reported consumption. Significant differences across beverages were revealed, showing a lower coverage rate for beer and spirits and a higher coverage rate for wine and cider. Changes in purchases of all beverages were captured fairly well, at least changes taking place from one month to another. Conclusions Self‐reported alcohol purchases achieve a higher coverage rate than found typically in studies based on self‐reported use of alcohol. If adjustments are to be made to correct for underreporting in self‐reported data on alcohol purchases, different weights should be applied to different beverages. Furthermore, at least major changes in how much alcohol is purchased in the population can be monitored using well‐designed population surveys.     

Estimated blood alcohol concentrations achieved by consuming supersized alcopops

Background: Producers of supersized alcopops have ignored requests from a number of state attorneys general to reduce the alcohol concentration in these products. To the contrary, new flavor options have since been released that contain even greater alcohol content so that some alcopop products now contain 5.5 standard alcoholic drinks in a single-serving can. Though alcohol content of supersized alcopops has risen, little attention has been paid to the blood alcohol concentration (BAC) level consumers can expect to achieve from drinking these products. Objectives: To estimate BAC levels expected from consuming one or two cans of supersized alcopop, relative to beer. Methods: Median weight data from the National Health and Nutrition Examination Survey were used in Matthews and Miller’s (1979) BAC estimation formula. Results: Consuming a single supersized alcopop over the course of 2 hours can put youth and young adults well over the legal per se driving limit of 0.08 g/dL. Consuming two cans puts them at risk of alcohol poisoning. Conclusions: Estimates provided here show that supersized alcopop consumers obtain dangerously high BAC levels. Reductions in the alcohol content of supersized alcopops should be an urgent priority for public health policy and law.     

Effects of beverage alcohol price and tax levels on drinking: a meta-analysis of 1003 estimates from 112 studies

Aims We conducted a systematic review of studies examining relationships between measures of beverage alcohol tax or price levels and alcohol sales or self‐reported drinking. A total of 112 studies of alcohol tax or price effects were found, containing1003 estimates of the tax/price–consumption relationship. Design Studies included analyses of alternative outcome measures, varying subgroups of the population, several statistical models, and using different units of analysis. Multiple estimates were coded from each study, along with numerous study characteristics. Using reported estimates, standard errors, t‐ratios, sample sizes and other statistics, we calculated the partial correlation for the relationship between alcohol price or tax and sales or drinking measures for each major model or subgroup reported within each study. Random‐effects models were used to combine studies for inverse variance weighted overall estimates of the magnitude and significance of the relationship between alcohol tax/price and drinking. Findings Simple means of reported elasticities are ?0.46 for beer, ?0.69 for wine and ?0.80 for spirits. Meta‐analytical results document the highly significant relationships (P < 0.001) between alcohol tax or price measures and indices of sales or consumption of alcohol (aggregate‐level r = ?0.17 for beer, ?0.30 for wine, ?0.29 for spirits and ?0.44 for total alcohol). Price/tax also affects heavy drinking significantly (mean reported elasticity = ?0.28, individual‐level r = ?0.01, P < 0.01), but the magnitude of effect is smaller than effects on overall drinking. Conclusions A large literature establishes that beverage alcohol prices and taxes are related inversely to drinking. Effects are large compared to other prevention policies and programs. Public policies that raise prices of alcohol are an effective means to reduce drinking.     

Alterations in ethyl alcohol pharmacokinetics during oral consumption of malt liquor beverages in African Americans

Background: Malt liquor (ML) beverages have become increasingly popular among urban minority groups, due partly to their inexpensive price and targeted advertising. We hypothesized that nonfermented by‐products contained in ML beverages will alter the pharmacokinetics (PK) and pharmacodynamic (PD) effects of its ethanol content. In addition, we determined the effect of alcohol dehydrogenase (ADH) genotypes on the PK following consumption of ML beverages. Methods: The study was conducted in 31 healthy adult African‐American social drinkers, mean ± SD age of 22.3 ± 1.3 years, and weight of 70.7 ± 10.9 kg. Participants were administered ethanol, in randomized order, 2‐weeks apart, in the form of oral ML beverage (6%v/v), or isocaloric solution of diet soda–ethanol (DS–Etoh) beverage (6%v/v). During each session the beverage was consumed over 4 minutes and breath alcohol concentrations (BrAC) as well as subjective and behavioral effects of ethanol were evaluated over 180 minutes. Pharmacokinetic parameters of ethanol were calculated using Michaelis–Menten elimination kinetics. The effect of ML and ADH genotype on PK was evaluated using the Wilcoxon rank‐sum test and the Wilcoxon signed rank test, respectively. Results: Results show a slower mean rate of absorption, K_a, (0.12 vs. 0.15 min^?1, p = 0.03) and a longer time to reach maximum concentration, T_max, (28 vs. 23 minute, p < 0.01) for the ML compared with DS–Etoh beverage. The ML beverage resulted in a larger area under the BrAC–time curve compared with DS–Etoh beverage (8.4 vs. 6.8 min g/dl, p = 0.02). There was no difference in the subjective PD effects between the 2 beverages. Conclusion: Results show that exposure to ethanol following the consumption of ML beverages is different compared to that following nonmalt beverages in African‐Americans. These differences may be related to nonfermented by‐products present in commercially available ML products. These PK differences do not appear to result in significant perceived alcohol PD changes, nor are they related to ADH genotype.     

Impact of Maryland’s 2011 alcohol sales tax increase on alcoholic beverage sales

ABSTRACT

Background: Increasing alcohol taxes has proven effective in reducing alcohol consumption, but the effects of alcohol sales taxes on sales of specific alcoholic beverages have received little research attention. Data on sales are generally less subject to reporting biases than self-reported patterns of alcohol consumption. Objectives: We aimed to assess the effects of Maryland’s July 1, 2011 three percentage point increase in the alcohol sales tax (6–9%) on beverage-specific and total alcohol sales. Methods: Using county-level data on Maryland’s monthly alcohol sales in gallons for 2010–2012, by beverage type, multilevel mixed effects multiple linear regression models estimated the effects of the tax increase on alcohol sales. We controlled for seasonality, county characteristics, and national unemployment rates in the main analyses. Results: In the 18 months after the tax increase, average per capita sales of spirits were 5.1% lower (p < 0.001), beer sales were 3.2% lower (p < 0.001), and wine sales were 2.5% lower (p < 0.01) relative to what would have been expected from sales trends in the 18 months prior to the tax increase. Overall, the alcohol sales tax increase was associated with a 3.8% decline in total alcohol sold relative to what would have been expected based on sales in the prior 18 months (p < 0.001). Conclusion: The findings suggest that increased alcohol sales taxes may be as effective as excise taxes in reducing alcohol consumption and related problems. Sales taxes also have the added advantages of rising with inflation and taxing the highest priced beverages most heavily.     

Is alcopop consumption in Switzerland associated with riskier drinking patterns and more alcohol‐related problems?

OBJECTIVES: To examine (a) whether consumers of alcopops compared to consumers of other alcoholic beverages but not alcopops have riskier drinking patterns and more alcohol-related consequences (e.g. truancy, scuffles, problems with parents) and (b) whether the amount of alcopops consumed is associated independently with risky drinking patterns and alcohol-related consequences over and above those associated with the amount of other alcoholic beverages consumed. SAMPLE: As part of the ESPAD international study, a cross-sectional national representative sample of 5,444 drinkers aged 13-16 years was interviewed by means of an anonymous, self-report questionnaire administered in a classroom setting. RESULTS: Earlier initiation of consumption, more frequent risky single occasion drinking (RSOD), and a higher likelihood of negative consequences for consumers than for non-consumers of alcopops were due mainly to higher overall consumption. Other alcoholic beverages had similar effects, and whether the same amount of alcohol was consumed as alcopops or as any conventional alcoholic beverage made no difference. CONCLUSIONS: Alcopops in Switzerland do not seem to be linked to specific riskier drinking patterns or consequences per se. Like all alcoholic beverages, they add to the problems caused by drinking and seem to be consumed in addition to conventional alcoholic beverages without replacing them. As the alcohol industry will continue to launch new beverages, prevention targeting alcohol consumption in general might be more effective than focusing on new beverages only.     

The Nature and Extent of Flavored Alcoholic Beverage Consumption among Underage Youth: Results of a National Brand-Specific Survey

Background: Flavored alcoholic beverages are popular among underage drinkers. Existing studies that assessed flavored alcoholic beverage use among youth relied upon respondents to correctly classify the beverages they consume, without defining what alcohol brands belong to this category. Objectives: The aim is to demonstrate a new method for analyzing the consumption of flavored alcoholic beverages among youth on a brand-specific basis, without relying upon youth to correctly classify brands they consume. Methods: Using a prerecruited Internet panel developed by Knowledge Networks, we measured the brands of alcohol consumed by a national sample of youth drinkers, aged 16–20 years, in the United States. The sample consisted of 108 youths who had consumed at least one drink of an alcoholic beverage in the past 30 days. We measured the brand-specific consumption of alcoholic beverages within the past 30 days, ascertaining the consumption of 380 alcohol brands, including 14 brands of flavored alcoholic beverages. Results: Measuring the brand-specific consumption of flavored alcoholic beverages was feasible. Based on a brand-specific identification of flavored alcoholic beverages, nearly half of the youth drinkers in the sample reported having consumed such beverages in the past 30 days. Flavored alcoholic beverage preference was concentrated among the top four brands, which accounted for almost all of the consumption volume reported in our study. Conclusions and scientific significance: These findings underscore the need to assess youth alcohol consumption at the brand level and the potential value of such data in better understanding underage youth drinking behavior and the factors that influence it.     

Effects of pure ethanol and alcopops on glucose, insulin, and the insulin-like growth factor system in healthy subjects.

INTRODUCTION: Alcohol induces disturbances in insulin-like growth factor-I (IGF-I) and IGF binding protein-1 (IGFBP-1) levels. The aim of the present study was to compare pure ethanol and alcopop effects on total and free IGF-I, IGFBP-1, IGF-I:IGFBP-1 complex, insulin and plasma glucose levels in healthy subjects. METHODS: Five males and seven females (21-51 years) consumed pure ethanol and alcopops with identical alcohol content in a cross-over design after 6h fasting. Blood samples were obtained for determination of serum ethanol and plasma glucose at 0, 30, 60, 90, 120 and 180 min. Serum total and free IGF-I, IGFBP-1, IGF-I:IGFBP-1 complex, and insulin were measured at 0, 60 and 180 min. RESULTS: Area under the curve for serum ethanol concentration was significantly less following alcopop compared to pure ethanol (1124+/-201 vs. 1691+/-359 mmol/Lh, P<0.01). Serum insulin and glucose levels were unchanged by ethanol while alcopop intake was followed by a transient increase in glucose and insulin levels (P<0.05). Pure ethanol and alcopop reduced free IGF-I levels by the end of the study period (P=0.05). IGFBP-1 and the IGF-I:IGFBP-1 complex increased following ethanol intake (P<0.05) while only a small transient IGFBP-1 increase was observed following alcopop intake. No change in total IGF-I was observed. CONCLUSION: Both drinks resulted in reduced free IGF-I levels, however, only pure ethanol increased IGFBP-1 and the IGF-I:IGFBP-1 complex. Alcopop intake was associated with a transient increase in IGFBP-1 and unchanged IGF-I:IGFBP-1 complex levels probably due to marked changes in insulin and glucose levels.     

Patterns of past alcohol consumption in the EPIC-Germany cohorts. European Investigation into Cancer and Nutrition

Information on life-long history of alcohol consumption might be more relevant to chronic diseases than current intake. The aim of this study was to describe past alcohol intake and consumption patterns in the EPIC-Germany cohorts, by sex and age, from 1949 to 1998. Past daily consumption of alcoholic beverages - beer, wine, and spirits - was assessed through a lifestyle questionnaire administered to 27,099 subjects of the EPIC-Potsdam and 25,449 subjects of the EPIC-Heidelberg cohort. Recruitment of the cohorts concentrated on men aged 40-64 and on women aged 35-64. For each alcoholic beverage, the consumption at ages 20, 30, and 40 was asked. The data were used to calculate previous mean consumption in 10-year intervals from 1949 to 1998. Alcohol intake was observed to be higher in the Heidelberg than in the Potsdam cohort. Differences between cohorts were most marked for wine consumption which was considerably higher in the Heidelberg cohort. Men consumed approximately 3 times the amount of alcohol of women. Men preferred to drink beer, women preferred to drink wine. For the Potsdam cohort, alcohol intake was observed to increase since 1949. For the Heidelberg cohort, a recent decrease in alcohol intake in males and females of 30 and 40 years of age was noted. The data indicate that collection of alcohol consumption data at various discrete points in time is essential to depict life-long history of alcohol consumption.     

Does minimum pricing reduce alcohol consumption? The experience of a Canadian province

Aims Minimum alcohol prices in British Columbia have been adjusted intermittently over the past 20 years. The present study estimates impacts of these adjustments on alcohol consumption. Design Time–series and longitudinal models of aggregate alcohol consumption with price and other economic data as independent variables. Setting British Columbia (BC), Canada. Participants The population of British Columbia, Canada, aged 15 years and over. Measurements Data on alcohol prices and sales for different beverages were provided by the BC Liquor Distribution Branch for 1989–2010. Data on household income were sourced from Statistics Canada. Findings Longitudinal estimates suggest that a 10% increase in the minimum price of an alcoholic beverage reduced its consumption relative to other beverages by 16.1% (P < 0.001). Time–series estimates indicate that a 10% increase in minimum prices reduced consumption of spirits and liqueurs by 6.8% (P = 0.004), wine by 8.9% (P = 0.033), alcoholic sodas and ciders by 13.9% (P = 0.067), beer by 1.5% (P = 0.043) and all alcoholic drinks by 3.4% (P = 0.007). Conclusions Increases in minimum prices of alcoholic beverages can substantially reduce alcohol consumption.     

Influence of unhealthy food and beverage marketing on children's dietary intake and preference: a systematic review and meta‐analysis of randomized trials

Marketing of foods and beverages high in fat, sugar and salt are suggested to contribute to poor dietary behaviours in children and diet‐related diseases later in life. This systematic review and meta‐analysis of randomized trials aimed to assess the effects of unhealthy food and beverage marketing on dietary intake (grams or kilocalories) and dietary preference (preference score or percentage of participants who selected specific foods/beverages) among children 2 to 18 years of age. We searched MEDLINE, EMBASE and PsycINFO up to January 2015 for terms related to advertising, unhealthy foods or beverages among children. Randomized trials that assessed the effects of unhealthy food and beverage marketing compared with non‐dietary advertisement or no advertisement in children were considered eligible. Two authors independently extracted information on study characteristics and outcomes of interest and assessed risk of bias and the overall quality of evidence using grade methodology. Meta‐analysis was conducted separately for dietary intake and preference using a random‐effects model. We identified 29 eligible studies, of which 17 studies were included for meta‐analysis of dietary preference and nine for meta‐analysis of dietary intake. Almost half of the studies were at high risk of bias. Our meta‐analysis showed that in children exposed to unhealthy dietary marketing, dietary intake significantly increased (mean difference [MD] = 30.4 kcal, 95% confidence interval [CI] 2.9 to 57.9, and MD = 4.8 g, 95%CI 0.8 to 8.8) during or shortly after exposure to advertisements. Similarly, children exposed to the unhealthy dietary marketing had a higher risk of selecting the advertised foods or beverages (relative risk = 1.1, 95%CI 1.0 to 1.2; P = 0.052). The evidence indicates that unhealthy food and beverage marketing increases dietary intake (moderate quality evidence) and preference (moderate to low quality evidence) for energy‐dense, low‐nutrition food and beverage. Unhealthy food and beverage marketing increased dietary intake and influenced dietary preference in children during or shortly after exposure to advertisements. © 2016 World Obesity     

Beverage choice among native american and african american urban women

BACKGROUND: Little is known about beverage preference, especially among understudied urban minority populations. Also, most studies do not differentiate between beer and malt liquor or among wine, wine coolers, and fortified wine. This article examines whether ethnicity or drinking frequency are associated with beverage choice, considering six types of alcoholic beverages: beer, wine, spirits, malt liquor, fortified wine, and wine coolers. METHODS: Data were analyzed from Native American (n = 70) and African American (n = 129) urban pregnant women who reported drinking in the 12 months before an index pregnancy. A small comparison group of white women (n = 22) was included. Women were queried about their consumption of each of six beverage types during the 12 months before pregnancy. RESULTS: The alcoholic beverage most often used, adjusted for other beverages consumed, was beer, followed in order by spirits, wine coolers, malt liquor, wine, and fortified wine. The Native American women preferred beer, which accounted for one third of total intake. In contrast, malt liquor and spirits each accounted for approximately a quarter of intake among African Americans. Compared with other drinkers, women who drank daily were significantly more likely to choose the beer and wine products with a higher alcohol content. In general, these bivariate results were borne out by multivariate analyses that controlled for age, marital status, and education. CONCLUSIONS: These findings suggest that when accuracy is desired, alcohol studies focusing on urban African American samples (and, to a lesser degree, Native American respondents) should consider not just beer, wine, and spirits consumption, but also stronger beer products, such as malt liquor; stronger wine products, such as fortified wine; and sweeter products, such as wine coolers.     

High alcohol consumption in middle‐aged adults is associated with poorer cognitive performance only in the low socio‐economic group. Results from the GAZEL cohort study

Aims To examine the association of alcohol consumption over 10 years with cognitive performance in different socio‐economic groups. Design Prospective cohort study, the French GAZEL study. Setting France. Participants Employees of France's national electricity and gas company. Measurements Alcohol intake was assessed annually, beginning in 1992, using questions on frequency and quantity of alcoholic beverages consumed in a week; used to define mean consumption and trajectory of alcohol intake over 10 years. Cognitive performance among participants aged ≥ 55 years (n = 4073) was assessed in 2002–04 using the Digit Symbol Substitution Test (DSST), a measure of psychomotor speed, attention and reasoning. Occupational position at age 35 and education were used as the markers of socio‐economic position. Findings All analyses were stratified by socio‐economic position. In the low occupational group, participants consuming a mean of more than 21 drinks per week had 2.1 points lower (95% CI: ?3.9, ?0.3) DSST score compared to those consuming four to 14 drinks per week. In participants with primary school education, the corresponding difference was 3.6 points (95% CI: ?7.1, ?0.0). No association between alcohol consumption and cognitive performance was observed in the intermediate and high socio‐economic groups, defined using either occupation or education. Analysis of trajectories of alcohol consumption showed that in the low socio‐economic groups large increase or decrease in alcohol consumption was associated with lower cognitive scores compared to stable consumption. Conclusions Our results suggest that high alcohol consumption is associated with poorer cognitive performance only in the low socio‐economic group, due possibly to greater cognitive reserve in the higher socio‐economic groups.     

Myocardial infarction and alcohol consumption: a population-based case-control study

Background and aimCoronary heart disease (CHD) is the leading cause of death in industrialized societies. Identifying and characterizing modifiable variables associated with CHD is an important issue for health policy. The aim of the present study was to analyze the association of non-fatal myocardial infarction with total alcohol consumption and type of alcoholic beverage consumed. Preference of the subjects' consumption for beer, wine, or spirits was set at 80% or more of total alcoholic beverage consumption.Methods and resultsA population-based case-control study (244 subjects and 1270 controls) was conducted. Male patients aged 25 to 74 years with first myocardial infarction (MI) were recruited in the same region as the healthy male controls, who were taken from a random sample representative of the Gerona population. Alcoholic beverage consumption during the preceding week was recorded. Multiple logistic regression analysis was performed to determine the association of alcohol consumption and non-fatal MI.Total alcohol consumption up to 30 g per day, adjusted for lifestyle and cardiovascular risk factors, was inversely associated (Odds ratio 0.14; 95% confidence interval 0.06–0.36) with the risk of non-fatal MI. Drinking up to 20 g of alcohol through wine, beer and spirits significantly decreased the adjusted risk of MI. Higher alcohol intake did not substantially reduce the risk. A preference for spirits was correlated with a significantly increased risk of non-fatal MI (P < 0.05).ConclusionModerate alcohol consumption, independent of the type of alcoholic beverage, was associated with non-fatal MI risk reduction.     

High- and low-alcohol-preferring mice show differences in conditioned taste aversion to alcohol

Background: Genetic differences in sensitivity to the aversive effects of alcohol may contribute to alcohol drinking behavior. The present study examined the development of conditioned taste aversion (CTA) to various doses of alcohol in two pairs of mouse lines selectively bred for high (HAP) and low (LAP) alcohol preference. Methods: Alcohol‐naïve, male and female HAP and LAP mice from both replicate 1 (HAP n= 29; LAP n= 28) and replicate 2 (HAP n= 34; LAP n= 35) were adapted to a 2‐hr per day water restriction regimen. During five conditioning trials at 48 hr intervals, mice received an intraperitoneal injection of saline or 2 g/kg or 4 g/kg alcohol immediately following 1 hr of access to a 0.20 M NaCl solution. Results: LAP mice of both replicates showed a significantly greater magnitude of CTA to both 2 g/kg and 4 g/kg alcohol compared with HAP mice of both replicates. There were no line differences in consumption of the NaCl solution in the saline control groups. Conclusions: These data suggest that mice selectively bred for low alcohol preference are more sensitive to the development of alcohol CTA than mice selectively bred for high alcohol preference. The present findings indicate that common genes mediate both alcohol preference and the aversive effects of alcohol as measured in the CTA paradigm.     

Reducing the standard serving size of alcoholic beverages prompts reductions in alcohol consumption

Aims

To test whether reducing the standard serving size of alcoholic beverages would reduce voluntary alcohol consumption in a laboratory (study 1) and a real‐world drinking environment (study 2). Additionally, we modelled the potential public health benefit of reducing the standard serving size of on‐trade alcoholic beverages in the United Kingdom.

Design

Studies 1 and 2 were cluster‐randomized experiments. In the additional study, we used the Sheffield Alcohol Policy Model to estimate the number of deaths and hospital admissions that would be averted per year in the United Kingdom if a policy that reduces alcohol serving sizes in the on‐trade was introduced.

Setting

A semi‐naturalistic laboratory (study 1), a bar in Liverpool, UK (study 2).

Participants

Students and university staff members (study 1: n = 114, mean age = 24.8 years, 74.6% female), residents from local community (study 2: n = 164, mean age = 34.9 years, 57.3% female).

Interventions and comparators

In study 1, participants were assigned randomly to receive standard or reduced serving sizes (by 25%) of alcohol during a laboratory drinking session. In study 2, customers at a bar were served alcohol in either standard or reduced serving sizes (by 28.6–33.3%).

Measurements

Outcome measures were units of alcohol consumed within 1 hour (study 1) and up to 3 hours (study 2). Serving size condition was the primary predictor.

Findings

In study 1, a 25% reduction in alcohol serving size led to a 20.7–22.3% reduction in alcohol consumption. In study 2, a 28.6–33.3% reduction in alcohol serving size led to a 32.4–39.6% reduction in alcohol consumption. Modelling results indicated that decreasing the serving size of on‐trade alcoholic beverages by 25% could reduce the number of alcohol‐related hospital admissions and deaths per year in the United Kingdom by 4.4–10.5% and 5.6–13.2%, respectively.

Conclusions

Reducing the serving size of alcoholic beverages in the United Kingdom appears to lead to a reduction in alcohol consumption within a single drinking occasion.     

Alcohol taxation policy in Thailand: implications for other low- to middle-income countries

Aim Prevention of drinking initiation is a significant challenge in low‐ and middle‐income countries that have a high prevalence of abstainers, including life‐time abstainers. This paper aims to encourage a debate on an alternative alcohol taxation approach used currently in Thailand, which aims specifically to prevent drinking initiation in addition to reduce alcohol‐attributable harms. Methods Theoretical evaluation, simulation and empirical analysis. Result The taxation method of Thailand, ‘Two‐Chosen‐One’ (2C1) combines specific taxation (as a function of the alcohol content) and ad valorem taxation (as a function of the price), resulting in an effective tax rate that puts a higher tax both on beverages which are preferred by heavy drinkers and on beverages which are preferred by potential alcohol consumption neophytes, compared to either taxation system alone. As a result of these unique properties of the 2C1 taxation system, our simulations indicate that 2C1 taxation leads to a lower overall consumption than ad valorem or specific taxation alone. In addition, it puts a relatively high tax on beverages attractive to young people, the majority of whom are currently abstaining. Currently, the abstention rates in Thailand are higher than expected based on its economic wealth, which could be taken as an indication that the taxation strategy is successful. Conclusion ‘Two‐chosen‐one’ (2C1) taxation has the potential to simultaneously reduce alcohol consumption and prevent drinking initiation among youth; however, additional empirical evidence is needed to assess its effectiveness in terms of the public health impact in low‐ and middle‐income countries.