Policy implications of the widespread practice of ‘pre‐drinking’ or ‘pre‐gaming’ before going to public drinking establishments—are current prevention strategies backfiring?

Aim   To describe the research, policy and prevention implications of pre-drinking or pre-gaming; that is, planned heavy drinking prior to going to a public drinking establishment.
Methods   The authors describe the phenomenon of pre-drinking, motivations for pre-drinking and its associated risks using available research literature, media and popular internet vehicles.
Results   Heavy drinking prior to going out has emerged as a common and celebrated practice among young adults around the world. Apparent motivations are: (i) to avoid paying for high priced drinks at commercial drinking establishments; (ii) to achieve drunkenness and enhance and extend the night out; and (iii) to socialize with friends, reduce social anxiety or enhance male group bonding before going out. Limited existing research on pre-drinking suggests that it is associated with heavy drinking and harmful consequences. We argue that policies focused upon reducing drinking in licensed premises may have the unintended consequence of displacing drinking to pre-drinking environments, possibly resulting in greater harms.
Conclusions   Effective policy and prevention for drinking in licensed premises requires a comprehensive approach that takes into account the entire drinking occasion (not just drinking that occurs in the licensed environment), as well as the 'determined drunkenness' goal of some young people.     

‘Alcohol,less is better’ project: outcomes of an Italian community‐based prevention programme on reducing per‐capita alcohol consumption

Aims To evaluate differences in the individual alcohol consumption after a community‐based prevention programme. Design settings and participants ‘Alcohol, less is better’ is a controlled intervention trial. The intervention adopted a community approach, based on the active involvement of community leaders and institutional or volunteer organizations. Between 1999 and 2006, 2.5 years of activities aiming at informing and sensitizing the community on the harmful effects of alcohol on social life and health were carried out in 10 selected small Italian communities, involving a total of 123 235 individuals. Eight communities were chosen as control group. Measurements Changes in self‐reported individual alcohol consumption before and after the intervention were assessed on a random sample of intervention (n = 3382) and control (n = 2644) populations, using telephone and mailed surveys. Linear and log‐linear models for repeated measures were used to evaluate differences between intervention and control samples. Findings Overall, a significant reduction (P < 0.001) of individual self‐reported alcohol consumption was observed in the intervention sample (?1.1 drinks/week) relative to control sample (+0.3 drinks/week). The reduction was significantly greater in males than in females (P for heterogeneity = 0.016). In the young (15–24‐year‐olds) intervention and control samples showed opposite trends (?0.4 drinks/week and +1.7 drinks/week, respectively). Conclusions A coordinated community‐based intervention can reduce alcohol consumption in the general population.     

The acute–aged care interface: Exploring the dynamics of ‘bed blocking’

Objective: To understand the dynamics underlying ‘bed‐blocking’ in Australian public hospitals that is frequently blamed on older patients. Methods: Analysis of primary and secondary data of utilisation patterns of hospital and aged care services by older Australians. Results: A model of the dynamics at the acute–aged care interface was developed, in which the pathway into permanent high‐care Residential Aged Care (RAC) is conceptualised as competing queues for available places by applicants from the hospital, the community and from within RAC facilities. The hospital effectively becomes a safety net to accommodate people with high‐care needs who cannot be admitted into RAC in a timely manner. Conclusion: The model provides a useful tool to explore some of the issues that give rise to access‐block within the public hospital system. Access‐block cannot be understood by viewing the hospital system in isolation from other sectors that support the health and well‐being of older Australians.