Individual and household-level socioeconomic position is associated with harmful alcohol consumption behaviours among adults

Aim: To examine associations between individual‐, household‐ and neighbourhood‐level socioeconomic position (SEP) and harmful alcohol consumption. Method: Adults aged 18–76 residing in 50 neighbourhoods in Melbourne completed a postal questionnaire (n= 2349, 58.7% response rate). Alcohol‐related behaviours were classified by risk of short‐ and long‐term harm. Individual‐, household‐ and neighbourhood‐level SEP were ascertained by education, household income and proportion of low‐income households, respectively. The association were examined by multi‐level logistic regression. Results: Participants lower education or household income were less likely to consume alcohol frequently compared to their more‐advantaged counterparts. Lower‐educated men were more likely to be at risk of short‐term harm [OR 1.75 (1.23 – 2.48)]. Low‐income women were less likely to be at risk of short‐term harm [OR 0.44 (0.23 – 0.81)]. Neighbourhood disadvantage was not associated with alcohol consumption. Conclusion: Men and women from socioeconomically advantaged backgrounds were more frequent consumers of alcohol, whereas their disadvantaged counterparts drank less frequently but in greater quantities on each drinking occasion Implications: Socioeconomic disadvantage at the individual and household levels may be an important determinant of alcohol consumption among Australian adults.     

Diverging trends in alcohol consumption and alcohol‐related harm in Victoria

Objective: To examine recent trends in alcohol‐related harm and risky drinking in Victoria, Australia. Methods: The study compiled eight measures of alcohol‐related harm from published and unpublished sources, covering data relating to health, crime, alcohol treatment and traffic crashes for the financial years 1999/2000 to 2007/08. In addition, published estimates of short and long‐term risky drinking from three‐sets of surveys between 2001 and 2007 were examined. Results: Six of the eight harm indicators substantially increased, while only alcohol‐related mortality and single‐vehicle night‐time crashes remained relatively stable. In particular, rates of emergency presentations for intoxication and alcohol‐related ambulance attendances increased dramatically. Contrastingly, survey‐derived estimates of the rate of risky‐drinking among Victorians were stable over the time‐period examined. Conclusions: Evidence across the data examined suggests significant increases in alcohol‐related harm taking place during a period of relatively stable alcohol consumption levels. This disparity may be accounted for by changing drinking patterns among small, high‐risk, subgroups of the population. Implications: The sharply increasing rates of alcohol‐related harm among Victorians suggest that changes to alcohol policies focusing on improving public health are necessary.     

Most recent risky drinking session with Australian teenagers

Objective : Despite declines in Australian alcohol consumption, youth alcohol related harms remain prevalent. These alcohol‐related consequences appear to be driven by a subset of risky drinkers who engage in ‘high intensity’ drinking episodes and are underrepresented in national health surveys. This project aims to investigate high risk drinking practices and alcohol‐related harms amongst young people not otherwise recorded in existing data. Methods : A community sample of the heaviest drinking 20–25% 16–19 year olds were surveyed across three Australian states (n=958; 80% metropolitan). We examined the context of their last risky drinking session through online and face‐to‐face surveys. Results : Males consumed a mean of 17 and females 14 standard drinks, and 86% experienced at least one alcohol‐related consequence during this session. More than a quarter of the face‐to‐face sample had Alcohol Use Disorders Identification Test (AUDIT) scores indicative of alcohol dependence. Indications of dependence were 2.3 times more likely among those who felt uncomfortable about seeking alcohol treatment, and less likely if harm reduction strategies were frequently used while drinking. Conclusions : It is clear this underrepresented population experiences substantial acute and potentially chronic consequences. Implications : Within the context of increasing alcohol‐related harms among young Australians, the understanding of this group's drinking habits should be prioritised.     

Strategies associated with low‐risk drinking: a population‐based study

Objective : To examine the relative frequency of use of seven strategies to moderate drinking (SMD) among low‐risk and risky drinkers. Methods : Cross‐sectional data from the 2013 National Drug Strategy Household Survey was used. The analytical sample included 11,462 Australians aged 18–64 who had consumed alcohol in the previous year. Logistic regression was used. Results : Analyses indicated a curvilinear relationship between use of SMD and alcohol consumption. Across the seven SMD, constant use of a strategy, compared with never using a strategy, was associated with low‐risk drinking. Never using a strategy, compared with using one rarely, was also associated with low‐risk drinking. When used occasionally, strategies that implied less alcohol consumed per hour (e.g. refuse unwanted drinks) increased the likelihood of low‐risk drinking, whereas less direct strategies (e.g. counting drinks) increased the likelihood of risky drinking. Conclusions : Adult Australians who drink at low levels use a range of strategies to moderate their alcohol consumption. Overall, consistent use of one or more SMD was associated with low‐risk drinking patterns. Implications: Public health responses to risky drinking may be enhanced by promoting the consistent use of SMD as a way to reduce overall alcohol consumption.     

Alcohol brief intervention in bars and taverns: a 12-month follow-up study of Operation Drinksafe in Australia

This study examined the effect of an alcohol brief interventionprogram on drinkers in bars and taverns. A 12-month follow-upwas conducted with 1211 patrons who took part in a program calledOperation Drinksafe involving 118 hotels and clubs in northcoast New South Wales, Australia. The brief intervention took~5 min and consisted of a personalized risk assessment usingthe Alcohol Use Disorders Identification Test (AUDIT) in combinationwith a breathalyser to determine blood alcohol concentration(BAC). At follow-up, almost half (46%) the participants reportedreduced their alcohol consumption. The mean AUDIT score reducedby 15%, weekly alcohol consumption by 13% and frequency of bingedrinking by 19%. Those previously drinking at ‘harmful’levels reduced most (AUDIT 29%, consumption 22% and binge frequency37%). Females had almost twice the odds of reducing consumptioncompared to males (OR 1.75, CI: 1.33–2.33) as did participantswith initial consumption above the mean (OR 2.03, CI: 1.58–2.60).Older respondents showed smaller reductions than young peoplein composite AUDIT score, but greater reductions on consumptionand binge frequency scales. Although a control group was notfeasible, these findings suggest that a brief intervention program,presented in an interesting way to drinkers in bars and taverns,may effectively reduce risky alcohol consumption. Brief interventionsmay be particularly beneficial for those drinking at hazardousand harmful levels who are ready to change their drinking pattern.The partnership between police and health services was the cornerstoneof this intervention, and helped to foster co-operation andacceptance from licensees and their customers.     

Awareness and correlates of short‐term and long‐term consequences of alcohol use among Australian drinkers

Objective: To investigate awareness of short‐term and long‐term consequences of alcohol use among a sample of Australian adult drinkers. Demographic correlates of the awareness of each consequence were also explored. Methods: Participants aged 18–45 years (n=1,061; mean age=33.2 years) drawn from an online panel completed a web‐based survey assessing demographics, awareness of alcohol warning labels, and awareness of seven short‐term and 12 long‐term consequences of alcohol use. Results: The level of awareness of short‐ and long‐term consequences ranged from 16% (breast cancer) to 69% (low coordination and slower reflexes). The study found consistent differences in awareness of consequences by gender, with some differences for specific consequences by age, education, SES, rurality and awareness of alcohol warning labels. Conclusions: Most consumers lack a sufficient understanding of the potential consequences of alcohol use. Particular subgroups of drinkers may not equate drinking with negative consequences. Implications for public health: Front‐of‐label alcohol warnings on all products and public health and education campaigns presenting messages targeting subgroups of drinkers could increase awareness of short‐ and long‐term negative health and social effects of alcohol use.     

Alcohol policy impact on young risky drinkers and their support for proposed measures

Objective: To explore the impacts of existing policies on young Australian risky drinkers' access to alcohol and to gauge their support for proposed alcohol measures. Methods: The 16–19 year old participants were recruited from three Australian states using non‐random convenience sampling, for either a face‐to‐face or online quantitative survey (N=958). The sample was deliberately selected to represent drinkers whose consumption placed them in the riskiest drinking 20–25% of their age bracket. Results: Half (49%) the sample who were younger than the Australian legal purchase age reported it was ‘easy’ to buy alcohol from bottle stores, and 75% of those who had tried to purchase alcohol, said it was ‘easy’ the last time they tried. Half of those under 18, who had attempted to enter a licensed venue, reported they did not have their identification checked last time they gained access. Ninety per cent of all respondents drank within a private location at their last risky drinking session. Sixty‐five per cent supported ‘increasing the price of [alcohol by 20¢] a standard drink if the extra 20¢ was used to support prevention and treatment of alcohol problems'. Conclusions: Age‐ or intoxication‐based restrictions to alcohol were commonly bypassed. Implications: Point‐of‐sale alcohol controls require improvement to prevent under age access. Given that a significant proportion of drinking occasions for those under 18 were in private premises, prevention strategies need to target these locations. There were diverse levels of support for strategies to reduce harm, including potential community backing for an evidence‐based proposed price policy.     

Recent trends in risky alcohol consumption and related harm among young people in Victoria, Australia

OBJECTIVE: To examine recent trends in the proportion of young people who drink at risky levels and the rate of alcohol-related harms experienced by young people in Victoria, Australia. METHODS: The study uses published data from a series of surveys that ask questions relating to alcohol consumption to ascertain whether the proportion of young people drinking at risky levels has increased over the time period in which data are available. Alcohol-caused hospital admissions and emergency department presentations for young people are also examined over recent years to assess trends in alcohol-related harms. RESULTS: The survey data shows mixed results, with no clear trend in the rate of risky drinking among young people. The harms data suggests that rates of alcohol-related harm, particularly acute intoxication, have increased dramatically over recent years. CONCLUSIONS: The relationship between survey-derived estimates of alcohol consumption and rates of alcohol-related harms is not as clear-cut as expected, and raise concerns about the sensitivity of population surveys in detecting changes in harmful drinking patterns. IMPLICATIONS: The current increasing trends in alcohol-related harms for young people in Victoria suggest the need for immediate public health interventions.     

Rurality,Region, Ethnic Community Make‐Up and Alcohol Use Among Rural Youth

Purpose: As the most widely used substance among adolescents in the United States, alcohol remains a critical public health issue. The majority of research in this area has focused on individual‐level variables. This study examined the contextual effects of rurality, geographic region, and community ethnicity in the prediction of alcohol use among adolescent youth. Method: Participants were 7th‐12th grade students from a sample of 260 rural communities across the United States, with oversampling for predominantly Mexican American and African American communities. The total sample comprised 213,225 students. Multilevel modeling was used to estimate both individual and contextual effects for use of alcohol and getting drunk. Findings: Those living in more rural communities were somewhat more likely to have used alcohol and gotten drunk than their less rural counterparts. Consistent with a trend toward a narrowing gender gap across a number of substances, gender differences in alcohol use were not large, except in the South. A minority in a community, eg, a white student in an African American community, had greater risk for alcohol use and getting drunk. Conclusions: Models of alcohol use among rural youth that include only individual‐level variables are likely to result in misleading results. While students from varying levels of rurality may not differ substantially from one another, geographic region and minority status within communities are likely to interact with individual‐level variables, resulting in unique patterns of alcohol use and getting drunk.     

“Fourteen Dollars for One Beer!” Pre‐drinking is associated with high‐risk drinking among Victorian young adults

Objective : Pre‐drinking entails consuming alcohol before attending licensed venues. We examined the relationship between pre‐drinking, intention to get drunk and high‐risk drinking among Victorians aged 18–24 years, to consider whether reducing pre‐drinking might ameliorate alcohol‐related harm. Methods : Variables within the 2009 Victorian Youth Alcohol and Drugs Survey (VYADS) dataset were analysed and compared with a thematic interpretation of research interviews involving 60 young adults living in Melbourne. High‐risk drinking was defined as consuming 11 or more standard drinks in a session at least monthly. Results : VYADS data show that pre‐drinking was a significant predictor of high‐risk drinking, even after intention to get drunk was controlled for. The most common explanation provided by interviewees for pre‐drinking was because it is cheaper to purchase alcohol at bottle shops than at bars and clubs. This was particularly emphasised by those who drank at a high‐risk level. Conclusions : The study suggests that people pre‐drink because they desire to be intoxicated, but also that pre‐drinking patterns and product choices exacerbate the likelihood of high‐risk drinking. Reducing availability of cheap packaged alcohol has potential to limit both pre‐drinking and high‐risk drinking among Victorian young adults. Implications : The study adds weight to calls to implement minimum alcohol pricing in Australia.     

Alcohol Consumption and Risky Sexual Behavior Among Persons Attending Alcohol Consumption Venues in Gaborone,Botswana

Alcohol use is a known key risk factor associated with risky sexual behavior that contributes to HIV transmission. This cross-sectional study used time location sampling to investigate alcohol use and risky sexual behaviors that occurred after ingesting alcohol among 609 patrons of alcohol venues in Gaborone, Botswana. Alcohol Use Disorders Identification Test (AUDIT) scores were categorized as low (1–7), medium (8–15), and high (16+) for analysis. Logistic regression models stratified by gender assessed the association between alcohol use and condom use at last sex after drinking alcohol. Among females, the odds of condom use during last sex after drinking alcohol were significantly lower for high compared to low AUDIT scores (AOR?=?0.17, 95 % CI 0.06–0.54). Among males, factors significantly associated with condom use at last sex after alcohol use were low levels of education (primary level compared to university and above AOR?=?0.13; 95 % CI 0.03–0.55) and beliefs that alcohol use did not increase risky sexual behaviors (AOR?=?0.26; 95 % CI 0.11–0.62). HIV prevention interventions should target females and emphasize sexual risks associated with alcohol use.     

Risk modifying effect of social capital on measures of heavy alcohol consumption, alcohol abuse, harms, and secondhand effects: national survey findings

STUDY OBJECTIVE: To examine associations between social capital and individual risk for alcohol abuse and harms and identify protective effect mechanisms. DESIGN: Multilevel multivariate analysis with individual level data from a national panel survey of drinking and a contextual measure of social capital reflecting college mean aggregate reports of student volunteerism. Outcomes include heavy episodic (binge) drinking, frequent drinking, frequent drunkenness, diagnosable alcohol abuse, intentional drunkenness, acquisition of binge drinking, harms, secondhand effects from others' drinking. SETTING: United States, 119 four year colleges. PARTICIPANTS: Representative samples of youth ages 18-24 surveyed in 1997 and 1999 using an anonymous mailed questionnaire (total n = 27 687). MAIN RESULTS: Students from colleges with higher levels of social capital reported reduced risks for binge drinking (adjusted OR 0.38, 95% CI 0.20 to 0.69, p = 0.002), frequent drunkenness (adjusted OR 0.58, 95% CI 0.34 to 0.98, p = 0.04), acquisition of binge drinking in college (adjusted OR 0.48, 95% CI 0.24 to 0.95, p = 0.03), and alcohol abuse (adjusted OR 0.55, 95% CI 0.34 to 0.91, p = 0.02) in multilevel multivariate analyses that controlled for individual volunteering, the measure on which social capital was based. Higher levels of social capital protected against multiple drinking related harms (adjusted OR 0.51, 95% CI 0.29 to 0.90, p = 0.02) and secondhand drinking effects (adjusted OR, 0.30, 95% CI 0.16 to 0.58, p = 0.0003). Significant cross level interactions exist between fraternity/sorority membership and social capital for measures of risky drinking. Harm reduction primarily reflects consumption modification. CONCLUSIONS: Social capital exerts strong protective effects on alcohol abuse and harm in college including among high risk students.     

The use of audit to assess level of alcohol problems in rural Vietnam

AIMS: To assess the accuracy and performance of AUDIT in detecting alcohol problems, as defined by ICD-10 and DSM-IV, in a rural district in Vietnam. METHODS: The study was conducted in a rural district of Vietnam. Five hundred men and women aged 18-60 were randomly selected for interview with AUDIT and CIDI 2.1. The ICD-10 and DSM-IV criteria for harmful use/alcohol abuse and alcohol dependence were used to evaluate AUDIT. RESULTS: Due to few cases of alcohol problems observed among women (1/282), we could only evaluate the validity of AUDIT in men. At cut-off point 7/8, AUDIT had a sensitivity of 81.8% and a specificity of 76.1% for detecting at-risk drinking. At this cut-off point, using ICD-10 criteria, the sensitivity was 100% for harmful use and 93.8% for alcohol dependence; the specificity was 69.9% for harmful use and 87.4% for alcohol dependence. The area under the ROC curve was 0.91 (0.84-0.98) for harmful use and 0.84 (0.74-0.94) for alcohol dependence (ICD-10). The agreement between ICD-10 and DSM-IV was higher for diagnosing alcohol dependence than alcohol abuse (Kappa coefficient: 0.98 vs 0.68). CONCLUSION: We confirmed that AUDIT is feasible to use in a rural community in a developing country. Different cut-off points are appropriate for different purposes, but for general population screening of at-risk drinking we found a cut-off point 7/8 to be optimal.     

Screening for high-risk and elevated alcohol consumption in day and shift workers by use of the AUDIT and CDT

BACKGROUND: Alcohol consumption levels and drinking patterns have been reported to vary between day and shift workers, although the results have been conflicting. Previous results indicate that questions about alcohol habits may be asked in the workplace. However, no studies have evaluated the Alcohol Use Disorders Identification Test (AUDIT) or the alcohol biomarker carbohydrate-deficient transferrin (CDT) in serum for this purpose. AIM: To investigate, in conjunction with routine health examinations, whether there is any difference between permanent day and shift workers in high-risk alcohol consumption, according to the AUDIT and CDT. Gamma-glutamyl transferase (GGT) in serum was included mainly as a comparison test. METHODS: The employees who attended for a regular health examination during the study period were offered voluntary alcohol screening with the AUDIT and CDT. RESULTS: Altogether, 990 employees (day, two-shift, and three-shift workers) participated in the study, 194 (20%) of whom screened positive with the AUDIT and/or CDT. There were no significant differences in the screening results between day and shift workers, whereas significantly fewer of the two-shift workers (odds ratio=0.5, 95% confidence interval=0.3-0.9) screened positive with CDT. CONCLUSIONS: The present findings on employees who attended for regular health examinations suggest that shift workers did not show a higher level of risky alcohol consumption than day workers, according to the results with the AUDIT, CDT and GGT. On the contrary, the two-shift workers appeared to drink significantly less.     

Audit-3 and audit-4: effectiveness of two short forms of the alcohol use disorders identification test

- AIMS: To identify suitable short versions of the Alcohol Use Disorders Identification Test (AUDIT) and to evaluate their effectiveness as screening tests for 'risky drinking' among men and women in primary health care (PHC) settings. METHODS: A total of 255 patients attending five PHC centres in Catalonia (Spain) were interviewed by clinicians regarding health status and drinking pattern. Patients also completed the AUDIT. Clinicians' diagnosis of risky drinking was used as a gold standard to evaluate the effectiveness of three forms of AUDIT. RESULTS: AUDIT-3 and AUDIT-4 performed similarly to AUDIT-10 in detecting risky drinking and had equivalent receiver operating characteristics curves and their areas under the curve. CONCLUSIONS: Both short forms of AUDIT seem to be as effective as the full AUDIT for detecting risky drinking among men and women in PHC settings.     

The effects of e‐cigarette minimum legal sale age laws on youth substance use

We use difference‐in‐differences models and individual‐level data from the national and state Youth Risk Behavior Surveillance System from 2005 to 2015 to examine the effects of e‐cigarette minimum legal sale age (MLSA) laws on youth cigarette smoking, alcohol consumption, and marijuana use. Our results suggest that these laws increased youth smoking participation by about one percentage point and approximately half of the increased smoking participation could be attributed to smoking initiation. We find little evidence of higher cigarette smoking persisting beyond the point at which youth age out of the laws. Our results also show little effect of the laws on youth drinking, binge drinking, and marijuana use. Taking these together, our findings suggest a possible unintended effect of e‐cigarette MLSA laws—rising cigarette use in the short term while youth are restricted from purchasing e‐cigarettes.     

The relationship between alcohol consumption and self-reported health status using the EQ5D: evidence from rural Australia

Alcohol misuse represents one of the leading causes of preventable death, illness and injury in Australia. Extensive research exists estimating the effect of risky alcohol use on mortality, but little research quantifies the impact of risky alcohol consumption on morbidity. Such estimates are required to more precisely measure the benefit of interventions aimed at reducing risky alcohol use. Ordered probit and tobit models are used in this research to analyse the impact of risky drinking on self-reported health status using questionnaire data from an age and gender stratified sample drawn from 20 rural communities in New South Wales which are part of a large randomised controlled trial of community based alcohol interventions. It is found that risky alcohol use is associated with lower self-reported health; however, the average effect is small apart for those drinking at very-high risk. The effect of alcohol on morbidity, derived from the current analyses, is lower than that commonly used in current economics analyses. If this is accurate for geographical regions other than rural Australia, then from a policy viewpoint, these economic analyses may tend to overemphasise interventions which are morbidity reducing, such as taxation, and place undue focus on alcohol as a risk factor and consequently adversely impact resource allocation decisions.     

Exploring young men's drinking using the AUDIT questionnaire.

This paper reports the findings of an AUDIT questionnaire administered to a sample of young (16-24-year-old) white males. Of the sample, 65% were drinking at potentially harmful levels. Averaging 45 U/week, 18-21 years was the age of highest alcohol consumption. Compared with 16-17- and 22-24-year-olds, this group recorded the highest proportion of hazardous drinkers and most negative consequences of drinking.