Cross‐promotional alcohol discounting in Australia's grocery sector: a barrier to initiatives to curb excessive alcohol consumption?

Objective: Excessive alcohol consumption is an increasing issue internationally. Pricing strategies, including discount restrictions, have been identified as one of the most effective policy means by which to reduce heavy alcohol consumption. In Australia, cross‐promotional alcohol discounts are increasingly used by supermarket chains as a marketing tool. The purpose of the present study is to provide preliminary data on the nature and extent of cross‐promotional alcohol discounting in the Australian grocery sector. Methods: A purposive sample of 34 supermarkets in Australia's three largest cities was selected and minor grocery purchases made to uncover the prevalence and level of cross‐promotional alcohol discounting. Results: Cross‐promotional ‘bundled’ discounts were very common with 33 of the 34 supermarkets offering a ‘two for one’ discount on bottles of wine. Even with minor purchases (mean purchase $1.35), the mean value of discounts received was substantial ($16.23). Conclusions: These results appear to be consistent with claims that major supermarket chains are using alcohol discounts as loss leaders to entice new consumers. Implications: These strategies are antithetical to public health strategies aimed at reducing excessive alcohol consumption. Further examination of the impact of major retailers on public health initiatives is warranted, particularly in light of increasing retailer concentration.     

Neighbourhood deprivation and alcohol consumption: does the availability of alcohol play a role?

BACKGROUND: Previous studies suggest that the physical availability of alcohol may mediate the association between neighbourhood-level material deprivation and alcohol consumption. This study tests the relationships between neighbourhood-level deprivation, alcohol availability, and individual-level alcohol consumption using a multilevel analysis. METHODS: Data are from cross-sectional surveys conducted between 1979 and 1990 as part of the Stanford Heart Disease Prevention Program (SHDPP). Women and men (n = 8197) living in four northern/central California cities and 82 neighbourhoods were linked to neighbourhood deprivation variables derived from the US census (e.g. unemployment, crowded housing) and to measures of alcohol availability (density of outlets in the respondent's neighbourhood, nearest distance to an outlet from the respondent's home, and number of outlets within a half mile radius of the respondent's home). Separate analyses were conducted for on- and off-sale outlets. RESULTS: The most deprived neighbourhoods had substantially higher levels of alcohol outlet density than the least deprived neighbourhoods (45.5% vs 14.8%, respectively). However, multilevel analyses showed that the least deprived neighbourhoods were associated with the heaviest alcohol consumption, even after adjusting for individual-level sociodemographic characteristics (OR 1.30, CI 1.08-1.56). Alcohol availability was not associated with heavy drinking and thus did not mediate the relationship between neighbourhood deprivation and heavy alcohol consumption. CONCLUSIONS: Although alcohol availability is concentrated in the most deprived neighbourhoods, women and men in least deprived neighbourhoods are most likely to be heavy drinkers. This mismatch between supply and demand may cause people in the most deprived neighbourhoods to disproportionately suffer the negative health consequences of living near alcohol outlets.     

Liquor landscapes: Does access to alcohol outlets influence alcohol consumption in young adults?

Few longitudinal studies have examined the impact of liquor licences on alcohol consumption, and none in young adults, the life stage when alcohol intake is at its highest. We examined associations between liquor licences (i.e., general licences, on-premise licences, liquor stores, and club licences) and alcohol consumption at 20-years (n=988) and 22-years (n=893), and whether changes in the licences between time-points influenced alcohol consumption (n=665). Only general licences were associated with alcohol consumption at 20-years (p=0.037), but by 22-years, all licences types were positively associated with alcohol consumption (p<0.05). Longitudinal analyses showed that for each increase in liquor stores over time, alcohol consumption increased by 1.22 g/day or 8% (p=0.030), and for each additional club licence, consumption increased by 0.90 g/day or 6% (p=0.007). Limiting liquor licences could contribute to a reduction in young adults’ alcohol intake.     

Is alcohol consumption a cofactor in the development of acquired immunodeficiency syndrome?

Excessive alcohol (EtOH) consumption and acquired immunodeficiency syndrome (AIDS) are two major public health problems in the United States. Overwhelming evidence is showing that heavy EtOH ingestion broadly suppresses the various arms of immune response, seriously impairing the body's normal host defense to invading microbes and tumorigenesis. The onset of clinical symptoms of AIDS (low CD4⁺ T cells count, opportunistic infections, and tumors) is quite variable among HIV' individuals with a mean incubation time 3–10 years following serocon version. Because of the deleterious effects of chronic EtOH consumption on Cyokine release, immune response, host defense, nutritional status, and oxidative stress, it has been believed to be a possible cofactor that could enhance the host's susceptibility to infections, and subsequently increase the rate of AIDS development. The purpose of this review is to present evidence indicating clinical disorders during EtOH ingestion in murine AIDS. These EtOH-induced abnormalities may promote a more rapid development of AIDS in HIV-infected individuals.     

TNF-α and IL-6 serum levels: Neurobiological markers of alcohol consumption in alcohol-dependent patients?

We investigated the serum levels of IL-6 and TNF-α in 30 male alcohol-dependent patients during withdrawal (day 1, 7, and 14) and compared them with the levels obtained from 18 healthy male controls. IL-6 (day 1: T = 2,593, p = 0.013; day 7: T = 2,315, p = 0.037; day 14: T = 1,650, p = 0.112) serum levels were significantly increased at the beginning of alcohol withdrawal. TNF-α (T = 3,202, p = 0.03) serum levels were significantly elevated in the patients' group during the whole period of withdrawal. IL-6 serum levels decreased significantly during withdrawal (F = 16.507, p < 0.001), whereas TNF-α levels did not change significantly (day 1–14). IL-6 serum levels were directly associated with alcohol consumption (r = 0.392, p = 0.047) on day 1. Moreover, the IL-6 serum levels were associated with alcohol craving (PACS total score day 1: r = −0.417, p = 0.022, the score of the obsessive subscale of the OCDS on day 14 [r = −0.549, p = 0.022]), depression (r = −0.507, p = 0.005), and trait anxiety (r = −0.674, p < 0.001) on day 1. We found an association with the duration of active drinking following the last period of abstinence and the TNF-α serum levels (day 1:r = 0.354, p = 0.009; day 7: r = 0.323, p = 0.022; day 14: r = 0.303, p = 0.034) as well as an association with the severity of alcohol dependence measured by the SESA scale (r = 0.454, p = 0.015). Moreover, we found a significant association between the BDNF serum levels and the TNF-α serum levels (r = −0.426, p = 0.021). Our results support an association between alterations in TNF-α and IL-6 serum levels and alcohol consumption.     

Are drinkers implicitly positive about drinking alcohol? Personalizing the alcohol-IAT to reduce negative extrapersonal contamination

AIMS: The advent of indirect measures, such as the Implicit Association test (IAT), has stimulated interest in implicit cognitions that may automatically steer addictive behaviours such as alcohol abuse. Counter-intuitively, recent IAT research has demonstrated that alcohol is implicitly associated with negative valence, regardless of the level of alcohol consumption. However, because the IAT is susceptible to extrapersonal contamination, this study examined whether previous findings reflect contamination of IAT effects by negative extrapersonal knowledge rather than personal associations with alcohol. METHODS: Implicit alcohol associations were measured with a personalized alcohol-IAT, designed to reduce extrapersonal contamination. Whether alcohol associations measured with the personalized IAT would predict drinking behaviour above the variance explained by self-reported alcohol-related expectancies and attitude was examined. RESULTS: In contrast to previous findings with the IAT, the personalized IAT yielded positive associations. Moreover, positive alcohol associations predicted drinking behaviour above self-reported alcohol expectancies and attitudes, demonstrating the incremental validity of the personalized IAT. CONCLUSIONS: The present findings support the hypothesis that previous findings with the alcohol-IAT at least partly reflect negative extrapersonal alcohol-related knowledge, and that implicit alcohol associations are positive rather than negative.     

Is alcohol and community sport a good mix? Alcohol management,consumption and social capital in community sports clubs

Objective: Community sports clubs provide an important contribution to the health and wellbeing of individuals and the community; however, they have also been associated with risky alcohol consumption. This study assessed whether a club's alcohol management strategies were related to risky alcohol consumption by members and levels of social capital, as measured in terms of participation in and perceived safety of the club. Method: A total of 723 sports club members from 33 community football clubs in New South Wales, Australia, completed a computer assisted telephone interview (CATI) and a management representative from each club also completed a CATI. The club representative reported on the club's implementation of 11 alcohol management practices, while club members reported their alcohol consumption and perceived levels of safety at the club and participation in the club. Results: A structural equation model identified having the bar open for more than four hours; having alcohol promotions; and serving intoxicated patrons were associated with increased risky alcohol consumption while at the club; which in turn was associated with lower levels of perceived club safety and member participation. Conclusion and implications: The positive contribution of community sports clubs to the community may be diminished by specific inadequate alcohol management practices. Changing alcohol management practices can reduce alcohol consumption, and possibly increase perceived aspects of social capital, such as safety and participation.     

Health consumer groups in the UK: a new social movement?

This paper argues that a health consumer movement has developed in the United Kingdom over the last decade. Drawing on two empirical studies of groups that promote and/or represent the interests of patients, users and carers, it argues that groups formed by people with personal experience of a condition are now more widespread. Feelings of pain and loss can lead to the identification of others in a similar position, and to the formation of groups and action in the political sphere. Research shows that groups share a common discourse and follow similar participative practices, and there is extensive networking. Informal and formal alliances have formed to pursue joint action and indicate a wider health consumer movement. As governments have also increased the opportunities for participation, this has the potential for patients and carers to shape services in ways more responsive to their needs.     

Severity of unhealthy alcohol consumption in medical inpatients and the general population: is the general hospital a suitable place for brief interventions?

Objectives

Evidence for brief interventions in general hospital (GH) settings is scarce, probably due to higher rates of dependent drinkers. The present study aims to compare unhealthy drinking patterns in GH patients with the general population (GP).

Methods

Sample 1 consisted of 4,075 individuals randomly drawn from registration office files, representing the non-institutionalised GP of a northern mixed rural–urban German area. Sample 2 consisted of 2,949 consecutively admitted patients from a GH covering the same area.

Results

Compared to individuals from the GP, GH patients revealed higher prevalence rates of alcohol dependence (1.3 vs. 5.5%) and alcohol abuse (1.2 vs. 2.8%), but did not differ significantly concerning at-risk drinking (5.1 vs. 6.2%). Multinomial logistic regression analysis controlling for age, sex and smoking using unrisky alcohol consumption as reference category belonging to the GH group was predictive for alcohol use disorders but not for at-risk drinking.

Conclusion

Data show that a substantial number of individuals with unhealthy drinking patterns without alcohol use disorders can easily be accessed in GH settings if appropriate screening measures are conducted.     

High consumption of Ω-3 polyunsaturated fatty acids decrease plasma homocysteine: a meta-analysis of randomized, placebo-controlled trials

Objective

High consumption of ω-3 polyunsaturated fatty acids (PUFAs) has been associated with lower plasma homocystine (Hcy) levels, but intervention studies in humans have been inconclusive. The objective was to systematically evaluate the effects of ω-3 PUFA supplementation on plasma Hcy levels.

Methods

A comprehensive search of Medline, EMBASE, the Cochrane Clinical Trials Registry, and bibliographies of relevant articles published from 1966 through September 2010 was undertaken. All randomized, placebo-controlled trials that compared ω-3 PUFA supplementation with placebo were included. Two investigators performed data extraction and quality scoring independently, with discrepancies resolved by consensus.

Results

Eleven trials including 702 subjects were analyzed. The outcomes studied were plasma Hcy level. Eleven randomized, placebo-controlled trials were included in this meta-analysis. Supplementation with ω-3 PUFAs was associated with a significant decrease in plasma Hcy level (weighted mean difference −1.59 μmol/L, 95% confidence interval −2.34 to −0.83) compared with control subjects.

Conclusion

This meta-analysis suggested that ω-3 PUFA supplementation can decrease plasma Hcy levels. The implications of these findings remain to be elucidated.     

Is social capital the key to inequalities in health?

There has been vigorous debate between the "social capital" and "neomaterialist" interpretations of the epidemiological evidence regarding socioeconomic determinants of health. We argue that levels of income inequality, social capital, and health in a community may all be consequences of more macrolevel social and economic processes that influence health across the life course. We discuss the many reasons for the prominence of social capital theory, and the potential drawbacks to making social capital a major focus of social policy. Intervening in communities to increase their levels of social capital may be ineffective, create resentment, and overload community resources, and to take such an approach may be to "blame the victim" at the community level while ignoring the health effects of macrolevel social and economic policies.     

Decomposing cross-country differences in levels of obesity and overweight: Does the social environment matter?

This paper examines the influence of environmental factors on weight gain and obesity. We take advantage of a markedly different pattern of obesity between Italy in Spain to undertake a non-linear decomposition analysis of differences in the prevalence of overweight and obesity between the two countries. The analysis is based on cross-sectional national surveys for 2003. We have attempted to isolate the influence of lifestyle factors, socio-economic and socio-environmental effects in explaining cross-country differences in BMI status. Our findings suggest that when the social environment (proxied by different measures of peer effects and regional BMI) is not controlled for, we explain about 27–42% of the overall Spain-to-Italy overweight and obesity gap. Differences in eating habits and education between the two countries are the main predictors of the gaps in obesity and overweight. However, when social environment is controlled for, our estimates explain between 76 and 92% of the obesity and overweight gap and the effect of eating habits are wiped out. These results suggest healthy body weight depends on cultural or environmental triggers that operate through individual level health production determinants.     

Is the apparent cardioprotective effect of recent alcohol consumption due to confounding by prodromal symptoms?

Previous research has reported a protective association between alcohol drinking and acute coronary heart disease in the 24-hour period after drinking. This study investigated whether this apparent protective association resulted from confounding due to the effect of prodromal symptoms on drinking behavior. In 1992, the authors conducted a case-control study that measured recent alcohol consumption and reasons for recent abstention from alcohol among patients with acute coronary heart disease identified from a community-based disease register and a representative control sample from the same community (Auckland, New Zealand). Cases were significantly more likely than controls to report recent abstention from drinking because they felt unwell. In unadjusted analyses, a protective association was observed between recent alcohol consumption and acute coronary heart disease; however, this association was weakened considerably after adjustment for the effect of prodromal symptoms on drinking behavior. The previously reported protective association between recent alcohol consumption and acute coronary heart disease appears to be largely due to the confounding effect of prodromal symptoms on drinking.     

Ignoring social factors in clinical decision rules: a contribution to health inequalities?

Much work has been published on health inequalities and thehealth-care system. Ignoring the fact that it is risky to summarizea literature review in a single sentence, I would suggest thatmost publications on this subject have focused on the conditionsof primary access to care. Far fewer papers have investigatedthe next step: what happens when patients have had a first contactwith the health-care system. While data are more sparse, they     

Low plasma vitamin E levels in major depression: diet or disease?

OBJECTIVE: Levels of vitamin E have been reported to be lower in patients suffering major depression, but whether this is due to inadequate dietary intake or the pathophysiology of depression is not known, and was the subject of the present study. SETTING: Wollongong, Australia. METHODS: Plasma vitamin E (alpha-tocopherol) was measured in 49 adults with major depression, age (mean+/-s.d.): 47+/-12 y. In a subset (n=19) usual dietary intake of vitamin E was determined by diet history. RESULTS: Subjects had significantly lower plasma alpha-tocopherol (4.71+/-0.13 mumol/mmol cholesterol) than has previously been reported for healthy Australians, and plasma alpha-tocopherol was inversely related to depression score (by Beck Depression Inventory) (r=-0.367, P<0.009). Diet analysis indicated that 89% of subjects met or exceeded the recommended intake for vitamin E, and dietary intake was not related to plasma alpha-tocopherol level in this subset. CONCLUSION: These findings suggest that plasma levels of alpha-tocopherol are lower in depression, but this is not likely to be the result of inability to meet recommended dietary intake. .