Professor Kypros Kypri

Aims: To estimate the effect of national restrictions on late-night availability of alcohol on alcohol-related assault at a population level as indicated by (1) change in hospitalizations for weekend assaults and (2) change in the proportion of assaults documented by police that occur at night. Design: Evaluation of a natural experiment, involving: (1) pre¿post comparisons of age-specific incidence rates, adjusted for seasonality and background trend using Poisson regression; and (2) interrupted time¿series analyses, using seasonal autoregressive integrated moving average (SARIMA) models of national data with no control site. Setting: New Zealand. Participants: (1) Inpatients discharged from NZ hospitals following assault during the weekend (Friday¿Sunday) from 2004 to 2016 (n¿=¿14 996) and (2) cases of assault recorded by NZ Police from 2012 to 2018. Intervention: introduction of national maximum trading hours for all on-licence (8¿a.m.¿4¿a.m.) and off-licence premises (7¿a.m.¿11¿p.m.), abolishing existing 24-hour licences, on 18 December 2013. Measurements: (1) Age-specific incidence of hospitalization for assault on Friday, Saturday or Sunday from the national hospital discharge data set, excluding short-stay emergency department admissions and (2) proportion of weekly police-documented assaults occurring between 9¿p.m. and 5.59¿a.m., from NZ Police Demand and Activity data set. Findings: Following the restrictions, weekend hospitalized assaults declined by 11% [incidence rate ratio (IRR)¿=¿0.89; 95% confidence interval (CI)¿=¿0.84, 0.94], with the greatest reduction among 15¿29-year-olds (IRR¿=¿0.82; 95% CI¿=¿0.76, 0.89). There was an absolute reduction (step change) of 1.8% (95% CI¿=¿0.2, 3.5%) in the proportion of police-documented assaults occurring at night, equivalent to 9.70 (95% CI¿=¿0.10, 19.30) fewer night-time assaults per week, out of 207.4. Conclusions: The 2013 implementation of national maximum trading hours for alcohol in NZ was followed by reductions in two complementary indicators of alcohol-related assault, consistent with beneficial effects of modest nation-wide restrictions on the late-night availability of alcohol.

Objectives: Nonresponse can bias prevalence estimates in population surveys. Effects of selective participation in behavior change intervention trials have been little studied. We tested hypotheses that trial participants who are hard to recruit are (1) more likely to be lost-to-follow-up and (2) less responsive to intervention. Study Design and Setting: We undertook a two-stage individual participant data meta-analysis of four alcohol intervention trials involving 9,251 university students in Australia, New Zealand, and Sweden, comparing participants who enrolled ¿late¿ (after the final invitation to participate) vs. ¿early¿ (before that). Outcomes were whether participants completed assessments at each trial's primary endpoint (late/early) and number of drinks consumed per week (intervention/control) among late enrolees vs. early enrolees. Results: Late enrolees were more likely to be lost-to-follow-up than early enrolees (OR 2.3, 95% CI: 1.7, 2.9). Intervention effect estimates were smaller for late vs. early enrolees, but not significantly so (RR = 0.93; 95% CI: 0.79, 1.08). Conclusion: Greater effort to recruit trial participants was associated with higher attrition, but there was no clear evidence of bias in effect estimation. The possibility that intervention effect estimates do not generalize beyond a relatively compliant minority of trial participants may warrant further study.

Background and Aims: Recent research suggests that parental supply of alcohol is associated with more risky drinking and alcohol-related harm among adolescents. However, the overall effect of parental supply throughout adolescence remains unclear, because parental supply of alcohol varies during adolescence. Due to the complexity of longitudinal data, standard analytical methods can be biased. This study examined the effect of parental supply of alcohol on alcohol-related outcomes in early adulthood using robust methods to minimize risk of bias. Design: Prospective longitudinal cohort study. Setting: Australia. Participants: A cohort of school students (n¿=¿1906) recruited in the first year of secondary school (average age 12.9¿years) from Australian schools in 2010¿11, interviewed annually for 7¿years. Measurements: The exposure variable was self-reported parental supply of alcohol (including sips/whole drinks) during 5¿years of adolescence (waves 1¿5). Outcome variables were self-reported binge drinking, alcohol-related harm and symptoms of alcohol use disorder, measured in the two waves after the exposure period (waves 6¿7). To reduce risk of bias, we used targeted maximum likelihood estimation to assess the (counterfactual) effect of parental supply of alcohol in all five waves versus no supply on alcohol-related outcomes. Findings: Parental supply of alcohol throughout adolescence saw greater risk of binge drinking [risk ratios (RR)¿=¿1.53; 95% confidence interval (CI)¿=¿1.27¿1.84] and alcohol-related harms (RR¿=¿1.44; 95% CI¿=¿1.22¿1.69) in the year following the exposure period compared with no supply in adolescence. Earlier initiation of parental supply also increased risk of binge drinking (RR¿=¿1.10; 95% CI¿=¿1.05¿1.14), and any alcohol-related harm (RR¿=¿1.09; 95% CI¿=¿1.05¿1.13) for each year earlier parental supply began compared with later (or no) initiation. Conclusions: Adolescents whose parents supply them with alcohol appear to have an increased risk of alcohol-related harm compared with adolescents whose parents do not supply them with alcohol. The risk appears to increase with earlier initiation of supply.

Introduction and Aims: Risk-based alcohol licensing (RBL) has been introduced in several jurisdictions in Australia, New Zealand and Canada with the intention of reducing harm in and around alcohol outlets. RBL involves tailoring licence fees or regulatory agency monitoring levels according to risk criteria such as trading hours, venue size and compliance history. The aim of this study was to document key informant perspectives including their perceptions of the purpose of RBL, how it works and its active ingredients. Design and Methods: We conducted semi-structured in-depth interviews with 28 key informants, including four government policy makers, four liquor licensing representatives, four local council members, eight police officers, six licensees, one academic and one community advocate from Victoria, Queensland, the Australian Capital Territory and Ontario, Canada. We analysed the transcripts using a thematic approach. Results: Informants varied in their opinions about whether RBL achieved its objective of reducing alcohol-related harm. They identified difficulties in enforcing the compliance history component of the scheme due to loopholes in legislation as a major shortfall, and the need to apply RBL to packaged liquor (off-licence) outlets. They also discussed the need to consider outlet density associated with the location of a venue when assessing venue risk. Discussion and Conclusions: RBL schemes vary by jurisdiction and emphasise different components. In general, informants surmised that RBL as implemented has probably had little or no preventive effect but suggested that it may be effective with greater monitoring and penalties large enough to deter bad practice.

Objective: Governments¿ limited adoption of evidence-based policies to reduce alcohol-related harm has been partly attributed to alcohol industry influence. A better understanding of industry political strategy may help protect public policy against vested interests. We examined how industry actors used scientific evidence in their submissions to government alcohol policy consultations. Method: We conducted a content analysis of 214 submissions from industry actors in 21 Australian public consultations between 2013 and 2017. Repre-sented industry actors included alcohol producers and retailers, trade associations, licensees, and associated entities that derive commercial benefit from alcohol (e.g., advertising companies). Adapting an existing framework, we classified industry practices into two categories: (a) misuse of evidence and (b) denial of the effectiveness of evidence-based strategies. Results: Almost all submissions (91%) denied the effectiveness of evidence-based strategies; the most common denial practices were making unsubstantiated claims about adverse effects of policies (76%) and promoting alternatives without evidence (71%). The misuse of scientific evidence was apparent in 66% of submissions. Trade asso-ciations, producers, and retailers were most likely to use such practices. Conclusions: The extent to which the examined industry actors misused scientific evidence in their submissions to a wide range of alcohol policy consultations in Australia suggests the need for governments to consider excluding the industry from consultation on the regulation of alcohol. (J. Stud. Alcohol Drugs, 81, 710¿718, 2020).

Background: Protective behavioral strategies (PBSs) have been proposed as useful individual-level approaches to reducing alcohol consumption and alcohol-related harm. However, recent research suggests that few of the recommended PBSs may be effective in reducing longer-term alcohol consumption, with some appearing to result in increased intake over time. Objectives: To identify factors associated with enactment of specific PBSs to inform alcohol control efforts that aim to encourage the use of effective strategies and attenuate the effects of strategies found to be associated with increased consumption. Methods: Australian adult drinkers (n = 2,003; 50% male) completed an online survey assessing their alcohol consumption, frequency of attending drinking venues, enactment of specific PBSs, and demographic characteristics. Results: Greater enactment of the PBS that has previously been found to be associated with reduced alcohol use (¿Count your drinks¿) was found among older respondents and those with lower levels of alcohol consumption. Older respondents were also more likely to enact two of the three PBSs that have been found to be associated with increased alcohol consumption (¿Use a designated driver¿ and ¿Leave drinking venues at a pre-determined time¿). Conclusions/Importance: Results suggest that enactment of specific PBSs may differ according to the individual-level variables of gender, age, and preferred beverage type, and the environmental-level variable of attendance at licensed premises. Randomized trials investigating the effectiveness of PBS interventions among drinker subgroups are needed to determine the extent to which enactment reduces alcohol consumption and alcohol-related harm and whether effects are moderated by the variables assessed in this study.

Objective: The Anglo-Celtic colonists of Australia and New Zealand brought with them heavy beer-drinking customs, and each country later developed similar temperance movements and alcohol policies. Yet their beer markets differed throughout the 20th century; for example, Australian men typically drank lager with 5% alcohol-by-volume (ABV), whereas New Zealand men drank ale with 4%ABV. We investigated the public health implications of recent developments in product availability, marketing, and country-level consumption patterns. Method: We analyzed official data reporting beverage-and strength-specific volumes of ethanol available for sale in beer from 2000 to 2016, a period in which the countries had similar consumption trends; and did a thematic analysis of ¿market intelligence¿ reports. Results: Per capita ethanol beer sales fell in both countries, accompanied by increases in market share of higher %ABV categories. Different definitions of beer strength hampered comparison between countries. In Australia, consumption of ethanol in mid-strength beer (3.01%¿3.5%ABV) increased, whereas consumption of low-strength beer (<3%ABV) decreased. In New Zealand, consumption of high-strength beer (4.351%¿5%ABV) increased whereas that of traditional mid-strength beer (2.501%¿ 4.35%ABV) decreased substantially. Market reports cited consumer health concerns and demand for ¿craft beer¿ (typically high-strength) as competing influences in both markets, and reduced-alcohol beer as ¿the alcoholic drinks industry¿s¿potentially lucrative¿shield against accusations of irresponsibility.¿ Conclusions: Declines in both high-and low-strength beer in Australia have potentially important implications. In New Zealand, the failure of low-strength beer to establish significant market share, along with increased consumption of high-strength beer, are noteworthy developments. Trend data on product ethanol content warrants scrutiny in public health surveillance globally, whereas research is needed on the role of ethanol content within industry strategy.

Background: Risk-based licensing (RBL) is among the more recent policy interventions to reduce alcohol-related harm in and around licensed venues. RBL sets licence fees to reflect the venue's propensity to cause harm as a means of encouraging operators to improve their practices. We assessed whether the introduction of RBL in the Australian states of Queensland and Victoria was associated with a reduction in the incidence of emergency department (ED) injury presentations. Methods: We employed an interrupted time series design using Prais-Winsten and Cochrane-Orcutt regression modelling to estimate step and slope parameters in injury incidence rates in each state. We defined the population as residents of the state, aged 15¿54 years, the age group we considered most likely to be exposed to the night-time economy. To reduce noise, we confined cases to presentations during times previously identified as correlated with a high probability of alcohol involvement, namely ¿high alcohol hours¿ (HAH). We adjusted our models for the alcopops tax, implemented shortly before RBL, and for assaults during low alcohol hours (LAH) as a proxy for other risk factors for assault. Results: RBL was not associated with an overall reduction in the incidence of ED injury presentations during HAH in Queensland (ß = 0.003; 95% CI: -0.010, 0.003, p = 0.318) or Victoria (ß=-0.010; 95% CI: -0.021, 0.001, p = 0.087). Post-hoc subgroup analyses showed a reduction in ED injury presentations among men aged 20¿39 years in Victoria (ß=-0.026; 95% CI:-0.012, -0.040, p-0.0003) but this was not replicated in Queensland. Conclusion: There was little evidence that RBL affected the incidence of ED presentations for injury. This may be due to weak financial penalties being applied to venues assessed as high-risk.

Background: Why adolescents' drinking is associated with their parents' drinking remains unclear. We examined associations in a prospective cohort study, adjusting for socio-demographic characteristics and family factors. Methods: We recruited 1927 children from grade 7 classes (mean age 13 years), and one of their parents, in three Australian states, contacted participants annually from 2010 to 2014, and analysed data from assessments at ages 13, 14, 15 and 16 years. We used the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) subscale to identify hazardous drinking in parents (score =5) and children (score =3) and constructed mixed-effect logistic regression models, accounting for clustering within school and adjusting for likely confounders. We evaluated the sensitivity of estimates by imputing missing values assuming the data were missing at random vs. missing not at random. Results: Parent hazardous drinking predicted mid-adolescent hazardous drinking, e.g. 15 years olds whose parents [adjusted odds ratio (aOR) 2.00; 95% confidence interval 1.51-2.64] or parents' partners (aOR 1.94; 1.48-2.55) were hazardous drinkers had higher odds of being hazardous drinkers at age 16. The magnitude of univariate associations changed little after adjusting for covariates, and sensitivity analyses confirmed the robustness of the association, across a wide range of assumptions about the missing data. Conclusions: The associations between parents' and their adolescent children's hazardous drinking are unlikely to be due to confounding by socio-demographic and family factors. Parents should be encouraged, and supported by public policy, to reduce their own alcohol consumption in order to reduce their children's risk of becoming hazardous drinkers.

Objective: We tested the hypothesis that participants who know the behavioral focus of a study and are thus aware that a particular behavior is being studied will modify that behavior, independently of any possible effect of assessment, thereby dismantling a Hawthorne effect into two putative components. Study Design and Setting: We undertook a three-arm individually randomized trial online among students: group A (control) were told they were completing a lifestyle survey; group B were told the focus of the survey was alcohol consumption; and group C additionally answered 20 questions on their alcohol use and its consequences before answering the same lifestyle questions as Groups A and B. Nondrinkers were excluded, and all groups were aware they would be followed up after 1 month. Results: Outcome data were obtained for 4,583 of 5,478 trial participants (84% follow-up rate). There were no differences between the three groups on primary (overall volume consumed) or secondary outcome measures (drinking frequency and amount per typical occasion) in the intervening 4 weeks. Conclusions: There is no evidence that any form of Hawthorne effect exists in relation to self-reported alcohol consumption online among university students in usual research practice. Attention to study contexts is warranted for investigating research participation effects.

Background: New Zealand's alcohol law reforms aimed to give communities greater control over alcohol availability. We investigated whether community participation in local liquor licensing increased and why people did not participate. Methods: We invited 4000 randomly selected residents to complete a questionnaire in 2014 about their views on alcohol in their community, participation in local alcohol decision-making, alcohol consumption, and experience of alcohol-related harm. In 2017, we surveyed a new sample of 4000 residents, and invited the 2014 respondents to complete a follow-up questionnaire. Results: Response fractions were 44% in 2014 (n = 1657) and 37% in 2017 (n = 1376) for population surveys, and 61% (n = 887) for follow-up. Cross-sectional comparisons showed no marked change in proportions reporting ever having participated in alcohol policy development (4.9% in 2014 versus 5.1% in 2017), or who objected to a licence application in the preceding year (1.0% versus 1.4%). Longitudinal comparisons also suggested little change. The most common reasons 2017 respondents gave for not participating were not knowing where to start (39%), lack of time (36%), and needing more information (32%), and this order was similar in 2014. Conclusion: Public participation in local liquor licencing is low and it has not increased substantially under the new legislation.

Monitoring levels of alcohol-related harm in populations requires indicators that are robust to extraneous influence. We investigated the validity of an indicator for police-attributed alcohol-related assault. We summarized offence records from Queensland Police, investigated patterns of missing data, and considered the utility of a surrogate for alcohol-related assault. Of 242 107 assaults from 2004-2014, in 35% of cases the drug used by the offender was recorded as a ¿ unknown'. Under various assumptions about non-random missingness the proportion of assaults judged to be alcohol-related varied from 30%-65%. We found a sharp increase in missing data from 2007 suggesting the downward trend from that point is artefactual. Conversely, we found a stable and increasing trend using a time-based surrogate. The volume of missing data and other limitations preclude valid estimation of trends using the police indicator, and demonstrate how misleading results can be produced. Our analysis supports the use of an empirically-based surrogate indicator.

Background and Aims: Business corporations¿ use of political donations to garner political influence is especially troubling in relation to products that damage human health. We sought to investigate patterns of donations to Australian political parties from tobacco, alcohol and gambling industry actors and the experiences of key informants. Design and Methods: We analysed public data on federal and state donations for 10 years to June 2015. We conducted 28 semi-structured interviews with current and former politicians, ex-political staffers and other key informants, concerning the role played by political donations of tobacco, alcohol and gambling companies in Australian politics. We examined temporal associations in donations data, and thematically analysed interviews. Results: Australian political parties declared donations of A$14 million (US$11 M) from tobacco ($1.9 M), alcohol ($7.7 M), gambling ($2.9 M) and supermarket ($1.7 M) entities, excluding donations below the $12 800 reporting threshold. Donations to the governing party increased substantially during debates about an alcohol tax and gambling law reform. Alcohol industry donations to major parties spiked ahead of elections. Interviewees identified the function of donations in terms of: (i) buying immediate influence; (ii) building long-term relationships; (iii) exploiting a flawed political system; and (iv) the need to look beyond donations, for example, to favour exchange; and the public's right to know about corporate influence on policy-makers. Discussion and Conclusions: The alcohol and gambling industries make substantial donations to influence particular decisions in the short term and build relationships over the long term. Banning corporate donations and publicly funding political parties warrant consideration to safeguard the integrity of public policy-making.

Background: Some parents supply alcohol to their children, reportedly to reduce harm, yet longitudinal research on risks associated with such supply is compromised by short periods of observation and potential confounding. We aimed to investigate associations between parental supply and supply from other (non-parental) sources, with subsequent drinking outcomes over a 6-year period of adolescence, adjusting for child, parent, family, and peer variables. Methods: We did this prospective cohort study using data from the Australian Parental Supply of Alcohol Longitudinal Study cohort of adolescents. Children in grade 7 (mean age 12 years), and their parents, were recruited between 2010 and 2011 from secondary schools in Sydney, Perth, and Hobart, Australia, and were surveyed annually between 2010 and 2016. We examined the association of exposure to parental supply and other sources of alcohol in 1 year with five outcomes in the subsequent year: binge drinking (more than four standard drinks on a drinking occasion); alcohol-related harms; and symptoms of alcohol abuse (as defined by Diagnostic and Statistical Manual of Mental Disorders, 4th edition [DSM-IV]), alcohol dependence, and alcohol use disorder (as defined by DSM-5). This trial is registered with ClinicalTrials.gov, number NCT02280551. Findings: Between September, 2010, and June, 2011, we recruited 1927 eligible parents and adolescents (mean age 12·9 years [SD 0·52]). Participants were followed up until 2016, during which time binge drinking and experience of alcohol-related harms increased. Adolescents who were supplied alcohol only by parents had higher odds of subsequent binge consumption (odds ratio [OR] 2·58, 95% CI 1·96¿3·41; p<0·0001), alcohol-related harm (2·53, 1·99¿3·24; p<0·0001), and symptoms of alcohol use disorder (2·51, 1·46¿4·29; p=0·0008) than did those reporting no supply. Parental supply of alcohol was not significantly associated with the odds of reporting symptoms of either alcohol abuse or dependence, compared with no supply from any source. Supply from other sources was associated with significant risks of all adverse outcomes, compared with no supply, with an even greater increased risk of adverse outcomes. Interpretation: Providing alcohol to children is associated with alcohol-related harms. There is no evidence to support the view that parental supply protects from adverse drinking outcomes by providing alcohol to their child. Parents should be advised that this practice is associated with risk, both directly and indirectly through increased access to alcohol from other sources. Funding: Australian Research Council, Australian Rotary Health, Foundation for Alcohol Research and Education, National Drug and Alcohol Research Centre.

Introduction and Aims. To investigate the association between smokeless tobacco consumption (STC) during pregnancy and risk of stillbirth. Design and Methods. We conducted a population-based case¿control study of 253 cases and 759 randomly selected control women in Madaripur, Bangladesh. We conducted a survey of two rural local government areas, including 8082 women, and identified cases based on self-report of a stillbirth outcome of each participant's first pregnancy. All were asked about STC during their first pregnancy and a range of risk markers and known confounders. Demographic and maternal variables associated either with stillbirth or STC were included in logistic regression models. Results. Of the 241 cases and 757 controls with complete exposure data, 32 cases (13.2%) and 18 controls (2.4%) reported STC during pregnancy [odds ratio 6.28; 95% confidence interval (CI) 3.45, 11.4]. After adjustment for education, household income, age at first pregnancy, vaccination during pregnancy, complications, exposure to arsenic in drinking water, place of delivery and antenatal care, excess risk was attenuated but remained significant [adjusted odds ratio (aOR) 2.87; 95% CI 1.36, 6.08]. There was a dose¿effect association, with women who used smokeless tobacco >5 times daily during their first pregnancy at greater risk of having a stillbirth (aOR 5.89; 95% CI 1.70, 20.3) than less frequent users (aOR 1.67; 95% CI 0.65, 4.29). Estimates were robust to extreme assumptions about missing exposure data. Discussion and Conclusions. STC during pregnancy was associated with an increased risk of stillbirth. This finding adds to the urgency of need for smokeless tobacco control strategies to be implemented in South Asia. [Hossain MS, Kypri K, Rahman B,Milton AH. Smokeless tobacco consumption and stillbirth: Population-based case¿control study in rural Bangladesh.

Purpose of Review: The addictions field lacks a coherent framework for strategies to reduce harm arising from the consumption of alcohol. We need to be able to clarify the mechanisms by which key strategies operate, and encompass aetiological factors that do not involve drinking. Recent Findings: We outline population and high-risk individual strategies focused on supply- and demand-side factors and propose a system laid out in two tables, for classifying consumption-focused and non-consumption-focused countermeasures. Summary: Some countermeasures belong in more than one cell, reflecting more than one underlying mechanism. The taxonomy will aid the synthesis of a vast scientific literature and guide new countermeasure development, evaluation, and policy.

Previous studies suggest that employing specific behavioral strategies when drinking can prevent excessive alcohol consumption and related harms. However, these studies have typically examined these ¿protective behavioral strategies¿ (PBSs) in combination, limiting understanding of whether individual strategies differ in their effectiveness. Further, most existing research is cross-sectional in design, precluding the determination of causal relationships between PBS use and alcohol consumption. To address these research gaps, the present study sought to longitudinally (i) identify which individual PBSs are significantly related to reduced alcohol consumption over time and (ii) explore the effectiveness of individual PBSs among specific population groups. The sample comprised 1328 Australian adult drinkers (47% male) who completed an online survey assessing engagement in PBSs and alcohol consumption at two time points approximately four weeks apart. Reported enactment of the PBS ¿Count your drinks¿ was associated with a significant reduction in alcohol consumption between T1 and T2. In contrast, enactment of the PBSs ¿Ask a friend to let you know when you have had enough to drink¿, ¿Put extra ice in your drink¿, ¿Use a designated driver¿, and ¿Leave drinking venues at a pre-determined time¿ was associated with an increase in alcohol consumption. The results thus suggest that many PBSs may not be effective in reducing alcohol consumption and that some may be associated with higher levels of intake. The results have implications for the development of harm-minimization campaigns designed to encourage drinkers to reduce their alcohol consumption.

Background: Early alcohol initiation is common and has been associated with the development of alcohol problems. Yet, past research on the association of age of initiation with later problem drinking has produced inconsistent findings. Using prospective data from the Australian Parental Supply of Alcohol Longitudinal Study cohort, this study examined age of alcohol initiation, and of first drunkenness, and associations with subsequent drinking in adolescence. Methods: A total of 1,673 parent¿child dyads recruited through Australian secondary schools completed annual surveys for 5¿years (grades 7 to 11). Limiting the sample to those adolescents who had initiated alcohol use by age 17 (n¿=¿839), multinomial logistic regression models were used to examine associations between (i) age of initiation to alcohol use (consuming at least 1 full serve) and (ii) age of first drunkenness, and 2 outcomes: (i) binge drinking (consuming >4 standard drinks on a single occasion), and (ii) the total number of alcoholic drinks consumed in the past year, adjusted for a range of potential child, parent, family, and peer covariates. Results: Fifty percent of adolescents reported alcohol use and 36% reported bingeing at wave 5 (mean age 16.9 years), and the mean age of initiation to alcohol use for drinkers was 15.1 years. Age of initiation was significantly associated with binge drinking and total quantity of alcohol consumed in unadjusted and adjusted models. Age of first drunkenness was associated with total quantity of alcohol consumed in unadjusted models but not adjusted models and was not associated with subsequent bingeing. Conclusions: Initiating alcohol use earlier in adolescence is associated with an increased risk of binge drinking and higher quantity of consumption in late secondary school, supporting an argument for delaying alcohol initiation for as long as possible to reduce the risk for problematic use in later adolescence and the alcohol-related harms that may accompany this use.

Background: Most trials of electronic alcohol screening and brief intervention (e-SBI) have been conducted in young people. The aim of this study was to evaluate the effect of e-SBI in adults with hazardous or harmful drinking. Methods: This individually randomized, parallel, two-group, double-blind controlled trial was conducted in the outpatient department of a large public hospital in Australia. Consenting adults who scored 5¿9 on the AUDIT-C (837/3225; 26%) were randomized in a 1:1 ratio by computer to screening alone (442/837; 53%) or to 10 min of assessment and personalized feedback on their alcohol consumption (comparisons with medical guidelines and age and sex-specific norms), peak blood alcohol concentration, expenditure on alcohol, and risk of alcohol dependence (395/837; 47%). The two primary outcomes, assessed six months after randomization, were the number of standard drinks (10 g ethanol) consumed by participants in the last seven days and their AUDIT score. Results: 693/837 (83%) and 635/837 (76%) participants were followed-up at 6 and 12 months, respectively. There was no statistically significant difference between the groups in the median number of standard drinks consumed in the last seven days (intervention: 12; control: 10.5; rate ratio, 1.12 [95% confidence interval, 0.96¿1.31]; P =.17) or in their median AUDIT score (intervention: 7; control: 7; mean difference, 0.28 [-0.42 to 0.98]; P =.44). Conclusion: These results do not support the implementation of an e-SBI program comprising personalized feedback and normative feedback for adults with hazardous or harmful drinking in the hospital outpatient setting.

Introduction and Aims. There is widespread concern about the nature, extent and impacts of lobbying by industries selling unhealthy commodities, which threatens public health and undermines important democratic processes. In the last decade, all Australian jurisdictions (except the Northern Territory) have established lobbyist registers with the stated objective of increasing the capacity of government and the public to scrutinise lobbying. Our aim was to assess whether the registers are fulfilling this objective. Design and Methods. We conducted web searches of registers in Australian jurisdictions in 2014 and 2015 to determine what type of information they collected and whether data were accessible. We supplemented searches with e-mails and phone calls to registrars to clarify policies and seek additional information. Results. We found that the data were lacking in critical details and historical information was difficult or impossible to obtain. None of the registers required in-house lobbyists to register or to be bound by the Lobbying Codes of Conduct. None required that informal lobbying (e.g. by government relations staff within a company) be recorded, and none provided detailed information about the nature and extent of lobbying activities. Discussion and Conclusions. The registers do not meet the stated objective of making lobbying activity transparent to the Australian public. Timely access to comprehensive information is essential to help promote the rational development of policy concerning tobacco, alcohol and gambling problems. There is an urgent need to reform lobbyist registers to ensure that they are comprehensive and transparent.

Bhutan is a low-middle-income country with poor roads, rapidly increasing motor vehicle use and heavy alcohol consumption. We estimated the proportion of emergency department patients presenting with injury who had positive blood alcohol. We sought to breathalyse and interview all adult patients (=18 years) presenting with injury at the Jigme Dorji Wangchuck National Referral Hospital in the capital city Thimphu, from April to October 2015. Breath tests and interviews were conducted with 339 (91%) of 374 eligible adult patients. A third (34%) were alcohol-positive and 22% had blood alcohol concentrations >0.08 g/dL. The highest alcohol-positive fractions were for assault (71%), falls (31%) and traffic crashes (30%). Over a third (36%) of patients had a delay of >2 h between injury and breath test. The results underestimate blood alcohol concentrations at the time of injury so the true prevalence of pre-injury alcohol impairment is greater than our estimates suggest. Countermeasures are urgently needed, particularly roadside random breath testing and alcohol controls.

Objective: To examine how health advice is provided in popular magazines and the quality of that advice. Methods: A prospective quantitative analysis of the quality of health advice provided in Australian magazines between July and December 2011 was conducted. A rating instrument was adapted from the Media Doctor Australia rating tool used to assess quality of health news reporting. Criteria included: recommends seeing a doctor; advice based on reliable evidence; advice clear and easily applied; benefits presented meaningfully; potential harms mentioned; evidence of disease mongering; availability and cost of treatments; obvious advertising; vested interest, and anecdotal evidence. Results: 163 health advice articles were rated showing a wide variation in the quality of advice presented between magazines. Magazines with ¿health¿ in the title, rated most poorly with only 36% (26/73) of these articles presenting clear and meaningful advice and 52% (38/73) giving advice based on reliable evidence. Conclusions: Australian magazines, especially those with health in the title, generally presented poor quality, unreliable health advice. Teen magazine Dolly provided the highest quality advice. Implications: Consumers need to be aware of this when making health choices.

Introduction and Aims: In December 1999, New Zealand lowered the alcohol minimum purchasing age from 20 to 18 years. We tested hypotheses that this change was associated with long-term increases in traffic injury attributable to alcohol-impaired driving among 18- to 19-year-olds (target age group) and 15- to 17-year-olds (affected by ¿trickle-down¿). Design and Methods: We undertook a controlled before-and-after comparison of rates of fatal and non-fatal traffic injury to persons of any age attributable to impaired drivers aged 18¿19 years and 15¿17 years, versus 20- to 21-year-olds. Crash data including assessment of driver alcohol impairment were recorded by New Zealand Police. The pre-change period was 1996¿1999. Post-change periods were 2000¿2003, 2004¿2007 and 2008¿2010. Outcomes were population-based and vehicle travel-based rates. Results: Compared with the change in injury rates attributable to alcohol-impaired 20- to 21-year-old male drivers, injuries attributable to 18- to 19-year-old male drivers increased in all post-change periods and significantly so in the second post-change period (incidence rate ratio [IRR] 1.3, 95% confidence interval [CI] 1.1 to 1.5). For 15- to 17-year-old male drivers, rates increased in all post-change periods compared with 20- to 21-year-olds, and more so in the second (IRR 1.2, 95% CI 1.1 to 1.4) and third (IRR 1.2, 95% CI 1.1 to 1.4) periods. There was a short-term relative increase in harm attributable to 18- to 19-year-old female drivers (IRR 1.5; 1.1 to 2.0). Results were similar for vehicle travel-based rates. Discussion and Conclusions: Reducing the alcohol minimum purchasing age was followed by long-term increases in the incidence of traffic injury attributable to male 15- to 19-year-old alcohol-impaired drivers. [Kypri K, Davie G, McElduff P, Langley J, Connor J. Long-term effects of lowering the alcohol minimum purchasing age on traffic crash injury rates in New Zealand. Drug Alcohol Rev 2017;36:178¿185].

Background Parents are a major supplier of alcohol to adolescents, yet there is limited research examining the impact of this on adolescent alcohol use. This study investigates associations between parental supply of alcohol, supply from other sources, and adolescent drinking, adjusting for child, parent, family and peer variables. Method A cohort of 1927 adolescents was surveyed annually from 2010 to 2014. Measures include: Consumption of whole drinks; binge drinking (>4 standard drinks on any occasion); parental supply of alcohol; supply from other sources; child, parent, family and peer covariates. Results After adjustment, adolescents supplied alcohol by parents had higher odds of drinking whole beverages [odds ratio (OR) 1.80, 95% confidence interval (CI) 1.33-2.45] than those not supplied by parents. However, parental supply was not associated with bingeing, and those supplied alcohol by parents typically consumed fewer drinks per occasion (incidence rate ratio 0.86, 95% CI 0.77-0.96) than adolescents supplied only from other sources. Adolescents obtaining alcohol from non-parental sources had increased odds of drinking whole beverages (OR 2.53, 95% CI 1.86-3.45) and bingeing (OR 3.51, 95% CI 2.53-4.87). Conclusions Parental supply of alcohol to adolescents was associated with increased risk of drinking, but not bingeing. These parentally-supplied children also consumed fewer drinks on a typical drinking occasion. Adolescents supplied alcohol from non-parental sources had greater odds of drinking and bingeing. Further follow-up is necessary to determine whether these patterns continue, and to examine alcohol-related harm trajectories. Parents should be advised that supply of alcohol may increase children's drinking.

Objective Scientific research is essential to the development of effective addiction treatment and drug policy. Actions that compromise the integrity of addiction science need to be understood. The aim of this study is to investigate funder (e.g. industry, government or charity) interference in addiction science internationally. Method Corresponding authors of all 941 papers published in an international specialist journal July 2004 to June 2009 were invited to complete a web questionnaire. A sensitivity analysis with extreme assumptions about non-respondents was undertaken. Results The questionnaire was completed by 322 authors (response fraction 34%), 36% (n = 117) of whom had encountered at least one episode (median = 3, Interquartile range = 4) of funder interference in their research: 56% in Australasia, 33% in Europe, and 30% in North America. Censorship of research outputs was the most common form of interference. The wording or writing of reports and articles, as well as where, when and how findings were released were the areas in which influence was most often reported. Conclusions Funder interference in addiction science appears to be common internationally. Strategies to increase transparency in the addiction science literature, including mandatory author declarations concerning the role of the funder, are necessary.

There is evidence that smoking and alcohol consumption are paired behaviours among university students, but we know little about how New Zealand students engage in these behaviours. We estimated prevalence of daily and occasional smoking among university students, and associations of smoking with drinking patterns, demographics and smokefree policies of the university. This research was conducted with 2822 university students, aged 17¿25, from five New Zealand universities who participated in an online health survey in 2013. Fourteen percent reported they currently smoke occasionally, and 3% reported smoking on a daily basis. Increasing age, living situation, drinking more often, and drinking more alcohol during drinking occasions were all associated with greater levels of smoking. Understanding patterns of smoking in relation to alcohol consumption may help efforts to further reduce smoking prevalence. Specifically, policy makers should consider approaches that de-couple tobacco and alcohol consumption, such as expanding the smokefree perimeter of bars and disallowing the sale of tobacco at premises licensed to sell alcohol.

Objective: There have been no trials in healthcare settings of genetic susceptibility feedback in relation to alcohol consumption. The purpose of this study was to determine the feasibility and acceptability of conducting a full-scale randomised trial estimating the effect of personalised genetic susceptibility feedback on alcohol consumption in hospital outpatients with risky drinking. Methods: Outpatients =18 years of age who reported drinking more than 14 standard drinks in the past week or in a typical week were asked to provide a saliva sample for genetic testing. Genetic susceptibility feedback was posted to participants 6 months after recruitment. The co-primary outcomes were the proportion of participants who (i) provided a saliva sample that could be genotyped, and (ii) spoke with a genetic counsellor. Secondary outcomes included changes in patients' weekly alcohol consumption; scores on scales measuring readiness to change, importance of changing and confidence in ability to change drinking habits; knowledge about which cancers are alcohol-attributable; and acceptability of the saliva collection procedure and the genetic-feedback intervention. McNemar's test and paired t-tests were used to test for differences between baseline and follow-up in proportions and means, respectively. Results: Of 100 participants who provided a saliva sample, 93 had adequate DNA for at least one genotyping assay. Three participants spoke to a genetic counsellor. Patients' readiness to change their drinking, their views on the importance of changing and their stated confidence in their ability to change increased between baseline and follow-up. There was no increase in patients' knowledge about alcohol-attributable cancers nor any reduction in how much alcohol they drank 4 months after receiving the feedback. Most participants (80%) were somewhat comfortable or very comfortable with the process used to collect saliva, 84% understood the genetic feedback, 54% found it useful, 10% had sought support to reduce their drinking after receiving the feedback, and 37% reported that the feedback would affect how much they drink in the future. Conclusion: Results of this study suggest it would be feasible to conduct a methodologically robust trial estimating the effect of genetic susceptibility feedback on alcohol consumption in hospital outpatients with risky drinking.

© 2015 Australasian Professional Society on Alcohol and other Drugs Introduction and Aims: The aim of this study was to investigate health knowledge, attitudes and smokeless tobacco quit attempts and intentions among married women in rural Bangladesh. Design and Methods: A cross-sectional survey was conducted using an interviewer administered, pretested, semistructured questionnaire. All 8082 women living in the Jhaudi and Ghotmajhee local government areas, aged =18 years with at least one pregnancy in their lifetime, were invited to participate. Questions covered smokeless tobacco consumption (STC), knowledge regarding its health effects, users' quit attempts and intentions and sociodemographic characteristics. Results: Eight thousand seventy-four women completed the survey (response rate 99.9%). Almost half (45%) of current consumers thought STC was good for their health and many ascribed medicinal values to it, for example 25% thought STC reduced stomach aches. A quarter had previously tried to quit and 10% intended to quit. After adjusting for potential confounders, inaccurate knowledge of STC health consequences was associated with being older [adjusted odds ratio (aOR) = 2.71, 95% confidence interval (CI) 1.99¿3.50], less educated (aOR = 2.18, 95% CI 1.66¿2.85), Muslim (aOR = 17.0, 95% CI 12.0¿23.9) and unemployed (aOR = 29.7, 95% CI: 25.2¿35.1). Having less education (aOR = 2.52, 95% CI 0.98¿6.45) and being unemployed (aOR = 1.52, 95% CI 1.03¿2.23) were associated with the intention to quit. Discussion and Conclusions: Large gaps exist in rural Bangladeshi women's understanding of the adverse health effects of STC. Health awareness campaigns should highlight the consequences of STC. Routine screening and cessation advice should be provided in primary healthcare and smokeless tobacco control strategies should be implemented. [Hossain MS, Kypri K, Rahman B, Akter S, Milton AH. Health knowledge and smokeless tobacco quit attempts and intentions among married women in rural Bangladesh: Cross-sectional survey. Drug Alcohol Rev 2016;35:514¿522] .

Aim: Bhutan is a low-middle income country that, like many others, experiences significant alcohol-related harm and low compliance with laws restricting availability and promotion. This study assessed changes in compliance of alcohol outlets with sales restrictions following a multi-sector programme aimed at improving this. Design: Pre-post design with covert observation of service practices. Setting: Thimphu, Bhutan, June-November 2013. Alcohol is not permitted for sale except from 1 to 10 p.m. Wednesday-Monday. Serving minors (< 18 years old) or intoxicated patrons is illegal. Participants: Seventy-one outlets selected randomly from all 209 on-premises outlets in downtown Thimphu. Intervention: Multi-sector programme involving visits to outlets, education of owners and staff, a toolkit and implementation checks. Measurements: Ten mystery-shopper visits were made to each outlet both before and after the intervention. We assessed compliance in five purchasing scenarios: (1) before 1 p.m., (2) after 10 p.m., (3) on Tuesdays and (4) shoppers who appeared to be underage or (5) intoxicated. Changes in compliance rates were assessed using multi-variable logistic regression models. Findings: Overall compliance increased from 20 to 34% [difference: 14%; 95% confidence interval (CI) = 7-22%]. Improvement was found in refusals of service before 1 p.m.: 10-34% (difference = 24%; 95% CI = 12-37%) and on Tuesdays: 43-58% (difference = 14%; 95% CI = 1-28%). Differences in refusal to serve alcohol: after 10 p.m. (difference = 15%; 95% CI = -8 to 37%); to underage patrons (difference = -5%; 95% CI = 14 to 4%); and to intoxicated patrons (difference = 7%; 95% CI = -7-20%) were not statistically significant. Younger servers, stand-alone bars and outlets permitting indoor smoking were each less likely to comply with the alcohol service laws. Conclusion: A multi-sector programme to improve compliance with legal restrictions on serving alcohol in Bhutan appeared to have a modest effect but even after the programme, in two-thirds of the occasions tested, the laws were broken. adj adj adj adj adj

Objective: To investigate reporting of alcohol consumption, we manipulated the contexts of questions in ways designed to induce social desirability bias. Method: We undertook a two-arm, parallel-group, individually randomized trial at an Australian public university. Students were recruited by email to a web-based ¿Research Project on Student Health Behavior.¿ Respondents answered nine questions about their physical activity, diet, and smoking. They were unknowingly randomized to a group presented with either (A) three questions about their alcohol consumption or (B) seven questions about their alcohol dependence and problems (under a prominent header labeled ¿Alcohol Use Disorders Identification Test¿), followed by the same three alcohol consumption questions from (A). Results: A total of 3,594 students (mean age = 27, SD = 10) responded and were randomized: 1,778 to Group A and 1,816 to Group B. Outcome measures were the number of days they drank alcohol, the typical number of drinks they consumed per drinking day, and the number of days they consumed six or more drinks. The primary analysis included participants with any alcohol consumption in the preceding 4 weeks (1,304 in Group A; 1,340 in Group B) using between-group, two-tailed t tests. Results: In Groups A and B, respectively, means (and SDs) of the number of days drinking were 5.89 (5.92) versus 6.06 (6.12), p = .49; typical number of drinks per drinking day: 4.02 (3.87) versus 3.82 (3.76), p = .17; and number of days consuming six or more drinks: 1.69 (2.94) versus 1.67 (3.25), p = .56. Conclusions: We could not reject the null hypothesis because earlier questions about alcohol dependence and problems showed no sign of biasing the respondents¿ subsequent reports of alcohol consumption. These data support the validity of university students¿ reporting of alcohol consumption in web-based studies.

BACKGROUND: Parents are a major supplier of alcohol to adolescents, often initiating use with sips. Despite harms of adolescent alcohol use, research has not addressed the antecedents of such parental supply. This study investigated the prospective associations between familial, parental, peer, and adolescent characteristics on parental supply of sips. METHODS: Participants were 1729 parent-child dyads recruited from Grade 7 classes, as part of the Australian Parental Supply of Alcohol Longitudinal Study. Data are from baseline surveys (Time 1) and 1-year follow-up (Time 2). Unadjusted and adjusted logistic regressions tested prospective associations between Time 1 familial, parental, peer, and adolescent characteristics and Time 2 parental supply. RESULTS: In the fully adjusted model, parental supply was associated with increased parentreport of peer substance use (odds ratio [OR] = 1.20, 95% confidence ratio [CI], 1.08-1.34), increased home alcohol access (OR = 1.07, 95% CI, 1.03-1.11), and lenient alcohol-specific rules (OR=0.88, 95% CI, 0.78-0.99). CONCLUSIONS: Parents who perceived that their child engaged with substance-using peers were more likely to subsequently supply sips of alcohol. Parents may believe supply of a small quantity of alcohol will protect their child from unsupervised alcohol use with peers. It is also possible that parental perception of peer substance use may result in parents believing that this is a normative behavior for their child's age group, and in turn that supply is also normative. Further research is required to understand the impacts of such supply, even in small quantities, on adolescent alcohol use trajectories.

Objectives: Telephone follow-up is not currently recommended as a strategy to improve retention in randomized trials. The aims of this study were to estimate the effect of telephone follow-up on retention, identify participant characteristics predictive of questionnaire completion during or after telephone follow-up, and estimate the effect of including participants who provided follow-up data during or after telephone follow-up on balance between randomly allocated groups in a trial estimating the effect of electronic alcohol screening and brief intervention on alcohol consumption in hospital outpatients with hazardous or harmful drinking. Method: Trial participants were followed up 6. months after randomization (June-December 2013) using e-mails containing a hyperlink to a web-based questionnaire when possible and by post otherwise. Telephone follow-up was attempted after two written reminders and participants were invited to complete the questionnaire by telephone when contact was made. Results: Retention before telephone follow-up was 62.1% (520/837) and 82.8% (693/837) afterward: an increase of 20.7% (173/837). Therefore, 55% (95% CI 49%-60%) of the 317 participants who had not responded after two written reminders responded during or after the follow-up telephone call. Age. <. 55. years, a higher AUDIT-C score and provision of a mobile/cell phone number were predictive of questionnaire completion during or after telephone follow-up. Balance between randomly allocated groups was present before and after inclusion of participants who completed the questionnaire during or after telephone follow-up. Conclusion: Telephone follow-up improved retention in this randomized trial without affecting balance between the randomly allocated groups.

In June 2012 the Alcohol Advisory Council (ALAC) ceased to be after more than three decades of providing advice on alcohol policy, undertaking health promotion activities, and funding research on the prevalence and causes of unhealthy alcohol use and strategies to address alcohol-related harm. Perversely, its dissolution followed soon after the Law Commission¿s ¿once in a generation¿ review recommending law reform to address New Zealand¿s substantial alcohol-related health burden. ALAC¿s functions were ostensibly taken over by the Health Promotion Agency (HPA) but this new entity was given less autonomy than ALAC and a remit including areas as disparate as rheumatic fever and sun safety. In addition, HPA was compromised from the start by the appointment of a food, alcohol and tobacco industry representative to its Board. ALAC sometimes fell short of community and scientists¿ expectations that it provide independent and fearless advice on politically contested matters, such as controls on alcohol marketing. However, it seems that the way the HPA has been set up makes effective action to address health and social problems caused by alcohol consumption in New Zealand unlikely.

Background: Epidemiological studies report markedly varying rates of adolescent alcohol involvement. Despite being a common adolescent behavior, a potential cause of this variation is that consumption of sips is either not measured or not distinguished from consumption of whole beverages. Methods: Participants were 1,843 grade 7 adolescents recruited across 49 Australian secondary schools (M age = 12.4, SD = 0.5). Quantity and frequency of lifetime and past 6-month consumption were assessed, distinguishing between sipping and drinking. For comparison with international population surveys, quantity was reported as any consumption, sipping only, and drinking only. Results: Combining sipping and drinking into a single category, lifetime consumption was reported by 67.3% of the present sample. Distinguishing lifetime consumption by sipping and drinking: only 7.8% of adolescents had consumed a whole beverage; the remaining 59.6% had only sipped. Consumption of whole beverages was mostly limited to 1 to 2 drinks (84.2% of drinkers). Sipping and drinking were also infrequent: 78.2% of sipping and 60.4% of drinking, occurred less than monthly. Heavy episodic consumption was uncommon (1.2% of the sample). When other population studies were inspected, a clear trend for higher drinking rates were found in those studies where sipping was counted as drinking and vice versa. Conclusions: Consumption of whole beverages appears infrequent in early adolescence, as sipping, but not drinking, was common in our sample. Comparing the present data with international population consumption measures highlights the need to more precisely measure and report adolescent consumption, particularly in relation to sipping.

Introduction and Aims: We examine the association between reducing the alcohol minimum purchasing age from 20 to 18 years in December 1999 and rates of weekend assault hospitalisation among young Maori in the following 12 years. Our previous work showed deleterious effects for young people overall. In keeping with Treaty of Waitangi principles, we sought to determine whether the policy was similarly detrimental for Maori. Design and Methods: We used Poisson regression to examine data from 1995 to 2011 on Maori hospitalised on Friday-Sunday following assault, separately by gender among 15- to 17-year-olds and 18- to 19-year-olds, versus 20- to 21-year-olds as a control for changes in economic and environmental factors. Results: There was no evidence to suggest weekend assault hospitalisations increased significantly more among 15- to 17-year-old or 18- to 19-year-old Maori males in the post-change periods (incidence rate ratios varied between 0.83 and 1.13; P values >0.25) compared with increases observed in 20- to 21-year-old Maori males. For Maori females, estimates were more variable, but overall, there was no evidence of the hypothesised effect (incidence rate ratios between 0.60 and 1.09; P values >0.07). Discussion and Conclusions: Overall, we find no evidence that lowering the minimum alcohol purchasing age increased weekend hospitalised assaults among young Maori. Inferences are compromised by lack of statistical power which underlines the importance of planning for evaluation of important policies well before they are implemented, particularly with a view to meeting obligations to Maori arising from the Treaty of Waitangi.

Background: What participants think about the nature of a study might affect their behaviour and bias findings. We tested two hypotheses: (1) participants told they were in an intervention trial would report lower alcohol consumption at follow-up than those told they were in a cohort study; (2) participants told they were in the intervention group in a trial would have lower alcohol consumption at follow-up than those told they were in the control group. Methods: Students from four universities (N = 72,903) were invited to participate in a 'research project on student drinking'. Of 10,415 respondents, 6,788 were moderate to heavy drinkers and were randomized. Group A ('cohort') were informed their drinking would be assessed at baseline and again in one month. Group B ('control') were told the study was an intervention trial and they were in the control group. Group C ('intervention') were told the study was an intervention trial and they were to receive the intervention. All were assessed and directed to read identical online alcohol education material. Whether and how long they accessed the material were recorded. One month later, alcohol intake was reassessed. Results: In relation to hypothesis 1, there were no differences between the groups on the prespecified outcome measures. In relation to hypothesis 2, there were no differences though all point estimates were in the hypothesized direction (that is, 'intervention' < 'control'). The 'cohort' and 'control' groups accessed the material to a similar extent (59% versus 57%) while the 'intervention' group were more likely to access it (78%) and to read it for longer (median 35 s (25th and 75th percentiles: 6, 97) versus medians of 7 s (0, 28) and 8 s (4, 42) for the 'cohort' and 'control' groups, respectively). Conclusions: Although the context given to the research participants significantly influenced access to the online information and reading time, this did not translate into any effect on drinking behaviour, for either hypothesis. This might be because of failure in the experimental paradigm or the possibility of weaker effects using the online approach.

Background: Technical and Further Education (TAFE) colleges are the primary provider of vocational education in Australia. Most TAFE students are young adults, a period when health risk behaviours become established. Furthermore, high rates of smoking, risky alcohol consumption, inadequate fruit and vegetable intake and insufficient physical activity have been reported in TAFE students. There have been no intervention studies targeting multiple health risk behaviours simultaneously in this population. The proposed trial will examine the effectiveness of providing TAFE students with electronic feedback regarding health risk behaviours and referral to a suite of existing online and telephone services addressing smoking, risky alcohol consumption, fruit and vegetable intake, and physical activity levels. Methods/Design: A two arm, parallel, cluster randomised trial will be conducted within TAFE campuses in New South Wales (NSW), Australia. TAFE classes will be randomly allocated to an intervention or control condition (50 classes per condition). To be eligible, students must be: enrolled in a course that runs for more than 6 months; aged 16 years or older; and not meet Australian health guideline recommendations for at least one of the following: smoking, alcohol consumption, fruit and/or vegetable intake, or physical activity. Students attending intervention classes, will undertake via a computer tablet a risk assessment for health risk behaviours, and for behaviours not meeting Australian guidelines be provided with electronic feedback about these behaviours and referral to evidence-based online programs and telephone services. Students in control classes will not receive any intervention. Primary outcome measures that will be assessed via online surveys at baseline and 6 months post-recruitment are: 1) daily tobacco smoking; 2) standard drinks of alcohol consumed per week; 3) serves of fruit consumed daily; 4) serves of vegetables consumed daily; and 5) metabolic equivalent minutes of physical activity per week. Discussion: Proactive enrolment to existing online and telephone services has the potential to address modifiable determinants of disease. This trial will be the first to examine a potentially scalable intervention targeting multiple health risk behaviours among students in the vocational training setting.

Objective: To estimate the prevalence and identify correlates of smokeless tobacco consumption among married rural women with a history of at least one pregnancy in Madaripur, Bangladesh. Materials and Methods: We conducted a cross-sectional survey using an interviewer administered, pre-tested, semi-structured questionnaire. All women living in the study area, aged 18 years and above with at least one pregnancy in their lifetime, who were on the electoral roll and agreed to participate were included in the study. Information on sociodemographic characteristics and smokeless tobacco consumption was collected. Smokeless tobacco consumption was categorized as 'Current', 'Ever but not current' and 'Never'. Associations between smokeless tobacco consumption and the explanatory variables were estimated using simple and multiple binary logistic regression. Results: 8074 women participated (response rate 99.9%). The prevalence of 'Current consumption', 'Ever consumption but not current', and 'Never consumption' was 25%, 44% and 31%, respectively. The mean age at first use was 31.5 years. 87% of current consumers reported using either Shadapata or Hakimpuree Jarda. Current consumption was associated with age, level of education, religion, occupation, being an income earner, marital status, and age at first use of smokeless tobacco. After adjustment for demographic variables, current consumption was associated with being over 25 years of age, a lower level of education, being an income earner, being Muslim, and being divorced, separated or widowed. Conclusion: The prevalence of smokeless tobacco consumption is high among rural women in Bangladesh and the age of onset is considerably older than that for smoking. Smokeless tobacco consumption is likely to be producing a considerable burden of non-communicable disease in Bangladesh. Smokeless tobacco control strategies should be implemented. © 2014 Hossain et al.

© 2014 Society for the Study of Addiction. AIM: To examine whether receipt of alcohol industry sponsorship is associated with problematic drinking in UK university students who play sport. METHODS: University students (n¿=¿2450) participating in sports were invited to complete a pen-and-paper questionnaire by research staff approaching them at sporting facilities and in university settings. Respondents were asked whether they, personally, their team and/or their club were currently in receipt of sponsorship (e.g. money, free or subsidized travel or sporting products) from an alcohol-related industry (e.g. bars, liquor stores, wholesalers), and whether they had solicited the sponsorship. Drinking was assessed using the Alcohol Use Disorders Identification Test (AUDIT). RESULTS: Questionnaires were completed by 2048 of those approached (response rate¿=¿83%). Alcohol industry sponsorship was reported by 36% of the sample. After accounting for confounders (age, gender, disposable income and location) in multivariable models, receipt of alcohol sponsorship by a team (adjusted ßadj ¿=¿0.41, P¿=¿0.013), club (ßadj ¿=¿0.73, P¿=¿0.017), team and club (ßadj ¿=¿0.79, P¿=¿0.002) and combinations of individual and team or club sponsorships (ßadj ¿=¿1.27, P¿ < ¿0.002) were each associated with significantly higher AUDIT-consumption substance scores. Receipt of sponsorship by team and club [adjusted odds ratio (aOR)¿=¿2.04; 95% confidence interval (CI)¿=¿1.04-3.99] and combinations of individual and team or club sponsorships (aOR¿=¿4.12; 95% CI¿=¿1.29-13.15) were each associated with increased odds of being classified a hazardous drinker (AUDIT score > 8). Respondents who sought out sponsorship were not at greater risk than respondents, or whose teams or clubs, had been approached by the alcohol industry. CONCLUSIONS: University students in the United Kingdom who play sport and who personally receive alcohol industry sponsorship or whose club or team receives alcohol industry sponsorship appear to have more problematic drinking behaviour than UK university students who play sport and receive no alcohol industry sponsorship. Policy to reduce or cease such sponsorship should be considered.

Objectives. We estimated the effects on assault rates of lowering the minimum alcohol purchasing age in New Zealand from 20 to 18 years. We hypothesized that the law change would increase assaults among young people aged 18 to 19 years (the target group) and those aged 15 to 17 years via illegal sales or alcohol supplied by older friends or family members. Methods. Using Poisson regression, we examined weekend assaults resulting in hospitalization from 1995 to 2011. Outcomes were assessed separately by gender among young people aged 15 to 17 years and those aged 18 to 19 years, with those aged 20 and 21 years included as a control group. Results. Relative to young men aged 20 to 21 years, assaults increased significantly among young men aged 18 to 19 years between 1995 and 1999 (the period before the law change), as well as the postchange periods 2003 to 2007 (incidence rate ratio [IRR] = 1.21; 95% confidence interval [CI] = 1.05, 1.39) and 2008 to 2011 (IRR = 1.20; 95% CI = 1.05, 1.37). Among boys aged 15 to 17 years, assaults increased during the postchange periods 1999 to 2003 (IRR = 1.28; 95% CI = 1.10, 1.49) and 2004 to 2007 (IRR = 1.25; 95% CI = 1.08, 1.45). There were no statistically significant effects among girls and young women. Conclusions. Lowering the minimum alcohol purchasing age increased weekend assaults resulting in hospitalization among young males 15 to 19 years of age.

IMPORTANCE: Unhealthy alcohol use is a leading contributor to the global burden of disease, particularly among young people. Systematic reviews suggest efficacy of web-based alcohol screening and brief intervention and call for effectiveness trials in settings where it could be sustainably delivered. OBJECTIVE: To evaluate a national web-based alcohol screening and brief intervention program. DESIGN, SETTING, AND PARTICIPANTS: A multisite, double-blind, parallel-group, individually randomized trial was conducted at 7 New Zealand universities. In April and May of 2010, invitations containing hyperlinks to the Alcohol Use Disorders Identification Test-Consumption (AUDITC) screening test were e-mailed to 14 991 students aged 17 to 24 years. INTERVENTIONS: Participants who screened positive (AUDIT-C score =4) were randomized to undergo screening alone or to 10 minutes of assessment and feedback (including comparisons with medical guidelines and peer norms) on alcohol expenditure, peak blood alcohol concentration, alcohol dependence, and access to help and information. MAIN OUTCOMES AND MEASURES: A fully automated 5-month follow-up assessment was conducted that measured 6 primary outcomes: consumption per typical occasion, drinking frequency, volume of alcohol consumed, an academic problems score, and whether participants exceeded medical guidelines for acute harm (binge drinking) and chronic harm (heavy drinking). A Bonferroni-corrected significance threshold of .0083 was used to account for the 6 comparisons and a sensitivity analysis was used to assess possible attrition bias. RESULTS: Of 5135 students screened, 3422 scored 4 or greater and were randomized, and 83% were followed up. There was a significant effect on 1 of the 6 prespecified outcomes. Relative to control participants, those who received intervention consumed less alcohol per typical drinking occasion (median 4 drinks [interquartile range {IQR}, 2-8] vs 5 drinks [IQR 2-8]; rate ratio [RR], 0.93 [99.17%CI, 0.86-1.00]; P = .005) but not less often (RR, 0.95 [99.17%CI, 0.88-1.03]; P = .08) or less overall (RR, 0.95 [99.17%CI, 0.81-1.10]; P = .33). Academic problem scores were not lower (RR, 0.91 [99.17%CI, 0.76-1.08]; P = .14) and effects on the risks of binge drinking (odds ratio [OR], 0.84 [99.17%CI, 0.67-1.05]; P = .04) and heavy drinking (OR, 0.77 [99.17%CI, 0.56-1.05]; P = .03) were not significantly significant. In a sensitivity analysis accounting for attrition, the effect on alcohol per typical drinking occasion was no longer statistically significant. CONCLUSIONS AND RELEVANCE: A national web-based alcohol screening and brief intervention program produced no significant reductions in the frequency or overall volume of drinking or academic problems. There remains a possibility of a small reduction in the amount of alcohol consumed per typical drinking occasion. TRIAL REGISTRATION: anzctr.org.au Identifier: ACTRN12610000279022. Copyright 2014 American Medical Association. All rights reserved.

This pilot study sought to test the feasibility of procedures to screen students for marijuana use in Student Health Services (SHS) and test the efficacy of a web-based intervention designed to reduce marijuana use and consequences. Students were asked to participate in voluntary screening of health behaviors upon arrival at SHS. One hundred and twenty-three students who used marijuana at least monthly completed assessments and were randomized to one of four intervention conditions in a 2 (intervention: Marijuana eCHECKUP TO GO vs. control). ×. 2 (site of intervention: on-site vs. off-site) between-groups design. Follow-up assessments were conducted online at 3 and 6. months. Latent growth modeling was used to provide effect size estimates for the influence of intervention on outcomes. One thousand and eighty undergraduate students completed screening. The intervention did not influence marijuana use frequency. However, there was evidence of a small overall intervention effect on marijuana-related consequences and a medium effect in stratified analyses in the on-site condition. Analyses of psychological variables showed that the intervention significantly reduced perceived norms regarding peer marijuana use. These findings demonstrate that it is feasible to identify marijuana users in SHS and deliver an automated web-based intervention to these students in different contexts. Effect size estimates suggest that the intervention has some promise as a means of correcting misperceptions of marijuana use norms and reducing marijuana-related consequences. Future work should test the efficacy of this intervention in a full scale randomized controlled trial. © 2013.

Objectives Behavioral intervention trials may be susceptible to poorly understood forms of bias stemming from research participation. This article considers how assessment and other prerandomization research activities may introduce bias that is not fully prevented by randomization. Study Design and Setting This is a hypothesis-generating discussion article. Results An additivity assumption underlying conventional thinking in trial design and analysis is problematic in behavioral intervention trials. Postrandomization sources of bias are somewhat better known within the clinical epidemiological and trials literatures. Neglect of attention to possible research participation effects means that unintended participant behavior change stemming from artifacts of the research process has unknown potential to bias estimates of behavioral intervention effects. Conclusion Studies are needed to evaluate how research participation effects are introduced, and we make suggestions for how research in this area may be taken forward, including how these issues may be addressed in the design and conduct of trials. It is proposed that attention to possible research participation effects can improve the design of trials evaluating behavioral and other interventions and inform the interpretation of existing evidence.© 2014 The Authors. Published by Elsevier Inc. All rights reserved.

Objective: There have been concerns about impacts of various aspects of taking part in research studies for a century. The concerns have not, however, been sufficiently well conceptualized to form traditions of study capable of defining and elaborating the nature of these problems. In this article we present a new way of thinking about a set of issues attracting long-standing attention. Study Design and Setting: We briefly review existing concepts and empirical work on well-known biases in surveys and cohort studies and propose that they are connected. Results: We offer the construct of "research participation effects" (RPEs) as a vehicle for advancing multi-disciplinary understanding of biases. Empirical studies are needed to identify conditions in which RPE may be sufficiently large to warrant modifications of study design, analytic methods, or interpretation. We consider the value of adopting a more participant-centred view of the research process as a way of thinking about these issues, which may also have benefits in relation to research methodology more broadly. Conclusion: Researchers may too readily overlook the extent to which research studies are unusual contexts, and that people may react in unexpected ways to what we invite them to do, introducing a range of biases. © 2014 The Authors.

Background: In 2005 a Bill was introduced to the New Zealand parliament to increase the alcohol minimum purchasing age (MPA) from 18 to 20 years and submissions were invited from interested parties. We sought to characterise and critique the arguments tendered for and against the proposal. Methods: We used template analysis to study written submissions on the Bill from 178 people and organisations in New Zealand. Independent raters coded submissions according to the source, whether for or opposed, and the arguments employed. Results: The most common sources of submissions were members of the public (28%), the alcohol industry (20%), and NGOs (20%). Overall, 40% opposed increasing the MPA, 40% were in favour, 4% supported a split MPA (18 years for on-premise, 20 years for off-premise), 7% were equivocal, and 8% offered no comment. The most common proponents of increasing the MPA were NGOs (36%) and members of the public (30%) and their arguments concerned the expected positive effects on public health (36%) and public disorder/property damage (16%), while 24% argued that other strategies should be used as well. The most common sources of opposition to increasing the MPA were the alcohol industry (50%) and the public (20%). It was commonly claimed that the proposed law change would be ineffective in reducing harm (22%), that other strategies should be used instead (16%), that it would infringe adult rights (15%), and that licensed premises are safe environments for young people (14%). There were noteworthy examples of NGOs and government agencies opposing the law change. The alcohol industry maximised its impact via multiple submissions appealing to individual rights while neglecting to report or accurately characterise the scientific evidence. Several health and welfare agencies presented confused logic and/or were selective in their use of scientific evidence. Conclusion: In contrast to the fragmented and inconsistent response from government and NGOs, the alcohol industry was organised and united, with multiple submissions from the sector with most at stake, namely the hospitality industry, and supporting submissions from the manufacturing, import, and wholesale sectors. Systematic reviews of research evidence should be routinely undertaken to guide the legislature and submissions should be categorised on the basis of pecuniary interest. © 2014 Elsevier B.V. All rights reserved.

Introduction and Aims: In many high-income countries, the responsibility for alcohol regulation is being devolved from central to local governments. Although seeking public input is typically required by law, there remains little empirical evidence on whether and how the public is involved. We investigated public participation in local liquor licensing and related regulation in New Zealand. Design and Methods: In 2007, we randomly sampled 2337 residents from the national electoral roll in seven communities and invited them to complete a postal questionnaire assessing their level of general community engagement, whether they had taken action on alcohol issues, and barriers to participation they perceived or encountered. Results: A total of 1372 individuals responded (59% response). Fifty-two percent were current members of community organisations, and 40% had ever taken action on a local issue. Respondents considered alcohol to be a major problem locally, but only 4% had been involved in action to address a problem, whereas 18% had considered taking action. In their communities, 12% and 24%, respectively, felt they could influence the number or location of alcohol outlets. There was little variation across communities. Discussion and Conclusion: Despite high levels of general community engagement and alcohol being widely regarded as a local problem, few community members reported acting on alcohol issues, and their self-efficacy to effect change was low. © 2013 Australasian Professional Society on Alcohol and other Drugs.

Aim.: The aim of this study was to estimate the prevalence and identify correlates of smokeless tobacco consumption among the South Asian residents of Sydney, Australia. Methods.: A cross-sectional survey was conducted using a pretested, self-administered mailed questionnaire among members of Indian, Pakistani and Bangladeshi community associations in Sydney. Results.: Of 1600 individuals invited to participate, 419 responded (26%). Prevalence rates of ever consumption, more than 100 times consumption and current consumption were 72.1%, 65.9% and 17.1%, respectively. Men (74.3%) were more likely to ever consume than women (67.6%). Over 96% of consumers reported buying smokeless tobacco products from ethnic shops in Sydney. Current consumption of smokeless tobacco products was associated with country of birth: Indians (odds ratio 5.7, 95% confidence interval 2.3-14.5) and Pakistanis (odds ratio 3.1, 95% confidence interval 1.5-6.5) were more likely to be current consumers than Bangladeshis after adjusting for sociodemographic variables. For ever consumption, there was a positive association with age (P for trend=0.013) and male gender (odds ratio 2.1, 95% confidence interval 1.5-3.1). Conclusions.: Given the availability of smokeless tobacco and the high prevalence and potential adverse health consequences of consumption, smokeless tobacco consumption may produce a considerable burden of non-communicable disease in Australia. Effective control measures are needed, in particular enforcement of existing laws prohibiting the sale of these products. © 2013 Australasian Professional Society on Alcohol and other Drugs.

Introduction and Aims.: In 2008 pub closing times were restricted from 5am to 3:30am in the central business district (CBD) of Newcastle, Australia. A previous study showed a one-third reduction in assaults in the 18 months following the restriction. We assessed whether the assault rate remained lower over the following 3.5 years and whether the introduction of a 'lockout' in nearby Hamilton was associated with a reduction in assaults there. Design and Methods.: We used a pre-post design with comparison against two post-change periods. The setting was Greater Newcastle (population 530 000) and subjects were persons apprehended for assault in the CBD and nearby Hamilton, an area with late trading pubs where a lockout and other strategies were implemented in 2010. Cases were police-recorded assault apprehensions occurring from 10pm to 6am in one pre-change period: January 2001 to March 2008, and two post-change periods: (i) April 2008 to September 2009 and (ii) October 2009 to March 2013. Negative binomial regression with terms for secular trend and seasonal effects was used to estimate Post1: Pre and Post2: Pre Incidence Rate Ratios and confidence intervals. Results.: In the CBD recorded assaults fell from 99/quarter before the restriction to 68/quarter in the first post-change period [incidence rate ratio (IRR) 0.67, 95% confidence interval (CI) 0.55-0.82] and 71/quarter (IRR: 0.68, 95% CI: 0.55-0.85) in the later post-change period. In the same periods in Hamilton, assault rates were 23, 24, and 22 per quarter respectively. Discussion and Conclusions.: The restriction in closing time was associated with a sustained lower assault rate in the Newcastle CBD. We find no evidence that lockouts and other outlet management strategies were effective in Hamilton. [Kypri K, McElduff P, Miller P. Restrictions in pub closing times and lockouts in Newcastle Australia 5 years on. Drug Alcohol Rev. © 2014 Australasian Professional Society on Alcohol and other Drugs.

Background: Reductions in drinking among individuals randomised to control groups in brief alcohol intervention trials are common and suggest that asking study participants about their drinking may itself cause them to reduce their consumption. We sought to test the hypothesis that the statistical artefact regression to the mean (RTM) explains part of the reduction in such studies. Methods: 967 participants in a cohort study of alcohol consumption in New Zealand provided data at baseline and again six months later. We use graphical methods and apply thresholds of 8, 12, 16 and 20 in AUDIT scores to explore RTM. Results: There was a negative association between baseline AUDIT scores and change in AUDIT scores from baseline to six months, which in the absence of bias and confounding, is RTM. Students with lower baseline scores tended to have higher follow-up scores and conversely, those with higher baseline scores tended to have lower follow-up scores. When a threshold score of 8 was used to select a subgroup, the observed mean change was approximately half of that observed without a threshold. The application of higher thresholds produced greater apparent reductions in alcohol consumption. Conclusions: Part of the reduction seen in the control groups of brief alcohol intervention trials is likely to be due to RTM and the amount of change is likely to be greater as the threshold for entry to the trial increases. Quantification of RTM warrants further study and should assist understanding assessment and other research participation effects. © 2013 The Authors.

Background: Few studies have examined the prevalence of unhealthy alcohol use in the hospital outpatient setting. Our aim was to estimate the prevalence of unhealthy alcohol use among patients attending a broad range of outpatient clinics at a large public hospital in Australia. Methods: Adult hospital outpatients were invited to complete the Alcohol Use Disorders Identification Test Consumption questions (AUDIT-C) using an iPad as part of a randomised trial testing the efficacy of alcohol electronic screening and brief intervention. Unhealthy alcohol use was defined as an AUDIT-C score =5 among men and =4 among women. Results: Sixty percent (3616/6070) of invited hospital outpatients consented, of whom 89% (3206/3616) provided information on their alcohol consumption (either reported they had not consumed any alcohol in the last 12 months or completed the AUDIT-C). The prevalence of unhealthy alcohol use was 34.7% (95% confidence interval [CI]: 33.0-36.3%). The prevalence among men aged 18-24 years, 25-39 years, 40-59 years and 60 years and older, was 74.4% (95% CI: 68.4-80.4%), 54.3% (95% CI: 48.7-59.8%), 44.1% (95% CI: 39.9-48.3%), and 27.0% (95% CI: 23.6-30.4%), respectively (43.1% overall; 95% CI: 40.8-45.5%). The prevalence among women aged 18-24 years, 25-39 years, 40-59 years, and 60 years and older, was 48.6% (95% CI: 39.2-58.1%), 36.9% (95% CI: 31.2-42.6%), 25.2% (95% CI: 21.5-29.0%) and 14.5% (95% CI: 11.7-17.3%), respectively (24.9% overall; 95% CI: 22.7-27.1%). Conclusion: A large number of hospital outpatients who are not currently seeking treatment for their drinking could benefit from effective intervention in this setting.

Background: High levels of drinking and alcohol-related problems are pervasive among university students in New Zealand and other high-income countries, where controls on alcohol availability and promotion are typically weak. Environmental interventions to reduce hazardous drinking and harm have shown promise in general populations, but require further evidence of effectiveness in university settings. The aim of this study was to estimate the effect of a community liaison and security program, Campus Watch, on drinking patterns and alcohol-related harm among university students. Methods: The study used a quasi-experimental design with non-equivalent control sites using before (2005) and after (2009) observations. Participants were full-time students aged 17-25 years selected randomly from the enrolment lists of six New Zealand universities. Changes in scores on the alcohol use disorders identification consumption scale (AUDIT-C) and alcohol-related harms at the intervention campus were compared with those at control campuses using linear and logistic regression models. Results: Compared to control campuses, AUDIT-C scores decreased in students at the intervention campus (ß= -0.5, 95% CI: -0.6 to -0.3). Campus Watch was associated with reductions in some harms (independent of its effect on drinking), such as aggression (aOR 0.66, 95% CI: 0.46 to 0.94), but not other harms, e.g., blackouts (aOR 1.06, 95% CI: 0.89 to 1.27). Conclusion: While not being focused on alcohol per se, Campus Watch reduced alcohol consumption and some related harms. Such programs may be useful in similar environments where controls on alcohol availability and promotion cannot be affected and where informal controls are weak.

Introduction and Aims: Better understanding of the circumstances of alcohol-related adverse events experienced by university students could identify opportunities for prevention. We aimed to identify situational and contextual factors associated with unintentional injury, assault, unsafe sex, sexual assault and drink-driving/riding amongst university students. Design and Methods: We conducted a Web-based survey of full-time students aged 17-25 years at five New Zealand universities (n=2683) and carried out between- and within-subjects comparisons (case-control and case-crossover, respectively) of situational and contextual characteristics of events in the last seven days and control drinking occasions. Results: The response fraction was 49%. For the seven days preceding the survey, 4.9% of women and 7.4% of men reported at least one of the defined events while they were drinking or soon after. The number of drinking locations and getting drunker than expected were strongly associated with risk of an event in both case-control and case-crossover models, independent of consumption. Total number of drinks, drinking later and into the morning, and drinking with close friends were also associated with increased risk in the case-control analysis. No gender difference was seen after controlling for drinking and contextual factors. Discussion and Conclusions: Strategies to reduce the duration and volume of alcohol consumption, including earlier closing of licensed premises, should be considered as countermeasures for alcohol-related adverse events. The use of two different comparison groups for the circumstances of adverse events when drinking can strengthen inferences about the contribution of contextual factors. © 2014 Australasian Professional Society on Alcohol and other Drugs.