Professor Kypros Kypri

Career Summary

Biography

Qualifications

• Doctor of Philosophy, University of Otago - New Zealand

Fields of Research

Professional Experience

Academic appointment

Professional appointment

Awards

Research Award

Invitations

Keynote Speaker

Speaker

Publications

For publications that are currently unpublished or in-press, details are shown in italics.

Chapter (2 outputs)

Journal article (189 outputs)

Conference (34 outputs)

Grants and Funding

Summary

Click on a grant title below to expand the full details for that specific grant.

20171 grants / $637,082

20161 grants / $29,117

20156 grants / $893,627

20142 grants / $1,192,021

20135 grants / $917,636

20126 grants / $744,829

20114 grants / $1,080,264

20105 grants / $979,330

20097 grants / $1,093,648

20085 grants / $124,300

20072 grants / $21,382

20063 grants / $372,500

20053 grants / $178,400

20042 grants / $1,185,000

20033 grants / $965,000

20012 grants / $603,000

20002 grants / $17,000

Research Supervision

Current Supervision

Past Supervision

Research Projects

Hospital Outpatient Alcohol Project (HOAP) 2012 -

Johnson, N. A., K. Kypri, J. B. Saunders, R. Saitz, J. Attia, A. Dunlop, C. Doran, P. McElduff, L. Wolfenden and J. McCambridge (2013). "The Hospital Outpatient Alcohol Project (Hoap): Protocol for an Individually Randomized, Parallel-Group Superiority Trial of Electronic Alcohol Screening and Brief Intervention Versus Screening Alone for Unhealthy Alcohol Use." Addict Sci Clin Pract 8: 14.
BACKGROUND: Electronic screening and brief intervention (e-SBI) is a promising alternative to screening and brief intervention by health-care providers, but its efficacy in the hospital outpatient setting, which serves a large proportion of the population, has not been established. The aim of this study is to estimate the effect of e-SBI in hospital outpatients with hazardous or harmful drinking. METHODS/DESIGN: This randomized controlled trial will be conducted in the outpatient department of a large tertiary referral hospital in Newcastle (population 540,000), Australia. Some 772 adults with appointments at a broad range of medical and surgical outpatient clinics who score 5-9 inclusive on the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) subscale will be randomly assigned in a 1:1 ratio to electronic alcohol screening alone (control) or to e-SBI. As randomization will be effected by computer, researchers and participants (who will be invited to participate in a study of alcohol use over time) will be blinded to group assignment. The primary analysis will be based on the intention-to-treat principle and compare weekly volume (grams of alcohol) and the full AUDIT score with a six-month reference period between the groups six months post randomization. Secondary outcomes, assessed six and 12 months after randomization, will include drinking frequency, typical occasion quantity, proportion who report binge drinking, proportion who report heavy drinking, and health-care utilization. DISCUSSION: If e-SBI is efficacious in outpatient settings, it offers the prospect of systematically and sustainably reaching a large number of hazardous and harmful drinkers, many of whom do not otherwise seek or receive help. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12612000905864.

Johnson, N. A., K. Kypri, J. Latter, P. McElduff, J. B. Saunders, R. Saitz, J. Attia, A. Dunlop, C. Doran, L. Wolfenden and J. McCambridge (2014). "Prevalence of Unhealthy Alcohol Use in Hospital Outpatients." Drug Alcohol Depend 144: 270-273.
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.

Johnson, N. A., K. Kypri, J. Latter, P. McElduff, J. Attia, R. Saitz, J. B. Saunders, L. Wolfenden, A. Dunlop, C. Doran and J. McCambridge (2015). "Effect of Telephone Follow-up on Retention and Balance in an Alcohol Intervention Trial." Prev Med Rep 2: 746-749.
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.

Effects of lowering the minimum alcohol purchasing age on traffic crash injury and assault rates 2012 - 2015

Kypri, K., G. Davie, P. McElduff, J. Connor and J. Langley (2014). "Effects of Lowering the Minimum Alcohol Purchasing Age on Weekend Assaults Resulting in Hospitalization in New Zealand." Am J Public Health 104(8): 1396-1401.
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.

Kypri, K., G. Davie, P. McElduff, J. Langley and J. Connor (2015). "Effects of Lowering the Alcohol Minimum Purchasing Age on Weekend Hospitalised Assaults of Young Maori in New Zealand." Drug Alcohol Rev 34(3): 299-303.
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.

Kypri, K., G. Davie, P. McElduff, J. Langley and J. Connor (2016). "Long-Term Effects of Lowering the Alcohol Minimum Purchasing Age on Traffic Crash Injury Rates in New Zealand." Drug Alcohol Rev.
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 2016].

Can personalised alcohol-related genetic risk information reduce unhealthy alcohol use among hospital outpatients? A Pilot Study 2014 - 2015

Johnson, N. A., K. Kypri, J. Latter, J. Attia, M. McEvoy, A. Dunlop and R. Scott (2016). "Genetic Feedback to Reduce Alcohol Consumption in Hospital Outpatients with Risky Drinking: Feasibility and Acceptability." Public Health Res Pract 26(4).
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.

Alcohol Responsibility Statements: The development and dissemination of responsible drinking messages 2014 - 2015

Professor Sandra Jones, Australian Catholic University

Consumers are exposed to a range of messages about responsible drinking from health organisations and industry bodies. The way these messages are interpreted by consumers has yet to be investigated. This project aims to examine the way that the general public responds to alcohol responsibility messages to inform advocacy around the development and dissemination of responsible drinking messages.

Electronic alcohol screening and personalised feedback to increase referral uptake in hospital outpatients with probable alcohol dependence 2012 - 2014

Many hospital outpatients are alcohol dependent but few seek help for their drinking. This study tested whether providing electronic screening and brief intervention and referral for treatment (e-SBIRT) increased uptake of specialist alcohol services in patients with alcohol dependence compared with screening and referral alone.

Roadside Alcohol Breath-testing in Bhutan to reduce the Incidence of Trauma (RABBIT) 2017 -

Road safety is of increasing concern in Bhutan. The national road network has expanded over 7000 kilometers since the start of the first road construction in 1961. Traffic volume has increased; between 2005 and 2010, the number of motor vehicles doubled from 28,472 to 53,832 in the country. By 2014, the number of registered vehicles jumped by 28% (68,744). According to a Bhutan Police report, drink driving accounts to approximately 27% out of the total 715 road crashes reported in 2015 in the country. Since facilities to investigate alcohol use in driving are rudimentary, this figure is likely to be a gross under estimate. Recent efforts to promote road safety include stepping up roadside inspections among motorists to deter drivers from violating road safety laws such license validity, however drink driving enforcement has been sub-optimal due to shortage of alcohol breath or blood testing equipment. Bhutan also has a high permissible alcohol level for a driver; 0.08g/100 ml of blood; this along with the growing number of vehicles in the country means the need to strengthen road safety enforcement and drink driving laws is urgent.
The objective of the project is to evaluate roadside alcohol breath testing enforcement to deter alcohol use among motorists in Thimphu, Bhutan.

Evaluation of New Zealand's alcohol reform legislation 2014 -

Maclennan, B., K. Kypri, J. Connor, T. Potiki and R. Room (2016). "New Zealand's New Alcohol Laws: Protocol for a Mixed-Methods Evaluation." BMC Public Health 16: 29.
BACKGROUND: Alcohol consumption is a major cause of mortality and morbidity globally. In response to strong calls from the public for alcohol law reform, the New Zealand Government recently reduced the blood alcohol limit for driving and introduced the Sale and Supply of Alcohol Act which aim to (1) improve community input into local decision-making on alcohol; (2) reduce the availability of alcohol; and (3) reduce hazardous drinking and alcohol-related harm. In this project we seek to evaluate the new laws in terms of these objectives. DESIGN AND METHODS: A policy evaluation framework is proposed to investigate the implementation and outcomes of the reforms. We will use quantitative and qualitative methods, employing a pre-post design. Participants include members of the public, local government staff, iwi (Maori tribal groups that function collectively to support their members) and community group representatives. Data will be collected via postal surveys, interviews and analysis of local government documents. Liquor licensing, police and hospital injury data will also be used. Community input into local government decision-making will be operationalised as: the number of objections per license application and the number of local governments adopting a local alcohol policy (LAP). Outcome measures will be the 'restrictiveness' of LAPs compared to previous policies, the number (per 1000 residents) and density (per square kilometre) of alcohol outlets throughout NZ, and the number of weekend late-night (i.e., post 10 pm) trading hours. For consumption and harm, outcomes will be the prevalence of hazardous drinking, harm from own and others' drinking, community amenity effects, rates of assault, and rates of alcohol-involved traffic crashes. Multiple regression will be used to model how the outcomes vary by local government area from before to after the law changes take effect. These measures will be complemented by qualitative analysis of LAP development and public participation in local decision-making on alcohol. DISCUSSION: The project will evaluate how well the reforms meet their explicit public health objectives.

Breath Alcohol and Injury in the Emergency Department (BRAINED) - Thimphu 2015 - 2016

Dorji, G., S. Pradhan, T. Tenzin, P. Miller, J. Connor and K. Kypri (2016). "Blood Alcohol and Injury in Bhutan: Targeted Surveillance in a National Referral Hospital Emergency Department." Inj Prev.
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.

Kypri, K., G. Dorji and C. Dalton (2016). "Alcohol and Economic Development: Observations on the Kingdom of Bhutan." Drug Alcohol Rev.
Bhutan is a small country undergoing rapid social change arising from income growth, urbanisation and Western cultural influence. Markers of poverty, namely infectious disease and infant mortality, have improved dramatically. The attention of health authorities is now focused on the non-communicable disease and injury burdens, to which alcohol consumption is a major contributor. The paper draws on official data to characterise the consumption of alcohol and related harm, and the nature of the alcohol market, with commentary on crucial aspects of availability policies and drink-driving regulation that need reform. 

Suppression clauses in government health research contracts: Scoping study 2015 - 2016

This project aims to address several research questions about the extent, causes and implications of the practices of suppression clauses in health research contracts.

Kypri, K. (2015). "Suppression Clauses in University Health Research: Case Study of an Australian Government Contract Negotiation." Med J Aust 203(2): 72-74.

Tobacco, alcohol and gambling industry research funding Australia/ New Zealand/ United Kingdom 2015 -

In many countries there is a strong community consensus opposed to the tobacco industry and its activities and many universities have banned the receipt of tobacco industry research funding. Alcohol and gambling industry funding of research has received comparatively little attention from advocates and arguably medical science as a whole is ambivalent about the practice. Accepting such funding has the obvious benefit of increasing revenue however this practice exposes researchers and universities to significant ethical risks and it is unclear whether these risks are properly considered in the decision to accept such funding.
This project includes data on research funding policies and practices at universities in Australia, New Zealand and the United Kingdom.

Corporate political activity of tobacco, alcohol and gambling companies in Australia 2014 -

Miller PG, Hancock L, Wakefield M, Kypri K, Livingstone C, Daube M, Giorgi C, Adams P, McCambridge J

Tobacco, alcohol and gambling are major casues of morbidity and prematue death in Australia. In all three areas of interest, policies long identified as effective (e.g. increasing price) have been continually been rejected or delayed by government. The research aims to identify Corporate Political Activity by these industries in Australia, investigating:

1. Financial strategies in the form of political donations and examine the potential to link these to policies in each state and territory.

2. a) formal documentary submissions to state and federal government bodies; and b) interpersonal tactics used with politicians and public servants.

3. constituency building strategies to shape public opinion.

Australian Parent Supply of Alcohol Longitudinal Study (APSALS) 2010 -

Aiken, A., M. Wadolowski, R. Bruno, J. Najman, K. Kypri, T. Slade, D. Hutchinson, N. McBride and R. P. Mattick (2015). "Cohort Profile: The Australian Parental Supply of Alcohol Longitudinal Study (Apsals)." Int J Epidemiol.
The Australian Parental Supply of Alcohol Longitudinal Study (APSALS) was established in 2010 to investigate the short- and long-term associations between exposure to early parental alcohol provision, early adolescent alcohol initiation, subsequent alcohol use and alcohol-related harms, controlling for a wide range of parental, child, familial, peer and contextual covariates. The cohort commenced with 1927 parent-child dyads comprising Australian Grade 7 school students (mean age = 12.9 years, range = 10.8-15.7 years), and a parent/guardian. Baseline, 1- and 2-year follow-up data have been collected, with > 90% retention, and a 3-year follow-up is under way. The data collected include child, familial, parental and peer factors addressing demographics, alcohol use and supply, parenting practices, other substance use, adolescent behaviours and peer influences. The cohort is ideal for prospectively examining predictors of initiation and progression of alcohol use, which increases markedly through adolescence.

Mattick, R. P., M. Wadolowski, A. Aiken, P. J. Clare, D. Hutchinson, J. Najman, T. Slade, R. Bruno, N. McBride, L. Degenhardt and K. Kypri (2016). "Parental Supply of Alcohol and Alcohol Consumption in Adolescence: Prospective Cohort Study." Psychol Med: 1-12.
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.

Wadolowski, M., R. Bruno, A. Aiken, C. Stone, J. Najman, K. Kypri, T. Slade, D. Hutchinson, N. McBride and R. P. Mattick (2015). "Sipping, Drinking, and Early Adolescent Alcohol Consumption: A Cautionary Note." Alcohol Clin Exp Res 39(2): 350-354.
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.

Wadolowski, M., D. Hutchinson, R. Bruno, A. Aiken, P. Clare, T. Slade, J. Najman, K. Kypri, N. McBride and R. P. Mattick (2015). "Early Adolescent Alcohol Use: Are Sipping and Drinking Distinct?" Alcohol Clin Exp Res 39(9): 1805-1813.
BACKGROUND: Sipping alcohol is common during early adolescence, but research has ignored the distinction between sipping and drinking whole alcohol beverages, conflating the 2, or else simply classifying "sippers" as abstainers. Research has not addressed whether sippers are different to drinkers, in relation to variables known to be associated with adolescent alcohol consumption, or considered whether sipping and drinking behaviors may have quite different associations. METHODS: Parent-child dyads (N = 1,823) were recruited in 3 states from Australian grade 7 classes. Multinomial logistic analyses compared adolescents who had only had a sip/taste of alcohol (sippers) with adolescents who had consumed at least a whole drink (drinkers) in the past 6 months. The multivariate model assessed a broad range of demographics, parenting practices, peer influences, and adolescent externalizing and internalizing behaviors, and controlled for school clustering. RESULTS: Compared to drinkers, sippers were less likely to come from 1-parent households (odds ratio [OR] = 0.59, 95% confidence interval [CI]: 0.35 to 0.98); less likely to come from low-socioeconomic status (SES) households (OR = 0.54, 95% CI: 0.31 to 0.94); more likely to come from families where parents provide stricter alcohol-specific rules (OR = 1.21, 95% CI: 1.11 to 1.32), stricter monitoring of the child's activities (OR = 1.10, 95% CI: 1.04 to 1.16), more consistent parenting practices (OR = 1.13, 95% CI: 1.05 to 1.23), and more positive family relationships (OR = 1.56, 95% CI: 1.02 to 2.43); and report having fewer substance-using peers (OR = 0.80, 95% CI: 0.70 to 0.91) and greater peer disapproval of any substance use (OR = 1.30, 95% CI: 1.19 to 1.42). After adjustment for confounders, the associations with household composition and SES were no longer significant, but the familial and peer associations remained significant in the multivariate analysis, chi(2) (40) = 1,493.06, p < 0.001. CONCLUSIONS: Sipping alcohol has different associations with known predictors of adolescent alcohol use than drinking whole beverages, and sipping may be a distinct or separable behavior. Future research should better define quantities of early consumption and assess the relationship between early sipping and drinking on long-term outcomes separately.

Wadolowski, M., D. Hutchinson, R. Bruno, A. Aiken, J. M. Najman, K. Kypri, T. Slade, N. McBride and R. P. Mattick (2016). "Parents Who Supply Sips of Alcohol in Early Adolescence: A Prospective Study of Risk Factors." Pediatrics 137(3): e20152611.
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 parent-report 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.

Pub extended trading hours: effects on drunkenness and alcohol-related harm 2015 - 2016

Professor Tanya Chikritzhs, National Drug Research Institute

The aim of this project is to inform and encourage evidence-based liquor licensing decisions in relation to extended late-night trading hours for licensed premises in Western Australia. At present, decisions in relation to trading hour extensions for licensed premises are made on an ad hoc basis, with inconsistent reference to research evidence. It is often claimed that currently available international research is either unrelated to the Perth context or is based on old, irrelevant data. Compounding matters, there has to date been little independent scientific research which has directly investigated whether late night trading hour extensions for pubs have an effect on levels of intoxication among patrons. As a result, decision makers must weigh-up arguments for and against that are often based on conjecture and anecdote.

Investigations of Research Participation Effects 2011 - 2015

Kypri, K., J. McCambridge, A. Wilson, J. Attia, P. Sheeran, S. Bowe and T. Vater (2011). "Effects of Study Design and Allocation on Participant Behaviour--Esda: Study Protocol for a Randomized Controlled Trial." Trials 12: 42.
BACKGROUND: What study participants think about the nature of a study has been hypothesised to affect subsequent behaviour and to potentially bias study findings. In this trial we examine the impact of awareness of study design and allocation on participant drinking behaviour. METHODS/DESIGN: A three-arm parallel group randomised controlled trial design will be used. All recruitment, screening, randomisation, and follow-up will be conducted on-line among university students. Participants who indicate a hazardous level of alcohol consumption will be randomly assigned to one of three groups. Group A will be informed their drinking will be assessed at baseline and again in one month (as in a cohort study design). Group B will be told the study is an intervention trial and they are in the control group. Group C will be told the study is an intervention trial and they are in the intervention group. All will receive exactly the same brief educational material to read. After one month, alcohol intake for the past 4 weeks will be assessed. DISCUSSION: The experimental manipulations address subtle and previously unexplored ways in which participant behaviour may be unwittingly influenced by standard practice in trials. Given the necessity of relying on self-reported outcome, it will not be possible to distinguish true behaviour change from reporting artefact. This does not matter in the present study, as any effects of awareness of study design or allocation involve bias that is not well understood. There has been little research on awareness effects, and our outcomes will provide an indication of the possible value of further studies of this type and inform hypothesis generation. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12610000846022.

McCambridge, J. and K. Kypri (2011). "Can Simply Answering Research Questions Change Behaviour? Systematic Review and Meta Analyses of Brief Alcohol Intervention Trials." PLoS One 6(10): e23748.
BACKGROUND: Participant reports of their own behaviour are critical for the provision and evaluation of behavioural interventions. Recent developments in brief alcohol intervention trials provide an opportunity to evaluate longstanding concerns that answering questions on behaviour as part of research assessments may inadvertently influence it and produce bias. The study objective was to evaluate the size and nature of effects observed in randomized manipulations of the effects of answering questions on drinking behaviour in brief intervention trials. METHODOLOGY/PRINCIPAL FINDINGS: Multiple methods were used to identify primary studies. Between-group differences in total weekly alcohol consumption, quantity per drinking day and AUDIT scores were evaluated in random effects meta-analyses. Ten trials were included in this review, of which two did not provide findings for quantitative study, in which three outcomes were evaluated. Between-group differences were of the magnitude of 13.7 (-0.17 to 27.6) grams of alcohol per week (approximately 1.5 U.K. units or 1 standard U.S. drink) and 1 point (0.1 to 1.9) in AUDIT score. There was no difference in quantity per drinking day. CONCLUSIONS/SIGNIFICANCE: Answering questions on drinking in brief intervention trials appears to alter subsequent self-reported behaviour. This potentially generates bias by exposing non-intervention control groups to an integral component of the intervention. The effects of brief alcohol interventions may thus have been consistently under-estimated. These findings are relevant to evaluations of any interventions to alter behaviours which involve participant self-report.

McCambridge, J., K. Kypri and A. Wilson (2012). "How Should Debriefing Be Undertaken in Web-Based Studies? Findings from a Randomized Controlled Trial." J Med Internet Res 14(6): e157.
BACKGROUND: Internet research may raise older ethical issues in new forms or pose new issues. It has been recommended that debriefing information online be kept very short, with further information including study results made available if requested by participants. There are no empirical studies that compare possible alternative methods of debriefing in online studies. OBJECTIVE: To undertake a randomized controlled trial evaluating how to implement the recommended approach by assessing the effects of two different approaches on accessing of additional information. METHODS: All 11,943 participants in the Effects of Study Design and Allocation (ESDA) study, which employed deception, were randomly assigned to one of two methods of debriefing: Group A received the debriefing information in the body of an email with links to protocol and results pages; Group B was presented with these links after clicking on an initial link in the body of the email to view the debriefing information on a website. Outcomes assessed were the proportions clicking on the links to the protocol and results summary and the time spent on these pages by those accessing them. RESULTS: The group who were presented with no debriefing information in the body of the email and went to a website for this information (Group B) were approximately twice as likely to subsequently access the protocol and the results summary. These differences between the two groups were highly statistically significant. Although these differences are clear, the overall proportions accessing such information were low, and there were no differences in mean time spent reading these pages. Only one quarter of Group B actually accessed debriefing information. CONCLUSIONS: In circumstances where the uptake of fuller information on study design, methods, and findings is deemed important, debriefing information may be better provided via a link and not included in the body of an email. Doing so may, however, reduce the extent of receiving any debriefing information at all. There is a wider need for high quality empirical studies to inform ethical evaluations. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12610000846022 (http://www.anzctr.org.au/).

Cunningham, J. A., K. Kypri and J. McCambridge (2013). "Exploratory Randomized Controlled Trial Evaluating the Impact of a Waiting List Control Design." BMC Med Res Methodol 13: 150.
BACKGROUND: Employing waiting list control designs in psychological and behavioral intervention research may artificially inflate intervention effect estimates. This exploratory randomized controlled trial tested this proposition in a study employing a brief intervention for problem drinkers, one domain of research in which waiting list control designs are used. METHODS: All participants (N = 185) were provided with brief personalized feedback intervention materials after being randomly allocated either to be told that they were in the intervention condition and that this was the intervention or to be told that they were in the waiting list control condition and that they would receive access to the intervention in four weeks with this information provided in the meantime. RESULTS: A total of 157 participants (85%) were followed-up after 4 weeks. Between-group differences were found in one of four outcomes (proportion within safe drinking guidelines). An interaction was identified between experimental manipulation and stage of change at study entry such that participant change was arrested among those more ready to change and told they were on the waiting list. CONCLUSIONS: Trials with waiting list control conditions may overestimate treatment effects, though the extent of any such bias appears likely to vary between study populations. Arguably they should only be used where this threat to valid inference has been carefully assessed.

McCambridge, J., K. Kypri, P. Bendtsen and J. Porter (2013). "The Use of Deception in Public Health Behavioral Intervention Trials: A Case Study of Three Online Alcohol Trials." Am J Bioeth 13(11): 39-47.
Some public health behavioral intervention research studies involve deception. A methodological imperative to minimize bias can be in conflict with the ethical principle of informed consent. As a case study, we examine the specific forms of deception used in three online randomized controlled trials evaluating brief alcohol interventions. We elaborate our own decision making about the use of deception in these trials, and present our ongoing findings and uncertainties. We discuss the value of the approach of pragmatism for examining these kinds of ethical issues that can arise in research on public health interventions.

McCambridge, J., K. Kypri and D. Elbourne (2014). "Research Participation Effects: A Skeleton in the Methodological Cupboard." J Clin Epidemiol 67(8): 845-849.
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" (RPE) 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.

McCambridge, J., K. Kypri and D. Elbourne (2014). "In Randomization We Trust? There Are Overlooked Problems in Experimenting with People in Behavioral Intervention Trials." J Clin Epidemiol 67(3): 247-253.
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.

McCambridge, J., K. Kypri and P. McElduff (2014). "Regression to the Mean and Alcohol Consumption: A Cohort Study Exploring Implications for the Interpretation of Change in Control Groups in Brief Intervention Trials." Drug Alcohol Depend 135: 156-159.
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.

Kypri, K., A. Wilson, J. Attia, P. J. Sheeran and J. McCambridge (2015). "Effects of Study Design and Allocation on Self-Reported Alcohol Consumption: Randomized Trial." Trials 16: 127.
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. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12610000846022.

Kypri, K., A. Wilson, J. Attia, P. Sheeran, P. Miller and J. McCambridge (2016). "Social Desirability Bias in the Reporting of Alcohol Consumption: A Randomized Trial." J Stud Alcohol Drugs 77(3): 526-531.
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.

Evaluation of risk-based licensing of alcohol sales for reducing alcohol-related harm 2015 -

Miller PG, Chikritzhs T, Kypri K, Graham K

Alcohol-related harm is a major public health and social order issue which requires sophisticated evidence-based policy. This project capitalises on a unique window of policy adoption across Australia to investigate the introduction of risk-based licensing schemes for the sale of alcohol, assessing their impacts, identifying modifiable elements and developing policy advice. There is an urgent need for evidence about which interventions are effective, and which of these can survive the political process. It builds on the teams extensive work and unique datasets around alcohol policy and licensed venues to analyse archival data and key stakeholder interviews in four states, using the most up-to-date and reliable methods.

Research Collaborations

The map is a representation of a researchers co-authorship with collaborators across the globe. The map displays the number of publications against a country, where there is at least one co-author based in that country. Data is sourced from the University of Newcastle research publication management system (NURO) and may not fully represent the authors complete body of work.

News

Nature: Censorship of addiction research is an abuse of science

May 29, 2017

Professor Kypros Kypri reported  in Nature: researchers must stand up to funders insisting on gagging clauses.

Web-based alcohol intervention has limited effect on consumption

March 25, 2014

New research from the University of Newcastle shows that a web-based self-assessment and feedback program for university students who drink hazardously produced little reduction in consumption.

Earlier pub closing times key to reducing alcohol-fuelled assaults

March 6, 2014

Earlier pub closing times have a large impact on curbing alcohol-fuelled violence, according to research my colleagues and I have published today in the international peer-reviewed journal Drug & Alcohol Review.

Newcastle research underpins statewide alcohol restrictions

January 22, 2014

University of Newcastle research that evaluated alcohol restrictions in Newcastle, identifying a 37 per cent drop in assaults, has underpinned sweeping changes announced by the State Government to curb alcohol-fuelled violence in Sydney.

Professor Kypros Kypri