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Background and Aims: The alcohol harm paradox (AHP) posits that disadvantaged groups suffer from higher rates of alcohol‐related harm compared with advantaged groups, despite reporting similar or lower levels of consumption on average. The causes of this relationship remain unclear. This study aimed to identify explanations proposed for the AHP. Secondary aims were to review the existing evidence for those explanations and investigate whether authors linked explanations to one another. Methods: This was a systematic review. We searched MEDLINE (1946–January 2021), EMBASE (1974–January 2021) and PsycINFO (1967–January 2021), supplemented with manual searching of grey literature. Included papers either explored the causes of the AHP or investigated the relationship between alcohol consumption, alcohol‐related harm and socio‐economic position. Papers were set in Organization for Economic Cooperation and Development high‐income countries. Explanations extracted for analysis could be evidenced in the empirical results or suggested by researchers in their narrative. Inductive thematic analysis was applied to group explanations. Results: Seventy‐nine papers met the inclusion criteria and initial coding revealed that these papers contained 41 distinct explanations for the AHP. Following inductive thematic analysis, these explanations were grouped into 16 themes within six broad domains: individual, life‐style, contextual, disadvantage, upstream and artefactual. Explanations related to risk behaviours, which fitted within the life‐style domain, were the most frequently proposed (n = 51) and analysed (n = 21). Conclusions: While there are many potential explanations for the alcohol harm paradox, most research focuses on risk behaviours while other explanations lack empirical testing. [ABSTRACT FROM AUTHOR]

Background and aims: Population‐level alcohol use data are available from high‐income countries, but limited research has been conducted in sub‐Saharan Africa. This systematic review and meta‐analysis aimed to summarize population‐level alcohol use in sub‐Saharan Africa. Method: Databases searched included PubMed, EMBASE, PsycINFO and AJOL, without language restrictions. Searches were also conducted in the Global Health Data Exchange (GHDx) and Google Scholar. Search terms encompassed 'substance' or 'substance‐related disorders' and 'prevalence' and 'sub‐Saharan Africa'. We included general population studies on alcohol use (including any use, high‐risk alcohol use and alcohol use disorders) from 2018 onwards. Prevalence data for alcohol use among sub‐Saharan African adolescents (10–17) and adults (18+) were extracted. Analyses included life‐time and past 12‐ and 6‐month alcohol use. Results: We included 141 papers. Among adolescents, the life‐time prevalence of alcohol use was 23.3% [95% confidence interval (CI) = 11.3–37.1%], 36.2% (CI = 18.4–56.1%) in the past year and 11.3% (CI = 4.5–20.4%) in the past 6 months. Among adolescents, 12‐month prevalence of alcohol use disorder and alcohol dependence were 7.7% (CI = 0.0–27.8%) and 4.1% (CI = 1.4–7.9%), respectively. Among adults, the life‐time prevalence of alcohol use was 34.9% (CI = 17.7–54.1%), 27.1% (CI = 5.0–56.4%) in the past year and 32.2% (CI = 19.8–46.0%) in the past 6 months. Among adults, the 12‐month prevalence of alcohol use disorder and alcohol dependence were 9.5% (CI = 0.0–30.4%) and 4.3% (CI = 0.8–9.8%), respectively. The highest weighted life‐time prevalence of alcohol use, 86.4%, was reported in Tanzania among adults. The highest weighted past 6‐month prevalence of alcohol use, 80.6%, was found in Zambia among adolescents. Conclusion: Alcohol use patterns vary across countries and subregions within sub‐Saharan Africa, and comprehensive population‐level data on alcohol use remain scarce in numerous sub‐Saharan African countries. The prevalence of alcohol use disorder is common among adolescents in sub‐Saharan Africa. [ABSTRACT FROM AUTHOR]

Background and Aims: The Scottish Government introduced minimum unit pricing (MUP) for alcohol on 1 May 2018. This means retailers in Scotland cannot sell alcohol to consumers for less than £0.50 per unit (1 UK unit = 8 g ethanol). The Government intended the policy to increase the price of cheap alcohol, cut alcohol consumption overall and particularly among those drinking at hazardous or harmful levels, and ultimately reduce alcohol‐related harm. This paper aims to summarise and assess the evidence to date evaluating the impact of MUP on alcohol consumption and related behaviours in Scotland. Argument: Evidence from analyses of population‐level sales data suggest, all else being equal, MUP reduced the volume of alcohol sold in Scotland by ~ 3.0% to 3.5%, with the largest reductions affecting cider and spirits sales. Analyses of two time series datasets on household‐level alcohol purchasing and individual‐level alcohol consumption suggest reductions in purchasing and consumption among those drinking at hazardous and harmful levels, but offer conflicting results for those drinking at the most harmful levels. These subgroup analyses are methodologically robust, but the underlying datasets have important limitations as they rely on non‐random sampling strategies. Further studies identified no clear evidence of reduced alcohol consumption among those with alcohol dependence or those presenting to emergency departments and sexual health clinics, some evidence of increased financial strain among people with dependence and no evidence of wider negative outcomes arising from changes in alcohol consumption behaviours. Conclusions: Minimum unit pricing for alcohol in Scotland has led to reduced consumption, including among heavier drinkers. However, there is uncertainty regarding its impact on those at greatest risk and some limited evidence of negative outcomes, specifically financial strain, among people with alcohol dependence. [ABSTRACT FROM AUTHOR]

Background and Aims: Even though a ban of alcohol marketing has been declared a 'best buy' of alcohol control policy, comprehensive systematic reviews on its effectiveness to reduce consumption are lacking. The aim of this paper was to systematically review the evidence for effects of total and partial bans of alcohol marketing on alcohol consumption. Methods: This descriptive systematic review sought to include all empirical studies that explored how changes in the regulation of alcohol marketing impact on alcohol consumption. The search was conducted between October and December 2022 considering various scientific databases (Web of Science, PsycINFO, MEDLINE, Embase) as well as Google and Google Scholar. The titles and abstracts of a total of 2572 records were screened. Of the 26 studies included in the full text screening, 11 studies were finally included in this review. Changes in consumption in relation to marketing bans were determined based on significance testing in primary studies. Four risk of bias domains (confounding, selection bias, information bias and reporting bias) were assessed. Results: Seven studies examined changes in marketing restrictions in one location (New Zealand, Thailand, Canadian provinces, Spain, Norway). In the remaining studies, between 17 and 45 locations were studied (mostly high‐income countries from Europe and North America). Of the 11 studies identified, six studies reported null findings. Studies reporting lower alcohol consumption following marketing restrictions were of moderate, serious and critical risk of bias. Two studies with low and moderate risk of bias found increasing alcohol consumption post marketing bans. Overall, there was insufficient evidence to conclude that alcohol marketing bans reduce alcohol consumption. Conclusions: The available empirical evidence does not support the claim of alcohol marketing bans constituting a best buy for reducing alcohol consumption. [ABSTRACT FROM AUTHOR]

Background and Aims: The Transformative Research on the Alcohol industry, Policy and Science (TRAPS) programme investigates the alcohol industry, with an innovative focus on public health sciences. TRAPS adds to an under‐developed literature on the study of alcohol industry influence on alcohol science and policymaking. This paper provides a synthesis of TRAPS findings to inform future research. Methods: We conducted an interpretive review of TRAPS research findings across its component studies, identifying and integrating the key contributions made by individual studies to the literature on alcohol policymaking and science, and identifying areas where TRAPS progress was limited. This produced themes for consideration in future research agenda setting. Results: TRAPS explored the interventions of the alcohol industry in science and policymaking using various methods, including systematic reviews and qualitative interviews. These studies identified the industry's activities in several key areas, such as the debate over minimum unit pricing (MUP), cardiovascular health and alcohol research and a long‐running public relations programme developed in close connection with the tobacco industry. Collectively, the research shows that alcohol policymaking has involved a contest between the research community and alcohol industry actors about whether and how science should be used to inform policy. Conclusions: The TRAPS programme demonstrates the need for a transdisciplinary approach to understand the nature of corporate political activity; the crucial role industry involvement in science plays in the development of corporate political power; and how public health actors have successfully overcome industry opposition to evidence‐based policies. Advances in alcohol policy should be underpinned by strong, reflexive public health sciences, alert to the role of industry in the alcohol harms under study and thorough in their investigation of the alcohol industry as an object of study in itself. [ABSTRACT FROM AUTHOR]

Background and aims: Alcohol consumption increased in the early phases of the COVID‐19 pandemic in the United States. Alcohol use disorder (AUD) and risky drinking are linked to harmful health effects. This paper aimed to project future health and cost impacts of shifts in alcohol consumption during the COVID‐19 pandemic. Design: An individual‐level simulation model of the long‐term drinking patterns for people with life‐time AUD was used to simulate 10 000 individuals and project model outcomes to the estimated 25.9 million current drinkers with life‐time AUD in the United States. The model considered three scenarios: (1) no change (counterfactual for comparison); (2) increased drinking levels persist for 1 year ('increase‐1') and (3) increased drinking levels persist for 5 years ('increase‐5'). Setting: United States. Participants: Current drinkers with life‐time AUD. Measurements: Life expectancy [life‐years (LYs)], quality‐adjusted life‐years (QALYs), alcohol‐related hospitalizations and associated hospitalization costs and alcohol‐related deaths, during a 5‐year period. Findings Short‐term increases in alcohol consumption (increase‐1 scenario) resulted in a loss of 79 000 [95% uncertainty interval (UI]) 26 000–201 000] LYs, a loss of 332 000 (104 000–604 000) QALYs and 295 000 (82 000–501 000) more alcohol‐related hospitalizations, costing an additional $5.4 billion ($1.5–9.3 billion) over 5 years. Hospitalizations for cirrhosis of the liver accounted for approximately $3.0 billion ($0.9–4.8 billion) in hospitalization costs, more than half the increase across all alcohol‐related conditions. Health and cost impacts were more pronounced for older age groups (51+), women and non‐Hispanic black individuals. Increasing the duration of pandemic‐driven increases in alcohol consumption in the increase‐5 scenario resulted in larger impacts. Conclusions: Simulations show that if the increase in alcohol consumption observed in the United States in the first year of the pandemic continues, alcohol‐related mortality, morbidity and associated costs will increase substantially over the next 5 years. [ABSTRACT FROM AUTHOR]

Background: Low‐Risk Alcohol Drinking Guidelines (LRDGs) aim to reduce the harms caused by alcohol. However, considerable discrepancies exist in the 'low‐risk' thresholds employed by different countries. Argument/analysis: Drawing upon Canada's LRDGs update process, the current paper offers the following propositions for debate regarding the establishment of 'low‐risk' thresholds in national guidelines: (1) as an indicator of health loss, years of life lost (YLL) has several advantages that could make it more suitable for setting guidelines than deaths, premature deaths or disability adjusted years of life (DALYs) lost. (2) Presenting age‐specific guidelines may not be the most appropriate way of providing LRDGs. (3) Given past overemphasis on the so‐called protective effects of alcohol on health, presenting cause‐specific guidelines may not be appropriate compared with a 'whole health' effect derived from a weighted composite risk function comprising conditions that are causally related to alcohol consumption. (4) To help people reduce their alcohol use, presenting different risk zones associated with alcohol consumption instead of a single low risk threshold may be advantageous. Conclusions: National LRDGs should be based on years of life lost and should be neither age‐specific nor cause‐specific. We recommend using risk zones rather than a single drinking threshold to help people assess their own risk and encourage the adoption of behaviours with positive health impacts across the alcohol use spectrum. [ABSTRACT FROM AUTHOR]

Background and aim: To understand the use of psychoactive substances, one must consider the context and the social circumstances in which the substance use occurs. This paper discusses alcohol use from a socio‐cultural perspective, based on the use of alcoholic beverages among the Portuguese servicemen who fought in the Portuguese Colonial War (1961–74). Method: In‐depth interviews were carried out with 17 former Portuguese soldiers. Simultaneously, extensive bibliographic and documentary research was carried out based on a broad set of biographical and autobiographical texts by former military personnel. Finally, an on‐line survey (n = 210) was conducted among ex‐combatants of the Portuguese Colonial War. Results: Alcohol drinking among Portuguese servicemen was high during the Portuguese Colonial War. Socio‐cultural factors (such as regarding alcohol consumption as therapeutic and affirming masculinity) explain why alcohol drinking was so intense and frequent, and why repeated drunken behaviour was tolerated and undervalued by the military authorities, who considered it normal and not a health problem or disorder. Conclusion: The use of alcohol in the Portuguese Colonial War is an empirical example of how what is considered 'acceptable', 'normal' or 'pathological' may depend more on socio‐cultural norms than on objective and measurable criteria, including clinical criteria. [ABSTRACT FROM AUTHOR]

Background and Aims: A range of experimental paradigms claim to measure the cognitive processes underpinning alcohol use, suggesting that heightened attentional bias, greater approach tendencies and reduced cue‐specific inhibitory control are important drivers of consumption. This paper identifies methodological shortcomings within this broad domain of research and exemplifies them in studies focused specifically on alcohol‐related attentional bias. Argument and analysis: We highlight five main methodological issues: (i) the use of inappropriately matched control stimuli; (ii) opacity of stimulus selection and validation procedures; (iii) a credence in noisy measures; (iv) a reliance on unreliable tasks; and (v) variability in design and analysis. This is evidenced through a review of alcohol‐related attentional bias (64 empirical articles, 68 tasks), which reveals the following: only 53% of tasks use appropriately matched control stimuli; as few as 38% report their stimulus selection and 19% their validation procedures; less than 28% used indices capable of disambiguating attentional processes; 22% assess reliability; and under 2% of studies were pre‐registered. Conclusions: Well‐matched and validated experimental stimuli, the development of reliable cognitive tasks and explicit assessment of their psychometric properties, and careful consideration of behavioural indices and their analysis will improve the methodological rigour of cognitive alcohol research. Open science principles can facilitate replication and reproducibility in alcohol research. [ABSTRACT FROM AUTHOR]

Background and Aims: This study explores the role of the public health advocacy coalition in alcohol policy development in Ireland. Compared with industry actors, much less is known about the membership, activities and influence of public health advocates in alcohol policymaking. To address this gap, this paper identifies several advocacy strategies, drawn from the advocacy coalition framework and other policy theories, and then analyses them in the context of recent Irish developments. Methods: The study used theory‐building process‐tracing to construct a record of the public health advocacy coalition and its campaign to promote the Public Health (Alcohol) Act 2018 in Ireland. Specifically, we drew upon 131 primary documents produced by advocates, 464 newspaper articles and 18 semi‐structured interviews with key advocates, public health experts and elected officials to undertake a thematic analysis. Results: Public health advocates in Ireland have developed sophisticated political strategies to foster major alcohol policy change. First, public health advocates led the formation of a broad‐based advocacy coalition that helped members to effectively pool their limited resources as well as coordinate their strategy and messaging. Secondly, issue‐framing and message discipline played a key role in the coalition's success. Advocates strategically focused upon the policy problem, specifically health harms, rather than the detailed content of the proposed measures. Finally, there is evidence of political learning, where advocates' prior experiences and knowledge of the political system in Ireland spurred innovations in campaigning. These strategies were interdependent and mutually reinforcing, and succeeded in building support for public health advocates' preferred policies among politicians and the general public. Discussion/conclusion: There are distinct capabilities that public health actors can mobilize in the policy process to win alcohol policy debates and capitalize on the constraints on industry influence on alcohol policymaking. [ABSTRACT FROM AUTHOR]

Background and aims: Alcohol's harm to others (AHTO) has become a key driver of national and international alcohol policy. This study aimed to produce a contemporary, comprehensive estimate of the correlates and harms from others' drinking in 2021 in Australia. Design, setting, participants and measurements: Across Australia, 2574 adults (1380 women; 1172 men) were sampled via two cross‐sectional survey modes: a random‐digit dial mobile phone sample of 1000 people and 1574 people from the Life in Australia™ panel survey. In 2021 participants were asked about harms they had experienced from the drinking of family, friends, co‐workers and the public in the past year. Applying combined sample weights from each mode, bivariable and adjusted multivariable logistic regressions were used to analyse differences in rates of AHTO by participant gender, age, residence in rural or metropolitan regions, country of birth, education and employment. Findings: In 2021, 23.6% reported being negatively affected by strangers' drinking and 21.3% by the drinking of someone they knew, with 34.3% reporting being negatively affected a lot or a little by either; 42.4% of respondents reported specific harms from strangers' drinking. Thus, 48.1% of respondents reported any harm (negative effects or specific harms) from others' drinking. Women, younger people, Australian‐born and heavier episodic drinkers reported significantly higher rates of AHTO compared with other respondents. Smaller percentages (7.5%) of participants reported being harmed substantially by others' drinking, including by people they knew (5.8%) or strangers (2.3%). Stratified analyses showed that heavier drinking, furloughed, younger men who were born overseas in English‐speaking countries were affected by others' drinking, whereas women were affected regardless of these factors (apart from age). Conclusions: More than one‐third of Australian adults appear to have been negatively affected by others' drinking in 2021, with women, younger people and heavier drinkers at greater risk. Substantial harm appears to be more likely to arise from the drinking of people Australians know than from strangers' drinking. [ABSTRACT FROM AUTHOR]

Background and Aims: Experiencing higher rates of stigma, marginalization and discrimination puts transgender individuals at risk for alcohol use and associated harms. Measures of harmful drinking were designed with cisgender people in mind, and some rely on sex‐ and gender‐based cut‐offs. The applicability of these measures for gender diverse samples remains unknown. The present study had two aims: (i) identify gender‐non‐inclusive language and cut‐offs in measures of harmful drinking, and (ii) systematically review research reporting psychometric properties of these measures in transgender individuals. Methods: We reviewed 22 measures of harmful drinking for gendered language and sex‐ and gender‐based cut‐off values and provided suggestions for revision when warranted. We also conducted a systematic narrative review, including eight eligible studies, summarizing the psychometric properties of measures of harmful drinking in transgender populations. Results: Six of 22 measures of harmful drinking were not gender inclusive, because of gendered language in the measure itself or use of sex‐ or gender‐based cut‐off scores. Only eight published studies reported psychometric data for these measures in transgender people. Apart from in one study, the Alcohol Use Disorders Identification Test (AUDIT) and Alcohol Use Disorders Identification Test Consumption (AUDIT‐C) appear reliable for transgender adults (Cronbach's α: AUDIT [0.81–0.87] and AUDIT [0.72–0.8)]). There is initial support for using uniform cut‐offs for transgender people for the AUDIT‐C (≥3) and binge drinking (≥5 drinks in a sitting). Conclusions: Most existing measures of harmful drinking appear to be gender inclusive (containing gender neutral language and uniform cut‐off scores across sex and gender groups) and some that are not easily adapted to be gender inclusive. [ABSTRACT FROM AUTHOR]

Aims: Alcohol biosensors, including the BACtrack Skyn, provide an objective and passive method of continuously assessing alcohol consumption in the natural environment. Despite the many strengths of the Skyn, six key challenges in the collection and processing of data include (1) identifying consumed alcohol; (2) identifying environmental alcohol; (3) identifying and determining the source of missing or invalid data; (4) achieving high participant adherence; (5) integrating Skyn and self‐report data; and (6) implications for statistical inference. In this report we outline these challenges, provide recommendations to address them and identify future needs. Design and settings: Procedures from several laboratory and field‐based pilot studies are presented to demonstrate practical recommendations for Skyn use. Data from a pilot study including a 7‐day ecological momentary assessment period are also presented to evaluate effects of environmental alcohol on BACtrack Skyn readings. Conclusions: To address challenges in the collection and processing of data from the BACtrack Skyn alcohol biosensor, researchers should identify goals in advance of data collection to anticipate the processing necessary to interpret Skyn data. The Transdermal Alcohol Sensor Data Macro (TASMAC) version 2.0 software can help to process data rapidly; identify drinking events, missing data and environmental alcohol; and integrate the sensor with self‐report data. Thorough participant orientation and regular contact in field studies can reduce missing data and enhance adherence. Many recommended methods for Skyn use are applicable to other alcohol sensors and wearable devices. [ABSTRACT FROM AUTHOR]

Background and aims: Alcohol use disorder is comorbid with numerous other forms of psychopathology, including externalizing disorders (e.g. conduct disorder) and, to a lesser extent, internalizing conditions (e.g. depression, anxiety). Much of the time, overlap among alcohol use disorder and other conditions is explored at the disorder level, assuming that criteria are co‐equal indicators of other psychopathology, even though alcohol use disorder criteria span numerous varied domains. Emerging evidence suggests that there are symptom clusters within the construct of alcohol use disorder that relate differentially with important external criteria, including psychopathology and allied personality traits (e.g. impulsivity, novelty‐seeking). The present study mapped individual alcohol use disorder criteria onto internalizing and externalizing dimensions. Design and participants: We used multivariate and factor analytical modeling and data from two large nationally representative samples of past year drinkers (n = 25 604; 19 454). Setting: United States. Measurements: Psychopathology was assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule, yielding alcohol use disorder criteria, internalizing diagnoses (i.e. major depressive disorder, dysthymia, social anxiety disorder, generalized anxiety disorder, specific phobia, agoraphobia and panic disorder) and externalizing diagnoses and symptoms (i.e. antisocial personality disorder, conduct disorder and three impulsivity items drawn from borderline personality disorder criteria). Alcohol consumption was assessed in terms of past‐year drinking frequency, usual amount of alcohol consumed on drinking days, binge drinking frequency, intoxication frequency, and maximum number of drinks in a 24‐hour period. Findings Four different patterns emerged. First, several alcohol use disorder criteria were relatively weakly associated with externalizing and internalizing. Secondly, withdrawal was associated with internalizing, but this association was not specific to distress. Thirdly, there was a general lack of specificity between alcohol use disorder criteria and narrower forms of internalizing, despite what might be predicted by modern models of addiction. Fourthly, recurrent use in hazardous situations reflected higher degrees of externalizing and lower internalizing liability. Conclusions: Different symptom combinations appear to yield differential expressions of alcohol use disorder that are disorder‐specific, or reflect broader tendencies toward externalizing, internalizing or both. [ABSTRACT FROM AUTHOR]

Aims: To test separatel the efficacy of a web‐based and a peer‐based brief intervention (BI), compared with an expanded usual care control (EUC) group, among military reserve component members using alcohoI in a hazardous and harmful manner. Design: In the randomized controlled trial, participants were assigned to: [1] web‐based BI with web‐based boosters (BI + web), [2] web‐based BI with peer‐based boosters (BI + peer) or [3] enhanced usual care (EUC). Setting: Michigan, USA. Participants: A total of 739 Michigan Army National Guard members who reported recent hazardous alcohol use; 84% were male, the mean age was 28 years. Intervention: The BI consisted of an interactive program guided by a personally selected avatar. Boosters were delivered either on the web or personally by a trained veteran peer. A pamphlet, given to all participants, included information on hazardous alcohol use and military‐specific community resources and served as the EUC condition. Measurements The primary outcome measure was binge drinking episodes in the past 30 days, measured at 12 months after the BI. Findings All randomized participants were included in the outcome analyses. In adjusted analyses, BI + peer [beta = −0.43, 95% confidence interval (CI) = −0.56 to −0.31, P < 0.001] and BI + web (beta = −0.34, 95% CI = −0.46 to −0.23, P < 0.001) reduced binge drinking compared with EUC. Conclusion: This satudy was a web‐based brief intervention for hazardous alcohol use, with either web‐ or peer‐based boosters, reduced binge alcohol use among Army National Guard members. [ABSTRACT FROM AUTHOR]

Aims: Likelihood of alcohol dependence (AD) is increased among people who transition to greater levels of alcohol involvement at a younger age. Indicated interventions delivered early may be effective in reducing risk, but could be costly. One way to increase cost‐effectiveness would be to develop a prediction model that targeted interventions to the subset of youth with early alcohol use who are at highest risk of subsequent AD. Design: A prediction model was developed for DSM‐IV AD onset by age 25 years using an ensemble machine‐learning algorithm known as 'Super Learner'. Shapley additive explanations (SHAP) assessed variable importance. Setting and Participants: Respondents reporting early onset of regular alcohol use (i.e. by 17 years of age) who were aged 25 years or older at interview from 14 representative community surveys conducted in 13 countries as part of WHO's World Mental Health Surveys. Measurements The primary outcome to be predicted was onset of life‐time DSM‐IV AD by age 25 as measured using the Composite International Diagnostic Interview, a fully structured diagnostic interview. Findings AD prevalence by age 25 was 5.1% among the 10 687 individuals who reported drinking alcohol regularly by age 17. The prediction model achieved an external area under the curve [0.78; 95% confidence interval (CI) = 0.74–0.81] higher than any individual candidate risk model (0.73–0.77) and an area under the precision‐recall curve of 0.22. Overall calibration was good [integrated calibration index (ICI) = 1.05%]; however, miscalibration was observed at the extreme ends of the distribution of predicted probabilities. Interventions provided to the 20% of people with highest risk would identify 49% of AD cases and require treating four people without AD to reach one with AD. Important predictors of increased risk included younger onset of alcohol use, males, higher cohort alcohol use and more mental disorders. Conclusions: A risk algorithm can be created using data collected at the onset of regular alcohol use to target youth at highest risk of alcohol dependence by early adulthood. Important considerations remain for advancing the development and practical implementation of such models. [ABSTRACT FROM AUTHOR]

Aims: The study's aim is to identify and classify the most important alcohol control policies in the Baltic countries (Estonia, Latvia and Lithuania) and Poland between 2000 and 2020. Methods: Policy analysis of Baltic countries and Poland, predicting potential policy impact on alcohol consumption, all‐cause mortality and alcohol‐attributable hospitalizations was discussed. Results: All Baltic countries implemented stringent availability restrictions on off‐premises trading hours and different degrees of taxation increases to reduce the affordability of alcoholic beverages, as well as various degrees of bans on alcohol marketing. In contrast, Poland implemented few excise taxation increases or availability restrictions and, in fact, reduced stipulations on prior marketing bans. Conclusions: This classification of alcohol control policies in the Baltic countries and Poland provides a basis for future modeling of the impact of implementing effective alcohol control policies (Baltic countries), as well as the effects of loosening such policies (Poland). [ABSTRACT FROM AUTHOR]

Aims: The aim of this study is to examine age, period and birth cohort trends in the prevalence of any alcohol‐related risky behaviour and to compare these trends between men and women. Design and setting: We used an age–period–cohort analysis of repeated cross‐sectional survey data from the Australian National Drug Strategy Household Survey from 2001 to 2016. Participants: Participants were 121 281 people aged 14–80 years who reported consuming alcohol in the past 12 months. Measurements: Any risky behaviour undertaken while under the influence of alcohol in the past 12 months (e.g. operating a motor vehicle) was measured: male or female. Findings Controlling for age and cohort, cubic spline models showed that any alcohol‐related risky behaviour declined with time among participants who consumed alcohol [2016 versus 2007 rate ratio (RR) = 0.80, 95% confidence interval (CI) = 0.76–0.84]. Risky behaviour peaked in the 1954 birth cohort (1954 versus 1971 RR = 1.42, 95% CI = 1.30–1.55) and then steadily declined with more recent birth cohorts (2002 versus 1971 RR = 0.32, 95% CI = 0.27–0.39). Risky behaviour peaked at age 21 years, followed by steady decline and stabilization at approximately age 70 years. Males were overall twice as likely as females to report alcohol‐related risky behaviour (RR = 2.10, 95% CI = 1.84–2.39), but this effect was smaller in cohorts born after 1980 [1980 prevalence rate ratios (PRR) = 2.09, 95% CI = 1.81–2.43; 2002 PRR = 1.31, 95% CI = 1.03–1.68]. Conclusions: Alcohol‐related risky behaviour in Australia has declined generally since 2001, with rates for recent cohorts having the sharpest decline. Risky behaviour remains most prevalent in young adults, and the male–female gap in risky behaviour is closing for more recent birth cohorts. These trends are consistent with alcohol consumption trends observed in Australia and world‐wide. [ABSTRACT FROM AUTHOR]

Aims: Role models around the adolescent, including parents, peers, best friends and older siblings, all act in ways to socialize the adolescent into alcohol use. This study aims to examine the effect of exposure to siblings' drinking alongside the more traditionally examined role models on alcohol use among adolescents. Design: A longitudinal study followed adolescents (45.6% male) who completed a questionnaire every 6 months over 3 years (seven in total). Setting: Netherlands Participants: This resulted in 5112 observations clustered in 765 participants aged between 10 and 16 years. Measurements: We examined three alcohol use measures: alcohol use in the last 6 months, in the last 4 weeks and binge drinking in the last 4 weeks—both cross‐sectionally at each time‐point and their change from one time‐point to the next in a series of multi‐level logistic regression models. Findings Results revealed a non‐significant difference in any of the exposure or alcohol use variables between those with or without older siblings. Higher exposure to sibling drinking was significantly associated with all alcohol use outcomes: use in the last 6 months, odds ratio (OR) = 1.54, 95% confidence interval (CI) = 1.25–1.91; last 4 weeks, OR = 2.04, 95% CI = 1.60–2.60; and binge drinking, OR = 2.35, 95% CI = 1.82–3.05. When adding the other role models (i.e. peers, mothers, fathers and best friends), the significant association between siblings' exposure and adolescents' alcohol use remains. Conclusions: It would appear that, after adjustment for the effect of role models, adolescents who are exposed to more sibling drinking are more likely to have drunk alcohol during the past 6 months and past 4 weeks and also to binge drink. [ABSTRACT FROM AUTHOR]

Aim: To examine the association of self‐reported COVID‐19 disease status with cutting down, past‐month and past‐year quit attempts and motivation to stop smoking. Design and setting: Repeat cross‐sectional survey, representative of the adult population in England. Participants: Past‐year smokers, n = 3338 (aged ≥ 18 years) responding between May 2020 and April 2021. Measurements: Outcomes were (i) currently cutting down, (ii) having made a quit attempt in the past month, (iii) having made a quit attempt in the past year and (iv) motivation to stop smoking. The explanatory variable was self‐reported COVID‐19 disease status (belief in never versus ever had COVID‐19). Covariates included age, sex, occupational grade, region, children in the household, alcohol use and survey month. Findings Of past‐year smokers, 720 (21.6%) reported past‐COVID‐19 infection and 48 (1.4%) reported current COVID‐19 infection. In adjusted analyses, rates of currently cutting down [adjusted odds ratio (aOR) = 1.12, 95% confidence interval (CI) = 0.93–1.34], past‐year quit attempts (aOR = 0.99, 95% CI = 0.82–1.19) and motivation to stop smoking (aOR = 1.04, 95% CI = 0.89–1.23) were comparable in those who did and did not report ever having had COVID‐19. People who reported ever having had COVID‐19 had 39% higher odds than those without of attempting to quit in the past month, but the confidence interval contained the possibility of no difference (aOR = 1.39, 95% CI = 0.94–2.06) and for some the quit attempt may have occurred before they had COVID‐19. Conclusion: During the first year of the COVID‐19 pandemic in England, rates of reducing smoking and attempting to quit in the past year were similar in smokers who did or did not self‐report ever having had COVID‐19. There was also little difference in motivation to stop smoking between groups. However, causal interpretation is limited by the study design, and there is potential misclassification of the temporal sequence of infection and changes to smoking behaviour. [ABSTRACT FROM AUTHOR]

The author comments on an article by J. Holmes which summarizes studies that explored whether the introduction of the minimum unit pricing (MUP) policy in 2018 has led to the theorized reduction in consumption in Scotland overall and among population groups most likely to experience alcohol-related harm. Topics include association of MUP with reduced deaths and hospital admissions caused by alcohol in Scotland and concern that MUP would unfairly affect those who drink at low moderate levels.

Aim: To compare the effectiveness of practitioner versus digitally delivered interventions for reducing hazardous and harmful alcohol consumption. Design: Systematic review and network meta‐analysis comprising comprehensive search for randomised controlled trials, robust screening and selection methods and appraisal with the Cochrane Risk of Bias tool. Network meta‐analyses were conducted in Stata using random effects, frequentist models. The confidence in network meta‐analysis (CINeMA) tool was used to assess confidence in effect sizes. Setting: Online or community or health settings where the intervention was immediately accessible without referral. Participants: Non treatment‐seeking hazardous or harmful drinkers. Measurements Primary outcome was mean difference in alcohol consumption (g/wk); secondary outcome was number of single high intensity drinking episodes. Baseline consumption was analysed as a covariate. Findings Of 201 included trials (94 753 participants), 152 reported a consumption outcome that could be converted to grams/week; 104 reported number of single high intensity drinking episodes. At 1 and 6 months, practitioner delivered interventions reduced consumption more than digitally delivered interventions (1 month: −23 g/wk (95% CI, −43 to −2); 6 months: −14 g/wk [95% CI, −25 to −3]). At 12 months there was no evidence of difference between practitioner and digitally delivered interventions (−6 g/wk [95% CI, −24 to 12]). There was no evidence of a difference in single high intensity drinking episodes between practitioner and digitally delivered interventions at any time point. Effect sizes were small, but could impact across a population with relatively high prevalence of hazardous and harmful drinking. Heterogeneity was a concern. Some inconsistency was indicated at 1 and 6 months, but little evidence was apparent at 12 months. Conclusion: Practitioner delivered interventions for reducing hazardous and harmful alcohol consumption are more effective than digitally delivered interventions up to 6 months; at 12 months there is no evidence of a difference. [ABSTRACT FROM AUTHOR]

Background and Aim: Alcohol craving is an urge to consume alcohol that commonly precedes drinking; however, craving does not lead to drinking for all people under all circumstances. The current study measured the correlation between neural reactivity and alcohol cues as a risk, and purpose in daily life as a protective factor that may influence the link between alcohol craving and the subsequent amount of consumption. Design: Observational study that correlated functional magnetic resonance imaging (fMRI) data on neural cue reactivity and ecological momentary assessments (EMA) on purpose in life and alcohol use. Setting: Two college campuses in the United States. Participants: A total of 54 college students (37 women, 16 men, and 1 other) recruited via campus‐based groups from January 2019 to October 2020. Measurements Participants underwent fMRI while viewing images of alcohol; we examined activity within the ventral striatum, a key region of interest implicated in reward and craving. Participants then completed 28 days of EMA and answered questions about daily levels of purpose in life and alcohol use, including how much they craved and consumed alcohol. Findings A significant three‐way interaction indicated that greater alcohol cue reactivity within the ventral striatum was associated with heavier alcohol use following craving in daily life only when people were previously feeling a lower than usual sense of purpose. By contrast, individuals with heightened neural alcohol cue reactivity drank less in response to craving if they were feeling a stronger than their usual sense of purpose in the preceding moments (binteraction = −0.086, P < 0.001, 95% CI = −0.137, −0.035). Conclusions: Neural sensitivity to alcohol cues within the ventral striatum appears to be a potential risk for increased alcohol use in social drinkers, when people feel less purposeful. Enhancing daily levels of purpose in life may promote alcohol moderation among social drinkers who show relatively higher reactivity to alcohol cues. [ABSTRACT FROM AUTHOR]

Aim: To measure the impact of taxes and prices on alcohol use with particular attention to the different context of rising alcohol consumption in low‐ and middle‐income countries. Methods: Systematic review: we searched MEDLINE, Embase, EconLit and LILACS, grey literature, hand‐searched five specialty journals and examined references of relevant studies. We considered all reviews that included studies that quantitatively examined the relationship between alcohol prices or taxes and alcohol use. At least two reviewers independently screened the articles and extracted the characteristics, methods and main results and assessed the quality of each included study. We identified 30 reviews. Results: There was overwhelming evidence that higher alcohol prices and taxes were associated with lower total alcohol consumption and that price responsiveness varied by beverage type. Total own‐price elasticities of alcohol demand were consistently negative and substantial enough to be policy meaningful; total own‐price elasticities for beer, wine and spirits were found to be approximately −0.3, −0.6 and −0.65. Reviews generally concluded that higher taxes and prices were associated with lower heavy episodic drinking and heavy drinking, although the magnitude of these associations was generally unclear. Reviews provided no evidence that alcohol price responsiveness differed by socioeconomic status, mixed and contradictory evidence with respect to age and sex and limited evidence that price responsiveness in low‐ and middle‐income countries was approximately the same as in high‐income countries. Conclusions: Taxes are effective in reducing alcohol use. Moreover, increasing the price of alcohol by increasing taxes can also be expected to increase tax revenue, because the demand for alcohol is most certainly inelastic. [ABSTRACT FROM AUTHOR]

Background and Aims: An initial dose of alcohol can motivate—or prime—further drinking and may precipitate (re)lapse and bingeing. Lab‐based studies have investigated the alcohol priming effect; however, heterogeneity in designs has resulted in some inconsistent findings. The aims of this meta‐analysis were to (i) determine the pooled effect size for motivation to drink following priming, measured by alcohol consumption and craving, and (ii) examine whether design characteristics influenced any priming effect. Methods: Literature searches of PsycINFO, PubMed and Scopus in October 2020 (updated October 2021) identified lab‐based alcohol priming studies that assessed effect of priming on motivation to drink. A tailored risk‐of‐bias tool assessed quality of lab‐based studies. Random effects meta‐analyses were computed on outcome data from 38 studies comparing the effect of a priming dose of alcohol against control on subsequent alcohol consumption/self‐reported craving. Study characteristics that might have affected outcomes were design type (within/between‐participant), dose of prime, time of motivation assessment, type of control drink (placebo alcohol/soft drink). Results: Relative to control, alcohol had a small‐to‐moderate priming effect on subsequent alcohol consumption (standardised mean difference [SMD] = 0.336 [95% CI, 0.171, 0.500]) and craving (SMD = 0.431 [95% CI, 0.306, 0.555]). Aspects of study design differentially affected consumption and craving. The size of the priming dose had no effect on consumption, but larger doses were sometimes associated with greater craving (with craving generally following the blood alcohol curve). Alcohol priming effects for consumption, but not craving, were smaller when compared with placebo, relative to soft drink, control. Conclusions: Lab‐based alcohol priming studies are a valid paradigm from which to investigate the impact of acute intoxication on alcohol motivation. Designs are needed that assess the impact of acute consumption on motivation to drink in more varied and realistic ways. [ABSTRACT FROM AUTHOR]

Aims: To estimate the effect of acute alcohol consumption on risk‐taking while gambling, examine blood alcohol concentration as a moderator and explore possible moderators of this effect. Design, Setting and Participants: A systematic review and meta‐analysis was completed. A Boolean search strategy was used to identify studies that included (a) alcohol consumption as an independent variable; (b) a gambling or risk‐taking task; (c) a control or placebo comparison; (d) human participants; and (e) English publications. Descriptive information, sample characteristics and experimental data were extracted from each study. Searched databases included: PsycINFO, Web of Science, Medline, Cochrane Library and ProQuest Dissertations and Theses. Included as participants were experiments that compared the effects of alcohol and non‐alcoholic or placebo beverages on risk‐taking while gambling. Measurement: Comprehensive Meta‐Analysis version 3.3.070 was used. Standardized mean differences of risk‐taking while gambling between the experimental and control conditions were calculated when studies did not report effect sizes. Random‐effects models were used for overall effect and meta‐regressions while mixed‐effects models were used for subgroup analyses. Findings Twenty articles containing 47 alcohol versus control comparisons met inclusion criteria. The overall Hedges'g for the difference between groups consuming alcohol and groups consuming a placebo or non‐alcoholic drink control was 0.03, 95% confidence interval (CI) = −0.07, 0.12, p = 0.60, indicating no significant difference. Larger effect sizes were found for studies using non‐alcoholic control drinks (Hedges' g = 0.30, 95% CI = 0.01, 0.58) compared to placebo beverages (Hedges' g = −0.03, 95% CI = −0.13, 0.06), Cochran's Q = 4.67, p = 0.03. Conclusions: Finding that acute alcohol consumption had no reliable effect on risk‐taking while gambling was consistent with existing animal research. No support was found for the relation between alcohol dose and risk‐taking. The significantly larger effect size for experiments using non‐alcoholic versus placebo beverages suggests the potential role of expectancy effects. [ABSTRACT FROM AUTHOR]

Background and Aims: The alcohol purchase task (APT), which presents a scenario and asks participants how many drinks they would purchase and consume at different prices, generates indices of alcohol reward value that have shown robust associations with alcohol‐related outcomes in numerous studies. The aim was to test its prospective validity at 4‐year follow‐up. Design: Prospective cohort study. Setting: General population sample of young Swiss men. Participants: A total of 4594 Swiss young men (median age = 21, 25th ‐ 75th quartiles = 20.5 ‐ 21.5) completed baseline questionnaires; among those, 4214 (91.7%) were successfully followed‐up 4 years later. Measurements Alcohol reward value parameters (i.e. intensity, the planned consumption when drinks are free; breakpoint, the price at which consumption would be suppressed; Omax, the maximum alcohol expenditure; Pmax, the price associated with Omax; and elasticity, the relative change in alcohol consumption as a function of the relative change in price) were derived from the APT at baseline and used to predict self‐reported weekly drinking amount, monthly binge drinking, alcohol‐related consequences and DSM‐5 alcohol use disorder criteria. Findings Regression analyses, adjusting for the baseline alcohol measure, age, linguistic region and socio‐economic indicators showed that intensity, breakpoint, Omax and elasticity significantly predicted all tested outcomes in the expected direction (e.g. standardized incidence rate ratio [95% confidence interval] = 1.11 [1.07–1.15], 1.07 [1.03–1.10], 1.08 [1.04–1.11], and 0.92 [0.89–0.95], respectively, for weekly drinking amount, all P < 0.001). Pmax did not significantly predict any outcomes. Non‐adjusted correlations, baseline adjusted regression and ancillary analyses using (1) latent alcohol variables, (2) multiple imputation for missing data and (3) replications in training and testing subsamples to evaluate predictive accuracy provided consistent findings. Conclusions: The alcohol purchase task demand curve measures of alcohol reward value are useful in characterizing alcohol‐related risk in young men and have long‐term predictive utility. [ABSTRACT FROM AUTHOR]

Background and Aims: In Finland, per‐capita alcohol consumption increased in the early 2000s and decreased after 2007. Our aim was to determine how these changes originated from changes in drinking practices. Design: Repeated cross‐sectional general‐population surveys. Setting: Finland in 2000, 2008 and 2016. Participants: Finnish residents aged 15–69 years (n = 6703, response rate 59–78%). Measurements Event‐level data on drinking occasions (n = 21 097). Types of drinking occasions (drinking practices) were identified with latent class analysis using occasion characteristics. The aggregated volume of consumption and intoxication occasions were decomposed into contributions from drinking practice classes and years. Findings Nine drinking occasion types were identified: three at home without company other than family (51% of occasions in 2016), three socializing occasions in different places and with different company (33%) and three party occasion types (16%). Both the frequency of drinking occasion types and the occasion type‐specific amounts of alcohol consumed contributed to aggregate‐level changes in alcohol use. Drinking at home without external company (with family only; for men, also alone) contributed most to the increase in alcohol use before 2008. Big parties in homes and bars became less common in the 2000s, contributing most to the decline in drinking after 2008. Conclusions: The rise in per‐capita alcohol consumption in Finland in the early 2000s appears to have been linked mainly to an increase in lighter drinking occasions at home without external company. The fall in per‐capita drinking after 2007 was linked mainly to a decrease in big parties in homes and in licensed premises. Changes in drinking frequency and the amounts of alcohol consumed per occasion changed in the same direction as alcohol affordability. [ABSTRACT FROM AUTHOR]

Background and aims: Survey questions on usual quantity and frequency of alcohol consumption are regularly used in screening tools to identify drinkers requiring intervention. The aim of this study was to measure age‐based differences in quantity and frequency of alcohol consumption on the Alcohol Use Disorders Identification Test (AUDIT) and how this relates to the prediction of harmful or dependent drinking. Design: Cross‐sectional survey. Setting: Australia. Participants: Data were taken from 17 399 respondents who reported any alcohol consumption in the last year and were aged 18 and over from the 2016 National Drug Strategy Household Survey, a broadly representative cross‐sectional survey on substance use. Measurement Respondents were asked about their frequency of consumption, usual quantity per occasion and the other items of the AUDIT. Findings In older drinkers, quantity per occasion [β = 0.53, 95% confidence interval (CI) = 0.43, 0.64 in 43–47‐year‐olds as an example] was a stronger predictor of dependence than frequency per occasion (β = 0.24, 95% CI = 0.17, 0.31). In younger drinkers the reverse was true, with frequency a stronger predictor (β = 0.54, 95% CI = 0.39, 0.69 in 23–27‐year‐olds) than quantity (β = 0.26, 95% CI = 0.18, 0.34 in 23–27‐year‐olds). Frequency of consumption was not a significant predictor of dependence in respondents aged 73 years and over (β = −0.03, 95% CI = −0.08, 0.02). Similar patterns were found when predicting harmful drinking. Despite this, as frequency of consumption increased steadily with age, the question on frequency was responsible for at least 65% of AUDIT scores in drinkers aged 53 years and over. Conclusions: In younger drinkers, frequent drinking is more strongly linked to dependence and harmful drinking subscale scores on the Alcohol Use Disorders Identification Test (AUDIT) than quantity per occasion, yet quantity per occasion has a stronger influence on the overall AUDIT score in this group. In older drinkers, frequency of consumption is not always a significant predictor of the AUDIT dependence subscale and is a weak predictor of the harmful drinking subscale. [ABSTRACT FROM AUTHOR]

Background and Aims: In India, alcohol per capita consumption (APC) has substantially increased over the past 2 decades. Although consumption does vary across the country, consistent state‐level data are lacking. We aimed to identify all state‐level alcohol exposure estimates since 2000 to (i) model consistent current drinking (CD) (12 months) prevalence estimates for all 36 states/union territories (UT) in 2019 and (ii) compare state‐level CD trends with national‐level APC trends. Design A systematic review for studies on the Indian state‐level prevalence of CD, lifetime abstinence (LA), alcohol use disorders (AUD) or the quantity of alcohol consumed among current drinkers (QU) was conducted. Subsequently, statistical modelling was applied. Setting: Data were collected and modelled for all Indian states/UTs. Participants: Studies since 2000 referring to the general adult population (≥15 years) of at least one Indian state/UT were eligible. The total sample size covered was ~29 600 000 (males: females, 1:1.6). Measurements Results on LA, AUD and QU were summarized descriptively. For (i) the state‐, sex‐ and age‐specific CD prevalence was estimated using random intercept fractional response models. For (ii) random intercept and slope models were performed. Findings Of 2870 studies identified, 30 were retained for data extraction. LA, AUD and QU data were available for 31, 36 and 12 states/UTs, respectively. CD model estimates ranged from 6.4% (95% CI = 2.1%–18.1%; males) in Lakshadweep and 1.3% (95% CI = 0.7%–2.6%; females) in Delhi to 76.1% (95% CI = 68.1%–82.6%; males) and 63.7% (95% CI = 49.4%–75.7%; females) in Arunachal Pradesh. Over time, CD decreased in most states/UTs in the observed data, contradicting increasing national‐level APC trends. Conclusions: Alcohol use (measured as consistent current drinking) in India has large regional variations, with alcohol consumption being most prevalent in the North‐East, Chhattisgarh, Telangana, Himachal Pradesh, Punjab and Jharkhand. [ABSTRACT FROM AUTHOR]

Background and Aims: Alcohol consumption changes markedly over the life course, with important implications for health and social development. Assessment of these patterns often relies on cross‐sectional data, which cannot fully capture how individuals' drinking changes as they age. This study used data from 18 waves of a general population panel survey to measure drinking trajectories over the life course in Australia. Design and Setting: Longitudinal survey data from the Household, Income and Labour Dynamics in Australia (HILDA) survey between 2001 and 2018. Participants: A total of 20 593 individuals ages 15 or above in two samples assessing quantity‐frequency (n = 20 569, 52.0% female) and risky single occasion drinking (RSOD), respectively, (n = 17 340, 52.5% female), interviewed as part of HILDA. Measurements Usual quantity of alcohol consumed per drinking occasion; frequency of drinking occasions per week; average daily consumption, calculated by combining reported usual quantity and frequency; and average reported frequency of RSOD per week. Findings Multilevel, mixed effects models run with fractional polynomial terms found similar male and female alcohol consumption trajectories for quantity‐frequency and RSOD measures. Usual quantity of alcohol consumed per drinking occasion (5.4 drinks for men, 3.8 for women) and RSOD frequency (0.56 occasions/week for men, 0.38 for women) peaked in young adulthood, whereas frequency of drinking occasions (2.5 occasions/week for men, 1.7 for women) peaked in middle age. Middle‐age drinkers had the highest average daily consumption of alcohol (1.4 drinks/day for 54‐year‐old men, 0.6 drinks for 57‐year‐old women) and engaged in RSOD slightly less than young adults. Conclusions: Alcohol consumption in Australia appears to vary substantially over the life course, with usual quantity per drinking occasion and frequency of risky single occasion drinking peaking during early adulthood and average daily consumption and frequency of consumption peaking in middle age. [ABSTRACT FROM AUTHOR]

Background and Aims: There is significant debate about whether or not changes in per‐capita alcohol consumption occur collectively across the entire distribution of drinking. This study used data from a decade of declining drinking in Australia to test the collectivity of drinking trends. Design Repeated cross‐sectional surveys (2010, 2013, 2016, 2019), analysed with quantile regression techniques assessing trends in drinking for 20 quantile groups. Setting: Australia. Participants: A general population sample (total n = 85 891; males = 39 182, females = 46 709) aged 14 years and over. Measurements Past‐year volume of alcohol consumed was measured using standard graduated frequency survey questions. Models were stratified by sex and age group. Findings Throughout the whole population, alcohol consumption had declined in all percentile groups, with the largest proportional declines evident for light and moderate drinkers [e.g. drinkers in the 25th percentile declined by 32.7%; 95% confidence interval (CI) = ‐41.6, ‐22.3% per wave]. Broadly collective declines were also found for younger men and women with significant declines in every percentile group, but older groups showed some evidence of polarization. For example, women aged 45–64 years significantly increased their consumption (2.9% per wave, 95% CI = 0.3–5.5%), while consumption for those in the 25th percentile fell significantly (‐16.7%, 95% CI = –27.6, ‐4.2%). Conclusions: The declines in Australian drinking since 2010 have included important deviations from the collectivity predicted by Skog's influential theory of collectivity of drinking, with markedly different patterns evident among different demographic groups. [ABSTRACT FROM AUTHOR]

Background and Aims: Black drinkers compared with White drinkers experience more alcohol‐related problems. Examination of social determinants of inequities in alcohol problems is needed. The current study measured (1) associations between acute stress and alcohol craving in the naturalistic environment for self‐identified Black and White individuals who drink alcohol and (2) whether a history of attention deficit hyperactivity disorder (ADHD) moderated these associations. Design and Setting: Observational study using ecological momentary assessment (EMA) to collect data from participants at six semi‐random time‐points throughout the day during a 10‐day period. A series of three‐level multi‐level models examined between‐ and within‐person associations for stress and alcohol and tested if these associations differed for Black and White adults. Participants: Participants were 229 adult drinkers (aged 21–35 years) who completed a larger study examining alcohol response for Black and White adults with and without a history of childhood ADHD. Measurements Momentary stress and alcohol craving, ADHD history and socio‐demographic characteristics (i.e. racial identity, sex, age, current education level, household income) were assessed. Participants were required to self‐identify as either 'African American or Black' or 'European American or White'. Findings Significant racial identity × stress interactions indicated that associations between stress and craving were stronger for Black compared with White adults across the 10‐day period (between‐person: B = 0.14, P = 0.007), concurrently within a given EMA time‐point (within‐person: B = 0.04, P = 0.001) and prospectively from time‐point to time‐point (within‐person: B = 0.05, P = 0.001). Results remained while accounting for income × stress interactions. Conclusions: Acute stress appears to be more strongly related to alcohol craving in self‐identified Black compared with self‐identified White individuals. This provides support for policy changes to eliminate structural inequities that increase stress exposure and the development of just‐in‐time culturally responsive interventions focused on coping with acute stress for Black individuals. [ABSTRACT FROM AUTHOR]

Background and aims: Smoking is associated with increased risk for brain aging/atrophy and dementia. Few studies have examined early associations with brain aging. This study aimed to measure whether adult men with a history of heavier smoking in early mid‐life would have older than predicted brain age 16–28 years later. Design Prospective cohort observational study, utilizing smoking pack years data from average age 40 (early mid‐life) predicting predicted brain age difference scores (PBAD) at average ages 56, 62 (later mid‐life) and 68 years (early old age). Early mid‐life alcohol use was also evaluated. Setting: Population‐based United States sample. Participants/cases: Participants were male twins of predominantly European ancestry who served in the United States military between 1965 and 1975. Structural magnetic resonance imaging (MRI) began at average age 56. Subsequent study waves included most baseline participants; attrition replacement subjects were added at later waves. Measurements Self‐reported smoking information was used to calculate pack years smoked at ages 40, 56, 62, and 68. MRIs were processed with the Brain‐Age Regression Analysis and Computation Utility software (BARACUS) program to create PBAD scores (chronological age—predicted brain age) acquired at average ages 56 (n = 493; 2002–08), 62 (n = 408; 2009–14) and 68 (n = 499; 2016–19). Findings In structural equation modeling, age 40 pack years predicted more advanced age 56 PBAD [β = −0.144, P = 0.012, 95% confidence interval (CI) = –0.257, −0.032]. Age 40 pack years did not additionally predict PBAD at later ages. Age 40 alcohol consumption, but not a smoking × alcohol interaction, predicted more advanced PBAD at age 56 (β = −0.166, P = 0.001, 95% CI = –0.261, –0.070) with additional influences at age 62 (β = −0.115, P = 0.005, 95% CI = –0.195, –0.036). Age 40 alcohol did not predict age 68 PBAD. Within‐twin‐pair analyses suggested some genetic mechanism partially underlying effects of alcohol, but not smoking, on PBAD. Conclusions: Heavier smoking and alcohol consumption by age 40 appears to predict advanced brain aging by age 56 in men. [ABSTRACT FROM AUTHOR]

Background and Aims: Alcohol consumption is increasing among older adults. Rethink My Drink is a brief internet-delivered intervention to reduce alcohol consumption and related harms, adapted specifically for older adults. This protocol for a large-scale randomised controlled trial will evaluate whether Rethink My Drink is effective in reducing alcohol consumption and cognitive decline in a sample of older risky drinkers, compared with an active control. Design: 1:1 parallel group, randomised controlled trial. Setting: Online trial in Australia. Participants: Hazardous or harmful drinkers (defined as those scoring =5 on the Alcohol Use Disorders Identification Test [AUDIT]) age 60 to 75 years old (n = 842). Participants will be recruited from August 2021 to August 2022 through online social media advertisements and community networks. Intervention and Comparator: Participants will be randomly allocated to receive access to Rethink My Drink (intervention) or Alcohol: The Facts (comparator), an online patient information booklet provided by New South Wales (NSW) Health. Measurements: Primary outcomes include (i) average weekly standard drinks and (ii) rate of cognitive decline. Secondary outcomes include (i) typical quantity of drinks per drinking day; (ii) heavy episodic drinking; (iii) age-specific risky drinking; (iv) alcoholrelated harms; (v) subjective cognitive complaints; and (vi) quality of life. All primary and secondary outcomes will be assessed at baseline, post-intervention (4 weeks) and 12 months. Effectiveness will be evaluated using multilevel linear regression, adjusting for baseline demographic differences. Bonferroni adjustments will be used to control for multiple comparisons. Multiple imputation, regression weighting and sensitivity analyses will assess the effect of attrition. Comments: This will be the first large-scale trial, internationally, to examine whether a brief internet-delivered intervention is effective in reducing alcohol consumption and cognitive decline among older adults. If successful, the intervention will provide an accessible and highly scalable treatment to reduce risky alcohol consumption in older adulthood. [ABSTRACT FROM AUTHOR]

Aim: To estimate changes in smoking, drinking and quitting behaviour from before to during the first COVID-19 lockdown in England, and whether changes differed by age, sex or social grade. Design: Representative cross-sectional surveys of adults, collected monthly between August 2018 and July 2020. Setting: England. Participants: A total of 36 980 adults (= 18 years). Measurements: Independent variables were survey month (pre-lockdown: August-February versus lockdown months: April-July) and year (pandemic: 2019/20 versus comparator: 2018/19). Smoking outcomes were smoking prevalence, cessation, quit attempts, quit success and use of evidence-based or remote cessation support. Drinking outcomes were high-risk drinking prevalence, alcohol reduction attempts and use of evidence-based or remote support. Moderators were age, sex and occupational social grade (ABC1 = more advantaged/C2DE = less advantaged). Findings: Relative to changes during the same time period in 2018/19, lockdown was associated with significant increases in smoking prevalence [+24.7% in 2019/20 versus 0.0% in 2018/19, adjusted odds ratio (aOR) = 1.35, 95% confidence interval (CI) = 1.12-1.63] and quit attempts (+39.9 versus -22.2%, aOR = 2.48, 95% CI = 1.76-3.50) among 18-34-year-olds, but not older groups. Increases in cessation (+156.4 versus -12.5%, aOR = 3.08, 95% CI = 1.86-5.09) and the success rate of quit attempts (+99.2 versus +0.8%, aOR = 2.29, 95% CI = 1.31-3.98) were also observed, and did not differ significantly by age, sex or social grade. Lockdown was associated with a significant increase in high-risk drinking prevalence among all socio-demographic groups (+39.5 versus -7.8%, aOR = 1.80, 95% CI = 1.64-1.98), with particularly high increases among women (aOR = 2.17, 95% CI = 1.87-2.53) and social grades C2DE (aOR = 2.34, 95% CI = 2.00-2.74). Alcohol reduction attempts increased significantly among high-risk drinkers from social grades ABC1 (aOR = 2.31, 95% CI = 1.78-3.00) but not C2DE (aOR = 1.25, 95% CI = 0.83-1.88). There were few significant changes in use of support for smoking cessation or alcohol reduction, although samples were small. Conclusions: In England, the first COVID-19 lockdown was associated with increased smoking prevalence among younger adults and increased high-risk drinking prevalence among all adults. Smoking cessation activity also increased: more younger smokers made quit attempts during lockdown and more smokers quit successfully. Socio-economic disparities in drinking behaviour were evident: high-risk drinking increased by more among women and those from less advantaged social grades (C2DE), but the rate of reduction attempts increased only among the more advantaged social grades (ABC1). [ABSTRACT FROM AUTHOR]

Background and Aims: Having a negative cognitive style may lead someone to feel hopeless about his or her situation and be more likely to engage in coping-motivated drinking. We, therefore, aimed to investigate the association between cognitive style and drinking to cope. Design: Prospective cohort study. Setting: The former Avon Health Authority in South West England. Participants: A total of 1681 participants of the Avon Longitudinal Study of Parents and Children. Measurements: Participants completed cognitive style questions at age 17 and a subset of drinking to cope questions at age 24. We used linear regression to test the association between cognitive style and drinking to cope, controlling for confounders. Alcohol consumption and dependence scales were included in a secondary analysis. Findings: A 20-point increase (that was the standard deviation of the exposure variable) in cognitive style score at age 17 was associated with an increase of 0.24 in drinking to cope scores at age 24 after adjustment for confounding variables (95% CI) = 0.08-0.41, P = 0.003). We found no evidence of an association between cognitive style and alcohol consumption (coefficient = 0.03, 95% CI = -0.08-0.14, P = 0.591) before or after adjustment. There was evidence for an association with alcohol dependence, but this was not present after adjusting for confounders (coefficient = 0.01, 95% CI = -0.04-0.05, P = 0.769). Conclusions: In young adults in England, there appears to be a positive association between negative cognitive style and subsequent drinking to cope. [ABSTRACT FROM AUTHOR]

Background and Aims: The three-question Alcohol Use Disorders Identification Test (AUDIT-C) is frequently used in healthcare for screening and brief advice about levels of alcohol consumption. AUDIT-C scores (0-12) provide feedback as categories of risk rather than estimates of actual alcohol intake, an important metric for behaviour change. The study aimed to (i) develop a continuous metric from the Extended AUDIT-C expressed in United Kingdom (UK) units (8 g pure ethanol), offering equivalent accuracy, and providing a direct estimator of weekly alcohol consumption (EWAC) and (ii) evaluate the EWAC's bias and error using the graduated-frequency (GF) questionnaire as a reference standard of alcohol consumption. Design: Cross-sectional diagnostic study based on a nationally-representative survey. Settings: Community dwelling households in England. Participants: A total of 22 404 household residents aged =16 years reporting drinking alcohol at least occasionally. Measurements: Computer-assisted personal interviews consisting of (i) AUDIT questionnaire with extended response items (the 'Extended AUDIT') and (ii) GF. Primary outcomes were: mean deviation <1 UK unit (metric of bias); root-mean-square deviation <2 UK units (metric of total error) between EWAC and GF. The secondary outcome was the receiver operating characteristic area under the curve for predicting alcohol consumption in excess of 14 and 35 UK units. Findings: EWAC had a positive bias of 0.2 UK units (95% CI = 0.08, 0.4) compared with GF. Deviations were skewed: whereas the mean error was 11 UK units/week [9.5, 11.9], in half of participants the deviation between EWAC and GF was between 0 and 2.1 UK units/week. EWAC predicted consumption in excess of 14 UK units/week with a significantly greater area under the curve (0.918 [0.914, 0.923]) than AUDIT-C (0.870 [0.864, 0.876]) or the full AUDIT (0.854 [0.847, 0.860]). Conclusions: A new estimator of weekly alcohol consumption, which uses answers to the Extended AUDIT-C, meets the targeted bias tolerance. It is superior in accuracy to AUDIT-C and the full 10-item AUDIT when predicting consumption thresholds, making it a reliable complement to the Extended AUDIT-C for health promotion interventions. [ABSTRACT FROM AUTHOR]

Aims: To examine changes in drinking behavior among United States (US) adults between March 10 and July 21, 2020, a critical period during the COVID‐19 pandemic. Design Longitudinal, internet‐based panel survey. Setting: The Understanding America Study (UAS), a nationally representative panel of US adults age 18 or older. Participants: A total of 4298 US adults who reported alcohol use. Measurements Changes in number of reported drinking days from March 11, 2020 through July 21, 2020 in the overall sample and stratified by sex, age, race/ethnicity, household structure, poverty status, and census region. Findings Compared with March 11, the number of drinking days per week was significantly higher on April 1 by an average of 0.36 days (95% CI = 0.30, 0.43), on May 1 by an average of 0.55 days (95% CI = 0.47, 0.63), on June 1 by an average of 0.41 days (95% CI = 0.33, 0.49), and on July 1 by an average of 0.39 days (95% CI = 0.31, 0.48). Males, White participants, and older adults reported sustained increases in drinking days, whereas female participants and individuals living under the federal poverty line had attenuated drinking days in the latter part of the study period. Conclusions: Between March and mid‐July 2020, adults in the United States reported increases in the number of drinking days, with sustained increases observed among males, White participants, and older adults. [ABSTRACT FROM AUTHOR]

Aim: To test the association of alcohol consumption with total and cause‐specific mortality risk. Design Prospective observational multi‐centre population‐based study. Setting: Sixteen cohorts (15 from Europe) in the MOnica Risk, Genetics, Archiving and Monograph (MORGAM) Project. Participants: A total of 142 960 individuals (mean age 50 ± 13 years, 53.9% men). Measurements Average alcohol intake by food frequency questionnaire, total and cause‐specific mortality. Findings In comparison with life‐time abstainers, consumption of alcohol less than 10 g/day was associated with an average 11% [95% confidence interval (CI) = 7–14%] reduction in the risk of total mortality, while intake > 20 g/day was associated with a 13% (95% CI = 7–20%) increase in the risk of total mortality. Comparable findings were observed for cardiovascular (CV) deaths. With regard to cancer, drinking up to 10 g/day was not associated with either mortality risk reduction or increase, while alcohol intake > 20 g/day was associated with a 22% (95% CI = 10–35%) increased risk of mortality. The association of alcohol with fatal outcomes was similar in men and women, differed somewhat between countries and was more apparent in individuals preferring wine, suggesting that benefits may not be due to ethanol but other ingredients. Mediation analysis showed that high‐density lipoprotein cholesterol explained 2.9 and 18.7% of the association between low alcohol intake and total as well as CV mortality, respectively. Conclusions: In comparison with life‐time abstainers, consuming less than one drink per day (nadir at 5 g/day) was associated with a reduced risk of total, cardiovascular and other causes mortality, except cancer. Intake of more than two drinks per day was associated with an increased risk of total, cardiovascular and especially cancer mortality. [ABSTRACT FROM AUTHOR]

Aims: To identify factors asociated with early and sustained cessation of heavy drinking. Design Retrospective cohort study over 5 years. Setting: Kaiser Permanente Northern California, United States. Participants: Adults reporting heavy drinking during primary care‐based alcohol screening between 1 June 2013 and 31 May 2014. The sample (n = 85 434) was 40.7% female and 33.8% non‐white; mean age was 50.3 years (standard deviation = 18.1). Measurements: Following US guidelines, early and sustained cessation of heavy drinking was defined as reporting lower‐risk drinking or abstinence at 1 year and to 5 years after achieving early cessation, respectively. Associations between patient characteristics and service use and cessation outcomes were examined using logistic regression with inverse probability weights addressing attrition. Findings Nearly two‐thirds of participants achieved early cessation of heavy drinking. Women [odds ratio (OR) = 1.39, 95% confidence interval (CI) = 1.35, 1.44], middle‐age (35–64 years: ORs = 1.16–1.19), non‐white race/ethnicity (ORs = 1.03–1.57), medical conditions (OR = 1.05, 95% CI = 1.04, 1.06), psychiatric (OR = 1.10, 95% CI = 1.06, 1.15) and drug use disorders (OR = 1.35, 95% CI = 1.17, 1.56) and addiction treatment (OR = 1.19, 95% CI = 1.09, 1.30) were associated with higher odds of early cessation, while older age (≥ 65 years: OR = 0.91, 95% CI = 0.86, 0.96), smoking (OR = 0.81, 95% CI = 0.77, 0.84), higher index drinking levels (exceeding both daily and weekly limits: OR = 0.30, 95% CI = 0.29, 0.32) and psychiatric treatment (OR = 0.91, 95% CI = 0.84, 0.99) were associated with lower odds. Among those who achieved early cessation (n = 19 200), 60.0% sustained cessation. Associations between patient factors and sustained cessation paralleled those observed in analyses of early cessation. Additionally, routine primary care (OR = 1.57, 95% CI = 1.44, 1.71) and addiction treatment post‐1 year (OR = 1.41, 95% CI = 1.19, 1.66) were associated with higher odds of sustained cessation. Lower‐risk drinking versus abstinence at 1 year was associated with lower odds of sustained cessation (OR = 0.62, 95% CI = 0.57, 0.66). Conclusions: Nearly two‐thirds of a large, diverse sample of patients who reported heavy drinking in a Californian health‐care system achieved early and sustained cessation of heavy drinking. Vulnerable subgroups (i.e. non‐white patients and those with psychiatric disorders), patients who received routine primary care and those who received addiction treatment were more likely to sustain cessation of heavy drinking than other participants. [ABSTRACT FROM AUTHOR]

Background and aims: Little is known about how perceived norms about alcohol consumption may influence high alcohol consumption rates in Uganda. This study estimated the accuracy of perceived norms about men's alcohol consumption and estimated the association between perceived norms and personal alcohol consumption. Design Cross‐sectional, whole‐population, sociocentric social network study. Setting: Eight rural villages in Rwampara District, southwestern Uganda in 2016–18. Participants: A total of 719 men aged 18 years and older (representing 91% of permanent resident men). Measurements Self‐reported frequent (≥ 4 days per week) and heavy alcohol consumption (six or more drinks on one occasion, more than three occasions of intoxication, or spending an excessive amount on alcohol). Participants also reported whether they thought most other men in their village engaged in frequent and heavy alcohol consumption (perceived norms). Using the network study design, we calculated alcohol consumption behavior within villages and social networks. Perceived norms were compared with aggregated self‐reports. Multivariable Poisson regression models were used to estimate the association between perceived norms and individual behavior. Findings Throughout villages, frequent and heavy alcohol consumption ranged from 7 to 37%. However, 527 (74%) participants perceived, contrary to fact, that most other men in their villages frequently consumed alcohol, and 576 (81%) perceived that most others heavily consumed alcohol. Overestimation of alcohol consumption by others was pervasive among socio‐demographic subgroups and was present irrespective of the actual consumption behavior at the village level and within social networks. Men who misperceived these alcohol consumption behaviors as being common were more likely to engage in frequent [adjusted relative risk (aRR) = 3.98; 95% confidence interval (CI) = 1.69–9.34) and heavy (aRR = 4.75; 95% CI = 2.33–9.69) alcohol consumption themselves. Conclusions: Most men in eight rural Ugandan villages incorrectly thought that frequent and heavy alcohol consumption were common among men in their villages. These misperceived norms had a strong positive association with individual drinking behavior. [ABSTRACT FROM AUTHOR]

Aims: To estimate change in young people's alcohol consumption during COVID‐19 restrictions in Australia in early‐mid 2020, and test whether those changes were consistent by gender and level of consumption prior to the pandemic. Design Prospective longitudinal cohort. Setting: Secondary schools in New South Wales, Tasmania and Western Australia. Participants: Subsample of a cohort (n = 443) recruited in the first year of secondary school in 2010–11. Analysis data included three waves collected in September 2017–July 2018, September 2018–May 2019 and August 2019–January 2020), and in May–June 2020. Measurements: The primary predictors were time, gender and level of consumption prior to the pandemic. Outcome variables, analysed by mixed‐effects models, included frequency and typical quantity of alcohol consumption, binge drinking, peak consumption, alcohol‐related harm and drinking contexts. Findings Overall consumption (frequency × quantity) during the restrictions declined by 17% [incidence rate ratio (IRR) = 0.83; 95% confidence interval (CI) = 0.73, 0.95] compared to February 2020, and there was a 35% decline in the rate of alcohol‐related harms in the same period (IRR = 0.66; 95% CI = 0.54, 0.79). Changes in alcohol consumption were largely consistent by gender. Conclusions: From a survey of secondary school students in Australia, there is evidence for a reduction in overall consumption and related harms during the COVID‐19 restrictions. [ABSTRACT FROM AUTHOR]

Background and Aims: The US state of South Dakota's 24/7 Sobriety Program (24/7) requires individuals charged or convicted of alcohol‐involved offenses to avoid alcohol and submit to twice‐daily or continuous alcohol testing. We evaluated the impact of the 24/7 program in the US state of Montana. Methods: Using data from everyone in Montana who was convicted of their second driving under the influence (DUI) offense from 2009 to August 2013, we described program violations among 24/7 participants and then estimated the effect of 24/7 participation on the probability of DUI re‐arrest. To address potential selection issues related to individual‐level 24/7 participation, we used an instrumental variables approach that exploits county‐level variation in program adoption. Results: Among 2768 people convicted of a second DUI in our analytical sample, 356 participated in 24/7 and were monitored for an average of 173 days (median = 112 days). Among the 332 participants monitored by breath test, 95.5% of scheduled alcohol breath tests were completed and did not lead to a program violation. After controlling for individual‐ and community‐level covariates as well as year and county fixed effects, our instrumental variable models suggested that participation in 24/7 reduced the 1‐year DUI re‐arrest probability by at least 80% (preferred model: 86% decrease; 8.9 percentage points) compared with a counterfactual group of people convicted of a second DUI over the same period but not assigned to the program. Conclusions: South Dakota USA's 24/7 Sobriety Program appears to work in Montana as well. Certain delivery of immediate but modest sanctions for repeat driving under the influence (DUI) arrestees who violate alcohol abstinence orders appears to be able to reduce future DUI arrests. [ABSTRACT FROM AUTHOR]

Background and aims: Although men's alcohol misuse and less gender‐equitable attitudes have been identified as risks for perpetration of intimate partner violence (IPV), less is known about how men's gender‐equitable attitudes and drinking act together to increase risk of IPV. This study aimed to assess the independent relationships of lower gender‐equitable attitudes and drinking to perpetration of IPV and their interaction among men in seven countries. Design Secondary analysis of the United Nations Multi‐Country Study on Men and Violence (UNMCS) and Nabilan Study databases consisting of (1) unadjusted and adjusted logistic regression to measure the association of perpetration of IPV with gender‐equitable men (GEM) scale score and regular heavy episodic drinking (RHED) and (2) meta‐analyses of prevalence and effect estimates adjusted for country‐level sites and countries. Setting and participants: A total of 9148 ever‐partnered 18–49‐year‐old men surveyed in 2011–15 from 18 sites in Bangladesh, Cambodia, China, Indonesia, Papua New Guinea, Sri Lanka and Timor Leste. Measurements The outcome variable is reported perpetration of physical or sexual IPV in the previous year. Independent variables: GEM scale scores; RHED, defined as six or more drinks in one session at least monthly (compared with other drinkers and abstainers). Findings Pooled past‐year prevalence of perpetration of IPV was 13% [95% confidence interval (CI) = 9–16%]. GEM scores and RHED were independently associated with perpetration of IPV overall and in most sites. Pooled odds ratios (ORs) for perpetration of IPV with less equitable GEM scores were 1.07 (95% CI = 1.04, 1.09) and with RHED were 3.42 (95% CI = 2.43, 4.81). A significant interaction between GEM score and RHED (P = 0.001) indicated that RHED increased the relationship of less gender‐equitable attitudes and perpetration of IPV. Conclusion: Both gender‐inequitable attitudes and drinking appear to be associated with perpetration of intimate partner violence by men, with regular heavy episodic drinking increasing the likelihood of intimate partner violence among men with less equitable gender attitudes. [ABSTRACT FROM AUTHOR]

Background and Aims: On 1 May 2018, Scotland became the first country in the world to introduce minimum unit pricing (MUP), a strength‐based floor price below which alcohol cannot be sold, across all alcoholic beverages. The legislation contains a sunset clause meaning a comprehensive mixed‐methods evaluation of its impact across a range of outcomes will inform whether it will continue beyond its sixth year. In this study, we assessed the impact of MUP on off‐trade alcohol sales (as a proxy for consumption) after its first year. Design, Setting and Participants: Controlled interrupted time–series regression was used to assess the impact of MUP on alcohol sales among off‐trade retailers in Scotland in the year after it was introduced, with England and Wales (EW) being the control group. In adjusted analyses, we included household disposable income, on‐trade alcohol sales and substitution between beverage categories as covariates. Measurements Weekly data on the volume of pure alcohol sold by off‐trade retailers in Scotland and EW between January 2013 and May 2019, expressed as litres of pure alcohol per adult. Findings The introduction of MUP in Scotland was associated with a 3.5% [95% confidence interval (CI) = 2.2–4.9%] reduction in off‐trade alcohol sales per adult after adjustment for the best available geographical control, disposable income and substitution. In unadjusted analysis, the introduction of MUP was associated with a 2.0% (95% CI = 0.4–3.6%) reduction in off‐trade alcohol sales per adult in Scotland. In EW, there was a 2.4% (95% CI = 0.8–4.0%) increase during the same time‐period. The reduction in off‐trade alcohol sales in Scotland was driven by reduced sales of spirits, cider and perry beverage categories. Conclusion: The implementation of minimum unit pricing for alcohol in Scotland in 2018 appears to have been associated with a reduction in off‐trade alcohol sales after its first year. [ABSTRACT FROM AUTHOR]

Aims: To describe the effect of alcohol policy on the incidence of intensive care unit (ICU) admissions associated with hazardous and harmful alcohol use in the Northern Territory (NT) of Australia Design, setting and participants: Before and after analysis of admissions to NT ICUs between April 2018 and September 2019, extending on both a descriptive study describing hazardous and harmful alcohol use and single‐centre analyses of harm minimization policies. After exclusions, 2281 (83%) admissions were analysed, 20.3% of which were associated with hazardous and harmful alcohol use. Measurements Primary outcome was the incidence of admissions associated with hazardous and harmful alcohol use in the 5 months preceding (baseline period) the introduction of new alcohol policies [full‐time stationing of Police Auxiliary Liquor Inspectors (PALIs) and minimum unit price (MUP)] compared with 12 months (post‐intervention) following. Secondary outcomes included measures of resource use [length of stay (LoS), need for mechanical ventilation] and mortality, stratified by site. Findings Overall, there was a 4.5% [95% confidence interval (CI) = 0.8–8.2%] absolute risk reduction between the time‐periods (95% CI = 23.4 versus 18.9% for baseline and post‐intervention, respectively, P = 0.01), predominantly due to a reduction in admissions associated with acute misuse (2.3%, 95% CI = −0.2 to 4.9% risk reduction, P = 0.06). There were regional differences, with a more marked relative risk reduction observed in Central Australia compared with the city of Darwin (27.0 versus 16.7% relative risk reduction, respectively). Conclusions: Introduction of new alcohol harm minimization policies in the Northern Territory of Australia appears to have reduced the number of intensive care unit admissions associated with hazardous and harmful alcohol use. Strength of effect varies by geographical region and chronicity of hazardous and harmful alcohol use. [ABSTRACT FROM AUTHOR]

Background and aims: An early meta‐analysis testing the concurrent validity of the Alcohol Purchase Task (APT), a measure of alcohol's relative reinforcing value, reported mixed associations, but predated a large number of studies. This systematic review and meta‐analysis sought to: (1) estimate the relationships between trait‐based alcohol demand indices from the APT and multiple alcohol indicators, (2) test several moderators and (3) analyze small study effects. Methods: A meta‐analysis of 50 cross‐sectional studies in four databases (n = 18 466, females = 43.32%). Sex, year of publication, number of APT prices and index transformations (logarithmic, square root or none) were considered as moderators. Small study effects were examined by using the Begg–Mazumdar, Egger's and Duval & Tweedie's trim‐and‐fill tests. Alcohol indicators were quantity of alcohol use, number of heavy drinking episodes, alcohol‐related problems and hazardous drinking. APT indices were intensity (i.e. consumption at zero cost), elasticity (i.e. sensitivity to increases in costs), Omax (i.e. maximum expenditure), Pmax (i.e. price associated to Omax) and breakpoint (i.e. price at which consumption ceases). Results: All alcohol demand indices were significantly associated with all alcohol‐related outcomes (r = 0.132–0.494), except Pmax, which was significantly associated with alcohol‐related problems only (r = 0.064). The greatest associations were evinced between intensity in relation to alcohol use, hazardous drinking and heavy drinking and between Omax and alcohol use. All the tested moderators emerged as significant moderators. Evidence of small‐study effects was limited. Conclusions: The Alcohol Purchase Task appears to have concurrent validity in alcohol research. Intensity and Omax are the most relevant indices to account for alcohol involvement. [ABSTRACT FROM AUTHOR]

The author on a study by John Holmes which examined whether the minimum unit pricing (MUP) for alcohol has the effects on alcohol consumption in Scotland. He discusses the trouble in demonstrating a policy according to Holmes, the implication of the model of evidence-based policy, and how a proper understanding of MUP's effectiveness in Scotland can be reached.