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INTRODUCTION Policy changes may contribute to increased alcohol-related risks to populations. These include privatisation of alcohol retailing, which influences density of alcohol outlets, location of outlets, hours of sale and prevention of alcohol sales to minors or intoxicated customers. Meta-analyses, reviews and original research indicate enhanced access to alcohol is associated with elevated risk of and actual harm. We assess the 10 Canadian provinces on two alcohol policy domains-type of alcohol control system and physical availability of alcohol-in order to track changes over time, and document shifting changes in alcohol policy. METHODS Our information was based on government documents and websites, archival statistics and key informant interviews. Policy domains were selected and weighted for their degree of effectiveness and population reach based on systematic reviews and epidemiological evidence. Government representatives were asked to validate all the information for their jurisdiction. RESULTS The province-specific reports based on the 2012 results showed that 9 of 10 provinces had mixed retail systems-a combination of government-run and privately owned alcohol outlets. Recommendations in each provincial report were to not increase privatisation. However, by 2017 the percentage of off-premise private outlets had increased in four of these nine provinces, with new private outlet systems introduced in several. DISCUSSION AND CONCLUSIONS Decision-making protocols are oriented to commercial interests and perceived consumer convenience. If public health and safety considerations are not meaningfully included in decision-making protocols on alcohol policy, then it will be challenging to curtail or reduce harms.

INTRODUCTION: Alcohol is a leading contributor to liver disease, however, estimating the proportion of liver disease deaths attributable to alcohol use can be methodologically challenging. METHODS: We compared three approaches for estimating alcohol-attributable liver disease deaths (AALDD), using the U.S. as an example. One involved summing deaths from alcoholic liver disease and a proportion from unspecified cirrhosis (direct method); two used population attributable fraction (PAF) methodology, including one that adjusted for per capita alcohol sales. For PAFs, the 2011–2015 Behavioral Risk Factor Surveillance System and per capita sales from the Alcohol Epidemiologic Data System were used to derive alcohol consumption prevalence estimates at various levels (excessive alcohol use was defined by medium and high consumption levels). Prevalence estimates were used with relative risks from two meta-analyses, and PAFs were applied to the 2011–2015 average annual number of deaths from alcoholic cirrhosis and unspecified cirrhosis (using National Vital Statistics System data) to estimate AALDD. RESULTS: The number of AALDD was higher using the direct method (28,345 annually) than the PAF methods, but similar when alcohol prevalence was adjusted using per capita sales and all alcohol consumption levels were considered (e.g., 25,145 AALDD). Using the PAF method, disaggregating non-drinkers into lifetime abstainers and former drinkers to incorporate relative risks for former drinkers yielded higher AALDD estimates (e.g., 27,686) than methods with all non-drinkers combined. DISCUSSION AND CONCLUSIONS: Using PAF methods that adjust for per capita sales and model risks for former drinkers yield more complete and possibly more valid AALDD estimates.

Alcohol's impact on global health is substantial and of a similar order of magnitude to that from COVID-19. Alcohol now also poses specific concerns, such as increased risk of severe lung infections, domestic violence, child abuse, depression and suicide. Its use is unlikely to aid physical distancing or other preventative behavioural measures. Globally, alcohol contributes to 20% of injury and 11.5% of non-injury emergency room presentations. We provide some broad comparisons between alcohol-attributable and COVID-19-related hospitalisations and deaths in North America using most recent data. For example, for Canada in 2017 it was recently estimated there were 105 065 alcohol-attributable hospitalisations which represent a substantially higher rate over time than the 10 521 COVID-19 hospitalisations reported during the first 5 months of the pandemic. Despite the current importance of protecting health-care services, most governments have deemed alcohol sales to be as essential as food, fuel and pharmaceuticals. In many countries, alcohol is now more readily available and affordable than ever before, a situation global alcohol producers benefit from and have helped engineer. We argue that to protect frontline health-care services and public health more generally, it is essential that modest, evidence-based restrictions on alcohol prices, availability and marketing are introduced. In particular, we recommend increases in excise taxation coupled with minimum unit pricing to both reduce impacts on health-care services and provide much-needed revenues for governments at this critical time.

INTRODUCTION AND AIMS There is a paucity of data on volume of alcohol use from Muslim majority countries. We aimed to present estimation methods for alcohol consumption with the use of survey data for these societies and provide an estimation for age 15+ per capita consumption of pure alcohol for Iran. DESIGN AND METHODS The Iranian Mental Health Survey was a nationally representative household survey on individuals aged 15-64 years, with a multistage, cluster sampling design. We used the 'Last Week' method and 'Quantity-Frequency' methods for gathering data on alcohol consumption and combined these to provide more complete estimates. RESULTS The response rate was 85.7%. From the total of 7840 respondents, 5.7% and 1% reported past 12 months and past week alcohol use, respectively. The highest estimation for age 15+ per capita consumption of pure alcohol was yielded by the 'combination method' (0.108 L ethanol/person/year) followed by the Quantity-Frequency method (0.079 L). The 'Last Week' method provided the lowest estimate (0.059 L). DISCUSSION AND CONCLUSIONS Unlike in surveys of non-Muslim countries, frequency of drinking from recent recall (last week) was much lower than from recall of usual drinking in the last year. We conclude that 0.108 L (SE = 0.03) is the best survey-based estimate of age 15+ per capita consumption, which translates to about 5 750 000 L of national consumption per year in Iran. However, this method is still likely to under-estimate per capita consumption due to evidence of under-reporting in the survey.

Introduction and aims People with severe alcohol dependence and unstable housing are vulnerable to multiple harms related to drinking and homelessness. Managed Alcohol Programs (MAP) aim to reduce harms of severe alcohol use without expecting cessation of use. There is promising evidence that MAPs reduce acute and social harms associated with alcohol dependence. The aim of this paper is to describe MAPs in Canada including key dimensions and implementation issues. Design and methods Thirteen Canadian MAPs were identified through the Canadian Managed Alcohol Program Study. Nine key informant interviews were conducted and analysed alongside program documents and reports to create individual case reports. Inductive content analysis and cross case comparisons were employed to identify six key dimensions of MAPs. Results Community based MAPs have a common goal of preserving dignity and reducing harms of drinking while increasing access to housing, health and social services. MAPs are offered as both residential and day programs with differences in six key dimensions including program goals and eligibility, food and accomodation, alcohol dispensing and administration, funding and money management, primary care services and clinical monitoring, and social and cultural connections. Discussion and conclusions MAPs consist of four pillars with the alcohol intervention provided alongside housing interventions, primary care services, social and cultural interventions. Availability of permanent housing and re-establishing social and cultural connections are central to recovery and healing goals of MAPs. Additional research regarding Indigenous and gendered approaches to program development as well as outcomes related to chronic harms and differences in alcohol management are needed.

Introduction and Aims The province of Saskatchewan, Canada introduced minimum prices graded by alcohol strength in April 2010. As previous research found this intervention significantly decreased alcohol consumption and alcohol-attributable morbidity, we aim to test the association between the intervention and the rate of emergency department (ED) visits in four alcohol-related injury categories [motor vehicle collisions (MVC), assaults, falls and total alcohol-related injuries]. Design and Methods Data on ED visits in the city of Regina were obtained from the Saskatchewan Ministry of Health. Auto-regressive integrated moving average time series models were used to test the immediate and lagged effects of the pricing intervention on rates of alcohol-related nighttime. ED visits and controlled for daytime rates of ED visits, economic variables, linear and seasonal trends, and auto-regressive and moving average effects. Results The implementation of an alcohol minimum pricing strategy in Saskatchewan was associated with decreased MVC-related ED visits for women aged 26 and over after a 6 month lag period (−39.4%, P

INTRODUCTION AND AIMS Managed alcohol programs (MAP) aim to reduce harms experienced by unstably housed individuals with alcohol use disorders by providing regulated access to beverage alcohol, usually alongside housing, meals and other supports. This study compares two methods of estimating participants' outside alcohol consumption in order to inform program policies and practices around alcohol dosing and reducing risks of alcohol-related illnesses. METHODS The total alcohol consumption of 65 people participating in Canadian MAPs was assessed comparing daily MAP records (1903 client days) with researcher-administered surveys over the same time period. A sub-sample of more complete daily MAP records for 39 people (696 client days) was also compared with the equivalent survey data on drinking. RESULTS Significantly more standard drinks per day (SDs, one SD = 17.05 mL ethanol) were reported in research interviews than recorded by program staff, whether for program administered drinks alone (means 16.04 vs. 8.32 SDs, t = 5.79, P

Introduction and Aims Managed alcohol programs (MAP) are intended for people with severe alcohol-related problems and unstable housing. We investigated whether MAP participation was associated with changes in drinking patterns and related harms. Design and Methods One hundred and seventy-five MAP participants from five Canadian cities (Hamilton, Ottawa, Toronto, Thunder Bay and Vancouver) and 189 same-city controls were assessed for alcohol consumption, health, safety and harm outcomes. Length of stay in a MAP was investigated as a predictor of drinking patterns, non-beverage alcohol consumption and related harms. Statistical controls were included for housing stability, age, gender, ethnic background and city of residence. Negative binomial regression and logistic regression models were used. Results Recently admitted MAP participants (≤2 months) and controls were both high consumers of alcohol, predominantly male, of similar ethnic background, similarly represented across the five cities and equally alcohol dependent (mean Severity of Alcohol Dependence Questionnaire = 29.7 and 31.4). After controlling for ethnicity, age, sex, city and housing stability, long-term MAP residents (>2 months) drank significantly more days (+5.5) but 7.1 standard drinks fewer per drinking day than did controls over the last 30 days. Long-term MAP residents reported significantly fewer alcohol-related harms in the domains of health, safety, social, legal and withdrawal. Discussion and Conclusions Participation in a MAP was associated with more frequent drinking at lower quantities per day. Participation was associated with reduced alcohol-related harms over the past 30 days. Future analyses will examine outcomes longitudinally through follow-up interviews, police and health care records.

Introduction and Aims Recall bias is a concern in self-reported alcohol consumption, potentially accounting for varying risk estimates for injury in emergency department (ED) studies. The likelihood of reporting drinking for the same 6-h period each day of the week for a full week preceding the injury event is analysed among injured ED patients. Design and Methods Probability samples of patients 18 years old and older were interviewed in two ED sites in Vancouver and one in Victoria, BC (n = 1191). Generalized estimating equation modelling was used to predict the likelihood of reporting drinking for the same 6-h period prior to the injury event for each day of the week, compared to day 7 as the reference recall day, for a full week preceding the event. Recall by frequency of drinking and frequency of heavy drinking was analysed. Results Drinking was significantly more likely to be reported for each of the first 3 days of recall compared to 7-day recall and highest for 1-day recall (odds ration 1.55; = 0.002). Patients who reported ≥ weekly drinking and 5+ drinking < monthly were significantly more likely to report drinking for each of the first 3 days of recall (compared to 7-day recall). Discussion Findings suggest the first 3 days prior to injury may be a less biased multiple-matched control period than longer periods of recall in case-crossover studies. Conclusion Length of accurate recall may be important to consider in case-crossover analysis and other study designs that rely on patient self-report such as the Timeline Followback. [Cherpitel CJ, Ye Y, Stockwell T, Vallance K, Chow C. Recall bias across 7 days in self-reported alcohol consumption prior to injury among emergency department patients. Drug Alcohol Rev 2017;00:000-000]

INTRODUCTION AND AIMS: Alcohol labelling is one strategy for communicating health information. This paper examines the impact of an alcohol labelling intervention on recall of and support for standard drink (SD) labels, estimating the number of SDs in alcohol containers, and intended and unintended use of SD labels. DESIGN AND METHODS: A quasi-experimental study was conducted in northern Canada where labels with a cancer warning, national drinking guidelines, and SD information were applied to alcohol containers in the single liquor store in the intervention site, while usual labelling continued in the two liquor stores in the comparison site. Three waves of surveys were conducted in both sites before and at two time-points after the labelling intervention with 2,049 cohort participants. Generalized estimating equations were applied to estimate changes in all outcomes. RESULTS: Participants in the intervention relative to the comparison site had greater odds of recalling (AOR=5.69, 95%CI=3.02, 10.71) and supporting SD labels (AOR=1.49, 95%CI=1.04, 2.12), and lower odds of reporting using SD labels to purchase high strength low cost alcohol (AOR=0.65, 95%CI=0.45, 0.93). Exposure to the labels had small but negligible effects on accurately estimating the number of SD in alcohol containers (AOR=1.06, 95%CI=0.59, 1.93) and using SD labels to drink within guidelines (AOR=1.04, 95%CI=0.75,1.46). DISCUSSION AND CONCLUSIONS: Evidence-informed labels with a health warning, national drinking guidelines, and SD information increased support for and decreased unintended use of SD labels. Such labels can improve accuracy in estimating the number of SDs in alcohol containers and adherence to drinking guidelines.

Introduction and aims There is increasing evidence suggesting the consumption of caffeinated alcoholic beverages is associated with risks over and above alcohol use on its own; however, research in this area remains limited. We examined whether gender differences existed in the relationship between the combined use of alcohol and caffeine (Alc + Caff) and risk for injury. Design and methods This emergency department study utilised case-control and case-crossover analyses to examine in situ session specific Alc + Caff use and injury risk for men and women, while controlling for socio-demographic variables, dose of alcohol and caffeine, other substance use, risk-taking propensity and context. The sample comprised 2804 individuals aged 18-years or older who presented to three hospital emergency departments in British Columbia. Results A relationship between Alc + Caff use and increased risk of injury was confirmed. Further, gender differences were found in the risk relationship between Alc + Caff use and injury. Women were found to have a higher risk injury propensity following Alc + Caff use in both the case-control (OR = 3.10, 95% CI = 1.78, 5.84) and case-crossover analyses (OR = 3.21, 95% CI = 1.69, 6.12), relative to men (OR = 1.69, 95% CI = 1.30, 2.30; OR = 1.38, 95% CI = 1.08, 1.86). These results remained even after controlling for demographic factors, risk-taking, context and other substance use. Discussion and conclusions Women may be at higher risk of injury than men following the consumption of alcohol mixed with caffeine. The findings offer support for differential low-risk drinking guidelines for men and women and the restriction and regulation of the sale and availability of caffeinated alcoholic beverages.

Introduction Saskatchewan's introduction in April 2010 of minimum prices graded by alcohol strength led to an average minimum price increase of 9.1% per Canadian standard drink (=13.45 g ethanol). This increase was shown to be associated with reduced consumption and switching to lower alcohol content beverages. Police also informally reported marked reductions in night-time alcohol-related crime. Objectives This study aims to assess the impacts of changes to Saskatchewan's minimum alcohol-pricing regulations between 2008 and 2012 on selected crime events often related to alcohol use. Methods Data were obtained from Canada's Uniform Crime Reporting Survey. Auto-regressive integrated moving average time series models were used to test immediate and lagged associations between minimum price increases and rates of night-time and police identified alcohol-related crimes. Controls were included for simultaneous crime rates in the neighbouring province of Alberta, economic variables, linear trend, seasonality and autoregressive and/or moving-average effects. Results The introduction of increased minimum-alcohol prices was associated with an abrupt decrease in night-time alcohol-related traffic offences for men (−8.0%, P

Introduction and Aims Alcohol pricing is an effective prevention policy. This paper compares the 10 Canadian provinces on three research-based alcohol pricing policies—minimum pricing, pricing by alcohol content and maintaining prices relative to inflation. Design and Methods The selection of these three policies was based on systematic reviews and seminal research papers. Provincial data for 2012 were obtained from Statistics Canada and relevant provincial ministries, subsequently sent to provincial authorities for verification, and then scored by team members. Results All provinces, except for Alberta, have minimum prices for at least one beverage type sold in off-premise outlets. All provinces, except for British Columbia and Quebec, have separate (and higher) minimum pricing for on-premise establishments. Regarding pricing on alcohol content, western and central provinces typically scored higher than provinces in Eastern Canada. Generally, minimum prices were lower than the recommended $1.50 per standard drink for off-premise outlets and $3.00 per standard drink in on-premise venues. Seven of 10 provinces scored 60% or higher compared to the ideal on indexing prices to inflation. Prices for a representative basket of alcohol products in Ontario and Quebec have lagged significantly behind inflation since 2006. Discussion and Conclusions While examples of evidence-based alcohol pricing policies can be found in every jurisdiction in Canada, significant inter-provincial variation leaves substantial unrealised potential for further reducing alcohol-related harm and costs. This comparative assessment of alcohol price policies provides clear indications of how individual provinces could adjust their pricing policies and practices to improve public health and safety. [Giesbrecht N, Wettlaufer A, Thomas G, Stockwell T, Thompson K, April N, Asbridge M, Cukier S, Mann R, McAllister J, Murie A, Pauley C, Plamondon L, Vallance K. Pricing of alcohol in Canada: A comparison of provincial policies and harm-reduction opportunities. Drug Alcohol Rev 2016;35:289–297]

There is a paucity of data on volume of alcohol use from Muslim majority countries. We aimed to present estimation methods for alcohol consumption with the use of survey data for these societies and provide an estimation for age 15+ per capita consumption of pure alcohol for Iran.The Iranian Mental Health Survey was a nationally representative household survey on individuals aged 15-64 years, with a multistage, cluster sampling design. We used the 'Last Week' method and 'Quantity-Frequency' methods for gathering data on alcohol consumption and combined these to provide more complete estimates.The response rate was 85.7%. From the total of 7840 respondents, 5.7% and 1% reported past 12 months and past week alcohol use, respectively. The highest estimation for age 15+ per capita consumption of pure alcohol was yielded by the 'combination method' (0.108 L ethanol/person/year) followed by the Quantity-Frequency method (0.079 L). The 'Last Week' method provided the lowest estimate (0.059 L).Unlike in surveys of non-Muslim countries, frequency of drinking from recent recall (last week) was much lower than from recall of usual drinking in the last year. We conclude that 0.108 L (SE = 0.03) is the best survey-based estimate of age 15+ per capita consumption, which translates to about 5 750 000 L of national consumption per year in Iran. However, this method is still likely to under-estimate per capita consumption due to evidence of under-reporting in the survey.

The province of Saskatchewan, Canada introduced minimum prices graded by alcohol strength in April 2010. As previous research found this intervention significantly decreased alcohol consumption and alcohol-attributable morbidity, we aim to test the association between the intervention and the rate of emergency department (ED) visits in four alcohol-related injury categories [motor vehicle collisions (MVC), assaults, falls and total alcohol-related injuries].Data on ED visits in the city of Regina were obtained from the Saskatchewan Ministry of Health. Auto-regressive integrated moving average time series models were used to test the immediate and lagged effects of the pricing intervention on rates of alcohol-related nighttime. ED visits and controlled for daytime rates of ED visits, economic variables, linear and seasonal trends, and auto-regressive and moving average effects.The implementation of an alcohol minimum pricing strategy in Saskatchewan was associated with decreased MVC-related ED visits for women aged 26 and over after a 6 month lag period (-39.4%, P 0.001). There was no significant abrupt effect of this intervention on ED visits of four injury types in any of four gender-age categories; however, rates of ED visits among young males for MVCs and assaults decreased substantially during this study.The minimum pricing policy change led to a lagged decrease in motor vehicle-collision-related ED visits for women older than 25. Of note, there did not appear to be an instantaneous effect on the rate of alcohol-related injury ED visits immediately after the policy implementation nor lagged effects for other gender-age groups.

We investigated coping strategies used by alcohol-dependent and unstably housed people when they could not afford alcohol, and how managed alcohol program (MAP) participation influenced these. The aim of this study was to investigate potential negative unintended consequences of alcohol being unaffordable.A total of 175 MAP residents in five Canadian cities and 189 control participants from nearby shelters were interviewed about the frequency they used 10 coping strategies when unable to afford alcohol. Length of stay in a MAP was examined as a predictor of negative coping while controlling for age, sex, ethnicity, housing stability, spending money and drinks per day. Multivariate binary logistic and linear regression models were used.Most commonly reported strategies were re-budgeting (53%), waiting for money (49%) or going without alcohol (48%). A significant proportion used illicit drugs (41%) and/or drank non-beverage alcohol (41%). Stealing alcohol or property was less common. Long-term MAP participants (2 months) exhibited lower negative coping scores than controls (8.76 vs. 10.63, P0.001) and were less likely to use illicit drugs [odds ratio (OR) 0.50, P = 0.02], steal from liquor stores (OR 0.50, P = 0.04), re-budget (OR 0.36, P0.001) or steal property (OR 0.40, P = 0.07). Long-term MAP participants were also more likely to seek treatment (OR 1.91, P = 0.03) and less likely to go without alcohol (OR 0.47, P = 0.01).People experiencing alcohol dependence and housing instability more often reduced their alcohol consumption than used harmful coping when alcohol was unaffordable. MAP participation was associated with fewer potentially harmful coping strategies.

Managed alcohol programs (MAP) aim to reduce harms experienced by unstably housed individuals with alcohol use disorders by providing regulated access to beverage alcohol, usually alongside housing, meals and other supports. This study compares two methods of estimating participants' outside alcohol consumption in order to inform program policies and practices around alcohol dosing and reducing risks of alcohol-related illnesses.The total alcohol consumption of 65 people participating in Canadian MAPs was assessed comparing daily MAP records (1903 client days) with researcher-administered surveys over the same time period. A sub-sample of more complete daily MAP records for 39 people (696 client days) was also compared with the equivalent survey data on drinking.Significantly more standard drinks per day (SDs, one SD = 17.05 mL ethanol) were reported in research interviews than recorded by program staff, whether for program administered drinks alone (means 16.04 vs. 8.32 SDs, t = 5.79, P 0.001) or including outside-program drinks as reported to staff (16.04 vs. 8.89 SDs, t = 5.37, P 0.001). Consistent results were found in the sub-sample. The number of outside drinks estimated by comparing program records with the research interviews, varied between 2.71 and 9.94 mean drinks per day per site.At two sites, MAP participants reported consuming more than twice the amount of alcohol administered on the program. At most sites, there was significant under-reporting of outside drinking. Addressing the problem of outside drinking and total daily consumption is critical for achieving program goals of both short and long-term harm reduction.

Managed alcohol programs (MAP) are intended for people with severe alcohol-related problems and unstable housing. We investigated whether MAP participation was associated with changes in drinking patterns and related harms.One hundred and seventy-five MAP participants from five Canadian cities (Hamilton, Ottawa, Toronto, Thunder Bay and Vancouver) and 189 same-city controls were assessed for alcohol consumption, health, safety and harm outcomes. Length of stay in a MAP was investigated as a predictor of drinking patterns, non-beverage alcohol consumption and related harms. Statistical controls were included for housing stability, age, gender, ethnic background and city of residence. Negative binomial regression and logistic regression models were used.Recently admitted MAP participants (≤2 months) and controls were both high consumers of alcohol, predominantly male, of similar ethnic background, similarly represented across the five cities and equally alcohol dependent (mean Severity of Alcohol Dependence Questionnaire = 29.7 and 31.4). After controlling for ethnicity, age, sex, city and housing stability, long-term MAP residents (2 months) drank significantly more days (+5.5) but 7.1 standard drinks fewer per drinking day than did controls over the last 30 days. Long-term MAP residents reported significantly fewer alcohol-related harms in the domains of health, safety, social, legal and withdrawal.Participation in a MAP was associated with more frequent drinking at lower quantities per day. Participation was associated with reduced alcohol-related harms over the past 30 days. Future analyses will examine outcomes longitudinally through follow-up interviews, police and health care records.

Saskatchewan's introduction in April 2010 of minimum prices graded by alcohol strength led to an average minimum price increase of 9.1% per Canadian standard drink (=13.45 g ethanol). This increase was shown to be associated with reduced consumption and switching to lower alcohol content beverages. Police also informally reported marked reductions in night-time alcohol-related crime.This study aims to assess the impacts of changes to Saskatchewan's minimum alcohol-pricing regulations between 2008 and 2012 on selected crime events often related to alcohol use.Data were obtained from Canada's Uniform Crime Reporting Survey. Auto-regressive integrated moving average time series models were used to test immediate and lagged associations between minimum price increases and rates of night-time and police identified alcohol-related crimes. Controls were included for simultaneous crime rates in the neighbouring province of Alberta, economic variables, linear trend, seasonality and autoregressive and/or moving-average effects.The introduction of increased minimum-alcohol prices was associated with an abrupt decrease in night-time alcohol-related traffic offences for men (-8.0%, P 0.001), but not women. No significant immediate changes were observed for non-alcohol-related driving offences, disorderly conduct or violence. Significant monthly lagged effects were observed for violent offences (-19.7% at month 4 to -18.2% at month 6), which broadly corresponded to lagged effects in on-premise alcohol sales.Increased minimum alcohol prices may contribute to reductions in alcohol-related traffic-related and violent crimes perpetrated by men. Observed lagged effects for violent incidents may be due to a delay in bars passing on increased prices to their customers, perhaps because of inventory stockpiling. [Stockwell T, Zhao J, Sherk A, Callaghan RC, Macdonald S, Gatley J. Assessing the impacts of Saskatchewan's minimum alcohol pricing regulations on alcohol-related crime. Drug Alcohol Rev 2017;36:492-501].

Introduction and Aims.Drinking guidelines have rarely provided recommendations for different age groups despite evidence of significant age effects on alcohol consumption and related risks. This study attempted to quantify the degree of risk associated with lower levels of consumption for people under 25 years of age, with the broader purpose of informing the development of Canadian low-risk drinking guidelines. Design and Methods.A random community-based sample of 540 youth aged 16–23 (54.4% female) completed an interview concerning alcohol consumption patterns and a broad range of acute health and social harms. Logistic regression analyses were designed to test whether there were discernible thresholds of risk as a function of both gender and age. Results.A significant proportion of young people consumed in excess of adult drinking limits recommended by the Centre for Addiction and Mental Health (CAMH) to minimise risk of alcohol-related harm. Compared with abstainers, rates of reported harm increased linearly with increasing frequency and quantity levels. However, problems were most strongly associated with consumption in excess of two drinks per occasion and a frequency of more than once a week. No independent effects of age or gender were identified. Discussion and Conclusions.The CAMH guidelines for adult drinkers do not adequately address acute risks for young people. More specific guideline recommendations for young people could be considered with a more prominent focus on drinking quantity (one to two drinks per occasion), and a recommended frequency of consumption (once a week).[Thompson KD, Stockwell T, MacDonald S. Is there a ‘low-risk’ drinking level for youth? The risk of acute harm as a function of quantity and frequency of drinking. Drug Alcohol Rev 2012;31:184–193]

Introduction and Aims.For consumers to follow drinking guidelines and limit their risk of negative consequences they need to track their ethanol consumption. This paper reviews published research on the ability of consumers to utilise information about the alcohol content of beverages when expressed in different forms, for example in standard drinks or units versus percentage alcohol content. Design and Methods.A review of the literature on standard drink definitions and consumer understanding of these, actual drink pouring, use of standard drinks in guidelines and consumer understanding and use of these. Results.Standard drink definitions vary across countries and typically contain less alcohol than actual drinks. Drinkers have difficulty defining and pouring standard drinks with over-pouring being the norm such that intake volume is typically underestimated. Drinkers have difficulty using percentage alcohol by volume and pour size information in calculating intake but can effectively utilise standard drink labelling to track intake. Discussion and Conclusions.Standard drink labelling is an effective but little used strategy for enabling drinkers to track their alcohol intake and potentially conform to safe or low-risk drinking guidelines.[Kerr WC, Stockwell T. Understanding standard drinks and drinking guidelines. Drug Alcohol Rev 2012;31:200–205]

Issue. Low-risk drinking guidelines have been developed independently in a number of jurisdictions resulting in different sets of advice with different definitions of 'low risk'. This paper discusses some of the fundamental issues addressed by an expert advisory panel during the course of developing national guidelines for Canadians and summarises key sets of evidence that were influential. Approach. The underlying reasoning and connection between the evidence and the guidelines is discussed in relation to: (i) how to minimise risk of long-term illnesses; (ii) how to minimise risk of short-term harms, for example injury; and (iii) alcohol use during pregnancy. Both absolute and relative risks were considered in the development of the guidelines. Findings. Meta-analyses of all-cause mortality were used to identify upper limits for usual drinking levels where potential benefits and risks were balanced for the average person in comparison with lifetime abstainers (10 standard drinks per week for women, 15 for men). Emergency room studies and situational risk factors were considered for advice on reducing short-term: (i) when not to drink at all; (ii) how to reduce intoxication; and (iii) upper limits for occasional daily consumption by adults aged 25 to 64 years (3 standard drinks for women, 4 for men). Shortcomings in the research data were highlighted. Implications. It was estimated that total compliance with these guidelines at a national level would result in substantially reduced per capita alcohol consumption and approximately 4600 fewer deaths per year.[Stockwell T, Butt P, Beirness D, Gliksman L, Paradis C. The basis for Canada's new low-risk drinking guidelines: A relative risk approach to estimating hazardous levels and patterns of alcohol use. Drug Alcohol Rev 2011]. Language: en

Introduction and Aims. Approval of alcohol policies by the public in democratic countries is critical for instituting social change. With respect to alcohol policies, mounting research indicates that a higher price per unit of ethanol is an effective approach for reducing alcohol-related problems, yet surveys have found this approach is usually unpopular. The purpose of this paper is to assess the relationship between amount of drinking and support for various alcohol policies. Design and Methods. A secondary analysis was conducted on the Canadian Addictions Survey, a randomized telephone survey of over 10 000 Canadians. The relationship between the amounts of drinking reported by the respondents was examined in relation to the perceived seriousness of alcohol problems in their communities and the endorsement of several alcohol policies. Results. Increased amount of drinking was significantly related to lower perceptions of drinking-related risks. Furthermore, heavier consumers had less favorable attitudes than lighter drinkers and abstainers toward alcohol policies, such as increased taxation. Aggregated data across the 10 Canadian provinces showed a strong effect size (r = -0.515, P = 0.128) between endorsement of alcohol taxation and rates of hospital separations for alcohol. Discussion and Conclusions. Results from this study show that the more that people drink, the more they oppose taxation. The implications of these findings are that as alcohol problems in communities become worse, the population may become more resistant to effective alcohol policies. Strategies are suggested for implementing effective policies. Language: en