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Introduction Estimates of alcohol consumption in the Behavioral Risk Factor Surveillance System are generally lower than those in other surveys of U.S. adults. This study compares the estimates of adults’ drinking patterns and the distribution of drinks consumed by average daily alcohol consumption from 2 nationwide telephone surveys. Methods The 2014–2015 National Alcohol Survey (n=7,067) and the 2015 Behavioral Risk Factor Surveillance System (n=408,069) were used to assess alcohol consumption among adults (≥18 years), analyzed in 2019. The weighted prevalence of binge-level drinking and the distribution of drinks consumed by average daily alcohol consumption (low, medium, high) were assessed for the previous 12 months using the National Alcohol Survey and the previous 30 days using the Behavioral Risk Factor Surveillance System, stratified by respondents’ characteristics. Results The prevalence of binge-level drinking in a day was 26.1% for the National Alcohol Survey; the binge drinking prevalence was 17.4% for the Behavioral Risk Factor Surveillance System. The prevalence of high average daily alcohol consumption among current drinkers was 8.2% for the National Alcohol Survey, accounting for 51.0% of total drinks consumed, and 3.3% for the Behavioral Risk Factor Surveillance System, accounting for 27.7% of total drinks consumed. Conclusions National Alcohol Survey yearly prevalence estimates of binge-level drinking in a day and high average daily consumption were consistently greater than Behavioral Risk Factor Surveillance System monthly binge drinking and high average daily consumption prevalence estimates. When planning and evaluating prevention strategies, the impact of different survey designs and methods on estimates of excessive drinking and related harms is important to consider.

Excessive alcohol use is a leading cause of preventable death in the United States (1) and costs associated with it, such as those from losses in workplace productivity, health care expenditures, and criminal justice, were $249 billion in 2010 (2). CDC used the Alcohol-Related Disease Impact (ARDI) application* to estimate national and state average annual alcohol-attributable deaths and years of potential life lost (YPLL) during 2011-2015, including deaths from one's own excessive drinking (e.g., liver disease) and from others' drinking (e.g., passengers killed in alcohol-related motor vehicle crashes). This study found an average of 93,296 alcohol-attributable deaths (255 deaths per day) and 2.7 million YPLL (29 years of life lost per death, on average) in the United States each year. Of all alcohol-attributable deaths, 51,078 (54.7%) were caused by chronic conditions, and 52,361 (56.0%) involved adults aged 35-64 years. Age-adjusted alcohol-attributable deaths per 100,000 population ranged from 20.3 in New Jersey and New York to 52.3 in New Mexico. YPLL per 100,000 population ranged from 613.8 in New York to 1,651.7 in New Mexico. Implementation of effective strategies for preventing excessive drinking, including those recommended by the Community Preventive Services Task Force (e.g., increasing alcohol taxes and regulating the number and concentration of alcohol outlets), could reduce alcohol-attributable deaths and YPLL.†.

Introduction In 2017, Canada increased alcohol excise taxes for the first time in over three decades. In this article, we describe a model to estimate various effects of additional tax and price policies that are predicted to improve health outcomes. Methods We obtained alcohol sales and taxation data for 2016/17 for all Canadian jurisdictions from Statistics Canada and product-level sales data for British Columbia. We modelled effects of alternative price and tax policies - revenue-neutral taxes, inflation-adjusted taxes and minimum unit prices (MUPs) - on consumption, revenues and harms. We used published price elasticities to estimate impacts on consumption and revenue and the International Model for Alcohol Harms and Policies (InterMAHP) to estimate impacts on alcohol-attributable mortality and morbidity. Results Other things being equal, revenue-neutral alcohol volumetric taxes (AVT) would have minimal influence on overall alcohol consumption and related harms. Inflation-adjusted AVT would result in 3.83% less consumption, 329 fewer deaths and 3762 fewer hospital admissions. A MUP of $1.75 per standard drink (equal to 17.05mL ethanol) would have reduced consumption by 8.68% in 2016, which in turn would have reduced the number of deaths by 732 and the number of hospitalizations by 8329 that year. Indexing alcohol excise taxes between 1991/92 and 2016/17 would have resulted in the federal government gaining approximately $10.97 billion. We estimated this could have prevented 4000-5400 deaths and 43 000-56 000 hospitalizations. Conclusion Improved public health outcomes would be made possible by (1) increasing alcohol excise tax rates across all beverages to compensate for past failures to index rates, and (2) setting a MUP of at least $1.75 per standard drink. While reducing alcohol-caused harms, these tax policies would have the added benefit of increasing federal government revenues.

This special issue on substance use issues comes at a critical time for Canadian health policy makers and researchers. Most attention is currently focussed on the opioid crisis and the potential impacts of cannabis legalization. However, our most widely used and harmful substances continue to be alcohol and nicotine. Our policies to reduce harms from these substances are failing. While alcohol control policies are being gradually abandoned, opportunities to maximize the harm reduction potential of new, alternative and safer nicotine delivery devices are not being grasped. More generally, a greater focus is needed on harm reduction strategies that are informed by the experience of marginalized people with severe substance use-related problems so as to not exacerbate health inequities. In order to better inform policy responses, we recommend innovative approaches to monitoring and surveillance that maximize the use of multiple data sources, such as those used in the Canadian Substance Use Costs and Harms (CSUCH) project. Greater attention to precision in defining patterns of risky use and harms is also needed to support policies that more accurately reflect and respond to actual levels of substance use-related harm in Canadian society.Ce numéro spécial sur les problèmes de consommation de substances paraît dans une période cruciale pour les responsables des politiques et pour les chercheurs canadiens en matière de santé. À l’heure actuelle, ce sont la crise des opioïdes et les répercussions possibles de la légalisation du cannabis qui retiennent le plus l’attention. Cependant, les substances les plus consommées et les plus nocives demeurent l’alcool et la nicotine. Les politiques visant à réduire les méfaits de ces substances ne suffisent pas : les politiques sur le contrôle de l’alcool sont progressivement abandonnées et on ne saisit pas les occasions de maximiser le potentiel de réduction des méfaits associé aux nouveaux dispositifs d’administration de nicotine plus sécuritaires. Plus généralement, il faut davantage cibler les stratégies de réduction des méfaits fondées sur l’expérience des personnes marginalisées ayant de graves problèmes de consommation de substances, de manière à ne pas aggraver les inégalités en matière de santé. Afin de mieux éclairer les interventions stratégiques, nous recommandons des approches novatrices de contrôle et de surveillance qui maximisent le recours à de multiples sources de données, comme celles utilisées dans le cadre du projet Coûts et méfaits de l’usage de substances au Canada (CEMUSC). Il faut également accorder une plus grande attention à la précision des définitions de ce qu’est une habitude de consommation à risque et un méfait, afin de favoriser l’adoption de politiques qui tiennent mieux compte des taux réels de méfaits liés à la consommation de substances dans la société canadienne et qui sont davantage capables de les contrer.Substance use in Canada cost $46 billion in 2017, with the great majority of these costs resulting from the use of tobacco and alcohol. Substance use-related costs, harms and rates of use have been increasing in Canada over the past decades for both legal and illegal substances, including those for cannabis. Canadian policies to address our most harmful substances, i.e. alcohol, cannabis and tobacco, are largely failing, despite significant opportunities to improve policies on pricing, taxation and marketing of legal substances. Canada's monitoring and surveillance efforts can be improved by developing more discerning measures of risk and maximizing the use of multiple data sources.Au Canada, la consommation de substances a coûté 46 milliards de dollars en 2017, la grande majorité de ces coûts découlant du tabagisme et de la consommation d’alcool. Au Canada, les taux de consommation de substances ainsi que les coûts et les méfaits connexes ont augmenté au cours des dernières décennies, que ce soit pour les substances légales ou illégales, en particulier le cannabis. Les politiques canadiennes en matière de lutte contre la consommation des substances les plus nocives, soit l’alcool, le cannabis et le tabac, sont en grande partie inefficaces, malgré d’importantes possibilités d’amélioration en matière de tarification, de taxation et de commercialisation des substances légales. Il est possible d’améliorer les efforts de contrôle et de surveillance au Canada en élaborant des mesures de risque bien pensées et en maximisant l’utilisation de multiples sources de données.

Objective Many countries propose low-risk drinking guidelines (LRDGs) to mitigate alcohol-related harms. North American LRDGs are high by international standards. We applied the International Model of Alcohol Harms and Policies (InterMAHP) to quantify the alcohol-caused harms experienced by those drinking within and above these guidelines. We customized a recent Global Burden of Disease (GBD) analysis to inform guidelines in high-income countries. Method Record-level death and hospital stay data for Canada were accessed. Alcohol exposure data were from the Canadian Substance Use Exposure Database. InterMAHP was used to estimate alcohol-attributable deaths and hospital stays experienced by people drinking within LRDGs, people drinking above LRDGs, and former drinkers. GBD relative risk functions were acquired and weighted by the distribution of Canadian mortality. Results More men (18%) than women (7%) drank above weekly guidelines. Adherence to guidelines did not eliminate alcohol-caused harm: those drinking within guidelines nonetheless experienced 140 more deaths and 3,663 more hospital stays than if they had chosen to abstain from alcohol. A weighted relative risk analysis found that, for both women and men, the risk was lowest at a consumption level of 10 g per day. For all levels of consumption, men were found to experience a higher weighted relative risk than women. Conclusions Drinkers following weekly LRDGs are not insulated from harm. Greater than 50% of alcohol-caused cancer deaths are experienced by those drinking within weekly limits. Findings suggest that guidelines of around one drink per day may be appropriate for high-income countries.

The problem central to this document is the estimation of change in disease attributable to an epidemiological exposure variable that stems from a change in the distribution of that variable. We require that both disease and exposure are quantifiable as real numbers, and then ask how to estimate the fraction of disease attributable to exposure, producing the general attributable fraction methodology. After the mathematical framework is in place, we explore the implications of a disease that is wholly attributable to a given risk factor, demonstrate why standard applications of the attributable fractions do not extend, and present general methodological considerations for this case. Finally, we demonstrate the methodology using the example of alcoholic psychoses.

OBJECTIVE: Policy makers require evidence-based estimates of the economic costs of substance use-attributable lost productivity to set strategies aimed at reducing substance use-related harms. Building on a study by Rehm et al. (2006), we provide estimates of workplace costs using updated methods and data sources. METHODS: We estimated substance use-attributable productivity losses due to premature mortality, long-term disability, and presenteeism/absenteeism in Canada between 2007 and 2014. Lost productivity was estimated using a hybrid prevalence and incidence approach. Substance use prevalence data were drawn from three national self-report surveys. Premature mortality data were from the Canadian Vital Statistics Death Database, and long-term disability and workplace interference data were from the Canadian Community Health Survey. RESULTS: In 2014, the total cost of lost productivity due to substance use was $15.7 billion, or approximately $440 per Canadian, an increase of 8% from 2007. Substances responsible for the greatest economic costs were alcohol (38% of per capita costs), tobacco (37%), opioids (12%), other central nervous system (CNS) depressants (4%), other CNS stimulants (3%), cannabis (2%), cocaine (2%), and finally other psychoactive substances (2%). CONCLUSION: In 2014, alcohol and tobacco represent three quarters of substance use-related lost productivity costs in Canada, followed by opioids. These costs provide a valuable baseline that can be used to assess the impact of future substance use policy, practice, and other interventions, especially important given Canada’s opioid crisis and recent cannabis legalization. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.17269/s41997-019-00271-8) contains supplementary material, which is available to authorized users.

Introduction Canadian distillers and brewers have claimed that between 50% and 80% of the price of alcoholic drinks are government taxes. These claims were made in campaigns to decrease alcohol taxation. Methods We investigated these claims using publicly available Statistics Canada data and provincial-level product sales data and breakdowns of the prices of typical alcohol beverages in major market sectors. Results In all cases, the rate of total sales tax and excise taxation are mostly between 20% and 30% of final retail prices, well below the industry claims.

Objective:Alcohol use causes approximately 10% of deaths among adults ages 20–65 in the United States. Although previous research has demonstrated differential age-related risk relationships, it is...

Alcohol minimum unit pricing is a strategy capable of reducing alcohol-related harm from cheap alcoholic beverages. We used the International Model of Alcohol Harms and Policies (InterMAHP), an open-access alcohol harms estimator and policy scenario modeler, to estimate the potential health benefits of introducing minimum unit pricing in Québec, Canada.Aggregated mortality and hospitalization data were obtained from official administrative sources. Alcohol sales and pricing data were obtained from the partial government retail monopoly and Nielsen. Exposure data were from the Canadian Substance Use Exposure Database. Average price changes under two minimum-unit-pricing scenarios were estimated by applying a product-level pricing analysis. The online InterMAHP tool was used to automate the estimation of observed alcohol-attributable harm and what was projected in each policy scenario.Alcohol was estimated to cause 2,850 deaths and 24,694 hospitalizations in Québec in 2014. Introducing minimum unit pricing of CAD$1.50 was estimated to reduce consumption by 4.4%, alcohol-attributable deaths by 5.9% (95% CI [0.2%, 11.7%]), and alcohol-attributable hospital stays by 8.4% (95% CI [3.2%, 13.7%]). Higher minimum unit pricing of CAD$1.75 was estimated to reduce alcohol-attributable deaths by 11.5% (95% CI [5.9%, 17.2%]) and alcohol-attributable hospital stays by 16.3% (95% CI [11.2%, 21.4%]).The results of this policy modeling study suggest that the introduction of minimum unit pricing between CAD$1.50 and $1.75 would substantially reduce the alcohol-caused burden of disease in Québec. The quantification of alcohol-caused death and disability, and the changes in these measures under two scenarios, was significantly automated by the open-access resource, InterMAHP.

Aims Building upon an existing methodology and conceptual framework for estimating the association between the use of substances and crime, we calculated attributable fractions that estimate the proportion of crimes explained by alcohol and six other categories of psychoactive substances. Design Cross-sectional surveys. Setting Canadian federal correctional institutions. Participants Canadian men (n = 27 803) and women (n = 1335) offenders who began serving a custodial sentence in a Canadian federal correctional institution between 2006 and 2016. Measurements Offenders completed the computerized assessment of substance abuse, a self-report tool designed to assess (1) whether the offence for which they were convicted would have occurred had they not been intoxicated from alcohol or another substance, (2) whether they committed the offence to support their alcohol or other substance use and (3) whether they were dependent on alcohol (alcohol dependence scale) or another substance (drug abuse screening test). Offences were grouped into four mutually exclusive categories: violent crimes, non-violent crimes, impaired driving and substance-defined crimes. This study focused on violent and non-violent crime categories. Substances assessed were: alcohol, cannabis, opioids, other central nervous system (CNS) depressants, cocaine, other CNS stimulants and other substances. Findings According to offender self-report, 42% of all violent and non-violent crime would probably not have occurred if the perpetrator had not been under the influence of, or seeking, alcohol or other substances. Between 2006 and 2016, 20% of violent crimes and 7% of non-violent crimes in Canada were considered attributable to alcohol. In contrast, all other psychoactive substance categories combined were associated with 26% of all violent crime and 25% of non-violent crime during the same time-frame. Conclusions Attributable fraction analyses show that more than 42% of Canadian crime resulting in a custodial sentence between 2006 and 2016 would probably not have occurred if the perpetrator had not been under the influence of or seeking alcohol or other drugs. Attributable fractions for alcohol and substance-related crime are a potentially useful resource for estimating the impact of alcohol and other substances on crime.

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.

Background Small area and regional estimates of substance use (SU) exposures are increasingly needed to support estimation of the burden of SU-attributable morbidity and mortality. There is also a need to assess SU prevalence for subgroups by place, time and sociodemographic characteristics to plan the efficient delivery of treatment and harm reduction services. However, the data available from national surveys are often insufficient to produce reliable estimates for subgroups because of small sample sizes. There are also often missing estimates for some jurisdictions and some years when no surveys were conducted. We describe new methods which utilize Canadian national survey data of SU, sales, SU attributable hospitalisations and demographic data to develop the Canadian Substance Use Exposure Database (CanSUED). Estimates from this database have been used in the study of Canadian Substance Use Costs and Harm (CSUCH). Methods Exposures were estimated for eight substance categories: alcohol, tobacco, opioids, cannabis, cocaine, other central nervous system (CNS) stimulants, other CNS depressants and other psychoactive substances. The design-based direct estimates of SU were based on the Canadian Alcohol and Drug Monitoring Survey (CADUMS) in 2008-2012, the Canadian Tobacco, Alcohol and Drug Survey (CTADS) in 2013, 2015 and 2017, per capita alcohol and tobacco sales, and rates of wholly SU-attributable hospitalisations for all Canadian jurisdictions by age and gender. Multilevel models were used to model the design-based estimates of SU to produce reliable estimates for subgroups when the coefficient of variation (CV) of the estimates were > 33.3% and to predict SU exposure in ten provinces in 2006, 2007, 2014 and 2016 and in the three territories for 2006-2017 by using empirical best linear unbiased prediction (EBLUP). Results Direct design-based estimates were based on the surveys from a total of 107,750 Canadians aged 15+. The analyses produced reliable estimates of SU prevalence by year-province-gender-age using mixed models with the EBLUP method. Correlational analyses show that the model-based estimates were significantly related to the design-based estimates produced from both the CADUMS/CTADS and Canadian Community Health Survey. The new model estimates indicate increases in binge drinking, cannabis use, other CNS depressant substance use and cocaine use between 2006 and 2017. Rates of use of opioids and tobacco showed declines. Rates of use of other substances were relatively stable or did not show overall change across the whole time period. Conclusion The mixed model-adjusted approaches produced reliable estimates for small areas and age-gender groups and help fill gaps caused by data suppression in local and national surveys. We suggest that these methods provide the most comprehensive and reliable estimates available of Canadian substance use by substance category, year, jurisdiction, age and gender. The methods could also be applied in other countries where similar data are available.

Background and aims Estimated alcohol consumption from national self-report surveys is often only 30-40% of official estimates based on sales or taxation data. Global burden of disease (GBD) estimates for alcohol adjust survey estimates up to 80% of total per capita consumption. This assumes that cohort studies needed to estimate relative risks for disease suffer less from under-reporting than typical national surveys. However, there is limited evidence on which to base that assumption. This paper aims to assess the extent of underestimation of alcohol consumption in cohort studies concerning alcohol and mortality compared with official total consumption estimates. Design Comparisons of estimated per capita consumption from a comprehensive sample of cohort studies against official estimates by country and year. Participants A total of 1 876 046 participants in 40 cohort studies from 18 countries on alcohol use and all-cause mortality identified by systematic review. Measurements Alcohol consumption data from the cohort studies were converted into usual grams of ethanol per day and then to total age 15+ per capita consumption. Matched estimates were sourced from the World Health Organization (WHO) Global Health Observatory. Findings The cohort studies had mean coverages of age 15+ per capita alcohol consumption of 61.71% (ranging from 29.19% for Russia to 96.53% for Japan), after weighting estimates by sample size for within-country estimates and by number of studies per country for the overall estimate. Regional estimates were higher for the United States (66.22%) and lower for western European countries (55.35%). Conclusions Underestimation of alcohol consumption in cohort studies is less than in typical population surveys. Because some under-coverage is caused by under-sampling heavier drinkers, the current practice of uplifting survey estimates to 80% of total population consumption in global burden of disease studies appears to be appropriate.

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

Aim To establish whether the population-level pattern of cannabis use by quantity is similar to the distributions previously reported for alcohol, in which a small subset of drinkers accounts for a majority of total population alcohol consumption. Method The current study pooled Waves 1–3 of the 2018 National Cannabis Survey (n = 18,900; 2584 past-three-month cannabis users), a set of stratified, population-based surveys designed to assess cannabis consumption and related behaviors in Canada. Each survey systematically measured self-reported cannabis consumption by quantity across seven of the major cannabis-product types. In order to enable the conversion of self-reported consumption of non-flower cannabis products into a standard joint equivalent (SJE: equal to 0.5 g of dried cannabis), we created conversion metrics for physical production equivalencies across cannabis products. Results Similar to the findings in the alcohol literature, study results show that cannabis consumption is highly concentrated in a small subset of users: the upper 10% of cannabis users accounted for approximately two-thirds of all cannabis consumed in the country. Males reported consuming more cannabis by volume than females (approximately 60% versus 40%), with young males (15–34 years old) being disproportionately represented in the heaviest-using subgroups. Conclusions Most of the cannabis used in Canada is consumed by a relatively small population of very heavy cannabis users. Future research should attempt to identify the characteristics of the heaviest-using groups, as well as how population-level cannabis consumption patterns relate to the calculus of cannabis-related harms in society.

Background Government alcohol monopolies were created in North America and Scandinavia to limit health and social problems. The Swedish monopoly, Systembolaget, reports to a health ministry and controls the sale of all alcoholic beverages with > 3.5% alcohol/volume for off-premise consumption, within a public health mandate. Elsewhere, alcohol monopolies are being dismantled with evidence of increased consumption and harms. We describe innovative modelling techniques to estimate health outcomes in scenarios involving Systembolaget being replaced by 1) privately owned liquor stores, or 2) alcohol sales in grocery stores. The methods employed can be applied in other jurisdictions and for other policy changes. Methods Impacts of the privatisation scenarios on pricing, outlet density, trading hours, advertising and marketing were estimated based on Swedish expert opinion and published evidence. Systematic reviews were conducted to estimate impacts on alcohol consumption in each scenario. Two methods were applied to estimate harm impacts: (i) alcohol attributable morbidity and mortality were estimated utilising the International Model of Alcohol Harms and Policies (InterMAHP); (ii) ARIMA methods to estimate the relationship between per capita alcohol consumption and specific types of alcohol-related mortality and crime. Results Replacing government stores with private liquor stores (Scenario 1) led to a 20.0% (95% CI, 15.3–24.7) increase in per capita consumption. Replacement with grocery stores (Scenario 2) led to a 31.2% (25.1–37.3%) increase. With InterMAHP there were 763 or + 47% (35–59%) and 1234 or + 76% (60–92%) more deaths per year, for Scenarios 1 and 2 respectively. With ARIMA, there were 850 (334–1444) more deaths per year in Scenario 1 and 1418 more in Scenario 2 (543–2505). InterMAHP also estimated 10,859 or + 29% (22–34%) and 16,118 or + 42% (35–49%) additional hospital stays per year respectively. Conclusions There would be substantial adverse consequences for public health and safety were Systembolaget to be privatised. We demonstrate a new combined approach for estimating the impact of alcohol policies on consumption and, using two alternative methods, alcohol-attributable harm. This approach could be readily adapted to other policies and settings. We note the limitation that some significant sources of uncertainty in the estimates of harm impacts were not modelled.

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

The existence and potential level of cardioprotection from alcohol use is contested in alcohol studies. Assumptions regarding the risk relationship between alcohol use and ischaemic heart disease (IHD) are critical when providing advice for national drinking guidelines and for designing alcohol harm monitoring systems. We use three meta-analyses regarding alcohol use and IHD risk to investigate how varying assumptions lead to differential estimates of alcohol-attributable (AA) deaths and weighted relative risk (RR) functions, in Australia and Canada. Alcohol exposure and mortality data were acquired from administrative sources and AA fractions were calculated using the International Model of Alcohol Harms and Policies. We then customized a recent Global Burden of Disease (GBD) analysis to inform drinking guidelines internationally. Australians drink slightly more than Canadians, per person, but are also more likely to identify as lifetime abstainers. Cardioprotective scenarios resulted in substantial differences in estimates of net AA deaths in Australia (between 2933 and 4570) and Canada (between 5179 and 8024), using GBD risk functions for all other alcohol-related conditions. Country-specific weighted RR functions were analyzed to provide advice toward drinking guidelines: Minimum risk was achieved at or below alcohol use levels of 10 g/day ethanol, depending on scenario. Consumption levels resulting in &lsquo, no added&rsquo, risk from drinking were found to be between 10 and 15 g/day, by country, gender, and scenario. These recommendations are lower than current guidelines in Australia, Canada, and some other high-income countries: These guidelines may be in need of downward revision.

OBJECTIVE: Systematic reviews and meta-analyses were completed studying the effect of changes in the physical availability of take-away alcohol on per capita alcohol consumption. Previous reviews examining this topic have not focused on off-premise outlets where take-away alcohol is sold and have not completed meta-analyses. METHOD: Systematic reviews were conducted separately for policies affecting the temporal availability (days and hours of sale) and spatial availability (outlet density) of take-away alcohol. Studies were included up to December 2015. Quality criteria were used to select articles that studied the effect of changes in these policies on alcohol consumption with a focus on natural experiments. Random-effects meta-analyses were applied to produce the estimated effect of an additional day of sale on total and beverage-specific consumption. RESULTS: Separate systematic reviews identified seven studies regarding days and hours of sale and four studies regarding density. The majority of articles included in these systematic reviews, for days/hours of sale (7/7) and outlet density (3/4), concluded that restricting the physical availability of take-away alcohol reduces per capita alcohol consumption. Meta-analyses studying the effect of adding one additional day of sale found that this was associated with per capita consumption increases of 3.4% (95% CI [2.7, 4.1]) for total alcohol, 5.3% (95% CI [3.2, 7.4]) for beer, 2.6% (95% CI [1.8, 3.5]) for wine, and 2.6% (95% CI [2.1, 3.2]) for spirits. The small number of included studies regarding hours of sale and density precluded meta-analysis. CONCLUSIONS: The results of this study suggest that decreasing the physical availability of take-away alcohol will decrease per capita consumption. As decreasing per capita consumption has been shown to reduce alcohol-related harm, restricting the physical availability of take-away alcohol would be expected to result in improvements to public health.