Search

Introduction: The current paper examines the proportion of drinking occasions and total alcohol consumed that takes place at off-premise locations. Comparisons are made between high-income countries: Australia, New Zealand, England and Scotland, and across drinker-types: high-risk and lower-risk., Methods: Data were taken from the International Alcohol Control study in Australia (N = 1789), New Zealand (N = 1979), England (N = 2844) and Scotland (N = 1864). The cross-national survey measures location and beverage-specific alcohol consumption. The number of drinking occasions and mean consumption across on- and off-premise locations and the proportion of drinking occasions that high- and lower-risk drinkers had at on- and off-premise locations was estimated for each country., Results: The majority of drinking occasions among high-risk drinkers occurred at off-premise locations across all four countries; Australia 80.1%, New Zealand 72.0%, England 61.7% and Scotland 60.7%. High-risk drinkers in Australia had significantly larger proportions of drinking occasions occurring at off-premise locations compared to England and Scotland. Across all countries, high-risk drinkers and lower-risk drinkers consumed significantly larger quantities of alcohol per occasion at off-premise locations compared to on-premises locations. Finally, the majority of total alcohol consumed occurred at off-premise locations across all countries for high- and lower-risk drinkers., Discussion and Conclusions: As the accessibility to alcohol outside of licensed premises continues to increase, particularly with the expansion of home delivery services, it is important to be mindful of the high proportion of heavy drinking occasions that occur off-premise., (© 2024 The Authors. Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

Background: The IAC Policy Index was developed to allow comparison in alcohol policy between countries and within countries over time including in low resource settings. It measures four effective alcohol policies and takes into account stringency of regulation and the actual impact on the alcohol environment, such as trading hours and prices paid. This framework was used to assess policy in Aotearoa New Zealand in a time period covering two relevant legislative changes. This is the first study to use an alcohol policy index to assess and describe legislative change within country., Methods: Data to calculate the IAC Policy Index was collected for 2013 and 2022. Stringency of policy was assessed from legislative statutes and impacts of policy on the alcohol environment from administrative data and specifically designed data collection., Results: The overall IAC Policy Index score improved over the time period. The scores for the separate policy areas reflected the legislative changes as hypothesised, but also independent changes in impact, given ecological changes including reduced enforcement of drink driving countermeasures and increased exposure to marketing in digital channels. The IAC Policy index reflects the changes in policy status observed in Aotearoa, NZ., Discussion: The IAC Policy Index provided a useful framework to assess and describe change in alcohol legislation contextualised by other influences on policy impact over time within a country. The results indicated the value of assessing stringency and impact separately as these moved independently., Conclusions: The IAC Alcohol Policy Index, measuring both stringency and actual impact on the alcohol environment with a focus on only the most effective alcohol policies provides meaningful insights into within-country policy strength over time. The IAC Policy Index used over time can communicate to policy makers successes and gaps in alcohol policy., (© 2024. The Author(s).)

Background and Aims: Quantifying the health burden of alcohol has largely focused upon harm to drinkers, which is an underestimate. There is a growing literature on alcohol's harm to others (HTO), but it lacks the systematic transfer of HTO into a comparative risk assessment framework. This study calculated disability-adjusted life years (DALYs) for fetal alcohol spectrum disorder (FASD), interpersonal violence and traffic injury due to another's drinking., Design: This study is a disease burden analysis, using modelling of DALYs for New Zealand in 2018., Setting and Participants: The study took place among the Aotearoa/New Zealand population in 2018., Measurements: The involvement of others' drinking was obtained from prevalence, alcohol-attributable fraction studies and administrative data. Disability weights (DW) for FASD were adapted from fetal alcohol syndrome (FAS) weights using a Beta-Pert probability distribution; for interpersonal injury, DWs used hospital events linked with injury compensation; for traffic injury, DWs used hospital events. Populations were stratified by ethnicity, age group and gender. A descriptive comparison was made with a previous estimate of DALYs for drinkers., Findings: In 2018, 78 277 healthy life years were lost in Aotearoa/New Zealand due to alcohol's HTO. The main contributor (90.3%) was FASD, then traffic crashes (6.3%) and interpersonal violence (3.4%). The indigenous population, Māori, was impacted at a higher rate (DALYs among Māori were 25 per 1000 population; among non-Māori 15 per 1000 population). The burden of HTO was greater than that to drinkers (DALYs HTO = 78 277; DALYs drinkers = 60 174)., Conclusions: Disability from fetal alcohol spectrum disorder (FASD) appears to be a major contributor to alcohol's harm to others in Aotearoa/New Zealand. Taking FASD into account, the health burden of harm to others is larger than harm to the drinker in Aotearoa/New Zealand, and ethnicity differences show inequity in harm to others. Quantification of the burden of harm informs the value of implementing effective alcohol policies and should include the full range of harms., (© 2024 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.)

Background: While alcohol use is an established risk factor for interpersonal violence, the extent to which people are affected by interpersonal violence from others' drinking has not yet been quantified for different world regions. This modelling study aims to provide the first estimates of the national and regional prevalence of interpersonal violence from others' drinking., Methods: An international systematic literature search (02/28/2023, Prospero: CRD42022337364) was conducted to identify general adult population studies assessing the prevalence of interpersonal violence from others' drinking with no restrictions to publication date or language. Reports that did not provide data on interpersonal violence from others' drinking (primary outcome), were no original research studies, or captured a selected group of people only, were excluded. Observed prevalence data were extracted and used to build fractional response regression models to predict past-year prevalence of emotional and physical violence from others' drinking in 2019. Random-effects meta-regression models were used to aggregate the observed prevalence of sexual and intimate partner violence. Study risk of bias (ROB) was assessed using a modified version of the Newcastle-Ottawa Scale., Findings: Out of 13,835 identified reports, 50 were included covering just under 830,000 individuals (women: 347,112; men: 322,331; men/women combined: 160,057) from 61 countries. With an average prevalence of 16·8% (95% CI: 15·2-18·3%) and 28·3% (95% CI: 23·9-32·4%) in men and women combined in the GBD super regions High Income and Central Europe, Eastern Europe, & Central Asia, respectively, emotional violence was the most common form of interpersonal violence from others' drinking. Physical violence averaged around 3% (women) and 5% (men) in both regions. The pooled prevalence of sexual violence from others' drinking in men and women was 1·3% (95% CI: 0·5-3·3%, 95% PI: 0·1-16·9%) and 3·4% (95% CI: 1·4-8·3%, 95% PI: 0·2-35·3%), respectively, and ranged between 0·4% (95% CI: 0·1-1·6%, 95% PI: 0·0-7·3%) and 2·7% (95% CI: 1·1-6·3%, 95% PI: 0·2-30·0%) for different forms of intimate partner violence. ROB was moderate or critical for most reports; accounting for critical ROB did not substantially alter our results., Interpretation: The share of the population experiencing harms from others' drinking is significant and should be an integral part of public health strategies., Funding: Research reported in this publication was supported by the Canadian Institutes of Health Research (CIHR; grant: CIHR FRN 477887)., Competing Interests: JM worked as consultant for non-profit public health organisations. All other authors have no conflict to declare., (© 2024 The Author(s).)

Background: About one million people in need of home care in Germany are assisted by 15,400 home care services. Home healthcare is mostly a complex endeavour because interprofessional collaboration is often challenging. This might negatively impact patient safety. The project interprof HOME aims to develop an interprofessional person-centred care concept for people receiving home care in a multistep approach. In one of the work packages we explored how people receiving home care, relatives, nurses, general practitioners, and therapists (physiotherapists, occupational therapists, and speech therapists) perceive collaboration in this setting., Methods: Semi-structured interviews were conducted with 20 people receiving home care and with 21 relatives. Additionally, we worked with nine monoprofessional focus groups involving nurses of home care services (n = 17), general practitioners (n = 14), and therapists (n = 21). The data were analysed by content analysis., Results: Three main categories evolved: "perception of interprofessional collaboration", "means of communication", and "barriers and facilitators". People receiving home care and relatives often perceive little to no interprofessional collaboration and take over a significant part of the organisational coordination and information exchange. Interprofessional collaboration in steady care situations does exist at times and mostly occurs in coordination tasks. Contact and information exchange are rare, however, interprofessional personal encounters are sporadic, and fixed agreements and permanent contact persons are not standard. These trends increase with the complexity of the healthcare situation. Joint collaborations are often perceived as highly beneficial. Means of communications such as telephone, fax, or e-mail are used differently and are often considered tedious and time-consuming. No interprofessional formal written or electronic documentation system exists. Personal acquaintance and mutual trust are perceived as being beneficial, while a lack of mutual availability, limited time, and inadequate compensation hinder interprofessional collaboration., Conclusions: Interprofessional collaboration in home care occurs irregularly, and coordination often remains with people receiving home care or relatives. While this individual care set-up may work sufficiently well in low complex care situations, it becomes vulnerable to disruptions with increasing complexity. Close interactions, joint collaboration, and fixed means of communication might improve healthcare at home. The findings were integrated into the development of the person-centred interprofessional care concept interprof HOME., Trial Registration: This study is registered on the International Clinical Trails registry platform ClinicalTrials.gov as NCT05149937 on 03/11/2021., (© 2024. The Author(s).)

Introduction: The price of alcoholic beverages can vary for a range of reasons, including tax. Risky drinkers purchase more low-cost alcoholic drinks than moderate drinkers, contributing to beverage-specific risks for that category. The study aimed to examine the proportion of total alcohol consumption comprised by each beverage type and their correlates. Australian and New Zealand populations were compared, where drinking cultures are similar, but taxation of alcohol differs., Method: Data was taken from the International Alcohol Control study in Australia (N=1580) and New Zealand (N =1979), a cross national survey that asks questions on beverage specific alcohol consumption at a range of different locations. Tax rates were obtained from previous analyses run on the dataset., Results: Ready to Drink (pre-mixed) beverages are more popular in New Zealand and the proportion of these drinks consumed out of total alcohol consumption by risky drinkers was correspondingly higher there. Conversely, the proportion of wine consumed by risky drinkers was higher in Australia. The consumption of spirits and beer by risky drinkers was similar in both countries., Discussion: Differences found for the proportion of beverages consumed by risky drinkers between the countries are fairly well aligned with differences in the taxation of each drink type. Future adaptations in taxation systems should consider the impact of taxes on preferential beverage choice and associated harms., Competing Interests: Declarations of Interest None., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Introduction: Foetal alcohol spectrum disorder (FASD) is 100% caused by alcohol. The lifelong disability caused by prenatal alcohol exposure cannot be reversed. Lack of reliable national prevalence estimates of FASD is common internationally and true of Aotearoa, New Zealand. This study modelled the national prevalence of FASD and differences by ethnicity., Methods: FASD prevalence was estimated from self-reported data on any alcohol use during pregnancy for 2012/2013 and 2018/2019, combined with risk estimates for FASD from a meta-analysis of case-ascertainment or clinic-based studies in seven other countries. A sensitivity analysis using four more recent active case ascertainment studies was performed to account for the possibility of underestimation., Results: We estimated FASD prevalence in the general population to be 1.7% (95% confidence interval [CI] 1.0%; 2.7%) in the 2012/2013 year. For Māori, the prevalence was significantly higher than for Pasifika and Asian populations. In the 2018/2019 year, FASD prevalence was 1.3% (95% CI 0.9%; 1.9%). For Māori, the prevalence was significantly higher than for Pasifika and Asian populations. The sensitivity analysis estimated the prevalence of FASD in the 2018/2019 year to range between 1.1% and 3.9% and for Māori, from 1.7% to 6.3%., Discussion and Conclusions: This study used methodology from comparative risk assessments, using the best available national data. These findings are probably underestimates but indicate a disproportionate experience of FASD by Māori compared with some ethnicities. The findings support the need for policy and prevention initiatives to support alcohol-free pregnancies to reduce lifelong disability caused by prenatal alcohol exposure., (© 2023 The Authors. Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

Aims: Children are an important group harmed by others' alcohol consumption. This study (1) compared the risk of occurrence of child maltreatment among children exposed versus not exposed to parents with an alcohol-attributable hospitalization or service use for mental health/addiction and (2) conducted sensitivity analyses to estimate the cases of child maltreatment that could be attributable to alcohol under two different conditions in New Zealand., Design: A cohort study conducted among children 0-17 years and their parents (years 2000-2017) using the Statistics New Zealand Integrated Data Infrastructure. The New Zealand Health Survey 2017 was also used., Setting: New Zealand., Participants: 58 359 children aged 0-17 years and their parents., Measurements: Survival analysis based on a Bayesian piecewise exponential model was used to estimate the risk of time to first substantiated child maltreatment event (identified from social service, hospital, mortality and police data) related to exposure to parents with an alcohol-attributable hospitalization or who used a mental health/addiction service (versus no exposure). Potential confounders were included for parents and children. The sensitivity analyses (i) estimated an alcohol-attributable admissions/service use fraction for maltreatment in 2017 and (ii) calculated a population-attributable fraction using the relative risk from the cohort and prevalence of hazardous drinking (AUDIT 8+) among parents in 2017., Findings: There was a 65.1% [1.65; 95% confidence interval (CI) = 1.46-1.86] increased risk of child maltreatment if a child was exposed to parents who had an alcohol-attributable hospitalized or mental health/addictions service use. The sensitivity analyses estimated that in 2017 14.6% (CI = 14.0-15.3%) and 11.4% (95% CI = 8.4-14.3%) of the documented cases of child maltreatment in New Zealand could be attributable to parents with severe or hazardous consumption., Conclusions: In New Zealand, exposure to parents with an alcohol-attributable hospitalization or service use is a risk factor for substantiated child maltreatment., (© 2022 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.)

Background: Alcohol policies stand out among other noncommunicable disease-relevant policies for the lack of uptake. Composite indicators have been developed to measure the effects of alcohol control policy. We investigated whether drinking patterns among demographic groups from general population samples of drinkers from diverse countries are associated with alcohol control policy as measured by the International Alcohol Control (IAC) Policy Index., Methods: Representative samples of adult drinkers from 10 countries (five high-income and five middle-income) were surveyed about alcohol consumption, using beverage and location-specific questions., Measurements: The IAC Policy Index was analyzed with frequency, typical occasion quantity, and volume consumed. Analyses used mixed models that included interactions between country IAC Policy Index score and age group, gender, and education level., Findings: Each increase in IAC policy index score (reflecting more effective alcohol policy) was associated with a 13.9% decrease in drinking frequency (p = 0.006) and a 16.5% decrease in volume (p = 0.001). With each increase in IAC Policy Index score, both genders decreased for all three measures, but men less so than women. Women decreased their typical occasion quantity by 1.2% (p = 0.006), frequency by 3.1% (p < 0.001), and total volume by 4.2% (p < 0.001) compared to men. Low and mid-education groups decreased their typical occasion quantity by 2.6% (p < 0.001) and 1.6% (p = 0.001), respectively, compared to high education, while for drinking frequency the low education group increased by 7.0% (p < 0.001). There was an overall effect of age (F = 19.27, p < 0.0001), with 18-19 and 20-24-year-olds showing the largest decreases in typical occasion quantity with increasing IAC policy index score., Conclusions: The IAC Policy Index, reflecting four effective policies, was associated with volume and frequency of drinking across 10 diverse countries. Each increase in the IAC Policy Index was associated with lower typical quantities consumed among groups reporting heavy drinking: young adults and less well-educated. There is value in implementing such alcohol policies and a need to accelerate their uptake globally., (© 2023 The Authors. Alcohol: Clinical and Experimental Research published by Wiley Periodicals LLC on behalf of Research Society on Alcohol.)

Introduction: Alcohol abstinence remains common among adults globally, although low and middle-income countries are experiencing declines in abstention. The effect of alcohol policies on lifetime abstinence is poorly understood. The International Alcohol Control (IAC) policy index was developed to benchmark and monitor the uptake of effective alcohol policies and has shown strong associations with alcohol per capita consumption and drinking patterns. Uniquely, the index incorporates both policy 'stringency' and 'impact', reflecting policy implementation and enforcement, across effective policies. Here we assessed the association of the IAC policy index with lifetime abstinence in a diverse sample of jurisdictions., Methods: We conducted a cross-sectional analysis of the relationship between the IAC policy index score, and its components, and lifetime abstinence among adults (15+ years) in 13 high and middle-income jurisdictions. We examined the correlations for each component of the index and stringency and impact separately., Results: Overall, the total IAC policy index scores were positively correlated with lifetime abstinence (r = 0.76), as were both the stringency (r = 0.62) and impact (r = 0.82) scores. Marketing restrictions showed higher correlations with lifetime abstinence than other policy domains (r = 0.80), including restrictions on physical availability, pricing policies and drink-driving prevention., Discussion and Conclusion: Our findings suggest that restricting alcohol marketing could be an important policy for the protection of alcohol abstention. The IAC policy index may be a useful tool to benchmark the performance of alcohol policy in supporting alcohol abstention in high and middle-income countries., (© 2022 The Authors. Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

Issues: Implementation of alcohol control policy is a global priority as alcohol contributes to negative individual health and societal impacts. However, there are no available reviews that comprehensively provide tools and measurements for assessing the implementation of alcohol control policy. This study reviews tools and measurements for assessing alcohol policy implementation. Policies considered include alcohol pricing and taxation, alcohol marketing control, physical availability control and drink-driving policy., Approach: We conducted a scoping review from Scopus, Web of Science and the World Health Organization's website. We included studies on policy implementation for the four most effective prevention policies published worldwide between 2000 and 2021., Key Findings: The search yielded 11,654 articles and these were narrowed down to 39 included studies. Of these 39 studies, almost half assessed the implementation of a drink-driving policy (n = 19), followed multipolicy (n = 12) and physical availability control (n = 8). There was no single study assessing policy implementation of pricing and taxation or alcohol marketing control. The majority of the studies were conducted in high-income countries (n = 31). Globally, there is no standardised tool or guidelines for measuring the policy implementation of these four policies. The tools for measuring policy implementation mostly focused on a single policy, and few covered multiple policies., Implications: We recommend developing standardised tools and measurements to monitor policy implementation across multiple policies at country levels., Conclusion: This review highlighted a lack of comprehensive and standardised tools to assess policy implementation and the limited number of studies on alcohol policy implementation in low- and middle-income countries., (© 2022 The Authors. Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

Background and Aims: This article summarizes the findings and conclusions of the third edition of Alcohol: No Ordinary Commodity. The latest revision of this book is part of a series of monographs designed to provide a critical review of the scientific evidence related to alcohol control policy from a public health perspective., Design: A narrative summary of the contents of the book according to five major issues., Findings: An extensive amount of epidemiological evidence shows that alcohol is a major contributor to the global burden of disease, disability and death in high-, middle- and low-income countries. Trends in alcohol products and marketing are described, indicating that a large part of the global industry has been consolidated into a small number of transnational corporations that are expanding their operations in Asia, Africa and Latin America. The main part of the book is devoted to a review of strategies and interventions designed to prevent or minimize alcohol-related harm. Overall, the most effective strategies to protect public health are taxation that decreases affordability and restrictions on the physical availability of alcohol. A total ban on alcohol marketing is also an effective strategy to reduce consumption. In addition, drink-driving counter-measures, brief interventions with at-risk drinkers and treatment of drinkers with alcohol dependence are effective in preventing harm in high-risk contexts and groups of hazardous drinkers., Conclusion: Alcohol policy is often the product of competing interests, values and ideologies, with the evidence suggesting that the conflicting interests between profit and health mean that working in partnership with the alcohol industry is likely to lead to ineffective policy. Opportunities for implementation of evidence-based alcohol policies that better serve the public good are clearer than ever before as a result of accumulating knowledge on which strategies work best., (© 2022 Society for the Study of Addiction.)

Implementation of effective alcohol control policies is a global priority. However, at the global and national levels, implementing effective policies is still challenging, as it requires commitment from multiple stakeholders. This review provides a synthesis of barriers and facilitators to implementing effective alcohol control policies. We conducted a scoping review from two main databases: Scopus and Web of Science, and the grey literature from the World Health Organization's website. We included any studies investigating barriers and facilitators to implementing four effective policies: Alcohol pricing and taxation, control of physical availability, alcohol marketing control, and drink-driving policy. Articles published between 2000 and 2021 were included. The search yielded 11,651 articles, which were reduced to 21 after the assessment of eligibility criteria. We found five main barriers: resource constraint; legal loopholes; lack of evidence to support policy implementation, particularly local evidence; low priority of policy implementation among responsible agencies; and insufficient skills of implementers. Facilitators, which were scarce, included establishing monitoring systems and local evidence to support policy implementation and early engagement of implementing agencies and communities. We recommend that national governments pay more attention to potential barriers and facilitators while designing alcohol control regulations and implementing effective policies.

This study developed a measurement tool to assess stringency and 'on-the-ground' impact of four key alcohol policy domains to create an alcohol policy index suitable for benchmarking alcohol policy and assessing change over time in middle- and high-income countries. It involved a collaboration between researchers in 12 diverse countries: New Zealand; Australia; England; Scotland; Netherlands; Vietnam; Thailand; South Africa; Turkey; Chile; Saint Kitts and Nevis and Mongolia. Data on the four most effective alcohol policy domains (availability, pricing policy, alcohol marketing, drink driving) were used to create an alcohol policy index based on their association with alcohol per capita consumption (APC) of commercial (recorded) alcohol. An innovation was the inclusion of measures of impact along with the stringency of the legislation or regulation. The resulting International Alcohol Control (IAC) Policy Index showed a very high negative correlation (-0.91) with recorded APC. Greater affordability of alcohol, an impact measure taking into account prices paid and countries' Gross Domestic Product, was predictive of higher APC (-0.80). Countries in which more modes of alcohol marketing are legally allowed and used had higher APC. Legislation on outlet density and drink driving predicted APC whereas trading hours did not. While stringency and impact measures varied between domains in terms of relationship with APC, overall, there was a strong correlation between impact and stringency (0.77). The IAC Policy Index, which includes measures of policy stringency and 'on-the-ground' impacts in relation to four key policy areas, was found to be strongly associated with commercial alcohol consumed in a number of diverse country settings. It showed a larger relationship than previous indices that include more policy dimensions. The index provides a relatively simple tool for benchmarking and communication with policy makers to encourage a strong focus on uptake of these four most effective alcohol policies., Competing Interests: Authors Karimu Byron and Gantuya Sengee were unavailable to confirm their authorship contributions. On their behalf, the corresponding author has reported their contributions to the best of their knowledge. The authors have declared that no competing interests exist., (Copyright: © 2022 Casswell et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The STADPLAN study is a cluster-randomised controlled trial including 27 home care services in Germany. It assesses the effect of an advance care planning (ACP) intervention delivered by trained nurses to older care-dependent patients. Patients received two ACP conversations and an information brochure. Nurses were educated through a two-day programme and topic guides structuring the conversations. Objectives of the process evaluation were to determine: [1] whether the intervention was implemented as planned, [2] which change mechanisms were observed, [3] whether targeted process outcomes were achieved and [4] in which way contextual factors influenced the implementation process., Methods: The process evaluation is based on a mixed methods approach following the recommendations of the UK-MRC framework for the development and evaluation of complex interventions. Qualitative and quantitative assessments were developed and analysed guided by a logic model comprising intervention, participants, mechanisms of change and context factors. The results of the main trial will be published elsewhere., Results: Educational programme and topic guides were mostly implemented as planned and resulted in motivation, knowledge, and perceived competencies to facilitate ACP conversations in nurses. Deviances in the performance of ACP conversations indicated patients' varied individual needs, but also obstacles like reluctance of patients and caregivers to participate actively and time constraints of nurse facilitators. Patients and caregivers reported increased awareness of ACP, planning and other activities indicating that targeted process outcomes could be achieved. The relevance of multifaceted contextual factors acting as barriers or facilitators for the engagement in ACP interventions on the individual, organisational and macro level was evident., Conclusions: The process evaluation elicits obstacles and achievements of the ACP intervention. The logic model organised a plethora of mixed methods data into a holistic picture of multifaceted results. Nurses as ACP facilitators in home care can fulfil a crucial initiating role based on a trusting relationship with their patients. To support older care-dependent people's ACP engagement, access should be simplified. Furthermore, education for nurse facilitators and sufficient resources for service provision are needed. Independent of monetary reimbursement, healthcare providers must respect patients' choice for or against any ACP intervention., Ethics and Trial Registration: Approved by the Ethics Committees of Martin Luther University Halle-Wittenberg (Ref.-No. 2019-045), Carl von Ossietzky University Oldenburg (Ref.-No. 2019-024), and University of Lübeck (Ref.-No. 19-080)., German Clinical Trials Register: DRKS00016886. Registered retrospectively 04/06/2019, first participant included 29/05/2019., (© 2022. The Author(s).)

Nurses' perspectives on their potential role in advance care planning in home care: A qualitative study Abstract. Background: Advance Care Planning (ACP) in long-term care in Germany has been identified as a potential area of nurses' responsibility. In the StAdPlan study (DRKS0016886), an ACP intervention in outpatient care was implemented and evaluated: Trained nurses conducted ACP conversations with patients. A comprehensive process evaluation was part of the study. Aim: A partial result of the process evaluation was analysing the perspective of nurses on their potential role as ACP facilitators for outpatients. Methods: Semi-structured interviews with nursing professionals and nursing service managers ( n = 42) were carried out prior to the implementation of the ACP intervention. A qualitative content analysis of the recorded interviews was performed. Results: Participants described the importance of ACP in outpatient care, their personal motivation and competence as well as necessary contextual conditions. Nursing professionals are motivated to offer ACP to patients to be able to care for them according to their wishes. For effective ACP conversations, nurse professionals considered in-depth knowledge of ACP, conversational skills and sufficient time resources as necessary. ACP consultations can be a suitable field of action for nurses as they have access and an established relationship of trust with patients. Conclusions: Under certain conditions, nurses' role in offering guidance on ACP in outpatient care was seen as feasible and beneficial. Prerequisites for implementation are financial resources and training for nurses for this service.

Introduction: This paper aimed to assess purchasing and drinking behaviour during the first COVID-19 pandemic restrictions in New Zealand., Method: A convenience sample was collected via Facebook from 2173 New Zealanders 18+ years during pandemic restrictions April/May 2020. Measures included: the quantity typically consumed during a drinking occasion and heavier drinking (6+ drinks on a typical occasion) in the past week; place of purchase including online alcohol delivery. Descriptive statistics were generated, logistic and linear regression models predicted heavier drinking and typical occasion quantity, respectively. Weighting was not applied., Results: During pandemic restrictions, around 75% of respondents purchased from supermarkets, 40% used online alcohol delivery services (18% for the first time during COVID-19). Purchasing online alcohol delivery during pandemic restrictions was associated with heavier drinking (75% higher odds) in the past week, while purchasing from supermarkets was not. About 58% of online purchasers under 25 reported no age checks. Sixteen percent of those purchasing online repeat ordered online to keep drinking after running out. Of respondents who had tried to buy alcohol and food online, 56% reported that alcohol was easier to get delivered than fresh food. Advertising for online alcohol delivery was seen by around 75% of the sample. Half of the sample reported drinking more alcohol during the restrictions., Discussion and Conclusions: Online alcohol delivery during the COVID-19 pandemic restrictions was associated with heavier drinking in the past week. The rapid expansion of online alcohol delivery coupled with a lack of regulatory control requires public health policy attention., (© 2020 Australasian Professional Society on Alcohol and other Drugs.)

Aims: To estimate the effect of national restrictions on late-night availability of alcohol on alcohol-related assault at a population level as indicated by (1) change in hospitalizations for weekend assaults and (2) change in the proportion of assaults documented by police that occur at night., Design: Evaluation of a natural experiment, involving: (1) pre-post comparisons of age-specific incidence rates, adjusted for seasonality and background trend using Poisson regression; and (2) interrupted time-series analyses, using seasonal autoregressive integrated moving average (SARIMA) models of national data with no control site., Setting: New Zealand., Participants: (1) Inpatients discharged from NZ hospitals following assault during the weekend (Friday-Sunday) from 2004 to 2016 (n = 14 996) and (2) cases of assault recorded by NZ Police from 2012 to 2018., Intervention: introduction of national maximum trading hours for all on-licence (8 a.m.-4 a.m.) and off-licence premises (7 a.m.-11 p.m.), abolishing existing 24-hour licences, on 18 December 2013., Measurements: (1) Age-specific incidence of hospitalization for assault on Friday, Saturday or Sunday from the national hospital discharge data set, excluding short-stay emergency department admissions and (2) proportion of weekly police-documented assaults occurring between 9 p.m. and 5.59 a.m., from NZ Police Demand and Activity data set., Findings: Following the restrictions, weekend hospitalized assaults declined by 11% [incidence rate ratio (IRR) = 0.89; 95% confidence interval (CI) = 0.84, 0.94], with the greatest reduction among 15-29-year-olds (IRR = 0.82; 95% CI = 0.76, 0.89). There was an absolute reduction (step change) of 1.8% (95% CI = 0.2, 3.5%) in the proportion of police-documented assaults occurring at night, equivalent to 9.70 (95% CI = 0.10, 19.30) fewer night-time assaults per week, out of 207.4., Conclusions: The 2013 implementation of national maximum trading hours for alcohol in NZ was followed by reductions in two complementary indicators of alcohol-related assault, consistent with beneficial effects of modest nation-wide restrictions on the late-night availability of alcohol., (© 2020 Society for the Study of Addiction.)

Objectives: To describe how for some high- and middle-income countries, the total volume of alcohol, including volume consumed in harmful drinking occasions, is distributed across drinking locations in each country., Methods: Population surveys of drinkers were conducted as part of the International Alcohol Control Study in New Zealand, Australia, Vietnam and Thailand. Consumption data were collected using a beverage- and location-specific measure that also allows for the measurement of unrecorded alcohol., Results: In the high-income countries, the percentage of absolute alcohol consumed in harmful drinking occasions was 44% in New Zealand and 51% in Australia. In the middle-income countries, the proportions were 55% in Vietnam and 66% in Thailand. The vast majority of alcohol was consumed in private homes (67% or above in all four countries). Private homes were also the location where the highest percentage of alcohol was consumed in harmful drinking occasions (range 33% in New Zealand to 44% in Vietnam). Unrecorded/untaxed alcohol was of considerable importance for heavier drinking occasions in private homes in Vietnam. Bars and nightclubs were more likely locations for harmful drinking in the high-income countries relative to the middle-income countries., Conclusions: As the majority of alcohol consumed in each country, including in harmful drinking occasions, was consumed in private homes, these findings make take-away alcohol a focus for alcohol policy including trading hour and pricing policies. Unrecorded alcohol was also of considerable importance in Vietnam, highlighting the importance of the policy responses being developed to address unrecorded alcohol., (© 2020 Australasian Professional Society on Alcohol and other Drugs.)

Background: This study aimed to assess the early impact of national alcohol trading hour restrictions on nighttime violence in New Zealand. The new national maximum trading hour restrictions prohibited 24-hour trading by reducing hours to between 8 am and 4 am for on-premises and between 7 am and 11 pm for take-away outlets., Methods: A telephone survey of alcohol outlets was undertaken to determine actual trading hours before the law change. Interrupted time-series analysis modeled weekly nighttime police calls for service for assault (i.e., between 9 pm and 6 am) and late-night police calls for service for assault (i.e., between 4 am and 6 am) from 2005 to 2015. Daytime police calls for service for assaults were used as the comparison group. Abrupt permanent changes and gradual permanent changes were assessed., Results: The survey found that only 1% of alcohol shops, 9% of supermarkets, and 6% of bars/nightclubs were affected by the hour restrictions because they did not trade as long as their licensed hours permitted in the first place. The time-series analysis found no effect of the national trading hour restrictions on nighttime police calls for service for assaults. However, a significant gradual permanent decrease of 12.4% was found for late-night assaults between 4 am and 6 am (i.e., those likely related to the on-premises hour restriction). This equated to a weekly average decrease of 4.3 police calls for service for assaults between 4 am and 6 am following the law change., Conclusions: The national trading hour restrictions for on-premises and take-away outlets affected only a small proportion of premises, and no change in the overall level of nighttime violence was found following the restrictions. Late-night assaults likely related to on-premises, however, did reduce showing the likely effectiveness of trading hour restrictions even when the impact of the law change on the ground was minimal., (© 2020 by the Research Society on Alcoholism.)

Introduction and Aims: This study aimed to assess the early impacts of a 2013 law change to restrict the social supply of alcohol to under 18s in New Zealand by assessing changes in social suppliers' behaviour., Design and Methods: National surveys of drinkers aged 16-65 years were collected before (2013) and after (2015) the law change. Suppliers were asked: to whom they supplied alcohol, how often and how much; if the supplier thought the alcohol they provided would be shared; whether the supplier had permission to supply from parent/guardian, and if they supervised their supply. General estimating equation models were used to conduct analyses., Results: Sons and daughters were commonly supplied to, as were friends, but friends were supplied greater quantities on average [13 drinks compared to four drinks for sons/daughters (at baseline)]. Following the law change, friends were less commonly supplied to (8% decrease), were supplied with fewer drinks (down from 13 to 11 drinks) and there was greater supervision of social supply to friends (16% increase) (and to other relatives). However, the number of drinks supplied by parents increased from four to six drinks., Discussion and Conclusions: There was evidence of some early reductions in social supply in relation to the law change, in particular where the legislation aimed to have effect; specifically, less supply to friends under 18 years. We found no effect of the new law on parental supply. As quantities supplied are still very high, further policy restriction and public health interventions would be appropriate., (© 2019 Australasian Professional Society on Alcohol and other Drugs.)

Introduction and Aims: A 2010 World Health Assembly resolution called on member states to intensify efforts to address alcohol-related harm. Progress has been slow. This study aims to determine the magnitude of public support for 12 alcohol policies and whether it differs by country, demographic factors and drinking risk (volume consumed)., Design and Methods: Data are drawn from seven countries participating in the International Alcohol Control Study which used country-specific sampling methods designed to obtain random, representative samples. The weighted total sample comprised 11 494 drinkers aged 16-65 years., Results: Drinking risk was substantial (24% 'increased' risk and 16% 'high' risk) and was particularly high in South Africa. Support varied by alcohol policy, ranging from 12% to 96%, but was above 50% for 79% of the possible country/policy combinations. Across countries, policy support was generally higher for policies addressing drink driving and increasing the alcohol purchase age. There was less support for policies increasing the price of alcohol, especially when funds were not earmarked. Policy support differed by country, and was generally higher in the five middle-income countries than in New Zealand. It also differed by age, gender, education, quantity/frequency of drinking, risk category and country income level., Discussion and Conclusions: We found a trend in policy support, generally being highest in the low-middle-income countries, followed by high-middle-income countries and then high-income countries. Support from drinkers for a range of alcohol policies is extensive across all countries and could be used as a catalyst for further policy action., (© 2017 The Authors Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

Introduction and Aims: To investigate if socio-economic disadvantage, at the individual- and country-level, is associated with heavier drinking in some middle- and high-income countries., Design and Methods: Surveys of drinkers were undertaken in some high- and middle-income countries. Participating countries were Australia, England, New Zealand, Scotland (high-income) and Peru, Thailand and Vietnam (middle-income). Disadvantage at the country-level was defined as per World Bank (categorised as middle-or high-income); individual-level measures were (i) years of education and (ii) whether and individual was under or over the poverty line in each country. Measures of heavier drinking were (i) proportion of drinkers that consumed 8+ drinks and (ii) three drinking risk groups (lower, increasing and higher). Multi-level logistic regression models were used., Results: Individual-level measures of disadvantage, lower education and living in poverty, were associated with heavier drinking, consuming 8+ drinks on a typical occasion or drinking at the higher risk level, when all countries were considered together. Drinkers in the middle-income countries had a higher probability of consuming 8+ drinks on a typical occasion relative to drinkers in the high-income countries. Interactions between country-level income and individual-level disadvantage were undertaken: disadvantaged drinkers in the middle-income countries were less likely to be heavier drinkers relative to those with less disadvantage in the high-income countries., Discussion and Conclusions: Associations between socio-economic disadvantage and heavier drinking vary depending on country-level income. These findings highlight the value of exploring cross-country differences in heavier drinking and disadvantage and the importance of including country-level measurements to better elucidate relationships., (© 2018 The Authors Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

Introduction and Aims: Cross-country studies on alcohol purchasing and access are rare. We examined where and when people access alcohol to understand patterns of availability across a range of middle- and high-income countries., Design and Methods: Surveys of drinkers in the International Alcohol Control study in high-income countries (Australia, England, Scotland, New Zealand and St Kitts and Nevis) and middle-income countries (Mongolia, South Africa, Peru, Thailand and Vietnam) were analysed. Measures were: location of purchase from on-premise and take-away outlets, proportion of alcohol consumed on-premise versus take-away outlets, hours of purchase, access among underage drinkers and time to access alcohol., Results: On-premise purchasing was prevalent in the high-income countries. However, the vast majority of alcohol consumed in all countries, except St Kitts and Nevis (high-income), was take-away. Percentages of drinkers purchasing from different types of on-premise and take-away outlets varied between countries. Late purchasing was common in Peru and less common in Thailand and Vietnam. Alcohol was easily accessed by drinkers in all countries, including underage drinkers in the middle-income countries., Discussion and Conclusions: In nine out of 10 countries the vast majority of alcohol consumed was take-away. Alcohol was readily available and relatively easy for underage drinkers to access, particularly in the middle-income countries. Research is needed to assess the harms associated with take-away consumption including late at night. Attention is needed to address the easy access by underage drinkers in the middle-income countries which has been less of a focus than in high-income countries., (© 2018 The Authors Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

Introduction and Aims: Gender and age patterns of drinking are important in guiding country responses to harmful use of alcohol. This study undertook cross-country analysis of drinking across gender, age groups in some high-and middle-income countries., Design and Methods: Surveys of drinkers were conducted in Australia, England, Scotland, New Zealand, St Kitts and Nevis (high-income), Thailand, South Africa, Mongolia and Vietnam (middle-income) as part of the International Alcohol Control Study. Drinking pattern measures were high-frequency, heavier-typical quantity and higher-risk drinking. Differences in the drinking patterns across age and gender groups were calculated. Logistic regression models were applied including a measure of country-level income., Results: Percentages of high-frequency, heavier-typical quantity and higher-risk drinking were greater among men than in women in all countries. Older age was associated with drinking more frequently but smaller typical quantities especially in high-income countries. Middle-income countries overall showed less frequent but heavier typical quantities; however, the lower frequencies meant the percentages of higher risk drinkers were lower overall compared with high-income countries (with the exception of South Africa)., Discussion and Conclusions: High-frequency drinking was greater in high-income countries, particularly in older age groups. Middle-income countries overall showed less frequent drinking but heavier typical quantities. As alcohol use becomes more normalised as a result of the expansion of commercial alcohol it is likely frequency of drinking will increase with a likelihood of greater numbers drinking at higher risk levels., (© 2018 The Authors Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

Introduction and Aims: To investigate behaviours related to four alcohol policy variables (policy-relevant behaviours) and demographic variables in relation to typical quantities of alcohol consumed on-premise in six International Alcohol Control study countries., Design and Methods: General population surveys with drinkers using a comparable survey instrument and data analysed using path analysis in an overall model and for each country., Measures: typical quantities per occasion consumed on-premise; gender, age; years of education, prices paid, time of purchase, time to access alcohol and liking for alcohol advertisements., Results: In the overall model younger people, males and those with fewer years of education consumed larger typical quantities. Overall lower prices paid, later time of purchase and liking for alcohol ads predicted consuming larger typical quantities; this was found in the high-income countries, less consistently in the high-middle-income countries and not in the low middle-income country. Three policy-relevant behaviours (prices paid, time of purchase, liking for alcohol ads) mediated the relationships between age, gender, education and consumption in high-income countries., Discussion and Conclusions: International Alcohol Control survey data showed a relationship between policy-relevant behaviours and typical quantities consumed and support the likely effect of policy change (trading hours, price and restrictions on marketing) on heavier drinking. The path analysis also revealed policy-relevant behaviours were significant mediating variables between the effect of age, gender and educational status on consumption. However, this relationship is clearest in high-income countries. Further research is required to understand better how circumstances in low-middle-income countries impact effects of policies., (© 2018 The Authors Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

Aim: To assess the impact of the Sale and Supply of Alcohol Act 2012 (SSAA) on the alcohol environment from 2013 to 2015., Method: A mixed methods study incorporating key informant interviews and administrative data to assess changes between 2013 and 2015. Perceptions of the alcohol environment, policy enforcement and policy compliance were thematically analysed and quantitative ratings summarised. Concurrent changes to drink driving law were included., Results: The SSAA led to a slight reduction in very late night availability in urban centres via the national 4am limit for on-licensed premises trading, which had strong compliance and enforcement. A slight increase in the perceived difficulty of obtaining licences was attributed to increased public opposition, licensing procedures and expanded application criteria. Proposed local alcohol policy (LAP) limits on trading hours and premise locations were delayed and weakened by extensive legal appeals from alcohol retailers. Only five LAPs were in force by 2015. No impact on number of premises, supply to minors or marketing was identified. Reductions in drink drive behaviour and increased availability of lower-strength beer were attributed to the lower legal blood alcohol limit for driving., Conclusion: Maximum trading hours were the only element of the SSAA found to create a swift change in the alcohol environment, by slightly reducing availability in main cities. LAPs and new licence criteria may gradually constrain future availability, but the strength of LAPs has been muted by alcohol industry appeals. Introducing national, evidence-based policy measures would assist the SSAA to achieve its aim of minimising harm more swiftly, as would measures to protect the LAP development process from alcohol industry influence., Competing Interests: All authors report grants from the Health Research Council of New Zealand during the conduct of the study.

Aims: To report population estimates of service use because of someone else's drinking in New Zealand, investigate whether greater exposure to heavy drinkers relates to greater service use and examine demographic predictors of such service use., Methods: A general population survey of respondents aged 12-80 years was conducted in New Zealand. The sample size was 3,068 and response rate 64%. Respondents' use of police and health-related services because of someone else's drinking were measured along with self-reports of heavy drinkers in their lives, demographic variables and own drinking., Results: Ten percent of New Zealanders reported having called the police at least once in the past 12 months because of someone else's drinking-corresponding to 378,843 New Zealanders making at least one call to police. Almost 7% of the sample, representing 257,613 New Zealanders, reported requiring health-related services at least once for the same reason., Conclusions: There are considerable numbers of New Zealanders requiring intervention from police or health-related services due to the effects of someone else's drinking. Further, increased exposure to heavy drinkers among respondents predicted increased service use. Heavy drinkers place increased burden on police and health-related services, not only because of directly attributable effects but because they impact others., Competing Interests: Nil.

The alcohol industry have attempted to position themselves as collaborators in alcohol policy making as a way of influencing policies away from a focus on the drivers of the harmful use of alcohol (marketing, over availability and affordability). Their framings of alcohol consumption and harms allow them to argue for ineffective measures, largely targeting heavier consumers, and against population wide measures as the latter will affect moderate drinkers. The goal of their public relations organisations is to 'promote responsible drinking'. However, analysis of data collected in the International Alcohol Control study and used to estimate how much heavier drinking occasions contribute to the alcohol market in five different countries shows the alcohol industry's reliance on the harmful use of alcohol. In higher income countries heavier drinking occasions make up approximately 50% of sales and in middle income countries it is closer to two-thirds. It is this reliance on the harmful use of alcohol which underpins the conflicting interests between the transnational alcohol corporations and public health and which militates against their involvement in the alcohol policy arena. [Caswell S, Callinan S, Chaiyasong S, Cuong PV, Kazantseva E, Bayandorj T, Huckle T, Parker K, Railton R, Wall M. How the alcohol industry relies on harmful use of alcohol and works to protect its profits. Drug Alcohol Rev 2016;35:661-664]., (© 2016 Australasian Professional Society on Alcohol and other Drugs.)

Background: Limited research suggests the context in which drinking occurs may contribute to specific alcohol-related consequences. Therefore the aims are to (i) determine whether the use of drinking contexts affects risks for several drinking consequences among young people in the general population and (ii) assess the degree to which additional risks are associated with greater levels of drinking in those contexts., Methods: A New Zealand survey of 16- to 29-year-olds asked about context-specific drinking and incidence of alcohol-related consequences grouped as follows: total, alcohol-related disorderly behavior, symptoms of dependence, effects of heavier drinking, and felt effects the next day. A context-specific dose-response model separated the effects of frequency (i.e., how often someone consumes 1 drink in each context) and context-specific quantity (i.e., the count of each successive drink consumed above the first), and these were estimated as predictors of consequences. Demographic covariates were included., Results: Exposure (number of visits): Increased exposure to drinking at bars/nightclubs, even at a very low level of consumption, that is, 1 drink, was independently related to the experience of greater consequences, including alcohol-related disorderly behavior. Risks for alcohol-related consequences were more strongly related to exposure to bars/nightclubs than they were to heavier drinking in that context. Greater use of private motor vehicles and outdoor public places was also associated with greater consequences (independently of the heavier drinking in these contexts). Quantity: Risk of consequences associated with others' home, restaurants, and own home depended primarily on quantity consumed., Conclusions: Bars/nightclubs are inherently risky contexts for drinking by young people and improved controls are required. Drinking at others' home, private motor vehicles, and outdoor public places were also associated with consequences; prevention efforts increasing the price and reducing the availability of takeaway alcohol should work to reduce consequences at these contexts. Innovative context-specific interventions may be useful., (Copyright © 2016 by the Research Society on Alcoholism.)

Background: Our goal was to investigate the role of behaviors amenable to policy change in mediating the relationship between alcohol consumption in off and on premises, age, and 2 measures of socioeconomic status (education and income)., Methods: A cross-sectional general population survey was analyzed by using Bayesian path analysis to understand direct and mediating pathways. A total of 1,900 drinkers (past 6 months), aged 18 to 65 years, living in households with landline phones participated in the study. Measures were as follows: typical quantities of alcohol consumed per occasion, frequency of drinking, both off and on premise; gender, age groups; and years of education, personal income, prices paid, time of purchase, and liking for alcohol advertisements., Results: Later times of purchase predicted larger quantities consumed (on and off premise) and more frequent drinking (on premise only). Younger people and males purchased later, and this mediated their heavier consumption. Lower prices paid predicted larger quantities consumed (on premise) and higher frequency of drinking (off premise). Younger and male respondents paid lower prices, and this mediated larger quantities consumed on premise and more frequent drinking off premise. Less well educated paid lower prices, and this mediated drinking more frequently off premise among this group. Liking for alcohol ads predicted drinking larger quantities and higher frequency both off and on premise. Younger and male respondents reported greater liking for ads, and this mediated their consumption of larger quantities and more frequent drinking both on and off premise. Those with higher income drank larger amounts on premise and more frequently on and off, but there were no mediating effects from the policy-relevant variables., Conclusions: Heavier drinking patterns by young people and those less well educated could be ameliorated by attention to alcohol policy., (Copyright © 2016 by the Research Society on Alcoholism.)

Aims: The minimum purchase age (MPA) for alcohol in New Zealand (NZ) was reduced from 20 to 18 years in 1999. We assessed the degree to which this change was associated with alterations in uses of drinking contexts, drinking and related problems., Methods: NZ National Alcohol Surveys among people 14+ years of age provided demographics, frequencies and amounts consumed in drinking places, and problem measures for 1995, 2000 and 2004. Censored regression estimates of parameters of a context-specific dose-response model identified MPA-associated changes in drinking and problems., Results: The lowered MPA was associated with more frequent drinking at pubs/nightclubs among the newly of-age 18-19-year-olds (b = 15.26, P = 0.009), moderated drinking quantities at these places (b = -0.94, P = 0.034) and greater quantities consumed at home (b = 1.01, P = 0.010) and others' homes (b = 0.87; P = 0.029). Drinking frequency and quantity in the 16-17-year age group increased at home (b = 22.11, P = 0.040 and b = 1.22, P = 0.002) and others' homes (b = 11.65, P = 0.002 and b = 0.91, P = 0.021). Problems associated with drinking contexts changed post-MPA (G(2)  ≥ 27.45, P ≤ 0.002), specifically increased association with drinking in pubs/nightclubs (b = 0.09, P < 0.001) across both age groups., Conclusions: The 1999 change in New Zealand's minimum purchase age for alcohol from 20 to 18 years appears to have been associated with substantive changes in uses of drinking contexts, drinking and associated drinking problems among 16-19-year-olds., (© 2015 Society for the Study of Addiction.)

Objectives: We assessed the long-term effect of lowering the minimum purchase age for alcohol from age 20 to age 18 years on alcohol-involved crashes in New Zealand., Methods: We modeled ratios of drivers in alcohol-involved crashes to drivers in non-alcohol-involved crashes by age group in 3 time periods using logistic regression, controlling for gender and adjusting for multiple comparisons., Results: Before the law change, drivers aged 18 to 19 and 20 to 24 years had similar odds of an alcohol-involved crash (P = .1). Directly following the law change, drivers aged 18 to 19 years had a 15% higher odds of being in an alcohol-involved crash than did drivers aged 20 to 24 years (P = .038). In the long term, drivers aged 18 to 19 years had 21% higher odds of an alcohol-involved crash than did the age control group (P ≤ .001). We found no effects for fatal alcohol-involved crashes alone and no trickle-down effects for the youngest group., Conclusions: Lowering the purchase age for alcohol was associated with a long-term impact on alcohol-involved crashes among drivers aged 18 to 19 years. Raising the minimum purchase age for alcohol would be appropriate.

Background: This study reports findings from the International Alcohol Control (IAC) study that assesses the impact of alcohol control policy on consumption and policy-related behaviors. Modeled on the International Tobacco Control study that uses longitudinal surveys with comparison between countries, the baseline survey was carried out in New Zealand. This study reports analysis of the purchasing behavior respondents report separately for on- and off-premise outlets, providing validation data for both alcohol consumption and reported prices., Methods: New Zealand is a high-income country with an adult per capita alcohol consumption (as of 2011) of 9.5 l. The survey was carried out among a nationally representative sample of drinkers. Interview data on place and time of purchase, amounts purchased, price paid, and consumption (beverage and location specific) was collected. Relationships between policy relevant variables and consumption were modeled taking into account demographic variables. Validation was provided by government data on alcohol available for consumption, aggregate expenditure and prices from the Consumer Price Index., Results: Drinkers paying low prices at on- or off-licensed premises had higher odds of consuming 6+ drinks on a typical occasion, as did drinkers purchasing alcohol at later times. Regarding frequency, drinkers purchasing at later times were more likely to be daily drinkers. Lower price in off licenses but not on licenses predicted daily drinking. The data collected accounted for approximately 96% of alcohol available for consumption and the prices accounted for 98% of aggregate expenditure., Conclusions: Valid survey data were collected to give an accurate picture of alcohol consumption and prices paid by drinkers. Heavy drinkers were more likely to buy cheaper alcohol and purchase at later times; 2 policy issues under discussion in many settings. This analysis suggests the IAC study that has the potential to provide data to contribute to the debate on appropriate policy responses to reduce alcohol-related harm., (Copyright © 2014 by the Research Society on Alcoholism.)

Objective: To assess relationships between area level deprivation and drinking patterns among adolescents., Method: This study uses data from the national New Zealand Alcohol Survey 2004 comprising 1828, age range 12-19 years. A multilevel linear regression was conducted using NZDep2001 (a composite deprivation measure) as the exposure and alcohol use (quantity and frequency) as outcome., Results: A J-shaped association was observed between area level deprivation and quantity of adolescents' alcohol use after controlling for age, sex, ethnicity, and individual socioeconomic position; where adolescents living in the most deprived areas consumed the heaviest quantities of alcohol. No association was found for frequency of drinking., Conclusion: This study found a J-shaped relationship between area-level disadvantage and increased quantities consumed, where adolescents living in the most deprived areas typically consumed the heaviest quantities of alcohol. However, our study has also highlighted that future research may better isolate an independent relationship between deprivation and consumption in adolescents by accounting for structural variables related to both deprivation and consumption, such as alcohol outlet density., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: This paper describes a new multicountry collaborative project to assess the impact of alcohol control policy. Longitudinal surveys of drinkers in a number of participating countries and analysis of the policy context allow for the assessment of change over time within countries and comparison between countries. The design of the study is modeled on the International Tobacco Control study and aims to assess the impact of alcohol policies in different cultural contexts on policy-related behaviors and alcohol consumption. A survey instrument and protocol for policy analysis have been developed by the initial participating countries: England, Scotland, Thailand, South Korea, and New Zealand. The first round of data collection is scheduled for 2011-2012., Measurements: The survey instrument (International Alcohol Control [IAC] survey) measures key policy relevant behaviors: place and time of purchase, amounts purchased and price paid; ease of access to alcohol purchase; alcohol marketing measures; social supply; perceptions of alcohol affordability and availability and salience of price; perceptions of enforcement; people's experiences with specific alcohol restrictions; support for policy and consumption (typical quantity, frequency using beverage and location-specific measures). The Policy Analysis Protocol (PoLAP) assesses relevant aspects of the policy environment including regulation and implementation., Results: It has proved feasible to design instruments to collect detailed data on behaviors relevant to alcohol policy change and to assess the policy environment in different cultural settings., Conclusions: In a policy arena in which the interest groups and stakeholders have different perceptions of appropriate policy responses to alcohol-related harm, a robust methodology to assess the impact of policy will contribute to the debate., (Copyright © 2012 by the Research Society on Alcoholism.)

Objective: The aim of this study was to assess trends in drinking patterns and alcohol-related problems among age and gender groups in the context of a liberalized alcohol policy environment., Method: Eleven comparable general population alcohol surveys were conducted between 1990 and 2000 in Auckland, New Zealand, during which a substantial number of liberalizing alcohol policy changes occurred. Measurements included typical-occasion quantity and frequency of drinking in the last 12 months. Self-reported alcohol-related problems in the last 12 months were divided into two groups based on risk curve analysis: threshold problems (experienced only once a high level of consumption is reached) and nonthreshold problems (those exhibiting a dose-response relationship). Age groups were 14-19, 20-24, 25-39, and 40-65 years., Results: Significant increases in typical-occasion quantity were found for young men and young women ages 14-19 years and for women 20-24 and 40-65 years. The increase was most marked among those 14-19 years old. Only women ages 25-39 years increased how often they drank. The prevalence of threshold problems significantly increased among male drinkers ages 14-19 and 40-65 years. The proportion of 14- to 19-year-olds experiencing threshold problems was observed to be higher in each year compared with those 40-65 years old, and the 14- to 19-year-olds experienced a greater year-on-year increase. Increases in nonthreshold alcohol-related problems occurred for the youngest and oldest males and for most female age groups (14-19, 25-39, and 40-65 years). The increase was most marked among those 14-19 years old., Conclusions: Increases in quantities consumed and alcohol-related problems were found predominantly among young people and women. The youngest age group, those 14-19 years old, experienced the most marked increases in quantity consumed and problems including, for males, the experience of more serious problems such as "had hands shake in the morning" (experienced only once a high level of consumption is reached).

Introduction and Aims: Significant changes have occurred in the alcohol environment in New Zealand recently and there has been debate about how trends in alcohol consumption may currently look. This paper reports trends in drinking over three general population samples in New Zealand., Design and Methods: Three nationally representative comparable surveys were analysed for trends in: prevalence of drinking, typical occasion quantity, annual frequency and heavier drinking (5+ drinks). Analyses assessed the mean difference of the measures at each year point. Adjustments for multiple comparisons were made. Analysis was undertaken for age and separately for gender., Results: Increases in quantities consumed on a typical occasion occurred for the majority of age groups between 1995 and 2000. Women were as likely as men to increase the quantities they consumed. Observing differences between age groups found that young people tended to show the greatest increases in quantity (including heavier drinking) and frequency of consumption between 1995 and 2000. Drinking levels remained relatively stable between 2000 and 2004 with the exception of increases in abstention for some of the younger groups and increases in quantities consumed and heavier drinking among some of the older men., Discussion and Conclusions: Increases in quantities consumed per occasion have occurred almost across the board between 1995 and 2000 in New Zealand. Women were as likely as men to increase the quantities they consumed. Young people tended to show the greatest increases in quantity (including heavier drinking) and frequency of consumption between 1995 and 2000. Drinking remained relatively stable between 2000 and 2004., (© 2010 Australasian Professional Society on Alcohol and other Drugs.)

Aim: There is a lack of research, internationally and in New Zealand, on the harms experienced as a result of drinking by others. Such effects have often been neglected in policy development and in estimates of the economic burden associated with alcohol consumption. This study describes the broad range of harms reported by New Zealanders due to the drinking of someone else., Method: A representative national survey was conducted using Computer Assisted Telephone Interviewing with New Zealanders aged 12 to 80 years (N=3068) in 2008/2009 (response rate - 64%). Harms experienced due to the drinking of others were reported along with demographic variables., Results: One in four respondents indicated that they had at least one heavy drinker in their life. Most of these respondents indicated they had experienced a range of harms because of this person's drinking. Further, 17% of respondents with children reported that their children experienced harm because of the drinking of someone else. Seventy-one percent of those sampled reported experiencing at least one harm because of the drinking of a stranger., Conclusion: A large proportion of New Zealanders report the experience of physical, social, economic, and psychological harms because of the drinking of others. These harms should be considered in the discussion of alcohol policy.

Aims: The impact of alcohol on those other than the drinker is an under-researched area with important policy implications. This study is a first step in investigating relationships between exposure to heavy drinkers in respondent's lives with measures of health status and wellbeing., Design Setting and Participants: A cross-sectional general population survey was carried out among 3068 New Zealand residents aged 12-80 years (response rate 64%) using an in-house computer-assisted telephone interviewing system., Measurements: Respondents' estimates of health status (European Quality of Life-5 Dimensions) and subjective wellbeing (Personal Wellbeing Index) were measured along with self-reports of heavy drinkers in their lives, demographic variables and own drinking., Findings: More than one in four of the sample had experienced someone they considered to be a heavy drinker in their environment in the past 12 months. An index of exposure to heavy drinkers, reflecting numbers of heavy drinkers and cohabitation, predicted lower health status and personal wellbeing while controlling for demographic variables and respondent's own drinking., Conclusions: Cross-sectional data from a general population sample suggest that there is a relationship between exposure to heavy drinkers and reduced personal wellbeing and poorer health status. Exposure to heavy drinkers may have negative impacts for others., (© 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.)

Aim: To identify independent relationships between socio-economic status and drinking patterns and related consequences and to identify socio-economic groups at risk for heavier consumption., Design and Setting: Three comparable national telephone surveys were utilized: 1995, 2000 and 2004. The respondents were aged 18-65 years. Contextual information includes that a number of liberalized alcohol policy changes occurred over the time of the surveys., Results: Educational qualification, income and occupation were associated independently with alcohol consumption. There were indications that the different dimensions of drinking (quantity and frequency) had different relationships with socio-economic status (SES). For example, lower SES groups drank heavier quantities while higher SES groups drank more frequently. SES, however, did not play a major role predicting drinking consequences once drinking patterns were controlled for, although there were some exceptions. It was the lower-to-average SES groups that were at greater risk for drinking heavier quantities compared to other SES groups in the population (as they had sustained increases in the quantities they consumed over time where other SES groups did not)., Conclusion: Socio-economic status was related independently to drinking patterns and there were indications that SES interacted differently with the different dimensions of drinking (quantity and frequency). For the most part, socio-economic status was not related independently to the experience of alcohol-related consequences once drinking patterns were accounted for. It was the lower-to-average SES groups that were at greater risk for drinking heavier quantities compared to other SES groups in the population.

Aim: This study examines the relationship between physical, socio-economic and social environments and alcohol consumption and drunkenness among a general population sample of drinkers aged 12-17 years. DESIGN, SETTING, PARTICIPANTS AND MEASURES: The study was conducted in Auckland, New Zealand. The design comprised two components: (i) environmental measures including alcohol outlet density, locality-based measure of willingness to sell alcohol (derived from purchase surveys of outlets) and a locality-based neighbourhood deprivation measure calculated routinely in New Zealand (known as NZDEP); and (ii) the second component was a random telephone survey to collect individual-level information from respondents aged 12-17 years including ethnicity, frequency of alcohol supplied socially (by parents, friends and others), young person's income; frequency of exposure to alcohol advertising; recall of brands of alcohol and self-reported purchase from alcohol outlets. A multi-level model was fitted to predict typical-occasion quantity, frequency of drinking and drunkenness in drinkers aged 12-17 years., Findings: Typical-occasion quantity was predicted by: frequency of social supply (by parents, friends and others); ethnicity and outlet density; and self-reported purchasing approached significance. NZDEP was correlated highly with outlet density so could not be analysed in the same model. In a separate model, NZDEP was associated with quantity consumed on a typical drinking occasion. Annual frequency was predicted by: frequency of social supply of alcohol, self-reported purchasing from alcohol outlets and ethnicity. Feeling drunk was predicted by frequency of social supply of alcohol, self-reported purchasing from alcohol outlets and ethnicity; outlet density approached significance. Age and gender also had effects in the models, but retailers' willingness to sell to underage patrons had no effects on consumption, nor did the advertising measures. The young person's income was influential on typical-occasion quantity once deprivation was taken into account., Conclusion: Alcohol outlet density was associated with quantities consumed among teenage drinkers in this study, as was neighbourhood deprivation. Supply by family, friends and others also predicted quantities consumed among underage drinkers and both social supply and self-reported purchase were associated with frequency of drinking and drunkenness. The ethnic status of young people also had an effect on consumption.

Aim: To report patterns of use of ready to drinks (RTDs) and to assess if RTD consumers have heavier drinking patterns. RTDs were introduced in 1995., Method: Data from a general population sample of 7201 respondents aged 14-65 years, in New Zealand in 2004, were modelled., Results: Nineteen per cent of respondents consumed RTDs. Respondents aged 14-17 and 18-24 years and females were the largest consumers of RTDs. Compared to beer, wine or spirits, being an RTD consumer predicted (1) higher typical occasion quantities for respondents aged 14-17, 18-24 and 25+ years and (2) heavier drinking for those aged 14-17 and 18-24 years. When amounts of beverages consumed were modelled, quantity of RTDs predicted higher typical occasion quantities among females of all ages. Among males beer was more predictive. Similar results were found for the heavier drinking measure. For 14-17-year-old females, RTDs consumption predicted higher annual frequency, but for the other females and males the amount of wine or beer consumed predicted higher frequency., Conclusion: RTDs were most popular among young people aged 14-17 years, and females. RTDs predicted higher typical occasion alcohol consumption and heavier drinking better than any other beverage for females aged 14-17 years. For the other age and gender groups, other beverages predicted higher quantity and frequency consumption.

Alcohol purchase surveys were undertaken as part of two New Zealand community action projects (one in a large metropolitan area and one in a small town) that aimed at reducing alcohol consumption-related harm for young people. Baseline surveys in both places indicated poor age verification practices. The two follow-up surveys in the metropolitan area showed a decrease in sales made without age identification between 2002 (60%) and 2003 (46%). However, an increase between 2003 (46%) and 2004 (55%) occurred. In the metropolitan area, regulatory staff in three out of seven jurisdictions increased enforcement due to the 2002 survey and follow-up work; this did not happen following the 2003 survey. In the small town, results indicated positive changes in verification practices over time. In addition, licensee meetings, host responsibility training, and a regional project all occurred following the surveys. The surveys have also had important indirect effects. Closer monitoring and enforcement activity due to the surveys has contributed to the amendment of alcohol legislation in New Zealand.

Aim: To assess alcohol-related harms and offences in New Zealand from 1990 to 2003, a period of alcohol policy liberalization, that included the lowering of the purchase age from 20 to 18 years in 1999., Design, Setting and Participants: Time trend analyses were carried out on routinely collected data for prosecutions for driving with excess alcohol; alcohol-involved vehicle crashes (all and fatal) and prosecutions for disorder offences. These were carried out separately for those aged 14-15, 16-17, 18-19, 20-24 and 25 years and over., Measurements: Rates of: prosecutions for driving with excess alcohol (1990-2003); rates of alcohol- involved vehicle crashes (all and fatal) (1990-2003); and rates of prosecutions for disorder offences (1994-2003)., Findings: Effects of alcohol policy liberalization: positive trends were found in the rates of prosecutions for disorder in the 16-17, 18-19, 20-24 and 25 + age groups; with 18-19-year-olds and 16-17-year-olds having the largest rates and largest positive trend in rates. For 16-17-year-olds, there was a positive trend in the rates of prosecutions for excess breath alcohol. Negative trends in rates were found for alcohol-related crashes (all and fatal) among all age groups. Negative trends for those over 16-17 years were found for prosecutions for driving with excess breath alcohol (this was prior to the lowering of the purchase age). Effects of lowering the minimum purchase age: the lowering of minimum purchase age coincided with an increase in the trend of alcohol-related crashes for 18-19-year-olds; the next largest increase was among the 20-24-year-olds (all other age groups also increased but at a much lower rate). A similar result was found for driving with excess alcohol for those aged 18-19 (and those aged 20-24 years). An increase in the rates of prosecutions for disorder offences occurred for the 14-15-year-old group following the lowering of the purchase age., Conclusion: The liberalization of alcohol throughout the 1990s may have influenced younger people more, as reflected in increases in their disorder offences and drink driving. The lowering of the minimum purchase age may have led to an increase in drink-driving among the 18-19-year-olds (those directly affected by the change in purchase age).

This paper describes the evaluation of a regional community action intervention to reduce access to alcohol from off-license premises by minors. The intervention focussed on: (1) monitoring alcohol sales made without age identification from off-licenses; (2) utilizing data on alcohol sales for media advocacy and direct contact with alcohol retailers and (3) working with key enforcement staff to encourage increased monitoring and enforcement of minimum purchase age legislation for off-licenses. Evaluation of this intervention used a case study design. Purchase survey data was obtained before and after intervention. Media items were monitored and included pre- and post-intervention phases. Interviews, with key enforcement staff, and document review were undertaken post-intervention. Purchase survey data showed a significant decrease (p < 0.05) in sales of alcohol made to young people without age identification pre- and post-intervention. Pre-intervention: 60% of visits resulted in a sale made without age identification; post-intervention this proportion was 46%. Principal component analysis of newsprint media indicated increased coverage of items advocating improved age checking for off-licenses following intervention. Interview data and document review indicate that some enforcement staff in the region implemented increased enforcement strategies including, controlled purchase operations and increased visits to off-licenses due to the intervention. Evaluation findings indicate that collaborative and intersectoral community action interventions implemented regionally can be effective in redirecting resources to achieve preventive outcomes at a population level.

Background: There are two main ways to assess alcohol consumption in a population: per capita estimates, usually derived from data on taxable alcohol available for consumption, and population-based surveys. Population-based survey estimates of alcohol consumption are often compared with estimates based on taxable alcohol available for consumption as a measure of validity. Discrepancies between these two measures occur, with the majority of population-based surveys substantially underestimating taxable alcohol available for consumption., Methods: This article argues, however, that high proportions of taxable alcohol available for consumption can be accounted for by population-based surveys and reports a method of data collection for a national alcohol survey that has accounted for 94% of the taxable alcohol in New Zealand., Results: The ability of the survey methodology to account for this proportion of taxable alcohol is likely due to the within-location beverage-specific alcohol consumption measures used in the survey, the process of recording the quantity of alcohol consumed, the use of a computer-assisted telephone interview system, and the population coverage achieved., Conclusions: Population-based surveys using the methodology outlined in this article may account for, if not exceed, the high proportions of taxable alcohol available for consumption estimates for some populations.

Approximately 3.9 kb of DNA, centromere proximal to the previously sequenced Y' element at the right end of chromosome XV in Saccharomyces cerevisiae strain YP1, has been sequenced. A number of the known sub-telomeric repeat sequences were identified, including Y', core X and STRs A, B. C and D. Several of these repeat elements contain potentially functional sequences. In addition, two other members of repeated gene families were identified. The first of these shows 61% and 60% DNA sequence identity to Enolases 1 and 2 respectively. The Enolase-like sequence appears to be species specific, with three copies being found in all strains of S. cerevisiae studied. The location of the three copies is the same for all strains. The second repeated sequence has homology with known open reading frames on chromosomes III, V and XI. There are five or six copies of this sequence in all S. cerevisiae and S. paradoxus strains studied and three in S. bayanus strains. The analysis of this region and comparison to sub-telomeric regions on other chromosomes gives some indication as to the potential functional and structural significance of sub-telomeric repeat sequences. In addition, these findings are consistent with the idea that sub-telomeric regions may be targets for unusual recombination events.