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Tolerance to the effects of alcohol is an important element in the diagnosis of alcohol use disorders (AUD); however, there is ongoing debate about its utility in the diagnosis AUD in adolescents and young adults. This study aimed to refine the assessment of tolerance in young adults by testing different definitions of tolerance and their associations with longitudinal AUD outcomes.Prospective cohort study.Australia.A contemporary cohort of emerging adults across Australia (n = 565, mean age = 18.9, range = 18-21 at baseline).Clinician-administered Structured Clinical Interview for DSM-IV Research Version (SCID-IV-RV) assessed for AUD criteria across five interviews, at 6-month intervals over 2.5 years. Tolerance definitions were operationalized using survey-type response (yes/no), clinician judgement (SCID-IV-RV), different initial drinking quantity and percentage increase thresholds and average heavy consumption metrics. AUD persistence was operationalized by the number of times AUD was present across the 2.5-year study period (n = 491), and new-onset AUD was operationalized as any new incidence of AUD during the follow-up period (n = 461).The (i) SCID-IV-RV clinician judgement [odds ratio (OR) = 2.50, P = 0.005], (ii) an initial drinking quantity threshold of four to five drinks and 50% minimum increase (OR = 2.48, P = 0.007) and (iii) 50% increase only (OR = 2.40, P = 0.005) were the tolerance definitions more strongly associated with any new onset of AUD throughout the four follow-up time-points than other definitions. However, these definitions were not associated with persistent AUD (Ps 0.05). Average heavy consumption definitions of tolerance were most strongly associated with persistent AUD (OR = 6.66, P = 0.001; OR = 4.65, P = 0.004) but not associated with new-onset AUD (Ps 0.05).Initial drink and percentage change thresholds appear to improve the efficacy of change-based tolerance as an indicator for new-onset alcohol use disorder diagnosis in self-report surveys of young adults. When predicting persistent alcohol use disorder, average heavy consumption-based indicators appear to be a better way to measure tolerance than self-reported change-based definitions.

Background: Parents are the main supplier of alcohol to children but it is not known whether mothers and fathers equally contribute to the supply of alcohol to their female and male children as these children transition to adulthood. Objectives: i) to determine whether the gender of the parent is associated with the gender of the adolescent offspring when alcohol is supplied and ii) whether the gender of the parent supplying is associated with gender differences in adolescent binge drinking and alcohol related harms. Methods: Longitudinal cohort of 1,927 (males = 1052) Australian adolescents (mean age 12.9 years), recruited in 2010/11 from schools in Australia and surveyed annually for six years. We assessed the association between adolescent and parent gender related to subsequent adolescent drinking, binge drinking (>4 standard drinks), and alcohol-related harms. Results: At mean age of 12.9 years about one in ten children report parental supply of alcohol which increases to about four in ten children by 17.8 years. Mothers consistently more often supply their daughters with alcohol than their sons, [Wave 5 OR 1.77 (1.53,2.05)], while mothers less often supply sons than their daughters, [Wave 5 OR 0.82 (0.71,0.95)]. Mothers’ supply of alcohol to daughters predicts substantially increased odds of daughters binge drinking, [OR 1.67 (1.10,2.53)] and experiencing alcohol related harms, [OR 1.65 (1.10,2.48)]. Conclusion: There is a need to involve both mothers and fathers and to equally target female and male children in programs to reduce the harmful consequences of parental supply of alcohol to their children.

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

BackgroundYoung people may have elevated risk for poorer mental health during the coronavirus disease 2019 (COVID-19) pandemic, yet longitudinal studies documenting this impact are lacking. This study assessed changes in mental health and help-seeking since COVID-19 restrictions in young Australians, including gender differences.MethodsData were drawn from a recent subsample (n = 443; 60% female; Mage = 22.0) of a prospective cohort originally recruited in secondary school to complete annual surveys. The subsample completed an additional COVID-19 survey during COVID-19 restrictions (May–June 2020), which was compared to responses from their latest annual survey (August 2019–March 2020). Mixed effect models with time and gender as the primary predictors were conducted for: (i) scores on the Patient Health Questionnaire Depression 9-item (PHQ-9) and Generalised Anxiety Disorder 7-item (GAD-7) modules assessed before and during COVID-19 restrictions, and (ii) self-reported help-seeking from a health professional in February 2020, and the month preceding May–June 2020.ResultsMean symptom scores increased from before to during COVID-19 restrictions on the PHQ-9 (coefficient: 1.29; 95% CI 0.72–1.86) and GAD-7 (0.78; 95% CI 0.26–1.31), but there was no increase in help-seeking over time (odds ratio 0.50; 95% CI 0.19–1.32). There was no evidence of differential changes by gender.ConclusionsThis study found increases in depression and anxiety symptoms but not greater help-seeking among young Australian adults during the first wave of the pandemic. Increasing availability and awareness of accessible treatment options and psychoeducation is critical, as well as further research into risk and protective factors to help target treatment to this vulnerable age group.

Background and aims: Experience of alcohol-induced memory blackouts in adolescence may be an important risk factor for later harms. This longitudinal study (i) modelled trajectories of alcohol-related blackouts throughout adolescence, (ii) explored early-adolescent predictors of blackout trajectories and (iii) examined the association between blackout trajectories and alcohol use disorder (AUD) symptoms. Design: Longitudinal study in which data from six annual surveys of a longitudinal cohort of Australian adolescents were used to model latent class growth trajectories of blackouts, adjusting for alcohol consumption frequency and typical quantity. Regression models were used to determine whether parent, child and peer factors at baseline (mean age = 12.9) predicted profiles of blackout trajectory membership and whether blackout trajectories predicted meeting criteria for AUD in early adulthood (mean age = 19.8). Setting and participants: Australian adolescents (n = 1821; mean age = 13.9-18.8 years). Measurements: Alcohol-related blackouts, alcohol consumption frequency, typical consumption quantity and DSM-5 AUD in early adulthood were all self-reported. Findings: We identified a three-class solution: delayed alcohol initiation, rare blackouts (n = 701; 38.5%); early initiation, rare blackouts (n = 869; 47.7%); and early initiation, increasing blackouts (n = 251; 13.8%). Female sex was associated with increased risk of early initiation, increasing blackouts relative to delayed initiation, rare blackouts [relative risk ratio (RRR) = 3.90; 99.5% confidence interval (CI) = 1.96, 7.76] and relative to early initiation, rare blackouts (RRR = 2.89; 99.5% CI = 1.42, 5.87). Early initiation, rare blackouts [odds ratio (OR) = 1.96; 99.5% CI = 1.17, 3.29] and early initiation, increasing blackouts (OR = 4.93; 99.5% CI = 2.32, 10.48) were each associated with increased odds of meeting criteria for AUD in early adulthood relative to delayed initiation, rare blackouts. Early initiation, increasing blackouts was associated with increased odds of meeting criteria for AUD in early adulthood relative to early initiation, rare blackouts (OR = 2.51; 99.5% CI = 1.18, 5.38). Conclusions: Females in Australia appear to be at higher risk of adolescent alcohol-related blackouts independent of alcohol consumption levels and age of initiation. Alcohol-related blackouts may be associated with later alcohol use disorder.

Objective:The Anglo-Celtic colonists of Australia and New Zealand brought with them heavy beer-drinking customs, and each country later developed similar temperance movements and alcohol policies. ...

AIMS: Despite legal age limits set for alcohol consumption, parents are one of the main suppliers of alcohol to underage minors. Although supply from non-parental sources has been found to be associated with greater risk of harm compared with parental supply, the association between parental supply and supply from other sources is unclear. This study investigated the associations between parental supply of sips and whole serves of alcohol on subsequent other supply, conditional on current supply from non-parental sources. METHODS: Data from the Australian Parental Supply of Alcohol Longitudinal Study cohort of adolescents was used. A cohort of 1927 Australian children recruited in grade 7 (mean age 12.9 years) was surveyed annually from 2010 to 2016 (94%, n = 1821 included for analyses). The primary outcome was alcohol exposure from other sources ('other supply'), including alcohol supply from other adults, friends, siblings, or self-supply, compared with adolescents reporting no supply from these sources. Analyses were conducted using random intercept logistic regression (to account for within-respondent correlation). RESULTS: Parental supply of alcohol alone was associated with increased odds of receiving alcohol from other non-parental sources in subsequent years (OR: 1.99; 95% CI: 1.65-2.39) after adjusting for confounders. Increased odds of subsequent other supply were associated with current parental supply of sips (OR: 1.92; 95% CI: 1.56-2.36) and whole drinks (OR: 2.76; 95% CI: 1.85-4.11). CONCLUSIONS: Parental supply of alcohol appears to increase the risk of subsequent supply of alcohol from other sources in certain contexts.

Background and aims In February 2014, pubs and bars in Kings Cross (KX) and the central business district (CBD) of Sydney, Australia were required to stop serving alcohol by 3 a.m. and operate a 'lockout' from 1.30 a.m. We studied changes in the incidence of assault during the following 5 years, including possible displacement. Design Controlled before-and-after ecological study. Setting Sydney, Australia. Participants/cases Assaults in specified areas in which police apprehended at least one person. Measurements We compared change in non-domestic assault in KX and the CBD with adjacent areas, other city areas, and outer suburbs, adjusting for the trend in the rest of the state during three periods: 6 p.m.-1.29 a.m. ('pre-lockout'), 1.30 a.m.-2.59 a.m. ('lockout') and 3 a.m.-6 a.m. ('after last-drinks'). We constructed interrupted time-series models with terms for secular trend and season, producing incidence rate ratios (IRR) for step and slope parameters. We performed sensitivity analyses on impacts of missing location data. Findings After the intervention, assaults fell 38% in KX (IRR for step change = 0.62, 95% CI = 0.49, 0.79) and 10% in the CBD (IRR = 0.90, 95% CI = 0.80, 0.99). Assaults continued declining in KX (IRR for slope = 0.990, 95% CI = 0.982, 0.998) and later increased in adjacent areas (IRR for slope = 1.006, 95% CI = 1.001, 1.011) and earlier in the evenings in both KX and the adjacent areas. The net reduction was 627 assaults over 60 months post-intervention, i.e. 10 fewer per month. Estimates were robust to extreme assumptions about missing data. Conclusions The 2014 alcohol supply restrictions for pubs and bars in Kings Cross (KX) and the central business district (CBD) of Sydney, Australia were followed by a substantial reduction in the incidence of assault in KX and to a lesser extent in the CBD, possibly displacing some cases to adjacent areas and earlier in the evening.

Background and Aims Recent research suggests that parental supply of alcohol is associated with more risky drinking and alcohol-related harm among adolescents. However, the overall effect of parental supply throughout adolescence remains unclear, because parental supply of alcohol varies during adolescence. Due to the complexity of longitudinal data, standard analytical methods can be biased. This study examined the effect of parental supply of alcohol on alcohol-related outcomes in early adulthood using robust methods to minimize risk of bias. Design Prospective longitudinal cohort study. Setting Australia Participants A cohort of school students (n = 1906) recruited in the first year of secondary school (average age 12.9 years) from Australian schools in 2010–11, interviewed annually for 7 years. Measurements The exposure variable was self-reported parental supply of alcohol (including sips/whole drinks) during 5 years of adolescence (waves 1–5). Outcome variables were self-reported binge drinking, alcohol-related harm and symptoms of alcohol use disorder, measured in the two waves after the exposure period (waves 6–7). To reduce risk of bias, we used targeted maximum likelihood estimation to assess the (counterfactual) effect of parental supply of alcohol in all five waves versus no supply on alcohol-related outcomes. Findings Parental supply of alcohol throughout adolescence saw greater risk of binge drinking [risk ratios (RR) = 1.53; 95% confidence interval (CI) = 1.27–1.84] and alcohol-related harms (RR = 1.44; 95% CI = 1.22–1.69) in the year following the exposure period compared with no supply in adolescence. Earlier initiation of parental supply also increased risk of binge drinking (RR = 1.10; 95% CI = 1.05–1.14), and any alcohol-related harm (RR = 1.09; 95% CI = 1.05–1.13) for each year earlier parental supply began compared with later (or no) initiation. Conclusions Adolescents whose parents supply them with alcohol appear to have an increased risk of alcohol-related harm compared with adolescents whose parents do not supply them with alcohol. The risk appears to increase with earlier initiation of supply.

INTRODUCTION AND AIMS Risk-based alcohol licensing (RBL) has been introduced in several jurisdictions in Australia, New Zealand and Canada with the intention of reducing harm in and around alcohol outlets. RBL involves tailoring licence fees or regulatory agency monitoring levels according to risk criteria such as trading hours, venue size and compliance history. The aim of this study was to document key informant perspectives including their perceptions of the purpose of RBL, how it works and its active ingredients. DESIGN AND METHODS We conducted semi-structured in-depth interviews with 28 key informants, including four government policy makers, four liquor licensing representatives, four local council members, eight police officers, six licensees, one academic and one community advocate from Victoria, Queensland, the Australian Capital Territory and Ontario, Canada. We analysed the transcripts using a thematic approach. RESULTS Informants varied in their opinions about whether RBL achieved its objective of reducing alcohol-related harm. They identified difficulties in enforcing the compliance history component of the scheme due to loopholes in legislation as a major shortfall, and the need to apply RBL to packaged liquor (off-licence) outlets. They also discussed the need to consider outlet density associated with the location of a venue when assessing venue risk. DISCUSSION AND CONCLUSIONS RBL schemes vary by jurisdiction and emphasise different components. In general, informants surmised that RBL as implemented has probably had little or no preventive effect but suggested that it may be effective with greater monitoring and penalties large enough to deter bad practice.

Supply of alcohol to adolescents is associated with increased alcohol consumption and harms including alcohol use disorder (AUD). We aimed to identify: (1) trajectories of alcohol supply to adolescents; (2) sociodemographic characteristics associated with supply trajectory; (3) patterns of alcohol consumption by supply trajectory; and (4) supply trajectory associations with adverse alcohol outcomes.We used Australian longitudinal survey data (N = 1813) to model latent trajectories of parent and peer alcohol supply over five annual follow-ups (Waves 2-6; MWe identified five alcohol supply classes: (1) minimal supply (n = 739, 40.8%); (2) early parent sips, late peer/parent whole drinks (n = 254, 14.0%); (3) late peer/parent whole drinks (n = 419, 23.1%); (4) early parent sips, mid peer/parent whole drinks (n = 293, 16.2%); (5) early peer/parent whole drinks (n = 108, 6.0%). Compared to minimal supply, the other classes were 2.7-12.9 times as likely to binge drink, 1.6-3.0 times as likely to experience alcohol-related harms, and 2.1-8.6 times as likely to report AUD symptoms at age 19.Earlier supply of whole drinks, particularly from peers, was associated with increased risk of early adulthood adverse alcohol outcomes. While minimal supply represented the lowest risk, supplying sips only in early-mid adolescence and delaying supply of whole drinks until late adolescence is likely to be less risky than earlier supply of whole drinks.

BACKGROUND: Different forms of alcohol-related harm (e.g., hangovers, fighting) may confer differential risk of clinically relevant alcohol problems. We examine: (i) patterns of transition in experiencing alcohol-related harms across adolescence; (ii) whether factors in early adolescence predict transition patterns; and (iii) whether transition patterns predict later alcohol use disorder (AUD) symptoms. METHODS: We used a longitudinal Australian cohort (n = 1828) to model latent class transition patterns of alcohol-related harms across three timepoints (Mage = 13.9, 16.8, 18.8 years). Regression models assessed whether child, peer, and parent factors in early adolescence (Mage = 12.9) predicted harms transition patterns and whether these patterns predicted AUD symptoms in early adulthood (Mage = 19.8). RESULTS: Five transition patterns characterized most of the cohort (n ≈ 1609, 88.0%): (i) minimal harms (n ≈ 381, 20.8%); (ii) late physiological harms (n ≈ 702, 38.4%); (iii) early physiological harms (n ≈ 226, 12.4%); (iv) late all harms (n ≈ 131, 7.2%); and (v) gradual all harms (n ≈ 169, 9.2%). With late physiological harms as the reference, females had increased risk of experiencing early physiological harms (relative risk [RR]: 2.15; 99.5% CI: 1.19, 3.90). Late all harms (RR: 1.71; CI: 1.19, 2.47) and gradual all harms (RR: 1.84; CI: 1.37, 2.47) were each associated with increased odds of meeting criteria for AUD, even when patterns of alcohol consumption are considered. CONCLUSIONS: Adolescents display heterogeneous transition patterns across physiological and psychosocial alcohol-related harms. Females are at greater risk of experiencing early physiological harms. Experience of both physiological and psychosocial harms in late adolescence is an important and potentially modifiable precursor to clinically relevant alcohol problems in early adulthood.

Introduction and aims: Associations between longer-term alcohol-related conditions and licensed outlet trading hours are not well understood. We investigated the association between nightlife-goers’ likelihood of an alcohol use disorder (AUD) and their preference for bars with special permits to remain open ‘late’ (i.e., spent more time there compared to any other venue) until 2 a.m. or 3 a.m. (Friday; Saturday) or midnight (Sunday) compared to bars with ‘standard’ closing times of midnight (Friday; Saturday) or 10 p.m. (Sunday). Design and methods: A cross-sectional observational study was conducted in four major nightlife areas of Perth, Australia, in 2015–2016. We conducted weekend street intercept surveys outside bars between 8 p.m. and 3 a.m. and screened participants who reported alcohol use prior to the survey and spent more time in a bar than any other venue type (n = 667) regarding their past year drinking pattern using AUDIT-C (n = 459). We used gender-specific logistic regression models to estimate associations between AUDIT-C categories (1–4, low risk; 5–7, hazardous; 8–12, active AUD) and preference for bars with different closing times (late vs. standard). Results: A large proportion of participants were hazardous drinkers or had active AUD (83% males; 65% females), and over half preferred a late to a standard closing bar. We found evidence of a positive association between preference for late closing bars and hazardous drinking females (OR = 3.48; 95% CI 1.47–8.23; p = 0.01), but not for females with active AUD, male hazardous drinkers, nor males with active AUD. Discussion and conclusions: Our study adds new evidence on associations between likelihood of AUD among nightlife-goers and trading hours. With increasing international relaxation of trading hours, evidence that late closing bars may be preferred by hazardous drinking females will be of concern to policymakers wanting to curb alcohol-related harms in the community.

Background Adolescents often display heterogenous trajectories of alcohol use. Initiation and escalation of drinking may be an important predictor of later harms. Previous attempts to conceptualise these trajectories lacked adjustment for known confounders of adolescent drinking, which our study has aimed to address by modelling dynamic changes in drinking whilst adjusting for parent, child, and peer factors. Methods Survey data from a longitudinal cohort of Australian adolescents (n = 1813) were used to model latent class alcohol use trajectories over five annual follow-ups (Mage=13.9 and 17.8 years). Regression models determined whether child, parent, and peer factors at baseline (Mage =12.9 years) predicted trajectory membership and whether trajectories predicted self-reported symptoms of AUD in early adulthood (Mage =18.8 years). Results We identified a four-class solution: abstaining (n = 352); late-onset moderate drinking (n = 503); early-onset moderate drinking (n = 663); and early-onset heavy drinking (n = 295). Alcohol-specific household rules reduced risk of early-onset heavy drinking compared to late-onset moderate drinking (RRR: 0.31; 99.5% CI: 0.11, 0.83), whereas substance-using peers increased this risk (RRR: 3.43; 99.5% CI: 2.10, 5.62). Early-onset heavy drinking increased odds of meeting criteria for AUD in early adulthood (OR: 7.68; 99.5% CI: 2.41, 24.47). Conclusions Our study provides evidence that early initiation and heavy alcohol use throughout adolescence is associated with increased risk of alcohol-related harm compared to recommended maximum levels of consumption (late-onset, moderate drinking). Key messages Parenting factors and peer influences in early adolescence should be considered to reduce risk of early initiation and heavy drinking, which in turn reduces risk of later harm.

Background Risk-based licensing (RBL) is among the more recent policy interventions to reduce alcohol-related harm in and around licensed venues. RBL sets licence fees to reflect the venue’s propensity to cause harm as a means of encouraging operators to improve their practices. We assessed whether the introduction of RBL in the Australian states of Queensland and Victoria was associated with a reduction in the incidence of emergency department (ED) injury presentations. Methods We employed an interrupted time series design using Prais-Winsten and Cochrane-Orcutt regression modelling to estimate step and slope parameters in injury incidence rates in each state. We defined the population as residents of the state, aged 15–54 years, the age group we considered most likely to be exposed to the night-time economy. To reduce noise, we confined cases to presentations during times previously identified as correlated with a high probability of alcohol involvement, namely ‘high alcohol hours’ (HAH). We adjusted our models for the alcopops tax, implemented shortly before RBL, and for assaults during low alcohol hours (LAH) as a proxy for other risk factors for assault. Results RBL was not associated with an overall reduction in the incidence of ED injury presentations during HAH in Queensland (β = 0.003; 95% CI: −0.010, 0.003, p = 0.318) or Victoria (β=−0.010; 95% CI: -0.021, 0.001, p = 0.087). Post-hoc subgroup analyses showed a reduction in ED injury presentations among men aged 20–39 years in Victoria (β=−0.026; 95% CI:-0.012, −0.040, p-0.0003) but this was not replicated in Queensland. Conclusion There was little evidence that RBL affected the incidence of ED presentations for injury. This may be due to weak financial penalties being applied to venues assessed as high-risk.

Background Why adolescents’ drinking is associated with their parents’ drinking remains unclear. We examined associations in a prospective cohort study, adjusting for socio-demographic characteristics and family factors. Methods We recruited 1927 children from grade 7 classes (mean age 13 years), and one of their parents, in three Australian states, contacted participants annually from 2010 to 2014, and analysed data from assessments at ages 13, 14, 15 and 16 years. We used the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) subscale to identify hazardous drinking in parents (score ≥5) and children (score ≥3) and constructed mixed-effect logistic regression models, accounting for clustering within school and adjusting for likely confounders. We evaluated the sensitivity of estimates by imputing missing values assuming the data were missing at random vs. missing not at random. Results Parent hazardous drinking predicted mid-adolescent hazardous drinking, e.g. 15 years olds whose parents [adjusted odds ratio (aOR) 2.00; 95% confidence interval 1.51–2.64] or parents’ partners (aOR 1.94; 1.48–2.55) were hazardous drinkers had higher odds of being hazardous drinkers at age 16. The magnitude of univariate associations changed little after adjusting for covariates, and sensitivity analyses confirmed the robustness of the association, across a wide range of assumptions about the missing data. Conclusions The associations between parents’ and their adolescent children’s hazardous drinking are unlikely to be due to confounding by socio-demographic and family factors. Parents should be encouraged, and supported by public policy, to reduce their own alcohol consumption in order to reduce their children’s risk of becoming hazardous drinkers.

Monitoring levels of alcohol-related harm in populations requires indicators that are robust to extraneous influence. We investigated the validity of an indicator for police-attributed alcohol-related assault. We summarized offence records from Queensland Police, investigated patterns of missing data, and considered the utility of a surrogate for alcohol-related assault. Of 242 107 assaults from 2004–2014, in 35% of cases the drug used by the offender was recorded as ‘unknown’. Under various assumptions about non-random missingness the proportion of assaults judged to be alcohol-related varied from 30%–65%. We found a sharp increase in missing data from 2007 suggesting the downward trend from that point is artefactual. Conversely, we found a stable and increasing trend using a time-based surrogate. The volume of missing data and other limitations preclude valid estimation of trends using the police indicator, and demonstrate how misleading results can be produced. Our analysis supports the use of an empirically-based surrogate indicator.

In the original publication [...]

Introduction and aims: Associations between bar trading hours, a government lever for controlling alcohol availability, nightlife-goer intoxication levels and their likelihood of alcohol use disorder (AUD) have not been explored. We investigated whether: (i) participant AUD was associated with blood alcohol concentration (BAC); and, (ii) any association between AUD and BAC was moderated by participant preferred bar (i.e., venue spent most time at) closing time. Design and methods: A cross-sectional observational study using a sample of nightlife-goers who went out drinking in Perth, Western Australia, on weekends in 2015-16. Participants who reported alcohol use that night and spent most time in a bar (n = 667) completed street intercept surveys including AUDIT-C (n = 459) and provided a breath sample to estimate BAC (n = 651). We used gender-specific multinomial logistic regression models to explore associations between participant AUDIT-C score (1–4, lower risk; 5–7, hazardous; 8–12, active AUD), preferred bar type (standard vs. late closing time based on absence or presence of an extended trading permit) and BAC (male: 0–0.049, 0.05–0.099, ≥0.1 g/100 mL; female: 0–0.049, 0.05–0.079, ≥0.08 g/100 mL). Results: Males with active AUD (RR = 3.31; 95% CI 1.30–8.42; p = 0.01) and females with hazardous/active AUD (RR = 9.75; 95% CI 2.78–34.21; p < 0.001) were both more likely to have high-range BAC than their counterparts typically drinking at lower risk. We also found preferred bar type moderated the association between AUDIT-C score and BAC for some males but no females. Males with active AUD and high-range BAC were less likely to prefer late closing bars than males usually drinking at lower risk and high-range BAC (RR = 0.12; 95% CI 0.02–0.96; p = 0.046). Discussion and conclusions: Our study provides evidence of positive associations between AUD and acute intoxication among nightlife-goers and on the moderating effect of bar closing times among males.

Background Governments commonly fund research with specific applications in mind. Such mechanisms may facilitate ‘research translation’ but funders may employ strategies that can also undermine the integrity of both science and government. We estimated the prevalence and investigated correlates of funder efforts to suppress health behaviour intervention trial findings. Methods Our sampling frame was lead or corresponding authors of papers (published 2007–2017) included in a Cochrane review, reporting findings from trials of interventions to improve nutrition, physical activity, sexual health, smoking, and substance use. Suppression events were based on a previous survey of public health academics. Participants answered questions concerning seven suppression events in their efforts to report the trial, e.g., [I was…] “asked to suppress certain findings as they were viewed as being unfavourable.” We also examined the association between information on study funder, geographical location, targeted health behaviour, country democracy rating and age of publication with reported suppression. Findings We received responses from 104 authors (50%) of 208 eligible trials, from North America (34%), Europe (33%), Oceania (17%), and other countries (16%). Eighteen percent reported at least one of the seven suppression events relating to the trial in question. The most commonly reported suppression event was funder(s) expressing reluctance to publish because they considered the results ‘unfavourable’ (9% reported). We found no strong associations with the subject of research, funding source, democracy, region, or year of publication. Conclusions One in five researchers in this global sample reported being pressured to delay, alter, or not publish the findings of health behaviour intervention trials. Regulation of funder and university practices, establishing study registries, and compulsory disclosure of funding conditions in scientific journals, are needed to protect the integrity of public-good research.

Governments' limited adoption of evidence-based policies to reduce alcohol-related harm has been partly attributed to alcohol industry influence. A better understanding of industry political strategy may help protect public policy against vested interests. We examined how industry actors used scientific evidence in their submissions to government alcohol policy consultations.We conducted a content analysis of 214 submissions from industry actors in 21 Australian public consultations between 2013 and 2017. Represented industry actors included alcohol producers and retailers, trade associations, licensees, and associated entities that derive commercial benefit from alcohol (e.g., advertising companies). Adapting an existing framework, we classified industry practices into two categories: (a) misuse of evidence and (b) denial of the effectiveness of evidence-based strategies.Almost all submissions (91%) denied the effectiveness of evidence-based strategies; the most common denial practices were making unsubstantiated claims about adverse effects of policies (76%) and promoting alternatives without evidence (71%). The misuse of scientific evidence was apparent in 66% of submissions. Trade associations, producers, and retailers were most likely to use such practices.The extent to which the examined industry actors misused scientific evidence in their submissions to a wide range of alcohol policy consultations in Australia suggests the need for governments to consider excluding the industry from consultation on the regulation of alcohol.

Introduction There is a concern in many countries about violence from late-night alcohol sales and appropriate regulatory responses. However, economic losses arising from this activity rarely feature in public debate. Credible estimates are lacking because economic evaluations have not taken a 'societal perspective', costing health, policing and criminal justice outcomes. Our aims were to: (i) develop an analytic model capable of informing cost-benefit analysis of policy changes; and (ii) estimate costs of alcohol-related assault (ARA) in a major city. Methods We employed decision-analytic cohort models of health and judicial consequences of ARA in Sydney, Australia. We constructed two 6-branch decision-analytic models of patient and offender pathways through the health and judicial systems. We produced overall estimates and analysed their sensitivity to key assumptions. Results Combining results from a Health model comprising 40 pathways and 137 cost events, and a Justice model comprising 20 pathways and 48 cost events, yielded an overall cost estimate of $85 093 per ARA, of which 64% was health-related, while 36% was justice-related. Estimates were sensitive to values assigned for 'pain, suffering, morbidity and wellbeing', and to costs of incarceration. Health service-related costs accounted for 1.3% of the total. Discussion and conclusion The costs of ARA are significant and dominated by incidents in which a victim does not necessarily receive acute medical care but suffers loss in quality-of-life, and where a perpetrator is processed through the criminal justice system. Being derived transparently, within a theoretical framework, the estimates are adaptable to inform cost-benefit analyses of policy options in Australia and other countries.

OBJECTIVES: Adolescents often display heterogenous trajectories of alcohol use. Initiation and escalation of drinking may be important predictors of later harms, including alcohol use disorder (AUD). Previous conceptualizations of these trajectories lacked adjustment for known confounders of adolescent drinking, which we aimed to address by modeling dynamic changes in drinking throughout adolescence while adjusting for covariates. METHODS: Survey data from a longitudinal cohort of Australian adolescents (n = 1813) were used to model latent class alcohol use trajectories over 5 annual follow-ups (mean age = 13.9 until 17.8 years). Regression models were used to determine whether child, parent, and peer factors at baseline (mean age = 12.9 years) predicted trajectory membership and whether trajectories predicted self-reported symptoms of AUD at the final follow-up (mean age = 18.8 years). RESULTS: We identified 4 classes: abstaining (n = 352); late-onset moderate drinking (n = 503); early-onset moderate drinking (n = 663); and early-onset heavy drinking (n = 295). Having more alcohol-specific household rules reduced risk of early-onset heavy drinking compared with late-onset moderate drinking (relative risk ratio: 0.31; 99.5% confidence interval [CI]: 0.11–0.83), whereas having more substance-using peers increased this risk (relative risk ratio: 3.43; 99.5% CI: 2.10–5.62). Early-onset heavy drinking increased odds of meeting criteria for AUD in early adulthood (odds ratio: 7.68; 99.5% CI: 2.41–24.47). CONCLUSIONS: Our study provides evidence that parenting factors and peer influences in early adolescence should be considered to reduce risk of later alcohol-related harm. Early initiation and heavy alcohol use throughout adolescence are associated with increased risk of alcohol-related harm compared with recommended maximum levels of consumption (late-onset, moderate drinking).

The Anglo-Celtic colonists of Australia and New Zealand brought with them heavy beer-drinking customs, and each country later developed similar temperance movements and alcohol policies. Yet their beer markets differed throughout the 20th century; for example, Australian men typically drank lager with 5% alcohol-by-volume (ABV), whereas New Zealand men drank ale with 4%ABV. We investigated the public health implications of recent developments in product availability, marketing, and country-level consumption patterns.We analyzed official data reporting beverage- and strength-specific volumes of ethanol available for sale in beer from 2000 to 2016, a period in which the countries had similar consumption trends; and did a thematic analysis of "market intelligence" reports.Per capita ethanol beer sales fell in both countries, accompanied by increases in market share of higher %ABV categories. Different definitions of beer strength hampered comparison between countries. In Australia, consumption of ethanol in mid-strength beer (3.01%-3.5%ABV) increased, whereas consumption of low-strength beer (3%ABV) decreased. In New Zealand, consumption of high-strength beer (4.351%-5%ABV) increased whereas that of traditional mid-strength beer (2.501%-4.35%ABV) decreased substantially. Market reports cited consumer health concerns and demand for "craft beer" (typically high-strength) as competing influences in both markets, and reduced-alcohol beer as "the alcoholic drinks industry's-potentially lucrative-shield against accusations of irresponsibility."Declines in both high- and low-strength beer in Australia have potentially important implications. In New Zealand, the failure of low-strength beer to establish significant market share, along with increased consumption of high-strength beer, are noteworthy developments. Trend data on product ethanol content warrants scrutiny in public health surveillance globally, whereas research is needed on the role of ethanol content within industry strategy.

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.

Background Parents frequently supply alcohol to their children, often only sips. We investigated whether supply of sips and whole drinks, from parents and other sources, are differentially associated with subsequent drinking outcomes. Methods A cohort of 1910 adolescents (mean age 12.9yrs) were surveyed annually over seven years from 2010−11. We examined prospective, adjusted associations between the quantity of supply from parental and non-parental sources in the preceding 12 months and five outcomes in the subsequent year, over several consecutive years: binge drinking; alcohol-related harms; symptoms of alcohol abuse, dependence and alcohol use disorder (AUD). Results In early waves, most parental supply comprised sips, while supply of whole drinks increased in later waves. Among those not receiving alcohol from other sources, parental supply of sips was associated with increased odds of binge drinking (OR: 1.85; 99.5 % CI: 1.17–2.91) and alcohol-related harms (OR: 1.70; 99.5 % CI: 1.20–2.42), but not with reporting symptoms of alcohol abuse, dependence or AUD, compared with no supply. Relative to no supply, supply of sips from other sources was associated with increased odds of binge drinking (OR: 2.04; 99.5 % CI: 1.14–3.67) only. Compared with supply of sips, supply of whole drinks by parents or others had higher odds of binge drinking, alcohol-related harms, symptoms of dependence and of AUD. Secondary analysis demonstrated that supply of larger quantities was associated with an increased risk of all outcomes. Conclusion Parental provision of sips is associated with increased risks and the supply of greater quantities was associated with an increasing risk of adverse outcomes. Clinical Trial Registration ClinicalTrials.gov (NCT02280551).

Background Most trials of electronic alcohol screening and brief intervention (e-SBI) have been conducted in young people. The aim of this study was to evaluate the effect of e-SBI in adults with hazardous or harmful drinking. Methods This individually randomized, parallel, two-group, double-blind controlled trial was conducted in the outpatient department of a large public hospital in Australia. Consenting adults who scored 5–9 on the AUDIT-C (837/3225; 26%) were randomized in a 1:1 ratio by computer to screening alone (442/837; 53%) or to 10 min of assessment and personalized feedback on their alcohol consumption (comparisons with medical guidelines and age and sex-specific norms), peak blood alcohol concentration, expenditure on alcohol, and risk of alcohol dependence (395/837; 47%). The two primary outcomes, assessed six months after randomization, were the number of standard drinks (10 g ethanol) consumed by participants in the last seven days and their AUDIT score. Results 693/837 (83%) and 635/837 (76%) participants were followed-up at 6 and 12 months, respectively. There was no statistically significant difference between the groups in the median number of standard drinks consumed in the last seven days (intervention: 12; control: 10.5; rate ratio, 1.12 [95% confidence interval, 0.96–1.31]; P = .17) or in their median AUDIT score (intervention: 7; control: 7; mean difference, 0.28 [-0.42 to 0.98]; P = .44). Conclusion These results do not support the implementation of an e-SBI program comprising personalized feedback and normative feedback for adults with hazardous or harmful drinking in the hospital outpatient setting.