Claire Wilkinson

Warnings on alcohol containers and advertisements: International experience and evidence on effects

ISSUES In light of possible introduction of alcohol warning labels in Australia and New Zealand, this paper discusses the international experience with and evidence of effects of alcohol warning labels. APPROACH The report describes international experience with providing information and warnings concerning the promotion or sale of alcoholic beverages, and considers the evidence on the effects of such information and warnings. The experience with and evaluations of the effects of tobacco warning labels are also considered. KEY FINDINGS The most methodologically sound evaluations of alcohol warning labels are based on the US experience. Although these evaluations find little evidence that the introduction of the warning label in the USA had an impact on drinking behaviour, there is evidence that they led to an increase in awareness of the message they contained. In contrast, evaluations of tobacco warning labels find clear evidence of effects on behaviour. IMPLICATIONS There is a need and opportunity for a rigorous evaluation of the impacts of introducing alcohol warning labels to add to the published work on their effectiveness. The experience with tobacco labels might guide the way for more effective alcohol warning labels. CONCLUSION Alcohol warning labels are an increasingly popular alcohol policy initiative. It is clear that warning labels can be ineffective, but the tobacco experience suggests that effective warning labels are possible. Any introduction of alcohol warning labels should be evaluated in terms of effects on attitudes and behaviour.

Distances to on‐ and off‐premise alcohol outlets and experiences of alcohol‐related amenity problems

INTRODUCTION AND AIMS There are a number of studies in recent years that have examined the relationship of alcohol outlets to the incidence of alcohol-related problems. Only a small number of these studies examine the types of alcohol-related problems which may be considered amenity problems, such as neighbourhood disturbance, litter and noise. This paper examines the association between the proximity of someones home to alcohol outlets and their experience of public amenity problems. DESIGN AND METHODS Data came from an Australian general population survey: the Alcohols Harm to Others Survey (2008). Two thousand six hundred and forty-nine Australians aged 18 years and over were asked about their experiences of a number of amenity-type problems and the distance they lived to the nearest on- and off-premise alcohol outlet. RESULTS Bivariate results showed that respondents living closer to on- and off-premise outlets reported more problems, with minor differences by distance to on- and off-premise outlet. In multivariate logistic regression analyses, controlling for possible confounding effects of the respondent and neighbourhood characteristics, living closer to on-premise outlets was independently associated with reporting being kept awake or disturbed at night and living closer to an off-premise outlet was independently associated with reporting property damage. DISCUSSION AND CONCLUSIONS A possible interpretation of the results is that respondents living close to on- and off-premise outlets experience more amenity problems than those living further away, but that these experiences are concentrated among demographic groups who live in these areas. Direction of influence cannot be inferred from these cross-sectional findings.

Recommendations for international gambling harm-minimisation guidelines: comparison with effective public health policy

Problem gambling represents a significant public health problem, however, research on effective gambling harm-minimisation measures lags behind other fields, including other addictive disorders. In recognition of the need for consistency between international jurisdictions and the importance of basing policy on empirical evidence, international conventions exist for policy on alcohol, tobacco, and illegal substances. This paper examines the evidence of best practice policies to provide recommendations for international guidelines for harm-minimisation policy for gambling, including specific consideration of the specific requirements for policies on Internet gambling. Evidence indicates that many of the public health policies implemented for addictive substances can be adapted to address gambling-related harms. Specifically, a minimum legal age of at least 18 for gambling participation, licensing of gambling venues and activities with responsible gambling and consumer protection strategies mandated, and brief interventions should be available for those at-risk for and experiencing gambling-related problems. However, there is mixed evidence on the effectiveness of limits on opening hours and gambling venue density and increased taxation to minimise harms. Given increases in trade globalisation and particularly the global nature of Internet gambling, it is recommended that jurisdictions take actions to harmonise gambling public health policies.

Enforcement of liquor licence provisions: The introduction of civilian licence inspectors in Victoria

As in many other societies, Australian states have alcohol licensing laws, which specify who can sell alcoholic beverages and under what conditions. Police commonly have the authority to enforce licensing provisions, but are often distracted from this task by more pressing responsibilities. The state of Victoria, Australia, moved in July 2009 to establish a Compliance Directorate (the Directorate), comprising 40 civilian inspectors, to assist and support the work of the Victoria Police in enforcing requirements pertaining to liquor licensees. This article explores early indicators of the impact of this body on licensee compliance in Victoria. The Directorate was presented by the government as a part of an effort to influence cultures that promote harmful consumption of alcohol. Analysis of data and interviews with policy and enforcement staff and licensees indicate that the Directorate has substantially improved enforcement of administrative provisions of licence conditions. In a climate where previously very little liquor licence enforcement existed, the Directorate has been required to negotiate conflicting views on appropriate approaches to regulation, potentially undermining its capacity to pose a real threat of enforcement action for licensees who are in breach of their obligations. Although civilian inspectors promote a better regulated alcohol industry, evidence indicates that provisions prohibiting sales to minors and the intoxicated (with greatest potential to impact on alcohol-associated harm) remain insufficiently enforced.

Per-capita Alcohol Consumption and All-cause Male Mortality in Australia, 1911–2006

AIMS Given the variety of relationships found between alcohol consumption and health using individual data (both negative and positive), the likely impact of changes in population-level alcohol consumption on health at the population level is not clear. This paper uses historical data from 1911 to 2006 to assess the relationship between changes in per-capita alcohol consumption on total male mortality in Australia. METHODS A longitudinal aggregate study using Australian per-capita alcohol consumption and mortality data from 1911 to 2006. Analysis is undertaken using autoregressive integrated moving average time-series methods. RESULTS Per-capita pure alcohol consumption has a significant association with male all-cause mortality, with an increase (decrease) of 1 l per-capita per year associated with a 1.5% increase (decrease) in male mortality (controlling for female mortality and smoking rates). The association between per-capita consumption and mortality was significant for all age groups, with a particularly strong effect among 15-29 year olds. CONCLUSION These results place Australia in the group of countries for which a positive association between per-capita alcohol consumption and total mortality can be demonstrated. Thus, despite the beneficial effects of alcohol consumption on health found in many studies, increases in consumption at the population level in Australia are associated with declines in population health. Thus, per-capita alcohol consumption in Australia is a significant contributor to rates of male mortality, particularly among young adults, suggesting an interaction between per-capita consumption and risky episodic drinking. The policies aiming to reduce population-level alcohol consumption and episodic risky drinking have the potential to substantially improve population-health outcomes in Australia, particularly among young men.

How did live music become central to debates on how to regulate the Victorian night-time economy? A qualitative analysis of Victorian newspaper reporting since 2003

Abstract In Victoria, Australia, considerations of live music have become central to debates on how to best regulate the late-night economy. This paper examines the origins of this consideration and the reasons it has become a key matter in policy discussion about late-night licensing regulation. Using a media analysis of 110 Victorian newspaper articles (2003–2016), this paper demonstrates how the newspaper media has exerted significant power in producing a live music discourse. The live music discourse was firmly established by 2010, driven by the Tote Hotel’s closure (referenced in 52 articles). The number of live music stakeholders engaged in the debate (80 quoted) far outweighed those from the government (26 quoted), impacting the overall presentation of the regulations along with the value of live music to the state. Gaps in media coverage, and the political context in which these matters were being debated aided advocates in facilitating subsequent regulatory change in favour of live-music venues. Consequently, it is argued that the media reporting contributed to a policy environment where perceptions of a threat to live music venues have become a barrier to restricting hours of sale in the future.

Middle-aged same-sex attracted women and the social practice of drinking

ABSTRACT As a group, middle-aged same-sex attracted women (SSAW) appear to consume more alcohol than exclusively heterosexual women in the same age range; however, few studies document their collective drinking practices or identify opportunities to reduce associated harms. Online surveys which included open-ended questions were completed by a self-selected sample of SSAW (N = 134) aged 36–51, recruited in Victoria, Australia. We identify 12 sub-elements of SSAW’s collective drinking practice using a schema grounded in social practice theory (SPT). Responses are compared for SSAW who consumed alcohol with others at moderate and at heavier levels, based on screening. Heavier drinking respondents were more likely to observe that: alcohol use is normalised for SSAW; they are not pressured to drink; drinking produces pleasurable effects; drinking facilitates management of uncomfortable moods and that venues welcoming SSAW are saturated with alcohol. In line with SPT, links between sub-elements described by heavier drinkers are explored to identify potential interventions. For example, we recommend an expansion of social opportunities without alcohol that engender affirming affective states for SSAW. Further, many SSAW’s commitment to the importance of moderation and rejecting coercion to drink could be used to combat the conviction that drinking is an inevitable response to discrimination experienced by sexual minorities. It was apparent that although they drank with other SSAW, our survey respondents did not share a consistent or altogether unique drinking culture. We suggest that an SPT approach entailing data coding to multiple sub-elements supports the identification of diverse configurations of drinking practice within heterogeneous subpopulations.

Commentary on ‘Communicating Messages About Drinking’: Using the ‘Big Legal Guns’ to Block Alcohol Health Warning Labels

Like the tobacco industry, the alcohol industry, with the support of governments in alcohol exporting nations, is looking to international trade and investment law as a means to oppose health warning labels on alcohol. The threat of such litigation, let alone its commencement, has the potential to deter all but the most resolute governments from implementing health warning labeling.

Addiction research centres and the nurturing of creativity: The Centre for Alcohol Policy Research (CAPR), Melbourne: A decade on Addiction research centres: CAPR Claire Wilkinson et al.

Established in 2006, the Centre for Alcohol Policy Research (CAPR) is Australias only research centre with a primary focus on alcohol policy. CAPR has four main areas of research: alcohol policy impacts; alcohol policy formation and regulatory processes involved in implementing alcohol policies; patterns and trends in drinking and alcohol problems in the population; and the influence of drinking norms, cultural practices and social contexts, particularly in interaction with alcohol policies. In this paper, we give examples of key publications in each area. During the past decade, the number of staff employed at CAPR has increased steadily and now hovers at approximately 10. CAPR has supported the development of independent researchers who collaborate on a number of international projects, such as the Alcohols Harm to Others study which is now replicated in approximately 30 countries. CAPR receives core funding from the Foundation for Alcohol Research and Education, and staff have been highly successful in securing additional competitive research funding. In 2016, CAPR moved to a new institutional setting at La Trobe University and celebrated 10 years of operation.

Alcohol policy research: putting together a global evidence base.

Alcohol consumption is a risk factor for an array of health and social problems internationally, from acute health and social harms (e.g. injury, assault and family breakdown) to chronic illnesses (e.g. liver cirrhosis) [1]. A substantial body of evidence highlights effective policy options to reduce harm from alcohol. However, many important areas of uncertainty remain. These include the importance of policy implementation and enforcement, the cross-jurisdictional generalisability of research findings and the reliability of many commonly-used outcome measures. Thus, in September 2014, researchers from over a dozen countries met inMelbourne to present their alcohol policy research at a thematic meeting of the Kettil Bruun Society for Social and Epidemiological Research on Alcohol (http://www.kettilbruun.org). This special section includes five papers from that meeting. Other papers from the meeting appear in three companion special issues: papers converging on the theme of price and/or taxation policy are published in Alcohol and Alcoholism, Vol. 50(6), 2015; papers based on qualitative data appear inContemporaryDrug Problems, Vol. 42(2), 2015; and a further collection of papers will be published in the International Journal of Alcohol and Drug Research, the Kettil Bruun Society journal. The papers in this special section provide a snapshot of research in the field, including research on the importance of policy implementation, the differential effects of policies in different settings and the potential interplay of policies with social relationships. The papers span a variety of methodological traditions—population survey analyses, systematic reviews, intervention evaluations and ecological studies. A prominent concern of alcohol policy research is examining the effectiveness of policy to reduce alcohol consumption and associated harms. In this tradition, researchers may examine the impact of alcohol policy changes or compare outcomes across jurisdictions with different policies. Most often a single alcohol policy is examined. For example, a tax on a particular beverage or Sunday closing [2,3]. However, alcohol policies do not occur in isolation. Jurisdictions may have very different alcohol policy environments—the combinations of existing alcohol policies—meaning that the impact of a particular policy (e.g. increasing taxes) may vary markedly. In this section, Erikson and colleagues [4] examine the association between different clusters of alcohol policies and alcohol consumption in the USA, focusing on particular configurations of alcohol policies at a state-level. The research incorporates measures of alcohol policy strength for each of 18 policies in each of 50 states as established in a previous piece of research [5]. In addition to different relative strength, the study also takes into account levels of policy enforcement (low, moderate or high). Using Latent Class Analysis, the authors find the 18 alcohol policies cluster into a four class typology: ‘weak except serving policies’, ‘average’, ‘strong for underage use’ and ‘strong policies overall’. Adjusted multivariate regression analyses suggest a relationship between the strong underage use policy class and lower consumption. Somewhat surprisingly, the level of enforcement did not affect the association between policy class and consumption. An important contribution of this paper is to consider groups of alcohol policies rather than assess them in isolation. One policy approach examined by Erikson and colleagues related to the physical availability of alcohol in a community, often measured via alcohol outlet density. Research examining the link between the density of alcohol outlets and alcohol-related harm is expanding rapidly. While systematic reviews of this research have generally found that alcohol outlet density is associated with alcohol problems [6,7], the precise nature of the link and the mechanism of the effects remain unclear [8]. In collaboration between two research groups, Gmel, Holmes and Studer [9] systematically review research on the association of outlet density and violence published since 2009. Not only do the authors update the two previous systematic literature reviews in this area, they also critically assess the applicability of the research evidence to informing licensing policy. The authors discuss the 65 studies included in their review in order for increasing study design strength—completely ecological studies, partial ecological studies (those that included individual-level data) and natural experiments. They suggest that the current evidence base is too diverse and hampered by design flaws to provide policy suggestions across jurisdictions. The authors make a number of recommendations for improving measurement and analysis in future research. In particular, they call for an end to simple cross-sectional analyses that operationalise alcohol availability using crude outlet density measures.