Melanie Kingsland

Tackling risky alcohol consumption in sport: a cluster randomised controlled trial of an alcohol management intervention with community football clubs.

Background An increased prevalence of risky alcohol consumption and alcohol-related harm has been reported for members of sporting groups and at sporting venues compared with non-sporting populations. While sports clubs and venues represent opportune settings to implement strategies to reduce such risks, no controlled trials have been reported. The purpose of the study was to examine the effectiveness of an alcohol management intervention in reducing risky alcohol consumption and the risk of alcohol-related harm among community football club members. Method A cluster randomised controlled trial of an alcohol management intervention was undertaken with non-elite, community football clubs and their members in New South Wales, Australia. Risky alcohol consumption (5+ drinks) at the club and risk of alcohol-related harm using the Alcohol Use Disorders Identification Test (AUDIT) were measured at baseline and postintervention. Results Eighty-eight clubs participated in the trial (n=43, Intervention; n=45, Control) and separate cross-sectional samples of club members completed the baseline (N=1411) and postintervention (N=1143) surveys. Postintervention, a significantly lower proportion of intervention club members reported: risky alcohol consumption at the club (Intervention: 19%; Control: 24%; OR: 0.63 (95% CI 0.40 to 1.00); p=0.05); risk of alcohol-related harm (Intervention: 38%; Control: 45%; OR: 0.58 (95% CI 0.38 to 0.87); p<0.01); alcohol consumption risk (Intervention: 47%; Control: 55%; OR: 0.60 (95% CI 0.41 to 0.87); p<0.01) and possible alcohol dependence (Intervention: 1%; Control: 4%; OR: 0.20 (95% CI 0.06 to 0.65); p<0.01). Conclusions With large numbers of people worldwide playing, watching and sports officiating, enhancing club-based alcohol management interventions could make a substantial contribution to reducing the burden of alcohol misuse in communities. Trial registration number ACTRN12609000224224.

A cluster randomised controlled trial of a comprehensive accreditation intervention to reduce alcohol consumption at community sports clubs: Study protocol

Introduction Excessive alcohol consumption is responsible for considerable harm from chronic disease and injury. Within most developed countries, members of sporting clubs consume alcohol at levels above that of communities generally. Despite the potential benefits of interventions to address alcohol consumption in sporting clubs, there have been no randomised controlled trials to test the effectiveness of these interventions. The aim of this study is to examine the effectiveness of a comprehensive accreditation intervention with community football clubs (Rugby League, Rugby Union, soccer/association football and Australian Rules football) in reducing excessive alcohol consumption by club members. Methods and analysis The study will be conducted in New South Wales, Australia, and employ a cluster randomised controlled trial design. Half of the football clubs recruited to the trial will be randomised to receive an intervention implemented over two and a half winter sporting seasons. The intervention is based on social ecology theory and is comprehensive in nature, containing multiple elements designed to decrease the supply of alcohol to intoxicated members, cease the provision of cheap and free alcohol, increase the availability and cost-attractiveness of non-alcoholic and low-alcoholic beverages, remove high alcohol drinks and cease drinking games. The intervention utilises a three-tiered accreditation framework designed to motivate intervention implementation. Football clubs in the control group will receive printed materials on topics unrelated to alcohol. Outcome data will be collected pre- and postintervention through cross-sectional telephone surveys of club members. The primary outcome measure will be alcohol consumption by club members at the club, assessed using a graduated frequency index and a seven day diary. Ethics and dissemination The study was approved by The University of Newcastle Human Research Ethics Committee (reference: H-2008-0432). Study findings will be disseminated widely through peer-reviewed publications and conference presentations. Trial registration number Australian New Zealand Clinical Trials Registry: ACTRN12609000224224.

Alcohol consumption and sport: a cross-sectional study of alcohol management practices associated with at-risk alcohol consumption at community football clubs.

BackgroundExcessive alcohol consumption is responsible for considerable harm from chronic disease and injury. Within most developed countries, members of sporting clubs participate in at-risk alcohol consumption at levels above that of communities generally. There has been limited research investigating the predictors of at-risk alcohol consumption in sporting settings, particularly at the non-elite level. The purpose of this study was to examine the association between the alcohol management practices and characteristics of community football clubs and at-risk alcohol consumption by club members.MethodsA cross sectional survey of community football club management representatives and members was conducted. Logistic regression analysis (adjusting for clustering by club) was used to determine the association between the alcohol management practices (including alcohol management policy, alcohol-related sponsorship, availability of low- and non-alcoholic drinks, and alcohol-related promotions, awards and prizes) and characteristics (football code, size and location) of sporting clubs and at-risk alcohol consumption by club members.ResultsMembers of clubs that served alcohol to intoxicated people [OR: 2.23 (95% CI: 1.26-3.93)], conducted ‘happy hour’ promotions [OR: 2.84 (95% CI: 1.84-4.38)] or provided alcohol-only awards and prizes [OR: 1.80 (95% CI: 1.16-2.80)] were at significantly greater odds of consuming alcohol at risky levels than members of clubs that did not have such alcohol management practices. At-risk alcohol consumption was also more likely among members of clubs with less than 150 players compared with larger clubs [OR:1.45 (95% CI: 1.02-2.05)] and amongst members of particular football codes.ConclusionsThe findings of this study suggest a need and opportunity for the implementation of alcohol harm reduction strategies targeting specific alcohol management practices at community football clubs.

Interventions in sports settings to reduce risky alcohol consumption and alcohol-related harm: a systematic review

BackgroundElevated levels of risky alcohol consumption and alcohol-related harm have been reported for sportspeople and supporters compared to non-sporting populations. Limited systematic reviews have been conducted to assess the effect of interventions targeting such behaviours.MethodsA review was undertaken to determine if interventions implemented in sports settings decreased alcohol consumption and related harms. Studies were included that implemented interventions within sports settings; measured alcohol consumption or alcohol-related injury or violence and were either randomised controlled trials, staggered enrolment trials, stepped-wedged trials, quasi-randomised trials, quasi-experimental trials or natural experiments. Studies without a parallel comparison group were excluded. Studies from both published and grey literature were included. Two authors independently screened potential studies against the eligibility criteria, and two authors independently extracted data from included studies and assessed risk of bias. The results of included studies were synthesised narratively.ResultsThe title and abstract of 6382 papers and the full text of 45 of these papers were screened for eligibility. Three studies met the inclusion criteria for the review. One of the included studies was a randomised controlled trial (RCT) of a cognitive-behavioural intervention with athletes within an Olympic training facility in the USA. The study reported a significant change in alcohol use between pre-test and follow-up between intervention and control groups. The other two studies were RCTs in community sports clubs in Ireland and Australia. The Australian study found a significant intervention effect for both risky alcohol consumption at sports clubs and overall risk of alcohol-related harm. The Irish study found no significant intervention effect.ConclusionsA limited number of studies have been conducted to assess the effect of interventions implemented in sports settings on alcohol consumption and related harms. While two of the three studies found significant intervention effects, it is difficult to determine the extent to which such effects are generalisable. Further controlled trials are required in this setting.Systematic review registrationPROSPERO CRD42014001739

Improving availability, promotion and purchase of fruit and vegetable and non sugar-sweetened drink products at community sporting clubs: a randomised trial

BackgroundAmateur sporting clubs represent an attractive setting for health promotion. This study assesses the impact of a multi-component intervention on the availability, promotion and purchase of fruit and vegetable and non sugar -sweetened drink products from community sporting club canteens. We also assessed the impact the intervention on sporting club revenue from the sale of food and beverages.MethodA repeat cross-sectional, parallel group, cluster randomized controlled trial was undertaken with amateur community football clubs in New South Wales, Australia. The intervention was conducted over 2.5 winter sporting seasons and sought to improve the availability and promotion of fruit and vegetables and non sugar-sweetened drinks in sporting club canteens. Trial outcomes were assessed via telephone surveys of sporting club representatives and members.ResultsEighty five sporting clubs and 1143 club members participated in the study. Relative to the control group, at follow-up, clubs allocated to the intervention were significantly more likely to have fruit and vegetable products available at the club canteen (OR = 5.13; 95% CI 1.70-15.38), were more likely to promote fruit and vegetable selection using reduced pricing and meal deals (OR = 34.48; 95% CI 4.18-250.00) and members of intervention clubs were more likely to report purchase of fruit and vegetable (OR = 2.58 95% CI; 1.08-6.18) and non sugar -sweetened drink (OR = 1.56; 95% CI 1.09-2.25) products. There was no significant difference between groups in the annual club revenue from food and non-alcoholic beverage sales.ConclusionThe findings demonstrate that the intervention can improve the nutrition environment of sporting clubs and the purchasing behaviour of members.Trial registrationAustralian New Zealand Clinical Trials Registry: ACTRN12609000224224.

Addressing alcohol use in community sports clubs: attitudes of club representatives

Thank you for the chance to reply to the two letters related to my editorial ‘From Norm to Eric: avoiding lifestyle drift in Australian health policy’. I thank Louise Sylvan for pointing out that the National Partnership Agreement on Preventive Health (NPAPH) has a budget of

Is alcohol and community sport a good mix? Alcohol management, consumption and social capital in community sports clubs.

872.1 million rather than that being the sum for the Australian National Preventive Health Agency (ANPHA). I also recognise that the social marketing I was critiquing is not the only measure being used as part of the whole ‘Taking Preventative Action’. I welcome the engagement of disadvantaged communities and particularly focus on low socio-economic areas but this does not resolve the fact that the use of individual level change strategies is not supported by evidence, especially in terms of their use with people who have the gamut of social determinants working against them. Without tackling the structural determinants of chronic illness little progress will be made in reducing health inequities. The use of fiscal and regulation measures in relation to tobacco is very important and I feel proud that the Australian Government is taking on Big Tobacco through its plain paper packaging legislation. However, the Eric campaign is targeted at issues of weight and exercise and little is being done through Taking Preventive Action to regulate the food industry. Instead much less effective voluntary self-regulation is being recommended. This is despite the strong recommendations from the National Preventive Health Taskforce concerning the use of fiscal mechanisms to reduce the consumption of junk foods. Access to healthy and affordable food for low income people is essential and strategies to ensure this are likely to be the most effective means of improving people’s diets. Our current levels of obesity didn’t happen because people suddenly started making unhealthy choices. They have come about because of fundamental changes to the design of our cities, the opportunities for active lifestyles, the use of cars rather than walking and the vastly increased supply of cheap high fat and sugar foods. The letter from Jeanette Ward makes a number of vital points for the future direction of health promotion. She points to the importance of macro-economic policy to health and the fact that the environments in which people live have a profound influence on their health. She also makes important points about the institutional reasons for the attractiveness of behavioural solutions and the importance of reforming curricula to ensure that all students receive a good grounding in the power and importance of the social determinants of health and health equity. While I agree that the Closing the Gap strategy is far from perfect it does at least pay serious attention to some social determinants of health. Jeanette Ward is correct that Aboriginal self-determination and community control should be at the centre of any strategy and measures to improve Aboriginal life expectancy. The Commission on the Social Determinants of Health stressed the key role of material, psychosocial and political empowerment to improving health. Let’s hope that the Australian National Preventive Health Agency takes these lessons to heart and becomes a key mechanism for implementing the CSDH’s recommendations in Australia. References 1. Baum F. From Norm to Eric: avoiding lifestyle drift in Australian health policy. Aust N Z J Public Health. 2011;35(5):404-6. 2. Commission on the Social Determinants of Health. Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health. Geneva: World Health Organization; 2008.

Interventions in sports settings to reduce alcohol consumption and alcohol-related harm: a systematic review protocol

Objective: Community sports clubs provide an important contribution to the health and wellbeing of individuals and the community; however, they have also been associated with risky alcohol consumption. This study assessed whether a clubs alcohol management strategies were related to risky alcohol consumption by members and levels of social capital, as measured in terms of participation in and perceived safety of the club.

Alcohol consumption and intoxication among people involved in police-recorded incidents of violence and disorder in non-metropolitan New South Wales

Introduction Alcohol consumption is a primary cause of physical, psychological and social harm to both the user and others. At both the professional and non-professional level, sports players and fans report consuming alcohol at greater levels than people not involved in sports. Limited systematic reviews have been conducted assessing interventions targeting alcohol consumption behaviour and related harms in the sporting context. Methods and analysis The review aims to determine if interventions implemented in the sport setting decrease alcohol consumption and related harms. Participants may include all persons regardless of age or other characteristics. Studies will be included which have implemented interventions within the sport setting and have either measured: alcohol consumption, excessive alcohol consumption or intoxication or alcohol-related injury or violence. Randomised controlled trials, staggered enrolment trials, stepped-wedged trials, quasi-randomised trials, quasi-experimental trials and natural experiments will be included. Studies without a parallel comparison group will be excluded. Data will be sourced from a range of electronic databases and sources of grey literature. Two authors will independently screen all titles and abstracts of papers identified through the search strategy. Two authors will independently examine the full text of all remaining papers to determine eligibility. Two authors will independently extract data from eligible studies and independently assess risk of bias by assessing the adequacy of study characteristics. Where studies are sufficiently homogeneous, trial results will be synthesised using a fixed-effects meta-analysis. Standardised mean differences will be used for continuous outcomes and RRs will be used for binary outcomes. Dissemination The findings of this study will be disseminated widely through mechanisms including peer-reviewed publications and conference presentations.

Facilitating police recording of the alcohol-related characteristics of assault incidents: a stepped wedge implementation trial

Objective: To describe, based on routinely recorded police data, the prevalence and characteristics of alcohol consumption among people involved in violence and disorder incidents in non‐metropolitan New South Wales (NSW).