Reducing alcohol harms whilst minimising impact on hospitality businesses: 'Sweetspot' policy options.

BACKGROUND: During COVID-19, hospitality businesses (e.g. bars, restaurants) were closed/restricted whilst off-sales of alcohol increased, with health consequences. Post-covid, governments face lobbying to support such businesses, but many health services remain under pressure. We appraised 'sweetspot' policy options: those with potential to benefit public services and health, whilst avoiding or minimising negative impact on the hospitality sector. METHODS: We conducted rapid non-systematic evidence reviews using index papers, citation searches and team knowledge to summarise the literature relating to four possible 'sweetspot' policy areas: pricing interventions (9 systematic reviews (SR); 14 papers/reports); regulation of online sales (1 SR; 1 paper); place-shaping (2 SRs; 18 papers/reports); and violence reduction initiatives (9 SRs; 24 papers/reports); and led two expert workshops (n = 11). RESULTS: Interventions that raise the price of cheaper shop-bought alcohol appear promising as 'sweetspot' policies; any impact on hospitality is likely small and potentially positive. Restrictions on online sales such as speed or timing of delivery may reduce harm and diversion of consumption from on-trade to home settings. Place-shaping is not well-supported by evidence and experts were sceptical. Reduced late-night trading hours likely reduce violence; evidence of impact on hospitality is scant. Other violence reduction initiatives may modestly reduce harms whilst supporting hospitality, but require resources to deliver multiple measures simultaneously in partnership. CONCLUSIONS: Available evidence and expert views point to regulation of pricing and online sales as having greatest potential as 'sweetspot' alcohol policies, reducing alcohol harm whilst minimising negative impact on hospitality businesses.

Support for a browser plug-in blocking online alcohol imagery among Australian participants: A qualitative interview study.

ISSUES ADDRESSED: Alcohol depictions are extremely common online, and there is a reported relationship between alcohol exposure and alcohol use. A browser plug-in specifically designed to block online alcohol depictions may be helpful to prevent the uptake of alcohol or increased alcohol use. METHODS: Twenty-five semi-structured interviews were conducted, examining participants' beliefs about the effects of online alcohol exposure and their support for developing the browser plug-in. RESULTS: Using reflexive thematic analysis, we found participants highlighted a clear impact of viewing alcohol online and offline alcohol use. Participants believed a browser plug-in that blocked alcohol was acceptable and would be especially useful for minors (to prevent alcohol initiation) and those who are aiming to reduce their alcohol use. CONCLUSIONS: Participants emphasised that viewing online alcohol exposure had an impact on drinking behaviours, such as increased craving and temptation. The browser plug-in was considered an easy intervention tool for both parents and people who are experiencing alcohol-related problems or trying to reduce their drinking. SO WHAT?: Participants' continuous support of an alcohol-blocking browser plug-in suggests that future health promotion strategies should consider the development of a prototype plug-in.

Drinking alcohol at home feels different from drinking in public places: a qualitative study of midlife Australians.

This paper shows how drinking in one's own home affords different affective experiences to drinking in public settings such as bars, pubs and restaurants. A thematic analysis of interviews with 40 Australians aged 30-65 identified three main variations in alcohol-associated feelings, sensations and urges. Alcohol was used at home to decelerate, but in contrast, people were enlivened when drinking in public venues. Drinking in public generated a sense of vigilance and greater requirement to self-monitor than usually felt necessary at home. For some, drinking at home seemed more habitual; governed by urges rather than intentionality, than drinking outside it did. Policy and interventions that target drinking in the home should be prioritised, such as those focussed on off-premise pricing and availability.

Alcohol's contribution to climate change and other environmental degradation: a call for research.

Climate change is the single biggest health threat facing humanity. The production, distribution and consumption of many fast-moving consumer goods contribute substantially to climate change, principally through releasing greenhouse gas emissions. Here we consider just some of the ways that alcohol-already a key contributor to an array of health, social and economic burdens-exacerbates environmental harms and climate change. We explore current evidence on alcohol production as a resource- and energy-intensive process, contributing to significant environmental degradation through water usage and other carbon emission costs. We argue that the impacts of alcohol production on climate change have been minimally explored by researchers. Yet the extent of the unfolding catastrophe beholds us to consider all available ways to mitigate unnecessary emissions, including from products such as alcohol. We then turn to suggestions for a research agenda on this topic, including investigations of commercial determinants, inequalities and product advice to help consumers choose lower-carbon options. We conclude by arguing that public health researchers already have an array of methodological expertise and experience that is well placed to produce the evidence needed to inform regulation and efforts by alcohol producers and consumers to minimize their contributions to environmental harms.

Strategies to support midlife women to reduce their alcohol consumption: an Australian study using human-centred design.

Alcohol consumption is causally associated with long-term health-related consequences, such as cancer and cardiovascular disease, and short-term harms, such as accidents and injuries. Alcohol consumption has increased among midlife women (aged 40-65) over the last two decades in high-income countries. This study aimed to centre women's voices by using co-design methodologies to investigate what women identify as strategies that could assist them and other women their age to reduce their alcohol consumption. Human-centred design workshops were undertaken with 39 women, and conventional qualitative content analysis was used to analyse information from written workshop materials to develop categories in the data and count their occurrence. Six categories, or strategies, emerged, listed here from most to least represented: 'Participate in alternative activities to drinking alcohol', 'Track alcohol consumption and set goals', 'Seek support from family and friends', 'Drink alcohol-free beverages', 'Reduce supply of alcohol in the home' and 'Seek professional support'. Our findings identify strategies that are realistic and feasible to midlife women; our sample, however, likely reflects a more affluent subsection of this group, and as such, any focus on individual-level strategies must be complemented by policies that increase equitable access to healthcare and act on the social and commercial determinants of health. An intersectional approach to alcohol and other drug research is required to examine how the interplay of gender and other markers of social identities shape alcohol consumption.

Educating students about volatile substance use in Australian schools: Is the current approach evidence-based, and how should we do it?

Australian national, state and territory school-based drug education policies advise that volatile substance use (VSU) should be excluded from general drug education curriculum for fear of alerting young people to the intoxicating properties of substances such as petrol, sprays and glues. We review evidence from the United States and United Kingdom on the effects of including volatile substances in school-based drug education, to argue that these policies are due for reconsideration. Nitrous oxide and nitrites are classified as volatile substances along with solvents such as those listed above, although their patterns of use, effects and harms are different. In an era of widespread social media access, more young people than in the past are likely to have heard about VSU. But because VSU is often short-term, parents and teachers may be unaware when young people in their care consume volatile substances. The general silence about VSU in schools, difficulty in detecting use and the varying sets of risks associated with inhaling different substances mean that young people may be unaware of toxicity or harm reduction strategies when they consume volatiles as drugs. We consider some implementation challenges to be negotiated if VSU education were introduced in Australian schools.

An observation study of mathematics instruction for students with IDD in grades K-2.

This observation study documents the amount and quality of mathematics instruction provided to students with intellectual and developmental disabilities in kindergarten through second grade in self-contained special education settings. We observed six special education teachers and their students (N = 12) during a total of 967 min allotted to early numeracy and mathematics instruction. Mathematics and early numeracy instruction comprised 61.2% of all observed time allotted for mathematics, followed by non-instruction (32.7%), mathematics assessment (5.7%), and instruction in other areas (0.3%). Observed mathematics content included Numbers and Quantitative Reasoning, and Measurement. Mean ratings of student engagement and instructional quality across areas were medium and low-average, respectively. Although student engagement did not differ by who was leading instruction, instructional quality differed between teachers and paraeducators. Class sizes were small, and teachers most often taught students as a whole class or individually. Students used technology, manipulatives, and printed instructional materials during learning.

Influencing the global governance of alcohol: Alcohol industry views in submissions to the WHO consultation for the Alcohol Action Plan 2022-2030.

BACKGROUND: In 2020, the Secretariat of the World Health Organization (WHO) conducted an open consultation, with public submissions, for the purpose of developing an Alcohol Action Plan to "strengthen implementation" of the WHO's 2010 Global Strategy to Reduce the Harmful Use of Alcohol. The consultation process and public submissions provided an opportunity to critically examine alcohol industry perspectives and arguments in relation to the global governance of alcohol. METHODS: 48 alcohol industry submissions to the WHO's 2020 consultation were included for analysis. Directed content analysis was used to examine the policy positions and arguments made by industry actors. Thematic analysis was employed to further explore the framing of industry arguments. RESULTS: In framing their arguments, alcohol industry actors positioned themselves as important stakeholders in policy debates; differentiated "normal" drinking from consumption that merits intervention; argued that alcohol policy should be made at the national, rather than global, level; and supported industry self-regulation or co-regulation rather than cost-effective public health measures to prevent harms from alcohol. CONCLUSION: The alcohol industry's submissions to the WHO's 2020 consultation could be seen as efforts to stymie improvements in the global governance of alcohol, and repeats several framing strategies that the industry has used in other forums, both national and global. However, their arguments appear to have had little traction in the creation of the Alcohol Action Plan. Changes from the Working Document to the adopted Action Plan show little acceptance by WHO of industry arguments.

Home alone: Patterns and perceptions of solitary home alcohol consumption in an Australian convenience sample.

INTRODUCTION: In contrast with extensive literature exploring sociable alcohol use, few studies focus on drinking alone at home, even though the home is the place where the majority of drinking occurs. METHODS: We draw on survey and interview data gathered in 2018/2019 prior to the COVID-19 pandemic, to identify prevalence and perceptions of solitary home drinking in an Australian convenience sample of heavy and light drinkers (LD). RESULTS: A substantial minority of survey participants identified drinking home alone, with over a quarter of heavy drinkers (27%) reporting that they only drank alone in their own home (compared to 15% of LD). In interviews, solitary home drinking was frequently constructed as signifying personal inadequacy, heavy consumption and harm. However, tensions arose through solitary home drinking bringing pleasures, such as relaxation. It was regarded as more socially acceptable for men than women and lighter home drinking patterns were viewed more positively than heavy drinking. Perceptions of what constitutes solitary home drinking varied, with some suggesting it includes drinking with others present who are not themselves drinking, and others using a more limited definition of consuming alcohol while alone in a house. DISCUSSION AND CONCLUSIONS: While strong social sanctions against it persist, solitary home drinking can reflect a lack of opportunity to drink with others and also be associated with more harmful regular patterns of alcohol use. Increasing recognition of home drinking provides a new imperative to better understand the complex stigmatisation that frames solitary home drinking and to explore opportunities to limit associated harms.

Sex differences in young children's perceptions of situational drinking norms over time.

OBJECTIVES: To date, there have been no previous studies examining sex differences in the development of alcohol-related perceptions over time, a potential avenue for targeted prevention and early intervention efforts. This article examines any potential sex differences in young children's development of situational drinking norms over time. METHOD: Two hundred ninety-eight children (aged 4-6 years at baseline) completed the Dutch electronic Appropriate Beverage Task-which involves attributing alcoholic beverages to adults in varying situational contexts-annually over 3 years (2015, 2016, 2017). Three-level regression models were estimated examining whether perceptions of situational drinking norms varied as a function of the sex of the participant and whether there were any changes over time. RESULTS: Over time children did not attribute more alcoholic beverages to adults in various situations, instead both boys and girls became more accurate at correctly identifying situations in which drinking is more common. Over time, both boys and girls attributed more alcoholic beverages in common situations and less in uncommon situations, with no significant sex differences in attributions of alcohol found. CONCLUSIONS: We identified no significant sex differences in the development of situational drinking norms over time, suggesting that education and prevention campaigns can be unified/nontargeted by sex. However, given our findings differ from previous studies that identify significant sex differences between children on the development of other alcohol-related cognitions beyond situational drinking norms, there is a need for more international research in this space to understand the importance and nature of the development of alcohol-related perceptions over time. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Validation of the revised Alcohol Expectancy Task [rAET].

Alcohol expectancies are well-established determinants of alcohol consumption. Traditionally, expectancies were assessed using self-report questionnaires. However, researchers have increasingly begun to explore the use of pictographic assessments, for example, the revised Alcohol Expectancy Task [rAET]. The current research aimed to examine the factor structure of the task in relation to the hypothesised expectancy dimensions, participants' endorsement of these dimensions, and whether rAET scores are associated with drinking patterns. The rAET presents participants with several illustrated scenarios in which people are displaying emotions, following the Circumplex Model of Affect. For each scenario, participants select which type of drink the person presented in the illustration was most likely to have drunk. The rAET was administered online to a convenience sample (n = 1,192, female: 50.7%, Mage = 36.8, SD = 13.7). The confirmatory factor analysis demonstrated adequate fit of the hypothesised four-factor model. Mean comparisons demonstrated that positive expectancies were more pronounced than negative expectancies, and a distinction between arousal and sedation expectancies was found. Results of a structural equation model found that positive sedation and positive arousal were related to high drinking frequency. There were no links between usual quantity of alcohol use or binge drinking. It appears that the rAET can be successfully used to assess alcohol expectancies in terms of the emotions that are expected to occur from alcohol consumption. Future research is needed to establish the tool's assessment properties in different settings, and its utility in predicting alcohol consumption in different age groups, particularly children and young adolescents. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

All alcohol exposure counts - testing parental, older sibling, best friend and peer exposure on young adolescent drinking in a seven-wave longitudinal study.

AIMS: Role models around the adolescent, including parents, peers, best friends and older siblings, all act in ways to socialize the adolescent into alcohol use. This study aims to examine the effect of exposure to siblings' drinking alongside the more traditionally examined role models on alcohol use among adolescents. DESIGN: A longitudinal study followed adolescents (45.6% male) who completed a questionnaire every 6 months over 3 years (seven in total). SETTING: Netherlands PARTICIPANTS: This resulted in 5112 observations clustered in 765 participants aged between 10 and 16 years. MEASUREMENTS: We examined three alcohol use measures: alcohol use in the last 6 months, in the last 4 weeks and binge drinking in the last 4 weeks-both cross-sectionally at each time-point and their change from one time-point to the next in a series of multi-level logistic regression models. FINDINGS: Results revealed a non-significant difference in any of the exposure or alcohol use variables between those with or without older siblings. Higher exposure to sibling drinking was significantly associated with all alcohol use outcomes: use in the last 6 months, odds ratio (OR) = 1.54, 95% confidence interval (CI) = 1.25-1.91; last 4 weeks, OR = 2.04, 95% CI = 1.60-2.60; and binge drinking, OR = 2.35, 95% CI = 1.82-3.05. When adding the other role models (i.e. peers, mothers, fathers and best friends), the significant association between siblings' exposure and adolescents' alcohol use remains. CONCLUSIONS: It would appear that, after adjustment for the effect of role models, adolescents who are exposed to more sibling drinking are more likely to have drunk alcohol during the past 6 months and past 4 weeks and also to binge drink.

Selective Skeletal Surveys for Infants With Skull Fractures: Examining the Rates of Return to Medical Care for Concern of Physical Abuse.

OBJECTIVES: This study aimed to describe which infants with a skull fracture (1) receive a child abuse pediatrician (CAP) consultation, (2) receive a skeletal survey, and (3) re-present to medical care before age 3 years with concerns for physical abuse. METHODS: We conducted a retrospective chart review of infants younger than 12 months who presented to the emergency department between January 1, 2005, and December 30, 2015, with a skull fracture. Medical records were reviewed for the skull fracture presentation and for all future medical evaluations at the same institution with concerns for physical abuse until 3 years of age. RESULTS: Of 366 infants with a skull fracture, a CAP was contacted for 272 (74%) and 76 (20.8%) infants who received a skeletal survey. Factors associated with skeletal survey acquisition included younger age (<6 months), no history to explain the skull fracture, other injuries on examination, and social risk factors. Six children (1.6%) re-presented to medical care with concerns of physical abuse before age 3 years. Five of these infants did not have a skeletal survey at the time of their skull fracture, and 1 was likely a case of missed physical abuse at the time of the skull fracture. DISCUSSION: Most skull fractures in infancy occur accidentally, and a skeletal survey may not be necessary for every infant. Obtaining a thorough history including social risk factors, performing a complete physical examination, and consulting with a CAP is an effective first step in the evaluation of physical abuse in infants with skull fractures.

Effects of exposure to mother's and father's alcohol use on young children's normative perceptions of alcohol.

BACKGROUND: While consumption of alcohol does not often begin until early adolescence, young children are highly capable of internalizing normative information through observational learning. We used a longitudinal multiple-informant family study to examine the impact of exposure to mothers' and fathers' drinking on young children's normative perceptions of who drinks alcohol. METHODS: Three hundred twenty-nine children (4 to 6 years old at baseline [Mage 4.78 (SD = 0.725)], 51% girls) completed the Dutch electronic appropriate beverage task [eABT] where they attributed alcoholic beverages to a variety of persons depicted in an illustrated scenario. Their parents completed an online survey that included information on alcohol use and exposure. RESULTS: Children more frequently exposed to their mothers' drinking provided females shown in the eABT illustrations with alcohol significantly more often than children less frequently exposed to mothers' drinking. There was no effect of mother's exposure on providing males in the eABT with alcoholic beverages. Similarly, children more frequently exposed to their fathers' drinking provided fathers with alcoholic beverages significantly more often than children less frequently exposed to their fathers' drinking. There was no effect of father's exposure on providing the females with alcoholic beverages, nor was there an effect of father's exposure on providing "other males" with alcohol. These patterns held after adjusting for age and sex. CONCLUSIONS: This study demonstrates that there are gender-specific effects of exposure to parents' (particularly mothers') drinking on young children's perceptions of person-specific drinking norms. The findings provide unique evidence in a young population group of effects on an understudied dimension of alcohol-related perceptions with implications for future drinking behavior.

Men and Women's Alcohol Consumption by 4- to 8-Year-Olds: A Longitudinal Investigation of Gendered Drinking Norms.

INTRODUCTION: Evidence suggests an association between perceived alcohol-related norms and personal consumption. These perceptions develop over years of observation and exposure to alcohol, likely beginning in early childhood, and likely differing by sex. Understanding the early development of perceptions of drinking may provide insight into the development of gendered drinking practices. The aim of this study was to explore boys' and girls' perceptions about men and women's alcohol consumption and whether and how these change over time as children age. METHODS: 329 children (aged 4-6 years at baseline) completed the Dutch electronic Appropriate Beverage Task annually for three consecutive years (2015 [baseline], 2016, 2017). Regression models were used to examine whether perceptions of consumption varied as a function of the gender of the adult, the participants' sex, and any changes over time. RESULTS: In illustrated pictures, children perceived that men (39%) drank alcoholic beverages more often than women (24%). Men were perceived to drink alcohol more frequently than women at baseline and this difference increased with age. Girls were more likely to perceive men drinking at baseline (aged 4-6), but there were few sex differences by time point three (aged 6-8). DISCUSSION/CONCLUSION: From a young age, children perceive that men drink more than women. These perceptions strengthen as children grow older, with young girls perceiving these gender differences at earlier ages than boys. Understanding children's perceptions of gendered drinking norms and their development over time can enable targeted prevention efforts.

Parents' management of alcohol in the context of discourses of 'competent' parenting: A qualitative analysis.

How parents manage potential tensions between normative discourses of 'competent parenting' and their desires to consume alcohol has received little attention. In this article, we explore the elements that encourage or constrain parents' drinking and investigate how parents consider and manage their alcohol use in the context of multiple social roles with sometimes conflicting demands and expectations around 'competent parenting'. Our analysis draws on 30 semi-structured interviews with Australian parents, conducted as part of a broader project which aimed to explore how home drinking is integrated into everyday life. While parents' accounts of drinking alcohol highlighted effects such as embodied experiences of relaxation and facilitating shared adult moments, many participants described drinking less than they otherwise would if their children were not present. Participants discussed various social roles and routines which constrained consumption, with drinking bounded by responsibility. As such, drinking emerged as something needing to be actively negotiated, particularly in light of discourses that frame expectations of what constitutes 'competent parenting'. When considering parents' alcohol consumption in the future, we argue that it is important to destigmatise their consumption by acknowledging the importance of adults' pleasure and wellbeing, alongside children's needs for safety and modelling of safer alcohol consumption.

Transport and migration of plutonium in different soil types and rainfall regimes.

Leaching and transport of contaminants is a complex interacting system affected by a suite of environmental factors. This study demonstrates the potential significance of weather events and moisture movement when interpreting plutonium (Pu) migration and advective transport in the soil matrix. Using a column transport experiment, two soil types, a sandy soil and clay-rich soil, were spiked with 238Pu as a tracer to observe the effect of simulated tropical and arid rainfall events on Pu mobility. Partition coefficients (Kd) were determined over a period of weeks and under varying rainfall rates to establish the impact of changing weather events on Pu mobility. The variability of these temporal Kds covers six orders of magnitude over a relatively brief time period. This demonstrates the necessity for non-static Kds to accurately describe Pu transport in these systems. The Pu Kds determined by these column transport experiments fall within the bounds of anticipated values (approximately 80-300,000 mL g-1) from immobile (magnitude 106 mL g-1) to moderately mobile (magnitude 101 mL g-1). The overall transport rate, shown by a decrease in calculated Kd, increases in environments where rainfall is more episodic, such as in arid regions as opposed to the consistently abundant rainfall in tropical regions. In contrast to the 238Pu spike, 239+240Pu resulting from contamination from nuclear tests in the sandy soil (aged for >30 years) showed higher mobility; we hypothesise that the ageing of the contamination, in particular Pu-bearing particles, accounts for this significant increase in Pu mobility. Low intensity, high frequency events in tropical sandy soil systems containing Pu particle contamination have the potential to mobilise Pu (>105 decrease in calculated Kd) over shorter periods of weeks, and not years as previously assumed. This increased mobility, when applied to radioecological models using Kd as a site-specific parameter, shows that there is likely to be a continued impact (risk quotient >1) on non-human biota in tropical sandy soil ecosystems.

Hepatitis C Virus Reflex Testing Protocol in an Emergency Department.

INTRODUCTION: Our aim was to measure hepatitis C virus (HCV) screening and linkage-to-care rates in an urban emergency department (ED) before and after implementing an HCV viral RNA (vRNA) reflex testing protocol within a HCV screening program for at-risk patients. Our hypothesis was that using a reflex testing protocol would increase HCV testing rates of at-risk patients in the ED, which would increase the linkage-to-care rate. METHODS: In August 2018, our institution implemented an automated, electronic health record-based HCV screening protocol in the ED for at-risk patients. In January 2019, we implemented an HCV vRNA reflex testing protocol (reflex testing) for all positive HCV antibody (Ab) tests that were initiated through the screening protocol. We compared completion rates of HCV vRNA testing and the rate of linkage to care for patients with positive HCV Ab test results before and after implementation of reflex testing (five months per study period). RESULTS: Prior to reflex testing implementation, 233/425 (55%) patients with a positive HCV Ab test had an HCV vRNA test performed, whereas 270/323 (84%) patients with a positive HCV Ab test result had vRNA testing after reflex testing implementation (odds ratio [OR], 4.2; 95% confidence interval (CI): 3.0-6.0; P < 0.001). Of the eligible patients with positive HCV Ab test results who could be linked to care, 45 (10.6%) were linked to care before HCV reflex implementation and 46 (14.2%) were linked to care with reflex testing (OR, 1.4; 95% CI: 0.9-2.2; P = 0.13). CONCLUSION: Implementing a reflex testing initiative into an HCV screening program in the ED can result in an increase of the percentage of patients who receive an HCV vRNA test after having had a positive HCV Ab. Hepatitis C virus vRNA reflex testing was not associated with a statistically significant increase in linkage-to-care rates for HCV Ab-positive patients; however, further studies are required.