Affordability of Alcoholic Beverages in the European Union.

BACKGROUND: From a public health perspective, alcohol taxation should be designed to reduce alcohol affordability and thus alcohol consumption and related harms. OBJECTIVES: In this brief report, we estimate alcohol affordability in European Union Member States and associated countries and investigate whether affordability is related to national alcohol excise duties. METHOD: Beverage-specific affordability for beer, wine, and spirits were estimated based on the number of standard drinks a household could purchase based on their median monthly disposable household income in 2020. To determine the pooled affordability of alcohol, the beverage-specific estimates were weighted by the share of the beverage-specific per capita consumption in total recorded consumption. Pearson and Spearman rank correlations were calculated to establish the association between alcohol affordability and alcohol excise duty rates. All data were retrieved from official sources. RESULTS: On average, a European household can purchase 1,628 standard drinks of alcohol with its monthly income, with affordability being highest in Germany, Austria, France, and Luxembourg. The affordability of spirits, but not that of beer or wine, was inversely correlated with the beverage-specific excise duty rates. CONCLUSIONS: Alcohol is affordable in the Member States of the European Union and associated countries, and low levels of excise duties on beer and wine appear to be unrelated to their affordability. Alcohol taxes should be increased to effectively reduce the affordability of alcoholic beverages in order to lower the alcohol-related health burden in Europe.

Public awareness of the alcohol-cancer link in the EU and UK: a scoping review.

BACKGROUND: Alcohol increases cancer risk, but less is known about public awareness of this link. This scoping review summarizes recent findings on the public awareness of alcohol as a cancer risk factor in European Union and UK. METHODS: Four databases (Web of Science, MEDLINE, PsycInfo, CINAHL) were searched for papers containing data on awareness of alcohol as cancer risk factor in EU or UK published between January 2017 and December 2022, and complemented with grey literature searches. RESULTS: In total, 45 studies were included covering 18 EU countries (Austria, Belgium, Cyprus, Czechia, Denmark, Finland, France, Germany, Hungary, Ireland, Italy, Netherlands, Poland, Romania, Slovakia, Slovenia, Spain, Sweden) and UK, presenting data collected between 2009 and 2022. Studies covered general population (17 studied a nationally representative sample), women, health professionals, patients and young people. Awareness of alcohol causing cancer in general was higher and studied more often than awareness of alcohol's impact on specific cancers. Among the EU general population, awareness of the link between alcohol and breast cancer ranged between 10% and 20%, head and neck cancer 15-25%, colorectal and oesophagus cancer 15-45% and liver cancer 40%. Awareness was higher among young people and specialized health professions and lower among women (the latter specifically for the breast cancer). CONCLUSIONS: While awareness rates varied depending on the exact question wording, many studies showed low awareness of the alcohol-cancer link, especially for specific types such as breast and colon cancer. Public should be better informed about alcohol consumption-related cancer risk.

The stigma of alcohol-related liver disease and its impact on healthcare.

People with alcohol-related liver disease (ALD) experience stigma and discrimination. This review summarises the evidence on stigma in healthcare and its implications for people with ALD, drawing from the literature on the stigma associated with mental illness and, specifically, alcohol use disorder (AUD). Public stigma, self-stigma and structural stigma all contribute to failure to seek help or delays in seeking help, inferior healthcare, and negative health outcomes, which increase the overall burden of ALD. Stigma can be experienced, but also anticipated and avoided, with both scenarios negatively impacting on ALD healthcare. Blaming people with ALD for their condition is central to the stigma of ALD. Stigma affects ALD healthcare at all stages, from prevention, early detection and intervention, to allocation of scarce resources in liver transplantation. People with lived experience need to be empowered to lead action against the stigmatisation of patients with ALD. Promulgating a dynamic model of individual and social responsibility for AUD, a continuum model of harmful alcohol use, and establishing training on ALD-related stigma for healthcare professionals are strategies to address stigma. Integrating addiction and ALD services, providing stigma-free prevention, and overcoming the frequent separation of addiction services from general healthcare are necessary. Beyond healthcare, addressing social inequality, the social dimensions of ALD risk and outcomes, and ensuring equal access to services is necessary to improve outcomes for all people with ALD. More research is needed on the stigma of ALD in low- and middle-income countries and in countries with restrictive drinking norms. Interventions to reduce the stigma of ALD and facilitate early help-seeking need to be developed and evaluated.

The Impact of Increasing the Minimum Legal Drinking Age from 18 to 20 Years in Lithuania on All-Cause Mortality in Young Adults-An Interrupted Time-Series Analysis.

AIMS: To determine the effect of an alcohol policy change, which increased the minimum legal drinking age (MLDA) from 18 years of age to 20 years of age on all-cause mortality rates in young adults (18-19 years old) in Lithuania. METHODS: An interrupted time series analysis was conducted on a dataset from 2001 to 2019 (n = 228 months). The model tested the effects of the MLDA on all-cause mortality rates (deaths per 100,000 individuals) in three age categories (15-17 years old, 18-19 years old, 20-22 years old) in order to control for general mortality trends in young adults, and to isolate the effects of the MLDA from other alcohol control policies. Additional models that included GDP as a covariate and a taxation policy were tested as well. RESULTS: There was a significant effect of the MLDA on all-cause mortality rates in those 18-19 years old, when modelled alone. Additional analyses controlling for the mortality rate of other age groups showed similar findings. Inclusion of confounding factors (policies on alcohol taxation, GDP) eliminated the effects of MLDA. CONCLUSIONS: Although there was a notable decline in all-cause mortality rates among young adults in Lithuania, a direct causal impact of MLDA on all-cause mortality rates in young adults was not definitively found.

Self-reported changes in alcohol and tobacco use during COVID-19: findings from the eastern part of WHO European Region.

BACKGROUND: The COVID-19 pandemic might impact substance use behaviours around the globe. In this study, we investigate changes in alcohol and tobacco use in the second half of 2020 in countries of the eastern part of the WHO European Region. METHODS: Self-reported changes in alcohol and tobacco use among 11 295 adults from 18 countries in the eastern part of the WHO European Region were collected between August 2020 and January 2021. The non-probabilistic sample was weighted for age, gender and education. For each country, proportions of respondents reporting a decrease, no change or increase in substance use over the past 3 months were examined, and multinomial regression models were used to test associations with age, gender and past-year alcohol use. RESULTS: In most countries, about half of the respondents indicating past-year alcohol or tobacco use reported no change in their substance use. Of those alcohol users who reported changes in their alcohol use, a larger proportion reported a decrease than an increase in most countries. The opposite was true for tobacco use. Women, young adults and past-year harmful alcohol users were identified as being more likely to change their substance use behaviour. CONCLUSION: We found diverging overall trends for alcohol and tobacco use in the second half of 2020. The patterns of change vary according to age, gender and past-year substance use. Individuals at risk to increase their substance use during the COVID-19 pandemic require most policy considerations.

Digital Assessment Tools Using Animation Features to Quantify Alcohol Consumption: Systematic App Store and Literature Review.

BACKGROUND: Accurate and user-friendly assessment tools for quantifying alcohol consumption are a prerequisite for effective interventions to reduce alcohol-related harm. Digital assessment tools (DATs) that allow the description of consumed alcoholic drinks through animation features may facilitate more accurate reporting than conventional approaches. OBJECTIVE: This review aims to identify and characterize freely available DATs in English or Russian that use animation features to support the quantitative assessment of alcohol consumption (alcohol DATs) and determine the extent to which such tools have been scientifically evaluated in terms of feasibility, acceptability, and validity. METHODS: Systematic English and Russian searches were conducted in iOS and Android app stores and via the Google search engine. Information on the background and content of eligible DATs was obtained from app store descriptions, websites, and test completions. A systematic literature review was conducted in Embase, MEDLINE, PsycINFO, and Web of Science to identify English-language studies reporting the feasibility, acceptability, and validity of animation-using alcohol DATs. Where possible, the evaluated DATs were accessed and assessed. Owing to the high heterogeneity of study designs, results were synthesized narratively. RESULTS: We identified 22 eligible alcohol DATs in English, 3 (14%) of which were also available in Russian. More than 95% (21/22) of tools allowed the choice of a beverage type from a visually displayed selection. In addition, 36% (8/22) of tools enabled the choice of a drinking vessel. Only 9% (2/22) of tools allowed the simulated interactive pouring of a drink. For none of the tools published evaluation studies were identified in the literature review. The systematic literature review identified 5 exploratory studies evaluating the feasibility, acceptability, and validity of 4 animation-using alcohol DATs, 1 (25%) of which was available in the searched app stores. The evaluated tools reached moderate to high scores on user rating scales and showed fair to high convergent validity when compared with established assessment methods. CONCLUSIONS: Animation-using alcohol DATs are available in app stores and on the web. However, they often use nondynamic features and lack scientific background information. Explorative study data suggest that such tools might enable the user-friendly and valid assessment of alcohol consumption and could thus serve as a building block in the reduction of alcohol-attributable health burden worldwide. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42020172825; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020172825.

[Potential impact of increased alcohol taxes on the alcohol-attributable burden of disease in Germany: a modelling study]. / Potenzielle Auswirkungen erhöhter Alkoholsteuern auf die alkoholbedingte Krankheitslast in Deutschland: Eine Modellierungsstudie.

BACKGROUND: In 2019, Germany was among the countries with the highest alcohol per capita consumption in the world, which contributes significantly to the burden of disease. AIM: In this modelling study, we estimate how many alcohol-attributable diseases and deaths in Germany could have been avoided in 2019 if current alcohol excise taxes were increased by 20%, 50%, and 100%. METHODS: The starting point for the modelling was the national beverage-specific alcohol taxes. Three scenarios were modelled under the assumption that the resulting tax increase would be fully transferred to the retail prices. Beverage-specific price elasticities were used. Based on the estimated resulting decline in annual per capita consumption and the disease-specific risk functions, we modelled the avoidable incidence and mortality for alcohol-attributable diseases for 2019. Alcohol-attributable diseases of the cardiovascular and digestive systems, alcohol dependence, epilepsy, and infectious diseases as well as injuries and accidents were considered. RESULTS: Overall, doubling the beverage-specific alcohol taxes could have avoided up to 200,400 alcohol-attributable cases of disease and injury as well as 2800 deaths in Germany in 2019. This corresponds to just under 7% of the modelled new alcohol-attributable cases of disease and death in Germany. DISCUSSION: Alcohol-attributable diseases and injuries are preventable and an increase in the alcohol taxes could substantially reduce the alcohol-attributable burden of disease in Germany.

Validation of a screening test for alcohol use, the Russian Federation.

OBJECTIVE: To validate a Russian-language version of the World Health Organization's Alcohol Use Disorders Identification Test (AUDIT). METHODS: We invited 2173 patients from 21 rural and urban primary health-care centres in nine Russian regions to participate in the study (143 declined and eight were excluded). In a standardized interview, patients who had consumed alcohol in the past 12 months provided information on their sociodemographic characteristics and completed the Russian AUDIT, the Kessler Psychological Distress Scale and the Composite International Diagnostic Interview to identify problem drinking and alcohol use disorders. We assessed the feasibility of administering the test, its internal consistency and its ability to predict hazardous drinking and alcohol use disorders in primary health care in the Russian Federation. FINDINGS: Of the 2022 patients included in the study, 1497 were current drinkers with Russian AUDIT scores. The test was internally consistent with good psychometric properties (Cronbach's α : 0.842) and accurately predicted alcohol use disorders and other outcomes (area under the curve > 75%). A three-item short form of the test correlated well with the full instrument and had similar predictive power (area under the curve > 80%). We determined sex-specific thresholds for all outcomes, as non-specific thresholds resulted in few women being identified. CONCLUSION: With the validated Russian AUDIT, there is no longer a barrier to introducing screening and brief interventions into primary health care in the Russian Federation to supplement successful alcohol control policies.

Fewer Cancer Cases in 4 Countries of the WHO European Region in 2018 through Increased Alcohol Excise Taxation: A Modelling Study.

INTRODUCTION: Prevention of cancer has been identified as a major public health priority for Europe, and alcohol is a leading risk factor for various types of cancer. This contribution estimates the number of cancer cases that could have potentially been averted in 2018 in 4 European countries if an increase in alcohol excise taxation had been applied. METHODS: Current country and beverage-specific excise taxation of 4 member states of the WHO European Region (Germany, Italy, Kazakhstan, and Sweden) was used as a baseline, and the potential impacts of increases of 20, 50, and 100% to current excise duties were modelled. A sensitivity analysis was performed, replacing the current tax rates in the 4 countries by those levied in Finland. The resulting increase in tax was assumed to be fully incorporated into the consumer price, and beverage-specific price elasticities of demand were obtained from meta-analyses, assuming less elasticity for heavy drinkers. Model estimates were applied to cancer incidence rates for the year 2018. RESULTS: In the 4 countries, >35,000 cancer cases in 2018 were caused by alcohol consumption, with the highest rate of alcohol-attributable cancers recorded in Germany and the lowest in Sweden. An increase in excise duties on alcohol would have significantly reduced these numbers, with between 3 and 7% of all alcohol-attributable cancer cases being averted if taxation had been increased by 100%. If the 4 countries were to adopt an excise taxation level equivalent to the one currently imposed in Finland, an even higher proportion of alcohol-attributable cancers could be avoided, with Germany alone experiencing 1,600 fewer cancer cases in 1 year. DISCUSSION/CONCLUSION: Increasing excise duties can markedly reduce cancer incidence in European countries.

Adaptation of and Protocol for the Validation of the Alcohol Use Disorders Identification Test (AUDIT) in the Russian Federation for Use in Primary Healthcare.

AIMS: To adapt and validate the Alcohol Use Disorders Identification Test (AUDIT) for use in the Russian Federation and countries with Russian-speaking populations by. METHODS: Systematic review of past use and validation of the Russian-language AUDIT. Interviews to be conducted with experts to identify problems encountered in the use of existing Russian-language AUDIT versions. A pilot study using a revised translation of the Russian-language AUDIT that incorporates country-specific drinking patterns in the Russian Federation. RESULTS AND CONCLUSIONS: The systematic review identified over 60 different Russian-language AUDIT versions without systematic validation studies. The main difficulties encountered with the use of the AUDIT in the Russian Federation were related to the lack of:A revised version of the Russian-language AUDIT was created based on the pilot studies, and was validated in primary healthcare facilities in all regions in 2019/2020.

Quantifying the global contribution of alcohol consumption to cardiomyopathy.

BACKGROUND: The global impact of alcohol consumption on deaths due to cardiomyopathy (CM) has not been quantified to date, even though CM contains a subcategory for alcoholic CM with an effect of heavy drinking over time as the postulated underlying causal mechanism. In this feasibility study, a model to estimate the alcohol-attributable fraction (AAF) of CM deaths based on alcohol exposure measures is proposed. METHODS: A two-step model was developed based on aggregate-level data from 95 countries, including the most populous (data from 2013 or last available year). First, the crude mortality rate of alcoholic CM per 1,000,000 adults was predicted using a negative binomial regression based on prevalence of alcohol use disorders (AUD) and adult alcohol per capita consumption (APC) (n = 52 countries). Second, the proportion of alcoholic CM among all CM deaths (i.e., AAF) was predicted using a fractional response probit regression with alcoholic CM crude mortality rate (from Step 1), AUD prevalence, APC per drinker, and Global Burden of Disease region as predictions. Additional models repeated these steps by sex and for the wider Global Burden of Disease study definition of CM. RESULTS: There were strong correlations (>0.9) between the crude mortality rate of alcoholic CM and the AAFs, supporting the modeling strategy. In the first step, the population-weighted mean crude mortality rate was estimated at 8.4 alcoholic CM deaths per 1,000,000 (95% CI: 7.4-9.3). In the second step, the global AAFs were estimated at 6.9% (95% CI: 5.4-8.4%). Sex-specific figures suggested a lower AAF among females (2.9%, 95% CI: 2.3-3.4%) as compared to males (8.9%, 95% CI: 7.0-10.7%). Larger deviations between observed and predicted AAFs were found in Eastern Europe and Central Asia. CONCLUSIONS: The model proposed promises to fill the gap to include AAFs for CM into comparative risk assessments in the future. These predictions likely will be underestimates because of the stigma involved in all fully alcohol-attributable conditions and subsequent problems in coding of alcoholic CM deaths.

Alcohol rehabilitation and cancer risk: a nationwide hospital cohort study in France.

BACKGROUND: Even though alcohol consumption is an established risk factor for cancer, evidence regarding the effect of a reduction or cessation of alcohol consumption on cancer incidence is scarce. Our main study aim was to assess the effect of alcohol rehabilitation and abstinence on cancer incidence in people with alcohol dependence. METHODS: We conducted a nationwide hospital retrospective cohort study which included all adults residing in mainland France and discharged in 2018-21. Multivariable Cox proportional hazards models were used to estimate the effect of rehabilitation treatment at hospital or a history of abstinence versus alcohol dependence without rehabilitation or abstinence on the risk for incident alcohol-associated cancers by sex, controlled for potential confounding risk factors. FINDINGS: 10 260 056 men and 13 739 369 women were discharged from French hospitals in 2018-21. Alcohol dependence was identified in 645 720 (6·3%) men and 219 323 (1·6%) women. Alcohol dependence was strongly related to alcohol-associated cancer sites in both sexes (hepatocellular carcinoma and oral, pharyngeal, laryngeal, oesophageal, and colorectal cancers), except for breast cancer. Rehabilitation treatment or abstinence was associated with significantly lower risks compared with alcohol dependence without rehabilitation or abstinence (adjusted hazard ratios: 0·58, 99·89% CI 0·56-0·60 in men and 0·62, 0·57-0·66 in women). Relative risk reductions were significant for each alcohol-associated cancer site in both sexes and supported by all subgroup and sensitivity analyses. INTERPRETATION: Our study results support the clear benefits of alcohol rehabilitation and abstinence in reducing the risk for alcohol-associated cancers. As only two in five patients with alcohol dependence were recorded with a history of rehabilitation treatment or abstinence, a large untapped potential exists for reducing cancer incidence. FUNDING: European Union's EU4Health programme.

How much do Europeans know about the link between alcohol use and cancer? Results from an online survey in 14 countries.

OBJECTIVE: In the EU, which has the highest drinking levels worldwide, cancer is the primary cause of alcohol-attributable deaths. Existing studies show gaps in public knowledge, but there is lack of systematic appraisal. The report presents original data from a cross-sectional survey conducted within the framework of an online experimental study in 14 European countries, which among other things assessed baseline knowledge of the alcohol-NCD link, particularly cancer. METHODS: Online questionnaire among adults who consume alcohol conducted in 14 countries in 2022-2023 using different recruitment strategies and applying population weights for the final sample. Baseline assessments measured participants' knowledge of alcohol-attributable health issues (with a specific focus on cancer). RESULTS: Baseline knowledge assessment showed that 90% indicated a causal role of alcohol for liver disease, 68% for heart diseases, and only 53% for cancer. Knowledge of specific alcohol-attributable cancer types was lower, with 39% aware of the link between alcohol use and colon cancer, 28% regarding oral cancer, and only 15% regarding female breast cancer. Knowledge levels varied across different countries and population groups. CONCLUSION: Most Europeans do not know which cancers can be caused by alcohol use and knowledge is low specifically for female breast cancer. More awareness raising and prevention efforts are needed, such as the placement of cancer-specific health warnings on alcohol container labels.

Designing and implementing an experimental survey on knowledge and perceptions about alcohol warning labels.

OBJECTIVES: This paper describes the design and implementation of an online survey experiment to investigate the effects of alcohol warning labels on alcohol-related knowledge, risk perceptions and intentions. METHOD: The survey collected self-reported data from 14 European countries through two waves of data collection with different recruitment strategies: dissemination via social media and public health agencies was followed by paid-for Facebook ads. The latter strategy was adopted to achieve broader population representation. Post-stratification weighting was used to match the sample to population demographics. RESULTS: The survey received over 34,000 visits and resulted in a sample size of 19,601 participants with complete data on key sociodemographic characteristics. The responses in the first wave were over-representing females and higher educated people, thus the dissemination was complemented by the paid-for Facebook ads targeting more diverse populations but had higher attrition rate. CONCLUSION: Experiments can be integrated into general population surveys. Pan-European results can be achieved with limited resources and a combination of sampling methods to compensate for different biases, and statistical adjustments.

Classifying national drinking patterns in Europe between 2000 and 2019: A clustering approach using comparable exposure data.

BACKGROUND AND AIMS: Previously identified national drinking patterns in Europe lack comparability and might be no longer be valid due to changes in economic conditions and policy frameworks. We aimed to identify the most recent alcohol drinking patterns in Europe based on comparable alcohol exposure indicators using a data-driven approach, as well as identifying temporal changes and establishing empirical links between these patterns and indicators of alcohol-related harm. DESIGN: Data from the World Health Organization's monitoring system on alcohol exposure indicators were used. Repeated cross-sectional hierarchical cluster analyses were applied. Differences in alcohol-attributable harm between clusters of countries were analyzed via linear regression. SETTING: European Union countries, plus Iceland, Norway and Ukraine, for 2000, 2010, 2015 and 2019. PARTICIPANTS/CASES: Observations consisted of annual country data, at four different time points for alcohol exposure. Harm indicators were only included for 2019. MEASUREMENTS: Alcohol exposure indicators included alcohol per capita consumption (APC), beverage-specific consumption and prevalence of drinking status indicators (lifetime abstainers, current drinkers, former drinkers and heavy episodic drinking). Alcohol-attributable harm was measured using age-standardized alcohol-attributable Disability-Adjusted Life Years (DALYs) lost and deaths per 100 000 people. FINDINGS: The same six clusters were identified in 2019, 2015 and 2010, mainly characterized by type of alcoholic beverage and prevalence drinking status indicators, with geographical interpretation. Two-thirds of the countries remained in the same cluster over time, with one additional cluster identified in 2000, characterized by low APC. The most recent drinking patterns were shown to be significantly associated with alcohol-attributable deaths and DALY rates. Compared with wine-drinking countries, the mortality rate per 100 000 people was significantly higher in Eastern Europe with high spirits and 'other' beverage consumption [ ß ^ $$ \hat{\beta} $$ = 90, 95% confidence interval (CI) = 55-126], and in Eastern Europe with high lifetime abstainers and high spirits consumption ( ß ^ $$ \hat{\beta} $$ = 42, 95% CI = 4-78). CONCLUSIONS: European drinking patterns appear to be clustered by level of beverage-specific consumption, with heavy episodic drinkers, current drinkers and lifetime abstainers being distinguishing factors between clusters. Despite the overall stability of the clusters over time, some countries shifted between drinking patterns from 2000 to 2019. Overall, patterns of drinking in the European Union seem to be stable and partly determined by geographical proximity.

Effect of alcohol health warning labels on knowledge related to the ill effects of alcohol on cancer risk and their public perceptions in 14 European countries: an online survey experiment.

BACKGROUND: Alcohol health-warning labels are a policy option that can contribute to the reduction of alcohol-related harms, but their effects and public perception depend on their content and format. Our study aimed to investigate the effect of health warnings on knowledge that alcohol causes cancer, the perceptions of three different message topics (responsible drinking, general health harm of alcohol, and alcohol causing cancer), and the role of images included with the cancer message. METHODS: In this online survey experiment, distributed in 14 European countries and targeting adults of the legal alcohol-purchase age who consumed alcohol, participants were randomly allocated to one of six label conditions using a pseudorandom number generator stratified by survey language before completing a questionnaire with items measuring knowledge and label perceptions. Effect on knowledge was assessed as a primary outcome by comparing participants who had increased knowledge after exposure to labels with the rest of the sample, for the six label conditions. Label perceptions were compared between label conditions as secondary outcomes. FINDINGS: 19 110 participants completed the survey and were eligible for analysis. Our results showed that a third of the participants exposed to the cancer message increased their knowledge of alcohol causing cancer (increase for 1131 [32·5%, 95% CI 29·8 to 35·2] of 3409 participants [weighted percentage] for text-only message; increase for 1096 [33·3%, 30·4 to 36·2] of 3198 [weighted percentage] for message inlcuding pictogram; and increase for 1030 [32·5%, 29·6 to 35·4] of 3242 [weighted percentage] for message including graphic image), compared with an increase for 76 (2·4%, -1·2 to 6·0) of 3018 participants who viewed the control message. Logistic regression showed that cancer messages increased knowledge compared with the control label (odds ratio [OR]text only 20·20, 95% CI 15·88 to 26·12; ORpictogram 21·16, 16·62 to 27·38; ORgraphic-image 20·61, 16·19 to 26·68). Cancer messages had the highest perceived impact and relevance, followed by general health harm and responsibility messages. Text-only and pictogram cancer messages were seen as clear, comprehensive, and acceptable, whereas those including an image of a patient with cancer had lower acceptability and the highest avoidance rating of all the labels. The only identified interaction between perceptions and experimental conditions (with gender) indicated higher comprehensibility and acceptability ratings of cancer labels than responsibility messages and control labels by women, with the results reversed in men. INTERPRETATION: Health warnings are an effective policy option to increase knowledge of alcohol causing cancer, with a generalisable effect across several countries. Europeans consider alcohol health-warning labels to be comprehensible and acceptable, with cancer-specific health warnings having the highest perceived impact and relevance. FUNDING: EU4Health.

Alcohol consumption and mortality in Russia since 2000: are there any changes following the alcohol policy changes starting in 2006?

AIMS: To elucidate the possible effects of Russian alcohol control policy on alcohol consumption and alcohol-related mortality for the period 2000-2010. METHODS: Narrative review including statistical analysis. Trends before and after 2006 are compared, 2006 being the date of implementation of the Russian government's long-term strategy to reduce alcohol-related harms. Mortality data were taken from the World Health Organization (WHO) database 'Health for All'. Data on recorded alcohol consumption were taken from the WHO, based on the Russian Statistical Service (Rosstat). For unrecorded consumption, the calculations of Alexandr Nemtsov were used. Russian public opinion surveys on drinking habits were utilized. Treatment data on alcohol dependence were obtained from the Moscow National Research Centre on Addictions. Information on alcohol policy was obtained from official reports. RESULTS: Marked fluctuations in all-cause and alcohol-associated mortality in the working-age population were observed during the reviewed period. A decrease in total consumption and mortality was noted since the end of 2005, when the Russian government initially adopted the regulation of alcohol production and sale. The consumption changes were driven by decreases in recorded and unrecorded spirit consumption, only partly compensated for by increases in beer and wine consumption. CONCLUSIONS: Alcohol is a strong contributor to premature deaths in Russia, with both the volume and the pattern of consumption being detrimental to health. The regulations introduced since 2006 seem to have positive effects on both drinking behavior and health outcomes. However, there is an urgent need for further alcohol-control strategies to reduce alcohol-related harm.

Assessing the impact of providing digital product information on the health risks of alcoholic beverages to the consumer at point of sale: A pilot study.

INTRODUCTION: There is an ongoing policy debate in the European Union regarding the best method of providing information to consumers on the health risks of alcohol use. One of the proposed channels is via the provision of QR codes. This study tested the usage rate of QR codes placed on point-of-sale signs in a supermarket in Barcelona, Catalonia over a 1-week period. METHODS: Nine banners with beverage-specific health warnings in large text were prominently displayed in the alcohol section of a supermarket. Each banner provided a QR code of relatively large image size that linked to a government website providing further information on alcohol-related harms. A comparison was made between the number of visits to the website and the number of customers in the supermarket (number of unique sales receipts) in a single week. RESULTS: Only 6 out of 7079 customers scanned the QR code during the week, corresponding to a usage rate of 0.085%, less than 1 per 1000. The usage rate was 2.6 per 1000 among those who purchased alcohol. DISCUSSION AND CONCLUSIONS: Despite the availability of prominently displayed QR codes, the overwhelming majority of customers did not make use of the QR codes to obtain further information on alcohol-related harms. This corroborates the results from other studies investigating customers' use of QR codes to obtain additional product information. Based on the current evidence, providing online access to information through QR codes will likely not reach a significant portion of consumers.

Classifying alcohol control policies enacted between 2000 and 2020 in Poland and the Baltic countries to model potential impact.

AIMS: The study's aim is to identify and classify the most important alcohol control policies in the Baltic countries (Estonia, Latvia and Lithuania) and Poland between 2000 and 2020. METHODS: Policy analysis of Baltic countries and Poland, predicting potential policy impact on alcohol consumption, all-cause mortality and alcohol-attributable hospitalizations was discussed. RESULTS: All Baltic countries implemented stringent availability restrictions on off-premises trading hours and different degrees of taxation increases to reduce the affordability of alcoholic beverages, as well as various degrees of bans on alcohol marketing. In contrast, Poland implemented few excise taxation increases or availability restrictions and, in fact, reduced stipulations on prior marketing bans. CONCLUSIONS: This classification of alcohol control policies in the Baltic countries and Poland provides a basis for future modeling of the impact of implementing effective alcohol control policies (Baltic countries), as well as the effects of loosening such policies (Poland).