Chlamydia Testing in New Zealand: Analysis of the 2014/2015 National Health Survey.

BACKGROUND: Diagnosis rates of Chlamydia trachomatis are high in New Zealand; 1.3% of men and 3.7% of women aged 15 to 29 years were diagnosed in 2016. Because testing rates are also higher in women, we sought to understand chlamydia testing by demographic and behavioral characteristics. METHODS: Chlamydia testing in the past year, sexual behavior, and demographic characteristics were reported in the population-based 2014/2015 New Zealand Health Survey. Those aged 16 to 44 years who had a sexual partner in the past year were included. Testing prevalence was calculated, and associations were modeled. RESULTS: A total of 1677 men and 2323 women participated (89% response rate). Of these, 5.6% (95% confidence interval, 4.3%-7.2%) of men and 16.6% (14.7%-18.7%) of women were tested in the past year. Likelihood of testing in men was associated with having multiple partners and any condomless sex (adjusted relative risk, 11.93; 95% confidence interval, 5.70-24.98) and multiple partners with consistent condom use (3.77, 1.40-10.15) compared with one sexual partner and consistent condom use, and with Maori ethnicity (1.87, 1.05-3.31) compared with European/other. Among women, testing was associated with multiple partners with and without condomless sex (3.61 [2.69-4.85] and 2.81 [1.95-4.05], respectively), pregnancy (1.61, 1.18-2.18), and Asian ethnicity (0.52, 0.30-0.89). CONCLUSIONS: The study confirms that New Zealand men are much less likely to be tested than women, a potential reason for ongoing high chlamydia incidence among both sexes. The high testing rate in women includes many at low risk, and this divergence from recommendations is another issue to address.

A polygenic score for age-at-first-birth predicts disinhibition.

BACKGROUND: A recent genome-wide association study identified molecular-genetic associations with age-at-first-birth. However, the meaning of these genetic discoveries is unclear. Drawing on evidence linking early pregnancy with disinhibitory behavior, we tested the hypothesis that genetic discoveries for age-at-first-birth predict disinhibition. METHODS: We included participants with genotype data from the two-decade-long Environmental Risk (E-Risk) Study (N = 1,999) and the four-decade-long Dunedin Study (N = 918). We calculated a genome-wide polygenic score for age-at-first-birth and tested whether it was associated with a range of disinhibitory outcomes across the life course, including low childhood self-control; risk for externalizing psychopathology; officially recorded criminal offending; substance dependence; informant reports of disinhibitory problems; and number of lifetime sexual partners. We further tested whether associations were attributable to accelerated pubertal maturation. RESULTS: In both cohorts, the age-at-first-birth polygenic score predicted low childhood self-control, externalizing psychopathology, officially recorded criminal offending, substance dependence, and number of sexual partners. Associations were modest, but robust across replication. Childhood disinhibition partly mediated associations between the polygenic score and reproductive behaviors. In contrast, associations were not attributable to accelerated pubertal timing. CONCLUSIONS: Genomic discoveries for age-at-first-birth are about more than reproductive biology: They provide insight into the disinhibitory traits and behaviors that accompany early parenthood. Age-at-first-birth is a useful proxy phenotype for researchers interested in disinhibition. Further, interventions that improve self-regulation abilities may benefit young parents and their children.

Blood alcohol and injury in Bhutan: targeted surveillance in a national referral hospital emergency department.

Bhutan is a low-middle-income country with poor roads, rapidly increasing motor vehicle use and heavy alcohol consumption. We estimated the proportion of emergency department patients presenting with injury who had positive blood alcohol. We sought to breathalyse and interview all adult patients (≥18 years) presenting with injury at the Jigme Dorji Wangchuck National Referral Hospital in the capital city Thimphu, from April to October 2015. Breath tests and interviews were conducted with 339 (91%) of 374 eligible adult patients. A third (34%) were alcohol-positive and 22% had blood alcohol concentrations >0.08 g/dL. The highest alcohol-positive fractions were for assault (71%), falls (31%) and traffic crashes (30%). Over a third (36%) of patients had a delay of >2 h between injury and breath test. The results underestimate blood alcohol concentrations at the time of injury so the true prevalence of pre-injury alcohol impairment is greater than our estimates suggest. Countermeasures are urgently needed, particularly roadside random breath testing and alcohol controls.

New Zealand's new alcohol laws: protocol for a mixed-methods evaluation.

BACKGROUND: Alcohol consumption is a major cause of mortality and morbidity globally. In response to strong calls from the public for alcohol law reform, the New Zealand Government recently reduced the blood alcohol limit for driving and introduced the Sale and Supply of Alcohol Act which aim to (1) improve community input into local decision-making on alcohol; (2) reduce the availability of alcohol; and (3) reduce hazardous drinking and alcohol-related harm. In this project we seek to evaluate the new laws in terms of these objectives. DESIGN AND METHODS: A policy evaluation framework is proposed to investigate the implementation and outcomes of the reforms. We will use quantitative and qualitative methods, employing a pre-post design. Participants include members of the public, local government staff, iwi (Maori tribal groups that function collectively to support their members) and community group representatives. Data will be collected via postal surveys, interviews and analysis of local government documents. Liquor licensing, police and hospital injury data will also be used. Community input into local government decision-making will be operationalised as: the number of objections per license application and the number of local governments adopting a local alcohol policy (LAP). Outcome measures will be the 'restrictiveness' of LAPs compared to previous policies, the number (per 1000 residents) and density (per square kilometre) of alcohol outlets throughout NZ, and the number of weekend late-night (i.e., post 10 pm) trading hours. For consumption and harm, outcomes will be the prevalence of hazardous drinking, harm from own and others' drinking, community amenity effects, rates of assault, and rates of alcohol-involved traffic crashes. Multiple regression will be used to model how the outcomes vary by local government area from before to after the law changes take effect. These measures will be complemented by qualitative analysis of LAP development and public participation in local decision-making on alcohol. DISCUSSION: The project will evaluate how well the reforms meet their explicit public health objectives.

Effects of small incentives on survey response fractions: randomised comparisons in national alcohol surveys conducted in New Zealand.

We experimentally evaluate inexpensive interventions to increase response fractions in two alcohol surveys. Residents on the New Zealand General and Maori electoral rolls were randomized to receive a survey pack with or without an offer of entry to a $500 prize draw. Subsequent randomization of sample members who did not initially respond allowed estimation of effects of offering a $5 donation to charity as an incentive to respond. Offering prize draw entry did not significantly increase responses in either population. Contrary to expectation, promising a $5 donation to non-respondents reduced subsequent responding in the group previously offered the prize draw incentive.

Alcohol use, mental well-being, self-esteem and general self-efficacy among final-year university students.

PURPOSE: We aimed to quantify associations between drinking and mental well-being, self-esteem and general self-efficacy among New Zealand university students approaching graduation. METHODS: A web-based survey was conducted across all eight New Zealand universities in 2011. Participants were enrolled in their final year of a bachelor degree or a higher qualification and were aged 25 years and under (n = 5082, response level 65 %). Measures included the Alcohol Use Disorders Identification Test-Consumption, Warwick-Edinburgh Mental Well-being Scale, and items from the Rosenberg Self-esteem Scale and General Self-efficacy Scale. Linear regression models were used to estimate associations between the psychological measures and (1) drinking patterns for all participants (abstention/moderate/hazardous); and (2) consumption indicators for non-abstaining participants (frequency/quantity/heavy drinking frequency), adjusting for a range of individual, social and personality characteristics, separately for men and women. RESULTS: Lower mental well-being was associated with a moderate or hazardous drinking pattern for men, and a hazardous pattern for women, compared to abstaining participants. Higher self-esteem was associated with any level of heavy drinking frequency for men, while the heaviest drinking women had a pattern of lower self-esteem. There was a general pattern of higher general self-efficacy for men and women who drank alcohol. CONCLUSIONS: We observed that higher levels of drinking were associated with small, yet statistically significant, differences in psychological outcomes for men and women. Our findings are of uncertain clinical significance; however, they underscore the importance of investigating a fuller range of social and personality factors that may confound the association of drinking and psychological outcomes.

Inconsistency in reporting abstention and heavy drinking frequency: associations with sex and socioeconomic status, and potential impacts.

AIMS: To describe inconsistencies in reporting past-year drinking status and heavy drinking occasions (HDOs) on single questions from two different instruments, and to identify associated characteristics and impacts. METHODS: We compared computer-presented Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) with categorical response options, and mental health interview (MHI) with open-ended consumption questions, completed on the same day. Participants were 464 men and 459 women aged 38 (91.7% of surviving birth cohort members). Differences in dichotomous single-item measures of abstention and HDO frequency, associations of inconsistent reporting with sex, socioeconomic status (SES) and survey order, and impacts of instrument choice on associations of alcohol with sex and SES were examined. RESULTS: The AUDIT-C drinking frequency question estimated higher past-year abstention prevalence (AUDIT = 7.6%, MHI = 5.4%), with one-third of AUDIT-C abstainers being MHI drinkers. Only AUDIT-C produced significant sex differences in abstainer prevalence. Inconsistencies in HDO classifications were bidirectional, but with fewer HDOs reported on the MHI than AUDIT-C question. Lower SES was associated with inconsistency in abstention and weekly+ HDOs. Abstention and higher HDO frequency were associated with lower SES overall, but sex-specific associations differed by instrument. CONCLUSIONS: In this context, data collection method affected findings, with inconsistencies in abstention reports having most impact. Future studies should: (a) confirm self-reported abstention; (b) consider piloting data collection methods in target populations; (c) expect impacts of sex and SES on measurements and analyses.

Effects of lowering the minimum alcohol purchasing age on weekend assaults resulting in hospitalization in New Zealand.

OBJECTIVES: We estimated the effects on assault rates of lowering the minimum alcohol purchasing age in New Zealand from 20 to 18 years. We hypothesized that the law change would increase assaults among young people aged 18 to 19 years (the target group) and those aged 15 to 17 years via illegal sales or alcohol supplied by older friends or family members. METHODS: Using Poisson regression, we examined weekend assaults resulting in hospitalization from 1995 to 2011. Outcomes were assessed separately by gender among young people aged 15 to 17 years and those aged 18 to 19 years, with those aged 20 and 21 years included as a control group. RESULTS: Relative to young men aged 20 to 21 years, assaults increased significantly among young men aged 18 to 19 years between 1995 and 1999 (the period before the law change), as well as the postchange periods 2003 to 2007 (incidence rate ratio [IRR] = 1.21; 95% confidence interval [CI] = 1.05, 1.39) and 2008 to 2011 (IRR = 1.20; 95% CI = 1.05, 1.37). Among boys aged 15 to 17 years, assaults increased during the postchange periods 1999 to 2003 (IRR = 1.28; 95% CI = 1.10, 1.49) and 2004 to 2007 (IRR = 1.25; 95% CI = 1.08, 1.45). There were no statistically significant effects among girls and young women. CONCLUSIONS: Lowering the minimum alcohol purchasing age increased weekend assaults resulting in hospitalization among young males 15 to 19 years of age.

Generating political priority for alcohol policy reform: A framework to guide advocacy and research.

INTRODUCTION: While effective policies exist to reduce alcohol-related harm, political will to enact them is low in many jurisdictions. We aimed to identify key barriers and strategies for strengthening political priority for alcohol policy reform. METHODS: A framework synthesis was conducted, incorporating relevant theory, key informant interviews (n = 37) and a scoping review. Thematic analysis informed the development of a framework for understanding and influencing political priority for alcohol policy. RESULTS: Twelve barriers and 14 strategies were identified at multiple levels (global, national and local). Major barriers included neoliberal or free trade ideology, the globalised alcohol industry, limited advocate capacity and the normalisation of alcohol harms. Strategies fell into two categories: sector-specific and system change initiatives. Sector-specific strategies primarily focus on influencing policymakers and mobilising civil society. Examples include developing a clear, unified solution, coalition building and effective framing. System change initiatives target structural change to reduce the power imbalance between industry and civil society, such as restricting industry involvement in policymaking and securing sustainable funding for advocacy. A key example is establishing an international treaty, similar to the Framework Convention on Tobacco Control, to support domestic policymaking. DISCUSSION AND CONCLUSIONS: Our findings provide a framework for understanding and advancing political priority for alcohol policy. The framework highlights that progress can be achieved at various levels and through diverse groups of actors. The importance of upstream drivers of policymaking was a key finding, presenting challenges for time-poor advocates, but offering potential facilitation through effective global leadership.

Quantifying alcohol-attributable disability-adjusted life years to others than the drinker in Aotearoa/New Zealand: A modelling study based on administrative data.

BACKGROUND AND AIMS: Quantifying the health burden of alcohol has largely focused upon harm to drinkers, which is an underestimate. There is a growing literature on alcohol's harm to others (HTO), but it lacks the systematic transfer of HTO into a comparative risk assessment framework. This study calculated disability-adjusted life years (DALYs) for fetal alcohol spectrum disorder (FASD), interpersonal violence and traffic injury due to another's drinking. DESIGN: This study is a disease burden analysis, using modelling of DALYs for New Zealand in 2018. SETTING AND PARTICIPANTS: The study took place among the Aotearoa/New Zealand population in 2018. MEASUREMENTS: The involvement of others' drinking was obtained from prevalence, alcohol-attributable fraction studies and administrative data. Disability weights (DW) for FASD were adapted from fetal alcohol syndrome (FAS) weights using a Beta-Pert probability distribution; for interpersonal injury, DWs used hospital events linked with injury compensation; for traffic injury, DWs used hospital events. Populations were stratified by ethnicity, age group and gender. A descriptive comparison was made with a previous estimate of DALYs for drinkers. FINDINGS: In 2018, 78 277 healthy life years were lost in Aotearoa/New Zealand due to alcohol's HTO. The main contributor (90.3%) was FASD, then traffic crashes (6.3%) and interpersonal violence (3.4%). The indigenous population, Maori, was impacted at a higher rate (DALYs among Maori were 25 per 1000 population; among non-Maori 15 per 1000 population). The burden of HTO was greater than that to drinkers (DALYs HTO = 78 277; DALYs drinkers = 60 174). CONCLUSIONS: Disability from fetal alcohol spectrum disorder (FASD) appears to be a major contributor to alcohol's harm to others in Aotearoa/New Zealand. Taking FASD into account, the health burden of harm to others is larger than harm to the drinker in Aotearoa/New Zealand, and ethnicity differences show inequity in harm to others. Quantification of the burden of harm informs the value of implementing effective alcohol policies and should include the full range of harms.

Risky drinking, risky sex: a national study of New Zealand university students.

BACKGROUND: Sexual risk taking and heavy alcohol use coexist in many populations of young people. A better understanding of the role of alcohol in sexual behaviors with health risks will inform preventive strategies. This study aimed to estimate the associations of risky sexual behavior with usual drinking pattern, with beliefs that alcohol will positively affect sexual experiences, and with drinking at the time of the sexual event. METHODS: We conducted a cross-sectional web-based survey of randomly selected university students on 8 New Zealand campuses in April 2009. Event-level data (drinking, partner type, and condom use at last sexual intercourse) were collected along with contextual data (usual alcohol consumption [AUDIT-C score], history of binge drinking, alcohol-related sexual enhancement expectancies). Regression models were used to estimate associations and potential mediation. RESULTS: The response rate was 50.6% (n = 2,921). After survey weighting, of those respondents who had ever had sex, 32% reported they had been drinking and 56% reported using a condom at last sex; 10.7% reported that their last sexual intercourse was with a nonregular partner and without a condom ("risky sex") (12.3% of men; 9.8% of women; p = 0.159). For both men and women, alcohol-sex expectancy scores and current drinking (AUDIT-C) scores were independently associated with amount of alcohol at last sex. For both men and women, the association of current drinking or expectancy with risky sex was mediated by alcohol at last sex. CONCLUSIONS: Of the complex factors that contribute to risky sexual behavior and negative sexual health outcomes, heavy drinking appears to be important and is potentially modifiable. Addressing environmental determinants of hazardous drinking is likely to reduce negative sexual health outcomes among university students and other young people. Continuing promotion of condom use is also necessary, and further integration of health promotion activities in alcohol and sexual health is warranted.

Foetal alcohol spectrum disorder in Aotearoa, New Zealand: Estimates of prevalence and indications of inequity.

INTRODUCTION: Foetal alcohol spectrum disorder (FASD) is 100% caused by alcohol. The lifelong disability caused by prenatal alcohol exposure cannot be reversed. Lack of reliable national prevalence estimates of FASD is common internationally and true of Aotearoa, New Zealand. This study modelled the national prevalence of FASD and differences by ethnicity. METHODS: FASD prevalence was estimated from self-reported data on any alcohol use during pregnancy for 2012/2013 and 2018/2019, combined with risk estimates for FASD from a meta-analysis of case-ascertainment or clinic-based studies in seven other countries. A sensitivity analysis using four more recent active case ascertainment studies was performed to account for the possibility of underestimation. RESULTS: We estimated FASD prevalence in the general population to be 1.7% (95% confidence interval [CI] 1.0%; 2.7%) in the 2012/2013 year. For Maori, the prevalence was significantly higher than for Pasifika and Asian populations. In the 2018/2019 year, FASD prevalence was 1.3% (95% CI 0.9%; 1.9%). For Maori, the prevalence was significantly higher than for Pasifika and Asian populations. The sensitivity analysis estimated the prevalence of FASD in the 2018/2019 year to range between 1.1% and 3.9% and for Maori, from 1.7% to 6.3%. DISCUSSION AND CONCLUSIONS: This study used methodology from comparative risk assessments, using the best available national data. These findings are probably underestimates but indicate a disproportionate experience of FASD by Maori compared with some ethnicities. The findings support the need for policy and prevention initiatives to support alcohol-free pregnancies to reduce lifelong disability caused by prenatal alcohol exposure.

Drinking concordance and relationship satisfaction in New Zealand couples.

AIMS: The aim of the study was to examine alcohol consumption patterns in New Zealand couples and the associations of these patterns with time spent drinking together and the level of satisfaction with the relationship. METHODS: Cross-sectional survey of a nationally representative sample of New Zealand residents aged 18-70 on the combined electoral roll in 2007. Using reports of the respondents' own drinking patterns and their reports of their partners' drinking, couples were classified as concordant, mildly discordant or discordant for both their drinking frequency and quantity of alcohol consumed per typical drinking occasion. The level of concordance was compared by demographic characteristics and relationship type. Ordinal logistic regression models were used to examine the associations between levels of concordance and both time spent drinking as a couple and level of happiness in the relationship (both reported by the respondent). RESULTS: The largest proportion of couples was classified as concordant for both frequency and quantity of alcohol consumed per typical drinking occasion regardless of the relationship type. For both drinking frequency and quantity per occasion, couples identified as discordant or mildly discordant were less likely to report having spent a large amount of time drinking with their partner (odds ratio 0.2-0.5). Reported level of happiness with the relationship was also associated with the degree of concordance of both drinking frequency and quantity. CONCLUSION: These findings suggest that drinking frequency and quantity of alcohol consumed per typical drinking occasion are concordant in most intimate partnerships and that discordance in either is associated with a lower level of happiness within the relationship.

Non-response bias in a web-based health behaviour survey of New Zealand tertiary students.

OBJECTIVE: There has been little investigation of non-response bias in web-based health surveys. We hypothesised that non-respondents have a higher prevalence of risk behaviours than respondents. METHOD: In 2005, random samples of students aged 17-25 years from 12 New Zealand tertiary institutions (n=7130) were invited to complete a web-based health behaviour survey, with three e-mail reminders. Early respondents (before 2nd reminder) were compared with late respondents (after 2nd reminder). Late respondents served as a proxy for non-respondents. RESULTS: 2607 students (37%) responded early, 676 (9%) responded late, and 3847 (54%) did not respond. There were differences between early and late respondents in high school binge drinking (38% vs 47%, p=0.002) and non-compliance with physical activity guidelines (12% vs 18%, p=0.004). Differences in overweight/obesity (26% vs 31%, p=0.058), smoking (18% vs 22%, p=0.091) and non-compliance with dietary guidelines (76% vs 77%, p=0.651) were non-significant but point estimates were in the expected direction. Estimated bias in prevalence of risk behaviours was an absolute difference of 1-4% and a relative difference of 0-21%. CONCLUSION: Respondents whose participation was hardest to elicit reported more risk behaviour. Assuming non-respondents' behaviour is similar or more extreme than that of late respondents, prevalence will have been substantially underestimated.

Older Drivers and Their Future Mobility: Views and Involvement of Their Adult Children.

In car-dependent societies like New Zealand, getting the right balance between mobility and safety could improve outcomes for older people but will require changes to policy and practice. Driving cessation is a major life transition with many impacts, and adult children are frequently involved in both the transition to non-driving and maintaining mobility afterward. This cross-sectional study (N = 675) sought perspectives of family members of drivers aged 65 or older enrolled in a longitudinal study. Most (94%) were adult children, two thirds were women, and 19% were moderately to extremely anxious about their parent's driving. Loss of independence, driving's role in identity, and reluctance to rely on family were recognized as important barriers to driving cessation. Most (80%) felt that families, as well as older drivers, would be adversely affected by driving cessation. Families identified accessible local information and services, alternative transport, and community-based programs for drivers and families as assistance most needed.

Changes in the incidence of assault after restrictions on late-night alcohol sales in New Zealand: evaluation of a natural experiment using hospitalization and police data.

AIMS: To estimate the effect of national restrictions on late-night availability of alcohol on alcohol-related assault at a population level as indicated by (1) change in hospitalizations for weekend assaults and (2) change in the proportion of assaults documented by police that occur at night. DESIGN: Evaluation of a natural experiment, involving: (1) pre-post comparisons of age-specific incidence rates, adjusted for seasonality and background trend using Poisson regression; and (2) interrupted time-series analyses, using seasonal autoregressive integrated moving average (SARIMA) models of national data with no control site. SETTING: New Zealand. PARTICIPANTS: (1) Inpatients discharged from NZ hospitals following assault during the weekend (Friday-Sunday) from 2004 to 2016 (n = 14 996) and (2) cases of assault recorded by NZ Police from 2012 to 2018. INTERVENTION: introduction of national maximum trading hours for all on-licence (8 a.m.-4 a.m.) and off-licence premises (7 a.m.-11 p.m.), abolishing existing 24-hour licences, on 18 December 2013. MEASUREMENTS: (1) Age-specific incidence of hospitalization for assault on Friday, Saturday or Sunday from the national hospital discharge data set, excluding short-stay emergency department admissions and (2) proportion of weekly police-documented assaults occurring between 9 p.m. and 5.59 a.m., from NZ Police Demand and Activity data set. FINDINGS: Following the restrictions, weekend hospitalized assaults declined by 11% [incidence rate ratio (IRR) = 0.89; 95% confidence interval (CI) = 0.84, 0.94], with the greatest reduction among 15-29-year-olds (IRR = 0.82; 95% CI = 0.76, 0.89). There was an absolute reduction (step change) of 1.8% (95% CI = 0.2, 3.5%) in the proportion of police-documented assaults occurring at night, equivalent to 9.70 (95% CI = 0.10, 19.30) fewer night-time assaults per week, out of 207.4. CONCLUSIONS: The 2013 implementation of national maximum trading hours for alcohol in NZ was followed by reductions in two complementary indicators of alcohol-related assault, consistent with beneficial effects of modest nation-wide restrictions on the late-night availability of alcohol.

Organisational travel plans for improving health.

BACKGROUND: Dependence on car use has a number of broad health implications, including contributing to physical inactivity, road traffic injury, air pollution and social severance, as well as entrenching lifestyles that require environmentally unsustainable energy use. Travel plans are interventions that aim to reduce single-occupant car use and increase the use of alternatives such as walking, cycling and public transport, with a variety of behavioural and structural components. This review focuses on organisational travel plans for schools, tertiary institutes and workplaces. These plans are closely aligned in their aims and intervention design, having emerged from a shared theoretical base. OBJECTIVES: To assess the effects of organisational travel plans on health, either directly measured, or through changes in travel mode. SEARCH STRATEGY: We searched the following electronic databases; Transport (1988 to June 2008), MEDLINE (1950 to June 2008), EMBASE (1947 to June 2008), CINAHL (1982 to June 2008), ERIC (1966 to June 2008), PSYCINFO (1806 to June 2008), Sociological Abstracts (1952 to June 2008), BUILD (1989 to 2002), Social Sciences Citation Index (1900 to June 2008), Science Citation Index (1900 to June 2008), Arts & Humanities Index (1975 to June 2008), Cochrane Database of Systematic Reviews (to August 2008), CENTRAL (to August 2008), Cochrane Injuries Group Register (to December 2009), C2-RIPE (to July 2008), C2-SPECTR (to July 2008), ProQuest Dissertations & Theses (1861 to June 2008). We also searched the reference lists of relevant articles, conference proceedings and Internet sources. We did not restrict the search by date, language or publication status. SELECTION CRITERIA: We included randomised controlled trials and controlled before-after studies of travel behaviour change programmes conducted in an organisational setting, where the measured outcome was change in travel mode or health. Both positive and negative health effects were included. DATA COLLECTION AND ANALYSIS: Two authors independently assessed eligibility, assessed trial quality and extracted data. MAIN RESULTS: Seventeen studies were included. Ten were conducted in a school setting, two in universities, and five in workplaces. One study directly measured health outcomes, and all included studies measured travel outcomes. Two cluster randomised controlled trials in the school setting showed either no change in travel mode or mixed results. A randomised controlled trial in the workplace setting, conducted in a pre-selected group who were already contemplating or preparing for active travel, found improved health-related quality of life on some sub scales, and increased walking. Two controlled before-after studies found that school travel interventions increased walking. Other studies were judged to be at high risk of bias. No included studies were conducted in low- or middle-income countries, and no studies measured the social distribution of effects or adverse effects, such as injury. AUTHORS' CONCLUSIONS: There is insufficient evidence to determine whether organisational travel plans are effective for improving health or changing travel mode. Organisational travel plans should be considered as complex health promotion interventions, with considerable potential to influence community health outcomes depending on the environmental context in which they are introduced. Given the current lack of evidence, organisational travel plans should be implemented in the context of robustly-designed research studies, such as well-designed cluster randomised trials.

Reducing alcohol-related harm and social disorder in a university community: a framework for evaluation.

BACKGROUND: In New Zealand and other middle to high income countries, university student are at high risk of alcohol-related injury and other problems due to their typical pattern of episodic heavy drinking. In 2007, one university implemented Campus Watch, a novel and extensive programme to reduce social disorder, including alcohol-related injury, in the university area. OBJECTIVES: To quantify the effects of this complex intervention. SETTING: A large public university campus and surrounding community in New Zealand. DESIGN: A health promotion evaluation model was used, examining: (1) how the programme was developed, introduced and received by the community? (process); (2) whether the programme affected behaviour? (impact); and (3) whether the programme reduced social disorder and alcohol-related harm in particular? (outcome). The outcome phase uses a non-equivalent control group design to measure changes occurring in the Campus Watch area compared with other universities, and with a same-city control site. PARTICIPANTS: Programme staff, university students and other community members. DATA: Interviews with university administrators and Campus Watch staff; surveys of local residents' views; Campus Watch incident data; national surveys of university students in 2005, 2007 and 2009; police data; fire department data. OUTCOME MEASURES: Prevalence of heavy episodic drinking; number of acute alcohol-related harms; incidence of antisocial behaviour, assault and street fires. ANALYSIS: Regression analyses will be used to examine changes in the intervention site relative to changes in the control areas.