Exploring the relationship between solitary drinking and living without other adults on alcohol consumption during the COVID-19 pandemic.

AIMS: The COVID-19 pandemic presents the opportunity to learn about solitary drinking as many people were forced to spend time at home. The aim of this study is to examine the relationship between solitary drinking and living without other adults on alcohol consumption. METHODS: A longitudinal study with four survey waves (between May and November 2020) obtained seven-day drinking diary data from Australian adults living in New South Wales. In May, a convenience sample of 586 participants (Mage = 35.3, SD = 14.8; 65.3% women) completed the first wave. Participants then completed a survey in June (n = 319, 54.4% response rate), July/August (n = 225, 38.4% response rate), and November (n = 222, 37.9% response rate). Information about alcohol consumption including risky drinking (more than four drinks on one occasion), household structure, solitary drinking, and demographics were collected. We conducted random-effects panel bivariate and multivariable regression analyses predicting the number of standard drinks and risky drinking. RESULTS: Participants with solitary drinking occasions consumed more and had more risky drinking occasions than participants with no solitary drinking occasions, which was also found to be the case during lockdown. Living without other adults was associated with less consumption and less risky drinking than living with other adults. However, participants who lived without other adults and had frequent solitary drinking occasions (solitary drinking in >50% drinking occasions) reported more consumption than participants without a solitary drinking occasion. CONCLUSIONS: Individuals who consume alcohol alone and live without other adults or spend long periods of time at home may be more at risk of alcohol-related harm.

Systematic Review and Dose-Response Meta-Analysis on the Relationship Between Alcohol Consumption and Sickness Absence.

AIMS: Alcohol consumption (AC) may cause workplace absence, but the findings of individual studies vary markedly. To date, no dose-response meta-analysis (DRMA) of the relationship between AC and sickness absence (SA) has been completed. This paper aims to estimate the dose-response relationship between AC and the risk of SA based on published observational studies. METHODS: We used DRMA and modelling to investigate the effects of varying doses of AC (including heavy episodic drinking (HED)) onSA. RESULTS: The meta-analysis included 21 studies (12 cohort studies and 9 cross-sectional). It showed that HED, risky (20-40 g of alcohol/day) and high-risk (>40 g of alcohol/day) drinkers had an elevated risk of SA when compared with light-to-moderate drinkers for both sexes. Those who abstained from alcohol had a higher risk of SA than those who drink moderately. CONCLUSIONS: Our results indicate that risky, high-risk drinking and HED may increase the risk of absenteeism. The implementation of population-based strategies may be appropriate to address the burdens of alcohol-related SA. Additionally, economic evaluations of alcohol policies should incorporate their impacts on SA. However, the current literature has substantial limitations, relying on modestly designed studies from just a few settings and more studies are needed-especially those that measure abstention in more nuancedways.

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.

A multi-country analysis of informal caregiving due to others' drinking.

The burden of caring for drinkers is seldom articulated as a social concern, or integrated in service planning or alcohol policy. This study aims to examine prevalence and predictors of informal caregiving due to others' drinking cross-nationally by surveying 20,728 respondents (18-64 years) in 11 countries. The outcome variable was respondent-reported informal caregiving due to others' drinking, analysed by socio-demographic factors and drinking pattern using logistic regression and meta-analysis. Estimated overall prevalence of informal caregiving due to others' drinking ranged from 9% in Nigeria to 47% in Thailand. In most countries, females reported a higher rate than males of caring for children and other dependents, but males reported a higher rate of driving family or friends somewhere or picking them up. Logistic regression analysis found differences between high-income countries and low- and middle-income countries in the relationship of caregiving with employment and household composition. Respondent's own drinking was positively correlated with the prevalence of caregiving in 10 out of 11 countries. In general, younger adults and those who are themselves risky drinkers are more likely to have had caring responsibilities. Although problematic drinking is concentrated in specific subpopulations, the burden of care for others' drinking extends widely across the population.

A gender-focused multilevel analysis of how country, regional and individual level factors relate to harm from others' drinking.

BACKGROUND: The aim of this study was to examine how gender, age and education, regional prevalence of male and female risky drinking and country-level economic gender equality are associated with harms from other people's drinking. METHODS: 24,823 adults in ten countries were surveyed about harms from drinking by people they know and strangers. Country-level economic gender equality and regional prevalence of risky drinking along with age and gender were entered as independent variables into three-level random intercept models predicting alcohol-related harm. FINDINGS: At the individual level, younger respondents were consistently more likely to report harms from others' drinking, while, for women, higher education was associated with lower risk of harms from known drinkers but higher risk of harms from strangers. Regional rate of men's risky drinking was associated with known and stranger harm, while regional-level women's risky drinking was associated with harm from strangers. Gender equality was only associated with harms in models in models that did not include risky drinking. CONCLUSIONS: Youth and regional levels of men's drinking was consistently associated with harm from others attributable to alcohol. Policies that decrease the risky drinking of men would be likely to reduce harms attributable to the drinking of others.

Acceptability and feasibility of a computer-based application to help Aboriginal and Torres Strait Islander Australians describe their alcohol consumption.

We examined acceptability and feasibility of a tablet application ("App") to record self-reported alcohol consumption among Aboriginal and Torres Strait Islander Australians. Four communities (1 urban; 3 regional/remote) tested the App, with 246 adult participants (132 males, 114 females). The App collected (a) completion time; (b) participant feedback; (c) staff observations. Three research assistants were interviewed. Only six (1.4%) participants reported that the App was "hard" to use. Participants appeared to be engaged and to require minimal assistance; nearly half verbally reflected on their drinking or drinking of others. The App has potential for surveys, screening, or health promotion.

Effects of Question Type and Order When Measuring Peak Consumption of Risky Drinking Events.

AIMS: There is new interest in measuring alcohol consumption during risky drinking events, but there is little guidance on how to best ask such questions. In this study, we contrast two different types of questions on peak consumption over a single heavy drinking occasion. We used a general question that ask respondents to recall the total amount consumed (total consumption question), and location-specific questions that ask respondents to recall consumption in each drinking location (location-specific peak consumption, LSPC). METHODS: Heavy drinkers (≥11 Australian Standard Drinks (ASD) per occasion for males, ≥8 for females) from the second wave of a prospective cohort study were recruited via landline random digit dial from Melbourne in 2012. Respondents were randomly assigned to surveys of different question order, and either first received total consumption (n = 127) or LSPC questions (n = 147). T-tests compared peak consumption between categories stratified by sex and consumption tercile. RESULTS: Mean peak consumption was 12.5 ASD. Irrespective of question order, consumption amounts for total consumption and LSPC questions were not significantly different for both sexes. However, drinkers in the highest tercile asked LSPC questions first provided significantly higher consumption estimates in response to the total consumption question than in response to the LSPC questions. CONCLUSION: At a population level, LSPC and total consumption questions produce similar estimates of peak consumption for risky drinking events. Except for heavy drinkers, general consumption questions may be sufficient when asking about these drinking events in consumption surveys, without the greater response burden of longer LSPC questions.

Adult low-risk drinkers and abstainers are not the same.

BACKGROUND: Alcohol consumption, even at low-levels, can not be guaranteed as safe or risk free. Specifically, the 2009 Australian National Health and Medical Research Council drinking guidelines recommend that adults should not drink more than two standard drinks on any day on average, and no more than four drinks on a single occasion. Nearly 40% of Australians aged 12 years and older drink alcohol but don't exceed these recommended limits, yet adult low-risk drinkers have been largely overlooked in Australian alcohol survey research, where they are usually grouped with abstainers. This paper examines the socio-demographic profile of low-risk drinking adults (18+ years old), compared to those who abstain. METHODS: Data from the 2013 National Drug Strategy Household Survey were used. In the past 12 months, 4796 Australians had not consumed alcohol and 8734 had consumed alcohol at low-risk levels, accounting for both average volume and episodic drinking (hereafter low-risk). RESULTS: Multivariate logistic regression results indicated that low-risk drinkers were more likely to be older, married, Australian-born, and reside in a less disadvantaged neighbourhood compared with abstainers. There was no significant difference by sex between low-risk drinkers and abstainers. CONCLUSIONS: The socio-demographic profile of low-risk drinkers differed from that of abstainers. Combining low-risk drinkers and abstainers into a single group, which is often the practice in survey research, may mask important differences. The study may support improved targeting of health promotion initiatives that encourage low-risk drinkers not to increase consumption or, in view of increasing evidence that low-risk drinking is not risk free, to move towards abstinence.

Children's experience of physical harms and exposure to family violence from others' drinking in nine societies.

AIM: To study caregiver reports of children's experience of physical harm and exposure to family violence due to others' drinking in nine societies, assess the relationship of harm with household drinking pattern and evaluate whether gender and education of caregiver affect these relationships. METHOD: Using data on adult caregivers from the GENAHTO (Gender and Alcohol's Harm to Others) project, child alcohol-related injuries and exposure of children to alcohol-related violence (CAIV) rates are estimated by country and pooled using meta-analysis and stratified by gender of the caregiver. Households with and without heavy or harmful drinker(s) (HHD) are compared assessing the interaction of caregiver gender on the relationship between reporting HHD and CAIV, adjusting for caregiver education and age. Additionally, the relationship between caregiver education and CAIV is analysed with meta-regression. RESULTS: The prevalence of CAIV varied across societies, with an overall pooled mean of 4% reported by caregivers. HHD was a consistent correlate of CAIV in all countries. Men and women in the sample reported similar levels of CAIV overall, but the relationship between HHD and CAIV was greater for women than for men, especially if the HHD was the most harmful drinker. Education was not significantly associated with CAIV. CONCLUSION: One in 25 caregivers with children report physical or family violence harms to children because of others' drinking. The adjusted odds of harm are significantly greater (more than four-fold) in households with a heavy or harmful drinker, with men most likely to be defined as this drinker in the household.

Time of Year Effects on Self-Reported Estimates of Past-Year Alcohol Consumption.

AIMS: This study examines the relationship between survey month completion and self-reported alcohol consumption in the last 12 months. It is hypothesized that respondents that complete the survey in the warmer months of the year will report greater alcohol consumption over the last 12 months compared with surveys completed in the colder months. METHODS: The alcohol consumption data was obtained from three waves of the National Drug Strategy Household Survey (NDSHS) from 2010, 2013 and 2016, between May and November each year (n = 74,252). The associations between month of survey completion and three measures of past-year alcohol consumption were examined using a mix of linear and logistic regression. All models were adjusted for survey year, mode of administration, state of residence, rurality, Socio-Economic Indexes for Areas (SEIFA), sex and age. RESULTS: Results varied by drinking measure. In general, there were higher estimates for respondents completing the survey in November and lower estimates in August and September. CONCLUSIONS: The results in this study demonstrate the significant relationship between month of survey completion and alcohol consumption in the last 12 months. Seasonal variations in alcohol consumption have the potential to impact respondents' accurate recall of alcohol consumption in the last 12 months and changes to survey timing have the potential to bias trend estimates of drinking behaviour.

Has the Relationship Between Alcohol Consumption and Alcohol-Related Risky Behaviour Changed in Australia? An Exploratory Study.

AIMS: Recent studies have pointed to diverging trends between alcohol consumption and harm rates. One explanation for these trends is the normalization hypothesis, which suggests that declines in alcohol consumption will result in more risky behaviour by the remaining drinkers as consumption becomes a more deviant behaviour. We examine how the relationship between alcohol consumption and risky behaviour has changed in Australia over a fourteen-year period. METHODS: Risky behaviour and alcohol consumption were obtained from six waves (2001, 2004, 2007, 2010, 2013, 2016) of the National Drug Strategy Household Survey (NDSHS). 115,115 respondents aged over 14 were included in this study. Poisson regression analyses were conducted to examine the relationship between risky behaviour and two measures of alcohol consumption (average volume per day and risky drinking occasions per month) over six NDSHS waves. Interaction terms between year and the drinking variables were included in each model to identify shifts in this relationship between consumption and harm. RESULTS: Respondents with greater alcohol consumption were more likely to report risky behaviour (IRR = 1.15, 95% CI = 1.13-1.16). Risky behaviour generally declined over time however older participants reported more risky behaviour over time. Generally, the relationship between alcohol consumption and risky behaviour has remained stable, with some very minor upward shifts for young drinkers (aged 14-29; highest IRR = 1.03, 95% CI = 1.01-1.04). CONCLUSIONS: We found little support for the normalization hypothesis-risky behaviour tends to shift consistently along with drinking levels. Results suggest that recent reductions in alcohol consumption should lead to reductions in rates of harm.

Patterns in Reduction or Cessation of Drinking in Australia (2001-2013) and Motivation for Change.

AIMS: This paper examines: (a) change over time (2001-2013) in recently reducing or ceasing drinking in the Australian population and (b) the reasons given for reducing or ceasing drinking in the most recent survey (2013); stratified by sex and age group. SHORT SUMMARY: Rates of reducing and ceasing drinking increased between 2001 and 2013 in Australia. Young people were more likely to modify drinking due to lifestyle and enjoyment reasons; older groups were more likely to report health reasons. These trends contribute to the broader context of declining alcohol consumption in Australia. METHODS: Data are from five waves of the National Drug Strategy Household Survey (N = 119,397). Logistic regression models with interaction terms were used to identify a shift in sex or age over time in predicting reduction or cessation of drinking and to predict motivations for reducing or ceasing drinking by sex and age. RESULTS: Reports of recently reducing the quantity or frequency of drinking increased from 2001 to 2007 and remained stable between 2007 and 2013. There was a steady increase in the number of Australians reporting recently ceasing drinking from 2001 to 2013, with a significant effect for age (younger groups more likely than older groups to cease drinking in the past two waves). Reasons for reducing or ceasing drinking varied by age, with older people more likely to report health reasons and younger people more likely to report lifestyle reasons or enjoyment. CONCLUSION: Increases over time in reports of reduction or cessation of drinking due to health, lifestyle, social and enjoyment reasons suggest that the social position of alcohol in Australia may be shifting, particularly among young people.

Patterns of drinking in Aboriginal and Torres Strait Islander peoples as self-reported on the Grog Survey App: a stratified sample.

BACKGROUND: The Grog Survey App is a visual and interactive tablet computer-based survey application. It has been shown to be an accurate and acceptable tool to help Indigenous Australians describe what they drink. METHODS: The Grog Survey App was used to enquire into patterns of drinking in a stratified sample of Indigenous Australians in urban and remote/regional sites during testing of the App. The App asked about the last four drinking occasions in the past 12 months, including preferred alcohol types and containers; and symptoms of alcohol dependence, based on ICD-11 descriptions. Drinking patterns are presented here using medians and interquartile ranges, and the thresholds set out by the Australian National and Health and Medical Research Council guidelines. Patterns of consumption are compared by gender and remoteness, using Wilcoxon rank-sum test to compare medians. Logistic regressions tested whether alcohol types and drinking containers varied by remoteness. RESULTS: In this stratified sample most people either consumed nothing (21.7%), or consumed quantities which placed them at short- (95.6%) or long-term risk (47.8%) of harms. Drinkers in remote areas were more likely to drink beer, but less likely to drink pre-mixed spirits. 'Stubbies' and other beer glasses were popular in urban areas, compared with 'slabs' (cases of beer) in remote/regional areas. The use of improvised containers (i.e. empty juice bottles) did not vary by remoteness. Nearly one in six (15%) current drinkers reported experiencing at least two symptoms of alcohol dependence at least monthly. Average drinks per day was the consumption measure most highly correlated with each dependence symptom (r = 0.34-0.38). CONCLUSIONS: The App was able to capture a wide range of preferred alcohol types and containers, and demonstrate a diversity in how alcohol is consumed. This detail was captured in a relative brief survey delivered using an interactive and appealing tablet computer-based application.

Harm from Known Others' Drinking by Relationship Proximity to the Harmful Drinker and Gender: A Meta-Analysis Across 10 Countries.

BACKGROUND: Drinking is a common activity with friends or at home but is associated with harms within both close and extended relationships. This study investigates associations between having a close proximity relationship with a harmful drinker and likelihood of experiencing harms from known others' drinking for men and women in 10 countries. METHODS: Data about alcohol's harms to others from national/regional surveys from 10 countries were used. Gender-stratified random-effects meta-analysis compared the likelihood of experiencing each, and at least 1, of 7 types of alcohol-related harm in the last 12 months, between those who identified someone in close proximity to them (a partner, family member, or household member) and those who identified someone from an extended relationship as the most harmful drinker (MHD) in their life in the last 12 months. RESULTS: Women were most likely to report a close male MHD, while men were most likely to report an extended male MHD. Relatedly, women with a close MHD were more likely than women with an extended MHD to report each type of harm, and 1 or more harms, from others' drinking. For men, having a close MHD was associated with increased odds of reporting some but not all types of harm from others' drinking and was not associated with increased odds of experiencing 1 or more harms. CONCLUSIONS: The experience of harm attributable to the drinking of others differs by gender. For preventing harm to women, the primary focus should be on heavy or harmful drinkers in close proximity relationships; for preventing harm to men, a broader approach is needed. This and further work investigating the dynamics among gender, victim-perpetrator relationships, alcohol, and harm to others will help to develop interventions to reduce alcohol-related harm to others which are specific to the contexts within which harms occur.

Developing a tablet computer-based application ('App') to measure self-reported alcohol consumption in Indigenous Australians.

BACKGROUND: The challenges of assessing alcohol consumption can be greater in Indigenous communities where there may be culturally distinct approaches to communication, sharing of drinking containers and episodic patterns of drinking. This paper discusses the processes used to develop a tablet computer-based application ('App') to collect a detailed assessment of drinking patterns in Indigenous Australians. The key features of the resulting App are described. METHODS: An iterative consultation process was used (instead of one-off focus groups), with Indigenous cultural experts and clinical experts. Regular (weekly or more) advice was sought over a 12-month period from Indigenous community leaders and from a range of Indigenous and non-Indigenous health professionals and researchers. RESULTS: The underpinning principles, selected survey items, and key technical features of the App are described. Features include culturally appropriate questioning style and gender-specific voice and images; community-recognised events used as reference points to 'anchor' time periods; 'translation' to colloquial English and (for audio) to traditional language; interactive visual approaches to estimate quantity of drinking; images of specific brands of alcohol, rather than abstract description of alcohol type (e.g. 'spirits'); images of make-shift drinking containers; option to estimate consumption based on the individual's share of what the group drank. CONCLUSIONS: With any survey platform, helping participants to accurately reflect on and report their drinking presents a challenge. The availability of interactive, tablet-based technologies enables potential bridging of differences in culture and lifestyle and enhanced reporting.

Correction to: Developing a tablet computer-based application ('App') to measure self-reported alcohol consumption in Indigenous Australians.

After publication of the original article [1] it was noted that the name of author, Peter Jack, was erroneously typeset in both the PDF and online formats of the manuscript as Peter Jack GradDipIndigH.

Changes in Smoking Rates Among Pregnant Women and the General Female Population in Australia, Finland, Norway, and Sweden.

INTRODUCTION: Smoking rates have dropped substantially in most developed countries in recent decades. This general trend has, however, not always been evident among women-particularly younger women. Smoking habits do, however, often change in connection with pregnancy and the aim of this study is to determine whether smoking during pregnancy follows general trends in smoking rates in the general female population in four countries with active anti-tobacco policies and decreasing population smoking rates. METHODS: Changes in rates of persistent smoking, that is, smoking in late pregnancy or daily smoking among all women of childbearing age were described according to age groups. Data were retrieved from the Australian Household Drug Surveys during 2000-2013 and from registries and surveys in Finland, Norway, and Sweden between 1995 and 2014. RESULTS: In general, persistent smoking has decreased and late-pregnancy smoking rates are lower than daily smoking rates among all women. However, younger women are more likely to be persistent smokers regardless of pregnancy status. In Norway and Finland, persistent smoking was most common among young pregnant women and in Sweden there was an increased polarization between age groups. In Australia, a steady decrease in smoking rates appears to have stalled in younger pregnant women. CONCLUSION: Although smoking has declined substantially in recent decades, there are groups lagging behind this general trend. Young pregnant women are of particular concern in this respect. The possibility that these findings reflect the changing characteristics of younger pregnant women is discussed. IMPLICATIONS: This study puts recent trends in maternal smoking into a broader context by relating developments to changes in smoking rates among women in general. By using similar data from four countries we were able to follow changes in smoking rates "within" groups of women within the four countries without being limited by methodological problems related to cross-country or inter-group comparisons. We were above all able to show that aggregate data disclose the strong age gradient in maternal smoking habits.

Measuring Time Spent Caring For Drinkers and Their Dependents.

AIMS: To quantify the extent of time spent by family and friends caring for drinkers and their dependents, to estimate the cost of this time and to measure which factors predict time spent caring. METHODS: Data are from a nationwide Alcohol's Harm to Others Survey of 2649 Australians, in which 778 respondents reported they were harmed by a known drinker. Time spent on four caring activities was self-reported by these respondents and tallied to estimate how many hours they spent caring for the drinker, the drinker's children or other dependents. Bivariate and multivariate linear regression models were employed to examine factors predicting time spent caring. RESULTS: Respondents who reported they were harmed by a drinker they knew had spent on average 32 h caring for this drinker and their dependents in the past 12 months. Applying these figures to the Australian population, but discounting by 90% because this time may be seen be a voluntary demonstration of connection, an annual cost of caring in 2008 would amount to AU$250 million. A significant positive association was found between time spent caring and the drinking level and drinking frequency of the heavy drinking other person. CONCLUSION: Caring for drinking family members, friends, co-workers and a drinker's dependents can be a substantial burden. Policy approaches that reduce population drinking and individual risky drinking levels are potential means to reduce the burden of caring due to others' drinking.

Queensland Alcohol-related violence and Night Time Economy Monitoring project (QUANTEM): a study protocol.

BACKGROUND: Alcohol-related harm is a substantial burden on the community in Australia and internationally, particularly harm related to risky drinking practices of young people in the night-time economy. This protocol paper describes a study that will report on the changes in a wide range of health and justice outcome measures associated with major policy changes in the state of Queensland, Australia. A key element includes trading hours restrictions for licensed premises to 2 am for the state and 3 am in Safe Night Precincts (SNPs). Other measures introduced include drinks restrictions after midnight, increased patron banning measures for repeat offenders, mandatory ID scanning of patrons in late-night venues, and education campaigns. METHODS: The primary aim of the study is to evaluate change in the levels of harm due to these policy changes using administrative data (e.g., police, hospital, ambulance, and court data). Other study elements will investigate the impact of the Policy by measuring foot traffic volume in SNPs, using ID scanner data to quantify the volume of people entering venues and measure the effectiveness of banning notices, using patron interviews to quantify the levels of pre-drinking, intoxication and illicit drug use within night-time economy districts, and to explore the impacts of the Policy on business and live music, and costs to the community. DISCUSSION: The information gathered through this project aims to evaluate the effectiveness of the Policy and to draw on these findings to inform future prevention and enforcement approaches by policy makers, police, and venue staff.