Alcohol, No Ordinary Commodity: policy implications for Canada.

Alcohol is a favorite psychoactive substance of Canadians. It is also a leading risk factor for death and disability, playing a causal role in a broad spectrum of health and social issues. Alcohol: No Ordinary Commodity is a collaborative, integrative review of the scientific literature. This paper describes the epidemiology of alcohol use and current state of alcohol policy in Canada, best practices in policy identified by the third edition of Alcohol: No Ordinary Commodity, and the implications for the development of effective alcohol policy in Canada. Best practices - strongly supported by the evidence, highly effective in reducing harm, and relatively low-cost to implement - have been identified. Measures that control affordability, limit availability, and restrict marketing would reduce population levels of alcohol consumption and the burden of disease attributable to it.

Alcohol: No Ordinary Commodity-a summary of the third edition.

BACKGROUND AND AIMS: This article summarizes the findings and conclusions of the third edition of Alcohol: No Ordinary Commodity. The latest revision of this book is part of a series of monographs designed to provide a critical review of the scientific evidence related to alcohol control policy from a public health perspective. DESIGN: A narrative summary of the contents of the book according to five major issues. FINDINGS: An extensive amount of epidemiological evidence shows that alcohol is a major contributor to the global burden of disease, disability and death in high-, middle- and low-income countries. Trends in alcohol products and marketing are described, indicating that a large part of the global industry has been consolidated into a small number of transnational corporations that are expanding their operations in Asia, Africa and Latin America. The main part of the book is devoted to a review of strategies and interventions designed to prevent or minimize alcohol-related harm. Overall, the most effective strategies to protect public health are taxation that decreases affordability and restrictions on the physical availability of alcohol. A total ban on alcohol marketing is also an effective strategy to reduce consumption. In addition, drink-driving counter-measures, brief interventions with at-risk drinkers and treatment of drinkers with alcohol dependence are effective in preventing harm in high-risk contexts and groups of hazardous drinkers. CONCLUSION: Alcohol policy is often the product of competing interests, values and ideologies, with the evidence suggesting that the conflicting interests between profit and health mean that working in partnership with the alcohol industry is likely to lead to ineffective policy. Opportunities for implementation of evidence-based alcohol policies that better serve the public good are clearer than ever before as a result of accumulating knowledge on which strategies work best.

Needs-Based Planning for Substance Use Treatment Systems: Progress, Prospects, and the Search for a New Perspective.

ABSTRACT: The articles presented in this issue of the Journal of Studies on Alcohol and Drugs (Supplement No. 18) describe the rapid improvements over the past decade in methods, theories, and data systems used for needs-based planning of addiction treatment services. In this concluding essay, the editors describe the progress, prospects, and implications of this new wave of research. It is concluded that these developments can be used to maximize the impact of treatment services at the population level.

RÉSUMÉ: Les articles dans ce Supplément, décrivent les améliorations rapides ayant eu lieu au cours de la dernière décennie quant aux méthodes, théories et systèmes de données qui sont utilisés pour la planification des services de traitement de la dépendance en s'appuyant sur les besoins populationnels. Dans cet essai de conclusion, les éditeurs décrivent les progrès, les perspectives et les implications de cette nouvelle vague de travaux de recherche. Il est conclu que ces développements peuvent être utilisés afin de maximiser l'impact des services au plan populationnel.

RESUMEN: Los documentos presentados en este Suplemento describen las rápidas mejoras en la última década en métodos, teorías y sistemas de datos utilizados para la planificación basada en las necesidades de servicios de tratamiento de adicciones. En este ensayo final, los editores describen los avances, perspectivas e implicaciones de esta nueva ola de investigación. Se concluye que estos desarrollos se pueden utilizar para maximizar el impacto de los servicios de tratamiento a nivel de la población.

[Sex and gender equity in research: rationale for the SAGER guidelines and recommended use]. / Equidad según sexo y de género en la investigación: justificación de las guías SAGER y recomendaciones para su uso.

BACKGROUND: Sex and gender differences are often overlooked in research design, study implementation and scientific reporting, as well as in general science communication. This oversight limits the generalizability of research findings and their applicability to clinical practice, in particular for women but also for men. This article describes the rationale for an international set of guidelines to encourage a more systematic approach to the reporting of sex and gender in research across disciplines. METHODS: A panel of 13 experts representing nine countries developed the guidelines through a series of teleconferences, conference presentations and a 2-day workshop. An internet survey of 716 journal editors, scientists and other members of the international publishing community was conducted as well as a literatura search on sex and gender policies in scientific publishing. RESULTS: The Sex and Gender Equity in Research (SAGER) guidelines are a comprehensive procedure for reporting of sex and gender information in study design, data analyses, results and interpretation of findings. CONCLUSIONS: The SAGER guidelines are designed primarily to guide authors in preparing their manuscripts, but they are also useful for editors, as gatekeepers of science, to integrate assessment of sex and gender into all manuscripts as an integral part of the editorial process.

Caveat Emptor: Predatory Publishers, Rogue Journals, and the Potential Corruption of Addiction Science.

The name predatory publisher has been applied by academic librarian Jeffrey Beall to describe an open-access, scholarly publishing business model in which publication fees are charged to authors without providing the editorial judgment, peer-review process, and publishing services associated with more established journals. In the addiction field, as many as 20 journal titles now operate according to this model, and most of their editors are either nonexistent or impossible to contact. Although predatory publishing should not be equated with open access, this article argues that predatory publishers are diluting scientific quality in the addiction field by taking advantage of the open-access movement. Beyond the damage done to the reputations of naive authors and figurehead editorial board members, there is a cascade of effects resulting from the shabby publication process itself. If the addiction field is to be protected from predatory publishers, all sectors need to be involved. Declarations of "buyer beware" and "the emperor has no clothes" are just the first steps in a process of preventing further damage to the integrity of addiction science. As described in this article, concerted action will be required by authors, editors, and professional societies.

Reliability and validity of the Alcohol Marketing Assessment Rating Tool (AMART).

OBJECTIVE: Current national responses to the monitoring and prevention of alcohol marketing to vulnerable populations, such as youth, typically rely on partial bans, co-regulation and industry self-regulation. Efforts to evaluate compliance with existing regulations are often cumbersome and resource intensive. We sought to develop a short questionnaire to assess compliance of alcohol advertising to existing alcohol industry self-regulated marketing codes. METHODS: Questions for the Alcohol Marketing Assessment Rating Tool (AMART) were taken from a longer rating instrument that was originally developed to detect violations of a self-regulated alcohol marketing code. Secondary analysis of data from three studies of alcohol advertisements was performed to determine the reliability and validity of AMART at detecting code violations, using the longer form as the criterion. One sample was used as an exploratory set. Two samples were used to validate the questionnaire. RESULTS: In the exploratory set, the reliability of AMART was considered near perfect (kappa = 0.92). Sensitivity was 97%, and specificity was 100%. Positive predictive value (PPV) was perfect and negative predictive value (NPV) was approximately 90%. In the validation sets, reliability was considered substantial to near perfect (kappa = 0.71-0.94). Specificity and PPV remained perfect, and NPV was 86%-90%. CONCLUSION: The AMART is a reliable tool to detect violations of a self-regulated marketing code in alcohol advertising. It significantly decreases the amount of resources needed to evaluate a finite number of advertisements.

[Sex and Gender Equity in Research: rationale for the SAGER guidelines and recommended use]. / Equidade de sexo e gênero na pesquisa: fundamentação das diretrizes SAGER e uso recomendado.

BACKGROUND: Sex and gender differences are often overlooked in research design, study implementation and scientific reporting, as well as in general science communication. This oversight limits the generalizability of research findings and their applicability to clinical practice, in particular for women but also for men. This article describes the rationale for an international set of guidelines to encourage a more systematic approach to the reporting of sex and gender in research across disciplines. METHODS: A panel of 13 experts representing nine countries developed the guidelines through a series of teleconferences, conference presentations and a 2-day workshop. An internet survey of 716 journal editors, scientists and other members of the international publishing community was conducted as well as a literature search on sex and gender policies in scientific publishing. RESULTS: The Sex and Gender Equity in Research (SAGER) guidelines are a comprehensive procedure for reporting of sex and gender information in study design, data analyses, results and interpretation of findings. CONCLUSIONS: The SAGER guidelines are designed primarily to guide authors in preparing their manuscripts, but they are also useful for editors, as gatekeepers of science, to integrate assessment of sex and gender into all manuscripts as an integral part of the editorial process.

CONTEXTO: Diferenças de sexo e gênero são muitas vezes negligenciadas no desenho da pesquisa, na implementação do estudo e no relato científico, bem como na comunicação científica em geral. Este descuido limita a capacidade de generalização dos achados das pesquisas e a sua aplicabilidade à prática clínica, em particular para as mulheres, mas também para os homens. Este artigo descreve a fundamentação lógica para um conjunto internacional de diretrizes, com o intuito de encorajar uma abordagem mais sistemática para o relato de sexo e gênero na pesquisa entre disciplinas. MÉTODOS: Um painel de 13 peritos, representando nove países, desenvolveu as diretrizes por meio de uma série de teleconferências, apresentações em conferências e uma oficina de dois dias. Realizou-se uma pesquisa na internet com 716 editores de revistas, cientistas e outros membros da comunidade editorial internacional, bem como uma busca bibliográfica sobre políticas de gênero e sexo na publicação científica. RESULTADOS: As diretrizes sobre Equidade de Sexo e Gênero em Pesquisa (Sex and Gender Equity in Research - SAGER) são um procedimento abrangente para relatar informações sobre sexo e gênero no desenho do estudo, na análise de dados, nos resultados e na interpretação dos achados. CONCLUSÕES: As diretrizes da SAGER destinam-se principalmente a orientar os autores na preparação de seus manuscritos, mas também são úteis para os editores, como guardiões da ciência, para integrar a avaliação de sexo e gênero em todos os manuscritos como parte integrante do processo editorial.

Harmful Use of Alcohol: A Shadow over Sub-Saharan Africa in Need of Workable Solutions.

Alcohol consumption and alcohol-attributable burden of disease in Africa are expected to rise in the near future, yet. increasing alcohol-related harm receives little attention from policymakers and from the population in general. Even where new legislation is proposed it is rarely enacted into law. Being at the center of social and cultural activities in many countries, alcohol's negative role in society and contribution to countries' burden of disease are rarely questioned. After the momentum created by the adoption in 2010 of the WHO Global Strategy and the WHO Regional Strategy (for Africa) to Reduce the Harmful Use of Alcohol, and the WHO Global Action Plan for the Prevention and Control of Non-Communicable Diseases, in 2013, little seems to have been done to address the increasing use of alcohol, its associated burden and the new challenges that derive from the growing influence of the alcohol industry in Africa. In this review, we argue that to have a positive impact on the health of African populations, action addressing specific features of alcohol policy in the continent is needed, namely focusing on particularities linked to alcohol availability, like unrecorded and illicit production, outlet licensing, the expansion of formal production, marketing initiatives and taxation policies.

Associations Between Thematic Content and Industry Self-Regulation Code Violations in Beer Advertising Broadcast During the U.S. NCAA Basketball Tournament.

BACKGROUND: Beer marketing in the United States is controlled through self-regulation, whereby the beer industry has created a marketing code and enforces its use. We performed a thematic content analysis on beer ads broadcast during a U.S. college athletic event and determined which themes are associated with violations of a self-regulated alcohol marketing code. METHODS: 289 beer ads broadcast during the U.S. NCAA Men's and Women's 1999-2008 basketball tournaments were assessed for the presence of 23 thematic content areas. Associations between themes and violations of the U.S. Beer Institute's Marketing and Advertising Code were determined using generalized linear models. RESULTS: Humor (61.3%), taste (61.0%), masculinity (49.2%), and enjoyment (36.5%) were the most prevalent content areas. Nine content areas (i.e., conformity, ethnicity, sensation seeking, sociability, romance, special occasions, text responsibility messages, tradition, and individuality) were positively associated with code violations (p < 0.001-0.042). There were significantly more content areas positively associated with code violations than content areas negatively associated with code violations (p < 0.001). CONCLUSIONS: Several thematic content areas were positively associated with code violations. The results can inform existing efforts to revise self-regulated alcohol marketing codes to ensure better protection of vulnerable populations. The use of several themes is concerning in relation to adolescent alcohol use and health disparities.

Screening, Brief Intervention and Referral to Treatment: implications of SAMHSA's SBIRT initiative for substance abuse policy and practice.

AIMS: This paper describes the major findings and public health implications of a cross-site evaluation of a national Screening, Brief Intervention and Referral to Treatment (SBIRT) demonstration program funded by the US Substance Abuse and Mental Health Services Administration (SAMHSA). METHODS: Eleven multi-site programs in two cohorts of SAMHSA grant recipients were each funded for 5 years to promote the adoption and sustained implementation of SBIRT. The SBIRT cross-site evaluation used a multi-method evaluation design to provide comprehensive information on the processes, outcomes and costs of SBIRT as implemented in a variety of medical and community settings. FINDINGS: SBIRT programs in the two evaluated SAMHSA cohorts screened more than 1 million patients/clients. SBIRT implementation was facilitated by committed leadership and the use of substance use specialists, rather than medical generalists, to deliver services. Although the quasi-experimental nature of the outcome evaluation does not permit causal inferences, pre-post differences were clinically meaningful and statistically significant for almost every measure of substance use. Greater intervention intensity was associated with larger decreases in substance use. Both brief intervention and brief treatment were associated with positive outcomes, but brief intervention was more cost-effective for most substances. Sixty-nine (67%) of the original performance sites adapted and redesigned SBIRT service delivery after initial grant funding ended. Four factors influenced SBIRT sustainability: presence of program champions, availability of funding, systemic change and effective management of SBIRT provider challenges. CONCLUSIONS: The US Substance Abuse and Mental Health Services Administration's Screening, Brief Intervention and Referral to Treatment (SBIRT) demonstration program was adapted successfully to the needs of early identification efforts for hazardous use of alcohol and illicit drugs. SBIRT is an innovative way to integrate the management of substance use disorders into primary care and general medicine. Screening, Brief Intervention and Referral to Treatment implementation was associated with improvements in treatment system equity, efficiency and economy.

Sex And Gender Equity in Research (SAGER): reporting guidelines as a framework of innovation for an equitable approach to gender medicine. Commentary.

Sex and gender are important determinants of health and influence research findings in a variety of ways, yet they are often overlooked and underreported. This oversight limits the generalizability of research findings and their applicability to clinical practice. The objective of this paper is to point out how journal editors can influence better reporting of sex and gender in research by establishing a methodological framework directly addressing authors of scientific publications, as well as referees, and indirectly affecting all the stakeholders in the research cycle, from funders to policy-makers and citizens. Such a framework is represented by the Sex And Gender Equity in Research (SAGER) guidelines, developed by the European Association of Science Editors (EASE) to encourage a more systematic approach to the reporting of sex and gender in research across disciplines. The paper includes the rationale and basic principles of the SAGER guidelines.

Sex and Gender Equity in Research: rationale for the SAGER guidelines and recommended use.

BACKGROUND: Sex and gender differences are often overlooked in research design, study implementation and scientific reporting, as well as in general science communication. This oversight limits the generalizability of research findings and their applicability to clinical practice, in particular for women but also for men. This article describes the rationale for an international set of guidelines to encourage a more systematic approach to the reporting of sex and gender in research across disciplines. METHODS: A panel of 13 experts representing nine countries developed the guidelines through a series of teleconferences, conference presentations and a 2-day workshop. An internet survey of 716 journal editors, scientists and other members of the international publishing community was conducted as well as a literature search on sex and gender policies in scientific publishing. RESULTS: The Sex and Gender Equity in Research (SAGER) guidelines are a comprehensive procedure for reporting of sex and gender information in study design, data analyses, results and interpretation of findings. CONCLUSIONS: The SAGER guidelines are designed primarily to guide authors in preparing their manuscripts, but they are also useful for editors, as gatekeepers of science, to integrate assessment of sex and gender into all manuscripts as an integral part of the editorial process.

Health promotion interventions and policies addressing excessive alcohol use: a systematic review of national and global evidence as a guide to health-care reform in China.

AIMS: Steady increases in alcohol consumption and related problems are likely to accompany China's rapid epidemiological transition and profit-based marketing activities. We reviewed research on health promotion interventions and policies to address excessive drinking and to guide health-care reform. METHODS: We searched Chinese- and English-language databases and included 21 studies in China published between 1980 and 2013 that covered each policy area from the World Health Organization (WHO) Global Strategy to Reduce the Harmful Use of Alcohol. We evaluated and compared preventive interventions to the global alcohol literature for cross-national applicability. RESULTS: In contrast with hundreds of studies in the global literature, 11 of 12 studies from mainland China were published in Chinese; six of 10 in English were on taxation from Taiwan or Hong Kong. Most studies demonstrated effectiveness in reducing excessive drinking, and some reported the reduction of health problems. Seven were randomized controlled trials. Studies targeted schools, drink-driving, work-places, the health sector and taxation. CONCLUSIONS: China is the world's largest alcohol market, yet there has been little growth in alcohol policy research related to health promotion interventions over the past decade. Guided by a public health approach, the WHO Global Strategy and health reform experience in Russia, Australia, Mexico and the United States, China could improve its public health response through better coordination and implementation of surveillance and evidence-based research, and through programmatic and legal responses such as public health law research, screening and early intervention within health systems and the implementation of effective alcohol control strategies.

Efficacy and the strength of evidence of U.S. alcohol control policies.

BACKGROUND: Public policy can limit alcohol consumption and its associated harm, but no direct comparison of the relative efficacy of alcohol control policies exists for the U.S. PURPOSE: To identify alcohol control policies and develop quantitative ratings of their efficacy and strength of evidence. METHODS: In 2010, a Delphi panel of ten U.S. alcohol policy experts identified and rated the efficacy of alcohol control policies for reducing binge drinking and alcohol-impaired driving among both the general population and youth, and the strength of evidence informing the efficacy of each policy. The policies were nominated on the basis of scientific evidence and potential for public health impact. Analysis was conducted in 2010-2012. RESULTS: Panelists identified and rated 47 policies. Policies limiting price received the highest ratings, with alcohol taxes receiving the highest ratings for all four outcomes. Highly rated policies for reducing binge drinking and alcohol-impaired driving in the general population also were rated highly among youth, although several policies were rated more highly for youth compared with the general population. Policy efficacy ratings for the general population and youth were positively correlated for reducing both binge drinking (r=0.50) and alcohol-impaired driving (r=0.45). The correlation between efficacy ratings for reducing binge drinking and alcohol-impaired driving was strong for the general population (r=0.88) and for youth (r=0.85). Efficacy ratings were positively correlated with strength-of-evidence ratings. CONCLUSIONS: Comparative policy ratings can help characterize the alcohol policy environment, inform policy discussions, and identify future research needs.

Alcohol and alcohol-related harm in China: policy changes needed.

In China, alcohol consumption is increasing faster than anywhere else in the world. A steady increase in alcohol production has also been observed in the country, together with a rise in alcohol-related harm. Despite these trends, China's policies on the sale and consumption of alcoholic beverages are weak compared with those of other countries in Asia. Weakest of all are its policies on taxation, drink driving laws, alcohol sale to minors and marketing licenses. The authors of this descriptive paper draw attention to the urgent need for public health professionals and government officials in China to prioritize population surveillance, research and interventions designed to reduce alcohol use disorders. They describe China's current alcohol policies and recent trends in alcohol-related harm and highlight the need for health officials to conduct a thorough policy review from a public health perspective, using as a model the World Health Organization's global strategy to reduce the harmful use of alcohol.

En Chine, la consommation d'alcool augmente plus rapidement que partout ailleurs dans le monde. Une augmentation constante de la production d'alcool a également observée dans le pays, ainsi qu'une augmentation des méfaits de l'alcool. Malgré ces tendances, les politiques de la Chine en matière de vente et de consommation de boissons alcoolisées sont faibles comparées à celles des autres pays d'Asie. Les plus faibles de toutes sont ses politiques sur la taxation, les lois relatives à l'alcool au volant, la vente d'alcool aux mineurs et la commercialisation des licences. Les auteurs de cet article descriptif attirent l'attention sur la nécessité urgente pour les professionnels de la santé publique et les fonctionnaires gouvernementaux chinois d'accorder la priorité à la surveillance de la population, la recherche et les interventions destinées à réduire les troubles liés à la consommation d'alcool. Ils décrivent les politiques actuelles sur l'alcool en Chine et les tendances récentes des méfaits de l'alcoolisme. Ils soulignent également la nécessité pour les autorités sanitaires de procéder à un examen approfondi de la politique dans une perspective de santé publique, en prenant comme modèle la stratégie globale de l'Organisation mondiale de la Santé afin de réduire l'usage nocif de l'alcool.

En China, el consumo de alcohol está aumentando con mayor rapidez que en cualquier otro lugar del mundo, y también se ha observado un crecimiento constante de la producción de alcohol en el país, junto con un aumento de los daños relacionados con esta sustancia. A pesar de estas tendencias, las políticas chinas sobre la venta y consumo de bebidas alcohólicas son débiles en comparación con las de otros países asiáticos. Las políticas más débiles son las que regulan los impuestos, las leyes de consumo y conducción, la venta de alcohol a menores de edad y las licencias para la venta de alcohol. Los autores de este artículo descriptivo llaman la atención sobre la necesidad urgente de que los funcionarios gubernamentales y los profesionales de la sanidad pública chinos den prioridad a la vigilancia de la población, a la investigación y a las intervenciones diseñadas para reducir los trastornos provocados por el consumo de alcohol. Describen las políticas actuales chinas relativas al alcohol, así como las tendencias presentes de los daños relacionados con el alcohol y destacan la necesidad de que los funcionarios de salud lleven a cabo una revisión de toda la política desde la perspectiva de la sanidad pública, usando como modelo la estrategia global de la Organización Mundial de la Salud para reducir el uso nocivo de alcohol.