Alcohol affordability: implications for alcohol price policies. A cross-sectional analysis in middle and older adults from UK Biobank.

BACKGROUND: Increasing the price of alcohol reduces alcohol consumption and harm. The role of food complementarity, transaction costs and inflation on alcohol demand are determined and discussed in relation to alcohol price policies. METHODS: UK Biobank (N = 502,628) was linked by region to retail price quotes for the years 2007 to 2010. The log residual food and alcohol prices, and alcohol availability were regressed onto log daily alcohol consumption. Model standard errors were adjusted for clustering by region. RESULTS: Associations with alcohol consumption were found for alcohol price (ß = -0.56, 95% CI, -0.92 to -0.20) and availability (ß = 0.06, 95% CI, 0.04 to 0.07). Introducing, food price reduced the alcohol price consumption association (ß = -0.26, 95% CI, -0.50 to -0.03). Alcohol (B = 0.001, 95% CI, 0.0004 to 0.001) and food (B = 0.001, 95% CI, 0.0005 to 0.0006) price increased with time and were associated (ρ = 0.57, P < 0.001). CONCLUSION: Alcohol and food are complements, and the price elasticity of alcohol reduces when the effect of food price is accounted for. Transaction costs did not affect the alcohol price consumption relationship. Fixed alcohol price policies are susceptible to inflation.

The Enduring Effects of Parental Alcohol, Tobacco, and Drug Use on Child Well-being: A Multilevel Meta-Analysis.

The effects of psychoactive substance abuse are not limited to the user, but extend to the entire family system, with children of substance abusers being particularly at risk. This meta-analysis attempted to quantify the longitudinal relationship between parental alcohol, tobacco, and drug use and child well-being, investigating variation across a range of substance and well-being indices and other potential moderators. We performed a literature search of peer-reviewed, English language, longitudinal observational studies that reported outcomes for children aged 0 to 18 years. In total, 56 studies, yielding 220 dependent effect sizes, met inclusion criteria. A multilevel random-effects model revealed a statistically significant, small detriment to child well-being for parental substance abuse over time (r = .15). Moderator analyses demonstrated that the effect was more pronounced for parental drug use (r = .25), compared with alcohol use (r = .13), tobacco use (r = .13), and alcohol use disorder (r = .14). Results highlight a need for future studies that better capture the effect of parental psychoactive substance abuse on the full breadth of childhood well-being outcomes and to integrate substance abuse into models that specify the precise conditions under which parental behavior determines child well-being.Registration: PROSPERO CRD42017076088.

A Longitudinal Study of European Students' Alcohol Use and Related Behaviors as They Travel Abroad to Study.

BACKGROUND: Travelling away from home can be associated with fewer limits on behavior, particularly for students who participate in exchange programs. AIMS: To examine the effects of eight moderators on change in alcohol use and related negative outcomes, drug use and unprotected sexual behavior in European study abroad students before, during, and after their time abroad. METHODS: A three wave (before departure, while abroad, and after their return) longitudinal design collecting data on the frequency and volume of alcohol consumed, heavy episodic drinking, alcohol-related outcomes, drug use, and unprotected casual sex. RESULTS: The baseline survey was completed by 1145 students participating in one or two semester exchange programs (67.5% spent up to a semester abroad), of which 906 participated in two or more waves, representing 42 and 33 countries of origin and destination, respectively. Mean age was 22.2 years (SD = 2.28) and 72.7% were female. Students increased the amount of alcohol consumed by 35% (B = 0.32; 95% CI 0.287-0.349) and experienced more alcohol-related consequences (B = 0.15; 95% CI 0.089-0.219) during the study abroad experience, though levels fell below pre-departure levels when they returned home. Factors related to greater alcohol use while abroad include pre-departure expectations about alcohol use during the study abroad experience, psychological adjustment to the host country, academic involvement, and host country living costs. No statistically meaningful change in drug use and unprotected sexual behavior was observed. CONCLUSIONS: Studying abroad exposes European students to additional time-limited alcohol-related health risks.

The relationship between alcohol use and long-term cognitive decline in middle and late life: a longitudinal analysis using UK Biobank.

Background: Using UK Biobank data, this study sought to explain the causal relationship between alcohol intake and cognitive decline in middle and older aged populations. Methods: Data from 13 342 men and women, aged between 40 and 73 years were used in regression analysis that tested the functional relationship and impact of alcohol on cognitive performance. Performance was measured using mean reaction time (RT) and intra-individual variation (IIV) in RT, collected in response to a perceptual matching task. Covariates included body mass index, physical activity, tobacco use, socioeconomic status, education and baseline cognitive function. Results: A restricted cubic spline regression with three knots showed how the linear (ß1 = -0.048, 95% CI: -0.105 to -0.030) and non-linear effects (ß2 = 0.035, 95% CI: 0.007-0.059) of alcohol use on mean RT and IIV in RT (ß1 = -0.055, 95% CI: -0.125 to -0.034; ß2 = 0.034, 95% CI: 0.002-0.064) were significant adjusting for covariates. Cognitive function declined as alcohol use increased beyond 10 g/day. Decline was more apparent as age increased. Conclusions: The relationship between alcohol use and cognitive function is non-linear. Consuming more than one UK standard unit of alcohol per day is detrimental to cognitive performance and is more pronounced in older populations.

Managing alcohol-related attendances in emergency care: can diversion to bespoke services lessen the burden?

Acute alcohol intoxication (AAI) has a long history of burdening emergency care services. Healthcare systems around the world have explored a variety of different services that divert AAI away from EDs to better manage their condition. Little formal evaluation has been undertaken, particularly in the UK where alcohol misuse is one of the highest in the world. In this article, we outline a brief history of diversionary services, introduce the concept of Alcohol Intoxication Management Services (AIMS) and describe examples of AIMS in the UK. We then describe Evaluating the Diversion of Alcohol-Related Attendances, a natural experiment including six cities with AIMS compared with six cities without, that involves an ethnographic study, records patient experiences in both AIMS and EDs, assesses impact on key performance indicators in healthcare and evaluates the cost-effectiveness of AIMS.

Process evaluation of an environmental health risk audit and action plan intervention to reduce alcohol related violence in licensed premises.

BACKGROUND: Alcohol-related violence is associated with licensed premise environments and their management. There is a lack of evidence for effective interventions to address these, and there are significant barriers to implementation. This study aims to understand how development and implementation processes can facilitate intervention reach, fidelity and receipt and therefore provides key process data necessary to interpret the results of the randomised controlled trial conducted in parallel. METHODS: A process evaluation, embedded within a randomised controlled trial. Intervention development and implementation were assessed via focus groups (n = 2) and semi-structured interviews (n = 22) with Environmental Health Practitioners (EHPs). Reach and fidelity were assessed via routinely collected intervention data, which was was collected from 276 licenced premises across Wales, UK. Case study semi-structured interviews with licensed premises proprietors (n = 30) explored intervention receipt. RESULTS: Intervention co-production with senior EHPs facilitated organisational adoption and implementation. Training events for EHPs played an important role in addressing wider organisational concerns regarding partnership working and the contextual integration of the intervention. EHPs delivered the intervention to 98 % of intervention premises; 35 % of premises should have received a follow up enforcement visit, however EHP confidence in dealing with alcohol risk factors meant only 7 % of premises received one. Premises therefore received a similar intervention dose regardless of baseline risk. Intervention receipt appeared to be greatest in premises with an existing commitment to prevention and those in urban environments. CONCLUSIONS: The study suggests that a collaborative approach to the development and diffusion of interventions is associated with high levels of organisational adoption, implementation and reach. However, the lack of enforcement visits represents implementation failure for a key mechanism of action that is likely to influence intervention effectiveness. To be effective, any future intervention may require a longer implementation period to develop EHP confidence in using enforcement approaches in this area and multiagency enforcement support, which includes the police, to deliver an adequate intervention dose.

A rank based social norms model of how people judge their levels of drunkenness whilst intoxicated.

BACKGROUND: A rank based social norms model predicts that drinkers' judgements about their drinking will be based on the rank of their breath alcohol level amongst that of others in the immediate environment, rather than their actual breath alcohol level, with lower relative rank associated with greater feelings of safety. This study tested this hypothesis and examined how people judge their levels of drunkenness and the health consequences of their drinking whilst they are intoxicated in social drinking environments. METHODS: Breath alcohol testing of 1,862 people (mean age = 26.96 years; 61.86 % male) in drinking environments. A subset (N = 400) also answered four questions asking about their perceptions of their drunkenness and the health consequences of their drinking (plus background measures). RESULTS: Perceptions of drunkenness and the health consequences of drinking were regressed on: (a) breath alcohol level, (b) the rank of the breath alcohol level amongst that of others in the same environment, and (c) covariates. Only rank of breath alcohol level predicted perceptions: How drunk they felt (b 3.78, 95 % CI 1.69 5.87), how extreme they regarded their drinking that night (b 3.7, 95 % CI 1.3 6.20), how at risk their long-term health was due to their current level of drinking (b 4.1, 95 % CI 0.2 8.0) and how likely they felt they would experience liver cirrhosis (b 4.8. 95 % CI 0.7 8.8). People were more influenced by more sober others than by more drunk others. CONCLUSION: Whilst intoxicated and in drinking environments, people base judgements regarding their drinking on how their level of intoxication ranks relative to that of others of the same gender around them, not on their actual levels of intoxication. Thus, when in the company of others who are intoxicated, drinkers were found to be more likely to underestimate their own level of drinking, drunkenness and associated risks. The implications of these results, for example that increasing the numbers of sober people in night time environments could improve subjective assessments of drunkenness, are discussed.

Characteristics associated with risk taking behaviours predict young people's participation in organised activities.

Participation in organised activities (OAs) such as sports and special groups can shape adolescent risk taking behaviours. Sensation seeking and inhibitory control play an important role in the emergence of adolescent risk taking behaviours and may explain variations in OA participation as well as inform the development of more effective interventions that use OAs. Data from the Avon Longitudinal Study of Parents and Children (England) were analysed using logistic regression to test whether inhibitory control and sensation seeking predicted participation in OAs at a mean age of 11.7 years (n = 2557) and 15.4 years (n = 2147). At 11 years of age higher sensation seeking predicted participation in any activity, sports and special groups while low inhibitory control predicted less participation in sports. At 15 years of age higher sensation seeking predicted participation in sports and activity breadth. Opportunities to develop targeted interventions aimed at increasing participation are discussed.

Children's toothbrushing frequency: the influence of parents' rationale for brushing, habits and family routines.

OBJECTIVES: To assess the relationship between parental and family factors and children's toothbrushing frequency at different times of day. METHODS: A cross-sectional questionnaire survey of predominantly low-socio-economic status parents of children aged 3-6 years (n = 296) in South Wales, UK. Data were collected on the child's weekly toothbrushing frequency (morning and evening), the parents' rationale for brushing their child's teeth in the morning and evening, the strength of a parent's habit for brushing a child's teeth in the morning and evening, and the extent to which the family's daily routines were stable from day to day. Socio-demographic details were also collected. RESULTS: Reported weekly brushing frequency was significantly (p < 0.001) higher in the morning (mean ± SD: 6.57 ± 1.37) than the evening (mean ± SD: 5.99 ± 2.15). Parents had significantly (p < 0.001) more interest in the cosmetic benefits of toothbrushing in the morning compared to the evening. Multivariate analysis showed that an increasing focus on the cosmetic benefits of toothbrushing was associated with significantly (p < 0.05) less weekly brushing in the evening. The extent to which brushing a child's teeth was 'habitual' was significantly (p < 0.001) associated with weekly toothbrushing frequency at both times of day. CONCLUSIONS: Parents' rationale for brushing their children's teeth can vary at both an individual level and at different times of day. Understanding these variations is important in designing interventions to improve brushing frequency for at-risk children. The results also demonstrate habituation as being an important factor in understanding toothbrushing frequency. Further research is required to understand the mechanisms involved in habit formation and maintenance with children's oral hygiene behaviour.

All-Wales licensed premises intervention (AWLPI): a randomised controlled trial to reduce alcohol-related violence.

BACKGROUND: Alcohol-related violence in and in the vicinity of licensed premises continues to place a considerable burden on the United Kingdom's (UK) health services. Robust interventions targeted at licensed premises are therefore required to reduce the costs of alcohol-related harm. Previous evaluations of interventions in licensed premises have a number of methodological limitations and none have been conducted in the UK. The aim of the trial was to determine the effectiveness of the Safety Management in Licensed Environments intervention designed to reduce alcohol-related violence in licensed premises, delivered by Environmental Health Officers, under their statutory authority to intervene in cases of violence in the workplace. METHODS/DESIGN: A national randomised controlled trial, with licensed premises as the unit of allocation. Premises were identified from all 22 Local Authorities in Wales. Eligible premises were those with identifiable violent incidents on premises, using police recorded violence data. Premises were allocated to intervention or control by optimally balancing by Environmental Health Officer capacity in each Local Authority, number of violent incidents in the 12 months leading up to the start of the project and opening hours. The primary outcome measure is the difference in frequency of violence between intervention and control premises over a 12 month follow-up period, based on a recurrent event model. The trial incorporates an embedded process evaluation to assess intervention implementation, fidelity, reach and reception, and to interpret outcome effects, as well as investigate its economic impact. DISCUSSION: The results of the trial will be applicable to all statutory authorities directly involved with managing violence in the night time economy and will provide the first formal test of Health and Safety policy in this environment. If successful, opportunities for replication and generalisation will be considered. TRIAL REGISTRATION: UKCRN 14077; ISRCTN78924818.

Parents' reasons for brushing or not brushing their child's teeth: a qualitative study.

BACKGROUND: Despite recent improvements in oral health, dental caries remains a significant source of morbidity for young children. Research has shown that regular toothbrushing with fluoride toothpaste reduces the risk of dental caries, but the factors that influence parental decisions about whether or not to brush their infant children's teeth at home are poorly understood. AIM: To develop an in-depth understanding of the issues that parents face from socio-economically deprived areas when trying to brush their young children's teeth at home. DESIGN: Fifteen parents of children aged 3-6 years took part in semi-structured telephone interviews, discussing factors relating to brushing their child's teeth at home. Thematic analysis was used to develop three themes. RESULTS: Parents discussed the difficulty of brushing their children's teeth in the evening, due to changing day-to-day routines, and the subsequent difficulty of forming a toothbrushing habit. Motivating factors for brushing children's teeth were largely short term. Satisfaction with brushing frequency was influenced more by perceptions of how often other parents brushed children's teeth than by the 'twice a day' norm or health outcomes. CONCLUSION: Results are discussed in relation to research and theories from the psychology and behavioural economics literature, and comparisons are drawn with assumptions inherent in more traditional oral health promotion messages.

Fearlessness in juvenile offenders is associated with offending rate.

Poor fear conditioning is a correlate of violent offending in adults, but there is no evidence concerning juvenile offenders. Our aim was to compare emotional learning in juvenile offenders and controls and establish whether crime rate is related to seriousness of emotional learning problems. To this end, emotional learning was assessed in 42 juvenile offenders by measuring skin conductance responding (SCR) during fear conditioning. Compared to controls, juvenile offenders showed lower conditioned SCRs to visual stimuli associated with a subsequent aversive stimulus and the magnitude of the SCR during fear acquisition was inversely associated with the number of their recorded offences. These findings suggest that juvenile offenders have impairments in the neural systems that subserve emotional learning. The implication is that using punitive measures to control persistent offenders is unlikely to be effective in an identifiable group of juvenile offenders.

A feasibility study of short message service text messaging as a surveillance tool for alcohol consumption and vehicle for interventions in university students.

BACKGROUND: Practitioners who come into contact with the intoxicated, such as those in unscheduled care, often have limited resources to provide structured interventions. There is therefore a need for cost-effective alcohol interventions requiring minimal input. This study assesses the barriers, acceptability and validity of text messaging to collect daily alcohol consumption data and explores the feasibility of a text-delivered intervention in an exploratory randomised controlled trial. METHODS: Study I. Participants (n = 82) completed the initial online screening survey and those eligible were asked each day, for 157 days via text message, to reply with the number of alcohol units consumed the previous day. Analyses compared standard measures of hazardous consumption with self-report alcohol use. Attrition and sampling biases were examined. Study I included secondary exploratory analyses using data from 70 participants to determine associations between events (including Christmas and other celebratory occasions) and consumption. Study I further included the thematic analysis of semi-structured interview data and assessed the feasibility of and barriers to surveillance and interventions delivered through text messaging. Developing findings from Study I, Study II developed an exploratory randomised control trial that delivered a single message on monthly alcohol expenditure in order to assess effect size and test generalisability. RESULTS: Self-report alcohol consumption data was significantly associated with FAST and AUDIT scores. Attrition from the study was not associated with greater alcohol use. Greater alcohol use was observed on Fridays, Saturdays and Wednesdays as were notable celebratory events. Interview data indicated that text messaging was acceptable to participants and preferred over email and web-based methods. The exploratory randomised controlled trial suggested that a simple text delivered intervention might be effective in eliciting a reduction in alcohol consumption in a future trial. CONCLUSIONS: The ubiquity of mobile telephones and the acceptability of text messaging suggests that this approach can be developed as a surveillance tool to collect high frequency consumption data to identify periods of vulnerability and that it can offer a platform through which targeted interventions can be delivered.

Hospital-based violence prevention programmes in South Wales Emergency Departments: A process evaluation protocol.

BACKGROUND: Addressing violence related harm is a global public health priority. While violence is primarily managed in the criminal justice system, healthcare supports and manages those injured by violence. Emergency Departments (EDs), the primary destination for those seriously injured, have emerged as a candidate location for violence prevention initiatives. There is limited evaluation of ED-based violence prevention, and a lack of guidance for the implementation and delivery of them. Nurse-led Violence Prevention Teams (VPTs) have been developed and implemented in two EDs in Wales, UK. This protocol describes methods used in the process evaluation of these VPTs. AIM: To understand how VPTs function, how they were implemented, and mechanisms of impact, as well as the exploration of wider contextual factors influencing their function. METHODS: Adopting a critical realist approach and informed by the Medical Research Council (MRC) guidance for process evaluations, the process evaluation will employ qualitative methods to collect and analyse data: a scoping review of evidence of effectiveness that considers the causal mechanisms underpinning violence; a documentary analysis to determine operational considerations concerning the development, implementation and delivery of the VPTs; a descriptive analysis of routine ED data to characterise the prevalence of violence-related attendances in each ED; interviews with professional stakeholders (N = 60) from the violence prevention ecologies in which the VPTs are embedded. DISCUSSION: This protocol outlines a process evaluation of a novel, nurse led violence prevention intervention. Findings will be used to inform policy makers' decision making on whether and how VPTs should be used in practice in other EDs across the UK, and the extent that a single operational model should be adjusted to address the local characteristic of violence. To the authors knowledge, this is the first process evaluation of a UK-based, nurse led Emergency Department Violence Prevention Team. TRIAL REGISTRATION: Protocol registration ISRCTN: 15286575. Registered 13th March, 2023.

An exploratory randomised controlled trial of a premises-level intervention to reduce alcohol-related harm including violence in the United Kingdom.

BACKGROUND: To assess the feasibility of a randomised controlled trial of a licensed premises intervention to reduce severe intoxication and disorder; to establish effect sizes and identify appropriate approaches to the development and maintenance of a rigorous research design and intervention implementation. METHODS: An exploratory two-armed parallel randomised controlled trial with a nested process evaluation. An audit of risk factors and a tailored action plan for high risk premises, with three month follow up audit and feedback. Thirty-two premises that had experienced at least one assault in the year prior to the intervention were recruited, match paired and randomly allocated to control or intervention group. Police violence data and data from a street survey of study premises' customers, including measures of breath alcohol concentration and surveyor rated customer intoxication, were used to assess effect sizes for a future definitive trial. A nested process evaluation explored implementation barriers and the fidelity of the intervention with key stakeholders and senior staff in intervention premises using semi-structured interviews. RESULTS: The process evaluation indicated implementation barriers and low fidelity, with a reluctance to implement the intervention and to submit to a formal risk audit. Power calculations suggest the intervention effect on violence and subjective intoxication would be raised to significance with a study size of 517 premises. CONCLUSIONS: It is methodologically feasible to conduct randomised controlled trials where licensed premises are the unit of allocation. However, lack of enthusiasm in senior premises staff indicates the need for intervention enforcement, rather than voluntary agreements, and on-going strategies to promote sustainability. TRIAL REGISTRATION: UKCRN 7090; ISRCTN: 80875696.

An Exploration of the Multiplicative Effect of "Other People" and Other Environmental Effects on Violence in the Night-Time Environment.

BACKGROUND: The characteristics of night-time environments (NTEs) in which alcohol is consumed and that contribute to violence are poorly described. We explore competing explanations for violence in the NTE, with a particular focus on the number of patrons and its association with assault-related visits to a hospital emergency department. Other environmental features including the weather and notable events were also considered. The primary aim was to stimulate debate around the causal mechanisms responsible for violence. METHODS: Assault-related ED visits occurring between 8 pm and 4 am were recorded at the University Hospital of Wales, the single Emergency Department (ED) serving Cardiff, Wales, United Kingdom. Footfall was derived from the total number of unique MAC addresses recorded per hour collected from ten wireless fidelity monitoring tools located in the city centre. A narrative review of the literature concerning alcohol and violence informed exploratory analyses into the association between night-time footfall, sporting events, the weather, and other potential predictors of assault-related visits to the ED. We developed analytic methods from formal accounts of queueing. RESULTS: International rugby matches at home, the weather (temperature), national holidays, the day of the week, and number of patrons in the NTE predicted assault-related injury (R2 = 0.70), with footfall yielding a positive non-linear exponential association consistent with predictions derived from mathematical models of queueing. DISCUSSION: Assault-related visits to the ED have a non-linear association with the number of people socialising in the night-time environment and are further influenced by the weather and notable events. Opportunities for further research that might inform policy and interventions aimed at better managing NTEs are discussed.

Predicting and measuring premises-level harm in the night-time economy.

AIMS: To assess associations between measures of premises-level alcohol-related harm and risk factors for harm. METHODS: Thirty-two licensed premises with a history of on-premises violent assault were recruited. An environmental survey of the drinking context of each premises was undertaken. Levels of patron intoxication were assessed using a breathalyser and a visual assessment of customers at each premises. Premise-level violence was identified via routine police and hospital emergency department data. Analyses examined associations between hospital and police data, surveyor and objective ratings of intoxication and the relationship between intoxication, drinking context and violence at the premises level. RESULTS: Hospital and police data were associated. Aggregate levels of surveyor-rated intoxication were associated with aggregate alcometer breath alcohol levels. Analyses further suggest that premises with the highest levels of violence also had customers whose entry-exit change in intoxication was greatest, were open for longer hours, had alcohol promotions and had visible security staff present. CONCLUSIONS: Police and hospital data can be used to identify violent premises and to assess outcomes from premises-level interventions to reduce violence. Relatively low-cost observational survey methods can be used to identify high-risk premises, and can be used as outcomes for premises-level interventions. Features of premises that promote intoxication are associated with violence, suggesting that targeting resources at risky premises will likely address two public health concerns: excessive intoxication and assault-related injury.

The health behaviours of European study abroad students sampled from forty-two countries: Data from a three-wave longitudinal study.

Research on travelling populations indicates that geographic mobility is associated with changes in health behaviours. However, there is currently little longitudinal data recording study abroad students' health behaviours other than alcohol use [1], [2], and that includes a variety of risk and protective factors related to students' demographics and their experiences abroad. The present dataset contains the original longitudinal data from a study of European study abroad students' and includes information on participants health-related behaviour: including physical exercise, diet, alcohol and drug use, and unprotected casual sex. Self-reported data were collected across three waves: on arrival in the host country, to assess pre-departure behaviour (T1), four months through the period abroad (T2), and four months after returning home (T3). Data on factors related to participants' demographics and their abroad experience, including motivations to study abroad, acculturation orientation and adjustment to the host environment, and perceptions regarding different referent peers' drinking behaviour were also collected. Data were collected in the 2015-2016 academic year. At T1 students in 200 cities from more than 40 European countries were approached by representatives from an international student association. Participants who completed at least two surveys were included (N = 908). The T1 survey was completed by 899 students (nine students provided an e-mail address but did not complete the survey at T1), 785 (86.5%) completed T2 survey, and 438 (48.2%) the T3 survey. The data article presents tables charting variables measured by survey wave and participants' socio-demographic and study abroad experience characteristics. With an acceptable drop-out across the three waves, these data may be of interest to researchers who wish to understand factors related to changes in health behaviours in this population and develop targeted health promotion interventions. Other stakeholders such as policy makers, international offices, health professionals in counselling service, student associations may also use these data to develop communication campaigns and intervene with reference to relevant risk and protective factors.

Visualisation and optimisation of alcohol-related hospital admissions ICD-10 codes in Welsh e-cohort data.

INTRODUCTION: The excessive consumption of alcohol is detrimental to long term health and increases the likelihood of hospital admission. However, definitions of alcohol-related hospital admission vary, giving rise to uncertainty in the effect of alcohol on alcohol-related health care utilization. OBJECTIVES: To compare diagnostic codes on hospital admission and discharge and to determine the ideal combination of codes necessary for an accurate determination of alcohol-related hospital admission. METHODS: Routine population-linked e-cohort data were extracted from the Secure Anonymised Information Linkage (SAIL) Databank containing all alcohol-related hospital admissions (n,= 92,553) from 2006 to 2011 in Wales, United Kingdom. The distributions of the diagnostic codes recorded at admission and discharge were compared. By calculating a misclassification rate (sensitivity-like measure) the appropriate number of coding fields to examine for alcohol-codes was established. RESULTS: There was agreement between admission and discharge codes. When more than ten coding fields were used the misclassification rate was less than 1%. CONCLUSION: With the data at present and alcohol-related codes used, codes recorded at admission and discharge can be used equivalently to identify alcohol-related admissions. The appropriate number of coding fields to examine was established: fewer than ten is likely to lead to under-reporting of alcohol-related admissions. The methods developed here can be applied to other medical conditions that can be described using a certain set of diagnostic codes, each of which can be a known sole cause of the condition and recorded in multiple positions in e-cohort data.