"They start on the zero-alcohol and they wanna try the real thing": Parents' views on zero-alcohol beverages and their use by adolescents.

OBJECTIVE: Zero-alcohol beverages containing 0.0-0.5% alcohol by volume may offer public health benefits if individuals use them to substitute for alcohol-containing products, thereby reducing alcohol use. There are, however, concerns that zero-alcohol beverages may encourage adolescents' earlier interest in alcohol and increase exposure to alcohol company branding. As this poses a challenge for parents, we studied parents' views on zero-alcohol beverages and their provision to adolescents. METHODS: We interviewed n=38 parents of 12-17-year-olds and used reflexive thematic analysis to interpret interview data. RESULTS: Parents considered zero-alcohol beverages to be 'adult beverages' that potentially supported reduced adult drinking but were unnecessary for adolescents. Parents were concerned that adolescent zero-alcohol beverage use could normalise alcohol consumption and be a precursor to alcohol initiation. There was a potential conflict between moderate provision in 'appropriate' contexts, and potential benefits, which were each supported by some parents. Uncertainty on health qualities was also reported. CONCLUSIONS: Parents reported conflicting and cautious views on zero-alcohol beverage provision to adolescents. IMPLICATIONS FOR PUBLIC HEALTH: As evidence on the impacts of zero-alcohol beverage availability develops, parent-targeted messages highlighting the potential risk of normalisation of alcohol use for young people could be developed, in conjunction with broader policy responses.

Which parents provide zero-alcohol beverages to adolescents? A survey of Australian parents' practices and intentions.

OBJECTIVE: Zero-alcohol beverages (<0.5% alcohol by volume) appear and taste similar to alcoholic beverages but are regulated similarly to soft drinks in many countries, blurring the distinction between alcoholic and non-alcoholic beverages. How parents view provision of zero-alcohol beverages to adolescents is likely a key determinant of adolescent consumption. We investigated factors associated with parents' provision of zero-alcohol beverages to adolescents, including attitudes toward zero-alcohol beverages and demographic, knowledge, and behavioural factors known to be associated with provision of alcoholic beverages. METHODS: We conducted an online cross-sectional survey of N = 1197 Australian parents of adolescents aged 12-17 years in April-May 2022. We examined associations with zero-alcohol beverage provision using binomial logistic regression, and with future provision intentions using multinomial logistic regression analyses. RESULTS: Factors significantly associated (p < .001) with parents' provision and future intentions to provide zero-alcohol beverages to their adolescent included beliefs that zero-alcohol beverages had benefits for adolescents (Adjusted Odds Ratio [AOR] 2.69 (provision); 3.72 (intentions)), provision of alcoholic beverages (AOR 2.67 (provision); 3.72 (intentions)), and an incorrect understanding of alcohol guidelines for adolescents (AOR 2.38 (provision); 1.95 (intentions)). CONCLUSIONS: Parents' provision and intentions to provide zero-alcohol beverages were associated with beliefs about zero-alcohol beverages as well as some factors associated with provision of alcoholic beverages. Precautionary advice to parents that the provision of zero-alcohol beverages may serve to normalise alcohol consumption may be warranted.

Alcohol consumption and mental health conditions: Insights from a South Australian population survey to inform policy and practice.

OBJECTIVE: Among individuals with a mental health condition co-occurring alcohol use disorders are common, but less is known about alcohol consumption in excess of recommended drinking guidelines. This study investigated the prevalence of lifetime risky drinking (>2 drinks daily) and single occasion risky drinking (>4 drinks on one occasion) among individuals with mental health conditions of different severities. METHODS: Data from representative cross-sectional population surveys among South Australians aged ≥15 years (n=11,761) were utilised. Logistic regression models assessed associations between risky alcohol consumption, presence of a mental health condition and demographic characteristics. RESULTS: Prevalence of lifetime risky drinking was greater among both males and females with a mental health condition (p>0.001). Single occasion risky drinking was more prevalent among males with a severe mental health condition (p=0.01). Adjusted logistic regressions showed that only females with a mental health condition had greater odds of exceeding lifetime risky drinking levels (OR=1.39, CI 1.11 to1.75). CONCLUSIONS: There are sex-specific relationships between risky alcohol consumption and mental health conditions. IMPLICATIONS FOR PUBLIC HEALTH: Risky alcohol consumption, in excess of guidelines, is of concern among those with a mental health condition and requires attention at an individual and population level.

Levels of Parental Drinking in the Presence of Children: An Exploration of Attitudinal Correlates.

AIMS: This study aimed to examine perceived social norms, the effect of parental drinking on these norms, alcohol use in front of children, and how norms and consumption vary based on child age and gender of the parent. METHODS: A cross-sectional online panel survey was undertaken with n = 1000 Australian adults (including 670 parents) aged 18-59 years. The survey assessed: alcohol consumption in front of children; normative attitudes towards drinking in the presence of children; and perceived social norms. RESULTS: Overall, 33.9% of parents reported drinking a glass of alcohol each day or a couple of times a week, 18.2% reported getting slightly drunk and 7.8% indicated getting visibly drunk each day or a couple of times a week with their children present. In total, 37.5% reported drinking in front of their children at least weekly. Fathers were more likely to drink in front of children than mothers. Most parents deemed drinking small amounts of alcohol in front of children as acceptable but did not accept drunkenness. Respondents were less concerned about a father drinking one or two drinks in front of their children than a mother. Social expectations were not related to child age, but norms related to others' perceived behaviour were. CONCLUSIONS: Many parents, particularly fathers consume alcohol in front of their children. There is a need to target health promotion strategies to adults and parents consuming in excess of health guidelines, and to the many parents who are consuming alcohol at higher levels in front of their children.

Depictions of Alcohol in Australian TV 'Bachelor In Paradise': A Content Analysis.

AIMS: To quantify the depictions of alcohol in the popular Australian reality TV show-Bachelor in Paradise (season 1: 2018). METHODS: All 16 episodes were coded in 1-min intervals for the presence of alcoholic beverage related content and non-alcoholic beverage content, and the categories of actual use, implied use and other references. RESULTS: Alcohol was highly prevalent in all episodes. Alcohol content occurred frequently, with 70.7% of intervals having any alcohol content. Actual alcohol use occurred in 31.9% of 1-min intervals, implied alcohol use occurred in 63.4% of intervals and other alcohol references occurred in 14.0% of intervals. Alcohol content was present in the first or second 1-min interval of all 16 episodes. Alcohol content was more than twice as prevalent as non-alcoholic content (34.0%). CONCLUSIONS: The high volume of alcohol content depicted in the show is of concern, due to the important influence it may have on the audience. Vulnerable viewers, especially minors and young adults, are being exposed to ubiquitous alcohol references. This may influence their perceptions of normal alcohol use, their attitudes toward alcohol and their own consumption of alcohol. A stronger regulatory regime is required in Australia to protect young people more effectively from depictions in television programs.

Parental drinking in Australia: Does the age of children in the home matter?

INTRODUCTION AND AIMS: Parental role modelling of alcohol use is known to influence alcohol consumption in adolescence and in later life. This study aimed to assess relationships between parental status, child age and alcohol consumption, which have not been well documented. DESIGN AND METHODS: Data were sourced from the 2013 Australian National Drug Strategy Household Survey. Analyses were conducted for 25-55 year olds (n = 11 591) by parental status, gender and age of youngest child in the household, controlling for socio-demographic factors. RESULTS: Parents were less likely than non-parents to exceed the alcohol guideline for increased lifetime risk (18.2% vs. 24.2%) and short-term risk: at least weekly (14.2% vs. 21.2%); and at least monthly (27.5% vs. 35.9%). Fathers were just as likely to exceed the guidelines for lifetime risk as other men, but those with children aged 0-2, were less likely to exceed the guideline for short-term risk. Women were least likely to exceed the guideline for lifetime risk if they had children aged 0-2, 6-11 or 15 years and over, or the guideline for short-term risk, if they had children aged 0-2, or 15 years and over in the household. Parents were more likely to report drinking in the home. DISCUSSION AND CONCLUSIONS: Parents were less likely to exceed alcohol guidelines than non-parents, especially mothers whose youngest child was an infant or in high school or older. Consistent with population rates in men, fathers were more likely to exceed alcohol guidelines than mothers, and this excess consumption warrants public health attention.

Measuring research impact: a large cancer research funding programme in Australia.

BACKGROUND: Measuring research impact is of critical interest to philanthropic and government funding agencies interested in ensuring that the research they fund is both scientifically excellent and has meaningful impact into health and other outcomes. The Beat Cancer Project (BCP) is a AUD $34 m cancer research funding scheme that commenced in 2011. It was initiated by an Australian charity (Cancer Council SA), and supported by the South Australian Government and the state's major universities. METHODS: This study applied Buxton and Hanney's Payback Framework to assess research impact generated from the BCP after 3 years of funding. Data sources were an audit of peer-reviewed publications from January 2011 to September 2014 from Web of Knowledge and a self-report survey of investigators awarded BCP research funding during its first 3 years of implementation (2011-2013). Of the 104 surveys, 92 (88%) were completed. RESULTS: The BCP performed well across all five categories of the Payback Framework. In terms of knowledge production, 1257 peer-reviewed publications were generated and the mean impact factor of publishing journals increased annually. There were many benefits to future research with 21 respondents (23%) reporting career advancement, and 110 higher degrees obtained or expected (including 84 PhDs). Overall, 52% of funded projects generated tools for future research. The funded research attracted substantial further income yielding a very high rate of leverage. For every AUD $1 that the cancer charity invested, the BCP gained an additional AUD $6.06. Five projects (5%) had informed policy and 5 (5%) informed product development, with an additional 31 (34%) and 35 (38%) projects, respectively, anticipating doing so. In terms of health and sector and broader economic benefits, 8 (9%) projects had influenced practice or behaviour of health staff and 32 (34%) would reportedly to do so in the future. CONCLUSIONS: Research impact was a priority of charity and government funders and led to a deliberate funding strategy. Emphasising research impact while maintaining rigorous, competitive processes can achieve the joint objectives of excellence in research, yielding good research impact and a high rate of leverage for philanthropic and public investment, as indicated by these early results.

The Australian NHMRC guidelines for alcohol consumption and their portrayal in the print media: a content analysis of Australian newspapers.

OBJECTIVE: To measure and characterise unpaid coverage in the Australian print media of the 2001, 2007 and 2009 National Health and Medical Research Council (NHMRC) Australian Guidelines to Reduce Health Risks from Drinking Alcohol. METHODS: A total of 172 articles published in Australian newspapers between 1999 and 2014 were content analysed using a coding framework aimed to define the article descriptors, article prominence, content, slant and guidelines. RESULTS: The majority (62.2%) of articles were published between 2007 and 2009, the predominant topic being 'the National Health and Medical Research Council guidelines" with less than two-thirds (59.2%) of the articles mentioning the specific guidelines for reducing alcohol-related harm. CONCLUSIONS: There was low unpaid print newspaper coverage of the guidelines, which may contribute to low community knowledge of the guidelines. Implications for public health: This study provides a foundation for developing further studies and highlights the need to improve awareness of the guidelines.

Sugar-sweetened beverage consumption, correlates and interventions among Australian Aboriginal and Torres Strait Islander communities: a scoping review protocol.

INTRODUCTION: Aboriginal and Torres Strait Islander communities of Australia experience poorer health outcomes in the areas of overweight and obesity, diabetes and cardiovascular disease. Contributing to this burden of disease in the Australian community generally and in Aboriginal and Torres Strait Islander communities, is the consumption of sugar-sweetened beverages (SSBs). We have described a protocol for a review to systematically scope articles that document use of SSBs and interventions to reduce their consumption with Aboriginal and Torres Strait Islander people. These results will inform future work that investigates interventions aimed at reducing harm associated with SSB consumption. METHODS AND ANALYSIS: This scoping review draws on a methodology that uses a six-step approach to search databases including PubMed, SCOPUS, CINAHL, Informit (including Informit: Indigenous Peoples), Joanna Briggs Institute EBP Database and Mura, between January 1980 and February 2017. Two reviewers will be engaged to search for and screen studies independently, using formulated selection criteria, for inclusion in our review. We will include primary research studies, systematic reviews including meta-analysis or meta-synthesis, reports and unpublished grey literature. Results will be entered into a table identifying study details and characteristics, summarised using a Preferred Reporting Items for Systematic Reviews and Meta-Analysis chart and then critically analysed. ETHICS AND DISSEMINATION: This review will not require ethics committee review. Results will be disseminated at appropriate scientific meetings, as well as through the Aboriginal and Torres Strait Islander community.

Prevalence, perceptions and predictors of alcohol consumption and abstinence among South Australian school students: a cross-sectional analysis.

BACKGROUND: Alcohol consumption by young people (particularly early initiation) is a predictor for poorer health in later life. In addition, evidence now clearly shows a causal link between alcohol and cancer. This study investigated prevalence, predictors of alcohol consumption among adolescents including perceptions of the link between alcohol and cancer, and the role of parents and peers. METHODS: A sample of Australian school students aged 12-17 years participated in a survey (n = 2885). Logistic regression analysis was undertaken to determine predictors. RESULTS: Alcohol use increased with age and by 16, most had tried alcohol with 33.1% of students aged 12-17 reporting that they drank at least occasionally (95% CI = 31.0-35.2). Awareness of the link between alcohol and cancer was low (28.5%). Smoking status and friends' approval were predictive of drinking, whereas parental disapproval was protective. Those aged 14-17 who did not think the link between alcohol and cancer was important were more likely to drink, as were those living in areas of least disadvantage. The only factors that predicted recent drinking were smoking and the perception that alcohol was easy to purchase. CONCLUSIONS: An education campaign highlighting the link between alcohol and cancer may have positive flow-on effects for young people, and schools should incorporate this messaging into any alcohol education programs. Consideration should be given to factors that serve to regulate under-aged accessibility of alcohol.

Alcohol consumption and NHMRC guidelines: has the message got out, are people conforming and are they aware that alcohol causes cancer?

OBJECTIVE: To examine self-reported alcohol consumption and relationships between consumption, awareness of the 2009 NHMRC guidelines of no more than two standard drinks per day, drinking in excess of the guideline threshold and perceptions of alcohol as a risk factor for cancer. METHODS: Questions were included in annual, cross-sectional surveys of approximately 2,700 South Australians aged 18 years and over from 2004 to 2012. Consumption data for 2011 and 2012 were merged for the majority of analyses. RESULTS: In 2011 and 2012, 21.6% of adults drank in excess of the guideline threshold (33.0% males; 10.7% females). While 53.5% correctly identified the NHMRC consumption threshold for women, only 20.3% did so for men (39.0% nominated a higher amount). A large minority said they did not know the consumption threshold for women (39.2%) or men (40.4%). In 2012, only 36.6% saw alcohol as an important risk factor for cancer. Important predictors of excess consumption for men were: higher household income; and not perceiving alcohol as an important risk factor for cancer. Predictors for women were similar but the role of household income was even more prominent. CONCLUSIONS: Men were nearly three times as likely to drink in excess of the guidelines as women. The majority of the population did not see an important link between alcohol and cancer. Awareness of the latest NHMRC guidelines consumption threshold is still low, particularly for men. IMPLICATIONS: A strategy to raise awareness of the NHMRC guidelines and the link between alcohol and cancer is warranted.

What happens when the price of a tobacco retailer licence increases?

OBJECTIVE: To measure the impact of a 15-fold licence fee increase on tobacco retailer licence renewals. METHODS: The regulatory change increasing tobacco licence fees (from $A12.90 to $A200 per annum) took effect on 1 January 2007. Government Tobacco Licence records (n=7093) were audited for 1 year prior to, and 2 years after the change. An interrupted time series analysis using ARIMA modelling was conducted to examine the impact of fee increases on the number of active licences. RESULTS: The total number of tobacco licences decreased by 23.7% from December 2007 to December 2009. The increased tobacco licence fee implemented on 1 January 2007, was associated with a significant reduction in the number of tobacco licences purchased or renewed in subsequent years. Of the 1144 entertainment licensees holding valid licences in December 2007, 30.9% no longer held a licence by December 2009, and 19.9% had reduced the number of points of sale within the same venue. CONCLUSIONS: Licensing of tobacco retailers has received little attention in tobacco control in Australia and internationally. Our data add to the growing body of evidence supporting further regulation of retail sale of tobacco. The results demonstrate that a tobacco licence price increase off a low base is a potentially effective method of reducing tobacco points of sale when consumer demand for cigarette products is low. However, further research is needed to identify additional measures that may be necessary to reduce the availability of tobacco products in areas where consumer demand for cigarettes is high.

Aboriginal and Torres Strait Islander utilisation of the Quitline service for smoking cessation in South Australia.

Smoking prevalence among Indigenous Australians far exceeds that of non-Indigenous Australians and is considered the greatest contributor to burden of disease for Indigenous Australians. The Quitline is a primary intervention for facilitating smoking cessation and, given the health implications of tobacco use, maximising its effectiveness for Indigenous Australians is imperative. However, the utilisation and effectiveness of this service within the Indigenous Australian population has not been examined. This study explores the utilisation of the South Australian Quitline by smokers identifying as Indigenous Australian. Quitline counsellors collected data regarding demographic characteristics, and smoking and quitting behaviour from Quitline callers in 2010. Results indicated that the proportion of Indigenous and non-Indigenous smokers who registered for the service was comparable. Demographic variables and smoking addiction at time of registration with the Quitline were similar for Indigenous and non-Indigenous callers. However, results indicated that Indigenous callers received significantly fewer callbacks than non-Indigenous callers and were significantly less likely to set a quit date. Significantly fewer Indigenous callers reported that they were still successfully quit at 3 months. Thus, Indigenous Australian callers may be less engaged with the Quitline and further research is required exploring whether the service could be tailored to make it more engaging for Indigenous Australians who smoke.

To what causes do people attribute their chronic breathlessness? A population survey.

OBJECTIVE: Chronic breathlessness is a daily experience for millions of people, despite current therapies. The objective of this study was to find out to what people attributed their breathlessness irrespective of health service utilization, and to understand the demographic characteristics in each diagnostic group. METHODS: A face-to-face, population-based survey (n=4432) asked community-dwelling South Australians the modified Medical Research Council (breathlessness) Scale (mMRC), and, if they were breathless was it chronic (daily for at least 3 of the last 6 months), total duration of this breathlessness and to what body system they attributed their breathlessness. Categorical and continuous variables were analyzed appropriately. RESULTS: With a participation rate of 63.7%, 8.9% of respondents had an mMRC score ≥1. Breathless people were older (54.3 years SD 19.5, versus 44.9 years SD 18.7; p<0.001), most often attributed their chronic breathlessness to lung disease (65%) and, if breathlessness was the result of lung disease, experienced chronic breathlessness for significantly longer periods of time (13.8 years, SD 15.8) compared with other attributed causes (5.7 years; SD 9.1; p<0.001). CONCLUSION: Breathlessness is widely encountered. The burden in prevalence and duration generated by lung disease greatly surpasses other causes. This underlines the need to intensify efforts to minimize the causes of chronic lung disease, and to more actively palliate the subjective symptom of chronic breathlessness.

Potential effectiveness of specific anti-smoking mass media advertisements among Australian Indigenous smokers.

Aboriginal and Torres Strait Islander Australians (Indigenous Australians) have more than twice the smoking prevalence of non-Indigenous Australians. Anti-smoking campaigns have demonstrated success in the general population but little is known about their impact among Indigenous people. A total of 143 Indigenous and a comparison group of 156 non-Indigenous smokers from South Australia were shown 10 anti-smoking advertisements representing a range of advertisements typically aired in Australia. Participants rated advertisements on a five-point Likert scale assessing factors including message acceptance and personalized effectiveness. On average, Indigenous people rated the mainstream advertisements higher than non-Indigenous people and were more likely to report that they provided new information. Advertisements with strong graphic imagery depicting the health effects of smoking were rated highest by Indigenous smokers. Advertisements featuring real people describing the serious health consequences of smoking received mixed responses. Those featuring an ill person were rated higher by Indigenous people than those featuring the family of the person affected by a smoking-related disease. With limited Indigenous-specific messages available and given the finite resources of most public health campaigns, exposure to mainstream strong graphic and emotive first-person narratives about the health effects of smoking are likely to be highly motivating for Indigenous smokers.

Predictors of chronic breathlessness: a large population study.

BACKGROUND: Breathlessness causes significant burden in our community but the underlying socio-demographic and lifestyle factors that may influence it are not well quantified. This study aims to define these predictors of chronic breathlessness at a population level. METHODS: Data were collected from adult South Australians in 2007 and 2008 (n = 5331) as part of a face-to-face, cross-sectional, whole-of-population, multi-stage, systematic area sampling population health survey. The main outcome variable was breathlessness in logistic regression models. Lifestyle factors examined included smoking history, smoke-free housing, level of physical activity and body mass index (obesity). RESULTS: The participation rate was 64.1%, and 11.1% of individuals (15.0% if aged ≥50 years) chronically had breathlessness that limited exertion. Significant bivariate associations with chronic breathlessness for the whole population and only those ≥50 included: increasing age; female gender; being separated/divorced/widowed; social disadvantage; smoking status; those without a smoke-free home; low levels of physical activity; and obesity. In multi-variate analyses adjusted for age, marital status (p < 0.001), physical activity (p < 0.001), obesity (p < 0.001), gender (p < 0.05) and social disadvantage (p < 0.05) remained significant factors. Smoking history was not a significant contributor to the model. CONCLUSIONS: There is potential benefit in addressing reversible lifestyle causes of breathlessness including high body mass index (obesity) and low levels of physical activity in order to decrease the prevalence of chronic breathlessness. Clinical intervention studies for chronic breathlessness should consider stratification by body mass index.

Smoking and mental illness: a population study in South Australia.

OBJECTIVE: To examine smoking prevalence and smoking behaviour among South Australians with a mental illness and compare findings to those with no mental illness. METHOD: Data were collected in three cross-sectional representative population surveys of South Australians aged ≥15 years from 2005 to 2007. Merged data yielded a total sample size of 8417. The main outcome measures were: smoking prevalence, measures of tobacco dependence, awareness of the health effects of active and passive smoking, smoke-free homes and cars, awareness of health warnings, and use of cessation aids by two measures of mental illness status. RESULTS: Overall 26.4% of the population with a general mental illness and 51.2% of the population with a severe mental illness smoked, compared to 18.7% of the population without a mental illness. People with a mental illness, particularly severe mental illness displayed higher measures of tobacco dependence. Smokers with a severe mental illness were less likely to have smoke-free homes (OR = 0.29, 95%CI 0.16-0.55). Television was an effective medium to present the health effects of smoking to all groups. Those with a general mental illness were more likely than those with no mental illness to have asked a general practitioner for advice to help them quit in the past year (OR = 2.02, 95%CI 1.07-3.84). CONCLUSIONS: Whilst smokers with a mental illness are more dependent on their smoking; they are interested in quitting. There are a number of mainstream tobacco control strategies that could be further utilized (e.g. mass media and health professional referrals to the Quitline) to increase cessation among this disadvantaged group.

The relationship between sun protection policy and associated practices in a national sample of early childhood services in Australia.

Limiting exposure to sunlight during childhood can significantly reduce the risk of skin cancer. This was the first national study to assess the sun protection policies and practices of early childhood services across Australia. It also examined the key predictors of services' sun protection practices. In 2007, 1017 respondents completed a self-administered survey about the sun protection policies and practices in their early childhood service (response rate of 59%). Most (95%) had a written sun protection policy. The most common policy inclusions were hat wearing (91%), sunscreen use (87%) and enforcement of policy (97%). Less frequently reported inclusions were protective clothing (69%), information for parents/caregivers (58%) and regular reviews/updates of policies (65%). Basic sun protection practices (e.g. required any type of hat and sunscreen use) were more commonly reported than extensive practices (required protective clothing or regularly applied sunscreen). Higher sun protection policy scores, being a formal childcare service as opposed to a kindergarten/pre-school and having SunSmart status as opposed to not, were associated with higher sun protection practice scores (P < 0.001). Sun protection policies may be improved through encouraging services to have more specific policy inclusions and to model their policies on the SunSmart Early Childhood Program.