Alcohol policy changes during the first three-months of the COVID-19 pandemic: Development and application of a classification scheme.

BACKGROUND: Policy changes in response to the COVID-19 pandemic have impacted on alcohol control. This study describes the development and application of a classification scheme to map alcohol policy changes during the first three-months of the COVID-19 pandemic in five countries and/or subnational jurisdictions. METHOD: A pre-registered systematic review of policy decisions from March to May 2020, in Australia/New South Wales, Canada/Ontario, Chile, Italy and the United Kingdom. One author extracted the data for each jurisdiction using a country-specific search strategy of government documents. We coded policy changes using an adapted WHO classification scheme, whether the policy was expected to tighten or loosen alcohol control, have mainly immediate or delayed impact on consumption and harm and impact the general population versus specific populations. We present descriptive statistics of policy change. RESULTS: We developed a classification scheme with four levels. Existing policy options were insufficient to capture policy changes in alcohol availability, thus we added seventeen new sub-categories. We found 114 alcohol control policies introduced across the five jurisdictions, covering five (out of ten) WHO action areas. The majority aimed to change alcohol availability, by regulating the operation of alcohol outlets. All countries introduced closures to on-premise alcohol outlets and, except Chile, allowed off-sales via take away or home delivery. We also observed several pricing policies introducing subsidies to support the alcohol industry. Seventy-four percent of policy changes were expected to tighten alcohol control and 12.3 % to weaken control. Weakening policy changes were mostly related to retail mode switching or expansion (allowing take away or home delivery). CONCLUSION: Alcohol control policies during the first three months of the COVID-19 pandemic were targeted primarily at alcohol availability and about one tenth might weaken alcohol control. Temporary changes to alcohol retail during the COVID-19 pandemic, if made permanent, could significantly expand alcohol availability.

Injection of Anabolic Steroids in Men Who Had Sex with Men in Madrid and Barcelona: Prevalence Correlates and Role as a Risk Factor for Transmitted Infections.

This study describes the prevalence of anabolic-androgenic steroid (AAS) injection, their main correlates, and the prevalence of specific AAS injection risk behaviours among men who have sex with men (MSM), an area insufficiently addressed in scientific research. Participants were HIV-negative MSM attending four HIV/STI diagnosis services: two clinics and two community programmes in Madrid and Barcelona. Participants answered an online self-administered questionnaire. Crude and adjusted lifetime prevalence and prevalence ratios (PRs) were calculated by different factors and using Poisson regression models with robust variance. Of the 3510 participants, 6.1% (95% CI: 5.3-6.9) had injected AAS before and 3.5% (95% CI: 2.9-4.2) had done so in the last 12 months. In the multivariate analysis, AAS injection was independently associated with being over 40 years old (aPR = 3.6; 95% CI: 2.0-6.5) and being born in Latin America (aPR = 2.5; 95% CI:1.9-3.4), and was less strongly associated (aPRs of around two) with having been recruited into STI clinics, having ever been paid for sex before, injected drugs, used drugs for sex, having been diagnosed with an STI before, and having been diagnosed with HIV at the recruitment consultation. Only three participants, 1.4%, of those who had injected AAS before had shared AAS or equipment for preparation or injecting before. Conclusions: In contrast to drugs, AAS injecting behaviours do not play a relevant, direct role in the transmission of blood-borne infections among MSM. However, AAS injectors have a higher prevalence of sexual risk behaviours. These findings should be confirmed using new studies that employ other sampling procedures.

Construction of an intercultural preventive strategy of alcohol use in rural Mapuche communities: A community-based participatory research.

The research presented in this paper consists of a case study that analyses the elements necessary for a culturally grounded methodological strategy for the prevention of problematic alcohol consumption in rural Mapuche communities in the Araucanía region. To do this, we proposed to answer the questions: what are the particularities that alcohol consumption adopts in the local space? And what are the elements that should be considered for an intercultural preventive strategy for alcohol consumption? Oriented to the perspective of community-based participatory research, data were collected through group interviews with the local community, participant observation and in-depth interviews with people who consumed alcohol, were recovering from consumption and nondrinkers. A total of 84 people participated and the information gathered was analysed using ATLAS.ti software. The results show key aspects that must be considered for the design, including: strengthening the cultural identity, providing spaces for shared reflection in places where the community converges (schools and rural health centres), and problematising alcohol consumption from their own conceptions of normal and problematic consumption. Therefore, there is a need to focus on strengthening intracultural processes in community spaces, with a preventive strategy within the logic of action research, with increasing degrees of community participation.

Alcohol policy in Chile: a systematic review of policy developments and evaluations.

AIMS: To comprehensively review enacted and proposed alcohol laws and existing impact evaluations of national alcohol policies in Chile. METHODS: We searched enacted laws in the Chilean National Library of Congress, proposed laws in the websites of the House of Deputies and Senate and impact evaluations in PubMed, Web of Science, Scopus, Scielo, JSTOR, Epistemonikos and OpenGrey from inception to February 2019. Eligibility criteria included enacted laws and proposed laws on national alcohol policies and research studies evaluating the impact of national alcohol policies. One author screened enacted laws and proposed laws; two authors independently screened research records. We included any national alcohol policy intervention and classified policies according to 10 World Health Organization (WHO) alcohol policy domains. We used the Cochrane EPOC Review Group criteria to assess risk of bias of research records. We registered the review protocol in PROSPERO, registration record CRD42016050156. RESULTS: We identified and screened 229 enacted laws, 138 proposed laws and 1538 research records. Of these, 72 enacted laws, 118 proposed laws and three research articles were eligible for synthesis. We found enacted policies in all WHO alcohol policy domains. Regarding the most cost-effective policies, Chile has made limited use of taxation, has not regulated alcohol marketing and has weakened alcohol availability regulation. We found a large number of proposed laws, 79% of which would strengthen alcohol control. The few impact evaluation studies examined drink-driving policies and found a short-term reduction of alcohol-related injuries and deaths. CONCLUSIONS: Chile has enacted alcohol policies in all World Health Organization policy domains, but has not adopted policies with highest likely cost-effectiveness. Only the impact of drink-driving policies has been evaluated.

Uso de las Escalas de Depresión Ansiedad Estrés (DASS-21) como Instrumento de Tamizaje en Jóvenes con Problemas Clínicos / Use of the Depression Anxiety Stress Scales (DASS-21) as Screening Tests in Clinical Youngsters

Resumen: Este estudio determinó los puntajes de corte de las Escalas abreviadas de Depresión, Ansiedad y Estrés (DASS-21) para detectar jóvenes en riesgo de problemas de salud mental. Se utilizó una muestra de 393 jóvenes no consultantes y una muestra clínica de 77 jóvenes consultantes en fase inicial de tratamiento. La presencia de sintomatologia fue utilizada como gold standard para determinar puntajes de corte entre jóvenes de población general asintomáticos y consultantes con sintomatologia clínica. Mediante análisis de curvas ROC se examinó la capacidad de discriminación de cada escala, y a través de análisis de sensibilidad y especificidad se determinaron puntajes de corte. El área bajo la curva para cada una de las escalas del DASS-21 fue mayor a 0.90. Para la escala de Depresión, se seleccionó un punto de corte de 6 (>5), con una sensibilidad de 88,46 y especificidad de 86,77. Para la escala de Ansiedad, el punto de corte correspondió a 5 (>4), con sensibilidad de 87,50 y especificidad de 83,38. En la escala Estrés, se seleccionó un punto de corte de 6 (>5), con una sensibilidad de 81,48 y especificidad de 71,36. Las escalas de Depresión, Ansiedad y Estrés (DASS-21) demostraron una adecuada utilidad como instrumento de tamizaje.

Abstract: The short version of Depression, Anxiety and Stress Scales (DASS-21; Lovibond y Lovibond, 1995) has been shown to have appropriate psychometric properties among Chilean adolescents and undergraduates. The current study was aimed at determining the cut-off scores of the Depression, Anxiety and Stress Scales (DASS-21) for screening Chilean youngsters at risk of mental health problems and requiring mental health treatment. The sample comprised 393 non-patients youngsters aged 15-24 and 77 youngsters at early stage of psychotherapy. The presence of symptoms was used as gold standard for estimating the cut-off betWeen non-symptomatic youngsters and symptomatic patients. Receiving Operating Characteristic (ROC) analyses allowed examining accuracy of each scale and sensitivity and specificity analysis was performed for determining the cut-off points. The area under the receiver operating characteristics curve (AUC) was higher than 0.9 for each scale of the DASS-21. The optimal cut-off score for the Depression scale was 6 and above, which resulted in sensitivity=88,46 and specificity=86,77, and a cut-off of 5 and above was optimal for the anxiety scale, with a sensitivity of 87,50 and specificity of 83,38.The Stress Scale had sensitivity of 81,48 and specificity of 71,36 at the optimal cut-off score of 6 and above. These findings suggest that the DASS-21 performs adequately as a screening tool to identify Chilean young people at risk of mental health problems.