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1.
Lancet ; 395(10219): 226-239, 2020 01 18.
Artigo em Inglês | MEDLINE | ID: mdl-31791690

RESUMO

This final report of the Lancet Commission into liver disease in the UK stresses the continuing increase in burden of liver disease from excess alcohol consumption and obesity, with high levels of hospital admissions which are worsening in deprived areas. Only with comprehensive food and alcohol strategies based on fiscal and regulatory measures (including a minimum unit price for alcohol, the alcohol duty escalator, and an extension of the sugar levy on food content) can the disease burden be curtailed. Following introduction of minimum unit pricing in Scotland, alcohol sales fell by 3%, with the greatest effect on heavy drinkers of low-cost alcohol products. We also discuss the major contribution of obesity and alcohol to the ten most common cancers as well as measures outlined by the departing Chief Medical Officer to combat rising levels of obesity-the highest of any country in the west. Mortality of severely ill patients with liver disease in district general hospitals is unacceptably high, indicating the need to develop a masterplan for improving hospital care. We propose a plan based around specialist hospital centres that are linked to district general hospitals by operational delivery networks. This plan has received strong backing from the British Association for Study of the Liver and British Society of Gastroenterology, but is held up at NHS England. The value of so-called day-case care bundles to reduce high hospital readmission rates with greater care in the community is described, along with examples of locally derived schemes for the early detection of disease and, in particular, schemes to allow general practitioners to refer patients directly for elastography assessment. New funding arrangements for general practitioners will be required if these proposals are to be taken up more widely around the country. Understanding of the harm to health from lifestyle causes among the general population is low, with a poor knowledge of alcohol consumption and dietary guidelines. The Lancet Commission has serious doubts about whether the initiatives described in the Prevention Green Paper, with the onus placed on the individual based on the use of information technology and the latest in behavioural science, will be effective. We call for greater coordination between official and non-official bodies that have highlighted the unacceptable disease burden from liver disease in England in order to present a single, strong voice to the higher echelons of government.


Assuntos
Alcoolismo/epidemiologia , Hepatopatias/epidemiologia , Hepatopatias/prevenção & controle , Obesidade/epidemiologia , Bebidas Alcoólicas/economia , Alcoolismo/complicações , Alcoolismo/terapia , Comércio , Redes Comunitárias/organização & administração , Comorbidade , Efeitos Psicossociais da Doença , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Legislação sobre Alimentos , Hepatopatias/diagnóstico , Hepatopatias/etiologia , Transplante de Fígado/estatística & dados numéricos , Obesidade/complicações , Pacotes de Assistência ao Paciente , Escócia , Reino Unido/epidemiologia
2.
Artigo em Inglês | MEDLINE | ID: mdl-31581441

RESUMO

Objective: Determine the prevalence of Dop, a system of labor payment via alcoholic beverages, in a South African province, and its influence on maternal drinking and fetal alcohol spectrum disorders (FASD). Methods: Data from studies of FASD epidemiology were analyzed. Results: Forty-two percent to 67% of mothers reported drinking. In 1999, 5% of women reported Dop allocations in their lifetime: 14% of mothers of FASD children and 1% of controls. In 2010, 1.1% of mothers reported lifetime Dop: 1.6% of FASD mothers and 0.7% of controls. Commercial alcohol sales have replaced the Dop system. Total FASD rates remained high in rural areas in 2010 and rose in urban settings. Urban rates of total FASD surpassed rural area rates in 2010. Correlation analysis did not reveal a strong or significant, direct relationship between Dop experience and heavy drinking (r = 0.123, p < 0.001, r2 = 0.015), or the diagnosis of FASD in children (OR = 0.003, p = 0.183). Conclusion: Dop, as a systematic practice, is dead and does not have a direct influence on alcohol availability, heavy maternal drinking, or the probability of an FASD diagnosis. Nevertheless, today's problematic drinking patterns were heavily influenced (shaped) by Dop and have negatively impacted the prevalence and severity of FASD.


Assuntos
Bebidas Alcoólicas/economia , Transtornos do Espectro Alcoólico Fetal/epidemiologia , Mães/estatística & dados numéricos , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Feminino , Humanos , Gravidez , Prevalência
3.
BMJ ; 366: l5274, 2019 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-31554617

RESUMO

OBJECTIVE: To assess the immediate impact of the introduction of minimum unit pricing in Scotland on household alcohol purchases. DESIGN: Controlled interrupted time series analysis. SETTING: Purchase data from Kantar Worldpanel's household shopping panel for 2015-18. PARTICIPANTS: 5325 Scottish households, 54 807 English households as controls, and 10 040 households in northern England to control for potential cross border effects. INTERVENTIONS: Introduction of a minimum price of 50p (€0.55; $0.61) per UK unit (6.25p per gram) for the sale of alcohol in Scotland on 1 May 2018. MAIN OUTCOME MEASURES: Price per gram of alcohol, number of grams of alcohol purchased from off-trade by households, and weekly household expenditure on alcohol. RESULTS: The introduction of minimum unit pricing in Scotland was associated with an increase in purchase price of 0.64p per gram of alcohol (95% confidence interval 0.54 to 0.75), a reduction in weekly purchases of 9.5 g of alcohol per adult per household (5.1 to 13.9), and a non-significant increase in weekly expenditure on alcohol per household of 61p (-5 to 127). The increase in purchase price was higher in lower income households and in households that purchased the largest amount of alcohol. The reduction in purchased grams of alcohol was greater in lower income households and only occurred in the top fifth of households by income that purchased the greatest amount of alcohol, where the reduction was 15 g of alcohol per week (6 to 24). Changes in weekly expenditure were not systematically related to household income but increased with increasing household purchases. CONCLUSIONS: In terms of immediate impact, the introduction of minimum unit pricing appears to have been successful in reducing the amount of alcohol purchased by households in Scotland. The action was targeted, in that reductions of purchased alcohol only occurred in the households that bought the most alcohol.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Bebidas Alcoólicas/economia , Comércio , Comportamento do Consumidor/economia , Comportamento do Consumidor/estatística & dados numéricos , Humanos , Análise de Séries Temporais Interrompida , Reino Unido
6.
Drug Alcohol Rev ; 38(5): 554-560, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31317592

RESUMO

INTRODUCTION AND AIMS: The health benefits of reducing excessive alcohol consumption are well-documented and widely accepted, but policies directed to this end are often regarded as damaging to the economy. Previous UK alcohol impact studies typically focus on what are in effect the 'gross' impacts of a fall in alcohol consumption considered in isolation, so that estimated economic impacts are always negative. Here we investigate the 'net' impacts of a reduction in consumption accounting for the reallocation of household spending and the expenditure of any increase in government revenues. DESIGN AND METHODS: We employ a health-augmented, Input-Output modelling framework. We simulate the impact of a reduction in alcohol consumption due to: a change in consumer tastes that generate a reallocation of household spending; an increase in alcohol duties accompanied by the use of increased revenues to stimulate government expenditure. RESULTS: We find evidence of a trade-off between employment and health benefits for the case of a tastes-induced switch from alcohol consumption, but this is less severe than past analyses would suggest (and does not apply to economic activity more generally). For the case of increased taxation on alcohol (and increased government spending) we find that there is in fact no trade-off between employment on the one hand and health on the other; employment and economic activity are stimulated while health outcomes improve. DISCUSSION AND CONCLUSIONS: There is a potential 'double-dividend' of improved health outcomes and increased economic activity as a consequence of a rise in alcohol duties.


Assuntos
Consumo de Bebidas Alcoólicas/legislação & jurisprudência , Bebidas Alcoólicas/legislação & jurisprudência , Modelos Econômicos , Políticas , Impostos/economia , Consumo de Bebidas Alcoólicas/economia , Consumo de Bebidas Alcoólicas/prevenção & controle , Bebidas Alcoólicas/economia , Comércio/economia , Humanos , Reino Unido
7.
BMC Public Health ; 19(1): 787, 2019 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-31221122

RESUMO

BACKGROUND: Alcohol consumption is a significant cause of disease, death and social harm, and it clusters with smoking tobacco and an unhealthy diet. Using automatically registered retail data for research purposes is a novel approach, which is not subject to underreporting bias. Based on loyalty card data (LoCard) obtained by a major Finnish retailer holding a market share of 47%, we examined alcohol expenditure and their associations with food and tobacco expenditures. METHODS: The data consisted of 1,527,217 shopping events in 2016 among 13,274 loyalty card holders from southern Finland. A K-means cluster analysis was applied to group the shopping baskets according to their content of alcoholic beverages. The differences in the absolute and relative means of food and tobacco between the clusters were tested by linear mixed models with the loyalty card holder as the random factor. RESULTS: By far, the most common basket type contained no alcoholic beverages, followed by baskets containing a small number of beers or ciders. The expenditure on food increased along with the expenditure on alcoholic beverages. The foods most consistently associated with alcohol purchases were sausages, soft drinks and snacks. The expenditure on cigarettes relative to total basket price peaked in the mid-price alcohol baskets. CONCLUSION: Clustering of unhealthy choices occurred on the level of individual shopping events. People who bought many alcoholic beverages did not trim their food budget. Automatically registered purchase data provide valuable insight into the health behaviours of individuals and the population.


Assuntos
Bebidas Alcoólicas/economia , Comércio/estatística & dados numéricos , Comportamento do Consumidor/estatística & dados numéricos , Alimentos/economia , Produtos do Tabaco/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Finlândia , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
8.
BMC Public Health ; 19(1): 665, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31146724

RESUMO

BACKGROUND: Public health policy is inevitably associated with either a strong presence or lack of public support. We investigated factors associated with both the public support of and opposition to health taxes and the media regulation regarding advertising harmful products in Korea. METHODS: We interviewed 1200 respondents that were recruited using an equal-probability sampling method in accordance with the 2016 Korean census. Our investigation examined the extent of support and opposition towards health taxes and the media regulation of advertising that targets the consumption of tobacco, alcohol, and unhealthy foods according to socioeconomic characteristics, health habits, body mass index (BMI), and exposure to the advertising of harmful products. The study was conducted using a univariate and stepwise multivariate regression analysis. RESULTS: The majority (71.8%) of the respondents were supportive of imposing health taxes in general. Despite a high prevalence of tobacco and alcohol consumption among the respondents, they strongly supported media regulation of tobacco (72.3%), alcohol (63.7%), and eating broadcasts (51.9%) food advertising (44.0%). Those that were non-smokers, earned a high-income, were married, or had a child were likely to support at least one kind of regulation regarding alcohol and smoking related advertising. An exposure to excessive advertising of unhealthy products was associated with increase of respondents supporting the media regulation. Those who regarded the media as being influential seemed to be more supportive of health taxes or media regulation. CONCLUSION: Our results indicated strong public support among the respondents for health taxes and the media regulation regarding the advertising of unhealthy products. Based on our data, we are optimistic that countries whose population show a high rate of tobacco, alcohol or unhealthy food consumption may launch public policy in addressing these factors.


Assuntos
/legislação & jurisprudência , Política de Saúde/legislação & jurisprudência , Meios de Comunicação de Massa/legislação & jurisprudência , Opinião Pública , Impostos/legislação & jurisprudência , Adulto , Bebidas Alcoólicas/efeitos adversos , Bebidas Alcoólicas/economia , Feminino , Alimentos/efeitos adversos , Alimentos/economia , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia , Produtos do Tabaco/efeitos adversos , Produtos do Tabaco/economia
9.
J Glob Health ; 9(1): 010421, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31131099

RESUMO

Background: Alcohol consumption is associated with elevated risks of disease and injury, and the best indicator of the level of consumption in a country is total alcohol per capita (APC) consumption among adults which comprises recorded consumption and unrecorded consumption. While recorded consumption can be assessed with small measurement bias via taxation or other governmental records, unrecorded consumption is more difficult to assess. The objectives of this study were to estimate the country-specific proportion and volume of unrecorded APC in 2015, to identify main sources of unrecorded alcohol and to assess to what extent experts perceive unrecorded alcohol as a public health, social, and financial problem. Methods: Estimates of unrecorded APC were based on a multilevel fractional response regression model using data from World Health Organization's (WHO) STEPwise approach to surveillance surveys (16 countries, 66 188 participants), estimates from the routine WHO reporting on key indicators of alcohol use (189 countries), and a nominal group expert assessment (42 countries, 129 experts). Expert assessments also included data on the sources of unrecorded alcohol and the perception of unrecorded alcohol as a public health, social, and financial problem. Results: The volume of global unrecorded APC was 1.6 L pure alcohol, representing 25% of the total APC. The volume of unrecorded APC was highest in Europe (2.1 L per capita), while the proportion of unrecorded APC was highest in the WHO Eastern Mediterranean region (57% of the total alcohol). In countries with available data, homemade alcohol was identified as a major source of unrecorded alcohol. The majority of experts considered unrecorded alcohol to be a public health (62%), social (60%), and financial problem (54%). Conclusions: High volumes of unrecorded alcohol are consumed globally; however, the volumes consumed and the sources of the unrecorded alcohol exhibit large geographical variation.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Saúde Global/estatística & dados numéricos , Adulto , Bebidas Alcoólicas/economia , Humanos , Registros , Impostos
10.
Int J Equity Health ; 18(1): 78, 2019 05 28.
Artigo em Inglês | MEDLINE | ID: mdl-31138225

RESUMO

BACKGROUND: Globally, alcohol consumption accounts for a substantial burden of disease, which translates into high social and economic costs. To address this burden, several policies (e.g. age and trading hour restrictions, increasing alcohol taxation) were implemented. Despite the existence of these policies evidence shows that alcohol misuse and alcohol-related harms have increased in South Africa over recent years. The objective of this paper is to assess progressivity and the changes in progressivity of alcohol expenditure at the household level in South Africa using datasets that span 15 years. METHODS: Data come from the 1995, 2000, 2005/06 and 2010/11 South Africa Income Expenditure Survey. Distribution of spending on alcoholic beverages were analyzed using standard methodologies. Changes in progressivity between 1995 and 2000, and between 2005/06 and 2010/11 were also assessed using the Kakwani index. RESULTS: Alcohol spending was regressive between 1995 and 2011 as the fraction of poorer households' expenditure spent on alcohol beverage exceeds that for the richest households. Also, the difference in Kakwani indexes of progressivity indicates that spending on alcoholic beverages has become less regressive between the same time periods. CONCLUSION: The results show no evidence that alcohol policy including taxation increased regressivity. Thus, there is an opportunity to further reduce the regressivity using coherent alcohol policies. This paper concludes that there is a need for further research to unpack why alcohol spending became less regressive over the years that goes beyond just looking at changes in the distribution of alcohol expenditure.


Assuntos
Consumo de Bebidas Alcoólicas , Bebidas Alcoólicas , Comportamento do Consumidor , Pobreza , Política Pública , Impostos , Adulto , Consumo de Bebidas Alcoólicas/economia , Consumo de Bebidas Alcoólicas/tendências , Bebidas Alcoólicas/economia , Alcoolismo/economia , Comportamento do Consumidor/economia , Características da Família , Feminino , Gastos em Saúde , Humanos , Renda , Masculino , África do Sul , Inquéritos e Questionários
11.
PLoS One ; 14(4): e0214865, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30969992

RESUMO

BACKGROUND: The 2010 World Health Organization Global Strategy to Reduce the Harmful Use of Alcohol recommends countries adopt evidence-based interventions. AIM: To update, summarize, and appraise the methodological rigour of systematic reviews of selected alcohol control interventions in the Strategy. METHODS: We searched for systematic reviews across PUBMED, EMBase and The Cochrane Library in 2016 and updated in 2017 with no language limits. Two investigators independently in duplicate conducted screening, eligibility, data extraction, and quality assessment using the ROBIS tool. We categorised interventions according to the WHO recommendations, and rated reviews as at high, low or unclear risk of bias. We applied a hierarchical approach to summarising review results. Where overlap existed we report results of high quality reviews and if none existed, by most recent date of publication. We integrated the ROBIS rating with the results to produce a benefit indication. RESULTS: We identified 42 systematic reviews from 5,282 records. Almost all eligible reviews were published in English, one in German and one in Portuguese. Most reviews identified only observational studies (74%; 31/42) with no studies from low or lower-middle income (LMIC) countries. Ten reviews were rated as low risk of bias. Methodological deficiencies included publication and language limits, no duplicate assessment, no assessment of study quality, and no integration of quality into result interpretation. We evaluated the following control measures as possibly beneficial: 1) community mobilization; 2) multi-component interventions in the drinking environment; 3) restricting alcohol advertising; 4) restricting on- and off-premise outlet density; 5) police patrols and ignition locks to reduce drink driving; and 6) increased price and taxation including minimum unit pricing. CONCLUSIONS: Robust and well-reported research synthesis is deficient in the alcohol control field despite the availability of clear methodological guidance. The lack of primary and synthesis research arising from LMIC should be prioritised globally.


Assuntos
Consumo de Bebidas Alcoólicas/prevenção & controle , Alcoolismo/prevenção & controle , Bebidas Alcoólicas/efeitos adversos , Bebidas Alcoólicas/economia , Dirigir sob a Influência/prevenção & controle , Medicina Baseada em Evidências , Redução do Dano , Humanos , Marketing , Meios de Comunicação de Massa , Política Pública , Impostos , Organização Mundial da Saúde
12.
Bull World Health Organ ; 97(3): 213-220, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30992634

RESUMO

To facilitate the policy response to noncommunicable diseases in Thailand, parliament adopted the Health Promotion Foundation Act in 2001. This Act led to the establishment of an autonomous government body, the Thai Health Promotion Foundation, called ThaiHealth. The foundation receives its revenue from a 2% surcharge of excise taxes on tobacco and alcohol. The fund supports evidence generation, campaigns and social mobilization to address noncommunicable disease risk factors, such as tobacco-use, harmful use of alcohol and sedentary behaviour. On average, its annual revenue is 120 million United States dollars (US$). Some notable ThaiHealth-supported public campaigns are for schools free of sweetened carbonated beverages; alcohol abstinence during three-month Buddhist lent; and nationwide physical activity. The percentage of people using tobacco decreased from 22.5% in 2001 to 18.2% in 2014. The annual per capita alcohol consumption decreased from 8.1 litres pure alcohol in 2005 to 6.9 litres in 2014. The percentage of the adult population doing at least 150 minutes of moderate-intensity or 75 minutes high-intensity aerobic exercise per week, increased from 66.3% in 2012 to 72.9% in 2017. A dedicated funding mechanism, a transparent and accountable organization, and the engagement of civil society organizations and other government agencies have enabled ThaiHealth to run these campaigns.


Assuntos
Programas Governamentais/organização & administração , Promoção da Saúde/organização & administração , Doenças não Transmissíveis/prevenção & controle , Consumo de Bebidas Alcoólicas/prevenção & controle , Bebidas Alcoólicas/economia , Dieta , Exercício , Programas Governamentais/economia , Comportamentos Relacionados com a Saúde , Promoção da Saúde/economia , Humanos , Avaliação de Programas e Projetos de Saúde , Fatores de Risco , Comportamento Sedentário , Prevenção do Hábito de Fumar , Fatores Socioeconômicos , Impostos/estatística & dados numéricos , Tailândia , Produtos do Tabaco/economia
13.
Am J Public Health ; 109(6): 899-905, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30998409

RESUMO

Objectives. To examine the association between neighborhood socioeconomic status (SES) and alcohol availability before and after deregulation in 2015 of the alcohol market in Ontario, Canada. Methods. We quantified alcohol access by number of alcohol outlets and hours of retail for all 19 964 neighborhoods in Ontario. We used mixed effects regression models to examine the associations between alcohol access and a validated SES index between 2013 and 2017. Results. Following deregulation, the number of alcohol outlets in Ontario increased by 15.0%. Low neighborhood SES was positively associated with increased alcohol access: lower-SES neighborhoods had more alcohol outlets within 1000 meters and were closer to the nearest alcohol outlets. Outlets located in low-SES neighborhoods kept longer hours of operation. Conclusions. We observed a substantial increase in alcohol access in Ontario following deregulation. Access to alcohol was greatest in low-SES neighborhoods and may contribute to established inequities in alcohol harms. Public Health Implications. Placing limits on number of alcohol outlets and the hours of operation in low-SES neighborhoods offers an opportunity to reduce alcohol-related health inequities.


Assuntos
Bebidas Alcoólicas/economia , Bebidas Alcoólicas/legislação & jurisprudência , Comércio , Características de Residência , Classe Social , Humanos , Estudos Longitudinais , Ontário , População Rural , População Urbana
14.
J Agric Food Chem ; 67(14): 4011-4022, 2019 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-30879302

RESUMO

Although to date more than 10 000 volatile compounds have been characterized in foods, a literature survey has previously shown that only 226 aroma compounds, assigned as key food odorants (KFOs), have been identified to actively contribute to the overall aromas of about 200 foods, such as beverages, meat products, cheeses, or baked goods. Currently, a multistep analytical procedure involving the human olfactory system, assigned as Sensomics, represents a reference approach to identify and quantitate key odorants, as well as to define their sensory impact in the overall food aroma profile by so-called aroma recombinates. Despite its proven effectiveness, the Sensomics approach is time-consuming because repeated sensory analyses, for example, by GC/olfactometry, are essential to assess the odor quality and potency of each single constituent in a given food distillate. Therefore, the aim of the present study was to develop a fast, but Sensomics-based expert system (SEBES) that is able to reliably predict the key aroma compounds of a given food in a limited number of runs without using the human olfactory system. First, a successful method for the quantitation of nearly 100 (out of the 226 known KFOs) components was developed in combination with a software allowing the direct use of the identification and quantitation data for the calculation of odor activity values (OAV; ratio of concentration to odor threshold). Using a rum and a wine as examples, the quantitative results obtained by the new SEBES method were compared to data obtained by applying an aroma extract dilution analysis and stable isotope dilution assays required in the classical Sensomics approach. A good agreement of the results was found with differences below 20% for most of the compounds considered. By implementing the GC × GC data analysis software with the in-house odor threshold database, odor activity values (ratio of concentration to odor threshold) were directly displayed in the software pane. The OAVs calculated by the software were in very good agreement with data manually calculated on the basis of the data obtained by SIDA. Thus, it was successfully shown that it is possible to characterize key food odorants with one single analytical platform and without using the human olfactory system, that is, by "artificial intelligence smelling".


Assuntos
Bebidas Alcoólicas/análise , Sistemas Especialistas , Aromatizantes/análise , Odorantes/análise , Vinho/análise , Bebidas Alcoólicas/classificação , Bebidas Alcoólicas/economia , Inteligência Artificial , Austrália , Cromatografia Gasosa , Humanos , Olfatometria , Olfato , Compostos Orgânicos Voláteis/análise , Vinho/classificação , Vinho/economia
15.
Drug Alcohol Rev ; 38(3): 294-301, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30860305

RESUMO

INTRODUCTION AND AIMS: The privatisation of the Washington Liquor Monopoly in 2012 offered a unique opportunity to study spirits purchasing behaviour changes from a government to licensed system. DESIGN AND METHODS: Four representative cross-sectional surveys of adults aged 18 and older in Washington state were recruited between January 2014 and October 2015 (Wave 1, N = 1202; W2, N = 804; W3, N = 823; W4, N = 662). Analyses compared spirits purchasing behaviours before privatisation from retrospective reports to current reports in the areas of travel distance, spirits quality, purchase frequency and size of bottle. Respondents also directly reported on changes in convenience, selection and prices. RESULTS: No significant changes were found in these aspects of purchasing. However, subgroup analyses found that younger drinkers 18-29 reduced travel distance and increased purchase frequency while drinkers aged 50 and older travelled further. Reduced travel distances were associated with grocery and drug stores while increased travel distances were associated with liquor superstores, wholesale stores and government stores in bordering states. Respondents reported that liquor purchasing was more convenient after privatisation but that the selection of spirits was better and prices were lower in the government-controlled stores. DISCUSSION AND CONCLUSIONS: The government monopoly stores were viewed as offering a wider selection of products and as having lower prices than those in the privatised system. The variety of store types in the licensed system allowed drinkers to select stores based on convenience, selection or prices, so that travel times increased for some buyers, presumably those seeking lower prices or a wider selection.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Bebidas Alcoólicas/provisão & distribução , Comércio/estatística & dados numéricos , Comportamento do Consumidor/estatística & dados numéricos , Privatização/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/economia , Bebidas Alcoólicas/economia , Estudos Transversais , Feminino , Governo , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Washington , Adulto Jovem
16.
Can J Public Health ; 110(4): 512-515, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30737723

RESUMO

Alcohol use leads to a substantial number of hospitalizations, and to increased health and social harms as well as economic costs in Ontario and across Canada. The effects of alcohol price changes on consumption and resulting harms have been firmly established; changes in the minimum price of alcohol have the greatest effect on consumption among people who for reasons of affordability consume low-priced alcoholic beverages, typically adolescents, people with lower socio-economic status, and people with harmful alcohol use. Decreases in inflation-adjusted minimum pricing in British Columbia from 2002 to 2006 have been associated with increases in deaths wholly attributable to alcohol. Furthermore, decreases in alcohol prices have been previously associated with increases in drink-driving, decreases in life expectancy, increases in road traffic injuries, violence, and alcohol poisonings, and long-term increases in deaths from infectious diseases, circulatory diseases, and digestive diseases. Based on the findings of previous studies, lowering the cost of alcohol will negatively impact the health of Ontarians and further strain a healthcare system with limited resources. Accordingly, Ontario should be strengthening alcohol policies to improve public health, including raising the minimum price of alcohol, rather than weakening alcohol policies.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Bebidas Alcoólicas/economia , Comércio , Saúde Pública/estatística & dados numéricos , Consumo de Bebidas Alcoólicas/economia , Consumo de Bebidas Alcoólicas/epidemiologia , Cerveja/economia , Canadá/epidemiologia , Custos e Análise de Custo , Humanos , Ontário/epidemiologia , Política Pública
19.
Eur J Health Econ ; 20(3): 439-454, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30276497

RESUMO

Many people drink more than the recommended level of alcohol, with some drinking substantially more. There is evidence that suggests that this leads to large health and social costs, and price is often proposed as a tool for reducing consumption. This paper uses quantile regression methods to estimate the differential price (and income) elasticities across the drinking distribution. This is also done for on-premise (pubs, bars and clubs) and off-premise (supermarkets and shops) alcohol separately. In addition, we examine the extent to which drinkers respond to price changes by varying the 'quality' of the alcohol that they consume. We find that heavy drinkers are much less responsive to price in terms of quantity, but that they are more likely to substitute with cheaper products when the price of alcohol increases. The implication is that price-based policies may have little effect in reducing consumption amongst the heaviest drinkers, provided they can switch to lower quality alternatives.


Assuntos
Consumo de Bebidas Alcoólicas/economia , Bebidas Alcoólicas/economia , Bebidas Alcoólicas/estatística & dados numéricos , Comércio/economia , Renda/estatística & dados numéricos , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Custos e Análise de Custo , Estudos Transversais , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Reino Unido/epidemiologia
20.
Eur J Cancer Prev ; 28(1): 45-53, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-28683009

RESUMO

The aim of this analysis is to examine long-term trends in alcohol consumption and associations with lagged data on specific types of cancer mortality, and indicate policy implications. Data on per capita annual sales of pure alcohol; mortality for three alcohol-related cancers - larynx, esophageal, and lip, oral cavity, and pharynx; and per capita consumption of tobacco products were extracted at the country level. The Unobservable Components Model was used for this time-series analysis to examine the temporal association between alcohol consumption and cancer mortality, using lagged data, from 17 countries. Statistically significant associations were observed between alcohol sales and cancer mortality, in the majority of countries examined, which remained after controlling for tobacco use (P<0.05). Significant associations were observed in countries with increasing, decreasing, or stable trends in alcohol consumption and corresponding lagged trends in alcohol-related cancer mortality. Curtailing overall consumption has potential benefits in reducing a number of harms from alcohol, including cancer mortality. Future research and surveillance are needed to investigate, monitor, and quantify the impact of alcohol control policies on trends in cancer mortality.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/mortalidade , Bebidas Alcoólicas/efeitos adversos , Internacionalidade , Neoplasias/etiologia , Neoplasias/mortalidade , Consumo de Bebidas Alcoólicas/tendências , Bebidas Alcoólicas/economia , Humanos , Mortalidade/tendências
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