Development of alcohol control law, Sao Tome and Principe.

The World Health Organization (WHO) African Region is struggling with increasing harm associated with alcohol consumption. Legislators of Sao Tome and Principe, concerned about this harm and the high prevalence of alcohol use disorders, designed a comprehensive alcohol control bill to tackle this situation. Input into the design of the bill was obtained through interviews involving many stakeholders. The process had five phases: (i) scoping the problem to understand the social burden of the harm caused by alcohol consumption; (ii) updating the evidence on alcohol policies and identifying areas for legislative interventions; (iii) drafting the bill; (iv) aligning the legislative framework of the bill; and (v) initiating the parliamentary procedure. The new bill scored 92/100 using a standardized alcohol control policy scale. The bill covers all domains of WHO's 2010 global strategy to reduce the harmful use of alcohol, and includes the three most cost-effective interventions for reducing alcohol consumption: increased excise taxes on alcohol; bans or comprehensive restrictions on exposure to alcohol advertising; and restrictions on the availability of retailed alcohol through reduced hours of sale. The National Assembly plenary session upheld the bill, which is now under evaluation of the specialized First Commission on Political, Legal, Constitutional and Ethical Affairs. Approval of the bill requires the final voting once it is back with the National Assembly and its promulgation by the President. Drafting an alcohol control bill which is country-led, inclusive, evidence-based and free of interference by the alcohol industry helps prioritize public health objectives over other interests.

La Région africaine de l'Organisation mondiale de la Santé (OMS) fait face à une hausse des dégâts causés par l'alcool. Préoccupés par la situation et par la forte prévalence des troubles liés à cette consommation, les législateurs de Sao Tomé-et-Principe ont élaboré un projet de loi détaillé afin d'y remédier. À l'origine de sa conception, plusieurs entretiens avec différentes parties prenantes. Le processus s'est divisé en cinq phases: (i) définir l'étendue du problème pour évaluer le fardeau que les dégâts provoqués par l'alcool font peser sur la société; (ii) actualiser les données probantes relatives aux politiques en matière d'alcool et identifier les domaines nécessitant une intervention législative; (iii) rédiger le projet de loi; (iv) aligner le cadre législatif du projet de loi; et enfin, (v) initier la procédure parlementaire. Le nouveau projet de loi a obtenu un score de 92/100 sur une échelle d'évaluation standard des mesures de lutte contre l'alcool. Il couvre tous les thèmes repris dans la Stratégie mondiale de l'OMS visant à réduire l'usage nocif de l'alcool, publiée en 2010. Il prévoit également les trois interventions les plus rentables en termes de diminution de la consommation d'alcool: l'augmentation des taxes d'accise sur l'alcool; l'interdiction ou l'instauration de conditions strictes en matière d'exposition à la publicité pour l'alcool; et une disponibilité restreinte des boissons alcoolisées dans le commerce en limitant les heures de vente. L'Assemblée nationale a soutenu le projet de loi en séance plénière. Il est désormais en cours d'évaluation au sein de la première Commission spécialisée en affaires politiques, juridiques, constitutionnelles et éthiques. Pour être adopté, le projet de loi doit revenir à l'Assemblée nationale pour un vote final, puis être promulgué par le président. Une loi globale de lutte contre l'alcool, élaborée par le pays lui-même, fondée sur des faits et n'ayant subi aucune ingérence de la part de l'industrie de l'alcool contribue à faire passer les objectifs de santé publique avant d'autres intérêts.

La Región de África de la Organización Mundial de la Salud (OMS) está tratando de hacer frente a los crecientes daños derivados del consumo de alcohol. Los legisladores de Santo Tomé y Príncipe, preocupados por estos daños y por la alta prevalencia de los trastornos por consumo de alcohol, diseñaron un proyecto de ley integral para el control del alcohol con el fin de solucionar esta situación. Las contribuciones al diseño del proyecto de ley se obtuvieron a través de entrevistas en las que participaron muchas partes interesadas. El proceso constó de cinco fases: (i) la delimitación del problema para comprender la carga social de los daños causados por el consumo de alcohol; (ii) la actualización de los datos sobre las políticas de alcohol y la identificación de las áreas de intervención legislativa; (iii) la redacción del proyecto de ley; (iv) la adaptación del marco legislativo del proyecto de ley; y (v) el inicio del procedimiento parlamentario. El nuevo proyecto de ley obtuvo una puntuación de 92/100 según una escala estandarizada de políticas para el control del alcohol. El proyecto de ley abarca todos los ámbitos de la estrategia mundial que la OMS puso en marcha en 2010 para reducir el uso nocivo del alcohol, e incluye las tres intervenciones más rentables para reducir el consumo de alcohol: el aumento de los impuestos especiales sobre el alcohol; la prohibición o la restricción general de la exposición a la publicidad del alcohol; y la restricción de la disponibilidad del alcohol al por menor mediante la reducción del horario de venta. La sesión plenaria de la Asamblea Nacional respaldó el proyecto de ley, que ahora está bajo evaluación de la Comisión Primera especializada en Asuntos Políticos, Jurídicos, Constitucionales y Éticos. La aprobación del proyecto de ley requiere la votación final una vez que regrese a la Asamblea Nacional y que el Presidente lo promulgue. La elaboración de un proyecto de ley para el control del alcohol que sea liderado por el país, inclusivo, basado en la evidencia y libre de interferencias por parte de la industria del alcohol ayuda a priorizar los objetivos de salud pública sobre otros intereses.

Alcohol use during the COVID-19 pandemic in Latin America and the Caribbean.

OBJECTIVE: To assess the association between drinking behaviors during the COVID-19 pandemic and quarantine, anxiety symptoms, and sociodemographic characteristics in Latin America and the Caribbean (LAC). METHOD: Data was collected through a cross-sectional online survey (non-probabilistic sample) conducted by the Pan American Health Organization between May 22 and June 30, 2020, in 33 countries and two territories of LAC. Participants were 18 years of age or older and must not have traveled outside of their country since March 15, 2020 (n= 12 328, M age= 38.1 years, 65% female). Four drinking behaviors (online socializing drinking [OSD], drinking with child present [DCP], drinking before 5 p.m. [DB5]), heavy episodic drinking [HED]) were response variables, and quarantining, anxiety symptoms and sociodemographic covariables were explanatory variables. RESULTS: Quarantine was positively associated with a higher frequency of OSD and with DCP, but negatively associated with a higher frequency of HED. Anxiety symptoms were associated with a higher frequency of HED, more OSD, and DB5. Higher incomes seemed to be more associated with all the studied drinking behaviors. Women tended to report less DB5 and less HED during the pandemic. CONCLUSIONS: Quarantine during the COVID-19 pandemic seems to affect drinking behavior and mental health indicators like anxiety symptoms. This study is the first effort to measure the consequences of the quarantine on alcohol consumption and mental health in LAC during the COVID-19 pandemic. Considering the associations found, screenings and brief interventions targeting alcohol consumption and mental health are recommended.

Assessing Sustainable Development Goal Target Indicator 3.5.2: Trends in alcohol per capita consumption in the Americas 1990-2016.

The objective of this study was to estimate trends in alcohol per capita consumption from 1990 to 2016 in the Region of the Americas, covering 35 Member States. Data from the WHO Global Information System on Alcohol and Health were used to calculate the annual percent change of alcohol per capita consumption in each of the 35 countries of the Americas. The Americas as a whole showed no change in the total period, with a slight decrease in the period 2010-2016. From 1990 to 2016, all the countries that presented a trend of annual increase in annual percent change of alcohol per capita consumption were in the Caribbean and Central America. Large increases were found in the recent years in Cuba, Colombia, Uruguay, El Salvador, and several countries of the Non-Latin Caribbean. In conclusion, alcohol use remains a significant obstacle to the achievement of Sustainable Development Goal 3.5. To date, the policy response has been inadequate in protecting the people in the Americas from alcohol-attributable harms. Improving country capacity to collect and analyze data on alcohol per capita consumption is urgently needed to monitor progress on the Sustainable Development Goals and to serve to promote proven alcohol policies for reducing the harmful use of alcohol.

El objetivo de este estudio es estimar las tendencias en el consumo per cápita de alcohol desde 1990 hasta el 2016 en 35 Estados Miembros de la Región de las Américas. Se emplearon datos del Sistema Mundial de Información sobre el Alcohol y la Salud de la OMS para calcular la variación porcentual por año del consumo per cápita de alcohol en cada uno de los 35 países de la Región. En general, la Región no mostró cambio en todo el período, salvo una disminución leve entre el 2010 y el 2016. De 1990 al 2016, todos los países que registraron una tendencia al alza en la variación anual porcentual del consumo per cápita de alcohol se encontraban en el Caribe y Centroamérica. En los últimos años se observó un aumento importante en Cuba, Colombia, Uruguay, El Salvador y varios países del Caribe no latino. En conclusión, el consumo de alcohol sigue siendo un obstáculo significativo para lograr el Objetivo de Desarrollo Sostenible 3.5. Hasta la fecha, la respuesta de las políticas ha sido inadecuada para proteger a la población de la Región de los daños atribuibles al alcohol. Es necesario mejorar de manera urgente la capacidad a nivel de país para recopilar y analizar datos sobre el consumo per cápita de alcohol a fin de monitorear el progreso de los Objetivos de Desarrollo Sostenible y promover políticas relativas al alcohol cuya eficacia en cuanto a la reducción del consumo nocivo ha sido comprobada.

O objetivo deste estudo foi estimar as tendências do consumo de álcool per capita de 1990 a 2016 na Região das Américas, cobrindo os 35 Estados Membros. Dados do Sistema Mundial de Informação sobre Álcool e Saúde da OMS foram usados para calcular a mudança percentual anual do consumo de álcool per capita de cada um dos 35 países das Américas. As Américas, como um todo, não mostraram mudança alguma no período total, com uma diminuição leve no período entre 2010 e 2016. De 1990 a 2016, todos os países que apresentaram uma tendência de aumento anual na mudança percentual anual do consumo de álcool per capita estão no Caribe e na América Central. Um grande aumento foi encontrado nos anos recentes em Cuba, Colômbia, Uruguai, El Salvador e vários países não latinos do Caribe. Em conclusão, o consumo de álcool continua sendo um obstáculo significativo para o cumprimento do Objetivo de Desenvolvimento Sustentável 3.5. Até o momento, a resposta política foi inadequada para proteger a população nas Américas dos danos atribuíveis ao álcool. Melhorar a capacidade dos países de coletar e analisar dados sobre o consumo de álcool per capita é urgentemente necessário para monitorar o progresso dos Objetivos de Desenvolvimento Sustentável e para promover políticas comprovadas de redução do consumo nocivo de álcool.

Road traffic injuries and substance use among emergency department patients in the Dominican Republic and Peru.

OBJECTIVE: To report demographic and substance use characteristics and risk of road traffic injury (RTI) from alcohol use, cannabis use, and combined use in a sample of emergency department patients from two countries in Latin America and the Caribbean. METHODS: A cross-sectional study in which patients 18 years and older admitted within six hours of suffering an RTI to one emergency department in Santa Domingo, Dominican Republic (n = 501) and in Lima, Peru (n = 431) were interviewed. Case-crossover analysis, based on self-reported use prior to the RTI, was used to analyze risk from alcohol, cannabis, and co-use. RESULTS: Overall, 15.3% reported alcohol use prior to the event and 2.5% cannabis use. Drivers using alcohol only were over twice as likely to have an RTI (OR = 2.46, p < 0.001), and nearly eight times more likely if using both alcohol and cannabis (OR = 6.89, p < 0.01), but risk was not elevated for cannabis alone. Significant differences were not found for passengers or pedestrians. CONCLUSIONS: Risk of RTI for drivers in these two samples is significantly elevated from alcohol use, and more so for co-use with cannabis. Differences between the two countries underscore the need for similar data from the region to determine risk of RTI from substance use, including risk for passengers and pedestrians. Data suggest that alcohol contributes significantly to the burden of RTI, which calls for more stringent enforcement of alcohol control policy related to drink driving in the region.

Dose-Response Relationship of Alcohol and Injury Cause: Effects of Country-Level Drinking Pattern and Alcohol Policy.

BACKGROUND: The dose-response relationship of alcohol and injury and the effects of country-level detrimental drinking pattern (DDP) and alcohol control policy on this relationship are examined for specific causes of injury. METHODS: The dose-response risk of injury is analyzed on 18,627 injured patients in 22 countries included in the International Collaborative Alcohol and Injury Study, using case-crossover analysis by cause of injury (traffic, violence, falls, other), DDP, and the International Alcohol Policy and Injury Index. RESULTS: Risk of all injury was higher at all volume levels in higher DDP countries compared to lower DDP countries and for each cause of injury. Risk of injury from traffic was significantly greater in higher DDP than lower DDP countries at 3.1 to 6 drinks (odds ratio (OR) = 2.64, confidence interval (CI) = 1.17 to 5.97) and at ≤3 drinks for falls (OR = 2.51, CI = 1.52 to 4.16) and injuries from other causes (OR = 1.72, CI = 1.10 to 2.69). Countries with higher restrictive alcohol policy were at a lower risk of injury at lower levels of consumption (≤3 drinks) for all injuries (OR = 0.72, CI = 0.56 to 0.92) and for injuries from other causes (OR = 0.46, CI = 0.29 to 0.73) and at a lower risk of traffic injuries at higher levels of consumption (≥10 drinks). At higher levels of consumption (≥10 drinks), countries with higher alcohol policy restrictiveness were at greater risk of all injuries (OR = 2.03, CI = 1.29 to 3.20) and those from violence (OR = 9.02, CI = 3.00 to 27.13) and falls (OR = 4.29, CI = 1.86 to 9.91). CONCLUSIONS: Countries with high DDP are at higher risk of injury from most causes at a given level of consumption, while countries with low restrictiveness of alcohol policy are at higher risk of injury at lower levels of consumption and at higher risk of traffic injuries at high levels of consumption. These findings underscore the importance of aggregate-level factors which need to be considered in developing effective intervention and prevention strategies for reducing alcohol-related injury.

Dose-Response Relative Risk of Injury From Acute Alcohol Consumption in 22 Countries: Are Women at Higher Risk Than Men?

AIMS: The risk of injury from alcohol consumption was analyzed by gender, controlling for frequency of heavy drinking occasions, and by cause of injury (traffic, violence, fall, other). METHODS: Case-crossover analysis was conducted on 18,627 injured patients arriving at the emergency department (ED) within six hours of the event. FINDINGS: Risk of injury was similar for females and males at ≤3 drinks prior to injury (OR = 2.74 vs. 2.76, respectively). At higher volume levels females were at greater risk than males, and significantly so at 3.1-6 drinks and 6.1-10 drinks (gender by volume interaction: OR = 0.60, CI = 0.39-0.93 and OR = 0.50, CI = 0.27-0.93, respectively). For those reporting 5+ ≥ monthly, females were at higher risk than males at all volume levels, and the gender by volume interaction was stronger than for those consuming 5+

Actual and predicted prevalence of alcohol consumption during pregnancy in Latin America and the Caribbean: systematic literature review and meta-analysis.

OBJECTIVE: To estimate the prevalence of alcohol consumption during pregnancy among the general population of Latin America and the Caribbean, by country, in 2012. METHODS: Three steps were taken: a comprehensive, systematic literature search; meta-analyses, assuming a random-effects model for countries with published studies; and regression modelling (data prediction) for countries with either no published studies or too few to obtain an estimate. RESULTS: Based on 24 existing studies, the pooled prevalence of alcohol consumption during pregnancy among the general population was estimated for Brazil (15.2%; 95% confidence interval [95%CI]: 10.4%-20.8%) and Mexico (1.2%; 95%CI: 0.0%-2.7%). The prevalence of alcohol consumption during pregnancy among the general population was predicted for 31 countries and ranged from 4.8% (95%CI: 4.2%-5.4%) in Cuba to 23.3% (95%CI: 20.1%-26.5%) in Grenada. CONCLUSIONS: Greater prevention efforts and measures are needed in the countries of Latin America and the Caribbean to prevent pregnant women from consuming alcohol during pregnancy and decrease the rates of Fetal Alcohol Spectrum Disorder. Additional high quality studies on the prevalence of alcohol consumption during pregnancy in Latin America and the Caribbean are also needed.

Exploring structural relationships between blood alcohol concentration and signs and clinical assessment of intoxication in alcohol-involved injury cases.

AIMS: Although the relationship between the Y90 (blood alcohol concentration, BAC) and Y91 (clinician intoxication assessment) ICD-10 codes has received attention recently, the role of 10 signs of intoxication in the Y91-Y90 relationship has not been studied yet. This work examines these signs in the estimation of alcohol intoxication levels of patients in medical settings. METHODS: Collected and analyzed were data on 1997 injured emergency room patients from 17 countries worldwide reporting drinking prior to injury or presenting with a non-zero BAC from 17 countries worldwide. A model is estimated describing how the 10 signs inform the Y91, Y90 prediction with the goal of the use of observations on patients in place of a biological measure. RESULTS: Signs were consistent with a single underlying construct that strongly predicted Y91. Smell of alcohol on breath predicted Y91 above its contribution through the construct and was stronger for those with tolerance to alcohol than for those without. Controlling for Y91, no sign further contributed to prediction of Y90 indicating that Y91 incorporated all intoxication sign information in predicting Y90. Variance explained was high for Y91 (R(2) = 0.84) and intoxication signs (above 0.72 for all but smell on the breath, 0.57) and lower for Y90 (0.38). CONCLUSION: Intoxication assessments are well predicted by overall intoxication severity, which itself is well represented by intoxication signs along with differential emphasis on smell of alcohol on breath, especially for those with alcohol tolerance. However, BAC levels remain largely unexplained by intoxication signs with a clinician's assessment serving as the primary predictive measure.

[Alcohol and public health in Latin America: how to prevent a health disaster?]. / Alcohol y salud pública en América Latina: ¿cómo impedir un desastre sanitario?

Alcohol consumption is a public health problem in Latin America, being responsible for thousands of annual deaths and millions of healthy life years lost to acute and chronic conditions caused by alcohol. Consumption is higher and more prevalent among men, but women and adolescent girls are increasing their consumption more rapidly than men and adolescent boys. Beer is the alcoholic beverage most consumed, followed by distilled spirits; however, there are countries differences as some countries drink mostly wine. The industry which produces, distributes and sells alcoholic beverages is powerful, mostly globalized and with great political influence, so the current situation favors commercial interests at the expense of public health. Public policies in Latin America are insufficient to respond to the situation at national level, with little o no regulatory control of the availability of alcoholic beverages, prices and taxation policies or government control of marketing and promotion. There is limited research which can inform policy actions. Gaps in prevention and treatment of alcohol consumption and related problems are discussed as well as some perspectives for the future.

Comparing taxes on alcoholic beverages in the Region of the Americas.

BACKGROUND AND AIMS: Excise taxes represent one of the most cost-effective policies to reduce the harmful use of alcohol. Existing information about their design is limited and no standardized metric has been used to compare tax levels in the Region of the Americas. This study aimed to compare alcohol excise tax policies throughout the Americas, compare tax levels and consider opportunities to improve the impact of excise taxes on alcohol consumption and health. DESIGN AND SETTING: Descriptive analysis using a method developed by the Pan American Health Organization and adapted from the World Health Organization's tobacco tax monitoring. Data were collected by surveying ministries of finance and reviewing tax legislation in effect as of November 2020 in the Region of the Americas. MEASUREMENTS: Tax policy design indicators, taxes as a percentage of the retail price of the most-sold brand of beer, wine and spirits, including a weighted average indicator across beverage types, and tax levels per standard drink (10 g ethanol) in international dollars at purchasing power parity. FINDINGS: Thirty-three countries in the Americas (94%) apply excise taxes on alcoholic beverages, with Argentina and Uruguay not applying them to wine. There is significant heterogeneity in excise tax design across countries and beverage types. Only a third of amount-specific excise taxes are regularly adjusted to avoid erosion. Regional median excise taxes represent the highest share of the price for spirits (21.4%) and the lowest for wine (11.0%). The regional median consumption-weighted average excise tax share across all beverage types is 12.0%. Excise tax shares are generally higher in Latin America than in the Caribbean and Canada. Excise tax levels per standard drink are generally lower for spirits than for other beverages. CONCLUSIONS: Alcohol excise tax policies vary significantly across the Americas, often reflecting national consumption patterns. To maximize their public health impact, tax rates could be increased and tax designs improved, particularly to ensure higher tax burdens on high-strength drinks.

The development of the Pan American Health Organization digital health specialist on alcohol use.

Introduction: On 19 November 2021 the Pan American Health Organization (PAHO) developed and deployed the first-ever digital health worker dedicated to alcohol-related topics, named Pahola. This paper describes this developmental process and the first results of its uptake and interactions with the public. Methods: PAHO secured a non-exclusive worldwide license with a technology company to use their Human OS ecosystem, which enables human-like interactions between digital people and users via an application. Google Digital flow ES was used to develop the conversations of Pahola on topics related to alcohol and health, screening of alcohol risk using the AUDIT and providing a quit/cut back plan to users, along with additional treatment services and resources in each country of the Americas. A communication campaign was also implemented from launching date until 31 December 2021. Results: Pahola attracted good attention from the media, and potentially reached 1.6 million people, leading to 236,000 sessions on its landing page, mostly through mobile devices. The average time people effectively spent talking to Pahola was five minutes. Major dropouts were observed in different steps of the conversation flow. Discussion: Pahola was quickly able to connect to a large worldwide population with reliable alcohol information. It could potentially increase the delivery of SBI and improve alcohol health literacy. However, its preliminary results pointed to much needed changes to its corpus and on its accessibility, which are being currently implemented.

Prioritizing Variables for Evaluating the Efficacy and Effectiveness of Brief Interventions for Reducing Alcohol Consumption: A Latin American Perspective.

OBJECTIVE: The purpose of this study was to identify priority variables to evaluate alcohol brief interventions from the perspective of experts in the field in Latin America. METHOD: A two-round Delphi procedure was carried out through online surveys of 465 individuals from 18 Latin American countries, including core outcome set developers, researchers, health professionals, users of healthcare services, journal editors, members of nongovernmental organizations, and policymakers. The questionnaire, in Spanish and Portuguese, rated 101 variables according to their relevance to the efficacy and effectiveness of brief interventions. RESULTS: Round 1 yielded 47 variables that met the consensus criterion of at least 70% of participants; Round 2 yielded 63 variables. To reduce the possible effect of varying levels of expertise, data were analyzed by subgroup, with consensus defined as 70% of each subgroup rating a variable as critical. Seventeen outcome variables met this criterion, 14 from the initial set and 3 suggested by the participants in Round 1. CONCLUSIONS: Only four outcomes coincide with the findings of a similar international Delphi study that underrepresented Latin American countries. The findings point to the importance of including a wider variety of professionals and cultural backgrounds in international consensus panels to minimize the risk of predominance of a single perspective.

Health literacy development is central to the prevention and control of non-communicable diseases.

The WHO's report Health literacy development for the prevention and control of non-communicable diseases (NCDs) delivers practical what-to-do how-to-do guidance for health literacy development to build, at scale, contextually-relevant public health actions to reduce inequity and the burden of NCDs on individuals, health systems and economies. The key premise for health literacy development is that people's health awareness and behaviours are linked to lifelong experiences and social practices, which may be multilayered, hidden and beyond their control. Meaningful community engagement, local ownership and locally driven actions are needed to identify health literacy strengths, challenges and preferences to build locally fit-for-purpose and implementable actions. Health literacy development needs to underpin local and national policy, laws and regulations to create enabling environments that reduce community exposures to NCD risk factors. Deficit approaches and siloed health system and policy responses need to be avoided, focusing instead on integrating community-based solutions through co-design, cognisant of people's daily experiences and social practices.

Mortality in the Americas from 2013 to 2015 resulting from diseases, conditions and injuries which are 100% alcohol-attributable.

AIMS: To describe mortality in the Americas from 2013 to 2015 inclusive resulting from diseases, conditions and injuries which are 100% attributable to alcohol consumption. DESIGN AND SETTING: Mortality registry, population-based study. The data come from 30 of the 35 countries of the Americas for the triennium of 2013 to 2015. PARTICIPANTS AND CASES: A total of 18 673 791 deaths coded by three-digit ICD-10 codes were analyzed. MEASUREMENTS: Cause (underlying), and age-specific and age-adjusted mortality rates were calculated by sex and country. FINDINGS: From 2013 to 2015 inclusive, among 30 of the 35 countries of the Americas, an average of 85 032 deaths per year were entirely attributable to alcohol. Men accounted for 83.1% of all 100% alcohol-attributable deaths, and death rates were higher for men than for women across all countries; however, the ratios of 100% alcohol-attributable deaths by sex varied by country. The majority of all 100% alcohol-attributable deaths occurred among those aged under 60 years (64.9%) and were due to liver disease (63.9%) followed by neuropsychiatric disorders (27.4%). Age-adjusted 100% alcohol-attributable mortality rates were highest in Nicaragua (23.2 per 100 000) and Guatemala (19.0 per 100 000), although the majority of all 100% alcohol-attributable deaths occurred in the United States 36.9%), Brazil (24.8%), and Mexico (18.4%). CONCLUSIONS: From 2013 to 2015, more than 85 000 deaths in the Americas were 100% attributable to alcohol. Most of those occurred in people under 60 years and the highest mortality rates occurred in the United States, Brazil and Mexico.

What is associated with the increased frequency of heavy episodic drinking during the COVID-19 pandemic? Data from the PAHO regional web-based survey.

BACKGROUND: To estimate the prevalence of changes in the frequency of self-reported heavy episodic drinking (HED) among drinkers in Latin America and Caribbean countries on alcohol consumption during the COVID-19 pandemic, and to assess self-reported factors associated with the increased frequency of HED. METHODS: Data from 12,328 adults who responded to the cross-sectional survey conducted in 33 countries of Latin America and the Caribbean by Pan American Health Organization were used. Logistic regression analyses were performed to estimate the effect of the sociodemographic characteristics, quarantine practices, and anxiety symptoms on the increase in frequency of HED among the 2019 drinkers. RESULTS: 65 % of drinkers in 2019 self-reported HED during the COVID-19 pandemic with 13.8 % of the drinkers reporting an increase in HED compared to a 33.38 % decrease in HED. Multivariable analysis indicated that male gender (aOR 1.29, 95 %CI 1.13; 1.49), higher income (aOR 1.64, 95 %CI 1.35; 1.99) and higher level of quarantine practices (aOR 1.10, 95 %CI 1.04; 1.16) were positively associated with increased frequency of HED; unemployment (aOR 0.78, 95 %CI 0.64; 0.96), student status (aOR 0.53, 95 %CI 0.43; 0.64) and living with children (aOR 0.91, 95 %CI 0.84; 0.99) were negatively associated with increased frequency of HED. A gradient of association was found between generalized anxiety disorder and an increase in HED frequency during the pandemic. CONCLUSION: Along with other measures to decrease the spread of COVID-19, it is important to include measures to reduce alcohol consumption and address mental health conditions in the national response to the pandemic.

Alcohol Policy Scores and Alcohol-Attributable Homicide Rates in 150 Countries.

INTRODUCTION: More comprehensive state-level alcohol policy environments are associated with lower alcohol-attributable homicide rates in the U.S., but few studies have explored this internationally. This study tests whether 3 national-level alcohol policy scores are associated with alcohol-attributable homicide rates. METHODS: Data were from the 2016 WHO Global Survey on Alcohol and Health and the 2017 Global Burden of Disease Study (N=150 countries). In 2020, the authors calculated domain-specific alcohol policy scores for physical availability, marketing, and pricing policies. Higher scores represented more comprehensive/restrictive alcohol policy environments. Negative binomial regressions with Benjamini-Simes-Hochberg multiple testing correction measured the associations between policies and alcohol-attributable homicide rates. Authors stratified countries by World Bank income group to determine whether the associations differed among low- and middle-income countries. RESULTS: A 10% increase in the alcohol policy score for pricing was associated with an 18% lower alcohol-attributable homicide rate among all the countries (incidence rate ratio=0.82, adjusted p-value or q<0.001) and with a 14% (incidence rate ratio=0.86, q=0.01) decrease among 107 low- and middle-income countries. More controls on days and times of retail sales (incidence rate ratio=0.96, q=0.01) and affordability of alcohol (incidence rate ratio=0.95, q=0.04) as well as adjusting excise taxes for inflation (incidence rate ratio=0.96, q<0.01) were associated with a 4%-5% lower alcohol-attributable homicide rate in the full sample. CONCLUSIONS: Countries with policies that reduce alcohol's affordability or days/hours of sales tend to have fewer alcohol-attributable homicides, regardless of their income level. Alcohol-attributable homicide rates are highest in low- and middle-income countries; policies that raise alcohol-relative prices may hold promise for curbing these harms.

Analysis of gaps in alcohol policies in Brazil using the Pan American Health Organization's Alcohol Policy Scoring.

BACKGROUND: National alcohol policies need to be systematized and evaluated to identify the gaps that should be filled by future laws. This study aims to search for and classify Brazilian public alcohol policies at the federal and state levels, based on the ten Alcohol Policy Scoring (APS) domains used by the Pan American Health Organization (PAHO), to identify any gaps METHODS: Documental research was carried out in two phases: document identification and content analysis. The search included laws, decrees, and ordinances for alcohol referred to in this text as regulatory documents (RD), enacted until December 31, 2019, in Brazil and its 26 states and the Federal District. The APS was used to classify and score the RD, which consists of ten policy domains (including pricing, availability, marketing, and health services), weighted according to the level of scientific evidence of each strategy RESULTS: We identified and categorized 435 valid RD (21 national laws and 414 state laws). Overall, Brazilian alcohol policies account for 51.6% (255/494) of the APS score. In the pricing policy domain, the second most robust indicator of the APS, the policy gap reached 87% in 25 states, demonstrating a weakness. Only the federal laws against drink-driving include all the recommended dimensions. There are important legislative contradictions in the definition of an alcoholic beverage and in the content of the policies to control marketing CONCLUSION: At the national level, the federal government adopted alcohol policies in several of the PAHO policy domains but enacted RD with little practical effect. At the subnational level, despite the autonomy to complement federal laws, the states have not yet addressed the most important gaps.

The "Outcome Reporting in Brief Intervention Trials: Alcohol" (ORBITAL) Core Outcome Set: International Consensus on Outcomes to Measure in Efficacy and Effectiveness Trials of Alcohol Brief Interventions.

OBJECTIVE: The purpose of this study was to report the "Outcome Reporting in Brief Intervention Trials: Alcohol" (ORBITAL) recommended core outcome set (COS) to improve efficacy and effectiveness trials/evaluations for alcohol brief interventions (ABIs). METHOD: A systematic review identified 2,641 outcomes in 401 ABI articles measured by 1,560 different approaches. These outcomes were classified into outcome categories, and 150 participants from 19 countries participated in a two-round e-Delphi outcome prioritization exercise. This process prioritized 15 of 93 outcome categories for discussion at a consensus meeting of key stakeholders to decide the COS. A psychometric evaluation determined how to measure the outcomes. RESULTS: Ten outcomes were voted into the COS at the consensus meeting: (a) typical frequency, (b) typical quantity, (c) frequency of heavy episodic drinking, (d) combined consumption measure summarizing alcohol use, (e) hazardous or harmful drinking (average consumption), (f) standard drinks consumed in the past week (recent, current consumption), (g) alcohol-related consequences, (h) alcohol-related injury, (i) use of emergency health care services (impact of alcohol use), and (j) quality of life. CONCLUSIONS: The ORBITAL COS is an international consensus standard for future ABI trials and evaluations. It can improve the synthesis of new findings, reduce redundant/selective reporting (i.e., reporting only some, usually significant outcomes), improve between-study comparisons, and enhance the relevance of trial and evaluation findings to decision makers. The COS is the recommended minimum and does not exclude other, additional outcomes.