Demographic risk factors for alcohol-related aggression in and around licensed venues

AIMS: Few studies have examined the role of gender and both area-level and individual socio-economic status (SES) as independent predictors of alcohol-related aggression (ARA) in and around licensed venues. METHODS: The aim of the present study was to investigate the relationship between gender, area-level SES and individual SES (operationalised as occupational category) and ARA in and around licensed venues. The sample comprised 697 men and 649 women aged 16-47, who completed a patron intercept survey as part of a larger study assessing trends in harm and stakeholders' views surrounding local community level interventions in dealing with alcohol-related problems in the night-time economy. RESULTS: Binary logistic regression analyses showed that age, gender, occupational category, area-level SES and level of intoxication at time of interview were all significant predictors of involvement in ARA. Being male doubled the odds of involvement in ARA, while age was a protective factor. Blue collar workers had more than double the odds of ARA involvement of professionals, while those living in the most socio-economically disadvantaged areas were over twice as likely to report experiencing ARA compared to those living in the most advantaged areas. However, assessment of the predictive model by gender revealed that effects of age, occupational category and area-level SES were restricted to male participants, with greater intoxication no longer predictive. CONCLUSIONS: ARA among patrons was significantly more likely to occur among men, those in blue collar occupations, and individuals living in low SES areas, suggesting both individual and area-level disadvantage may play a role in ARA.

Randomized controlled trial of proactive web-based alcohol screening and brief intervention for university students

BACKGROUND: University students drink more heavily than their nonstudent peers and are often unaware that their drinking is risky and exceeds normative levels. We tested the efficacy of a proactive Web-based alcohol screening and brief intervention program. METHODS: A randomized controlled trial was conducted at an Australian university in 2007. Invitations were sent to 13 000 undergraduates (age range, 17-24 years) to complete a Web-based Alcohol Use Disorders Identification Test. Of 7237 students who responded, 2435 scored in the hazardous/harmful range (> or =8) and were randomized, and 2050 (84%) completed at least 1 follow-up assessment. Intervention was 10 minutes of Web-based motivational assessment and personalized feedback. Controls received only screening. Follow-up assessments were conducted at 1 and 6 months with observers and participants blinded to allocation. Outcome measures were drinking frequency, typical occasion quantity, overall volume, number of personal problems, an academic problems score, prevalence of binge drinking, and prevalence of heavy drinking. RESULTS: Mean (SD) baseline Alcohol Use Disorders Identification Test scores for control and intervention groups were 14.3 (5.1) and 14.2 (5.1), respectively. After 1 month, participants receiving intervention drank less often (rate ratio [RR], 0.89; 95% confidence interval [CI], 0.83-0.94), smaller quantities per occasion (RR, 0.93; 95% CI, 0.88-0.98), and less alcohol overall (RR, 0.83; 95% CI, 0.78-0.90) than did controls. Differences in alcohol-related harms were nonsignificant. At 6 months, intervention effects persisted for drinking frequency (RR, 0.91; 95% CI, 0.85-0.97) and overall volume (RR, 0.89; 95% CI, 0.82-0.96) but not for other variables. CONCLUSION: Proactive Web-based screening and intervention reduces drinking in undergraduates, and such a program could be implemented widely.

Patron banning in the nightlife entertainment districts: a key informant perspective

OBJECTIVE: Alcohol-related harm in and around licensed venues is associated with substantial costs. Many interventions have been introduced in an effort to combat these harms, and one such intervention is known as patron banning. Patron banning involves prohibiting patrons who have been violent or disorderly in a licensed venue in an attempt to reduce alcohol-related harm. It can be implemented by the venue, by members of police, or by liquor accords. This study aimed to obtain key informant perspectives on the benefits of patron banning as well as on the effectiveness of patron banning in reducing alcohol-related harm. METHOD: Thirty-six key informants provided perspectives on patron banning through in-depth interviews that were part of a larger study. RESULTS: Key informants were supportive of patron banning for reducing alcohol-related harm, noting that it had many benefits including increased venue safety, general risk management, and deterrence of antisocial behavior. Although processes for banning were not always consistent, identification scanners were generally recognized as a way to ensure that patron banning was enforced. CONCLUSIONS: Key informants viewed patron banning as an effective measure for increasing patron safety and reducing alcohol-related harms.

Key stakeholder perspectives of drink restrictions in Newcastle, Australia

Background: The problems associated with alcohol consumption in or around licensed premises in the nighttime economy are extensive. One intervention designed to address these problems is drink restrictions. The aim of the current study is to gain different key stakeholder perspectives on drink restriction interventions, including their ability to reduce alcohol-related harms. Method: This study involves an analysis of key stakeholder perspectives on the introduction of drink restrictions. Interviews were conducted with 23 key stakeholders, including venue licencees, security, and police from Newcastle, Australia. Drink restrictions, including limits on shots and umber of drinks, were part of a mandatory set of interventions, which were implemented as a result of legislative change in New South Wales. As such, key stakeholders were able to provide insight into the implementation and practicality of the restrictions. All interviews were analyzed using thematic analysis.Results: Overall, key stakeholders were mixed in their support for drink restrictions, particularly because of the issues associated with customer preloading and practicality of enforcement. Stakeholders remained unconvinced of the impact of the restrictions on reducing harm. Conclusions: Key stakeholders believe that drink restrictions would almost certainly be more likely to reduce alcohol-related harm in the nighttime economy as part of a larger intervention. However, it is unclear how much impact they have as a standalone harm reduction measure.

"As long as it doesn't spill over into class": harms arising from students` alcohol use, and the role of policy in reducing them

While there is considerable evidence about the prevalence of student alcohol use, little empirical work has examined the range and level of exposure to alcohol-related risks facing student populations, and the views of key stakeholders about these. This study was conducted at a large multi-campus university in order to gauge the scale and severity of students’ alcohol-related problems, and ways in which these may be mitigated. Student perspectives on campus based policy making with respect to alcohol were also canvassed. This study utilised a range of evaluative instruments, including standardised questionnaire protocols, structured interviews and focus groups. Data gained from students showed a large level of exposure to alcohol-related harm, and staff informants reported student harms such as drink-driving, interpersonal aggression, social nuisance, inadequate security, sexually risky behaviour, and physical malaise. As a group, students seem receptive to campus-based policies that have a harm reduction focus, but are less supportive of institutionalised measures aimed at the student body. Given the divergence of views about the harms arising from student drinking, and a general repudiation of institutional policy measures which may lessen these, the development of harm-reducing policy on alcohol remains challenging.

Influence of family factors and supervised alcohol use on adolescent alcohol use and harms : similarities between youth in different alcohol policy contexts

Objective: Harm-minimization policies suggest that alcohol use is a part of normal adolescent development and that parents should supervise their children's use to encourage responsible drinking. Zero-tolerance policies suggest that all underage alcohol use should be discouraged. This article compared hypotheses derived from harm-minimization and zero-tolerance policies regarding the influence of family context and supervised drinking on adolescent alcohol use and related harms among adolescents in Washington State, USA, and Victoria, Australia. two states that have respectively adopted zero-tolerance and harm-minimization policies.

Method: Representative samples of seventh-grade students (N = 1,945:989 females) were recruited from schools in each state. Students completed comprehensive questionnaires on alcohol use, related problem behaviors, and risk and protective factors annually from 2002 to 2004 when they were in ninth grade.

Results: Relationships between family context and alcohol use and harmful use were very similar in both states. Adult-supervised settings for alcohol use were associated with higher levels of harmful alcohol consequences. Adult-supervised alcohol use mediated the links between favorable parental attitudes to alcohol use and ninth-grade alcohol use for students in both states.

Conclusions: Despite policy differences in the two states, relationships between family context variables and alcohol use and harmful use are remarkably similar. Adult-supervised settings for alcohol use resulted in higher levels of harmful alcohol consequences, contrary to predictions derived from harm-minimization policy. Findings challenge the harm-minimization position that supervised alcohol use or early-age alcohol use will reduce the development of adolescent alcohol problems.

Alcohol and community sporting clubs

This paper examines the link between alcohol consumption and community sporting clubs. The paper argues that there are steps sporting clubs can take to reduce the link between alcohol and sport, and by so doing, clubs will create a setting that will cultivate and develop healthy individuals; sporting clubs will be more sustainable and attractive to the community; and there will be greater opportunities for recruiting new players and members. Drawing on published and unpublished literature, this paper begins by examining the prevalence of alcohol
consumption and related harms in sporting clubs. It then explores the implications of these alcohol consumption levels. Based on published evidence, a framework is then suggested to guide sporting clubs and influential stakeholders about steps they can take to address the management and consumption of alcohol in their club. Interspersed
through the document are case studies of sporting clubs from across Australia. These case studies highlight practical examples of reported evidence and best-practice. The paper aims to be relevant to a variety of stakeholders associated with sporting clubs including board members, committee members, coaches, fitness staff, managers and patrons.

Changes in injury-related hospital emergency department presentations associated with the imposition of regulatory versus voluntary licensing conditions on licensed venues in two cities

Introduction and Aims
Regulatory and collaborative intervention strategies have been developed to reduce the harms associated with alcohol consumption on licensed venues around the world, but there remains little research evidence regarding their comparative effectiveness. This paper describes concurrent changes in the number of night-time injury-related hospital emergency department presentations in two cities that implemented either a collaborative voluntary approach to reducing harms associated with licensed premises (Geelong) or a regulatory approach (Newcastle).

Design and Methods
This paper reports findings from Dealing with Alcohol-Related problems in the Night-Time Economy project. Data were drawn from injury-specific International Classification of Disease, 10th Revision codes for injuries (S and T codes) presenting during high-alcohol risk times (midnight—5.59 am, Saturday and Sunday mornings) at the emergency departments in Geelong Hospital and Newcastle (John Hunter Hospital and the Calvary Mater Hospital), before and after the introduction of licensing conditions between the years of 2005 and 2011. Time-series, seasonal autoregressive integrated moving average analyses were conducted on the data obtained from patients' medical records.

Results
Significant reductions in injury-related presentations during high-alcohol risk times were found for Newcastle since the imposition of regulatory licensing conditions (344 attendances per year, P < 0.001). None of the interventions deployed in Geelong (e.g. identification scanners, police operations, radio networks or closed-circuit television) were associated with reductions in emergency department presentations.

Discussion and Conclusions
The data suggest that mandatory interventions based on trading hours restrictions were associated with reduced emergency department injury presentations in high-alcohol hours than voluntary interventions. [Miller P, Curtis A, Palmer D, Busija L, Tindall J, Droste N, Gillham K, Coomber K, Wiggers J. Changes in injury-related hospital emergency department presentations associated with the imposition of regulatory versus voluntary licensing conditions on licensed venues in two cities. Drug Alcohol Rev 2014]*

Aggression-related alcohol expectancies and barroom aggression among construction tradespeople

INTRODUCTION AND AIMS: Few studies have investigated the relationship of barroom aggression with both general and barroom-specific alcohol expectancies. The present study investigated these associations in a rarely studied and high-risk population: construction tradespeople. DESIGN AND METHODS: Male construction tradespeople (n = 211) aged 18-35 years (M = 21.91, SD = 4.08 years) participated in a face-to-face questionnaire assessing general and barroom-specific alcohol expectancies and perpetration of physical and verbal barroom aggression as well as control variables, age, alcohol consumption and trait aggression. RESULTS: Sequential logistic regression analyses revealed that general alcohol-aggression expectancies of courage or dominance were not predictive of either verbal or physical barroom aggression after controlling for age, alcohol consumption and trait aggression. However, barroom-specific alcohol expectancies were associated with both verbal and physical barroom aggression, with positive associations found for expected hyper-emotionality and protective effects for expected cognitive impairment. DISCUSSION AND CONCLUSIONS: In a population where rates of risky drinking and barroom aggression are high, specific expectations about the effects of drinking in bars may influence subsequent aggressive behaviour in bars. [Zinkiewicz L, Smith G, Burn M, Litherland S, Wells S, Graham K, Miller P. Aggression-related alcohol expectancies and barroom aggression among construction tradespeople. Drug Alcohol Rev 2015;00:000-00].

Typology of alcohol consumers in five Australian nighttime entertainment districts

INTRODUCTION AND AIMS: Understanding how types of alcohol consumers differ is important for public policy targeted at reducing adverse events. The aims of the present study were to identify typologies of alcohol consumers in Australian nighttime entertainment districts based on risk factors for harm and to examine variation between the identified groups in drinking setting and harms. DESIGN AND METHODS: Street-intercept surveys were conducted with 5556 alcohol consumers in and around licensed venues in five Australian cities between November 2011 and June 2012. Latent class analysis identified groups based on age and sex, and blood alcohol concentration, pre-drinking, energy drink use and illicit drug use during that night. RESULTS: Four classes were identified: general patron group (33%), young pre-drinker group (27%), intoxicated male pre-drinker group (31%) and intoxicated illicit drug male group (9%). The proportion of the general patron group interviewed decreased over the night, while the other groups increased (particularly in regional cities). As compared with the general patron group, the remaining three groups reported increased odds of being involved in aggression and any alcohol-related injuries in the past 3 months, with highest rates of harm amongst the intoxicated illicit drug male group. DISCUSSION AND CONCLUSIONS: Alcohol consumers in nighttime entertainment districts are not a homogeneous group. One-third have a low likelihood of risky consumption practices; however, representation of this consumer class diminishes throughout the night. Elevated harms amongst groups characterised by certain risk factors (e.g. pre-drinking and illicit drug use) emphasise the importance of addressing these behaviours in public policy.

Drug education with special needs populations : identifying and understanding the challenges

Students with special developmental needs (e.g. learning disabilities, attentional disorders, intellectual disability, conduct disorders, sensory deficits, acquired brain injury) face particular challenges with respect to academic achievement and psychosocial development, whether they are educated in mainstream settings, special settings, or a combination of these. These groups are typically poorly researched with respect to drug and alcohol use and education, however there is some evidence to indicate that they face an elevated risk of experiencing drug-related harms. The aim of the present paper is to highlight the particular challenges facing this heterogeneous population with respect to access to school-based drug education. Special learning challenges facing such students are described, and some suggestions are provided for researchers and practitioners in the drug education field.

Three dimensions of the male gender role as correlates of alcohol and cannabis involvement in young Australian men

This study examined 3 aspects of the male gender role and their relationship to alcohol and cannabis involvement in young adult Australian men (N = 160) aged between 18 and 25 years. Higher scores on the Restrictive Emotionality scale, which assessed gender ,role conflict, were found to relate to both alcohol-related problems and cannabis use. Higher scores on the Antifemininity scale, which assessed traditional attitudes toward men, were also found to be associated with alcohol-related problems. However, lower scores on another aspect of gender role conflict, Restrictive Affectionate Behavior Between Men, and lower scores on one aspect of traditional attitudes toward men, Status Rationality, correlated with higher frequency levels of alcohol and cannabis use.

Interventions to reduce harm associated with adolescent substance use

A major proportion of the disease burden and deaths for young people in developed nations is attributable to misuse of alcohol and illicit drugs. Patterns of substance use established in adolescence are quite stable and predict chronic patterns of use, mortality, and morbidity later in life. We integrated fi ndings of systematic reviews to summarise evidence for interventions aimed at prevention and reduction of harms related to adolescent substance use. Evidence of efficacy was available for developmental prevention interventions that aim to prevent onset of harmful patterns in settings such as vulnerable families, schools, and communities, and universal strategies to reduce attractiveness of substance use. Regulatory interventions aim to increase perceived costs and reduce availability and accessibility of substances. Increasing price, restricting settings of use, and raising legal purchase age are eff ective in reducing use of alcohol and tobacco and related harms. Screening and brief intervention are efficacious, but efficacy of a range of treatment approaches has not been reliably established. Harm-reduction interventions are effective in young people involved in risky and injecting substance use.

Gambling and corporate social responsibility (CSR) : re-defining industry and state roles on duty of care, host responsibility and risk management

During the 1990s, states embraced legalised gambling as a means of supplementing state revenue. But gaming machines (EGMs, pokies, VLTs, Slots) have become increasingly controversial in countries such as Australia, Canada and New Zealand, which experienced unprecedented roll-out of gaming machines in casino and community settings; alongside revenue windfalls for both governments and the gambling industry. Governments have recognised that gambling results in a range of social and economic harms and, similar to tobacco and alcohol, have introduced public policies predicated on harm minimisation. Yet despite these, gaming losses have continued to climb in most jurisdictions, along with concerns about gambling-related harms. The first part of this article discusses an emerging debate in Ontario Canada, that draws parallels between host responsibility in alcohol and gambling venues. In Canada, where government owns and operates the gaming industry, this debate prompts important questions on the role of the state, duty of care and regulation ‘in the public interest’ and on CSR, host responsibility and consumer protection. This prompts the question: Do governments owe a duty of care to gamblers?

The article then discusses three domains of accumulating research evidence to inform questions raised in the Ontario debate: evidence that visible behavioural indicators can be used with high confidence to identify problem gamblers on-site in venues as they gamble; new systems using player tracking and loyalty data that can provide management with high precision identification of problem gamblers and associated risk (for protective interventions); and research on technological design features of new generation gaming products in interaction with players, that shows how EGM machines can be the site for monitoring/protecting players. We then canvass some leading international jurisdictions on gambling policy CSR and consumer protection.

In light of this new research, we ask whether the risk of legal liability poses a tipping point for more interventionist public policy responses by both the state and industry. This includes a proactive role for the state in re-regulating the gambling industry/products; instituting new forms of gaming machine product control/protection; and reinforcing corporate social responsibility (CSR) and host responsibility obligations on gambling providers – beyond self-regulatory codes. We argue the ground is shifting, there is new evidence to inform public policy and government regulation and there are new pressures on gambling providers and regulators to avail themselves of the new technology – or risk litigation

Cue reward salience predicts craving in response to alcohol cues

Many studies have shown that regular drinkers react to alcohol-related stimuli (i.e., cue reactivity) with a variety of appetitive responses, in particular, increased urge to drink. Recent research has focused on accounting for variability in responses to alcohol-related stimuli by examining drinking histories and personality. The aim of the current study was to extend this line of work by investigating the role of reinforcement expectancies (‘cue reward salience’) in alcohol cue reactivity research. In this study, ‘cue reward salience’ refers to the notion that appetitive responses will only ensue if the individual finds the stimulus to be equal to or more rewarding than initial expectations. Sixty-one regular drinkers completed a standard cue reactivity assessment whereby reactions (i.e., urge to drink and affect) to the sight, smell and taste of alcohol are measured and compared to a control condition. Results indicated significant increases in positive urge to drink but no changes in affect. Analyses revealed that drinking level and trait reward sensitivity were significant predictors of the urge to drink response. In addition, ‘cue reward salience’ accounted for significant additional variance in predicting urge to drink alcohol. Discussion focuses on the importance of measuring reinforcement expectancies when conducting cue reactivity studies.