A cluster randomised controlled trial of a comprehensive accreditation intervention to reduce alcohol consumption at community sports clubs: study protocol

Introduction: Excessive alcohol consumption isresponsible for considerable harm from chronicdisease and injury. Within most developed countries,members of sporting clubs consume alcohol at levels above that of communities generally. Despite the potential benefits of interventions to address alcohol consumption in sporting clubs, there have been no randomised controlled trials to test the effectiveness of these interventions. The aim of this study is to examine the effectiveness of a comprehensive accreditation intervention with community football clubs (Rugby League, Rugby Union, soccer/association football and Australian Rules football) in reducing excessive alcohol consumption by club members.
Methods and analysis: The study will be conducted in New South Wales, Australia, and employ a cluster randomised controlled trial design. Half of the football clubs recruited to the trial will be randomised to receive an intervention implemented over two and a half winter sporting seasons. The intervention is based on social ecology theory and is comprehensive in nature, containing multiple elements designed to decrease the supply of alcohol to intoxicated members, cease the provision of cheap and free alcohol, increase the availability and costattractiveness of non-alcoholic and low-alcoholic beverages, remove high alcohol drinks and cease drinking games. The intervention utilises a three-tiered accreditation framework designed to motivate intervention implementation. Football clubs in the control group will receive printed materials on topics unrelated to alcohol. Outcome data will be collected pre- and postintervention through cross-sectional telephone surveys of club members. The primary outcome measure will be alcohol consumption by club members at the club, assessed using a graduated frequency index and a seven day diary.
Ethics and dissemination: The study was approved by The University of Newcastle Human Research Ethics Committee (reference: H-2008-0432). Study findings will be disseminated widely through peer-reviewed publications and conference presentations.

What is the optimal level of population alcohol consumption for chronic disease prevention in England? Modelling the impact of changes in average consumption levels

Objective To estimate the impact of achieving alternative average population alcohol consumption levels on chronic disease mortality in England.

Design A macro-simulation model was built to simultaneously estimate the number of deaths from coronary heart disease, stroke, hypertensive disease, diabetes, liver cirrhosis, epilepsy and five cancers that would be averted or delayed annually as a result of changes in alcohol consumption among English adults. Counterfactual scenarios assessed the impact on alcohol-related mortalities of changing (1) the median alcohol consumption of drinkers and (2) the percentage of non-drinkers.

Data sources Risk relationships were drawn from published meta-analyses. Age- and sex-specific distributions of alcohol consumption (grams per day) for the English population in 2006 were drawn from the General Household Survey 2006, and age-, sex- and cause-specific mortality data for 2006 were provided by the Office for National Statistics.

Results The optimum median consumption level for drinkers in the model was 5 g/day (about half a unit), which would avert or delay 4579 (2544 to 6590) deaths per year. Approximately equal numbers of deaths from cancers and liver disease would be delayed or averted (∼2800 for each), while there was a small increase in cardiovascular mortality. The model showed no benefit in terms of reduced mortality when the proportion of non-drinkers in the population was increased.

Conclusions Current government recommendations for alcohol consumption are well above the level likely to minimise chronic disease. Public health targets should aim for a reduction in population alcohol consumption in order to reduce chronic disease mortality.

Moving beyond the restrictions : the evaluation of the Alice Springs alcohol management plan

There have been a number of evaluations of alcohol management in the Alice Springs region. Interestingly, an evaluation in 1975 emphasised the need for government and other agencies to view the issues holistically and to address them accordingly. The outcomes of this evaluation point to a similar situation with comparable recommendations.

The situation in Alice Springs is unique in some respects but has parallel characteristics to other towns and communities in Australia. Alice Springs is an important regional supply, service-orientated, and tourism town. Its people have diverse backgrounds and appear as durable as the environment they live in. Associated with this is a hard drinking culture that permeates the community with a range of issues regardless of one’s cultural background.

The research group found a community that in many ways is ruptured and fragmented when it comes to the ways and means of how such challenges can be confronted. This situation is exemplified by the perception that alcohol problems are confined to a minority of drinkers that seemingly pervades the dialogue surrounding drinking and its effects in the town.

Nevertheless, a positive outcome of such discourse is the fact that people do care about their community and are very keen to live in a town where there are more responsible attitudes toward drinking. There is some way to go; the first thing that everyone needs to accept is that it is a community problem. Non-Indigenous and Indigenous individuals, groups and organisations all have a responsibility therefore in addressing the challenges and working toward better solutions. Government have an important role of course, however the acceptance by the community that it is a community problem is paramount.

Some of the community and government initiatives are having a positive effect on drinking in the town. However, some of the initiatives, such as certain restrictions, can and should not be considered, on their own, as long-term solutions. Other processes need to be implemented, oversighted and managed in an effective manner. An important component of such processes is data that is well managed, available, and appropriate for those agencies involved.

Towards a standardised methodology for estimating alcohol-caused death, injury and illness in Australia

Two key methodological issues underlying different methods for calculating estimates of the number of alcohol-caused deaths are identified and recommendations suggested for future work.

1. How to adjust alcohol aetiologic fractions across time and place to reflect different levels of risky drinking. A common approach is outlined for both acute and chronic alcohol-related conditions. In the absence of consistent, reliable and regionally specific measures of the prevalence of risky alcohol consumption from national surveys, the use of per capita consumption data as a means of adjusting alcohol population aetiologic fractions over time and across regions is recommended.

2. Whether abstainers or low-risk drinkers should be used as the reference group when assessing the impact of alcohol consumption and how the resulting information is best presented. It is recommended that when abstainers are used as the reference group, the costs and benefits for both 'low-risk' and 'risky/high-risk' drinking should be identified. Using this approach, it was estimated that for Australia in 1998 there was a net benefit of 5,100 lives saved due to low-risk drinking, while there was a net loss of 2,737 lives due to risky/high-risk drinking. On its own, the figure of a net saving of 2,363 lives per year is a simplistic and potentially misleading picture of alcohol as a net benefit to public health and safety. For public health communications, there is still value in providing estimates using the low-risk drinking contrast, of the number of lives saved if risky/high-risk drinkers all became low-risk drinkers (n=3,292 in 1998). The use of the abstinence contrast, however, allows the more complex picture of alcohol's impact on public health to be apparent, e.g. including the estimated 1,505 deaths associated with low-risk drinking (mostly from cancer).

Analysis of the stages of change model of drug and alcohol treatment readiness among prisoners

A classification and regression tree (CART) analysis was applied to data for 237 male participants (M = 31.93 years, SD = 7.64) in a prison-based substance abuse treatment program to study the integrity of the Stages of Change model of treatment readiness. Using the Stages of Change Questionnaire (STOCQ), participants were assigned to Contemplation (102), Action (118), or Maintenance (17) groups. A CART analysis then examined differences in the overall group profiles on the basis of scores on the Psychological Inventory of Criminal Thinking, the Situational Confidence Questionnaire, and the Carlson Psychological Survey. The assumption of discrete stages of change was not supported. Alternative models are suggested: one based on states of change and one on personality characteristics. A focus on equal attention to both cognitive and behavioral aspects of substance abuse treatment readiness is suggested.

Evaluation of an alcohol intervention training program for nurses in rural Australia

Aim: This paper reports on the development, implementation and evaluation of the Alcohol Intervention Training Program (AITP) designed to enhance nurses’ capacity to work with farming men and women who misuse alcohol.

Background: In rural and regional areas where alcohol-related behaviours and problems are relatively elevated, nurses may be the key health professionals dealing with individuals who misuse alcohol. However, they are often ill-equipped to do this, have low confidence in their ability to do so, and perceive numerous barriers. Training is required for these nurses.

Methods: We developed the AITP to enhance nurses’ capacity to work with people with alcohol-related problems. The data were collected during 2010. An intervention group of 15 rural nurses completed the AITP. Nurses’ perceived barriers, attitudes, and perceived performance in working with clients with alcohol problems, and the frequency of engaging with this client group were evaluated. Scores on these measures were compared to those of a control group of 17 nurses’ pre-treatment, post-treatment and at 3-month follow-up.

Results: Participation in the AITP resulted in initial improvements in attitudes to working with alcohol problems, but no change in perceived barriers to doing so. The level of engagement with clients having alcohol-related problems increased, as did perceptions of work performance.

Conclusion: The AITP enhances the ability of rural nurses to address the alcohol and associated health issues of clients in rural and regional areas. However, the program needs refinement and further evaluation.

The association between alcohol interventions and Dui incidents in Geelong, Victoria

Introduction and aims : Driving under the influence of alcohol is a major public health problem, every year affecting the lives of billions around the world - and not least in Australia. Since 2001, several Traffic Accident Commission (TAC), police, and community interventions have been implemented in Geelong, Australia to curb drink driving. The current paper aims to assess the impact of 13 alcohol interventions on drink-driving rates in the Geelong region of Australia. The interventions comprised seven TAC media campaigns, three Victoria Police operations, two community interventions targeting licensed premises, and the alcohol interlock program.

Method : This study examined two types of Victoria Police frequency data: Driving under the influence (DUI) offences, and roadside preliminary breath testing (PBT) rates. Multiple regressions were carried out to determine if any of the interventions were significantly associated with frequency fluctuations in the data.

Results : Of the 13 alcohol interventions examined, three TAC campaigns and one Victoria Police operation precipitated significant decreases in drink-driving rates, while another three TAC campaigns were associated with significant increases in drink-driving rates. Over one in five (22.5%) had recorded prior DUI offences.

Conclusions : The most promising approach to curbing DUI-rates in Geelong, appear to be through informative media campaigns which show people specific settings where they might become mildly intoxicated without being aware of it, such as TAC’s ‘Education 1’ campaign. However, there remains a worrying level of recidivist drink drivers in Geelong suggesting the need for tailored approaches.

Global patterns for upper ceilings on migration distance in sea turtles and comparisons with fish, birds and mammals

1. Some animals migrate huge distances in search of resources with locomotory mode (flying/swimming/walking) thought to drive the upper ceilings on migration distance. Yet in cross-taxa comparisons, upper ceilings on migration distance have been ignored for one important group, sea turtles. 2. Using migration distances recorded for 407 adult and 4715 juvenile sea turtles across five species, we show that for adult cheloniid turtles, the upper ceiling on species migration distances between breeding and foraging habitats (1050–2850 km across species) is similar to that predicted for equivalent-sized marine mammals and fish. 3. In contrast, by feeding in the open ocean, adult leatherback turtles (Dermochelys coriacea) and juveniles of all turtle species can travel around 12 000 km from their natal regions, travelling across the widest ocean basins. For juvenile turtles, this puts their maximum migration distances well beyond those expected for equivalent-sized marine mammals and fish, but not those found in some similar sized birds. 4. Post-hatchling turtles perform these long-distance migrations to juvenile foraging sites only once in their lifetime, while adult turtles return to their breeding sites every few (generally ?2) years. Our results highlight the important roles migration periodicity and foraging mode can play in driving the longest migrations, and the implications for Marine Protected Area planning are considered in terms of sea turtle conservation.

Rethinking social work in a global world

 Book review of: Rethinking social work in a global world, by Gai Harrison & Rose Melville, 2010.

Energy drinks and alcohol: research supported by industry may be downplaying harms

Mixing alcohol with so called energy drinks has become popular, but with what risk? Peter Miller worries that research does not consider real world levels of consumption and that researchers’ conflicts of interest need to be declared in full.

Debating the international legitimacy of the G20: global policymaking and contemporary international society

There have been growing debates about the legitimacy and the future of the G20 (the Group of Twenty) leaders forum despite this forum playing a prominent role in response to the 2008 Global Financial Crisis. While states within the G20 assert the legitimacy of the G20, states outside the G20 actively question this forum’s legitimacy. This article contends that while the G20 is important to contemporary global governance and efforts to create a common framework of rules for global capitalism, this ongoing debate demonstrates that the legitimacy of the G20 is fundamentally uncertain and problematic because the G20’s membership and connection to existing forms of multilateralism remain contentious. This article contends that G20 leaders need to consider these issues in light of the prevailing expectations of states in contemporary international society.

Commentary on Stuart et al. (2013): Domestic violence and interventions to reduce alcohol use

This study, reported by Gregory Stuart and colleagues, offers empirical evidence to support the hypothesis that perpetrators of domestic violence who receive a brief intervention to address alcohol use in addition to a 40-hour group batterer programme will not only consume fewer drinks (and on fewer days) than those who only receive the batterer programme, but will also be less likely to be aggressive and violent.Although these effects fade over time, these findings are significant in the context of an area in which the efficacy of many behaviour change programmes has yet to be demonstrated adequately [2], and in which there is a pressing need to develop more effective interventions.