Reinforcement sensitivity theory : a paradigm for understanding the motivational processes underlying alcohol use

Provides an examination of the processes which motivate individuals to drink alcohol. It was found that heavier drinkers are highly sensitive to reward yet more likely to experience negative affect, both generally, and in response to alcohol-related cues. Based on these findings a model focusing on the links between personality, mood and craving for alcohol was developed.

The Alcohol Intervention Training Program (AITP) : a response to alcohol misuse in the farming community

Background
Farm men and women in Australia have higher levels of problematic alcohol use than their urban counterparts and experience elevated health risks associated with excessive alcohol consumption. The Sustainable Farm Families (SFF) program has worked successfully with farm men and women to address health, well- being and safety and has identified that further research and training is required to understand and address alcohol misuse behaviours. This project will add an innovative component to the program by training health professionals working with farm men and women to discuss and respond to alcohol-related physical and mental health problems.

Methods/Design
A mixed method design with multi-level evaluation will be implemented following the development and delivery of a training program (The Alcohol Intervention Training Program {AITP}) for Sustainable Farm Families health professionals. Pre-, post- and follow-up surveys will be used to assess both the impact of the training on the knowledge, confidence and skills of the health professionals to work with alcohol misuse and associated problems, and the impact of the training on the attitudes, behaviour and mental health of farm men and women who participate in the SFF project. Evaluations will take a range of forms including self-rated outcome measures and interviews.

Discussion
The success of this project will enhance the health and well-being of a critical population, the farm men and women of Australia, by producing an evidence-based strategy to assist them to adopt more positive alcohol-related behaviours that will lead to better physical and mental health.

Association of risky alcohol consumption and accreditation in the 'Good Sports' alcohol management programme

Background Involvement in community sports clubs is often associated with high levels of risky alcohol consumption; however, developing prevention-focused interventions in these settings can be complex. We examined the association of reduced risky alcohol consumption with the implementation of the Good Sports Programme (GSP)—a programme that accredits clubs in three stages, on the basis of their implementation of alcohol-related harm reduction strategies.

Methods Using a cross section of football and cricket clubs, consumption was compared between clubs accredited at level 1, 2 or 3 of the GSP and clubs not accredited (92 clubs; 1924 individuals). Drinking above Australian guidelines for short-term risk (more than four standard drinks) on the last playing day prior to the survey and drinking at the club over the last 12 months at average levels exceeding short- and long-term risk (more than two standard drinks) guidelines were also examined.

Results Multilevel modelling indicated that higher accreditation stage (0, 1, 2, 3) was associated with a 0.79 reduction in the odds of risky consumption on the playing day; a 0.85 reduction in the odds for short-term risky drinking, and a 0.86 reduction in long-term risky drinking.

Conclusions The findings suggest that higher accreditation in the GSP is associated with reduced rates of risky alcohol use at a population level.

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.

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).

Alcohol sponsorship of community football clubs : the current situation

Issue addressed: There is accumulating evidence supporting a link between alcohol industry sponsorship and alcohol-related problems in both community and elite-level sports. Little is known, however, about the current status of such sponsorship, particularly of community sport. This study aimed to assess associations between alcohol industry sponsorship and different community football clubs in Australia.

Methods: The study involved 101 community football clubs across New South Wales, Australia. One representative from each club took part in a cross-sectional telephone survey designed to assess club (football code, number of players, socioeconomic and geographic descriptors) and alcohol industry sponsorship (money, equipment, free alcohol or discounted alcohol) characteristics. Chi-square analysis was used to test associations between club characteristics, and: i) any alcohol industry sponsorship; and ii) type of sponsorship.

Results: Eighty-eight per cent of clubs reported receiving sponsorship from the alcohol industry, and most clubs (82%) were sponsored by a licensed premises. There were no significant associations between club characteristics and source of alcohol industry sponsorship. However, small clubs were found to be significantly more likely to receive free or discounted alcohol sponsorship than larger clubs (p=0.05).

Conclusions: This exploratory study suggests a significant presence of alcohol industry sponsorship among community football clubs in Australia.

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.

Patron offending and intoxication in night time entertainment districts (POINTED) : a study protocol

Risky alcohol consumption is the subject of considerable community concern in Australia and internationally, particularly the risky drinking practices of young people consuming alcohol in the night-time economy. This study will determine some of the factors and correlates associated with alcohol-related risk-taking, offending and harm in and around licensed venues and night-time entertainment precincts across five Australian cities (three metropolitan and two regional). The primary aim of the study is to measure levels of pre-drinking, drinking in venues, intoxication, illicit drug use and potentially harmful drinking practices (such as mixing with energy drinks) of patrons in entertainment areas, and relating this to offending, risky behaviour and harms experienced. The study will also investigate the effects of license type, trading hours, duration of drinking episodes and geographical location on intoxication, offending, risk-taking and experience of harm. Data collection involves patron interviews (incorporating breathalysing and drug testing) with 7500 people attending licensed venues. Intensive venue observations (n=112) will also be undertaken in a range of venues, including pubs, bars and nightclubs. The information gathered through this study will inform prevention and enforcement approaches of policy makers, police and venue staff.

Alcohol consumption and sport: a cross-sectional study of alcohol management practices associated with at-risk alcohol consumption at community football clubs

Background
Excessive alcohol consumption is responsible for considerable harm from chronic disease and injury. Within most developed countries, members of sporting clubs participate in at-risk alcohol consumption at levels above that of communities generally. There has been limited research investigating the predictors of at-risk alcohol consumption in sporting settings, particularly at the non-elite level. The purpose of this study was to examine the association between the alcohol management practices and characteristics of community football clubs and at-risk alcohol consumption by club members.

Methods
A cross sectional survey of community football club management representatives and members was conducted. Logistic regression analysis (adjusting for clustering by club) was used to determine the association between the alcohol management practices (including alcohol management policy, alcohol-related sponsorship, availability of low- and non-alcoholic drinks, and alcohol-related promotions, awards and prizes) and characteristics (football code, size and location) of sporting clubs and at-risk alcohol consumption by club members.

Results
Members of clubs that served alcohol to intoxicated people [OR: 2.23 (95% CI: 1.26-3.93)], conducted ‘happy hour’ promotions [OR: 2.84 (95% CI: 1.84-4.38)] or provided alcohol-only awards and prizes [OR: 1.80 (95% CI: 1.16-2.80)] were at significantly greater odds of consuming alcohol at risky levels than members of clubs that did not have such alcohol management practices. At-risk alcohol consumption was also more likely among members of clubs with less than 150 players compared with larger clubs [OR:1.45 (95% CI: 1.02-2.05)] and amongst members of particular football codes.

Conclusions
The findings of this study suggest a need and opportunity for the implementation of alcohol harm reduction strategies targeting specific alcohol management practices at community football clubs.

Beyond the primary influences of parents and peers on very young adolescent alcohol use: Evidence of independent community associations

This study examined the extent to which young adolescent alcohol use was related to alcohol-related norms and law enforcement of underage alcohol use, after accounting for known strong parent and peer correlates. Our sample consisted of 7,674 students (X̅ age = 12 years) from 30 Australian communities. Two-level (individuals nested within communities) binary logistic regression was used to examine relationships between recent alcohol use (last 30 days) and perceived community norms about alcohol use, perceived law enforcement of underage alcohol use, parent alcohol use, parent permissiveness of adolescent alcohol use, peer alcohol use, and demographic factors. Results indicated that community norms and perceived law enforcement of alcohol use were associated with alcohol use and this association was independent of parent and peer factors. After accounting for proximal social correlates, community factors were significantly associated with alcohol use among very young adolescents.

The association between sports participation, alcohol use and aggression and violence: a systematic review

Objectives
To review the current research on alcohol-related violence and sports participation.

Methods
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to identify relevant studies for inclusion. A search of six databases (EBSCOhost) was conducted.

Results
A total of 6890 studies was were identified in the initial search. Of these, 11 studies met the inclusion criteria. The majority of the studies were from the US (n = 10) and focused on collegiate athletes (n = 7), adolescents (n = 3), professional/former professional athletes (n = 1).

Conclusion
The reviewed research indicates higher rates of alcohol use and violence in athlete populations when compared against non-athlete populations. Masculinity, violent social identity and antisocial norms connected to certain sports stand out as potential factors that may impact the association between sport and violence in athlete populations.

Alcohol, masculinity, honour and male barroom aggression in an Australian sample

Introduction and Aims
The link between alcohol and men's aggression is well established, although growing evidence also points to individual and learned social factors. The aim of the present study was to investigate the relationships between male alcohol-related aggression (MARA) among young Australian men and heavy episodic drinking, trait aggression, masculinity, concerns about social honour and expected positive consequences of MARA.

Design and Methods
The total sample comprised 170 men aged 18–25 years who completed an online questionnaire exploring beliefs and attitudes towards MARA.

Results
Those who reported heavy episodic drinking were more likely to be involved in an incident of MARA. In addition, those who were involved in MARA had higher levels of trait aggression, concern for social honour and expected positive consequences of aggression in bars than did those without such involvement. The relationship between socially constructed masculinity factors (a combined variable reflecting masculinity, social honour and expected positive consequences) and MARA was mediated by heavy episodic drinking. Social honour accounted for almost all of the predictive power of masculinity factors. Heavy episodic drinking and trait aggression remained significant predictors of MARA in a multivariate model.

Discussion and Conclusions
The findings from the current study may assist in developing preventative techniques for young men which target masculinity concerns and the consequences of participating in MARA.

Key stakeholder views of venue lockouts in Newcastle and Geelong

A substantial proportion of the problems associated with alcohol and interpersonal violence arise in or around licensed premises. One intervention, called lockouts, involves stopping people entering venues at an allocated time (for example, 1:30 am), although the venue can continue to sell alcohol until a specified closing time (for example, 3:30 am). 

Self-reported risk-taking behavior during matched-frequency sessions of alcohol versus combined alcohol and energy drinks consumption: Does co-ingestion increase risk-taking?

Background: Emerging evidence indicates that consumers of alcohol mixed with energy drink (AmED) self-report lower odds of risk-taking after consuming AmED versus alcohol alone. However, these studies have been criticized for failing to control for relative frequency of AmED versus alcohol-only consumption sessions. These studies also do not account for quantity of consumption and general alcohol-related risk-taking propensity. The aims of the present study were to (i) compare rates of risk-taking in AmED versus alcohol sessions among consumers with matched frequency of use and (ii) identify consumption and person characteristics associated with risk-taking behavior in AmED sessions. Methods: Data were extracted from 2 Australian community samples and 1 New Zealand community sample of AmED consumers (n = 1,291). One-fifth (21%; n = 273) reported matched frequency of AmED and alcohol use. Results: The majority (55%) of matched-frequency participants consumed AmED and alcohol monthly or less. The matched-frequency sample reported significantly lower odds of engaging in 18 of 25 assessed risk behaviors in AmED versus alcohol sessions. Similar rates of engagement were evident across session type for the remaining behaviors, the majority of which were low prevalence (reported by <15%). Regression modeling indicated that risk-taking in AmED sessions was primarily associated with risk-taking in alcohol sessions, with increased average energy drink (ED) intake associated with certain risk behaviors (e.g., being physically hurt, not using contraception, and driving while over the legal alcohol limit). Conclusions: Bivariate analyses from a matched-frequency sample align with past research showing lower odds of risk-taking behavior after AmED versus alcohol consumption for the same individuals. Multivariate analyses showed that risk-taking in alcohol sessions had the strongest association with risk-taking in AmED sessions. However, hypotheses of increased risk-taking post-AmED consumption were partly supported: Greater ED intake was associated with increased likelihood of specific behaviors, including drink-driving, sexual behavior, and aggressive behaviors in the matched-frequency sample after controlling for alcohol intake and risk-taking in alcohol sessions. These findings highlight the need to consider both personal characteristics and beverage effects in harm reduction strategies for AmED consumers.

Web-based alcohol screening and brief intervention for Māori and non-Māori: the New Zealand e-SBINZ trials

BACKGROUND: Hazardous alcohol consumption is a leading modifiable cause of mortality and morbidity among young people. Screening and brief intervention (SBI) is a key strategy to reduce alcohol-related harm in the community, and web-based approaches (e-SBI) have advantages over practitioner-delivered approaches, being cheaper, more acceptable, administrable remotely and infinitely scalable. An efficacy trial in a university population showed a 10-minute intervention could reduce drinking by 11% for 6 months or more among 17-24 year-old undergraduate hazardous drinkers. The e-SBINZ study is designed to examine the effectiveness of e-SBI across a range of universities and among Māori and non-Māori students in New Zealand. METHODS/DESIGN: The e-SBINZ study comprises two parallel, double blind, multi-site, individually randomised controlled trials. This paper outlines the background and design of the trial, which is recruiting 17-24 year-old students from seven of New Zealand's eight universities. Māori and non-Māori students are being sampled separately and are invited by e-mail to complete a web questionnaire including the AUDIT-C. Those who score >4 will be randomly allocated to no further contact until follow-up (control) or to assessment and personalised feedback (intervention) via computer. Follow-up assessment will occur 5 months later in second semester. Recruitment, consent, randomisation, intervention and follow-up are all online. Primary outcomes are (i) total alcohol consumption, (ii) frequency of drinking, (iii) amount consumed per typical drinking occasion, (iv) the proportions exceeding medical guidelines for acute and chronic harm, and (v) scores on an academic problems scale. DISCUSSION: The trial will provide information on the effectiveness of e-SBI in reducing hazardous alcohol consumption across diverse university student populations with separate effect estimates for Māori and non-Māori students. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12610000279022.