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.

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]*

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.

Aptamer-based therapeutics of the past, present and future: from the perspective of eye-related diseases

 Aptamers have emerged as a novel and powerful class of biomolecules with an immense untapped potential. The ability to synthesise highly specific aptamers against any molecular target make them a vital cog in the design of effective therapeutics for the future. However, only a minutia of the enormous potential of this dynamic class of molecule has been exploited. Several aptamers have been studied for the treatment of eye-related disorders, and one such strategy has been successful in therapy. This review gives an account of several eye diseases and their regulatory biomolecules where other nucleic acid therapeutics have been attempted with limited success and how aptamers, with their exceptional flexibility to chemical modifications, can overcome those inherent shortcomings.

Study protocol: asking questions about alcohol in pregnancy (AQUA): a longitudinal cohort study of fetal effects of low to moderate alcohol exposure

Despite extensive research, a direct correlation between low to moderate prenatal alcohol exposure (PAE) and Fetal Alcohol Spectrum Disorders has been elusive. Conflicting results are attributed to a lack of accurate and detailed data on PAE and incomplete information on contributing factors. The public health effectiveness of policies recommending complete abstinence from alcohol during pregnancy is challenged by the high frequency of unplanned pregnancies, where many women consumed some alcohol prior to pregnancy recognition. There is a need for research evidence emphasizing timing and dosage of PAE and its effects on child development.

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.

Typology of alcohol mixed with energy drink consumers: motivations for use

Background: Previous research on alcohol mixed with energy drinks (AmED) has shown that use is typically driven by hedonistic, social, functional, and intoxication-related motives, with differential associations with alcohol-related harm across these constructs. There has been no research looking at whether there are subgroups of consumers based on patterns of motivations. Consequently, the aims were to determine the typology of motivations for AmED use among a community sample and to identify correlates of subgroup membership. In addition, we aimed to determine whether this structure of motivations applied to a university student sample. Methods: Data were used from an Australian community sample (n = 731) and an Australian university student sample (n = 594) who were identified as AmED consumers when completing an online survey about their alcohol and ED use. Participants reported their level of agreement with 14 motivations for AmED use; latent classes of AmED consumers were identified based on patterns of motivation endorsement using latent class analysis. Results: A 4-class model was selected using data from the community sample: (i) taste consumers (31%): endorsed pleasurable taste; (ii) energy-seeking consumers (24%): endorsed functional and taste motives; (iii) hedonistic consumers (33%): endorse pleasure and sensation-seeking motives, as well as functional and taste motives; and (iv) intoxication-related consumers (12%): endorsed motives related to feeling in control of intoxication, as well as hedonistic, functional, and taste motives. The consumer subgroups typically did not differ on demographics, other drug use, alcohol and ED use, and AmED risk taking. The patterns of motivations for the 4-class model were similar for the university student sample. Conclusions: This study indicated the existence of 4 subgroups of AmED consumers based on their patterns of motivations for AmED use consistently structured across the community and university student sample. These findings lend support to the growing conceptualization of AmED consumers as a heterogeneous group in regard to motivations for use, with a hierarchical and cumulative class order in regard to the number of types of motivation for AmED use. Prospective research may endeavor to link session-specific motives and outcomes, as it is apparent that primary consumption motives may be fluid between sessions.

Web-based alcohol screening and brief intervention for university students: a randomized trial

IMPORTANCE: Unhealthy alcohol use is a leading contributor to the global burden of disease, particularly among young people. Systematic reviews suggest efficacy of web-based alcohol screening and brief intervention and call for effectiveness trials in settings where it could be sustainably delivered. OBJECTIVE: To evaluate a national web-based alcohol screening and brief intervention program. DESIGN, SETTING, AND PARTICIPANTS: A multisite, double-blind, parallel-group, individually randomized trial was conducted at 7 New Zealand universities. In April and May of 2010, invitations containing hyperlinks to the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) screening test were e-mailed to 14,991 students aged 17 to 24 years. INTERVENTIONS: Participants who screened positive (AUDIT-C score ≥4) were randomized to undergo screening alone or to 10 minutes of assessment and feedback (including comparisons with medical guidelines and peer norms) on alcohol expenditure, peak blood alcohol concentration, alcohol dependence, and access to help and information. MAIN OUTCOMES AND MEASURES: A fully automated 5-month follow-up assessment was conducted that measured 6 primary outcomes: consumption per typical occasion, drinking frequency, volume of alcohol consumed, an academic problems score, and whether participants exceeded medical guidelines for acute harm (binge drinking) and chronic harm (heavy drinking). A Bonferroni-corrected significance threshold of .0083 was used to account for the 6 comparisons and a sensitivity analysis was used to assess possible attrition bias. RESULTS: Of 5135 students screened, 3422 scored 4 or greater and were randomized, and 83% were followed up. There was a significant effect on 1 of the 6 prespecified outcomes. Relative to control participants, those who received intervention consumed less alcohol per typical drinking occasion (median 4 drinks [interquartile range {IQR}, 2-8] vs 5 drinks [IQR 2-8]; rate ratio [RR], 0.93 [99.17% CI, 0.86-1.00]; P = .005) but not less often (RR, 0.95 [99.17% CI, 0.88-1.03]; P = .08) or less overall (RR, 0.95 [99.17% CI, 0.81-1.10]; P = .33). Academic problem scores were not lower (RR, 0.91 [99.17% CI, 0.76-1.08]; P = .14) and effects on the risks of binge drinking (odds ratio [OR], 0.84 [99.17% CI, 0.67-1.05]; P = .04) and heavy drinking (OR, 0.77 [99.17% CI, 0.56-1.05]; P = .03) were not significantly significant. In a sensitivity analysis accounting for attrition, the effect on alcohol per typical drinking occasion was no longer statistically significant. CONCLUSIONS AND RELEVANCE: A national web-based alcohol screening and brief intervention program produced no significant reductions in the frequency or overall volume of drinking or academic problems. There remains a possibility of a small reduction in the amount of alcohol consumed per typical drinking occasion. TRIAL REGISTRATION: anzctr.org.au Identifier: ACTRN12610000279022.

Evaluating a school-based alcohol program: the WARP experience

The Western Alcohol Reduction Program (WARP) is a community designed and lead, secondary school-based, program that seeks to address issues related to alcohol use by young people in the Melbourne western metropolitan region. Taking a whole-of community approach, the program consisted of six programs for a class of 20 students from schools in western Melbourne. The program sought to highlight negative influences of alcohol on life outcomes, and addresses the issues of alcohol-related behaviour in assaults, injuries and preventable consequences of risk-taking behaviour. The findings of this evaluation suggest that students have modified some of their drinking behaviours over the program, have modified some of their risky behaviours and have increased their knowledge in some areas. This program, designed specifically to meet the needs of the local school and students, has the potential to increase the alcohol- and drug-related knowledge of students, while also having a positive impact on alcohol-related behaviours.

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.

The density of alcohol outlets and adolescent alcohol consumption: an Australian longitudinal analysis

 Higher density of alcohol outlets has been linked to increased levels of adolescent alcohol-related behaviour. Research to date has been cross-sectional. A longitudinal design using two waves of annual survey data from the Australian arm of the International Youth Development Study was used. The sample comprised 2835 individuals with average age at wave 2 of 14 years (SD=1.67; range=11–17 years). GSEM was used to examine how absolute levels of alcohol outlet density was associated with student-reported alcohol use one year later, while controlling for prior alcohol use, risk factors at wave one and changes in density over the 2 years. Adolescents' perception of alcohol availability and friends' alcohol use were tested as potential mediators of the association between alcohol outlet density and adolescent alcohol use. Elasticity modelling identified a 10% increase in overall density at wave one was associated with an approximately 17% increase in odds of adolescent alcohol consumption at wave two. Living in areas with a higher density of outlets was associated with a statistically significant increase in the likelihood of adolescents developing early age alcohol consumption.

Improving the implementation of responsible alcohol management practices by community sporting clubs: A randomised controlled trial

INTRODUCTION AND AIMS: Despite an increased prevalence of risky alcohol consumption and alcohol-related harm among members of sporting groups and at sporting venues, sporting clubs frequently fail to implement alcohol management practices consistent with liquor legislation and best practice guidelines. The aim of this study was to assess the impact of a multi-strategy intervention in improving the implementation of responsible alcohol management practices by sports clubs. DESIGN AND METHODS: A randomised controlled trial was conducted with 87 football clubs, with half randomised to receive a multi-strategy intervention to support clubs to implement responsible alcohol management practices. The 2-year intervention, which was based on implementation and capacity building theory and frameworks, included project officer support, funding, accreditation rewards, printed resources, observational audit feedback, newsletters, training and support from state sporting organisations. Interviews were undertaken with club presidents at baseline and post-intervention to assess alcohol management practice implementation. RESULTS: Post-intervention, 88% of intervention clubs reported implementing '13 or more' of 16 responsible alcohol management practices, which was significantly greater than the proportion of control groups reporting this level of implementation (65%) [odds ratio: 3.7 (95% confidence interval: 1.1-13.2); P = 0.04]. All intervention components were considered highly useful and three-quarters or more of clubs rated the amount of implementation support to be sufficient. DISCUSSION AND CONCLUSIONS: The multi-strategy intervention was successful in improving alcohol management practices in community sports clubs. Further research is required to better understand implementation barriers and to assess the long-term sustainability of the change in club alcohol management practices.

Social desirability bias in the reporting of alcohol consumption: a randomized trial

OBJECTIVE: To investigate reporting of alcohol consumption, we manipulated the contexts of questions in ways designed to induce social desirability bias. METHOD: We undertook a two-arm, parallel-group, individually randomized trial at an Australian public university. Students were recruited by email to a web-based "Research Project on Student Health Behavior." Respondents answered nine questions about their physical activity, diet, and smoking. They were unknowingly randomized to a group presented with either (A) three questions about their alcohol consumption or (B) seven questions about their alcohol dependence and problems (under a prominent header labeled "Alcohol Use Disorders Identification Test"), followed by the same three alcohol consumption questions from (A). RESULTS: A total of 3,594 students (mean age = 27, SD = 10) responded and were randomized: 1,778 to Group A and 1,816 to Group B. Outcome measures were the number of days they drank alcohol, the typical number of drinks they consumed per drinking day, and the number of days they consumed six or more drinks. The primary analysis included participants with any alcohol consumption in the preceding 4 weeks (1,304 in Group A; 1,340 in Group B) using between-group, two-tailed t tests. RESULTS: In Groups A and B, respectively, means (and SDs) of the number of days drinking were 5.89 (5.92) versus 6.06 (6.12), p = .49; typical number of drinks per drinking day: 4.02 (3.87) versus 3.82 (3.76), p = .17; and number of days consuming six or more drinks: 1.69 (2.94) versus 1.67 (3.25), p = .56. CONCLUSIONS: We could not reject the null hypothesis because earlier questions about alcohol dependence and problems showed no sign of biasing the respondents' subsequent reports of alcohol consumption. These data support the validity of university students' reporting of alcohol consumption in web-based studies.

"If you can have one glass of wine now and then, why are you denying that to a woman with no evidence": Knowledge and practices of health professionals concerning alcohol consumption during pregnancy.

BACKGROUND: Alcohol consumption during pregnancy has the potential to cause significant harm to the foetus and the current Australian guidelines state that it is safest not to drink alcohol while pregnant. However, conflicting messages often appear in the media and it is unclear if the message to avoid alcohol is being effectively conveyed to pregnant women. AIMS: This research aims to explore the advice that health professionals provide to pregnant women about alcohol consumption; the knowledge of health professionals regarding the effects of alcohol consumption; and their consistency with following the Australian guidelines. METHODS: Ten semi-structured face to face interviews were conducted with health professionals who regularly provide antenatal care. These include midwives, obstetricians, and shared care general practitioners. A six-stage thematic analysis framework was used to analyse the interview data in a systematic way to ensure rigour and transparency. The analysis involved coding data extracts, followed by identifying the major themes. FINDINGS: Health professionals displayed adequate knowledge that alcohol can cause physical and mental difficulties that are lifelong; however, knowledge of the term FASD and the broad spectrum of difficulties associated with alcohol consumption during pregnancy was limited. Although health professionals were willing to discuss alcohol with pregnant women, many did not make this a routine part of practice, and several concerning judgements were noted. CONCLUSION: Communication between health professionals and pregnant women needs to be improved to ensure that accurate information about alcohol use in pregnancy is being provided. Further, it is important to ensure that the national guidelines are being supported by health professionals.