The economic burden of ill health due to diet, physical inactivity, smoking, alcohol and obesity in the UK : an update to 2006-07 NHS costs

Background: Estimates of the economic cost of risk factors for chronic disease to the NHS provide evidence for prioritization of resources for prevention and public health. Previous comparable estimates of the economic costs of poor diet, physical inactivity, smoking, alcohol and overweight/obesity were based on economic data from 1992–93.

Methods: Diseases associated with poor diet, physical inactivity, smoking, alcohol and overweight/obesity were identified. Risk factor-specific population attributable fractions for these diseases were applied to disease-specific estimates of the economic cost to the NHS in the UK in 2006–07.

Results: In 2006–07, poor diet-related ill health cost the NHS in the UK £5.8 billion. The cost of physical inactivity was £0.9 billion. Smoking cost was £3.3 billion, alcohol cost £3.3 billion, overweight and obesity cost £5.1 billion.

Conclusion: The estimates of the economic cost of risk factors for chronic disease presented here are based on recent financial data and are directly comparable. They suggest that poor diet is a behavioural risk factor that has the highest impact on the budget of the NHS, followed by alcohol consumption, smoking and physical inactivity.

Youth alcohol and other drug use in the United States and Australia: a cross-national comparison of three state-wide samples

Although youth drug and alcohol harm minimization policies in Australia are often contrasted with the abstinence and zero tolerance policies adopted in the United States, there has been little research directly comparing youth substance use behaviour in the two countries. Three state representative samples in Victoria, Australia (n = 7898) and in the US states of Oregon (n = 15 224) and Maine (n = 16 245) completed a common cross-sectional student survey. Rates of alcohol use (lifetime alcohol use, recent use in the past 30 days), alcohol use exceeding recommended consumption limits (binge drinking: five or more drinks in a session), other licit drug use (tobacco use), and norm-violating substance use (substance use at school, use in the past 30 days of marijuana or other illicit drug use) were compared for males and females at ages 12-17. Rates were lower (odds ratios 0.5-0.8) for youth in Maine and Oregon compared to Victoria for lifetime and recent alcohol use, binge drinking and daily cigarette smoking. However, rates of recent marijuana use and recent use of other illicit drugs were higher in Maine and Oregon, as were reports of being drunk or high at school. In contradiction of harm minimization objectives, Victoria, relative to the US states of Oregon and Maine, demonstrated higher rates of alcohol use exceeding recommended consumption limits and daily tobacco use. However, findings suggested that aspects of norm-violating substance use (substance use at school, marijuana use and other illicit drug use) were higher in the US states compared to Victoria.

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.

Alcohol and drug use in Australian male sex workers: its relationship to the safety outcome of the sex encounter

This paper describes the self-reporting patterns of alcohol and drug consumption among male sex workers (MSWs) in three Australian cities during commercial sex encounters, and examines to what extent alcohol and drugs are used and whether this is related to the safe/unsafe outcome of the commercial sex encounter. One hundred and eighty-six MSWs from Brisbane, Sydney and Melbourne completed a diary following each commercial sex encounter over a two-week period. MSWs reported 2,087 commercial sex encounters during the study period. Alcohol or drug consumption was reported in 50.5% of the encounters.

Sporting clubs, alcohol and young people : enduring tensions and emerging possibilities

This paper examines data from a research project that investigated the cultural drivers of drinking in 14-24 year-old Australians, funded by Drinkwise Australia and the Department of Health and Ageing. At the same time that we were working on this project a moral panic about young people, risk and binge drinking had once more energised public debate. Prominent here was the highly politicised imputation of a strategic taxation levy on ready to drink products (alcopopos). This qualitative, interview-based project examined two separate but related aspects of young people's alcohol use: the roles played by sporting clubs, as community hubs, in shaping young people's use of alcohol: and young people's drinking biographies over different phases of their lives. This paper will focus on the sporting club study to discuss issues related to the positioning and serving of alcohol in the relation to young people. As part of the study, we conducted interviews with club administrators and young people in a range of sporting clubs. Insights from the study give rise to the potential for clubs to play an active and influential role in helping young people create positive/responsible approaches to alcohol consumption.

Measuring quality of life in alcohol and other drug users - the need for improvement

Objective : The use of Quality of Life (QoL) -related measures in Alcohol and Other Drug-related research has increased dramatically over the past decade. However, there remains a great deal of confusion about which type of QoL measure is most valid, what each constrict actually measures and the ethicality of the process of QoL measurement and its subsequent transfer to monetary value. This is particularly important in regard to subsequent resource allocation on the basis of Quality Adjusted Life Years (QALYs). We aim to review the logic of current QoL -related measurement and determine the most conceptually valid way of measuring QoL.

Methods : This review considers some of the broad principles that concern quality of life assessment. These are discussed in relation to health-related quality of life (HRQoL) and the measurement of subjective well-being.

Results : We argue that there are serious logical and methodological issues concerning HRQoL measurement, to the extent that the instruments may not be regarded as valid measures of life quality as this term is generally understood.

Conclusions : It is recommended that HRQoL measurement be abandoned in favour of three separate forms of measurement as medical symptoms, subjective well-being and specific dimensions of psychological ill-being.

The regulation of research by funding bodies : an emerging ethical issue for the alcohol and other drug sector?

The degree to which funding bodies can and do control the content and dissemination of research products raises important issues which need to be openly debated by the alcohol and other drug (AOD) sector. Current policies relating to censorship and other means of controlling research topics or output are explored alongside an examination of how some institutions, particularly some academic journals, deal with such issues. We argue that regulation of research by funding bodies clearly contravenes the scientific ideal of freedom of information and open access to knowledge. Using international ethical guidelines, we also demonstrate that regulation raises concerns in relation to the ethical concept of beneficence. A number of examples specific to harm reduction strategies are presented in order to demonstrate how censorship might conceivably increase the harms associated with drug use. The commentary closes with recommendations concerning the establishment the prevalence of censorship and other forms of control over research in the AOD sector, and the role that ethics committees, journal editorial boards and professional societies might play in resisting the imposition of unacceptable conditions on publication of findings.

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.

Prevention of alcohol and other drug problems in culturally and linguistically diverse communities

Australia has long been known as a multicultural society. In 2009 around one-quarter of Australia’s population was born overseas and immigrants come from more than 200 countries. While most of Australia’s migrants come from New Zealand, the United Kingdom, India or China, the fastest growing immigrant populations are from sub-Saharan and northern Africa, and the Middle East. Immigrants from a non-English speaking country, as well as their children and grandchildren, are commonly referred to as culturally and linguistically diverse (CLD) as a way of acknowledging differences in ethnic identity and affiliation, as well as cultural and language practices and preferences. Culturally and linguistically diverse groups in Australia face many health challenges, one of which is a potential vulnerability to alcohol and other drug (AOD) use.

The primary aim of this paper is to identify and evaluate primary prevention programs and initiatives aimed at preventing AOD harms in CLD communities.

The prevalence of work-related deaths associated with alcohol and drugs in Victoria, Australia, 2001 - 6

To describe the presence of alcohol, cannabis and amphetamines in work-related injury deaths in Victoria, 2001–6, an observational study of work-related deaths reported to the State Coroner's Office, Victoria, Australia was conducted. Case and postmortem forensic toxicology data were obtained from the National Coroner's Information System for work-related injury deaths with positive toxicology screens. Over 6 years there were 43 worker deaths in a total of 355 unintentional work-related injury deaths. The coroner mentioned the presence of alcohol/drugs in 22 of the 43 worker deaths with positive toxicology screens. Toxicology screens were positive for alcohol and/or drugs in 79 work-related deaths overall. Overall, alcohol was present in 26 (7%) work-related deaths and cannabis or amphetamines in 20 (6%). Incidents were mainly transport related. Alcohol and/or drugs were present in a significant portion of work-related deaths. Research is needed to determine the relative contribution of alcohol and drugs compared with other contributing factors to work-related deaths.

I don't know anyone that has two drinks a day : young people, alcohol and the government of pleasure

Problematic alcohol consumption is a major public health, health education and health promotion issue in Australia and internationally. In an effort to better understand young people's drinking patterns and motivations we investigated the cultural drivers of drinking in 14–24 year-old Australians. We interviewed 60 young people in the state of Victoria aged 20–24 about their drinking biographies. At the time of interviewing, the draft guidelines on low-risk drinking were released by the National Health and Medical Research Council, Australia, and we asked our participants what they knew about them and if they thought they would affect their drinking patterns. Their responses indicate that pleasure and sociability are central to young people's drinking cultures which is supported by a range of research. However, O’Malley and Valverde claim that pleasure is silenced and/or deployed strategically in neo-liberal governance discourses about drugs and alcohol such as these guidelines which raises questions about the limits of such discourses to affect changes in drinking patterns.