The social gradient of alcohol availability in Victoria, Australia (original) (raw)
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Australian and New Zealand Journal of Public Health, 1999
To examine the cross-sectional ecologic associations between apparent per-capita alcohol consumption, alcohol-related hospital admission rates, and the distributions of socio-demographic factors for people residing in 76 Local Government Areas (LGAs) in Victoria, during the 1995-1996 fiscal year. Visitor-adjusted per-capita alcohol consumption was obtained from wholesale sales data from the Liquor Licensing Commission Victoria. Alcohol-related hospital admission rates were extracted from the Victorian Inpatient Minimum Dataset, and adjusted by the appropriate aetiologic fractions. Summary socio-demographic measures were derived from the 1996 Census. Their associations were analysed using multiple linear regression. Per-capita alcohol consumption ranged from 4 to 14 litres absolute alcohol/year and alcohol-related hospital admission rates ranged from 5 to 25 per 10,000 residents/year (external-cause diagnoses) and 8-37 per 10,000 residents/year (disease diagnoses). Higher levels of per-capita consumption were associated with higher admission rates (r = 0.45 for external cause diagnoses, r = 0.66 for disease diagnoses, and r = 0.70 for all diagnoses), each per-capita increase of one litre/year corresponding to increased admission rates of 0.6, 1.5 and 2.1 per 10,000 person-years, respectively. Further adjustments by summary socio-demographic measures reduced, but did not modify, the associations between per-capita consumption and admission rates. Summary measures of sales-based per-capita alcohol consumption and socio-demographic environments may provide useful indicators of alcohol-related morbidity in Victorian communities.
Neighbourhood deprivation and access to alcohol outlets: A national study
Health & Place, 2009
People living in poor areas suffer higher mortality than those in wealthy areas. Environmental factors partly explain this association, including exposure to pollutants and accessibility of healthcare. We sought to determine whether proximity to alcohol outlets varied by area deprivation in New Zealand. Roadway travel distance from each census unit to the nearest alcohol outlet was summarised according to socioeconomic deprivation for each area. Analyses were conducted by license type (pubs/bars, clubs, restaurants, off-licenses) and community urban-rural status. Strong associations were found between proximity to the nearest alcohol outlet and deprivation, there being greater access to outlets in moredeprived urban areas.
Health and Place, 2009
People living in poor areas suffer higher mortality than those in wealthy areas. Environmental factors partly explain this association, including exposure to pollutants and accessibility of healthcare. We sought to determine whether proximity to alcohol outlets varied by area deprivation in New Zealand. Roadway travel distance from each census unit to the nearest alcohol outlet was summarised according to socioeconomic deprivation for each area. Analyses were conducted by license type (pubs/bars, clubs, restaurants, off-licenses) and community urban-rural status. Strong associations were found between proximity to the nearest alcohol outlet and deprivation, there being greater access to outlets in moredeprived urban areas.
BMJ Open, 2019
Introduction: Alcohol use and misuse are associated with substantial health and social issues in Australia and internationally. Pricing policy is considered as one of the most effective means to reduce risky drinking and related harms. This protocol paper describes a study that will model and estimate the effects, effectiveness and cost– benefit of alcohol pricing policy initiatives in reducing risky drinking, health and social harms, and health inequalities among subpopulations in Australia. Methods and analysis: The study is a modelling and epidemiological study using data from various resources, such as survey, previous literatures and response agencies. A number of statistical procedures will be undertaken to evaluate the impact of different alcohol pricing policy initiatives on various outcomes, including alcohol consumption in population subgroups, and health and social problems, and to measure health inequalities and cost-effectiveness of those proposed pricing policies, such as a 10% tax increase on all alcohol beverages or introduction of a minimum unit price. Ethics and dissemination: The ethics approval of this study was obtained from the College Human Ethics SubCommittee of the La Trobe University on 9 November 2017 (Ref: S17-206). While examining the heterogeneous effects of price policy across population subgroups, this study will provide the first comprehensive estimates of the likely impacts of alcohol price changes on health inequalities. The study will also provide sophisticated economic analyses of the impact of price policy changes, which is critical information for policy makers and will assist policy makers in directing resources to a more efficient alcohol strategy. Results will be made available to communities and societies, health departments and other researchers
2012
Aims and objectives The aim of this project was to examine and report on the impact of various alcohol control measures on levels of alcohol consumption and related harm in Central Australia for the period 2000-2010. Specific objectives were to: • describe trends in alcohol consumption in Central Australia; • describe trends in key indicators of alcohol-related harm; • describe key interventions aimed at reducing alcohol-related harm; • identify any changes in consumption and indicators of harm and to test whether, or to what extent, these can be attributed to particular interventions or combinations of them; and, • report on the implications for alcohol policy and strategies to reduce alcoholrelated harm. Methods The project was conducted in three overlapping stages using both quantitative and qualitative methods. Data on wholesale sales of alcoholic beverages were converted to litres of pure alcohol and were used as a proxy measure of consumption. Alcohol-related hospital separations, emergency department presentations and police incident data were used as indicators of harm. The geographic area of study was the Central Northern Territory Statistical SubDivision with 'Greater Darwin' as a control region. Two methods were used to calculate an appropriate population denominator for the calculation of rates: Estimated Residential Population (ERP) aged ≥15 years plus data on tourist numbers from various sources; and Adjusted Enumerated Population (AEP) based on adjustments to, and extrapolations from, the Enumerated Populations of persons aged ≥15 years at the 1996, 2001 and 2006 Censuses. The differences between these were small and for convenience, the latter was used. xi Further analyses were conducted using categorisations of alcohol-attributable hospital separations by commonly associated drinking pattern (i.e. acute conditions largely associated with short term drinking to intoxication and chronic, conditions which are typically associated with long term exposure) as well as level of alcoholattributable aetiologic fraction (high/medium/low/wholly). After introduction of the LSP, there was no evidence of significant change in wholly alcohol-attributable conditions (e.g. alcohol abuse, alcoholic gastritis, alcoholic psychosis, alcoholic liver cirrhosis). However, observed trends were significantly lower than forecast trends in: acute cases, particularly assaults; and conditions had 'medium' and 'low' level alcohol-attributable aetiologic fractions. A disparate proportion of the burden of separations for alcohol-attributable conditions recorded by the Alice Springs Hospital occurred among the Indigenous population and much of this was underpinned by hospitalisation for assault. Emergency Department presentations Data for alcohol-attributable Emergency Department presentations were restricted to the period from Q3 2003 onwards and did not contain sufficient information to accurately assess many acute conditions (including assault, road crashes, falls etc.). Analyses were therefore restricted primarily to presentations for chronic diseases. This was a significant limitation, as it is acute rather than chronic conditions that are most likely to be responsive to alcohol restrictions in the time-frames under consideration. Over the study period, Emergency Department presentations for alcohol-attributable chronic conditions doubled from 3.5 to 7.0 per 1000 persons. Although there was some negative impact upon this due to restrictions on the availability of takeaways >2 litres, the data indicate that this indicator continued to rise regardless of the restrictions and that after the introduction of the LSP the rate of increase exceed that compared to that expected had the pre-LSP trend continued. However, this rise is unlikely to be a function of the restrictions. A better indicator of the impact of restrictions than ED presentations for chronic conditions was Alice Springs Hospital ED presentations coded at triage as assault. In contrast to chronic conditions, and similar to alcohol-attributable hospital separations, after the introduction of the LSP, the observed rate of presentations per 1000 persons identified at triage as assault was significantly lower than that predicted on the basis of prior trends-especially from Q1 2008 onwards. Crime and Public Order Use of homicide data to measure the impact of restrictions in Alice Springs was precluded because the number was too low and variability between intervals over time was too high to subject them to statistical analyses. Analyses of other Police incident data showed that, over the study period, there were extreme fluctuations in protective custody and drink driving incidents, and there had been statistically significant increases in domestic violence and protective custody incidents. However, we were advised by officers from the NT Police that the frequency of these incidents was particularly susceptible to changes in policing policy and the allocation of resources The greatest statistically discernible impact of this reduction in consumption was a reduction in the rates of assaults-as evident in hospital separation and Emergency Department triage presentation data-and reductions in hospital separations for alcohol-attributable conditions. While the evidence presented in this study shows that price-related alcohol restrictions have had a significant effect in reducing alcohol consumption, it also shows that price is not the only variable impacting upon levels of consumption and related-harm. That levels of consumption in Central Australia remain over 30 per cent higher than the national average, that some indicators of harm continued to rise (albeit at reduced rates), and that rates of some indicators are considerably greater xiii among Indigenous than non-Indigenous residents of Central Australia indicates that significant demand factors are also driving the level of consumption. This evidence indicates that while alcohol control measures are an effective means of reducing consumption and related harm-as endorsed by Australian Governments under the National Drug Strategy-they need to be part of a comprehensive strategy that also aims to reduce harm and demand. In the latter regard, it is important that demand reduction strategies not be conceived too narrowly. As well as focusing on interventions specifically targeting alcohol use, such as prevention and health promotion, demand reduction strategies need also to focus on broad-based interventions which address the underlying social determinants of health and alcohol and other drug use, including early childhood development, education and employment programs.
BMC Public Health, 2012
Background: Excessive alcohol use is a significant problem in rural and remote Australia. The factors contributing to patterns of alcohol use have not been adequately explained, yet the geographic variation in rates suggests a potential contribution of district-level factors, such as socio-economic disadvantage, rates of population change, environmental adversity, and remoteness from services/population centres. This paper aims to investigate individual-level and district-level predictors of alcohol use in a sample of rural adults. Methods: Using baseline survey data (N = 1,981) from the population-based Australian Rural Mental Health Study of community dwelling residents randomly selected from the Australia electoral roll, hierarchal logistic regression models were fitted for three outcomes: 1) at-risk alcohol use, indicated by Alcohol Use Disorders Identification Test scores ≥8; 2) high alcohol consumption (> 40 drinks per month); and 3) lifetime consequences of alcohol use. Predictor variables included demographic factors, pre-dispositional factors, recent difficulties and support, mental health, rural exposure and district-level contextual factors. Results: Gender, age, marital status, and personality made the largest contribution to at-risk alcohol use. Five or more adverse life events in the past 12 months were also independently associated with at-risk alcohol use (Adjusted Odds Ratio [AOR] 3.3, 99%CI 1.2, 8.9). When these individual-level factors were controlled for, at-risk alcohol use was associated with having spent a lower proportion of time living in a rural district (AOR 1.7, 99%CI 1.3, 2.9). Higher alcohol consumption per month was associated with higher district-level socio-economic ranking, indicating less disadvantage (AOR 1.2, 99%CI 1.02, 1.4). Rural exposure and district-level contextual factors were not significantly associated with lifetime consequences of alcohol use.
Individual and community correlates of young people's high-risk drinking in Victoria, Australia
Drug and Alcohol Dependence, 2008
Objectives: To examine key individual-and community-level correlates of regular very high-risk drinking (more than 20 drinks at least 12 times a year for males and more than 11 drinks at least 12 times a year for females) among young (16-24) drinkers in Victoria. Methods: CATI survey of 10,879 young Victorian drinkers. Multi-level modelling of correlates of proportion drinking at very high-risk levels at both individual (e.g. age, gender) and community levels (e.g. alcohol outlet density, remoteness). Results: One-fifth of the sample reported regular (at least monthly) very high-risk drinking. Significant individual-level correlates of very high-risk drinking included age, gender, cultural background, recreational spending money, life stage, living situation, family conflict and age at first drink. Significant community-level correlates included remoteness (living in a rural area) and packaged liquor outlet density. Conclusions: The study highlights a range of important factors relating to regular drinking of dangerous amounts of alcohol by youth. Interventions aimed at preventing early initiation or managing recreational spending should be explored. Further, regulatory management of packaged liquor outlets and or remote rural communities in Victoria with high levels of dangerous drinking should be a priority.