![The distribution of drinkers in England, 2014 [i] (40)](https://www.researchgate.net/profile/Robyn-Burton-4/publication/311309087/figure/fig4/AS:434796485713920@1480674968164/The-distribution-of-drinkers-in-England-2014-i-40_Q320.jpg)
![The proportion of adults drinking more than 14 units [i] of alcohol per week by age and gender, England, 2014 (40)](https://www.researchgate.net/profile/Robyn-Burton-4/publication/311309087/figure/fig5/AS:434796485713924@1480674968581/The-proportion-of-adults-drinking-more-than-14-units-i-of-alcohol-per-week-by-age-and_Q320.jpg)
Content uploaded by Robyn Burton
Author content
All content in this area was uploaded by Robyn Burton on Dec 02, 2016
Content may be subject to copyright.
A preview of the PDF is not available
The public health burden of alcohol and the effectiveness and cost-effectiveness of alcohol control policies: an evidence review
Abstract and Figures
Alcohol is a prominent commodity in the UK marketplace. It is widely used in numerous social situations. For many, alcohol is associated with positive aspects of life; however there are currently over 10 million people drinking at levels which increase their risk of health harm. Among those aged 15 to 49 in England, alcohol is now the leading risk factor for ill-health, early mortality and disability and the fifth leading risk factor for ill health across all age groups.
Since 1980, sales of alcohol in England and Wales have increased by 42%, from roughly 400 million litres in the early 1980s, with a peak at 567 million litres in 2008, and a subsequent decline. This growth has been driven by increased consumption among women, a shift to higher strength products, and increasing affordability of alcohol, particularly through the 1980s and 1990s. Over this period, the way in which alcohol is sold and consumed also changed. In 2016 there were 210,000 licensed premises in England and Wales, a 4% increase on 2010. There has been a shift in drinking location such that most alcohol is now bought from shops and drunk at home. Although consumption has declined in recent years, levels of abstinence have also
increased. Consequently, it is unclear how much of the decline is actually related to drinkers consuming less alcohol and how much to an increasing proportion of the population not drinking at all.
In recent years, many indicators of alcohol-related harm have increased. There are now over 1 million hospital admissions relating to alcohol each year, half of which occur in the lowest three socioeconomic deciles. Alcohol-related mortality has also increased, particularly for liver disease which has seen a 400% increase since 1970, and this trend is in stark contrast to much of Western Europe. In England, the average age at
death of those dying from an alcohol-specific cause is 54.3 years. The average age of death from all causes is 77.6 years. More working years of life are lost in England as a result of alcohol-related deaths than from cancer of the lung, bronchus, trachea, colon, rectum, brain, pancreas, skin, ovary, kidney, stomach, bladder and prostate, combined.
Despite this burden of harm, some positive trends have emerged over this period, particularly indicators which relate to alcohol consumption among those aged less than 18 years, and there have been steady reductions in alcohol-related road traffic crashes.
The public health burden of alcohol is wide ranging, relating to health, social or economic harms. These can be tangible, direct costs (including costs to the health, criminal justice and welfare systems), or indirect costs (including the costs of lost productivity due to absenteeism, unemployment, decreased output or lost working
years due to premature pension or death). Harms can also be intangible, and difficult to cost, including those assigned to pain and suffering, poor quality of life or the emotional distress caused by living with a heavy drinker. The spectrum of harm ranges from those that are relatively mild, such as drinkers loitering near residential streets, through to those that are severe, including death or lifelong disability. Many of these harms impact upon other people, including relationship partners, children, relatives, friends, coworkers
and strangers.
In sum, the economic burden of alcohol is substantial, with estimates placing the annual cost to be between 1.3% and 2.7% of annual GDP. Few studies report costs on the magnitude of harm to people other than the drinker, so the economic burden of alcohol consumption is generally underestimated. Crucially, the financial burden which alcohol-related harm places on society is not reflected in its market price, with taxpayers picking up a larger amount of the overall cost compared to the individual drinkers. This should provide impetus for governments to implement effective policies to reduce the public health impact of alcohol, not only because it is an intrinsically desirable societal goal, but because it is an important aspect of economic growth and competitiveness.
Reflecting three key influencers of alcohol consumption – price (affordability), ease of purchase (availability) and the social norms around its consumption (acceptability) – an extensive array of policies have been developed with the primary aim of reducing the public health burden of alcohol. The present review evaluates the effectiveness and cost-effectiveness of each of these policy approaches.
Figures - uploaded by Robyn Burton
Author content
All figure content in this area was uploaded by Robyn Burton
Content may be subject to copyright.
... According to Public Health England (Burton et al, 2016), alcohol is increasingly a leading cause of death in the 50-69 age group in England. This group has the highest rate of alcohol consumption, and it is a particular problem among women (Burton et al, 2016;Nazarko, 2019). ...
... According to Public Health England (Burton et al, 2016), alcohol is increasingly a leading cause of death in the 50-69 age group in England. This group has the highest rate of alcohol consumption, and it is a particular problem among women (Burton et al, 2016;Nazarko, 2019). With consumption rising rapidly overall, there is an increased risk that young and middle-aged people will develop alcohol-related dementia in the future (Sachdeva et al, 2016;Sabia et al, 2018). ...
Dementia is one of the leading causes of death both in the UK and worldwide. Approximately 1 million people have been diagnosed with this condition in the UK. Although there are many types of dementia, this article will focus on alcohol-related dementia. Alcohol has become a leading cause of death in the 50−69-year age group in England, and with consumption rising rapidly, there is an increased risk that young and middle-aged people will develop alcohol-related dementia in the future. The aim of this article is to review the evidence base and discuss whether alcohol-related dementia is a sub-class of dementia or a separate entity.
... Approximately 1 in 4 adults in the UK regularly drink alcohol at levels above recommended lower-risk guidelines, accounting for significant health and social costs (Burton et al., 2016;NICE, 2010). Further, harms associated with Alcohol Use Disorder (AUD), 1 including alcohol-related deaths are expected to continue to rise following the COVID-19 pandemic (Angus et al., 2022;Garnett et al., 2021). ...
... 13 This policy area has been widely regarded as ineffective on its own, and recommended only to support other effective policy options. [13][14][15] Nevertheless, temporary abstinence campaigns may differ from other options under the same policy area as a small but growing body of evidence suggests some effectiveness in reducing consumption and improving health. 9 16 17 A prospective study of Dry January participants, who self-enrolled on the campaign website, demonstrated that the campaign led to a reduction in drinking frequency, drinking quantity and intoxication episodes. ...
Rationale
A small number of earlier studies have suggested an effect of temporary abstinence campaigns on alcohol consumption. However, all were based on self-reported consumption estimates.
Objectives
Using a time series of 23-year monthly alcohol sales data, this study examined the effect of an annual temporary abstinence campaign, which has been organised annually since 2003 during the Buddhist Lent period (spanning 3 months), on population-level alcohol consumption.
Methods
Data used in the analysis included a time series of monthly alcohol sales data from January 1995 to September 2017 and the midyear population counts for those years. Generalised additive models (GAM) were applied to estimate trends as smooth functions of time, while identifying a relationship between the Buddhist Lent abstinence campaigns on alcohol consumption. The sensitivity analysis was performed using a seasonal autoregressive integrated moving average with exogenous variables (SARIMAX) model.
Intervention
The Buddhist Lent abstinence campaign is a national mass media campaign combined with community-based activities that encourages alcohol abstinence during the Buddhist Lent period, spanning 3 months and varying between July and October depending on the lunar calendar. The campaign has been organised annually since 2003.
Main outcome
Per capita alcohol consumption using monthly alcohol sales data divided by the midyear total population number used as a proxy.
Results
Median monthly per capita consumption was 0.43 (IQR: 0.37 to 0.51) litres of pure alcohol. Over the study period, two peaks of alcohol consumption were in March and December of each year. The significant difference between before-campaign and after-campaign coefficients in the GAM, −0.102 (95% CI: −0.163 to –0.042), indicated an effect of the campaign on alcohol consumption after adjusting for the time trend and monthly seasonality, corresponding to an average reduction of 9.97% (95% CI: 3.65% to 24.18%). The sensitivity analyses produced similar results, where the campaign was associated with a decrease in consumption of 8.1% (95% CI: 0.4% to 15.7%).
Conclusions
This study demonstrated that the temporary abstinence campaign was associated with a decrease in population-level alcohol consumption during campaign periods. The finding contributed to a growing body of evidence on the effectiveness of emerging temporary abstinence campaigns.
... Instead, industry participants emphasised a need for more public information campaigns, despite the lack of evidence for the effectiveness of privately sponsored public messaging on alcohol harms. 10 These suggestions are at odds with the evidence, 10 civil society, 11 and guidance from the WHO. 12 Second, on industry claiming credit for positive trends while downplaying its role in alcohol harms. The alcohol industry has claimed credit for positive trends in alcohol use (for example, declines in youth drinking), 13 while downplaying, or avoiding responsibility for, negative trends (for example, all time highs in alcohol related deaths across the UK). ...
Objective and rationale
This study assessed support for novel tobacco compared with alcohol control policies among adults in Great Britain in 2021–2023. Objectives were to assess 1) overall level of support for tobacco compared to alcohol control policies; 2) level of support for tobacco compared to alcohol control policies among people who smoke tobacco or who consume alcohol at increasing and higher risk levels, or who do both; 3) level of support for tobacco compared to alcohol control policies among different sociodemographic groups?
Methods
Data were collected in September/October 2021–2023 in a monthly population-based survey on smoking and drinking behaviour of adults across Great Britain (N = 6311), weighted to match the overall population. Outcome measure was level of support for each seven tobacco and alcohol control policies.
Results
More people were in support of tobacco than alcohol control policies (e.g., 57 % vs. 51 % for tax-related policies). This trend was apparent across all sociodemographic subgroups. With one exception, the policies included in this study were supported by more than half of the participants. The exception was decreasing the visibility of alcohol products in shops, which received 41 % of support. People who engaged in the behaviour targeted by policies (tobacco more so than alcohol use) were generally less supportive.
Conclusion
Overall, public support for tobacco and alcohol control policies is high in Great Britain. With one exception, the policies were supported by over half of participants, suggesting that the public is in favour of government regulations to reduce smoking and drinking prevalence in Great Britain.
The prevalence of obesity, metabolic syndrome, and the associated long-term chronic diseases (cardiovascular disease, type II diabetes, cancer, Alzheimer’s disease, depression) have reached epidemic levels in the United States and Western nations. In response to this public health calamity, the author of this paper presents and defends a novel bioethical argument: the consistency argument for outlawing SSBs (sugar-sweetened beverages) for child consumption (the “consistency argument”). This argument’s radical conclusion states that the government is justified in outlawing SSBs consumption for child consumption. The reasoning is as follows: if one accepts that the physical harm caused by chronic alcohol consumption justifies the government outlawing alcoholic beverages for child consumption, and there is strong evidence that comparable physical harms result from chronic SSBs consumption, then, mutatis mutandis, the government is also justified in outlawing child consumption of SSBs. To support this argument, the author provides extensive evidence based on epidemiological observational studies, interventional studies, controlled trials, large meta-analyses, and the pathophysiology and biological mechanisms of action behind SSBs and chronic disease. Chronic consumption of large doses of SSBs and alcoholic beverages both drive the same diseases: obesity and insulin resistance, cardiovascular disease, hypertension, and cancer. Chronic SSB consumption carries the additional risk of Alzheimer’s disease, dementia, and depression. The author concludes this paper by considering prominent objections to the consistency argument, and then demonstrating that each objection is unsound.
Background: Alcohol industry organisations occupy a prominent position in UK alcohol policy, but their involvement has been contested by public health bodies on the basis that a conflict of interest (COI) exists between their economic objectives and those of public health. There are ongoing debates in the research literature about how to conceptualise COI and mitigate this in health research and practise. However, less attention has been paid to these issues in relation to the alcohol industry specifically. This article explores similarities and differences in beliefs among alcohol policy actors regarding COI and the implications of engagement with the alcohol industry in the context of UK public health policy.
Methods: Semi-structured interviews with a range of policy actors (n=26) including medical professionals, parliamentarians, civil servants, academic researchers, health campaigners, and alcohol industry representatives. Interviews with alcohol industry representatives were supplemented with an analysis of industry responses to a public consultation. All data was thematically coded using NVivo software.
Results: Two competing "coalitions" were identified, expressing beliefs about COI linked to alcohol industry engagement. Both divergent and convergent beliefs were expressed by the two coalitions in relation to the type of industry actor, form of engagement, the policy issue under discussion and the stage of policy process.
Conclusion: Alcohol policy is a complex and contested space in which policy actors have differing, nuanced and contingent understandings of COI and identify varying risks associated with alcohol industry engagement. In identifying the areas of convergence and diversion in both understanding and evaluation of COI in alcohol-specific settings, these findings will assist both decision-makers and non-governmental actors in developing policies and guidelines to manage potential COI in future.
Background Increased taxation is recognised worldwide as one of the most effective interventions for decreasing tobacco and harmful alcohol use, with many variations of policy options available. This rapid scoping review was part of a NIHR-funded project (‘SYNTAX’ 16/105/26) and was undertaken during 2018 to inform interviews to be conducted with UK public health stakeholders with expertise in alcohol and tobacco pricing policy. Methods Objectives: To synthesise evidence and debates on current and potential alcohol and tobacco taxation options for the UK, and report on the underlying objectives, evidence of effects and mediating factors. Eligibility criteria: Peer-reviewed and grey literature; published 1997–2018; English language; UK-focused; include taxation interventions for alcohol, tobacco, or both. Sources of evidence: PubMed, Scopus, Cochrane Library, Google, stakeholder and colleague recommendations. Charting methods Excel spreadsheet structured using PICO framework, recording source characteristics and content. Results Ninety-one sources qualified for inclusion: 49 alcohol, 36 tobacco, 6 both. Analysis identified four policy themes: changes to excise duty within existing tax structures, structural reforms, industry measures, and hypothecation of tax revenue for public benefits. For alcohol, policy options focused on raising the price of cheap, high-strength alcohol. For tobacco, policy options focused on raising the price of all tobacco products, especially the cheapest products, which are hand-rolling tobacco. For alcohol and tobacco, there were options such as levies that take money from the industries to help reduce the societal costs of their products. Due to the perceived social and economic importance of alcohol in contrast to tobacco, policy options also discussed supporting pubs and small breweries. Conclusions This review has identified a set of tax policy options for tobacco and alcohol, their objectives, evidence of effects and related mediating factors. The differences between alcohol and tobacco tax policy options and debates suggest an opportunity for cross-substance policy learning.
The article reviews the large body of evidence on how taxation affects the consumption of tobacco, alcohol, and sugar-sweetened beverages (SSB). There is abundant evidence that demand for tobacco, alcohol, and SSB is price-responsive and that tax changes are quickly passed on to consumers. This suggests that taxes can be highly effective in changing consumption and reducing the burden of diseases associated with consuming these products. Tobacco, alcohol, and SSB industries oppose taxation on similar grounds, mostly on the regressivity of taxes since regressive taxes take a larger percentage of income from low income earners than from middle and high income earners; but also on the effects taxes might have on employment and economic activity; and, in the case of tobacco, the effects taxation has on illicit trade.
Contrary to industry arguments, evidence shows that taxation may have short-term negative financial consequences for low-income households. However, medium and long-term financial benefits from reduced healthcare costs, better health, and welfare largely compensate for such consequences. Moreover, taxation does not negatively affect aggregate economic activity or employment, as consumers switch demand to other products that generate employment and may compensate for any employment loss in taxed sectors. Evidence also shows the revenues generated are generally spent on labour-intensive services. In the case of illicit trade in tobacco, evidence shows that illicit trade has not increased globally (rather the opposite) despite increases in tobacco taxes. Profit-maximising smugglers increase illicit cigarette prices along with the increases in licit cigarette prices. This implies that even when increased taxes divert some demand to the illicit market, they push prices up in the illicit market, discouraging consumption.
Background: Increased taxation is recognised worldwide as one of the most effective interventions for decreasing tobacco and harmful alcohol use, with many variations of policy options available. This rapid scoping review was part of a NIHR funded project (‘SYNTAX’ 16/105/26) and was undertaken during 2018 to inform interviews to be conducted with UK public health stakeholders with expertise in alcohol and tobacco pricing policy.
Methods : Objectives : To synthesise evidence and debates on current and potential alcohol and tobacco taxation options for the UK, and report on the underlying objectives, evidence of effects and mediating factors. Eligibility criteria : Peer-reviewed and grey literature; published 1997–2018; English language; UK-focused; include taxation interventions for alcohol, tobacco, or both. Sources of evidence : PubMed, Scopus, Cochrane Library, Google, stakeholder and colleague recommendations.
Charting methods : Excel spreadsheet structured using PICO framework, recording source characteristics and content.
Results : Ninety-one sources qualified for inclusion: 49 alcohol, 36 tobacco, 6 both. Analysis identified four policy themes: changes to excise duty within existing tax structures, structural reforms, industry measures, and hypothecation of tax revenue for public benefits. For alcohol, policy options focused on raising the price of cheap, high-strength alcohol. For tobacco, policy options focused on raising the price of all tobacco products, especially the cheapest products, which are hand-rolling tobacco. For alcohol and tobacco, there were options such as levies that take money from the industries to help reduce the societal costs of their products. Due to the perceived social and economic importance of alcohol in contrast to tobacco, policy options also discussed supporting pubs and small breweries.
Conclusions : This review has identified a set of tax policy options for tobacco and alcohol, their objectives, evidence of effects and related mediating factors. The differences between alcohol and tobacco tax policy options and debates suggest an opportunity for cross-substance policy learning.
Background: Drinking is influenced by youth perceptions of how their peers drink. These perceptions are often incorrect, overestimating peer drinking norms. If inaccurate perceptions can be corrected, young people may drink less. Objectives: To determine whether social norms interventions reduce alcohol-related negative consequences, alcohol misuse or alcohol consumption when compared with a control (ranging from assessment only/no intervention to other educational or psychosocial interventions) among university and college students. Search methods: The following electronic databases were searched up to July 2015: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, PsycINFO. The Cumulative Index to Nursing and Allied Health Literature (CINAHL) only to March 2008. Reference lists of included studies and review articles were manually searched. No restriction based on language or date was applied. Selection criteria: Randomised controlled trials or cluster-randomised controlled trials that compared a social normative intervention versus no intervention, alcohol education leaflet or other 'non-normative feedback' alcohol intervention and reported on alcohol consumption or alcohol-related problems in university or college students. Data collection and analysis: We used standard methodological procedures as expected by Cochrane. Each outcome was analysed by mode of delivery: mailed normative feedback (MF); web/computer normative feedback (WF); individual face-to-face normative feedback (IFF); group face-to-face normative feedback (GFF); and normative marketing campaign (MC). Main results: A total of 70 studies (44,958 participants) were included in the review, and 63 studies (42,784 participants) in the meta-analyses. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence. Outcomes at four or more months post-intervention were of particular interest to assess when effects were sustained beyond the immediate short term. We have reported pooled effects across delivery modes only for those analyses for which heterogeneity across delivery modes is not substantial (I² < 50%). Alcohol-related problems at four or more months: IFF standardised mean difference (SMD) -0.14, 95% confidence interval (CI) -0.24 to -0.04 (participants = 2327; studies = 11; moderate quality evidence), equivalent to a decrease of 1.28 points in the 69-point alcohol problems scale score. No effects were found for WF or MF. Binge drinking at four or more months: results pooled across delivery modes: SMD -0.06, 95% CI -0.11 to -0.02 (participants = 11,292; studies = 16; moderate quality evidence), equivalent to 2.7% fewer binge drinkers if 30-day prevalence is 43.9%. Drinking quantity at four or more months: results pooled across delivery modes: SMD -0.08, 95% CI -0.12 to -0.04 (participants = 21,169; studies = 32; moderate quality evidence), equivalent to a reduction of 0.9 drinks consumed each week, from a baseline of 13.7 drinks per week. Drinking frequency at four or more months: WF SMD -0.11, 95% CI -0.17 to -0.04 (participants = 9929; studies = 10; moderate quality evidence), equivalent to a decrease of 0.17 drinking days/wk, from a baseline of 2.74 days/wk; IFF SMD -0.21, 95% CI -0.31 to -0.10 (participants = 1464; studies = 8; moderate quality evidence), equivalent to a decrease of 0.32 drinking days/wk, from a baseline of 2.74 days/wk. No effects were found for GFF or MC. Estimated blood alcohol concentration (BAC) at four or more months: peak BAC results pooled across delivery modes: SMD -0.08, 95% CI -0.17 to 0.00 (participants = 7198; studies = 11; low quality evidence), equivalent to a reduction in peak BAC from an average of 0.144% to 0.135%. No effects were found for typical BAC with IFF. Authors' conclusions: The results of this review indicate that no substantive meaningful benefits are associated with social norms interventions for prevention of alcohol misuse among college/university students. Although some significant effects were found, we interpret the effect sizes as too small, given the measurement scales used in the studies included in this review, to be of relevance for policy or practice. Moreover, the significant effects are not consistent for all misuse measures, heterogeneity was a problem in some analyses and bias cannot be discounted as a potential cause of these findings.
Background:
Legislative limits on trading hours for licensed premises have a long history in Australia as a key policy approach to managing alcohol-related problems. In recent years, following substantial extensions to permitted hours of sale, there has been renewed attention to policies aimed at reducing late-night trading hours. Restrictions on on-premise alcohol sales have been implemented in Australia after 3.30 am in Newcastle, and after 3 am in Kings Cross and the Sydney central business district in New South Wales. In July 2016, similar restrictions were introduced state-wide after 2 am, or 3 am in 'safe night precincts', in Queensland. Similar policy changes have occurred internationally (e.g. in the UK and the Nordic countries) and there is a growing body of research examining the impacts of trading hour policies on alcohol-related harm. Although there has been a series of reviews of the research in this area, the most recent is now 5 years old and limited to studies published before March 2008. Objective and importance of study: To examine recent (2005-2015) research about the impact of changing the hours of sale of alcohol on alcohol-related harms. The ongoing public discussion about trading hours policy in Australia can benefit from an up-to-date and comprehensive review of the research.
Methods:
Systematic review of the literature that considered the impact of policies that extended or restricted trading hours. MEDLINE, Core Collection, PsychINFO and EMBASE databases were searched from January 2005 to December 2015. Articles were summarised descriptively, focusing on studies conducted in Australia and published since the previous reviews.
Results:
The search identified 21 studies, including seven from Australia. There were 14 studies published since previous reviews. A series of robust, well-designed Australian studies demonstrate that reducing the hours during which on-premise alcohol outlets can sell alcohol late at night can substantially reduce rates of violence. The Australian studies are supported by a growing body of international research.
Conclusion:
The evidence of effectiveness is strong enough to consider restrictions on late trading hours for bars and hotels as a key approach to reducing late-night violence in Australia.
This is the protocol for a review and there is no abstract. The objectives are as follows: To evaluate the benefits and harms of reducing or banning advertising of alcohol, via any format including advertising in the press, television, on the Internet, using social media and product placement in films, on alcohol consumption in adults and adolescents.
This one-year Oxford Internet Institute research project set out to explore the lessons learnt by the online gambling industry with respect to the successful application of age verification processes. These experiences and lessons were compared with age verification techniques applied in other industries including parts of the online retail and social gaming sectors. Specifically we sought to:
• Understand the rationale for the use or non-use of age verification in three case studies, (online gambling, online sale of age-restricted goods and social gaming)
• Explore lessons learnt from the development and deployment of existing age verification practices in these sectors
• Identify examples of good practice to inform future practice across online industry sectors
Our study investigated these objectives in three overlapping steps: a literature review of academic research, policy documents and publicly available market analysis; 38 in-depth interviews with experts on age verification drawn from across three online industry sectors as well as regulatory bodies, identity and payment providers and children’s charities; a workshop with experts in the field to gain feedback on draft findings.
Background and aims:
This is the first study to examine the effect of alcohol marketing exposure on adolescents' drinking in a cross-national context. The aim was to examine reciprocal processes between exposure to a wide range of alcohol marketing types and adolescent drinking, controlled for non-alcohol branded media exposure.
Design:
Prospective observational study (11-12- and 14-17-month intervals), using a three-wave autoregressive cross-lagged model.
Setting:
School-based sample in 181 state-funded schools in Germany, Italy, Netherlands, Poland.
Participants:
A total of 9075 eligible respondents participated in the survey (mean age 14 years, 49.5% male.
Measurements:
Adolescents reported their frequency of past-month drinking and binge drinking. Alcohol marketing exposure was measured by a latent variable with 13 items measuring exposure to online alcohol marketing, televised alcohol advertising, alcohol sport sponsorship, music event/festival sponsorship, ownership alcohol-branded promotional items, reception of free samples and exposure to price offers. Confounders were age, gender, education, country, internet use, exposure to non-alcohol sponsored football championships and television programmes without alcohol commercials.
Findings:
The analyses showed one-directional long-term effects of alcohol marketing exposure on drinking (exposure T1 on drinking T2: β = 0.420 (0.058), P < 0.001, 95% confidence interval (CI) = 0.324-0.515; exposure T2 on drinking T3: β = 0.200 (0.044), P < 0.001, 95% CI = 0.127-0.272; drinking T1 and drinking T2 on exposure: P > 0.05). Similar results were found in the binge drinking model (exposure T1 on binge T2: β = 0.409 (0.054), P < 0.001, 95% CI = 0.320-0.499; exposure T2 on binge T3: β = 0.168 (0.050), P = 0.001, 95% CI = 0.086-0.250; binge T1 and binge T2 on exposure: P > 0.05).
Conclusions:
There appears to be a one-way effect of alcohol marketing exposure on adolescents' alcohol use over time, which cannot be explained by either previous drinking or exposure to non-alcohol-branded marketing.
We use counterfactual analysis techniques to evaluate the impact of a 2 MUP significantly reduces the purchases of at-risk households by up to −0.92 [90% CI: −1.55, −0.28] standard drinks at the highest quantiles and has substantially less effect on households purchasing at light and moderate levels. A $2 MUP may reduce the proportions of male and female shoppers purchasing at the public health threshold of more than two standard drinks per household member per day by −3.03 [90% CI: −4.83, −1.22] percentage points (relative variation: −17%); and −1.85 [90% CI: −2.60, −1.10] percentage points (relative variation:−22%), respectively. Implementing an MUP on alcohol thus promises significant positive impacts on public health. Copyright
Objective To evaluate the potential impact of two alcohol control policies under consideration in England: banning below cost selling of alcohol and minimum unit pricing.
Design
Modelling study using the Sheffield Alcohol Policy Model version 2.5.
Setting
England 2014-15.
Population
Adults and young people aged 16 or more, including subgroups of moderate, hazardous, and harmful drinkers.
Interventions
Policy to ban below cost selling, which means that the selling price to consumers could not be lower than tax payable on the product, compared with policies of minimum unit pricing at £0.40 (€0.57; $0.75), 45p, and 50p per unit (7.9 g/10 mL) of pure alcohol.
Main outcome measures
Changes in mean consumption in terms of units of alcohol, drinkers’ expenditure, and reductions in deaths, illnesses, admissions to hospital, and quality adjusted life years.
Results
The proportion of the market affected is a key driver of impact, with just 0.7% of all units estimated to be sold below the duty plus value added tax threshold implied by a ban on below cost selling, compared with 23.2% of units for a 45p minimum unit price. Below cost selling is estimated to reduce harmful drinkers’ mean annual consumption by just 0.08%, around 3 units per year, compared with 3.7% or 137 units per year for a 45p minimum unit price (an approximately 45 times greater effect). The ban on below cost selling has a small effect on population health—saving an estimated 14 deaths and 500 admissions to hospital per annum. In contrast, a 45p minimum unit price is estimated to save 624 deaths and 23 700 hospital admissions. Most of the harm reductions (for example, 89% of estimated deaths saved per annum) are estimated to occur in the 5.3% of people who are harmful drinkers.
Conclusions
The ban on below cost selling, implemented in the England in May 2014, is estimated to have small effects on consumption and health harm. The previously announced policy of a minimum unit price, if set at expected levels between 40p and 50p per unit, is estimated to have an approximately 40-50 times greater effect.