Sally Casswell’s research while affiliated with Massey University and other places

Background Alcohol is a global health issue with a high level of controversy. After being absent from World Health Organization (WHO) global governing body discussions for about 20 years, alcohol re-entered the agenda in 2005. The expression ‘harmful use of alcohol’ became the compromise language after hard negotiations, an example of ‘adopted language” that has remained for almost 20 years. This article analyses the background and use of the expression 'harmful use of alcohol' in the context of WHO governing bodies, current challenges and implications for public health. Methods The article is based on textual analysis of source documents from the time periods 2004–2010 and 2019–2022 and the authors’ experience from involvement in the global alcohol policy scene for more than 20 years: WHO governing body records and other documents were analysed, as well as Member State and Non-State Actors’ positions and contributions in consultations and statements in WHO governing body debates. Results The introduction of the concept ‘harmful use of alcohol’ in WHO documents from 2005 onwards was a political compromise between approaches focussed either on ‘alcohol abuse’ or a wider concept of harm from alcohol consumption. It has permeated into national alcohol policy documents, academic literature about alcohol harm and UN documents, and been embraced by the alcohol industry. However, it has not prevented and some would argue that it has enabled development of normative statements from WHO that include recommendations for population wide interventions. The relatively new evidence of harm from alcohol at low levels and questioning of evidence suggesting a beneficial effect of moderate use of alcohol together with industry appropriation of 'harmful use' have led to increasing critique of the framing implied by ‘harmful use of alcohol’. Conclusions The language used in WHO documents holds political power in that it may influence the subsequent course of events. This is accentuated by the normative role of WHO in global health policy and the uptake of negotiated language beyond WHO documents. In the next five years it will be possible and valuable to examine in more detail the extent to which this power was made manifest and the need and possible ways to effect change.

Large language models show promising capability in some qualitative content analysis tasks; however, research reporting their performance in identifying initial codes that underpin subsequent analysis is scarce. This paper explores the suitability of GPT-4 to assist in building a codebook for a discourse network analysis (DNA) of a recent alcohol policy reform. DNA is a codebook-driven approach to identifying groupings of actors who use similar policy framings. The paper uses GPT-4 to identify initial codes (‘concepts’) and related quotes in 108 news articles and interviews. The results produced by GPT-4 are compared to a codebook prepared by researchers. GPT-4 identified over two-thirds of the concepts found by the researchers, and it was highly accurate in screening out a large volume of irrelevant media items. However, GPT-4 also provided many irrelevant concepts that required researcher review and removal. The discussion reflects on the implications for using GPT-4 in codebook preparation for DNA and other situations, including the need for human involvement and sample testing to understand its strengths and limitations, which may limit efficiency gains.

Alcohol taxation is a key policy to reduce consumption and alcohol harm but evidence on tax design and indicators to assess taxation policy are lacking. Tax design and two indicators: tax as a share of lowest retail price and affordability, were investigated in eight high-income and nine middle-income jurisdictions. Collaborators populated the International Alcohol Control (IAC) study online Alcohol Policy Tool, providing measures of tax design , tax rates; and typical lowest prices available for retail take-away alcohol. These data were used to calculate tax/share of retail price. Affordability of alcohol was assessed against Gross National Income per capita. High-income jurisdictions had higher tax/share and higher affordability on average compared with middle-income jurisdictions. Over the sample as a whole there was no association between these two indicators of tax policy. The tax designs used also varied with high-income jurisdictions more likely to use specific excise tax reflecting potency and middle-income jurisdictions more likely to utilise ad valorem and specific volume based taxes and to use more than one method across a beverage. Increased alcohol taxation to reduce alcohol consumption and harm is established as a high impact policy and is believed to work by affecting affordability. However, less is known about the best taxation methods to reduce affordability or the best measures to monitor and compare alcohol taxation between countries and over time. In this sample of high and middleincome jurisdictions tax/price share was not found to predict affordability, suggesting the need to further research indicators of alcohol affordability.

Introduction Considerable evidence exists on the most effective policy to reduce alcohol harm; however, a tool and index to allow comparisons of policy status of the most effective policies between similar jurisdictions and change over time within a jurisdiction has not been widely used. The International Alcohol Control (IAC) Policy Index is designed to address this gap and monitor the alcohol policy environment with regard to four effective policy domains (tax/pricing, availability, marketing and drink driving). Methods This study compares IAC Policy Index scores across 11 high‐income jurisdictions: Aotearoa (Māori language name for New Zealand); Australia; Finland; Norway; the Netherlands; (Republic of Ireland; Lithuania; Ontario; Alberta; Quebec; British Columbia). Collaborators in the 11 high‐income jurisdictions populated the online Alcohol Policy Tool with available indicators. The team in Aotearoa New Zealand sought to validate information and worked with collaborators to clarify any uncertainties in the data. Results Lithuania, Norway, Finland and Ireland scored above average on the IAC Policy Index. The jurisdictions varied in terms of the strength of policy in different domains, with drink driving legislation showing the greatest consistency and marketing the strongest relationship between stringency of policy and impact on the ground. Discussion and Conclusions Results in high‐income jurisdictions suggested the IAC Policy Index provides a useful overview of core alcohol policy status, allows for comparisons between jurisdictions and has the potential to be useful in alcohol policy debate.

Introduction Many countries, including Aotearoa New Zealand, have socioeconomic and ethnic inequities in alcohol outlet density, yet the potential contribution of alcohol licensing systems is almost unexplored. After licensing reforms in Aotearoa in 2012, community groups and Māori (the Indigenous people) continued to struggle to influence decisions, prompting calls for reform and authority for Māori reflecting Te Tiriti o Waitangi obligations. This study explored factors in the failure of public objections in under‐resourced neighbourhoods. Methods In a descriptive, multimethod qualitative study, we analysed eight decisions to grant off‐licence approvals in socioeconomically deprived areas. Each licence was opposed. Hearing participants and local residents were interviewed. Data were thematically analysed to identify factors affecting objector influence, alignment with Indigenous rights and residents' awareness of alcohol issues and licensing processes. Results Residents identified relevant local harms but were largely unaware of opportunities to object. Objectors faced structural barriers to accessing and influencing hearings that were exacerbated by resource challenges, including travel costs, lost income, competing social issues and limited legal representation. Evidence of area deprivation supported objectors' arguments regarding risk, but a lack of official data on harms undermined them. Māori input was excluded by legal barriers and failures to recognise relevant rights and elements of culture. Discussion and Conclusions Structural barriers, including racism, restricted the influence of under‐resourced communities and Māori in licensing decisions and weakened risk assessment, which may hinder community efforts to reduce their disproportionate exposure to alcohol outlets. Licensing systems should be reviewed from equity and Indigenous perspectives.

Background The alcohol industry uses many of the tobacco industry’s strategies to influence policy-making, yet unlike the Framework Convention on Tobacco Control, there is no intergovernmental guidance on protecting policies from alcohol industry influence. Systematic assessment of alcohol industry penetration and government safeguards is also lacking. Here, we aimed to identify the nature and extent of industry penetration in a cross-section of jurisdictions. Using these data, we suggested ways to protect alcohol policies and policy-makers from undue industry influence. Methods As part of the International Alcohol Control Study, researchers from 24 jurisdictions documented whether 22 indicators of alcohol industry penetration and government safeguards were present or absent in their location. Several sources of publicly available information were used, such as government or alcohol industry reports, websites, media releases, news articles and research articles. We summarised the responses quantitatively by indicator and jurisdiction. We also extracted examples provided of industry penetration and government safeguards. Results There were high levels of alcohol industry penetration overall. Notably, all jurisdictions reported the presence of transnational alcohol corporations, and most (63%) reported government officials or politicians having held industry roles. There were multiple examples of government partnerships or agreements with the alcohol industry as corporate social responsibility activities, and government incentives for the industry in the early COVID-19 pandemic. In contrast, government safeguards against alcohol industry influence were limited, with only the Philippines reporting a policy to restrict government interactions with the alcohol industry. It was challenging to obtain publicly available information on multiple indicators of alcohol industry penetration. Conclusion Governments need to put in place stronger measures to protect policies from alcohol industry influence, including restricting interactions and partnerships with the alcohol industry, limiting political contributions and enhancing transparency. Data collection can be improved by measuring these government safeguards in future studies.

Objectives. To assess the exposure of Chinese adolescents to proalcohol advertising and explore its association with alcohol consumption. Methods. A nationally and regionally representative school-based survey was conducted in mainland China in 2021 among students in grades 7 through 12, aged 13 to 18 years. We assessed adolescent exposure to proalcohol advertising and its association with alcohol consumption. Results. A total of 57 336 students participated in the survey, and the exposure percentage of proalcohol advertising was 66.8%, with no difference between boys and girls or between urban and rural areas. The top 3 exposure channels were television (51.8%), the Internet (43.6%), and outdoor billboards (42.0%). The exposure was higher among students who had consumed alcohol in the past 30 days (80.1% vs 65.1%; adjusted odds ratio [AOR] = 1.29) and in the past 12 months (77.3% vs 61.7%; AOR = 1.30). However, no significant correlation was observed between advertising exposure and drunkenness. Conclusions. Approximately two thirds of Chinese adolescents have been exposed to proalcohol advertising in the past 30 days, with television, the Internet, and outdoor billboards being the most prevalent channels. Exposure to proalcohol advertising exhibits a positive correlation with drinking. ( Am J Public Health. Published online ahead of print June 13, 2024:e1–e10. https://doi.org/10.2105/AJPH.2024.307680 )

Background The IAC Policy Index was developed to allow comparison in alcohol policy between countries and within countries over time including in low resource settings. It measures four effective alcohol policies and takes into account stringency of regulation and the actual impact on the alcohol environment, such as trading hours and prices paid. This framework was used to assess policy in Aotearoa New Zealand in a time period covering two relevant legislative changes. This is the first study to use an alcohol policy index to assess and describe legislative change within country. Methods Data to calculate the IAC Policy Index was collected for 2013 and 2022. Stringency of policy was assessed from legislative statutes and impacts of policy on the alcohol environment from administrative data and specifically designed data collection. Results The overall IAC Policy Index score improved over the time period. The scores for the separate policy areas reflected the legislative changes as hypothesised, but also independent changes in impact, given ecological changes including reduced enforcement of drink driving countermeasures and increased exposure to marketing in digital channels. The IAC Policy index reflects the changes in policy status observed in Aotearoa, NZ. Discussion The IAC Policy Index provided a useful framework to assess and describe change in alcohol legislation contextualised by other influences on policy impact over time within a country. The results indicated the value of assessing stringency and impact separately as these moved independently. Conclusions The IAC Alcohol Policy Index, measuring both stringency and actual impact on the alcohol environment with a focus on only the most effective alcohol policies provides meaningful insights into within-country policy strength over time. The IAC Policy Index used over time can communicate to policy makers successes and gaps in alcohol policy.