A large body of research has pointed out that advertising has an impact on gambling behavior. However, little is known about how actual gambling marketing regulations impact online gambling behavior and marketing expenditure. Recently, a Spanish law-the Royal Decree 958/2020-came into force, which, in general terms, limits the marketing of gambling products. The current study aimed to examine the effect of the Spanish Royal Decree 958/2020 on gambling behavior (i.e., new accounts, active accounts, deposits, and total money bet) and marketing expenditure (i.e., advertising, bonuses, affiliation, and sponsorship) based on data from the Directorate General for Regulation of Gambling.

We used Seasonal Autoregressive Integrated Moving Average (SARIMA) models to examine the impact of the implementation of Royal Decree 958/2020 on both online gambling behavior and marketing expenditure.

The entry into force of the Spanish Royal Decree (applied between November 2020 and August 2021) led to a permanent decrease in gambling behavior, in particular new accounts (-263k; p = .003) and total money bet (-€216M; p = .034). Additionally, regulatory measures had an impact on marketing strategies, specifically, reducing money earmarked for advertising (-€20M; p = .004), bonuses (-€2.6M; p = .048), and sponsorship (-€5.3M; p < .001).

These findings demonstrate that regulatory measures aimed at limiting gambling advertising, bonuses, and sponsorships impact new accounts (i.e., new gamblers) and total money gambled, but hardly active accounts (i.e., regular gamblers). This study can serve as a model for countries where gambling advertisements have not yet been regulated.

Building on the success of tobacco health warning labels, EU Member States and institutions are increasingly considering similar requirements for alcohol products. While industry responses to pricing and availability policies have been widely studied, their framing of Alcohol Health Warning Labels (AHWLs) as a policy solution remains comparatively underexplored. This paper examines how alcohol industry stakeholders responded to the EU notification process for Ireland's proposed alcohol labelling regulations, introduced under Ireland's Public Health (Alcohol) Act 2018.

This paper analyses 16 submissions from alcohol industry actors to the European Commission regarding Ireland's proposed alcohol warning label regulations. Qualitative methods, specifically thematic analysis, were used to examine industry arguments. The research team first reviewed five submissions to inductively develop a codebook, which was then applied to the remaining submissions, with new codes added as necessary. Two team members independently coded each submission, and thematic content was refined through team discussion.

Alcohol industry arguments against AHWLs fall into four main themes: lack of evidence supporting the content of health warning labels and their broader use, negative trade and economic impacts of AHWLs, potential risks to EU governance posed by Ireland's labels, and the industry's self-positioning as responsible actors committed to public health. In addition, we identify novel industry strategies related to the intricacies of AHWLs, including a heightened focus on wording and language, coordination of activities across multiple governance levels, and tailored framing to suit the institutional context.

Alcohol industry actors employ arguments similar to those seen in other policy debates, which continue to pose a significant barrier to evidence-based alcohol policymaking. The analysis suggests that industry actors can strategically adapt their arguments to varying institutional settings and policy instruments, demonstrating their political dexterity and reinforcing the barriers to policy progress. These findings highlight the need for further research into the alcohol industry's influence and provide insights for jurisdictions considering labelling legislation.

Continuing high levels of population physical inactivity necessitate effective government policies to cultivate healthy physical activity (PA) environments. The Physical Activity Environment Policy Index (PA-EPI) is a monitoring framework and tool to assess the implementation of policies that promote PA. This study aims to assess the extent of PA policy implementation in the Netherlands and identify recommendations for action to improve its PA environment, using the PA-EPI.

The PA-EPI application was a stepwise process in which evidence of policy implementation was collected and validated by government officials. A cross-sectoral coalition of non-government independent experts then rated the extent of implementation of 45 indicators of ideal good practice, comparing them against international best practice. On the basis of these expert ratings, a scorecard categorized indicators into high, medium, low or none/very little implementation. In turn, future implementation recommendations were identified by independent experts, prioritized and disseminated.

The evidence validation by government officials (N = 15) yielded minor changes. Independent experts (N = 14) gave 10 out of the 45 indicators a low implementation score, 28 a medium score and 7 a high score. The policy domain of transport and the infrastructure support domain of monitoring and intelligence received high implementation scores. The policy domains of mass media and workplace and the infrastructure support domains of leadership, funding and resources and workforce development received only low scores. Some domains received both high and low implementation scores (i.e. the policy domains of education and sport and recreation for all and the infrastructure support domain of governance). A total of 36 policy recommendations and 26 infrastructure support recommendations were identified. The top prioritized policy recommendations fell within the urban design, education, transport, and sport and recreation for all domains. For infrastructure support, the top prioritized recommendations related to the leadership, funding and resources, and governance domains.

The results reveal important policy implementation gaps and strengths across several domains in the Netherlands. Prioritized recommendations are provided for the government to address these implementation gaps and monitor policy change.

To systematically review and synthesize evidence from reviews about the effectiveness and cost-effectiveness of population-level policies to reduce alcohol use.

We searched peer-reviewed literature using eight electronic bibliographic databases, grey literature using two databases, two search engines, and two working paper repositories, and examined references of included studies. At least two reviewers independently screened articles for inclusion, extracted detailed characteristics, and assessed the risk of bias of each included study. We considered all reviews that included studies which quantitatively examined the relationship between alcohol consumption and population-level policies that seek to regulate the public availability and marketing of alcoholic beverages. After screening according to a set of predetermined criteria, we included 32 reviews.

We found consistent evidence that addressing alcohol availability (introducing or increasing minimum purchasing age, restrictions on temporal availability, decreasing outlet density, government monopolization) was associated with lower alcohol use; and a general lack of evidence on the associations between alcohol marketing (marketing self-regulation, advertising from government authorities, regulating the volume of advertising from alcohol manufacturers, and introducing warning labels) and alcohol consumption, which precludes any conclusions about these regulations. Additionally, we found scarce evidence about the cost-effectiveness of population-level policies to reduce alcohol use, which is likely due to the relatively low cost of implementation and enforcement of these policies.

The Government of Ontario began expanding privatized alcohol sales in 2015 with further expansions starting in August 2024. Evidence from reviews suggests that this increase in availability will result in increased alcohol consumption.

Public perceptions of alcohol and its related harms and policies are shaped by multiple discourses and can influence behaviour and policy support. As part of a FrameWorks-informed project to test framing approaches to improve public understanding and support for evidence-based alcohol policies in the UK, this research aimed to (i) summarise relevant evidence; (ii) compare how public understanding of alcohol harms differs from those of academic and charity experts; and (iii) develop novel framing approaches.

(1) a literature review including systematic, scoping and targeted components to understand previous evidence on effective framing from behaviour change, UK alcohol policy and FrameWorks literatures; (2) comparison of public views of alcohol harms and policies from four focus groups (n = 20) with those of public health experts; (3) an iterative process involving workshops and stakeholder consultation to develop 12 novel framing approaches.

We found no previous study that directly tested framing approaches for alcohol policy advocacy. Our narrative summary of 35 studies found that explaining diverse harms may be important, whereas framing that engenders empathy, emphasises dependence or invokes a sense of crisis may be less effective. In focus groups, the public linked alcohol to pleasure/socialising, whilst understandings of harm focused on severe alcohol problems and individual deficits of biology or personality, with policy proposals focused mainly on treatment/support services. Public health experts highlighted more diverse harms and solutions, emphasising environmental and commercial causes. Comparison of public and expert views yielded six tasks for novel framing approaches to deepen public understanding. The team co-developed initial framing ideas (n = 31), before finalising 12 narrative framing approaches based on values (n = 5), metaphors (n = 3) and explanation (n = 4).

In the United Kingdom, public and expert understandings of alcoholrelated harms, causes and solutions differ. Along with prior evidence, these differences can inform novel framing approaches designed to deepen public understanding.

To describe the incidence and key demographic, socioeconomic and clinical characteristics of individuals with liver disease in Wales.

This study is designed as a retrospective observational study that linked data of anonymised identified individuals from primary, secondary care and mortality data from the Secure Anonymised Information Linkage (SAIL) Databank in Wales.

All Welsh residents who registered with a SAIL-contributing general practitioner (GP) and diagnosed with liver disease from 2004 to 2022.

Our primary outcome is the annual age-standardised incidence rate of liver disease. Secondary outcome is the numbers and frequencies of underlying aetiology and the associated comorbidities.

Between 2004 and 2022, 111 098 individuals received a diagnosis of liver disease in Wales and were included in this study. The incidence of liver disease increased threefold during the study period (97.7 per 100 000 inhabitants in 2004 to 316.2 per 100 000 inhabitants in 2022). A total of 79 992 individuals (72%) entered the cohort with the underlying aetiology of liver disease, including alcohol-related liver disease, non-alcoholic fatty liver disease (NAFLD), viral hepatitis, metabolic, haemochromatosis and autoimmune liver diseases. NAFLD has contributed to most of the change in incidence.

We observed increasing incidence rates of liver disease in Wales, with NAFLD showing a particularly sharp increase and frequently identified as an underlying condition. A better understanding of the incidence of liver disease is the first step towards effective prevention, early detection and targeted intervention to improve patient outcomes.

Alcohol use is common and associated with varying degrees of harm. Heavy alcohol use can lead to the development of an alcohol use disorder (AUD). The stigma and discrimination that people with AUD often face can act as barriers to seeking clinical services and may negatively impact the quality of care they receive. This paper outlines best practices for working with people who use alcohol, emphasizing the importance of addressing stigma in caring for and communicating with clients. Written from a harm-reduction perspective, it highlights the significance of client-driven goal setting and autonomy, meeting clients where they are regarding their behavior change goals, and maintaining a non-judgmental, compassionate stance.

Regulations to restrict alcohol promotion and requirements for mandatory display of information about health risks associated with alcohol use have been minimal and hard-won in Australia. This study (i) outlines an approach to monitoring alcohol industry use of health messages on alcohol products and (ii) reports prevalence and nature of government-mandated health-related information and voluntary health messages on alcohol products.

Images of 5,923 alcohol products sold in four large alcohol stores in Sydney were captured. Data were collected in-store and via web-scraping. Label content was extracted from the images.

There was high compliance (97%-99%) with government-mandated requirements other than the pregnancy warning label (63%). Presence of voluntary health-related messages was common (65%), but typically present in the form of DrinkWise (an industry-led social aspects/public relations organisation) statements that are unlikely to be effective.

This study provides a unique and systematic approach to examining alcohol industry compliance with government-mandated on-product information requirements and voluntary inclusion of other health-related messages.

The results demonstrate the need for ongoing monitoring to enforce alcohol industry compliance with Australia's existing and future labelling regulations and to assess the industry's voluntary use of other forms of health messaging.

Alcohol, a significant public health concern, contributes to a substantial burden on emergency services. Identifying avoidable causes of Emergency Department (ED) presentations may reduce hospital overcrowding and benefit public health.

This prevalence study aims to provide a detailed analysis of patients presenting to the ED at Mercy University Hospital (MUH) as "Apparently Drunk" in 2022 and 2023.

Data were sourced from the Integrated Patient Management Information System at MUH. All patients recorded as "Apparently Drunk" were included. Data collected included demographics, associated injuries or complaints, mode of arrival, admission status, and discharge status. Descriptive statistics were used to summarise the data and trends were examined by comparing 2022 and 2023 data.

A total of 1662 presentations were categorised as "Apparently Drunk," representing 3% of all ED visits. There was an 18% increase in such presentations from 2022 to 2023. The majority of patients were male (72%). The median age was 39 years. Notably, 23% of the presentations involved people experiencing homelessness, and 81% were conveyed by ambulance. Significant associated injuries included head injuries (7%), falls/collapses (6%), mental health issues (5%), and assaults (4%).

The findings indicate a growing trend in patients presenting to the ED as "Apparently Drunk". The high incidence among people experiencing homelessness and the substantial resource utilisation underscores the need for targeted public health interventions and integrated services. Policymakers should consider these findings in the context of potential legislative changes that may impact alcohol availability.

The COVID-19 pandemic led to changes in alcohol consumption in England. Evidence suggests that one-fifth to one-third of adults increased their alcohol consumption, while a similar proportion reported consuming less. Heavier drinkers increased their consumption the most and there was a 20% increase in alcohol-specific deaths in England in 2020 compared with 2019, a trend continuing through 2021 and 2022. This study aimed to quantify future health, healthcare, and economic impacts of changes in alcohol consumption observed during the COVID-19 pandemic.

This study used a validated microsimulation model of alcohol consumption and health outcomes. Inputted data were obtained from the Alcohol Toolkit Study, and demographic, health and cost data from published literature and publicly available datasets. Three scenarios were modelled: short, medium, and long-term, where 2020 drinking patterns continue until the end of 2022, 2024, and 2035, respectively. Disease incidence, mortality, and healthcare costs were modelled for nine alcohol-related health conditions. The model was run from 2020 to 2035 for the population of England and different occupational social grade groups.

In all scenarios, the microsimulation projected significant increases in incident cases of disease, premature mortality, and healthcare costs, compared with the continuation of pre-COVID-19 trends. If COVID-19 drinking patterns continue to 2035, we projected 147,892 excess cases of diseases, 9,914 additional premature deaths, and £1.2 billion in excess healthcare costs in England. The projections show that the more disadvantaged (C2DE) occupational social grade groups will experience 36% more excess premature mortality than the least disadvantaged social group (ABC1) under the long-term scenario.

Alcohol harm is projected to worsen as an indirect result of the COVID-19 pandemic and inequalities are projected to widen. Early real-world data corroborate the findings of the modelling study. Increased rates of alcohol harm and healthcare costs are not inevitable but evidence-based policies and interventions are required to reverse the impacts of the pandemic on alcohol consumption in England.

On 1 January 2020, Vietnam introduced a new law with harsher fines and penalties for driving under the influence of alcohol. Reports of empty beer restaurants following this implementation suggested the new law has the potential to reduce population-level alcohol consumption. This pilot study aims to quantify short-term changes in alcohol consumption levels after the implementation of the new law and assess whether it could lead to a reduction in total alcohol consumption in the population.

Wastewater samples were collected from two sites along a sewage canal in Hanoi during two periods: Period 1 (15 December 2018 to 14 January 2019) and Period 2 (15 December 2019 to 14 January 2020). Ethyl sulfate, a specific metabolite of alcohol, was quantified to monitor the trend of alcohol consumption. Both interrupted time series and controlled interrupted time series approaches were utilised, with Period 1 and Period 2 serving as the control and intervention periods, respectively.

Our analysis indicated that the implementation of the new law did not result in an immediate and significant reduction in alcohol consumption at the population level. Meanwhile, there was no significant difference in alcohol consumption between weekdays and weekends both before and after the implementation of the new law.

Long-term monitoring is needed to assess the impact of stricter DUI policy on alcohol consumption in the urban areas of Vietnam.

Physically locating liquor stores near schools can strongly influence the chances of youth accessing and consuming alcohol, and may also increase children's exposure to alcohol advertising. Investigating the association between the presence of a liquor store near a school and the prevalence of outdoor alcohol advertising is crucial from a policy perspective, as it can inform future regulations on the placement of liquor stores and outdoor advertising near educational institutions.

All outdoor alcohol advertising within a 500 m radius (audit zone) of 64 randomly selected schools from local government areas across metropolitan Perth was identified by direct observation; recording the size, setting, location and content of each advertisement. Results were compared based on whether the school audit zone contained a liquor store or not.

Over half (n = 36, 56%) of all school audit zones had at least one alcohol advertisement, with an average number of 5.9 alcohol advertisements per zone (SD = 10.2). The majority (97.9%) of advertisements were in the 38 audit zones containing a liquor store (average = 9.7, SD = 11.9 per zone), compared to zones without a liquor store (average = .3, SD = .7 per zone).

Perth school zones containing a liquor store in their 500 m radius had, on average, 30 times more outdoor alcohol advertising, compared with school zones without a nearby liquor store. SO WHAT?: The siting of liquor stores and the display of alcohol advertisements around educational settings require combined policy, planning and public health approaches to mitigate children's exposure to alcohol marketing, especially during school transit.

Zero alcohol products (ZAPs) could reduce alcohol-related harms by acting as a substitute for alcoholic beverages. However, concerns have been raised regarding the potential for these products to expose young people to additional alcohol-related stimuli, further normalising alcohol use and acting as a gateway to underage alcohol consumption. Scarce research has examined whether these concerns are warranted.

This project comprised two parts involving Australian adolescents aged 15-17 years. Part 1 was a series of 5 online focus groups (n = 44) that provided initial insights into perceptions of and experiences with ZAPs. Part 2 was a national online survey (n = 679) that assessed the generalisability of the focus group findings and identified factors associated with ZAP-related attitudinal and behavioural outcomes.

ZAPs were found to be salient and attractive to Australian adolescents. Over a third of surveyed adolescents (37%) had tried ZAPs. The focus group participants and survey respondents generally perceived ZAPs in a positive light, seeing them as a useful alternative to alcohol for both adolescents and adults who want to circumvent social expectations to use alcohol. Some of the study participants acknowledged the potential for ZAPs to serve as a gateway to alcohol use and recommended reducing their visibility and accessibility.

ZAPs are likely exposing minors to additional alcohol-related stimuli potentially increasing their risk of underage alcohol consumption. Regulatory responses to ZAPS need to protect young people from the potential adverse consequences of ZAPs exposure while enabling the products to be used by adults as an alcohol substitute.

Alcohol use is linked to a wide and complex range of individual and societal harms. Decisions on whether and how to address alcohol-related harms are shaped by the way in which such problems are understood, particularly through the use of language and concepts in professional and lay discourse. However, all terms and concepts have a complex set of implications which vary by context. For example, some language, particularly that associated with a historically dominant 'alcoholism' model, may be clearly harmful in some contexts (eg, via public stigma) and potentially valuable in others (eg, via facilitating recovery processes), or hold 'mixed blessings'. Careful empirical attention is required to assess the implications of key terms and concepts used in efforts to understand and address alcohol use and problems amongst the public, researchers, policy makers and practitioners.

We take an author-led and empirically informed approach to critically evaluate common terms and concepts to describe alcohol use and related constructs.

We identify how alcohol-related framing and discourse is highly relevant to alcohol-related outcomes via key issues including stigma, public health goals, political and commercial interests.

Recommendations are made for key partners to consider in the use and evolution of key terms and concepts relating to the broad spectrum of alcohol use and problems.

This paper analyses the degree of persistence in the level of consumption of alcohol in the Group of Seven (G7) countries by using fractional integration. The series under examination are annual sales of pure alcohol in litres per person aged 15 years and older, annually from 1960 to 2021, and we look at the influence that external shocks might have had on the series in these countries. The results indicate that only France displays a significant negative trend and thus a continuous decrease in the level of alcohol consumption. For the rest of the countries, the time trend is insignificant. Dealing with persistence, Japan is the only country that shows clear evidence of reversion to the mean. Policy recommendations are reported at the end of the manuscript.

Alcohol consumption has decreased in England in recent decades, while alcohol-specific death rates have remained relatively stable. Age-period-cohort (APC) models offer the potential for understanding these paradoxical trends. This study aimed to use an APC model approach to measure long-term trends in alcohol abstention and consumption in England from 2001 to 2019.

The study used grouped and proxy-variable APC models of repeat cross-sectional survey data, set in England (2001-19). Participants were residents in England aged 13 years or over who took part in the Health Survey for England.

Outcome variables were alcohol abstention and consumption in units. We created nine age groups (13-15, 16-17, 18-24, 25-34, until 65-74 and 75+, reference 45-54 years), four periods (2001-04, 2005-09, 2010-14 to 2015-19, reference 2005-09) and 18 5-year birth cohorts (1915-19 to 2000-04, reference 1960-64). We proxied age effects (systolic and diastolic blood pressure), period effects (alcohol affordability, internet usage and household alcohol expenditure) and birth cohort effects (prevalence of smoking and prevalence of overweight).

The odds of abstaining were considerably larger at young ages, 13-15 years [odds ratio (OR) = 5.38; 95% confidence interval (CI) = 4.50-6.43], were lowest during the first period, 2001-04 (OR = 0.83; 95% CI = 0.79-0.86) and had a U-shaped pattern by birth cohort. For units of alcohol, the incidence rate ratio (IRR) increased until age 18-24 years (IRR = 1.41, 95% CI = 1.34-1.48) and decreased afterwards, were highest during the first period, 2001-04 (IRR = 1.07; 95% CI = 1.05-1.08) and showed an inverted J-shape by birth cohort. Our proxy variable approach revealed that using blood pressure measures, alcohol affordability and prevalence of overweight as proxies resulted in APC effects that differed from our base-case model. However, internet usage, household expenditure on alcohol and smoking prevalence resulted in APC effects similar to our base-case model.

The discrepancy between decreasing alcohol consumption and increasing alcohol-related deaths observed in England from 2001 to 2019 may, in part, be explained by the halt in abstention trends since 2010 and a slight consumption decline since 2001.

Globally alcohol consumption is a leading risk factor for premature death and disability and is associated with crime, social and economic consequences. Local communities may be able to play a role in addressing alcohol-related issues in their area.

To evaluate the effectiveness and cost-benefit of an asset-based community development approach to reducing alcohol-related harm and understand the context and factors that enable or hinder its implementation.

A mixed-methods evaluation. Area-level quasi-experimental trial analysed using four different evaluation methods (a stepped-wedge design where each area was a control until it entered the intervention, comparison to matched local/national controls and comparison to synthetic controls), alongside process and economic evaluations.

Ten local authorities in Greater Manchester, England.

The outcomes evaluation was analysed at an area level. Ninety-three lay persons representing nineareas completed questionnaires, with 12 follow-up interviews in five areas; 20 stakeholders representing ten areas were interviewed at baseline, with 17 follow-up interviews in eight areas and 26 members of the public from two areas attended focus groups.

Professionals in a co-ordinator role recruited and supported lay volunteers who were trained to become alcohol health champions. The champion's role was to provide informal, brief alcohol advice to the local population and take action to strengthen restrictions on alcohol availability.

Numbers of alcohol-related hospital admissions, accident and emergency attendances, ambulance call-outs, street-level crime and antisocial behaviour in the intervention areas (area size: 1600-5500 residents). Set-up and running costs were collected alongside process evaluation data exploring barriers and facilitators.

Routinely collected quantitative data on outcome measures aggregated at the intervention area and matched control and synthetic control areas. Data from policy documents, licensing registers, meeting notes, invoices, time/cost diaries, training registers, questionnaires, interviews, reflective diaries and focus groups.

The intervention rolled out in nine out of ten areas, seven of which ran for a full 12 months. Areas with better-established infrastructure at baseline were able to train more champions. In total, 123 alcohol health champions were trained (95 lay volunteers and 28 professionals): lay volunteers self-reported positive impact. Champions engaged in brief advice conversations more readily than taking action on alcohol availability. There were no consistent differences in the health and crime area-level indicators between intervention areas and controls, as confirmed by using three different analysis methods for evaluating natural experiments. The intervention was not found to be cost-beneficial.

Although the sequential roll-out order of the intervention was randomised, the selection of the intervention areas was not. Self-reported impact may have been subject to social desirability bias due to the project's high profile.

There was no measurable impact on health and crime outcomes. Possible explanations include too few volunteers trained, volunteers being unwilling to get involved in licensing decisions, or that the intervention has no direct impact on the selected outcomes.

Future similar interventions should use a coproduced community outcomes framework. Other natural experiment evaluations should use methodological triangulation to strengthen inferences about effectiveness.

This trial is registered as ISRCTN81942890.

This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 15/129/03) and is published in full in Public Health Research; Vol. 12, No. 9. See the NIHR Funding and Awards website for further award information.

Alcohol control policies are implemented to reduce alcoholism and related harms around the globe. This work examines the effects of a policy that restricted when alcohol could be purchased on child outcomes in Russia. To identify causal impacts, I exploit variation in the timing and severity of the restriction, which was implemented in Russian states between 2005 and 2010. Utilizing household survey data and a difference-in-differences estimation approach, I find that the policy has improved children's physical health, with younger children being more affected, and additionally has decreased a variety of risky behavior indicators. Potential mechanisms for these effects include alcohol consumption, parental employment, household income, family stability, and time use. This work demonstrates that policies controlling parental substance access can have important effects on child health.

In 1996, a multicomponent community-based alcohol prevention program in Responsible Beverage Service (RBS) targeting licensed premises was developed by STAD (Stockholm Prevents Alcohol and Drug Problems) and implemented in Stockholm, Sweden. The program consists of community mobilization and collaboration, training, and enforcement. Early evaluations have shown a significant increase in the refusal rates of alcohol service to intoxicated patrons, from 5% in 1996 to 70% in 2001, and a 29% decrease in the frequency of police-reported violence. A cost-effectiveness analysis showed a cost-saving ratio of 1:39. The program was institutionalized by a collaborative steering group consisting of community stakeholders. This study aimed to evaluate the long-term effects over 20 years of the RBS program. The indicator chosen was the rate of alcohol overserving to obviously intoxicated patrons at licensed premises in Stockholm.

A 20-year follow-up study was conducted using the same procedure as the baseline and previous follow-ups. Professional male actors (pseudopatrons) were trained by an expert panel to enact a standardized scene of obvious alcohol-intoxication. In 2016, 146 licensed premises located in the central part of Stockholm were randomly selected and visited. A review of program implementation from its initiation 1996 was conducted, examining critical events, including commitment from key actors in the community, training of bar staff, and enforcement.

At the 20-year follow-up, pseudopatrons were refused alcohol service in 76.7% of the attempts, which was at the same level (70%) as in the follow-up in 2001, thus indicating sustained effects of the RBS program. Compared with previous follow-ups, serving staff used more active intervention techniques in 2016 toward intoxicated patrons, such as refusing to take the order (56.9% in 2016 vs. 42.0% in 2001), and fewer passive techniques, such as ignoring patrons (6.5% in 2016 vs. 15.5% in 1999) or contacting a colleague (4.1% in 2016 vs. 25% in 2001).

The sustained long-term effects of the RBS program are unique and can be explained by the high level of institutionalization of the multicomponent program, which is still ongoing in Stockholm. These findings can inform the dissemination of the program to other countries and settings.

On 1 May 2018, Scotland introduced minimum unit pricing (MUP), a strength-based floor price below which alcohol cannot be sold, throughout all alcoholic beverages. The legislation necessitates an evaluation of its impact across a range of outcomes that will inform whether MUP will continue beyond its sixth year. We measured the impact of MUP on per-adult alcohol sales (as a proxy for consumption) after 3 years of implementation.

Controlled interrupted time-series regression was used to assess the impact of MUP on alcohol sales in Scotland after 3 years of implementation, with England and Wales (EW) being the control group. In adjusted analyses, we included household disposable income, on-trade alcohol sales (in off-trade analyses) and substitution between drink categories (in drink category analyses) as covariates.

Weekly data were assessed on the volume of pure alcohol sold in Scotland and EW between January 2013 and May 2021, expressed as litres of pure alcohol per adult. The impact of MUP on total (on- and off-trade combined), off-trade and on-trade alcohol sales was assessed separately.

The introduction of MUP in Scotland was associated with a 3.0% (95% confidence interval = 1.8-4.2%) net reduction in total alcohol sales per adult after adjustment for the best available geographical control, disposable income and substitution. This reflects a 1.1% fall in Scotland in contrast to a 2.4% increase in EW. The reduction in total alcohol sales in Scotland was driven by reduced sales of beer, spirits, cider and perry. The reduction in total sales was due to reductions in sales of alcohol through the off-trade. There was no evidence of any change in on-trade alcohol sales.

Minimum unit pricing has been effective in reducing population-level alcohol sales in Scotland in the 3 years since implementation.

To systematically assess the Canadian federal government's current alcohol policies in relation to public health best practices.

The 2022 Canadian Alcohol Policy Evaluation (CAPE) Project assessed federal alcohol policies across 10 domains. Policy domains were weighted according to evidence for their relative impact, including effectiveness and scope. A detailed scoring rubric of best practices was developed and externally reviewed by international experts. Policy data were collected between June and December 2022, using official legislation, government websites, and data sources identified from previous iterations of CAPE as sources. Contacts within relevant government departments provided any additional data sources, reviewed the accuracy and completeness of the data, and provided amendments as needed. Data were scored independently by members of the research team. Final policy scores were tabulated and presented as a weighted overall average score and as unweighted domain-specific scores.

Compared to public health best practices, the federal government of Canada scored 37% overall. The three most impactful domains-(1) pricing and taxation, (2) marketing and advertising controls, and (3) impaired driving countermeasures-received some of the lowest scores (39%, 10%, and 40%, respectively). Domain-specific scores varied considerably from 0% for minimum legal age policies to 100% for controls on physical availability of alcohol.

Many evidence-informed alcohol policies have not been adopted, or been adopted only partially, by the Canadian federal government. Urgent adoption of the recommended policies is needed to prevent and reduce the enormous health, social, and economic costs of alcohol use in Canada.

Current alcohol product labelling tends to include ambiguous messages such as 'drink responsibly'. Consumers who identify as responsible drinkers may not pay heed to health warning messages, believing that they are not the intended target.

We aimed to determine how responses to responsible drinking labels would differ from responses to positively and negatively framed health messages. We also explored if prototype perceptions would moderate the message impact.

A between groups, three arm (ambiguous, positive or negative messages) experiment recruited 465 participants. Outcomes were drinking intentions and label acceptability (novelty, believability, personal relevance, and potential to change behaviour). Measures of heavy and responsible drinker prototype perceptions were included for exploratory moderation analyses.

Positive and negative messages were rated significantly more likely to change behaviour than ambiguous messages. There was also a moderation effect: participants with stronger favourability and similarity to the responsible drinker prototype intended to drink more alcohol in the future after exposure to negatively framed labels, but not after exposure to ambiguous or positively framed labels.

Drink responsibly' messages are unlikely to lead to behaviour change. Incorporating theoretical moderators may have value in developing our understanding of the impact of alcohol product labelling.

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.

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.

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.

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.

Per capita alcohol consumption using monthly alcohol sales data divided by the midyear total population number used as a proxy.

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%).

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.

A health warning label (HWL) cautioning about the link between alcohol and cancer may be able to communicate alcohol risks to consumers and potentially counter health-oriented nutrition advertising on ready-to-drink alcoholic beverages. This study aimed to examine the independent and combined effects of nutrient content claims (e.g. 0 g sugar) and a HWL on perceived product characteristics and intentions to consume, and whether these effects differed by gender and age.

A between-subjects randomized experiment. Participants were randomized to view one of six experimental label conditions: nutrient content claims plus nutrition declaration (NCC + ND), ND only, NCC + ND + HWL, ND + HWL, HWL only and no NCC, ND or HWL, all on a ready-to-drink (RTD) vodka-based soda container.

Alcohol consumers (n = 5063; 52% women) in Canada aged 18-64 recruited through a national online panel.

Participants completed ratings of perceived product characteristics, perceived product health risks, and intentions to try, buy, binge and drink the product.

Compared with the reference condition NCC + ND (current policy scenario in Canada), the other five experimental label conditions were associated with lower ratings for perceiving the product as healthy. All experimental conditions with a HWL were associated with lower product appeal, higher risk perceptions and reduced intentions to try, buy and binge. The experimental condition with a HWL only was associated with intentions to consume fewer cans in the next 7 days (β = -0.72, 95% confidence interval [CI] = -1.37,-0.08) versus the reference. Few interactions were observed, suggesting that label effects on outcomes were similar by gender and age.

Health warning labels on alcohol packaging appear to be associated with lower product appeal, higher perceived health risks and reduced consumption intentions, even in the presence of nutrient content claims.

We explored the early impact of changes to the UK alcohol tax system, implemented in August 2023, on the strength and price of alcoholic products available for sale on the website of the largest supermarket in England.

Our comparative descriptive study using longitudinal brand-level data was not preregistered and should be considered exploratory.

Data were collected weekly (May to October 2023) using automated web scraping tools. Outcomes were product strength (% alcohol by volume [ABV]) and price (per 10 mL of pure alcohol and per litre of product). We undertook paired t-tests, two-sample Kolmogorov-Smirnov tests, and quantile regression to compare outcomes before and after the tax changes. Beer, cider, spirits, and ready-to-drinks (RTDs) were analysed separately.

There was a reduction in the mean strength of beer, driven by manufacturers reformulating a small number of weaker beers, moving them into a lower tax band (<3.5%ABV). The mean price per 10 mL of alcohol and per litre of product was significantly higher after the new tax system for beer, cider, and spirits and significantly lower for RTDs. Increases in the price of beer tended to occur across the entire distribution, whereas increases in the price of cider occurred among more expensive products.

Changes to product strength tended to occur among weaker products near the new lowest tax band, suggesting tax bands may be a potential stimulus for change. Reformulation of stronger products would have better public health potential. Longer term monitoring, including data on purchasing/consumption, is required.

Higher availability of alcohol is associated with higher levels of alcohol consumption and harm. Alcohol is increasingly accessible online, with rapid delivery often offered by a third-party driver. Remote delivery and online availability are important from a public health perspective, but to date, relatively little research has explored the availability of alcohol offered by online platforms.

This cross-sectional exploratory study describes the availability of alcohol on the third-party platform Deliveroo within London, England.

We extracted the number of outlets offering alcohol on Deliveroo for each London borough and converted these into crude rates per 1000 population (18-64 years). Outlets were grouped as outlets exclusively selling alcohol, off-licenses, and premium. We calculated Pearson correlation coefficients to explore the association between borough's crude rate of outlets per 1000 population and average Indices of Multiple Deprivation (IMD) 2019 scores. We extracted the number of outlets also selling tobacco or e-cigarettes and used non-Deliveroo drivers. We searched addresses of the top 20 outlets delivering to the most boroughs by outlet type (60 total) to determine their associated premise.

We identified 4277 total Deliveroo-based outlets offering alcohol across London, including outlets delivering in multiple boroughs. The crude rate of outlets per 1000 population aged 18-64 years was 0.73 and ranged from 0.22 to 2.29 per borough. Most outlets exclusively sold alcohol (3086/4277, 72.2%), followed by off-licenses (770/4277, 18.0%) and premium (421/4277, 9.8%). The majority of outlets exclusively selling alcohol sold tobacco or e-cigarettes (2951/3086, 95.6%) as did off-licenses to a lesser extent (588/770, 76.4%). Most outlets exclusively offering alcohol used drivers not employed by Deliveroo (2887/3086, 93.6%), and the inverse was true for premium outlets (50/421, 11.9%) and off-licenses (73/770, 9.5%). There were 1049 unique outlets, of which 396 (37.8%) were exclusively offering alcohol-these outlets tended to deliver across multiple boroughs unlike off-licenses and premium outlets. Of outlets with confirmed addresses, self-storage units were listed as the associated premise for 85% (17/20) of outlets exclusively offering alcohol, 11% (2/19) of off-licenses, and 12% (2/17) of premium outlets. We found no significant relationship between borough IMD scores and crude rate of outlets per 1000 population overall (P=.87) or by any outlet type: exclusively alcohol (P=.41), off-license (P=.58), and premium (P=.18).

London-based Deliveroo outlets offering alcohol are common and are sometimes operating from self-storage units that have policies prohibiting alcohol storage. This and the potential for increased alcohol accessibility online have implications for public health given the relationship between alcohol's availability and consumption or harm. There is a need to ensure that regulations for delivery are adequate for protecting children and vulnerable adults. The Licensing Act 2003 may require modernization in the digital age. Future research must explore a relationship between online alcohol availability and deprivation.

The American, European, and Latin American liver societies have proposed a change in the nomenclature we use to describe alcohol-related liver disease and non-alcoholic fatty liver disease. Additionally, a term encompassing both is now advocated: steatotic liver disease, which includes metabolic dysfunction associated steatotic liver disease (MASLD) and MASLD with greater alcohol consumption (MetALD). These classifications offer increased relevance for clinicians, researchers, and patients alike. In this Viewpoint, we discuss the basis for this nomenclature shift and how it was developed. We also explore the challenges that will be faced in the adoption of such change. The proposed change seeks to banish stigma associated with phrasing such as alcoholic and fatty. However stigma, particularly related to the term fatty, is culturally nuanced, and reflects different entities depending on location. If such a change is internationally accepted, there will be wide-reaching effects on practitioners in primary care and metabolic medicine, and on patients. We discuss those effects and the opportunities the nomenclature change could offer, particularly for patients with alcohol and metabolic risk factors who represent a group previously ignored by clinical trials.

Alcohol use is declining among US adolescents/early young adults and increasing among other adults, with increases in adult binge drinking more concentrated in females than males. Reasons for drinking are historically patterned by age and sex, and if historically variant, could suggest that changes over time could in part explain age- and sex-differential cohort effects.

We analyzed longitudinal Monitoring the Future data for individuals born from 1958 to 1990. These individuals were aged 29/30 from 1987 to 2020, and first surveyed at age 18 from 1976 to 2008 (N = 14,190). Five reasons for drinking were analyzed (social, enhancement, avoid problems, relax, boredom). Drinking for social reasons and to relax were most prevalent. Total effects of birth cohort predicting past-2-week binge drinking were estimated with polynomial regression models by age; indirect effects through mediators were estimated.

Drinking reasons exhibited dynamic time trends across birth cohort and sex. Notable increases were observed in social reasons: among women aged 29/30, social reasons increased from 53% to 87% from 1987 to 2020. Social reasons to drink had prominent positive indirect effects at adult ages (age 23/24 and above among men; age 19 and above among women), indicating that binge drinking would have increased less were it not for the increase in social reasons for drinking. Social reasons also mediated adult male/female differences, indicating that part of the reason sex differences are diminishing is the more rapid increases in social reasons for drinking among women. Indirect effects were also observed for drinking to relax and for boredom, and limited indirect effects were observed for enhancement and to avoid problems.

Changing endorsement of drinking reasons, especially social reasons, among US adult drinkers mediate cohort effects in binge drinking in the US adult population and explain in part why binge drinking is converging by sex.

The study aimed to estimate the impact of introducing a draught alcohol-free beer, thereby increasing the relative availability of these products, on alcohol sales and monetary takings in bars and pubs in England.

Randomised crossover field trial.

England.

Fourteen venues that did not previously sell draught alcohol-free beer.

Venues completed two intervention periods and two control periods in a randomised order over 8 weeks. Intervention periods involved replacing one draught alcoholic beer with an alcohol-free beer. Control periods operated business as usual.

The primary outcome was mean weekly volume (in litres) of draught alcoholic beer sold. The secondary outcome was mean weekly revenue [in GBP (£)] from all drinks. Analyses adjusted for randomised order, special events, season and busyness.

The adjusted mean difference in weekly sales of draught alcoholic beer was -20 L [95% confidence interval (CI) = -41 to +0.4], equivalent to a 4% reduction (95% CI = 8% reduction to 0.1% increase) in the volume of alcoholic draught beer sold when draught alcohol-free beer was available. Excluding venues that failed at least one fidelity check resulted in an adjusted mean difference of -29 L per week (95% CI = -53 to -5), equivalent to a 5% reduction (95% CI = 8% reduction to 0.8% reduction). The adjusted mean difference in weekly revenue was +61 GBP per week (95% CI = -328 to +450), equivalent to a 1% increase (95% CI = 5% decrease to 7% increase) when draught alcohol-free beer was available.

Introducing a draught alcohol-free beer in bars and pubs in England reduced the volume of draught alcoholic beer sold by 4% to 5%, with no evidence of the intervention impacting net revenue.

Background: There is a yet unmet opportunity to utilize data on taxes and individual behaviors to yield insight for analyzing studies involving alcohol and cigarette use.Objectives: To inform the direction and strength of their mutual associations by leveraging the fact that taxation can affect individual consumption, but individual consumption cannot affect taxation.Methods: We linked state-level data on cigarette and beer taxes in 2009-2020 with individual-level data on self-reported current cigarette and alcohol use from the Behavioral Risk Factor Surveillance System, a telephone survey by the Centers for Disease Control and Prevention that is representative of the population of each state in the United States. We constructed linear and logistic models to examine associations between a $1 increase in cigarette taxes per pack and a $1 increase in beer taxes per gallon and self-reported cigarette use and alcohol consumption (assessed as any current intake, average drinks/day, heavy drinking, and binge drinking), adjusting for survey year and individual characteristics.Results: Among 2,968,839,352 respondents (49% male), a $1 increase in beer taxes was associated with .003 (95% confidence interval [CI] -.013, .008) fewer drinks/day and lower odds of any drinking (odds ratio [OR] = .81 95%CI .80, .83), heavy drinking (OR = .96 95%CI .93, .99), binge drinking (OR = .82 95%CI .80, .83), and smoking (OR = .98 95%CI .96, 1.00). In contrast, a $1 increase in cigarette taxes was associated with lower odds of smoking (OR = .94 95%CI .94, .95) but .007 (95%CI .005, .010) more drinks/day, and higher odds of any drinking (OR = 1.10 95%CI 1.10, 1.11), heavy drinking (OR = 1.02 95%CI 1.01, 1.02), and binge drinking (OR = .82 95%CI .80, .83).Conclusion: Higher beer taxes were associated with lower odds of drinking and smoking, but higher cigarette taxes were associated with lower odds of smoking and higher alcohol consumption. These results suggest that alcohol intake may be a determinant of cigarette use rather than cigarette use as a determinant of alcohol intake.

Alcohol policy studies have traditionally focused on formal policymaking processes. Retail cooperatives, however, have rarely been studied as sites of public health interventions. Migros, a cooperatively owned chain of supermarkets in Switzerland, has long forbidden alcohol sales in its supermarkets. Focusing on processes of framing, this study explores a recent unsuccessful attempt to reverse the long-standing ban via membership vote in 2022.

The study draws on a range of data sources, including company documents, a televised debate, and the results of a large online survey among the general population conducted ahead of the referendum. Using thematic analysis, it investigates various campaign-related arguments, including those made by Migros management, NGOs, and other key campaign participants.

Proponents and opponents used a combination of public health, economic/market-oriented, and corporate social responsibility (CSR) frames. Migros's longstanding dedication to CSR, its participatory governance structure, and the regional political dynamics in the Swiss context are essential in understanding the nature and impact of framing.

Alcohol-related harm arises from a complex interaction between different social, political, and economic factors. Reducing harm requires approaches that consider the range of contexts and measures that can shape alcohol availability.

Public health law is an important tool in non-communicable disease (NCD) prevention. There are different approaches available for achieving policy objectives, including government, co-, quasi- and self-regulation. However, it is often unclear what legal design features drive successes or failures in particular contexts. This scoping review undertakes a descriptive analysis, exploring the design characteristics of legal instruments that have been used for NCD prevention and implemented and evaluated in OECD countries.

A scoping review was conducted across four health and legal databases (Scopus, EMBASE, MEDLINE, HeinOnline), identifying study characteristics, legal characteristics and regulatory approaches, and reported outcomes. Included studies focused on regulation of tobacco, alcohol, unhealthy foods and beverages, and environmental pollutants.

We identified 111 relevant studies evaluating 126 legal instruments. Evaluation measures most commonly assessed implementation, compliance and changes to the built and lived environment. Few studies evaluated health or economic outcomes. When examining the design and governance mechanisms of the included legal instruments, government regulation was most commonly evaluated (n = 90) and most likely to be reported effective (64%). Self-regulation (n = 27) and quasi-regulation (n = 5) were almost always reported to be ineffective (93% and 100% respectively). There were few co-regulated instruments evaluated (n = 4) with mixed effectiveness. When examining public health risks, food and beverages including alcohol were more likely to be self- or quasi-regulated and reported as ineffective more often. In comparison, tobacco and environmental pollutants were more likely to have government mandated regulation. Many evaluations lacked critical information on regulatory design. Monitoring and enforcement of regulations was inconsistently reported, making it difficult to draw linkages to outcomes and reported effectiveness.

Food and alcohol regulation has tended to be less successful in part due to the strong reliance on self- and quasi-regulation. More work should be done in understanding how government regulation can be extended to these areas. Public health law evaluations are important for supporting government decision-making but must provide more detail of the design and implementation features of the instruments being evaluated - critical information for policy-makers.

Health risk information is insufficient as a means of reducing alcohol use, particularly when it evokes negative emotional states amongst those for whom it is most personally relevant. Appraisal biases, or 'defensive processing', may be employed to mitigate the psychological discomfort posed by such information. Few studies have evaluated the role of defensive processing in people with different levels of alcohol consumption.

Online participants (n = 597) completed measures of defensive processing of a health risk infographic, perceived susceptibility and severity of alcohol use, efficacy for resisting alcohol use, unrealistic optimism, the Alcohol Use Disorder Identification Test - Consumption (AUDIT-C) and demographics.

AUDIT-C scores were positively and linearly associated with all defensive processing measures (Pearson's correlation r from.16 to .36), threat and susceptibility (r = .16) and unrealistic optimism (r = .50). AUDIT-C scores were also negatively associated with efficacy for controlling alcohol use (r = -0.48).

People with alcohol use disorder (AUD) engaged in much more defensive processing of alcohol-related messages, offering an explanation for why such messages are limited at eliciting behaviour change. High levels of unrealistic optimism in people with alcohol use disorder may reflect low problem recognition in order to maintain a problem-free drinking identity.

International systematic reviews suggest an association between alcohol availability and increased alcohol-related harms. Alcohol availability is regulated through separate locally administered licensing systems in England and Scotland, in which local public health teams have a statutory role. The system in Scotland includes a public health objective for licensing. Public health teams engage to varying degrees in licensing matters but no previous study has sought to objectively characterise and measure their activity, examine their effectiveness, or compare practices between Scotland and England.

To critically assess the impact and mechanisms of impact of public health team engagement in alcohol premises licensing on alcohol-related harms in England and Scotland.

We recruited 39 diverse public health teams in England (n = 27) and Scotland (n = 12). Public health teams more active in licensing were recruited first and then matched to lower-activity public health teams. Using structured interviews (n = 66), documentation analysis, and expert consultation, we developed and applied the Public Health Engagement In Alcohol Licensing (PHIAL) measure to quantify six-monthly activity levels from 2012 to 2019. Time series of PHIAL scores, and health and crime outcomes for each area, were analysed using multivariable negative binomial mixed-effects models to assess correlations between outcome and exposure, with 18-month average PHIAL score as the primary exposure metric. In-depth interviews (n = 53) and a workshop (n = 10) explored public health team approaches and potential mechanisms of impact of alcohol availability interventions with public health team members and licensing stakeholders (local authority licensing officers, managers and lawyers/clerks, police staff with a licensing remit, local elected representatives).

Nineteen public health team activity types were assessed in six categories: (1) staffing; (2) reviewing and (3) responding to licence applications; (4) data usage; (5) influencing licensing stakeholders/policy; and (6) public involvement. Usage and intensity of activities and overall approaches varied within and between areas over time, including between Scotland and England. The latter variation could be explained by legal, structural and philosophical differences, including Scotland's public health objective. This objective was felt to legitimise public health considerations and the use of public health data within licensing. Quantitative analysis showed no clear evidence of association between level of public health team activity and the health or crime outcomes examined, using the primary exposure or other metrics (neither change in, nor cumulative, PHIAL scores). Qualitative data suggested that public health team input was valued by many licensing stakeholders, and that alcohol availability may lead to harms by affecting the accessibility, visibility and norms of alcohol consumption, but that the licensing systems have limited power to act in the interests of public health.

This study provides no evidence that public health team engagement in local licensing matters was associated with measurable downstream reductions in crime or health harms, in the short term, or over a 7-year follow-up period. The extensive qualitative data suggest that public health team engagement is valued and appears to be slowly reorienting the licensing system to better address health (and other) harms, especially in Scotland, but this will take time. A rise in home drinking, alcohol deliveries, and the inherent inability of the licensing system to reduce - or in the case of online sales, to contain - availability, may explain the null findings and will continue to limit the potential of these licensing systems to address alcohol-related harms.

Further analysis could consider the relative success of different public health team approaches in terms of changing alcohol availability and retailing. A key gap relates to the nature and impact of online availability on alcohol consumption, harms and inequalities, alongside development and study of relevant policy options. A national approach to licensing data and oversight would greatly facilitate future studies and public health input to licensing.

Our interview data and therefore PHIAL scores may be limited by recall bias where documentary evidence of public health activity was not available, and by possible variability in grading of such activity, though steps were taken to minimise both. The analyses would have benefited from additional data on licensing policies and environmental changes that might have affected availability or harms in the study areas.

The study was registered with the Research Registry (researchregistry6162) on 26 October 2020. The study protocol was published in BMC Medical Research Methodology on 6 November 2018.

This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number 15/129/11.

Alcohol is a harmful, toxic and addictive substance that causes many diseases and injuries. Alcohol use also incurs a financial cost to the health care system and wider economy. This project aimed to undertake a cost impact analysis of alcohol-related harms at the local level in New South Wales (NSW). The alcohol-related harms costing model is an interactive tool designed for use by local health districts, stakeholders such as Liquor and Gaming NSW, NSW Independent Liquor and Gaming Authority and community stakeholders.

Costs included in the analysis were alcohol-related hospitalisations, deaths, crimes, emergency department attendances, outpatient presentations and their impacts on productivity. Two local government areas (LGA) were used as case studies to demonstrate local impacts.

In 2019-2020, the total cost of alcohol-related harms for NSW was estimated at $9 billion, at a rate of $120.3 million per 100,000 population. The total costs were comprised of alcohol-attributable premature mortality ($8.3 billion), non-fatal health care costs ($275 million) and crime costs ($457 million). A comparative analysis of two case study LGAs estimated that alcohol-related harms cost $195 million for the Northern Beaches LGA and $351 million for the Central Coast LGA.

This research has developed a 'proof-of-concept' model to estimate the cost of alcohol-related harms at the local level in Australia, empowering health agencies and local community stakeholders to use economic evidence in their submissions in response to new liquor licence applications and other policies that impact their local community. This economic evidence can be used to improve the quality of decisions on alcohol regulation and policies. There are a number of future research opportunities that would enhance the economic evidence available to liquor licensing decision-makers.

Excessive alcohol consumption is often followed by feelings of regret. This study aimed to explore country differences in experiences of drunkenness and regrets and predictors of experiencing a greater number of regrettable drinking occasions.

This study draws on a sample of 82,821 respondents from 31 countries who completed the 2020 Global Drug Survey. Respondents were asked to report how many times in the last year they had been drunk, how many of those times they felt regret afterwards and to complete a range of sociodemographic measures.

In the last 12 months, the median times drunk was 6 and the median number of regretted occasions was 2. There was an inverse relationship between times drunk and regret. Respondents who got drunk more often regretted it a smaller percentage of the time than those who got drunk less often. Respondents from Argentina and Colombia regretted being drunk the most and Denmark the least. Being younger, in higher AUDIT categories were associated with more times drunk. Being a woman, having mental health conditions were associated with more regretted occasions.Discussion and conclusions: Country variations may reflect relative acceptability of being drunk. Those who drink more, per occasion, may become accustomed to the consequences and feel fewer regrets. Interventions promoting reduced alcohol consumption may benefit from encouraging people to consider their future regret following a drinking occasion but should account for lower levels of regret in those who get drunk more often.

The proliferation of alcohol outlets has led to increased physical availability of alcohol, harmful alcohol consumption and related harm in Nigeria. This study explored alcohol licensing legislations and licensing systems across local government councils (LGC) in South-West, Nigeria.

Twenty-four LGCs across three states participated in the study. Data were generated from: (i) documents containing LGC liquor licensing legislations; and (ii) semi-structured interviews conducted with 50 LGC officials (16 legislative council clerks and 34 finance officers [director of finance, rate officers and revenue collectors]) were thematically analysed using NVivo.

Nine of the sampled LGC enacted liquor licence bylaws. These mostly specified categories of liquor licences issued and licensing fees. None of the liquor licence bylaw contained regulations for controlling physical availability of alcohol and outlet density. Finance officials were licensing officers and there were no licensing committees across the LGCs. The LGC officials were unanimous in stating that generating revenue from licensing fees was the main objective for licensing alcohol outlets. The LGCs licensed alcohol outlets indiscriminately and failed to regulate outlet density.

The absence of regulations for controlling outlet density has implications for physical availability of alcohol in Nigeria. Our findings strongly suggest the need to develop national liquor licensing legislation with public health objectives and implementing regulations for controlling temporal and spatial availability of alcohol. Each LGC should inaugurate a licensing committee with clearly defined roles and responsibilities for licensing stakeholders such as LGC health officials, law enforcement agencies and community members.