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Aims: This study aimed to prospectively examine the explanatory value of the protection motivation theory (PMT) for the intention to use manner of drinking protective behavioral strategies (MD PBS) and to explore its invariance across genders., Method: A targeted sampling procedure was used to recruit 339 young adults in the community (Mage = 21.1; SD = 2.21; female = 50.7%) who completed baseline and 2-month follow-up measures of the PMT constructs and intentions to use each of the five MD PBS., Results: Regression analyses revealed that the coping appraisal components (response efficacy and self-efficacy) had greater explanatory power for the intention to use MD PBS than the threat appraisal components (perceived vulnerability and perceived severity). Perceived vulnerability to alcohol consequences was not prospectively associated with any specific behavioral intention or with the total MD PBS score. In contrast, perceived severity was prospectively associated with the intention to use three out of five PBS and the total MD score. Regression coefficients revealed gender invariance for all six models., Conclusions: Our findings suggest that interventions aimed at encouraging young adults to use alcohol MD PBS would be most effective if they included components that enhance self-efficacy in using these strategies and emphasize their perceived usefulness in reducing alcohol-related consequences., (© The Author(s) 2024. Medical Council on Alcohol and Oxford University Press.)

Aim: Intervention design may be improved through evaluating the feedback from those who have been exposed to such interventions. As such, here the perspectives of the intervention group from a recent randomized control trial investigating the effectiveness of a digital alcohol intervention, in terms of perceived suitability and usefulness of the support tool they engaged with, were investigated., Methods: Respondents (N=475; 45% of the intervention group) answered five quantitative questions addressing user experience, completed the 10-item System Useability Scale, and were offered the opportunity to write free-text feedback. Quantitative measures were analysed using ordinal and linear regression with baseline characteristics as predictors, and free-text responses were evaluated using content analysis., Results: Overall, respondents were positive towards the intervention in terms of it fitting their needs, the usefulness of the tools included, and the usefulness of text message content. The intervention was perceived as more helpful by respondents with lower total weekly alcohol consumption, higher self-reported confidence in their ability to reduce their drinking, and the perceived importance there of, at baseline. The free-text comments revealed the value of reminders as prompts to reflect on one's own drinking behaviour. Nonetheless, criticisms of the intervention were voiced, primarily highlighting the repetitive nature of the reminders and the lack of individuation in advice. Some also feltlike the intervention was impersonal and targeted only a specific drinking pattern., Conclusions: Experiences of the intervention group in this trial were generally positive, though there may be demand for more individualised, targeted intervention design., (© The Author(s) 2023. Medical Council on Alcohol and Oxford University Press.)

Aims: To estimate the use of home alcohol delivery and other methods of obtaining alcohol, rates of ID checking for home alcohol delivery purchases, and associations with alcohol-related consequences., Methods: Surveillance data from 784 lifetime drinkers participating in the 2022 Rhode Island Young Adult Survey were used. The method of obtaining alcohol (e.g. type of purchase, gifted, theft) was assessed. The Alcohol Use Disorders Identification Test, Brief Young Adults Alcohol Consequences Questionnaire, and a drinking and driving question were used to measure high-risk drinking behaviors, experiencing negative alcohol questions, and history of drinking and driving. Logistic regression models adjusting for sociodemographic variables were used to estimate main effects., Results: About 7.4% of the sample purchased alcohol through a home delivery or to-go purchase; 12.1% of participants who obtained alcohol this way never had their ID checked during the purchase attempt, and 10.2% of these purchases were completed by participants under the legal purchase age. Home delivery/to-go purchases were associated with high-risk drinking. Alcohol theft was associated with high-risk drinking, experiencing negative alcohol consequences, and drinking and driving., Conclusions: Home alcohol delivery and to-go purchases may provide an opportunity for underage access to alcohol, but their current use as a method of obtaining alcohol is rare. Stronger ID checking policies are needed. Alcohol theft was linked to several negative alcohol outcomes, and home-based preventive interventions should be considered., (© The Author(s) 2023. Medical Council on Alcohol and Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Alcohol use is a leading risk factor for premature death and disability. To tackle this issue, more systematic and accurate screening for at-risk consumption is needed in healthcare systems, especially by general practitioners (GPs). We assessed the frequency of at-risk consumption screening by GPs in France. We also identified characteristics associated with more frequent screening and greater use of validated screening tools by these healthcare providers. A cross-sectional survey was conducted among a representative sample of French GPs. Multinomial logistic regressions were used to identify factors associated with more frequent screening and greater use of validated screening tools. Response rate was of 73%. Of the 2412 participants, 42.8% screened all their patients systematically and repeatedly, while 48.0% never used standardized tools to screen potentially at-risk patients. Among other characteristics, being aware of and using the "early identification and brief intervention" screening strategy, and feeling absolutely comfortable talking with patients about reducing or stopping their alcohol use, were both associated with more frequent screening and use of standardized tools. Our results on at-risk alcohol use screening highlight an improvement over data from previous studies. Nevertheless, better training of French GPs in good alcohol screening practices-specifically, increased screening frequency and greater use of standardized tools-may improve identification of at-risk patients., (© The Author(s) 2023. Medical Council on Alcohol and Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Aims: Despite alcohol consumption being a dose-dependent risk factor for breast cancer, a recent study conducted in the UK found <20% of women attending breast screening programmes were aware of this relationship and proposed proper information campaigns need to be conducted. We aimed to investigate the awareness of this relationship among a related sample of Italian women to evaluate whether similar information campaigns should also be conducted in Italy., Methods: The questionnaire used by the UK study was translated into Italian, slightly modified for the Italian context, validated and submitted to a sample of Italian women., Results: Overall 507 women were interviewed. Among them, 160 were classified as breast cancer screening attenders (SG), 44 as symptomatic breast clinic attenders (CAG) and 303 as non-screening group (NSG). Alcohol was correctly identified as a risk factor for breast cancer by 16.9, 11.4 and 14.9% of participants of SG, CAG and NSG, respectively without differences between the three groups. Despite the methodological differences, the rates of participants who correctly identified alcohol as a risk factor among women attending breast screening programmes were surprisingly similar between the study conducted in UK (15.7%) and the present study (16.9%)., Conclusion: The results of the present study confirm the limited awareness of the relationship between alcohol consumption and risk of developing breast cancer among women and suggest the urgent need to conduct proper awareness-raising campaigns to counter this in the Italian female population., (© The Author(s) 2021. Medical Council on Alcohol and Oxford University Press. All rights reserved.)

Aims: Many parents in contact with children's social care services misuse alcohol however do not meet the threshold for specialist alcohol treatment, and typically do not receive appropriate support for their needs. Brief alcohol interventions have been found to be effective in healthcare settings, however, it is unknown whether the brief intervention structure delivered within health settings would transfer well into children's social care. This paper aims to examine the characteristics of brief intervention for alcohol misusing parents which social care practitioners consider to be important and acceptable to implement in this sector., Methods: We assessed preferences for, and acceptability of, brief alcohol intervention with parents in contact with children's social care using a discrete choice experiment. We recruited 205 children's social care practitioners from London and the North East of England. Data were analysed using mixed logit which accounted for repeated responses., Findings: Six attributes showed statistically significant coefficients, suggesting that a brief intervention with these attributes would encourage implementation. These were: level of alcohol-related risk targeted; intervention recipient; timing of intervention; duration of sessions; number of sessions and intervention structure. The attribute of most importance identified based on the attribute with the largest coefficient in the conditional logit model was risk level., Conclusions: Brief alcohol interventions delivered to parents in social care should focus on the impact upon children and the wider family, they should be a flexible part of on-going casework and should be more intensive and less structured., (© The Author(s) 2022. Medical Council on Alcohol and Oxford University Press.)

Introduction: Alcohol use by young people is associated with a range of psychological and physical harms. However, similar harms are also reported with disinhibitory conditions such as conduct problems that are said to precede and predispose to alcohol misuse. We explored whether alcohol use or indicators of underlying disinhibition predict psychological and physical harms in a cohort of young people., Methods: We used data from a randomised controlled intervention trial that identified young people who consumed alcohol (n = 756), mean age = 15.6 years, attending emergency departments (EDs) in England. Disinhibition was measured by the self-report Strengths and Difficulties Questionnaire hyperactivity and conduct problem items, and alcohol-related harms by questions from the ESPAD, a major European school survey. We conducted a mediation analysis with a primary outcome of frequency of engaging in alcohol-related harms 12 months after screening in ED, exploring for the mediating influence of alcohol consumed at six months. We included age, gender, allocated group and baseline consumption as covariates and adjusted for the multi-level nature of the study, where young people were nested within EDs., Results: Conduct problems and to a lesser extent hyperactivity predicted harms at twelve months. This effect was not mediated by alcohol consumed at 6 months., Conclusions: Among young drinkers underlying behavioural attributes predict harm independently of alcohol use. This suggests that the harms associated with alcohol use are attributable more to underlying disinhibitory characteristics than the quantity of alcohol consumed., (© The Author(s) 2021. Medical Council on Alcohol and Oxford University Press. All rights reserved.)

Aims: To correct risky alcohol use among young adults, current personalized feedback interventions (PFIs) use social influence information related to distal referent groups. Although current PFIs have been effective, little consideration has been given to strategies applying more concrete sources of social influence, namely the influence of specific people within one's social network during actual drinking contexts. The current study evaluated a novel PFI, providing feedback regarding the presence or absence of particular individuals within a participant's close network along with the number of drinks consumed and consequences experienced during several specific drinking occasions., Methods: TurkPrime users (N = 338) identified five close others with whom they sometimes drank. They also provided details about their five most recent drinking occasions and noted which of their network members were present. Participants were then randomized to receive or not receive feedback consisting of a list of drinking events, negative consequences and who was present., Results: Feedback participants intended to consume fewer drinks over the next month relative to control (b = -0.25, P = 0.001). Analyses were inconclusive as to whether this effect was stronger for those who received more feedback (b = -0.01, P = 0.857)., Conclusions: Results provide preliminary support for the efficacy of a novel social influence-based intervention, which provides personalized feedback indicating social contexts that are more and less likely to lead to negative alcohol-related experiences., (© The Author(s) 2022. Medical Council on Alcohol and Oxford University Press. All rights reserved.)

Aims: College students who drink are at an increased risk of driving after drinking and alcohol-involved traffic accidents and deaths. Furthermore, the persistence of driving after drinking over time underscores a need for effective interventions to prevent future drunk driving in adulthood. The present study examined whether brief alcohol interventions (BAIs) for college students reduce driving after drinking., Methods: A two-step meta-analysis of individual participant data (IPD) was conducted using a combined sample of 6801 college students from 15 randomized controlled trials (38% male, 72% White and 58% first-year students). BAIs included individually delivered Motivational Interviewing with Personalized Feedback (MI + PF), Group Motivational Interviewing (GMI), and stand-alone Personalized Feedback (PF) interventions. Two outcome variables, driving after two+/three+ drinks and driving after four+/five+ drinks, were checked, harmonized and analyzed separately for each study and then combined for meta-analysis and meta-regression analysis., Results: BAIs lowered the risk of driving after four+/five+ drinks (19% difference in the odds of driving after drinking favoring BAIs vs. control), but not the risk of driving after two+/three+ drinks (9% difference). Subsequent subgroup analysis indicated that the MI + PF intervention was comparatively better than PF or GMI., Conclusions: BAIs provide a harm reduction approach to college drinking. Hence, it is encouraging that BAIs reduce the risk of driving after heavy drinking among college students. However, there may be opportunities to enhance the intervention content and timing to be more relevant for driving after drinking and improve the outcome assessment and reporting to demonstrate its effect., (© The Author(s) 2021. Medical Council on Alcohol and Oxford University Press.)

Aim: Investigate changes in alcohol use and related harm using the first multisite, controlled, longitudinal study of Managed Alcohol Programs (MAPs). MAPs provide regular doses of alcohol, accommodation, social supports and healthcare to unstably housed people with alcohol dependence., Methods: A multisite, quasi-experimental, longitudinal study was conducted in day centres, shelters and residential programs for unstably housed people. There were 59 MAP participants from six Canadian cities and 116 local controls. Self-reported alcohol consumption and harms were assessed at 0-2, 6 and 12 months. Liver function test results were accessed for MAP participants., Results: Both groups had similar reductions in mean drinks per day (MAP: -8.11; controls: -8.54 controls, P < 0.001) and days drinking per month (MAP: -2.51 days, P < 0.05; control: -4.81 days, P = 0.0001) over 6--12 months. Both reduced non-beverage alcohol consumption. MAP participants reported significantly fewer harms at both 0-2 and 6 months than controls. MAP participants had similar total consumption to controls, but spread out over more days (25.41 versus 19.64 days per month, P = 0.001). After leaving a MAP, participants' liver status deteriorated, with increases in both aspartate transaminase and bilirubin levels. MAP sites with effective policies on outside drinking drank less and had fewer harms., Conclusion: MAP participants drank less hazardously than controls, especially with effective management of non-MAP drinking. Reductions in alcohol use and harms occurred for both groups, although MAP participants reported fewer harms at 0-6 months. Departing an MAP was associated with deterioration in liver status. Although providing stable housing, MAPs did not worsen health or increase alcohol use., (© The Author(s) 2021. Medical Council on Alcohol and Oxford University Press. All rights reserved.)

Aim: Resuming drinking is a main contributant to recurrence in alcoholic pancreatitis. We assessed current clinical practice in the Netherlands regarding alcohol in managing patients with a first episode of acute alcoholic pancreatitis., Methods: A survey was distributed to 35 hospitals affiliated with the Dutch Pancreatitis Study Group. We evaluated current support based on various components of brief interventions, the participation of psychosocial healthcare providers, the cooperation with the primary care physicians and the presence of a protocol and its implementation., Results: The response rate was 100% (n = 35). Psychoeducation is the most frequently performed intervention in current support treatment (97% of hospitals). In 17% of hospitals, healthcare providers with a psychosocial background routinely participate in current support treatment; 37% of hospitals create an individual treatment plan in which goals regarding alcohol cessation are specified and only 46% of hospitals provide the primary care physician with specific discharge information; 31% of hospitals indicate that the treatment is uniformly performed within their division of Gastroenterology. Protocols are available in 3% of the hospitals surveyed. Opportunities to involve the patient's social network were not given sufficient priority., Conclusion: Among Dutch hospitals, there is no routine management strategy with regard to enhancing treatment for heavy alcohol use in alcoholic pancreatitis patients. There is a need to test a validated support program in randomized studies. Meanwhile, possible opportunities for effecting change are often missed., (© The Author(s) 2021. Medical Council on Alcohol and Oxford University Press.)

Aims: To treat excessive alcohol consumption, general practices (GPs) are recommended to use non-directive implementation strategies. Directive implementation, however, may be perceived by general practice patients as something positive because of possibly indicating higher GP engagement and a more consistent treatment. In our study, we aimed to assess the readiness of patients to be treated with BI in the hypothetical event of excessive alcohol consumption either by a GP using non-directive recommendations according to WHO or by a GP using directive instructions. Additionally, we assessed the patients' dispositional readiness to disclose alcohol-associated personal information, termed alcohol consumption self-disclosure, in order to analyze its influence on their readiness to be treated with brief intervention (BI)., Methods: When consulting their GP, a convenience sample of general practice patients was asked by questionnaire. By means of a between-subject design, they were asked for the readiness to be treated either with non-directive BI or with directive BI. Repeated-measure ANCOVA was used to analyze the main- and interaction effects., Results: A sample of 442 general practice patients preferred the non-directive BI, F(1, 423) = 5.56, P < 0.05. We found moreover a two-way interaction between implementation and alcohol consumption self-disclosure, F(1, 423) = 18.89, P < 0.001, showing that only patients with low self-disclosure preferred the non-directive BI, t(428) = 3.99, P < 0.001., Conclusions: Future research should investigate the reasons for the patients' preference for the non-directive BI and may develop strategies to overcome the possibly low readiness of general practice patients to be treated with BI., (© The Author(s) 2020. Medical Council on Alcohol and Oxford University Press. All rights reserved.)

Aims: This paper analyses the content of news media messages on drinking during pregnancy in Australia over an 18-year period to understand whether and how the nature of messages communicated to women has changed over time., Methods: Factiva was used to search Australian newspapers from 2000 to 2017, resulting in a sample of 1394 articles from the 18 major national and state-based newspapers. Content analysis of articles was undertaken, and Poisson regression analysis was used to assess changes over time., Results: The largest number of articles on drinking during pregnancy was published in 2007. Themes that significantly increased over time included Harms to the Child (from 0.97% in 2008 to 29.69% in 2015) and Prevention Initiatives (from 0% in 2005 to 12.50% in 2017). Articles endorsing women not consuming alcohol during pregnancy significantly increased over time (from 20.69% in 2001 to 53.78% in 2013), matched by a decreasing trend in the proportion of articles presenting mixed advice (from 15.93% in 2009 to 0% in 2017). The largest number of articles adopted no position in relation to women's consumption., Conclusions: A stronger abstinence message during pregnancy has been communicated through Australian newspaper media over time. The mixed messaging and large number of articles not endorsing a position on consumption may reflect the inconclusiveness of the evidence on harms from low to moderate levels of alcohol consumption during pregnancy. Opportunities remain for researchers to work with public health advocates to disseminate balanced messages based on evidence-based research., (© The Author(s) 2020. Medical Council on Alcohol and Oxford University Press. All rights reserved.)

Aim: To assess the feasibility and acceptability of screening for alcohol misuse and delivering brief advice to eligible patients attending NHS dental practices in London., Methods: A two-arm cluster randomized controlled feasibility trial was conducted. Twelve dental practices were recruited and randomized to intervention and control arms. Participants attending for a dental check were recruited into the study and were eligible if they consumed alcohol above recommended levels assessed by the AUDIT-C screening tool. All eligible participants were asked to complete a baseline socio-demographic questionnaire. Six months after the completion of baseline measures, participants were contacted via telephone by a researcher masked to their allocation status. The full AUDIT tool was then administered. Alcohol consumption in the last 90 days was also assessed using the Form 90. A process evaluation assessed the acceptability of the intervention., Results: Over a 7-month period, 229 participants were recruited (95.4% recruitment rate) and at the 6 months follow-up, 176 participants were assessed (76.9% retention rate). At the follow-up, participants in the intervention arm were significantly more likely to report a longer abstinence period (3.2 vs. 2.3 weeks respectively, P = 0.04) and non-significant differences in AUDIT (44.9% vs. 59.8% AUDIT positive respectively, P = 0.053) and AUDIT C difference between baseline and follow-up (-0.67 units vs. -0.29 units respectively, P = 0.058). Results from the process evaluation indicated that the intervention and study procedures were acceptable to dentists and patients., Conclusions: This study has demonstrated the feasibility and acceptability of dentists screening for alcohol misuse and providing brief advice., (© The Author(s) 2019. Medical Council on Alcohol and Oxford University Press. All rights reserved.)

Aims: To review the effectiveness of workplace interventions in reducing alcohol consumption among employees., Methods: Systematic search of science databases from inception till May 2018 for trials where an intervention was tested against a control and data presented as amount of alcohol consumed per week. Quality of trials was assessed by Cochrane risk of bias tool. Meta-analysis was performed with random-effects model and pooled mean difference (MD) was reported with 95% confidence interval. Publication bias was assessed using Egger's test., Results: Seven trials with 1291 participants could be included. No outcome assessments were blinded. There was positive effect of workplace intervention on reduction of alcohol consumption with pooled MD of -2.25 [95% CI: -4.20 to -0.30]. The effect was only seen where subjects had a baseline alcohol consumption of over 15 standard drinks per week. There was no heterogeneity across the trials (I2=0%). Funnel plot was symmetrical shaped and Egger's test confirmed that there was no publication bias. Two studies found no advantages to intervention on differences on the AUDIT test., Conclusion: There is weak evidence for workplace interventions (varying modes) as a way of facilitating reduction in the consumption of alcohol among employees but only among the heavier consumers., (© The Author(s) 2019. Medical Council on Alcohol and Oxford University Press. All rights reserved.)

Aim: This paper briefly reviews the history of alcohol policy development in Europe leading to the current consensus in the health field on strategic priorities. There is a review of recent policy developments in selected European countries, both EU and non-EU members., Methods: Narrative review of published journal articles, publications from WHO, and other health organisations and government publications., Results: The implementation of the WHO policy priorities has been variable across Europe. At EU level, there has been a recent pattern of trade considerations taking priority over health and a disinvestment in alcohol research and advocacy. Among EU member states new implementation of WHO strategies have been limited to a few smaller countries and regions. In Russia, there have been considerable falls in mortality following the introduction of controls on price, availability and marketing., Conclusion: The implementation of WHO strategy at national level in Europe is highly dependent on the local political circumstances. Where there is concern about alcohol harm and political will, the WHO strategic priorities have been highly influential.In order to build public and political support for prevention, alcohol policy advocates should ensure that there is good data on trends within age, gender, and income groups and develops policies to respond to these trends. The concept of proportionate universalism, where interventions are understood to have a broad population effect but the effect is greater on the groups most in need, may be more useful than the traditional alcohol policy field conceptualisations of whole population and targeted measures., (© The Author(s) 2019. Medical Council on Alcohol and Oxford University Press. All rights reserved.)

Background: Public sector bodies have called for policies and programmes to shift collective social norms in disfavour of the harmful use of alcohol. This article aims to identify and summarize the evidence and propose how policies and programmes to shift social norms could be implemented and evaluated., Design: Review of reviews for all years to July 2017., Data Sources: Searches on OVID Medline, Healthstar, Embase, PsycINFO, AMED, Social Work Abstracts, CAB Abstracts, Mental Measurements Yearbook, Joanna Briggs Institute EBP, Health and Psychosocial Instruments, International Pharmaceutical Abstracts, International Political Science Abstracts, NASW Clinical Register and Epub Ahead of Print databases., Eligibility: All reviews, without language or date restrictions resulting from combining the terms ((review or literature review or review literature or data pooling or comparative study or systematic review or meta-analysis or pooled analysis) and (social norms or culture) and (alcohol drinking))., Results: Two relevant reviews were identified. One review of community-based interventions found one study that demonstrated small changes in parental disapproval of under-age drinking. One review stressed that collective social norms about drinking are malleable and not uniform in any one country. Three factors are proposed to inform programmes: provide information about the consequences of the harmful use of alcohol, and their causes and distribution; act on groups, not individuals; and strengthen environmental laws, regulations and approaches., Conclusions: Purposeful policies and programmes could be implemented to change collective social norms in disfavour of the harmful use of alcohol; they should be evidence-based and fully evaluated for their impact.

Aims: To assess the effectiveness of mass media messages to reduce alcohol consumption and related harms using a systematic literature review., Methods: Eight databases were searched along with reference lists of eligible studies. Studies of any design in any country were included, provided that they evaluated a mass media intervention targeting alcohol consumption or related behavioural, social cognitive or clinical outcomes. Drink driving interventions and college campus campaigns were ineligible. Studies quality were assessed, data were extracted and a narrative synthesis conducted., Results: Searches produced 10,212 results and 24 studies were included in the review. Most campaigns used TV or radio in combination with other media channels were conducted in developed countries and were of weak quality. There was little evidence of reductions in alcohol consumption associated with exposure to campaigns based on 13 studies which measured consumption, although most did not state this as a specific aim of the campaign. There were some increases in treatment seeking and information seeking and mixed evidence of changes in intentions, motivation, beliefs and attitudes about alcohol. Campaigns were associated with increases in knowledge about alcohol consumption, especially where levels had initially been low. Recall of campaigns was high., Conclusion: Mass media health campaigns about alcohol are often recalled by individuals, have achieved changes in knowledge, attitudes and beliefs about alcohol but there is little evidence of reductions in alcohol consumption., Short Summary: There is little evidence that mass media campaigns have reduced alcohol consumption although most did not state that they aimed to do so. Studies show recall of campaigns is high and that they can have an impact on knowledge, attitudes and beliefs about alcohol consumption.

Aims: Health advice can be framed in terms of prescriptive rules (what people should do, e.g. you should drink alcohol within recommended limits) or proscriptive rules (what people should not do, e.g. you should not drink alcohol above recommended limits). The current research examines the differing effect that these two types of injunction have on participants' moral norms, reactance, attitudes and intentions to consume alcohol within moderation, and their subsequent alcohol consumption., Methods: Participants (N = 529) completed an online questionnaire which asked them to report their previous 7 days' alcohol consumption. They then read either a proscriptive or a prescriptive health message and completed measures of moral norms, reactance, attitudes and intentions to drink alcohol only within recommended limits. Subsequent alcohol consumption was reported 7 days later., Results: The results showed that across all participants, the proscriptive message elicited stronger moral norms than did the prescriptive message, which in turn were associated with more positive attitudes and intentions to drink within recommended limits. For male participants who reported drinking more alcohol than recommended at baseline, the proscriptive message elicited more reported alcohol consumption over the subsequent 7 days., Conclusions: Proscriptive messages may be effective at eliciting stronger moral norms to drink within government recommended guidelines. However, reactance may occur for high relevance groups. Practical and theoretical implications are discussed.

Aims: Alcohol consumption during pregnancy remains a public health problem despite >40 years of attention. Little is known about how state policies have evolved and whether policies represent public health goals or efforts to restrict women's reproductive rights., Methods: Our data set includes US state policies from 1970 through 2013 obtained through original legal research and from the National Institute for Alcohol Abuse and Alcoholism's (NIAAA)'s Alcohol Policy Information System. Policies were classified as punitive to women or supportive of them. The association between numbers of punitive policies and supportive policies in 2013 with a measure of state restrictions on reproductive rights and Alcohol Policy Effectiveness Scores (APS) was estimated using a Pearson's correlation., Results: The number of states with alcohol and pregnancy policies has increased from 1 in 1974 to 43 in 2013. Through the 1980s, state policy environments were either punitive or supportive. In the 1990s, mixed punitive and supportive policy environments began to be the norm, with punitive policies added to supportive ones. No association was found between the number of supportive policies in 2013 and a measure of reproductive rights policies or the APS, nor was there an association between the number of punitive policies and the APS. The number of punitive policies was positively associated, however, with restrictions on reproductive rights., Conclusion: Punitive alcohol and pregnancy policies are associated with efforts to restrict women's reproductive rights rather than effective efforts to curb public health harms due to alcohol use in the general population. Future research should explore the effects of alcohol and pregnancy policies., Short Summary: The number of states with alcohol and pregnancy policies has increased since 1970 (1 in 1974 and 43 in 2013). Alcohol and pregnancy policies are becoming increasingly punitive. These punitive policies are associated with efforts to restrict women's reproductive rights rather than policies that effectively curb alcohol-related public health harms., (© The Author 2017. Medical Council on Alcohol and Oxford University Press. All rights reserved.)

Aims: The objective was to evaluate a campaign designed to influence social norms and re-establish boundaries around the issue of unwanted sexual attention in pubs and clubs. In particular, the campaign aimed to raise awareness, and reduce the acceptability, of unwanted sexual attention when drunk., Methods: A before-after-with-control group study design was used to evaluate campaign effectiveness. The data was further segmented to explore gender differences and between individuals who reported enjoying going out to get drunk and those who did not., Results: The experimental group with campaign recall demonstrated a significant change in their attitudes to harmful drinking behaviours and unwanted sexual attention compared to the control group. A number of gender differences as well as drink-enjoyment-related differences pre- and post-campaign were observed. Female respondents who were able to recall the campaign demonstrated a significantly lower tolerance of unwanted sexual attention than those who were unable to recall it in either the experimental or control regions. The campaign had limited impact on people who enjoy drunken night outs (DNOs). However, those who do not enjoy DNOs demonstrated significantly higher negative attitudes towards harmful drinking post-campaign recall., Conclusion: The campaign was effective in shifting attitudes towards unwanted sexual attention and harmful drinking behaviour. This was particularly observed among female respondents and those who do not enjoy DNOs., Short Summary: Drinkaware's 'You Wouldn't Sober, You Shouldn't Drunk' behavioural change campaign targets young adults living in North-West England participating in 'drunken nights out'. The experimental group with campaign recall demonstrated a significant change in their attitudes to harmful drinking behaviours and unwanted sexual attention compared to the control group., (© The Author 2017. Medical Council on Alcohol and Oxford University Press. All rights reserved.)

Aims: To compare the clinical effectiveness and cost-effectiveness of a stepped-care intervention versus a minimal intervention for the treatment of older hazardous alcohol users in primary care., Method: Multi-centre, pragmatic RCT, set in Primary Care in UK. Patients aged ≥ 55 years scoring ≥ 8 on the Alcohol Use Disorders Identification Test were allocated either to 5-min of brief advice or to 'Stepped Care': an initial 20-min of behavioural change counselling, with Step 2 being three sessions of Motivational Enhancement Therapy and Step 3 referral to local alcohol services (progression between each Step being determined by outcomes 1 month after each Step). Outcome measures included average drinks per day, AUDIT-C, alcohol-related problems using the Drinking Problems Index, health-related quality of life using the Short Form 12, costs measured from a NHS/Personal Social Care perspective and estimated health gains in quality adjusted life-years measured assessed EQ-5D., Results: Both groups reduced alcohol consumption at 12 months but the difference between groups was small and not significant. No significant differences were observed between the groups on secondary outcomes. In economic terms stepped care was less costly and more effective than the minimal intervention., Conclusions: Stepped care does not confer an advantage over a minimal intervention in terms of reduction in alcohol use for older hazardous alcohol users in primary care. However, stepped care has a greater probability of being more cost-effective., Trial Registration: Current controlled trials ISRCTN52557360., Short Summary: A stepped care approach was compared with brief intervention for older at-risk drinkers attending primary care. While consumption reduced in both groups over 12 months there was no significant difference between the groups. An economic analysis indicated the stepped care which had a greater probability of being more cost-effective than brief intervention., (© The Author 2017. Medical Council on Alcohol and Oxford University Press. All rights reserved.)

Aims: To explore the potential impact of a minimum unit price (MUP: 50 pence per UK unit) on the alcohol consumption of ill Scottish heavy drinkers., Methods: Participants were 639 patients attending alcohol treatment services or admitted to hospital with an alcohol-related condition. From their reported expenditure on alcohol in their index week, and assuming this remained unchanged, we estimated the impact of a MUP (50 ppu) on future consumption. (Around 15% purchased from both the more expensive on-sale outlets (hotels, pubs, bars) and from off-sales (shops and supermarkets). For them we estimated the change in consumption that might follow MUP if (i) they continued this proportion of 'on-sales' purchasing or (ii) their reported expenditure was moved entirely to off-sale purchasing (to maintain consumption levels))., Results: Around 69% of drinkers purchased exclusively off-sale alcohol at <50 ppu. Their drinking, post MUP, may reduce by a mean of 33%. For this group, from a population of very heavy, ill consumers, we were unable to show a differential effect across multiple deprivation quintiles. For other drinkers there might be no reduction, especially if after MUP there were many products priced close to 50 ppu. Moving away from on-sales purchases could support, for some, an increase in consumption., Conclusions: While a proportion of our harmed, heavy drinkers might be able to mitigate the impact of MUP by changing purchasing habits, the majority are predicted to reduce purchasing. This analysis, focusing specifically on harmed drinkers, adds a unique dimension to the evidence base informing current pricing policy., Short Summary: From drink purchasing data of heavy drinkers, we estimated the impact of legislating £0.50 minimum unit price. Over two thirds of drinkers, representing all multiple deprivation quintiles, were predicted to decrease alcohol purchasing; remainder, hypothetically, could maintain consumption. Our data address an important gap within the evidence base informing policy., (© The Author 2017. Medical Council on Alcohol and Oxford University Press. All rights reserved.)

Aim: To assess the effectiveness of two personalized digital interventions (OneTooMany and Drinks Meter) compared to controls., Method: Randomized controlled trial (AEARCTR-0,001,082). Volunteers for the study, aged 18-30, were randomly allocated to one of two interventions or one of two control groups and were followed up 4 weeks later. Primary outcomes were AUDIT-C, drinking harms and pre-loading. Drinks Meter provided participants with brief screening and advice for alcohol in addition to normative feedback, information on calories consumed and money spent. OneTooMany presented a series of socially embarrassing scenarios that may occur when drinking, and participants were scored according to if/how recently they had been experienced., Results: The study failed to recruit and obtain sufficient follow-up data to reach a prior estimated power for detecting a difference between groups and there was no indication in the analysable sample of 402 subjects of a difference on the primary outcome measures (Drinks Meter; AUDIT-C IRR = 0.98 (0.89-1.09); Pre-loading IRR = 1.01 (0.95-1.07); Harms IRR = 0.97 (0.79-1.20); OneTooMany; AUDIT-C IRR = 0.96 (0.86-1.07); Pre-loading IRR = 0.99 (0.93-1.06); Harms IRR = 1.16 (0.94-1.43)., Conclusion: Further research is needed on the efficacy of such instruments and their ingredients. However, recruitment and follow-up are a challenge., (© The Author 2017. Medical Council on Alcohol and Oxford University Press. All rights reserved.)

Objectives: Being obese and drinking more than 14 units of alcohol per week places men at very high risk of developing liver disease. This study assessed the feasibility of a trial to reduce alcohol consumption. It tested the recruitment strategy, engagement with the intervention, retention and study acceptability., Methods: Men aged 35-64 years who drank >21 units of alcohol per week and had a BMI > 30 were recruited by two methods: from GP patient registers and by community outreach. The intervention was delivered by a face to face session followed by a series of text messages. Trained lay people (Study Coordinators) delivered the face to face session. Participants were followed up for 5 months from baseline to measure weekly alcohol consumption and BMI., Results: The recruitment target of 60 was exceeded, with 69 men recruited and randomized. At baseline, almost all the participants (95%) exceeded the threshold for a 19-fold increase in the risk of dying from liver disease. The intervention was delivered with high fidelity. A very high follow-up rate was achieved (98%) and the outcomes for the full trial were measured. Process evaluation showed that participants responded as intended to key steps in the behaviour change strategy. The acceptability of the study methods was high: e.g. 80% of men would recommend the study to others., Conclusions: This feasibility study identified a group at high risk of liver disease. It showed that a full trial could be conducted to test the effectiveness and cost-effectiveness of the intervention., Trial Registration: Current controlled trials: ISRCTN55309164., Trial Funding: National Institute for Health Research Health Technology Assessment (NIHR HTA)., Short Summary: This feasibility study recruited 69 men at high risk of developing liver disease. The novel intervention, to reduce alcohol consumption through the motivation of weight loss, was well received. A very high follow-up rate was achieved. Process evaluation showed that participants engaged with key components of the behaviour change strategy., (© The Author 2017. Medical Council on Alcohol and Oxford University Press.)

Aims: Health information can be used to try to persuade people to follow safe drinking recommendations. However, both the framing of information and the dispositional characteristics of message recipients need to be considered. An online study was conducted to examine how level of autonomy moderated the effect on drinking behaviour of gain- and loss-framed messages about the short- vs. long-term consequences of alcohol use., Methods: At Time 1, participants (N = 335) provided demographic information and completed a measure of autonomy. At Time 2, participants reported baseline alcohol use and read a gain-framed or loss-framed health message that highlighted either short- or long-term outcomes of alcohol consumption. Alcohol consumption was reported 7 days later., Results: The results showed a significant three-way interaction between message framing (loss vs. gain), temporal focus (short-term vs. long-term) and autonomy. For low-autonomy (but not high-autonomy) individuals, the loss-framed health message was associated with lower levels of alcohol consumption than was the gain-framed message but only if the short-term outcomes were conveyed., Conclusion: This research provides evidence that the interaction between message framing and temporal focus may depend on a person's level of autonomy, which has implications for health promotion and the construction of effective health communication messages., Short Summary: We examined how autonomy moderated the effect on drinking behaviour of gain- and loss-framed messages about the short- vs. long-term consequences of alcohol use. For low-autonomy individuals, the loss-framed health message was associated with lower alcohol consumption than was the gain-framed message but only if the short-term outcomes were conveyed., (© The Author 2016. Medical Council on Alcohol and Oxford University Press. All rights reserved.)

Aims: Defensiveness in response to threatening health information related to excessive alcohol consumption prevents appropriate behaviour change. Alternatively, self-affirmation may improve cognitive-affective processing of threatening information, thus contributing to successful self-regulation., Methods: Effects of an online self-affirmation procedure were examined in at-risk university student drinkers. Participants were randomly assigned to a self-affirmation (writing about personally relevant values) or control task (writing about values relevant to another person) prior to presentation of alcohol-related threatening information. Assessment of prosocial feelings (e.g. 'love') after the task served as a manipulation check. Generic and personalized information regarding the link between alcohol use and cancer was presented, followed by assessment of perceived threat, message avoidance and derogation. Page dwell-times served as indirect indices of message engagement. Alcohol consumption and intention to drink less were assessed during the first online session and at 1-week and 1-month follow-up., Results: Although self-affirmation resulted in higher levels of prosocial feelings immediately after the task, there was no effect on behaviour in the self-affirmation group. Effects on intention were moderated by gender, such that men showed lower intention immediately after self-affirmation, but this increased at 1-week follow-up. Women's intention to reduce consumption in the self-affirmation group reduced over time. Trend-level effects on indices of derogation and message acceptance were in the predicted direction only in men., Conclusion: It is feasible to perform self-affirmation procedures in an online environment with at-risk drinkers. However, use of internet-based procedures with this population may give rise to (gender-dependent) effects that are substantially diluted compared with lab-based experiments., (© The Author 2016. Medical Council on Alcohol and Oxford University Press. All rights reserved.)

Aims: Only one study has examined message framing on college drinking, but did so in a laboratory setting among a general sample of college students. The current study was designed to: (a) compare the efficacy of emailed interventions differing by message framing and temporal context on alcohol involvement among heavy drinking college students and (b) examine need for cognition (NFC), consideration of future consequences (CFC) and self-efficacy as putative moderators., Methods: Hazardous drinking college students (N = 220) were randomly assigned to conditions in a 2 (Frame: gain vs. loss) × 2 (Temporal Context: long-term vs. short-term consequences) factorial design. Participants received four emails on heavy drinking consequences phrased in a manner consistent with their condition. After each message, participants were given a manipulation check. Participants were sent a 1-month follow-up assessment. Primary outcome measures were heavy episodic drinking (HED) and alcohol-related problems. We hypothesized two main effects (less alcohol consumption in the gain-frame and short-term condition), qualified by a Frame × Temporal Context interaction with substantially less alcohol involvement in the gain-frame/short-term condition., Results: There was very little study attrition (96.4% completed follow-up survey, 93.2-99.5% completed manipulation checks), and strong effects were observed for the manipulations. A 2 × 2 ANCOVA, controlling for baseline alcohol involvement, revealed no consistent main effects or interactions on either outcome. No moderation was observed for any putative moderator., Conclusions: These results do not replicate prior laboratory-based research. The null findings may be attributed to the heavy drinking sample or electronic means of message delivery., (© The Author 2015. Medical Council on Alcohol and Oxford University Press. All rights reserved.)

Aims: We make a case study of Finland to study the connections between socioeconomic status, alcohol use, related harm and possibilities for intervention by means of alcohol pricing., Methods: A review of Finnish studies on the topic., Results: The socioeconomic differences in severe alcohol-related harm were great, and in the past two decades, these differences have widened. Alcohol-related mortality has also strongly contributed to both the level and widening of socioeconomic differences in life expectancy. Both in 2004, when alcohol prices were abruptly cut, and in the longer term with more gradual changes in lowest prices of alcohol, the lowest socioeconomic groups were most affected in absolute-but not so clearly in relative-terms, particularly among men. However, these effects are sometimes weak, not fully consistent by gender and across different measures of harm., Conclusions: The large and increasing socioeconomic differences in alcohol-related harm in Finland underline the importance of reducing these differences. The finding that particularly among men the impact of reduced alcohol prices on health has often in absolute terms been the greatest in the lower socioeconomic groups suggests that policies aimed at keeping the price of alcoholic beverages high may help to both minimize the overall level of alcohol-related health problems and to reduce absolute inequalities., (© The Author 2015. Medical Council on Alcohol and Oxford University Press. All rights reserved.)

Aims: To investigate how changes in alcohol price and affordability are related to aggregate level alcohol consumption in Australia to help to inform effective price and tax policy to influence consumption., Material and Methods: Annual time series data between 1974 and 2012 on price and per-capita consumption for beer, wine and spirits and average weekly income were collected from the Australian Bureau of Statistics. Using a Vector Autoregressive model and impulse response analysis, the dynamic responses of alcohol consumption to changes in alcohol prices and affordability were estimated., Results: Alcohol consumption in Australia was negatively associated with alcohol price and positively associated with the affordability of alcohol. The results of the impulse response analysis suggest that a 10% increase in the alcohol price was associated with a 2% decrease in the population-level alcohol consumption in the following year, with further, diminishing, effects up to year 8, leading to an overall 6% reduction in total consumption. In contrast, when alcohol affordability increased, per-capita alcohol consumption increased over the following 6 years., Conclusions: Our findings suggest that increasing alcohol prices or taxes can help to reduce alcohol consumption at the population level in Australia. However, the impact of affordability in our findings highlights that pricing policies need to consider increases in income to ensure effectiveness. Alcohol price policy should only cautiously focus on individual beverage types, because increasing the price of one beverage generally leads to an increase in consumption of substitutes., (© The Author 2015. Medical Council on Alcohol and Oxford University Press. All rights reserved.)

Aims: There are many consequences of binge drinking compared with light or moderate drinking behaviors. The prevalence rate and intensity of binge drinking is highest among the college-aged population. Given the popularity and high use of the Internet among college students, a novel approach for programming is through Internet-based interventions. The purpose of this study was to conduct a systematic review of Internet-based interventions targeting binge drinking among the college population., Methods: Eligibility criteria included peer-reviewed articles evaluating Internet-based interventions for binge drinking prevention among college students published between 2000 and 2014. Only English language articles were included. Review articles and articles only explaining intervention pedagogies were not included. After a systematic screening process, a total of 14 articles were included for the final review. Each article was read thoroughly in order to extract the following variables: study design and sample size, average age of participants, underpinning theoretical framework, and intervention description and duration. This review also synthesized a methodological assessment with variables such as outcome measures, sample size justification, number of measurements and use of process evaluations., Results: All studies but one reported a significant reduction in the frequency and quantity of alcohol consumption and problems related with heavy drinking. Furthermore, Internet-based interventions appeared to be more effective than traditional print-based interventions; however, face-to-face interventions were typically more effective., Conclusions: This review supports using the Internet as a brief intervention approach that can effectively support efforts to reduce binge drinking among college students., (© The Author 2015. Medical Council on Alcohol and Oxford University Press. All rights reserved.)

Aims: There is little information on the extent to which African countries are addressing alcohol consumption and alcohol-related harm, which suggests that evaluations of national alcohol policies are needed in this region. The aim of this article is to examine the strength of a mix of national alcohol control policies in African countries, as well as the relationship between alcohol policy restrictiveness scores and adult alcohol per capita consumption (APC) among drinkers at the national level., Methods: We examined national alcohol policies of 46 African countries, as of 2012, in four regulatory categories (price, availability, marketing and drink-driving), and analyzed the restrictiveness of national alcohol policies using an adapted Alcohol Policy Index (API). To assess the validity of the policy restrictiveness scores, we conducted correlational analyses between policy restrictiveness scores and APC among drinkers in 40 countries., Results: Countries attained a mean score of 44.1 of 100 points possible, ranging from 9.1 (Sao Tomé and Principe) to 75.0 (Algeria), with low scores indicating low policy restrictiveness. Policy restrictiveness scores were negatively correlated with and APC among drinkers (rs = -0.353, P = 0.005)., Conclusions: There is great variation in the strength of alcohol control policies in countries throughout the African region. Tools for comparing the restrictiveness of alcohol policies across countries are available and are an important instrument to monitor alcohol policy developments. The negative correlation between policy restrictiveness and alcohol consumption among drinkers suggests the need for stronger alcohol policies as well as increased training and capacity building at the country level., (© The Author 2015. Medical Council on Alcohol and Oxford University Press. All rights reserved.)

Aims: To understand how US cancer control plans address alcohol use, an important but frequently overlooked cancer risk factor, and how many US adults are at risk., Methods: We reviewed alcohol control efforts in 69 comprehensive cancer control plans in US states, tribes and jurisdictions. Using the 2011 Behavioral Risk Factor Surveillance System, we assessed the prevalence of current alcohol use among US adults and the proportion of these drinkers who exceeded guidelines for moderate drinking., Results: Most comprehensive cancer control plans acknowledged alcohol use as a cancer risk factor but fewer than half included a goal, objective or strategy to address alcohol use. More than half of US adults reported current alcohol use in 2011, and two of three drinkers exceeded moderate drinking guidelines at least once in the past month. Many states that did not address alcohol use in comprehensive cancer control plans also had a high proportion of adults at risk., Conclusion: Alcohol use is a common cancer risk factor in the USA, but alcohol control strategies are not commonly included in comprehensive cancer control plans. Supporting the implementation of evidence-based strategies to prevent the excessive use of alcohol is one tool the cancer control community can use to reduce the risk of cancer., (Published by Oxford University Press on behalf of Medical Council on Alcohol 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Aims: The portrayal of alcohol in the news media, including newspapers, plays an important role in influencing societal norms and setting public agendas. We present the first large-scale examination of news coverage of alcohol-related issues in Australian newspapers., Method: Content analysis was performed on a sample of alcohol-related newspaper articles (n = 4217) published across Australia from 2000 to 2011. Articles were coded for type, theme, prominence, topic slant, opinion slant and sources/spokesperson., Results: Across the period, the most common themes were promotion (21%), drink-driving (16%) and restrictions/policy (16%). Themes of restrictions/policy and responsible beverage services became more common over time. Promotion and business-related articles significantly declined over time. Overall, the topic slant of the majority of news related articles disapproved of alcohol use. Disapproval increased over time while approval of alcohol use decreased. While the slant of opinion pieces was predominantly approving of alcohol, this decreased over time. Presence of an alcohol industry representative in articles declined over time., Conclusion: The presentation of alcohol use in Australian newspapers became more disapproving over time, which may suggest that harmful alcohol use has become less acceptable among the broader Australian community.

Aims: Populations in countries emerging from armed conflict may have elevated levels of harmful alcohol use due to risk factors such as trauma exposure, increased daily stressors, elevated levels of mental health disorders, urbanization, and weak alcohol control policies and institutions. This study explores the challenges and opportunities for strengthening alcohol control policies in post-conflict countries., Methods: Exploratory qualitative approach: experts (from United Nations agencies, non-governmental organizations, academic institutions and independent consultants) selected on the basis of their experience were interviewed. Thematic analysis identified key emergent themes., Results: Perceived challenges to addressing harmful alcohol use in post-conflict countries included: lack of priority and recognition among key actors; limited resources and capacity, including in policy enforcement; and the role of the alcohol industry. Perceived opportunities included: increasing recognition of the harmful health and social effects of alcohol globally; sharing information, experience, and expertise to more effectively strengthen alcohol control policies; and collecting better data to advocate and inform stronger alcohol policies., Conclusion: This exploratory study provides a starting point to better understand the alcohol policy environment in post-conflict settings but considerably more research is required.

Aims: The aim of the study was to summarize results of recent epidemiological research on adolescent alcohol use and its consequences, to outline the risk factors for drinking in adolescents and to consider effective treatment and preventative interventions., Methods: A literature review of relevant studies on adolescent alcohol use., Results: Alcohol use and other risk-taking behaviours such as smoking, substance use and risky sexual behaviour emerge in adolescence and tend to cluster together. Heavy alcohol consumption in late adolescence appears to persist into adulthood and is associated with alcohol problems, including dependence, premature death and diminished work capacity. Early identification of adolescent risk factors may be helpful in preventing and/or attenuating risk., Conclusion: There is a need for high-quality long-term prospective cohort studies to investigate the long-term consequences of adolescent drinking and further work is needed to identify the most effective intervention strategies.

Aim: The aim of the study was to explore the evidence base on alcohol screening and brief intervention for adolescents to determine age appropriate screening tools, effective brief interventions and appropriate locations to undertake these activities., Methods: A review of existing reviews (2003-2013) and a systematic review of recent research not included in earlier reviews., Results: The CRAFFT and AUDIT tools are recommended for identification of 'at risk' adolescents. Motivational interventions delivered over one or more sessions and based in health care or educational settings are effective at reducing levels of consumption and alcohol-related harm., Conclusion: Further research to develop age appropriate screening tools needs to be undertaken. Screening and brief intervention activity should be undertaken in settings where young people are likely to present; further assessment at such venues as paediatric emergency departments, sexual health clinics and youth offending teams should be evaluated. The use of electronic (web/smart-phone based) screening and intervention shows promise and should also be the focus of future research.

Aims: The evaluation aimed to assess the impact of The Alcohol Improvement Programme (AIP). This was a UK Department of Health initiative (April 2008-March 2011) aiming to contribute to the reduction of alcohol-related harm as measured by a reduction in the rate of increase in alcohol-related hospital admissions (ARHAs)., Methods: The evaluation (March 2010-September 2011) used a mix of qualitative and quantitative methods to assess the impact of the AIP on ARHAs, to describe and assess the process of implementation, and to identify elements of the programme which might serve as a 'legacy' for the future., Results: There was no evidence that the AIP had an impact on reducing the rise in the rate of ARHAs. The AIP was successfully delivered, increased the priority given to alcohol-related harm on local policy agendas and strengthened the infrastructure for the delivery of interventions., Conclusion: Although there was no measurable short-term impact on the rise in the rate of ARHAs, the AIP helped to set up a strategic response and a delivery infrastructure as a first, necessary step in working towards that goal. There are a number of valuable elements in the AIP which should be retained and repackaged to fit into new policy contexts.

Aims: Breath alcohol concentration (BrAC) estimation training has been effective in increasing estimation accuracy in social drinkers. Predictors of estimation accuracy may identify populations to target for training, yet potential predictors typically are not evaluated. In addition, the therapeutic efficacy of estimation training as a preventive strategy for problematic drinking is unknown., Methods: Forty-six social drinkers with a recent binge history were randomly assigned to an intervention or control group (n = 23 per group). In each of three sessions (pretraining, training, testing), participants consumed alcohol (0.32, 0.24, 0.16 and 0.08 g/kg, in random order) every 30 min (total dose: 0.8 g/kg). Participants provided five BrAC estimates within 3 h of alcohol administration. The intervention group, but not control group, received internal and external training. During testing, participants provided BrAC estimates, but received no feedback. Participants returned for two follow-up visits to complete self-report measures., Results: BrAC estimation training improved intervention group estimation accuracy within the laboratory. Together, training, low trait anxiety and low risk expectancy predicted high testing accuracy. There were no significant group differences in subsequent alcohol consumption, behavior under the influence or risk expectancy regarding potentially hazardous behaviors., Conclusion: BrAC estimation training is effective in the laboratory but may not translate into naturalistic settings.

Aims: This study tests whether enhancing alcohol risk messages with self-affirmation, the process of focusing on cherished aspects of oneself, increases intentions to reduce alcohol consumption and reduces actual alcohol consumption. It was also examined whether these effects differed by risk status as indicated by standard drinks consumed in an average week., Methods: Participants (n = 121) were randomly allocated to a self-affirmation or matched control condition before viewing emotive graphic alcohol warning posters in a questionnaire-based study., Results: There were significant increases in intentions to reduce alcohol consumption in self-affirmed participants, and these effects were stronger in participants with higher behavioural risk. Intentions in turn significantly predicted a reduction in self-reported alcohol consumption., Conclusions: These findings support the use of self-affirmation to enhance alcohol awareness campaigns, particularly in individuals with high behavioural risk.

Aims: To assess the effectiveness and acceptability of a brief community-based educational program on changing the drinking pattern of alcohol in a rural community., Methods: A longitudinal cohort study was carried out in two rural villages in Sri Lanka. One randomly selected village received a community education program that utilized street dramas, poster campaigns, leaflets and individual and group discussions. The control village had no intervention during this period. The Alcohol Use Disorder Identification Test (AUDIT) was used to measure the drinking pattern before and at 6 and 24 months after the intervention in males over 18 years of age in both villages. The recall and the impact of various components of the intervention were assessed at 24 months post-intervention., Results: The intervention was associated with the development of an active community action group in the village and a significant reduction in illicit alcohol outlets. The drama component of the intervention had the highest level of recall and preference. Comparing the control and intervention villages, there were no significant difference between baseline drinking patterns and the AUDIT. There was a significant reduction in the AUDIT scores in the intervention village compared with the control at 6 and 24 months (P < 0.0001)., Conclusions: A community-based education program had high acceptance and produces a reduction in alcohol use that was sustained for 2 years.

Aims: To examine the use of a cue-reminder to target alcohol use among youth in social contexts., Methods: Two experiments were conducted. First, among 92 late adolescents, we tested if a cue-reminder could be effectively associated with information about empowerment, awareness and monitoring of one's own limits with regard to alcohol use. Second, among 107 young adults, the effect of the cue in a real-life drinking setting was examined., Results: The first study showed that adolescents in the experimental condition recalled more empowerment information compared with adolescents in the control condition (mean 2.00 ± 0.92 vs mean 1.52 ± 0.96, P = 0.017), indicating the possibility of creating an association between a symbol (cue-reminder) and empowerment information with regard to alcohol use. In the second study, significant interaction effects between general drinking frequency and condition were found in relation to having an alcoholic consumption (β = -0.24; P = 0.027) and to the amount of alcoholic consumptions (β = -0.24; P = 0.035), suggesting that the presence of the cue-reminder in a drinking situation may have an inhibitory effect on alcohol consumption among frequent drinkers., Conclusion: The cue-reminder seems to have the potential to function as an intervention to reduce excessive alcohol use in social settings.

Aims: To examine whether Dutch and Norwegian adults differ in their opinion on policy measures that may prevent young people from problematic drinking., Methods: Data were derived from a web-based cross-sectional study. In this study, only Dutch and Norwegian adults (aged ≥24 years) were included (n(NL) = 5023, n(NO) = 1916). Opinions on policy items concerning restrictive and educational measures were examined together with alcohol consumption., Results: Differences between the opinions of the Dutch and Norwegians concerning the restrictive and educational measures were small. In both countries, the support for restrictive measures was predicted by female gender, higher age and less own alcohol consumption. For the educational measures, the explained variance in the Norwegian and Dutch sample was relatively low; this indicates that opinion was more strongly predicted by other factors., Conclusion: This study indicates that, despite the differences between the Dutch and Norwegian alcohol policy, differences in opinion are small between Dutch and Norwegian respondents, especially regarding restrictive measures that may prevent young people from drinking.