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ObjectiveTo estimate the prevalence of hand-arm vibration (HAV) in Australian workplaces.MethodsThe Australian Workplace Exposure Survey (AWES)—Hearing was a cross-sectional telephone survey of Australian workers conducted in 2016–2017. Respondents were asked about the time spent using tools or performing tasks known to be associated with HAV during their most recent working day. We created a library of HAV magnitude levels for each tool/task and estimated each worker’s daily HAV exposure level using standard formulae. We categorized each worker as to whether they exceeded the daily occupational limits of 2.5 and 5.0 m/s2. Results were extrapolated to the Australian working population using a raked weighting method.ResultsIn our sample of 4991 workers, 5.4% of men and 0.7% of women exceeded the HAV action limit of 2.5 m/s2 on their most recent working day. We estimate that 3.8% of the Australian workforce exceeds the HAV limit of 2.5 m/s2 and 0.8% exceeds the 5 m/s2 limit. Men were more likely to exceed the HAV limits than women, as were those with trade qualifications, and those who worked in remote locations. Workers in the construction, farming, and automobile industries had the highest prevalence of HAV exposure. Tool groups that contributed to higher exposure levels included: compactors, rollers, and tampers; power hammers and jackhammers; and underground mining equipment.ConclusionsHAV is common in the Australian working population. Given the health risks associated with this exposure, reduction strategies and interventions should be developed, with engineering controls as the starting point for exposure reduction strategies.

This paper examines the social realist paintings of the art groups Yiyanhui and the Equator Art Society which emerged during the 1950s in Malaya and Singapore. Their works centred on the social functions of art and its subject matters featured the working class, the Japanese occupation and anti-British colonial sentiment. Their artworks are viewed here as cultural productions shaped by the negotiation between dominant-subordinate relationships within a postcolonial framework. It is argued that the artistic productions examined here may be viewed not only for its overarching “social realist” endeavours but, also as a struggle to rewrite the narrative of the Chinese in Malaya against of the prevailing static representations forwarded by the colonial campaign. The first part of the paper illustrates how colonial discourse in the local press propagated an image of the Chinese as inherently susceptible to communism, untrustworthy, and opportunistic. The second part of the paper shows how the artists resisted this essentialist image of Chinese identity and offered a more complex picture of a Chinese-Malayan identity. Through a combination of interviews, written artist’s statements, formal and contextual considerations of the artworks, as well as a cultural studies framework, I demonstrate how a different narrative is being offered by these artists through two related processes in identity construction: qualifications for authenticity and belonging, the articulation of ambivalence. Resistance thus, is explored as encompassing a network of strategies employed by these artists as a way to reject colonialist representations of otherness and gain authorial agency against the intellectual and ideological dominance of colonial discourse.

Designing and funding chemotherapy care to meet patient expectations is challenging. Issues including convenience, outcomes, cost, and continuity of care are all potentially important and the appropriate trade-off between them is not clear. Regions with significant geographic spread and concentration of care in metropolitan areas pose a particular problem as ensuring low-cost convenient care is potentially difficult. However, the relative value of different aspects of chemotherapy are as yet unknown. The objective of this work is to quantify the relative value of different aspects of chemotherapy service delivery in an older Australian general population sample. A discrete choice experiment was administered in an older Australian general population sample without cancer. The survey approach asks a series of hypothetical choice tasks and allows estimation of the relative value of different aspects of care. Analysis considered the average respondent, and then also explored the level of preference divergence across the population. One thousand and sixty-two individuals provided data and were included in the analysis. There was a strong population preference for home-based chemotherapy, for follow-up by a specialist, for psycho-social support, and for low cost care. These strong population preferences should be considered when designing chemotherapy care. This poses a significant challenge, both logistically and financially. However, this information can help policy makers identify the components of good value care.

Background Health behaviours and mental illness have been found to be strongly correlated, both across and within individuals. However, establishing the precise nature of this link, particularly in terms of causality and its direction, remains a challenge. Much of the relevant existing research follow an experimental design and focus on measuring how changes in health behaviours affect mental health. Objective The study examines changes in mental health and health behaviours within individuals across time and evaluates the evidence for a causal pathway from psychological distress to risky health behaviours. Method Using a population representative longitudinal survey providing data from Australian households, this study employs a fixed-effects panel model framework to account for unobserved time-invariant individual heterogeneity. An instrumental variable estimation strategy is employed to specifically evaluate the evidence of a causal pathway from psychological distress to risky health behaviours. Results The results confirm strong within-individual associations between psychological distress and health behaviours. Further evidence supports a causal relationship from psychological distress to health behaviours, though only for men and lifestyle habits. The case for a direct causal pathway is less straightforward when considering dietary habits, and potentially also for women. This lack of clarity suggests at least some of the observed within-individual associations reflect causal effects of psychological distress on risky health behaviours. Conclusions Given the substantial burden of disease associated with unhealthy behaviours, further research examining potential causal pathways from mental health to health behaviours should be a priority, as there is the potential to reduce health burden through mental health improvements.

ObjectiveTo determine the current prevalence of exposure to workplace noise and ototoxic chemicals, including co-exposures.MethodA cross-sectional telephone survey of nearly 5000 Australian workers was conducted using the web-based application, OccIDEAS. Participants were asked about workplace tasks they performed and predefined algorithms automatically assessed worker’s likelihood of exposure to 10 known ototoxic chemicals as well as estimated their full shift noise exposure level (LAeq,8h) of their most recent working day. Results were extrapolated to represent the Australian working population using a raked weighting technique.ResultsIn the Australian workforce, 19.5% of men and 2.8% of women exceeded the recommended full shift noise limit of 85 dBA during their last working day. Men were more likely to be exposed to noise if they were younger, had trade qualifications and did not live in a major city. Men were more likely exposed to workplace ototoxic chemicals (57.3%) than women (25.3%). Over 80% of workers who exceeded the full shift noise limit were also exposed to at least one ototoxic chemical in their workplace.ConclusionThe results demonstrate that exposures to hazardous noise and ototoxic chemicals are widespread in Australian workplaces and co-exposure is common. Occupational exposure occurs predominantly for men and could explain some of the discrepancies in hearing loss prevalence between genders.

Background The mental health impacts of COVID-19 have been considerable with many individuals experiencing significant anxiety and depression. Online cognitive behavioural therapy (iCBT) programs provide scalable access to psychological interventions, however the effectiveness of these programs during the pandemic has not been investigated. This study examined the uptake and effectiveness of iCBT for symptoms of anxiety and depression during the first eight months of the pandemic in Australia (March- October 2020) and compared outcomes to the 12 months prior to COVID-19. Methods 6,132 adults commenced iCBT (5,074 during the pandemic and 1,058 in the year before) and completed measures of anxiety and depression symptom severity, and psychological distress pre- and post-treatment. Results In the COVID-19 period, we observed a 504% increase in the number of monthly course registrations compared to the year prior (with a peak increase of 1,138% between April and June 2020). Baseline anxiety and depression symptom severity were similar for the COVID and pre-COVID groups. Prior to and during the pandemic, the iCBT course was associated with large effect size reductions in anxiety (g = 0.94–1.18) and depression (g = 0.92–1.12) symptom severity, as well as psychological distress (g = 1.08–1.35). Limitations lack of control group and long-term follow-up, as well as lack of detailed information about course users (e.g., health status and life context). Conclusion Results indicate the considerable increase in demand for psychological support during the COVID-19 pandemic in Australia and demonstrate the effectiveness and scalability of iCBT for symptoms of anxiety and depression.

ObjectiveFamilial hypercholesterolaemia (FH) is characterised by elevated low-density lipoprotein (LDL)-cholesterol and increased risk of cardiovascular disease. However, FH remains substantially underdiagnosed and undertreated. We employed a two-stage pragmatic approach to identify and manage patients with FH in primary healthcare.MethodsMedical records for 232 139 patients who attended 15 general practices at least once in the previous 2 years across five Australian States were first screened for potential risk of FH using an electronic tool (TARB-Ex) and confirmed by general practitioner (GP) clinical assessment based on phenotypic Dutch Lipid Clinic Network Criteria (DLCNC) score. Follow-up GP consultation and management was provided for patients with phenotypic FH.ResultsA total of 1843 patients were identified by TARB-Ex as at potential risk of FH (DLCNC score ≥5). After GP medical record review, 900 of these patients (49%) were confirmed with DLCNC score ≥5 and classified as high-risk of FH. From 556 patients subsequently clinically assessed by GPs, 147 (26%) were diagnosed with phenotypic FH (DLCNC score >6). Follow-up GP consultation and management for 77 patients resulted in a significant reduction in LDL-cholesterol (−16%, pConclusionsA pragmatic approach integrating electronic medical record tools and clinical GP follow-up consultation is a feasible method to identify and better manage patients with FH in the primary healthcare setting.Trial registration number12616000630415.

Objectives: To describe the numbers of degree completions, variety of available courses and demographics of students who study public health in Australia. Methods: We utilised national completions data from universities between 2001 and 2018 and analysed data for students who had completed degrees labelled as public health at the bachelor's and master's by coursework level. Results: There have been 21,000 master's by coursework public health graduates since 2001, and 15,770 public health bachelor's degrees. Nearly two‐thirds of all students study in a ‘broad’ degree, such as a Bachelor of Health Science or Master of Public Health. There has been an increase in the proportion of overseas students and a decreasing proportion of Indigenous students over this time. Conclusions: Given the growth of graduates with public health degrees, there should be an increased focus on relevant job opportunities, as supply may be outpacing demand. Implications for public health: We note three potential issues with public health education and practice in Australia. Firstly, there may be an oversupply of graduates relative to opportunities. Secondly, there may be inconsistencies in the delivery of public health courses. Thirdly, curricula may need to be revised, owing to differences in student composition.

The delivery and coordination of public health functions is essential to national and global health, however, there are considerable problems in defining the people who work in public health, as well as estimating their number. Therefore, the aim of this systematic review was to identify and explore research which has defined and enumerated public health workforces. In particular, how were such workforces defined? Who was included in these workforces? And how did researchers make judgments about the size of a workforce? In this systematic review, we identified 82 publications which enumerated a public health workforce between 2000 and November 2018. Most workforce definitions were unique and study-specific and included workers based on their occupation or their place of work. Common occupations included public health nurses and physicians, epidemiologists, and community health workers. National workforces varied by size, with the United States and Switzerland having the largest public health workforces per-capita, although definitions used varied substantially. Normative assessments (e.g., assessments of ideal workforce size) were informed through opinion, benchmarks or “service-target” models. There are very few regular, consistent enumerations within countries, and fewer still which capture a substantial proportion of the public heath workforce. Assessing the size of the public health workforce is often overlooked and would be aided by fit-for-purpose data, alignment of occupations and functions to international standards, and transparency in normative methods.

Background: Occupational noise-induced hearing loss (ONIHL) is one of the most common yet preventable occupational diseases. The aim of this study was to estimate the economic burden of ONIHL in the Australian working population by quantifying and monetising ONIHL&mdash, related loss of Quality Adjusted Life Years (QALY) and Productivity Adjusted Life Years (PALYs). Methods: We simulated the number of moderate-to-severe ONIHL by multiplying the age-specific prevalence of occupational noise exposure by the excess risks of ONIHL. Life table modelling was applied to workers with ONIHL. The QALY and PALY weights attributable to hearing loss were sourced from published data. The 2016 Gross Domestic Product per full-time equivalent worker in Australia was used to estimate the cost of productivity loss due to ONIHL. The cost due to the loss of well-being was quantified using willingness to pay thresholds derived from an Australian longitudinal study. Results: Under current occupational noise exposure levels in Australia, we estimated that over 80,000 male workers and over 31,000 female workers would develop ONIHL over 10 years of exposure. Following this cohort until the age of 65 years, the estimated loss of QALYs and PALYs were 62,218 and 135,561 respectively, with a projected loss of AUD 5.5 billion and AUD 21.3 billion due to well-being and productivity loss, respectively. Reducing noise exposure at work would substantially reduce the economic burden of ONIHL. Conclusion: ONIHL imposes substantial burden on Australian economy. Interventions to reduce occupational noise exposure are warranted.

BACKGROUND Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and guide sheath (EBUS-GS) are gaining popularity for diagnosis and staging of lung cancer compared to CT-guided transthoracic needle aspiration (CT-TTNA), blind fiber-optic bronchoscopy, and mediastinoscopy. This paper aimed to examine predictors of higher costs for diagnosing and staging lung cancer, and to assess the effect of EBUS techniques on hospital cost. MATERIAL AND METHODS Hospital costs for diagnosis and staging of new primary lung cancer patients presenting in 2007-2008 and 2010-2011 were reviewed retrospectively. Multiple linear regression was used to determine relationships with hospital cost. RESULTS We reviewed 560 lung cancer patient records; 100 EBUS procedures were performed on 90 patients. Higher hospital costs were associated with: EBUS-TBNA performed (p

Background: It is not well understood what occupations public health graduates have after graduation, nor is it well known whether their education provides them with the relevant knowledge and skills to feel well matched to their occupations. Furthermore, it is commonly presumed that public health graduates work in government, and investments in education would bolster this workforce. Methods: We aimed to describe the common occupations of Australian public health graduates, describe the heterogeneity of graduate destinations, describe the level of mismatch that graduates report, and compare these results with other fields of study. We used eight years of Australian graduate survey data (2008–2015) from the Graduate Destinations Survey, examining outcomes data from 8900 public health graduates from four levels of education. We compared occupation and industry heterogeneity, and level of occupational mismatch between public health graduates, and graduates from other fields of education. Results: Public health graduates report having a broad set of occupations in a broad set of industries after graduation, and this breadth is dissimilar to most health degrees. Furthermore, public health graduates tend to have average or lower-than-average rates of mismatch. Conclusions: Despite going into a broad set of occupations and industries, graduates from public health tend to report being well prepared given their education. Given that both occupation and industry outcomes are heterogeneous for graduates, an investment in public health education does not guarantee an increase in the governmental public health workforce.

Background Concerns about pathology testing such as the value provided by new tests and the potential for inappropriate utilization have led to a greater need to assess costs and benefits. Economic evaluations are a formal method of analyzing costs and benefits, yet for pathology tests, questions remain about the scope and quality of the economic evidence. Objective To describe the extent and quality of published evidence provided by economic evaluations of pathology tests from 2010 to 2015. Methods Economic evaluations relating to pathology tests from 2010 to 2015 were reviewed. Eight databases were searched for published studies, and details recorded for the country, clinical focus, type of testing, and consideration of sensitivity, specificity, and false test results. The reporting quality of studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist and cost-effectiveness ratios were analyzed for publication bias. Results We found 356 economic evaluations of pathology tests, most of which regarded developed countries. The most common economic evaluations were cost-utility analyses and the most common clinical focus was infectious diseases. More than half of the studies considered sensitivity and specificity, but few studies considered the impact of false test results. The average Consolidated Health Economic Evaluation Reporting Standards checklist score was 17 out of 24. Cost-utility ratios were commonly less than $10,000/quality-adjusted life-year or more than $200,000/quality-adjusted life-year. Conclusions The number of economic evaluations of pathology tests has increased in recent years, but the rate of increase has plateaued. Furthermore, the quality of studies in the past 5 years was highly variable, and there is some question of publication bias in reporting cost-effectiveness ratios.

Methamphetamine use is a problem for health and criminal justice systems (CJS) worldwide. Methamphetamine is used at higher rates in CJS-involved populations than the general community. This systematic review synthesises the evidence for health and CJS outcomes post-CJS contact for people reporting pre-CJS methamphetamine use. Academic databases were searched to identify peer-reviewed original studies using a longitudinal design that investigated associations between pre-CJS methamphetamine use and health and criminal justice outcomes after CJS contact. Identified studies were screened in two stages: title and abstract, then full-text. Data from the included studies were extracted and analysed. Results are reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Nine studies met the inclusion criteria: five investigated health and four investigated CJS outcomes. Pre-CJS methamphetamine use was associated with subsequent hospitalisation for drug-induced psychosis, increased risk of recidivism and higher crime costs after CJS contact. Pre-CJS methamphetamine use was not associated with subsequent hospitalisation for non-drug induced psychosis or post-release mortality. Current evidence suggests that pre-CJS contact methamphetamine use increases the risk of subsequent drug-induced psychosis and recidivism. There is a need for more longitudinal research that measures mediators and moderators of health and criminal justice outcomes after CJS contact, to inform targeted prevention. Methamphetamine use is a major problem that is contributing to serious mental illness and recidivism among CJS-involved populations. Prioritising treatment during CJS contact is recommended. Further research to identify key opportunities during health service and CJS contact for intervention is needed.

Objective To determine if increasing hospitalisations for non-valvular atrial fibrillation (NVAF) in Western Australia (WA) was due to incident (first-ever) or repeat hospitalisations, an ageing population structure, changing procedural practice or a combination of these factors. Methods We conducted a longitudinal retrospective population study on all WA residents aged 25–94 years between 2000 and 2013, with a principal hospital discharge diagnosis of NVAF. Person-linked hospital morbidity and mortality records were used to measure annual rate ratios (RRs) and 95% confidence intervals (CIs) in the total and incident NVAF (25–94 years) hospitalisations, further stratified by sex and by age-specific standardised groups (25–44, 45–64, 65–75, 75–84, 85–94 years). Results There were 55,532 total hospitalisations for NVAF between 2000 and 2013, patient mean age 68.3 years, and 58% male. Annual age- and sex- standardised rates for total NVAF hospitalisation increased by 3.0%/year (RR 1.030; 95%CI; 1.028, 1.038), and in both men and women. The largest absolute increase in hospitalisation rate occurred in those aged 85–94 years (∆613/100,000 men and women combined). Incident NVAF hospitalisations showed a borderline decline of 0.5%/year (RR 0.99; 95%CI; 0.99, 1.0) with a statistically significant trend in women but not men. The rate of AF admissions associated with a catheter ablation increased by 13%/year (95%CI; 13.1%, 15.3%). Conclusion The increasing rates of total hospitalisation for NVAF is driven more by repeat than incident admissions, escalating hospitalisations in the very elderly, and more frequent interventional procedures. These drivers have major economic and healthcare planning implications.

Objective It is useful for reviewers of economic evaluations to assess quality in a manner that is consistent and comprehensive. Checklists can allow this, but there are concerns about their reliability and how they are used in practice. We aimed to describe how checklists have been used in systematic reviews of health economic evaluations. Methods Meta-review with snowball sampling. We compiled a list of checklists for health economic evaluations and searched for the checklists’ use in systematic reviews from January 2010 to February 2018. We extracted data regarding checklists used, stated checklist function, subject area, number of reviewers, and issues expressed about checklists. Results We found 346 systematic reviews since 2010 that used checklists to assess economic evaluations. The most common checklist in use was developed in 1996 by Drummond and Jefferson, and the most common stated use of a checklist was quality assessment. Checklists and their use varied within subject areas; 223 reviews had more than one reviewer who used the checklist. Conclusions Use of checklists is inconsistent. Eighteen individual checklists have been used since 2010, many of which have been used in ways different from those originally intended, often without justification. Different systematic reviews in the same subject areas would benefit from using one checklist exclusively, using checklists as intended, and having 2 reviewers complete the checklist. This would increase the likelihood that results are transparent and comparable over time.

Context Construction industry workers are at high risk of occupational noise exposure. Although regulations and guidelines for this industry specify the use of noise controls, workers continue to be exposed to hazardous noise levels. Objectives The objectives of this study were (i) to collate and describe full-shift noise exposure experienced by construction workers; (ii) to review trends in full-shift exposure over time and between countries; and (iii) to identify any occupational categories within the construction industries that have higher levels of exposure. Results Of the 1171 studies found using key terms, 25 contained noise exposure measurements that met our inclusion criteria. Sample populations were predominantly from large construction sites and primarily comprised occupations known to engage in noisy workplace activities. Studies spanned over 36 years with all having average full-shift noise exposure over 85 A-weighted decibels (dBA). No time trend in full-shift noise exposure levels for construction workers was observed. Construction workers in the subgroup occupations of mason, sheet metal workers, carpenters, concrete workers, and operating engineers consistently had mean LAeq,8h over the 85 dBA limit. Conclusion Studies spanning 36 years in 10 countries consistently show construction workers have been exposed to hazardous noise levels. There has been no significant change over time of the average full-shift exposure levels of construction workers, including in all occupational subgroups except iron-workers. Some variability in full-shift measures is due to sampling methods and population characteristics and to a lesser extent, methods used to derive exposure levels.

International audience; Elicitor-induced resistance against diseases is an attractive strategy that could contribute to reduce the use of fungicides for plant protection. However, activation of defenses has an energetic cost that plants have to fuel by a mobilization of their primary metabolism with possible adverse effect on their physiology. In this context, this study was performed to determine whether elicitor-induced resistance of grapevine leaves against downy mildew impacted its development and metabolism. The elicitor PS3 (sulfated beta-glucan laminarin) was sprayed on grapevine herbaceous cuttings grown in greenhouses once or three times, and its impact was studied on young and older grapevine leaves, prior to, and after Plasmopara viticola inoculation. PS3 did not affect grapevine development during the time course of the experiment. A metabolomic analysis, mainly focused on primary metabolites, highlighted a leaf age dependent effect of PS3 treatment. Nitrogen compounds, and sugars to a lesser extent, were impacted. The results obtained complete the current knowledge of the impact of elicitor-induced resistance on plant physiology. They will be helpful to guide further experiments required to better determine the costs and benefits of elicitor-induced resistance in plants.

ObjectivesOccupational noise exposure is a major cause of hearing loss worldwide. In order to inform preventative strategies, we need to further understand at a population level which workers are most at risk.MethodsWe have developed a new questionnaire-based algorithm that evaluates an individual worker’s noise exposure. The questionnaire and supporting algorithms are embedded into the existing software platform, OccIDEAS. Based on the tasks performed by a worker during their most recent working shift and using a library of task-based noise exposure levels, OccIDEAS estimates whether a worker has exceeded the full-shift workplace noise exposure limit (LAeq,8h≥85 dBA). We evaluated the validity of the system in a sample of 100 construction workers. Each worker wore a dosimeter for a full working shift and was then interviewed using the OccIDEAS software.ResultsThe area under the receiver operating characteristic curve was 0.81 (95% CI 0.72 to 0.90) indicating that the ability of OccIDEAS to identify construction workers with an LAeq,8h≥85 dBA was excellent.ConclusionThis validated noise questionnaire may be useful in epidemiological studies and for workplace health and safety applications.

article i nfo The grapevine downy mildew (Plasmopara viticola) provokes severe damages and destroys the harvest in the absence of an effective protection. Numerous fungicide treatments are thus generally necessary. To promote a sustainable production, alternative strategies of protection including new antifungal molecules, resistant geno- types or elicitor-induced resistance are under trial. To evaluate the relevance of these strategies, resistance tests are required. In this context, three image analysis methods were developed to read the results of tests performed to assessP.viticolasporulation and mycelial development, and H 2 O 2 production in leaves. They have been validated using elicitors of plant defenses. These methods are reliable, innovative, rapid, and their modular concept allows their further adaptation to other host-pathogen systems. © 2013 Elsevier B.V. All rights reserved.

Objective The aim of the present study was to estimate the revenues collected by government and industry from alcohol consumption by young Australians in 2010. Methods Statistical analyses were performed on data from the Australian National Drug Strategy Household Survey 2010 and alcohol data collected from an online retailer to calculate the proportion, frequency, quantity and revenues from alcohol consumption by young Australians. Results One-third of adolescents (12–17 years old) and 85% of young adults (18–25 years old) consume alcohol. More than half the adolescents’ alcohol consumption is from ready-to-drink spirits. Revenue generated from alcohol consumption by 12–25 year olds is estimated at $4.8 billion in 2010 (2014 Australian dollars): $2.8 billion to industry (sales) and $2.0 billion to government (taxes). Conclusions Alcohol consumption by young Australians is prevalent, and young Australian drinkers consume alcohol in substantial amounts. The industry and taxation revenue from young drinkers is also considerable. It would be in the public interest to divert some of this revenue towards health initiatives to reduce drinking by young people, especially given the high societal costs of alcohol consumption. What is known about the topic? Australian adolescents aged 12–17 years consume substantial amounts of alcohol, and substantial amounts of revenue are generated from alcohol sales to them. What does this paper add? This paper provides recent estimates of alcohol consumption and revenue generated by Australian adolescents, and extends estimates to young adults aged 18–25 years. What are the implications for practitioners? A substantial proportion of Australian young people consume alcohol. The sales and taxation revenue generated from young people’s drinking is substantial at A$4.8 billion in 2010 and is higher in real terms than estimates from previous studies. Some of the alcohol taxation revenue could be diverted to health promotion and education for young people, because the costs of alcohol consumption in terms of health outcomes and productivity losses for these age groups are expected to be especially high.