Power and Other Commercial Determinants of Health: An Empirical Study of the Australian Food, Alcohol, and Gambling Industries.

BACKGROUND: Commercial determinants of health (CDoH) represent a critical frame for exploring undue corporate and commercial influence over health. Power lenses are integral to understanding CDoH. Impacts of food, alcohol, and gambling industries are observable CDoH outcomes. This study aims to inform understanding of the systems and institutions of commercial and/or corporate forces working within the Australian food, alcohol, and gambling industries that influence health and well-being, including broader discourses materialised via these systems and institutions. METHODS: Twenty semi-structured interviews were conducted with key-informants on Australian public policy processes. Interviewees were current and former politicians, political staff members, regulators and other public servants, industry representatives, lobbyists, journalists, and researchers with expertise and experience of the Australian food, alcohol, and/ or gambling industries. Interviews sought participants' perceptions of Australian food, alcohol, and gambling industries' similarities and differences, power and influence, relationships, and intervention opportunities and needs. RESULTS: Strategies and tactics used by Australian food, alcohol and gambling industries are similar, and similar to those of the tobacco industry. They wield considerable soft (eg, persuasive, preference-shaping) and hard (eg, coercive, political, and legal/economic) power. Perceptions of this power differed considerably according to participants' backgrounds. Participants framed their understanding of necessary interventions using orthodox neoliberal discourses, including limiting the role of government, emphasising education, consumer freedom, and personal choice. CONCLUSION: Food, alcohol, and gambling industries exercise powerful influences in Australian public policy processes, affecting population health and well-being. Per Wood and colleagues' framework, these manifest corporate, social, and ecological outcomes, and represent considerable instrumental, structural, and discursive power. We identify power as arising from discourse and material resources alike, along with relationships and complex industry networks. Addressing power is essential for reducing CDoH harms. Disrupting orthodox discourses and ideologies underpinning this should be a core focus of public health (PH) advocates and researchers alike.

Can counter-advertising dilute marketing effects of alcohol sponsorship of elite sport: A field experiment.

AIMS: To test whether showing spectators counter-advertisements exposing alcohol harms alone, or exposing alcohol harms and alcohol sponsorship, before watching an alcohol-sponsored sporting event promotes less favourable post-event attitudes and intentions towards alcohol sponsor brands and alcohol in general. DESIGN: On-line between-subjects experiment. SETTING: Australia. PARTICIPANTS: A sample of Australian adults aged 18-49 years who planned to watch an alcohol-sponsored National Rugby League (NRL) State of Origin series game was recruited through an online panel. INTERVENTIONS: Participants were randomly assigned to one of three counter-advertising conditions: control (neutral advertisement); counter-advertisement exposing alcohol harms; and counter-advertisement exposing alcohol sponsorship and harms, to view at least four times during the week before watching the alcohol-sponsored sporting event. MEASUREMENTS: Participants (n = 1932) completed a pre-test questionnaire a week before the sporting event. Within 4 days of watching the sporting event, participants completed post-test measures assessing sponsor brand awareness, attitudes and preferences towards the brand, as well as knowledge, attitudes and intentions for alcohol in general (n = 1075). FINDINGS: Compared with the control advertisement, the counter-advertisement exposing alcohol sponsorship and harms promoted higher (6-13%) awareness of sponsor brands, less favourable attitudes towards sponsor brands and drinking beer, lower purchase intentions for sponsor brands (Cohen's d = 0.15, 0.31, 0.27, respectively) and perceived less image-based similarity and fit between the sporting event and sponsor brands (Cohen's d = 0.20 and 0.56). Both counter-advertisements promoted lower perceptions of the appropriateness of consuming alcohol while watching sport (Cohen's d = 0.22 and 0.34), higher awareness of alcohol harms (6-34%) and higher intentions (8-13%) to reduce alcohol consumption than the control advertisement. CONCLUSIONS: At alcohol-sponsored sporting events, counter-advertisements addressing alcohol harms may promote knowledge of harms and intentions to drink less. Counter-advertisements that additionally expose and critique alcohol sponsorship may detract from perceptions of sponsor brand image and intentions to purchase the sponsor's products.

The Relationship Between Weight Stigmatization, Avoidance, Enjoyment and Participation in Physical Activity and Sport, and Psychological Distress.

Objectives: The psychosocial factors affecting physical activity (PA) and sport participation are not well understood but need to be to gain the psychological benefits of PA and sport. In this study, we sought to establish the relationship between weight stigmatization, the tendency to avoid, or participate in and/or enjoy PA and sport, and psychological distress.Methods: We collected demographic details and measures of the constructs of interest from 578 undergraduate students via an online survey. We ran bivariate correlations and multivariate linear regression models to establish statistical relationships between the variables of interest. Results: In bivariate correlations, weight stigmatization and the tendency to avoid PA were significantly associated with greater psychological distress. Greater enjoyment of PA and sport was related with less psychological distress; however, participation in PA and sport was not associated with psychological distress. In multivariate regression analyses, weight stigma, internalized weight stigma and the tendency to avoid PA and sport were significant predictors of psychological distress, accounting for 22% of the variance in psychological distress scores.Conclusion: In this study, we found that addressing internalized weight stigma requires urgent action to promote better mental health through PA and sport participation. We propose a conceptual model to explore these relationships.

Which alcohol products might be affected by the introduction of a minimum unit price in Western Australia? Findings from a survey of alcohol retail prices.

INTRODUCTION: Minimum unit price (MUP) policies establish a retail floor price below which alcohol may not be sold, and have been shown to reduce harmful alcohol use. We aimed to collect retail price data to estimate the proportion of alcohol products that would potentially be impacted by a MUP policy in Western Australia. METHODS: We purposively sampled the four largest off-premises alcohol retail chains, a further random sample of other off-premise alcohol outlets (n = 16) and on-premise inner-city outlets (n = 11). Using website data from May to June 2021, we estimated the proportion of products across four beverage categories priced ≤A$1.30, ≤A$1.50 and ≤A$1.75 per standard drink (10 g alcohol). RESULTS: Of 27,797 off-premise products identified, 5.7% were available at ≤$1.30 per standard drink, 7.6% at ≤$1.50 and 10.4% at ≤$1.75. The proportion of products available at ≤$1.30 per standard drink varied by beverage category: 7.8% wine, 2.9% beer and cider, <0.1% spirits, 0.0% ready-to-drink spirits. Cask-packaged wines represented only 1.9% of off-premise wine products and 98.9% of this cask wine was priced ≤$1.30 per standard drink. No on-premise products were priced ≤$1.75 per standard drink. DISCUSSION AND CONCLUSIONS: A comprehensive survey of alcohol prices in Western Australia found only a small proportion of products would potentially be affected by a MUP of $1.30 to $1.75 per standard drink. A MUP policy has potential to target the small proportion of alcohol products available at very low prices (i.e., off-premise cask wine), with negligible impact on other off-premise beverage categories, and no impact on on-premises products.

Can counter-advertising exposing alcohol sponsorship and harms influence sport spectators' support for alcohol policies? An experimental study.

BACKGROUND: Exposure to alcohol advertising and sponsorship through elite sport is associated with harmful use of alcohol. Owing to strong financial and cultural ties between alcohol and sport in Australia, policy action to restrict alcohol sport sponsorship is unlikely to occur without strong public support for change. This study tested whether exposure to counter-advertising exposing industry marketing of harmful products-a technique shown to be effective in tobacco control-promotes higher support for policy change and less favourable beliefs about the alcohol industry among sport spectators. METHODS: A sample of 1,075 Australian adults aged 18-49 years who planned to watch an National Rugby League (NRL) State of Origin series game, featuring prominent alcohol sponsorship, was recruited through an online panel and randomly assigned to one of three conditions: control (neutral advertisement); counter-advertisement exposing alcohol harms; counter-advertisement exposing alcohol sponsorship and harms. Participants completed a pre-test questionnaire and viewed their assigned counter-advertisement multiple times in the 5-7 days before the NRL game. Within four days of watching the game, participants completed post-test measures. RESULTS: Compared to both the control advertisement and the counter-advertisement exposing alcohol harms, participants who viewed the counter-advertisement exposing alcohol sponsorship and harms were significantly more likely to indicate support for each of four policies aimed at restricting sports-related alcohol marketing, including the complete removal of alcohol sponsorship from sport (51% vs. 32% and 37%). They were also significantly less likely to agree with statements such as "alcohol companies should be allowed to sponsor sport since their products are legal" (39% vs. 63% and 60%) and significantly less likely to report liking alcohol companies in general (38% vs. 59% and 54%). There were no significant differences in policy support or industry beliefs between participants who saw the counter-advertisement exposing alcohol harms and those who saw the control advertisement. CONCLUSION: Counter-advertising employing messages that expose and critique the intent and impact of pervasive alcohol sponsorship in sport has potential to bolster public support for policies targeting alcohol sport sponsorship, diminish beliefs supportive of alcohol industry marketing strategies and enhance negative views of alcohol companies and their marketing practices.

Weight Stigma and Avoidance of Physical Activity and Sport: Development of a Scale and Establishment of Correlates.

Participation in sport and physical activity (PA) is declining, and the psychosocial factors underpinning avoidance of these activities are not understood. This study developed and tested a new measure assessing the tendency to avoid PA and sport because of weight stigma and appearance-related concerns. University students (n = 581, mean age = 19.8 years) completed an online survey at two time points. Demographic details and measures of weight stigmatization, appearance evaluations, and enjoyment and participation in PA or sport were taken. In addition, we developed and tested a new measure of the tendency to avoid physical activity and sport (TAPAS). Psychometric testing of the scale was conducted, and correlates of TAPAS were examined. The ten-item TAPAS provided a single factor solution, and the final scale score was predictive of lower levels of enjoyment of, and participation in, physical activity and sport (p < 0.001). The scale also displayed good internal and test-retest reliability. This study provides a new measure for assessing people's tendency to avoid PA and sport because of weight stigma or appearance-related concerns. The results suggest that initiatives seeking to increase participation in PA and sport may need to address weight stigma and associated appearance related concerns.

Gambling and homelessness: A systematic review and meta-analysis of prevalence.

INTRODUCTION: There is growing concern internationally about co-occurring gambling and homelessness. We systematically review prevalence estimates in help-seeking and community samples. METHODS: Adopting PRISMA guidelines, we searched CINAHL Plus, Cochrane Library, Embase, Ovid MEDLINE, PsychINFO, Proquest Central, PubMed, Scopus, Web of Science, and Google Scholar for relevant peer-reviewed articles in English. Primary outcomes examined in narrative and quantitative syntheses included prevalence of: (i) gambling in persons experiencing homelessness; (ii) harmful gambling in persons experiencing homelessness; and, (iii) homelessness in persons experiencing harmful gambling. RESULTS: Searches identified 917 records after removing duplicates. After screening, 45 articles providing 54 prevalence estimates across 12 countries were included, with help-seeking (k = 37) and community based sample (k = 8) estimates pooled separately. Gambling prevalence (all timeframes) in help-seeking samples of persons experiencing homelessness is low (28.7%, 95% CI: 17.3-41.7, k = 14) compared to the general population (approximately 60-80%). However, harmful gambling prevalence (including problem, pathological, and disordered gambling) in help-seeking samples of persons experiencing homelessness is high (16.5%, 95% CI: 10.2-24.2, k = 20) compared to the general population (approximately 1-7%). Additionally, homelessness prevalence is high in help-seeking samples of persons experiencing harmful gambling (23.6%, 95% CI: 18.4-29.2, k = 4) compared to the general population (<1%). Meta-analysis found high between-study heterogeneity and risk of bias from small samples sizes. CONCLUSIONS: There are high rates of harmful gambling in persons experiencing homelessness and, concurrently, high rates of homelessness in persons experiencing harmful gambling. Improvements in sampling and measurement are needed to strengthen robustness and generalizability of prevalence estimates, which can potentially inform the scale and targeting of clinical interventions, support services, and policy responses.

Gambling and homelessness in older adults: a qualitative investigation.

BACKGROUND AND AIMS: Homelessness is one of the most significant harms associated with gambling and appears to affect older adults disproportionately, but the relationship has received little research attention. This exploratory study investigated how gambling and homelessness is linked in older adults. METHODS: Using qualitative research methods, we undertook in-depth semi structured face-to-face individual and group interviews to gather data from a purposive sample (n = 48) of key informants working in service provision for older adults (aged 50+ years) experiencing gambling-related harm and/or homelessness in Victoria, Australia. Thematic analysis of data focused on evaluating mechanisms and identifying contextual conditions that activate pathways between gambling and homelessness. RESULTS: The relationship between gambling and homelessness in older adults is often indirect and non-linear, and can represent a reflexive cycle. Experiencing periods of homelessness into older age can contribute to gambling, often because the adverse impacts of homelessness on older adults' mental and material wellbeing increase the appeal of gambling. Additionally, comorbidities (e.g. substance use, mental illness, past trauma) and structural conditions (e.g. gambling accessibility, poverty, housing insecurity) can activate gambling. Furthermore, because gambling in the older homeless adult population is frequently hidden and regularly overlooked by service providers, it often continues unabated. Gambling in older adults can also contribute to the onset of first-time homelessness. Large and rapid losses from high-intensity gambling frequently characterize this route to homelessness. Such gambling is often triggered by major life events and changes (e.g. bereavement, job loss, relationship difficulties), and the outcomes are often worsened by the conduct of gambling operators and creditors. CONCLUSIONS: The link between gambling and homelessness in older adults is complex, with connecting mechanisms often contingent upon individual, interpersonal and structural conditions and contexts. There is potential for preventative and ameliorative action given many of the underlying conditions appear modifiable through policy intervention.

The Relationship between Weight Stigma, Physical Appearance Concerns, and Enjoyment and Tendency to Avoid Physical Activity and Sport.

Participation in physical activity and sport is on the decline and there is a poor understanding of the psychosocial factors that contribute to people's reluctance to participate. We examined whether there were relationships between factors such as weight stigma, weight bias internalization, appearance evaluation, and fears of negative appearance evaluations, and enjoyment and avoidance of physical activity and sport. Undergraduate students (N = 579) completed a survey assessing demographics, and the variables described above. In hierarchal multivariate regression models, weight stigma (ß = -0.16, p < 0.001), appearance evaluation (ß = 0.19, p = 0.001), and weight bias internalization (ß = -0.19, p = 0.003) were associated with lower enjoyment of physical activity and sport. Weight stigma (ß = 0.46, p = 0.001), weight bias internalization (ß = 0.42, p = 0.001), and fear of negative appearance evaluations (ß = 0.16, p = 0.000) were also significantly associated with the tendency to avoid physical activity and sport. Serial mediation analysis showed the relationship between weight stigma and enjoyment of physical activity and sport was through appearance evaluation and weight bias internalization (indirect effect = -0.007, SE = 0.002, 95% CI = -0.01, -0.02). Similarly, the relationship between weight stigma and avoidance of physical activity and sport was through weight bias internalization and fear of negative appearance evaluations (indirect effect = 0.11, SE = 0.03, 95% CI = 0.05, 0.16). These results suggest that weight stigma and concerns about one's physical appearance influence people's enjoyment and reasoning for avoiding physical activity and sport. Research is needed to identify ways to reduce body-related stigma and increase enjoyment and participation in physical activity and sport.

When the pubs closed: beer consumption before and after the first and second waves of COVID-19 in Australia.

AIMS: Restrictions to alcohol availability during the first and second waves of the COVID-19 pandemic in Australia included closures of businesses where alcohol is sold for on-premises consumption (pubs, bars, restaurants and cafes), but not where alcohol is sold for off-premises consumption (take-away and home delivery). This study aimed to compare beer consumption before and after restrictions to alcohol availability during the first and second waves of COVID-19 in Australia. DESIGN: Interrupted time-series analysis. SETTING: Australia. PARTICIPANTS: Estimated resident population aged 15+ years. MEASUREMENTS: Seasonally adjusted estimates of beer per capita consumption measured in litres of alcohol (LALs) per week, disaggregated by on- and off-premises sales. FINDINGS: First-wave restrictions (week beginning 23 March 2020) were associated with a significant immediate reduction in on-premises beer per capita consumption [-0.013 LALs, 95% confidence interval (CI) = -0.013 to -0.012, P = < 0.001], but no significant change in off-premises beer per capita consumption. Partial removal of first-wave restrictions (week beginning 18 May 2020) was associated with a significant immediate increase in on-premises beer per capita consumption (+0.003 LALs, 95% CI = 0.001 to 0.004, P = 0.006), but no significant change in off-premises beer per capita consumption. Second-wave restrictions (week beginning 06 July 2020) were associated with a significant immediate reduction in on-premises beer per capita consumption (-0.004 LALs, 95% CI = -0.006 to -0.002, P = 0.001) but, again, no significant change in off-premises beer per capita consumption. CONCLUSION: Restricting the availability of on-premises alcohol during the first and second waves of the COVID-19 pandemic in Australia was associated with significant reductions in on-premises beer consumption, but no significant changes in off-premises beer consumption.

Heterogenous wealth effects of minimum unit price on purchase of alcohol: Evidence using scanner data.

One of the key arguments given to oppose the "sin taxes" is that they are regressive in nature and place disproportionately higher cost on the poor thereby reducing their net wealth. The response to a reduction in net wealth attributed to tax can potentially have significant effects through an increase in alcohol purchase by heavy drinkers reinforcing or even offsetting the direct price or substitution effect of these taxes in reducing alcohol consumption. Comparatively little is known empirically about the net wealth effect associated with changes in alcohol tax policy, and this study aims to help fill this gap in the literature. In this study we aim to estimate how the wealth effects of introducing a minimum unit price (MUP) of A$2.00 per standard drink vary over the distribution (quantiles) of alcohol consumers. The data used in this study is a longitudinal panel of 1,395 households' daily alcohol purchases (scanner data) recorded over a full year. Our analysis involves (i) quantile regression to estimate income elasticity over the distribution of consumption, and (ii) using these elasticities to estimate the potential wealth effects of a hypothetical change in alcohol prices from introducing an MUP policy. We control for consumer demographic characteristics, alcohol product prices and prices of close substitutes, and quarterly seasonal effects. We find that the estimated wealth effect from increasing the price of alcohol under a MUP policy is not significant at any point over the distribution of alcohol consumers. The policy increases per capita tax impact by less than A$5.00 per week for light/moderate consumers (50th-80th quantile) and decreases their daily per capita alcohol consumption by less than 0.02 standard drinks. Wealth effects attributable to an MUP policy are likely to be negligible. Substitution effects of the policy dominate the wealth effects in generating key health related outcomes such as reductions in alcohol consumption.

Aggression and violence at ambulance attendances where alcohol, illicit and/or pharmaceutical drugs were recorded: A 5-year study of ambulance records in Victoria, Australia.

BACKGROUND: This study describes the frequency and characteristics of aggression and/or violence in ambulance attendances involving alcohol, illicit and/or pharmaceutical drug use in Victoria, Australia between January 2012 and January 2017. METHODS: Patient characteristics, context, and substance use involvement in ambulance attendances were examined to determine associations with attendances where aggression and/or violence was recorded. RESULTS: There were 205,178 ambulance attendances where use of alcohol, pharmaceutical drugs or illicit substances contributed to the reason for the attendance. Paramedics recorded acts of aggression and/or violence in 11,813 (5.76 %) of these attendances. Aggression/violence was more likely to be recorded in certain contexts. Compared with attendances where aggression/violence was not recorded, attendances where aggression/violence was recorded were significantly more likely to involve younger and male patients, and occur on Friday and Saturday nights. Alcohol intoxication was involved in more than half of attendances where aggression/violence was recorded, and was almost twice as prevalent as those involving illicit drug use where aggression/violence was recorded. This pattern was consistent across all hours, high-alcohol hours only, by metropolitan/regional location, and by police co-attendance. CONCLUSIONS: Aggression and violence are frequently recorded in ambulance attendances involving alcohol, pharmaceutical drugs or illicit substances, and, most often involve alcohol. This violence poses a recurring threat to the health and safety of paramedics, bystanders, and patients. Greater priority should be given to reducing alcohol-related violence through evidence-based policy measures targeting high-risk groups (e.g. young adult males) and contexts (e.g. weekends, late at night) where harm is most likely to occur.

Effects of changes to the taxation of beer on alcohol consumption and government revenue in Australia.

BACKGROUND: In 1988, the Australian government introduced a single nominal rate of tax on all beer products calculated on alcohol content. However, in 2000/01, varying nominal rates of tax were introduced for beer products according to three alcohol content levels (low-/mid-/high-strength) and container type (on-/off-premises). Little is known about the effect of the different tax policies on alcohol consumption and government revenue. METHODS: We undertake time series analysis over 1989-2016 to examine the effect of beer tax policies in two sub-periods (before/after 2000/01) on category-level beer consumption per capita and government revenue. We also test if the policy changes in 2000/01 had immediate or long-term effects on total (all beer category) consumption over 1989-2016. Data includes monthly domestic beer sales volumes by category (in litres of alcohol), monthly government revenue from beer tax (AUD$), and inflation-adjusted tax rates (AUD$ per litre of alcohol). RESULTS: Before 2000/01, the single nominal tax rate had a significant positive effect on revenue, but no significant effect on consumption. After 2000/01, the relatively higher nominal tax rates for two beer categories (mid- and high-strength off-premises) had a significant negative effect on their consumption, and a significant negative effect on revenue in one category (mid-strength off-premises). However, across the full period examined (1989-2016), the level and slope of total beer consumption was not significantly affected by the tax policy changes in 2000/01. CONCLUSION: Raising alcohol taxes has the potential to reduce consumption and increase government revenue, but has been underutilised for these public health and public finance objectives in Australia.

Alcohol use in family, domestic and other violence: Findings from a cross-sectional survey of the Australian population.

INTRODUCTION AND AIMS: The link between alcohol and experience of violence is well-documented, but there is a paucity of empirical research on the role of alcohol specifically in family and domestic violence (FDV) in Australia. The aim of the current study was to describe the relationship between alcohol use and FDV in the Australian population, and to examine key differences between three different types of violence: family violence, intimate partner violence (IPV) and other violence. DESIGN AND METHODS: An online panel survey was conducted using a stratified random sampling design. RESULTS: In total, 5118 respondents were included, of whom 44.5% reported experiencing violence in their lifetime, and 6.0% reported recent (past year) experience of violence. Recent violent incidents were comprised of IPV (41.8%), family violence (13.1%) and other violence (45.1%). Approximately one-third of all violent incidents experienced (either as a victim or perpetrator) were alcohol-related, and 37.8% of respondents who experienced IPV and 27.8% of those who experienced family violence reported past year heavy-episodic drinking. Alcohol use was associated with higher rates of physical violence and injury at IPV incidents. Alcohol consumed at IPV incidents was most often purchased from a supermarket liquor store (37.0%) and consumed at the respondent's home, regardless of the distance between the purchase location and incident location. DISCUSSIONS AND CONCLUSIONS: This study found that alcohol is frequently involved in FDV incidents, particularly IPV. Alcohol use was associated with a higher chance of physical violence and of injury at IPV incidents.

Pricing as a means of controlling alcohol consumption.

Background: Reducing the affordability of alcohol, by increasing its price, is the most effective strategy for controlling alcohol consumption and reducing harm. Sources of data: We review meta-analyses and systematic reviews of alcohol tax/price effects from the past decade, and recent evaluations of tax/price policies in the UK, Canada and Australia. Areas of agreement: While the magnitudes of price effects vary by sub-group and alcoholic beverage type, it has been consistently shown that price increases lead to reductions in alcohol consumption. Areas of controversy: There remains, however, a lack of consensus on the most appropriate taxation and pricing policy in many countries because of concerns about effects by different consumption level and income level and disagreement on policy design between parts of the alcoholic beverage industries. Growing points: Recent developments in the research highlight the importance of obtaining accurate alcohol price data, reducing bias in estimating price responsiveness, and examining the impact on the heaviest drinkers. Areas timely for developing research: There is a need for further research focusing on the substitution effects of taxation and pricing policies, estimation of the true tax pass-through rates, and empirical analysis of the supply-side response (from alcohol producers and retailers) to various alcohol pricing strategies.

Are Alcohol Taxation and Pricing Policies Regressive? Product-Level Effects of a Specific Tax and a Minimum Unit Price for Alcohol.

AIMS: To compare estimated effects of two policy alternatives, (i) a minimum unit price (MUP) for alcohol and (ii) specific (per-unit) taxation, upon current product prices, per capita spending (A$), and per capita consumption by income quintile, consumption quintile and product type. METHODS: Estimation of baseline spending and consumption, and modelling policy-to-price and price-to-consumption effects of policy changes using scanner data from a panel of demographically representative Australian households that includes product-level details of their off-trade alcohol spending (n = 885; total observations = 12,505). Robustness checks include alternative price elasticities, tax rates, minimum price thresholds and tax pass-through rates. RESULTS: Current alcohol taxes and alternative taxation and pricing policies are not highly regressive. Any regressive effects are small and concentrated among heavy consumers. The lowest-income consumers currently spend a larger proportion of income (2.3%) on alcohol taxes than the highest-income consumers (0.3%), but the mean amount is small in magnitude [A$5.50 per week (95%CI: 5.18-5.88)]. Both a MUP and specific taxation will have some regressive effects, but the effects are limited, as they are greatest for the heaviest consumers, irrespective of income. Among the policy alternatives, a MUP is more effective in reducing consumption than specific taxation, especially for consumers in the lowest-income quintile: an estimated mean per capita reduction of 11.9 standard drinks per week (95%CI: 11.3-12.6). CONCLUSION: Policies that increase the cost of the cheapest alcohol can be effective in reducing alcohol consumption, without having highly regressive effects.

Child and adolescent exposure to alcohol advertising in Australia's major televised sports.

INTRODUCTION AND AIMS: Exposure to alcohol advertising is associated with greater alcohol consumption in children and adolescents, and alcohol advertising is common in Australian sport. We examine child, adolescent and young adult exposure to alcohol advertising during three televised sports in Australia: Australian Football League (AFL), cricket and the National Rugby League (NRL). METHODS: Alcohol advertising and audience viewing data were purchased for all AFL, cricket and NRL TV programs in Australia for 2012. We estimated children and adolescents (0-17 years) and young adults (18-29 years) exposure to alcohol advertising during AFL, cricket and NRL programs in the daytime (06:00-20:29 h), and night-time (20:30-23:59 h). RESULTS: There were 3544 alcohol advertisements in AFL (1942), cricket (941) and NRL programs (661), representing 60% of all alcohol advertising in sport TV, and 15% of all alcohol advertisements on Australian TV. These programs had a cumulative audience of 26.9 million children and adolescents, and 32 million young adults. Children and adolescents received 51 million exposures to alcohol advertising, with 47% of this exposure occurring during the daytime. Children and adolescents exposure to alcohol advertising was similar to young adults and peaked after 8.30pm. DISCUSSION AND CONCLUSIONS: Child and adolescent and young adult's exposure to alcohol advertising is high when viewing sport TV in Australia in the daytime and night-time. Current alcohol advertising regulations are not protecting children and adolescents from exposure, particularly in prominent televised sports. The regulations should be changed to reduce children and adolescent excessive exposure to alcohol advertising when watching sport. [Carr S, O'Brien KS, Ferris J, Room R, Livingston M, Vandenberg B, Donovan RJ, Lynott D. Child and adolescent exposure to alcohol advertising in Australia's major televised sports. Drug Alcohol Rev 2016;35:406-411].