Reducing alcohol harms whilst minimising impact on hospitality businesses: 'Sweetspot' policy options.

BACKGROUND: During COVID-19, hospitality businesses (e.g. bars, restaurants) were closed/restricted whilst off-sales of alcohol increased, with health consequences. Post-covid, governments face lobbying to support such businesses, but many health services remain under pressure. We appraised 'sweetspot' policy options: those with potential to benefit public services and health, whilst avoiding or minimising negative impact on the hospitality sector. METHODS: We conducted rapid non-systematic evidence reviews using index papers, citation searches and team knowledge to summarise the literature relating to four possible 'sweetspot' policy areas: pricing interventions (9 systematic reviews (SR); 14 papers/reports); regulation of online sales (1 SR; 1 paper); place-shaping (2 SRs; 18 papers/reports); and violence reduction initiatives (9 SRs; 24 papers/reports); and led two expert workshops (n = 11). RESULTS: Interventions that raise the price of cheaper shop-bought alcohol appear promising as 'sweetspot' policies; any impact on hospitality is likely small and potentially positive. Restrictions on online sales such as speed or timing of delivery may reduce harm and diversion of consumption from on-trade to home settings. Place-shaping is not well-supported by evidence and experts were sceptical. Reduced late-night trading hours likely reduce violence; evidence of impact on hospitality is scant. Other violence reduction initiatives may modestly reduce harms whilst supporting hospitality, but require resources to deliver multiple measures simultaneously in partnership. CONCLUSIONS: Available evidence and expert views point to regulation of pricing and online sales as having greatest potential as 'sweetspot' alcohol policies, reducing alcohol harm whilst minimising negative impact on hospitality businesses.

Test purchasing of same day and rapid online alcohol home delivery in two Australian jurisdictions.

OBJECTIVE: With same day online alcohol sales increasing, there is a need to study their regulation. Test purchasing of alcohol home delivery was conducted to measure compliance with regulations for identification checks and unattended deliveries in two Australian jurisdictions (Perth, Western Australia and Geelong, Victoria), which have differing regulations. METHOD: Alcohol orders for same day or rapid (<2 hours) delivery on Friday and Saturday nights were made by research assistants aged 18-24 years in Perth (n=34) and Geelong (n=29). An observation checklist was used to record the delivery interaction, with a specific focus on checking of photo identification at time of delivery and whether deliveries were left unattended. RESULTS: Average time from order to delivery for rapid deliveries was less than one hour in both sites (Perth = 50 minutes; Geelong = 36 minutes). More than 20% of deliveries were made without an identification check in both sites (Perth = 24%; Geelong = 21%). CONCLUSIONS: This pilot study showed alcohol can be delivered to the home within one hour, and not all deliveries include an identification check at point of delivery. These findings indicate a need for policies that empower regulators and police to undertake 'mystery shopper' monitoring to reduce potential harms and improve compliance with alcohol delivery policy.

Alcohol policy changes during the first three-months of the COVID-19 pandemic: Development and application of a classification scheme.

BACKGROUND: Policy changes in response to the COVID-19 pandemic have impacted on alcohol control. This study describes the development and application of a classification scheme to map alcohol policy changes during the first three-months of the COVID-19 pandemic in five countries and/or subnational jurisdictions. METHOD: A pre-registered systematic review of policy decisions from March to May 2020, in Australia/New South Wales, Canada/Ontario, Chile, Italy and the United Kingdom. One author extracted the data for each jurisdiction using a country-specific search strategy of government documents. We coded policy changes using an adapted WHO classification scheme, whether the policy was expected to tighten or loosen alcohol control, have mainly immediate or delayed impact on consumption and harm and impact the general population versus specific populations. We present descriptive statistics of policy change. RESULTS: We developed a classification scheme with four levels. Existing policy options were insufficient to capture policy changes in alcohol availability, thus we added seventeen new sub-categories. We found 114 alcohol control policies introduced across the five jurisdictions, covering five (out of ten) WHO action areas. The majority aimed to change alcohol availability, by regulating the operation of alcohol outlets. All countries introduced closures to on-premise alcohol outlets and, except Chile, allowed off-sales via take away or home delivery. We also observed several pricing policies introducing subsidies to support the alcohol industry. Seventy-four percent of policy changes were expected to tighten alcohol control and 12.3 % to weaken control. Weakening policy changes were mostly related to retail mode switching or expansion (allowing take away or home delivery). CONCLUSION: Alcohol control policies during the first three months of the COVID-19 pandemic were targeted primarily at alcohol availability and about one tenth might weaken alcohol control. Temporary changes to alcohol retail during the COVID-19 pandemic, if made permanent, could significantly expand alcohol availability.

Exploring the relationship between solitary drinking and living without other adults on alcohol consumption during the COVID-19 pandemic.

AIMS: The COVID-19 pandemic presents the opportunity to learn about solitary drinking as many people were forced to spend time at home. The aim of this study is to examine the relationship between solitary drinking and living without other adults on alcohol consumption. METHODS: A longitudinal study with four survey waves (between May and November 2020) obtained seven-day drinking diary data from Australian adults living in New South Wales. In May, a convenience sample of 586 participants (Mage = 35.3, SD = 14.8; 65.3% women) completed the first wave. Participants then completed a survey in June (n = 319, 54.4% response rate), July/August (n = 225, 38.4% response rate), and November (n = 222, 37.9% response rate). Information about alcohol consumption including risky drinking (more than four drinks on one occasion), household structure, solitary drinking, and demographics were collected. We conducted random-effects panel bivariate and multivariable regression analyses predicting the number of standard drinks and risky drinking. RESULTS: Participants with solitary drinking occasions consumed more and had more risky drinking occasions than participants with no solitary drinking occasions, which was also found to be the case during lockdown. Living without other adults was associated with less consumption and less risky drinking than living with other adults. However, participants who lived without other adults and had frequent solitary drinking occasions (solitary drinking in >50% drinking occasions) reported more consumption than participants without a solitary drinking occasion. CONCLUSIONS: Individuals who consume alcohol alone and live without other adults or spend long periods of time at home may be more at risk of alcohol-related harm.

Characteristics of high- and low-risk drinkers who use online alcohol home delivery in Western Australia.

INTRODUCTION: Variation in alcohol availability is an important driver of levels of consumption and harm, with recent increases in online alcohol home delivery use expanding availability. There is limited research on the impacts of these changes and the characteristics of consumers who use alcohol home delivery. METHODS: This study presents findings from an online survey (n = 465) of Western Australian adults who had purchased alcohol for home delivery within the past 6 months. Analyses compared high-risk and low-risk drinkers on use of, and exposure to, alcohol home delivery. RESULTS: Compared to low-risk drinkers, high-risk drinkers were significantly more likely to make more frequent online purchases (odds ratio 5.42), utilise same day delivery (odds ratio 2.91) and purchase through specialised online-only retailers (odds ratio 2.69). High-risk drinkers also reported receiving deliveries while intoxicated more often (odds ratio 11.62), and ordering alcohol for delivery to continue a current drinking session (odds ratio 7.47). High-risk drinkers also received advertising for alcohol home delivery more frequently (odds ratio 1.60) than low-risk drinkers. High-risk drinkers also ordered larger quantities of alcohol than low-risk drinkers (M = 49 vs. 32 standard drinks). DISCUSSION AND CONCLUSIONS: Findings from this study indicate that these services are popular with high-risk drinkers and potentially undermine other policy efforts to reduce drinking. Within Australia, stronger legislation (such as mandatory delay between order and delivery) and monitoring (e.g., test purchasing for compliance) are recommended.

'The convenience is a double-edged sword': Qualitative interviews with people who use online alcohol delivery services.

INTRODUCTION: The past decade has seen a shift towards online purchasing and home delivery of alcohol, with this trend accelerated due to the COVID-19 pandemic. However, research in this area is limited. This study aims to explore how and why people use online alcohol delivery services. METHODS: Semi-structured qualitative interviews (mean = 12.5 min; range = 7-19.5 min) with a convenience sample of 40 Australians ≥18 years who purchase alcohol online for delivery at least once per month. Reflexive thematic analysis was used to analyse and report the data. RESULTS: Three themes were generated. (i) The convenience is a 'double-edged sword': almost all participants expressed that they use alcohol delivery services because they reduce difficulty in obtaining alcohol by saving time or energy/effort; however, for some this could lead them to purchase and consume more alcohol than they otherwise would have. (ii) Cost savings motivate online purchases: some participants expressed that they could access alcohol more cheaply online than in-store due to promotions, cost-comparisons and the ability to shop at low-cost outlets. (iii) Initiating or increasing use during the COVID-19 pandemic: for some people continued or increased use had been maintained as they had grown accustomed to the convenience or changed shopping habits. DISCUSSION AND CONCLUSION: Participants purchased alcohol online for home delivery primarily for convenience; however, for some the convenience could lead them to purchase and consume more alcohol than they otherwise would have. Targeted improvements to the regulation of these services are needed to minimise the risks they may pose for alcohol harm.

An overlooked effect: domestic violence and alcohol policies in the night-time economy.

BACKGROUND AND AIMS: Restrictive late-night alcohol policies are aimed at reducing alcohol-related violence but, to date, no evaluations of their impact on family and domestic violence have been conducted. This study aimed to measure whether modifying the drinking environment and restricting on-site trading hours affected reported rates of family and domestic violence. DESIGN, SETTING AND PARTICIPANTS: This study used a non-equivalent control group design with two treatment sites and two matched control sites with pre- and postintervention data on rates of family and domestic violence assaults within local catchment areas of four late-night entertainment precincts in New South Wales, Australia, covering a population of 27 309 people. Participants comprised monthly counts of police-recorded incidents of domestic violence assaults from January 2001 to December 2019. INTERVENTIONS AND COMPARATORS: Two variations of restrictive late-night interventions were used: restricted entry to late-night venues after 1:30 a.m., trading ceasing at 3:30 a.m. and other restrictions on alcohol service (Newcastle); and restricted entry to late-night venues after 1 a.m. and a range of restrictions on alcohol service (Hamilton). The comparators were no restrictions on late-night trading or modifications of the drinking environment (Wollongong and Maitland). MEASUREMENTS: Measurements involved the rate, type and timing of reported family and domestic violence assaults. FINDINGS: Reported rates of domestic violence assaults fell at both intervention sites, while reported domestic violence assaults increased over time in the control sites. The protective effects in Newcastle were robust and statistically significant across three main models. The relative reduction associated with the intervention in Newcastle was 29% (incidence rate ratio = 0.71, 95% confidence interval: 0.60-0.83) and an estimated 204 assaults were prevented across the duration of the study. The protective effects found in Hamilton were not consistently supported across the three main models. CONCLUSIONS: Increases to late-night alcohol restrictions may reduce rates of domestic violence.

Cross-sectional survey of a convenience sample of Australians who use alcohol home delivery services.

INTRODUCTION: Online alcohol purchasing and home delivery has increased in recent years, accelerated by the onset of the coronavirus disease 2019 pandemic. This article aims to investigate the purchasing and drinking behaviour of Australians who use online alcohol delivery services. METHOD: A cross-sectional self-report survey with a convenience sample of 1158 Australians ≥18 years (49.3% female) who used an online alcohol delivery service in the past 3 months, recruited through paid social media advertisements from September to November 2021. Quota sampling was used to obtain a sample with age and gender strata proportional to the Australian adult population. Descriptive statistics were generated and logistic regression used to explore variables that predict hazardous/harmful drinking (Alcohol Use Disorders Identification Test score ≥8). RESULTS: One-in-five (20.1%, 95% confidence interval [CI] 17.8-22.5) participants had used an alcohol delivery service to extend a home drinking session because they had run out of alcohol and wanted to continue drinking and, of these, one-third (33.9%, 95% CI 27.9-40.4) indicated that if the service was not available they would have stopped drinking. Using delivery services in this way was associated with six times higher odds of drinking at hazardous/harmful levels (odds ratio 6.26, 95% CI 3.78-10.36). Participants ≤25 years were significantly more likely to report never having their identification verified when receiving their alcohol delivery at the door compared with purchasing takeaway alcohol in-person at a bottle shop (p < 0.001, McNemar). DISCUSSION AND CONCLUSION: Given the risks associated with alcohol delivery, regulation of these services should be improved to meet the same standards as bricks-and-mortar bottle shops.

Piloting a classification framework for the types of evidence used in alcohol policymaking.

INTRODUCTION: Most studies of alcohol policy have focussed on the role of industry. However, little is known about the evidence base used in alcohol policymaking or policymakers' actions in the field. Here, we mapped the different evidence types used in a case study to construct a classification framework of the evidence types used in alcohol policymaking. METHODS: Using a case study from the state-level in Australia, we used content analysis to delineate the evidence types cited across six phases of a policymaking process. We then grouped these types into a higher-level classification framework. We used descriptive statistics to study how the different evidence types were used in the policymaking process. RESULTS: Thirty-one evidence types were identified in the case study, across four classes of knowledge: person knowledge, shared knowledge, studied knowledge and practice knowledge. The participating public preferenced studied knowledge. Policymakers preferenced practice knowledge over all other types of knowledge. DISCUSSION AND CONCLUSION: The classification framework expands on models of evidence and knowledge used across public health, by mapping new evidence types and proposing an inductive method of classification. The policymakers' preferences found here are in line with theories regarding the alcohol industry's influence on policymaking. The classification framework piloted here can provide a useful tool to examine the evidence base used in decision-making. Further study of evidence types used in policymaking processes can help inform research translation and advocacy efforts to produce healthier alcohol policies.

Improved yield of recombinant human IFN-α2b from mammalian cells using heterologous signal peptide approach.

The Type I Interferon cytokine family member, Interferon-α2b (hIFN-α2b), modulates a number of important biological mechanisms including anti-proliferation, immunoregulation and antiviral responses. Due to its role in the immune system, hIFN-α2b has been used as a therapeutic modulator in hepatitis C as well as some forms of leukaemia. Clinical grade hIFN-α2b is typically produced in bacterial expression systems that involves complex refolding protocols and subsequent loss of yields. In this study, we describe an expression and purification system for hIFN-α2b from mammalian cells. Application of the Trypsin-1 signal peptide-propeptide domain significantly improved the expression and secretion of hIFN-α2b from HEK293 cells. We established a simple purification strategy that yields homogenous, pure hIFN-α2b that is stable and biologically active.

You've got mail: Drinks are on sale! A study to assess volume and content of direct marketing received from online alcohol retailers in Australia.

BACKGROUND: Customers of online alcohol retailers are exposed to marketing displayed on alcohol retailers' websites and may also receive direct marketing via email and text message once contact details are provided in an online sale. To date, this direct marketing activity from online alcohol retailers has not been studied. This study aims to document the quantity and content of marketing material received by customers of online alcohol retailers in Australia, and whether the material complies with relevant regulation. METHODS: A cross-sectional study of direct marketing from the 100 most popular online alcohol retailers in Australia. Marketing material received via email and text message was collected for three-months from March to June 2021. Email and text messages were coded for 17 variables in four categories: primary purpose of the communication; compliance with relevant regulations; marketing themes and practices used; and offers, promotions, and discounts. RESULTS: We received 1496 emails from 85 of the 100 retailers. Of the retailers who sent emails, the number sent varied widely (Mdn=8; IQR=2-21). Seven retailers sent a total of 18 text messages. The primary purpose of most emails (67.4%) was to advertise a special or offer a discount. Almost all emails (98.6%) complied with spam legislation to include an unsubscribe link, but around half (46.5%) of emails from retailers in jurisdictions where the inclusion of a liquor license number is mandatory, failed to include one. The most common marketing theme was to link specific times or events to drinking (18.8%). Almost half (48.5%) of emails advertised free or discounted delivery for purchasing over a specified threshold. CONCLUSION: Most online alcohol retailers in Australia are engaging in direct marketing to their customers via email. More research is needed to understand how these emails may influence purchasing and consumption.

Online alcohol sales and home delivery: An international policy review and systematic literature review.

BACKGROUND: Online alcohol sales are experiencing rapid growth in many places, accelerated by the COVID-19 pandemic, prompting new laws and regulations. There are no comprehensive and systematic analyses of the laws or their effectiveness. OBJECTIVE: To summarise international policies governing online alcohol sale and delivery, including changes occurring with COVID-19, and examine available evidence of retailer compliance with such policies. METHOD: A policy review of 77 jurisdictions in six English-speaking OECD countries: United States, Canada, United Kingdom, Ireland, Australia and New Zealand. We synthesised policies according to ten elements identified as potentially relevant for public health regulation. A systematic literature review of compliance evaluations in Medline, Medline Epub, EMBASE, CINAHL, Web of Science and Google Scholar. RESULTS: 72 of 77 jurisdictions permitted online alcohol sales and home delivery. Few jurisdictions require age verification at the time of purchase (n = 7), but most require it at delivery (n = 71). Since the COVID-19 pandemic began, most jurisdictions (69%) have either temporarily or permanently relaxed liquor regulations for alcohol home delivery. Three articles examined retailer compliance with age restrictions and found relatively low compliance (0%-46%). CONCLUSION: Many jurisdictions permit the online sale and delivery of alcohol, but regulation of these sales varies widely. In most, regulations do not meet the same standard as bricks-and-mortar establishments and may be insufficient to prevent youth access.

Understanding local government responses to alcohol-related harm.

INTRODUCTION: Local governments (LG) have a key role in reducing alcohol-related harm, yet, Australian research investigating this is limited. This study aimed to explore Australian LGs' role in alcohol policy by investigating how LGs respond to alcohol-related harm and what influences their responses. METHODS: A collective case study approach guided two-stage purposive sampling. Victorian metropolitan and regional LGs were invited to participate based on alcohol-related harm profiles. Officers within LGs with alcohol policy knowledge participated in semi-structured interviews. Transcripts were analysed deductively using a pre-existing alcohol policy framework and inductively using thematic analysis. RESULTS: Nine officers from eight LGs participated. LG responses to alcohol-related harm predominately included bans on alcohol in public spaces, licensed premises planning and alcohol-free youth events. Half implemented liquor forums/accords and most implemented education programs in sporting clubs, schools or workplaces. In some LGs, the reduction of alcohol-related harm was not considered a priority. Key influences on alcohol initiatives were legislation, the composition of licensed venues, extent of alcohol-related harms, resources and priorities, and stakeholder feedback. DISCUSSION AND CONCLUSIONS: While particular policies were widespread, participating LGs varied greatly in activity in, and responses to, reducing alcohol-related harm. LGs reported varied influences on their responses. LGs recognised the long-term health harms of alcohol in their health planning documents, however, most prioritised interventions targeting short-term amenity and safety harms. Changes to Victorian planning and liquor licensing legislation to give additional powers to LGs and providing pre-developed alcohol programs with dedicated funding should be considered.

Improved secretion of recombinant human IL-25 in HEK293 cells using a signal peptide-pro-peptide domain derived from Trypsin-1.

OBJECTIVE: To compare the effects of human Trypsin-1 signal peptide and pro-peptide on the expression and secretion efficiency of human Interleukin-25 from mammalian cells. RESULTS: The signal peptide and combined signal peptide-pro-peptide sequence of human Trypsin-1 improved the secretion of human IL-25 from 1.7 to 3.2 µg/ml and 1.7 to 8.2 µg/ml, respectively. Deletion analysis identified the minimal Trypsin-1 derived secretion domain that maintains improved human Interleukin-25 production and secretion. The presence of Trypsin-1 pro-peptide sequence does not affect the function of secreted human Interleukin-25. CONCLUSION: The Trypsin-1 signal peptide-pro-peptide sequence increased human IL-25 expression and secretion in mammalian cells by fivefold.

Applying a 'harm to others' research framework to illicit drugs: political discourses and ambiguous policy implications.

During the past decade, 'alcohol's harm to others' (AHTO) has emerged as an international approach to studying alcohol problems and informing policy. The AHTO approach seeks to increase political will for alcohol policy by mapping, measuring and often costing harms beyond the person who drinks (e.g. family members, co-workers). In this paper we consider the implications of a 'harm to others' approach for illicit drugs. We ask whether it could and should be used as a policy tool, given the high risks of further stigmatizing people who use drugs. We consider the ways in which the concept and measurement of 'harm to others' may be either productive or potentially harmful, depending on the extent to which the AHTO is replicated for illicit drugs. Shifting the language may assist: the term 'harm from others' appears to carry less risk of stigma. In addition, all harms inclusive of drug supply and drug consumption need to be included if a full picture of harms that accrue to other people from illicit drugs is to be achieved.