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Yamazaki T, Schnabl B. Acute alcohol-associated hepatitis: Latest findings in non-invasive biomarkers and treatment. Liver Int 2025; 45:e15608. [PMID: 37183549 PMCID: PMC10646153 DOI: 10.1111/liv.15608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/15/2023] [Accepted: 05/03/2023] [Indexed: 05/16/2023]
Abstract
Acute alcohol-associated hepatitis (AH) is a syndrome that occurs in heavy and long-term drinkers and results in severe jaundice and liver failure. The mortality rate in severe cases is 20%-50% at 28 days, and in cases that do not improve despite appropriately timed corticosteroid therapy, the mortality rate reaches 70% at 6 months. The only curative treatment is early liver transplantation, but less than 2% of patients with severe AH are eligible. In order to improve the prognosis, diagnostic tools are needed to detect appropriate cases at risk of severe conditions, and new therapies need to be developed that can replace corticosteroids. Recent research has revealed that the pathogenesis of AH involves a complex of factors, including changes in the gut microbiota, inflammatory and cytokine signalling, oxidative stress and mitochondrial dysfunction, and abnormalities in the hepatic regenerative capacity. Non-invasive diagnostic tools focusing on these specific pathologies have been reported in recent years. In addition, several novel agents targeting specific pathways are currently being developed and tested in clinical trials. This review will provide an overview of alcohol-associated hepatitis and focus on the latest diagnostic tools, particularly non-invasive biomarkers, and novel therapies.
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Affiliation(s)
- Tomoo Yamazaki
- Department of Medicine, University of California San Diego, La Jolla, California, USA
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Nagano, Matsumoto, Japan
| | - Bernd Schnabl
- Department of Medicine, University of California San Diego, La Jolla, California, USA
- Department of Medicine, VA San Diego Healthcare System, California, San Diego, USA
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Bergsvik D, Grøtting MW, Rossow I. Effect of a small increase in off-premises trading hours on alcohol sales in Norway: A stepped-wedge cluster-randomized controlled trial. Addiction 2025; 120:86-94. [PMID: 39374933 PMCID: PMC11638516 DOI: 10.1111/add.16683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 09/01/2024] [Indexed: 10/09/2024]
Abstract
BACKGROUND AND AIMS Evidence of the effect of limiting off-premises alcohol trading hours is still scarce. This study tested the effect of a small extension in trading hours on alcohol sales in alcohol monopoly outlets in Norway. DESIGN The extension of trading hours was implemented within a stepped-wedge cluster-randomized trial design. Eligible state monopoly outlets (n = 229) were clustered into trade districts (n = 62), which were block-randomized to one of three sequences regarding date of implementation: 1 September 2020 (n = 21 districts, 82 outlets), 1 December 2020 (n = 21 districts, 73 outlets) and 1 March 2021 (n = 20 districts, 74 outlets). Outcomes were followed-up for a 1-year period. SETTING AND PARTICIPANTS Study participants were state monopoly outlets in urban and rural trade districts in all parts of Norway. MEASUREMENTS Monthly alcohol sales in litres of pure alcohol per trade district and per outlet were measured from March 2020 to March 2022 (primary outcome). We applied a linear mixed-effect model with two-way fixed effects within a difference-in-difference framework. As a robustness check we considered the effects of cross-border trade and effects in subgroups of outlets. Trading hours in monopoly outlets were extended by 1 hour on Saturdays. The extension was permanent. Pre-intervention periods and not-yet-treated units served as control conditions. FINDINGS We did not find a statistically significant effect of the small extension in trading hours on monthly alcohol sales (i) per trade district [average treatment effect: -185.5 litres, 95% confidence interval (CI) = -1159.9, 788.9] and (ii) per outlet (-35.3 litres, 95% CI = -142.1, 72.0). These findings were consistent across estimation methods and model specifications. CONCLUSION There is no clear evidence that a small extension in off-premises trading hours affected alcohol sales in monopoly outlets in Norway.
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Affiliation(s)
- Daniel Bergsvik
- Department of Alcohol, Tobacco and Drug ResearchNorwegian Institute of Public HealthOsloNorway
| | - Maja Weemes Grøtting
- Department of Alcohol, Tobacco and Drug ResearchNorwegian Institute of Public HealthOsloNorway
| | - Ingeborg Rossow
- Department of Alcohol, Tobacco and Drug ResearchNorwegian Institute of Public HealthOsloNorway
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Schulte A, Liu G, Subbaraman MS, Kerr WC, Leslie D, Roberts SCM. Relationships Between Alcohol Policies and Infant Morbidities and Injuries. Am J Prev Med 2024; 66:980-988. [PMID: 38340136 PMCID: PMC11195443 DOI: 10.1016/j.amepre.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/22/2023] [Accepted: 01/01/2024] [Indexed: 02/12/2024]
Abstract
INTRODUCTION Previous research has found that policies specifically focused on pregnant people's alcohol use are largely ineffective. Therefore, the purpose of this study is to analyze the relationships between general population policies regulating alcohol physical availability and outcomes related to pregnant people's alcohol use, specifically infant morbidities and injuries. METHODS Outcome data were obtained from Merative MarketScan, a longitudinal commercial insurance claims data set. Policy data were obtained from the National Institute on Alcohol Abuse and Alcoholism's Alcohol Policy Information System, the National Alcohol Beverage Control Association, and Liquor Handbooks and merged using policies in effect during the estimated year of conception. Relationships between state-level policies regulating sites, days/hours, and government monopoly of liquor sales and infant morbidities and injuries were examined. Analyses used logistic regression with individual controls, fixed effects for state and year, state-specific time trends, and SEs clustered by state. The study analysis was conducted from 2021 to 2023. RESULTS The analytic sample included 1,432,979 infant-birthing person pairs, specifically people aged 25-50 years who gave birth to a singleton between 2006 and 2019. A total of 3.1% of infants had a morbidity and 2.1% of infants had an injury. State government monopoly on liquor sales was associated with reduced odds of infant morbidities and injuries, whereas gas station liquor sales were associated with increased odds of infant morbidities and injuries. Allowing liquor sales after 10PM was associated with increased odds for infant injuries. No effect was found for allowing liquor sales in grocery stores or on Sundays. CONCLUSIONS Findings suggest that limiting alcohol availability for the general population may help reduce adverse infant outcomes related to pregnant people's alcohol use.
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Affiliation(s)
- Alex Schulte
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, Oakland, California.
| | - Guodong Liu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | | | - William C Kerr
- Alcohol Research Group, Public Health Institute, Emeryville, California
| | - Douglas Leslie
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Sarah C M Roberts
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, Oakland, California
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Nicosia N, Smart R, Schell TL. Effects of restricting alcohol sales on fatal violence: Evidence from Sunday sales bans. Drug Alcohol Depend 2023; 253:110982. [PMID: 37980844 PMCID: PMC11665804 DOI: 10.1016/j.drugalcdep.2023.110982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION Homicides and suicides are the second- and third-leading causes of death among young people (aged 10-24) in the US. While a substantial share of these deaths involve alcohol, evidence is needed on whether specific alcohol policies, such as day-based sales restrictions, help prevent these deaths. METHODS We constructed total and firearm-related homicide and suicide counts by state, year, and day-of-week from the Multiple Cause of Death Micro-data 1990-2019. Repeals of Sunday bans were taken from the Alcohol Policy Information System. Two-way fixed effects Poisson models with standard errors clustered at state-level and population offset control for state, year and day-of-the-week fixed effects and state time-varying covariates. RESULTS Repealing Sunday bans is associated with an increase in homicides (IRR=1.125; 95% confidence interval [CI]:1.02-1.24) and firearm homicides (IRR=1.17; 95% CI:1.03-1.33). Analyses by day-of-the-week show significant associations with homicides not only on Sundays, but also other days, consistent with delays in death. There was no significant relationship for suicides. CONCLUSION Restricting alcohol availability may prove a useful policy tool to reduce homicides, given that day-based restrictions are associated with changes in deaths rather than only shifting across days-of-the-week.
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Calvert C, Jones-Webb R, Erickson D, Lenk K, Toomey T, Nelson T. Effects of Sunday Liquor Sales Legalization on Alcohol Policy Attitudes and Alcohol Purchasing Behavior. JOURNAL OF DRUG EDUCATION 2023; 52:47-62. [PMID: 38013419 DOI: 10.1177/00472379231217846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
We examined how legalization of Sunday alcohol sales relates to attitudes towards Sunday sales, and how both attitudes and alcohol consumption patterns relate to Sunday alcohol purchasing. A total of 1,384 adults of legal drinking age completed a survey one year post-legalization of Sunday sales. A majority of respondents (51%) were supportive of Sunday sales legalization both before and after legalization. People were more likely to support Sunday sales legalization if they reported binge drinking (PR: 2.19; CI: 1.51 3.18). Following Sunday sales legalization, 59% of participants reported purchasing alcohol in Minnesota on Sunday. Binge drinking (PR: 1.39; CI: 1.27, 1.52) or supporting Sunday sales legalization (PR: 1.85; CI: 1.56, 2.17) were associated with higher likelihood of purchasing alcohol on Sunday. Legalizing Sunday sales may have increased access to alcohol for people with more unhealthy drinking behaviors.
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Affiliation(s)
- Collin Calvert
- Department of Epidemiology and Community Health, University of Minnesota, School of Public Health, Minneapolis, USA
| | - Rhonda Jones-Webb
- Department of Epidemiology and Community Health, University of Minnesota, School of Public Health, Minneapolis, USA
| | - Darin Erickson
- Department of Epidemiology and Community Health, University of Minnesota, School of Public Health, Minneapolis, USA
| | - Kathleen Lenk
- Department of Epidemiology and Community Health, University of Minnesota, School of Public Health, Minneapolis, USA
| | - Traci Toomey
- Department of Epidemiology and Community Health, University of Minnesota, School of Public Health, Minneapolis, USA
| | - Toben Nelson
- Department of Epidemiology and Community Health, University of Minnesota, School of Public Health, Minneapolis, USA
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Subbaraman MS, Sesline K, Kerr WC, Roberts SC. Associations between state-level general population alcohol policies and drinking outcomes among women of reproductive age: Results from 1984 to 2020 National Alcohol Surveys. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:1773-1782. [PMID: 38051149 PMCID: PMC10849058 DOI: 10.1111/acer.15156] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 07/13/2023] [Accepted: 07/16/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Policies specific to alcohol use during pregnancy have not been found to reduce risks related to alcohol use during pregnancy. In contrast, general population alcohol policies are protective for the general population. Here, we assessed whether US state-level general population alcohol policies are related to drinking outcomes among women of reproductive age. METHODS We conducted secondary analyses of 1984-2020 National Alcohol Survey data (N = 13,555 women ≤44 years old). State-level policy exposures were government control of liquor retail sales, heavy beer at gas stations, heavy beer at grocery stores, liquor at grocery stores, Sunday off-premise liquor sales, and blood alcohol concentration (BAC) driving limits (no law, 0.10 limit, 0.05-0.08 limit). Outcomes were past 12-month number of drinks, ≥5 drink days, ≥8 drink days, and any DSM-IV alcohol abuse/dependence symptoms. Regressions adjusted for individual and state-level controls, clustering by state, and included fixed effects for survey month and year. RESULTS Allowing Sunday off-premise liquor sales versus not was related to having 1.20 times as many drinks (95% CI: 1.01, 1.42), 1.41 times as many ≥5 drink days (95% CI: 1.08, 1.85), and 1.91 times as many ≥8 drink days (95% CI: 1.28, 2.83). BAC limits of 0.05-0.08 for driving versus no BAC limit was related to 0.51 times fewer drinks (95% CI: 0.27, 0.96), 0.28 times fewer days with ≥5 drinks (95% CI: 0.10, 0.75), and 0.20 times fewer days with ≥8 drinks (95% CI: 0.08, 0.47). CONCLUSIONS US state-level policies prohibiting Sunday off-premise liquor sales and BAC limits of 0.05-0.08 for driving are related to less past 12-month overall and heavy drinking among women 18-44 years old.
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Affiliation(s)
- Meenakshi S. Subbaraman
- Behavioral Health and Recovery Studies, Public Health Institute, 555 12th St, Oakland, CA 94607 USA
| | - Katrina Sesline
- Alcohol Research Group, 6001 Shellmound Ave, Suite 450, Emeryville, CA 94608, United States
| | - William C. Kerr
- Alcohol Research Group, 6001 Shellmound Ave, Suite 450, Emeryville, CA 94608, United States
| | - Sarah C.M. Roberts
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California, San Francisco, Department of Obstetrics, Gynecology & Reproductive Sciences, Oakland, CA, USA
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Kilian C, Lemp JM, Llamosas-Falcón L, Carr T, Ye Y, Kerr WC, Mulia N, Puka K, Lasserre AM, Bright S, Rehm J, Probst C. Reducing alcohol use through alcohol control policies in the general population and population subgroups: a systematic review and meta-analysis. EClinicalMedicine 2023; 59:101996. [PMID: 37256096 PMCID: PMC10225668 DOI: 10.1016/j.eclinm.2023.101996] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/19/2023] [Accepted: 04/19/2023] [Indexed: 06/01/2023] Open
Abstract
We estimate the effects of alcohol taxation, minimum unit pricing (MUP), and restricted temporal availability on overall alcohol consumption and review their differential impact across sociodemographic groups. Web of Science, Medline, PsycInfo, Embase, and EconLit were searched on 08/12/2022 and 09/26/2022 for studies on newly introduced or changed alcohol policies published between 2000 and 2022 (Prospero registration: CRD42022339791). We combined data using random-effects meta-analyses. Risk of bias was assessed using the Newcastle-Ottawa Scale. Of 1887 reports, 36 were eligible. Doubling alcohol taxes or introducing MUP (Int$ 0.90/10 g of pure alcohol) reduced consumption by 10% (for taxation: 95% prediction intervals [PI]: -18.5%, -1.2%; for MUP: 95% PI: -28.2%, 5.8%), restricting alcohol sales by one day a week reduced consumption by 3.6% (95% PI: -7.2%, -0.1%). Substantial between-study heterogeneity contributes to high levels of uncertainty and must be considered in interpretation. Pricing policies resulted in greater consumption changes among low-income alcohol users, while results were inconclusive for other socioeconomic indicators, gender, and racial and ethnic groups. Research is needed on the differential impact of alcohol policies, particularly for groups bearing a disproportionate alcohol-attributable health burden. Funding Research reported in this publication was supported by the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health under Award Number R01AA028009.
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Affiliation(s)
- Carolin Kilian
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Julia M. Lemp
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Laura Llamosas-Falcón
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Tessa Carr
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Yu Ye
- Alcohol Research Group, Public Health Institute, Emeryville, CA, United States
| | - William C. Kerr
- Alcohol Research Group, Public Health Institute, Emeryville, CA, United States
| | - Nina Mulia
- Alcohol Research Group, Public Health Institute, Emeryville, CA, United States
| | - Klajdi Puka
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Aurélie M. Lasserre
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Sophie Bright
- School of Health and Related Research (ScHARR), Faculty of Medicine, Dentistry & Health, University of Sheffield, Sheffield, England, UK
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health & Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Program on Substance Abuse & WHO Collaborating Centre, Public Health Agency of Catalonia, Barcelona, Spain
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Charlotte Probst
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Wakil A, Mohamed M, Tafesh Z, Niazi M, Olivo R, Xia W, Greenberg P, Pyrsopoulos N. Trends in hospitalization for alcoholic hepatitis from 2011 to 2017: A USA nationwide study. World J Gastroenterol 2022; 28:5036-5046. [PMID: 36160652 PMCID: PMC9494933 DOI: 10.3748/wjg.v28.i34.5036] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/01/2022] [Accepted: 07/25/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Severe alcoholic hepatitis (AH) is one of the most lethal manifestations of alcohol-associated liver disease. In light of the increase in alcohol consumption worldwide, the incidence of AH is on the rise, and data examining the trends of AH admission is needed. AIM To examine inpatient admission trends secondary to AH, along with their clinical outcomes and epidemiological characteristics. METHODS The National Inpatient Sample (NIS) database was utilized, and data from 2011 to 2017 were reviewed. We included individuals aged ≥ 21 years who were admitted with a primary or secondary diagnosis of AH using the International Classification of Diseases (ICD)-9 and its correspondent ICD-10 codes. Hepatitis not related to alcohol was excluded. The national estimates of inpatient admissions were obtained using sample weights provided by the NIS. RESULTS AH-related hospitalization demonstrated a significant increase in the USA from 281506 (0.7% of the total admission in 2011) to 324050 (0.9% of the total admission in 2017). The median age was 54 years. The most common age group was 45-65 years (range 57.8%-60.7%). The most common race was white (63.2%-66.4%), and patients were predominantly male (69.7%-71.2%). The primary healthcare payers were Medicare (29.4%-30.7%) and Medicaid (21.5%-32.5%). The most common geographical location was the Southern USA (33.6%-34.4%). Most patients were admitted to a tertiary care center (50.2%-62.3%) located in urban areas. Mortality of AH in this inpatient sample was 5.3% in 2011 and 5.5% in 2017. The most common mortality-associated risk factors were acute renal failure (59.6%-72.1%) and gastrointestinal hemorrhage (17.2%-20.3%). The total charges were noted to range between $25242.62 and $34874.50. CONCLUSION The number of AH inpatient hospitalizations significantly increased from 2011 to 2017. This could have a substantial financial impact with increasing healthcare costs and utilization. AH-mortality remained the same.
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Affiliation(s)
- Ali Wakil
- Department of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Mujtaba Mohamed
- Department of Gastroenterology and Hepatology, Marshall University Hospital, Huntington, WV 25701, USA
| | - Zaid Tafesh
- Department of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Mumtaz Niazi
- Department of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Raquel Olivo
- Department of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Weiyi Xia
- Department of Biostatistics & Epidemiology, Rutgers School of Public Health, Piscataway, NJ 08854, USA
| | - Patricia Greenberg
- Department of Biostatistics & Epidemiology, Rutgers School of Public Health, Piscataway, NJ 08854, USA
| | - Nikolaos Pyrsopoulos
- Department of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
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Abstract
Alcoholic hepatitis is the severest clinical presentation of alcoholic liver disease. Lacking an effective pharmacologic treatment, alcoholic hepatitis is associated with a poor prognosis and its recovery relies mostly on abstinence. With alcohol use disorder being universally on the rise, the impact of alcoholic hepatitis on society and health-care costs is expected to increase significantly. Prognostic factors and liver biopsy can help with timely diagnosis, to determine eligibility and response to corticosteroids, and for prognostication and transplant referral. Although recent discoveries in the pathophysiology of alcoholic hepatitis are encouraging and could pave the way for novel treatment modalities, a multidisciplinary approach considering timely identification and treatment of liver-related complications, infectious and metabolic disease, malnutrition, and addiction counseling should be emphasized. Apart from proper selection of candidates, transplant programs should provide adequate post-transplant addiction support in order to make of early liver transplantation for alcoholic hepatitis the ultimate sobering experience in the next decade.
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Affiliation(s)
- Vikrant Rachakonda
- Division of Gastroenterology and Hepatology, Starzl Transplantation Institute, and Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Ramon Bataller
- Division of Gastroenterology and Hepatology, Starzl Transplantation Institute, and Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Andres Duarte-Rojo
- Division of Gastroenterology and Hepatology, Starzl Transplantation Institute, and Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, PA, 15213, USA
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Stockwell T, Sherk A, Norström T, Angus C, Ramstedt M, Andréasson S, Chikritzhs T, Gripenberg J, Holder H, Holmes J, Mäkelä P. Estimating the public health impact of disbanding a government alcohol monopoly: application of new methods to the case of Sweden. BMC Public Health 2018; 18:1400. [PMID: 30577827 PMCID: PMC6303908 DOI: 10.1186/s12889-018-6312-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 12/07/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Government alcohol monopolies were created in North America and Scandinavia to limit health and social problems. The Swedish monopoly, Systembolaget, reports to a health ministry and controls the sale of all alcoholic beverages with > 3.5% alcohol/volume for off-premise consumption, within a public health mandate. Elsewhere, alcohol monopolies are being dismantled with evidence of increased consumption and harms. We describe innovative modelling techniques to estimate health outcomes in scenarios involving Systembolaget being replaced by 1) privately owned liquor stores, or 2) alcohol sales in grocery stores. The methods employed can be applied in other jurisdictions and for other policy changes. METHODS Impacts of the privatisation scenarios on pricing, outlet density, trading hours, advertising and marketing were estimated based on Swedish expert opinion and published evidence. Systematic reviews were conducted to estimate impacts on alcohol consumption in each scenario. Two methods were applied to estimate harm impacts: (i) alcohol attributable morbidity and mortality were estimated utilising the International Model of Alcohol Harms and Policies (InterMAHP); (ii) ARIMA methods to estimate the relationship between per capita alcohol consumption and specific types of alcohol-related mortality and crime. RESULTS Replacing government stores with private liquor stores (Scenario 1) led to a 20.0% (95% CI, 15.3-24.7) increase in per capita consumption. Replacement with grocery stores (Scenario 2) led to a 31.2% (25.1-37.3%) increase. With InterMAHP there were 763 or + 47% (35-59%) and 1234 or + 76% (60-92%) more deaths per year, for Scenarios 1 and 2 respectively. With ARIMA, there were 850 (334-1444) more deaths per year in Scenario 1 and 1418 more in Scenario 2 (543-2505). InterMAHP also estimated 10,859 or + 29% (22-34%) and 16,118 or + 42% (35-49%) additional hospital stays per year respectively. CONCLUSIONS There would be substantial adverse consequences for public health and safety were Systembolaget to be privatised. We demonstrate a new combined approach for estimating the impact of alcohol policies on consumption and, using two alternative methods, alcohol-attributable harm. This approach could be readily adapted to other policies and settings. We note the limitation that some significant sources of uncertainty in the estimates of harm impacts were not modelled.
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Affiliation(s)
- Tim Stockwell
- Canadian Institute for Substance Use Research (CISUR), Department of Psychology, University of Victoria, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2 Canada
| | - Adam Sherk
- Canadian Institute for Substance Use Research (CISUR), Social Dimensions of Health Program, University of Victoria, Victoria, BC Canada
| | - Thor Norström
- Swedish Institute for Social Research, Stockholm University, Stockholm, Sweden
| | | | - Mats Ramstedt
- The Swedish Council for Information on Alcohol and Other Drugs (CAN), Stockholm, Sweden
| | - Sven Andréasson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Tanya Chikritzhs
- Health Sciences, National Drug Research Institute, Curtin University, Perth, Australia
| | - Johanna Gripenberg
- Department of Clinical Neuroscience, Stockholm Prevents Alcohol and Drug Problems (STAD), Karolinska Institutet, Stockholm, Sweden
| | - Harold Holder
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA USA
| | | | - Pia Mäkelä
- National Institute for Health and Welfare, Helsinki, Finland
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Yörük BK, Lee J. Did Legalization of Sunday Alcohol Sales Increase Crime in the United States? Evidence From Seven States. J Stud Alcohol Drugs 2018; 79:816-825. [PMID: 30573011 PMCID: PMC6308168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVE This study investigates the impact of the legalization of Sunday alcohol sales on several different types of criminal activity in the United States. METHOD The 2000-2010 data from the Federal Bureau of Investigation's National Incident-Based Reporting System (NIBRS) for seven states (n = 1,746,249) and difference-in-differences type models are used to estimate the effect of the legalization of Sunday alcohol sales on different types of criminal activity. RESULTS States that legalized Sunday sales of alcohol experienced up to a 16% to 23% increase in the total number of violent and property crimes committed on Sundays (p < .01). However, the aggregate impact of this policy change on crimes committed on all days of the week is not significant because of either positive or statistically insignificant spillover effects of the repeal of Sunday alcohol sales bans on crimes committed on Mondays through Saturdays. These results are robust under alternative model specifications. CONCLUSIONS We find evidence that the negative effects of legalizing Sunday alcohol sales on criminal activity are day specific, and the overall crime trends are not affected by this policy change. These findings are particularly important given the ongoing public policy debates about the relevancy of the restrictions on Sunday sales of alcohol at off-premise locations.
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Affiliation(s)
- Bariş K Yörük
- Department of Economics, University at Albany, SUNY, Albany, New York
| | - Jungtaek Lee
- Department of Economics, University at Albany, SUNY, Albany, New York
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Yörük BK, Lee J. Did Legalization of Sunday Alcohol Sales Increase Crime in the United States? Evidence From Seven States. J Stud Alcohol Drugs 2018; 79:816-825. [PMID: 30573011 PMCID: PMC6308168 DOI: 10.15288/jsad.2018.79.816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 07/09/2018] [Indexed: 11/21/2023] Open
Abstract
OBJECTIVE This study investigates the impact of the legalization of Sunday alcohol sales on several different types of criminal activity in the United States. METHOD The 2000-2010 data from the Federal Bureau of Investigation's National Incident-Based Reporting System (NIBRS) for seven states (n = 1,746,249) and difference-in-differences type models are used to estimate the effect of the legalization of Sunday alcohol sales on different types of criminal activity. RESULTS States that legalized Sunday sales of alcohol experienced up to a 16% to 23% increase in the total number of violent and property crimes committed on Sundays (p < .01). However, the aggregate impact of this policy change on crimes committed on all days of the week is not significant because of either positive or statistically insignificant spillover effects of the repeal of Sunday alcohol sales bans on crimes committed on Mondays through Saturdays. These results are robust under alternative model specifications. CONCLUSIONS We find evidence that the negative effects of legalizing Sunday alcohol sales on criminal activity are day specific, and the overall crime trends are not affected by this policy change. These findings are particularly important given the ongoing public policy debates about the relevancy of the restrictions on Sunday sales of alcohol at off-premise locations.
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Affiliation(s)
- Baris K. Yörük
- Department of Economics, University at Albany, SUNY, Albany, New York
| | - Jungtaek Lee
- Department of Economics, University at Albany, SUNY, Albany, New York
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Woodruff SI, Hurtado SL, Simon-Arndt CM, Lawrenz J. An exploratory case study of environmental factors related to military alcohol misuse. BMC Public Health 2018; 18:902. [PMID: 30029602 PMCID: PMC6053706 DOI: 10.1186/s12889-018-5843-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/12/2018] [Indexed: 12/29/2022] Open
Abstract
Background Alcohol misuse has been an ongoing issue for the US Armed Services, with the Marine Corps maintaining the highest levels of problematic drinking. Broad environmental, social, and policy factors play an important role in alcohol misuse but are rarely studied as objective measures. Methods This case study used a pattern-matching approach to examine the associations between objective on- and off-base community environmental risk and protective factors and 4 objective alcohol-related outcomes at 3 large Marine Corps installations. The study utilized existing aggregated data from Marine Corps electronic data sources and information from internet searches of installation and community services and characteristics. Installation-level alcohol misuse outcomes included the rates of personnel receiving non-medical alcohol services, combined inpatient and outpatient alcohol-related primary diagnoses, alcohol-related domestic violence, and driving under the influence arrests. Installation-level environmental correlates included dollars spent on alcohol sales, density of alcohol outlets, extent of alternative activities, and installation and off-base sociodemographic factors. Results In general, younger age, enlisted pay grade, and being stationed overseas were related with higher rates of alcohol-related problems among Marines. Greater on-base alcohol sales (both in bars and stores), as well as a greater density of restaurants and bars that serve alcohol, were associated with alcohol misuse outcomes. Several community factors were also associated with alcohol misuse. The hypothesized protective effects of alternative activities were inconsistent. Conclusions Findings suggest that environmentally-oriented strategies, particularly restricting on-base sales of alcohol, may help to reduce alcohol-related harm in the Marine Corps.
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Affiliation(s)
- Susan I Woodruff
- School of Social Work, Center for Alcohol and Drug Studies and Services, San Diego State University, 5500 Campanile Drive, HH 203, San Diego, CA, 92182, USA.
| | | | | | - Jessica Lawrenz
- San Diego State University Research Foundation, San Diego, CA, USA
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Ritter A, Livingston M, Chalmers J, Berends L, Reuter P. Comparative policy analysis for alcohol and drugs: Current state of the field. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 31:39-50. [PMID: 26944717 DOI: 10.1016/j.drugpo.2016.02.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 01/19/2016] [Accepted: 02/01/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND A central policy research question concerns the extent to which specific policies produce certain effects - and cross-national (or between state/province) comparisons appear to be an ideal way to answer such a question. This paper explores the current state of comparative policy analysis (CPA) with respect to alcohol and drugs policies. METHODS We created a database of journal articles published between 2010 and 2014 as the body of CPA work for analysis. We used this database of 57 articles to clarify, extract and analyse the ways in which CPA has been defined. Quantitative and qualitative analysis of the CPA methods employed, the policy areas that have been studied, and differences between alcohol CPA and drug CPA are explored. RESULTS There is a lack of clear definition as to what counts as a CPA. The two criteria for a CPA (explicit study of a policy, and comparison across two or more geographic locations), exclude descriptive epidemiology and single state comparisons. With the strict definition, most CPAs were with reference to alcohol (42%), although the most common policy to be analysed was medical cannabis (23%). The vast majority of papers undertook quantitative data analysis, with a variety of advanced statistical methods. We identified five approaches to the policy specification: classification or categorical coding of policy as present or absent; the use of an index; implied policy differences; described policy difference and data-driven policy coding. Each of these has limitations, but perhaps the most common limitation was the inability for the method to account for the differences between policy-as-stated versus policy-as-implemented. CONCLUSION There is significant diversity in CPA methods for analysis of alcohol and drugs policy, and some substantial challenges with the currently employed methods. The absence of clear boundaries to a definition of what counts as a 'comparative policy analysis' may account for the methodological plurality but also appears to stand in the way of advancing the techniques.
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Affiliation(s)
- Alison Ritter
- Drug Policy Modelling Program, National Drug and Alcohol Research Centre, UNSW, Sydney, NSW 2052, Australia.
| | - Michael Livingston
- Centre for Alcohol Policy Research (CAPR), Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3000, Australia
| | - Jenny Chalmers
- Drug Policy Modelling Program, National Drug and Alcohol Research Centre, UNSW, Sydney, NSW 2052, Australia
| | - Lynda Berends
- Centre for Health and Social Research, Australian Catholic University, Melbourne, VIC 3000, Australia
| | - Peter Reuter
- School of Public Policy and Department of Criminology, University of Maryland, College Park, MD 20742, USA
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Kingsland M, Wiggers JH, Vashum KP, Hodder RK, Wolfenden L. Interventions in sports settings to reduce risky alcohol consumption and alcohol-related harm: a systematic review. Syst Rev 2016; 5:12. [PMID: 26791417 PMCID: PMC4721008 DOI: 10.1186/s13643-016-0183-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 01/04/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Elevated levels of risky alcohol consumption and alcohol-related harm have been reported for sportspeople and supporters compared to non-sporting populations. Limited systematic reviews have been conducted to assess the effect of interventions targeting such behaviours. METHODS A review was undertaken to determine if interventions implemented in sports settings decreased alcohol consumption and related harms. Studies were included that implemented interventions within sports settings; measured alcohol consumption or alcohol-related injury or violence and were either randomised controlled trials, staggered enrollment trials, stepped-wedged trials, quasi-randomised trials, quasi-experimental trials or natural experiments. Studies without a parallel comparison group were excluded. Studies from both published and grey literature were included. Two authors independently screened potential studies against the eligibility criteria, and two authors independently extracted data from included studies and assessed risk of bias. The results of included studies were synthesised narratively. RESULTS The title and abstract of 6382 papers and the full text of 45 of these papers were screened for eligibility. Three studies met the inclusion criteria for the review. One of the included studies was a randomised controlled trial (RCT) of a cognitive-behavioural intervention with athletes within an Olympic training facility in the USA. The study reported a significant change in alcohol use between pre-test and follow-up between intervention and control groups. The other two studies were RCTs in community sports clubs in Ireland and Australia. The Australian study found a significant intervention effect for both risky alcohol consumption at sports clubs and overall risk of alcohol-related harm. The Irish study found no significant intervention effect. CONCLUSIONS A limited number of studies have been conducted to assess the effect of interventions implemented in sports settings on alcohol consumption and related harms. While two of the three studies found significant intervention effects, it is difficult to determine the extent to which such effects are generalisable. Further controlled trials are required in this setting. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42014001739.
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Affiliation(s)
- Melanie Kingsland
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, 2308, Australia.
| | - John H Wiggers
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, 2308, Australia.
- Hunter New England Population Health, Locked Bag 10, Wallsend, New South Wales, 2287, Australia.
| | - Khanrin P Vashum
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, 2308, Australia.
| | - Rebecca K Hodder
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, 2308, Australia.
- Hunter New England Population Health, Locked Bag 10, Wallsend, New South Wales, 2287, Australia.
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, 2308, Australia.
- Hunter New England Population Health, Locked Bag 10, Wallsend, New South Wales, 2287, Australia.
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Jinjuvadia R, Liangpunsakul S. Trends in Alcoholic Hepatitis-related Hospitalizations, Financial Burden, and Mortality in the United States. J Clin Gastroenterol 2015; 49:506-11. [PMID: 25198164 PMCID: PMC4276725 DOI: 10.1097/mcg.0000000000000161] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Alcoholic hepatitis (AH) is the most florid manifestation of alcoholic liver disease which accounts for significant morbidity, mortality, and financial burden. Aim of this study is to evaluate temporal trend of hospitalizations from AH and evaluate its financial impact. METHODS The National Inpatient Sample databases (from 2002 to 2010) which are collected as part of Healthcare Cost and Utilization Project by Agency for Healthcare Research and Quality were utilized. Individuals aged 21 years and older were included. The hospitalizations with primary diagnosis of AH were captured by ICD-9 codes. The national estimates of hospitalization were derived using sample weights provided by National Inpatient Sample. Simple linear regression method was used to assess trends in mortality and length of stay over time. RESULTS We observed the increased in total cases of AH-related hospitalization from 249,884 (0.66% of total admission in 2002) to 326,403 (0.83% of total admission in 2010). The significant increase in the total admission rate was attributable mainly to the rise in inpatient hospitalization for secondary diagnosis of AH (0.48% in 2002 to 0.67% in 2010). Most of the AH-related hospitalization were males. Hepatic encephalopathy was found to be the most common admitting diagnosis for individuals hospitalized with secondary diagnosis of AH (8.9% in 2002 and 8.6% in 2010). There was a significant decrease in inpatient mortality for primary diagnosis of AH from 10.07% (in 2002) to 5.76% (in 2010) (absolute risk reduction: 4.3%). Average cost of hospitalization related to primary diagnosis of AH was $27,124 and $46,264 in 2002 and 2010, respectively. After adjusting for inflation, the additional cost of each hospitalization seemed to increase by 40.7% in 2010 compared with 2002 (additional cost per hospitalization $11,044 in 2010 compared with 2002). Federal (Medicare) or state (Medicaid) supported health insurance program are the main primary expected payers for these AH hospitalizations (∼25% to 29%). Despite increase in cost per hospitalization, length of stay for hospitalization due to primary diagnosis of AH was not observed to decrease substantially over time (6.7 d in 2002 to 6.1 d in 2010). CONCLUSIONS AH-related hospitalization continued to increase during the study period, despite the decrease in the in-hospital mortality rate. Substantial increases in health care cost and utilization among hospitalized AH patients were observed.
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Affiliation(s)
| | - Suthat Liangpunsakul
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University Medical Center, Indianapolis, Indiana
- Roudebush Veterans Administration Medical Center, Indianapolis, Indiana
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Guo X, Huang YG. The development of alcohol policy in contemporary China. J Food Drug Anal 2015; 23:19-29. [PMID: 28911442 PMCID: PMC9351742 DOI: 10.1016/j.jfda.2014.05.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 01/23/2014] [Accepted: 05/12/2014] [Indexed: 12/15/2022] Open
Abstract
Over recent years, an increase in alcohol-related problems has been noted in China. Taking effective measures against the problem requires clear reviewing and understanding of the evolution of the Chinese alcohol policy. This study is aimed to evaluate the alcohol policy with special focus on reviewing the alcohol production and consumption situation in China and assessing the changes in Chinese alcohol policy along with other related fields. This article finishes with a set of recommended policy changes that could help solve the recent alcohol-related problems and analyze the major impediments.
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Affiliation(s)
- Xu Guo
- School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, China.
| | - Yong-Guang Huang
- Liquor-making Science and Technology Publishing House, Guizhou Provincial Light Industry Scientific Research Institute, Guiyang, Guizhou, China
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Yörük BK. Can technology help to reduce underage drinking? Evidence from the false ID laws with scanner provision. JOURNAL OF HEALTH ECONOMICS 2014; 36:33-46. [PMID: 24732386 PMCID: PMC4057953 DOI: 10.1016/j.jhealeco.2014.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 03/04/2014] [Accepted: 03/12/2014] [Indexed: 06/03/2023]
Abstract
Underage drinkers often use false identification to purchase alcohol or gain access into bars. In recent years, several states have introduced laws that provide incentives to retailers and bar owners who use electronic scanners to ensure that the customer is 21 years or older and uses a valid identification to purchase alcohol. This paper is the first to investigate the effects of these laws using confidential data from the National Longitudinal Survey of Youth, 1997 Cohort (NLSY97). Using a difference-in-differences methodology, I find that the false ID laws with scanner provision significantly reduce underage drinking, including up to a 0.22 drink decrease in the average number of drinks consumed by underage youth per day. This effect is observed particularly in the short-run and more pronounced for non-college students and those who are relatively younger. These results are also robust under alternative model specifications. The findings of this paper highlight the importance of false ID laws in reducing alcohol consumption among underage youth.
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Affiliation(s)
- Barış K Yörük
- Department of Economics, University at Albany, SUNY, 1400 Washington Avenue, Albany, NY 12222, United States.
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