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Biomedical subjects

T Stockwell

Publications and source records attributed to T Stockwell.

At least 19 recordsLinked to original sources
PubMed2001

Supply and demand for alcohol in Australia: relationships between industry structures, regulation and the marketplace.

Aspects of alcohol supply and demand relationships are examined in relation to the two main beverage varieties in Australia, wine and beer. It is argued that this case study illustrates how the 'supply side' is able to create and protect demand for alcohol through both taking advantage of and influencing government regulation of the market for alcohol. In relation to low alcohol beer the impact on public health and safety has been extremely positive. In relation to the creation of cask wine in the late 1960s there have been demonstrably deleterious effects. Preferential taxation arrangements for the Australian wine industry have dramatically increased both exports and home consumption. One unintended consequence has been the creation of a major new market for cheap bulk wines that have had a devastating public health impact, particularly on Aboriginal communities, and also the invention of 'alco-pops'. Two-thirds of all table wine consumed in Australia now comes in a cask and 90% of this product is manufactured by three multi-national companies that wield enormous power and political influence to maintain the status quo. The Australian beer industry is well known internationally for its export of 'full strength' (around 5% by volume) beers. What is less well known is its commercial success in the development of low and mid-strength varieties for home consumption. In some States these now comprise 40% by volume of the beer market. This development can largely be attributed to State taxation arrangements, to drink-driving law enforcement, marketing strategies and to a decade of intense competition between several major brewers. This case study indicates how alcohol taxation policy can have major impacts on public health (both positive and negative) but that in a modern market economy it is difficult for governments to act in the public interest due to pressures from vested interest groups.

Journal Article↗
PubMed2000

The role of social and health statistics in measuring harm from alcohol.

Since excess use of alcohol contributes to so many varieties of health and social harms, in most countries, there are many potential sources of data indicative of alcohol-related harms. In few instances, compilation and interpretation of these data are straightforward, but, mostly, they are open to various sources of measurement error, which need to be taken into account if they are to be applied for research purposes. Police and health statistics are the major source of such information, but the underlying systems are not usually set up with the purpose of monitoring alcohol-related events. In both of these domains, types of events can be identified, which are wholly attributable to excess alcohol use, i.e. drunk-driving, alcoholic liver cirrhosis. Specific alcohol-related events are particularly prone to variations in, respectively, police enforcement practices, medical diagnostic fashion and sensitivity to prejudices about alcohol-related problems. A case will be made in this paper for the use of multiple surrogate measures of alcohol-related harm drawn from several sources in order to measure and track local, regional and national trends. For health statistics on mortality and morbidity, the aetiologic fraction (AF) method will be recommended for such monitoring purposes. It will also be recommended that these data be categorised by the degree to which cases are attributable to alcohol and also by whether the underlying hazardous drinking pattern is a brief drinking bout or a sustained pattern of heavy intake over a number of years. Nighttime occurrences of road crashes, public violence from both police and emergency room attendance data will also be recommended. It will be argued that routine recording of alcohol relatedness of events is usually unreliable, and the above surrogate measures are preferable. Recommendations will also be made for utilising national surveys of drinking behaviour to improve the calculation of alcohol-related morbidity and mortality, as well as refine estimates of per capita alcohol consumption, another major 'surrogate' measure of alcohol-related harm. The arguments will be illustrated with reference to Australia's National Alcohol Indicators Project and related research projects.

Alcohol-Related Disorders↗
PubMed1999

The relationship between alcohol consumption patterns and injury.

AIMS AND DESIGN: A case-control design was employed to quantify the risk of injury after the recent consumption of alcohol. PARTICIPANTS AND SETTING: A total of 797 cases and 797 controls were interviewed throughout 1997. A response rate of 82% was calculated for eligible cases who were approached by an interviewer. The rate for interviews conducted of all people presenting with an injury during the study period was 67%. Cases were injured patients from a hospital emergency unit. Controls were matched on suburb and were interviewed at home regarding activities leading up to the time of their matched case's injury. MEASUREMENTS: Cases and controls were questioned about the injury event and alcohol and other drug use consumed in the 6 hours prior to the injury. They were also breath-tested and medical records were checked for validation purposes. FINDINGS: Logistic regression analysis produced an odds ratio of 3.4 (95% CI: 1.8-6.4) for the risk of sustaining an injury after consuming more than 60 g of alcohol in a 6-hour period, after controlling for demographic variables. The risk of injury at different levels of alcohol use was substantially higher for females with a significant odds ration of 9.6 at greater than 60 g of alcohol compared to 2.1 for men. CONCLUSIONS: These results need to be interpreted cautiously, but provide additional support that the risk of injury increases with the quantity of alcohol consumed and that the risk of injury is significantly higher for women.

Adolescent↗
PubMed1999

The Northern Territory's cask wine levy: health and taxation policy implications.

OBJECTIVE: To examine the effect of the application, and removal, in the Northern Territory of a levy on the sale of cask wine--a beverage shown to contribute disproportionately to alcohol-related harm. METHOD: Using data on licensee purchases of alcoholic beverages and ABS population data, estimates were made of per capita consumption of pure alcohol by beverage type. Time series variables were analysed using multiple linear regression analysis. RESULTS: Prior to the introduction of the levy, quarterly per capita consumption of cask wine among persons aged > or = 15 years was 0.73 litres. During the levy period, this fell to 0.49 litres and following removal of the levy rose to 0.58 litres. Imposition of the levy had no significant effect on the consumption of other beverages. CONCLUSIONS: Taxation is an effective means of reducing excessive alcohol consumption and related harm. IMPLICATIONS: In the interests of public health, support should be given to the introduction of a tiered tax based on alcohol content.

Adolescent↗
PubMed1999

Beverage sales and drinking and driving: the role of on-premise drinking places.

OBJECTIVE: The relationships between on-premise drinking places, beverage specific alcohol sales and drinking and driving were examined in a time series cross-sectional study of place-of-last-drink data from Perth, Western Australia. METHOD: At arrest, 2,411 drinking drivers reported their last location of consumption. Tabulated by 57 premises over 4 years, the rates at which individual premises were referenced as the place-of-last-drink were taken to reflect the relative distributions of numbers of drinking drivers coming from different premise types (hotels, taverns and nightclubs). The data were then statistically related to measures of premise types and characteristics and beverage specific alcohol sales. RESULTS: Significant cross-sectional relationships were obtained between measures of premise types, alcohol sales and drinking and driving. Greatest numbers of drinking drivers came from taverns and from places selling greater amounts of beer and spirits. Significant longitudinal effects were obtained for sales of beer, proportions of high alcohol beer sold and sales of spirits. CONCLUSIONS: As a whole, the results suggest that, at least for Western Australia, outlets selling greater amounts of beer and spirits, and greater amounts of high alcohol beer, will produce larger numbers of drinking drivers.

Accidents, Traffic↗
PubMed1998

Can training bar staff in responsible serving practices reduce alcohol-related harm?

A responsible service training programme aimed at reducing alcohol-related harm was implemented in a popular entertainment area over several months in 1992-93. Another popular entertainment area provided a control site. A number of evaluation measures were used: breath tests on 872 patrons from selected venues; drink driving data; risk assessments; the use of 'pseudo patrons'; and knowledge and attitude changes among trained bar staff (n = 88). Compared to control sites the intervention sites showed an immediate pre- to post-test reduction in patrons rated by researchers as extremely drunk and an eventual reduction from pre-test to follow-up in patrons with blood alcohol levels > = 0.08. There was also a small but significant increase in knowledge among bar staff. There was no significant reduction in patrons with blood alcohol levels > = 0.15 or in the number of drink driving offences from intervention sites during the study period. Pseudo drunk patrons were rarely refused service, identification was rarely checked and non-photographic identification was accepted on most occasions. The less than satisfactory outcome is attributed to poor implementation of the training and a lack of support among managers. The positive results from one venue, whose manager embraced the programme, served to highlight the importance of management support. It is suggested that mandatory training and routine enforcement of licensing laws are essential if the goals of responsible serving are to be met.

Journal Article↗
PubMed1998

Alcohol consumption and injury in Western Australia: a spatial correlation analysis using geographic information systems.

Geographic information systems technology was used to describe, in geographical terms, the nature and strength of the relationship in Western Australia between alcohol consumption and the rates of related injury: night-time assaults (10 p.m. to 6 a.m.); minor night-time road crashes (10 p.m. to 6 a.m.), weighted by traffic density; and hospital E-code (external-cause) morbidity, weighted by alcohol aetiologic fractions. The data were aggregated by five conventional state regions: northern, central, western, southern and Perth metropolitan. There was a general association, of equal significance for males and females, between estimated per capita alcohol consumption and the selected rates of injury in the five regions. However, the nature and strength of association between alcohol consumption and individual injury measures varied. Night-time assaults and hospital E-code morbidity were strongly, associated with consumption. Minor night-time crashes had only a weak association. The variation in the relationship between alcohol consumption and injury suggests that prevention strategies need to take into account the particular drinking patterns and associated harm that occur in different regions of the state, and to develop a range of targeted responses. High rates of consumption and injury in most country areas support the need for greater regional prevention efforts.

Adolescent↗
PubMed1998

Consumption of different alcoholic beverages as predictors of local rates of night-time assault and acute alcohol-related morbidity.

OBJECTIVE: To determine whether population levels of consumption of some alcoholic beverages are more closely associated with levels of harm than others, particularly if consumption of cask wine is more strongly related to rates of acute alcohol problems than consumption of bottled wine as a consequence of the extremely low rates of federal tax levied on the former. METHOD: A database of alcohol consumption and related problems was established for 130 areas of Western Australia. Demographic and economic data for these areas were included from the 1991 census. Empirically derived assumptions regarding the mean wholesale price of cask and bottled wine were utilised. Regression analyses examined the extent to which the consumption of different alcoholic beverages predicted levels of major varieties of harm. RESULTS: Only cask wine and high-strength beer consumption were significantly associated with rates of night-time assault; consumption of all beverage varieties except bottled wine was significantly associated with rates of acute alcohol-related morbidity. Further analyses, which included controls for an effect of total alcohol consumption, confirmed the pronounced contributions of cask wine and high-strength beer to rates of night assaults and acute alcohol-related morbidity. The proportion of all alcohol consumed as low-alcohol beer was significantly negatively associated with these harms. CONCLUSIONS: The beverages most associated with rates of night-time assaults and acute alcohol-related morbidity are those with the lowest federal taxation per standard drink, i.e. cask not bottled wine and regular-strength not low-alcohol beer.

Adult↗
PubMed1996

Unravelling the preventive paradox for acute alcohol problems.

Kreitman's discussion of the preventive paradox in relation to the prevention of alcohol problems has had profound implications for alcohol policy and has generated considerable controversy [1]. It is argued here that although Kreitman should be credited with the important observation that alcohol-related harm is not confined to a few dependent drinkers, none the less an apparent paradox is not an ideal platform from which to recommend policy. Furthermore, Kreitman's own data and data from an Australian survey of drinking are used to demonstrate that a commonplace truth underlies his apparently paradoxical findings. It is shown that the preventive paradox disappears when consideration is given to the amount of alcohol consumed on either (i) the day of highest alcohol intake out of the last four, or (ii) the day on which acute alcohol-related harm occurred. Episodic heavy consumption by people whose average alcohol intake can be classified as 'low' or 'medium' risk contributes to the bulk of such experiences of harm. It is suggested that the importance of intoxication as a public health and safety issue has been neglected. This neglect is compounded when public education campaigns and prevention policy are only based on average rates of alcohol consumption. Advice regarding the low risk levels of consumption for different types of harm should form one component of a comprehensive harm reduction policy. Other elements of such a policy should include a variety of other measures of proven effectiveness in relation to reducing levels of intoxication and related problems.

Journal Article↗