Understanding recent trends in alcohol
consumption and harm in Australia
Michael Livingston
Background
Perception that alcohol is an increasing problem in
Australia society
– “Epidemic of binge drinking” (Rudd)
– “...
Context
General trend towards more liberalised alcohol
controls nationally
– Victoria typifies the trends
– New acts in 19...
Context – Victorian licences
0
1000
2000
3000
4000
5000
6000
7000
General licences
On-premise licences
Packaged licences
Context
Changes in type of licences
– Expansion of “big box” liquor stores
– E.g. Dan Murphys had 5 stores in 1998, now ha...
Context
Carragher, N. & Chalmers, J. (2012) What are the options? Pricing and taxation policy reforms to
redress excessive...
Implications
Increased affordability of alcohol linked with
increases in consumption and problems in many
previous studies...
Trends in alcohol-related harm
Rely largely on proxy measures
– E.g. Late night weekend assaults
– Proportions of various ...
Trends in alcohol-related harm
Detailed data examined for Victoria (1999-2008)
– Including analyses of trends in different...
Victorian trends
0.0
10.0
20.0
30.0
40.0
50.0
60.0
1999-00 2000-01 2001-02 2002-03 2003-04 2004-05 2005-06 2006-07 2007-08...
Victorian trends
Sharp increases in six separate indicators
– Some evidence of recent plateaus in ambulance
attendances an...
National trends
Limited data
– NSW data suggests assaults on licensed premises and
assaults flagged by police as „alcohol-...
Population sub-groups
Trends in Victorian harm rates examined by
age, sex, rurality and socio-economic status
– No obvious...
Gender convergence
0
5
10
15
20
25
30
35
40
45
1998-99 1999-2000 2000-2001 2001-02 2002-03 2003-04 2004-05 2005-06 2006-07...
Consumption
Some (mixed) evidence that harms are increasing
Implies changes in amount, pattern or context of
alcohol consu...
Consumption
Per-capita consumption steady at ~ 10 litres pure alcohol
0
2
4
6
8
10
12
14
Consumption
0
4
8
12
16
20
24
28
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
NDSHS VPHS NHS
Long-term risky dri...
Consumption
Short-term risky drinking (Victoria and Australia)
0%
5%
10%
15%
20%
25%
30%
2001 2002 2003 2004 2005 2006 200...
Consumption
Prevalence of underage drinking
0%
10%
20%
30%
40%
50%
60%
70%
80%
2001 2004 2007 2010
NDSHS (14-17) ASSAD (12...
Teenage drinking trends
Replicated in US and many European countries
– Sweden, Finland, Ireland, Norway, Russia etc
– Alth...
Teenage drinking trends
No strong evidence that alcohol is being replaced by
other substances
– Declines in: cannabis, amp...
Overall Australian trends
Reasonable evidence of increasing rates of harm
– Although not entirely consistent
No measurable...
Possible explanations for diverging
trends in Australia
Changes in coding practices in health and police
systems
– Mortali...
Attitude shifts
Clear evidence that public attitudes towards alcohol
are shifting
– Greater media concern
– More worry abo...
Drug of ‘most concern’ for the general
community
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
2001 2004 2007 2010
Alcohol Tobacco...
Drug causes the most deaths
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
2001 2004 2007 2010
Alcohol Tobacco
Meth/Amphetamine...
Support for restrictive policies
0
0.5
1
1.5
2
2.5
3
3.5
4
1995 1998 2001 2004 2007 2010
Price Outlets Trading hours
Media focus of alcohol stories
Azar, White, Bland, Livingston, Room, Chikritzhs, Durkin, Wakefield (submitted) Something’s...
Changing attitudes
Changing attitudes to alcohol could influence the
observed trends
– Increase alcohol coding by clinicia...
Another potential explanation:
diverging consumption
Potential explanation if:
– Overall consumption patterns mask diverge...
Is Australian consumption diverging?
Examine changes in the distribution of alcohol
consumption in Australia from 2001 to ...
Episodic drinking
Are trends in „risky drinking‟ consistent across
differing definitions?
- Compare 5+ with 20+
- Small bu...
Episodic drinking
Demographic analyses
– Increases in 20+ drinking for both men and women
– 20+ drinking increasing among ...
Distribution of volume consumed
Examine consumption levels for 20 quantiles of the
population.
– Comparing how much of the...
Change in total volume consumed
Population
quantile 2001 2010 Change
1 0.00 0.00 na
2 0.00 0.00 na
3 0.00 0.00 na
4 0.07 0...
Change in total volume consumed
Population
quantile 2001 2010 Change
1 0.00 0.00 na
2 0.00 0.00 na
3 0.00 0.00 na
4 0.07 0...
Distribution of volume consumed
There has been some shift in the abstaining
population (17% - 20%)
– Reanalyse volume shif...
Summary
Very heavy episodic drinking has increased slightly
in Australia over the past decade, even while
„risky drinking‟...
Summary
Some evidence against the collectivity of drinking
cultures
– Skog‟s theory predicts consumption will shift propor...
Some caution
These are relatively small shifts and, while
statistically significant, my represent „noise‟ in
the data
– 20...
Conclusions
Victorian and Australian alcohol trend data
provides a confusing picture
– Some (inconsistent) evidence of har...
Conclusions
Understanding trends is critical
– Tends to drive the policy debate
• Headlines/media attention tends to focus...
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Understanding recent trends in alcohol consumption and harm in Australia

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Understanding recent trends in alcohol consumption and harm in Australia

  1. 1. Understanding recent trends in alcohol consumption and harm in Australia Michael Livingston
  2. 2. Background Perception that alcohol is an increasing problem in Australia society – “Epidemic of binge drinking” (Rudd) – “Drink until you drop culture” (Scippione) – “Binge drinking out of control” (AMA) This presentation will try to summarise the available data to assess the validity of this perception – Strengths and weaknesses of various data sources – Mix of Victorian and national data – Implications for policy
  3. 3. Context General trend towards more liberalised alcohol controls nationally – Victoria typifies the trends – New acts in 1987 and 1998, steady erosion of restrictions – Increasing involvement of the big grocery chains in the packaged liquor market – Late night trading increasingly prevalent
  4. 4. Context – Victorian licences 0 1000 2000 3000 4000 5000 6000 7000 General licences On-premise licences Packaged licences
  5. 5. Context Changes in type of licences – Expansion of “big box” liquor stores – E.g. Dan Murphys had 5 stores in 1998, now has ~ 200 – ~ 100 First Choice Stores – Various states encouraging „small bar‟ licences, although it‟s not clear how much impact these have had Increased competition in the packaged liquor environment has contributed to increasing affordability of alcohol
  6. 6. Context Carragher, N. & Chalmers, J. (2012) What are the options? Pricing and taxation policy reforms to redress excessive alcohol consumption and related harms in Australia. Sydney: BOCSAR
  7. 7. Implications Increased affordability of alcohol linked with increases in consumption and problems in many previous studies – Some contestation over the relative impact of price changes on heavy drinkers, but reasonable evidence that harms decline with price increases Outlet numbers and trading hours associated with a range of harms in Australian and international studies – Victorian research shows harm rates at the local level are strongly associated with outlet densities
  8. 8. Trends in alcohol-related harm Rely largely on proxy measures – E.g. Late night weekend assaults – Proportions of various injuries/diseases (e.g. ~40% of assault hospital admissions etc) – Single vehicle late night traffic accidents Some more direct measures – Alcohol caused ambulance attendances (still relying on paramedic perceptions) – Admissions/presentations for alcohol specific conditions (relying on reliable coding)
  9. 9. Trends in alcohol-related harm Detailed data examined for Victoria (1999-2008) – Including analyses of trends in different population groups Broader data presented nationally – Relying on previously published work
  10. 10. Victorian trends 0.0 10.0 20.0 30.0 40.0 50.0 60.0 1999-00 2000-01 2001-02 2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 2008-09 2009-10 Rateper10,000population Hospitalisations ADIS treatment episodes Ambulance presentations (metro Melbourne) Alcohol-related D.V. E.D. Presentations (intoxication) Night-time assaults
  11. 11. Victorian trends Sharp increases in six separate indicators – Some evidence of recent plateaus in ambulance attendances and assaults (although most recent ambo data shows a further increase) – Stable trends in alcohol-related deaths and serious single vehicle night-time traffic accidents – Road traffic deaths may be held down by ongoing road safety initiatives, but lack of trend in deaths data raises questions – Still: consistent upward trends in 6 of 8 indicators suggestive of increases in harm in Victoria
  12. 12. National trends Limited data – NSW data suggests assaults on licensed premises and assaults flagged by police as „alcohol-related‟ are declining, although domestic violence is increasing (possibly due to increased reporting). – NSW hospitalisations increasing, emergency presentations stable since 2009 after large increases – Other states publish limited data – Last NAIP bulletin covered 1996-2005 – Generally increasing alcohol-related hospitalisations (particularly in Victoria, Tasmania and NT) – Generally falling alcohol-related deaths
  13. 13. Population sub-groups Trends in Victorian harm rates examined by age, sex, rurality and socio-economic status – No obvious and consistent patterns across outcome types – E.g. Emergency presentation increasing faster in urban areas, hospital admissions and violence in rural aras – Sharp increases for younger Victorians in emergency data, but not in assault data – Some (inconsistent) evidence of gender convergence
  14. 14. Gender convergence 0 5 10 15 20 25 30 35 40 45 1998-99 1999-2000 2000-2001 2001-02 2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 Male 15-19 ED Female 15-19 ED Male 35-49 Hosp Female 35-49 Hosp
  15. 15. Consumption Some (mixed) evidence that harms are increasing Implies changes in amount, pattern or context of alcohol consumption Very little objective data on consumption (just national estimates based on tax), so tend to rely on survey-based estimates
  16. 16. Consumption Per-capita consumption steady at ~ 10 litres pure alcohol 0 2 4 6 8 10 12 14
  17. 17. Consumption 0 4 8 12 16 20 24 28 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 NDSHS VPHS NHS Long-term risky drinking (Victoria and Australia)
  18. 18. Consumption Short-term risky drinking (Victoria and Australia) 0% 5% 10% 15% 20% 25% 30% 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 NDSHS VPHS
  19. 19. Consumption Prevalence of underage drinking 0% 10% 20% 30% 40% 50% 60% 70% 80% 2001 2004 2007 2010 NDSHS (14-17) ASSAD (12-15) ASSAD (16-17)
  20. 20. Teenage drinking trends Replicated in US and many European countries – Sweden, Finland, Ireland, Norway, Russia etc – Although not everywhere (e.g. France, Greece, Croatia etc) No clear explanation for sharp reductions in youth drinking – Cultural reaction to heavy drinking parents (cohort born in 1970-80s heaviest drinking cohort) – Alternative means of entertainment (recent Swedish paper showed strong –ve association between computer/internet use and drinking)
  21. 21. Teenage drinking trends No strong evidence that alcohol is being replaced by other substances – Declines in: cannabis, amphetamines, ecstasy, opiates and cocaine – Use of any illicit drugs has dropped from 20% in 2005 to 15% in 2011 Teenage attitudes to alcohol shifting – But in line with general population shifts Small increases in abstention among older young people – E.g. 18-24 year olds from 7% (2001) to 12% (2011)
  22. 22. Overall Australian trends Reasonable evidence of increasing rates of harm – Although not entirely consistent No measurable increase in consumption – Total volume is steady as are most measures of risky drinking – Some evidence of declining drinking, particularly among young people
  23. 23. Possible explanations for diverging trends in Australia Changes in coding practices in health and police systems – Mortality trend is flat – Inconsistencies nationally raise questions Problems with consumption data – Per-capita consumption excludes cider – Survey trends are not necessarily reliable Something else?
  24. 24. Attitude shifts Clear evidence that public attitudes towards alcohol are shifting – Greater media concern – More worry about alcohol as a problem – Increased support for restrictions – Attitude changes not limited to particular subgroups of the population
  25. 25. Drug of ‘most concern’ for the general community 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 2001 2004 2007 2010 Alcohol Tobacco Meth/Amphetamines Heroin
  26. 26. Drug causes the most deaths 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 2001 2004 2007 2010 Alcohol Tobacco Meth/Amphetamines Heroin
  27. 27. Support for restrictive policies 0 0.5 1 1.5 2 2.5 3 3.5 4 1995 1998 2001 2004 2007 2010 Price Outlets Trading hours
  28. 28. Media focus of alcohol stories Azar, White, Bland, Livingston, Room, Chikritzhs, Durkin, Wakefield (submitted) Something’s brewing: changing trends in alcohol coverage in Australian newspapers 2000-2011
  29. 29. Changing attitudes Changing attitudes to alcohol could influence the observed trends – Increase alcohol coding by clinicians/shift police emphasis on night-time assaults thus pushing up trends – Contrastingly may make reporting heavy drinking less socially desirable thus driving down estimates of risky drinking However: hard to imagine liver cirrhosis increases of >50% driven solely by attitude changes
  30. 30. Another potential explanation: diverging consumption Potential explanation if: – Overall consumption patterns mask divergent trends for heavy (↑) and moderate drinkers (↓) – Harm rates driven by heaviest drinkers Diverging consumption within a population is counter to Skog‟s theory of the collectivity of drinking cultures – Some evidence in Swedish studies of young people that trends are not consistent across different drinking groups
  31. 31. Is Australian consumption diverging? Examine changes in the distribution of alcohol consumption in Australia from 2001 to 2010 – Four waves of large population (14+) survey (n>20,000 per wave) – Steady (if poor) response rates and coverage rates of per- capita consumption – Consumption data collected using standard (and consistent) graduated frequency questions
  32. 32. Episodic drinking Are trends in „risky drinking‟ consistent across differing definitions? - Compare 5+ with 20+ - Small but significant *increase* in 20+ drinking (9% - 10.5%) & decrease in 5+ drinking (43% - 40%) 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 2001 2004 2007 2010 20+ 5+
  33. 33. Episodic drinking Demographic analyses – Increases in 20+ drinking for both men and women – 20+ drinking increasing among older respondents (>30) – Drinking in general declining among young people – Biggest increases in 20+ drinking in rural areas (10.6% - 14.8%)
  34. 34. Distribution of volume consumed Examine consumption levels for 20 quantiles of the population. – Comparing how much of the total alcohol each quantile consumes from wave to wave – Particular interest in shifts at the heaviest end of the distribution
  35. 35. Change in total volume consumed Population quantile 2001 2010 Change 1 0.00 0.00 na 2 0.00 0.00 na 3 0.00 0.00 na 4 0.07 0.00 -100% 5 0.11 0.04 -62% 6 0.21 0.13 -41% 7 0.46 0.28 -38% 8 0.68 0.55 -19% 9 1.21 1.00 -18% 10 1.55 1.54 -1% 11 2.20 2.09 -5% 12 3.27 2.67 -18% 13 4.09 3.52 -14% 14 5.38 4.65 -14% 15 6.63 6.01 -9% 16 7.90 7.51 -5% 17 10.61 10.01 -6% 18 14.36 14.11 -2% 19 19.05 19.58 3% 20 37.05 38.79 5%
  36. 36. Change in total volume consumed Population quantile 2001 2010 Change 1 0.00 0.00 na 2 0.00 0.00 na 3 0.00 0.00 na 4 0.07 0.00 -100% 5 0.11 0.04 -62% 6 0.21 0.13 -41% 7 0.46 0.28 -38% 8 0.68 0.55 -19% 9 1.21 1.00 -18% 10 1.55 1.54 -1% 11 2.20 2.09 -5% 12 3.27 2.67 -18% 13 4.09 3.52 -14% 14 5.38 4.65 -14% 15 6.63 6.01 -9% 16 7.90 7.51 -5% 17 10.61 10.01 -6% 18 14.36 14.11 -2% 19 19.05 19.58 3% 20 37.05 38.79 5%
  37. 37. Distribution of volume consumed There has been some shift in the abstaining population (17% - 20%) – Reanalyse volume shifts looking only at drinkers – More consistent with Skog‟s theory – The decision whether or not to drink is different to the decision about how much to drink Broadly similar results – Drinking by the lightest 80% of drinkers declined by 3.3%, by the top 10% increased by 6.4%
  38. 38. Summary Very heavy episodic drinking has increased slightly in Australia over the past decade, even while „risky drinking‟ rates are declining There have been small but consistent shifts in the total distribution of consumption in Australia over the same period, with the heaviest drinkers representing an increasing proportion of total consumption
  39. 39. Summary Some evidence against the collectivity of drinking cultures – Skog‟s theory predicts consumption will shift proportionally across the distribution What do these findings mean for population-level interventions? – Per-capita consumption is steady, but very heavy drinking is increasing – Possible contribution to mismatch between harm and consumption trends
  40. 40. Some caution These are relatively small shifts and, while statistically significant, my represent „noise‟ in the data – 2013 survey wave available next year for further analyses Broad issues of interpreting survey data, particularly on very heavy drinking – Non-response, recall bias, untrue responses ... Unlikely to be enough of a shift to explain such major increases in harms – Harms tend to be spread widely across the drinking pop‟n
  41. 41. Conclusions Victorian and Australian alcohol trend data provides a confusing picture – Some (inconsistent) evidence of harm increases – Generally stable levels of consumption, which obscure: • Major reductions in teenage drinking • Declines in 5+ drinking, particularly among young adults • Increases in 20+ drinking and drinking by the heaviest drinkers – Big shifts in attitudes towards alcohol
  42. 42. Conclusions Understanding trends is critical – Tends to drive the policy debate • Headlines/media attention tends to focus on change in problems, not just their level – Crucial for understanding the impact of policy changes • E.g. Increased availability of alcohol in Victoria linked to increases in harm rates, despite limited evidence that consumption has been affected Standard national reporting of trends across diverse outcome measures crucial – Surveys provide necessary level of detail on consumption, but reliability an increasing concern

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