Jennie Connor

Background and aims: Quantifying the health burden of alcohol has largely focused upon harm to drinkers, which is an underestimate. There is a growing literature on alcohol‘s harm to others (HTO), but it lacks the systematic transfer of HTO into a comparative risk assessment framework. This study calculated disability‐adjusted life years (DALYs) for fetal alcohol spectrum disorder (FASD), interpersonal violence and traffic injury due to another‘s drinking. Design: This study is a disease burden analysis, using modelling of DALYs for New Zealand in 2018. Setting and participants: The study took place among the Aotearoa/New Zealand population in 2018. Measurements: The involvement of others’ drinking was obtained from prevalence, alcohol‐attributable fraction studies and administrative data. Disability weights (DW) for FASD were adapted from fetal alcohol syndrome (FAS) weights using a Beta–Pert probability distribution; for interpersonal injury, DWs used hospital events linked with injury compensation; for traffic injury, DWs used hospital events. Populations were stratified by ethnicity, age group and gender. A descriptive comparison was made with a previous estimate of DALYs for drinkers. Findings: In 2018, 78 277 healthy life years were lost in Aotearoa/New Zealand due to alcohol's HTO. The main contributor (90.3%) was FASD, then traffic crashes (6.3%) and interpersonal violence (3.4%). The indigenous population, Māori, was impacted at a higher rate (DALYs among Māori were 25 per 1000 population; among non‐Māori 15 per 1000 population). The burden of HTO was greater than that to drinkers (DALYs HTO = 78 277; DALYs drinkers = 60 174). Conclusions: Disability from fetal alcohol spectrum disorder (FASD) appears to be a major contributor to alcohol's harm to others in Aotearoa/New Zealand. Taking FASD into account, the health burden of harm to others is larger than harm to the drinker in Aotearoa/New Zealand, and ethnicity differences show inequity in harm to others. Quantification of the burden of harm informs the value of implementing effective alcohol policies and should include the full range of harms.

Introduction: While effective policies exist to reduce alcohol‐related harm, political will to enact them is low in many jurisdictions. We aimed to identify key barriers and strategies for strengthening political priority for alcohol policy reform.Methods: A framework synthesis was conducted, incorporating relevant theory, key informant interviews (n = 37) and a scoping review. Thematic analysis informed the development of a framework for understanding and influencing political priority for alcohol policy.Results: Twelve barriers and 14 strategies were identified at multiple levels (global, national and local). Major barriers included neoliberal or free trade ideology, the globalised alcohol industry, limited advocate capacity and the normalisation of alcohol harms. Strategies fell into two categories: sector‐specific and system change initiatives. Sector‐specific strategies primarily focus on influencing policymakers and mobilising civil society. Examples include developing a clear, unified solution, coalition building and effective framing. System change initiatives target structural change to reduce the power imbalance between industry and civil society, such as restricting industry involvement in policymaking and securing sustainable funding for advocacy. A key example is establishing an international treaty, similar to the Framework Convention on Tobacco Control, to support domestic policymaking.Discussion and Conclusions: Our findings provide a framework for understanding and advancing political priority for alcohol policy. The framework highlights that progress can be achieved at various levels and through diverse groups of actors. The importance of upstream drivers of policymaking was a key finding, presenting challenges for time‐poor advocates, but offering potential facilitation through effective global leadership.

Introduction: Foetal alcohol spectrum disorder (FASD) is 100% caused by alcohol. The lifelong disability caused by prenatal alcohol exposure cannot be reversed. Lack of reliable national prevalence estimates of FASD is common internationally and true of Aotearoa, New Zealand. This study modelled the national prevalence of FASD and differences by ethnicity.Methods: FASD prevalence was estimated from self‐reported data on any alcohol use during pregnancy for 2012/2013 and 2018/2019, combined with risk estimates for FASD from a meta‐analysis of case‐ascertainment or clinic‐based studies in seven other countries. A sensitivity analysis using four more recent active case ascertainment studies was performed to account for the possibility of underestimation.Results: We estimated FASD prevalence in the general population to be 1.7% (95% confidence interval [CI] 1.0%; 2.7%) in the 2012/2013 year. For Māori, the prevalence was significantly higher than for Pasifika and Asian populations. In the 2018/2019 year, FASD prevalence was 1.3% (95% CI 0.9%; 1.9%). For Māori, the prevalence was significantly higher than for Pasifika and Asian populations. The sensitivity analysis estimated the prevalence of FASD in the 2018/2019 year to range between 1.1% and 3.9% and for Māori, from 1.7% to 6.3%.Discussion and Conclusions: This study used methodology from comparative risk assessments, using the best available national data. These findings are probably underestimates but indicate a disproportionate experience of FASD by Māori compared with some ethnicities. The findings support the need for policy and prevention initiatives to support alcohol‐free pregnancies to reduce lifelong disability caused by prenatal alcohol exposure.

Introduction and Aims: Bhutan has a high incidence of alcohol‐related disease. With economic development, motorised transport is proliferating, increasing the potential for traffic injury. We investigated drink‐driving in the country's largest urban environment.Methods: Working with police, we set up checkpoints at major thoroughfares in Thimphu, on Tuesday, Friday and Saturday nights, from May to July 2017. Police directed cars to testing bays where drivers were breathalysed and interviewed.Results: All 1596 drivers stopped by police were breathalysed, and 212 (13%) tested positive. Blood alcohol of >0.02 g/dL (which we defined as ‘probable impairment’) was detected in 178 drivers (11%), while 67 (4.2%) exceeded the legal limit of 0.08 g/dL. Probable impairment was more common in men, older drivers, on Tuesdays (versus Fridays or Saturdays) and later at night.Conclusion: Drink‐driving is very common at night‐time in Bhutan. Routine roadside random breath‐testing, and media campaigns emphasising the risk of apprehension and consequent serious financial and social penalties, should be considered to deter drink‐driving.

Aims: To estimate the effect of national restrictions on late‐night availability of alcohol on alcohol‐related assault at a population level as indicated by (1) change in hospitalizations for weekend assaults and (2) change in the proportion of assaults documented by police that occur at night.Design: Evaluation of a natural experiment, involving: (1) pre–post comparisons of age‐specific incidence rates, adjusted for seasonality and background trend using Poisson regression; and (2) interrupted time–series analyses, using seasonal autoregressive integrated moving average (SARIMA) models of national data with no control site.Setting: New Zealand.Participants: (1) Inpatients discharged from NZ hospitals following assault during the weekend (Friday–Sunday) from 2004 to 2016 (n = 14 996) and (2) cases of assault recorded by NZ Police from 2012 to 2018. Intervention: introduction of national maximum trading hours for all on‐licence (8 a.m.–4 a.m.) and off‐licence premises (7 a.m.–11 p.m.), abolishing existing 24‐hour licences, on 18 December 2013.Measurements: (1) Age‐specific incidence of hospitalization for assault on Friday, Saturday or Sunday from the national hospital discharge data set, excluding short‐stay emergency department admissions and (2) proportion of weekly police‐documented assaults occurring between 9 p.m. and 5.59 a.m., from NZ Police Demand and Activity data set.Findings: Following the restrictions, weekend hospitalized assaults declined by 11% [incidence rate ratio (IRR) = 0.89; 95% confidence interval (CI) = 0.84, 0.94], with the greatest reduction among 15–29‐year‐olds (IRR = 0.82; 95% CI = 0.76, 0.89). There was an absolute reduction (step change) of 1.8% (95% CI = 0.2, 3.5%) in the proportion of police‐documented assaults occurring at night, equivalent to 9.70 (95% CI = 0.10, 19.30) fewer night‐time assaults per week, out of 207.4.Conclusions: The 2013 implementation of national maximum trading hours for alcohol in NZ was followed by reductions in two complementary indicators of alcohol‐related assault, consistent with beneficial effects of modest nation‐wide restrictions on the late‐night availability of alcohol.