Minimum pricing of alcohol versus volumetric taxation:which policy will reduce heavy consumption without adversely affecting light and moderate consumers?

Background We estimate the effect on light, moderate and heavy consumers of alcohol from implementing a minimum unit price for alcohol (MUP) compared with a uniform volumetric tax. Methods We analyse scanner data from a panel survey of demographically representative households (n = 885) collected over a one-year period (24 Jan 2010–22 Jan 2011) in the state of Victoria, Australia, which includes detailed records of each household's off-trade alcohol purchasing. Findings The heaviest consumers (3% of the sample) currently purchase 20% of the total litres of alcohol (LALs), are more likely to purchase cask wine and full strength beer, and pay significantly less on average per standard drink compared to the lightest consumers (A$1.31 [95$2.21 [95% CI 2.10–2.31]). Applying a MUP of A$1 per standard drink has a greater effect on reducing the mean annual volume of alcohol purchased by the heaviest consumers of wine (15.78 LALs [95$393.60 [95% CI 374.19–413.00]) and beer ($108.26 [95$552.46 [95% CI 530.55–574.36] and $163.92 [95% CI 152.79–175.03], respectively). Both a MUP and uniform volumetric tax have little effect on changing the annual cost of wine and beer for light and moderate consumers, and likewise little effect upon their purchasing. Conclusions While both a MUP and a uniform volumetric tax have potential to reduce heavy consumption of wine and beer without adversely affecting light and moderate consumers, a MUP offers the potential to achieve greater reductions in heavy consumption at a lower overall annual cost to consumers

Validation of the theoretical domains framework for use in behaviour change and implementation research

Background An integrative theoretical framework, developed for cross-disciplinary implementation and other behaviour change research, has been applied across a wide range of clinical situations. This study tests the validity of this framework. Methods Validity was investigated by behavioural experts sorting 112 unique theoretical constructs using closed and open sort tasks. The extent of replication was tested by Discriminant Content Validation and Fuzzy Cluster Analysis. Results There was good support for a refinement of the framework comprising 14 domains of theoretical constructs (average silhouette value 0.29): 'Knowledge', 'Skills', 'Social/Professional Role and Identity', 'Beliefs about Capabilities', 'Optimism', 'Beliefs about Consequences', 'Reinforcement', 'Intentions', 'Goals', 'Memory, Attention and Decision Processes', 'Environmental Context and Resources', 'Social Influences', 'Emotions', and 'Behavioural Regulation'. Conclusions The refined Theoretical Domains Framework has a strengthened empirical base and provides a method for theoretically assessing implementation problems, as well as professional and other health-related behaviours as a basis for intervention development

Consenso brasileiro sobre políticas públicas do álcool Brazilian consensus on public policies on alcohol

Esse é um resumo de uma reunião na qual vários especialistas, representando diversas organizações médicas e universitárias brasileiras, criaram um consenso sobre as principais políticas que deveriam ser implementadas pelos diferentes níveis de governo no Brasil. Há mais de 30 anos a OMS vem buscando um consenso internacional sobre as ações com maior potencial de trazer benefícios sociais. Essa busca trouxe duas conclusões importantes: 1) A pesquisa estabelece, sem margem à dúvida, que existem medidas de eficácia comprovada para reduzir os custos e os danos relacionados ao uso de álcool, visando ao bem comum; 2) É possível desenvolver estratégias que influenciam tanto a quantidade de álcool consumida por uma comunidade quanto os comportamentos de consumo e os contextos de alto risco causadores dos problemas relacionados ao consumo de álcool. Os objetivos deste Consenso são: 1) Tornar as evidências científicas mais acessíveis para os que elaboram políticas públicas; 2) Facilitar a avaliação das diversas estratégias disponíveis segundo critérios de efetividade, suporte científico, custo e viabilidade de transposição cultural; 3) Familiarizar o profissional de saúde, e em especial os que trabalham em saúde mental, sobre as prioridades da política do álcool.<br>This is the summary of a meeting where a group of experts, representing several health organizations and academic departements from different parts of Brazil, created a consensus about the main alcohol policies which should be implemented by different levels of the brazilian government. The World Health Organization has been suggesting for 30 years the actions that should be implemented for the public good. Two important conclusions were reached: 1) The research establishes beyond doubt that public health measures of proven effectiveness are available to serve the public good by reducing the widespread costs and pain related to alcohol use; 2) To that end, it is appropriate to deploy responses that influence both the total amount of alcohol consumed by a population and the high-risk contexts and drinking behaviours that are so often associated with alcohol-related problems. To conceive of these intrinsically complementary approaches as contractory alternatives would be a mistake. The objectives of the consensus are: 1) To make the scientific evidences more available to the Brazilian policy makers; 2) To facilitate the evaluation of the available estrategies according their effectivity, scientific support, cost and cultural adaptability; 3) To make the brazilian health professionais familiar with the priorities of alcohol policies

Escalating penalties for repeat offenders: a note on the role of information

Optimal law enforcement, Escalating sanctions, Repeat offender, Imperfect information, K42, H23,