Trajectories of alcohol-related harm among young people

In many high-income countries such as Australia, alcohol use has declined in young people since the early 2000s but there is conflicting evidence around reductions in alcohol-related harm. A key issue around quantifying alcohol-related harm is that different data sources can show vastly different patterns due to varying sample characteristics or methods of measurement. The studies comprising this thesis aimed to address these gaps by using a variety of data sources to examine: 1) trends in self-reported harms across age, period, and birth cohort using national surveys (n=121,281); 2) developmental patterns of blackouts, a very common harm, and predictors of high-risk patterns in a recent birth cohort (n=1,821); 3) developmental transitions between different types of alcohol-related harm and predictor of high-risk patterns in a recent birth cohort (n=1,828); and 4) risk factors for experiencing clinical alcohol-related harm for the first time at a younger age and compare rates of subsequent harm by age at first experience of clinical harm in a linked cohort (n=10,300). Several notable findings were identified. National data indicate that alcohol-related risky behaviours are much less common in recent birth cohorts, though they continue to be most prevalent in young people. Males generally had twice the prevalence of risky behaviours compared to females, but with reduced effect among more recent birth cohorts. Longitudinal cohort data indicated that escalating experience of harms, particularly blackouts and psychosocial harms (e.g., getting into fights) increased risk of early adulthood alcohol use disorder symptoms. Females were at higher risk of experiencing physiological harms such as blackouts earlier in life compared to males. Finally, analyses of linked hospital service data indicated that females were at higher risk of accessing hospital services for an alcohol-related problem for the first time at a younger age. Younger people were more likely to have subsequent injury-related ED presentations but less likely to be hospitalised. Past year hospital service access rates in this cohort were much higher than the same-aged general population. This thesis highlights important developments in young peoples’ experience of alcohol-related harm. The identification of a closing male-female gap in harms and of female status as a risk factor for early harm warrants future research and shifts to the approach of harm reduction and prevention among young people

The Strengths Model in Hong Kong

Mental health practice involves the continuous process of learning and refinement, especially when practitioners focus on the strengths and aspirations of individuals who are coping with serious mental illnesses (Tse et al., 2016). Cross-cultural considerations include beliefs, language, the role of social support, and the distinctive characteristics of specific communities that require localization in designing and offering mental health services. In this chapter, we describe the experience of adopting the Strengths Model in Hong Kong, starting with an introduction to the mental health system in the city. We then illustrate the development and implementation of the Strengths Model for the Chinese population in Hong Kong. We also briefly review research studies focusing on the Strengths Model in mental health practice in this cultural context (Tsoi et al., 2018; Tsoi, Tse, Canda, & Lo, 2019; Tse et al., 2019). The process of localization described in this chapter required the building of complex relationships among Strengths Model founders, scholars, organizations, caseworkers, and people facing mental health challenges

Patterns of alcohol use in adolescents: early predictors and adulthood outcomes.

Alcohol is one of the leading risk factors for death and disability in young people . Although people usually first start drinking alcohol at around 15-16 years of age, this can vary, and adolescents often follow different patterns or “trajectories” of drinking. The age at which an adolescent first consumes alcohol and how quickly they escalate their alcohol use may be important predictors of alcohol-related problems in early adulthood....

Tracking the decline in Australian adolescent drinking into adulthood.

BACKGROUND AND AIMS: Adolescent drinking in Australia (and many other countries) has declined substantially since the early 2000s. This study aimed to test whether these declines have been maintained into adulthood and whether they are consistent across sub-groups defined by sex and socio-economic status. DESIGN: Quasi-cohorts were constructed from seven repeated waves of cross-sectional household survey data (2001-2019). Participants were a total of 20 733 respondents age between 14 and 24 (male: 9492; female: 11 241) in Australia MEASUREMENTS: Participants were grouped into five cohorts based on their birth year (from 1979-1983 to 1999-2003). Three measures of drinking were assessed: any past-year consumption (yes/no), past-year regular risky drinking (12 or more drinking episodes of >40 g of pure alcohol, yes/no) and total volume of alcohol consumed in the past year (in Australian standard drinks, 10 g of alcohol). Socio-economic status was measured based on neighbourhood of residence. FINDINGS: Drinking declines were consistent across socio-economic groups on all measures and trends were broadly similar for women and men. More recent birth cohorts had significantly lower levels of drinking across all three measures (odds ratios between 0.31 and 0.70 for drinking and risky drinking, coefficients between -0.28 and -0.80 for drinking volume). There were significant interactions between birth cohort and age for past-year drinking and past-year regular risky drinking, with cohort differences diminishing as age increased. CONCLUSIONS: Lighter drinking adolescent cohorts appear to partly 'catch up' to previous cohorts by early adulthood, but maintain lower levels of drinking and risky drinking up to the age of 24. These ongoing reductions in drinking are spread evenly across socio-economic groups

Validation of the Australian beverage picture set: A controlled picture set for cognitive bias measurement and modification paradigms

Objective Research on implicit biases toward alcoholic stimuli require validated picture sets that (a) contain a wide range of alcoholic and non‐alcoholic beverages recognised by the sample population, (b) control for featural differences that do not pertain to the beverage itself, and (c) elicit a desired effect upon viewing, with alcoholic beverages resulting in an increased urge to drink in heavy drinkers. To validate the Australian Beverage Picture Set (OzBPS); a stimulus set to be used in alcohol‐related cognitive bias research in Australian populations. Method A range of alcoholic and non‐alcoholic beverages were photographed under controlled conditions in both active (opening, serving, drinking and pouring) and passive contexts (beverage, beverage with empty glass, beverage with full glass). Following that, 98 undergraduates completed an identification and ratings task (measuring valence, arousal, urge to drink and familiarity). Finally, participants completed a questionnaire indexing alcohol consumption. Results After eliminating beverages that were not easily identified as alcoholic or non‐alcoholic, the analysis validated the picture set, revealing a linear relationship between habitual heavy drinking and an increased urge to drink in response to alcoholic beverages. Furthermore, we included a novel pouring context, which was found to elicit a stronger urge to drink compared to other drinking contexts. Conclusions The OzBPS is a valid image set that will facilitate future research into cognitive correlates of drinking behaviour

Age, period and cohort effects on alcohol-related risky behaviours in Australia from 2001 to 2016.

AIMS: The aim of this study is to examine age, period and birth cohort trends in the prevalence of any alcohol-related risky behaviour and to compare these trends between men and women. DESIGN AND SETTING: We used an age-period-cohort analysis of repeated cross-sectional survey data from the Australian National Drug Strategy Household Survey from 2001 to 2016. Participants were 121 281 people aged 14-80 years who reported consuming alcohol in the past 12 months. MEASUREMENTS: Any risky behaviour undertaken while under the influence of alcohol in the past 12 months (e.g. operating a motor vehicle) was measured: male or female. FINDINGS: Controlling for age and cohort, cubic spline models showed that any alcohol-related risky behaviour declined with time among participants who consumed alcohol. Risky behaviour peaked in the 1954 birth cohort and then steadily declined with more recent birth cohorts. Risky behaviour peaked at age 21 years, followed by steady decline and stabilization at approximately age 70 years. Males were overall twice as likely as females to report alcohol-related risky behaviour, but this effect was smaller in cohorts born after 1980. CONCLUSIONS: Alcohol-related risky behaviour in Australia has declined generally since 2001, with rates for recent cohorts having the sharpest decline. Risky behaviour remains most prevalent in young adults, and the male-female gap in risky behaviour is closing for more recent birth cohorts. These trends are consistent with alcohol consumption trends observed in Australia and world-wide

Australian Parental Supply of Alcohol Longitudinal Study (APSALS)

Aiken, A., Wadolowski, M., Bruno, R., Najman, J., Kypri, K., Slade, T., ... & Mattick, R. P. (2015). Cohort profile: The Australian Parental Supply of Alcohol Longitudinal Study (APSALS). International journal of epidemiology, 46(2), e6-e6

Alcohol use among young Australian adults in May-June 2020 during the COVID-19 pandemic : a prospective cohort study

AIMS: To estimate change in young people's alcohol consumption during COVID-19 restrictions in Australia in early-mid 2020, and test whether those changes were consistent by gender and level of consumption prior to the pandemic. DESIGN: Prospective longitudinal cohort. SETTING: Secondary schools in New South Wales, Tasmania and Western Australia. PARTICIPANTS: Subsample of a cohort (n = 443) recruited in the first year of secondary school in 2010-11. Analysis data included three waves collected in September 2017-July 2018, September 2018-May 2019 and August 2019-January 2020), and in May-June 2020. MEASUREMENTS: The primary predictors were time, gender and level of consumption prior to the pandemic. Outcome variables, analysed by mixed-effects models, included frequency and typical quantity of alcohol consumption, binge drinking, peak consumption, alcohol-related harm and drinking contexts. FINDINGS: Overall consumption (frequency × quantity) during the restrictions declined by 17% [incidence rate ratio (IRR) = 0.83; 95% confidence interval (CI) = 0.73, 0.95] compared to February 2020, and there was a 35% decline in the rate of alcohol-related harms in the same period (IRR = 0.66; 95% CI = 0.54, 0.79). Changes in alcohol consumption were largely consistent by gender. CONCLUSIONS: From a survey of secondary school students in Australia, there is evidence for a reduction in overall consumption and related harms during the COVID-19 restrictions

Definition matters: assessment of tolerance to the effects of alcohol in a prospective cohort study of emerging adults.

BACKGROUND AND AIMS: Tolerance to the effects of alcohol is an important element in the diagnosis of alcohol use disorders (AUD); however, there is ongoing debate about its utility in the diagnosis AUD in adolescents and young adults. This study aimed to refine the assessment of tolerance in young adults by testing different definitions of tolerance and their associations with longitudinal AUD outcomes. DESIGN: Prospective cohort study. A contemporary cohort of emerging adults across Australia (n = 565, mean age = 18.9, range = 18-21 at baseline). MEASUREMENTS: Clinician-administered Structured Clinical Interview for DSM-IV Research Version (SCID-IV-RV) assessed for AUD criteria across five interviews, at 6-month intervals over 2.5 years. Tolerance definitions were operationalized using survey-type response (yes/no), clinician judgement (SCID-IV-RV), different initial drinking quantity and percentage increase thresholds and average heavy consumption metrics. AUD persistence was operationalized by the number of times AUD was present across the 2.5-year study period (n = 491), and new-onset AUD was operationalized as any new incidence of AUD during the follow-up period (n = 461). FINDINGS: The (i) SCID-IV-RV clinician judgement, (ii) an initial drinking quantity threshold of four to five drinks and 50% minimum increase and (iii) 50% increase only were the tolerance definitions more strongly associated with any new onset of AUD throughout the four follow-up time-points than other definitions. However, these definitions were not associated with persistent AUD. Average heavy consumption definitions of tolerance were most strongly associated with persistent AUD but not associated with new-onset AUD. CONCLUSIONS: Initial drink and percentage change thresholds appear to improve the efficacy of change-based tolerance as an indicator for new-onset alcohol use disorder diagnosis in self-report surveys of young adults. When predicting persistent alcohol use disorder, average heavy consumption-based indicators appear to be a better way to measure tolerance than self-reported change-based definitions