Monitoring: consumption trends, international comparisons, harms, costs, method development

A critical component of policy-related research is the capacity and expertise to demonstrate the dimensions and magnitude of the problem and its change over time. Therefore, CAPR monitors consumption trends, harms to the drinker and those around the drinker such as partners, children, friends and strangers, and the social and economic costs resulting from alcohol consumption.

Analyses of such issues will provide high-level evidence for policy initiatives directed towards reducing overall consumption and rates of harm both to the individual and community.

To provide more precise and thus more convincing evidence to demonstrate the magnitude of alcohol consumption and related harms, CAPR develops and implements innovative methods, such as smartphone apps and touch-screen tasks, and works with new data collection techniques, such as transdermal alcohol monitors.

Subsequently, these new methods aim to complement knowledge derived from traditional alcohol consumption survey items. Together they can provide convincing evidence for policy advisors to implement changes in favour of public health.

Research Team:

Project leaders, Senior researchers: Sarah Callinan, Anne-Marie Laslett, Amy Pennay, Robin Room, Sandra Kuntsche, Emmanuel Kuntsche, Jason Jiang, Kylie Lee, Michelle Fitts, Sarah MacLean

Research officers, PhD/honours/ma students: Gabriel Caluzzi, Rakhi Vashishtha, Janette Mugavin, Yvette Mojica Perez, Megan Cook, Chris Cheers, Kelly Van Egmond

Projects within this area:

The aim of this stream of work is to better understand how alcohol consumption, attitudes to alcohol and alcohol-related harms, are changing in Australia. This relates closely to the program of work that CAPR conducts around young people, but its overall aim is to provide a broader, population-level outlook on this topic.

A key outcome to date has been the validation of existing surveys conducted regularly in Australia as reliable measures of trends at the population level. While it is clear that surveys substantially under-estimate the true level of alcohol consumption in Australia, work led by former CAPR Senior Research Fellow Michael Livingston has shown that these surveys capture trends quite well. Other recent work has also identified that there have been substantial changes in attitudes to alcohol in Australia and has provided valuable insights on gender convergence in alcohol consumption, and demonstrating that men still continue to drink at the riskiest levels.

The other important component of this stream of work involves better understanding how population-level changes in drinking affect population rates of various alcohol-related harms. CAPR has a long history of work on this topic, but some of the recent work showing that changes in per-capita consumption influence cancer mortality rates is particularly exciting.

La Trobe Researchers: Robin Room

Funders:  National Health and Medical Research Centre,  Career Development Fellowship; Australian Research Council Discovery Project

Teenagers are drinking less: A qualitative & quantitative examination (ARC DP)

CAPR staff first identified a sharp decline in youth drinking in Australia in 2014. Recent estimates suggest that the average amount of alcohol consumed by an Australian adolescent has fallen by more than 50% since the early 2000s. This is consistent with declines in many other countries.

CAPR has been building a significant research agenda in this space, predominantly via a major ARC grant awarded in 2016 that funded a project to better understand these declines.

This project funds two PhD students: Rakhi Vashishtha and Gabriel Caluzzi, who are trying to better understand what has driven these changes in youth drinking. Both students have passed their confirmation of candidature and are immersed in their projects. Rakhi has conducted a systematic review of studies examining explanations for youth drinking declines worldwide, finding some evidence that parenting has changed as well as identifying significant research gaps in the literature. Gabriel has completed 50 in depth interviews with Victorian young people to try and develop a more nuanced understanding of the role of alcohol in their lives, and has also worked closely with Amy on a book chapter examining the links between changing youth culture and alcohol.

Alongside this work, CAPR has continued to build international collaborations on this topic, including some work on Swedish young people and as co-coordinators of a major international meeting on the decline in youth drinking to be held in April 2019. Key papers in 2018 include the first analysis of Australian data on factors influencing individual decisions to cut back on drinking and an overview paper pointing to the need for better international collaboration on the topic. A highlight of 2018 was Amy’s success with a highly competitive ARC DECRA grant that will fund her work to continue exploring this topic over the next three years.

Researchers: Amy Pennay, Sarah MacLean, Dan Lubman, John Holmes, Rachel Herring, Paul Dietze

Funder: Australian Research Council  Discovery Project grant.

Relevant publications by CAPR:

Pennay A, Holmes J, Törrönen J, Livingston M, Kraus L, Room R. Researching the decline in adolescent drinking: The need for a global and generational approach. Drug and alcohol review. 2018 Apr;37:S115-9.

MacLean S, Pennay A, Room R. ‘You’re repulsive’: Limits to acceptable drunken comportment for young adults. International Journal of Drug Policy. 2018 Mar 1;53:106-12.

Pennay A, Callinan S, Livingston M, Lubman DI, Holmes J, MacLean S, Herring R, Dietze P. Patterns in Reduction or Cessation of Drinking in Australia (2001–2013) and Motivation for Change. Alcohol and alcoholism. 2018 Oct 20;54(1):79-86.

Harms to others: multinational study (NIAAA & WHO-Thai Health)

CAPR’s collaborations on alcohol’s harm to others, through the Gender and Alcohol’s Harm To Others (GENAHTO) group in the USA, Canada, Switzerland, Denmark and beyond, continue to strengthen as we co-publish findings from low and high-income countries on the social location of who is affected by others’ drinking, on how people have been affected by a range of harms, of how spouses in particular are affected and how children have been affected.

Internationally, as advisors on the World Health Organization and Thai Health Promotion Foundation Harm from Others’ Drinking project‘s phase 2, we have expanded our focus to study how people attending emergency departments, police stations and family and women’s services are affected by others’ drinking. Final preparation for the launch of our book, 'Harm To Others: Patterns in Nine Societies', edited by the  CAPR team, is near complete, with its launch expected in June 2019.

Researchers: Anne-Marie Laslett, Robin Room, Orratai Waleewong, Oliver Stanesby, Sarah Callinan

Adult drinking and child maltreatment in families, communities and societies protection (ARC DECRA)

This project aims to measure how adult drinking is linked to child maltreatment within families, communities and societies. Leveraging extensive international collaboration, the project will use data from 20 countries, including Australia, and expects to develop new knowledge about links between adult drinking, fathering, community-level alcohol availability, societal drinking patterns and harms to children. Expected outcomes include national and cross-national policy-relevant data and analysis that will inform the prevention of alcohol-related child maltreatment and alcohol policy globally. This should produce significant reductions in the economic and human costs of alcohol-related child abuse and neglect for children, families and societies.

La Trobe Researcher: Anne-Marie Laslett was awarded an Australian Research Council Discovery Early Career Research Award for 2019-2022

Better methods to collect alcohol use data (‘Grog’ App)

The Grog Survey App project is being led by the University of Sydney and the Aboriginal Drug and Alcohol Council of South Australia, and other partners, in colaboration with Robin and Sarah Callinan. The study aims to develop, pilot and test a tablet computer-based application (‘App’) to help Aboriginal and Torres Strait Islander Australians describe their alcohol use behaviours.

This survey App has been shown to be an accurate and reliable way to measure alcohol consumption compared with a clinical interview conducted by an Aboriginal health professional. Feedback from Aboriginal research assistants also suggests that the experience of completing the App and receiving its one-off brief intervention has helped more than half of the participants to reflect on their drinking.

Michelle Fitts of CAPR has been working closely with University of Sydney staff on stage 2 of the project. This involves assessing the practical feasibility of the App as a population survey tool in a remote and urban community.

La Trobe Researchers:  Robin Room and Sarah Callinan.

This study is funded by the National Health and Medical Research Council and supported by the Centre of Research Excellence in Indigenous Health and Alcohol.

Refined alcohol expectancy task (RAET)

In the study of alcohol consumption and its antecedents, a particular focus has been on better understanding how individuals develop beliefs about the likely outcomes of alcohol consumption (alcohol expectancies). Alcohol expectancies are important predictors of different drinking patterns and alcohol-related harms. In the past researchers have relied on questionnaires to assess expectancies, however questionnaires are time-consuming and dependent on self-report which is subject to bias.

The Alcohol Expectancy Task was developed to overcome such limitations. This improved tool will present different illustrated scenarios and ask people to indicate what they think a person has been drinking by choosing from four alcoholic (e.g. beer) and eight non-alcoholic beverages (e.g. coffee).

Megan and Emmanuel are working on a project led by researchers at Edge Hill University, Lancashire, UK, to revise this task in order to address limitations and to assess its validity in other age groups and cultures.

This involves research with participants in Australia, the UK and the US. The revised task will be a valuable resource enabling researchers to better understand one dimension of alcohol-related cognitions – expectancies – which are important precursors of consumption and harms.

La Trobe Researchers: Emmanuel Kuntsche, Megan Cook

Relevant CAPR publications:

Paper from the initial AET study, which this project aims to improve upon. - Kuntsche E, Kuntsche S. Development and initial validation of the alcohol expectancy task. Alcoholism: Clinical and Experimental Research. 2017 Aug;41(8):1461-70.

Transdermal alcohol monitor validation study (LTU PhD Scholarship)

The overwhelming majority of alcohol research relies on self-reporting, which has several limitations, particularly underreporting, mainly due to recall bias. La Trobe Research Start-up funding allowed Emmanuel to purchase 20 transdermal alcohol monitors, which enable alcohol consumption measurement entirely free from recall bias and response burden. In September 2018, supervised by Emmanuel, Cassandra and Michael Livingston, Kelly started her PhD at CAPR, validating the transdermal alcohol monitors to determine their accuracy, reliability, and usability. These transdermal monitors will also enable gathering objective data on alcohol consumption over time.
Kelly is currently writing a systematic review summarising the current state of knowledge in transdermal alcohol measurement, aiming to provide an overview of the currently available technology and the recent advances towards converting the transdermal readings into an estimation of breath alcohol concentration. The main component of her PhD project will be a lab study, where participants will consume alcohol while wearing a transdermal monitors. The results of this project will enable improved interpretation of transdermal alcohol data and improved future usefulness of the devices for large-scale studies undertaken at CAPR and elsewhere.

La Trobe Researchers: Emmanuel Kuntsche, Kelly van Egmond

Funder: La Trobe University

Impact of misclassified ex-drinkers on reported benefits of alcohol use (LTU RFA)

(Description coming soon)

Attitude towards non-drinkers in Australia and the relationship to problematic alcohol use (LTU PhD Scholarship)

With more and more Australians choosing not to drink, Christopher’s PhD is the first study of its kind to examine attitudes towards non-drinkers in an Australian population. The studies which form his PhD aim to examine and define drinker’s attitudes towards non-drinkers in Australia, and create and validate a new measure of these attitudes in a large sample. He will also examine how these attitudes may relate to problematic alcohol consumption. As the negative appraisal of non-drinkers is suggested as a barrier to reducing alcohol consumption, it is proposed that an understanding of these attitudes may allow the development of health promotion strategies that aim to create a more supportive space for moderate drinking in our community.

La Trobe Researchers: Christopher Cheers, supervised by Sarah Callinan & Amy Pennay

Low risk drinkers: Who are they and what influences their drinking patterns? (LTU PhD Scholarship)

From a cultural-political standpoint, low-risk drinking and abstinence have been offered up as national aspirations at different points in Australia’s history. However, in more recent times, greater emphasis has been placed on low-risk drinking. Despite this, adult low-risk drinkers have been largely overlooked in Australian alcohol survey research. Janette’s PhD project aims to investigate the factors associated with low-risk drinking and identify strategies and approaches low-risk drinkers use to manage their consumption levels. A key focus of this project is to better understand the role of alcohol in the lives of low-risk drinkers.

La Trobe Researchers: Janette Mugavin, supervised by Robin Room, Sarah MacLean & Sarah Callinan

Teenagers are drinking less: An examination of the factors shaping recent developments in youth drinking cultures (quantitative component) (PhD funded via ARC project)

Rakhi’s PhD project is part of a broader ARC-funded grant to try to understand the drivers of recent declines in adolescent drinking in Australia. To do this, she is conducting a range of studies – a systematic review of existing analyses that have looked at this question globally, an exploration of trends in other risk and protective factors and a series of empirical analyses of existing survey data to test specific theories, including changes in parenting practices, changes in leisure time activities and major policy changes. The findings of this work will complement the qualitative work that Gabriel Caluzzi is conducting for his PhD and will provide critical new insights into this major generational shift in drinking practices.

Researchers: Rakhi Vashishtha, supervised by Michael Livingston, Amy Pennay & Paul Dietze

Teenagers are drinking less: An examination of the factors shaping recent developments in youth drinking cultures (qualitative component)

This PhD project is part of a broader ARC-funded grant to try to understand the drivers behind the sharp declines in youth drinking in Australia since the early 2000s. Nowadays young Australians are drinking less than previous generations at the same age. A development mirrored in other countries. To better understand these trends, Gabriel Caluzzi’s PhD project has involved 50 interviews with young Victorian’s aged 16-19 in order to develop a nuanced understanding of the changing role of alcohol in young adults’ lives.

Researchers: Gabriel Caluzzi, supervised by Amy Pennay, Michael Livingston and Sarah MacLean

The role of cost and context on alcohol consumption in Australia: an international comparison study

The relationship between population levels of drinking and alcohol related harm is already well-established. However, recent trends in Australia have identified diverging patterns whereby consumptions levels are decreasing while alcohol related harms are on the rise. While no reason has been isolated to explain this change, it has occurred alongside the unprecedented growth of alcohol sales outlets. Given this, Alex’s PhD will explore the ways in which the cost and context of alcohol consumption mediate harmful drinking. International comparisons of culturally similar countries will allow for the potential identification of effective policy strategies to aid in the reduction of alcohol related harms.

Alexandra Torney, supervised by Sarah Callinan.

Understanding the short and long term impacts of COVID-19 on alcohol consumption

To contain the spread of the coronavirus (COVID-19), the Australian government introduced restrictions on public gathering which led to the closure of many non-essential businesses (such as licensed premises). The unprecedented nature of COVID-19 can elicit many different responses and experiences (stress, loneliness and boredom) for people which may lead to changes in alcohol consumption and other unhealthy coping behaviours. Yvette’s PhD project will provide insights into how people’s alcohol consumption and drinking patterns changed during the COVID-19 pandemic and as restrictions were eased throughout the country. The relationship between mental health and alcohol consumption during the pandemic will also be explored.

Researchers: Yvette Mojica Perez, supervised by Sarah Callinan, Michael Livingston and Amy Pennay.