Welcome to SHAAP’s (Scottish Health Action on Alcohol Problems) weekly media monitoring service.

02 June 2016


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This briefing aims to provide a ‘snap shot’ of latest news on alcohol and health policy. The inclusion of an article in the briefing should not imply that SHAAP approves or condones the content.

SHAAP provides a coordinated, coherent and authoritative medical and clinical voice on the need to reduce the impact of alcohol related harm on the health and wellbeing of the people in Scotland. SHAAP was set up by the Scottish Medical Royal Colleges, through their Scottish Intercollegiate Group (SIGA) and is governed by an Executive Committee made up of members of the Royal Colleges.

Exploring the rise and fall of alcohol-related mortality in Scotland

The rise and fall of alcohol-related mortality in Scotland is partly due to changes in affordability, according to reports published in Public Health.

New research has found that the rise in alcohol-related mortality during the 1990s and early 2000s in Scotland, and the subsequent decline, were likely to be explained in part by increasing then decreasing alcohol affordability. The research was undertaken to understand better what the independent impact of the Scottish Government's alcohol strategy was. Other factors aside from the strategy and the affordability of alcohol were also considered including migration, historical social, economic and political change, the alcohol market, social norms, and health services.

"Alcohol has been suggested to be the most harmful substance misused in societies when wider harms on health and social outcomes such as violence and reduced economic output, are taken into account," explained lead investigator Dr. Gerry McCartney of NHS Health Scotland, Glasgow, UK. "Our work evaluated the extent to which differing trends in income, demographic change, and the consequences of an earlier period of social, economic, and political change might explain differences in the magnitude and trends in alcohol-related mortality between 1991 and 2011 in Scotland compared to England & Wales.

We found that increasing alcohol affordability during the 1990s is likely to have been important in explaining the rise in alcohol-related harms. It also seems likely that a generation of people negatively affected by the rapidly changing economy during the 1980s was subsequently at particularly high risk. We hypothesized that this was linked to the rise in unemployment and the breaking down of the social fabric in many communities following on from the changed government approach."

The research team used a variety of methods including literature review, descriptive analysis of routine data, narrative synthesis, comparative time trend analyses, and arithmetic modelling.

"Given the likely importance of alcohol affordability in driving the downward trend in alcohol-related mortality, any future increase in incomes or decline in prices might be expected to increase alcohol-related harms in Scotland once again, commented Dr. McCartney. "The most recent trends in consumption, harms, and alcohol affordability provide an early indication of this. It is therefore important that a comprehensive range of alcohol control policies is in place to prevent this."

Source: Science Daily, 26th May


Online alcohol marketing linked to drinking among European teens

Adolescents in Europe may be just as susceptible to online alcohol marketing as their counterparts elsewhere, according to a recent study in four countries that links the ads with kids' likelihood of drinking and of binge drinking.

There have been similar results from studies conducted in the U.S., Scotland and the Pacific, said lead author Avalon de Bruijn of the European Center for Monitoring Alcohol Marketing in Heerde, the Netherlands, but “it was a surprise to me that the impact of online advertising was so strong and the exposure so high among young people in these countries.”

Alcohol marketing seems unavoidable on the internet, de Bruijn told Reuters Health by email.

The researchers surveyed more than 9,000 students around age 14 at schools in Germany, Italy, the Netherlands and Poland. About 4,500 kids said they never drank alcohol and were categorized as non-drinkers; all others were categorized as drinkers. In addition, one quarter of all the participants said that they had five or more drinks at once in the past 30 days and were classified as binge drinkers.

The students answered questions about having seen promotional emails or joke emails mentioning alcohol brands and websites for alcohol brands or whose content was about drinking. They were also asked about using mobile phone or computer screensavers containing an alcohol brand name or logo and about having used a profile website on social media that contained an alcohol advertisement.

Two-thirds said they had noticed an alcohol ad online, and one third had used a profile website with an alcohol ad. One fourth received promotional emails containing alcohol advertisements and one in five looked at websites for alcohol brands. The proportion of kids who had downloaded a screensaver featuring an alcohol brand ranged from just under one in three in Italy to one in six in Poland.

In each country, higher exposure to online alcohol marketing was tied to greater odds of being a drinker and of binge drinking, according to the results in Alcohol and Alcoholism.

“Existing research suggests that exposure to alcohol marketing increases the risk of starting to drink and to increase the amount and frequency of drinking among drinkers,” de Bruijn said, though the current study cannot prove that one factor causes the other.

Active engagement with online marketing materials was also found to be more closely linked to drinking behavior than passive exposure to them, the report notes.

All types of alcohol advertising have been tied in past research to higher levels of drinking, de Bruijn said. “However, the impact of online alcohol marketing is especially influential. This might be explained by the interactive and personalized character of online alcohol advertising.”

Past research has also shown that price policies and restricting the number of alcohol vendors in a certain area can reduce binge drinking among youth, she said.

“Given that teens are spending considerable amount of time online, it is not surprising that advertising and marketing are influential in the online realm,” said Dana Litt of the Center for the Study of Health and Risk Behaviors at the University of Washington in Seattle, who was not part of the new study.

But it is possible that adolescents who drink more are seeking out alcohol advertising and marketing more than adolescents who are not drinkers, Litt told Reuters Health by email.

“It may not be feasible to reduce the volume of alcohol marketing teens view online, but it is probably more realistic, at least in the short term, to work on teaching our kids how to be more savvy ‘consumers’ of this alcohol content by teaching media literacy skills,” she said.

Most alcohol advertisers have pledged to voluntarily limit ads targeting teens but the nature of the internet makes it very hard to monitor and enforce these regulations, Litt said.

“In most EU countries the volume of online alcohol advertisements in not regulated by law and only by insufficient voluntary codes by the alcohol industry,” de Bruijn said. “There is a responsibility of EU Member States and the European Union to regulate this in order to protect children and adolescents against harmful exposure to online alcohol advertisements.”

Source: Reuters, 26th May


Health NGOs: Commission 'listened' to industry on alcohol advertising

A new European Commission proposal to reform advertising rules on television and online has opened a new battlefield for health NGOs, advertisers and the alcohol industry.

The Commission presented a new draft proposal last Wednesday (25 May) of the Audiovisual Media Services Directive (AVMSD), which governs EU-wide coordination of national legislation on all audiovisual media, both traditional TV broadcasts and on-demand services.

The objective of the proposed review was to make Europe’s audiovisual media landscape fit for purpose in the digital age.

The AVMSD is the only available EU media regulation on alcohol advertising and has two articles dedicated to it (article 9.1 and article 22).

In order to update the directive, the executive conducted an evaluation of current rules, held a public consultation, and commissioned a study to measure minors’ exposure to alcohol advertising.

The draft proposal focuses on the development of self-and co-regulation to protect minors from alcohol advertising, and does not impose any particular model on member states, who remain free to apply their own system.

Commission “listened” to industry

Several health NGOs, including the European Centre for Monitoring Alcohol Marketing (EUCAM) and the European Public Health Alliance (EPHA), reacted negatively to the executive’s proposal, claiming that it lacked further restrictions on alcohol advertising.

They also accused the executive of “willingly” ignoring a vast body of research showing that alcohol industry self-regulation stands at odds with improving public health.

“This shows how market interests are put above European public health,” the NGOs said in a statement.

EUCAM’s President, Wim van Dalen, told he was very disappointed with the proposals. “This AVMSD is in no way protecting young people against the proven harmful impact of alcohol marketing,” he said suggesting that the Commission gave in to industry pressure.

DG Connect probably listened with big ears to the arguments of the alcohol industry,” he said.

Commission defends its proposal

Currently, the AVMSD prohibits alcohol advertising specifically aimed at minors (on TV and on-demand services) and subjects alcohol advertising on TV to stricter rules. For example, alcohol advertising shall not link alcohol consumption with driving, with enhanced physical performance, with social or sexual success, with therapeutic or sedative effects etc.

Contacted by EurActiv, European Commission spokesperson for the Digital Single Market, Nathalie Vandystadt, said that the draft proposal maintained and improved these rules according to a “problem-driven and evidence-based approach”.

When it comes to alcohol advertising, based on the evidence gathered and a detailed impact assessment, effective measures depend very much on the circumstances of each EU member state, she said, stressing the difficulties of adopting an EU-wide approach.

“For example, as regards limiting the hours during which alcohol advertising can be broadcast (so-called watersheds), the study shows that the time at which children watch TV changes from one member state to the other. It is therefore difficult to have an EU approach. Also watersheds are not always the most efficient solution,” Vandystadt noted.

“If efficiently designed, self and co-regulatory systems can be very effective because they involve and address all relevant stakeholders and in particular the advertising industry,” she concluded.

“Watersheds not always an efficient solution”

EurActiv also spoke with European Commission analysts, who said that watersheds had not always resulted in effective solutions.

“For example, in the Netherlands, which has a watershed, the study shows minors are slightly more exposed to alcohol advertising than in the UK, where they have a co-regulatory system,” a Commission expert said, adding that Denmark, which does not have any statutory restrictions on alcohol advertising other than the minimum ones of the AVMSD, has the second lowest exposure.

“This is indicating the effectiveness of self-regulatory measures, although other factors may also be at play.”

The analyst continued, saying that 24 member states have been active in this domain in order to protect viewers, and in particular minors, from exposure to alcohol advertising – but in very diverse manners, such as including bans on advertising for certain types of alcohol, prohibiting alcohol advertising on certain (public) channels, limiting the hours during which alcohol advertising can be broadcast.

Protecting minors

Commenting on the draft proposal, Adam Gagen, Director of Legal and Public Affairs at the World Federation of Advertisers, said it was important that the European Commission strengthened the call for robust co/self-regulatory systems on alcohol advertising.

“This builds on the detailed rules already in place at EU and national level, and is consistent with the approach taken in the proposal on other key issues,” he told EurActiv, adding that such a system will drive member states, civil society and industry to expand and enhance protections for minors no matter where or how they watch TV.

Gagen said that minors already spend the majority of their time online, and this is only going to increase.

“Much is already being done, but the Commission’s proposal helps to ensure that further action and innovation to protect minors will keep pace with technological developments, and will remain a top priority across the EU,” he added.

Industry satisfied

SpiritsEurope, which represents the spirits and liquor producers in Europe, welcomed the Commission’s proposal saying it favours a healthy policy mix allowing rules to be adapted as rapidly as necessary.

Paul Skehan, Director General of SpiritsEurope, told EurActiv that selling alcohol to minors is illegal, and rightfully so are ads targeted at them.

However, he insisted, commercial communications for alcoholic beverages were framed by strict national regulations, and were supplemented by national self-regulatory codes looking at advertising content and placement.

“In practice, self-regulatory rules applied to marketing communications of spirits drinks go well beyond the provisions in the AVMSD, and apply to all media indistinctively,” he noted.

“By allowing room for effective self and co-regulation to complement statutory legislation, the past AVMSD has allowed us to develop responsive systems,” Skehan said.

Liberalising advertising times

Another aspect of the new proposal is the liberalisation of broadcast advertising times, which for different reasons the World Federation of Advertisers and EUCAM oppose.

Currently, there is a limit of 12 minutes of advertising per hour, a cap that the Commission proposed lifting altogether.

The World Federation of Advertisers believes this particular proposal goes too far, saying it could put viewers’ TV experience at risk.

“The removal of the 20% cap per hour currently in place means that, if member states were to implement such a change, people will likely see far more advertising in and around primetime television, thus interrupting their favourite TV shows and events,” Gagen stated.

For their part, health NGOs fear this liberalisation will increase the possibilities of harmful content for minors.

“Because of a liberalisation of broadcast advertising times, it is possible that minors will be exposed to an even greater number of alcohol advertisements,” EUCAM notes.

Source: EurActive, 1st June


EU countries oppose Irish plans for alcohol health warnings

Irish plans for health warnings on alcohol products are being opposed by several EU countries.

France, Germany, Italy, Netherlands, Slovakia, Austria, Bulgaria, Czech Republic, Poland, Romania and Spain have all raised concerns about Ireland’s Public Health Alcohol Bill.

The legislation includes provisions to prevent the sale of very cheap alcohol, including mandatory health warnings, calorie labelling and a ban on broadcasting ads before 9pm.

The new programme for government includes a commitment to passing the bill, which aims to curb alcohol consumption.

The proposed law was approved last December and is currently at the second stage in the Seanad.

But 11 EU countries, including some of Europe's biggest beer and wine producers, are worried about its possible effect on trade.

Ireland has until the end of July to issue a response to each member state.

Dublin MEP Brian Hayes said today that he was concerned the intervention could delay the legislation.

"Member states must be able to react to ongoing health concerns, which are particular to those member states, in a determined and coordinated way," he said.

"Health concerns and a proper response to Ireland's binge drinking culture are best tackled at a local level irrespective of internal market concerns."

Meanwhile, officials in the Department of Health are continuing to assess the implications of a European Court of Justice judgment on minimum alcohol pricing, which is also included in the bill.

Last December, the court ruled that a Scottish plan to introduce a minimum unit price would breach EU law.

Source: Newstalk news, 29th May

A new analysis concludes that all levels of alcohol use - even light drinking - are associated with raised risk for breast cancer, with higher consumption linked to higher risk. The researchers also summarize the biological mechanism behind the link and the impact on global breast cancer incidence and deaths due to drinking.

The study paper, by Dr. Kevin D. Shield from the International Agency for Research on Cancer (IARC) in Lyon, France, and colleagues, is published in the journal Alcoholism: Clinical and Experimental Research.

The findings address a long-standing debate about whether light alcohol consumption is linked to raised risk of breast cancer.

The link between alcohol consumption and cancer was officially declared in 1987, when a working group of the IARC - an agency of the World Health Organization (WHO) - listed cancers of the oral cavity, pharynx, larynx, esophagus, and liver as "causally related to the consumption of alcoholic beverages."

Since then, many studies have found links between alcohol consumption and breast cancer, and another review in 2007 by the IARC added breast cancer and colorectal cancer to the former list of cancers.

The authors also note that as recently as 2014, studies have revealed convincing evidence that alcohol raises the risk of breast cancer. However, the question of whether light drinking is linked to breast cancer remains somewhat controversial.

The new study is in three parts. First, the authors review and summarize the literature on the biology of the link between alcohol use and breast cancer. Then, they examine evidence about the size of risk and how it relates to levels of alcohol consumption. Finally, they assess the global impact of such a link, with an emphasis on light alcohol consumption.

Source: Medical News Today, 1st June


Unique effects of caffeinated alcohol consumption in adolescents

Heavy joint consumption of highly caffeinated energy drinks and alcohol has become more common among adolescents/young adults, and has been associated with an increase of hazardous behaviors. However, virtually no research has explored caffeine and alcohol co-consumption or its long-term consequences in adolescent animals. This animal study seeks to understand the neurobehavioral consequences of this form of binge drinking, extending a previously established mouse model of voluntary binge caffeine and alcohol co-consumption to explore adolescent consumption and responses into adulthood.

Researchers provided adolescent and adult male C57BL/6J mice with daily limited access to caffeine (0.03% w/v), alcohol (ethanol; 20% v/v), a combined alcohol/caffeine solution, or water for 14 days using a binge-like drinking paradigm called Drinking-in-the-Dark (DID). This concentration of caffeine (0.03% w/v) is similar to that found in common energy drinks such as Red Bull©. Home cage locomotor activity was measured during DID in a subset of mice. Following DID, all mice rested for 18 days so that adolescents reached adulthood, whereupon all mice underwent seven days of continuous access two-bottle choice drinking for 10% (v/v) alcohol or water.

Results show that co-consumption with caffeine significantly increased alcohol intake and resulting blood alcohol concentrations (BACs) in both adolescent and adult mice. In addition, adolescent mice exhibited a uniquely robust locomotor stimulant response to caffeinated alcohol consumption. Together with human findings, these results suggest that caffeine co-consumption with alcohol may increase binge alcohol consumption in adolescents/young adults. Furthermore, this age group may be particularly sensitive to the additive stimulant effects of caffeinated alcohol consumption, an effect that may be related to the high incidence of associated negative outcomes in this population. These observations are particularly concerning given the heightened plasticity of the adolescent brain.

Source: Science Daily, 1st June
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