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Item A mixed-methods evaluation of an intervention for enhancing alcohol screening in adults aged 50+ attending primary health care(CSIRO Publishing on behalf of The Royal New Zealand College of General Practitioners, 2025-01-02) Towers A; Newcombe D; White G; McMenamin J; Sheridan J; Rahman J; Moore A; Stokes TIntroduction Adults aged 50 years and over are drinking more than ever but primary health care (PHC) professionals find it challenging to screen them for alcohol-related harm, despite being at greater risk for harm than younger drinkers. Aim This intervention aimed to enhance alcohol screening for this cohort by (a) introducing an algorithm in the patient management system to automate detection of alcohol risk in patients and (b) providing training to support health professionals' practice of, knowledge about, and comfort with alcohol screening in this cohort. Methods Eleven PHC practices in Aotearoa New Zealand took part in this intervention, including 41 PHC health professionals. Development and integration of the automated alcohol screening process within PHC patient management systems was undertaken in parallel with health professional training approaches. Results Screening rates increased substantially at intervention initiation but fell immediately with the onset of the New Zealand COVID-19 national lockdown. Two-thirds of health professionals identified the system screening prompts, over 40% felt this changed their screening practice, and 33% increased their awareness of - and felt more comfortable screening for - alcohol-related risk in those aged 50+. Discussion We illustrated an initial increase in alcohol screening rates in those aged 50+ as a result of this intervention, but this increase could not be sustained in part due to COVID-19 disruption. However, health professionals indicated that this intervention helped many change their practice and enhanced their awareness of such risk and comfort in screening for alcohol-related risk in those aged 50+.Item Assessing alcohol industry penetration and government safeguards: the International Alcohol Control Study(BMJ Publishing Group, 2024-11-24) Leung JYY; Casswell S; Randerson S; Athauda L; Banavaram A; Callinan S; Campbell O; Chaiyasong S; Dearak S; Dumbili EW; Romero-García L; Gururaj G; Kalapat R; Karki K; Karlsson T; Kong M; Liu S; Maldonado Vargas ND; Gonzalez-Mejía JF; Naimi T; Nthomang K; Oladunni O; Owino K; Herrera Palacio JC; Phatchana P; Pradhan PMS; Rossow I; Shorter G; Sibounheuang V; Štelemėkas M; Son DT; Vallance K; van Dalen W; Wettlaufer A; Zamora A; Jankhotkaew J; Veitch EBACKGROUND: The alcohol industry uses many of the tobacco industry's strategies to influence policy-making, yet unlike the Framework Convention on Tobacco Control, there is no intergovernmental guidance on protecting policies from alcohol industry influence. Systematic assessment of alcohol industry penetration and government safeguards is also lacking. Here, we aimed to identify the nature and extent of industry penetration in a cross-section of jurisdictions. Using these data, we suggested ways to protect alcohol policies and policy-makers from undue industry influence. METHODS: As part of the International Alcohol Control Study, researchers from 24 jurisdictions documented whether 22 indicators of alcohol industry penetration and government safeguards were present or absent in their location. Several sources of publicly available information were used, such as government or alcohol industry reports, websites, media releases, news articles and research articles. We summarised the responses quantitatively by indicator and jurisdiction. We also extracted examples provided of industry penetration and government safeguards. RESULTS: There were high levels of alcohol industry penetration overall. Notably, all jurisdictions reported the presence of transnational alcohol corporations, and most (63%) reported government officials or politicians having held industry roles. There were multiple examples of government partnerships or agreements with the alcohol industry as corporate social responsibility activities, and government incentives for the industry in the early COVID-19 pandemic. In contrast, government safeguards against alcohol industry influence were limited, with only the Philippines reporting a policy to restrict government interactions with the alcohol industry. It was challenging to obtain publicly available information on multiple indicators of alcohol industry penetration. CONCLUSION: Governments need to put in place stronger measures to protect policies from alcohol industry influence, including restricting interactions and partnerships with the alcohol industry, limiting political contributions and enhancing transparency. Data collection can be improved by measuring these government safeguards in future studies.Item Exploring the substitution of cannabis for alcohol and other drugs among a large convenience sample of people who use cannabis.(BioMed Central Ltd, 2024-11-05) Wilkins C; Romeo J; Rychert M; Graydon-Guy TBackground The substitution of cannabis for alcohol and other drugs has been conceptualised in a harm reduction framework as where cannabis is used to reduce the negative side-effects, addiction potential, and social stigma of other drugs. There is currently mixed evidence with recent reviews suggesting cannabis co-use patterns may vary by age and ethnicity. Yet few studies have had large enough samples to examine this demographic variation in detail. Aims To explore the co-use of cannabis with alcohol and other drugs within demographic subgroups of a large sample of people who use cannabis. Specifically: (1) whether cannabis is being substituted for other drugs, and (2), whether cannabis use leads to more, less or the same level of other drug use. Method Online convenience survey promoted via Facebook™ completed by 23,500 New Zealand respondents. Those who had used cannabis and any of eight other substances in the same six-month period were asked if their use of cannabis had any impact on their use of each other substance (“a lot more”, “little more”, “no impact/same”, “little less”, “a lot less”). Frequency and quantity used of each other drug was compared by co-use group. Generalised logistic regression models were developed to predict co-use categories. Results Significant proportions reported cannabis use led to “less” alcohol (60%), synthetic cannabinoid (60%), morphine (44%) and methamphetamine (40%) use. Those who reported using “less” had lower frequency and amount used of other drugs. Approximately seven-out-ten reported cannabis use had “no impact” on LSD, MDMA, and cocaine use. One-in-five reported using cannabis led to “more” tobacco use. Young adults (21–35-years) were more likely to report cannabis use led to “less” drinking and methamphetamine use. Adolescent co-users (16–20 years) reported mixed impacts. Māori were more likely to report cannabis use resulted in “less” alcohol, tobacco, methamphetamine, and LSD use. Students and those living in cities were less likely to report cannabis use lowering use of other substances. Conclusion Cannabis and other drug co-use patterns are moderated by life stages, lifestyles, cultural perspectives, and urbanicity. Harm reduction initiatives and policy reforms should take account of these moderating factors.Item The impact of alcohol pricing policies on public health in Hong Kong, China: A modelling study.(Elsevier B.V., 2022-06-24) Ng CS; Au M; Ma R; Leung JYY; Quan JBackground Contrary to most developed economies, Hong Kong has reduced and eliminated taxes on beer and wine over the last 15 years and observed increasing alcohol consumption. Methods We applied econometric epidemiological modelling to assess the impact of reverting ad valorem taxation to pre-2008 levels (20% on wine and 40% on beer) on consumption and health outcomes. We used 15 years of industry sales and pricing data (2004-2018) to derive 25 own-price and cross-price elasticity estimates. We applied risk functions from the World Health Organization 2018 Global Status Report to assess the impact on 25 alcohol-attributable conditions. Findings An estimated 616 deaths (91.3% in men) were attributable to alcohol in 2018. Raising taxes to pre-2008 levels is estimated to reduce consumption of pure alcohol consumption by 8.0%, 15.9%, and 31.1%; and reduce alcohol-attributable deaths by 11.6%, 21.8%, and 40.2% assuming 25%, 50% and 100% pass through rates of taxes to consumers. The largest projected decreases in alcohol-attributable mortality in absolute numbers are alcohol abuse, alcohol dependence, and alcoholic psychoses (wholly alcohol-attributable disorders). The largest absolute number of new alcohol-attributable cases in 2018 were hypertension, alcohol dependence and alcohol abuse; which are estimated to be reduced by 31.3%, 34.2%, and 34.3% respectively by raising taxes to pre-2008 levels. The alcohol-attributable health burden and absolute reductions in health harms are far greater in men. Interpretation Reversing the 2008 alcohol tax reductions is potentially effective in averting the alcohol-attributable health burden and thus mitigate against the avoidable harms of alcohol-related disease. Funding Health and Medical Research Fund, Food and Health Bureau of the Hong Kong SAR, China [03170067].Item The drinking patterns of older New Zealanders: National and international comparisons(Health promotion Agency, 2017-12-01) Towers A; Sheridan J; Newcombe DItem Alcohol problems and socio-economic status : a regional study : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Sociology at Massey University(Massey University, 1981) Pitcher, DouglasThe problem was to explore the apparent relations between occupational status and drinking behaviour and to resolve, if possible, the confusions about which status positions were most likely to consume alcohol and experience problems. The thesis investigates the hypothesis that people occupying high status positions are more vulnerable to high levels of alcohol consumption and alcohol related problems. It was presumed that ranking occupations in terms of the Elley-Irving SES scale, and educational attainment would permit the test of this assumed relationship. The study focused on a sample of 869 males selected from a larger survey of health related issues in the five counties which comprise the Wanganui Hospital Board's area. All males over 15 years of age, employed in a full time occupation who were, or ever had been regular drinkers were interviewed about their levels of consumption, and any alcohol related problems they may have experienced. The general trend of the findings suggested an association between alcohol misuse and low SES. A higher percentage of low status drinkers worried about their drinking; regarded themselves as heavy drinkers; were regarded by others as heavy drinkers; and indicated heavy patterns of consumption (400 + grams of alcohol per week). No relationship between SES and regular drinking was found, although a positive association between regular drinking and educational attainment was suggested. The lack of statistical significance restricts the extent to which we can draw any clear inferences as to the nature of the relationships involved. In conclusion it could be stated that although the findings are not significant they suggest occupational vulnerability is more characteristic of low status occupations. Certain methodological inadequacies make it impossible to draw any firm conclusions concerning alternate hypotheses, for example that low SES positions are more vulnerable. Overreporting by the low SES group, and underreporting by those of high status may have biased the findings. An alternative theory is proposed to the effect that both ends of the status occupational hierarchy are characterised by high vulnerability.Item The effects of ethanol on catecholamine and serotonin metabolism in man : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Biochemistry at Massey University(Massey University, 1981) Cook, Neil JamesChemical and gas chromatographic methods for the estimation of catecholamine and serotonin metabolites in normal urine have been investigated with the aim of applying them to the study of the effects of ethanol on biogenic amine metabolism. It was concluded that both methods would be incapable of accurately demonstrating any changes in urinary metabolite levels that were expected to occur as a consequence of ethanol ingestion. A GCMS technique for quantitating five acidic catecholamine and serotonin metabolites was developed, and was found to exhibit excellent specificity and sensitivity. When applied to the analysis of alcoholic metabolites, the technique was subject to interference from extraneous compounds, and further development is required. The GCMS technique was applied to the analysis of catecholamine and serotonin metabolites in the urine of normal male adults who had ingested ethanol. It was concluded that ethanol induces a shift in metabolism away from oxidative toward reductive pathways for adrenaline, noradrenaline and serotonin, but not for dopamine. An increased HVA excretion observed after ethanol ingestion was shown to be possibly due to the diuretic effect of ethanol. This work provides a clarification of the diverse results previously reported in the literature, but it was, however, concluded that there are still several aspects of this field of alcohol research that require estensive investigation before a complete understanding of the ways in which ethanol influences catecholamine and serotonin metabolism can be achieved.Item The immobilization of Kluyveromyces fragilis and Saccharomyces cerevisiae in polyacrylamide gel : a thesis presented in partial fulfilment of the requirements for the degree of Master of Technology in Biotechnology at Massey University(Massey University, 1980) Dillon, Judith AnnThe search for new energy sources has indicated that biomass, in the form of green plant materials and biological wastes, can provide a perpetual energy source if converted to a useful form. This study investigated the production of ethanol by the fermentation of sugars using immobilized cells. The experimental procedure involved the immobilization of two yeast species, Kluyveromyces fragilis NRRL Y 1109 and Saccharomyces cerevisiae NCYC 240, in polyacrylamide gel for the fermentation of lactose and glucose respectively. The gel methodology of two previous authors, Chibata et al. (1974) and Neuhoff (1973) was used. The former author's gel was used as a basis for batch experiments to determine the gel composition for maximum ethanol producing activity by both cell species as initial trials with this gel yielded encouraging results. Variations in monomer, BIS and cell concentration revealed that a gel containing 15% (w/v) acrylamide, 1.5% (w/v) BIS and 25% (w/v) cells in addition to 0.6% (w/v) BDMAP and 0.25% (w/v) ammonium persulfate in tris-HCl buffer pH 7.1 polymerised at 0°C produced the greatest activity in immobilized K. fragilis cells with an activity retention for immobilization of 80%. The gel composition for greatest activity in immobilized S. cerevisiae cells differed only slightly from that above containing 20% (w/v) acrylamide, 1.6% (w/v) BIS and 40% (w/v) cells and resulted in a 46% activity retention for immobilization. Further experiments at various substrate concentrations indicated that the gel imposed small or negligible limitations on the diffusion of substrate and product. Experiments to increase the cell activity retention for the immobilization of S. cerevisiae using the Neuhoff (1973) gel were unsuccessful but produced some important results. It was found that exposure to gel components, especially to the acrylamide monomer, reduced the ethanol producing ability and the viability of the cells. The general protective agents Tween 80, glycerol, gelatin and dithiothreitol proved ineffective. To minimize this damage to the cells the gels were polymerised at 0°C with rapid polymerisation being induced by high initiator and accelerant concentrations. Repeated use of the immobilized cells indicated that the simple substrate medium, of the suqar in distilled water used previously, was not sufficient to maintain stable ethanol producing activity. Although trials involving supplementation with a salt solution were unsuccessful, the incorporation 0.5% (w/v) peptone in the medium and the use of protein-containing media, such as whey, was found to stabilize activity. Experiments in continuous processing revealed that immobilized K. fragilis cells produced ethanol from deproteinised whey at an efficiency of 70 to 80% over extended periods with complete substrate utilization of full strength whey being achieved at flowrates of 0.15 SV. The half life of the activity of the immobilized cells was estimated to be at least 50 days. The experimental results suggest that this approach to fermentation may be industrially acceptable for the production of ethanol. However, a costing exercise on the production of ethanol from whey indicates that unless the product is a highly priced commodity, such as a pharmaceutical, the process is unlikely to be economically feasible due to the high cost of the immobilization support monomer.Item Biochemical and haematological aspects of ethanol metabolism in humans : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Biochemistry at Massey University, New Zealand(Massey University, 1983) Kwok, Hon WingMacrocytosis or raised mean cell volume (MCV) (which as measured by the Coulter S counter) is one of the results of alcohol abuse. There is a need to identify (chronic) alcoholics by laboratory tests. The obvious measurement of blood alcohol is not suitable as ethanol is so rapidly cleared from the body. It is usually undetectable 2 – 3 hours after drinking. To this the following battery of tests: MCV, fast haemoglobin, gamma glutamyl transferase and thiamine, have been examined These tests which were performed, on a population consisting of 115 random hospital patients, 14 patients attending diabetic clinic and 13 'normal' volunteers. For ethical reasons it was not possible to obtain samples from known alcoholics. Instead those samples which contained red cells above 92 fl of MCV were suspected of including alcoholics and correlated with other parameter which may be assumed to be elevated in alcoholics. The results showed that there were 23 abnormal findings likely to be associated with heavy drinkings in 70 bloods selected for high MCV.Item The acetone butanol ethanol fermentation : preliminary studies on some practical aspects : a thesis presented in partial fulfilment of the requirements for the degree of Master of Technology in Biotechnology(Massey University, 1982) Gapes, James RichardThe dilute nature of solvents at the end of fermentation and slow overall rate of fermentation are major economic burdens on a commercial plant producing acetone, butanol, and ethanol. A preliminary feasibility costing of such a plant showed the cost of fermenters represents almost 50% of the total purchased equipment cost, and emphasised the need for improvements in the fermentation. Experiments were performed in 10-litre and 30-litre pressure vessels, a 1.5-litre vessel at atmospheric pressure, and trial runs in 100 ml bottles. Good correlations were found for the different fermentation headspace pressures (100 to 250 kPa abs.) and minimum observed pH's (pH 4.2 to pH 4.65) with final butanol yields (0.92 to 11.6 g/1); increases in both parameters correlating with increased butanol concentration. Ethanol was found to be correlated with pressure only, and acetone with neither parameter directly. Other chemical species present in the broth were also correlated with each other. It was found that a tree diagram drawn using the strongest correlations resembled closely the known metabolism of the organism in terms of the metabolic pathways, specification of active forms of the metabolites, and effect of external influences. Use of multiple linear regression in this manner was named The Factor Correlation Method, and is potentially useful for research on metabolism and similar investigation on a much broader basis. Application of this technique showed that the pressure effect was possibly due to more than a single metabolic cause, and further experiments also emphasised the complex nature of the pressure effect. The experimental work also highlighted the potential hazard of culture degeneration leading to substandard fermentation yields and eventual nonviability. Discussion on the experimental results and of the literature suggests the phenomenon is due to infection by lysogenic phage rather than spontaneous mutation, and an approximate model based on simultaneous partial differential equations parallels some observed characteristics of the phenomenon. Other topics include theoretical exercises with laboratory work on the water tolerance of methanol-petrol mixtures, the error associated with cell enumeration using a haemocytometer, and evaluation of growth and solvent production characteristics and some relevant parameters.