Aims To examine country differences in reasons for abstaining including the association of reasons with country abstaining rate and drinking pattern. Participants Samples of men and women from eight countries participating in the GENACIS (Gender Alcohol and Culture: an International Study) project.

Methods Surveys were conducted with 3338 life-time abstainers and 3105 former drinkers. Respondents selected all applicable reasons for not drinking from a provided list. Analyses included two-level hierarchical linear modelling (HLM) regression.

Findings Reasons for abstaining differed significantly for life-time abstainers compared to former drinkers, by gender and age, and by country-level abstaining rate and frequency of drinking. Life-time abstainers were more likely than former drinkers to endorse 'no interest', 'religion' and 'upbringing' and more reasons overall. Gender differences, especially among former drinkers, suggested that norms restricting drinking may influence reasons that women abstain ('no interest', 'not liking taste') while drinking experiences may be more important considerations for men ('afraid of alcohol problems', 'bad effect on activities'). Younger age was associated with normative reasons ('no interest', 'taste', 'waste of money') and possibly bad experiences ('afraid of problems'). Reasons such as 'religion', 'waste of money' and 'afraid of alcohol problems' were associated with higher country-level rates of abstaining. Higher endorsement of 'drinking is bad for health' and 'taste' were associated with a country pattern of less frequent drinking while 'not liking effects' was associated with higher drinking frequency.

Conclusions Reasons for abstaining depend on type of abstainer, gender, age and country drinking norms and patterns.

Alcohol consumption causes injury in a dose-response manner. The most common mode of sustaining an alcohol-attributable injury is from a single occasion of acute alcohol consumption, but much of the injury literature employs usual consumption habits to assess risk instead. An analysis of the acute dose-response relationship between alcohol and injury is warranted to generate single occasion- and dose-specific relative risks. A systematic literature review and meta-analysis was conducted to fill this gap. Linear and best-fit first-order model were used to model the data. Usual tests of heterogeneity and publication bias were run. Separate meta-analyses were run for motor vehicle and non-motor vehicle injuries, as well as case-control and case-crossover studies. The risk of injury increases non-linearly with increasing alcohol consumption. For motor vehicle accidents, the odds ratio increases by 1.24 (95% CI: 1.18-1.31) per 10-g in pure alcohol increase to 52.0 (95% CI: 34.50-78.28) at 120 g. For non-motor vehicle injury, the OR increases by 1.30 (95% CI: 1.26-1.34) to an OR of 24.2 at 140 g (95% CI: 16.2-36.2). Case-crossover studies of non-MVA injury result in overall higher risks than case-control studies and the per-drink increase in odds of injury was highest for intentional injury, at 1.38 (95% CI: 1.22-1.55). Efforts to reduce drinking both on an individual level and a population level are important. No level of consumption is safe when driving and less than 2 drinks per occasion should be encouraged to reduce the risk of injury.

AIM - This paper assesses alcohol policies and interventions in Finland and the Canadian province of Ontario, using the policy options and interventions recommended in WHO's Global strategy to reduce the harmful use of alcohol (2010).

DATA & METHODS - The information and data are based on archival sources, surveys, legislative and government documents, and published papers. The paper assesses both jurisdictions on 10 areas in the WHO document and their sub-topics: 1. leadership, 2. health services response, 3. community action, 4. drinking and driving policies and countermeasures, 5. availability of alcohol, 6. marketing of alcoholic beverages, 7. pricing policies, 8. reducing the negative consequences of drinking and alcohol intoxication, 9. reducing the public health impact of illicit alcohol and informally produced alcohol, and 10. monitoring and surveillance.

RESULTS - Ontario had several recent noteworthy developments in line with WHO recommendations: health services response, controls of drinking and driving, pricing policies, reducing the negative consequences of drinking and intoxication, and monitoring and surveillance. Finland has emphasised pricing policies in recent years, and there have also been significant developments in community action, controls of drinking and driving, alcohol advertising, and monitoring and surveillance.

CONCLUSIONS - Challenges and opportunities for strengthening the policy responses are noted, as well as topics for future research.

BACKGROUND: Given the recent international debates about the effectiveness and appropriate age setpoints for legislated minimum legal drinking ages (MLDAs), the current study estimates the impact of Canadian MLDAs on mortality among young adults. Currently, the MLDA is 18 years in Alberta, Manitoba and Quebec, and 19 years in the rest of Canada.

METHODS: Using a regression-discontinuity approach, we estimated the impacts of the MLDAs on mortality from 1980 to 2009 among 16- to 22-year-olds in Canada.

RESULTS: In provinces with an MLDA of 18 years, young men slightly older than the MLDA had significant and abrupt increases in all-cause mortality (14.2%, p=0.002), primarily due to deaths from a broad class of injuries [excluding motor vehicle accidents (MVAs)] (16.2%, p=0.008), as well as fatalities due to MVAs (12.7%, p=0.038). In provinces/territories with an MLDA of 19 years, significant jumps appeared immediately after the MLDA among males in all-cause mortality (7.2%, p=0.003), including injuries from external causes (10.4%, p<0.001) and MVAs (15.3%, p<0.001). Among females, there were some increases in mortality following the MLDA, but these jumps were statistically non-significant.

CONCLUSIONS: Canadian drinking-age legislation has a powerful impact on youth mortality. Given that removal of MLDA restrictions was associated with sharp upturns in fatalities among young men, the MLDA likely reduces population-level mortality among male youth under the constraints of drinking-age legislation. Alcohol-control policies should target the transition across the MLDA as a pronounced period of mortality risk, especially among males.

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