Publications by authors named "Tanya Chikritzhs"

166 Publications

Alcohol and the Risk of Injury.

Nutrients 2021 Aug 13;13(8). Epub 2021 Aug 13.

National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA 6008, Australia.

Globally, almost four and a half million people died from injury in 2019. Alcohol's contribution to injury-related premature loss of life, disability and ill-health is pervasive, touching individuals, families and societies throughout the world. We conducted a review of research evidence for alcohol's causal role in injury by focusing on previously published systematic reviews, meta-analyses and where indicated, key studies. The review summarises evidence for pharmacological and physiological effects that support postulated causal pathways, highlights findings and knowledge gaps relevant to specific forms of injury (i.e., violence, suicide and self-harm, road injury, falls, burns, workplace injuries) and lays out options for evidence-based prevention.
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http://dx.doi.org/10.3390/nu13082777DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8401155PMC
August 2021

Size does matter: An exploration of the relationship between licensed venue capacity and on-premise assaults.

Alcohol Clin Exp Res 2021 06 22;45(6):1298-1303. Epub 2021 Jun 22.

School of Psychology, Deakin University, Geelong, Vic., Australia.

Aims: Venue capacity has been proposed as a factor associated with increased number of violent incidents on-premises, though no specific research has demonstrated this association, and instead has tended to focus on the relationship between crowding and aggression. The aim of current paper is to investigate the association between venue capacity and the number of violent incidents on-premises.

Methods: Venue capacity data (the maximum capacity listed on the liquor license) were obtained for all venues in central Melbourne from 2010 until 2016. These data were then matched with police-recorded on-premises assaults that occurred within high-alcohol hours (Friday and Saturday 8 pm-6 am) inside the venue.

Results: Analyses were conducted on 5729 venue-years (yearly assault counts per venue, per year) across central Melbourne. Compared with venues that have a maximum capacity of between 0 and 100 patrons, venues with higher capacities have increasingly more recorded assaults. Venues with maximum capacities between 501 and 1000 are 6.1 times more likely to have an assault recorded compared with venues with a maximum capacity between 0 and 100. Further, each additional high-alcohol hour that a venue can be open for is associated with a 72% increase in the number of recorded assaults.

Conclusions: Greater venue capacity was found to be strongly associated with an increased risk of violent incidents for any given venue. This was further exacerbated by late-night trading which substantially adds to the risk of assaults inside the venue.
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http://dx.doi.org/10.1111/acer.14621DOI Listing
June 2021

Patterns of drinking in Aboriginal and Torres Strait Islander peoples as self-reported on the Grog Survey App: A representative urban and remote sample.

Drug Alcohol Rev 2021 Jun 21. Epub 2021 Jun 21.

The University of Sydney, Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Sydney, Australia.

Introduction: Measuring self-reported alcohol use is challenging in any population, including when episodic drinking may be common. Drinking among Indigenous Australians has been shown to vary greatly within and between communities. However, most survey methods assume 'regular' patterns of drinking. National estimates have also been shown to underestimate alcohol use among this group. This paper describes drinking patterns in two representative community samples (urban and remote).

Methods: Indigenous Australians (aged 16+ years) in two South Australian sites were recruited to complete the Grog Survey App. The App is a validated, interactive tablet-based survey tool, designed to help Indigenous Australians describe their drinking. Drinking patterns were described using medians and interquartile ranges; gender and remoteness were compared using Wilcoxon rank-sum tests. Spearman correlations explored the relationship between drinking patterns and age. Logistic regressions tested if beverage or container preference differed by remoteness or gender.

Results: Three-quarters of participants (77.0%, n = 597/775) were current drinkers. Median standard drinks per occasion was 7.8 (78 g), 1.3 drinking occasions per month (median). Three-quarters of current drinkers (73.7%) reported a period without drinking (median: 60 days). Remote drinkers were more likely to drink beer. Improvised containers were used by 40.5% of drinkers.

Discussion And Conclusions: Episodic drinking with extended 'dry' periods and from non-standard drinking containers was common in this representative sample of Indigenous Australians. The diversity of container use and beverage preference, by gender and remoteness, illustrates nuances in drinking patterns between communities. It shows the importance of community-level data to inform local strategies addressing alcohol misuse.
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http://dx.doi.org/10.1111/dar.13333DOI Listing
June 2021

A randomized controlled trial of the effectiveness of combinations of 'why to reduce' and 'how to reduce' alcohol harm-reduction communications.

Addict Behav 2021 10 3;121:107004. Epub 2021 Jun 3.

Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Rd, Melbourne, VIC, Australia. Electronic address:

Introduction: Alcohol is a major source of harm worldwide. The aim of this study was to experimentally assess the effects of exposing Australian adult drinkers to combinations of 'why to reduce' and 'how to reduce' alcohol harm-reduction messages.

Methods: Three online surveys were administered over six weeks: Time 1 at baseline (n = 7,995), Time 2 at three weeks post-baseline (n = 4,588), and Time 3 at six weeks post-baseline (n = 2,687). Participants were randomly assigned to one of eight conditions: (1) a control condition; (2) a 'why to reduce' television advertisement; (3-5) one of three 'how to reduce' messages referring to the following protective behavioral strategies (PBSs): Keep count of your drinks, Decide how many drinks and stick to it, It's okay to say no; and (6-8) the television advertisement combined with each PBS message individually. Intention-to-treat analyses were conducted to determine effects of condition assignment on changes over time in attempts to reduce alcohol consumption and amount of alcohol consumed.

Results: Participants assigned to the 'TV ad' and 'TV ad + Keep count of your drinks PBS' conditions reported significant increases in attempts to reduce alcohol consumption. Only participants assigned to the 'TV ad + Keep count of your drinks PBS' condition exhibited a significant reduction in alcohol consumed (-0.87 drinks per person per week).

Conclusions: Well-executed 'why to reduce' alcohol harm-reduction advertisements can encourage drinkers to attempt to reduce their alcohol consumption. These ads may be effectively supplemented by specific 'how to reduce' messages designed to encourage drinkers to monitor their intake.
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http://dx.doi.org/10.1016/j.addbeh.2021.107004DOI Listing
October 2021

Queensland Alcohol-related violence and Night-time Economy Monitoring (QUANTEM): Rationale and overview.

Drug Alcohol Rev 2021 Jul 18;40(5):693-697. Epub 2021 May 18.

Centre for Health Services Research, The University of Queensland, Brisbane, Australia.

This commentary introduces the special section on the outcomes of the Queensland Alcohol-related violence and Night-time Economy Monitoring project and outlines the political and policy context of the interventions put in place under the Queensland government's Tackling Alcohol-Fuelled Violence strategy. The development of the strategy was informed by alcohol policy initiatives trialled in other major Australian cities over the past two decades. The articles in this special section examine the impact of the Tackling Alcohol-Fuelled Violence policy stages on alcohol-related harms and local economies across selected entertainment precincts (Safe Night Precincts). A rich array of data were utilised, including administrative health and justice data, data reflective of nightlife trading (i.e. foot traffic data, ID scanner data and live music performances) and street surveys. Findings have implications for research, policy and practice and demonstrate the need for comprehensive evaluations that can accommodate the complexities of modern alcohol policy in Australia.
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http://dx.doi.org/10.1111/dar.13270DOI Listing
July 2021

The combined impact of higher-risk on-license venue outlet density and trading hours on serious assaults in night-time entertainment precincts.

Drug Alcohol Depend 2021 06 12;223:108720. Epub 2021 Apr 12.

School of Psychology, Deakin University, Geelong Waterfront Campus, Vic, 3220, Australia.

Background: Night-time entertainment precincts (NEPs) are clusters of higher-risk on-licence venues, that pose a significant burden on health and social order services. Outlet density and trading hours are two of the most well researched contributors to alcohol availability within NEPs; increases in outlet density and late-night trading hours within NEPs have been independently associated with increased assaults. This is the first study to examine both factors across cities to predict alcohol-related assaults.

Methods: Licensing data were used to investigate the effect of outlet density and trading hours on police recorded serious assaults in nine NEPs (9 cross-sectional units) across Queensland from January 2010 to July 2018 at monthly intervals (102 longitudinal units). Multi-level models were used to determine i) whether precinct-level trading hours moderated the relationship between outlet density and serious assaults; and ii) the impact of outlets closing before 12am, 3am, and 5am on serious assaults.

Findings: The positive relationship between outlet density and assaults was stronger in precincts with trading hours ending at 5am compared to 3am (IRR = 1.01, p = 0.03). The amount of venues closing before 12am was associated with reduced numbers of assaults (IRR = 0.97, p = 0.04), while venues closing between 12:01am-3am and 3:01am-5am were associated with increased assaults (IRR = 1.02, p<0.01; IRR = 1.01, p = 0.02).

Conclusions: Late night service of alcohol creates more harm in areas of high outlet density, whereas early closing venues in areas where outlet density is low is associated with reduced number of assaults. This relationship should be taken into account in the development of future alcohol policies.
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http://dx.doi.org/10.1016/j.drugalcdep.2021.108720DOI Listing
June 2021

Attitudinal factors associated with drink counting.

Drug Alcohol Rev 2021 Sep 14;40(6):1056-1060. Epub 2021 Mar 14.

Food Policy Division, The George Institute for Global Health, Sydney, Australia.

Introduction: 'Count your drinks' is a protective behavioural strategy (PBS) that has been found to be effective in reducing alcohol consumption. Previous research has shown that females, older people and low-risk drinkers are more likely to use this strategy, but little is known about the attitudinal factors associated with engaging in drink counting. This information is important for developing effective interventions to encourage use of this PBS. The aim of this paper was to assess whether the following attitudinal factors are associated with frequency of enactment of the 'Count your drinks' PBS: (i) perceived ease of use; (ii) perceived effectiveness; (iii) personal relevance; and (iv) believability.

Methods: A total of 683 Australian drinkers completed an online survey assessing demographic variables, alcohol consumption, frequency of drink counting and attitudes to the 'Count your drinks' PBS. A hierarchical regression analysis was used to determine whether the attitudinal factors were associated with frequency of enactment after controlling for demographic and alcohol-related factors.

Results: Attitudes to the 'Count your drinks' PBS accounted for 28% of the variance in reported frequency of drink counting. Perceptions of personal relevance, ease of use and effectiveness were found to be significantly associated with frequency of enactment.

Discussion And Conclusions: Interventions designed to encourage drinkers to count their drinks should aim to increase the perceived personal relevance, ease of use and effectiveness of this strategy.
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http://dx.doi.org/10.1111/dar.13277DOI Listing
September 2021

The impact of a minimum unit price on wholesale alcohol supply trends in the Northern Territory, Australia.

Aust N Z J Public Health 2021 Feb;45(1):26-33

National Drug Research Institute, Curtin University, Western Australia.

Objective: The Northern Territory (NT) Government introduced a minimum unit price (MUP) of $1.30 per standard drink (10g pure alcohol) explicitly aimed at reducing the consumption of cheap wine products from October 2018. We aimed to assess the impact of the NT MUP on estimates of beverage-specific population-adjusted alcohol consumption using wholesale alcohol supply data.

Methods: Interrupted time series analyses were conducted to examine MUP effects on trends in estimated per capita alcohol consumption (PCAC) for cask wine, total wine and total alcohol, across the NT and in the Darwin/Palmerston region.

Results: Significant step decreases were found for cask wine and total wine PCAC in Darwin/Palmerston and across the Northern Territory. PCAC of cask wine decreased by 50.6% in the NT, and by 48.8% in Darwin/Palmerston compared to the prior year. PCAC for other beverages (e.g. beer) were largely unaffected by MUP. Overall, PCAC across the Territory declined, but not in Darwin/Palmerston.

Conclusion: With minimal implementation costs, the Northern Territory Government's MUP policy successfully targeted and reduced cask wine and total wine consumption. Cask wine, in particular, almost halved in Darwin/Palmerston where the impact of the MUP was able to be determined and considering other interventions. Implications for public health: Implementation of a minimum unit price for retail alcohol sales is a cost-effective way to reduce the consumption of high alcohol content and high-risk products, such as cheap cask wine.
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http://dx.doi.org/10.1111/1753-6405.13055DOI Listing
February 2021

The swinging pendulum of alcohol policy in the Northern Territory.

Anaesth Intensive Care 2021 Jan 18;49(1):8-11. Epub 2021 Jan 18.

School of Population and Global Health, University of Western Australia, Perth, Australia.

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http://dx.doi.org/10.1177/0310057X20986309DOI Listing
January 2021

Pregnancy, partners and alcohol warning labels.

Addiction 2021 08 27;116(8):1949-1951. Epub 2020 Dec 27.

Department of Paediatric Clinical Physiology, The Queen Silvia Children's Hospital, Gothenburg, Sweden.

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http://dx.doi.org/10.1111/add.15369DOI Listing
August 2021

Time for carefully tailored set of alcohol policies to reduce health-care burden and mitigate potential unintended consequences?

Drug Alcohol Rev 2021 01 7;40(1):17-18. Epub 2020 Oct 7.

Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada.

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http://dx.doi.org/10.1111/dar.13185DOI Listing
January 2021

The elusiveness of representativeness in general population surveys for alcohol: Commentary on Rehm et al.

Authors:
Tanya Chikritzhs

Drug Alcohol Rev 2021 02 21;40(2):166-168. Epub 2020 Sep 21.

National Drug Research Institute, Health Sciences, Curtin University, Perth, Australia.

For alcohol researchers, it is increasingly difficult to mount a rational argument for stoically pressing on with well-worn probabilistic survey approaches and analysis of survey data as if representativeness remains assured, particularly when negative consequences for science, society and individuals are foreseeable. Some of the most striking examples of biases in action come from large surveys of marginalised populations that use approaches presupposed to be gold standard. Remarkably ill-suited to their populations of interest, the conspicuous failings of these surveys have, for many years, demanded we find better ways. Work in this area has begun to demonstrate the utility of alternative approaches and solutions that, more likely than not, are transferable to general population surveys.
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http://dx.doi.org/10.1111/dar.13175DOI Listing
February 2021

The elusiveness of representativeness in general population surveys for alcohol: Commentary on Rehm et al.

Authors:
Tanya Chikritzhs

Drug Alcohol Rev 2021 02 21;40(2):166-168. Epub 2020 Sep 21.

National Drug Research Institute, Health Sciences, Curtin University, Perth, Australia.

For alcohol researchers, it is increasingly difficult to mount a rational argument for stoically pressing on with well-worn probabilistic survey approaches and analysis of survey data as if representativeness remains assured, particularly when negative consequences for science, society and individuals are foreseeable. Some of the most striking examples of biases in action come from large surveys of marginalised populations that use approaches presupposed to be gold standard. Remarkably ill-suited to their populations of interest, the conspicuous failings of these surveys have, for many years, demanded we find better ways. Work in this area has begun to demonstrate the utility of alternative approaches and solutions that, more likely than not, are transferable to general population surveys.
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http://dx.doi.org/10.1111/dar.13175DOI Listing
February 2021

Recruiting a representative sample of urban South Australian Aboriginal adults for a survey on alcohol consumption.

BMC Med Res Methodol 2020 07 6;20(1):183. Epub 2020 Jul 6.

Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, King George V Building, 83-117 Missenden Road, Camperdown, NSW, 2050, Australia.

Background: Population estimates of alcohol consumption vary widely among samples of Aboriginal and Torres Strait Islander (Indigenous) Australians. Some of this difference may relate to non-representative sampling. In some communities, household surveys are not appropriate and phone surveys not feasible. Here we describe activities undertaken to implement a representative sampling strategy in an urban Aboriginal setting. We also assess our likely success.

Methods: We used a quota-based convenience sample, stratified by age, gender and socioeconomic status to recruit Indigenous Australian adults (aged 16+) in an urban location in South Australia. Between July and October 2019, trained research staff (n = 7/10, Aboriginal) recruited community members to complete a tablet computer-based survey on drinking. Recruitment occurred from local services, community events and public spaces. The sampling frame and recruitment approach were documented, including contacts between research staff and services, and then analysed. To assess representativeness of the sample, demographic features were compared to the 2016 Australian Bureau of Statistics Census of Population and Housing.

Results: Thirty-two services assisted with data collection. Many contacts (1217) were made by the research team to recruit organisations to the study (emails: n = 610; phone calls: n = 539; texts n = 33; meetings: n = 34, and one Facebook message). Surveys were completed by 706 individuals - equating to more than one third of the local population (37.9%). Of these, half were women (52.5%), and the average age was 37.8 years. Sample characteristics were comparable with the 2016 Census in relation to gender, age, weekly individual income, Indigenous language spoken at home and educational attainment.

Conclusion: Elements key to recruitment included: 1) stratified sampling with multi-site, service-based recruitment, as well as data collection events in public spaces; 2) local services' involvement in developing and refining the sampling strategy; and 3) expertise and local relationships of local Aboriginal research assistants, including health professionals from the local Aboriginal health and drug and alcohol services. This strategy was able to reach a range of individuals, including those usually excluded from alcohol surveys (i.e. with no fixed address). Carefully pre-planned stratified convenience sampling organised in collaboration with local Aboriginal health staff was central to the approach taken.
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http://dx.doi.org/10.1186/s12874-020-01067-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7339418PMC
July 2020

Is foetal alcohol syndrome in children as old as alcohol consumption?

Acta Paediatr 2020 10 1;109(10):1926-1927. Epub 2020 Jul 1.

National Drug Research Institute, Curtin University, Bentley, WA, Australia.

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http://dx.doi.org/10.1111/apa.15416DOI Listing
October 2020

Safety first: Beliefs of older peers supplying alcohol to underage friends.

Health Promot J Austr 2021 Jul 28;32(3):407-415. Epub 2020 Aug 28.

National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.

Issue Addressed: Underage drinkers most commonly source alcohol from older peers. However, few studies have examined older peers' supply-related beliefs and motivations.

Methods: A sample of 270 risky drinkers aged 18-19 years were interviewed in Australia where the legal purchase age is 18. They were asked about their provision to underage friends, awareness of secondary supply legislation (intended to prohibit such supply) and 24 psycho-legal beliefs around supply.

Results: Half (49%) provided alcohol to a 16- to 17-year-old friend to drink at a party they were both attending at least twice a year. Three-quarters reported provision was okay so long as the recipient(s) were in a safe environment, and 46% reported "everyone gives alcohol to teenagers if they are in a safe environment." There was significantly higher agreement that "my friends would think I was mean if I did not give alcohol to a friend under the age of 18" (37%), compared to "my friends would think I was uncool if I did not give alcohol to a friend under the age of 18" (26%). Two thirds (69%) felt more responsible for an underage friend's safety if they provided the alcohol. A multivariate logistic regression revealed supply was more likely if the supplier: was aged 18 compared to 19 (95% CI OR: 1.57, 4.84), male (1.06, 3.27), of a higher SES quintile (1.08, 1.80) and believed alcohol supply to minors was morally acceptable (1.01, 1.33) and normal (1.04, 1.38). Knowledge of regulatory strategies (68%) designed to prevent supply to minors, and their perceived deterrent value did not significantly impact supply.

Conclusions: Supply of alcohol to underage peers was perceived as morally and socially acceptable in a group of 18- to 19-year-old risky drinkers. SO WHAT?: Opportunities include harm reduction initiatives that prioritise caring responsibilities towards friends, as opposed to relying on external enforcement measures alone.
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http://dx.doi.org/10.1002/hpja.378DOI Listing
July 2021

The Association between the Australian Alcopops Tax and National Chlamydia Rates among Young People-an Interrupted Time Series Analysis.

Int J Environ Res Public Health 2020 02 19;17(4). Epub 2020 Feb 19.

Kirby Institute, University of New South Wales, Level 6, Wallace Wurth Building, High Street, Kensington NSW 2052, Australia.

A national tax increase, which became known as the "alcopops tax", was introduced in Australia on the 27th April 2008 on ready-to-drink alcoholic beverages, which are consumed predominantly by young people. The affordability of alcohol has been identified as the strongest environmental driver of alcohol consumption, and alcohol consumption is a well-known risk factor in the spread of sexually transmitted infections via its association with sexual risk-taking. We conducted a study to investigate whether there was any association between the introduction of the tax and changes in national chlamydia rates: (i) notification rates (diagnoses per 100,000 population; primary outcome and standard approach in alcohol taxation studies), and (ii) test positivity rates (diagnoses per 100 tests; secondary outcome) among 15-24 and 25-34-year-olds, using interrupted time series analysis. Gender- and age-specific chlamydia trends among those 35 and older were applied as internal control series and gender- and age-specific consumer price index-adjusted per capita income trends were controlled for as independent variables. We hypothesised that the expected negative association between the tax and chlamydia notification rates might be masked due to increasing chlamydia test counts over the observation period (2000 to 2016). We hypothesised that the association between the tax and chlamydia test positivity rates would occur as an immediate level decrease, as a result of a decrease in alcohol consumption, which, in turn, would lead to a decrease in risky sexual behaviour and, hence, chlamydia transmission. None of the gender and age-specific population-based rates indicated a significant immediate or lagged association with the tax. However, we found an immediate decrease in test positivity rates for 25-34-year-old males (27% reduction-equivalent to 11,891 cases prevented post-tax) that remained detectable up to a lag of six months and a decrease at a lag of six months for 15-24-year-old males (31% reduction-equivalent to 16,615 cases prevented) following the tax. For no other gender or age combination did the change in test positivity rates reach significance. This study adds to the evidence base supporting the use of alcohol taxation to reduce health-related harms experienced by young people and offers a novel method for calculating sexually transmitted infection rates for policy evaluation.
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http://dx.doi.org/10.3390/ijerph17041343DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7068511PMC
February 2020

Understanding risk-based licensing schemes for alcohol outlets: A key informant perspective.

Drug Alcohol Rev 2020 03 16;39(3):267-277. Epub 2020 Feb 16.

National Drug Research Institute, Curtin University, Perth, Australia.

Introduction And Aims: Risk-based alcohol licensing (RBL) has been introduced in several jurisdictions in Australia, New Zealand and Canada with the intention of reducing harm in and around alcohol outlets. RBL involves tailoring licence fees or regulatory agency monitoring levels according to risk criteria such as trading hours, venue size and compliance history. The aim of this study was to document key informant perspectives including their perceptions of the purpose of RBL, how it works and its active ingredients.

Design And Methods: We conducted semi-structured in-depth interviews with 28 key informants, including four government policy makers, four liquor licensing representatives, four local council members, eight police officers, six licensees, one academic and one community advocate from Victoria, Queensland, the Australian Capital Territory and Ontario, Canada. We analysed the transcripts using a thematic approach.

Results: Informants varied in their opinions about whether RBL achieved its objective of reducing alcohol-related harm. They identified difficulties in enforcing the compliance history component of the scheme due to loopholes in legislation as a major shortfall, and the need to apply RBL to packaged liquor (off-licence) outlets. They also discussed the need to consider outlet density associated with the location of a venue when assessing venue risk.

Discussion And Conclusions: RBL schemes vary by jurisdiction and emphasise different components. In general, informants surmised that RBL as implemented has probably had little or no preventive effect but suggested that it may be effective with greater monitoring and penalties large enough to deter bad practice.
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http://dx.doi.org/10.1111/dar.13043DOI Listing
March 2020

Drinking risk varies within and between Australian Aboriginal and Torres Strait Islander samples: a meta-analysis to identify sources of heterogeneity.

Addiction 2020 10 1;115(10):1817-1830. Epub 2020 Apr 1.

Discipline of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW, Australia.

Background And Aims: To reduce health and social inequities, it is important to understand how drinking patterns vary within and between Indigenous peoples. We aimed to assess variability in estimates of Indigenous Australian drinking patterns and to identify demographic and methodological factors associated with this.

Design: A three-level meta-analysis of Australian Aboriginal and Torres Strait Islander ('Indigenous') drinking patterns [International Prospective Register of Systematic Reviews (PROSPERO) no. CRD42018103209].

Setting: Australia.

Participants: Indigenous Australians.

Measurements: The primary outcomes extracted were drinking status, single-occasion risk and life-time risk. Moderation analysis was performed to identify potential sources of heterogeneity. Moderators included gender, age, socio-economic status, local alcohol restrictions, sample population, remoteness, Australian state or territory, publication year, Indigenous involvement in survey design or delivery and cultural adaptations.

Findings: A systematic review of the literature revealed 41 eligible studies. For all primary outcomes, considerable heterogeneity was identified within ( = 51.39-68.80%) and between ( = 29.27-47.36%) samples. The pooled proportions (P) of current drinkers [P = 0.59, 95% confidence interval (CI) = 0.53-0.65], single-occasion (P = 0.34, 95% CI = 0.24-0.44) and life-time (P = 0.21, 95% CI = 0.15-0.29) risk were all moderated by gender, age, remoteness and measurement tool. Reference period moderated proportions of participants at single-occasion risk.

Conclusions: Indigenous Australian drinking patterns vary within and between communities. Initiatives to reduce high-risk drinking should take account of this variability.
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http://dx.doi.org/10.1111/add.15015DOI Listing
October 2020

Effects of Extensions and Restrictions in Alcohol Trading Hours on the Incidence of Assault and Unintentional Injury: Systematic Review.

J Stud Alcohol Drugs 2020 01;81(1):5-23

School of Psychology, Deakin University, Geelong Waterfront Campus, Geelong, Victoria, Australia.

Objective: We undertook a systematic review to assess the effects of extensions and restrictions in trading hours of on- and off-license alcohol outlets. We included new primary studies that help address limitations in previous reviews.

Method: We systematically searched electronic databases and reference lists, up to December 2018, and contacted the authors of eligible studies. Studies were eligible if (a) the design was randomized, or nonrandomized with at least one control site/series; (b) the intervention evaluated extensions or restrictions in trading hours at on- or off-license premises; and (c) the outcome measures were assault, unintentional injury, traffic crash, drink-driving offenses, or hospitalization. Two reviewers independently extracted data using a standard form that included study quality indicators.

Results: After screening 3,857 records, we selected 22 studies for the systematic review, all of which used an interrupted time series design. In the included studies, extension of trading hours concerned on-license premises only, whereas restriction concerned both on- and off-license premises. Extending trading hours at on-license premises was typically followed by increases in the incidence of assault, unintentional injury, or drink-driving offenses. Conversely, restricting trading hours at on- and off-license premises was typically followed by decreases in the incidence of assault and hospitalization.

Conclusions: On balance, this review augments existing evidence that harm typically increases after extensions in on-license alcohol trading hours. It provides new evidence that alcohol-related harm decreases when on- and off-license trading hours are restricted.
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January 2020

Factors Associated with Engagement in Protective Behavioral Strategies among Adult Drinkers.

Subst Use Misuse 2020 8;55(6):878-885. Epub 2020 Jan 8.

School of Psychology, Curtin University, Bentley, Australia.

Protective behavioral strategies (PBSs) have been proposed as useful individual-level approaches to reducing alcohol consumption and alcohol-related harm. However, recent research suggests that few of the recommended PBSs may be effective in reducing longer-term alcohol consumption, with some appearing to result in increased intake over time. To identify factors associated with enactment of specific PBSs to inform alcohol control efforts that aim to encourage the use of effective strategies and attenuate the effects of strategies found to be associated with increased consumption. Australian adult drinkers ( = 2,003; 50% male) completed an online survey assessing their alcohol consumption, frequency of attending drinking venues, enactment of specific PBSs, and demographic characteristics. Greater enactment of the PBS that has previously been found to be associated with reduced alcohol use ('Count your drinks') was found among older respondents and those with lower levels of alcohol consumption. Older respondents were also more likely to enact two of the three PBSs that have been found to be associated with increased alcohol consumption ('Use a designated driver' and 'Leave drinking venues at a pre-determined time'). Results suggest that enactment of specific PBSs may differ according to the individual-level variables of gender, age, and preferred beverage type, and the environmental-level variable of attendance at licensed premises. Randomized trials investigating the effectiveness of PBS interventions among drinker subgroups are needed to determine the extent to which enactment reduces alcohol consumption and alcohol-related harm and whether effects are moderated by the variables assessed in this study.
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http://dx.doi.org/10.1080/10826084.2019.1708944DOI Listing
June 2021

Implications of Cardioprotective Assumptions for National Drinking Guidelines and Alcohol Harm Monitoring Systems.

Int J Environ Res Public Health 2019 12 6;16(24). Epub 2019 Dec 6.

National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia.

The existence and potential level of cardioprotection from alcohol use is contested in alcohol studies. Assumptions regarding the risk relationship between alcohol use and ischaemic heart disease (IHD) are critical when providing advice for national drinking guidelines and for designing alcohol harm monitoring systems. We use three meta-analyses regarding alcohol use and IHD risk to investigate how varying assumptions lead to differential estimates of alcohol-attributable (AA) deaths and weighted relative risk (RR) functions, in Australia and Canada. Alcohol exposure and mortality data were acquired from administrative sources and AA fractions were calculated using the International Model of Alcohol Harms and Policies. We then customized a recent Global Burden of Disease (GBD) analysis to inform drinking guidelines internationally. Australians drink slightly more than Canadians, per person, but are also more likely to identify as lifetime abstainers. Cardioprotective scenarios resulted in substantial differences in estimates of net AA deaths in Australia (between 2933 and 4570) and Canada (between 5179 and 8024), using GBD risk functions for all other alcohol-related conditions. Country-specific weighted RR functions were analyzed to provide advice toward drinking guidelines: Minimum risk was achieved at or below alcohol use levels of 10 g/day ethanol, depending on scenario. Consumption levels resulting in 'no added' risk from drinking were found to be between 10 and 15 g/day, by country, gender, and scenario. These recommendations are lower than current guidelines in Australia, Canada, and some other high-income countries: These guidelines may be in need of downward revision.
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http://dx.doi.org/10.3390/ijerph16244956DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6950575PMC
December 2019

From eye rolls to punches: experiences of harm from others' drinking among risky-drinking adolescents across Australia.

Public Health Res Pract 2019 Dec 4;29(4). Epub 2019 Dec 4.

National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.

Objectives: Exploration of experience of harms due to another person's drinking within a demographic particularly vulnerable to these consequences. Importance of study: Largest sampling of young Australian risky drinkers, who are underrepresented in general population surveys. The range of harms due to others' drinking reported here is more comprehensive than documented elsewhere.

Study Type: Cross-sectional self-report survey.

Methods: Participants were 14-19 years old and screened as being within the riskiest-drinking 25% for their age cohort. The convenience sample of 3465 was recruited primarily by social media advertising. Face-to-face interviews were conducted in all eight Australian capital cities (n = 596), supplemented by online surveys (n = 2869). Past 12-month experience of 13 harms due to others' drinking was assessed by age, gender and perpetrator.

Results: Females were more likely to experience seven harms, mainly characterised by fear and harassment, including being harassed or bothered at a party or some other private setting (41% vs 34% of males, p < 0.001), being given unwanted sexual attention (71% vs 47%, p < 0.001) and being put in fear (33% vs 20%, p < 0.001). Males were more likely to experience three harms, characterised by aggression: being yelled at, criticised or verbally abused (38% vs 33% of females, p = 0.002), being pushed or shoved (42% vs 28%, p < 0.001) and being physically hurt (17% vs 11%, p < 0.001). Teenagers of a legal alcohol-purchase age were more likely to experience harassment in public settings (49% vs 32-34%, p < 0.001) and unwanted sexual attention (66% vs 51-59%, p < 0.001) compared with younger teenagers. Seven of the harms studied were more likely (p < 0.01) to be perpetrated by people the respondents knew, and five (those associated with fear and aggression) were more likely to be perpetrated by strangers.

Conclusion: Young people who are risky drinkers commonly experience multiple harms from others' drinking. Many of these alcohol harms to others are reported here for the first time, as previous studies of adolescent drinking have focused almost exclusively on the harms young people have experienced from their own drinking. This refocusing on the harms caused by the drinking of others may prompt greater community concern and concomitant calls for better alcohol regulation.
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http://dx.doi.org/10.17061/phrp2941927DOI Listing
December 2019

Effects of a Risk-Based Licensing Scheme on the Incidence of Alcohol-Related Assault in Queensland, Australia: A Quasi-Experimental Evaluation.

Int J Environ Res Public Health 2019 11 21;16(23). Epub 2019 Nov 21.

School of Psychology, Deakin University, Geelong Waterfront Campus, Geelong, VIC 3220, Australia.

Amid concerns about increasing alcohol-related violence in licensed premises, Queensland introduced a system of risk-based licensing (RBL) in 2009, the first of five Australian jurisdictions to do so. Under RBL, annual license fees are supposed to reflect the risk of harm associated with the outlet's trading hours and record of compliance with liquor laws. The objective is to improve service and management practices thereby reducing patron intoxication and related problems. Using police data, we defined cases as assaults that occurred during so-called 'high-alcohol hours', and compared a pre-intervention period of 2004-2008 with the post-intervention period 2009-2014. We employed segmented linear regression, adjusting for year and time of assault (high vs. low alcohol hours), to model the incidence of (1) all assaults and (2) a subset that police indicated were related to drinking in licensed premises. We found a small decrease in all assaults (β = -5 per 100,000 persons/year; 95% CI: 2, 9) but no significant change in the incidence of assault attributed to drinking in licensed premises (β = -8; 95% CI: -18, 2). Accordingly, we concluded that the results do not support a hypothesis that RBL is effective in the prevention of harm from licensed premises. There may be value in trialing regulatory schemes with meaningful contingencies for non-compliance, and, in the meantime, implementing demonstrably effective strategies, such as trading hour restrictions, if the aim is to reduce alcohol-related violence.
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http://dx.doi.org/10.3390/ijerph16234637DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6926782PMC
November 2019

Consistency of Drinker Status Over Time: Drinking Patterns of Ex-Drinkers Who Describe Themselves as Lifetime Abstainers.

J Stud Alcohol Drugs 2019 09;80(5):552-556

Centre for Alcohol Policy Research, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia.

Objective: Misclassification of self-reported lifetime abstainers from alcohol has been shown to bias studies that examine the long-term health effects of alcohol, notably the health benefits from moderate drinking. This article uses 16 waves of longitudinal data to examine the consistency of self-reported drinker status.

Method: Participants were drawn from the 17,964 respondents who completed the Household Income and Labour Dynamics in Australia survey in 2016. Of these, 807 participants met the inclusion criterion of completing at least six surveys between 2001 and 2016 and reported that they had never consumed alcohol in 2016. The drinking status of the participants in the previous 15 waves was examined for inconsistencies.

Results: Less than half (44%) of respondents who described themselves as lifetime abstainers in 2016 had consistently given this response in all previous surveys. A further 8% had described themselves as ex-drinkers at some point without reporting any actual consumption, whereas the remaining 48% had reported alcohol consumption in a previous survey. The reported consumption of these respondents was generally low, and most drank rarely. However, 5% of self-reported lifetime abstainers had reported risky levels of consumption in a previous survey.

Conclusions: Most survey respondents who reported that they had never consumed alcohol in 2016 did report consuming at least some alcohol (or at least being an ex-drinker) in previous surveys. Self-report of lifetime abstention may not be accurately separating lifetime abstainers from ex-drinkers, possibly biasing work on the harms and benefits of moderate consumption.
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September 2019

Patterns of drinking in Aboriginal and Torres Strait Islander peoples as self-reported on the Grog Survey App: a stratified sample.

BMC Med Inform Decis Mak 2019 09 5;19(1):180. Epub 2019 Sep 5.

Discipline of Addiction Medicine, Indigenous Health and Substance Use, The University of Sydney, Faculty of Medicine and Health, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, King George V Building 83-117 Missenden Road, Camperdown, New South Wales, 2050, Australia.

Background: The Grog Survey App is a visual and interactive tablet computer-based survey application. It has been shown to be an accurate and acceptable tool to help Indigenous Australians describe what they drink.

Methods: The Grog Survey App was used to enquire into patterns of drinking in a stratified sample of Indigenous Australians in urban and remote/regional sites during testing of the App. The App asked about the last four drinking occasions in the past 12 months, including preferred alcohol types and containers; and symptoms of alcohol dependence, based on ICD-11 descriptions. Drinking patterns are presented here using medians and interquartile ranges, and the thresholds set out by the Australian National and Health and Medical Research Council guidelines. Patterns of consumption are compared by gender and remoteness, using Wilcoxon rank-sum test to compare medians. Logistic regressions tested whether alcohol types and drinking containers varied by remoteness.

Results: In this stratified sample most people either consumed nothing (21.7%), or consumed quantities which placed them at short- (95.6%) or long-term risk (47.8%) of harms. Drinkers in remote areas were more likely to drink beer, but less likely to drink pre-mixed spirits. 'Stubbies' and other beer glasses were popular in urban areas, compared with 'slabs' (cases of beer) in remote/regional areas. The use of improvised containers (i.e. empty juice bottles) did not vary by remoteness. Nearly one in six (15%) current drinkers reported experiencing at least two symptoms of alcohol dependence at least monthly. Average drinks per day was the consumption measure most highly correlated with each dependence symptom (r = 0.34-0.38).

Conclusions: The App was able to capture a wide range of preferred alcohol types and containers, and demonstrate a diversity in how alcohol is consumed. This detail was captured in a relative brief survey delivered using an interactive and appealing tablet computer-based application.
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http://dx.doi.org/10.1186/s12911-019-0879-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6729068PMC
September 2019

Short screening tools for risky drinking in Aboriginal and Torres Strait Islander Australians: modified AUDIT-C and a new approach.

Addict Sci Clin Pract 2019 07 1;14(1):22. Epub 2019 Jul 1.

NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Discipline of Addiction Medicine, Indigenous Health and Substance Use, Faculty of Medicine and Health, The University of Sydney, King George V Building, Level 6, 83-117 Missenden Road, Camperdown, NSW, 2050, Australia.

Background: Alcohol consumption among Indigenous Australians can involve a stop-start pattern of drinking, with consumption well above recommended guidelines on each occasion. Such intermittent drinking patterns can make screening for risky drinking difficult. This study evaluates the ability of several short alcohol screening tools, contained in the Grog Survey Application, to detect short- or long-term risky drinking as defined by Australian guidelines. Tested tools include a modification of Alcohol Use Disorders Identification Test-Consumption (AUDIT-Cm).

Methods: Alcohol consumption was assessed in current drinkers in the past year (n = 184) using AUDIT-Cm and using the last four drinking occasions (Finnish method). Sensitivity and specificity were assessed relative to the Finnish method, for how AUDIT-Cm score (3 + for women, 4 + for men), and how subsets of AUDIT-Cm questions (AUDIT-1m and AUDIT-2m; and AUDIT-3mV alone) were able to determine short- or long-term risk from drinking. Responses to AUDIT-Cm were used to calculate the average standard drinks consumed per day, and the frequency at which more than four standard drinks were consumed on single occasions. Finally, shorter versions of the Finnish method (1, 2, or 3 occasions of drinking) were compared to the full Finnish method, by examining the percentage of variance retained by shorter versions.

Results: AUDIT-Cm has a high sensitivity in detecting at-risk drinking compared with the Finnish method (sensitivity = 99%, specificity = 67%). The combination of AUDIT-1m and AUDIT-2m was able to classify the drinking risk status for all but four individuals in the same way as the Finnish method did. For the Finnish method, two drinking sessions to calculate drinks per drinking occasion, and four to calculate frequency resulted in nearly identical estimates to data on all four of the most recent drinking occasions (r = 0.997).

Conclusions: The combination of AUDIT-1m and AUDIT-2m may offer advantages as a short screening tool, over AUDIT-3mV, in groups where intermittent and high per occasion drinking is common. As an alternative to the full Finnish method, the quantity consumed on the last two occasions and timing of the last four occasions may provide a practical short screening tool.
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http://dx.doi.org/10.1186/s13722-019-0152-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6600888PMC
July 2019

Risk-based licensing of alcohol venues and emergency department injury presentations in two Australian states.

Int J Drug Policy 2019 08 22;70:99-106. Epub 2019 Jun 22.

School of Psychology, Deakin University, Geelong, Australia.

Background: Risk-based licensing (RBL) is among the more recent policy interventions to reduce alcohol-related harm in and around licensed venues. RBL sets licence fees to reflect the venue's propensity to cause harm as a means of encouraging operators to improve their practices. We assessed whether the introduction of RBL in the Australian states of Queensland and Victoria was associated with a reduction in the incidence of emergency department (ED) injury presentations.

Methods: We employed an interrupted time series design using Prais-Winsten and Cochrane-Orcutt regression modelling to estimate step and slope parameters in injury incidence rates in each state. We defined the population as residents of the state, aged 15-54 years, the age group we considered most likely to be exposed to the night-time economy. To reduce noise, we confined cases to presentations during times previously identified as correlated with a high probability of alcohol involvement, namely 'high alcohol hours' (HAH). We adjusted our models for the alcopops tax, implemented shortly before RBL, and for assaults during low alcohol hours (LAH) as a proxy for other risk factors for assault.

Results: RBL was not associated with an overall reduction in the incidence of ED injury presentations during HAH in Queensland (β = 0.003; 95% CI: -0.010, 0.003, p = 0.318) or Victoria (β=-0.010; 95% CI: -0.021, 0.001, p = 0.087). Post-hoc subgroup analyses showed a reduction in ED injury presentations among men aged 20-39 years in Victoria (β=-0.026; 95% CI:-0.012, -0.040, p-0.0003) but this was not replicated in Queensland.

Conclusion: There was little evidence that RBL affected the incidence of ED presentations for injury. This may be due to weak financial penalties being applied to venues assessed as high-risk.
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http://dx.doi.org/10.1016/j.drugpo.2019.06.014DOI Listing
August 2019

Alcohol supply as a favour for a friend: Scenarios of alcohol supply to younger friends and siblings.

Health Promot J Austr 2020 Jan 26;31(1):112-120. Epub 2019 Jun 26.

National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.

Issues Addressed: Adolescents under the legal purchase age primarily source their alcohol through social networks. This study assessed the provision context from the perspective of both underage recipients and their suppliers who were older peers and siblings.

Methods: Interviewer-administered surveys were conducted with 590 risky-drinking (50 g alcohol per session, at least monthly) adolescents. Participants of legal purchase age (18- to 19-year-olds; n = 269) reported their provision to 16- to 17-year-olds under eight scenarios. Those aged 14-17 (n = 321) reported receipt of alcohol under the same scenarios plus two parental supply contexts.

Results: Purchase-age participants reported supply: to an underage friend (67%), an acquaintance (44%) or a sibling (16%) to drink at the same party; to a friend (43%) or sibling (20%) to take to another party (20%) and to a stranger near a bottle shop (5%). Supply to a friend at the same party was more likely if money was exchanged (60% vs 40%; P < 0.001). Almost all (98%) 14- to 17-year-olds reported receiving alcohol from an adult (including 36% from a parent for consumption away from the parent), with a similar pattern of receipt scenarios as those reported by the 18- to 19-year-olds.

Conclusions: Provision of alcohol was more frequent with a friend than a sibling or stranger, in close environmental proximity, and if money was exchanged. SO WHAT?: As supply may be sensitive to monetary considerations, the incidence of underage receipt may be affected by community-wide pricing measures. Traditional alcohol availability regulations should be supplemented by strategies relating to the social nature of supply and demand.
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http://dx.doi.org/10.1002/hpja.264DOI Listing
January 2020

Asking about the last four drinking occasions on a tablet computer as a way to record alcohol consumption in Aboriginal and Torres Strait Islander Australians: a validation.

Addict Sci Clin Pract 2019 05 1;14(1):15. Epub 2019 May 1.

NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Discipline of Addiction Medicine, Faculty of Medicine and Health, The University of Sydney, King George V Building, 83-117 Missenden Road, Camperdown, NSW, 2050, Australia.

Background: Alcohol consumption among Indigenous Australians can be irregular, depending on social and geographic context. The Finnish method uses the last four drinking occasions to estimate drinking quantity and pattern. The Grog Survey App is an interactive and visual tablet computer application which uses touch-screen technology to deliver questions on drinking.

Methods: Alcohol consumption recorded on the Grog Survey App using the last four occasions (Finnish) method was compared with a clinical interview conducted by an Indigenous Australian health professional. To assess convergent validity, Spearman's ranked correlations between consumption estimates from the App and from interview were calculated. Sensitivity and specificity analyses were used to compare how well the App and clinical interview agreed when classifying drinkers' risk. To assess criterion validity, average grams alcohol per day as estimated by the App (and by interview) were compared against presence of self-reported withdrawal tremors (from App or interview). Test-retest reliability was assessed by correlations between measures of alcohol consumption recorded on two occasions.

Results: The App recorded higher numbers of standard drinks consumed per drinking occasion than the interview. There was reasonable agreement between the App and interview across common reference periods (sensitivity 92.7%, specificity 69.8%, short-term risk; sensitivity 70.7%, specificity 68.8%, long-term risk). Average consumption recorded by the App was as good or better predictor of withdrawal tremors than consumption as estimated by interview.

Conclusions: The Finnish method, as delivered by the App, offers an innovative way to collect survey data on alcohol in a population with an intermittent drinking pattern.
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http://dx.doi.org/10.1186/s13722-019-0148-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6492339PMC
May 2019
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