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Do health ‘days’, ‘weeks’ and ‘months’ achieve anything? Alcohol as a case study

It has become very common for organisations, in Australia and internationally, to adopt specific days, weeks or months to raise awareness and promote action regarding particular health conditions or issues.


Many international days are established by United Nations resolutions. For example, 24 March is World Tuberculosis Day, which is followed closely by World Autism Awareness Day on 2 April. World No-Tobacco Day falls at the end of March (31); World Mental Health Day is on 10 October, and World AIDS Day on 1 December.

In Australia, October is busy, with Foot Health Month, National Nutrition Week (16–22) and the Cancer Council’s Pink Ribbon Day, which supports Australian women affected by breast and gynaecological cancers. Movember, an initially Australian and now international month of focus on men’s health, occurs each November, and White Ribbon Day (25 November) is the headline day for the campaign to prevent men’s violence against women.

Events of widely varying scales and types are held on these days, weeks and months. Some are largely about raising awareness, and involve marches, speeches or other commemorative activities; others also raise funds; and still others encourage direct participation in the issue.

Perhaps the best examples of these ‘participatory’ days and months – and certainly the most numerous, in Australia at least – are those relating to alcohol. In the rest of this article we describe the most prominent of the Australian alcohol-focused days and months, and examine what is known about their effects, preceded by an overview of consumption of alcohol as a health problem.

Alcohol and health.

Most Australians have tried alcohol. People drink socially, while participating in cultural events, as part of religious observance or due to peer influence. Other motivations are pleasure, relaxation, mood alteration, enhanced creativity, intoxication, addiction, boredom, habit, to overcome inhibitions, to escape, forget, or ‘drown sorrows’.

Alcohol consumption is undeniably a part of Australian culture. Nevertheless, alcohol is a direct or indirect cause of considerable harm to health in Australia, affecting families, bystanders and the broader community as well as drinkers themselves.

Alcohol is a central nervous system depressant, and its consumption can have both short-term and long-term health effects. Short-term effects are mainly related to injuries to drinkers or people affected by the drinker’s behaviour. Excessive drinking impairs judgement and coordination, contributing to crime, violence, anti-social behaviour and accidents. Longer-term effects of harmful drinking include chronic conditions such as high blood pressure, cardiovascular disease, liver damage, dementia, mental health problems, alcohol dependence and various cancers.

National Health and Medical Research Council (NHMRC) guidelines for alcohol consumption

  1. For healthy men and women, drinking no more than four standard drinks on a single occasion reduces the risk of alcohol-related injury arising from that occasion.
  2. For children and young people under 18 years of age, not drinking alcohol is the safest option.
    1. Parents and carers should be advised that children under 15 years of age are at the greatest risk of harm from drinking and that, for this age group, not drinking alcohol is especially important.
    2. For young people aged 15−17 years, the safest option is to delay the initiation of drinking for as long as possible.
  3. Maternal alcohol consumption can harm the developing foetus or breastfeeding baby.
    1. For women who are pregnant or planning a pregnancy, not drinking is the safest option.
    2. For women who are breastfeeding, not drinking is the safest option. (Risky drinking can also affect men’s fertility.)

People who consume more than two standard drinks per day (on average, over a 12-month period) are defined as ‘lifetime risky drinkers’. People consuming five or more standard drinks on a single drinking occasion are defined as ‘single-occasion risky drinkers’.

Trends in alcohol consumption.

Recent trends in alcohol use revealed in the National Drug Strategy Household Survey suggest that Australians are becoming more aware of alcohol’s ability to harm their health.

  • The prevalence of daily drinking declined significantly between 2010 and 2013, from 7.2 per cent to 6.5 per cent – the lowest level since 1991.
  • Fewer people aged 12–17 are drinking; the proportion abstaining increased significantly between 2010 and 2013 (from 64 per cent to 72 per cent).
  • Young people are delaying starting drinking: in 2013, the age at which 14–24-year-olds first tried alcohol increased to 15.7 years (from 14.4 years in 1998).
  • In 2013, compared to 2010, fewer Australians exceeded the NHMRC lifetime alcohol risk and single-occasion risk guidelines.
  • The proportion of people who exceeded the NHMRC single-occasion risk guidelines at least once a month declined significantly (from 29 per cent to 26 per cent).

However, the picture is somewhat different for rural and remote communities.

In an earlier article we noted that people who lived outside major cities were 25 per cent more likely to have experienced a substance use disorder (overwhelmingly, alcohol) in their lifetime than their urban counterparts.

Moreover, the National Drug Strategy Household Survey shows that the proportions of people in outer regional and remote and very remote areas drinking at risky levels have not changed over time, despite significant declines for people in major cities and inner regional areas.

 

Table 1 shows how the proportion of the population consuming alcohol at dangerous levels increases with remoteness.

Table 1: Percentage of people consuming alcohol at risky levels, by remoteness classification, 2013

  Major cities Inner regional Outer regional Remote and very remote
Lifetime risk 17 19 23 35
Single-occasion risk 25 27 32 42

Source: National Drug Strategy Household Survey 2013

Alcohol-free campaigns.

Several organisations promote alcohol-free months and days as ways to reduce alcohol-related harm. Some simultaneously raise funds for charitable institutions.
The most prominent Australian alcohol-free campaigns are febfast, Dry July, Ocsober and Hello Sunday Morning.

febfast-logo

febfast.

febfast is an annual health and charity event that encourages people to forgo alcohol in February, while raising money to support young people experiencing alcohol and other drug-related problems. Dr Tessa Hillgrove and Dr Lisa Thomson evaluated febfast, surveying participants in the 2011 program about their perceptions of its effect on their alcohol consumption.

The study found that febfast participants initially reported drinking more often, and more on each occasion, than a separately surveyed representative sample of Australian alcohol drinkers. Nearly twice as many febfast participants reported drinking at levels associated with long-term harm at least once per week in the previous three months (63 per cent versus 34 per cent). Similarly, many more febfast participants drank at levels that risked short-term harm once a week or more often (32 versus 17 per cent).

When interviewed four months after participating in febfast, survey respondents reported that, as a result of their participation, they had more alcohol-free days every week (65 per cent of respondents), reduced the frequency of drinking alcoholic beverages (51 per cent), and were drinking less on each occasion (44 per cent). Most participants (85 per cent) also reported that febfast meant they had saved money, slept better and lost weight.

dj16_what-is-dry-july

Dry July.

Dry July encourages people to give up alcohol for the month of July and simultaneously raise funds for cancer patients and their families and carers.

According to Brett Macdonald, chief executive of Dry July in Australia, a survey of 3000 Dry July participants conducted in August 2015 found 65 per cent believed they had reduced their drinking in the month after participation, and that many reported feeling healthier, sleeping better and becoming more productive.

A survey of participants in Dry July’s equivalent in the United Kingdom, Dry January, found that 78 per cent of those taking the challenge completed a month ‘more or less’ without alcohol (meaning they had only one or two occasions of low-risk drinking). The campaign produced an estimated mean ongoing reduction in usual/habitual alcohol consumption of between 21 per cent and 23 per cent.

A separate study of Dry January participants, also in 2015, involved 102 healthy men and women aged in their forties, many drinking twice the recommended maximum amount of alcohol per week. All had blood tests and liver scans and answered detailed questionnaires.

Four weeks after Dry January, the participants recorded a mean 40 per cent reduction in liver fat and lost about three kilograms in weight. Their cholesterol levels improved and their insulin resistance (a measurement of diabetes risk) fell 28 per cent.

Gautam Mehta, a liver specialist who oversaw the study, said ‘It’s an important study which shows the benefit from a month’s abstinence. What we can’t say is how durable those benefits are.’ Data collected three and six months after Dry January are yet to be published.

ocsober-2016

Ocsober.

Ocsober encourages Australians to give up alcohol in October and help raise funds to teach children how to stand up to the pressures of alcohol abuse.

No data on Ocsober’s effectiveness in reducing alcohol consumption is available. The Ocsober website suggests that Ocsober’s emphasis is on fundraising for education to reduce future alcohol-related harm, rather than on the benefits of participant abstinence, in contrast to febfast and Dry July.

The funds Ocsober generates support Life Education Australia, the largest non-profit provider of drug and health education to Australian children. Every year, Life Education Australia visits 3000 schools and pre-schools, works with 30 000 teachers and connects with over 600 000 children.

hello-sunday-morning_logo_1413249393__01935

Hello Sunday Morning.

Hello Sunday Morning (HSM) describes itself as ‘a movement towards a better drinking culture.’ According to its website, since 2010 HSM has grown to be the largest online movement for alcohol behaviour change in the world.

Hello Sunday Morning’s purpose is to use digital technology to support individuals to change their relationship with alcohol. It has a smartphone app, its own community platform and a blog, and is integrated with Twitter, Facebook, Instagram and other social networking platforms, to which members (over 94 000 in mid-October 2016) can post images and text about their hangover-free Sunday mornings.

In 2015, the Centre for Alcohol Policy Research collected and analysed alcohol consumption and blog data from 345 HSM members to explore how participation affected drinking behaviour. Their research shows that Victorian HSM users reported significant benefits from the program, and that HSM:

  • reduces individuals’ drinking – nearly two-thirds of the sample reported reduced alcohol consumption after the program
  • enables members to share strategies and find social support to reduce alcohol consumption (42 per cent)
  • has other substantial benefits, with 53 per cent of the sample reporting improved physical health and 51 per cent feeling more positive about themselves.

Expert opinion about alcohol campaigns.

Some experts have questioned the value and long-term effects of alcohol abstinence campaigns, while others characterise them as moderately beneficial.

Writing in the British Medical Journal, Professor Ian Hamilton of York University said there was no reliable evidence that anyone would derive long-term benefit from a month of abstinence. ‘People may even think a month off gives them permission to indulge in dangerous binges when they’ve completed the challenge,’ he said. Professor Hamilton concluded that the campaigns were ‘parched of evidence’ of health benefits and could have unintended dangerous consequences, especially for heavy drinkers, who need medical supervision to reduce alcohol use.

When asked about Professor Hamilton’s views for an article in the Sydney Morning Herald, Professor Wayne Hall of Queensland University said that such campaigns were likely to appeal to the many Australians who drink to excess and are therefore at risk of accidents, fights, falls and inappropriate social behaviour, rather than heavy drinkers who need medical assistance to withdraw. He added ‘I think the possible downsides are so remote and the risks so low, that the potential benefits, although modest, are worth it.’

Conclusion.

Alcohol-free months and days are popular methods of reducing alcohol-related harm, both for individuals through reduced personal consumption and for the community as a whole.

The evidence for their effectiveness is best described as moderate, as it is largely based on self-selected samples who supply self-reported data, with little longitudinal measurement and usually no control groups. Similarly, while the evidence for the benefit of a month’s abstinence for individual health is promising, long-term data is needed.

Whatever their shortcomings, alcohol-free campaigns are clearly successful methods of raising awareness of alcohol as a health problem and providing avenues and support for behavioural change. When multiplied across a large population, even a small reduction in individual alcohol consumption is positive for public health.