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Abstract
Alcohol is a widely used and socially acceptable drug. Its misuse contributes to considerable individual and community level harm. This harm represents a major public health issue and is one of the leading causes of preventable mortality, morbidity and injury in many developed countries. Despite limited research in rural and regional areas there is evidence of disproportionate alcohol consumption and related harm.
A postal survey was designed and implemented in twenty regional communities in NSW, Australia. Methods to improve response rates were incorporated. The results of a randomised controlled trial (Chapter 2) suggest a follow-up telephone call is not a cost- effective strategy to improve response rates when additional surveys have been sent to non-responders.
The results of the large survey of regional residents on patterns of alcohol consumption (Chapter 3) provide evidence of higher levels of risky drinking in regional areas. Excessive drinking on a single occasion is disproportionately high. Data on the effect of alcohol on people other than the drinker indicate the „second-hand effects‟ of alcohol are significant.
Differences between regional communities were examined (Chapter 4), providing one of the first examinations of individual and community factors associated with risky alcohol consumption. Being young, male, unmarried, Australian-born, and having a higher income were the individual characteristics associated with risky drinking. Communities with more GPs and less police had higher proportions of individuals at risk for harm in the long-term. Communities with more hotels and clubs had higher proportions of individuals reporting single occasion risky drinking.
To complement the survey data, routinely collected data were used to ascertain a suitable measure for alcohol-related crime (Chapter 5). Differences between communities in alcohol-related crime, and associated community factors, were examined (Chapter 6). Communities with less disadvantage, more GPs and more hotels and clubs had more alcohol-related crime. These results, combined with the findings in Chapter 4, suggest strategies addressing the price and availability of alcohol may impact alcohol-related harm.
The analyses in this thesis highlight the importance of tailoring alcohol-related policy and intervention strategies to individual communities, using population specific data on alcohol consumption and harms.