OBJECTIVE:The purpose of this study was to estimate the lifetime risk of alcohol-attributable mortality and morbidity in the United States based on a person's average lifetime weekly alcohol consumption to assess the impact of per-occasion alcohol consumption on health. METHOD:Lifetime risks were estimated using a cause-specific modeling approach that combined exposure data from national health surveys, relative risks, population data from the U.S. Census Bureau, mortality data from the Centers for Disease Control and Prevention, and morbidity data from the Institute for Health Metrics and Evaluation. A narrative review assessed the health impact of per-occasion alcohol consumption on health. RESULTS:At low levels of consumption, no protective net effect of alcohol consumption on health was observed. Elevated mortality and morbidity risks were associated with alcohol consumption starting at relatively low levels. Males consuming >6.5 (95% CI [<1, 13.5]) and females consuming >7.0 (95% CI [<1, 11.5]) drinks per week had life-time alcohol-attributable mortality risks >1:1,000. At >8.5 (95% CI [2.5, 13]) drinks per week for both males and females, these risks increased to >1:100. At 14 drinks per week for males (the upper limit of the former Dietary Guidelines for males), the risk of an alcohol-caused death was 1:25 (4%). Drinking patterns also impacted risk. Above 1 drink per occasion, higher consumption was associated with progressively increased risks of breast cancer, cardiovascular disease, and injury. CONCLUSIONS:Alcohol consumption, including at what may be perceived as "moderate" levels, is associated with increased mortality and morbidity risks. These results support tightening alcohol use guidance in the United States, for both males and females, to no more than 1 drink per day.

BACKGROUND:Alcohol is a leading cause of global death and disability yet labelling requirements for alcohol products remain inconsistent across WHO Member States and comparatively weak in Canada, where Bill S-202 to mandate warnings is currently under review. In contrast, tobacco and cannabis are subject to more rigorous government mandated labelling requirements. This study compares federally-mandated labelling requirements for alcohol, tobacco, and cannabis across WHO regions to contextualize Canada's position within the global landscape and assess whether Canadian alcohol labelling requirements align with the documented health burden. METHODS:A systematic secondary data synthesis and document review of labelling regulations across all 194 WHO Member States was conducted in February 2023. Sources included WHO reports and regulatory databases on alcohol, tobacco, and cannabis labelling. Comparative analyses were undertaken across WHO regions. Labelling requirements were categorized by the presence and content of health warnings, including labelling design elements, and ingredient information, including allergens, calories, and additives, and content displays. RESULTS:While 32.5% of WHO Member States mandate alcohol health warnings, 84.5% WHO Member States mandate tobacco health warnings. Further, all jurisdictions with legal recreational cannabis require multiple labelling measures, including health warnings and ingredient information. In Canada, alcohol remains the only controlled substance without federally mandated warning labels. INTERPRETATION:Strengthening alcohol labelling requirements represents a policy strategy with high population reach to support informed decision-making and reduce substance-related harms. Establishing evidence-based minimum international standards for alcohol labelling could strengthen global regulatory coherence, while leadership from countries such as Canada may help catalyse progress internationally.

INTRODUCTION:This article provides an overview of alcohol exposure and attributable mortality and burden of disease in the World Health Organization Western Pacific Region, and trends in alcohol exposure over the past two decades. METHODS:We employed a comparative risk assessment and trend analyses to evaluate alcohol exposure patterns and attributable burden. RESULTS:In 2019, almost half a million deaths and more than 22 million disability-adjusted life years lost were attributable to the consumption of alcohol in the Western Pacific Region, representing 3.5% (95% uncertainty interval 2.5, 4.8) of all deaths and 4.4% (95% uncertainty interval 3.6, 5.4) of all disability-adjusted life years lost. This was caused by an average consumption of 6.06 litres of pure alcohol per year (APC; 95% confidence interval 4.46-7.84), higher than the global average of 5.45 litres. Trends in APC have varied across subregions: China saw increasing consumption up to 2016, with a marked decrease since then, likely due to an anti-corruption campaign prohibiting consumption in public spaces and during official functions. In other Asian countries, consumption steadily increased until the COVID-19 pandemic, then decreased during it, and has now partially returned to pre-pandemic levels. APC in Oceania including Australasia was relatively stable between 2000 and 2020 and has decreased since. DISCUSSION AND CONCLUSIONS:Overall, alcohol use remains high and normalised in the region, necessitating robust alcohol control policies. Strengthening these efforts is particularly critical in some Asian countries that experienced the largest increases in levels of alcohol consumption between 2000 and 2024.

Importance:Alcohol marketing is ubiquitous. Although numerous longitudinal studies have examined its association with youth drinking, few have been synthesized in a meta-analysis. Objective:To quantify the longitudinal association between alcohol marketing exposure and youth drinking. Data Sources:MEDLINE, Scopus, and PsycInfo from inception to September 2, 2025. Study Selection:Longitudinal population-based studies assessing marketing exposure and drinking in youth younger than 25 years. Data Extraction and Synthesis:Data were extracted independently and in duplicate. The Risk of Bias in Nonrandomized Studies-of Exposures (ROBINS-E) tool was used to assess risk of bias, and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to assess evidence certainty. Main Outcomes and Measures:Exposures included television advertising, other channel (eg, online) advertising, alcohol portrayals in entertainment media (brand placement), promotional activities, branded merchandise ownership, advertisement or brand liking, and composite exposure measures. Continuous exposures were scaled to reflect low-to-high comparisons, odds ratios were converted to relative risks (RRs), and multilevel meta-analysis was conducted to obtain pooled RRs. Subgroups were compared by exposure type, outcome, and risk of bias. Results were narratively synthesized where meta-analysis was not possible. Results:A total of 19 cohorts were identified (10 high-income countries; 23 publications; 94 RRs; n = 82 498). All studies were judged to be at risk of bias for self-report outcome assessment. There was an increased risk of youth drinking with high vs low advertising exposure (RR, 1.50 [95% CI, 1.37-1.63]), with moderate certainty of evidence (upgraded due to evidence of dose response). Narrative synthesis suggested that changes in attitudes and cognitions mediated the association. In subgroup analyses, exposure to television advertising was found to have the strongest association with drinking. Conclusions and Relevance:The results of this systematic review and meta-analysis show an association between alcohol marketing exposure and drinking outcomes across a variety of exposure types. Additional research is needed using single exposure measures that capture multiple marketing channels, to better address risk of bias, and to include studies from low- to middle-income countries, where alcohol marketing is expanding.

Although alcohol is a leading cause of health and social harms in Canada, policies directed at alleviating the public health burden created by alcohol are rarely adopted and often reversed. This study analyses alcohol-related policy lobbying activity to better understand how lobbying might impact policy development in Canada. This was deemed not human subjects research. A cross-sectional analysis was conducted using data from the federal Canadian Registry of Lobbyists to characterize the frequency and nature of alcohol industry and public health lobbying activities between May 2022 and May 2023. In this period, there was substantially more lobbying activity by alcohol industry representatives compared to public health stakeholders. Over three-quarters of lobby groups represented alcohol industry organizations (n = 13) compared to public health organizations (n = 4), with industry recording a majority of registered lobbyists (81.3%), meetings reported (66.2%), and number of officials lobbied (71.2%). Alcohol industry organizations predominantly lobbied bureaucrats in policy making/governance roles (54.2% of industry meetings), while public health stakeholders mainly lobbied legislators (60.4% of public health meetings). The alcohol industry's dominance in federal lobbying activities may enable corporate influence over alcohol policy development and undermine public health approaches. The nature of lobbying in Canada has international implications for the regulation of a product that is an important commercial determinant of health, showing the potential role lobbying may play in weakening alcohol regulation.

Alcohol taxation is a key policy to reduce consumption and alcohol harm but evidence on tax design and indicators to assess taxation policy are lacking. Tax design and two indicators: tax as a share of lowest retail price and affordability, were investigated in eight high-income and nine middle-income jurisdictions. Collaborators populated the International Alcohol Control (IAC) study online Alcohol Policy Tool, providing measures of tax design, tax rates; and typical lowest prices available for retail take-away alcohol. These data were used to calculate tax/share of retail price. Affordability of alcohol was assessed against gross national income (GNI) per capita. High-income jurisdictions had higher tax/share and higher affordability on average compared with middle-income jurisdictions. Over the sample as a whole there was no association between these two indicators of tax policy. The tax designs used also varied with high-income jurisdictions more likely to use specific excise tax reflecting potency and middle-income jurisdictions more likely to utilise ad valorem and specific volume based taxes and to use more than one method across a beverage. Increased alcohol taxation to reduce alcohol consumption and harm is established as a high impact policy and is believed to work by affecting affordability. However, less is known about the best taxation methods to reduce affordability or the best measures to monitor and compare alcohol taxation between countries and over time. In this sample of high- and middle-income jurisdictions tax/price share was not found to predict affordability, suggesting the need to further research indicators of alcohol affordability.

AIMS:Economic development leading a country from a low- to middle-income status is usually associated with increases in alcohol consumption and decreases in all-cause mortality, despite increases in alcohol-attributable mortality. We analyzed this tradition for India during the years 2000-19, with attention to alcohol policy. METHODS:Joinpoint analysis identified points of trend change and associated slopes for alcohol-attributable mortality and burden (disability-adjusted life years) between 2000 and 2019. Structural equation modeling assessed the relationship among adult alcohol per capita consumption, gross domestic product per capita at purchasing power parity (GDP-PPP per capita), alcohol-attributable mortality, and all-cause mortality, where mortality rates were log-transformed in the models. Pearson correlation was evaluated among study variables. Literature review examined alcohol policies in India. RESULTS:During the first decade between 2000 and 2019, a rapidly and steadily increasing GDP-PPP per capita was associated with marked increases in alcohol consumption and decreases in all-cause mortality, despite increasing alcohol-attributable mortality. After 2010, the economic growth still increased, but the increase in alcohol consumption halted, likely due to strong alcohol control policies in availability restrictions (dry states, dry periods, high legal purchasing age and restrictions in density, and purchasing hours), as well as a high tax share on final price. CONCLUSION:Alcohol policies seem to have prevented further increases in alcohol consumption and attributable harm and thus should be upheld. Otherwise, increases in these harms will prevent India from fully reaping the health benefits of economic development.

To evaluate existing alcohol policies in Canadian provinces and territories (P/Ts) against evidence-based best practice policies aimed at reducing alcohol-related harms and improving population health. Alcohol policies in Canadian P/Ts were evaluated across 11 policy domains. The scoring rubric was formulated based on the latest evidence-based public health criteria. Policy domains were weighted to reflect their relative effectiveness and scope. Data were collected by the research team, reviewed and validated by government contacts, and scored by designated team members. Scores were calculated for each P/T and policy domain. Additionally, a Best Existing Policies (BEP) score was calculated to demonstrate the score that could be achieved by any P/T if they adopted all the best policies currently in place somewhere in Canada. Scored against best practice policy criteria, the average score across all P/Ts was 37

BACKGROUND:Data on alcohol consumption and associated health harms are essential to evaluate progress in achieving global health goals. This study aims to estimate global alcohol consumption from 2000 to 2020, and the global burden of alcohol-attributable harms from 2000 to 2019. METHODS:In this global analysis, adult per capita consumption data estimates were modelled on the basis of sales, survey, and traveller data. Drinking status and past 30-day heavy episodic drinking were estimated through regression analyses of 540 surveys from 174 countries. Alcohol-attributable harms were estimated using a comparative risk assessment methodology by combining alcohol consumption data with corresponding relative risks obtained from meta-analyses and cohort studies. Mortality and morbidity data were obtained from WHO Global Health Estimates. FINDINGS:Globally, average alcohol consumption in 2019 among adults was 5·5 L (95% uncertainty interval 4·9-6·2), which increased from 5·1 L (4·6-5·7) in 2000. From 2019 to 2020 alcohol consumption decreased to 4·9 L (4·3-5·6). In 2019, alcohol consumption was associated with 2·6 (2·3-3·1) million deaths (4·7% of all deaths) and 116·0 million disability-adjusted life-years (DALYs) lost (4·6% of all DALYs lost). In contrast to alcohol consumption, the number of alcohol-attributable deaths decreased by 31·0% and DALYs lost per 100 000 people decreased by 27·4% from 2000 to 2019. INTERPRETATION:Alcohol is attributed to a large burden of disease, which disproportionately affects people in Eastern Europe and in Central and Southern Sub-Saharan Africa, and young people. Accordingly, these regions should implement policies such as alcohol taxation increases, availability reductions, and marketing restrictions to reduce alcohol-related harms. FUNDING:WHO.

INTRODUCTION:Considerable evidence exists on the most effective policy to reduce alcohol harm; however, a tool and index to allow comparisons of policy status of the most effective policies between similar jurisdictions and change over time within a jurisdiction has not been widely used. The International Alcohol Control (IAC) Policy Index is designed to address this gap and monitor the alcohol policy environment with regard to four effective policy domains (tax/pricing, availability, marketing and drink driving). METHODS:This study compares IAC Policy Index scores across 11 high-income jurisdictions: Aotearoa (Māori language name for New Zealand); Australia; Finland; Norway; the Netherlands; (Republic of Ireland; Lithuania; Ontario; Alberta; Quebec; British Columbia). Collaborators in the 11 high-income jurisdictions populated the online Alcohol Policy Tool with available indicators. The team in Aotearoa New Zealand sought to validate information and worked with collaborators to clarify any uncertainties in the data. RESULTS:Lithuania, Norway, Finland and Ireland scored above average on the IAC Policy Index. The jurisdictions varied in terms of the strength of policy in different domains, with drink driving legislation showing the greatest consistency and marketing the strongest relationship between stringency of policy and impact on the ground. DISCUSSION AND CONCLUSIONS:Results in high-income jurisdictions suggested the IAC Policy Index provides a useful overview of core alcohol policy status, allows for comparisons between jurisdictions and has the potential to be useful in alcohol policy debate.

BackgroundThe 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.MethodsAs 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.ResultsThere 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.ConclusionGovernments 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.

To systematically assess the Canadian federal government’s current alcohol policies in relation to public health best practices. The 2022 Canadian Alcohol Policy Evaluation (CAPE) Project assessed federal alcohol policies across 10 domains. Policy domains were weighted according to evidence for their relative impact, including effectiveness and scope. A detailed scoring rubric of best practices was developed and externally reviewed by international experts. Policy data were collected between June and December 2022, using official legislation, government websites, and data sources identified from previous iterations of CAPE as sources. Contacts within relevant government departments provided any additional data sources, reviewed the accuracy and completeness of the data, and provided amendments as needed. Data were scored independently by members of the research team. Final policy scores were tabulated and presented as a weighted overall average score and as unweighted domain-specific scores. Compared to public health best practices, the federal government of Canada scored 37

AIMS:The aims of this study were to identify alcohol-related population surveys administered in the Americas, determine which alcohol-related measures are examined and identify coverage gaps regarding alcohol-related measures. METHODS:As part of the Global Information System on Alcohol and Health study, a systematic search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria to identify regionally or nationally representative survey reports of the general population from 1 January 2010 to 6 August 2019. Alcohol-related measures extracted from surveys were categorized into 10 domains: alcohol consumption status; alcohol consumption; unrecorded alcohol consumption; drinking patterns; symptoms of dependence and/or harmful use; drinking during pregnancy; treatment coverage; second-hand harms; economic; and other. RESULTS:The systematic search identified 7417 survey reports, 94 of which were new and included in this study, with an additional 11 studies included from a previous systematic study of alcohol surveys. In total, 94 unique surveys and 161 unique survey waves were located, representing 105 unique survey questionnaires covering 30 countries. No population surveys were found for five member states; namely, Antigua and Barbuda, Dominica, Haiti, Saint Vincent and the Grenadines and Saint Kitts and Nevis. All countries with population-based alcohol surveys had had a population survey probing alcohol use in the past year/month. Questions regarding heavy episodic drinking, alcohol use disorders, treatment-seeking for alcohol use, drinking during pregnancy, harms to others and the amounts spent on alcohol were asked in 26, 25, 10, 6, 22 and 11 countries, respectively. CONCLUSIONS:The heterogeneity in alcohol-related population surveys in the Americas from 2010 to 2019 limits their comparability throughout countries and over time. Future surveys should implement a standardized set of core questions to provide consistency in the monitoring of alcohol consumption and alcohol-related harms.

Alcohol is a favorite psychoactive substance of Canadians. It is also a leading risk factor for death and disability, playing a causal role in a broad spectrum of health and social issues. Alcohol: No Ordinary Commodity is a collaborative, integrative review of the scientific literature. This paper describes the epidemiology of alcohol use and current state of alcohol policy in Canada, best practices in policy identified by the third edition of Alcohol: No Ordinary Commodity, and the implications for the development of effective alcohol policy in Canada. Best practices – strongly supported by the evidence, highly effective in reducing harm, and relatively low-cost to implement – have been identified. Measures that control affordability, limit availability, and restrict marketing would reduce population levels of alcohol consumption and the burden of disease attributable to it.

To reduce deaths, morbidity, and social problems from alcohol in Canada, a multi-dimensional robust response is needed, including a comprehensive alcohol control strategy at the provincial, territorial, and federal levels. Alcohol container labels with health and standard drink information are an essential component of this strategy. This commentary provides a rationale for the mandatory labelling of all alcohol products, summarizes Canadian initiatives to date to legislate alcohol container warning labels, and addresses myths and misconceptions about labels. Canadians deserve direct, accessible information about (1) the inherent health risks associated with alcohol consumption, (2) the number of standard drinks per container and volume of a standard drink, and (3) guidance for preventing or reducing consumption-related health risks. Enhanced health labels on alcohol containers are long overdue.

INTRODUCTIONManaged Alcohol Programs (MAPs) are designed to improve health and housing outcomes for unstably housed people with an alcohol use disorder (AUD). The present study assesses the association of MAP participation with healthcare and mortality outcomes.METHODSA retrospective cohort study assessed health outcomes for 205 MAP participants and 128 controls recruited from five Canadian cities in 2006-2017. Survival and negative binomial regression models were used to calculate hazard ratios (HR) of death and emergency room (ER) visits and hospital bed days (HBDs). Covariates included age, sex, AUD severity and housing stability score.RESULTSIn fully adjusted models, compared with times outside MAPs, participants had significantly reduced risk of mortality (HR = 0.37, P = 0.0001) and ER attendance (HR = 0.74, P = 0.0002), and fewer HBDs yearly (10.40 vs 20.08, P = 0.0184). Over the 12 years, people enrolled in a MAP at some point had significantly fewer HBDs per year than controls after MAP enrolment (12.78 vs 20.08, P = 0.0001) but not significantly different rates of death or ER presentation. MAP participants had significantly more alcohol-related but significantly fewer nonalcohol-related ER presentations than controls.CONCLUSIONAttendance at a MAP was associated with reduced risk of mortality or morbidity and less hospital utilization for individuals with unstable housing and severe AUDs. MAPs are a promising approach to reduce mortality risk and time spent in hospital for people with an AUD and experiencing homelessness.

Evidence for effective government policies to reduce exposure to alcohol’s carcinogenic and hepatoxic effects has strengthened in recent decades. Policies with the strongest evidence involve reducing the affordability, availability and cultural acceptability of alcohol. However, policies that reduce population consumption compete with powerful commercial vested interests. This paper draws on the Canadian Alcohol Policy Evaluation (CAPE), a formal assessment of effective government action on alcohol across Canadian jurisdictions. It also draws on alcohol policy case studies elsewhere involving attempts to introduce minimum unit pricing and cancer warning labels on alcohol containers. Canadian governments collectively received a failing grade (F) for alcohol policy implementation during the most recent CAPE assessment in 2017. However, had the best practices observed in any one jurisdiction been implemented consistently, Canada would have received an A grade. Resistance to effective alcohol policies is due to (1) lack of public awareness of both need and effectiveness, (2) a lack of government regulatory mechanisms to implement effective policies, (3) alcohol industry lobbying, and (4) a failure from the public health community to promote specific and feasible actions as opposed to general principles, e.g., ‘increased prices’ or ‘reduced affordability’. There is enormous untapped potential in most countries for the implementation of proven strategies to reduce alcohol-related harm. While alcohol policies have weakened in many countries during the COVID-19 pandemic, societies may now also be more accepting of public health-inspired policies with proven effectiveness and potential economic benefits.

ABSTRACTAimsTo compare systematically the alcohol‐attributable mortality and burden of disease estimates for 2016 from a recent study by Shield and colleagues and the Global Burden of Disease study 2017 (GBD).MethodThis study compared estimates of alcohol‐attributable mortality and disability adjusted life years (DALYs) lost for 2016 with regards to absolute and relative differences, by region and by cause of disease or injury. Relative differences between the two studies are reported herein as percentage (%) differences. A difference of 10% or more was considered meaningful.ResultsThe studies estimated similar global levels of overall alcohol‐attributable mortality for 2016 (Shield and colleagues estimated 5.1% more alcohol‐attributable mortality than the GBD study) but not alcohol‐attributable DALYs lost (18.3% difference). There were marked differences by region and cause of disease or injury. Compared with the results from Shield and colleagues, the GBD study estimated a lower alcohol‐attributable burden in Eastern Europe by 252 770 alcohol‐attributable deaths (45.2% difference) and 6.1 million alcohol‐attributable DALYs lost (32.9% difference) and in Western sub‐Saharan Africa by 124 200 alcohol‐attributable deaths (55.7% difference) and 7.0 million alcohol‐attributable DALYs lost (63.4% difference), and estimated a higher alcohol‐attributable burden in East Asia by 227 100 alcohol‐attributable deaths (48.0% difference) and 2.2 million DALYs lost (11.0% difference). With regard to the cause of disease or injury, Shield and colleagues attributed an overall detrimental effect to alcohol on ischaemic heart disease mortality, whereas the GBD study attributed a net beneficial effect. The GBD study, as compared with Shield and colleagues’ study, estimated a lower alcohol‐attributable mortality because of liver cirrhosis and injuries by 262 500 (44.6% difference) and 398 800 (46.2% difference), respectively.ConclusionsDifferences in estimates of the alcohol‐attributable burden of disease in two recent studies indicate the need to improve the accuracy of underlying data and risk relations to obtain more consistent estimates and to formulate, advocate for, and implement alcohol policies more effectively.