Introduction and AimsGender and age patterns of drinking are important in guiding country responses to harmful use of alcohol. This study undertook cross‐country analysis of drinking across gender, age groups in some high‐and middle‐income countries.Design and MethodsSurveys of drinkers were conducted in Australia, England, Scotland, New Zealand, St Kitts and Nevis (high‐income), Thailand, South Africa, Mongolia and Vietnam (middle‐income) as part of the International Alcohol Control Study. Drinking pattern measures were high‐frequency, heavier‐typical quantity and higher‐risk drinking. Differences in the drinking patterns across age and gender groups were calculated. Logistic regression models were applied including a measure of country‐level income.ResultsPercentages of high‐frequency, heavier‐typical quantity and higher‐risk drinking were greater among men than in women in all countries. Older age was associated with drinking more frequently but smaller typical quantities especially in high‐income countries. Middle‐income countries overall showed less frequent but heavier typical quantities; however, the lower frequencies meant the percentages of higher risk drinkers were lower overall compared with high‐income countries (with the exception of South Africa).Discussion and ConclusionsHigh‐frequency drinking was greater in high‐income countries, particularly in older age groups. Middle‐income countries overall showed less frequent drinking but heavier typical quantities. As alcohol use becomes more normalised as a result of the expansion of commercial alcohol it is likely frequency of drinking will increase with a likelihood of greater numbers drinking at higher risk levels.

This study's aim was to examine selected objectively-measured and child specific built environment attributes in relation to proportion of out-of-school time spent in moderate-to-vigorous physical activity (%MVPA) and active travel in a group of ethnically and socio-economically diverse children (n=236) living in Auckland, New Zealand. Street connectivity and distance to school were related to the proportion of trips made by active modes. Ratio of high speed to low speed roads and improved streetscape for active travel were related to %MVPA on weekdays only. Inconsistent results were found for destination accessibility. Local destinations (particularly schools) along a safe street network may be important for encouraging children's activity behaviours.

There are well-established frameworks for comparing the performance of health systems cross-nationally on multiple dimensions. A sub-set of such comprehensive schema is taken up by criteria specifically applied to health service delivery, including hospital performance. We focus on evaluating hospital performance, using the New Zealand public hospital sector over the period 2001-2009 as a pragmatic and illustrative case study for cross-national application. We apply a broad three-dimensional matrix--efficiency, effectiveness, equity--each based on two measures, and we undertake ranking comparisons of 35 hospitals. On the efficiency dimension--relative stay, day surgery--we find coefficients of variation of 10.8% and 8.5% respectively in the pooled data, and a slight trend towards a narrowing of inter-hospital variation over time. The correlation between these indicators is low (.20). For effectiveness--post-admission mortality, unplanned readmission--the coefficient of variation is generally higher (24.1% and 12.2%), and the trend is flat. The correlation is again low (.21). The equity dimension is assessed by quantifying the degree of ethnic and socio-economic variation for each hospital. The coefficient of variation is much higher--40.7-66.5% for ethnicity, 55.8-84.4% for socio-economic position--the trend over time is mixed, and the correlation is moderate (.41). On averaging the rank of hospitals across all measures it is evident that there is limited consistency across the three constituent dimensions. While it is possible to assess hospital performance across three dimensions using an illustrative set of standard measures derived from routine data, there appears to be little consistency in hospital rankings on these New Zealand data for the period 2001-2009. However, the methodology of using rankings derived from readily available data--possibly allied with multiple or composite indicator models--has potential for the cross-national comparison of hospital profiles, and assessments in three dimensions provide a more holistic and rounded account of performance.

Introduction This paper aimed to assess purchasing and drinking behaviour during the first COVID‐19 pandemic restrictions in New Zealand. Method A convenience sample was collected via Facebook from 2173 New Zealanders 18+ years during pandemic restrictions April/May 2020. Measures included: the quantity typically consumed during a drinking occasion and heavier drinking (6+ drinks on a typical occasion) in the past week; place of purchase including online alcohol delivery. Descriptive statistics were generated, logistic and linear regression models predicted heavier drinking and typical occasion quantity, respectively. Weighting was not applied. Results During pandemic restrictions, around 75% of respondents purchased from supermarkets, 40% used online alcohol delivery services (18% for the first time during COVID‐19). Purchasing online alcohol delivery during pandemic restrictions was associated with heavier drinking (75% higher odds) in the past week, while purchasing from supermarkets was not. About 58% of online purchasers under 25 reported no age checks. Sixteen percent of those purchasing online repeat ordered online to keep drinking after running out. Of respondents who had tried to buy alcohol and food online, 56% reported that alcohol was easier to get delivered than fresh food. Advertising for online alcohol delivery was seen by around 75% of the sample. Half of the sample reported drinking more alcohol during the restrictions. Discussion and Conclusions Online alcohol delivery during the COVID‐19 pandemic restrictions was associated with heavier drinking in the past week. The rapid expansion of online alcohol delivery coupled with a lack of regulatory control requires public health policy attention.

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Introduction and AimsThe International Alcohol Control (IAC) Study is a multi‐country collaborative project to assess patterns of alcohol consumption and the impact of alcohol control policy. The aim of this paper is to report the methods and implementation of the IAC.Design and MethodsThe IAC has been implemented among drinkers 16–65 years in high‐ and middle‐income countries: Australia, England, Scotland, New Zealand, St Kitts and Nevis, Thailand, South Africa, Peru, Mongolia and Vietnam (the latter four samples were sub‐national). Two research instruments were used: the IAC survey of drinkers and the Alcohol Environmental Protocol (a protocol for policy analysis). The survey was administered via computer‐assisted interview and the Alcohol Environmental Protocol data were collected via document review, administrative or commercial data and key informant interviews.ResultsThe IAC instruments were readily adapted for cross‐country use. The IAC methodology has provided cross‐country survey data on key measures of alcohol consumption (quantity, frequency and volume), aspects of policy relevant behaviour and policy implementation: availability, price, purchasing, marketing and drink driving. The median response rate for all countries was 60% (range 16% to 99%). Where data on alcohol available for consumption were available the validity of survey consumption measures were assessed by calculating survey coverage found to be 86% or above. Differential response bias was handled, to the extent it could be, using post‐stratification weights.Discussion and ConclusionsThe IAC study will allow for cross‐country analysis of drinking patterns, the relationship between alcohol use and policy relevant behaviour in different countries.

The alcohol industry have attempted to position themselves as collaborators in alcohol policy making as a way of influencing policies away from a focus on the drivers of the harmful use of alcohol (marketing, over availability and affordability). Their framings of alcohol consumption and harms allow them to argue for ineffective measures, largely targeting heavier consumers, and against population wide measures as the latter will affect moderate drinkers. The goal of their public relations organisations is to 'promote responsible drinking'. However, analysis of data collected in the International Alcohol Control study and used to estimate how much heavier drinking occasions contribute to the alcohol market in five different countries shows the alcohol industry's reliance on the harmful use of alcohol. In higher income countries heavier drinking occasions make up approximately 50% of sales and in middle income countries it is closer to two-thirds. It is this reliance on the harmful use of alcohol which underpins the conflicting interests between the transnational alcohol corporations and public health and which militates against their involvement in the alcohol policy arena. [Caswell S, Callinan S, Chaiyasong S, Cuong PV, Kazantseva E, Bayandorj T, Huckle T, Parker K, Railton R, Wall M. How the alcohol industry relies on harmful use of alcohol and works to protect its profits. Drug Alcohol Rev 2016;35:661-664].

BackgroundThe aim of this study was to determine the associations between body size and built environment walkability variables, as well as the mediating role of physical activity and sedentary behaviours with body size.MethodsObjective environment, body size (body mass index (BMI), waist circumference (WC)), and sedentary time and physical activity data were collected from a random selection of 2033 adults aged 20–65 years living in 48 neighbourhoods across four New Zealand cities. Multilevel regression models were calculated for each comparison between body size outcome and built environment exposure.Results and DiscussionStreet connectivity and neighborhood destination accessibility were significant predictors of body size (1 SDchange predicted a 1.27 to 1.41 % reduction in BMI and a 1.76 to 2.29 % reduction in WC). Significantrelationships were also observed for streetscape (1 SD change predicted a 1.33 % reduction in BMI) anddwelling density (1 SD change predicted a 1.97 % reduction in BMI). Mediation analyses revealed asignificant mediating effect of physical activity on the relationships between body size and street connectivity and neighbourhood destination accessibility (explaining between 10.4 and 14.6 % of the total effect). No significant mediating effect of sedentary behaviour was found. Findings from this cross-sectional study of a random selection of New Zealand adults are consistent with international research. Findings are limited to individual environment features only; conclusions cannot be drawn about the cumulative and combined effect of individual features on outcomes.ConclusionsBuilt environment features were associated with body size in the expected directions. Objectively-assessed physical activity mediated observed built environment-body size relationships.