Key challenges for alcohol epidemiology and alcohol control policy evaluation

Background:

A number of systematic reviews and meta-analyses have revealed a surprising lack of data on alcohol epidemiology and policy evaluations.

Methods:

Narrative review of reviews

Results:

In the latest IARC Handbook (20A), it became clear that there are insufficient data on the impact of cessation, and even more so, the reduction of alcohol use for cancer incidence.  This is only the last instance, where causality between consumption and cancer incidence is clear, but we lack data on the impact of alcohol reduction.  In the field, we automatically assume, that the risk curves for increases and decreases in alcohol consumption are parallel, which may not always be the case, e.g., if consumption has changed brain processes.  Another common problem is the cumulative impact of consumption over time, exactly measured in cohorts with repeated measurements of alcohol consumption, and indicators for disease progression.

Similar problems are with policy evaluations.  While there is sufficient evidence, that marketing and advertisements for alcoholic beverages have a causal effect on initiation and patterns of drinking, the effectiveness of marketing bans has not yet been established.  This is not the exception: for other policies recommended by the World Health Organization, such as screening and brief interventions, or some aspects of taxation (e.g., impact on health inequalities), we lack studies on its impact on the population level, so most of the conclusions are based on modelling and or problematic assumptions.  Overall, the field does not engage in rigoros empirical research, using complex designs and statistical analyses for establishing causality and population impact in policy evaluations.

Conclusions:

While funding statistics seem to indicate that alcohol research continues to florish, complex and truely interdisciplinary designs are lacking, so key questions for both alcohol epidemiology and regarding the effectiveness of alcohol control policies remain unanswered.