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      Reducing alcohol use through alcohol control policies in the general population and population subgroups: a systematic review and meta-analysis

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          Summary

          We estimate the effects of alcohol taxation, minimum unit pricing (MUP), and restricted temporal availability on overall alcohol consumption and review their differential impact across sociodemographic groups. Web of Science, Medline, PsycInfo, Embase, and EconLit were searched on 08/12/2022 and 09/26/2022 for studies on newly introduced or changed alcohol policies published between 2000 and 2022 (Prospero registration: CRD42022339791). We combined data using random-effects meta-analyses. Risk of bias was assessed using the Newcastle–Ottawa Scale. Of 1887 reports, 36 were eligible. Doubling alcohol taxes or introducing MUP (Int$ 0.90/10 g of pure alcohol) reduced consumption by 10% (for taxation: 95% prediction intervals [PI]: −18.5%, −1.2%; for MUP: 95% PI: −28.2%, 5.8%), restricting alcohol sales by one day a week reduced consumption by 3.6% (95% PI: −7.2%, −0.1%). Substantial between-study heterogeneity contributes to high levels of uncertainty and must be considered in interpretation. Pricing policies resulted in greater consumption changes among low-income alcohol users, while results were inconclusive for other socioeconomic indicators, gender, and racial and ethnic groups. Research is needed on the differential impact of alcohol policies, particularly for groups bearing a disproportionate alcohol-attributable health burden.

          Funding

          Research reported in this publication was supported by the doi 10.13039/100000027, National Institute on Alcohol Abuse and Alcoholism; of the doi 10.13039/100000002, National Institutes of Health; under Award Number R01AA028009.

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          Most cited references66

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          The PRISMA 2020 statement: an updated guideline for reporting systematic reviews

          The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews.
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            Interrater reliability: the kappa statistic

            The kappa statistic is frequently used to test interrater reliability. The importance of rater reliability lies in the fact that it represents the extent to which the data collected in the study are correct representations of the variables measured. Measurement of the extent to which data collectors (raters) assign the same score to the same variable is called interrater reliability. While there have been a variety of methods to measure interrater reliability, traditionally it was measured as percent agreement, calculated as the number of agreement scores divided by the total number of scores. In 1960, Jacob Cohen critiqued use of percent agreement due to its inability to account for chance agreement. He introduced the Cohen’s kappa, developed to account for the possibility that raters actually guess on at least some variables due to uncertainty. Like most correlation statistics, the kappa can range from −1 to +1. While the kappa is one of the most commonly used statistics to test interrater reliability, it has limitations. Judgments about what level of kappa should be acceptable for health research are questioned. Cohen’s suggested interpretation may be too lenient for health related studies because it implies that a score as low as 0.41 might be acceptable. Kappa and percent agreement are compared, and levels for both kappa and percent agreement that should be demanded in healthcare studies are suggested.
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              Basics of meta-analysis: I(2) is not an absolute measure of heterogeneity.

              When we speak about heterogeneity in a meta-analysis, our intent is usually to understand the substantive implications of the heterogeneity. If an intervention yields a mean effect size of 50 points, we want to know if the effect size in different populations varies from 40 to 60, or from 10 to 90, because this speaks to the potential utility of the intervention. While there is a common belief that the I(2) statistic provides this information, it actually does not. In this example, if we are told that I(2) is 50%, we have no way of knowing if the effects range from 40 to 60, or from 10 to 90, or across some other range. Rather, if we want to communicate the predicted range of effects, then we should simply report this range. This gives readers the information they think is being captured by I(2) and does so in a way that is concise and unambiguous. Copyright © 2017 John Wiley & Sons, Ltd.
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                Author and article information

                Contributors
                Journal
                eClinicalMedicine
                EClinicalMedicine
                eClinicalMedicine
                Elsevier
                2589-5370
                10 May 2023
                May 2023
                10 May 2023
                : 59
                : 101996
                Affiliations
                [a ]Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
                [b ]Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
                [c ]Alcohol Research Group, Public Health Institute, Emeryville, CA, United States
                [d ]Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
                [e ]Addiction Medicine, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
                [f ]School of Health and Related Research (ScHARR), Faculty of Medicine, Dentistry & Health, University of Sheffield, Sheffield, England, UK
                [g ]Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
                [h ]Department of Psychiatry, University of Toronto, Toronto, ON, Canada
                [i ]Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
                [j ]Dalla Lana School of Public Health & Department of Psychiatry, University of Toronto, Toronto, ON, Canada
                [k ]Program on Substance Abuse & WHO Collaborating Centre, Public Health Agency of Catalonia, Barcelona, Spain
                [l ]I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
                Author notes
                []Corresponding author. Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada. carolin.kilian@ 123456camh.ca
                Article
                S2589-5370(23)00173-6 101996
                10.1016/j.eclinm.2023.101996
                10225668
                37256096
                8f742ced-6956-4329-805b-1bb225480c73
                © 2023 The Author(s)

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                : 13 March 2023
                : 19 April 2023
                : 19 April 2023
                Categories
                Review

                alcohol policy,alcohol consumption,effectiveness,socioeconomic status,race,ethnicity

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