ࡱ>  bjbjVV $<<7  TGGGL+dGO  )))@OBOBOBOBOBOBO$R'UTfO-)c)g)|))fO Ou,u,u,)p8 7 @Ou,)@Ou,u,bPI$6N `PGS*XtLr,OO0OL.{U*{UNN8{ULN))u,)))))fOfO{+)))O)))){U))))))))) :  18 February 2011 Secretariat Justice and Electoral Select Committee Private Bag 18888 Parliament Buildings Wellington 6160 To the Justice and Electoral Select Committee Submission on the Alcohol Reform Bill from the Paediatric Society of New Zealand Thank you for the opportunity to contribute to alcohol law reform in New Zealand. We see this as an important opportunity to reduce the extensive harms caused by alcohol, to protect children and young people as vulnerable members of society, and to create lasting change in societal attitudes towards alcohol. This submission is from the Paediatric Society of New Zealand (PSNZ), a multi-disciplinary organisation with a membership of more than 450 child health professionals with wide-ranging expertise in clinical practice and research. Dr Amanda DSouza and Dr Shanthi Ameratungawould like to appear before the committee to speak to our submission. Yours sincerely, Dr Rosemary MarksMollie WilsonDr Amanda DSouzaPresidentCEO  Contact Person: Dr Amanda DSouza, Senior Lecturer Department of Paediatrics, University of Otago, PO Box 7343, Wellington South 6242, Phone 64 021 0330 547 Email amanda.dsouza@otago.ac.nz Summary There is a tremendous amount of harm caused by alcohol to those directly affected by drinking, to those affected by the drinking of others, and is highly costly to society in economic and social terms. Alcohol misuse by parents and caregivers causes profound harm to children and increases the risk of death, maltreatment, injury, and poor physical and psychological health. Drinking patterns among adults and youth are powerfully shaped by wider factors such as the relentless marketing and sponsorship practices of the alcohol industry, cheap alcohol pricing and easy availability, the extent of drink-driving counter-measures, adult role-modelling of drinking behaviours and wider social norms around alcohol. Alcohol legislation has a fundamental part to play in reducing harm from alcohol, in ensuring that there is the correct balance between harms and benefits, in shaping social norms, and importantly, in protecting the most vulnerable members of society. Our recommendations, and those of the Law Commission, are based on very strong evidence on cost-effective interventions to reduce alcohol-related harm, most of which relate to modifying the environment in which alcohol is marketed  ADDIN EN.CITE  ADDIN EN.CITE.DATA [1-5]. Alcohol reform that does not include the most effective actions is unlikely to achieve the objectives of reform, and misses addressing the profound harm from alcohol misuse to drinkers and others affected by their drinking, and allows the high economic and social costs to society to continue. Alcohol reform that misses the most cost-effective measures, or which has delayed implementation (such as after the Rugby World Cup), is a missed opportunity and carries ongoing risk to public health and safety. Vested interests can undermine the development of an appropriate and effective public health response. The Paediatric Society supports comprehensive alcohol reform as a necessary measure to protect children and young people and improve their health and well-being. We urge the Commission to show the strong leadership in alcohol reform that is greatly needed and to include in legislation the most cost-effective measures to reduce the very high level of alcohol-related harm, namely, around alcohol pricing, availability, marketing, sponsorship, and drink-driving. Key recommendations That the Committee adopts a strong and comprehensive approach to alcohol reform as recommended by the Law Commission. That the Committee ensures that the wide-ranging and potentially long-term impact of alcohol misuse on New Zealands most vulnerable citizens be a central consideration in alcohol reform. That the Committee ensure that the development of an effective public health response to alcohol-related harm, particularly to protect the health and well-being of children and young people, is not subverted by vested interests such as the alcohol industry. That the Committee recommend a substantial increase in alcohol excise tax, which is ring-fenced for use in prevention, treatment, and research, focused on further reducing alcohol related harm. That the Committee establish a minimum price for a standard drink, and end the sale of cheap alcohol. That the Committee recommend the end of all alcohol marketing and sponsorship, except for objective printed product information. That the Committee recommend reducing the blood alcohol content limits for adult drivers to 0.05mg/ml or lower. That the Committee recommend major reductions in alcohol availability, including reducing the density of outlets and opening hours of such outlets, and ending the normal supermarket sale of alcohol as it is not an ordinary commodity. That the Committee returns the purchase age for both on- and off-license to 20 years, and abandon the plan for a conscience vote on the purchase age. That the Committee ensure there are adequate and accessible treatment services for people of all ages, particularly including young people or those with care-giving responsibilities, who are at an early stage of habit formation or engaging in harmful drinking. Background The harm from alcohol, the most commonly used recreational drug in New Zealand, is far-reaching, not only to drinkers, but to those affected by the drinking of others, and is highly costly to society in economic and social terms  ADDIN EN.CITE Law Commission200991991991927Law Commission,Alcohol in our lives : an issues paper on the reform of New Zealands liquor laws (NZLC IP15)Issues paper152009Law Commission201092092092027Law Commission,Alcohol in Our Lives: Curbing the Harm (NZLC R114)2010[5-6]. It is associated with many different health conditions with more than half of alcohol-related deaths being due to injuries ADDIN EN.CITE Connor200510041004100427Connor, JBroad, JRehm, JHoorn, SVJackson, RTThe Burden of Death, Disease and Disability Due to Alcohol in New Zealand 2005WellingtonAlcohol Advisory Council of New Zealand[7], contributes to many emergency department presentations, and is responsible for much crime and violence  ADDIN EN.CITE ALAC201010051005100527ALAC,Ministry of Health,Police,ACC,Alcohol Quick Facts2010Wellingtonwww.ndp.govt.nz/moh.nsf/pagescm/7752/$File/alcohol-factsheets.pdf[8]. The cost to New Zealand of alcohol-related injuries to innocent victims is estimated to be more than half a billion dollars per year  ADDIN EN.CITE Connor200910031003100317Connor, JennieCasswell, SallyThe burden of road trauma due to other people's drinkingAccident Analysis & PreventionAccident Analysis & Prevention1099-1103415Drink drivingAlcoholInjuryAlcohol-related harm20090001-4575doi: DOI: 10.1016/j.aap.2009.06.019http://www.sciencedirect.com/science/article/B6V5S-4WPHPDP-1/2/751ebef98fa97198074725f73c948981[9]. Alcohol also contributes to health inequalities  ADDIN EN.CITE Casswell200910001000100017Casswell, SallyThamarangsi, ThaksaphonReducing harm from alcohol: call to actionThe LancetThe Lancet2247-2257373968220090140-6736doi: DOI: 10.1016/S0140-6736(09)60745-5http://www.sciencedirect.com/science/article/B6T1B-4WM2BX7-18/2/4c93d88eb1dde5f4562bb6c7c77ea68b2009/7/3/[10]. Children and young people are especially vulnerable developmentally and because they are dependent on others for their care and protection. The damage from growing up in an environment where parents or caregivers misuse alcohol has received less attention yet is serious, is potentially long-lasting and highly costly to society. Adult and youth drinking patterns are powerfully shaped by wider factors such as the relentless marketing and sponsorship practices of the alcohol industry, cheap alcohol pricing and easy availability, the extent of drink-driving counter-measures, adult role-modelling of drinking behaviours and wider social norms around alcohol  ADDIN EN.CITE  ADDIN EN.CITE.DATA [5, 10-12]. The Paediatric Society strongly supports the objectives of the Alcohol Reform Bill, including measures to reduce harmful drinking in young people. We applaud the plan to reduce to zero the limit for young drivers/those progressing through the Graduated Driver Licensing System. However, the Bill is missing the most effective and important measures recommended by the Law Commission, internationally accepted measures based on very strong scientific evidence. We note that alcohol-related harm to babies and younger children is also a serious issue that warrants greater attention. Alcohol-related harm to children and young people Alcohol can cause harm to children and young people in many different ways. Foetal alcohol spectrum disorder and the direct harm of alcohol misuse on the drinker are well known  ADDIN EN.CITE Elliott200888488488427Elliott, LColeman, KSuebwongpat, ANorris, SFetal Alcohol Spectrum Disorders (FASD): systematic reviews of prevention, diagnosis and mangement. HSAC Report912008Law Commission200991991991927Law Commission,Alcohol in our lives : an issues paper on the reform of New Zealands liquor laws (NZLC IP15)Issues paper152009Law Commission201092092092027Law Commission,Alcohol in Our Lives: Curbing the Harm (NZLC R114)2010[5-6, 13]. Parental or caregiver alcohol misuse is associated with an increased risk of child abuse and neglect, unintentional injury, Sudden Infant Death Syndrome, a multitude of psychological and behavioural problems, and the childs own substance abuse later in life  ADDIN EN.CITE  ADDIN EN.CITE.DATA [14-30]. Alcohol misuse can affect parenting capacity (such as the ability to be responsive to a childs emotional needs and to provide appropriate care and protection, supervision, and guidance), causes conflict and violence, and affects living conditions and family functioning  ADDIN EN.CITE Girling200689489489427Girling, MHuakau, JCasswell, SConway, KFamilies and Heavy Drinking - Impacts on Children's Wellbeing. Systematic ReviewBlue Skies Report 6/062006WellingtonFamilies Commission[28]. With regard to road traffic injury, most innocent victims are car passengers, including almost all children who are injured by drink driving  ADDIN EN.CITE Connor200910031003100317Connor, JennieCasswell, SallyThe burden of road trauma due to other people's drinkingAccident Analysis & PreventionAccident Analysis & Prevention1099-1103415Drink drivingAlcoholInjuryAlcohol-related harm20090001-4575doi: DOI: 10.1016/j.aap.2009.06.019http://www.sciencedirect.com/science/article/B6V5S-4WPHPDP-1/2/751ebef98fa97198074725f73c948981[9]. New Zealand has a high level of child maltreatment deaths compared to most other OECD countries  ADDIN EN.CITE UNICEF200352552552527UNICEF,A League Table of Child Maltreatment Deaths in Rich Nations2003September 2003FlorenceInnocenti Research Centre Innocenti Report CArd Issue No 1[31]. A recent report found that of 35 child homicide events by caregivers in NZ between 2002-2006, 49% involved alcohol or drug abuse by the perpetrator/s prior to, or at the time of the event  ADDIN EN.CITE Martin201092792792727Martin, JPritchard, RLearning from Tragedy: Homicide within Families in New Zealand 2002-20062010WellingtonMinistry of Social Development[32]. A recent Australian report found that 33.2% of substantiated child maltreatment cases between 2001-2005 involved alcohol  ADDIN EN.CITE Laslett201091791791727Laslett, A-M.Catalano, PChikritzhs, TDale, CDoran, CFerris, JJainullabudeen, TLivingston, MMatthews, SMugavin, JRoom, RSchlotterlein, MWilkinson, CThe Range and Magnitude of Alcohol's Harm to Others2010Fitzroy, VictoriaAER Centre for Alcohol Policy Research, Turning Poing Alcohol and Drug Centre, Eastern Health[33]. There is no similar data for NZ, however, alcohol is likely to be a significant factor for many of the 15,771 cases of substantiated maltreatment reported to Child Youth and Family for the year to June 2009  ADDIN EN.CITE Mardani201092592592527Mardani, JPreventing child neglect in New Zealand - a public health assessment of the evidence, current approach, and best practice guidance2010WellingtonOffice of the Children's Commissioner[34]. Although accurate statistics are not available, significant numbers of New Zealand children are likely to be exposed to alcohol misuse. The 2008/09 ALAC survey described 25% of adults aged 18 or over as binge drinkers and 37% of these binge drinkers had children aged 15 or younger  ADDIN EN.CITE Palmer200996396396327Palmer, SKalafatelis, EALAC Alcohol Monitor - Adults & Youth 2008-09 Drinking Behaviours Report2009Research New Zealand[35]. The 2006/07 NZ Health Survey found that of adult New Zealanders, many of whom will have parenting responsibilities, 17.7% of European/Others, 32.9% of Mori and 23% of Pacific populations had a hazardous drinking pattern  ADDIN EN.CITE <EndNote><Cite><Author>Ministry of Health</Author><Year>2009</Year><RecNum>770</RecNum><record>77077027Ministry of Health,Alcohol Use in New Zealand: Key results of the 2007/08 New Zealand Alcohol and Drug Use Survey2009Wellington Ministry of Health[36]. Drinking by young people is an important issue and is powerfully shaped by wider factors. Of particular concern, young adults experience the highest rates of alcohol-related road traffic injuries, including those due to other people's drinking  ADDIN EN.CITE Connor200910031003100317Connor, JennieCasswell, SallyThe burden of road trauma due to other people's drinkingAccident Analysis & PreventionAccident Analysis & Prevention1099-1103415Drink drivingAlcoholInjuryAlcohol-related harm20090001-4575doi: DOI: 10.1016/j.aap.2009.06.019http://www.sciencedirect.com/science/article/B6V5S-4WPHPDP-1/2/751ebef98fa97198074725f73c948981[9]. The nationally representative Youth07 survey found that 61% of students currently drink alcohol, and of these students, 30% drink weekly or more often  ADDIN EN.CITE Adolescent Health Research Group200810021002100227Adolescent Health Research Group,Youth07: The Health and Wellbeing of Secondary School Students in New Zealand. Initial Findings.2008AucklandThe University of Auckland[37]. One-third (34%) of students report that they had engaged in binge drinking (5 or more drinks within 4 hours) in the last 4 weeks. Among current drinkers, substantial numbers of students reported problems from drinking alcohol such as unsafe sex (14%), unwanted sex (7%), or injuries (22%). Sixteen percent of students who currently drink alcohol had been told by friends or family that they needed to cut down their drinking. Almost a quarter of the students reported being exposed to drink driving as passengers in motor vehicles inthe 4 weeks before the survey. Reducing alcohol-related harm to children and young people Our recommendations, and those of the Law Commission, are based on very strong evidence on cost-effective interventions to reduce alcohol-related harm, most of which relate to modifying the environment in which alcohol is marketed  ADDIN EN.CITE  ADDIN EN.CITE.DATA [1-4]. Alcohol reform that does not include the most effective actions is unlikely to achieve the objectives of reform, and misses addressing the profound harm from alcohol misuse to drinkers and others affected by their drinking, and allows the high economic and social costs to society to continue. Some of the most cost-effective strategies to reduce alcohol-related harm include making alcohol more expensive and less available, and banning alcohol advertising and sponsorship  ADDIN EN.CITE  ADDIN EN.CITE.DATA [1-4, 10]. There is good evidence on the use of brief interventions delivered in health care settings with the aim of identifying heavy drinking and motivating an individual to take action, and good evidence on effective treatments  ADDIN EN.CITE Anderson200999999999917Anderson, PeterChisholm, DanFuhr, Daniela C.Effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcoholThe LancetThe Lancet2234-2246373968220090140-6736doi: DOI: 10.1016/S0140-6736(09)60744-3http://www.sciencedirect.com/science/article/B6T1B-4WM2BX7-17/2/44c510eff12058156dc7848924f7ef9c2009/7/3/[1]. Although less evidence is available on specific interventions to reduce alcohol-related harm to children, home-visiting programmes, parenting programmes and screening parents for hazardous drinking in child health settings are promising; however, these require careful implementation and are more costly  ADDIN EN.CITE  ADDIN EN.CITE.DATA [38-40]. It is increasingly apparent that vested interests, such as the alcohol industry, are using tactics similar to those of the tobacco industry, to undermine the development of an appropriate and effective public health response to a serious public health threat  ADDIN EN.CITE Casswell200910001000100017Casswell, SallyThamarangsi, ThaksaphonReducing harm from alcohol: call to actionThe LancetThe Lancet2247-2257373968220090140-6736doi: DOI: 10.1016/S0140-6736(09)60745-5http://www.sciencedirect.com/science/article/B6T1B-4WM2BX7-18/2/4c93d88eb1dde5f4562bb6c7c77ea68b2009/7/3/[10]. Conclusion Alcohol misuse causes profound harm to children and young people and increases the risk of death, maltreatment, injury, and poor physical and psychological health. Alcohol legislation has a fundamental part to play in reducing harm from alcohol, in ensuring there is the correct balance between harms and benefits, in shaping social norms, and importantly, in protecting the most vulnerable members of society. The current alcohol reform process offers great potential to make a lasting difference, but only if wider measures are included in legislation as recommended by the Law Commission References  ADDIN EN.REFLIST 1. Anderson, P., D. Chisholm, and D.C. Fuhr, Effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol. The Lancet, 2009. 373(9682): p. 2234-2246. 2. WHO Regional Office for Europe, Evidence for the effectiveness and cost-effectiveness of interventions to reduce alcohol-related harm. 2009. 3. NICE (National Institute for Health and Clinical Excellence), Alcohol use disorders: Preventing the development of hazardous and harmful drinking, in NICE public health guidance 24. 2010, NICE: London. 4. Babor, T., et al., Alcohol: No Ordinary Commodity. Research and Public Policy. 2010, Oxford University Press: New York. 5. Law Commission, Alcohol in Our Lives: Curbing the Harm (NZLC R114). 2010. 6. Law Commission, Alcohol in our lives : an issues paper on the reform of New Zealands liquor laws (NZLC IP15), in Issues paper. 2009. 7. Connor, J., et al., The Burden of Death, Disease and Disability Due to Alcohol in New Zealand 2005, Alcohol Advisory Council of New Zealand: Wellington. 8. ALAC, et al., Alcohol Quick Facts. 2010,  HYPERLINK "http://www.ndp.govt.nz/moh.nsf/pagescm/7752/$File/alcohol-factsheets.pdf:" www.ndp.govt.nz/moh.nsf/pagescm/7752/$File/alcohol-factsheets.pdf: Wellington. 9. Connor, J. and S. Casswell, The burden of road trauma due to other people's drinking. Accident Analysis & Prevention, 2009. 41(5): p. 1099-1103. 10. Casswell, S. and T. Thamarangsi, Reducing harm from alcohol: call to action. The Lancet, 2009. 373(9682): p. 2247-2257. 11. Beaglehole, R. and R. Bonita, Alcohol: a global health priority. The Lancet, 2009. 373(9682): p. 2173-2174. 12. Anderson, P., et al., Impact of alcohol advertising and media exposure on adolescent alcohol use: a systematic review of longitudinal studies. Alcohol and Alcoholism 2009. 44(3): p. 229-243. 13. Elliott, L., et al., Fetal Alcohol Spectrum Disorders (FASD): systematic reviews of prevention, diagnosis and mangement. HSAC Report. 2008. 14. Rossow, I., Suicide, violence and child abuse: a review of the impact of alcohol consumption on social problems. Contemporary Drug Problems 2000. 37: p. 397-433. 15. Kelleher, K., et al., Alcohol and Drug Disorders among Physically Abusive and Neglectful Parents in a Community-Based Sample. American journal of public health, 1994. 84(10): p. 1586-1590. 16. Chaffin, M., K. Kelleher, and J. Hollenberg, Onset of physical abuse and neglect: Psychiatric, substance abuse, and social risk factors from prospective community data. Child Abuse & Neglect, 1996. 20(3): p. 191-203. 17. Walsh, C., H.L. MacMillan, and E. Jamieson, The relationship between parental substance abuse and child maltreatment: findings from the Ontario Health Supplement. Child Abuse & Neglect, 2003. 27(12): p. 1409-1425. 18. Dube, S., et al., Growing up with parental alcohol abuse: exposure to childhood abuse, neglect, and household dysfunction. Child Abuse & Neglect, 2001. 25: p. 1627-1640. 19. Ammerman, R., et al., Child Abuse Potential in Parents with Histories of Substance Use Disorder. Child Abuse & Neglect, 1999. 23(12): p. 12251238. 20. Wolock, I. and S. Magura, Parental substance abuse as a predictor of child maltreatment re-reports. Child Abuse & Neglect, 1996. 20(12): p. 1183-1193. 21. Norstrom, T., Family violence and total consumption of alcohol. Nordic Studies on Alcohol and Drugs, 1993. 10: p. 311-318. 22. Freisthler, B., B. Needell, and P. Gruenewald, Is the physical availability of alcohol and illicit drugs related to neighborhood rates of child maltreatment? Child Abuse & Neglect 2005. 29: p. 1049-1060. 23. Bijur, P., et al., Parental Alcohol Use, Problem Drinking, and Children's Injuries. Journal of the American Medical Association, 1992. 267(23): p. 3166-3171. 24. Damashek, A., et al., Relation of Caregiver Alcohol Use to Unintentional Childhood Injury. Journal of Pediatric Psychology, 2009. 34(4): p. 344-353. 25. Winqvist, S., et al., Parental alcohol misuse is a powerful predictor for the risk of traumatic brain injury in childhood. Brain Injury, 2007. 21(10): p. 1079-85. 26. Blair, P., et al., Hazardous cosleeping environments and risk factors amenable to change: case-control study of SIDS in south west England. British Medical Journal, 2009. 339(b3666). 27. Carpenter, R., et al., Sudden unexplained infant death in 20 regions in Europe: case control study. The Lancet, 2004. 363(9494): p. 185-191. 28. Girling, M., et al., Families and Heavy Drinking - Impacts on Children's Wellbeing. Systematic Review, in Blue Skies Report 6/06. 2006, Families Commission: Wellington. 29. Lynskey, M., D. Fergusson, and L. Horwood, The effect of parental alcohol problems on rates of adolescent psychiatric disorders. Addiction, 1994. 89: p. 1277-1286. 30. Hutchinson, M., The second-hand effects of alcohol misuse on children - the evidence and policy interface, in 2010/2011 Summer Studentship Project. 2011, University of Otago: Wellington. 31. UNICEF, A League Table of Child Maltreatment Deaths in Rich Nations. 2003, Innocenti Research Centre: Florence. 32. Martin, J. and R. Pritchard, Learning from Tragedy: Homicide within Families in New Zealand 2002-2006. 2010, Ministry of Social Development: Wellington. 33. Laslett, A.-M., et al., The Range and Magnitude of Alcohol's Harm to Others. 2010, AER Centre for Alcohol Policy Research, Turning Poing Alcohol and Drug Centre, Eastern Health: Fitzroy, Victoria. 34. Mardani, J., Preventing child neglect in New Zealand - a public health assessment of the evidence, current approach, and best practice guidance. 2010, Office of the Children's Commissioner: Wellington. 35. Palmer, S. and E. Kalafatelis, ALAC Alcohol Monitor - Adults & Youth 2008-09 Drinking Behaviours Report. 2009, Research New Zealand. 36. Ministry of Health, Alcohol Use in New Zealand: Key results of the 2007/08 New Zealand Alcohol and Drug Use Survey. 2009, Ministry of Health: Wellington. 37. Adolescent Health Research Group, Youth07: The Health and Wellbeing of Secondary School Students in New Zealand. Initial Findings. 2008, The University of Auckland: Auckland. 38. Wilson, C.R., et al., Parental Alcohol Screening in Pediatric Practices. Pediatrics, 2008. 122(5): p. e1022-1029. 39. Werner, M., A. Joffe, and A. Graham, Screening, Early Identification, and Office-based Intervention with Children and Youth Living in Substance-abusing Families. Pediatrics, 1999. 103: p. 1099-1112. 40. Dawe, S., P. Harnett, and S. Frye, Improving outcomes for children living in families with parental substance misuse: What do we know and what should we do, in Child Abuse Prevention Issues, 29. 2008, Australian Institute of Family Studies: Melbourne.   Alcohol misuse can be defined as the personal use of alcohol such as to threaten or damage the health or social adjustment of the user or those other persons directly affected by his or her drinking.     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Research and Public Policy.Second 2010New YorkOxford University PressNICE (National Institute for Health and Clinical Excellence)201095595595527NICE (National Institute for Health and Clinical Excellence),Alcohol use disorders: Preventing the development of hazardous and harmful drinkingNICE public health guidance 242010LondonNICEWHO Regional Office for Europe200998998998927WHO Regional Office for Europe,Evidence for the effectiveness and cost-effectiveness of interventions to reduce alcohol-related harm2009http://www.euro.who.int/document/E92823.pdfDBabor201084184184113Babor, TCaetano, RCasswell, SEdwards, GGiesbrecht, NGraham, KGrube, JHill, LHolder, HHomel, RLivingston, MOsterberg, ERehm, JRoom, RRossow, IAlcohol: No Ordinary Commodity. Research and Public Policy.Second 2010New YorkOxford University PressNICE (National Institute for Health and Clinical Excellence)201095595595527NICE (National Institute for Health and Clinical Excellence),Alcohol use disorders: Preventing the development of hazardous and harmful drinkingNICE public health guidance 242010LondonNICEWHO Regional Office for Europe200998998998927WHO Regional Office for Europe,Evidence for the effectiveness and cost-effectiveness of interventions to reduce alcohol-related harm2009http://www.euro.who.int/document/E92823.pdfAnderson200999999999917Anderson, PeterChisholm, DanFuhr, Daniela C.Effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcoholThe LancetThe Lancet2234-2246373968220090140-6736doi: DOI: 10.1016/S0140-6736(09)60744-3http://www.sciencedirect.com/science/article/B6T1B-4WM2BX7-17/2/44c510eff12058156dc7848924f7ef9c2009/7/3/Casswell200910001000100017Casswell, SallyThamarangsi, ThaksaphonReducing harm from alcohol: call to actionThe LancetThe Lancet2247-2257373968220090140-6736doi: DOI: 10.1016/S0140-6736(09)60745-5http://www.sciencedirect.com/science/article/B6T1B-4WM2BX7-18/2/4c93d88eb1dde5f4562bb6c7c77ea68b2009/7/3/Casswell200910001000100017Casswell, SallyThamarangsi, ThaksaphonReducing harm from alcohol: call to actionThe LancetThe Lancet2247-2257373968220090140-6736doi: DOI: 10.1016/S0140-6736(09)60745-5http://www.sciencedirect.com/science/article/B6T1B-4WM2BX7-18/2/4c93d88eb1dde5f4562bb6c7c77ea68b2009/7/3/F DWilson200899299299217Wilson, Celeste R.Harris, Sion KimSherritt, LonLawrence, NohelaniGlotzer, DeborahShaw, Judith S.Knight, John R.Parental Alcohol Screening in Pediatric PracticesPediatricsPediatricse1022-102912252008November 1, 2008http://pediatrics.aappublications.org/cgi/content/abstract/122/5/e102210.1542/peds.2008-1183Werner199998898898817Werner, MJJoffe, AGraham, AVScreening, Early Identification, and Office-based Intervention with Children and Youth Living in Substance-abusing FamiliesPediatricsPediatrics1099-11121031999Dawe200886686686627Dawe, SHarnett, PFrye, SImproving outcomes for children living in families with parental substance misuse: What do we know and what should we doChild Abuse Prevention Issues, 292008MelbourneAustralian Institute of Family StudiesDyK yK http://www.ndp.govt.nz/moh.nsf/pagescm/7752/$File/alcohol-factsheets.pdf:yX;H,]ą'c$$If!vh555S5D#v#v#vS#vD:V 555S5D4yti^% 666666666vvvvvvvvv66666>66666666666666666666666666666666666666666666666h6666666666666666666666666666666666666666666666666666666666666666662 0@P`p28 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH b`b Normal$ d*$a$ @CJOJQJ_HmH sH tH 88  Heading 1$@&588  Heading 2$@&>*  Heading 3p$$ \R" b2> Y!r"B%(*-0R3"68;>bA2DGI*$@&a$56@CJ88  Heading 4$@&CJ<<  Heading 5$@&5CJ<@<  Heading 6$@&5CJBB  Heading 7$$@&a$5CJ>>  Heading 8$$@&a$5DA`D Default Paragraph FontVi@V 0 Table Normal :V 44 la (k ( 0No List NN Address$a$5OJQJhmH sH tH u8@8 Header  !CJ8 8 Footer  !CJ0U@!0 Hyperlink>*B*@V1@ FollowedHyperlink>*B* ZBBZ  Body Text$ p@ *$1$a$@htH uV>RV Title$ p@ *$1$a$5CJ0htH u6P@b6  Body Text 2CJjCrj Body Text Indent($ 0*$^`a$@CJ<Q<  Body Text 3$a$CJ(W( `Strong5D`D  No SpacingCJ_HmH sH tH FF ~ Title Char5@CJ0OJQJhtH pp ~0List Paragraph"$ d*$^a$@CJOJQJaJtH v^v ~0 Normal (Web)($ ddd*$[$\$a$@CJOJPJQJaJtH ^J^ q<Subtitle$ d*$a$56@CJmH sH tH LL q< Subtitle Char56CJOJQJmH sH b@b !-O Footnote Text $ d*$a$@CJOJQJtH @O@  -OFootnote Text ChartH @&`!@ -OFootnote ReferenceH*.X@1. -OEmphasis6]j@Cj  Table Grid7:V$0$PK![Content_Types].xmlj0Eжr(΢Iw},-j4 wP-t#bΙ{UTU^hd}㨫)*1P' ^W0)T9<l#$yi};~@(Hu* Dנz/0ǰ $ X3aZ,D0j~3߶b~i>3\`?/[G\!-Rk.sԻ..a濭?PK!֧6 _rels/.relsj0 }Q%v/C/}(h"O = C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_6LR7`0̞O,En7Lib/SeеPK!kytheme/theme/themeManager.xml M @}w7c(EbˮCAǠҟ7՛K Y, e.|,H,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+& 8PK!Ptheme/theme/theme1.xmlYOo6w toc'vuر-MniP@I}úama[إ4:lЯGRX^6؊>$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! 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Arial Narrow7.@ Calibri?= *Cx Courier New;Wingdings7MarlettA BCambria Math"qh 򦤢f CvGCvG!mr43qHX $P{2! xx TAX INVOICEracpDenise(                           ! " # $ % & ' Oh+'0H    (08@ TAX INVOICEracpNormalDenise6Microsoft Office Word@H'@`uC@lϦ@wCv՜.+,D՜.+,< hp  racpG  TAX INVOICE Title 8@ _PID_HLINKSA@VJhttp://www.ndp.govt.nz/moh.nsf/pagescm/7752/$File/alcohol-factsheets.pdf:   !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`bcdefghijklmnopqrstuvwxyz{|}~Root Entry F`ISData a 1Table'VWordDocument $SummaryInformation(DocumentSummaryInformation8MsoDataStoreB`P0DVKB3IEY==2B`PItem  PropertiesUCompObj y    F'Microsoft Office Word 97-2003 Document MSWordDocWord.Document.89q Paediatric Society of New Zealand: Submissions
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Submissions

The Paediatric Society believes all children and youth should, by right, attain optimal physical, mental and social health and wellbeing.  By working as a coordinated national network of health professionals the Society dedicates its efforts and resources to making official submissions to both Government and Non-Government organisations on issues that will impact on the health and wellbeing of children and young people.

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