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Results
Of 1 429 884 presentations to EDs in Queensland, 869 603 came from hospitals that contributed data for the entire duration of the study. Of these, 125 511 were for alcohol-related harm in young people using the broad definition; 88 806 (71%) were males. There were 12 049 presentations over the same period using the narrow definition, of whom 7303 (61%) were males. This compared with 90 531 using the broad definition, and 9709 presentations using the narrow definition, for people aged 30–49 years. Of these, 60 558 (67%) and 6483 (67%), respectively were males Over the same period, there were 3938 EDIS presentations relating to asthma in people aged 15–29 years and 4861 presentations for appendicitis (total n=8799), of whom 3868 (44%) were males.

Results
Of 1 429 884 presentations to EDs in Queensland, 869 603 came from hospitals that contributed data for the entire duration of the study. Of these, 125 511 were for alcohol-related harm in young people using the broad definition; 88 806 (71%) were males. There were 12 049 presentations over the same period using the narrow definition, of whom 7303 (61%) were males. This compared with 90 531 using the broad definition, and 9709 presentations using the narrow definition, for people aged 30–49 years. Of these, 60 558 (67%) and 6483 (67%), respectively were males Over the same period, there were 3938 EDIS presentations relating to asthma in people aged 15–29 years and 4861 presentations for appendicitis (total n=8799), of whom 3868 (44%) were males.

Figure 1 shows the time series decomposition of the number of people presenting for alcohol-related harms in 15–29 and 30–49-year-olds. Figure 2 shows the time series of presentations for asthma and appendicitis presentations. Each figure shows the original, seasonally adjusted and trend series that removes both seasonal variation and random fluctuations from month to month. In all cases, the results showed considerable stability. We found similar results for the narrow definition of alcohol-related harms.

Figure 1 shows the time series decomposition of the number of people presenting for alcohol-related harms in 15–29 and 30–49-year-olds. Figure 2 shows the time series of presentations for asthma and appendicitis presentations. Each figure shows the original, seasonally adjusted and trend series that removes both seasonal variation and random fluctuations from month to month. In all cases, the results showed considerable stability. We found similar results for the narrow definition of alcohol-related harms.

Modeling to inform infectious disease control

The effectiveness of this measure has been extensively debated.11 ,12 In particular, it is unclear whether young people reduced harmful consumption, absorbed the price increase or changed to other alcoholic drinks with no effect on alcohol-related harm. Alcohol sales data reported a substantial fall in the sales of ready-to-drink beverages in the 3 months following introduction of the tax, with a smaller shift to other beverages (beer and spirits) and a net reduction in overall sales.13 However, sales data can be contradictory with reports from Europe that increasing the tax on alcopops did not influence total alcohol consumption when the price of other beverages remained unchanged.2 Moreover, sales data reflect overall consumption, not the amount of risky drinking in certain population groups.14 ,15 Neither do they take into account changes in the alcohol content of drinks over time.16 Indicators of health outcomes, such as health service use, may therefore be more appropriate to assess the success of such policies.

The effectiveness of this measure has been extensively debated.11 ,12 In particular, it is unclear whether young people reduced harmful consumption, absorbed the price increase or changed to other alcoholic drinks with no effect on alcohol-related harm. Alcohol sales data reported a substantial fall in the sales of ready-to-drink beverages in the 3 months following introduction of the tax, with a smaller shift to other beverages (beer and spirits) and a net reduction in overall sales.13 However, sales data can be contradictory with reports from Europe that increasing the tax on alcopops did not influence total alcohol consumption when the price of other beverages remained unchanged.2 Moreover, sales data reflect overall consumption, not the amount of risky drinking in certain population groups.14 ,15 Neither do they take into account changes in the alcohol content of drinks over time.16 Indicators of health outcomes, such as health service use, may therefore be more appropriate to assess the success of such policies.

The effectiveness of this measure has been extensively debated.11 ,12 In particular, it is unclear whether young people reduced harmful consumption, absorbed the price increase or changed to other alcoholic drinks with no effect on alcohol-related harm. Alcohol sales data reported a substantial fall in the sales of ready-to-drink beverages in the 3 months following introduction of the tax, with a smaller shift to other beverages (beer and spirits) and a net reduction in overall sales.13 However, sales data can be contradictory with reports from Europe that increasing the tax on alcopops did not influence total alcohol consumption when the price of other beverages remained unchanged.2 Moreover, sales data reflect overall consumption, not the amount of risky drinking in certain population groups.14 ,15 Neither do they take into account changes in the alcohol content of drinks over time.16 Indicators of health outcomes, such as health service use, may therefore be more appropriate to assess the success of such policies.

However, all of these would have had the effect of reducing alcohol-related harms so any bias would have been to enhance the apparent effect of the alcopops tax. It would not explain our finding of no change in alcohol-related harms. Wider societal influences such as the economy may also affect alcohol consumption. Other authors have attempted to control for this by using alcohol sales although, as noted previously, these may be an imprecise measure of alcohol-related harms in specific populations. Furthermore, sales in Australia actually declined from a high of 10.76 L of pure alcohol per person in 2006 to 10.30 L in 2010/2011; for spirits and alcopops the comparable figures were 2.26 and 2.05 L, respectively.33 Any bias would therefore have again been in the direction of inflating any effects of the alcopops tax.

A further drawback was the time taken to obtain the necessary approvals, extract, code and link the data. This means we only have data up to 2010. On the other hand, it may be difficult to ascribe an effect more than 2 years after the increase in alcopops tax in the face of other policy, societal and macroeconomic change. In addition, this is the time-frame when sales data showed a drop in the purchase of alcopops and so would also be the time when any health gains should have occurred. The percentage of males in the 15–29-year-old and 30–49-year-old presentations for alcohol-related harm was similar but higher than for the other controls who presented with appendicitis or asthma. On the other hand, the results were consistent across all comparison groups (appendicitis, asthma or older presentations for alcohol-related harm) and when males and females were analysed separately. Lastly, the results may not necessarily apply elsewhere or to measures that target other types of alcoholic drink or population.