Alcohol-related Deaths Research Articles

Compassion or stigma? How adults bereaved by alcohol or drugs experience services.

How to promote compassionate care within public services is a concern in several countries; specifically, some British healthcare scandals highlight poor care for service users who may readily be stigmatised as 'other'. The article therefore aims to understand better the relationship between stigma and compassion. As people bereaved by a drug- or alcohol-related death often experience stigma, the article draws on findings from a major British study, conducted during 2012-2015 by the authors, of people bereaved in this way, in order to see how service provision can be improved. One hundred and six bereaved family members were interviewed in depth about their experiences of loss and support. Thematic analysis developed theoretical understandings of participants' lived experiences. This article analyses our data on how bereaved people experienced stigma and kindness from practitioners of all kinds. We found that stigma can be mitigated by small acts of kindness from those encountered after the death. Stigma entails stereotyping, othering and disgust, each of which has emotional and cognitive aspects; kindness entails identification and fellow feeling; professionalism has classically entailed emotional detachment, but interviewees found cold professionalism as disturbing as explicit disgust. Drawing on theories concerning the end of life, bereavement and emotional labour, the article analyses the relationship between stigma, kindness and professionalism, and identifies some strategies to counter stigmatisation and foster compassion.

Health benefits from moderate drinking: a critical review

Although alcohol consumption is a leading cause of preventable death and social problems worldwide, many studies have found an association between low-dose consumption and reduced risk of cardiovascular (CVD) disease. Despite important limitations in the underlying research, this idea has been promoted extensively, used to argue against the adoption of effective alcohol policies and led some doctors to advise patients to drink for better health. There are a number of grounds for scepticism about these claims. There have been no randomised studies of low-dose alcohol consumption with disease or death outcomes to confirm findings from non-randomised studies. There are many methodological problems with observational studies, most importantly confounding and misclassification. In contrast to observational studies, a recent large Mendelian randomisation study found that having a genetic disposition that causes less drinking was associated with a significantly reduced risk of coronary disease, even among those who consume modest amounts of alcohol. Recent research has also challenged some of the purported mechanisms for the protective effect of moderate drinking, eg the effect on and impact of blood lipids. This paper will provide methodological critique of the scientific basis for the claim that low-dose alcohol confers health benefits. It is concluded that the protective effects of moderate drinking may be spurious. Governments should strengthen effective alcohol control policies to reduce alcohol-related deaths, social problems and economic costs. Physician advice to patients should focus on reducing consumption among current drinkers, and should discourage drinking initiation or increased consumption on the basis of health-related considerations.

Effects of local extrinsic mortality rate, crime and sex ratio on preventable death in Northern Ireland.

Individual investment in health varies greatly within populations and results in significant differences in the risk of preventable death. Life history theory predicts that individuals should alter their investment in health (somatic maintenance) in response to ecological cues that shift the perceived fitness payoffs to such investments. However, previous research has failed to isolate the effects of different ecological factors on preventable death, and has often relied on macro-level data without individual controls. Here, we test some key predictions concerning the local ecology-that higher extrinsic mortality rate (EMR), crime rate and mate-scarcity (male/female-biased sex ratio) at the ward-level-will be associated with a higher risk of preventable death. We use census-based data from Northern Ireland (n = 927 150) on preventable death during an 8.7-year period from the 2001 Census and run Cox regressions for (i) accident/suicide or alcohol-related death and (ii) deaths from preventable diseases, for men and women separately, controlling for a wide range of individual variables. We find evidence of ward-level EMR and crime rate being positively associated with preventable death among men, particularly men with low socioeconomic position. There was a tentative relationship between male-biased sex ratio and preventable death among women, but not among men. Both behaviours that might lead to 'risky' death and health neglect might be adaptive responses to local ecologies. Efforts to reduce crime might be as effective as those to reduce extrinsic mortality, and both could have positive effects on various health behaviours.

The Public Health Responsibility Deal: why alcohol industry partnerships are bad for health?

The results from the evaluation of the Public Health Responsibility Deal Alcohol Network 1, 2 raise questions about what evidence exists to support alcohol industry partnerships as effective mechanisms for reducing alcohol harm. These reports corroborate findings from previous studies that show initiatives based on partnerships with drinks industry actors and voluntary agreements have minimal, if any, impact on rates of alcohol consumption and its associated health and social problems 3. This growing body of evidence is unsurprising: how can corporations legally obliged to prioritize the interests of their shareholders consider actions that would essentially diminish their sales and profits? The revelations that an alcohol industry-funded body interfered with data during the evaluation process of the Responsibility Deal pose further difficult questions about industry's role in public health policy 4. This highlights the pressing need for information on the effectiveness of alcohol industry partnerships to be subject to careful scrutiny, and suggests that we should be investigating if such partnerships have a detrimental impact on public health. There is evidence to indicate a number ways in which alcohol industry-led initiatives can have a negative impact on public health outcomes. First, they can lead directly to increased harms through promotion of irresponsible drinking, neglect of safe retailing practices or generation of stigma among vulnerable groups 5-7. Secondly, industry partnerships can divert resources and attention away from evidenced-based interventions, presenting significant opportunity costs for public health outcomes. Commentators have argued that the UK Department of Health's prioritization of the Responsibility Deal was to the detriment of other evidence-based measures outlined in the Government's Alcohol Strategy, such as minimum unit pricing, which was discarded in the face of drinks industry opposition 8. Perhaps more importantly, partnerships with drinks industry bodies legitimize their place at the table, enshrining conflicts of interest in public health policymaking and enabling Big Alcohol to influence the wider policy agenda. The WHO Director General, Dr Margaret Chan, has voiced her concerns on this issue, stating that alcohol policies ‘must be protected from distortion by commercial or vested interests’ 9. Similar to the tobacco industry, alcohol companies have reportedly worked to undermine public health objectives in the pursuit of economic goals by discrediting evidence to support effective policies, co-opting policymakers and launching aggressive lobbying campaigns designed to ‘kill off’ regulations intended to save lives 8, 10-12. Analysis of corporate documents indicates that tobacco and alcohol companies have worked together, shared information and similar arguments to defend their products and prevent or delay restrictions being placed upon them 10, 11. However, in spite of the similarities between these two ‘unhealthy commodity industries’, the approaches taken to public–private partnerships and protecting public health from conflicts of interest are very different. The World Health Organization (WHO) guidelines for implementing article 5.3 of the Framework Convention for Tobacco Control (FCTC) stipulate that governments must not enter into partnership agreements with tobacco companies. The WHO FCTC, of which the United Kingdom is a signatory, explicitly acknowledges well-documented evidence that tobacco companies have ‘worked for years with the express intention of subverting the role of governments and WHO in implementing public health policies to combat the tobacco epidemic’ 13. Conversely, alcohol industry partnerships form the cornerstone policies for the UK Government in dealing with alcohol-related harm 14 and there has been much speculation over the government's justification for reneging its commitment to introduce minimum unit pricing. Despite clear evidence, commissioned by the government 15, that the policy would not penalize ‘responsible drinkers’, the government followed closely the unsubstantiated industry-promoted narrative that it would, in fact, do this 16. The longer-term impact of the Responsibility Deal on public health is unknown. All the available evidence indicates that this industry partnership has not generated any improvements in rates of alcohol-related hospital admissions or deaths. Further research is required in order to estimate what the opportunity costs to public health have been, due to delays in implementing evidence-based policies such as minimum unit pricing. Research is also needed urgently into the wider impact of corporate behaviour on public health, in order to inform the management of conflicts of interest in public policymaking. The Institute of Alcohol Studies receives funding from the Alliance House Foundation.

Changes in mortality due to major alcohol-related diseases in four Nordic countries, France and Germany between 1980 and 2009: a comparative age-period-cohort analysis.

To investigate age, period and cohort effects on time trends of alcohol-related mortality in countries with different drinking habits and alcohol policies. Age-period-cohort (APC) analyses on alcohol-related mortality were conducted in Denmark, Finland, Norway, Sweden, France and Germany. Cases included alcohol-related deaths in the age range 20-84 years between 1980 and 2009. Mortality data were taken from national causes of death registries and covered the ICD codes alcoholic psychosis, alcohol use disorders, alcoholic liver disease and toxic effect of alcohol. In all countries changes across age, period and cohort were found to be significant for both genders [effect value with confidence interval (CI) shown in Supporting information, Table S1]. Period effects pointed to an increase in alcohol-related mortality in Denmark, Finland and Germany and a slightly decreasing trend in Sweden, while in Norway an inverse U-shaped curve and in France a U-shaped curve was found. Compared with the cohorts born before 1960, the risk of alcohol-related mortality declined substantially in cohorts born in the 1960s and later. Pairwise between-country comparisons revealed more statistically significant differences for period (P < 0.001 for all 15 comparisons by gender) than for age [P < 0.001 in seven (men) and four (women) of 15 comparisons] or cohort [P < 0.01 in two (men) and three (women) of 15 comparisons]. Strong period effects suggest that temporal changes in alcohol-related mortality in Denmark, Finland, Norway, Sweden, France and Germany between 1980 and 2009 were related to secular differences affecting the whole population and that these effects differed across countries.

IQ and alcohol-related morbidity and mortality among Swedish men and women: the importance of socioeconomic position.

AimsTo investigate the association between intelligence in childhood and later risk of alcohol-related disease and death by examining (1) the mediating effect of social position as an adult and (2) gender as a possible moderator.DesignCohort study.Setting and participants21 809 Swedish men and women, born in 1948 and 1953, from the Swedish “Evaluation Through Follow-up” database were followed until 2006/2007.MeasurementsIQ was measured in school at the age of 13 and alcohol-related disease and death (International Classification of Disease codes) were followed from 1971 and onwards.FindingsWe found an increased crude HR of 1.23 (95% CI 1.18 to 1.29) for every decrease in group of IQ test results for alcohol-related admissions and 1.14 (95% CI 1.04 to 1.24) for alcohol-related death. Social position as an adult was found to mediate both outcomes. Gender was not found to moderate the association. However, adjusting for socioeconomic position lowered the risk more among men than among women.ConclusionsThere was an inverse, graded association between IQ and alcohol-related disease and death, which at least partially was mediated by social position as an adult. For alcohol-related death, complete mediation by socioeconomic position as an adult was found. Gender does not moderate this association. The role of socioeconomic position may differ between the genders.

Boards of trustees must assume responsibility for making alcohol prevention on campus a top priority

ABSTRACTFew colleges have made the prevention of alcohol-related injuries and deaths an institutional priority, and even fewer have implemented prevention strategies with a solid evidentiary base. We look to presidents to provide leadership on this issue, but those who do are atypical. Boards of trustees should step in by asserting that student wellness be a primary focus in the institution's strategic plan, with specific, measurable goals; holding the president accountable for progress in reducing high-risk drinking and its consequences; and mandating a line item in the annual budget, with adequate staffing and revenues to put evidence-based practices in place. Boards will be more likely to respond when led to focus on the cost implications of the campus alcohol problem; the link between high-risk drinking and mission-critical institutional objectives such as academic performance, student engagement, and retention; and the institution's potential liability if evidence-based prevention strategies are not in place.

Mortality Related to Alcohol and Tobacco Consumption - A Benchmarking of Regional Trends and Levels

Regional characteristics are being increasingly taken into account in studies on the determinants of health and health-care. A systematic observation and inclusion of regional particularities has, however, been absent from strategic planning and financing decisions to date. Furthermore, regional-level changes over time have, for the most part, not been considered in the existing studies. Accordingly, this article seeks to depict both the levels and trends in potentially avoidable mortality on the district level and to establish a benchmark that shows the theoretical goals for the reduction in avoidable deaths in each district. Gender-specific and age-standardised potentially avoidable deaths were determined for each of the 413 German districts in the period from 2000 to 2008 on the basis of cause of death statistics provided by statistical agencies of the German federal states. Deaths due to lung cancer and alcohol-related diseases were taken into account as these are considered to be avoidable through primary prevention. The district-specific benchmark values were ascertained using 2 linear hierarchic nested models and tested for significance using an F-test. Overall, the lung cancer mortality was found to have declined amongst men and gradually increased amongst women during the time period under consideration. The benchmark for deaths from lung cancer in women shows that the increase in mortality is principally observed in West German and urban districts. In relation to the alcohol-related deaths we also see an east-west divide, with higher rates in eastern Germany. Shrinking districts in eastern Germany were able, however, to record a big reduction in rates in recent years. An unfortunate development in the trend of alcohol-related mortality in women was notably observed in regional areas of Bavaria. The analysis offers decision makers the possibility of pinpointing regions with high intervention need. Increasing lung cancer mortality rates in women living in cities points to, for example, a heightened need for anti-smoking campaigns in urban areas. In relation to alcohol-related diseases, a heightened need for target group-specific prevention was identified in East German districts as well as some districts in Bavaria.

Creative Responses to a Drug- or Alcohol-Related Death

This article takes a sociocultural approach to examining creative responses to a traumatic death and loss and their contribution to further understanding of grief, identity, and continuing bonds. Based on qualitative interviews with family members bereaved after a drug- or alcohol-related death, the article explores how, in circumstances which threaten identity and continuity of being, grief may find expression through public and private creativity. Indeed, such creativity was apparent despite negative cultural representations of such deaths invalidating the grief of those left behind, who may suffer profound guilt, isolation, and disturbing memories. While interviewees reported such negative effects, psychologically considered symptomatic of complicated grief disorder, they also conveyed creative responses to negative stereotypes, rebuilding identities, and continuing bonds. These responses, through which interviewees communicated both vulnerability and resilience, revealed a complex and nuanced picture of grief following traumatic loss.

Surveillance of US Death Rates from Chronic Diseases Related to Excessive Alcohol Use.

To assess the utility of multiple-cause (MC) death records for surveillance of US mortality rates from chronic causes related to excessive alcohol use. The Alcohol-Related Disease Impact (ARDI) resource produced estimates of the population 'alcohol attributable fraction' (AAF) due to excessive drinking for each alcohol-related (AAF > 0%) cause of death, and used AAFs to estimate numbers of alcohol-related deaths from alcohol-related underlying causes (UC) in adults age 20-64 and 65+ years in 2006-2010. For surveillance, this study used MC death file to identify individual deaths (2006-2010) with an 'alcohol-induced' cause (AAF = 100%) anywhere on the certificate, and to obtain US rates of premature death (ages 15-64 and 65-74 years) for 1999-2012. Using the selected MC records, numbers of deaths from alcohol-related chronic UC (2006-2010) were 81% of ARDI estimates for age 20-64, but only 40% for 65+ years. The MC records identified substantial numbers of deaths from causes (e.g. certain infectious diseases) not included as alcohol-related in ARDI, but included in surveillance of premature death rates for chronic UC. Also, premature death rates for chronic alcohol-induced causes using only the UC (as in routine mortality statistics) were only about half the rates based on MC; all rates increased in recent years but some reached statistical significance only by using MC. Using MC records underestimated total US deaths from alcohol-related chronic causes as the UC, but enhanced surveillance of rates for premature deaths involving chronic causes that may be related to excessive alcohol use.

PWE-138 Increasing burden of alcohol related brain injury is disproportionate to hospital admissions with liver disease

Introduction Patients with alcohol related brain injury (ARBI) including Korsakoff’s syndrome frequently present to hospital with cognitive impairment, physical illness and consequences of greater risk-taking behaviour. We studied the impact of ARBI admissions on an acute hepatology unit and compared this with trends in hospitalisation for alcohol related liver disease over a 5 year period. Method We studied a large acute hospital serving a population of over 650,000 in the highest national quintile for both alcohol related admissions and cirrhosis deaths. We analysed hospital episode statistics and departmental databases for 5 consecutive financial years from 2009–2014, focusing on Korsakoff’s syndrome, specific liver disorders including complications of cirrhosis and alcohol related admissions in general. A cohort of frequently attending patients with ARBI were selected for detailed analysis of admission patterns and clinical outcomes. Results During the 5 years from 2009/10 to 2013/14, admissions with ARBI increased by over 120% ( p .05) while annual bed days rose from 103 to a peak of 484, accounting for 1,351 bed days in total. Mean length of stay for ARBI increased by 56% overall. Some 64% of stays were for more than 14 days, 38% were over 28 days and 28% were over 42 days. However, admissions with alcohol related liver disease did not change substantially ( p =NS) and, similarly, hospital-wide alcohol related admissions increased only marginally from 1,993 to 2,031 per 100,000 across the study period. Detailed case analysis found that 13 individuals (mean age 50 years, range 42–59) with Korsakoff’s syndrome accounted for over 90% of the ARBI bed days along with 297 ED attendances during the study, requiring a mean of 19.6 inpatient days per person per year. Conclusion Patients with Korsakoff’s syndrome pose significant clinical challenges with recurrent, prolonged admissions to hospital. Both the numbers of admissions and bed occupancy due to ARBI have substantially increased over the last 5 years, out of proportion to other markers of alcohol-related harm including acute and chronic liver disease. Further work may be needed to improve community and hospital care for these vulnerable individuals. Disclosure of interest None Declared.

Differences in College Greek Members’ Binge Drinking Behaviors: A Dry/Wet House Comparison

College Greek life students self-report high rates of binge drinking and experience more alcohol-related problems than students who are not members of the Greek system. But little research has been conducted to measure differences in alcohol-free housing (dry) and alcohol-allowed housing (wet). The purpose of this quantitative study was to investigate the alcohol consumption of Greek houses (dry sorority, wet fraternity, dry fraternity). It was found that in the Greek community, university students' scores on the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) were significantly lower for dry sorority housing members than both the wet fraternity and dry fraternity housing members, with no significant difference found between the wet and dry fraternity participants. Regardless of type, Greek-affiliated students' drinking levels appear to be high and exceed what is considered safe on the AUDIT-C for both female and male Greek students.Keywords: binge drinking, college students, AUDIT-C, Greek system, wet/dry housingThroughout the literature, research findings indicate that university students affiliated with the Greek system consume more alcohol and experience more alcohol-related problems than students who are not members of the Greek system (Barry, 2007; Borsari, Hustad, & Capone, 2009; Ragsdale et al., 2012). In particular, self-reported binge drinking is significantly higher among members of this community (Barry, 2007; Chauvin, 2012; Page & O'Hegarty, 2006). Research also indicates that students who come to college with a prior drinking history may seek out venues for continuing this behavior in college, as indicated by the variable of high school binge drinking being the best predictor of Greek student binge drinking (Chauvin, 2012). Borsari et al. (2009) concluded that students who use alcohol heavily in high school may self-select into the Greek system in order to find an environment supportive of their behavior. However, it also has been found that students who join a fraternity in their first year significantly increase their drinking and alcohol-related consequences compared to those who do not join (Park, Sher, & Krull, 2008).Consequences of Binge DrinkingThere are numerous costs associated with college students engaging in binge drinking behaviors, both to the students themselves and others. It is estimated that per university, the total yearly cost of alcohol-related emergency department visits is around $500,000 (Mundt & Zakletsaia, 2012). Negative consequences of binge drinking can range in severity from a hangover to alcohol-related problems with law enforcement to suicide attempts (Gillespie, Holt, & Blackwell, 2007). Alcohol consumption among undergraduate college students contributes annually to an estimated 600,000 alcohol-related unintentional injuries, 700,000 assaults by another student who was drinking, 1,500 alcohol-related student deaths, 97,000 sexual assaults, 400,000 acts of alcohol-related unprotected sex and 100,000 incidences of being too intoxicated to know if sex was consensual (Hingson, Zha, & Weitzman, 2009). Further, it has been found that 50% of men who commit rape on college campuses were drinking at the time of the offense (Cole, 2006), and women who drink on college campuses are more likely to be the victim of a sexual assault (McCauley, Calhoun, & Gidycz, 2010).The literature provides that college students who are members of the Greek community are at greater risk for experiencing negative consequences from heavy drinking (LaBrie, Kenney, Mirza, & Lac, 2011; Nguyen, Walters, Rinker, Wyatt, & DeJong, 2011; Soule, Barnett, & Moorhouse, 2015). Fraternity and sorority membership has been positively associated with driving after drinking (LaBrie et al., 2011) and owning a fake ID (Nguyen et al., 2011). Fraternity and sorority members reported that they were twice as likely as non-Greek college students to engage in sex with someone without getting consent and were one and a half times more likely to forget what they did or where they were after drinking (Soule et al. …

Life Course Trajectories of Labour Market Participation among Young Adults Who Experienced Severe Alcohol-Related Health Outcomes: A Retrospective Cohort Study.

BackgroundLong-term employment trajectories of young problem drinkers are poorly understood.MethodsWe constructed retrospective labour market participation histories at ages 18–34 of 64 342 persons born in 1969–1982. Beginning from the year of each subject’s 18th birthday, we extracted information from the records of Statistics Finland on educational attainment, main type of economic activity, months in employment, and months in unemployment for a minimum of seven years (range 7–16 years). We used information on the timing of alcohol-related hospitalizations and deaths in the same period to define problem drinkers with early onset limited course, early onset persistent course, and late onset problem drinking.ResultsEarly onset limited course problem drinkers improved their employment considerably by age, whereas early onset persistent problem drinkers experienced a constant decline in their employment by age. From the age of 18 to 34, early onset persistent problem drinkers were in employment merely 12% of the time, in comparison with 39% among the early onset limited course problem drinkers, and 58% among the general population.ConclusionsThese results indicate that young adults who were retrospectively defined as having early onset persistent course problem drinking were extensively marginalized from the labour market early on during their life course, and that their employment trajectory was significantly worse compared to other problem drinkers.

Minimum prices for alcohol and educational disparities in alcohol-related mortality.

Minimum price of alcohol is one of the proposed set of alcohol policies in many high-income countries. However, the extent to which alcohol-related harm is associated with minimum prices across socioeconomic groups is not known. Using Finnish national registers in 1988-2007, we investigated, by means of time-series analysis, the association between minimum prices for alcohol overall, as well as for various types of alcoholic beverages, and alcohol-related mortality, among men and women ages 30-79 years across three educational groups. We defined quarterly aggregations of alcohol-related deaths, based on a sample including 80% of all deaths, in accordance with information on both underlying and contributory causes of death. About 62,500 persons died from alcohol-related causes during the 20-year follow-up. The alcohol-related mortality rate was more than threefold higher among those with a basic education than among those with a tertiary education. Among men with a basic education, an increase of 1% in the minimum price of alcohol was associated with a decrease of 0.03% (95% confidence interval = 0.01, 0.04%) in deaths per 100,000 person-years. Changes in the minimum prices of distilled spirits, intermediate products, and strong beer were also associated with changes in the opposite direction among men with a basic education and among women with a secondary education, whereas among the most highly educated there were no associations between the minimum prices of any beverages and mortality. Moreover, we found no evidence of an association between lower minimum prices for wine and higher rates of alcohol-related mortality in any of the population sub-groups. The results reveal associations between higher minimum prices and lower alcohol-related mortality among men with a basic education and women with a secondary education for all beverage types except wine.

Is local alcohol outlet density related to alcohol-related morbidity and mortality in Scottish cities?

Alcohol consumption may be influenced by the local alcohol retailing environment. This study is the first to examine neighbourhood alcohol outlet availability (on- and off-sales outlets) and alcohol-related health outcomes in Scotland. Alcohol-related hospitalisations and deaths were significantly higher in neighbourhoods with higher outlet densities, and off-sales outlets were more important than on-sales outlets. The relationships held for most age groups, including those under the legal minimum drinking age, although were not significant for the youngest legal drinkers (18–25 years). Alcohol-related deaths and hospitalisations were higher in more income-deprived neighbourhoods, and the gradient in deaths (but not hospitalisations) was marginally larger in neighbourhoods with higher off-sales outlet densities. Efforts to reduce alcohol-related harm should consider the potentially important role of the alcohol retail environment.

Clinical features and prognostic factors in patients with head and neck cancer: Results from a multicentric study

BackgroundThe purpose of this study is to evaluate whether demographics, lifestyle habits, clinical data and alcohol dehydrogenase polymorphisms rs1229984 and rs1573496 associated with first primary head and neck (HNC) are associated with overall survival, recurrence, and second primary cancer (SPC). MethodsWe conducted a follow-up study in five centres including 801 cases. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for overall survival, recurrence and SPC. ResultsFive-years overall survival was 62% for HNC cases, 55% for oral cavity, 53% for oropharynx, 41% for hypopharynx, and 71% for larynx. Predictors of survival were older ages (HR=1.18 for 5 years increase; CI: 1.07–1.30), higher tumour stage (HR=4.16; CI: 2.49–6.96), and high alcohol consumption (HR=3.93; CI: 1.79–8.63). A combined therapy (HR=3.29; CI: 1.18–9.13) was associated with a worst prognosis for oral cavity cancer. The only predictor was higher tumour stage (HR=2.25; CI: 1.26–4.03) for recurrence, and duration of smoking (HR=1.91; CI: 1.00–3.68) for SPC. ADH1B rs1229984 polymorphism HRs for HNC and oesophageal cancer death and for alcohol related cancer death were 0.67 (95% CI: 0.42–1.08), and 0.64 (95% CI: 0.40–1.03), respectively. ConclusionsThe survival expectation differs among HNC sites. Increasing age and stage, and high alcohol consumption were unfavourable predictors of HNC survival overall. Duration of tobacco consumption before the first primary tumour was a risk factor for SPC.

Psychosocial and Demographic Correlates of Alcohol Related Mortality

Background Alcohol-related deaths (ARD) in the UK have doubled in the last 15-20 years. Thisstudy examines the psychosocial and demographic correlates of alcohol-relatedmorality. Aims and Objectives To examine 1) whether stressful life events affect ARD and combined alcohol anddrug related fatality (CDAF). 2) The demographic distributions of ARD and CDAF.3) The difference in the proportion of suicide and accidental death among ARDand CDAF's. Methods Cross-sectionalcohort study utilising the psychological autopsy method. Data was collected atWest London Coroner's office from 2006-2008. Of 429 autopsies, 278 met inclusioncriteria, of which 48 and 52 were ARD and CDAF respectively. Results The majority (96% for ARD and 76.9% for CDAF) were males. For ARD 50% were aged under 44yrs. However, for CDAFthe majority were under 44yrs. Combined the majority (60%) were under 44yrs. CDAF had a normal distribution across the 5 age groups, peaking at 35-44. ARDpeaked in 45-54 and 16-24 age groups. Conclusion There is a clear difference in the demographic distribution among ARD and CDAFcases. No statistically significant difference in the proportion of suicide andaccidental deaths were identified. However, further amendments to the SocialReadjustment Rating Scale could provide a better insight as to whether lifeevents have an influence on an individual's suicidal tendencies.

Premature Mortality Costs Associated with Lifestyle Factors among US Citizens

Purpose: The leading causes of mortality in the US include chronic diseases such as heart disease, stroke, and cancer. These diseases may also be classified as major “lifestyle” diseases that trace partially to imprudent living and risky behavior. Design: To examine the monetary costs of lifestyle choices. Setting: USA Subjects: USA citizens Measures: We utilized the most recent data from the National Center for Health Statistics and mortality costs from the USA Census Bureau in order to estimate the costs of lifestyle decisions leading to premature death. Analysis: This study examines the monetary costs associated with six personal lifestyle decisions- smoking, diet, excessive alcohol consumption, illicit drug use, accidents, sexually transmitted infections-and consequent premature mortalities. Results: Our study showed that 40.0% of the 2.47 million deaths annually in the USA may be attributed to lifestyle decisions. The majority of premature deaths that occurred were associated with three lifestyle decisions-smoking, obesity or excessive alcohol consumption. Smoking, obesity, sexually transmitted infections and accidents decreased vis-a-vis the previous decade; whereas, illicit drugs and alcohol-related premature deaths increased from the previous decade. Conclusion: The value of lifetime earnings lost among individuals as a consequence of lifestyle choices is $241 billion annually. The prospect for future declines in these premature deaths will most likely depend on a decrease in risk factors, continued lifestyle modification and population-based intervention strategies.

Alcohol use disorders: current approaches to diagnosis and treatment

Alcohol abuse and alcoholism are the leading causes of disability, health worsening and increased mortality. Diagnosis of alcohol use disorders is based on the formal criteria of ICD-10 and DSM-V. Sobriety-oriented therapy has extremely low efficiency. The difficulties of therapy are compounded by the fact that less than 10% patients with alcohol use disorder participate in treatment programs. Serious expectations in addressing unsatisfactory efficiency of alcoholism treatment are associated with WHO reducing alcohol consumption strategy. Nalmefene is the first and still only drug registered as a medicine for reducing alcohol use. Recent studies show that the decrease of alcohol consumption using nalmefene creates opportunities for significant lessening of alcohol-related morbidity, injuries and deaths.

A qualitative study of alcohol risk perceptions among drinkers in Benue State, Nigeria

There is evidence in the scientific literature linking alcohol-related deaths and morbidities with excessive alcohol consumption, yet individuals are often undeterred by their experiences of negative alcohol-related outcomes. In seeking to understand this behavior, this exploratory qualitative study was undertaken among Benue State civil servants in Makurdi, Nigeria to explore their reasons for drinking, perception of alcohol risk and, how these shape their alcohol consumption behaviors. Utilizing a purposive and network/snowball sampling technique, twenty-nine self administered open ended questionnaires were administered and analyzed. Findings indicated that drinking was primarily undertaken for enhancement and coping motives. Also, drinkers had knowledge of, and had experienced some alcohol-related dangers such as fights, rape, injury, and driving under the influence of alcohol. However, their drinking motives were valued over and above these experiences of negative alcohol effects, thereby minimizing the perception of personal susceptibility to alcohol related risk. Problem drinking status, the availability of alternative substitutes to drinking and, drinking motives together determine alcohol risk perceptions and drinking behavior. Therefore, in order to fully understand drinking behavior, the influences of drinking motives, personal experiences, drinking status, availability of alcohol substitutes and, risk perceptions should be considered. Keywords: Alcohol risk perceptions, drinking motives, and hazardous drinking