Average Volume Of Alcohol Consumption Research Articles

Is the association between alcohol use and sickness absence modified by socioeconomic position? findings from the Stockholm public health cohort

BackgroundThe distribution of sickness absence tends to be socially patterned less is however known about the underlying mechanisms and pathways of the social gradient found in sickness absence. The present study aims to investigate (i) if the risk function between average volume of alcohol consumption and sickness absence is modified by socio-economic position (SEP), and (ii) whether such an effect modification can be attributed to differences in drinking patterns and other risk factors including other lifestyle behaviours, health status, and working conditions.MethodsThe study was based on data from the Stockholm public health cohort 2006, with an analytical sample of 13 855 respondents aged 18–64 years. Self-reported information on occupational class (a measure of SEP), alcohol consumption, other lifestyle behaviour, health and working conditions was collected from the survey. The outcome of long-term (> 14 days) sickness absence between 2006 and 2008 was obtained from national registers. Negative binomial regression was used to estimate the Incidence Rate Ratios (IRR) with 95% confidence intervals (CI).ResultsIn the initial analyses, heavy drinking manual workers had a 5-fold increased risk of long-term sickness absence compared to non-manual employees who were moderate drinkers, and approximately 60% of the excess risk among heavy drinking manual workers was attributable to an interaction between alcohol use and SEP. Adjusting for working conditions was associated with the largest attenuation of the risk estimate, compared to other lifestyle behaviors and health. In the fully adjusted model, the IRR was further attenuated for the manual workers and the joint effect of SEP and heavy drinking remained in the final model with an attributable proportion of 49%.ConclusionsIndividuals in Sweden with lower levels of SEP appear to be more vulnerable to alcohol consumption in relation to sickness absence, where differences in working conditions explained a large part but not all of the differential vulnerability.

COVID-19 lockdown leads to changes in alcohol consumption patterns. Results from the Polish national survey

The objective of this study was to investigate the effects of nationwide lockdown during the Novel Coronavirus Disease 2019 (COVID-19) pandemic on an average volume of alcohol consumption and drinking patterns. A survey was conducted with a random sample of 4072 people. The authors found a significant influence of the pandemic period on alcohol consumption compared to the pre-pandemic period. The vast majority of respondents reduced the frequency of consumption of all types of alcohol. However, when the population was divided into subgroups, this differentiation demonstrated that particular groups are more vulnerable to alcohol misuse. Higher frequency of alcohol consumption during the COVID-19 pandemic lockdown was most often found in the group of men, people aged 18–24 years, inhabitants of big cities, and remote workers. Besides, significant differences were observed in subpopulations concerning different types of alcohol. Results emphasized the importance of monitoring and implementation of actions aimed at reducing the potential psychosocial impact of COVID-19, including alcohol-related disorders.

Understanding the differential effect of alcohol consumption on the relation between socio-economic position and alcohol-related health problems: results from the Stockholm Public Health Cohort.

AimTo test (i) whether the harmful effects of average volume of alcohol consumption (AC) and heavy episodic drinking (HED) differ by socio‐economic position (SEP), and (ii) if so, to what extent such differential effects can be attributed to an unequal distribution of harmful levels and patterns of drinking, health, life‐style and social factors.DesignA longitudinal cohort study with baseline in 2002 or 2006, with record‐linkage to national registers.SettingStockholm County, Sweden.ParticipantsA total of 37 484 individuals, aged 25–70 years, responding to the survey in 2002 or 2006.MeasurementsThe outcome of alcohol‐related health problems was obtained from the National Patient Register and Cause of Death Register using the Swedish index diagnoses related to alcohol use. Self‐reported information on occupational class (measure of SEP), AC, HED as well as other health‐related factors were extracted from the surveys. Average follow‐up time was 13.3 years.FindingsDuring follow‐up, a total of 1237 first‐time events of alcohol‐related health problems occurred. After initial adjustments, heavy drinking appeared to be more harmful to individuals with low SEP compared with high SEP (P = 0.001). Differences in HED frequency explained the largest part of the differential effect of AC. Engaging in weekly HED was more harmful to individuals with low SEP (P = 0.031) than high SEP. Differences in AC, together with other factors, explained a large part of the differential effect of HED.ConclusionsThe greater adverse impact of alcohol consumption on health in Sweden on people with lower socio‐economic position may be largely attributable to higher prevalence of heavy episodic drinking, as well as other behavioral and social risk factors.

한국 성인에서 성별에 따른 음주량 및 폭음과 치주염의 관련성: 2013~2014 국민건강영양조사

본 연구는 2013~2014년 국민건강영양조사 원시자료를 사용하여 만 19세 이상 성인을 대상으로 성별을 구분하여 평균 음주량 및 폭음 빈도와 치주염의 관련성을 살펴보았다. 평균 음주량과 치주염과의 관련성을 살펴본 결과, 남자에서는 평균 음주량과 치주염은 J자 형태의 관련성을 보였으며, 특히 경도 음주군을 기준으로 중등도 음주군(1.25배)과 고도 음주군(1.39배)에서 치주염 위험이 유의하게 증가하였다. 반면, 여자에서는 평균 음주량과 치주염은 유의한 관련성이 없었다. 폭음 빈도와 치주염과의 관련성 연구 결과, 남자에서는 폭음 빈도가 증가할수록 치주염의 위험이 유의하게 높아지는 경향을 보였지만, 여자에서는 폭음 빈도와 치주염은 유의한 관련성이 없었다. 결론적으로 본 연구를 통해 남자에서 과도한 음주량 및 폭음을 하는 경우 치주염이 유의하게 증가함을 확인하였다. 지역사회에서 치주염 예방을 위해서는 올바른 음주습관 형성을 위한 정확한 정보제공과 다양한 홍보교육 전략이 필요할 것이다. We investigated the gender-specific association between average volume of alcohol consumption, binge drinking, and periodontitis using representative nationwide data. In total, we included 3,549 men and 4,810 women, aged 19 years and older, who participated in the sixth Korea National Health and Nutrition Examination Survey performed in 2013~2014. According to the average volume of alcohol consumption, study participants were grouped as follows: mild drinkers (0.1~2.0 drinks/day in men and 0.1~1.0 drink/day in women), moderate drinkers (2.1~4.0 drinks/day in men and 1.1~2.0 drinks/day in women), and heavy drinkers (>4.0 drinks/day in men and >2.0 drinks/day in women). Additionally, binge drinking was categorized as never (no binge drinking), rarely (<1 time/month), occasionally (1 time/month), frequently (1 time/week), and always (almost every day/week). Periodontitis was defined as a community periodontal index equal to code 3 or greater. In men, after controlling for covariates, the association between average volume of alcohol consumption and periodontitis showed a J-shaped curve; the risk of periodontitis was significantly higher in moderate drinkers (odds ratio [OR], 1.25; 95% confidence interval [CI], 1.01~1.56) and heavy drinkers (OR, 1.39; 95% CI, 1.04~1.87) than in mild drinkers. In contrast, no significant association between average volume of alcohol consumption and periodontitis was observed in women. In a fully adjusted analysis, which used 'never binge drinking' as a reference, a significant dose-response relationship between binge drinking and periodontitis was observed only in men: rarely (OR, 1.64; 95% CI, 1.16~2.34), occasionally (OR, 1.51; 95% CI, 1.05~2.16), frequently (OR, 1.58; 95% CI, 1.07~2.33), and always (OR, 2.56; 95% CI, 1.56~4.22) (p for trend=0.005). In conclusion, unhealthy drinking patterns such as moderate or heavy alcohol consumption and binge drinking were significantly associated with periodontitis in men but not in women.

Modelling the impact of alcohol consumption on cardiovascular disease mortality for comparative risk assessments: an overview.

BackgroundAlthough alcohol consumption has long been considered as a risk factor for chronic disease, the relationship to cardiovascular disease (CVD) is complex and involves at least two dimensions: average volume of alcohol consumption and patterns of drinking. The objective of this contribution was to estimate the burden of CVD mortality caused by alcohol consumption.MethodsRisk assessment modelling with alcohol-attributable CVD mortality as primary outcome. The mortality burden of ischaemic heart disease (IHD) and ischaemic stroke (IS) attributable to alcohol consumption was estimated using attributable-fraction methodology. Relative Risk (RR) data for IHD and IS were obtained from the most comprehensive meta-analyses (except for Russia and surrounding countries where alcohol RR data were obtained from a large cohort study). Age-group specific RRs were calculated, based on large studies. Data on mortality were obtained from the World Health Organization’s Global Health Estimates and alcohol consumption data were obtained from the Global Information System on Alcohol and Health. Risk of former drinkers was modelled taking into account global differences in the prevalence of sick quitters among former drinkers. Alcohol-attributable mortality estimates for all other CVD causes except IHD and IS were obtained from the 2014 Global Status Report on Alcohol and Health.ResultsAn estimated 780,381 CVD deaths (441,893 and 338,490 CVD deaths among men and women respectively) were attributable to alcohol consumption globally in 2012, accounting for 1.4 % of all deaths and 26.6 % of all alcohol-attributable deaths. This is in contrast to the previously estimated 1,128,273 CVD deaths attributable to alcohol consumption globally, and represents a decrease of 30.8 % in alcohol-attributable CVD mortality and of 10.6 % in the global burden of all alcohol-attributable deaths.ConclusionsWhen the most comprehensive and recent systematic reviews and meta-analyses are taken as bases, the net impact of alcohol consumption on CVD is lower than previously estimated.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3026-9) contains supplementary material, which is available to authorized users.

Alcohol Consumption as a Risk Factor for Acute and Chronic Pancreatitis: A Systematic Review and a Series of Meta-analyses

BackgroundPancreatitis is a highly prevalent medical condition associated with a spectrum of endocrine and exocrine pancreatic insufficiencies. While high alcohol consumption is an established risk factor for pancreatitis, its relationship with specific types of pancreatitis and a potential threshold have not been systematically examined. MethodsWe conducted a systematic literature search for studies on the association between alcohol consumption and pancreatitis based on PRISMA guidelines. Non-linear and linear random-effect dose–response meta-analyses using restricted cubic spline meta-regressions and categorical meta-analyses in relation to abstainers were conducted. FindingsSeven studies with 157,026 participants and 3618 cases of pancreatitis were included into analyses. The dose–response relationship between average volume of alcohol consumption and risk of pancreatitis was monotonic with no evidence of non-linearity for chronic pancreatitis (CP) for both sexes (p=0.091) and acute pancreatitis (AP) in men (p=0.396); it was non-linear for AP in women (p=0.008). Compared to abstention, there was a significant decrease in risk (RR=0.76, 95%CI: 0.60–0.97) of AP in women below the threshold of 40g/day. No such association was found in men (RR=1.1, 95%CI: 0.69–1.74). The RR for CP at 100g/day was 6.29 (95%CI: 3.04–13.02). InterpretationThe dose–response relationships between alcohol consumption and risk of pancreatitis were monotonic for CP and AP in men, and non-linear for AP in women. Alcohol consumption below 40g/day was associated with reduced risk of AP in women. Alcohol consumption beyond this level was increasingly detrimental for any type of pancreatitis. FundingThe work was financially supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (R21AA023521) to the last author.

Can Wine and Moderate Alcohol Intake Work as Functional Food Nutraceuticals? A Tribute to Dr. Serge C. Renaud

Alcohol appears to be a double-edged sword because moderate alcohol intake is protective whereas drinking more than 10 drinks in a week appears to have adverse effects on morbidity and mortality. Recently, the exponential nature of the relation between average alcohol consumption and mortality has been demonstrated in Russia. This study revealed that substantial numbers of people report drinking three or more half-litre bottles of vodka per week. However, the exponential curves for dose-response relations between average volume of alcohol consumption and the mortality risk of various diseases is not fully explained. The variation in mortality may be due to presence of confounders such as physical activity, greater consumption of fish and salads which are rich sources of omega-3 fatty acids and polyphenolics. It is possible that patients with type 2 diabetes, moderate alcohol us-e, particularly wine consumption, is associated with reduced risks of cardiovascular events and all-cause mortality. Serge C. Renaud gave the definition of the French paradox and suggested that the inhibition of platelet reactivity by wine may be one explanation for protection from CAD in France. It is known that aging of alcohol also increases 1, 1-diphenyl-2-picrylhydrazyl radical scavenging activity and therefore moderate drinking of aged whisky and other alcoholic drinks in moderation may provide beneficial effects. Excess of alcohol intake causes decreases in vitamin B1, B6 and B12 as well as in folic acid, antioxidants vitamins A,E ,C and beta carotene, flavonoids, amino acids, coenzyme Q10, l-carnitine, omega-3 fatty acids as well as in minerals magnesium, potassium, calcium, copper, zinc, chromium and selenium. Alcoholism also has a direct adverse effects on cell membrane, mitochondria and genes. Alcoholic cirrhosis, fatty liver, cardiomyopathy, hypertriglyceridemia, hyperuricemia, oxidative stress and inflammation are well known adverse effects of alcoholism. It also damages the brain causing dementia, depression and psychosis. However, moderate alcohol intake up to 10 drinks per week may have beneficial effects on the risk of all these problems. Moderate alcohol intake increases HDL-C, and decreases C-reactive proteins, IL-6, TNF-alpha, Lp (a), plasminogen activator inhibiter-1, insulin resistance which are risk markers of CVDs, type 2 diabetes and cancer. These beneficial effects are enhanced by omega-3 fatty acids and polyphenolics that are rich in Mediterranean style diets. Vodka and spirits can be made healthly if enriched with fish oil or alpha- linolenic acid (rich source of w-3) and cocoa (flavanol) which can repair this deficiency. It is like a cleaning drink for the all the organs of the body. If standard Vodka is 40% alcohol, then we need +/- 1-g DHA per 500-ml bottle.

Alcohol abuse: critical pathophysiological processes and contribution to disease burden.

Alcohol abuse; the most common and costly form of drug abuse, is a major contributing factor to many disease categories. The alcohol-attributable disease burden is closely related to the average volume of alcohol consumption, with dose-dependent relationships between amount and duration of alcohol consumption and the incidence of diabetes mellitus, hypertension, cardiovascular disease, stroke, and pneumonia. The frequent occurrence of alcohol use disorders in the adult population and the significant and widespread detrimental organ system effects highlight the importance of recognizing and further investigating the pathophysiological mechanisms underlying alcohol-induced tissue and organ injury.

지역사회 건강한 성인에서 알코올 섭취량 및 폭음과 동맥경직도의 관련성

지역사회 성인을 대상으로 알코올 섭취량과 동맥경직도의 관련성을 파악하였으며, 아울러 폭음과 동맥경직도의 관련성을 살펴보았다. 지역사회기반 코호트 연구에 참여한 50세 이상 성인 5944명을 대상으로 하루 평균 알코올 소비량(g/day)과 월 폭음 빈도를 조사하였다. 상완-발목동맥 맥파전도속도(baPWV)를 측정한 후 남녀 각각에서 baPWV 4사분위에 해당하는 집단을 'high baPWV'로 정의하였다. 남성 알코올 섭취군의 교차비는 비음주군과 비교해서 유의한 차이가 없었지만, >40.0 g/d 알코올 섭취군의 교차비는 유의하게 증가하였다. 모든 여성 알코올 섭취군의 교차비는 비음주군에 비해서 유의한 차이가 없었다. 남성에서는 비폭음군에 비해 주 1회 미만 폭음군 및 주 1회 이상 폭음군의 high baPWV에 대한 교차비가 유의하게 증가하였다. 여성에서는 비폭음군에 비해 주 1회 이상 폭음군의 교차비가 유의하게 증가하였다. 남녀 모두에서 적당한 음주는 동맥경직도의 위험성이 낮은 반면, 과도한 음주는 동맥경직도의 위험성이 증가하였으며, 전반적으로 알코올 섭취량과 baPWV로 측정한 동맥경직도 사이에는 J자 형태의 관련성이 있었다. 또한 알코올 섭취량을 포함한 기존의 심혈관 위험요인과는 독립적으로 남녀 모두에서 폭음이 동맥경직도와 유의한 관련성이 있었다. Objectives: The purpose of this study was to investigate the association of the average volume of alcohol consumption and binge drinking with arterial stiffness. Methods: The study population consisted of 5944 community-dwelling healthy adults aged 50 years and older. Average volume of alcohol consumption was calculated and frequency of binge drinking defined as the consumption of 7 or more drinks for men and 5 or more for women on a single occasion, was assessed using a structured interview. High brachial-ankle pulse wave velocity (baPWV), a marker of arterial stiffness, was defined as the highest gender-specific quartile of maximal baPWV distribution in the study population. Results: Compared to never drinkers, the multivariate-adjusted odds ratio (OR) of men who consumed 0.1-10.0, 10.1-20.0, 20.1-40.0, and >40.0 g/day was 0.93, 1.18, 1.38, and 2.36, respectively. The OR was 0.90, 0.97, 1.45, and 1.82 in women consuming 0.1-5.0, 5.1-10.0, 10.1-20.0, and >20.0 g/day, respectively. Binge drinking of <1 day/week (OR=1.66, 95% confidence interval [CI]=1.13-2.42) and <TEX>${\geq}1$</TEX> day/week (OR=1.61, 95% CI=1.04-2.50) were associated with increased risk for high baPWV in men, and binge drinking of <TEX>${\geq}1$</TEX> day/week (OR=3.12, 95% CI=1.16-8.34) was associated with increased risk for high baPWV in women. Conclusions: A J-shaped relationship between the average volume of alcohol consumption and high baPWV was observed, suggesting the detrimental effects of heavy alcohol drinking on arterial stiffness. Binge drinking was also significant risk factors for increased arterial stiffness, independently of the average volume of alcohol consumption.

Different guidelines for different countries? On the scientific basis of low‐risk drinking guidelines and their implications

The scientific evidence for low-risk drinking guidelines was examined in a narrative review focusing on three points: definition of exposure, the best way to select outcomes and risk relations and how to determine thresholds. With respect to exposure, at least two dimensions should be incorporated: average volume of alcohol consumption and patterns of irregular heavy drinking occasions. Mortality should be selected as the most severe outcome, and a disaggregated approach should be adopted incorporating the regional demographic and cause of death structure. Finally, our plea is for establishing a general threshold for acceptable risk on a societal level rather than ad hoc specific committees setting norms for specific risks. Acceptable thresholds will be different if the risk is to oneself or to others.

Combining best evidence: a novel method to calculate the alcohol-attributable fraction and its variance for injury mortality.

BackgroundThe alcohol-attributable fraction for injury mortality is defined as the proportion of fatal injury that would disappear if consumption went to zero. Estimating this fraction has previously been based on a simplistic view of drinking and associated risk. This paper develops a new way to calculate the alcohol-attributable fraction for injury based on different dimensions of drinking, mortality data, experimental data, survey research, new risk scenarios, and by incorporating different distributions of consumption within populations. For this analysis, the Canadian population in 2005 was used as the reference population.MethodsBinge drinking and average daily consumption were modeled separately with respect to the calculation of the AAF. The acute consumption risk was calculated with a probability-based method that accounted for both the number of binge drinking occasions and the amount of alcohol consumed per occasion. The average daily consumption was computed based on the prevalence of daily drinking at various levels. These were both combined to get an overall estimate. 3 sensitivity analyses were performed using different alcohol consumption parameters to test the robustness of the model. Calculation of the variance to generate confidence limits around the point estimates was accomplished via Monte Carlo resampling methods on randomly generated AAFs that were based on the distribution and prevalence of drinking in the Canadian population.ResultsOverall, the AAFs decrease with age and are significantly lower for women than men across all ages. As binge drinking increases, the injury mortality AAF also increases. Motor vehicle collisions show the largest relative increases in AAF as alcohol consumption is increased, with over a 100% increase in AAF from the lowest to highest consumption category. Among non-motor vehicle collisions, the largest change in total AAF occurred both for homicide and other intentional injuries at about a 15% increase in the AAF from the lowest to the highest binge consumption scenarios.ConclusionsThis method combines the best available evidence to generate new alcohol-attributable fractions for alcohol-attributable injury mortality. Future research is needed to refine the risk function for non-motor vehicle injury types and to investigate potential interactions between binge drinking and average volume of alcohol consumption.

Economic efficiency of alcohol policy.

Economic efficiency of alcohol policy.

The relation between different dimensions of alcohol consumption and burden of disease: an overview.

As part of a larger study to estimate the global burden of disease and injury attributable to alcohol: to evaluate the evidence for a causal impact of average volume of alcohol consumption and pattern of drinking on diseases and injuries; to quantify relationships identified as causal based on published meta-analyses; to separate the impact on mortality versus morbidity where possible; and to assess the impact of the quality of alcohol on burden of disease. Systematic literature reviews were used to identify alcohol-related diseases, birth complications and injuries using standard epidemiological criteria to determine causality. The extent of the risk relations was taken from meta-analyses. Evidence of a causal impact of average volume of alcohol consumption was found for the following major diseases: tuberculosis, mouth, nasopharynx, other pharynx and oropharynx cancer, oesophageal cancer, colon and rectum cancer, liver cancer, female breast cancer, diabetes mellitus, alcohol use disorders, unipolar depressive disorders, epilepsy, hypertensive heart disease, ischaemic heart disease (IHD), ischaemic and haemorrhagic stroke, conduction disorders and other dysrhythmias, lower respiratory infections (pneumonia), cirrhosis of the liver, preterm birth complications and fetal alcohol syndrome. Dose-response relationships could be quantified for all disease categories except for depressive disorders, with the relative risk increasing with increased level of alcohol consumption for most diseases. Both average volume and drinking pattern were linked causally to IHD, fetal alcohol syndrome and unintentional and intentional injuries. For IHD, ischaemic stroke and diabetes mellitus beneficial effects were observed for patterns of light to moderate drinking without heavy drinking occasions (as defined by 60+ g pure alcohol per day). For several disease and injury categories, the effects were stronger on mortality compared to morbidity. There was insufficient evidence to establish whether quality of alcohol had a major impact on disease burden. Overall, these findings indicate that alcohol impacts many disease outcomes causally, both chronic and acute, and injuries. In addition, a pattern of heavy episodic drinking increases risk for some disease and all injury outcomes. Future studies need to address a number of methodological issues, especially the differential role of average volume versus drinking pattern, in order to obtain more accurate risk estimates and to understand more clearly the nature of alcohol-disease relationships.

AVERAGE VOLUME OF ALCOHOL CONSUMED, TYPE OF BEVERAGE, DRINKING PATTERN AND THE RISK OF DEATH FROM ALL CAUSES

The objective was to investigate associations between average volume of alcohol consumption, type of beverage and drinking pattern and all-cause mortality in the Melbourne Collaborative Cohort Study. Average consumption, including type of beverage, was estimated from beverage-specific questions on quantity and frequency of consumption. Pattern of consumption was estimated from a 7-day diary. During an average of 10.5 years of follow-up of 36 984 participants, 1971 deaths occurred. For both men and women, mortality curves were J-shaped (nadir at 9-12 g/day of alcohol consumption; upper protective dose of 42-76 g/day). Wine consumption was associated with lower mortality (for men, minimum hazard ratio (HR) at 20-39 g/day of wine consumption: 0.69; 95% confidence interval (CI): 0.54-0.87; for women, minimum HR at 1-19 g/day: 0.82; 95% CI: 0.70-0.98). Beer was associated with an increased risk for men (test for trend, P = 0.05), but not for women. After adjustment for total amount of alcohol consumed, the number of drinking-days was inversely associated with the risk of dying in men (P-trend = 0.04). These results confirm previous findings about the effect of average volume of alcohol and type of beverage and suggest that drinking pattern is an independent risk factor for all-cause mortality.

Alcohol consumption and burden of disease in the Americas: implications for alcohol policy

To describe patterns of alcohol consumption in the Americas, to estimate the burden of disease attributable to alcohol in the year 2000, and to suggest implications for policies to reduce alcohol-related disease burden. Two dimensions of alcohol exposure were included in this secondary data analysis: average volume of alcohol consumption and patterns of drinking. There were two main outcome measures: mortality (number of deaths) and disability-adjusted life years (DALYs) lost (number of years of life lost due to premature mortality and disability). Separate estimates were obtained for different sexes, age groups and WHO regions. Despite regional variations, alcohol consumption in the Americas averaged more than 50% higher than worldwide consumption. Patterns of irregular heavy drinking prevailed. Alcohol consumption caused a considerable disease burden: 4.8% of all the deaths and 9.7% of all DALYs lost in the year 2000 were attributable to drinking, with most of the burden occurring outside North America. Intentional and unintentional injuries accounted for 59.8% of all alcohol-related deaths and 38.4% of the alcohol-related disease burden. Of all risk factors compared here, alcohol accounted for the greatest proportion of risk, followed by smoking. Interventions should be implemented to reduce the high burden of alcohol-related disease in the Americas. Given the epidemiological structure of this burden, injury prevention including, but not restricted to, prevention of traffic injuries, as well as appropriate treatment options, should play an important role in comprehensive plans to reduce the alcohol-related public health burden.

SCHOOL MATTERS: DRINKING DIMENSIONS AND THEIR EFFECTS ON ALCOHOL-RELATED PROBLEMS AMONG ONTARIO SECONDARY SCHOOL STUDENTS

To test the hypotheses that average volume of alcohol consumption and patterns of drinking, each influence alcohol-related problems and that both act at individual and aggregate levels. The 2003 cycle of the Ontario Student Drug Use Survey obtained self-administered questionnaires from a representative classroom-based survey of 2455 Ontario secondary school students (grades 9-12) from 74 schools, with a student completion rate of 72%. Average volume of alcohol consumption was assessed using a quantity-frequency measure. Heavy drinking occasions were operationalized by four dummy variables indicating less than monthly, monthly, weekly and daily consumption of five or more drinks per occasion, with never having a heavy drinking occasion serving as the reference group. Alcohol-related problems were measured by using seven items of the Alcohol Use Disorders Identification Test. As hypothesized, both the average volume of alcohol consumption and patterns of drinking influenced alcohol-related problems at the student level, independently of each other. At the school level, both determinants significantly influenced the problems, but not when simultaneously entered into the equation. Future prevention of alcohol-related problems in adolescents should consider both the average volume and patterns of drinking. Both prevention and research should also try to include environmental determination of alcohol-related problems.

The Global Distribution of Average Volume of Alcohol Consumption and Patterns of Drinking

Aims: To make quantitative estimates on a global basis of exposure of disease-relevant dimensions of alcohol consumption, i.e. average volume of alcohol consumption and patterns of drinking. Design: Secondary data analysis. Measurements: Level of average volume of drinking was estimated by a triangulation of data on per capita consumption and from general population surveys. Patterns of drinking were measured by an index composed of several indicators for heavy drinking occasions, an indicator of drinking with meals and an indicator of public drinking. Average volume of consumption was assessed by sex and age within each country, and patterns of drinking only by country; estimates for the global subregions were derived from the population-weighted average of the countries. For more than 90% of the world population, per capita consumption was known, and for more than 80% of the world population, survey data were available. Findings: On the country level, average volume of alcohol consumption and patterns of drinking were independent. There was marked variation between WHO subregions on both dimensions. Average volume of drinking was highest in established market economies in Western Europe and the former Socialist economies in the Eastern part of Europe and in North America, and lowest in the Eastern Mediterranean region and parts of Southeast Asia including India. Patterns were most detrimental in the former Socialist economies in the Eastern part of Europe, in Middle and South America and parts of Africa. Patterns were least detrimental in Western Europe and in developed countries in the Western Pacific region (e.g., Japan). Conclusions: Although exposure to alcohol varies considerably between regions, the overall exposure by volume is quite high and patterns are relatively detrimental. The predictions for the future are not favorable, both with respect to average volume and to patterns of drinking.

Alcohol as a Risk Factor for Global Burden of Disease

Aim: To make quantitative estimates of the burden of disease attributable to alcohol in the year 2000 on a global basis. Design: Secondary data analysis. Measurements: Two dimensions of alcohol exposure were included: average volume of alcohol consumption and patterns of drinking. There were also two main outcome measures: mortality, i.e. the number of deaths, and disability-adjusted life years (DALYs), i.e. the number of years of life lost to premature mortality or to disability. All estimates were prepared separately by sex, age group and WHO region. Findings: Alcohol causes a considerable disease burden: 3.2% of the global deaths and 4.0% of the global DALYs in the year 2000 could be attributed to this exposure. There were marked differences by sex and region for both outcomes. In addition, there were differences by disease category and type of outcome; in particular, unintentional injuries contributed most to alcohol-attributable mortality burden while neuropsychiatric diseases contributed most to alcohol-attributable disease burden. Discussion/Conclusions: The underlying assumptions are discussed and reasons are given as to why the estimates should still be considered conservative despite the considerable burden attributable to alcohol globally.

The relationship of average volume of alcohol consumption and patterns of drinking to burden of disease: an overview.

As part of a larger study to estimate the global burden of disease attributable to alcohol: to quantify the relationships between average volume of alcohol consumption, patterns of drinking and disease and injury outcomes, and to combine exposure and risk estimates to determine regional and global alcohol-attributable fractions (AAFs) for major disease and injury categories. DESIGN, METHODS, SETTING: Systematic literature reviews were used to select diseases related to alcohol consumption. Meta-analyses of the relationship between alcohol consumption and disease and multi-level analyses of aggregate data to fill alcohol-disease relationships not currently covered by individual-level data were used to determine the risk relationships between alcohol and disease. AAFs were estimated as a function of prevalence of exposure and relative risk, or from combining the aggregate multi-level analyses with prevalence data. Average volume of alcohol consumption was found to increase risk for the following major chronic diseases: mouth and oropharyngeal cancer; oesophageal cancer; liver cancer; breast cancer; unipolar major depression; epilepsy; alcohol use disorders; hypertensive disease; hemorrhagic stroke; and cirrhosis of the liver. Coronary heart disease (CHD), unintentional and intentional injuries were found to depend on patterns of drinking in addition to average volume of alcohol consumption. Most effects of alcohol on disease were detrimental, but for certain patterns of drinking, a beneficial influence on CHD, stroke and diabetes mellitus was observed. Alcohol is related to many major disease outcomes, mainly in a detrimental fashion. While average volume of consumption was related to all disease and injury categories under consideration, pattern of drinking was found to be an additional influencing factor for CHD and injury. The influence of patterns of drinking may be underestimated because pattern measures have not been included in many epidemiologic studies. Generalizability of the results is limited by methodological problems of the underlying studies used in the present analyses. Future studies need to address these methodological issues in order to obtain more accurate risk estimates.

Alcohol and cardiovascular disease--more than one paradox to consider. Average volume of alcohol consumption, patterns of drinking and risk of coronary heart disease--a review.

The effect of average volume of alcohol on coronary heart disease (CHD) is J-shaped in established market economies. Light to moderate drinkers have less risk than abstainers, with heavy drinkers displaying the highest level of risk. This relationship between average volume of alcohol consumption and CHD is modified by different patterns of drinking. Heavy drinking occasions as well as drinking outside meals are related to increased CHD risk, independently of volume of drinking. Beverage type does not seem to have much impact, even though there are some indications that wine is more protective than other forms of alcohol. Physiological mechanisms have been identified to explain this complex relationship between alcohol and CHD. Since patterns of drinking are important in determining CHD risk, they should be included in future epidemiologic studies, together with biomarkers further to test hypotheses about pathways.