Alcohol Use Research Articles

Mobile street clinics and harm reduction: pathways to provide care to homeless people in Brazil

Abstract Homeless people (HP) are defined as a heterogeneous group that lives in extreme poverty, with weakened or severed family ties, lacking access to conventional housing, and using public spaces as residence. In terms of health, mental health conditions are prominent as a primary treatment demand, with care aimed at addressing needs arising from the use of alcohol and other drugs being a priority in serving HP. In this context, mobile street clinics (MSC) provide health services directly in street environments, focusing on individuals who use alcohol and other substances through harm reduction approaches. Harm reduction is defined as a set of practices aimed at minimizing the adverse health effects of alcohol and drug use without necessarily eliminating usage. Moreover, it represents an ethical and political direction in care, confronting the logic of criminalization and compulsory abstinence, enhancing access to health care for alcohol and other drug users through strategies that foster autonomy development. In the current study, we conducted an integrative review assessing the facilitators and barriers for HP access to mental health services. Preliminary results indicated that MSC, the connection between healthcare workers and the HP they serve, and the implementation of local street-based actions were the main facilitators of access for individuals who engage in harmful use of alcohol and other drugs to mental health services. Conversely, stigma, services’ lack of adjustment to the lifestyles of homeless people, and excessive bureaucracy were identified as the principal barriers of access. MSC, through their harm reduction activities, have emerged as a potential care technology to facilitate access to health services for homeless people. This research aims to present harm reduction as an ethical and political direction of care through the actions of mobile street clinics, as a way to facilitate access to health services for the homeless people. Key messages • Homeless people require mental health care tailored to the use of alcohol and other drugs, and harm reduction strategies implemented through mobile street clinics prove to be an effective form of care. • Mobile street clinics and harm reduction are important care technologies that enhance access to health services for the homeless population.

5.Y.2. Alcohol intoxication among adolescents in Italy, Belgium and The Netherlands

Abstract Excessive drinking behavior poses a significant risk to the health of adolescents and contributes to high social and health costs. It is also well-documented that engaging in risky drinking behavior at a young age increases the likelihood of developing alcohol use disorders and other mental health disorders later in life. Therefore, the timely development of adequate interventions to prevent and reduce such behavior is an important public health task. The initial step here is to gather comprehensive data on the phenomenon. Studying alcohol intoxication data among adolescents is an important source in this context. In the Netherlands, data on alcohol intoxication in adolescents have been routinely collected for several years, leading to a successful transmural framework aimed at supporting these young individuals and their parents. As countries are at varying stages in addressing this issue, the objective of this workshop is to facilitate mutual learning about effective prevention initiatives targeting problematic alcohol use in young people. The workshop will feature presentations from four studies representing three countries: Italy, Belgium, and the Netherlands. Allegra Ferrari from Italy will discuss alcohol-related emergencies among adolescents admitted to an emergency department in Genoa, emphasizing the importance of urgent interventions to mitigate adolescent alcohol use. Hanna van Roozendaal from Belgium will present data from both retrospective and prospective studies on adolescents with acute alcohol intoxication in Antwerp hospitals, exploring the feasibility of follow-up interventions. Louise Pigeaud from the Netherlands will share data from a cohort of individuals under 18 years presented with acute alcohol intoxication symptoms at an emergency department between 2015-2023 to monitor trends in admission characteristics. Finally, Guido van Hal will focus more in depth on the differences and similarities in adolescents accessing emergency care for acute alcohol intoxication in Italy, Belgium and The Netherlands. The workshop will conclude with an open discussion on topics such as the necessary data to be registered for minors with acute alcohol intoxication, the most effective methods for preventing/reducing alcohol intoxication in these age groups, and the potential transferability of the successful Dutch transmural framework to other countries. Key messages • Acute alcohol intoxication and problematic alcohol use in minors can lead to significant alcohol-related issues in adulthood. • Collecting and analyzing high-quality data can facilitate the development of interventions aimed at reducing and preventing alcohol-related issues in adolescents.

Recovery of Executive Functions in Alcohol Use Disorder: role of Neuropsychological Rehabilitation

Abstract Background Alcohol Use Disorder (AUD) is a growing public health concern with high incidence of executive functions (EFs) changes, affecting disease progression and treatment effectiveness. Inconsistencies persist in studies on the role of neuropsychological rehabilitation (NR) in EF recovery within AUD interventions. Our aim is to analyse the effect of NR on EFs in AUD interventions. Methods A prospective cohort study included 65 participants of both sexes, diagnosed with AUD, free of psychiatric comorbidities or severe neurological conditions. They underwent alcohol detoxification in hospital/home from 2021 to 2023, completing three evaluation moments (M1-Baseline, M2-3 months, M3-6 months). Patients receiving usual treatment (WTG-weekly therapeutic groups) - were compared to those with additional Neuropsychological Rehabilitation (NRG) regarding Sociodemographic and Severity of Alcohol Dependence Questionnaires, Hospital Anxiety and Depression Scale, Frontal Assessment Battery (FAB), Number and Letters Subscale of Weschler Adult Intelligence Scale (WAIS). Our main outcome was FAB-general executive functioning, and secondary outcome was WAIS-working memory. Friedman test compared assessments across the three points (alpha 5%). Results Statistically significant differences were found for FAB in both groups, (p < 0.001) between M1 and both M2 and M3, indicating improved executive functioning, particularly in NRG. Working memory also improved in both groups (WTG: p = 0.036; NRG: p < 0.001), with NRG showing better M2 performance. Conclusions There is evidence that neuropsychological rehabilitation facilitates the recovery of executive functions and may play a pivotal role in relapse prevention. It is crucial that the treatment of these situations incorporates public health, preventive and damage minimization measures. KeyWords: Executive Function; Neuropsychological Rehabilitation; Alcohol Use Disorder. Key messages • Recovery of executive functions is crucial from a Public Heath perspective in AUD populations, minimizing morbidity, permanent disabilities and contributing to more effective healthcare services. • Integrating Neuropsychological Rehabilitation into standard Alcohol Use Disorder treatments can enhance treatment effectiveness, reducing disease burden.

Abstract Strengths and difficulties Lithuania

Abstract Background Most mental health disorders begin before the age of 18, peaking at 14.5 years (Solmi, 2022) and manifest as emotional and behavioural difficulties that are more frequent in institutional social care (ISC): former foster care recipients have higher rates of depression and PTSD than the general population (Pecora, 2009). The rate of children living in residential care facilities in Europe and Central Asia is double the global average (UNICEF, 2024). This study aims to assess and compare the mental health of children in ISC centers and regular high schools. Methods A cross-sectional study was conducted in ISC centres and high schools in 2022-2023. The sample size consisted of children aged 11-17 living in ISC (n = 49) or in families (n = 193). Online anonymous survey was applied to assess the prevalence of endured violence, substance use and measure mental health outcomes using the Strengths and Difficulties Questionnaire (SDQ-25). Results A total of 242 respondents (age mean 14.6, SD = 2.12) in ISC and families showed similar poor mental health rates (42% and 44%, respectively). Prosocial behaviour problems were exhibited more by boys (p < 0.05), whereas emotional symptoms were more common in families (p < 0.001): 90% normal SDQ-25 scores in ISC vs 60% in families. Enduring psychological (38% vs 60.2%) violence was more prevalent among children in families (p < 0.05); smoking - in ISC, alcohol use - in families (p < 0.05). In both groups enduring physical violence was associated with smoking and alcohol use (p < 0.05), and overall poor SDQ-25 results strongly correlated (p < 0.001, r = 0.815, r = 0.610, respectively) with hyperactivity. Conclusions A significant part of study participants reported poor mental health outcomes with most problems in relationships with peers. Mental health risk factors such as violence or substance abuse are associated with poor emotional wellbeing while being more common among children living with families. Key messages • Children living in ISC and in families demonstrate similar level of mental health problems. • Varying prevalence of substance abuse among children living in different settings highlights the importance of environmental factors when addressing the issue.

Supply of Alcohol in Early Childhood Leads to Higher Rates of Drinking in Adolescence

Abstract Background Adolescents often experience their first encounter with alcohol at home, provided by parents who perceive it as a means of safeguarding their children against later alcohol-related issues. However, research shows that parental supply of alcohol is a risk factor for adolescent drinking. Notably, existing studies solely focused on parental supply during adolescence, neglecting the prospective evaluation of parental alcohol provision during early childhood on later alcohol use. Methods The data came from the Czech part of the European Longitudinal Study of Pregnancy and Childhood (ELSPAC), a longitudinal birth cohort study (N = 5,777). Mothers reported on the frequency of offering alcohol to children when children were 3, 5, 7, and 11 years old. The outcome was adolescent alcohol use at ages 15 and 18, reported by adolescents, mothers, and pediatricians. Control variables included sex, maternal education, family structure, and parental alcohol consumption. Results Three classes of children were identified based on parental alcohol supply: abstainers (75.5% of sample), infrequent sippers (16.2%), and frequent sippers (8.3%). Parental drinking increased the risk of both infrequent and frequent sipping. These classes were entered into two structural models (age 15 and age 18 alcohol use modeled as latent factors), alongside covariates. Compared to abstainer class, infrequent and frequent childhood sippers exhibited significantly higher alcohol consumption at age 15 (β = .21, p < .001; β = .25, p < .001, respectively) and age 18 (β = .11, p < .05; β = .24, p < .001, respectively). Conclusions This study represents the first prospective investigation quantifying early childhood alcohol exposure and its subsequent association with adolescent alcohol consumption. Findings emphasize the influence of family dynamics on alcohol behaviors, underscoring the necessity for targeted preventive measures, particularly within families with higher parental alcohol consumption. Key messages • Offering alcohol to children at ages 3-11, even infrequently, significantly increases the risk of more frequent drinking at ages 15 and 18, compared to those with no early exposure. • Parents who drink are more likely to have children who sip alcohol early, leading to higher alcohol consumption in adolescence. Prevention efforts should focus on family habits and early education.

Educational attainment and cardiovascular outcomes in prostate cancer: observations from 3700 men in 6 countries in the RADICAL PC study

Abstract Background Educational attainment has been associated with improved cardiovascular outcomes in individuals with or at high risk for cardiovascular disease (CVD). There is little information on the relationship between education and CVD outcomes in individuals with cancer. Also, we have limited understanding of what mediates the relationship between education and these outcomes. Purpose To evaluate the relationship between educational attainment in patients with PC and CVD event (CVE) or all-cause mortality. Methods We prospectively studied 3,778 men with PC from 55 sites in 7 countries (median age 69 years), 46% on ADT. Inclusion criteria were one of: PC diagnosed in the past 12 months; started ADT within the past 6 months; or plan to start ADT in the next month. Educational attainment was classified as those who attained primary school education vs. those who attained high school education vs. those who attained greater than high school education. Participants were followed for a median of 2.5 years from enrolment to document CVE: myocardial infarction, angina, stroke, cerebrovascular disease, peripheral arterial disease, arterial revascularization, heart failure, venous thromboembolism, and atrial fibrillation. The primary outcome for this analysis was CVE or death. All outcomes were evaluated by Cox proportional hazards models adjusted sequentially for age, race, physical activity levels, tobacco use, and alcohol use. Results Among 3,778 participants, 726 (19%) achieved primary school education, 1,001 (27%) high school, and 2,051 (54%) greater than high school education. On univariate analysis, as compared with participants with greater than high school education, those with high school education and primary school education had respective HR (95% CI) of 1.33 (1.05-1.69) and 2.19 (1.71-2.83). Adding age, race, tobacco, and alcohol use to the Cox model progressively attenuated the association between education and the primary outcome. Eventually, after adjustment for these characteristics and physical activity levels, the relationship between education and the primary outcome was no longer significant (Table). Conclusion This finding suggests that patterns of tobacco and alcohol use and physical activity, which are modifiable behaviors, account for the relationship between education and death or CVE in patients with prostate cancer.Table

Work context and drinking behavior in the French public service: a qualitative study

IntroductionAlcohol use disorders (AUD) are a major public health problem. Among the working population, alcohol is the most frequently used psychoactive substance, as well as the most inappropriately used. Alcohol consumption reduces the worker’s psychophysical integrity, leads to an increase in inappropriate behavior, accidents and injuries, and affects the safety and health of other workers. Thus, the workplace must play an essential role in prevention. Particularly in France, in the civil service, a specific professional sector made up of many professionals exposed to stress, the prevention of AUD must play an essential role. The objective of this study was to describe the framework of alcohol consumption in the French public service in order to understand the sources of alcohol consumption behaviors and to identify the prevention measures to be implemented, in order to reduce the risk of transition to an alcohol use disorder.MethodsThis descriptive qualitative study was based on focus groups. Sampling was purposive and data saturation was verified. Coding was “in vivo,” descriptive and pattern-oriented. Analysis was inductive thematic, and the COREQ guidelines were followed.ResultsFirstly, the presence of alcohol in the workplace has been characterized by a before-and-after a prohibition law, and by the revelation of mechanisms for avoiding the ban. Then, the three main determinants for alcohol use disorders were: society, work and personal factors. Lastly, the prevention initiatives identified must be based on both collective and individual approaches. They must be encouraged by the hierarchy, include screening, accompaniment to care, and take into account both work in the workplace and work at home. The fight against work-related alcohol use disorders must be part of the corporate culture.DiscussionPreventing alcohol-related disorders among civil servants will help fight the burden of non-communicable diseases.

Trends in the association between alcohol use and generalized anxiety in Finnish adolescents

Abstract Background During the past two decades, alcohol use has decreased among adolescents, but on the contrary, anxiety symptoms have increased (at least among females). These diverging trends set interesting opportunities to examine whether the strength of the well-known correlation/co-occurrence between alcohol use and anxiety has also changed. This study aims to examine changes in the co-occurrence and associations between heavy episodic drinking (HED) and generalized anxiety among adolescents in Finland from 2013 to 2023. Methods Data from the Finnish School Health Promotion Study between 2013-2023 covered 874 110 participants aged 13-20. Generalized anxiety was measured using Generalized Anxiety Disorder Scale (GAD-7) (range 0-21), and heavy episodic drinking was measured as reported heavy drunkenness once a month or more often versus less than once a month. Yearly prevalence estimates of co-occurrence were analyzed for those with moderate to severe anxiety symptoms (>10) and monthly or more frequent HED. Associations between anxiety and HED were analyzed using logistic regression and time-varying effect modelling. Interactions between time and anxiety predicting HED were also considered. Results The moderate to severe anxiety symptoms increased from 10.7% to 20.9% and HED decreased from 18.0% to 11.8% between 2013 and 2023. The proportion of those with both HED and moderate to severe anxiety increased from 2.9% in 2013 to 3.6% in 2023. The association between anxiety symptoms and HED was stable during the study period, with odds ratios ranging between 1.06 and 1.07. Conclusions During the past decade, diverging trends in generalized anxiety symptoms and heavy episodic drinking have not changed the association between them. The proportion of adolescents with these co-occurring health concerns has increased in females. This calls for continuous efforts to strengthen the integration of mental health and substance use prevention and services. Key messages • The association between generalized anxiety and heavy episodic drinking has not changed in adolescents in Finland between 2013 and 2023. • The proportion of those with both moderate to severe anxiety symptoms and heavy episodic drinking has increased in females and remained stable in males during the past decade (2.9% - 3.6%).

Alcohol related emergencies among adolescents admitted in a referral acute-care center for adults in Genoa, northwest Italy

Abstract Background As a result of underage drinking, adolescents have an increased risk of physical, mental, emotional, and social harm. Methods In order to assess the emergencies for alcohol use, data of the emergency department (ED) of San Martino Hospital - the referral acute-care center for adults in Genoa, Northwest Italy - was analyzed retrospectively. 330 records of 320 adolescents visiting the ED between 2014 and 2023 were considered. Results The median age of access was 16 (IQR 2), 54.8% were males, 17.4% had foreign nationalities, and the average blood alcohol concentration (BAC) was 1.8 g/L (SD 0.7), with 14.7% testing positive for other substances (6.1% benzodiazepines and 11.2% other drugs). 16.8%, 46.6% and 36.6% were assigned an emergency, urgent, and not-urgent acuity code. 2.8% had a repeated episode, 3.4% had to be removed for inappropriate behavior, 7.8% left spontaneously, 13.1% were hospitalized for additional care (5.5% in the Psychiatry ward). The average length of stay was 1.24 days (SD 5.86). Multivariable logistic regression showed that higher age, an emergency code and the use of other substances were positively associated with hospitalization [ORs 1.74 (95%CI 1.1-2.7), p 0.01; 7.1 (95%CI 2.2-22.4) p < 0.001; and 15.6 (95%CI 6.8-35.6) p < 0.001, respectively]. Admission in Psychiatry, in particular, was strongly associated with the use of other substances [OR 11.8 (95%CI 3.8-36.6), p < 0.001]. Multivariable linear regression showed that, in comparison with other access reasons, accidents and decreased consciousness were associated with higher BAC [beta 0.6 (95%CI 0.1-1.1), p 0.01; beta 0.8 (95%CI 0.3-1.2) p < 0.001]. Length of stay, however, was associated with lower BAC [beta -0.2 (95%CI -0.3 -0.01), p 0.04]. Conclusions In Italy, binge drinking affects 120,000 adolescents aged 11-17. Our findings highlight the harm of this practice and support the need for prompt interventions to reduce the onset and prevalence of adolescent alcohol use.

Insomnia treatment effects on negative emotionality among veterans in treatment for alcohol use disorder.

Insomnia symptoms are pervasive and persistent in alcohol use disorder (AUD), though little is known about the mechanisms that underlie this association. We previously found that cognitive behavioral therapy for insomnia (CBT-I) reduced alcohol-related problems among veterans by improving insomnia severity (NCT03806491). In this planned secondary analysis of the same clinical trial data, we tested negative emotionality as one potential mechanism to explain this effect. Specifically, we tested the change in negative emotionality as a mediator of the association between change in insomnia symptoms and alcohol-related outcomes (craving, heavy drinking frequency, and alcohol-related problems). Participants were 67 veterans in treatment for AUD who also met the criteria for insomnia disorder (91% male, 84% White, average age = 46.3 years). Participants were randomized to five sessions of CBT-I or a single-session sleep hygiene control. Assessments occurred at baseline, immediately posttreatment (~6 weeks after baseline), and at 6-week follow-up. Measures included the Insomnia Severity Index, Penn Alcohol Craving Scale, Timeline Followback, and Short Inventory of Problems. We created a latent negative emotionality indicator based on five validated and reliable measures of negative emotionality. Contrary to hypotheses, CBT-I did not improve negative emotionality relative to sleep hygiene control. However, across both treatment conditions, decreases in insomnia symptoms from baseline to posttreatment were associated with concurrent decreases in negative emotionality, which in turn predicted reductions in alcohol craving and heavy drinking. Negative emotionality may help explain links between insomnia symptoms and alcohol-related outcomes.

Risk factors for the gambling, smoking and alcohol consumption triad in Portuguese adolescents

Abstract Background Addiction to gambling, tobacco, and alcohol poses significant risks to mental, social, and physical health, particularly during adolescence, a critical period for habit formation. This study investigates risk factors linked to these habits among Portuguese adolescents. Methods This cross-sectional study used the 2019 ESPAD questionnaire, targeting 16-year-old adolescents. The sample comprised 4,365 responses. Descriptive analysis determined the prevalence of gambling, smoking, and alcohol use, as well as social, economic, and behavioral factors. Bivariate associations were assessed using the Exact Fisher test, and multiple logistic regression identified key predictors for the outcome of interest (cumulative presence of gambling, smoking and alcohol consumption). Statistical analysis was conducted with SPSS version 29.0, with a significance level of p < 0.05. Results Among adolescents, 6.2% presented probable problematic gambling according to the Lie/Bet test, with 3.7% spending at least 30 minutes a day gambling. In the past 30 days, 14.3% smoked, 42.7% drank alcohol, and 10.5% engaged in binge drinking. The behavioral triad was observed in 56 individuals. Male gender (OR = 2.024; 95% CI: 1.097-3.734; p = 0.024), problematic online gaming behavior (OR = 2.041; 95% CI: 1.005-4.144; p = 0.048) and going out at night at least once a week (OR = 1.439; 95% CI: 1.242-1.669; p < 0.001) significantly increased the risk of the behavioral triad. In contrast, parental control (parents knowing where the adolescent is on Saturday night) had a significant protective effect (OR = 0.162; 95% CI: 0.086-0.303; p < 0.001). Conclusions The study underscores the importance of parental supervision to curb risky behaviors in adolescents. It suggests implementing public health programs in schools, leveraging gaming for early screening, and tightening online gambling regulations to mitigate future health risks associated with gambling, smoking, and alcohol use. Key messages • Absence of parental supervision, male gender, problematic online gaming and frequently going out at night are risk factors for this behavioral triad. • Public health strategies are needed to prevent gambling addiction, emphasizing parental awareness, identification of at-risk students, and comprehensive school-based approaches.

Differences and similarities in adolescents accessing emergency care for acute alcohol intoxication in three urban regions in Italy, Belgium, and The Netherlands

Abstract Background Excessive drinking among adolescents in Western Europe is prevalent, posing significant health risks and societal costs. Early initiation of alcohol use and binge drinking are associated with adult alcohol use disorders. Collecting comprehensive data on adolescent drinking patterns is crucial for developing effective prevention strategies. Methods To gain insight into the demographic and clinical characteristics of acute alcohol intoxication (AAI), we analysed emergency department access data of adolescents aged 14-17 years presenting with AAI symptoms from 2015-2023. Three urban regions were included: the Reinier de Graaf Gasthuis in Delft (The Netherlands), eight combined hospitals in Antwerp (Belgium) and the IRCCS San Martino Hospital in Genoa (Italy). Results A total of 1841 patients with symptoms of AAI were included. The mean age of patients in the Netherlands was statistically significant younger than in Italy and Belgium (15.7 compared to 15.9 and 16.0 years old, respectively). Moreover, the blood alcohol concentration was higher in the Netherlands and Belgium compared to Italy (2.0‰ compared to 1.95‰ and 1.8‰ respectively). The distribution of sex was nearly equal in the Netherlands, while statistically significant differences were observed with a higher proportion of males in Italy (54.8%) and Belgium (56.8%). Combined drug use was lower in Belgium with 10.0%, compared to 13.4% in The Netherlands and 14.7% in Italy. The most common reason for admission was ‘reduced consciousness’ in the total population (45.2%). Conclusions This is one of the first international studies which combines data on AAI in minors. In the future, efforts should be made to establish a common European database where records of AAI can be stored and analysed more efficiently for prevention purposes.

Income inequality and risky health behaviors of affluent adolescents in the post-Communist Europe

Abstract Background We aim to study the “golden youth” hypothesis and examine the risky behaviors of adolescents with high socioeconomic position (SEP) in post-Communist countries of Europe (PCCE) in relation to income inequality. Methods Adolescents aged 11-15 years from 14 PCCE participating in the Health Behavior in School-aged Children survey 2017/18 were included. A K-means cluster analysis was conducted to group adolescents based on tobacco smoking, alcohol use, binge drinking, and bullying perpetration. Generalized linear mixed models were fitted. Results Four clusters of adolescents were identified. The percentage of high-SEP adolescents in Cluster 1 (low risky behaviors) was slightly less compared to middle and low-SEP groups (70.9% vs 73.1% vs 73.9%, respectively). High-SEP adolescents were more likely to be in Cluster 2, characterized by frequent alcohol consumption but moderate binge drinking (14.3% vs 12.6% vs 10.7%). The prevalence of risky behaviors was similar between high and low-SEP adolescents in Cluster 3 (high smoking, frequent alcohol use, binge drinking, and moderate bullying) (8.0% vs 7.7% vs 8.2%) and Cluster 4 (high levels of bullying perpetration) (6.7% vs 6.5% vs 7.2%). Countries with higher Gini index were at a greater risk of reporting risky behaviors. High-SEP adolescents were more likely to engage in risky behaviors in countries with high income inequality. The odds ratios comparing high- vs. low-SEP adolescents ranged from 0.89 in the least unequal to 1.67 in the most unequal countries for multiple risky behaviors (Cluster 3: P-interaction = 0.042) and from 0.61 to 1.19 for bullying perpetration (Cluster 4: P-interaction = 0.030). Conclusions High-SEP adolescents in PCCE might be at an increased risk for unhealthy and vicious behaviors, especially in countries with high income inequality. This study highlights the need for policies that address income inequality to ensure the well-being of adolescents across socioeconomic strata in PCCE. Key messages • High-SEP adolescents might be at an increased risk for unhealthy behavior in PCCE. • Wide income inequality might contribute to risky behaviors among high-SEP adolescents.

Alcohol-related premature mortality in Northern Dimension partnership countries 2003-2021

Abstract Background Potential Years Life Lost (PYLL) is an established method to measure, follow trends and compare disease burden within and between countries. Northern Dimension Partnership in Health and Social wellbeing (NDPHS) network was established in 2003 and includes the following countries: Estonia, Finland, Germany, Iceland, Latvia, Lithuania, Norway, Poland, Russia, and Sweden. Due to the Russian invasion to Ukraine, Russia is now excluded from the collaboration. Iceland is not included in the analyses due to too small number of events. Methods Premature mortality was defined as a death before the age of 70 years. Alcohol-related deaths included the following ICD-codes: E24.4, F10, G31.2, G62.1, G72.1, I42.6, K29.2, K70, K85.2, K86.0, Q86.0, R78.0, X45, X65, Y15, K73, K74.0-K74.2, K74.6, O354, P043 and G4051. PYLL-rates per 100,000 population are presented separately for men and women in four time points: 2003, 2013, 2017 and 2021. Data were obtained from Eurostat and analyses are standardized to EU standard population. Results In the whole NDPHS area, alcohol related PYLL-rates declined between 2003 and 2017: from 527 to 458 in men, and from 159 to 134 in women. However, between 2017 and 2021 the rates increased: to 509 in men and to 154 in women. In 2021, the highest alcohol-related PYLL-rates were in Latvia (1696 in men and 530 in women) and the lowest in Norway (94 in men and 43 in women). Thus, the differences between countries in alcohol-related PYLL-rates were 20-fold in meles and 10-fold in females. In all countries the rates were 2-3 times higher in men compared to women. Conclusions Alcohol use is an important cause of premature mortality and disease burden in NDPHS area. There are marked differences in alcohol-related PYLL-rates between sexes and countries. The increase in alcohol-related PYLL-rates between 2017 and 2021 may be related to the Covid-pandemic. Key messages • Alcohol use is an important cause of premature mortality and disease burden in NDPHS countries, and there are marked differences in alcohol-related mortality between sexes and countries. • Reduction of total alcohol consumption is an evidence-based most effective public health measure to reduce alcohol-related health harms.

Emergency Department Utilization for Postpartum Behavioral Health Problems and Assault Injury During the COVID-19 Pandemic.

Objective: Distinctive stressors facing pregnant and postpartum individuals during the COVID-19 pandemic may have affected their emergency department (ED) care-seeking for behavioral health concerns and violence victimization. We tested whether the incidence of postpartum behavioral health and assault injury ED visits differed for individuals according to their months of postpartum pandemic exposure. Methods: We used statewide, longitudinally linked hospital and ED administrative claims data from California to classify all individuals with hospital deliveries between January 1, 2016, and December 31, 2020, according to their months of postpartum pandemic exposure. Outcomes comprised 12-month incidence of any ED visit for a psychiatric disorder, drug use disorder/overdose, alcohol use disorder/intoxication, or assault injury, defined using International Classification of Diseases-Clinical Modification, version 10 codes. Risk ratios compared the incidence of each outcome among people with 1-12 months of postpartum pandemic exposure to those with 0 months of exposure. Results: Compared to people with 0 months of postpartum pandemic exposure (n = 1,163,215), delivering people with 1-12 month' exposure (range: n = 26,836 to n = 273,561) were approximately equally likely to have a postpartum ED visit for a psychiatric disorder, drug use disorder, or alcohol use disorder, after adjusting for demographic differences (most p > 0.10). The incidence of assault injury was significantly lower among delivering individuals with 11 or 12 months of pandemic exposure (RRadj = 0.70 and 0.91, respectively; both p < 0.01) compared to those with 0 months. Conclusions: Contrary to expectations, the pandemic did not appear to have affected ED utilization for most behavioral health conditions among postpartum individuals, but assault injury ED visits declined.

INSATISFAÇÃO CORPORAL EM ADOLESCENTES E A RELAÇÃO COM AS MÍDIAS SOCIAIS DIGITAIS

Body dissatisfaction and the use of social networks are current phenomena that mark female adolescence and therefore require evaluation. Objective: to analyze the relationship between the use of social media and body dissatisfaction in female adolescents. Methodology: This is a literature review consisting of nine scientific articles found in the databases: SciElo and PubMed. Results and Discussion: The articles selected for this study, through the analysis of their elements, allowed the understanding that social networks exert a strong influence on the development of body dissatisfaction (BD) in adolescent girls, because these networks present information about the so-called ideal body, which is equally unattainable for most women. It was also identified that body dissatisfaction causes serious consequences to the psychological and physical health of adolescents, such as: problems with self-esteem, distorted selfperceptions, hatred of one’s own body, depression, insomnia, social isolation, alcohol use, restrictive diets, eating disorders, among other complications. Therefore, actions aimed at resolving and/or alleviating this scenario were demonstrated, such as interventions aimed at periodically withdrawing from social networks, healthy diets and self-acceptance. Final considerations: Although the social pressure on women’s bodies is an old phenomenon, it currently has strong allies in the media and social networks. Therefore, the relevance of the topic discussed in this article for science and society is considered and it is suggested that further studies be developed on this subject.

Impact of the transition to retirement on alcohol consumption: a longitudinal analysis within SHARE

Abstract In an ageing society, the impact of retirement on behavioural risk factors and health status needs to be carefully assessed. Evidence on the short-term and long-term effects of retirement on alcohol consumption are contrasting and inconsistent. A longitudinal study was conducted based on data from the Survey on Health, Ageing and Retirement (SHARE) collected between 2004 and 2020 in 27 European countries and Israel. A repeated measure generalised estimating equation (GEE) model was fitted to estimate the relative risks (RR) and corresponding 95% confidence intervals (CI) of alcohol consumption (frequency, quantity, and binge drinking) at different time periods before and after retirement. We selected a cohort of 8,998 individuals who were employed at baseline and retired during follow-up (median follow-up: 9 years; maximum: 16 years). Compared to the year of retirement, the RR for habitual daily or near-daily drinking was 0.88 (95%CI 0.76-1.02) 10 years before retirement and 0.92 (95%CI 0.83-1.02). This pattern reversed post-retirement with a RR of 1.12 (95%CI 1.01-1.23) 3-4 years after retirement and 1.28 (95%CI 1.11-1.48) 10 years or more after retirement. No significant changes in the consumption of high volumes (more than 8 units of alcohol) were observed: while the frequency of regular drinking might increase post-retirement, the instances of heavy episodic drinking do not necessarily rise. Additionally, a reduction in occasional heavy drinking episodes was noted both before (RR 0.86; 95%CI 0.77-0.95, 5-9 years prior) and after retirement (RR 0.78; 95%CI 0.66-0.93, more than 10 years after). These findings underscore the complexity of alcohol use behaviours in the context of retirement. The increase in regular drinking post-retirement might be attributed to changes in daily structure, social interactions, or coping mechanisms for life transitions. The decline in binge drinking suggests a shift towards more moderated consumption patterns as individuals age. Speakers/Panelists Licia Iacoviello University of Insubria, Varese, Italy João Vasco Santos University of Porto, CINTESIS, ARS Norte, Porto, Portugal

CKD incidence, predictors &amp; progression: African migrants vs. Non-Migrants (RODAM cohort study)

Abstract Background Limited longitudinal data exist on chronic kidney disease (CKD) in African populations undergoing epidemiological transitions. We investigated incidence, long-term predictors, and progression of CKD among Ghanaians residing in rural- and urban-Ghana, and Ghanaian migrants in the Netherlands (Amsterdam). Methods We analysed data from 2183 participants in the transcontinental population-based prospective RODAM-cohort, followed for approximately seven years. CKD incidence and its progression to end-stage renal disease (ESRD) were defined using KDIGO criteria. CKD incidence was calculated using age-and sex-standardization for those without CKD at baseline. Long-term predictors of CKD incidence were identified using one-step robust Poisson regression. CKD progression to ESRD from baseline was also assessed using robust Poisson regressions. Results Overall age-and-sex standardized CKD incidence was 11.0% (95%CI; 9.3%-12.3%). Rural and urban-Ghanaians had higher CKD incidence (12.5%;8.5%-15.5%; 12.3%;8.2%-15.8%; respectively) than Amsterdam-Ghanaians (7.6%; 5.4%-10.6%). Residence in Amsterdam was associated with lower CKD incidence compared to rural Ghana after adjustments (Incidence Rate Ratio=0.34; 0.13-0.89), but not with urban-Ghana (IRR=1.07; 0.69-1.67). CKD incidence predictors were advanced age, female sex, alcohol consumption, uric acid levels, and hypertension. CKD progression to ESRD was 2.5% (1.4%-3.6%) in rural- Ghana, 2.3% (1.3%-3.2%) in urban-Ghana and 0.0% in Amsterdam. Conclusions One-tenth of Ghanaians developed CKD over seven-years, with higher incidence in Ghana compared to Europe. Age, female sex, alcohol use, uric acid levels, and hypertension were predictive factors. CKD progression to ESRD was minimal. High CKD incidence among Ghanaians, especially among non-migrants, calls for in-depth assessment of contributing factors and targeted interventions. Key messages • We observed higher CKD Rates in Rural/Urban Ghana vs. Amsterdam:Indicating geographic Disparities. • CKD Predictors: Age, Sex, Alcohol, Uric Acid, Hypertension (Minimal ESRD Progression). Interventions target: Non-Migrant Ghanaians.

Linking health-related behaviours to quality of life in older adults: A latent class analysis

Abstract Background Life expectancy and healthy life years diverge considerably in Austria, and quality of life (QoL) varies widely among older people. Identifying the factors most relevant to QoL in older people is crucial. We aimed to investigate the association between health behaviour, including lifestyle and preventive behaviour, and QoL in this population. Methods Cross-sectional data from the Austrian Health Interview Survey (2019) were used, including 3,995 individuals aged 65 years and older. We performed latent class analysis (LCA) to identify patterns of health behaviours. Variables were selected based on the WHO framework of Active Ageing including factors related to lifestyle (physical exercise, fruit/vegetable intake, BMI, oral health, smoking, alcohol use) and the health care system (satisfaction, unmet needs, participation in screening, health checks and vaccination). Domain scores of the WHOQOL-BREF were used for QoL assessment. Class differences were assessed by survey regressions. Results In the LCA, four different behavioural classes emerged among the older-aged Austrian population, including (class 1) ‘best preventive behaviour and very good lifestyle’ (17.7%), (class 2) ‘worst lifestyle and worst preventive behaviour, high unmet healthcare needs and unsatisfied with the system’ (16.5%), (class 3) ‘very good preventive behaviour and best lifestyle, but worst vaccination probability’ (24.8%) and (class 4) ‘poor preventive behaviour, good lifestyle, but no physical activity’ (41.0%). The classes with unhealthy lifestyles (classes 2 and 4) had worse QoL in all domains compared to the classes with healthy lifestyles (classes 1 and 3). The four classes differ on demographic, socio-economic and health characteristics. Conclusions To improve the QoL of the older population, policies and interventions need to be tailored to the specific characteristics and needs of each behavioural class. Key messages • This study explores the relationship between health behaviour and QoL in older Austrians. • Findings support the development of differentiated interventions targeting different types of behaviour.

Stressors and symptoms explaining sexual orientation inequalities in mental health services usage: A longitudinal study with young adults

Abstract Background Sexual minority (i.e., lesbian, gay, and bisexual [LGB], and other non-heterosexual) individuals are more likely to use mental health services than heterosexuals; however, evidence is scarce about factors contributing to this difference. Methods This study uses longitudinal data from a population-based sample of young adults (aged 18- 36) in Sweden (N = 1,137). We use mediation analysis to examine whether common mental health symptoms (i.e., depressive, anxiety and social anxiety symptoms, suicidality, and alcohol use) mediate sexual orientation differences in mental health services use; and to understand whether adding general stressors (i.e., low social support, loneliness, and perceived stress) to these models increases the total effect explained. Afterwards, we use logistic regression models to understand how minority-specific stressors (e.g., family reaction and dimensions of sexual minority identity) predict mental health service use among sexual minority individuals (N = 498), adjusting for common mental health symptoms. Results Common mental health symptoms only partially mediate the associations and the direct effect for sexual orientation remain significant (β = 0.11, p &amp;lt; 0.01). Adding general stressors to these models only slightly increase the total effect explained and the direct effect remained significant (β = 0.11, p &amp;lt; 0.01). Among sexual minority individuals, after adjusting for common mental health symptoms, a difficult process of coming out (β = 0.12, p &amp;lt; 0.05) and negative family reaction towards one’s sexual orientation (β = 0.15, p &amp;lt; 0.05) predicted use of mental health services. Conclusions Overall, these results show that minority-specific stressors contribute to help-seeking behaviours among sexual minority individuals, regardless of psychiatric morbidity, highlighting the potential role of mental health services empowering sexual minority individuals to cope with minority stress.