Dimensions Of Alcohol Consumption Research Articles

Dimensions of alcohol consumption among adolescents: a field study

Alcohol is one of the most commonly used legal substances. Adolescent drinking behaviors cover a spectrum ranging from total abstinence to dependence. This research aimed to estimate the prevalence of consumption of different alcoholic beverages among Romanian adolescents. Another objective was to investigate the context (e.g., places where consumption occurs or the people with whom adolescents use this substance) as well as the pattern of consumption (e.g., reasons for drinking or frequency of ethanol intoxication). The sample included 688 adolescents (321 girls and 367 boys). Comparative data are presented.

Before and After the Pandemic: Alcohol Consumption and Related Problems in Argentina

The impact of the COVID-19 pandemic and isolation measures on alcohol consumption remains unknown among Latin-American countries. This paper characterizes differences in alcohol consumption and related problems before and after the pandemic among Argentinians from different genders, age groups, income levels, and behaviors regarding the acquisition of alcoholic beverages. Through an online survey 1446 participants were assessed regarding four alcohol consumption dimensions (frequency, quantity, heavy episodic drinking -HED- and alcohol-related problems) three months prior and after the first cases in the country and subsequent lockdown measures. Overall, participants reported small reductions for usual consumption and moderate ones for HED and related problems. As expected, very high reductions were found for those underage (14 to 18 years), and young adults (19 to 24 years). Those who had an increase in income after the pandemic did not report changes in consumption, while those whose income remained equal or lowered reported reductions. Those who did not report special behaviors to acquire alcohol (e.g. pre-stocking) informed decreases in consumption compared to those who did. This study provides new evidence on the impact of environmental factors in public health, suggesting restricted access to alcohol generates a significant decrease in alcohol consumption and related problems.

Childbirth and Alcohol Consumption Impact of Recent Childbirth on Alcohol Consumption

While the devastating effects of parental alcohol use on children’s health are well known, the specific impact of childbirth on parental alcohol consumption has rarely been examined in the general population. We sought to examine patterns of alcohol use associated with childbirth. Data were drawn from the US National Epidemiologic Survey on Alcohol and Related Conditions. We compared successively the characteristics of alcohol use among females living with a child under 1 year with (i) those of females not living with children under 1 year and (ii) those of females living with an older child. Mean daily ethanol intake was lower among females living with a child under 1 than among females either not living with children under 1 year (p < 0.001) or living with an older child (p < 0.01). Moreover, low-to-mild drinking frequencies fell among females living with a child under 1, compared with females either not living with children under 1 year (adjusted odds ratio (AOR) = 0.56; 95% CI [0.40, 0.80] for at least once a month and AOR = 0.40; 95% CI [0.27, 0.58] for less than once a month) or living with an older child (AOR = 0.52; 95% CI [0.36, 0.75] for at least once a month and AOR = 0.66, 95% CI [0.46, 0.94] for less than a month). No significant difference was found for males. Our study suggests that childbirth, as opposed to motherhood per se, reduces several (though not all) dimensions of alcohol consumption in females, but not in males.

A narrative review of alcohol consumption as a risk factor for global burden of disease.

Since the original Comparative Risk Assessment (CRA) for alcohol consumption as part of the Global Burden of Disease Study for 1990, there had been regular updates of CRAs for alcohol from the World Health Organization and/or the Institute for Health Metrics and Evaluation. These studies have become more and more refined with respect to establishing causality between dimensions of alcohol consumption and different disease and mortality (cause of death) outcomes, refining risk relations, and improving the methodology for estimating exposure and alcohol-attributable burden. The present review will give an overview on the main results of the CRAs with respect to alcohol consumption as a risk factor, sketch out new trends and developments, and draw implications for future research and policy.

Alcohol and steatosis: The Japanese paradox — Authors' reply

We thank Lonardo et al. (2016) for their comments on our meta-analysis on the relationship between alcohol consumption and hepatic steatosis (Roerecke et al., 2016). We would like to clarify our position on overall risk associated with alcohol consumption and specifically on the risk of hepatic steatosis. First, as we have stated in our paper, we are in agreement with Lonardo et al. that a distinction between alcoholic and non-alcoholic hepatic steatosis has little meaning because alcohol is only one of the risk factors for liver disease, including non-alcoholic fatty liver disease. Different dimensions of alcohol consumption should be distinguished in this regard as non-regular binge drinking among moderate drinkers seems to increase the risk for hepatic steatosis. However, other risk factors also play a role, and the interactions among all risk factors determine the overall risk for liver injury. The large heterogeneity we observed in countries other than Japan underlines that risk factors other than alcohol play a substantial role in risk for hepatic steatosis and precludes us from clearly identifying the role alcohol plays in the development of hepatic steatosis. Thus, categorizing the etiology of liver injury based on one risk factor does not make much sense. Second, when talking about risk associated with alcohol consumption, it makes little sense to use words such as safe. Rather, risk needs to be examined for each disease outcome separately because pathways and risk differ from disease to disease, and the same amount of alcohol may be associated with a low risk for one disease outcome but with high risk for another. For example, the risk for breast cancer is elevated no matter how little alcohol is consumed (Shield et al., 2016), and no level of alcohol consumption is safe in this case. Consequently, guidelines for alcohol consumption are considered ‘low-risk’ drinking guidelines (Stockwell & Room, 2012), i.e. no level of alcohol consumption is safe. Third, the term paradox gives evidence that we do not yet fully understand the etiology of liver disease and the role alcohol plays in it. Any comprehensive theory of alcohol's effect on hepatic steatosis or other forms of liver disease should be able to explain the difference in associations our meta-analysis has shown.

An Assessment of the Demographic and Clinical Correlates of the Dimensions of Alcohol Use Behaviour

To identify population-based clinical and demographic correlates of alcohol use dimensions. Using data from a population-based sample of Great Britain (n=7849), structural equation modelling (SEM) was used to identify associations between demographic and clinical variables and two competing dimensional models of the Alcohol Use Disorders Identification Test (AUDIT). A two-factor SEM fit best. In this model, Factor 1, alcohol consumption, was associated with male sex, younger age, lower educational attainment, generalized anxiety disorder (GAD) and suicide attempts. Factor 2, alcohol-related problems, was associated with the demographic variables (to a lesser extent) and to a wider range of clinical variables, including depressive episode, GAD, mixed anxiety and depressive disorder, obsessive compulsive disorder, phobia, suicidal thoughts and suicide attempts. The one-factor SEM was associated with demographic and all assessed clinical correlates; however, this model did not fit the data well. Two main conclusions justify the two-factor approach to alcohol use classification. First, the model fit was considerably superior and, second, the dimensions of alcohol consumption and alcohol-related problems vary considerably in their associations with measures of demographic and clinical risk. A one-factor representation of alcohol use, for instance, would fail to recognize that measures of affective/anxiety disorders are more consistently related to alcohol-related problems than to alcohol consumption. It is suggested therefore that to fully understand the complexity of alcohol use behaviour and its associated risk, future research should acknowledge the basic underlying dimensional structure of the construct.

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.

Rehm et al. Respond to "Never, or Hardly Ever?"

In this issue of the Journal, Dr. Klatsky (1) raised a couple of open questions with respect to defining the best control group for alcohol epidemiology in his insightful commentary regarding our finding (2) that more than half of the people stating lifetime abstention in a representative US panel survey had elsewhere reported drinking before. Here, we respond to his comments, trying to further illuminate the best way to define this control group. We completely agree with Dr. Klatsky that the exact wording of the questions plays an important role. Much work in alcohol epidemiology has been done on defining the best way to elicit drinking reports (3, 4). Work on the wording of the introduction to these questions usually dealing with distinguishing whether the respondent is a lifetime or a “current” abstainer has been less methodological. However, as laid out in our paper (2), defining this control group has important implications for alcohol epidemiology; thus, the wording of such queries should receive the same methodological attention as other measures of exposure. Therefore, we believe that the exact wording should be reported (1). Dr. Klatsky's commentary (1) deals mainly with the relation between alcohol consumption and chronic disease. For this outcome, an adequate control group would be people for whom alcohol exposure could not reasonably have a biologic impact, that is, a mixture of lifetime abstention and very low levels of infrequent drinking (1, 2). However, almost half of the mortality and morbidity burden from alcohol stems from injuries (5), with different dimensions of alcohol consumption being relevant, especially amount of intake before the event. The best control group here is no drinking before the event or, in cohort studies, its best correlate. Even moderate drinking has some effects on psychomotor abilities (6), and its risk would then be determined by the overall frequency of different kinds of drinking occasions, each associated with a specific relative risk of injury (7). While moderate drinking is already associated with an elevated risk compared with abstention, the relative risks tend to increase exponentially with increasing intake (refer, for example, to Borkenstein et al. (8)). Finally, we could not agree more with Dr. Klatsky's contention (1) that other measurement errors, such as underreporting, could have an even more important effect on epidemiologic indicators of public health importance, such as alcohol attributable fractions (2, 9). We see 3 consequences for future work here: first, even for complex indicators, we should always give confidence intervals and conduct sensitivity analyses (e.g., for confidence intervals around attributable fractions, refer to Natarajan et al. (10)). Second, alcohol epidemiology should start correcting for regression dilution bias based on measurement error of exposure, as is now standard in epidemiologic research on other risk factors (11). Third, triangulation of different data sources will help avoid some of the main problems of measurement error, such as underreporting (12). Overall, we hope that the above-mentioned steps will provide some guidance for future research in alcohol epidemiology and will help reduce the effects of measurement errors.

Relationships among alcohol use, hyperarousal, and marital abuse and violence in Vietnam veterans.

Alcohol use (frequency and quantity) and the hyperarousal feature of PTSD were examined in relation to male-perpetrated marital abuse and violence using data from 376 couples who participated in the National Vietnam Veterans Readjustment Study. Veteran's self-reported hyperarousal was significantly associated with partner's report of physical violence and psychological abuse toward her. Differential relationships were found between veteran's self reported drinking frequency and drinking quantity and the outcomes; of the two components, only the average quantity consumed per occasion was independently related to husband-to-wife violence. Moreover, a complex interaction emerged between hyperarousal and the two dimensions of alcohol consumption in predicting violence, with the relationship between hyperarousal and violence varying as a function of both drinking frequency and drinking quantity.

Average Volume of Alcohol Consumption, Drinking Patterns and Related Burden of Mortality in Young People in Established Market Economies of Europe

Objective: To determine the burden of mortality in young people (age 15–29) in established market economies in Europe in 1999, which is attributable to alcohol consumption. Two dimensions of alcohol consumption were considered: average volume of consumption, and patterns of drinking. Methods: Mortality data were obtained from the WHO EIP data bank, average volume data from the WHO global databank on alcohol, pattern of drinking data from a questionnaire sent out to experts, from the published literature and from the WHO global databank. Methods are explained and discussed in detail in two other contributions to this volume. Results: More than 8,000 deaths of people aged 15–29 in Europe in 1999 were attributable to alcohol. Young males show a higher proportion of alcohol-attributable deaths (12.8%) than females (8.3%). Both average volume and patterns of drinking contribute to alcohol-related death. Conclusions: Alcohol-related deaths constitute a considerable burden in young people in Europe.

Alcohol use and psychosocial well-being among older adults.

The objective of this study was to examine the relationships of three dimensions of alcohol consumption (frequency of drinking, usual total weekly consumption and quantity per occasion) with social and leisure status, stress and psychological well-being among people ages 65 and older. Nurse interviewers completed in-house surveys with 826 older persons (65% women) in one community (67% response rate of the census sample). Overall, relationships tended to be modest or nil. Those relationships between negative functioning and heavier alcohol use that did emerge tended to be associated with higher quantity drinking (i.e., drinks per drinking day) and to some extent volume, but not with frequency of drinking. Of the psychosocial variables, poorer psychological well-being, especially depression, was most highly correlated with heavier drinking. These results were the same controlling for sex, age, education, health and use of depressant medications. Higher quantity and volume of alcohol use among older people show a modest positive association with poorer psychological well-being, independent of other potentially confounding variables such as sex, age, health or use of depressant medications. Frequency of drinking, however, was not related to psychosocial status.

Development and Evaluation of the Revised Alcohol Evaluation Instrument

This study reports on the development of a revised version of the Alcohol Evaluation Instrument (ALCEVAL-R). Items in the four major areas of the ALCEVAL-R were factor analyzed separately and relationships among factors were examined. Results suggest that the ALCEVAL-R measures clinically meaningful aspects of the alcoholic patient's occupational and social status, and reveals important dimensions of alcohol consumption and of the personal and social consequences of alcohol abuse.