Alcohol Epidemiology Research Articles

Why Do Only Some Cohort Studies Find Health Benefits From Low-Volume Alcohol Use? A Systematic Review and Meta-Analysis of Study Characteristics That May Bias Mortality Risk Estimates.

Assumptions about alcohol's health benefits profoundly influence global disease burden estimates and drinking guidelines. Using theory and evidence, we identify and test study characteristics that may bias estimates of all-cause mortality risk associated with low-volume drinking. We identified 107 longitudinal studies by systematic review with 724 estimates of the association between alcohol consumption and all-cause mortality for 4,838,825 participants with 425,564 recorded deaths. "Higher-quality" studies had a mean cohort age of 55 years or younger, followed up beyond 55 years, and excluded former and occasional drinkers from abstainer reference groups. "Low-volume" alcohol use was defined as between one drink per week (>1.30 g ethanol/day) and two drinks per day (<25 g ethanol/ day). Mixed linear regression was used to model relative risks (RRs) of mortality for subgroups of higher- versus lower-quality studies. As predicted, studies with younger cohorts and separating former and occasional drinkers from abstainers estimated similar mortality risk for low-volume drinkers (RR = 0.98, 95% CI [0.87, 1.11]) as abstainers. Studies not meeting these quality criteria estimated significantly lower risk for low-volume drinkers (RR = 0.84, [0.79, 0.89]). In exploratory analyses, studies controlling for smoking and/or socioeconomic status had significantly reduced mortality risks for low-volume drinkers. However, mean RR estimates for low-volume drinkers in nonsmoking cohorts were above 1.0 (RR = 1.16, [0.91, 1.41]). Studies with lifetime selection biases may create misleading positive health associations. These biases pervade the field of alcohol epidemiology and can confuse communications about health risks. Future research should investigate whether smoking status mediates, moderates, or confounds alcohol-mortality risk relationships.

A Bayesian method for addressing multinomial misclassification with applications for alcohol epidemiological modeling

In this article, we describe a new command, bamm, that implements a Bayesian method for addressing misclassification in multinomial data; see Swartz et al. (2004, Canadian Journal of Statistics 32: 285–302). We also describe a postestimation command, bammdx, that was developed to provide additional estimation diagnostics. We describe the method and the new commands and then present results from both a simulation study demonstrating bamm’s performance under a known misclassification data-generating process and an empirical example from alcohol epidemiology modeling.

The epidemiology of alcohol burns at a major burn centre in North China

This study was designed to explore the epidemiological characteristics and potential preventive strategies of alcohol burns. In this five-year, retrospective study, 163 patients with alcohol burns (admitted from 1 January 2015 to 31 May 2020 were included. There was a male-to-female ratio of 1.1:1, a mean age of 34.1±16.8 years, and a mean burn size of 13.3±13.7% total body surface area (TBSA). The number of patients with alcohol burns was similar year by year during the five-year period. Just over half of patients (n=84, 51.5%) sustained a third-degree burn injury, which was significantly associated with a longer hospital stay and the need for surgery. The most prevalent aetiology was cupping (n=49, 29.5%), followed by cooking hotpot (n=37, 22.7%). Of the patients, seven (4.29%) sustained injuries during experiments at school and one patient sustained injury when using alcohol spray for disinfection against COVID-19. The incidence of facial burn injury (n=105, 64.4%) was significantly higher than previously reported data (33.2%). The result of the study showed that cupping and hotpot were the main causes of alcohol burns in Beijing, which should be taken into consideration for prevention. It is necessary to strengthen safety management of classes at school where experiments are undertaken and to educate the general public on the proper means of disinfecting against COVID-19.

The socioeconomic gradient of alcohol use

In The Lancet Global Health, Yuanwei Xu and colleagues1 make a useful contribution to the alcohol epidemiology field by using data from 336 287 adult participants (aged ≥15 years) on current and heavy episodic drinking (HED) from 55 low-income and middle-income countries (LMICs). The focus on HED is particularly important given the effect of HED on health and social outcomes.2 Previous research on the socioeconomic gradient of alcohol use has centred on high-income countries and research in LMICs was limited to single countries or subnational studies.

Normalization of non-drinking and implications for alcohol epidemiology.

Normalization of non-drinking and implications for alcohol epidemiology.

Cohort effects on gender differences in alcohol use in the United States: How much is explained by changing attitudes towards women and gendered roles?

Gender differences in binge drinking have converged in recent cohorts, due in part to faster decreases in consumption among boys in adolescence, and faster increases in consumption among women in young to middle adulthood. Changes in education and occupation explain a portion, but not all, of these differences; the present study examines how attitudes about gender, religion and family additionally explain cohort effects in binge drinking by sex. Data were drawn from the Monitoring the Future panel studies, including >54,000 participants who were high school seniors from 1976 through 2006, followed to age 29/30 from 1988 through 2016. The main effect relationship between cohort and binge drinking was assessed, and 28 items on gender, religion and family were evaluated to determine if mediation criteria were met; mediation models assessed direct and indirect effects. Results indicated that gender, religion and family attitudes and beliefs among US adults across the 20 th and 21 st centuries have shifted dramatically but not monotonically. US adolescents and adults have largely become less religious; some attitudes on women and family have become less conservative and some more. Among men, views on marriage showed the largest mediation effects; agreeing with the statement ‘one partner is too restrictive’ mediated 3.35% of the cohort effect (95% C.I. 2.42, 4.31) and ‘couples should live together before they are married’ mediated 1.6% of the cohort effect (95% C.I. −2.37, −0.8). Among women, declines in religious service attendance mediated 2.0% of cohort effects in binge drinking (95% C.I. −3.03, −1.09), as well as similar family attitudes as men. In conclusion, changes in social roles, as well as some gender, and religious views, partially mediate cohort effects on binge drinking for men and women. The dynamic changes in how adolescents and adults view family and gender are important components of alcohol epidemiology.

Beyond Behaviour: How Health Inequality Theory Can Enhance Our Understanding of the 'Alcohol-Harm Paradox'.

There are large socioeconomic inequalities in alcohol-related harm. The alcohol harm paradox (AHP) is the consistent finding that lower socioeconomic groups consume the same or less as higher socioeconomic groups yet experience greater rates of harm. To date, alcohol researchers have predominantly taken an individualised behavioural approach to understand the AHP. This paper calls for a new approach which draws on theories of health inequality, specifically the social determinants of health, fundamental cause theory, political economy of health and eco-social models. These theories consist of several interwoven causal mechanisms, including genetic inheritance, the role of social networks, the unequal availability of wealth and other resources, the psychosocial experience of lower socioeconomic position, and the accumulation of these experiences over time. To date, research exploring the causes of the AHP has often lacked clear theoretical underpinning. Drawing on these theoretical approaches in alcohol research would not only address this gap but would also result in a structured effort to identify the causes of the AHP. Given the present lack of clear evidence in favour of any specific theory, it is difficult to conclude whether one theory should take primacy in future research efforts. However, drawing on any of these theories would shift how we think about the causes of the paradox, from health behaviour in isolation to the wider context of complex interacting mechanisms between individuals and their environment. Meanwhile, computer simulations have the potential to test the competing theoretical perspectives, both in the abstract and empirically via synthesis of the disparate existing evidence base. Overall, making greater use of existing theoretical frameworks in alcohol epidemiology would offer novel insights into the AHP and generate knowledge of how to intervene to mitigate inequalities in alcohol-related harm.

The role of alcohol and other drugs on emergency department traumatic injury mortality in the United States

BackgroundAlcohol and other drugs (AOD) increase the risk of traumatic injury occurring, but data suggest a protective benefit in preventing trauma-related mortality. The objective of this study is to describe the epidemiology of AOD-related traumatic injury in the US over a recent 7 year period and assess the interaction of traumatic injury and AOD on pre-admission fatality on both an additive scale using incidence contrasts and on a statistical multiplicative scale using survey-adjusted logistic regression. MethodsUsing the National Emergency Department Sample (NEDS), we describe the epidemiology of alcohol and substance-related emergency department traumatic injury over a recent period. AOD-related injury was assessed using survey-adjusted counts and means. Ratio estimates and differences were calculated using simulations based on survey-adjusted counts and standard errors. Differences in trends over time were evaluated by comparing the slopes of linear regression equations with year as the predictor variable. ResultsAlcohol and substance-related emergency department injury discharges increased 9.8 % during the study period. There was a statistically significant interaction between traumatic injury death and AOD on both an additive scale and multiplicative scale. (Odds Ratio for interaction term = 1.76, 95 % CI = 1.53, 2.03). ConclusionsAOD use does not provide a protective benefit in the setting of trauma, but rather is an important contributor to traumatic injury mortality.

Alcohol associated liver disease 2020: A clinical practice guideline by the Italian Association for the Study of the Liver (AISF)

Alcohol use disorder which includes alcohol abuse and dependence represents one of the leading risk factors for premature mortality in Europe and it is responsible of over 200 conditions, including neuropsychiatric disorders, chronic diseases, cancers and accidents leading to permanent disability. Alcohol use disorder represents the most common cause of liver damage in the Western world, with a wide spectrum of diseases ranging from steatosis, steatohepatitis, fibrosis, cirrhosis and cancer. The present clinical practice guidelines by the Italian Association for the Study of the Liver (AISF) are focused on the current knowledge about epidemiology, pathophysiology, clinical features, diagnosis and treatment of alcohol associated liver disease, aiming to provide practical recommendations on the management of this complex pathological condition.

Epidemiology of alcohol and drug screening among pedestrian fatalities in the United States, 2014–2016

Objective: U.S. pedestrian fatalities increased by 25% between 2010 and 2015. Risk factors include distractions, the built environment, urbanization, economic variables, and weather conditions. Of interest is the role of alcohol and drugs in premature death among pedestrians. This study sought to explore the prevalence of substance use screenings among pedestrian fatalities in the United States between 2014 and 2016.Methods: Data were collected from the Fatality Analysis Reporting System provided by the NHTSA. Pedestrian crash variables included demographics as well as information regarding alcohol or drug testing status. Frequency and cross-tabulation tables were constructed to assess the prevalence of screening by person, place, and time. Log-linear analyses were completed to explore age, race, and sex differences. A 3-year examination period was used to control for yearly fluctuations and to incorporate an increasing trend in cases.Results: Pedestrian fatalities accounted for 84% of all deaths among vulnerable road users during the examination period. Those most at risk were white males between the ages of 45 and 64. Over all states, 74.7% of fatalities were tested for alcohol and 67.1% were tested for drugs; further, 66.5% of cases were tested for both alcohol and drugs and 24.8% were tested for neither substance. Cases screened for both alcohol and drugs ranged from 2.9% in North Carolina to 95.7% in Nevada and those testing for neither substance ranged from a high of 68.9% in Indiana to a low of 1.1% in Maryland. Log-linear regression revealed significant differences in alcohol screening by age and race but not by sex. Differences in drug screening were not identified for any demographic variable. Fatalities tested for alcohol were significantly more likely to be tested for drugs; only 8.2% were screened solely for alcohol and 0.05% were screened for drugs alone.Conclusions: Preventive strategies become more important as pedestrian crashes and fatalities increase. Risk reduction in the form of policy change, alterations to the built environment, or interdisciplinary approaches to injury prevention is dependent upon best evidence supported in part by more deliberate and consistent screening.

Addiction Lives: Moira Plant.

Addiction Lives: Moira Plant.

Spatial Epidemiology of Alcohol- and Drug-Related Health Problems Among Northern Plains American Indians: Nebraska and South Dakota, 2007 to 2012.

Despite high abstinence rates, American Indians experience elevated rates of many alcohol and other drug problems. American Indians also predominantly reside in poor and rural areas, which may explain some observed health disparities. We investigated whether geographic areas including reservations or large American Indian populations exhibited greater incidence of alcohol- and drug-related hospitalizations. We obtained inpatient hospitalization records for 2 Northern Plain states (Nebraska and South Dakota) for the years 2007 to 2012. We constructed zip code counts for 10 categories of hospitalization with diagnoses or injury causation commonly associated with alcohol or drug use. We related these to community sociodemographic characteristics using Bayesian Poisson space-time regression models and examined associations with and without controls for whether each zip code was located within an American Indian reservation. Controlling for other demographic and economic characteristics, zip codes with greater percentage of American Indians exhibited greater incidence for all 10 substance abuse-related health outcomes (9 of 10 well supported); zip code areas within American Indian reservations had greater incidence of self-inflicted injury and drug dependence and abuse, and reduced incidence of alcohol cirrhosis and prescription opioid poisoning. However, the analyses generally demonstrated no well-supported differences in incidence associated with local residence percentages of American Indian versus African American. In our analyses, ethnicity or heredity alone did not account for alcohol- and drug-related hospitalizations among Native populations. Aspects of social, economic, and political dimensions of Native lives must be considered in the etiology of alcohol- and drug-related problems for rural-dwelling indigenous peoples.

All drinking is not equal: how a social practice theory lens could enhance public health research on alcohol and other health behaviours.

The social meanings, settings and habitual nature of health-related activities and their integration into our daily lives are often overlooked in quantitative public health research. This reflects an overly individualized approach to epidemiological surveillance and evaluations of public health interventions, based on models of behaviour that are rooted in social cognition and rational choice theories. This paper calls for a new approach to alcohol epidemiology and intervention research informed by theories of practice. Practices are conceptualized as routinized types of human activity that are made up of, and can be recognized by, the coming together of several interwoven elements in the same situation (e.g. materials, meanings, skills, locations, timings). Different practices are interconnected-they can occur simultaneously (e.g. drinking and eating), hold each other in place (e.g. after-work drinks) or compete for time (e.g. parenting versus socializing). Applying these principles to alcohol research means shifting attention away from individuals and their behaviours and instead making drinking practices an important unit of analysis. Studying how drinking practices emerge, persist and decay over time, how they spread through populations and local or social networks and how they relate to other activities of everyday life promises new insights into how, why, where, when and with whom drinking and getting drunk occur. Theories of practice provide a framework for generating new explanations of stability and change in alcohol consumption and other health behaviours. This framework offers potential for novel insights into the persistence of health inequalities, unanticipated consequences of policies and interventions and new interventions targets through understanding which elements of problematic practices are likely to be most modifiable. We hope this will generate novel insights into the emergence and decay of drinking practices over time and into the geographical and socio-demographic patterning of drinking. Theories of practice-informed research would consider how alcohol policies and population-level interventions might differentially affect different drinking practices.

Health Risk Factors Associated with Lifetime Abstinence from Alcohol in the 1979 National Longitudinal Survey of Youth Cohort.

The choice and definition of a comparison group in alcohol-related health studies remains a prominent issue in alcohol epidemiology due to potential biases in the risk estimates. The most commonly used comparison group has been current abstainers; however, this includes former drinkers who may have quit drinking due to health problems. Lifetime abstention could be the best option, but measurement issues, selection biases due to health and other risk factors, and small numbers in populations are important concerns. This study examines characteristics of lifetime abstention and occasional drinking that are relevant for alcohol-related health studies. This study used data from the National Longitudinal Survey of Youth 1979 cohort of 14 to 21year olds followed through 2012 (n=7,515). Definitions of abstinence and occasional drinking were constructed based on multiple measurements. Descriptive analyses were used to compare the definitions, and in further analysis, lifetime abstainers (n=718) and lifetime minimal drinkers (n=1,027) were compared with drinkers across demographics and early-life characteristics (i.e., religion, poverty, parental education, and family alcohol problems) in logistic regression models. Using a strict measurement of zero drinks from adolescence to the 50s, only 1.7% of the sample was defined as lifetime abstainer compared to a broader definition allowing a total of 1 drink over the lifetime that included 9.5% and to lifetime minimal drinking (a total of 3 drinks or less a month), which accounted for 13.7%. Factors significantly associated with lifetime abstention and lifetime minimal drinking included religion, poverty, having no family alcohol problems, Hispanic ethnicity, foreign-born, and female gender. Importantly, work-related health limitations in early life were significantly associated, but not childhood physical and mental health problems. Alcohol-related health studies should utilize lifetime classifications of drinkers and abstainers, and, in doing so, should account for early-life socioeconomic adversity and childhood health factors or consider these as unmeasured confounders.

On bias in alcohol epidemiology and the search for the perfect study.

Commentary to: Selection biases in observational studies affect associations between ‘moderate’ alcohol consumption and mortality

Age at Onset of Alcohol Use and Alcohol Use Disorder: Time-trend Study in Patients Seeking De-addiction Services in Kerala.

Background:Declining age at onset of alcohol consumption over years has been one of the alarming findings in the epidemiology of alcoholism. The study was done to examine whether there was a decline in the age at onset of alcohol use and use disorder in subjects categorized as birth cohorts over the last 60 years seeking de-addiction services from a teaching hospital.Materials and Methods:A time-trend study, based on data collected from records, was done among 700 randomly selected subjects seeking de-addiction services. The study was done in a Government Medical College. Besides birth year, family history of alcohol use disorder and psychiatric comorbidity were the main independent variables studied. Trend was tested by linear regression.Results:There was a significant linear decline in the age at onset of alcohol use and use disorder. The mean age at onset of alcohol use and alcohol use disorder declined from 24 to 17 years and 46 to 21 years, respectively, from the pre-1950 birth cohort to the post-1985 birth cohort. Surprisingly, there was a plateau for mean age at onset of alcohol use during 1960s. The trend was significant even after adjusting for variables related to age at onset of alcohol consumption.Conclusions:The trend of decreasing age at onset of alcohol use and alcohol use disorder over time has policy implications. Further studies are needed for exploring mediating or causal factors for the decline in the age at onset of alcohol use and use disorder.

A seven-year study about the epidemiology of smoking, alcohol, drugs and psychotropic consumption along with legal abortion in cases referred to forensic medicine centers in Fars since 2007-2013

Introduction: Smoking, alcohol, and drugs consumption has increased among the women of child-bearing age. This rise and its negative consequences on the children's health have been considered by planners and WHO health centers. This study aimed to examine the prevalence of smoking, alcohol and drugs consumption among women of childbearing age who received abortion permission with either maternal or fetal causes from forensic medicine centers. Method: This is a descriptive-analytical study which was conducted during the years 2007- 2013. The total sample size was 1,664, of which 339 and 1325 had maternal and fetal abortion causes, respectively. The items registered in the questionnaire included demographic and obstetric variables, maternal or fetal causes of abortion, the simultaneous use of hookah and cigarettes, alcohol, psychotropic substances and drugs. The data were analyzed using descriptive statistics in SPSS software, version 11.5. Results: The most frequent age for women was between 25 and 30 years (31.5%). The legal abortion rate was 8.5% among women aged under 20 years old. The prevalence of substance consumption was 40.7% among women with either maternal or fetal cause abortion. It was estimated that 78.3% belonged to cigarette and hookah, 14.62% to drug and psychotropic and finally 5.31% to alcohol beverage consumption. Conclusion: In Iran, legal abortion approval is either by maternal or fetal causes. According to this study, the coincidence of pregnancy with cigarette and hookah consumption has the most prevalence. Substance abuse prevention, treatment, and control policy are one of the essential matters related to the care both before and during pregnancy.

Substance Abuse, General Principles

1. Kirstin A. M. Nackers, MD* 2. Patricia Kokotailo, MD, MPH* 3. Sharon J. L. Levy, MD† 1. *Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI. 2. †Division of Developmental Medicine, Boston Children’s Hospital, Boston, MA. The American Academy of Pediatrics recommends screening for alcohol and other drug use at adolescent health supervision visits and appropriate acute-care visits, (1) yet many clinicians find addressing substance use with youth to be a challenge. After completing this article, the reader should be able to: 1. Describe the use trends for alcohol and common other drugs by youth in the United States. 2. Explain the primary care clinician’s role in screening and management of alcohol and substance use. 3. Using motivational interviewing techniques, adopt an in-office brief intervention across the spectrum of adolescent substance use. 4. Analyze the utility of urine drug testing in various clinical situations, such as random screening in a low-risk patient/population, testing an adolescent who self-reports ongoing substance use, monitoring adherence to treatment for a substance use disorder, and evaluating a patient with signs/symptoms of acute toxicity. Adolescent drug and alcohol use remains a major issue in the United States. The American Academy of Pediatrics (AAP) recommends screening for use of these substances at adolescent health supervision visits and appropriate acute-care visits. (1) Primary care clinicians (PCCs) serve an important role in both the identification and management of alcohol and substance use disorders (SUDs). This role comes with many challenges, including managing the dynamics of families that may be in crisis, issues of adolescent confidentiality, and high variability of local resources to support patients in need of treatment for SUDs. In this article, we review the epidemiology of alcohol and substance use, the approach to screening and treatment, the issue of adolescent confidentiality, and the role of urine drug testing. ### Epidemiology The epidemiology of adolescent substance use must be …

Commentary on Lovatt et al. (2015): Lay and standard alcohol epidemiology--rival approaches or the beginnings of a dialogue?

Keywords: Alcohol; alcohol consumption; drinking guidelines; health advice; lay epidemiology; qualitative research; UK; units

Culture-Specific Characteristics of Alcohol Related Disorders and Culture- Sensitive Approach in Ethiopian Immigrants and Ethnic Arabic Groups in Israel

Israel, being a multi-cultural society, faces different unhealthy alcohol intake patterns among various ethnic groups, which in turn need to be addressed in a culture sensitive manner. This article focuses, as an example to the complexity of the issue, on two diverse ethnical groups- the new Jewish immigrants of Ethiopian origin and the Arab population in Israel. The great heterogeneity within these two populations themselves is presented. The Arab speaking population is diverse- most of which are Muslims of different sects, including Bedouins, whose religion prohibits alcohol intake; Christians of different denominations, Druze, Samaritans and others. The Ethiopian “Beta Yisrael” (House of Israel) Jewish tribe, whose members have been immigrating to Israel since 1977, but what seemingly seems to be a homogeneous community, is in fact quite heterogenic culturally, when it comes to developing proper prevention and treatment programs. This heterogeneity finds its expression in varying alcohol intake patterns and epidemiology. Thus, cultural beliefs and behaviors relating to alcohol abuse and abstinence that are relevant to effective culture sensitive interventions are presented too. But how can one plan effective preventive and treatment interventions to suit this heterogeneity? The Integrative Culture Sensitive Assessment and Treatment Model presented, delineates the major stages and the basic steps one must take to implement a culture sensitive preventive or treatment intervention, be it in an individual medical setting or a group or community based public health intervention. Finally, some insights as to culture sensitive interventions in treating alcohol related disorders are presented. “Wine is not for kings… not for kings to drink, nor any strong drink for princes, lest they drink and forget what has been ordained and infringe on the rights of the poor. Give strong drink to the hapless and wine to the embittered. Let them drink and forget their poverty and put their troubles out of mind.” (Proverbs 31, 4-7). “Even if your illness [alcoholism] doesn’t kill you, it’ll still destroy your home.” (Ethiopian proverb).