Low-risk Drinking Guidelines Research Articles

Low-risk drinking guidelines to reduce alcohol-related harm: Delphi survey to explore aspects ‘beyond epidemiology’

Background: Low-risk drinking guidelines across Europe portray a wide variation. We turned to European experts to identify areas of agreement and disagreement on questions relevant to forming and communicating low-risk guidelines: need and purpose of guidelines, criterion for low risk, desired components and stratification, views over evidence base and communication aspects.Methods: A policy Delphi survey carried out in two rounds in 2015 with public health and addiction experts (n = 51), using the web-based eDelfoi survey tool. Both closed and open-ended questions were used and free-format comments were invited. Frequency counts are presented, and textual answers and comments were subjected to qualitative content analysis. In the second round, key questions were repeated, and new questions, formulated based first-round comments, were presented.Results: The experts considered as the main rationale for drinking guidelines the public’s right to be informed about risks of drinking. Separate guidelines were called for regarding longer term average consumption and drinking on single occasions, and at-risk groups and high-risk situations were identified that require special attention. Scepticism arose from the complexity of alcohol-related risks and, in particular, from the need to differentiate the advice for various subgroups.Conclusions: The Delphi survey provided insight into aspects of forming low-risk drinking guidelines that go beyond the epidemiology and will potentially help towards more aligned messages in future guidelines.

Alcohol consumption and low-risk drinking guidelines among adults: a cross-sectional analysis from Alberta's Tomorrow Project.

Moderate to heavy alcohol consumption is a risk factor for all-cause mortality and cancer incidence. Although cross-sectional data are available through national surveys, data on alcohol consumption in Alberta from a large prospective cohort were not previously available. The goal of these analyses was to characterize the levels of alcohol consumption among adults from the Alberta's Tomorrow Project in the context of cancer prevention guidelines. Furthermore, we conducted analyses to examine the relationships between alcohol consumption and other high-risk or risk-related behaviours. Between 2001 and 2009, 31 072 men and women aged 35 to 69 years were enrolled into Alberta's Tomorrow Project, a large provincial cohort study. Data concerning alcohol consumption in the past 12 months were obtained from 26 842 participants who completed self-administered health and lifestyle questionnaires. We conducted cross-sectional analyses on daily alcohol consumption and cancer prevention guidelines for alcohol use in relation to sociodemographic factors. We also examined the combined prevalence of alcohol consumption and tobacco use, obesity and comorbidities. Approximately 14% of men and 12% of women reported alcohol consumption exceeding recommendations for cancer prevention. Higher alcohol consumption was reported in younger age groups, urban dwellers, those with higher incomes and those who consumed more red meat. Moreover, volume of daily alcohol consumption was positively associated with current tobacco use in both men and women. Overall, men were more likely to fall in the moderate and high-risk behavioural profiles and show higher daily alcohol consumption patterns compared to women. Despite public health messages concerning the adverse impact of alcohol consumption, a sizeable proportion of Alberta's Tomorrow Project participants consumed alcohol in excess of cancer prevention recommendations. Continued strategies to promote low-risk drinking among those who choose to drink could impact future chronic disease risk in this population.

Can a Label Help me Drink in Moderation? A Review of the Evidence on Standard Drink Labelling

ABSTRACTIntroduction: Understanding the concept of a standard drink (SD) is foundational knowledge to many public health policies aimed at reducing alcohol-related harms. These policies include adhering to low-risk drinking guidelines, screening brief intervention and referral activities, and counter alcohol-impaired driving initiatives. A lack of awareness of SDs might preclude the effectiveness of these interventions. A systematic review was conducted to review the evidence about how effective alcohol labels are in communicating SD information to the consumer. Methods: A systematic review was conducted to identify peer-reviewed articles and grey literature from relevant indexes from January 1990 to January 2016. Additionally, policy makers and researchers in countries where standard drink labels (SDLs) have been implemented were consulted to help identify relevant literature. The search strategy was focused on the impact of SDLs relative to a range of outcomes, including awareness of SDs, pouring behaviors, and consumption patterns. Results: Eleven records were eligible for inclusion. The evidence suggests that knowledge of the definition of an SD is low. However, SDLs can help individuals more accurately identify and pour an SD. SDLs need to be supported by educational initiatives to help the consumer understand the SD information provided on the beverage container. To date, there has been no comprehensive evaluation of the impact of SDLs. Conclusions: SDLs have the potential to increase awareness of SDs and facilitate the monitoring of personal alcohol consumption in the context of a comprehensive alcohol strategy. However, their impact on drinking behaviors requires further exploration, especially among high-risk populations.

"We Have a Right to Know": Exploring Consumer Opinions on Content, Design and Acceptability of Enhanced Alcohol Labels.

This study aimed to refine content and design of an enhanced alcohol label to provide information that best supports informed drinking and to gauge consumer acceptability of enhanced alcohol labels among a subset of consumers. Five focus groups (n = 45) were conducted with stakeholders and the general public (age 19+) across one jurisdiction in northern Canada. Interviews were transcribed and analyzed using NVivo software. The majority of participants showed strong support for enhanced alcohol labels with an emphasis on the consumers' right to know about the health risks related to alcohol. Participants preferred larger labels that included standard drink (SD) information, national low-risk drinking guidelines presented as a chart with pictograms, cancer health messaging and a pregnancy warning. Supporting introduction of the labels with a web resource and an educational campaign was also recommended. Displaying enhanced labels on alcohol containers that include SD information, low-risk drinking guidelines and other health messaging in an accessible format may be an effective way to better inform drinkers about their consumption and increase awareness of alcohol-related health risks. Introduction of enhanced labels shows potential for consumer support. Focus group findings indicate strong support for enhanced alcohol labels displaying SD information, national drinking guidelines, health messaging and a pregnancy warning. Introduction of enhanced alcohol labels in tandem with an educational campaign may be an effective way to better inform Canadian drinkers and shows potential for consumer support.

Testing the Efficacy of Alcohol Labels with Standard Drink Information and National Drinking Guidelines on Consumers' Ability to Estimate Alcohol Consumption.

Despite the introduction of national drinking guidelines in Canada, there is limited public knowledge of them and low understanding of 'standard drinks (SDs)' which limits the likelihood of guidelines affecting drinking behaviour. This study tests the efficacy of alcohol labels with SD information and Canada's Low-Risk Drinking Guidelines (LRDGs) as compared to %ABV labels on consumers' ability to estimate alcohol intake. It also examines the label size and format that best supports adults' ability to make informed drinking choices. This research consisted of a between-groups experiment (n = 2016) in which participants each viewed one of six labels. Using an online survey, participants viewed an alcohol label and were asked to estimate: (a) the amount in a SD; (b) the number of SDs in an alcohol container and (c) the number of SDs to consume to reach the recommended daily limit in Canada's LRDG. Results indicated that labels with SD and LRDG information facilitated more accurate estimates of alcohol consumption and awareness of safer drinking limits across different beverage types (12.6% to 58.9% increase in accuracy), and labels were strongly supported among the majority (66.2%) of participants. Labels with SD and LRDG information constitute a more efficacious means of supporting accurate estimates of alcohol consumption than %ABV labels, and provide evidence to inform potential changes to alcohol labelling regulations. Further research testing labels in real-world settings is needed. Results indicate that the introduction of enhanced alcohol labels combining standard drink information and national drinking guidelines may be an effective way to improve drinkers' ability to accurately assess alcohol consumption and monitor intake relative to guidelines. Overall support for enhanced labels suggests probable acceptability of introduction at a population level.

Usual Alcohol Consumption and Risks for Nonfatal Fall Injuries in the United States: Results From the 2004–2013 National Health Interview Survey

ABSTRACT Background: Acute alcohol consumption is known to be a risk factor for fall injuries. Objective: The study sought to determine whether usual alcohol consumption increases the risk for nonfatal fall injuries. Method: Data from 289,187 sample adults in the 2004–2013 U.S. National Health Interview Surveys were analyzed. Of these, 3,368 (∼1%) reported a total of 3,579 fall-injury episodes requiring medical consultation in the past 3 months. Latent class analysis based on four contextual indicators identified four ecological subtypes of fall injury within two age groups (18–49 and 50+). Five drinking patterns (i.e., lifetime abstainer, former drinker, low-risk drinker, increased-risk drinker, and highest-risk drinker) were categorized according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA) low-risk drinking guidelines. Controlling for potential confounders, negative binomial regression estimated the adjusted rates of any type and subtypes of fall injury, by gender, for each drinking pattern relative to lifetime abstainer. Results: Compared with lifetime abstainers, the adjusted rate of any fall injury for adults ages 18–49 was significantly higher among highest-risk drinkers (men: incidence rate ratio [IRR] = 2.59, 95% confidence interval [CI] [1.60, 4.20]; women: IRR = 1.90, 95% CI [1.24, 2.91]) and increased-risk drinkers (men: IRR = 1.94, 95% CI [1.25, 3.00]; women: IRR = 1.51, 95% CI [1.11, 2.07]). Furthermore, highest-risk drinkers had higher adjusted rates of either leisure- or sports-related fall injuries than lifetime abstainers. Conclusions: Alcohol consumption exceeding NIAAA's low-risk drinking guidelines is associated with elevated rates of nonfatal fall injuries. Findings underscore the importance of adhering to these recommendations.

Combining alcohol interventions with tobacco addictions treatment in primary care\u2014the COMBAT study: a pragmatic cluster randomized trial

BackgroundTobacco and alcohol use present multiplicative risk for aerodigestive cancers. Reducing alcohol consumption improves smoking cessation outcomes and reduces cancer risk. Risky alcohol consumption and smoking are often treated separately despite concurrent treatment potentially leading to better outcomes for each. However, no rapidly scalable program exists for combined interventions in primary care clinics spread across wide geographic areas. This cluster randomized trial aims to report on the effects of a novel clinical decision support system (CDSS) on intervention rates by primary care practitioners addressing risky alcohol use in a smoking cessation program.Methods/designWe will be implementing a clinical decision support system (CDSS) in 221 primary care sites participating in the Smoking Treatment for Ontario Patients (STOP) program across Ontario, Canada. Sites will be blindly allocated to one of two clinical decision support systems guiding practitioners to provide a risky alcohol use intervention to smokers attempting to quit using nicotine replacement therapy (NRT). Risky alcohol use is defined as drinking above the Canadian Cancer Society’s low-risk drinking guidelines. Primary analysis will measure the proportion of risky drinkers offered an alcohol intervention in each CDSS arm at baseline. Patients will be contacted by phone or email to track smoking cessation and alcohol consumption rates at 6- and 12-month follow-up.DiscussionUpon completion of the trial, the effect of different clinical decision support systems on practitioner behaviour, and on client tobacco and alcohol use, will be discussed. If the CDSS successfully promotes SBIRT for risky alcohol use in a primary care setting and/or improves patient-level outcomes, including smoking cessation rates and alcohol use reduction, this tool can be used as a model for other web-based behaviour change interventions integrated into primary care practice.Trial registrationClinicalTrials.gov NCT03108144

Life-time risk of mortality due to different levels of alcohol consumption in seven European countries: implications for low-risk drinking guidelines.

Low-risk alcohol drinking guidelines require a scientific basis that extends beyond individual or group judgements of risk. Life-time mortality risks, judged against established thresholds for acceptable risk, may provide such a basis for guidelines. Therefore, the aim of this study was to estimate alcohol mortality risks for seven European countries based on different average daily alcohol consumption amounts. The maximum acceptable voluntary premature mortality risk was determined to be one in 1000, with sensitivity analyses of one in 100. Life-time mortality risks for different alcohol consumption levels were estimated by combining disease-specific relative risk and mortality data for seven European countries with different drinking patterns (Estonia, Finland, Germany, Hungary, Ireland, Italy and Poland). Alcohol consumption data were obtained from the Global Information System on Alcohol and Health, relative risk data from meta-analyses and mortality information from the World Health Organization. The variation in the life-time mortality risk at drinking levels relevant for setting guidelines was less than that observed at high drinking levels. In Europe, the percentage of adults consuming above a risk threshold of one in 1000 ranged from 20.6 to 32.9% for women and from 35.4 to 54.0% for men. Life-time risk of premature mortality under current guideline maximums ranged from 2.5 to 44.8 deaths per 1000 women in Finland and Estonia, respectively, and from 2.9 to 35.8 deaths per 1000 men in Finland and Estonia, respectively. If based upon an acceptable risk of one in 1000, guideline maximums for Europe should be 8-10g/day for women and 15-20g/day for men. If low-risk alcohol guidelines were based on an acceptable risk of one in 1000 premature deaths, then maximums for Europe should be 8-10g/day for women and 15-20g/day for men, and some of the current European guidelines would require downward revision.

Alcohol harm reduction advertisements: a content analysis of topic, objective, emotional tone, execution and target audience

BackgroundPublic health mass media campaigns may contribute to reducing the health and social burden attributed to alcohol consumption, but little is known about which advertising characteristics have been used, or have been effective, in alcohol harm reduction campaigns to date. As a first step towards encouraging further research to identify the impact of various advertising characteristics, this study aimed to systematically identify and examine the content of alcohol harm reduction advertisements (ads).MethodAds were identified through an exhaustive internet search of Google, YouTube, Vimeo, and relevant government and health agency websites. Eligible ads were: English language, produced between 2006 and 2014, not primarily focused on drink-driving or alcohol in pregnancy, and not alcohol industry funded. Systematic content analysis of all ads was performed; each ad was double-coded.ResultsIn total, 110 individual ads from 72 different alcohol harm reduction campaigns were identified, with the main source countries being Australia (40%) and the United Kingdom (26%). The dominant topic for 52% of ads was short-term harms, while 10% addressed long-term harms, 18% addressed underage drinking, 17% communicated a how-to-change message, and 3% advocated for policy change. The behavioural objective of most ads was to motivate audiences to reduce their alcohol consumption (38%) or to behave responsibly and/or not get drunk when drinking (33%). Only 10% of all ads mentioned low-risk drinking guidelines. Eighty-seven percent of ads used a dramatisation execution style and 74% had a negative emotional tone. Ninety percent of ads contained messages or content that appeared to target adults, and 36% specifically targeted young adults.ConclusionsSome message attributes have been employed more frequently than others, suggesting several promising avenues for future audience or population-based research to compare the relative effectiveness of different characteristics of alcohol harm reduction ads. Given most alcohol-attributable harm is due to long-term disease, these findings suggest future campaigns may fill a potentially important gap if they were to focus on long-term harms. There is scope for such long-term harm campaigns to place greater emphasis on encouraging reduced personal consumption of alcohol, potentially through more frequent communication of low-risk drinking guidelines.

A preliminary randomized controlled trial of contingency management for alcohol use reduction using a transdermal alcohol sensor.

We tested the efficacy of daily contingent reinforcement for reducing alcohol use compared with (yoked) non-contingent reinforcement (NR) using a transdermal alcohol sensor to detect alcohol use. Pilot randomized controlled design with 1 baseline week, 3 intervention weeks and 1-month follow-up. New England, USA. Heavy drinking adults (46.7% female) not seeking treatment were randomized to (1) an escalating schedule of cash reinforcement (CR; n=15) for days on which alcohol was neither reported nor detected or (2) yoked NR (n=15). Reinforcement for CR participants started at $5 and increased $2 every subsequent day on which alcohol was not detected or reported, to a maximum of $17. Participants received no reinforcement for days on which alcohol use was detected or reported, and the reinforcer value was re-set to $5 the day after a drinking day. NR participants were yoked to the daily reinforcer value of an individual in the CR condition, in order of enrollment. Paired participants in CR and NR therefore received the same amount of money, but the amount for the NR participant was not behavior-related. The primary outcome was percentage of days without sensor-detected drinking. Secondary outcomes were number of consecutive days with no detected drinking, peak transdermal alcohol concentration (TAC), self-reported drinks per week and drinking below NIH low-risk guidelines. Controlling for baseline, CR had a higher percentage of days with no drinking detected (54.3%) than NR (31.2%) during intervention weeks [P=0.05, Cohen's d=0.74; 95% confidence interval (CI)=0.007-1.47]. The longest period of consecutive days with no drinking detected was 8.0 for CR versus 2.9 for NR (P=0.03, d=0.85; 95% CI=0.08-1.61). Peak TAC during intervention showed a non-significant group difference (P=0.20; d=0.48; 95% CI=0.00-1.18); a similar result was found for drinks per week (P=0.12; d=0.59; 95% CI=0.00-1.30). Four times more participants in CR drank below NIH low-risk drinking guidelines during intervention than did participants in NR: 31.1 versus 7.1% (P=0.07; d=0.71; 95% CI=-0.04 to 1.46). At 1-month follow-up, the highest number of consecutive days without drinking (self-report) did not differ significantly between conditions (P=0.26), but showed a medium effect size (d=0.44; 95% CI=-0.32 to 1.18). Cash incentives linked to a transdermal alcohol sensor can reduce heavy alcohol consumption while the incentives are in operation.

Analgesic Effects of Alcohol: A Systematic Review and Meta-Analysis of Controlled Experimental Studies in Healthy Participants.

This meta-analysis provides robust evidence for the analgesic properties of alcohol, which could potentially contribute to alcohol misuse in pain patients. Strongest analgesia occurs for alcohol levels exceeding World Health Organization guidelines for low-risk drinking and suggests raising awareness of alternative, less harmful pain interventions to vulnerable patients may be beneficial.

Trends in binge drinking in Canada from 1996 to 2013: a repeated cross-sectional analysis.

Heavy drinking is a major factor in morbidity and mortality worldwide. Little information is available on trends in Canada regarding alcohol abuse. We sought to estimate abstinence, binge drinking and alcohol intake exceeding low-risk drinking guidelines in the Canadian population from 1996 to 2013. The data sources for this analysis were a series of cross-sectional national health surveys of the Canadian population carried out by Statistics Canada between 1996 and 2013. These were cross-sectional files from the National Population Health Surveys of 1996 and 1998, plus the Canadian Community Health Surveys from 2000 to 2013. Respondents were aged 18 years and older. The proportion of binge drinkers increased steadily from 13.7% (95% confidence interval [CI] 13.2%-14.2%) in 1996 to 19.7% (95% CI 19.1%-20.3%) in 2013. The corresponding proportions for men were 20.8% (95% CI 19.9%-21.7%) in 1996, and 25.7% (95% CI 24.7%-26.6%) in 2013; for women, these proportions were 6.9% (95% CI 6.4%-7.5%) in 1996, and 13.8% (95% CI 13.1%-14.5%) in 2013. No significant increases were seen in the proportion of people who exceeded low-risk drinking guidelines or of abstainers during the same period. The rate of self-reported binge drinking in Canada has increased from 1996 to 2013, relatively more so among women than among men. No evidence of an increase in the proportion of people exceeding low-risk drinking guidelines or of abstainers was seen during the same period. These results suggest that binge drinking is of particular concern regarding intervention strategies aimed at improvement of public health.

Governmental standard drink definitions and low-risk alcohol consumption guidelines in 37 countries.

One of the challenges of international alcohol research and policy is the variability in and lack of knowledge of how governments in different nations define a standard drink and low-risk drinking. This study gathered such information from governmental agencies in 37 countries. A pool of 75 countries that might have definitions was created using World Health Organization (WHO) information and the authors' own judgement. Structured internet searches of relevant terms for each country were supplemented by efforts to contact government agencies directly and to consult with alcohol experts in the country. Most of the 75 national governments examined were not identified as having adopted a standard drink definition. Among the 37 that were so identified, the modal standard drink size was 10g pure ethanol, but variation was wide (8-20g). Significant variability was also evident for low-risk drinking guidelines, ranging from 10-42g per day for women and 10-56g per day for men to 98-140g per week for women and 150-280g per week for men. Researchers working and communicating across national boundaries should be sensitive to the substantial variability in 'standard' drink definitions and low-risk drinking guidelines. The potential impact of guidelines, both in general and in specific national cases, remains an important question for public health research.

Do "Moderate" Drinkers Have Reduced Mortality Risk? A Systematic Review and Meta-Analysis of Alcohol Consumption and All-Cause Mortality.

Previous meta-analyses of cohort studies indicate a J-shaped relationship between alcohol consumption and allcause mortality, with reduced risk for low-volume drinkers. However, low-volume drinkers may appear healthy only because the "abstainers" with whom they are compared are biased toward ill health. The purpose of this study was to determine whether misclassifying former and occasional drinkers as abstainers and other potentially confounding study characteristics underlie observed positive health outcomes for lowvolume drinkers in prospective studies of all-cause mortality. A systematic review and meta-regression analysis of studies investigating alcohol use and mortality risk after controlling for quality-related study characteristics was conducted in a population of 3,998,626 individuals, among whom 367,103 deaths were recorded. Without adjustment, meta-analysis of all 87 included studies replicated the classic J-shaped curve, with low-volume drinkers (1.3-24.9 g ethanol per day) having reduced mortality risk (RR = 0.86, 95% CI [0.83, 0.90]). Occasional drinkers (<1.3 g per day) had similar mortality risk (RR = 0.84, 95% CI [0.79, 0.89]), and former drinkers had elevated risk (RR = 1.22, 95% CI [1.14, 1.31]). After adjustment for abstainer biases and quality-related study characteristics, no significant reduction in mortality risk was observed for low-volume drinkers (RR = 0.97, 95% CI [0.88, 1.07]). Analyses of higher-quality bias-free studies also failed to find reduced mortality risk for low-volume alcohol drinkers. Risk estimates for occasional drinkers were similar to those for low- and medium-volume drinkers. Estimates of mortality risk from alcohol are significantly altered by study design and characteristics. Meta-analyses adjusting for these factors find that low-volume alcohol consumption has no net mortality benefit compared with lifetime abstention or occasional drinking. These findings have implications for public policy, the formulation of low-risk drinking guidelines, and future research on alcohol and health.

An adaptation of the Yesterday Method to correct for under-reporting of alcohol consumption and estimate compliance with Canadian low-risk drinking guidelines.

To estimate compliance with Canada's Low-Risk Alcohol Drinking Guidelines (LRDG) in different groups of drinkers after adjusting for underreporting of alcohol use, and to identify which types of beverage are more likely to be consumed when LRDGs are exceeded. Our sample consisted of 43,242 Canadians aged 15 and over who had responded to the Canadian Alcohol and Drug Use Monitoring Survey, 2008-2010. Consumption in excess of LRDG was estimated for subgroups of drinkers after adjustment for under-reporting of consumption. Responses to Beverage-Specific Yesterday questions were used to make age-, gender- and beverage-specific corrections to under-reporting for data from the last 12 months Quantity-Frequency questions. Statistics Canada data on sales of beer, wine and spirits were also incorporated into the adjusted calculations. After adjustment for under-reporting, non-compliance with weekly LRDG limits to reduce risk of long-term harm increased from 6.8% to 27.3% among drinkers, and from 42.3% to 68.3% with respect to drinks. Non-compliance with daily LRDG limits to reduce risk of short-term harm increased from 16.7% to 38.6% among drinkers, and from 53.3% to 80.5% with respect to drinks. After adjustment, over 92% of total consumption occurred on risky drinking days among underage Canadians and over 91% of consumption reported by young adults took place during risky drinking occasions. Wine was least likely to be drunk in a risky fashion, spirits were the most likely. When corrections for under-reporting are made, most Canadian alcohol consumption occurs on days when national LRDG are exceeded, especially for underage and young adult drinkers.

How much did you actually drink last night? An evaluation of standard drink labels as an aid to monitoring personal consumption

Background: Barriers exist for drinkers who wish to comply with low-risk guidelines when these are expressed in terms of numbers of “standard drinks” of alcohol. The increasing variability of container sizes and alcoholic strengths mean that percent alcohol by volume (%ABV) labels alone may be insufficient. Aims: To investigate whether standard drink (SD) labels would improve drinkers’ accuracy when estimating personal alcohol consumption. Setting: Private liquor stores near the University of Victoria, BC. Design: A 2 × 3 × 3 experimental design was employed with two labels (%ABV and SD), three beverages (beer, wine, and spirits) and three beverage strengths in balanced order. Subjects estimated the number of standard drinks that would be consumed in scenarios involving containers of their preferred beverages presented with different labels. Participants: A convenience sample of 301 liquor store patrons, aged 19 years and over. Measurements: Participants’ accuracy was determined by the relative and absolute percent errors in their estimations in comparison with correct answers. Results: Estimates were significantly more accurate with SD than %ABV labels in almost all the scenarios. Significantly more underestimation errors were made with %ABV labels. Mixed model regression analysis indicated younger respondents, beer drinkers and those with higher education made significantly fewer errors. Most (82.7%) supported SD labelling and believed SD labels would help them to comply with low-risk drinking guidelines (68.3%). Conclusions: The addition of clear SD labels helps consumers to make more accurate estimates of the SD content of their usual beverages than %ABV labels alone and would be more likely to help them comply with drinking guidelines.

Effectiveness of guided and unguided low-intensity internet interventions for adult alcohol misuse: a meta-analysis.

BackgroundAlcohol misuse ranks within the top ten health conditions with the highest global burden of disease. Low-intensity, Internet interventions for curbing adult alcohol misuse have been shown effective. Few meta-analyses have been carried out, however, and they have involved small numbers of studies, lacked indicators of drinking within low risk guidelines, and examined the effectiveness of unguided self-help only. We therefore conducted a more thorough meta-analysis that included both guided and unguided interventions.MethodsSystematic literature searches were performed up to September 2013. Primary outcome was the mean level of alcohol consumption and drinking within low risk guidelines for alcohol consumption at post-treatment.FindingsWe selected 16 randomised controlled trials (with 23 comparisons and 5,612 participants) for inclusion. Results, showed a small but significant overall effect size in favour of Internet interventions (g = 0.20, 95% CI: 0.13–0.27, p<.001). Participants in Internet interventions drunk on average 22 grams of ethanol less than controls and were significantly more likely to be adhering to low-risk drinking guidelines at post-treatment (RD 0.13, 95% CI: 0.09–0.17, p<.001). Subgroup analyses revealed no significant differences in potential moderators for the outcome of alcohol consumption, although there was a near-significant difference between comparisons with waitlist control and those with assessment-only or alcohol information control conditions (p = .056).ConclusionsInternet interventions are effective in reducing adult alcohol consumption and inducing alcohol users to adhere to guidelines for low-risk drinking. This effect is small but from a public health point of view this may warrant large scale implementation at low cost of Internet interventions for adult alcohol misuse. Moderator analyses with sufficient power are, however, needed in order to assess the robustness of these overall results and to assess whether these interventions may impact on subgroups with different levels of success.

Changes in Alcohol Intake and Their Relationship with Health Status over a 24‐Year Follow‐Up Period in Community‐Dwelling Older Adults

To determine whether alcohol use changes over time in older adults and whether alcohol intake is associated with common chronic diseases. Twenty-four-year longitudinal study. Southern California community. One thousand seventy-six members of the Rancho Bernardo cohort aged 50 to 89 at baseline. Participants completed two to six research visits at approximately 4-year intervals between 1984 and 2009. At each visit, participants completed standard questionnaires on alcohol use, chronic diseases, and behaviors. Mixed-effects linear models were used to examine changes in average weekly alcohol intake over time and in relationship to health status. Prevalence and frequency of alcohol use was high throughout the study, with more than 60% of participants reporting weekly alcohol intake. The average amount consumed declined with advancing age, regardless of the presence of any of the eight most common chronic diseases. Prevalence of drinking in excess of age- and sex-specific low-risk guidelines was high across all visits and did not vary according to disease burden. At the final visit, 29% of participants drank in excess of low-risk drinking guidelines, including 28% of those with hypertension and 31% with diabetes mellitus. Prevalence and frequency of alcohol intake remained stable over a 24 year follow-up in this cohort of educated, white, middle-class, older adults, although average amount consumed decreased with advancing age. Despite this decrease, a high proportion of older adults, including those with common chronic health conditions, drank in excess of current guidelines. Clinicians should provide more education on the importance of older adults moderating alcohol intake.

Alcohol Use During Pregnancy in Canada: How Policy Moments Can Create Opportunities for Promoting Women’s Health

This article addresses the challenge of igniting action on health promotion for women in Canada with respect to alcohol use during pregnancy. We illustrate that accelerated action on health promotion for women that engages multiple levels of players, women-centred and harm-reduction frameworks and a gendered approach to understanding women’s lives can be achieved when the right policy moment occurs. We illustrate this by describing the opportunity afforded by the Olympic Games in 2010, where the BC government used the Games to encourage action on women’s health promotion and the prevention of alcohol use in pregnancy. We suggest that the 2011 announcement of new low-risk drinking guidelines that recommend lower intake of alcohol for women than for men offers another, to date unused, opportunity.

Alcohol use during pregnancy in Canada: how policy moments can create opportunities for promoting women's health.

This article addresses the challenge of igniting action on health promotion for women in Canada with respect to alcohol use during pregnancy. We illustrate that accelerated action on health promotion for women that engages multiple levels of players, women-centred and harm-reduction frameworks and a gendered approach to understanding women's lives can be achieved when the right policy moment occurs. We illustrate this by describing the opportunity afforded by the Olympic Games in 2010, where the BC government used the Games to encourage action on women's health promotion and the prevention of alcohol use in pregnancy. We suggest that the 2011 announcement of new low-risk drinking guidelines that recommend lower intake of alcohol for women than for men offers another, to date unused, opportunity.