Drinking Patterns

Drinking Patterns (42)

BACKGROUND AND AIMS: Alcohol consumption is an important risk factor for cardiovascular morbidity and mortality worldwide. The highest levels of alcohol consumption are observed in Europe, where alcohol as contributing cause of coronary heart disease (CHD) is also most significant. We aimed to describe alcohol consumption patterns across European regions and adherence to the current guidelines in patients with a recent CHD event. METHODS: The ESC-EORP survey (EUROASPIRE V) has been conducted in 2016-2017 at 131 centers in 27 European countries in 7350 patients with a recent CHD. Median alcohol consumption, as well as the proportion of abstainers and excessive drinkers (i.e. >70 g/week for women and >140 for men, as recommended by the European guidelines on cardiovascular prevention), was calculated for each region. To assess adherence to guidelines, proportions of participants who were advised to reduce excessive alcohol consumption and participants who were incorrectly not advised were calculated per region. RESULTS: Mean age was 64 years (SD: 9.5), 75% were male. Abstention rates were 53% in males and 77% in females, whereas excessive drinking was reported by 9% and 5% of them, respectively. Overall, 57% of the participants were advised to reduce alcohol consumption. In the total population, 3% were incorrectly not advised, however, this percentage differed per region (range: 1%-9%). In regions where alcohol consumption was highest, participants were less often advised to reduce their consumption. CONCLUSION: In this EUROASPIRE V survey, the majority of CHD patients adhere to the current drinking guidelines, but substantial heterogeneity exists between European regions.

AIMS: The aims of the article are (a) to estimate coverage rates (i.e. the proportion of 'real consumption' accounted for by a survey compared with more reliable aggregate consumption data) of the total, the recorded and the beverage-specific annual per capita consumption in 23 European countries, and (b) to investigate differences between regions, and other factors which might be associated with low coverage (prevalence of heavy episodic drinking [HED], survey methodology).

METHODS: Survey data were derived from the Standardised European Alcohol Survey and Harmonising Alcohol-related Measures in European Surveys (number of surveys: 39, years of survey: 2008-2015, adults aged 20-64 years). Coverage rates were calculated at the aggregated level by dividing consumption estimates derived from the surveys by alcohol per capita estimates from a recent global modelling study. Fractional response regression models were used to examine the relative importance of the predictors.

RESULTS: Large variation in coverage across European countries was observed (average total coverage: 36.5, 95% confidence interval [CI] [33.2; 39.8]), with lowest coverage found for spirits consumption (26.3, 95% CI [21.4; 31.3]). Regarding the second aim, the prevalence of HED was associated with wine- and spirits-specific coverage, explaining 10% in the respective variance. However, neither the consideration of regions nor survey methodology explained much of the variance in coverage estimates, regardless of the scenario.

CONCLUSION: The results reiterate that alcohol survey data should not be used to compare or estimate aggregate consumption levels, which may be better reflected by statistics on recorded or total per capita consumption.

RATIONALE: Binge drinking (BD), characterized by recurring alternations between intense intoxication episodes and abstinence periods, is the most frequent alcohol consumption pattern in youth and is growing in prevalence among older adults. Many studies have underlined the specific harmful impact of this habit by showing impaired abilities in a wide range of cognitive functions among binge drinkers, as well as modifications of brain structure and function.

AIMS: Several controversies and inconsistencies currently hamper the harmonious development of the field and the recognition of BD as a specific alcohol consumption pattern. The main concern is the absence of consensual BD conceptualization, leading to variability in experimental group selection and alcohol consumption evaluation. The present paper aims at overcoming this key issue through a two-step approach.

METHODS AND CONCLUSIONS: First, a literature review allows proposing an integrated BD conceptualization, distinguishing it from other subclinical alcohol consumption patterns. Six specific characteristics of BD are identified, namely, (1) the presence of physiological symptoms related to BD episodes, (2) the presence of psychological symptoms related to BD episodes, (3) the ratio of BD episodes compared to all alcohol drinking occasions, (4) the frequency of BD episodes, (5) the consumption speed and (6) the alternation between BD episodes and soberness periods. Second, capitalizing on this conceptual clarification, we propose an evaluation protocol jointly measuring these six BD characteristics. Finally, several research perspectives are presented to refine the proposed conceptualization.

OBJECTIVE: Many countries propose low-risk drinking guidelines (LRDGs) to mitigate alcohol-related harms. North American LRDGs are high by international standards. We applied the International Model of Alcohol Harms and Policies (InterMAHP) to quantify the alcohol-caused harms experienced by those drinking within and above these guidelines. We customized a recent Global Burden of Disease (GBD) analysis to inform guidelines in high-income countries.

METHOD: Record-level death and hospital stay data for Canada were accessed. Alcohol exposure data were from the Canadian Substance Use Exposure Database. InterMAHP was used to estimate alcohol-attributable deaths and hospital stays experienced by people drinking within LRDGs, people drinking above LRDGs, and former drinkers. GBD relative risk functions were acquired and weighted by the distribution of Canadian mortality.

RESULTS: More men (18%) than women (7%) drank above weekly guidelines. Adherence to guidelines did not eliminate alcohol-caused harm: those drinking within guidelines nonetheless experienced 140 more deaths and 3,663 more hospital stays than if they had chosen to abstain from alcohol. A weighted relative risk analysis found that, for both women and men, the risk was lowest at a consumption level of 10 g per day. For all levels of consumption, men were found to experience a higher weighted relative risk than women.

CONCLUSIONS: Drinkers following weekly LRDGs are not insulated from harm. Greater than 50% of alcohol-caused cancer deaths are experienced by those drinking within weekly limits. Findings suggest that guidelines of around one drink per day may be appropriate for high-income countries.

BACKGROUND & AIMS: Uncertainty still exists on the impact of low to moderate consumption of different drink types on population health. We therefore investigated the associations of different drink types in the form of beer/cider, champagne/white wine, red wine and spirits with various health outcomes.

METHODS: Over 500,000 participants were recruited to the UK Biobank cohort. Alcohol consumption was self-reported as pints beer/cider, glasses champagne/white wine, glasses of red wine, and measures of spirits per week. We followed health outcomes for a median of 7.02 years and reported all-cause mortality, cardiovascular events, ischemic heart disease, cerebrovascular events, and cancer.

RESULTS: In continuous analysis after excluding non-drinkers, beer/cider and spirits intake associated with an increased risk for all-cause mortality (beer/cider: hazard ratio, 1.56; 95% confidence interval, 1.45-1.68; spirits: 1.47; 1.35-1.60), cardiovascular events (beer/cider: 1.25; 1.17-1.33; spirits: 1.25; 1.16-1.36), ischemic heart disease (beer/cider:1.12; 0.99-1.26 [P = 0.056]; spirits: 1.17; 1.02-1.35), cerebrovascular disease (beer/cider: 1.63; 1.32-2.02; spirits: 1.59; 1.25-2.02) and cancer (beer/cider: 1.14; 1.05-1.24; spirits: 1.14; 1.03-1.26), while both champagne/white wine and red wine associated with a decreased risk for ischemic heart disease only (champagne/white wine: 0.84; 0.72-0.98; red wine: 0.88; 0.77-0.99).

CONCLUSIONS: Our findings do not support the notion that alcohol from any drink type is beneficial to health. Consuming low levels of beer/cider and spirits already associated with an increased risk for all health outcomes, while wine showed opposite protective relationships only with ischemic heart disease.

Public health groups, researchers, the beverage alcohol industry, and other stakeholders have promoted and applied the concept of "responsible drinking" for the past 50 years. However, little is known about the state of the existing responsible drinking evaluation research and its application to policy and practice. This project provides a scoping review of studies evaluating responsible drinking interventions.

Two primary research questions guided this investigation: (1) To what extent have authors attempted to define the concept of responsible drinking while evaluating responsible drinking interventions? and (2) What is the state of the responsible drinking intervention evaluation literature? We retrieved 49 peer-reviewed articles that evaluated interventions designed to promote "responsible drinking."

Four articles provided, or attempted to provide, an explicit definition of responsible drinking; these four definitions lacked consensus. The existing responsible drinking interventions varied considerably in terms of the messages they attempted to convey (e.g., avoid binge drinking, use protective behavioral strategies, stick to relatively safe drinking limits), again suggesting lack of consensus.

We observed greater consensus concerning the approach to evaluating responsible drinking interventions: studies typically recruited college students to complete brief, well-controlled experiments and measured potential predictors of drinking behavior (e.g., attitudes, expectancies, intentions) rather than actual drinking behavior. We discuss limitations of this methodological approach and the need for greater consensus regarding the concept of responsible drinking.

BACKGROUND: In January 2016, the UK announced and began implementing revised guidelines for low-risk drinking of 14 units (112 g) per week for men and women. This was a reduction from the previous guidelines for men of 3-4 units (24-32 g) per day. There was no large-scale promotion of the revised guidelines beyond the initial media announcement. This paper evaluates the effect of announcing the revised guidelines on alcohol consumption among adults in England.

METHODS: Data come from a monthly repeat cross-sectional survey of approximately 1700 adults living in private households in England collected between March 2014 and October 2017. The primary outcomes are change in level and time trend of participants' Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) scores.

RESULTS: In December 2015, the modelled average AUDIT-C score was 2.719 out of 12 and was decreasing by 0.003 each month. After January 2016, AUDIT-C scores increased immediately but non-significantly to 2.720 (beta=0.001, CI -0.079 to 0.099) and the trend changed significantly such that scores subsequently increased by 0.005 each month (beta=0.008, CI 0.001 to 0.015), equivalent to 0.5% of the population increasing their AUDIT-C score by 1 point each month. Secondary analyses indicated the change in trend began 7 months before the guideline announcement and that AUDIT-C scores reduced significantly but temporarily for 4 months after the announcement (beta=-0.087, CI -0.167 to 0.007).

CONCLUSIONS: Announcing new UK drinking guidelines did not lead to a substantial or sustained reduction in drinking or a downturn in the long-term trend in alcohol consumption, but there was evidence of a temporary reduction in consumption.

OBJECTIVES: The aims of this study were to: (1) describe alcohol industry corporate social responsibility (CSR) actions conducted across six global geographic regions; (2) identify the benefits accruing to the industry ('doing well'); and (3) estimate the public health impact of the actions ('doing good').

SETTING: Actions from six global geographic regions.

PARTICIPANTS: A web-based compendium of 3551 industry actions, representing the efforts of the alcohol industry to reduce harmful alcohol use, was issued in 2012. The compendium consisted of short descriptions of each action, plus other information about the sponsorship, content and evaluation of the activities. Public health professionals (n=19) rated a sample (n=1046) of the actions using a reliable content rating procedure.

OUTCOME MEASURES: WHO Global strategy target area, estimated population reach, risk of harm, advertising potential, policy impact potential and other aspects of the activity.

RESULTS: The industry actions were conducted disproportionately in regions with high-income countries (Europe and North America), with lower proportions in Latin America, Africa and Asia. Only 27% conformed to recommended WHO target areas for global action to reduce the harmful use of alcohol. The overwhelming majority (96.8%) of industry actions lacked scientific support (p<0.01) and 11.0% had the potential for doing harm. The benefits accruing to the industry ('doing well') included brand marketing and the use of CSR to manage risk and achieve strategic goals.

CONCLUSION: Alcohol industry CSR activities are unlikely to reduce harmful alcohol use but they do provide commercial strategic advantage while at the same time appearing to have a public health purpose.

BACKGROUND: The consumption of addictive substances is common in adolescence and raises concerns about future addiction. We investigated addictive substance consumption among young people to inform the design of drug intervention programmes.

METHODS: Participants were a population-based sample of 14- to 24-year-olds from Paredes, northern Portugal. A self-report questionnaire measured social and health variables, including tobacco, alcohol and illicit drug consumption. Results Data were analysed for 731 valid responses. Participants who had drunk alcohol did so first at 14.7 years (mean); 15.3% (95% confidence intervals [CI]: 12.9-18.1) drank alcohol regularly (more than 1/week, adjusted for age and sex) (95% CI: 12.9-18.1). Participants who had smoked tobacco did so first at 14.8 years (mean); 16.6% (95% CI: 14.0-19.5) were regular smokers. Illicit drug consumption was reported by 16.7% of participants (95% CI: 14.2-19.6) and 10.4% consumed drugs regularly.

CONCLUSION: We found a high prevalence of addictive substance consumption, particularly alcohol. As cultural attitudes likely influence alcohol consumption, a multigenerational approach is needed to address adolescent consumption. Participants' main sources of drug information were family members. Strategies are needed to promote drug literacy in parents and other relatives to change adolescents' culturally acquired habits of addictive substance consumption.

BACKGROUND AND AIMS: UK alcohol consumption per capita has fallen by 18% since 2004, while the alcohol-specific death rate has risen by 6%. Inconsistent consumption trends across the population may explain this. Drawing on the theory of the collectivity of drinking cultures and age-period-cohort analyses, we tested whether consumption trends are consistent across lighter and heavier drinkers for three temporal processes: (i) the life-course, (ii) calendar time and (iii) successive birth cohorts.

DESIGN: Sex-specific quantile age-period-cohort regressions using repeat cross-sectional survey data.

SETTING: Great Britain, 1984-2011. PARTICIPANTS: Adult (18+) drinkers responding to 17 waves of the General Lifestyle Survey (total n = 175 986).

MEASUREMENTS: Dependent variables: the 10th, 25th, 50th, 75th, 90th, 95th and 99th quantiles of the logged weekly alcohol consumption distribution (excluding abstainers). INDEPENDENT VARIABLES: seven age groups (18-24, 25-34... 65-74, 75+ years), five time-periods (1984-88... 2002-06, 2008-11) and 16 five-year birth cohorts (1915-19... 1990-94). Additional control variables: ethnicity and UK country.

FINDINGS: Within age, period and cohort trends, changes in consumption were not consistently in the same direction at different quantiles of the consumption distribution. When they were, the scale of change sometimes differed between quantiles. For example, between 1996-2000 and 2008-2011, consumption among women decreased by 18% [95% confidence interval (CI) = -32 to -2%] at the 10th quantile but increased by 11% (95% CI = 2-21%) at the median and by 28% (95% CI = 19-38%) at the 99th quantile, implying that consumption fell among lighter drinkers and rose among heavier drinkers. This type of polarized trend also occurred between 1984-88 and 1996-2000 for men and women. Age trends showed collectivity, but cohort trends showed a mixture of collectivity and polarization.

CONCLUSIONS: Countervailing alcohol consumption and alcohol-related harm trends in the United Kingdom may be explained by lighter and heavier drinkers having different period and cohort trends, as well as by the presence of cohort trends that mean consumption may rise in some age groups while falling in others.

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