INTRODUCTION: 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.

Published in General Health

BACKGROUND: Hazardous and harmful alcohol use and high blood pressure are central risk factors related to premature non-communicable disease (NCD) mortality worldwide. A reduction in the prevalence of both risk factors has been suggested as a route to reach the global NCD targets. This study aims to highlight that screening and interventions for hypertension and hazardous and harmful alcohol use in primary healthcare can contribute substantially to achieving the NCD targets.

METHODS: A consensus conference based on systematic reviews, meta-analyses, clinical guidelines, experimental studies, and statistical modelling which had been presented and discussed in five preparatory meetings, was undertaken. Specifically, we modelled changes in blood pressure distributions and potential lives saved for the five largest European countries if screening and appropriate intervention rates in primary healthcare settings were increased. Recommendations to handle alcohol-induced hypertension in primary healthcare settings were derived at the conference, and their degree of evidence was graded.

RESULTS: Screening and appropriate interventions for hazardous alcohol use and use disorders could lower blood pressure levels, but there is a lack in implementing these measures in European primary healthcare. Recommendations included (1) an increase in screening for hypertension (evidence grade: high), (2) an increase in screening and brief advice on hazardous and harmful drinking for people with newly detected hypertension by physicians, nurses, and other healthcare professionals (evidence grade: high), (3) the conduct of clinical management of less severe alcohol use disorders for incident people with hypertension in primary healthcare (evidence grade: moderate), and (4) screening for alcohol use in hypertension that is not well controlled (evidence grade: moderate). The first three measures were estimated to result in a decreased hypertension prevalence and hundreds of saved lives annually in the examined countries.

CONCLUSIONS: The implementation of the outlined recommendations could contribute to reducing the burden associated with hypertension and hazardous and harmful alcohol use and thus to achievement of the NCD targets. Implementation should be conducted in controlled settings with evaluation, including, but not limited to, economic evaluation.

Published in General Health

BACKGROUND: Several studies have investigated the predictors of alcohol consumption behavior among adolescents and young adults. However, the body of evidence about the relationship between in particular psychological factors and alcohol consumption among individuals in the second half of life is still limited. Hence, we aimed at identifying factors associated with alcohol consumption among individuals aged 40 and above, especially focusing on psychological correlates.

METHODS: Data were derived from a population-based sample of community-dwelling individuals aged 40 to 95 years (n = 7820) in Germany. Alcohol consumption was rated as 'never' (never drinkers), 'rarer than once a month', 'one to three times a month', 'once a week', 'several times a week' (occasional drinkers), and 'daily' (daily drinkers). Socio-economic factors, the illness level and physical activity were considered as possible determinants of alcohol consumption. In addition, positive and negative affect, life satisfaction, optimism, self-esteem, self-efficacy, and self-regulation were included as psychological factors. Multinomial regressions were used to identify factors associated with drinking behavior.

RESULTS: 12.0% of the individuals were daily drinkers, 76.5% were occasional drinkers, and 11.5% of the individuals never drank alcohol. After adjusting for various potential confounders, multinomial logistic regressions revealed that, compared with never drinking, occasional and daily drinking were positively associated with a decreased loneliness, a higher life satisfaction, a higher positive affect, a higher optimism, a higher self-efficacy (occasional drinkers), a higher self-esteem, and less perceived stress. In addition, occasional and daily drinking were positively associated with less physical illnesses, male gender, and income as compared with never drinking.

CONCLUSIONS: The current study extends the existing literature on alcohol consumption behavior by new insights of correlates of drinking behavior among individuals in the second half of life. Since interventions are available to address this risk factor, this might help to identify individuals with increased alcohol consumption.

Published in Drinking Patterns

INTRODUCTION: The benefits of alcohol consumption for cardiovascular and metabolic health may have been overstated due to inappropriate comparisons with abstainers and inadequate control for confounding factors including physical activity and mental health. We examined alcohol consumption and cardio-metabolic health in a cohort of young Australian adults overcoming these limitations.

METHODS: Cross-sectional data of a cohort of 2200 participants (age range 25-36 years) from the 2004-06 Childhood Determinants of Adult Health were used. Alcohol consumption was assessed from questionnaire and cardio-metabolic risk factors were measured in clinics. Linear and log binomial regression were used to examine total alcohol consumption (categories: none 0 g/day; light >0-10 g/day [reference]; moderate >10-20 g/day; heavy >20-30 g/day; very heavy >30 g/day) against dichotomous metabolic syndrome and its components: waist circumference, triglycerides, high-density lipoprotein cholesterol, blood pressure and glucose. Covariates included socio-demographics, smoking, diet, physical activity, fitness, depression and anxiety.

RESULTS: Of the 2220 participants (48% males, mean (standard deviation) age 29.5 (2.5) years), most were classified in the 'light drinking' group (54.2%), less were in the 'non-drinking' (13.2%), 'heavy' (5.2%) or 'very heavy' (5.5%) drinking groups. Only moderate drinking was associated with a significantly lower prevalence of metabolic syndrome (prevalence ratio = 0.64, p < 0.05) compared with light drinking. Higher levels of alcohol consumption were associated with higher high-density lipoprotein cholesterol (beta = 0.05, ptrend < 0.001). Very heavy compared to light drinkers had higher systolic (beta = 3.01 mm Hg, p < 0.01) and diastolic (beta = 2.07 mm Hg, p < 0.05) blood pressure.

CONCLUSION: Moderate alcohol consumption was associated with a lower prevalence of MetS, and more favourable levels of lipids but not glucose or blood pressure even when compared to light consumption and with account for a range of confounding factors.

Published in Cardiovascular System
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