Drinking Patterns (12)
Is burden of disease differentially linked to spirits? A systematic scoping review and implications for alcohol policy
By eboursMost epidemiological research on alcohol as a risk factor is based on the assumption that outcomes are linked to pattern and level of alcohol exposure, where different beverages are converted into grams of ethanol. This review examines this basic assumption, that alcohol has the same impact, independent of beverage type.
We conducted a systematic search on comparative research of beverage-specific alcohol exposure and consequences. Research was divided by methodology (survey, case-control, cohort, time-series analyses, interventional research). Overall, many studies showed higher risks for spirits compared to beer or wine; however, most research was not controlled adequately for confounders such as patterns of drinking. While there is no conclusive evidence for spirits being associated with more harm, given the same pattern and level of alcohol exposure, some evidence supports for certain outcomes such as injuries and poisonings, a potential excess risk with spirits consumption due to rapid ethanol intake and intoxication.
Accordingly, encouraging people to opt for beverages with lower alcohol content via taxation strategies has the potential to reduce alcohol-attributable harm. This does not necessarily involve switching beverage type, but also can achieved within the same beverage category, by shifting from higher to lower concentration beverages.
Adolescent wine consumption is inversely associated with long-term weight gain: results from follow-up of 20 or 22 years
By eboursBACKGROUND: Several studies have suggested a link between the type of alcoholic beverage consumption and body weight. However, results from longitudinal studies have been inconsistent, and the association between adolescent alcohol consumption long-term weight gain has generally not been examined.
METHODS: The study was based on data from 720 Danish adolescents aged between 15 to 19 years at baseline from the Danish Youth and Sports Study (YSS). Self-reported alcohol use, height, weight, smoking, social economic status (SES) and physical activity levels were assessed in baseline surveys conducted in 1983 and 1985, and in the follow up survey which was conducted in 2005. Multiple linear regression analyses were used to examine the association between alcohol consumption in adolescence and subsequent weight gain later in midlife.
RESULTS: There was no significant association between total alcohol consumption during adolescence and change in BMI into midlife (P = 0.079) (beta - 0.14; 95% CI -0.28, 0.005). Wine consumption was found to be inversely associated to subsequent BMI gain (P = 0.001) (beta - 0.46; 95% CI -0.82, - 0.09) while the results were not significant for beer and spirit. The relationship did not differ by gender, but smoking status was found to modify the relationship, and the inverse association between alcohol and BMI gain was seen only among non-smokers (P = 0.01) (beta - 0.24; 95% CI -0.41, - 0.06) while no association was found among smokers. Neither adolescent nor attained socioeconomic status in adulthood modified the relationship between alcohol intake and subsequent BMI gain.
CONCLUSION: Among non-smoking adolescents, consumption of alcohol, and in particular wine, seems to be associated with less weight gain until midlife.
TRIAL REGISTRATION: The YSS cohort was retrospectively registered on August 2017. (Study ID number: NCT03244150 ).
Why is adolescent drinking declining? A systematic review and narrative synthesis
By eboursBACKGROUND: Adolescent drinking has declined across many developed countries from the turn of the century. The aim of this review is to explore existing evidence examining possible reasons for this decline.
METHODS: We conducted systematic searches across five databases: Medline, PsycINFO, CINAHL, Informit Health and Scopus. Studies were included if association between declining alcohol consumption and potential explanatory factors were measured over time. Narrative synthesis was undertaken due to substantial methodological heterogeneity in these studies.
RESULTS: 17 studies met the inclusion criteria. Five studies found moderate evidence for changes in parental practices as a potential cause for the decline. Five studies that examined whether alcohol policy changes influenced the decline found weak evidence of association. Three studies explored whether alcohol use has been substituted by illicit substances but no evidence was found. Two studies examined the effect of a weaker economy; both identified increase in adolescent alcohol use during times of economic crisis. One study indicated that changes in exposure to alcohol advertising were positively associated with the decline and another examined the role of immigration of non-drinking populations but found no evidence of association. One study tested participation in organised sports and party lifestyle as a potential cause but did not use robust analytical methods and therefore did not provide strong evidence of association for the decline.
CONCLUSIONS: The most robust and consistent evidence was identified for shifts in parental practices. Further research is required using robust analytical methods such as ARIMA modelling techniques and utilising cross-national data.
Sociodemographics, lifestyle factors and health status indicators associated with alcohol consumption and related behaviours: a Brazilian population-based analysis
By eboursOBJECTIVES: To investigate how various alcohol-drinking behaviours are associated with sociodemographics, lifestyle factors and health status indicators in Brazil. STUDY DESIGN: This study is based on a household survey of 53,034 adults aged 18 + years from all 26 Brazilian capitals and the Federal District conducted in 2017.
METHODS: Sex-stratified relationships were modelled using logistic regressions and controlled for capital-specific effects. Main outcome measures included regular alcohol use, weekly alcohol use, heavy episodic drinking (HED), frequent HED and drinking and driving.
RESULTS: Overall (unadjusted) prevalence of regular alcohol consumption is 41%. Among drinkers, approximately 70% drink on a weekly basis, and 46% are heavy episodic drinkers. Among this latter group, close to 44% are frequent heavy episodic drinkers (i.e. at least four times in a month). Among regular drinkers who also are drivers, the prevalence of drinking and driving is 28%. These prevalences are considerably higher in men. The relationships investigated vary by drinking behaviour and sex, with some factors consistently associated with various behaviours, when present. Population (men or women) at greatest risk include (largely) younger individuals (up to 700% increase in odds) who are single or divorced, those who are less health conscious and watch television or use mobile devices during leisure time 4 + hours per day and do not have diabetes.
For drinking and driving, the additional risk factors include speeding behaviour, the use of mobile devices while driving and HED. Education, race/ethnicity and other health status indicators are differently associated with various drinking behaviours. For women, in particular, the results also show differences in odds of up to 360% and 1430% across cities for frequent HED and drinking and driving, respectively. Similarly, indigenous women are at greatest risk of weekly alcohol use and HED.
CONCLUSIONS: HED and drinking and driving are problematic, as the association with other factors suggests a clustering of risky behaviours that may exacerbate the consequences of drinking behaviours.
Measuring the effects on quality of life and alcohol consumption of a program to reduce binge drinking in Spanish adolescents
By eboursAIM: To present a comparison between the effects on health due to a reduction in binge drinking (BD) and health-related quality of life (HRQoL), as a result of ALERTA ALCOHOL, an intervention aimed at reducing BD in Spanish adolescents.
METHODS: A two-arm cluster randomized controlled trial was conducted with an intervention and a control group, randomized at the school level, following individuals over four months. The study population consisted of Andalusian adolescents aged 15 to 19 years who were enrolled in urban public high schools (n=1247). Participants were assigned randomly to receive the intervention. The main outcomes studied were the number of occasions of BD in the last 30 days, which was directly obtained from the answers given by the adolescents, and HRQoL measured with the EQ-5D-5L questionnaire. The model of estimation was the generalized estimating equations (GEE) approach.
RESULTS: The program showed a BD reduction at the 4-month follow-up, although it was not shown to significantly increase the HRQoL in adolescents who reduced the number of occasions of BD and had received the intervention. However, it was shown that those who would predictably reduce the number of occasions of BD controlled by several sociodemographic variables perceived a higher HRQoL, as did those who had a greater adherence to the program.
CONCLUSIONS: Higher adherence to a web-based computer-tailored intervention to prevent BD in adolescents has a positive effect on decreasing the number of occasions of BD in adolescents as well as on increasing participants' HRQoL, although this second effect is very small, which could be due to the short follow-up time. This fact is quite important and should be assessed extensively to corroborate the results and translate into health policy.
Binge Drinking Among Older Adults in the United States, 2015 to 2017
By eboursOBJECTIVES: Binge drinking is a risk factor for a range of harms. This study estimates the national prevalence of binge drinking and adds to our understanding of correlates of binge drinking among older adults in the United States.
DESIGN: Cross-sectional analysis.
SETTING/PARTICIPANTS: A total of 10 927 adults, aged 65 years or older, from the 2015 to 2017 administrations of the US National Survey on Drug Use and Health.
MEASUREMENTS: We estimated the prevalence of past-month binge alcohol use (five or more drinks on the same occasion for men and four or more drinks on the same occasion for women). Characteristics of past-month binge drinkers, including demographics, substance use, serious mental illness, mental health treatment utilization, chronic disease, and emergency department (ED) use, were compared to participants who reported past-month alcohol use without binge drinking. Comparisons were made using chi(2) tests. We then used multivariable generalized linear models using Poisson and log link to examine the association between covariates and binge drinking among all past-month alcohol users aged 65 years or older.
RESULTS: Of 10 927 respondents, 10.6% (95% CI = 9.9%-11.2%) were estimated to be current binge drinkers. Binge drinkers were more likely to be male, have a higher prevalence of current tobacco and/or cannabis use, and have a lower prevalence of two or more chronic diseases compared to nonbinge drinkers. In multivariable analysis, among past-month alcohol users, the prevalence of binge drinking was higher among non-Hispanic African Americans than whites (adjusted prevalence ratio [aPR] = 1.44; 95% CI = 1.16-1.80), tobacco users (aPR = 1.52; 95% CI = 1.33-1.74), cannabis users (aPR = 1.41; 95% CI = 1.11-1.80), and those who visited the ED in the past year (aPR = 1.16; 95% CI = 1.00-1.33).
CONCLUSION: Over a tenth of older adults in the United States are estimated to be current binge drinkers. Results confirm the importance of screening for binge drinking behaviors among older adults to minimize harms.
Association of binge drinking in adolescence and early adulthood with high blood pressure: findings from the National Longitudinal Study of Adolescent to Adult Health (1994-2008)
By eboursBACKGROUND: An investigation of the risk of high blood pressure (HBP) associated with heavy alcohol consumption in adolescence and early adulthood is lacking. Therefore, we aimed to investigate the association between binge drinking from adolescence to early adulthood and the risk of HBP in early adulthood.
METHODS: We applied logistic regression to publicly available, population-representative data from waves I (1994-1995; ages 12-18) and IV (2007-2008; ages 24-32) of the National Longitudinal Study of Adolescent to Adult Health (n=5114) to determine whether past 12-month binge drinking in adolescence (wave I) and early adulthood (wave IV) was associated with HBP in early adulthood after adjusting for covariates, including smoking and body mass index. HBP was defined according to both the former and new classifications.
RESULTS: HBP was significantly, positively associated with infrequent binge drinking (less than once a week) in adolescence based on the new classification (overall: OR 1.23, 95% CI 1.02 to 1.49; male: OR 1.35, 95% CI 1.00 to 1.81) and frequent binge drinking (heavy consumption) in adolescence based on the former classification (overall: OR= 1.64, 95% CI 1.22 to 2.22; male: OR= 1.79, 95% CI 1.23 to 2.60). The risk of HBP was high when participants engaged in frequent binge drinking in both adolescence and early adulthood, especially based on the former classification (overall: OR 2.43, 95% CI 1.13 to 5.20; female: OR 5.81, 95% CI 2.26 to 14.93).
CONCLUSION: Binge drinking in adolescence may increase risk of HBP in early adulthood. This association is independent of other important risk factors for HPB, such as smoking and obesity.
Exploring the characteristics of newly defined at-risk drinkers following the change to the UK low risk drinking guidelines: a retrospective analysis using Health Survey for England data
By eboursBACKGROUND: Alcohol guidelines enable individuals to make informed choices about drinking and assist healthcare practitioners to identify and treat at-risk drinkers. The UK Low Risk Drinking Guidelines were revised in 2016 and the weekly guideline for men was reduced from 21 to 14 units per week. This study sought to retrospectively establish 1) the number of additional at-risk male drinkers in England, 2) which demographic characteristics were associated with being an at-risk drinker under the previous versus new guidelines.
METHODS: Average weekly alcohol consumption for men aged 16+ from the cross-sectional nationally representative Health Survey for England were used to 1) calculate annual population prevalence estimates for newly defined at-risk (> 14 to 21 vs 14 vs </=14 units/week) guidelines to assess characteristics associated with being at-risk drinkers under each guideline using 2015 data (N = 2982).
RESULTS: Population prevalence estimates of newly defined at-risk drinkers ranged from 10.2% (2014 = 2,182,401 men)-11.2% (2011 = 2,322,896 men). Under the new guidelines, men aged 55-74 (OR = 1.63,95% CI = 1.25-2.12); men in managerial/professional occupations (OR = 1.64,95% CI = 1.34-2.00); current smokers (OR = 2.26,95% CI = 1.73-2.94), ex-regular smokers (OR = 2.01,95% CI = 1.63-2.47) and ex-occasional smokers (OR = 1.85,95% CI = 1.25-2.74); men from the North East (OR = 2.08,95% CI = 1.38-3.13) and North West (OR = 1.91,95% CI = 1.41-2.60) of England all had greater odds, and non-white men had reduced odds (OR = 0.53,95% CI = 0.34-0.80) of being at-risk drinkers, as they had under the previous guidelines. Under the new guidelines only: a higher percentage of at-risk drinkers aged 16-34 (32% vs 19%) attenuated the odds of men aged 35-54 being at-risk (OR = 1.18,95% CI = 0.92-1.51); a higher percentage of married at-risk drinkers (37% vs 24%) attenuated the odds of single men being at-risk (OR = 1.28,95% CI = 0.99-1.67); men from the West Midlands (OR = 1.68,95% CI = 1.17-2.42) and London (OR = 1.53,95% CI = 1.03-2.28) had greater odds of being at-risk drinkers.
CONCLUSIONS: The change to the Low Risk Drinking Guidelines would have resulted in more than 2 million additional male at-risk drinkers in England. Most groups with greater odds of being at-risk drinkers under the new guidelines were those already known to be drinking the most, strengthening the case for targeted screening and education. Additionally, under the new guidelines, a marked proportion of 16-35 year olds and married men were at-risk and men in the West Midlands and London had greater odds of being at-risk drinkers. These groups may benefit from specific education around the new Low Risk Drinking Guidelines.
Patterns of alcohol consumption and alcohol-related harm among European university students
By eboursBACKGROUND: To compare patterns of alcohol consumption and alcohol-related harm from a survey of university students sampled from universities in Denmark, England, Germany, Italy, Portugal and Switzerland.
METHODS: A total of 2191 university students (70% female, 90% white ethnic group, age range 18-25) completed the survey. Participants completed measures of demographic variables (age, age of onset, ethnic group and sex) and the Alcohol Use Disorders Identification Test (AUDIT), which was the primary outcome.
RESULTS: Sixty-three percent of the sample scored negative for harmful drinking on the AUDIT (<8), with 30% categorized as hazardous drinkers, 4% harmful drinkers and 3% with probable dependence. Analysis of variance, including demographic factors as covariates, identified a main effect of country on AUDIT scores F(5, 2086) = 70.97, P < 0.001, partial eta square = 0.15. AUDIT scores were highest in England (M = 9.99; SD = 6.17) and Denmark (M = 9.52; SD = 4.86) and lowest in Portugal (M = 4.90; degrees = 4.60). Post hoc tests indicated large effect size differences between scores in Denmark and England and scores in all other countries (0.79 < d < 0.94; all P's < 0.001).
CONCLUSIONS: European university students in our sample mainly reported low risk patterns of alcohol consumption and alcohol-related harm. However, students from Northern European countries had significantly higher AUDIT scores compared with students from Central and Southern European countries. Research is needed to replicate the present study using nationally representative samples to estimate the prevalence of alcohol use disorders among university students in different European countries.
Does binge drinking between the age of 18 and 25 years predict alcohol dependence in adulthood? A retrospective case-control study in France
By eboursOBJECTIVE: A retrospective case-control study was conducted to evaluate whether frequent binge drinking between the age of 18 and 25 years was a risk factor for alcohol dependence in adulthood.
SETTING: The Department of Addictive Medicine and the Clinical Investigation Center of a university hospital in France.
PARTICIPANTS: Cases were alcohol-dependent patients between 25 and 45 years and diagnosed by a psychiatrist. Consecutive patients referred to the Department of Addictive Medicine of a university hospital between 1 January 2017 and 31 December 2017 for alcohol dependence were included in the study. Controls were non-alcohol-dependent adults, defined according to an Alcohol Use Disorders Identification Test score of less than 8, and were matched on age and sex with cases. Data on sociodemographics, behaviour and alcohol consumption were retrospectively collected for three life periods: before the age of 18 years; between the age of 18 and 25 years; and between the age of 25 and 45 years. Frequency of binge drinking between 18 and 25 years was categorised as frequent if more than twice a month, occasional if once a month and never if no binge drinking.
RESULTS: 166 adults between 25 and 45 years were included: 83 were alcohol-dependent and 83 were non-alcohol-dependent. The mean age was 34.6 years (SD: 5.1). Frequent binge drinking between 18 and 25 years occurred in 75.9% of cases and 41.0% of controls (p<0.0001). After multivariate analysis, frequent binge drinking between 18 and 25 years was a risk factor for alcohol dependence between 25 and 45 years: adjusted OR=2.83, 95% CI 1.10 to 7.25.
CONCLUSIONS: Frequent binge drinking between 18 and 25 years appears to be a risk factor for alcohol dependence in adulthood. Prevention measures for binge drinking during preadulthood, especially frequent binge drinking, should be implemented to prevent acute consequences as injury and death and long-term consequences as alcohol dependence.
TRIAL REGISTRATION NUMBER: NCT03204214; Results.
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The Mediterranean Diet and Cardiovascular Disease: Gaps in the Evidence and Research Challenges
By eboursIn this article, we critically evaluate the evidence relating to the effects of the Mediterranean diet (MD) on the risk of cardiovascular disease (CVD). Strong evidence indicating that the MD prevents CVD has come from prospective cohort studies. However, there is only weak supporting evidence from randomized controlled trials (RCTs) as none have compared subjects who follow an MD and those who do not. Instead, RCTs have tested the effect of 1 or 2 features of the MD. This was the case in the Prevenciomicronn con Dieta Mediterranea (PREDIMED) study: the major dietary change in the intervention groups was the addition of either extravirgin olive oil or nuts. Meta-analyses generally suggest that the MD causes small favorable changes in risk factors for CVD, including blood pressure, blood glucose, and waist circumference. However, the effect on blood lipids is generally weak. The MD may also decrease several biomarkers of inflammation, including C-reactive protein. The 7 key features of the MD can be divided into 2 groups. Some are clearly protective against CVD (olive oil as the main fat; high in legumes; high in fruits/vegetables/nuts; and low in meat/meat products and increased in fish). However, other features of the MD have a less clear relationship with CVD (low/moderate alcohol use, especially red wine; high in grains/cereals; and low/moderate in milk/dairy). In conclusion, the evidence indicates that the MD prevents CVD. There is a need for RCTs that test the effectiveness of the MD for preventing CVD. Key design features for such a study are proposed.
Knowledge of low-risk drinking and its relationship with a reduction in alcohol consumption: Results from six waves of an Australian national survey
By eboursThis study examined changes in public knowledge of low-risk drinking, explored factors associated with knowledge level and its relationship with a reduction in alcohol consumption. Data (n=153,820) of six waves of the National Drug Strategy Household Survey, conducted during the period 2001-2016, were analysed. Australian Guidelines to Reduce Health Risks from Drinking Alcohol was applied to compute participants' knowledge of low-risk drinking. This guideline was introduced in 2001 and later revised in 2009. Multivariable log-binomial regression model was used to analyse the pooled dataset. Subgroup analysis examined the relationship between knowledge score and a reduction in alcohol consumption across drinker categories. Public knowledge was better for long-term than short-term low-risk drinking, and women had better knowledge than men. Since 2010 there has been a small increase in knowledge of low-risk drinking. Although level of knowledge improved over time, it appears to align more towards the 2001-guideline, particularly for the recommended limits for men. Those who were relatively old; were women; received at least year-10 or more education; were not residing in the most disadvantaged areas; identified themselves as either light-, social-, heavy- or binge-drinkers; were currently/previously married; or perceived their health 'excellent' were significantly more likely than others to have an accurate knowledge of low-risk drinking. There was a positive association between knowledge score and the reduction in alcohol consumption among the self-reported social drinkers, heavy drinkers and binge drinkers. Tailored interventions are recommended for those who lack adequate knowledge and drink at a risky level.