15 October 2014 In Dementia

OBJECTIVE: To determine whether alcohol consumption is causally associated with cognitive impairment in older men as predicted by mendelian randomization.

METHODS: Retrospective analysis of a cohort study of 3,542 community-dwelling men aged 65 to 83 years followed for 6 years. Cognitive impairment was established by a Mini-Mental State Examination score of 23 or less. Participants provided detailed information about their use of alcohol during the preceding year and were classified as abstainers, occasional drinkers, and regular drinkers: mild (/=35 drinks/wk). We genotyped the rs1229984 G-->A variant of the alcohol dehydrogenase 1B (ADH1B) gene, which is associated with lower prevalence of alcohol abuse and dependence. Other measures included age, education, marital status, smoking and physical activity, body mass index, diabetes, hypertension, and cardiovascular diseases.

RESULTS: At study entry, rs1229984 G-->A polymorphism was associated with lower prevalence of regular use of alcohol and decreased consumption among regular users. Six years later, 502 men (14.2%) showed evidence of cognitive impairment. Abstainers and irregular drinkers had higher odds of cognitive impairment than regular drinkers (odds ratio [OR] = 1.23, 95% confidence interval [CI] = 1.00-1.51, after adjustment for other measured factors). The rs1229984 G-->A polymorphism did not decrease the odds of cognitive impairment (AA/GG OR = 1.35, 95% CI = 0.29-6.27; GA/GG OR = 1.05, 95% CI = 0.71-1.55).

CONCLUSIONS: Alcohol consumption, including heavy regular drinking and abuse, is not a direct cause of cognitive impairment in later life. Our results are consistent with the possibility, but do not prove, that regular moderate drinking decreases the risk of cognitive impairment in older men.

OBJECTIVES: To document quantity and cash value of underage and adult Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)-defined abusive and dependent drinking as well as underage drinking and adult DSM-IV-defined abusive and dependent drinking combined to the alcohol industry.

DESIGN: Analysis of multiple cross-sectional national data sets.

SETTING: The 2001 National Household Survey on Drug Abuse, the 2001 Youth Risk Behavior Survey, the 2001 Behavioral Risk Factor Surveillance Survey, the 2000 US Census, the 2000 to 2001 National Epidemiological Survey on Alcohol and Related Conditions, and the 2001 Adams Business Research.

PARTICIPANTS: A total of 260,580 persons aged 12 years and older across 4 data sources.

MAIN EXPOSURE: Underage drinking or pathological drinking defined as meeting the DSM-IV criteria for abusive or dependent drinking.

MAIN OUTCOME MEASURES: Total amount of alcohol consumed and the cash value for alcohol consumed among underage and adult drinkers with DSM-IV-defined alcohol abuse and dependence as well as all underage drinkers combined with adult drinkers with DSM-IV-defined alcohol abuse and dependence.

RESULTS: The short-term cash value of underage drinking to the alcohol industry was 22.5 billion dollars in 2001-17.5% of total consumer expenditures for alcohol. The long-term commercial value of underage drinking is the contribution of underage drinking to maintaining consumption among adult drinkers with alcohol abuse and dependence, which was equal to at least 25.8 billion dollars in 2001.

CONCLUSIONS: The combined value of illegal underage drinking and adult pathological drinking to the industry was at least 48.3 billion dollars, or 37.5% of consumer expenditures for alcohol, in 2001. Alternative estimates suggest that these costs may be closer to 62.9 billion dollars, or 48.8% of consumer expenditures for alcohol.

Wagenaar et al.'s meta-analysis assessing the impact of price on drinking in this issue of Addiction is a true tour de force that will serve as an invaluable resource for researchers, public health practitioners, alcohol control advocates and policy makers for many years to come. Using state-of-the-art methods applied to a comprehensive set of English-language studies from economics and other social sciences, public health and other fields, they demonstrate clearly that higher alcoholic beverage taxes and prices reduce alcohol use. They find that this applies across beverages, with spirits and wine consumption more responsive to price than beer drinking, and that it applies to not only overall consumption, but also to measures of heavy drinking.These findings provide a strong rationale for using increases in alcoholic beverage taxes to promote public health by reducing drinking. Further support comes from the extensive literature that examines the relationships between alcoholic beverage taxes and prices and a variety of consequences of alcohol use and abuse. The Centers for Disease Control and Prevention estimate that excessive alcohol use resulted in 79 000 deaths annually in the United States from 2001 to 2005. In a recent study, Wagenaar and his colleagues found that the 1983 and 2002 alcoholic beverage tax increases in Alaska reduced alcohol-related disease mortality significantly, including deaths from liver cirrhosis, acute alcohol poisoning, alcohol-related cancers, cardiovascular diseases and others. In a series of studies, Markowitz et al. have shown that higher alcoholic beverage taxes and prices reduce violence, including spouse abuse, child abuse, suicide and other violent crime. Others have documented the reductions in fatal traffic crashes among youth, young adults and adults caused by alcohol that result from higher taxes and prices. Still others have shown that higher alcohol taxes and prices reduce other health consequences of alcohol use and abuse, including non-fatal work-place accidents , teenage pregnancy and the incidence of sexually transmitted diseases. At the same time, higher alcoholic beverage taxes and prices can improve educational outcomes among youths and young adults. In addition to the public health toll resulting from the morbidity, mortality and violence it causes, alcohol use and abuse impose substantial economic costs. The most recent estimates for the United States indicate that the economic costs of alcohol abuse were nearly $200 billion in 1998. Economists have shown that existing alcoholic beverage taxes fall well short of the costs that alcohol abusers impose on society. Despite the large and growing literature that higher alcoholic beverage taxes would reduce drinking and its consequences significantly, many governments are unwilling to raise these taxes. The stability of these taxes results in inflation eroding their value over time and, as a result, to declining real alcoholic beverage prices. In the United States, for example, rare federal tax increases and infrequent state tax increases have contributed to a sharp reduction in inflation-adjusted beer, wine and spirits prices over the past few decades. Given Wagenaar et al.'s findings on the relationships between prices and drinking, these falling prices have led to more drinking than would have been the case had taxes and prices kept pace with inflation and, as a result, greater consequences from alcohol abuse. This stands in clear contrast to cigarette taxes in the United States, which have risen sharply over the past two decades, raising inflation-adjusted cigarette prices and reducing significantly youth smoking initiation and leading many adult smokers to quit.The price elasticity estimates from Wagenaar et al.'s meta-analysis demonstrate that higher alcoholic beverage taxes can both reduce drinking and its consequences and raise new revenues for governments. The inelastic estimates they obtain for beer, wine, spirits and overall alcohol consumption imply that the quantity of alcohol consumed falls relatively less than price rises. For example, their estimated price elasticity of -0.44 for total alcohol means that a 10% increase in alcoholic beverage prices would reduce overall alcohol consumption by 4.4%. Given that alcohol beverage taxes account for only a fraction of the price of alcohol, relatively large increases in taxes will raise prices by a smaller percentage. If, for example, alcohol taxes account for one-quarter of alcoholic beverage prices, a doubling of the tax will raise the price by 25% (assuming that the tax is passed on fully to consumers). This price increase would reduce consumption by 11% while at the same time resulting in a nearly 80% rise in alcoholic beverage tax revenues.Perhaps the current economic downturn and resulting revenue needs of governments, coupled with the strong evidence-base on the benefits of higher taxes and prices reviewed thoroughly by Wagenaar et al. and others, will stimulate national and subnational governments to raise their alcoholic beverage taxes.

OBJECTIVE: To explore whether early age of drinking onset is prospectively associated with respondents unintentionally injuring themselves and others when respondents were under the influence of alcohol, controlling for current alcohol dependence/abuse, frequency of consuming 5 drinks per occasion, and other demographic characteristics.

METHODS: From 2001 to 2002, in-person interviews were conducted with a national multistage probability sample of 43,093 adults aged 18 years older. From 2004 to 2005, of 39,959 eligible respondents, 34,653 were reinterviewed. The cumulative 2-survey response rate was 70.2%. Respondents were asked the age at which they first started drinking (not counting tastes or sips), diagnostic questions for alcohol dependence and abuse, questions about behaviors that increase risk of injury, and whether respondents, when under the influence of alcohol, injured themselves or someone else as a driver in a motor vehicle crash or in some other way.

RESULTS: Logistic regression analyses revealed that the younger respondents were when they started drinking, the greater the likelihood that, between the 2 surveys, they experienced alcohol dependence/abuse, drank 5 drinks per occasion at least weekly drove under the influence of alcohol, and placed themselves in situation after drinking where they could be hurt. After controlling for those injury risk and sociodemographic characteristics, respondents who began drinking at earlier ages remained more likely between the 2 surveys to have, under the influence of alcohol, unintentionally injured themselves and someone else. More than one third of those injuries occurred when respondents 25 years of age were under the influence, although only 7% of respondents were 25 years of age. Persons other than respondents experienced 20% of those unintentional injuries, more than one third of them in traffic.

CONCLUSION: Delaying drinking onset may help reduce unintentional alcohol-related injuries that drinkers may inflict on themselves and others.

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