17 May 2016 In General Health

IMPORTANCE: Excess alcohol consumption and alcohol use disorders (AUDs) are associated with substantially increased mortality. Efforts to reduce this toll require an understanding of their causes.

OBJECTIVE: To clarify the degree to which the excess mortality associated with AUDs arises (1) from the predispositions of the person who develops AUD (and which would likely be shared by close relatives) and (2) as a direct result of AUD itself.

DESIGN, SETTING, and PARTICIPANTS: A prospective cohort and co-relative design study involving all individuals born in Sweden from 1940 to 1965 who had neither died nor migrated prior to 1973 or age 15 years (N = 2821036). They were followed up from January 1, 1973, until December 31, 2010. Alcohol use disorder was assessed from medical, criminal, and pharmacy registries. Half-siblings, full-siblings, and monozygotic twin pairs discordant for AUD were obtained from the Multi-Generation and Twin Register.

MAIN OUTCOME AND MEASURE: Death obtained from the Swedish Death registry.

RESULTS: Our cohort (1447887 males and 1373149 females) included 131895 males and 42163 females registered with AUD. The mean (SD) age at first AUD registration was 39 (13.4) years. We ascertained 127347 and 76325 deaths in the male and female subsamples, respectively. Controlling for sex, educational status, and year of birth, the mortality hazard ratio associated with AUD was 5.83 (95% CI, 5.76-5.90) and varied-with an inverted U-shaped function-by age. Examining the AUD-mortality association in the general population and in relative pairs discordant for AUD exposure demonstrated substantial familial confounding in early to mid-adulthood: the AUD-associated mortality hazard ratio was much lower in discordant close relatives than in the general population. In middle to late adulthood, evidence for familial confounding decreased with increasing evidence for a direct effect of AUD on elevated mortality. In the oldest age group (65-70 years), the mortality hazard ratios were similar across the population and all relative pairs, suggesting that the excess mortality was largely a result of having AUD. Adding years since onset of AUD to the model showed that both increasing age and increasing years of duration of AUD contributed to the reduction of familial confounding in the association between AUD and elevated mortality.

CONCLUSIONS AND RELEVANCE: Excess mortality associated with AUD arises both from the predispositions of the person who develops AUD and the direct result of having AUD. The effect of predisposition is more prominent early in the life course and in the early years of AUD. The direct effect of AUD becomes progressively more important later in life and with longer duration of AUD. These results have implications for interventions seeking to reduce the elevated AUD-associated mortality.

BACKGROUND: In Mediterranean countries, the information on the prevalence of binge drinking and associated socio-demographic variables is very scarce. Moreover, there are no reported data on the amount of alcohol ingested and the type of beverage consumed during drinking episodes. This study describes the prevalence and characteristics of binge drinking in the adult population of Madrid, Spain.

METHODS: Data were taken from a telephone survey conducted during the period 2000 to 2005 on 12,037 persons, representative of the population aged 18 to 64 years in the Madrid Region. Binge drinking was defined as the intake of >or=80 g of alcohol in men or >or=60 g in women, during any drinking session in the preceding 30 days. In this analysis, the threshold between moderate and heavy average weekly alcohol consumption was set at 40 g/d for men and 24 g/d for women.

RESULTS: Prevalence of binge drinking was 14.4% (95% confidence interval, CI: 13.5 to 15.3%) in men and 6.5% (95% CI: 5.8 to 7.1%) in women. Prevalence was higher among persons: in the youngest age group (30.8% among men and 18.2% among women aged 18 to 24 years); having the highest educational level (14.5% in male and 9.2% in female university graduates); and with a heavy average consumption of alcohol (55.3% in men and 50.0% in women). However, 3 of 4 binge drinkers of both sexes showed a moderate average consumption. Among binge-drinkers, average monthly episodes of binge drinking were 3.2 in men and 2.6 in women, with 5.4 and 2 episodes/person/year, respectively. During each episode, a mean of 119 g of alcohol was ingested by men and 83 g by women, with spirits accounting for 72% of total alcohol intake.

CONCLUSIONS: Prevalence of binge drinking is high in Madrid, particularly among younger men with higher education, and heavy average alcohol consumption. Binge drinking is characterized by frequent episodes, where large amounts of alcohol are ingested, mainly from spirits.

Working from a life course perspective, this study examined the paradoxical association between academic status and drinking across the transition to young adulthood with multilevel modeling and a nationally representative sample of young people from the Add Health data project (n = 6,308). Taking academically advanced courses in high school was associated with lower rates of current drinking and binge drinking during high school (grades 9-12) but higher rates of both after high school (age range: 20-26). This positive longitudinal association between academic status and drinking was explained partly, but not completely, by educational, family, and work circumstances in young adulthood. The association was less likely to occur among students who attended high schools in which high achievement was the norm. Thus, the association between academic status and drinking behavior reverses across the transition to young adulthood, especially in certain types of peer environments within the educational system.

BACKGROUND: The serious negative health consequences of heavy drinking among adolescents is cause for concern, especially among adolescents aged 15 to 20 years with a low educational background. In the Netherlands, there is a lack of alcohol prevention programs directed to the drinking patterns of this specific target group. The study described in this protocol will test the effectiveness of a web-based brief alcohol intervention that aims to reduce alcohol use among heavy drinking adolescents aged 15 to 20 years with a low educational background.

METHODS/DESIGN: The effectiveness of the What Do You Drink (WDYD) web-based brief alcohol intervention will be tested among 750 low-educated, heavy drinking adolescents. It will use a two-arm parallel group cluster randomized controlled trial. Classes of adolescents from educational institutions will be randomly assigned to either the experimental (n = 375: web-based brief alcohol intervention) or control condition (n = 375: no intervention). Primary outcomes measures will be: 1) the percentage of participants who drink within the normative limits of the Dutch National Health Council for low-risk drinking, 2) reductions in mean weekly alcohol consumption, and 3) frequency of binge drinking. The secondary outcome measures include the alcohol-related cognitions, attitudes, self-efficacy, and subjective norms, which will be measured at baseline and at one and six months after the intervention.

DISCUSSION: This study protocol presents the study design of a two-arm parallel-group randomized controlled trial to evaluate the effectiveness of the WDYD web-based brief alcohol intervention. We hypothesized a reduction in mean weekly alcohol consumption and in the frequency of binge drinking in the experimental condition, resulting from the web-based brief alcohol intervention, compared to the control condition. 

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