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The effects of alcohol-related harms to others on self-perceived mental well-being in a Canadian sample
Abstract
Objectives
To examine (1) the harms related to the drinking of others in five Canadian provinces, stratified by socio-demographic variables, and (2) the relationship between these harms and mental well-being. MethodsA telephone survey sampled 375 adults from British Columbia, Saskatchewan, Ontario, Quebec, and Nova Scotia. Harms related to the drinking of others were measured through 16 questions in the domains of psychological, physical, social, and financial harms. Self-perceived mental well-being was measured with his or her mental well-being. ResultsIn 2012, 40.1% of Canadian adults surveyed experienced harm in the previous year related to the drinking of another person. These harms were more frequent among people who had a higher education level, were widowed, separated, divorced or never married, and were employed. Psychological, physical, and financial harms related to the drinking of others were significantly correlated to a person’s mental well-being. Conclusions
Harms related to the drinking of others are prevalent in this Canadian survey. Furthermore, the psychological, physical, and financial harms related to the drinking of others negatively impact the mental well-being of the affected individuals.
... Inconsistent findings have been reported with regards to the effects of socio-economic status [8,9] and education [8,10]. Respondents 0 alcohol use has been consistently shown to increase the risk of HTO [11,12]. ...
... Though not specific to university students, subjects who reported harm also reported increased rates of depression and recent distress [13,18]. Students reporting harm specifically report poor academic performance [12]. ...
... Our students with alcohol use-but not tobacco use-had higher odds of reporting all forms of HTO. This finding has been consistently reported [11,12,30] and is accounted for by the propensity of alcohol users to put themselves into situations involving alcohol use among others, thus increasing the likelihood of experiencing HTO. ...
Introduction and aims:
There is a paucity of studies on the harms experienced by college students from India due to others' drinking, despite their increased risk. We studied the prevalence and correlates of harm from others' drinking among college students in the state of Kerala, India.
Design and methods:
A total of 5784 students from 58 colleges completed a self-administered questionnaire, which included the World Health Organization-Thai Health Harm to Others from Drinking Master Protocol and other structured instruments to assess correlates. The frequencies of various harms were determined and a mixed effect multivariable negative binomial regression model was used to identify the factors responsible for harms.
Results:
Of the 4487 valid responses, 68.3% were females. The mean age of the sample was 19.5 years. Harm from others' drinking was reported by 68.7% of respondents. Among various harm domains, psychological harm was reported by 65.7%, physical by 15.2%, financial by 20.9%, and property harm by 5.0%. Strangers were the most common perpetrators. Being male and having a part-time job increased harms. Increasing age, urban residence, and staying in a hostel were correlated with psychological-but not physical-harm. Subjects who reported harm had higher odds of reporting alcohol use and psychological distress. 'Any harm' or psychological harm was associated with suicidal thoughts; only physical harm was correlated with suicidal attempts.
Discussion and conclusions:
The high prevalence of harms from others' drinking and its negative correlates underscore the need for colleges to focus on second-hand effects in programs for tackling alcohol use.
... An earlier survey from the USA reported a slightly higher proportion of respondents reporting physical violence -28.3% had ever been pushed, hit, or assaulted, by someone who had been drinking, reducing to 2.4% in the last 12 months [survey 30 (33)]. In an earlier USA survey, among those reporting crime victimisation (6.7% of male respondents and 4.1% of female respondents), 71 Being physically harmed 4 was the type of harm least commonly reported in a Canadian survey [survey 12 (36)]. Only 7.0% (95% CI: 1.1%, 12.9%) of respondents who experienced physical harm. ...
... In Canada, experiencing AHTO was correlated to a respondent's self-reported mental wellbeing [survey 12 (36)]. Self-reported mental well-being was associated with the number of types of physical AHTO and the number of financial AHTO. ...
... In Canada, being put at-risk in the car and being physically injured in a car were grouped alongside experiencing unwanted sexual attention and being physically hurt and were aggregated as 'physical harms', and reported by 4.1% (95% CI: 0.0%, 10.1%) of respondents [survey 12 (36)]. Figures for individual survey items relating to third party harms on the road were not reported. ...
... alcohol harm to others (AHTO)] in relation to various health measures (e.g. 6,[13][14][15][16][17]. For example, Casswell et al. 6 found that an increasing index score of exposure to the number and proximity of known heavy drinkers was associated with poorer health status and lower scores of wellbeing. ...
... Another study 14 found that knowing a heavy drinker outside the household was related to adverse effects on both health status and subjective well-being, whereas knowing a heavy drinker within the household was negatively associated only with health status. Lewis-Laietmark et al. 16 found that different types of harms related to the drinking of others were negatively associated with the subjective mental well-being of the affected individuals. Finally, a study by Thompson et al.,17 found that different types of AHTO (strains and threats) among post-secondary students were associated negatively with mental well-being and positively with anxiety and depression. ...
... Covariates were selected a priori based on previous literature (e.g. [13][14][15][16][17]. ...
Background:
Studies have examined the self-rated health (SRH) of the drinker, but only few have examined the health of those affected by a heavy drinker. This Nordic study aimed to examine the association between exposure to heavy drinkers and SRH.
Methods:
Data come from surveys from the five Nordic countries that participated in the Reducing Alcohol-Related Harm Standardized European Survey in 2015 (n = 7065 aged 18-64 years). Variables included a five-point Likert-scale question on one's SRH, a question on whether the respondent knew a heavy drinker in the last 12 months, and covariates. The 'fair', 'poor' and 'very poor' response categories were combined and are referred to as poor SRH. Multiple logistic regression models were used to examine the relationship between knowing a heavy drinker and one's SRH.
Results:
Country-pooled adjusted analyses showed a significant relationship between knowing (and being negatively affected by) a heavy drinker and poor SRH [odds ratios (OR) = 1.39, 95% confidence intervals (CI): 1.02-1.89 for heavy drinker in household; OR = 1.23, 95% CI: 1.07-1.42 for other known heavy drinker, compared to not knowing a heavy drinker or knowing a heavy drinker, but not being negatively affected]. A graded relationship appeared such that increasing proximity of the known heavy drinker increased likelihood to report poor SRH.
Conclusion:
Knowing and being negatively affected by someone close who drinks heavily increases the likelihood of reporting poor SRH. These results have implications for public health messaging regarding the well-being of relatives of heavy drinkers.
... Yet for every death many more will suffer other negative effects, including hospitalisation (Laslett et al., 2010), and broader effects on health and well-being (e.g. lower mental well-being; Lewis-Laietmark et al., 2017), placing large financial impacts on society (Laslett et al., 2010). In the United Kingdom (UK) the negative consequences of alcohol are estimated to cost society £21 billion annually (HM Government, 2012). ...
... Equally, developing understanding of the differential impacts of AHTOs is warranted to provide more comprehensive assessments of their impact. For instance, whilst emerging studies suggest that experience of AHTOs is associated with lower mental well-being, they also suggest that the type of harm experienced, by whom and at what frequency may be mediating factors Karriker-Jaffe, Greenfield, & Kaplan, 2017;Lewis-Laietmark et al., 2017). ...
... Consistent with studies suggesting much higher levels of involvement in alcohol-related violence in men (Greenfield et al., 2009;Laslett et al., 2011), we found that females were less likely to experience feeling physically threatened than males. Whilst our study did not find an association between any direct harm and low mental well-being in adjusted analyses, similar to other studies we found associations between individual harms and low mental well-being (Bellis et al., 2018;Greenfield et al., 2016;Karriker-Jaffe et al., 2017;Lewis-Laietmark et al., 2017). Participants experiencing alcohol-related financial issues, emotional neglect and property damage were twice as likely to report low mental well-being than individuals who had not experienced these harms. ...
Aim:
To explore the nature and magnitude of alcohol's harms to others (AHTOs), and associations with mental well-being.
Methods:
Cross-sectional survey implemented amongst 891 randomly selected Welsh residents (aged 18+ years), via computer assisted telephone interviews. Questions established past 12-month experience of nine direct harms resulting from another person's alcohol consumption (e.g. violence) and five linked outcomes (e.g. concern for a child). The source (e.g. partner/stranger) and frequency of the AHTO were collected, and respondents' socio-demographics, drinking behaviours and mental well-being status.
Results:
During the past 12 months, 43.5% of respondents had experienced at least one direct harm (45.5% at least one direct harm/linked outcome). In demographically adjusted analyses, the odds of experiencing any direct harm decreased sequentially as age group increased (Adjusted Odds Ratio [AORs]: 1.9 [age 65-74 years] - 4.2 [age 18-34 years]), and was higher amongst binge drinkers (AOR, 1.5, p < 0.05). Associations between age group and suffering the direct harms anxiety, disrupted sleep, feeling threatened, property damage and emotional neglect were found. Experience of feeling threatened was lower amongst females (AOR 0.6, p < 0.05). In demographically adjusted analyses, low mental well-being was higher amongst those who had suffered alcohol-related financial issues (AOR 2.2, p < 0.001), emotional neglect (AOR 2.3, p < 0.01) and property damage (AOR 2.2, p < 0.05).
Conclusion:
AHTOs place a large, although unequal burden on adults in Wales. Individuals' drinking patterns are associated with experience of AHTOs. Critically, experience of some harms is associated with low mental well-being.
... Past studies have analyzed the association between exposure to AHTO and HRQoL and mental well-being [6,18,19]; however, these only assessed participants' general characteristics, socioeconomic status, and frequency of exposure to an excessive drinker [13], without considering other factors related to HRQoL, such as activity limitation [20], body mass index [21], physical activity [22], smoking habits [23], and history of chronic diseases [24,25]. ...
... In this study, exposure to AHTO was higher among the unemployed, but there was no association with household income. Similarly, previous studies reported no significant relationship between exposure to AHTO and low economic status [14,19]. These findings suggest that high exposure to AHTO is associated with behavioral factors (e.g., the individual's involvement in high-risk drinking), health-related factors (e.g., stress level and subjective health status), and environmental factors (e.g., the presence of heavy drinkers around the individual) as well as low SES. ...
This study aimed to investigate the association between exposure to alcohol’s harm to others (AHTO) and health-related quality of life HRQoL using a nationally representative sample. Data from 2016–2018 of 17,346 South Korean individuals aged ≥19 years were obtained from the Korea National Health and Nutrition Examination Survey. HRQoL was evaluated using the European Quality of Life–5 Dimensions (EQ-5D) index. A significant positive association was found between exposure to AHTO and lower EQ-5D scores (p = 0.022). In the final model of multiple regression analysis, participants’ HRQoL decreased by 0.932 points when exposed to AHTO (R2 = 36.5%, p < 0.001). In addition, the exposure to AHTO group had significantly higher odds ratios (OR) for pain/discomfort (OR: 1.42, 95% CI: 1.15–1.75) and anxiety/depression (OR: 1.55, 95% CI: 1.68–2.80) compared to the non-AHTO group. Further studies are required for intervention when exposed to reduce the pain/discomfort and anxiety/depression in AHTO victims as well as to reduce the incidence of AHTO.
... 5 Those with higher educational attainment were more likely to experience any harm in a Canadian study. 30 The current study shows that being retired lowers the odds of experiencing harm and aggressive harm compared with all other employment statuses. This association was independent of age. ...
... A cross-sectional survey in Canada also reported that those who were retired were least likely to experience harm. 30 Data from two surveys conducted in the USA show that those who were unemployed were significantly more likely to experience AHTO than those who were employed. 23 24 Data from Denmark show that employment might be significantly associated with experiencing harm but no conclusive results were provided, and the wide CIs show that estimates lacked precision. ...
Objectives
To estimate the prevalence, the frequency and the perpetrators of alcohol-related harm to others (AHTO) and identify factors associated with experiencing harm and aggressive harm.
Design
Cross-sectional survey.
Setting
England.
Participants
Adults (general population) aged 16 and over.
Outcome measures
Percentage of respondents who experienced harm. Socioeconomic and demographic factors associated with the outcomes. Outcomes were (1) experienced harm/did not experience harm and (2) experienced aggressive harm (physically threatened, physically hurt and forced/pressured into something sexual)/did not experience an aggressive harm (no aggressive harm plus no harm at all).
Results
Data to support a response rate calculation were not collected; 96.3% of people surveyed completed the AHTO questions. The weighted sample was 4874; 20.1% (95% CI 18.9 to 21.4, N=980) reported experiencing harm in the previous 12 months and 4.6% (95% CI 4.0 to 5.4, N=225) reported experiencing an aggressive harm. Friends and strangers were the dominant perpetrators. Most harms (74.8%) occurred less than monthly. Factors associated with experiencing harm were: younger age (p<0.001), drinking harmfully/hazardously (p<0.001), white British (p<0.001 compared to other white groups and Asian groups and p=0.017 compared to black groups), having a disability (p<0.001), being educated (p<0.001 compared to no education) and living in private rented accommodation (p=0.004 compared with owned outright). Being in the family stage of life (defined as having children in the household) had significantly lower odds of harm (p=0.006 compared to being single), as did being retired (p<0.001 compared to being employed). Factors associated with experiencing an aggressive harm were similar.
Conclusions
This exploratory study, using data collected through the Alcohol Toolkit Survey, shows that AHTO affects 20.1% of the population of England. Even apparently minor harms, like being kept awake, can have a negative impact on health, while aggressive harms are clearly of concern. Using a standard methodology to measure harm across studies would be advantageous. Policies that focus on alcohol must take into consideration the impact of drinking on those other than the drinker.
... However, while most studies assessed only a self-rated degree of impact on personal wellbeing and compared subgroups of individuals reporting HTO, only a few studies compared health-related variables in individuals experiencing HTO to individuals reporting no HTO, and all these studies were restricted to alcohol-related harm. In general, knowing that heavy drinking was related to lower self-rated health [23,25] and lower quality of life and/or wellbeing [25][26][27][28][29], increasing with the number of known heavy drinkers, the number of types of harm were more pronounced in more closely associated relationships or individuals living in one household with the heavy-drinking person. ...
Aims:
To estimate the prevalence of family members affected by addictive disorders (FMA) with regard to various types of addictive disorders, and self-rated health and depression in the general population.
Design:
Cross-sectional general population survey.
Setting:
The "German Health Update" study GEDA 2014/2015, a nationally representative panel of German residents aged 15 or older.
Participants:
24,824 residents aged 15 years or older.
Measurements:
Participants were asked if they had a family member with current or past addictive disorder, the type of addiction and the relationship status. In addition, self-rated health and depression were assessed using standardized questionnaires.
Findings:
9.5% (95% confidence interval (CI) 9.0-10.0) of respondents reported being affected by a current addictive disorders of a relative (cFMA), with a further 4.5% (95% CI 4.2-4.9) reported having been affected by the addictive disorders of a relative in the past but not within the last 12 months (pFMA). Most FMAs reported having been affected by disorders due to alcohol, followed by cannabis and other drugs. Compared with lifetime non-FMAs, FMAs reported significantly (p<.001) higher Odds Ratios for depression (cFM 2.437; 95% CI 2.082-2.853; pFMA 1.850; 95% CI 1.519-2.253) and ill-health (cFMA 1.574; 95% CI 1.374-1.805; pFMA 1.297; 95% CI 1.082-1.555).
Conclusions:
In Germany, family members affected by addictive disorder are a substantial group within the general population. This groups is characterised by ill-health and has not yet been adequately addressed by the addiction treatment system.
... This disorder causes various types of physical and mental disability at considerable levels (Samokhvalov, Popova, Room, Ramonas, & Rehm, 2010) and is closely associated with high mortality through serious comorbid medical conditions such as heart disease, stroke, cancer, and liver cirrhosis (Schuckit, 2009;Schwarzinger, Thi ebaut, Baillot, Mallet, & Rehm, 2017). Moreover, AUD can become a psychological and financial burden on the patient's family, friends, and coworkers, as well as the surrounding community and society at large (Greenfield, Karriker-Jaffe, Kaplan, Kerr, & Wilsnack, 2015;Lewis-Laietmark et al., 2017). Despite such harmful outcomes, the treatment rate for AUD is known to be unacceptably low (Hasin, Stinson, Ogburn, & Grant, 2007;Shield, Rehm, Rehm, Gmel, & Drummond, 2014). ...
Introduction
Although screening tools are available for alcohol use disorders (AUD), such as the Alcohol Use Disorders Identification Test (AUDIT), these tools do not directly qualify individual drinking behavior for patients with AUD. Therefore, the aim of this study was to develop a new self-report questionnaire for identify the characteristic of drinking behavior pattern in patients with AUD.
Methods
The study team developed a self-administered 20-item questionnaire for drinking behavior pattern (DBP-20) based on semistructured interviews of patients with AUD. The DBP-20 and AUDIT were administered to 232 patients with AUD and 222 normal drinkers (1 ≤ AUDIT < 20) as controls. Exploratory factor analysis of the DBP-20 was conducted for patients with AUD, followed by comparisons of its item and subscale scores between patients with AUD and controls. Correlations of AUDIT with total and subscale scores of the DBP-20 were also analyzed. Receiver operating characteristic (ROC) analyses for the DBP-20 and its subscales were performed to distinguish patients with AUD from controls.
Results
Exploratory factor analysis revealed a multidimensional 4-factor model of the DBP-20: coping with negative affect, automaticity, enhancement, and social use. Significant differences in DBP-20 total and subscale scores were observed for patients with AUD versus controls for all factors, except the social use subscale. Both the coping with negative affect and automaticity subscale scores as well as total DBP-20 scores were highly correlated with AUDIT scores. Total DBP-20 scores showed the greatest sensitivity, negative predictive value, and area under the ROC curve to distinguish patients with AUD from normal drinkers.
Conclusion
Drinking as coping with negative affect and automaticity may be specific for patients with AUD. DBP-20 may help patients with AUD to be aware of their own targeted problematic drinking behaviors and seek their personalized behavioral approaches in a collaborative relationship with therapists.
... While mental health problems may lead to increased risk for problematic drinking, alcohol use itself is a significant risk factor for depression and suicide (Norström and Rossow, 2016). Heavy drinking and AUD increase psychological and financial burdens on individuals who engage in these behaviors (Lewis-Laietmark et al., 2017;Greenfield et al., 2015). Therefore, increased alcohol use may exacerbate mental health problems such as depression experienced during the COVID-19 pandemic. ...
Physical distancing measures to curb COVID-19 transmission introduced mental health and economic stressors, possibly impacting problematic drinking. This cross-sectional study examines mental health and economic stressors early in the COVID-19 pandemic which may be associated with heavy alcohol use and increased alcohol use. We administered an online survey of U.S. adults via social media April 5 to May 5, 2020. High-risk drinking was defined by WHO risk drinking levels, a daily average of ≥4 drinks for men and ≥3 drinks for women. Participants reported retrospective assessments of increased alcohol use if their past-week alcohol consumption exceeded their past-year average weekly alcohol consumption. We used logistic regression to assess possible covariates of high-risk drinking and increased alcohol use. Among 2175 participants, 10% (n = 222) reported high-risk drinking, and 36% (n = 775) reported increased alcohol consumption. In multivariable analysis, high-risk drinking was significantly associated with household job loss (OR = 1.41, 95%CI = (1.06, 1.88)) and depressive symptoms (OR = 1.05, 95% CI = (1.02, 1.07)), and women had higher odds of high-risk drinking than men (OR = 2.37, 95% CI = (1.32, 4.69)). Previous mental health diagnosis was not significantly associated with high-risk drinking during the pandemic (OR = 1.31, 95% CI = (0.98, 1.76)) in univariable analysis. High-risk drinkers were more almost six times as likely to report retrospective assessments of increased alcohol consumption, controlling for mental health and economic stressors (OR = 5.97, 95% CI = (4.35, 8.32)). Findings suggest a need for targeted interventions to address the complex mental health and economic stressors that may increase alcohol consumption and high-risk drinking during and after the pandemic.
... Excessive alcohol consumption has been recognized as one of the leading preventable risk factors of premature loss of health due to either numerous health disorders or injuries leading to a considerable social burden [1]. Moreover, these consequences include effects on people other than drinkers themselves [2]. Despite a slight decline within the last few years, the alcohol-attributable social health burden still remains, particularly high in Central and Eastern Europe. ...
Background:
The article analyzes selected indicators of alcohol use (weekly use, drunkenness within last month) and the ability of adolescents to buy alcohol in Slovakia between 2010 and 2018.
Methods:
Health Behavior in School-Aged Children (HBSC) is a cross-sectional questionnaire study. A standardized uniform questionnaire was used to create a representative sample of 15-year-old adolescents. Two surveys carried out in Slovakia in 2010 (n = 1568) and 2018 (n = 1298) were analyzed.
Results:
Weekly alcohol use and drunkenness declined only in boys, not in girls. Affordability of alcohol (not being prevented from buying it) declined among weekly drinking boys (from 60.4 to 34.1%) but remained almost unchanged in girls from a higher socioeconomic group compared to those from a lower one (57.9% vs. 30.6% in 2018).
Conclusions:
Affordability of alcohol in boys decreased with a decline in alcohol use, corresponding with implemented legislative measures. However, it remained unchanged in girls from a higher socioeconomic group.
... These recent findings are consistent with the well-demonstrated relationship of excessive alcohol consumption to numerous adverse health consequences [2][3][4][5], and to increased morbidity and mortality worldwide [6][7][8]. Excessive alcohol consumption additionally places psychological and financial burdens not only on those who engage in these behaviors, but also their families, friends, coworkers and society as a whole [9,10]. Many studies have identified individual-level determinants of alcohol consumption [2,3,11], but. ...
Background
Alcohol use and abuse constitute a major public health problem and identifying their determinants is a priority. Social network analysis can indicate how characteristics of social networks are related to individual health behaviors. A growing number of studies have used social network analysis to examine how social network characteristics influence adult alcohol consumption, but this literature has never been systematically reviewed and summarized. The current paper systematically reviews empirical studies that used social network analysis to assess the influence of social network characteristics on drinking behaviors in adults.MethodsA literature search of PubMed/MEDLINE, EMBASE, PsycINFO and Web of Science databases and a review of the reference lists of retrieved articles was conducted in March 2019. Two reviewers independently screened 5,510 non-duplicate records, and further screened the full text of 150 articles to determine their eligibility for inclusion. Seventeen articles were judged eligible and included.ResultsMost studies were conducted among young adults (mean age
... Appendix 2: An overview of all surveys included in this review and their key features68% of respondents completed the web questionnaire, 32% were interviewed by telephone8 The original 2008 survey included 2,649 respondents, however to be eligible, respondents had to have completed both the 2008 and 2011 survey leaving a sample size of 1,106. A sub-sample of 83 respondents who experienced harm in 2008 and 2011, or stopped experiencing harm between 2008 and 2011 were also analysed to gain a deeper understanding risk in the car …forced or pressured into sex …they negatively affected a social occasion …had to stop seeing them …failure to do something they were counted on to do …break or damage something that mattered to you …couldn't bring friends home …they did not do their share of their work around the house …had to leave home or sleep somewhere else …less money for household expenses The original 2008 survey included 2,649 respondentsto be eligible, respondents had to have completed both surveys 10 A sub-sample of 83 respondents were analysed for greater insight11 Drawn from a larger sample of 6,957: to be eligible, participants had to have data relating to depression12 Measures of distress and depression were not over a specific period, measures of harm were over the previous 12 months 13 Measured using the 'Center for Epidemiologic Studies Depression scale (CES-D8)'14 Based on "How much distress are you currently experiencing in your life?" divided into at least some distress and not much/none risk in the car when they were driving …forced or pressured into sex or something sexual …break or damage something that mattered to you …had to take on extra responsibilities caring for children or others …could not bring friends home …had to leave home to stay somewhere else …avoid seeing other friends/family because you were embarrassed …injured in a car accident In the analysis all measures relating to healthcare were collapsed into a single variable defined as 'experiencing/not experiencing having to use health services' leave home and stay elsewhere …forced or pressured into sex or something sexual …gone out of your way to avoid drunk people or places where drinkers are known to hang out …been kept awake at night or disturbed …been annoyed by people vomiting, urinating or littering …experienced trouble or noise related to licensed venue …felt unsafe waiting for or using public transport …felt unsafe in any other public place ...
... While researchers have not studied the consequences of experiencing these harms on the college experience in detail, preliminary evidence suggests that students who experience HTO tend to have lower grades and lower satisfaction with school, and these effects may be larger for students who do not drink (Cabalatungan, 2015). Furthermore, the general HTO literature concludes that people who experience HTO, particularly from known drinkers, are more likely to experience distress (Karriker-Jaffe et al., 2017) and reduced mental health Lewis-Laietmark et al., 2017). ...
Background:
A growing literature shows that drinkers can harm bystanders through alcohol-related harms to others (HTO). The burden of HTO is particularly consequential in college environments, where heavy alcohol consumption and related harms are highly prevalent. A key limitation to the current literature on HTO among college students is that the determinants of HTO in college settings are not well-described.
Objective:
This article presents an evidence- and theory-based conceptual framework of HTO among United States college students.
Methods:
This study used a literature review in Embase, PsycInfo, PubMed, and Web of Science to determine the prevalence of HTO among college students and literature gaps. Researchers supplemented college HTO literature with broader HTO literature to develop a conceptual framework.
Results:
Prevalence estimates for HTO among college populations range from 59% to 84%. Literature on HTO among college students is mostly confined to brief sections of larger surveys. The college HTO literature lacks the level of detail necessary to support methodologically rigorous research.
Conclusions:
HTO are prevalent among college populations but their prevalence and etiology are not well understood. This likely leads to systematic undercounting of the impact of alcohol in college settings, exacerbating the "translation" gap between what the research says is effective and what colleges actually do. Better understanding of HTO mechanisms through which drinkers harm those around them would inform alcohol research and policy on college campuses, and lead to more accurate assessments of the degree to which stronger alcohol policies could benefit all students, regardless of their drinking patterns.
... Surveys conducted in 2008 in Australia Laslett et al., 2010;Mugavin, Livingston, & Laslett, 2014) and New Zealand (Casswell et al., 2011) have now led to a diversity of national studies of harm from others' drinking, in Canada ( Lewis- Laietmark et al., 2017), Ireland (Hope, 2008), Denmark (Seid, Grittner, Greenfield, & Bloomfield, 2015), and Northern Europe ( Moan et al., 2015;Ramstedt et al., 2015). ...
Aims:
Most alcohol research has focused on how drinking harms the drinker. Research on alcohol's harms to others (AHTO) has studied primarily single or small groups of countries. This article describes the methodology of a new multinational study - GENAHTO - of how social and cultural contexts are related to AHTO, from the perspectives of both perpetrators and victims.
Design:
The GENAHTO Project uses surveys in 21 countries that provide data from drinkers who report causing harms to others, and surveys in 16 countries that provide data from victims of AHTO. The countries surveyed vary widely in alcohol policies, drinking cultures, gender-role definitions, and socioeconomic conditions.
Participants:
More than 140,000 men and women, aged 15-84, participated in the surveys.
Measures:
Individual-level measures include demographics, alcohol use patterns, and alcohol-related harms. Regional- and societal-level measures include socioeconomic conditions, drinking patterns, alcohol policies, gender inequality, and income inequality.
Findings:
The project seeks to identify characteristics of AHTO victims and perpetrators; within-country regional differences in AHTO; and associations between national alcohol polices and individual and regional levels of AHTO.
Conclusions:
GENAHTO is the first project to assess AHTO in diverse societies. Its findings can inform policies to abate AHTO in varying cultural contexts.
... H EAVY DRINKING AND alcohol use disorders (AUD) have many adverse consequences (Centers for Disease Control and Prevention, 2018;Grant et al., 2015Grant et al., , 2017Greenfield et al., 2015;Hasin et al., 2017;Lewis-Laietmark et al., 2017), contributing to morbidity and mortality worldwide (Rehm et al., 2003Room et al., 2005). In U.S. adults over the past 10 years, the prevalence of heavy drinking and AUD has increased (Grant et al., 2015(Grant et al., , 2017. ...
Background
Abstinence is often the treatment aim for AUD, but this may deter individuals who prefer drinking‐reduction goals from entering treatment, and be an overly restrictive endpoint in alcohol clinical trials. Non‐abstinent drinking reductions that predict improvement in how individuals feel or function may be useful clinical trial outcomes, e.g., reductions in the 4‐category World Health Organization (WHO) drinking risk levels. To investigate the clinical relevance of these reductions, we examined their relationship to two outcomes of interest to medical providers: liver disease, and positive scores on an alcohol screening measure.
Methods
Current drinkers in a U.S. national survey (n=21,925) interviewed in 2001–02 (Wave 1) and re‐interviewed 3 years later (Wave 2). WHO drinking risk levels, liver disease and the Alcohol Use Disorder Identification Test‐Consumption (AUDIT‐C) were assessed at both waves. Adjusted odds ratios (aOR) were used to indicate the association of change in WHO drinking risk levels with Wave 2 liver disease and AUDIT‐C scores.
Results
Wave 1 very‐high‐risk drinkers who reduced one, two, or three WHO drinking risk levels had significantly lower odds of Wave 2 liver disease (aOR=0.34, 0.23, 0.17) and positive AUDIT‐C scores (aOR=0.27, 0.09, 0.03). Wave 1 high‐risk drinkers who reduced one or two WHO risk levels had significantly lower odds of positive AUDIT‐C scores (aOR=0.61, 0.25). Adjusting for alcohol dependence or AUDIT‐C scoring variations did not affect results.
Conclusions
In the highest‐risk drinkers, reductions in WHO drinking risk levels predicted lower likelihood of liver disease and positive AUDIT‐C scores. Results add to findings that reductions in the 4‐category WHO drinking risk levels are a meaningful indicator of how individuals feel and function, and could serve as non‐abstinent endpoints in clinical trials. Results also connect the WHO risk drinking levels to commonly‐used alcohol screening questions, which may be more familiar to health care providers.
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... Alcohol use is of international public health concern with approximately 3.3 million deaths and 5.1% of the global burden of disease and injury attributable to alcohol consumption in 2014. 1 In addition, there is a growing body of evidence illustrating the harms caused by those who drink alcohol to individuals around them and to wider communities (eg, through alcohol-related violence and antisocial behaviour). [2][3][4] Understanding why people choose particular drink types and whether different drinks elicit Do emotions related to alcohol consumption differ by alcohol type? An international cross-sectional survey of emotions associated with alcohol consumption and influence on drink choice in different settings Kathryn Ashton, 1 Mark A Bellis, 1 Alisha R Davies, 1 Karen Hughes, 1 Open Access different emotions may help inform more effective public health interventions. ...
Objectives
To examine the emotions associated with drinking different types of alcohol, explore whether these emotions differ by sociodemographics and alcohol dependency and whether the emotions associated with different drink types influence people’s choice of drinks in different settings.
Design
International cross-sectional opportunistic survey (Global Drug Survey) using an online anonymous questionnaire in 11 languages promoted through newspapers, magazines and social media from November 2015 to January 2016.
Study population
Individuals aged 18–34 years who reported consumption of beer, spirits, red and white wine in the previous 12 months and were resident in countries with more than 200 respondents (n=21 countries; 29 836 respondents).
Main outcome measures
Positive and negative emotions associated with consumption of different alcoholic beverages (energised, relaxed, sexy, confident, tired, aggressive, ill, restless and tearful) over the past 12 months in different settings.
Results
Alcoholic beverages vary in the types of emotions individuals report they elicit, with spirits more frequently eliciting emotional changes of all types. Overall 29.8% of respondents reported feeling aggressive when drinking spirits, compared with only 7.1% when drinking red wine (p<0.001). Women more frequently reported feeling all emotions when drinking alcohol, apart from feelings of aggression. Respondents’ level of alcohol dependency was strongly associated with feeling all emotions, with the likelihood of aggression being significantly higher in possible dependent versus low risk drinkers (adjusted OR 6.4; 95% CI 5.79 to 7.09; p<0.001). The odds of feeling the majority of positive and negative emotions also remained highest among dependent drinkers irrespective of setting.
Conclusion
Understanding emotions associated with alcohol consumption is imperative to addressing alcohol misuse, providing insight into what emotions influence drink choice between different groups in the population. The differences identified between sociodemographic groups and influences on drink choice within different settings will aid future public health practice to further comprehend individuals’ drinking patterns and influence behaviour change.
... However, while most studies assessed only a self-rated degree of impact on personal wellbeing and compared subgroups of individuals reporting HTO, only a few studies compared health-related variables in individuals experiencing HTO to individuals reporting no HTO, and all these studies were restricted to alcohol-related harm. In general, knowing that heavy drinking was related to lower self-rated health [23,25] and lower quality of life and/or wellbeing [25][26][27][28][29], increasing with the number of known heavy drinkers, the number of types of harm were more pronounced in more closely associated relationships or individuals living in one household with the heavy-drinking person. ...
The purpose of the work is to study the adverse influence of drinkers on the alcohol status of representatives of their microsocial environment. In four regions of Ukraine (Kharkiv, Luhansk and Zaporizhzhia regions, as well as the city of Kyiv), during 2018—2021, 1531 people were examined, who belonged to three qualitatively different comparison groups: patients with alcohol dependence (329 people); healthy relatives of alcohol-dependent patients (238 people) and representatives of the general population (964 people). The main research tools were the questionnaire of the international research consortium GENAHTO (Gender, Alcohol, and Harms to Others) and Alcohol Use Disorders Identification Test (AUDIT). The obtained data were processed by methods of mathematical statistics (variance and cluster analysis) on a computer using Excel 2016 computational tables (with the Data Analysis package) and also the software package SPSS-15. It was shown that the presence of drinkers in the environment (DIE) of the men significantly increases the proportion of people with risky and dangerous alcohol consumption, as well as with probable alcohol dependence, while there was no such effect for women. It has been established that the direction of the influence of DIE on the alcohol status of women depends on the level of alcohol problems in DIE: the prenosological level of these problems in DIE contributes to the alcoholization of women; and the nosological level acts as an anti-risk factor for such alcoholization. It is shown that relatively small changes in the style of alcoholization of the respondents as a result of DIE exposure are accompanied by disproportionately large (many times greater!) changes in the indicators of the harmful effects of alcohol consumption and, especially, in indicators of dependence.
Objectives:. This study aimed to analyse deaths due to external causes in males in northwest Slovakia.
Study design: This was a cross-sectional autopsy study.
Methods: The autopsy registry provided information on fatalities in males in northwest Slovakia due to external causes in 2015. Data were analysed by age, cause of death and blood alcohol concentration (BAC), and the contribution to overall mortality was calculated.
Results: From a total of 305 fatalities, the dominant cause of death was unintentional (other than traffic; 56.7%), followed by intentional (26.6%) and traffic (16.7%). A BAC of ≥0.5 g/kg was found in 43.9% of deaths. Lower levels of BACs (0.5–1.9 g/kg) were observed in relatively high proportions among the younger (aged ≤34 years) and older (aged ≥65 years) males (17.9% and 14.0%, respectively), as well as in the traffic and intentional injury cause of death categories (23.5% and 19.8%, respectively). Male deaths due to external causes had a 6.2% contribution to overall mortality in northwest Slovakia.
Conclusions: Alcohol intoxication frequently co-occurs with fatalities from external causes, including at lower BACs, indicating the harmful role of alcohol at all concentrations.
Full text link: https://reader.elsevier.com/reader/sd/pii/S0033350622000075?token=F575C094FB2DC14078461ADFFC5A3693D2126008439D894E574631C82571F8F7BD38BD6A09B323A56FDFB34E1912A9F7&originRegion=eu-west-1&originCreation=20220215173412
The purpose of the work is to study the adverse influence of drinkers on the affective status of representatives of their microsocial environment. In four regions of Ukraine (Kharkiv, Lugansk and Zaporizhzhia regions, as well as the city of Kyiv), during 2018—2021, 1742 people were examined, who belonged to three qualitatively different comparison groups: patients with alcohol dependence (AD) (393 people); healthy relatives of alcohol-dependent patients (274 people) and representatives of the general population (1075 people). Of these surveyed, respondents were identified who had drinkers in the environment: 288 persons among healthy people and 121 persons among patients with AD. Further research focused on this particular contingent. The main research tool was the questionnaire of the international research consortium GENAHTO (Gender, Alcohol, and Harms to Others) and Hamilton Depression Rating Scale (HDRS). The obtained data were processed by methods of mathematical statistics (variance and cluster analysis) on a computer using Excel 2016 computational tables (with the Data Analysis package) and also the software package SPSS-15. It was shown that the presence of drinkers in environment of the women significantly increases the proportion of people with depressive disorders among them, while among the male respondents, this effect was not found. It was revealed that the presence of drinkers in environment of the women significantly increases the severity of such manifestations of depression as: insomnia, weight loss, sexual dysfunctions; suicidal tendencies and guilt. Using cluster analysis, the following typical symptom complexes (important for choosing the optimal therapeutic tactics) were established: insomnia-somatoform, hypochondriacal and anxiety-agitational (the latter — with a sense of guilt and an increased risk of suicidal activity).
Background
Most of the research on alcohol use and being cyberbullied has focused on the correlation between the two. Less is known about the recent epidemiology of adolescent current alcohol use. Objective: To describe the trends in current alcohol use among adolescence that self-report being cyberbullied across sex and racial/ethnic groups. Methods: The data from the present study came from the national Youth Risk Behavior Surveys (YRBS) from 2011 to 2017. We estimated the prevalence of current alcohol use across years by biological sex and race/ethnicity. Further we tested for linear and quadratic trends. Results: We observed statistically significant decreases in alcohol use cyberbullied (b= −0.12, p < 0.00), and non-cyberbullied individuals (b=-0.15, p < 0.00). Further, we found significant decreases for cyberbullied males (b= −0.10, p < 0.01), females (b= −0.17, p < 0.01) blacks (b= −0.39, p < 0.00), and Hispanics (b= −0.17, p < 0.01). Whites and other races were did not have a significant change. We also found significant decreases for cyberbullied white males and females, black males (b=-0.46, p < 0.03) and females (b= −0.37, p < 0.02), Hispanic males (b=-0.33, p < 0.00). White males and females and other males and females did not have significant changes in alcohol use prevalence. Conclusions: Consistent with national trends, alcohol use among adolescents is decreasing. The decrease is occurring within those that are being cyberbullied. Further research with different data are necessary to further validate these results.
Heavy drinking and alcohol use disorder are major public health problems. Practitioners not specialising in alcohol treatment are often unaware of the guidelines for preventing, identifying, and treating heavy drinking and alcohol use disorder. However, a consensus exists that clinically useful and valuable tools are available to address these issues. Here, we review existing information and developments from the past 5 years in these areas. We also include information on heavy drinking and alcohol use disorder among individuals with co-occurring psychiatric disorders, including drug use disorders. Areas covered include prevention; screening, brief intervention, and referral for treatment; evidence-based behavioural interventions; medication-assisted treatment; technology-based interventions (eHealth and mHealth); and population-level interventions. We also discuss the key topics for future research.
Aims:
Multinational studies of drinking and the harms it may cause typically treat countries as homogeneous. Neglecting variation within countries may lead to inaccurate conclusions about drinking behavior, and particularly about harms drinking causes for people other than the drinkers. This study is the first to examine whether drinkers' self-reported harms to others from drinking vary regionally within multiple countries.
Design setting and participants:
Analyses draw on survey data from 12,356 drinkers in 46 regions (governmental subunits) within 10 countries, collected as part of the GENACIS project (Wilsnack et al., 2009).
Measures:
Drinkers reported on eight harms they may have caused others in the past 12 months because of their drinking. The likelihood of reporting one or more of these eight harms was evaluated by multilevel modeling (respondents nested within regions nested within countries), estimating random effects of country and region and fixed effects of gender, age, and regional prevalence of drinking.
Findings:
Reports of causing one or more drinking-related harms to others differed significantly by gender and age (but not by regional prevalence of drinking), but also differed significantly by regions within countries.
Conclusions:
National and multinational evaluations of adverse effects of drinking on persons other than the drinkers should give more attention to how those effects may vary regionally within countries.
The emergent and growing body of research on alcohol's harm to others (AHTO), or secondhand effects of drinking, has important implications for prevention, intervention, and policy. Those victimized by other drinkers tend to favor effective alcohol policies more than their nonvictimized peers, but often a community's impulse will be to combat AHTO by targeting and stigmatizing individual heavy drinkers, rather than taking a public health approach to reducing harm. Here we discuss opportunities and challenges in selecting ways of reducing AHTO. We make a case for adopting joint public health and individual approaches to reduce AHTO.
Importance
Lack of current and comprehensive trend data derived from a uniform, reliable, and valid source on alcohol use, high-risk drinking, and DSM-IV alcohol use disorder (AUD) represents a major gap in public health information.
Objective
To present nationally representative data on changes in the prevalences of 12-month alcohol use, 12-month high-risk drinking, 12-month DSM-IV AUD, 12-month DSM-IV AUD among 12-month alcohol users, and 12-month DSM-IV AUD among 12-month high-risk drinkers between 2001-2002 and 2012-2013.
Design, Setting, and Participants
The study data were derived from face-to-face interviews conducted in 2 nationally representative surveys of US adults: the National Epidemiologic Survey on Alcohol and Related Conditions, with data collected from April 2001 to June 2002, and the National Epidemiologic Survey on Alcohol and Related Conditions III, with data collected from April 2012 to June 2013. Data were analyzed in November and December 2016.
Main Outcomes and Measures
Twelve-month alcohol use, high-risk drinking, and DSM-IV AUD.
Results
The study sample included 43 093 participants in the National Epidemiologic Survey on Alcohol and Related Conditions and 36 309 participants in the National Epidemiologic Survey on Alcohol and Related Conditions III. Between 2001-2002 and 2012-2013, 12-month alcohol use, high-risk drinking, and DSM-IV AUD increased by 11.2%, 29.9%, and 49.4%, respectively, with alcohol use increasing from 65.4% (95% CI, 64.3%-66.6%) to 72.7% (95% CI, 71.4%-73.9%), high-risk drinking increasing from 9.7% (95% CI, 9.3%-10.2%) to 12.6% (95% CI, 12.0%-13.2%), and DSM-IV AUD increasing from 8.5% (95% CI, 8.0%-8.9%) to 12.7% (95% CI, 12.1%-13.3%). With few exceptions, increases in alcohol use, high-risk drinking, and DSM-IV AUD between 2001-2002 and 2012-2013 were also statistically significant across sociodemographic subgroups. Increases in all of these outcomes were greatest among women, older adults, racial/ethnic minorities, and individuals with lower educational level and family income. Increases were also seen for the total sample and most sociodemographic subgroups for the prevalences of 12-month DSM-IV AUD among 12-month alcohol users from 12.9% (95% CI, 12.3%-17.5%) to 17.5% (95% CI, 16.7%-18.3%) and 12-month DSM-IV AUD among 12-month high-risk drinkers from 46.5% (95% CI, 44.3%-48.7%) to 54.5% (95% CI, 52.7%-56.4%).
Conclusions and Relevance
Increases in alcohol use, high-risk drinking, and DSM-IV AUD in the US population and among subgroups, especially women, older adults, racial/ethnic minorities, and the socioeconomically disadvantaged, constitute a public health crisis. Taken together, these findings portend increases in many chronic comorbidities in which alcohol use has a substantial role.
This paper examines the association between use of protective devices, frequency of acute health problems and health-protection information received by participants engaged in the Prestige oil spill clean-up in Asturias and Cantabria, Spain.
We studied 133 seamen, 135 bird cleaners, 266 volunteers and 265 paid workers selected by random sampling, stratified by type of worker and number of working days. Information was collected by telephone interview conducted in June 2003. The association of interest was summarized, using odds ratios (OR) obtained from logistic regression.
Health-protection briefing was associated with use of protective devices and clothing. Uninformed subjects registered a significant excess risk of itchy eyes (OR:2.89; 95%CI:1.21-6.90), nausea/vomiting/dizziness (OR:2.25; 95%CI:1.17-4.32) and throat and respiratory problems (OR:2.30; 95%CI:1.15-4.61). There was a noteworthy significant excess risk of headaches (OR:3.86: 95%CI:1.74-8.54) and respiratory problems (OR:2.43; 95%CI:1.02-5.79) among uninformed paid workers. Seamen, the group most exposed to the fuel-oil, were the worst informed and registered the highest frequency of toxicological problems.
Proper health-protection briefing was associated with greater use of protective devices and lower frequency of health problems. Among seamen, however, the results indicate poorer dissemination of information and the need of specific guidelines for removing fuel-oil at sea.
Objective:
To examine how sociodemographic factors and alcohol consumption are related to a four-way typology of causing harm to others and/or being harmed by others' and one's own drinking.
Data and methods:
Data from the 2011 Danish national survey (n = 2,569) were analyzed with multi nomial logistic regression.
Results:
Younger age and heavy drinking were significant correlates of both causing harm and being harmed. Women and better educated respondents were more likely to report negative effects on relationship and family from another's drinking. Better educated respondents had higher risks for work, financial, or injury harms from another's drinking. Mean alcohol consumption and risky single occasion drinking were related to both causing harm and being harmed from one's own drinking.
Conclusions:
Drinking variables were the strongest correlates of causing harm and being harmed. Efforts to reduce risky drinking may also help reduce exposures to collateral harm.
Background: The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution.
Methods: Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk–outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990–2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol.
Findings: All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8–58·5) of deaths and 41·6% (40·1–43·0) of DALYs. Risks quantified account for 87·9% (86·5–89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa.
Interpretation: Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.
Aims: To compare alcohol consumption and alcohol problems measures as predictors of current psychological distress.
Design: A household survey. Logistic regression models investigated the association between alcohol measures and high psychological distress.
Setting: New Zealand population sample.
Participants: 12488 adults aged 15 and over.
Measures: Alcohol use was measured by the Alcohol Use Disorders Identification Test (AUDIT). The AUDIT was separated into two component factors, the first 3 items (AUDIT-C) denoting consumption and the remaining 7 items denoting problems. Psychological distress was measured using the K10, with high psychological distress defined as a score of 12 or more.
Findings: A J-shaped association was found between AUDIT score and high psychological distress. High distress was present in 6.5% of the population, 10.1% of abstainers and 35.1% of those with AUDIT scores 20 and over. Excluding abstainers, scores on the AUDIT-C were only associated with an excess of high distress at very high consumption levels indicated by a score of 10 or more. On the problems factor, the percentage with high distress was 4.5% in drinkers scoring 0, 6.1% for scores 1-3, 9.4% for scores 4-7 and 24.1% for scores of 8 or more. Results from logistic regression models including both consumption and problems factors as predictors showed that problems were stronger predictors of psychological distress than was consumption.
Conclusions: The association between alcohol consumption and current mental health is relatively weak, except in the presence of very heavy consumption or alcohol problems.
Quantification of the disease burden caused by different risks informs prevention by providing an account of health loss different to that provided by a disease-by-disease analysis. No complete revision of global disease burden caused by risk factors has been done since a comparative risk assessment in 2000, and no previous analysis has assessed changes in burden attributable to risk factors over time.
METHODS We estimated deaths and disability-adjusted life years (DALYs; sum of years lived with disability [YLD] and years of life lost [YLL]) attributable to the independent effects of 67 risk factors and clusters of risk factors for 21 regions in 1990 and 2010. We estimated exposure distributions for each year, region, sex, and age group, and relative risks per unit of exposure by systematically reviewing and synthesising published and unpublished data. We used these estimates, together with estimates of cause-specific deaths and DALYs from the Global Burden of Disease Study 2010, to calculate the burden attributable to each risk factor exposure compared with the theoretical-minimum-risk exposure. We incorporated uncertainty in disease burden, relative risks, and exposures into our estimates of attributable burden.
FINDINGS In 2010, the three leading risk factors for global disease burden were high blood pressure (7·0% [95% uncertainty interval 6·2-7·7] of global DALYs), tobacco smoking including second-hand smoke (6·3% [5·5-7·0]), and alcohol use (5·5% [5·0-5·9]). In 1990, the leading risks were childhood underweight (7·9% [6·8-9·4]), household air pollution from solid fuels (HAP; 7·0% [5·6-8·3]), and tobacco smoking including second-hand smoke (6·1% [5·4-6·8]). Dietary risk factors and physical inactivity collectively accounted for 10·0% (95% UI 9·2-10·8) of global DALYs in 2010, with the most prominent dietary risks being diets low in fruits and those high in sodium. Several risks that primarily affect childhood communicable diseases, including unimproved water and sanitation and childhood micronutrient deficiencies, fell in rank between 1990 and 2010, with unimproved water and sanitation accounting for 0·9% (0·4-1·6) of global DALYs in 2010. However, in most of sub-Saharan Africa childhood underweight, HAP, and non-exclusive and discontinued breastfeeding were the leading risks in 2010, while HAP was the leading risk in south Asia. The leading risk factor in Eastern Europe, most of Latin America, and southern sub-Saharan Africa in 2010 was alcohol use; in most of Asia, North Africa and Middle East, and central Europe it was high blood pressure. Despite declines, tobacco smoking including second-hand smoke remained the leading risk in high-income north America and western Europe. High body-mass index has increased globally and it is the leading risk in Australasia and southern Latin America, and also ranks high in other high-income regions, North Africa and Middle East, and Oceania.
INTERPRETATION Worldwide, the contribution of different risk factors to disease burden has changed substantially, with a shift away from risks for communicable diseases in children towards those for non-communicable diseases in adults. These changes are related to the ageing population, decreased mortality among children younger than 5 years, changes in cause-of-death composition, and changes in risk factor exposures. New evidence has led to changes in the magnitude of key risks including unimproved water and sanitation, vitamin A and zinc deficiencies, and ambient particulate matter pollution. The extent to which the epidemiological shift has occurred and what the leading risks currently are varies greatly across regions. In much of sub-Saharan Africa, the leading risks are still those associated with poverty and those that affect children.
FUNDING Bill & Melinda Gates Foundation.
To estimate avoidable burden and avoidable costs of alcohol abuse in Canada for the year 2002.
A policy effectiveness approach was used. The impact of six effective and cost-effective alcohol policy interventions aimed to reduce alcohol consumption was modeled. In addition, the effect of privatized alcohol sales that would increase alcohol consumption and alcohol-attributable costs was also modeled. The effects of these interventions were compared with the baseline (aggregate) costs obtained from the second Canadian Study of Social Costs Attributable to Substance Abuse.
It was estimated that by implementing six cost-effective policies from about 900 million to two billion Canadian dollars per year could be saved in Canada. The greatest savings due to the implementation of these interventions would be achieved in the lowering of productivity losses, followed by health care, and criminality. Substantial increases in burden and cost would occur if Canadian provinces were to privatize alcohol sales.
The implementation of proven effective population-based interventions would reduce alcohol-attributable burden and its costs in Canada to a considerable degree.
One possible reason for the continued neglect of statistical power analysis in research in the behavioral sciences is the inaccessibility of or difficulty with the standard material. A convenient, although not comprehensive, presentation of required sample sizes is provided. Effect-size indexes and conventional values for these are given for operationally defined small, medium, and large effects. The sample sizes necessary for .80 power to detect effects at these levels are tabled for 8 standard statistical tests: (1) the difference between independent means, (2) the significance of a product-moment correlation, (3) the difference between independent rs, (4) the sign test, (5) the difference between independent proportions, (6) chi-square tests for goodness of fit and contingency tables, (7) 1-way analysis of variance (ANOVA), and (8) the significance of a multiple or multiple partial correlation.
Proper assessment of the harms caused by the misuse of drugs can inform policy makers in health, policing, and social care. We aimed to apply multicriteria decision analysis (MCDA) modelling to a range of drug harms in the UK.
Members of the Independent Scientific Committee on Drugs, including two invited specialists, met in a 1-day interactive workshop to score 20 drugs on 16 criteria: nine related to the harms that a drug produces in the individual and seven to the harms to others. Drugs were scored out of 100 points, and the criteria were weighted to indicate their relative importance.
MCDA modelling showed that heroin, crack cocaine, and metamfetamine were the most harmful drugs to individuals (part scores 34, 37, and 32, respectively), whereas alcohol, heroin, and crack cocaine were the most harmful to others (46, 21, and 17, respectively). Overall, alcohol was the most harmful drug (overall harm score 72), with heroin (55) and crack cocaine (54) in second and third places.
These findings lend support to previous work assessing drug harms, and show how the improved scoring and weighting approach of MCDA increases the differentiation between the most and least harmful drugs. However, the findings correlate poorly with present UK drug classification, which is not based simply on considerations of harm.
Centre for Crime and Justice Studies (UK).
A subsample (n = 2,550) of the 2005 US National Alcohol Survey of adults was used to estimate prevalence and correlates of six externalities from alcohol abuse--family problems, assaults, accompanying intoxicated driver, vehicular accident, financial problems and vandalized property--all from another's drinking. On a lifetime basis, 60% reported externalities, with a lower 12-month rate (9%). Women reported more family/marital and financial impacts and men more assaults, accompanying drunk drivers, and accidents. Being unmarried, older, white and ever having monthly heavy drinking or alcohol problems was associated with more alcohol externalities. Publicizing external costs of drinking could elevate political will for effective alcohol controls.
To describe the 12-month prevalence of physical and sexual assault, and the association of assault with drinking by the perpetrator.
Population-based survey of 16,480 adult New Zealanders, using computer assisted telephone interviewing (CATI).
Nearly 7% of men and 3% of women reported having been physically assaulted in the previous year, with 44% of these people having suffered more than one assault. One percent of women and 0.4% of men reported sexual assault, with 45% assaulted more than once. More than half of all physical assaults and sexual assaults involved a perpetrator who was reported to have been drinking. Perpetrators who had been drinking at the time were more likely to be strangers or other people outside the respondent's family, rather than relatives, and the assaults were less likely to have occurred inside the respondent's home, compared with assaults where the perpetrator was not drinking. Physical and sexual assaults were also associated with usual drinking patterns of the victims.
Alcohol use by someone other than the victim is involved in more than half of reported assaults. Our findings suggest that, in New Zealand, more than 62,000 physical assaults and 10,000 sexual assaults occur every year which involve a perpetrator who has been drinking. Of these, 10,500 incidents require medical attention and 17,000 involve police. This burden can be reduced using population-based strategies of demonstrated effectiveness.
Alcohol: No Ordinary Commodity - Research and Public Policy Second Edition is a collaborative effort by an international group of addiction scientists to improve the linkages between addiction science and alcohol policy. It presents the accumulated scientific knowledge on alcohol research that has a direct relevance to the development of alcohol policy on local, national, and international levels. It provides an objective analytical basis on which to build relevant policies globally, and informs policy makers who have direct responsibility for public health and social welfare. By locating alcohol policy primarily within the realm of public health, this book draws attention to the growing tendency for governments, both national and local, to consider alcohol misuse as a major determinant of ill health, and to organize societal responses accordingly. The scope of the book is comprehensive and international. The authors describe the conceptual basis for a rational alcohol policy and present new epidemiological data on the global dimensions of alcohol misuse. The core of the book is a critical review of the cumulative scientific evidence in seven general areas of alcohol policy: pricing and taxation; regulating the physical availability of alcohol; modifying the environment in which drinking occurs; drink-driving countermeasures; marketing restrictions; primary prevention programs in schools and other settings; and treatment and early intervention services. The final chapters discuss the current state of alcohol policy in different parts of the world and describe the need for a new approach to alcohol policy that is evidence-based, realistic, and coordinated.
Self-regulation is a complex process that involves consumers’ persistence, strength, motivation, and commitment in order to be able to override short-term impulses. In order to be able to pursue their long-term goals, consumers typically need to forgo immediate pleasurable experiences that are detrimental to reach their overarching goals. Although this sometimes involves resisting to simple and small temptations, it is not always easy, since the lure of momentary temptations is pervasive. In addition, consumers’ beliefs play an important role determining strategies and behaviors that consumers consider acceptable to engage in, affecting how they act and plan actions to attain their goals. This dissertation investigates adequacy of some beliefs typically shared by consumers about the appropriate behaviors to exert self-regulation, analyzing to what extent these indeed contribute to the enhancement of consumers’ ability to exert self-regulation.
This paper examines the association between psychological distress and persons' perceptions of their physical well-being. Associations between psychological distress and ratings of health status within four diverse data sets are examined, controlling for physical health status as well as for sociodemographic variables. The results indicate that, despite variation in the characteristics of the population under study, the mode of data collection employed, and the specific questions used to measure psychological distress, distress remains a statistically significant correlate of perceived health status.
To gain population norms for the short form 36 health survey questionnaire (SF36) in a large community sample and to explore the questionnaire's internal consistency and validity.
Postal survey by using a booklet containing the SF36 and several other items concerned with lifestyles and illness.
The sample was drawn from computerised registers of the family health services authorities for Berkshire, Buckinghamshire, Northamptonshire, and Oxfordshire.
13,042 randomly selected subjects aged 18-64 years.
Scores for the eight health dimensions of the SF36.
The survey achieved a response rate of 72% (n = 9332). Internal consistency of the different dimensions of the questionnaire was high. Normative data broken down by age, sex, and social class were consistent with those from previous studies.
The SF36 is a potentially valuable tool in medical research. The normative data provided here may further facilitate its validation and use.
A 10-question screening scale of psychological distress and a six-question short-form scale embedded within the 10-question scale were developed for the redesigned US National Health Interview Survey (NHIS).
Initial pilot questions were administered in a US national mail survey (N = 1401). A reduced set of questions was subsequently administered in a US national telephone survey (N = 1574). The 10-question and six-question scales, which we refer to as the K10 and K6, were constructed from the reduced set of questions based on Item Response Theory models. The scales were subsequently validated in a two-stage clinical reappraisal survey (N = 1000 telephone screening interviews in the first stage followed by N = 153 face-to-face clinical interviews in the second stage that oversampled first-stage respondents who screened positive for emotional problems) in a local convenience sample. The second-stage sample was administered the screening scales along with the Structured Clinical Interview for DSM-IV (SCID). The K6 was subsequently included in the 1997 (N = 36116) and 1998 (N = 32440) US National Health Interview Survey, while the K10 was included in the 1997 (N = 10641) Australian National Survey of Mental Health and Well-Being.
Both the K10 and K6 have good precision in the 90th-99th percentile range of the population distribution (standard errors of standardized scores in the range 0.20-0.25) as well as consistent psychometric properties across major sociodemographic subsamples. The scales strongly discriminate between community cases and non-cases of DSM-IV/SCID disorders, with areas under the Receiver Operating Characteristic (ROC) curve of 0.87-0.88 for disorders having Global Assessment of Functioning (GAF) scores of 0-70 and 0.95-0.96 for disorders having GAF scores of 0-50.
The brevity, strong psychometric properties, and ability to discriminate DSM-IV cases from non-cases make the K10 and K6 attractive for use in general-purpose health surveys. The scales are already being used in annual government health surveys in the US and Canada as well as in the WHO World Mental Health Surveys. Routine inclusion of either the K10 or K6 in clinical studies would create an important, and heretofore missing, crosswalk between community and clinical epidemiology.
This study explores the associations between individual characteristics such as income and education with health behaviours and utilization of preventive screening.
Data from the Canadian National Population Health Survey (NPHS) 1998-9 were used. Independent variables were income, education, age, sex, marital status, body mass index, urban/rural residence and access to a regular physician. Dependent variables included smoking, excessive alcohol use, physical activity, blood pressure checks, mammography in past year and Pap smear in past 3 years. Logistic regression models were developed for each dependent variable.
13,756 persons 20 years of age and older completed the health portion of the NPHS. In general, higher levels of income were associated with healthier behaviours, as were higher levels of education, although there were exceptions to both. The results for age and gender also varied depending on the outcome. The presence of a regular medical doctor was associated with increased rates of all preventive screening and reduced rates of smoking.
These results expand upon previous data suggesting that socioeconomic disparities in healthy behaviours and health promotion continue to exist despite equal access to medical screening within the Canadian healthcare context. Knowledge, resources and the presence of a regular medical doctor are important factors associated with identified differences.
Economic arguments for acting for health are increasingly important for policymakers, yet to date there has been no consideration of the likely economic burden of alcohol on the global level. A review of existing cost estimates was conducted, with each study disaggregated into different cost areas and the methodology of each element evaluated. The range of figures produced from more robust studies was then applied tentatively on the global level. The reviewed studies suggested a range of estimates of 1.3-3.3% of total health costs, 6.4-14.4% of total public order and safety costs, 0.3 - 1.4 per thousand of GDP for criminal damage costs, 1.0-1.7 per thousand of GDP for drink-driving costs, and 2.7-10.9 per thousand of GDP for work-place costs (absenteeism, unemployment and premature mortality). On a global level, this suggests costs in the range of US dollars 210-665 billion in 2002. These figures cannot be understood without considering simultaneously six key problems: (i) the methods used by each study; (ii) who pays these costs; (iii) the 'economic benefits' of premature deaths; (iv) establishing causality; (v) omitted costs; and (vi) the applicability of developed country estimates to developing countries. Alcohol exerts a considerable economic burden worldwide, although the exact level of this burden is a matter of debate and further research. Policymakers should consider economic issues alongside evidence of the cost-effectiveness of particular policy options in improving health, such as in the WHO's CHOICE project.
There is increasing international interest in the concept of mental well-being and its contribution to all aspects of human life. Demand for instruments to monitor mental well-being at a population level and evaluate mental health promotion initiatives is growing. This article describes the development and validation of a new scale, comprised only of positively worded items relating to different aspects of positive mental health: the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS).
WEMWBS was developed by an expert panel drawing on current academic literature, qualitative research with focus groups, and psychometric testing of an existing scale. It was validated on a student and representative population sample. Content validity was assessed by reviewing the frequency of complete responses and the distribution of responses to each item. Confirmatory factor analysis was used to test the hypothesis that the scale measured a single construct. Internal consistency was assessed using Cronbach's alpha. Criterion validity was explored in terms of correlations between WEMWBS and other scales and by testing whether the scale discriminated between population groups in line with pre-specified hypotheses. Test-retest reliability was assessed at one week using intra-class correlation coefficients. Susceptibility to bias was measured using the Balanced Inventory of Desired Responding.
WEMWBS showed good content validity. Confirmatory factor analysis supported the single factor hypothesis. A Cronbach's alpha score of 0.89 (student sample) and 0.91 (population sample) suggests some item redundancy in the scale. WEMWBS showed high correlations with other mental health and well-being scales and lower correlations with scales measuring overall health. Its distribution was near normal and the scale did not show ceiling effects in a population sample. It discriminated between population groups in a way that is largely consistent with the results of other population surveys. Test-retest reliability at one week was high (0.83). Social desirability bias was lower or similar to that of other comparable scales.
WEMWBS is a measure of mental well-being focusing entirely on positive aspects of mental health. As a short and psychometrically robust scale, with no ceiling effects in a population sample, it offers promise as a tool for monitoring mental well-being at a population level. Whilst WEMWBS should appeal to those evaluating mental health promotion initiatives, it is important that the scale's sensitivity to change is established before it is recommended in this context.
I present software for analysing complex survey samples in R. The sampling scheme can be explicitly described or represented by replication weights. Variance estimation uses either replication or linearisation.
To examine whether alcohol's harms to others are more prevalent in socioeconomically disadvantaged neighbourhoods and whether men or women are at differential risk in these neighbourhoods.
Cross-sectional survey data from 2000 and 2005 National Alcohol Surveys were linked to geo-referenced indicators of neighbourhood disadvantage from the US 2000 Decennial Census. The pooled sample included 10 121 adults (54% female; average age 44.4 years; 69% White; 13% African-American; 13% Hispanic). A dichotomous indicator denoted neighbourhoods based on the top quartile on a five-item measure of disadvantage (alpha = 0.90). We examined past-year family problems due to someone else's drinking (marriage difficulties and/or financial trouble) and victimisation by someone who had been drinking (having property vandalised and/or being pushed, hit or assaulted).
During the prior 12 months, 6% of women and 3% of men experienced family problems from someone else's drinking, and 4% of women and 7% of men reported being victimised by drinkers. Multivariate logistic regression models adjusting for individual-level socioeconomic status and other demographic characteristics showed the relationship between neighbourhood disadvantage and harms from someone else's drinking was moderated by gender, with significantly higher odds of family problems in disadvantaged neighbourhoods for men but not for women, as well as significantly higher odds of crime victimisation in disadvantaged neighbourhoods for women but not men.
Experiences of harms from someone else's drinking in disadvantaged neighbourhoods vary for men and women. Targeted intervention strategies are needed to reduce alcohol's harm to others. [Karriker-Jaffe KJ, Greenfield TK. Gender differences in associations of neighbourhood disadvantage with alcohol's harms to others: A cross-sectional study from the USA. Drug Alcohol Rev 2014].
To examine the association between alcohol use and psychological distress among adolescents in a range of developing countries.
Secondary data analysis of the Global School-Based Student Health Survey was conducted using nationally representative data from 12 developing countries: Botswana, Grenada, Indonesia, Kenya, Myanmar, the Philippines, Saint Lucia, Saint Vincent and the Grenadines, the Seychelles, Thailand, Trinidad and Tobago, and Uganda. The surveys were conducted between 2003 and 2008 and involved 32,001 adolescents primarily aged 13-15 years. We used multivariate logistic regression analysis to determine the association between alcohol use and psychological distress.
The prevalence of past 30-day alcohol use and lifetime drunkenness varied widely across countries, as did the occurrence of psychological distress (anxiety-induced sleeplessness and/or depression). The risk of psychological distress was significantly higher among adolescents when using alcohol in all countries except Myanmar. In nine of the 12 countries, past 30-day alcohol use was associated with psychological distress, while students who had been drunk at least once in their lifetime had an increased risk of experiencing psychological distress in 11 of the study countries.
The high prevalence of alcohol use among adolescents and the strength of the association with psychological distress present a major public health challenge in developing countries. The urgent need to reduce adolescent alcohol use necessitates the implementation of context- and culture-specific strategies that reduce the physical availability of alcohol.
Web surveys appear to be attaining lower response rates than equivalent mail surveys. One reason may be that there is currently little information on effective strategies for increasing response to Internet-based surveys. Web users are becoming more impatient with high-burden Web interactions. The authors examined the decision to respond to a Web survey by embedding a series of experiments in a survey of students at the University of Michigan. A sample of over 4,500 students was sent an e-mail invitation to participate in a Web survey on affirmative action policies. Methodological experiments included using a progress indicator, automating password entry, varying the timing of reminder notices to nonrespondents, and using a prenotification report of the anticipated survey length. Each of these experiments was designed to vary the burden (perceived or real) of the survey request. Results of these experiments are presented.
This chapter differentiates the stressful consequences of social organization from the stressful antecedents of psychological disorder. The pivotal distinction concerns whether the occurrence of stressors is viewed as socially determined, or as independent of social placement. Recent research is evaluated concerning both the social distribution of stress and social variation in response to stress. Two particularly productive areas of inquiry are also reviewed: self-efficacy as a mediator between social position and stress; and the intersection of macro- and micro-stress processes in economic and occupational spheres, with emphasis upon gender stratification. This review concludes that the occurrence of systemic stressors is not necessarily an indication of a social system run amok but may reflect instead the system functioning precisely as it is supposed to function.
Recent epidemiological and social studies have increasingly pointed to the importance of drinking patterns in explaining consequences of alcohol consumption. This paper presents recommendations for research in the area based on the presentations and discussions of the first “International Conference on Social and Health Effects of Different Drinking Patterns” held in Toronto in November 1995. In particular, the social dimension in pattern research, and the relationship between patterns of drinking and causalities as well as social harm, are stressed. The paper also argues for better theories, incorporating knowledge from related basic disciplines. In addition, we emphasize the need for improved methodologies and standardized methods for assessing drinking patterns. Finally, implications of research on drinking patterns for polity and programme development are discussed.
This study examines the impact of a social desirability response bias as a personality characteristic (self-deception and impression management) and as an item characteristic (perceived desirability of the behavior) on self-reported ethical conduct. Findings from a sample of college students revealed that self-reported ethical conduct is associated with both personality and item characteristics, with perceived desirability of behavior having the greatest influence on self-reported conduct. Implications for research in business ethics are drawn, and suggestions are offered for reducing the effects of a socially desirable response bias.
The present meta-analytic review examined the relationship between interpersonal violence and psychological distress, utilizing 50 published or prepublication empirical studies. Studies were included in the review if they quantified psychological distress following childhood sexual or physical abuse, rape, criminal assault, or partner (domestic) physical abuse or rape. The overall effect size, though heterogeneous, was clinically and practically significant, demonstrating empirically that interpersonal violence has deleterious effects on psychological functioning. Within victimized groups, specific objective and subjective stressor-related factors were examined for the magnitude of their effect on resulting psychological distress. Subjective factors, such as general appraisal, self-blame, and perceived life threat, contributed twice as much to the magnitude of psychological distess as did objective factors, such as physical injury, force, and use of a weapon. Generally, psychological distress in the domains of intra- and interpersonal functioning emerged as theoretically and clinically important avenues for further research.
Accurate information concerning alcohol consumption level and patterns is vital to formulating public health policy. The objective of this paper is to critically assess the extent to which survey design, response rate and alcohol consumption coverage obtained in random digit dialling, telephone-based surveys impact on conclusions about alcohol consumption and its patterns in the general population. Our analysis will be based on the Canadian Alcohol and Drug Use Monitoring Survey (CADUMS) 2008, a national survey intended to be representative of the general population. The conclusions of this paper are as follows: (1) ignoring people who are homeless, institutionalized and/or do not have a home phone may lead to an underestimation of the prevalence of alcohol consumption and related problems; (2) weighting of observations to population demographics may lead to a increase in the design effect, does not necessarily address the underlying selection bias, and may lead to overly influential observations; and (3) the accurate characterization of alcohol consumption patterns obtained by triangulating the data with the adult per capita consumption estimate is essential for comparative analyses and intervention planning especially when the alcohol coverage rate is low like in the CADUMS with 34%.
To analyse the links between other people's drinking and mental health and to explore the effects on mental health of heavy and problematic drinkers both within and outside spousal relationships.
A secondary analysis of data obtained as part of the Alcohol's Harm to Others survey from 2622 randomly sampled Australian adults interviewed by telephone between October and December 2008.
Self-reported anxiety or depression and satisfaction with mental wellbeing; the presence of heavy and problematic drinkers in respondents' lives.
Identification of at least one heavy drinker in the respondents' social network of friends, family and co-workers was significantly negatively associated with self-reported mental wellbeing and anxiety or depression. If the heavy drinker was identified by the respondent as someone whose drinking had had a negative impact on their life in the past year, the adverse effect on mental wellbeing and anxiety was much greater.
Our findings support a causal pathway between alcohol use and mental health problems by way of someone else's drinking. The association with adverse mental health is substantial regardless of the type of relationship an individual has with the heavy drinker whose drinking has had an adverse effect on them.
This analysis aimed to estimate the burden of disease and injury caused and prevented by alcohol in 2004 for Canadians aged 0-69 years and compare the effects of different magnitudes of adjustment of survey data on these estimates.
Alcohol indicators were obtained from the Canadian Alcohol and Drug Use Monitoring Survey 2008 and were corrected to 80% coverage using adult per capita recorded and unrecorded consumption. Risk relations were taken from meta-analyses. Estimates of burden of disease and injury were obtained from the World Health Organization.
In 2004, 4,721 (95% CI 1,432-8,150) deaths and 274,663 (95% CI 201,397-352,432) disability-adjusted life years lost (DALYs) of Canadians 0-69 years of age were attributable to alcohol. This represented 7.1% (95% CI 2.1-12.2%) of all deaths and 9.3% (95% CI 6.8-11.9%) of DALYs for this age range. The sensitivity analysis showed that the outcome estimates varied substantially based on the adjusted coverage rate.
More attention to burden of disease and injury statistics is required to accurately characterize alcohol-related harms. This burden is preventable and could be reduced by implementation of more effective policies.
This study aims to document the adverse effects of drinkers in Australia on people other than the drinker.
Cross-sectional survey.
In a national survey of Australia, respondents described the harmful effects they experienced from drinkers in their households, family and friendship networks, as well as work-place and community settings.
A randomly selected sample of 2,649 adult Australians.
Problems experienced because of others' drinking were ascertained via computer-assisted telephone interviews. Respondent and drinker socio-demographic and drinking pattern data were recorded.
A total of 70% of respondents were affected by strangers' drinking and experienced nuisance, fear or abuse, and 30% reported that the drinking of someone close to them had negative effects, although only 11% were affected by such a person 'a lot'. Women were more affected by someone they knew in the household or family, while men were more affected by strangers, friends and co-workers. Young adults were consistently the most negatively affected across the majority of types of harm.
Substantial proportions of Australians are affected by other people's drinking, including that of their families, friends, co-workers and strangers. These harms range in magnitude from noise and fear to physical abuse, sexual coercion and social isolation.
Data are reported on the background and performance of the K6 screening scale for serious mental illness (SMI) in the World Health Organization (WHO) World Mental Health (WMH) surveys. The K6 is a six-item scale developed to provide a brief valid screen for Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV) SMI based on the criteria in the US ADAMHA Reorganization Act. Although methodological studies have documented good K6 validity in a number of countries, optimal scoring rules have never been proposed. Such rules are presented here based on analysis of K6 data in nationally or regionally representative WMH surveys in 14 countries (combined N = 41,770 respondents). Twelve-month prevalence of DSM-IV SMI was assessed with the fully-structured WHO Composite International Diagnostic Interview. Nested logistic regression analysis was used to generate estimates of the predicted probability of SMI for each respondent from K6 scores, taking into consideration the possibility of variable concordance as a function of respondent age, gender, education, and country. Concordance, assessed by calculating the area under the receiver operating characteristic curve, was generally substantial (median 0.83; range 0.76-0.89; inter-quartile range 0.81-0.85). Based on this result, optimal scaling rules are presented for use by investigators working with the K6 scale in the countries studied.
Despite clear evidence of the major contribution alcohol makes to the global burden of disease and to substantial economic costs, focus on alcohol control is inadequate internationally and in most countries. Expansion of industrial production and marketing of alcohol is driving alcohol use to rise, both in emerging markets and in young people in mature alcohol markets. Cost-effective and affordable interventions to restrict harm exist, and are in urgent need of scaling up. Most countries do not have adequate policies in place. Factors impeding progress include a failure of political will, unhelpful participation of the alcohol industry in the policy process, and increasing difficulty in free-trade environments to respond adequately at a national level. An effective national and international response will need not only governments, but also non-governmental organisations to support and hold government agencies to account. International health policy, in the form of a Framework Convention on Alcohol Control, is needed to counterbalance the global conditions promoting alcohol-related harm and to support and encourage national action.
This paper reviews the evidence for the effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol, in the areas of education and information, the health sector, community action, driving while under the influence of alcohol (drink-driving), availability, marketing, pricing, harm reduction, and illegally and informally produced alcohol. Systematic reviews and meta-analyses show that policies regulating the environment in which alcohol is marketed (particularly its price and availability) are effective in reducing alcohol-related harm. Enforced legislative measures to reduce drink-driving and individually directed interventions to already at-risk drinkers are also effective. However, school-based education does not reduce alcohol-related harm, although public information and education-type programmes have a role in providing information and in increasing attention and acceptance of alcohol on political and public agendas. Making alcohol more expensive and less available, and banning alcohol advertising, are highly cost-effective strategies to reduce harm. In settings with high amounts of unrecorded production and consumption, increasing the proportion of alcohol that is taxed could be a more effective pricing policy than a simple increase in tax.
Alcohol consumption has been identified as an important risk factor for chronic disease and injury. In the first paper in this Series, we quantify the burden of mortality and disease attributable to alcohol, both globally and for ten large countries. We assess alcohol exposure and prevalence of alcohol-use disorders on the basis of reviews of published work. After identification of other major disease categories causally linked to alcohol, we estimate attributable fractions by sex, age, and WHO region. Additionally, we compare social costs of alcohol in selected countries. The net effect of alcohol consumption on health is detrimental, with an estimated 3.8% of all global deaths and 4.6% of global disability-adjusted life-years attributable to alcohol. Disease burden is closely related to average volume of alcohol consumption, and, for every unit of exposure, is strongest in poor people and in those who are marginalised from society. The costs associated with alcohol amount to more than 1% of the gross national product in high-income and middle-income countries, with the costs of social harm constituting a major proportion in addition to health costs. Overall, we conclude that alcohol consumption is one of the major avoidable risk factors, and actions to reduce burden and costs associated with alcohol should be urgently increased.
Current issues in alcohol-related violence are highlighted through the examination of correlational studies between alcohol and violent crime. Alcohol is associated with violent crime at a greater than chance level and at a significantly higher level than it is associated with nonviolent crime. Heavy drinking and a verbal argument usually precede the violent act and the victim is as likely as the offender to initiate the altercation. However, it is the precipitator of the altercation who is more likely to be intoxicated. Alcohol and aggression are more strongly related than expected with violent offenders demonstrating psychopathology. Marital violence appears related to alcohol independent of other marital problems. Although there exists a strong correlational relationship between alcohol and violent crime, the nature of the evidence prohibits the establishment of a causal link. In particular, methodological problems, such as a lack of appropriate comparison groups, make it difficult to draw conclusions in this area.
Recent epidemiological and social studies have increasingly pointed to the importance of drinking patterns in explaining consequences of alcohol consumption. This paper presents recommendations for research in the area based on the presentations and discussions of the first "International Conference on Social and Health Effects of Different Drinking Patterns" held in Toronto in November 1995. In particular, the social dimension in pattern research, and the relationship between patterns of drinking and casualties as well as social harm, are stressed. The paper also argues for better theories, incorporating knowledge from related basic disciplines. In addition, we emphasize the need for improved methodologies and standardized methods for assessing drinking patterns. Finally, implications of research on drinking patterns for policy and programme development are discussed.
AIMS, DESIGN AND SETTING: The economic costs of alcohol, tobacco and illicit drugs in Canadian society in 1992 are estimated utilizing a cost-of-illness framework and recently developed international guidelines.
For causes of disease or death (using ICD-9 categories), pooled relative risk estimates from meta-analyses are combined with prevalence data by age, gender and province to derive the proportion attributable to alcohol, tobacco and/or illicit drugs. The resulting estimates of attributable deaths and hospitalizations are used to calculate associated health care, law enforcement, productivity and other costs. The results are compared wit other studies, and sensitivity analyses are conducted on alternative measures of alcohol consumption, alternative discount rates for productivity costs and the use of diagnostic-specific hospitalization costs.
The misuse of alcohol, tobacco and illicit drugs cost more than $18.4 billion in Canada in 1992, representing $649 per capita or 2.7% of GDP. Alcohol accounts for approximately $7.52 billion in costs, including $4.14 billion for lost productivity, $1.36 billion for law enforcement and $1.30 billion in direct health care costs. Tobacco accounts for approximately $9.56 billion in costs, including $6.82 billion for lost productivity and $2.68 billion for direct health costs. The economic of illicit drugs are estimated at $1.4 billion.
Substance abuse exacts a considerable toll to Canadian society in terms of illness, injury, death and economic costs.
The comparability of general population studies on alcohol from nine European countries is evaluated from three points of view: (1) methodologic aspects influencing alcohol estimates, (2) variation between countries in coverage of sales estimates of alcohol consumption, and (3) associations between type of question used to measure alcohol consumption and gender differences in alcohol consumption. With respect to methodologic aspects, it was found that the studies differed on most of the 10 points included in this comparison. The coverage of sales estimates by surveys varies between 39% (Germany) and 56% (France). With respect to type of question and gender differences, it was found that more elaborate sets of questions on alcohol consumption are associated with smaller gender differences in the prevalence of heavy drinking (>600 g 100% alc/mo). It is concluded that the methodologic differences between studies and the differences in sales coverage do not allow cross-national comparison of survey estimates of alcohol consumption of different European countries. Compared with more elaborate sets of questions on alcohol consumption, simple questions on alcohol consumption are likely to underestimate gender differences in the prevalence of heavier drinking.
Public Law 102-321 established a block grant for adults with "serious mental illness" (SMI) and required the Substance Abuse and Mental Health Services Administration (SAMHSA) to develop a method to estimate the prevalence of SMI.
Three SMI screening scales were developed for possible use in the SAMHSA National Household Survey on Drug Abuse: the Composite International Diagnostic Interview Short-Form (CIDI-SF) scale, the K10/K6 nonspecific distress scales, and the World Health Organization Disability Assessment Schedule (WHO-DAS). An enriched convenience sample of 155 respondents was administered all screening scales followed by the 12-month Structured Clinical Interview for DSM-IV and the Global Assessment of Functioning (GAF). We defined SMI as any 12-month DSM-IV disorder, other than a substance use disorder, with a GAF score of less than 60.
All screening scales were significantly related to SMI. However, neither the CIDI-SF nor the WHO-DAS improved prediction significantly over the K10 or K6 scales. The area under the receiver operating characteristic curve of SMI was 0.854 for K10 and 0.865 for K6. The most efficient screening scale, K6, had a sensitivity (SE) of 0.36 (0.08) and a specificity of 0.96 (0.02) in predicting SMI.
The brevity and accuracy of the K6 and K10 scales make them attractive screens for SMI. Routine inclusion of either scale in clinical studies would create an important, and heretofore missing, crosswalk between community and clinical epidemiology.
This study considered whether monthly variation in self-reports of recent alcohol consumption differs systematically by race.
Telephone survey data collected by the Centers for Disease Control's Behavioral Risk Factor Surveillance System (BRFSS) were used to measure self-reports of drinking and heavy episodic drinking in the 30 days before the interview. The sample (N = 1,087,813) comprises adults over the years 1985-2000. Monthly variation in self-reports of any drinking and heavy episodic use were evaluatedusing logistic regression, controlling for demographic characteristics, year effects and state clustering.
The previously documented "January effect" in past month alcohol consumption--that people interviewed in January are much more likely to report drinking behavior relative to the overall odds--is found to exist for every racial group. Seasonal variation in reports of heavy episodic use, however, differs substantially by race. Black and white respondents are more likely to report this behavior when interviewed in January, whereas the associated peak for Hispanic men is in June. Asians reveal no significantly different heavy episodic drinking behavior in any month relative to the overall odds. Cultural specific factors may contribute to this racial variation in heavy episodic drinking behavior.
Demographic characteristics, such as race and ethnicity are important determinants of seasonal variation in self-reports of recent alcohol consumption and should be taken into account by researchers and policymakers.
To compare alternative survey methods for estimating (a) levels of at risk alcohol consumption and (b) total volume of alcohol consumed per capita in comparison with estimates from sales data and to investigate reasons for under-reporting.
The homes of respondents who were eligible and willing to participate.
A total of 21,674 Australians aged 14 years and older.
A 2001 national household survey of drug use, experiences and attitudes with weights applied for age, sex, geographic location and day of week of interview.
Self-completion questionnaire using quantity-frequency (QF) and graduated-frequency (GF) methods plus two questions about consumption 'yesterday': one in standard drinks, another with empirically based estimates of drink size and strength.
The highest estimate of age 14 + per capita consumption of 7.00 l of alcohol derived from recall of consumption 'yesterday' or 76.8% of the official estimate. The lowest was QF with 49.8%. When amount consumed 'yesterday' was recalled in standard drinks this estimate was 5.27 l. GF questions yielded higher estimates than did QF questions both for total volume (5.25 versus 4.54 l) and also for the proportion of the population at risk of long-term alcohol-related harm (10.6%versus 8.1%). With the detailed 'yesterday' method 61% of all consumption was on high risk drinking days.
Questions about typical quantities of alcohol consumed can lead to underestimates, as do questions about drinking 'standard drinks' of alcohol. Recent recall methods encourage fuller reporting of volumes plus more accurate estimates of unrecorded consumption and the proportion of total alcohol consumption that places drinkers at risk of harm. However, they do not capture longer-term drinking patterns. It is recommended that both recent recall and measures of longer-term drinking patterns are included in national surveys.
To explore the extent and distribution of experienced negative consequences from other people's drinking and to explore what characterizes the victims of these harms. DESIGN, PARTICIPANTS AND MEASUREMENTS: Cross-sectional survey in a national sample of adults. Net sample comprised 2170 respondents. Negative consequences from others' drinking during the past 12 months were assessed by seven items.
The more severe types of consequences (being physically hurt or property damage) were reported less often (by 3.1% and 4.8%, respectively) than the least severe type of consequence (being kept awake at night by drunk people, reported by 21.2%), thus leaving the four other types of consequences (being harassed in public places, being harassed in private parties, being scolded at and being afraid of drunk people in public areas) somewhere in between. The extent to which the respondents had been subject to social harm from others' drinking displayed a very skewed distribution. The majority reported not to have experienced any such harms, whereas a small proportion had been harmed repeatedly and in various ways. Multivariate analyses showed that social harms from others' drinking were most often reported by younger persons, women, those with high education level, those who reported a higher annual alcohol intake, more frequent episodes of intoxication and more frequent visits to public drinking places. The impact of intoxication frequency on victimization from alcohol-related social harms was stronger for women than for men. Similar individual characteristics were also associated with victimization from physical harm and victimization in the public sphere.
Relatively minor harms from others' drinking are experienced quite frequently. The social victims of others' drinking tend to drink heavily themselves, yet in contrast to what characterizes social consequences of own drinking, we find that the burden of social harms from others' drinking is to a larger extent carried by women than by men.
Two new screening scales for psychological distress, the K6 and K10, have been developed but their relative efficiency has not been evaluated in comparison with existing scales.
The Australian National Survey of Mental Health and Well-Being, a nationally representative household survey, administered the WHO Composite International Diagnostic Interview (CIDI) to assess 30-day DSM-IV disorders. The K6 and K10 were also administered along with the General Health Questionnaire (GHQ-12), the current de facto standard of mental health screening. Performance of the three screening scales in detecting CIDI/DSM-IV mood and anxiety disorders was assessed by calculating the areas under receiver operating characteristic curves (AUCs). Stratum-Specific Likelihood Ratios (SSLRs) were computed to help produce individual-level predicted probabilities of being a case from screening scale scores in other samples.
The K10 was marginally better than the K6 in screening for CIDI/DSM-IV mood and anxiety disorders (K10 AUC: 0.90, 95%CI: 0.89-0.91 versus K6 AUC: 0.89, 95%CI: 0.88-0.90), while both were significantly better than the GHQ-12 (AUC: 0.80, 95%CI: 0.78-0.82). The SSLRs of the K10 and K6 were more informative in ruling in or out the target disorders than those of the GHQ-12 at both ends of the population spectrum. The K6 was more robust than the K10 to subsample variation.
While the K10 might outperform the K6 in screening for severe disorders, the K6 is preferred in screening for any DSM-IV mood or anxiety disorder because of its brevity and consistency across subsamples. Precision of individual-level prediction is greatly improved by using polychotomous rather than dichotomous classification.
Telephone surveys are critical for examining cross-sectional characteristics of population subgroups, tracking trends in prevalence of conditions and risk behaviors over time, identifying risk factors associated with multiple health conditions, and assessing the effects of interventions. Technology has aided telephone research through advances such as computer-assisted telephone interviewing. However, technology such as answering machines and caller ID has contributed to declines in response rates and has increased costs of conducting telephone surveys. The exponential increase in cell phone utilization presents a challenge to the tradition of random digit dial (RDD) surveys of households. Because telephone surveys are used by other industries such as marketing and public opinion polling, the marketplace may help drive innovation and adaptation. Cell phones have made telephone communication an even greater part of the everyday culture and could make potential telephone survey respondents even more accessible to public health researchers.
The aim of this study was to estimate costs attributable to substance use and misuse in Canada in 2002.
Based on information about prevalence of exposure and risk relations for more than 80 disease categories, deaths, years of life lost, and hospitalizations attributable to substance use and misuse were estimated. In addition, substance-attributable fractions for criminal justice expenditures were derived. Indirect costs were estimated using a modified human capital approach.
Costs of substance use and misuse totaled almost Can. $40 billion in 2002. The total cost per capita for substance use and misuse was about Can. $1,267: Can. $463 for alcohol, Can. $262 for illegal drugs, and Can. $541 for tobacco. Legal substances accounted for the vast majority of these costs (tobacco: almost 43% of total costs; alcohol: 37%). Indirect costs or productivity losses were the largest cost category (61%), followed by health care (22%) and law enforcement costs (14%). More than 40,000 people died in Canada in 2002 because of substance use and misuse: 37,209 deaths were attributable to tobacco, 4,258 were attributable to alcohol, and 1,695 were attributable to illegal drugs. A total of about 3.8 million hospital days were attributable to substance use and misuse, again mainly to tobacco.
Substance use and misuse imposes a considerable economic toll on Canadian society and requires more preventive efforts.