Cannabis Policy and Consumption: Taking into account Substitution Effects

Background: Previous studies examining the cannabis-alcohol substitution effect have found that medical cannabis policies may result in substituting the use of cannabis in place of alcohol use. Objectives: This study adds to the literature on cannabis-alcohol substitution by analyzing the effect of decriminalization, medicinal cannabis, and adult-use legalization cannabis policies (2002-2019) on cannabis and alcohol use and substance substitution for all 50 states and the District of Columbia (N=867). Results: Results support the notion that liberalized cannabis policies can increase the prevalence of cannabis use. An adult-use legalization specific analysis yielded findings suggesting a complex and heterogenous effect of such laws on cannabis-alcohol complementation. Conclusion: Given the lack of clarity and heterogenous effects of cannabis laws, policy makers should carefully take into consideration the benefits of medical cannabis laws, along with the risks of decriminalization and adult-use legalization.

Association between Alcohol Consumption and Health-Related Quality of Life among Hospital and Ambulatory Care Patients with Past Year Depressive Symptoms

BACKGROUND

Little is known about how substance use affects health-related quality of life (HRQOL) in depressed individuals. Here, associations between alcohol consumption and HRQOL in hospital and ambulatory care patients with past-year depressive symptoms are analyzed.

METHOD

The sample consisted of 590 participants (26.8% non-drinkers) recruited via consecutive screenings. Individuals with alcohol use disorders were excluded. HRQOL was assessed with the Veterans Rand 12-item health survey (VR-12). Multivariable fractional polynomials (MFP) regression analyses were conducted (1) to test for non-linear associations between average daily consumption and HRQOL and (2) to analyze associations between alcohol consumption and the physical and mental health component summaries of the VR-12 and their subdomains.

RESULTS

Alcohol consumption was positively associated with the physical health component summary of the VR-12 (p = 0.001) and its subdomains general health (p = 0.006), physical functioning (p < 0.001), and bodily pain (p = 0.017), but not with the mental health component summary (p = 0.941) or any of its subdomains. Average daily alcohol consumption was not associated with HRQOL.

CONCLUSION

Alcohol consumption was associated with better physical HRQOL. Findings do not justify ascribing alcohol positive effects on HRQOL. Data indicate that non-drinkers may suffer from serious health disorders. The results of this study can inform the development of future alcohol- and depression-related interventions.

Prospective associations between alcohol consumption and psychological well-being in midlife

BACKGROUND

Alcohol consumption potentially influences psychological well-being in beneficial and harmful ways, but prospective studies on the association show mixed results. Our main purpose was to examine prospective associations between alcohol consumption and psychological well-being in middle-aged men and women.

METHODS

The study sample included 4148 middle-aged individuals (80% men) from the Copenhagen Aging and Midlife Biobank who reported their alcohol consumption (average weekly consumption and frequency of binge drinking) at baseline in 2004 or 2006 and reported their psychological well-being (satisfaction with life and vitality) at follow-up in 2009-2011. Analyses were adjusted for sociodemographic factors, lifestyle, social relations, and morbidity.

RESULTS

For satisfaction with life at follow-up, lower scores were observed in men and women who were alcohol abstinent at baseline as well as in men with heavy alcohol consumption compared with moderate alcohol consumption at baseline. Moreover, men with weekly binge drinking at baseline had lower satisfaction with life scores at follow-up than men with moderate frequency of binge drinking (1-3 times/month). In relation to vitality at follow-up, alcohol abstinence at baseline in men and women and heavy alcohol consumption at baseline in men were associated with lower scores compared with moderate alcohol consumption (yet in men these findings were not robust to adjustment for covariates).

CONCLUSIONS

Alcohol abstinence seems to be prospectively associated with adverse psychological well-being (vitality and life satisfaction) in men and women, while heavy alcohol consumption seems to be prospectively associated with adverse satisfaction with life in men. Finally, a prospective association between weekly binge drinking and lower life satisfaction was observed in men.

Reaction Time and Visual Memory in Connection to Hazardous Drinking Polygenic Scores in Schizophrenia, Schizoaffective Disorder and Bipolar Disorder

The purpose of this study was to explore the association of cognition with hazardous drinking Polygenic Scores (PGS) in 2649 schizophrenia, 558 schizoaffective disorder, and 1125 bipolar disorder patients in Finland. Hazardous drinking PGS was computed using the LDPred program. Participants performed two computerized tasks from the Cambridge Automated Neuropsychological Test Battery (CANTAB) on a tablet computer: the 5-choice serial reaction time task, or Reaction Time (RT) test, and the Paired Associative Learning (PAL) test. The association between hazardous drinking PGS and cognition was measured using four cognition variables. Log-linear regression was used in Reaction Time (RT) assessment, and logistic regression was used in PAL assessment. All analyses were conducted separately for males and females. After adjustment of age, age of onset, education, household pattern, and depressive symptoms, hazardous drinking PGS was not associated with reaction time or visual memory in male or female patients with schizophrenia, schizoaffective, and bipolar disorder.

Estimation of Lifetime QALYs Based on Lifestyle Behaviors

Various lifestyle behaviors have been known to affect health-related quality of life (HRQL) and life expectancy. However, the impact on quality-adjusted life years (QALYs), which can be used for health economics, has not been clarified. The purpose of this study was to estimate the impact of lifestyle behaviors on lifetime QALYs. We first examined the relationship between lifestyle behaviors and HRQL as measured by the EQ-5D-5L among 4000 participants via a web-based survey. The results of multiple regression analysis showed that physical activity and sleep were significantly related to HRQL. Therefore, we used microsimulation to estimate QALYs from physical activity and sleep, which were determined to be significant in the regression analysis. The results showed that there was a difference of 3.6 QALYs between the recommended lifestyle scenario (23.4 QALYs; 95%CI 3.6 to 35.1) and the non-recommended lifestyle scenario (19.8 QALYs; 95%CI 3.1 to 31.6). This difference was greater in the younger age group than in the older age group. The results also indicated a large difference in QALYs between physical activity and sleep. These findings may provide a significant suggestion for future health promotion measures.

Reaction Time and Visual Memory in Connection to Alcohol Use in Persons with Bipolar Disorder

The purpose of this study was to explore the association of cognition with hazardous drinking and alcohol-related disorder in persons with bipolar disorder (BD). The study population included 1268 persons from Finland with bipolar disorder. Alcohol use was assessed through hazardous drinking and alcohol-related disorder including alcohol use disorder (AUD). Hazardous drinking was screened with the Alcohol Use Disorders Identification Test for Consumption (AUDIT-C) screening tool. Alcohol-related disorder diagnoses were obtained from the national registrar data. Participants performed two computerized tasks from the Cambridge Automated Neuropsychological Test Battery (CANTAB) on A tablet computer: the 5-choice serial reaction time task, or reaction time (RT) test and the Paired Associative Learning (PAL) test. Depressive symptoms were assessed with the Mental Health Inventory with five items (MHI-5). However, no assessment of current manic symptoms was available. Association between RT-test and alcohol use was analyzed with log-linear regression, and eβ with 95% confidence intervals (CI) are reported. PAL first trial memory score was analyzed with linear regression, and β with 95% CI are reported. PAL total errors adjusted was analyzed with logistic regression and odds ratios (OR) with 95% CI are reported. After adjustment of age, education, housing status and depression, hazardous drinking was associated with lower median and less variable RT in females while AUD was associated with a poorer PAL test performance in terms of the total errors adjusted scores in females. Our findings of positive associations between alcohol use and cognition in persons with bipolar disorder are difficult to explain because of the methodological flaw of not being able to separately assess only participants in euthymic phase.

Reaction Time and Visual Memory in Connection with Alcohol Use in Schizophrenia and Schizoaffective Disorder

The purpose of this study was to explore the association between cognition and hazardous drinking and alcohol use disorder in schizophrenia and schizoaffective disorder. Cognition is more or less compromised in schizophrenia, and schizoaffective disorder and alcohol use might aggravate this phenomenon. The study population included 3362 individuals from Finland with diagnoses of schizophrenia or schizoaffective disorder. Hazardous drinking was screened with the AUDIT-C (Alcohol Use Disorders Identification Test for Consumption) screening tool. Alcohol use disorder (AUD) diagnoses were obtained from national registrar data. Participants performed two computerized tasks from the Cambridge Automated Neuropsychological Test Battery (CANTAB) on a tablet computer: The Five-Choice Serial Reaction Time Task (5-CSRTT) or the reaction time (RT) test and the Paired Associative Learning (PAL) test. The association between alcohol use and the RT and PAL tests was analyzed with log-linear regression and logistic regression, respectively. After adjustment for age, education, housing status, and the age at which the respondents had their first psychotic episodes, hazardous drinking was associated with a lower median RT in females and less variable RT in males, while AUD was associated with a poorer PAL test performance in terms of the total errors adjusted scores (TEASs) in females. Our findings of positive associations between alcohol and cognition in schizophrenia and schizoaffective disorder are unique.

Impact of Comorbid Alcohol Use Disorder on Health-Related Quality of Life Among Patients With Depressive Symptoms

Background and Aim: In psychiatric clinical practice, comorbidity of depression and alcohol use disorder (AUD) is common. Both disorders have a negative impact on health-related quality of life (HRQoL) in general population. However, research on the impact of comorbid AUD on HRQoL among clinically depressed patients is limited. The purpose of this study was to explore the impact of a psychosocial treatment intervention on HRQoL for depressive patients in specialized psychiatric care with a special focus on the impact of AUD on HRQoL. Material and Methods: Subjects were 242 patients of the Ostrobothnia Depression Study (ClinicalTrials.gov Identifier NCT02520271). Patients referred to specialized psychiatric care who scored at least 17 points on the Beck Depression Inventory at baseline and who had no psychotic disorders were included in the ODS. The treatment intervention in ODS comprised behavioral activation for all but began with motivational interviewing for those with AUD. HRQoL was assessed regularly during 24-month follow-up by the 15D instrument. In the present study, HRQoL of ODS patients with or without AUD was compared and the factors explaining 15D score analyzed with a linear mixed model. In order to specify the impact of clinical depression on HRQoL during the early phase of treatment intervention, a general population sample of the Finnish Health 2011 Survey was used as an additional reference group. Results: HRQoL improved among all ODS study sample patients regardless of comorbid AUD during the first year of follow-up. During 12-24 months of follow-up the difference between groups was seen as HRQoL continued to improve only among the non-AUD patients. A combination of male gender, anxiety disorder, and AUD was associated with the poorest HRQoL in this sample. In combined sample analyses with the reference group, clinical depression had an impact on HRQoL in short-term follow-up regardless of the treatment intervention. Conclusions: This study suggests that, in terms of improvement in HRQoL, the heterogenous group of depressive patients in specialized psychiatric care can be successfully treated with behavioral activation in combination with motivational interviewing for those with AUD. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT02520271. Ostrobothnia Depression Study (ODS). A Naturalistic Follow-up Study on Depression and Related Substance Use Disorders. (2015). Available online at: https://clinicaltrials.gov/ct2/show/NCT02520271.

The Association between Alcohol Drinking Patterns and Health-Related Quality of Life in the Korean Adult Population: Effects of Misclassification Error on Estimation of Association

The purpose of this study was to investigate the association between drinking patterns and health-related quality of life (HRQoL) in the Korean general population and to validate the estimation of the association of alcohol use on HRQoL when former drinkers are separated from never drinkers and low-risk drinkers depending on gender. Data were collected from 23,055 adults (over 19 years old) who completed the Korean National Health and Nutritional Examination Survey (2010-2013). Multivariate logistic and linear regression analyses were performed to investigate the association between drinking patterns and HRQoL. When former drinkers were separated from never drinkers and low-risk drinkers to control for misclassification bias, there were gender differences in the associations between alcohol use and HRQoL. Although the estimation of the association of alcohol use was not valid in men, the estimation of association was valid in women, as low-risk women drinkers showed better HRQoL than nondrinkers. Therefore, when conducting research related to alcohol and health, analyses should correct for the various confounding variables and minimize the misclassification bias of drinking patterns. It is also necessary to consider gender characteristics when intervening to improve HRQoL related to drinking.

The association of health behavioral risk factors with quality of life in northern Sweden-A cross-sectional survey

BACKGROUND

It is well known that behavioral risk factors such as obesity, smoking, physical activity, diet, and excessive alcohol are linked to general health in northern Sweden. This study aimed to explore the joint relationship between these risk factors and the quality of life (QoL).

METHODS

Data were collected from Sweden's national public health survey between February and May 2014 in the four northern counties in Sweden. QoL was assessed using the EuroQol (EQ-5D). Multivariable regression analysis was used to examine the relationship between five risk factors: BMI, physical activity, smoking status, fruit and vegetable intake, and alcohol consumption and QoL.

RESULTS

Data from 17 138 complete questionnaires showed that individuals who were not obese, did at least 30 minutes of physical activity daily, consumed at least 3 portions of vegetable or fruits, were not smoking daily, and who did not report being drunk at least once every week were found to have better QoL (P < .005). The mean EQ-5D score ranged from 0.85 to 0.79. Approximately, two thirds of the studied population reported being physically active for at least 30 minutes every day and two fifths of them had a normal BMI. Only around 7% of the sample reported that they were eating the recommended daily level of fruits and vegetables.

CONCLUSIONS

The results of the study suggest that QoL has a significant relationship with lifestyle behaviors. This finding would emphasize the role of interventions to improve population health.

Correlates of Poor Self-Assessed Health Status among Socially Disadvantaged Populations in Poland

Self-assessment of health is recommended as valuable source of information about subjective health status. The present study was performed to evaluate the correlates of self-rated health status among beneficiaries of social care in Poland. This assessment could be crucial for the implementation of targeted preventive measures among this valuable population. The study population consisted of 1710 beneficiaries of social care from the Piotrkowski District. The relationship between self-rated health status and its correlates (sociodemographic, lifestyle factors, and health conditions) was examined using logistic regression, with a poor health rating as the outcome. Overall, 11% of respondents declared poor self-assessed health status. Men more often rated health status as poor (15%) as compared to women (8.5%) (p < 0.001). The odds of a poor assessment of health increased with age, being unemployed or disabled/retired (OR = 2.34 95%CI (1.34–4.19) or OR = 9.07 95%CI (3.68–22.37), respectively), and additionally with poor life satisfaction (OR = 5.14 95% CI (1.94–13.64)). Regarding lifestyle characteristics, only binge drinking was associated with poor health status assessment (OR = 12.62 95%CI (3.71–42.87)). In addition, having any illness or health problems decreased health status (OR = 4.26 95%CI (1.36–13.31)). Socially-disadvantaged populations, especially men who poorly rated their health status, still constituted a large percentage of the population, which is an important public health problem. Increasing knowledge about the correlates of health status will allow greater prevention strategies to be developed for the population.

Alcohol’s harms to others: the self-rated health of those with a heavy drinker in their lives

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.

Alcohol use and sickness absence due to all causes and mental- or musculoskeletal disorders: a nationally representative study

Background

Previous studies have not distinguished between different alcohol-use histories, which could have contributed to the current inconsistent evidence regarding the relationship between alcohol use and subsequent sickness absence. We thus examined alcohol use and subsequent diagnosis-specific sickness absence in groups with different levels of alcohol use, as well as in lifelong abstainers, former drinkers, and people with clinical alcohol use disorders.

Methods

The data of the population-based Health 2000 Survey (BRIF8901) of 3666 Finns aged 30–55 were linked with national registers on medically certified sickness absences lasting for > 10 working days (long-term) for all causes (2000 − 2010) and for mental or musculoskeletal disorders (2004-2010), as well as with registers on pensions and death (2000-2010). Alcohol use was assessed by questionnaire. Chronic somatic diseases were evaluated at baseline in a clinical examination, and common mental and alcohol use disorders using the Composite International Diagnostic Interview (CIDI). Cox regression analyses were conducted with censoring for death and retirement from work.

Results

During an average 10-year follow-up, 56.0% of the participants had at least one long-term sickness absence period. Compared with light drinkers, those having an alcohol use disorder had increased risk of all-cause sickness absence (HR = 1.27; 95% CI = 1.04 − 1.54) and sickness absence due to mental disorders (HR = 2.16; 95% CI = 1.39 − 3.35), when somatic and mental disorders as well as demographic, lifestyle-related and occupational factors at baseline were accounted for. Lifelong abstainers did not differ from light drinkers. Also high-volume drinking (HR = 1.52; 95% CI 1.03 − 2.25) and former drinking (HR = 1.57; 95% CI = 1.15 − 2.15) were associated with long-term sickness absence due to mental disorders. Alcohol use was not predictive of sickness absence due to musculoskeletal disorders.

Conclusions

These results highlight the need to distinguish between former drinking and lifelong abstinence, as only former drinking was associated with sickness absence. Alcohol use disorder and high-volume drinking were strongly predictive of sickness absence due to mental disorders. Identifying people with excessive alcohol use e.g. in occupational health care, and mapping and supporting their mental health may help in preventing sickness absences.

Alcohol Habits and Health Care Use in Patients with Psychiatric Disorders

OBJECTIVE

It is common for persons with psychiatric disorders to also have alcohol problems. Studies in the general population as well as in clinical samples have found hazardous or harmful alcohol habits to be particularly prevalent in the presence of psychiatric disorders. This study sought to explore the relationships between drinking habits and health care utilization (psychiatric as well as general medical) in persons seeking psychiatric treatment and to investigate the associations among age, sex, and type or number of diagnoses and health care use and costs. For the planning of targeted interventions, we also sought to identify subgroups with a high prevalence of hazardous drinking habits.

METHODS

From a psychiatric clinic for affective disorders at a university hospital in Sweden, patients who had been screened for hazardous drinking (N = 609) were selected. Patients with primary psychosis or substance use disorder receive treatment at other clinics and did not participate. Medical records data were grouped and compared. The International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) was used for diagnoses and the Alcohol Use Disorders Identification Test for screening. Patients were grouped by drinking habits and sex, age, and diagnosis group, and their psychiatric as well as general medical health care use was compared.

RESULTS

Abstainers used psychiatric care more than all other drinking groups (p < .001). Psychiatric health care costs were higher in abstainers and low-risk drinkers (1.64 to 1). No differences in general medical care could be identified between drinking groups. Specific subgroups with higher rates of hazardous drinking could not be identified (44% of all males and 34% of all females reported such habits). Inconclusive results from previous research are most likely due to different methods used to classify drinking problems.

CONCLUSIONS

Abstainers and low-risk drinkers used psychiatric health care to a higher cost than the other drinking groups. Possible explanations are discussed from a clinical and scientific perspective. This study clarifies the need for uniform measures when classifying alcohol use in studies of relationships between alcohol use and health care use. There is also a need to separate former drinkers from abstainers in future studies.

Residual Effects: Young Adult Diagnostic Drinking Predicts Late-Life Health Outcomes

OBJECTIVE

This study examined the residual effects of young adult diagnostic drinking on health outcomes four decades later in late life. Results were differentiated by drinking status during midlife.

METHOD

A subsample of Vietnam Era Twin Registry members, all of whom had a lifetime diagnosis of alcohol dependence, was grouped according to life span drinking patterns as assessed by the Lifetime Drinking History interview in 2001. Those drinking at diagnostic levels (endorsing three or more alcohol dependence symptoms) before age 30 were then grouped based on their midlife drinking status (i.e., drinking at diagnostic levels vs. at minimal [nonsymptomatic] levels throughout midlife). Linear (or logistic) regression models were used to examine the association between life span drinking patterns and health outcomes in late life (about age 64).

RESULTS

Those who drank at diagnostic levels in young adulthood and in midlife exhibited significant health liabilities on every late-life health measure; those who drank at diagnostic levels for 5 or more years in young adulthood but drank only at minimal levels or not at all in midlife still exhibited similar liabilities on most late-life health measures. Only those individuals who drank diagnostically for less than 5 years in young adulthood displayed normal levels of late-life health.

CONCLUSIONS

This study identified residual effects resulting from persistent young adult diagnostic drinking (5 or more years) that resulted in negative health outcomes in late life even after decades of remission. There is a distal but surprisingly strong association between persistent early life diagnostic drinking and late-life morbidity.

The association between alcohol drinking and self-reported mental and physical functioning: a prospective cohort study among City of Helsinki employees

OBJECTIVES

Alcohol drinking is associated with ill health but less is known about its contribution to overall functioning. We aimed to examine whether alcohol drinking predicts self-reported mental and physical functioning 5-7 years later.

DESIGN

A prospective cohort study.

SETTING

Helsinki, Finland.

PARTICIPANTS

40-year-old to 60-year-old employees of the City of Helsinki (5301 women and 1230 men) who participated in a postal survey in 2000-2002 and a follow-up survey in 2007.

PRIMARY AND SECONDARY OUTCOME MEASURES

Mental and physical functioning measured by the Short Form 36 Health Survey.

RESULTS

Alcohol drinking was differently associated with mental and physical functioning. Heavy average drinking, binge drinking and problem drinking were all associated with subsequent poor mental functioning except for heavy average drinking among men, whereas only problem drinking was associated with poor physical functioning. Also, non-drinking was associated with poor physical functioning. Problem drinking was the drinking habit showing most widespread and strongest associations with health functioning. The associations between problem drinking and poor mental functioning and with poor physical functioning among women remained after adjusting for baseline mental functioning, sociodemographic factors, working conditions and other health behaviours.

CONCLUSIONS

Alcohol drinking is associated especially with poor mental functioning. Problem drinking was the drinking habit strongest associated with poor health functioning. The results call for early recognition and prevention of alcohol problems in order to improve health functioning among employees.

Worsening of health and a cessation or reduction in alcohol consumption to special occasion drinking across three decades of the life course

Background

Ex-drinkers suffer from worse health than drinkers; however, whether a worsening of health is associated with a change in drinking status from early adulthood has not been previously investigated. We assess whether a worsening of health is associated with a cessation in consumption or reduction to special occasion drinking from early adulthood to middle age.

Methods

Multinomial logistic regression assessing whether a change in self-reported limiting longstanding illness (LLI) was associated with ceasing alcohol consumption, or a reduction to special occasion drinking compared with being a persistent drinker from age 23 in separate models at ages 33, 42, and 50. All models adjusted for sex, poor psychosocial health, education, marital status, and children in the household. Sample included participants from Great Britain followed longitudinally in the National Child Development Study from ages 23 to 33 (N = 5,529), 42 (N = 4,787), and 50 (N = 4,476).

Results

Developing an LLI from the previous wave was associated with ceasing alcohol consumption at ages 33 (odds ratio [ORs] = 2.71, 95% confidence interval [CI] = 1.16–4.93), 42 (OR = 2.44, 95%CI = 1.24–4.81), and 50 (OR = 3.33, 95%CI = 1.56–7.12) and a reduction to special occasion drinking at ages 42 (OR = 2.04, 95%CI = 1.40–2.99) and 50 (OR = 2.04, 95%CI = 1.18–3.53). Having a persistent LLI across 2 waves increased the odds of ceasing consumption at ages 42 (OR = 3.22, 95%CI = 1.06–9.77) and 50 (OR = 4.03, 95%CI = 1.72–9.44) and reducing consumption to special occasion drinking at ages 33 (OR = 3.27, 95%CI = 1.34–8.01) and 42 (OR = 2.25, 95%CI = 1.23–4.50). Persistent drinkers at older ages had the best overall health suffering less from previous poor health compared with those who reduced or ceased consumption at an earlier time point.

Conclusions

Developing an LLI was associated with a cessation in alcohol consumption and a reduction in consumption to special occasion drinking from early adulthood. Persistent drinkers who drank at least till 50 were the healthiest overall. Health selection is likely to influence nondrinking across the life course.

Preference weights for the spectrum of alcohol use in the U.S. Population

BACKGROUND

Little is known about the cost-utility of population-based alcohol interventions. One barrier to research has been the lack of preference weights needed to calculate Quality Adjusted Life Years (QALYs). Preference weights can be estimated from measures of health-related quality of life (HRQOL). The objective of this study was to describe preference weights for the full spectrum of alcohol use.

METHODS

This cross-sectional study included participants in both the National Health Interview Survey (NHIS; 1999-2002) and the Medical Expenditure Panel Survey (MEPS; 2000-2003). The AUDIT-C alcohol screen was derived from NHIS with scores categorized into 6 groups (0,1-3, 4-5, 6-7, 8-9, 10-12 points), ranging from nondrinking (0) to very severe unhealthy alcohol use (10-12). AUDIT-C scores were mapped to EQ-5D and SF-6D preference weights using the linked datasets and analyses adjusted for demographics.

RESULTS

Among 17,440 participants, mean EQ-5D and SF-6D preference weights were 0.82 (95% CI 0.82-0.83) and 0.79 (95% CI 0.79-0.80), respectively. Adjusted EQ-5D preference weights for nondrinking (0.80; 95% CI 0.79-0.81) and moderate unhealthy drinking (0.85; 95% CI 0.84-0.86) were significantly different from low-risk drinking (0.83; 95% CI 0.83-0.84), but no other differences were significant. Results for the SF-6D were similar.

CONCLUSIONS

This study provides EQ-5D and SF-6D preference weights for various alcohol use categories in a representative U.S. adult sample. However, neither measure suggested meaningful differences in HRQOL based on AUDIT-C categories. Self-reported alcohol consumption may not be associated with preference weights or generic instruments may not capture alcohol-related differences in HRQOL.

Bidirectional associations between alcohol consumption and health-related quality of life amongst young and middle-aged women

BACKGROUND

Evidence from cross-sectional studies has suggested a positive association between moderate alcohol consumption and health-related quality of life but prospective data remain scarce.

OBJECTIVES

To examine the bidirectional relationships between alcohol consumption and health-related quality of life using a longitudinal study design.

METHODS

A total of 92 448 participants of the Nurses' Health Study II reported their alcohol consumption (in 1991, 1995, 1999 and 2003) and health-related quality of life (in 1993, 1997 and 2001). Using generalized estimating equations, we modelled the physical and mental component summary (PCS and MCS) scores as a function of alcohol consumption 2 years earlier (n = 88 363) and vice versa (n = 84 621).

RESULTS

Greater alcohol consumption was associated with better PCS scores 2 years later in a dose-response manner up to ~1 serving daily [mean difference (β) = 0.67 ± 0.06 PCS units, for moderate versus infrequent drinkers]. After adjustment for previous PCS, a similar but attenuated pattern was observed (β = 0.33 ± 0.07). Moderate alcohol consumption was not related to MCS, whereas moderate-to-heavy alcohol consumption was associated with lower MCS scores (β = -0.34 ± 0.15). Higher PCS scores were associated with greater alcohol consumption 2 years later, also after adjustment for previous alcohol consumption (β = 0.53 ± 0.05 g day(-1) ). MCS was not associated with alcohol consumption 2 years later.

CONCLUSION

Amongst young and middle-aged women, moderate alcohol intake was associated with a small improvement in physical health-related quality of life 2 years later and vice versa. Moderate alcohol consumption was not associated with mental health-related quality of life in either direction.

Alcohol use, mental well-being, self-esteem and general self-efficacy among final-year university students

PURPOSE

We aimed to quantify associations between drinking and mental well-being, self-esteem and general self-efficacy among New Zealand university students approaching graduation.

METHODS

A web-based survey was conducted across all eight New Zealand universities in 2011. Participants were enrolled in their final year of a bachelor degree or a higher qualification and were aged 25 years and under (n = 5082, response level 65 %). Measures included the Alcohol Use Disorders Identification Test-Consumption, Warwick-Edinburgh Mental Well-being Scale, and items from the Rosenberg Self-esteem Scale and General Self-efficacy Scale. Linear regression models were used to estimate associations between the psychological measures and (1) drinking patterns for all participants (abstention/moderate/hazardous); and (2) consumption indicators for non-abstaining participants (frequency/quantity/heavy drinking frequency), adjusting for a range of individual, social and personality characteristics, separately for men and women.

RESULTS

Lower mental well-being was associated with a moderate or hazardous drinking pattern for men, and a hazardous pattern for women, compared to abstaining participants. Higher self-esteem was associated with any level of heavy drinking frequency for men, while the heaviest drinking women had a pattern of lower self-esteem. There was a general pattern of higher general self-efficacy for men and women who drank alcohol.

CONCLUSIONS

We observed that higher levels of drinking were associated with small, yet statistically significant, differences in psychological outcomes for men and women. Our findings are of uncertain clinical significance; however, they underscore the importance of investigating a fuller range of social and personality factors that may confound the association of drinking and psychological outcomes.

Patterns of alcohol consumption and health-related quality of life in older adults

BACKGROUND

Health-related quality of life (HRQOL) is a more powerful predictor of health services use and mortality than many objective measures of health. However, in older adults the association between main alcohol drinking patterns and HRQOL is uncertain.

METHODS

A prospective cohort with 2163 community-dwelling individuals aged ≥ 60 years was recruited in Spain in 2008-2010 and followed-up through 2012. At baseline, participants reported alcohol consumption. HRQOL was measured with the SF-12 questionnaire, at baseline and in 2012.

RESULTS

In cross-sectional analyses at baseline, compared to non-drinkers, better scores on the physical component summary (PCS) of the SF-12 were reported in moderate (β=1.59 [95% confidence interval 0.61-2.58]) and heavy drinkers (β=2.18 [0.57-3.79]). Better scores on the PCS were also reported by drinkers who adhered to the Mediterranean drinking pattern (MDP) (β=1.43 [0.30-2.56]) as well as those who did not (β=1.89 [0.79​-2.99]). However, no association was observed between average alcohol consumption or the MDP and the mental component summary (MCS) of the SF-12; or between beverage preference or drinking with meals and either the PCS or MCS scores. In prospective analyses, women who reportedly drank exclusively with meals showed better scores on the PCS than women who drank only outside of meals (β=3.64 [0.79-6.50]).

CONCLUSIONS

The small association between alcohol consumption and better physical HRQOL found at baseline was not apparent after a few years of follow-up. Medical advice on alcohol consumption cannot be grounded on its effects on HRQOL.

Epidemiology of depression at Traditional Chinese Medicine Hospital in Shanghai, China

BACKGROUND

Though Chinese Traditional Medicine (TCM) is one of the most important parts of health care system in China, studies on the epidemiology of depression in TCM are scarce and mental health issues in TCM have been neglected for longtime.

METHODS

This was an interview-based survey. The prevalence of depression and suicidal risk in outpatients at a TCM hospital was identified by a one-stage diagnosing process using the Mini International Neuropsychiatric Interview. Associated risk factors, role impairment, and service utility were also assessed.

RESULTS

A total of 2000 outpatients aged from 18 to 65years completed the survey with a response rate of 87.0%. The estimated prevalence of major depressive disorder was 13.2% for lifetime and 4.9% for current. No significant gender differences were found. Depression was more common in patients who lacked social support, experienced family economic burden and health burden, and underwent negative life events, poor self-rated health, or with moderate/severe sleep problem than in their correspondents; all with statistical significance (OR: 1.83-6.82). Patients with depression reported a mean of 82.7days and 99.3days of sick leave due to their physical and mental condition, respectively, which was much longer than those without depression (24.8days and 25.8days, respectively). Only 30.0% of patients with depression sought professional help from psychiatrists/psychologists or used antidepressants.

LIMITATIONS

The recall bias could not be ruled out in this study and could have led to an underestimation of true prevalence and the unmet need for treatment. Since this study was cross-sectional, the causal relationships between sociodemographic factors and depression cannot be determined.

CONCLUSIONS

Depression is common at TCM hospitals. The impairments due to depression are striking, and unmet needs for treatment are pervasive. Consequently, mental health services in TCM should not be neglected any longer.

Contribution of primary care to health: an individual level analysis from Tibet, China

Introduction

There have been significant improvements in health outcomes in Tibet, health disparities between Tibet and the rest of China has been greatly reduced. This paper tests whether there was a positive association between good primary care and better health outcomes in Tibet.

Method

A validated Tibetan version of the Primary Care Assessment Tool (PCAT-T) was used to collect data on 1386 patients aged over 18 years old accessing primary care. Self-rated health (SRH) was employed to measure health outcomes. A multiple binary logistic regression model was used to explore the association between primary care quality and self-rated health status after controlling for socio-demographic and lifestyle variables.

Results

This study found that primary care quality had a significant positive association with self-rated health status. Among the nine domains of PCAT-T, family centeredness domain had the highest Odds Ratio (OR = 1.013) with SRH. Patients located in rural area, with higher education levels, without depression, and less frequent drinking were more likely to self-rate as “good health” compared with the reference group.

Conclusions

In Tibet, higher quality primary care was associated with better self-rated health status. Primary care should be much strengthened in future health system reform in Tibet.

The Effect of a Patient-Provider Educational Intervention to Reduce At-Risk Drinking on Changes in Health and Health-Related Quality of Life Among Older Adults: The Project SHARE Study

BACKGROUND

At-risk drinking, defined as alcohol use that is excessive or potentially harmful in combination with select comorbidities or medications, affects about 10% of older adults in the United States and is associated with higher mortality. The Project SHARE intervention, which uses patient and provider educational materials, physician counseling, and health educator support, was designed to reduce at-risk drinking among this vulnerable population. Although an earlier study showed that this intervention was successful in reducing rates of at-risk drinking, it is unknown whether these reductions translate into improved health and health-related quality of life (HRQL).

OBJECTIVE

The aim of this study was to examine changes in health and HRQL of older adult at-risk drinkers resulting from a patient-provider educational intervention.

RESEARCH DESIGN

A randomized controlled trial to compare the health and HRQL outcomes of patients assigned to the Project SHARE intervention vs. care as usual at baseline, 6- and 12-months post assignment. Control patients received usual care, which may or may not have included alcohol counseling. Intervention group patients received a personalized patient report, educational materials on alcohol and aging, a brief provider intervention, and a telephone health educator intervention.

SUBJECTS

Current drinkers 60years and older accessing primary care clinics around Santa Barbara, California (N=1049).

MEASUREMENTS

Data were collected from patients using baseline, 6- and 12-month mail surveys. Health and HRQL measures included mental and physical component scores (MCS and PCS) based on the Short Form-12v2 (SF-12v2), the SF-6D, which is also based on the SF-12, and the Geriatric Depression Scale (GDS). Adjusted associations of treatment assignment with these outcomes were estimated using generalized least squares regressions with random provider effects. Regressions controlled for age group, sex, race/ethnicity, marital status, education, household income, home ownership and the baseline value of the dependent variable.

RESULTS

After regression adjustment, the intervention was associated with a 0.58 point (95% CI: -0.06, 1.21) increase in 6-month MCS and a 0.14 point (95% CI: 0.01, 0.26) improvement in 12-month GDS score, compared to the control group. The intervention also increased adjusted SF-6D scores by 0.01 points at both 6 and 12months (6-month 95% CI: 0.01, 0.02; 12-month 95% CI: 0.01, 0.01).

CONCLUSIONS

Despite the previously shown effectiveness of the Project SHARE intervention to reduce at-risk drinking among older adults, this effect translated into effects on health and HRQL that were statistically but not necessarily clinically significant. Effects were most prominent for patients who received physician discussions, suggesting that provider counseling may be a critical component of primary care-based interventions targeting at-risk alcohol use.

Focus points in prevention actions against legal substances' abuse

AIM

To determine the factors associated with alcohol and tobacco abuse in Slovenian general population.

MATERIAL AND METHODS

We performed an observational cross-sectional study in a representative sample of 1002 Slovenian inhabitants in June 2011. It was performed using a method of computer-assisted telephone interview. The telephone interview consisted of questions about the prevalence and duration of preselected health-related symptoms in the past month, questions about the presence of chronic diseases, question about the presence of current smoking, EQ-5D questionnaire and AUDIT-C questionnaire.

RESULTS

Risky drinking was found in 103 (14.3 %) of the sample and smoking was found in 226 (22.6 %) of the sample. Men reported risky drinking more often when compared with women (17.7 vs. 10.5 %, P = 0.007). Multivariate analysis showed that male sex, current tobacco smoking, lower education level, self-reported presence of anxiety/depression and self-reported presence of muscle pain and excessive fatigue in the past month were independently associated with risky drinking and that male sex, lower education and income, the presence of chronic disease, self-reported problems in daily activities, risky drinking, self-reported troubles in sleeping and restless leg syndrome were independently associated with current tobacco smoking.

CONCLUSION

Risky alcohol drinking and smoking are still major public health problems in Slovenia and are associated with known demographic risk factors but also with some symptoms of somatoform disorders. These findings should be incorporated into the guidelines for family physicians as the important focus points for screening and intervening against legal substances' abuse in their patients.

The association between alcohol consumption patterns and health-related quality of life in a nationally representative sample of South Korean adults

This study examined the relationship between alcohol consumption and health-related quality of life (HRQOL) in a nationally representative sample of middle-aged to older South Koreans. Data collected from 3,408 men and 3,361 women aged ≥ 40 years were obtained from the 2010 and 2011 Korea National Health and Nutrition Examination Survey. Based on the World Health Organization guidelines, the participants were categorized into zones I (0–7), II (8–15), III (16–19), or IV (20–40) according to their Alcohol Use Disorders Identification Test (AUDIT) scores, with a higher zone indicating a higher level of alcohol consumption. Data collected from the AUDIT and EuroQol 5-Dimension (EQ-5D) test were subjected to multiple regression analysis in order to examine the relationship between alcohol consumption patterns and health-related quality of life, and to identify intersex and interzone differences. Significant intersex differences were found for the mean total AUDIT and EQ-5D scores and the proportion of participants rating their pain/discomfort and impairment in mobility and usual activities as “moderate” or “severe” (p < 0.001). The analysis of the EQ-5D scores by alcohol consumption pattern and sex suggested the existence of an inverted U-shaped relationship between the total AUDIT and EQ-5D scores. The HRQOL of moderate alcohol drinkers was higher than that of non-drinkers and heavy drinkers. The results of this study will be valuable in designing appropriate interventions to increase the HRQOL impaired by the harmful use of alcohol, in comparing HRQOL among different countries, and in implementing alcohol-related health projects.

Abstinence and current or former alcohol use as predictors of disability retirement in Finland

Aim: According to previous studies, abstinence from alcohol increases the risk of disability retirement (DR). We studied whether former alcohol users’ poor mental or physical health might have contributed to this result. Methods: Prospective population-based study of 3621 occupationally active Finns aged 30–55 years at baseline. Disability pension data for 2000−2011 was retrieved from national pension records. We examined medically certified disability retirement due to all causes and due to mental disorders among lifelong abstainers, former drinkers, those with an alcohol use disorder irrespective of consumption and current users, further classified according to weekly intake of alcohol. Chronic somatic diseases were evaluated in a clinical examination and common mental and alcohol use disorders using the Composite International Diagnostic Interview. Cox regression was used. Results: Neither lifelong abstinence nor alcohol consumption, even at hazardous levels, without alcohol use disorder was associated with disability retirement. Compared with light drinkers, former drinkers’ hazard ratio for DR due to mental disorders was 2.67 (95% CI 1.39−5.13), allowing for somatic and mental morbidity, physical and psychosocial workload, health behaviour and socio-demographic factors. The respective hazard ratio of DR due to all causes for those with alcohol use disorder was 2.17 (1.49−3.16) and of DR due to mental disorders 4.04 (2.02 to 8.06). Conclusions: Lifelong abstinence did not predict disability retirement. Former drinkers and people with alcohol use disorders were at a multi-fold risk of work disability due to mental disorders compared with light drinkers, thus it is important to support their work ability.

Changes in alcohol drinking and subsequent sickness absence

Aims: The aim was to examine whether changes in alcohol drinking are associated with sickness absence. Methods: Repeated postal questionnaires on alcohol drinking were conducted among employees of the City of Helsinki in 2000–2 and 2007 to assess changes in drinking habits between these two time points. Data on the number of self-certified and medically confirmed sickness absences were derived from the employer’s register. Sickness absences were followed from 2007 until the end of 2010 among employees participating in both questionnaire surveys. The study includes 3252 female and 682 male employees 40–60 years old at baseline. Poisson regression was used in the data analysis and population attributable fractions (PAFs) were calculated. Results: Alcohol drinking was associated especially with self-certified sickness absence. Rate ratios (RRs) and 95% confidence intervals (CIs) for increasing weekly average drinking were 1.38, 1.18–1.62 among women and 1.58, 1.18–2.12 among men. Also stable problem drinking (for women 1.39, 1.26–1.54, for men 1.44, 1.10–1.87) and among women stable heavy drinking (1.53, 1.20–1.94) increased self-certified sickness absence. There were associations between alcohol drinking and medically confirmed sickness absence but these were mainly explained by health and health behaviours. Also, a decrease in weekly average drinking was associated with sickness absence among women whereas among men former problem drinking increased sickness absence. According to the PAF values, problem drinking had a stronger contribution to sickness absence than weekly average drinking. Conclusions: Alcohol drinking is particularly associated with self-certified sickness absence. Reducing adverse drinking habits is likely to prevent sickness absence.

The association of pattern of lifetime alcohol use and cause of death in the European prospective investigation into cancer and nutrition (EPIC) study

BACKGROUND

There is limited evidence for an association between the pattern of lifetime alcohol use and cause-specific risk of death.

METHODS

Multivariable hazard ratios were estimated for different causes of death according to patterns of lifetime alcohol consumption using a competing risks approach: 111 953 men and 268 442 women from eight countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study were included. Self-reported alcohol consumption at ages 20, 30, 40 or 50 years and at enrollment were used for the analysis; 26 411 deaths were observed during an average of 12.6 years of follow-up.

RESULTS

The association between lifetime alcohol use and death from cardiovascular diseases was different from the association seen for alcohol-related cancers, digestive, respiratory, external and other causes. Heavy users (>5 drinks/day for men and >2.5 drinks/day for women), regardless of time of cessation, had a 2- to 5-times higher risk of dying due to alcohol-related cancers, compared with subjects with lifetime light use (≤1 and ≤0.5 drink/week for men and women, respectively). Compared with lifetime light users, men who used <5 drinks/day throughout their lifetime had a 24% lower cardiovascular disease mortality (95% confidence interval 2-41). The risk of death from coronary heart disease was also found to be 34-46% lower among women who were moderate to occasionally heavy alcohol users compared with light users. However, this relationship was only evident among men and women who had no chronic disease at enrollment.

CONCLUSIONS

Limiting alcohol use throughout life is associated with a lower risk of death, largely due to cardiovascular disease but also other causes. However, the potential health benefits of alcohol use are difficult to establish due to the possibility of selection bias and competing risks related to diseases occurring later in life.

Alcohol consumption and risky drinking patterns in Malaysia: findings from NHMS 2011

AIMS

To identify the characteristics of current drinker and risky alcohol-drinking pattern by profiles in Malaysia.

METHODS

We analyzed data from the National Health and Morbidity Survey 2011. It was a cross-sectional population-based with two stages stratified random sampling design. A validated Alcohol Use Disorder Identification Test Malay questionnaire was used to assess the alcohol consumption and its alcohol related harms. Analysis of complex survey data using Stata Version 12 was done for descriptive analysis on alcohol use and risky drinking by socio-demography profiles. Logistic regression analysis was used to measure the association of risky drinking status with the socio-demography characteristics.

RESULTS

The prevalence of current alcohol use was 11.6% [95% confidence interval (CI): 10.5, 12.7], among them 23.6% (95% CI: 21.0, 26.4) practiced risky drinking. The onset for alcohol drinking was 21 years old (standard deviation 7.44) and majority preferred Beer. Males significantly consumed more alcohol and practiced risky drinking. Current alcohol use was more prevalent among urbanites, Chinese, those with high household income, and high education. Conversely, risky drinking was more prevalent among rural drinkers, Bumiputera Sabah and Sarawak, low education and low household income. The estimated odds of risky drinking increased by a factor of 3.5 among Males while a factor of 2.7 among Bumiputera Sabah and Sarawak. Education status and household income was not a significant predictor to risky drinking.

CONCLUSION

There was an inverse drinking pattern between current drinker and risky drinking by the socio-demography profiles. Initiating early screening and focused intervention might avert further alcohol related harms and dependence among the risky drinkers.

Quality of life and social engagement of alcohol abstainers and users among older adults in South Africa

Background

The literature from developed countries suggests a relationship between alcohol use and quality of life and social engagement, where harmful drinkers have lower quality of life and less social engagement. Despite the high rates of harmful alcohol use in South Africa, little is known about the association between drinking pattern and quality of life and social engagement in this context. We aimed to determine if quality of life and social engagement varied across different drinking patterns among older South African adults, contributed to drinking pattern when controlling for socio-demographic factors, and varied differentially between genders.

Methods

This is a secondary analysis of data from the Survey on Global Ageing and Adult Health (SAGE). Alcohol use was measured as self-reports of use over the previous seven days, and we constructed gender-specific alcohol variables. The WHO Quality of Life-scale was used to measure quality of life, and social engagement was measured by frequency of participation in social activities. We used ANOVA to observe differences in quality of life and social engagement scores across drinking patterns, and regression models were used to identify factors independently associated with drinking pattern.

Results

There were 2572 (84.4%) lifetime abstainers, and 475 (15.6%) persons who had a drink in the last 7 days. In bivariate analysis, quality of life was lowest among at risk drinking men compared to abstainers (OR = 0.21, p = 0.02), although this association was not significant in adjusted analysis. Social engagement did not vary statistically significantly across the drinking patterns in the total sample or within gender.

Conclusions

Quality of life and social engagement were not independently associated with drinking pattern among older adults in South Africa in this sample. In order to better understand their alcohol use, further exploratory research is warranted to identify other potentially relevant subjective factors of alcohol use among older adults in South Africa.

Abstention, alcohol consumption, and common somatic symptoms: the Hordaland Health Study (HUSK)

BACKGROUND

The association between alcohol consumption and somatic symptoms is unclear.

PURPOSE

The aim of this study was to examine the cross-sectional association between the whole continuum of alcohol consumption, ranging from abstention to high-level consumption, and the overall level of common somatic symptoms in a large population-based sample.

METHODS

Data are from the Hordaland Health Study, conducted in 1997-1999 with participants aged 40-46 years (N = 15,018). The main exposure was a categorical variable based on self-reported abstention and alcohol consumption, while self-reported overall level of somatic symptoms was the outcome. The outcome was defined by the mean overall frequency of 17 commonly experienced somatic symptoms. Potential confounders included sociodemographic information, somatic diagnoses, and health-related behaviors. Linear regression models were computed in the statistical analyses.

RESULTS

We found no association between different levels of alcohol consumption and overall level of somatic symptoms. Abstainers reported, however, a higher overall level of somatic symptoms compared to those who consumed alcohol at any level, even after adjusting for potential confounders. Investigating the individual somatic symptoms, we found that the abstainers had a higher frequency of 10 of the 17 symptoms compared to the remainder, while higher frequency was found for only 2 somatic symptoms among the 5% with the highest alcohol consumption.

CONCLUSIONS

We found no support for an association between alcohol consumption and overall level of somatic symptoms. There was, however, a small association between being abstinent and increased level of somatic symptoms. These findings may have several different explanations, and further investigation is called for.

Persistent long-standing illness and non-drinking over time, implications for the use of lifetime abstainers as a control group

BACKGROUND

Non-drinkers are shown to have worse health than moderate drinkers in later life. We examine the preceding health status of non-drinkers in early adulthood, and secondly whether persistent poor health is associated with persistent non-drinking.

METHODS

Using two prospective British birth cohort studies established in 1958 (National Child Development Study (NCDS)) and in 1970 (British Cohort Study (BCS)), participants who reported 'never' or 'never had an alcoholic drink' to drinking status questions in successive waves from 23 to 26 years in the NCDS/BCS were derived as 'lifetime abstainers'. Logistic regression on the odds of being a lifetime abstainer was carried out on changes in limiting long-standing illness (LLSI) in the NCDS and long-standing illness (LSI) in the BCS, adjusting for sex, education, poor psychosocial health, marital and parental status.

RESULTS

Participants with an LLSI in consecutive waves since 23 years had 4.50 times the odds of someone who did not have an LLSI of being a lifetime abstainer at 33 years (95% CI 1.99 to 10.18) and 7.02 times the odds at 42 years (2.39 to 20.66) after adjusting for all factors. Similarly, in the BCS, having an LSI in consecutive waves resulted in higher odds of being a lifetime abstainer at 30 years (OR 2.80, 1.88 to 4.18) and 34 years (OR 3.33, 2.01 to 5.53).

CONCLUSIONS

Persistent LSI was associated with remaining a non-drinker across adulthood. Studies comparing the health outcomes of moderate drinkers to lifetime abstainers that do not account for pre-existing poor health may overestimate the better health outcomes from moderate alcohol consumption.

Alcohol Consumption among the Oldest Old and How It Changes during Two Years

This longitudinal study aimed to examine the pattern of alcohol consumption (using the AUDIT-C) among the oldest old (80+) and how it changed two years later. Five hundred seventy-six persons from the Gothenburg metropolitan area were interviewed between 2008 and 2011. Men represented a higher proportion of at-risk consumers (21.8%) than women (14.5%), but there was no sex difference in binge drinking (13.8% versus 12%). Men decreased their weekly consumption and also the proportion of binge drinking, and women decreased only in binge drinking. Further studies of the causality between alcohol consumption and health are suggested.

Cross-cultural patterns of the association between varying levels of alcohol consumption and the common mental disorders of depression and anxiety: secondary analysis of the WHO Collaborative Study on Psychological Problems in General Health Care

BACKGROUND

Alcohol consumption is associated with several complications of both physical and mental health. Light or moderate alcohol consumption may have beneficial effects on physical or mental health but this effect is still controversial and research in the mental health field is relatively scarce. Our aim was to investigate the association between varying levels of alcohol consumption and the common mental disorders of depression and anxiety in a large international primary care sample.

METHODS

The sample consisted of 5438 primary care attenders from 14 countries who participated in the WHO Collaborative Study of Psychological Problems in General Health Care. Alcohol use was assessed using Alcohol Use Disorders Identification Test (AUDIT) and the mental disorders were assessed with the Composite International Diagnostic Interview (CIDI).

RESULTS

Light to moderate alcohol consumption was associated with a lower prevalence of depression and generalized anxiety disorder compared to abstinence while excessive alcohol consumption was associated with a higher prevalence of depression. This non-linear association was not substantially affected after adjustment for a range of possible confounding variables, including the presence of chronic disease and the current physical status of participants and was evident in different drinking cultures.

CONCLUSION

The study confirms that excessive drinking is associated with an increased prevalence of depression, but also raises the possibility that light/moderate drinking may be associated with a reduced prevalence of both depression and anxiety. Any causal interpretation of this association is difficult in the context of this cross-sectional study and further longitudinal studies are needed.

Associations between IQ and alcohol consumption in a population of young males: a large database analysis

PURPOSE

This study aimed at exploring the relationship between intelligence quotient (IQ) and alcohol consumption in a large sample of young males. This study explored whether IQ influences alcohol drinking and which pathways might be involved. We further hypothesized that IQ differences between lifetime abstainers and former drinkers exist, and that they primarily result from different group characteristics.

METHOD

Within a psychiatric-epidemiological survey using a cross-sectional design IQ-tests were administered to approximately 50,000 Swiss conscripts at age of about 20 years. The sample was divided into four alcohol consumption categories (rare, occasional, moderate and daily drinking) and two non-drinker categories (former drinking and lifetime abstinence). Probabilities for different levels of consumption or former drinking against lifetime abstention in relation to IQ were estimated using multinomial logistic regression. Models were adjusted for education, disability pension, tobacco/cannabis use, migration, parental alcohol disorders, and mental health.

RESULTS

After adjusting for confounders full-scale IQ displayed positive associations with being a rare (OR 1.13; CI 95 % 1.07-1.19), occasional (OR 1.41; CI 95 % 1.33-1.48), and moderate drinker (OR 1.53; CI 95 % 1.45-1.62), and negative associations with being a former drinker (OR 0.85; CI 95 % 0.79-0.93). Daily drinking was positively associated only with the performance subscale IQ (OR 1.12; CI 95 % 1.02-1.22). Confounders contributed significantly to the IQ-alcohol association and, therefore, highlight the distinction of non-drinkers into lifetime abstainers and former drinkers.

CONCLUSIONS

Our data confirmed the positive link between IQ and moderate drinking. Lower IQ in non-drinkers, however, seems to be related to earlier consumption and the presence of other risk factors.

Quality of life among hazardous and harmful drinkers: EQ-5D over a 1-year follow-up period

PURPOSE

To investigate the ability of the EQ-5D to discriminate between levels of alcohol risk in a large sample of hazardous and harmful drinkers, and to explore the relationship between transitions between alcohol risk levels and changes in EQ-5D up to 12 months.

METHODS

This is a web-based randomised controlled trial evaluating a novel intervention for hazardous and harmful alcohol consumption. EQ-5D scores were compared among groups of drinkers at baseline (low/medium/high risk according to self-reported past week alcohol consumption), and changes in EQ-5D scores were estimated as a function of changes in alcohol consumption level.

RESULTS

Baseline EQ-5D scores were dominated by problems with anxiety/depression, which increased with alcohol risk level, whilst high-risk drinkers also experienced more problems with physical HRQoL dimensions. However, the tool demonstrated a considerable ceiling effect. At follow-up, despite considerable reductions in alcohol consumption across the sample, significant changes in aggregated EQ-5D index scores were only observed for high-risk drinkers at baseline who reduced their drinking, with small improvements (0.04-0.06) compared to those who did not reduce.

CONCLUSIONS

Our results suggest that the three-option EQ-5D may not be an optimal primary end point for measuring clinical and cost-effectiveness in randomised controlled trials of interventions among hazardous and harmful alcohol users, although further testing of the sensitivity of the tool in these populations is needed.

Development of the Japanese 15D instrument of health-related quality of life: verification of reliability and validity among elderly people

OBJECTIVE

The 15D is a self-administered questionnaire for assessment of health-related quality of life, which contains 15 questions with 5 response options each. This study was conducted to evaluate the reliability and validity of the Japanese 15D.

METHODS

The subjects were 430 community-dwelling elderly people. Each item of the 15D was scored on a 5-point Likert scale, with level 1 being the best, score 1. Reliability was assessed by determination of the internal consistency and test-retest reliability. Criterion-based validity was assessed using the Japanese version of the Nottingham Health Profile (NHP) and Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG index). Acceptability was assessed by inquiring about the time required to complete the questionnaire and the burden felt in responding to it.

RESULTS

The answers of 423 individuals who responded to all items were analyzed. The median time required to complete the questionnaire was 5.0 minutes, and the proportion of subjects who indicated that the questionnaire was easy to complete was 98.3%. The Cronbach's alpha coefficients for all 15 items in the 2 surveys were 0.793 and 0.792, respectively. The intraclass correlation coefficients for the 15 items ranged from 0.44 to 0.72. In the relationship between the 15D and the NHP, the correlation coefficients between the corresponding domains were higher than those between non-corresponding domains. The prevalence of disability in higher-level functional capacity was higher in the "level 2 to 5" group than in the "level 1" group.

CONCLUSIONS

The Japanese version of the 15D showed sufficient internal consistency and moderate repeatability. Because of the short time required to complete the Japanese 15D and the significant relationships between the scores on the 15D and the NHP, and between the 15D and higher-level functional capacity, the acceptability and validity of the Japanese 15D were considered to be sufficient.

Alcohol use and health-related quality of life among hospital outpatients in South Africa

AIMS

This study examined the association of alcohol use and health-related quality of life (HRQOL) in a clinic population in South Africa.

METHODS

A probability sample of 1532 (56.4% men and women 43.6%) patients from different hospital outpatient departments completed the Alcohol Use Disorder Identification Test and the social functioning (SF)-12 Health Survey. Physical and Mental Health Component Summaries and primary scales of the SF-12 were used as measures of HRQOL.

RESULTS

The study did not find a significant association between alcohol-use disorders and HRQoL [Physical Component Summary (PCS) and Mental health Component Summary (MCS)] in this clinic population. However, probable alcohol dependence was associated with poorer quality of life in three areas of functioning measured by the SF-12 (physical functioning, general health and mental health) compared with patients not meeting the criteria of alcohol dependence. The magnitude of the decrement in the PCS and MCS for daily or almost daily tobacco use, severe psychological distress and the number of other chronic conditions was significantly greater than for alcohol abuse or dependence.

CONCLUSION

It appears that hospital outpatients in this study did not experience a diminished quality of life related to their alcohol use compared with other attenders at these clinics. Also, intervention studies with hazardous drinkers may not be able to identify treatment-related changes in global HRQoL.

Psychosocial problems in childhood and later alcohol consumption: a life course approach with historical information

AIMS

Childhood psychosocial problems have been associated with poor alcohol habits in adulthood. The purpose of this study was to investigate further the association in men by using information from historical health records.

METHODS

As part of the epidemiological FinDrink Study, we examined the association between childhood psychosocial problems and total ethanol consumption, binge drinking, and abstinence in later life among Finnish men. The participants were a sample from the Kuopio Ischaemic Heart Disease Risk Factor Study (KIHD), a population-based cohort study in eastern Finland. The data on childhood psychosocial factors were collected from health records (n = 952, 35.5% of the entire study sample), mainly from the 1930s to the 1950s. Questionnaire data on alcohol consumption were obtained from the baseline examinations of the KIHD cohort in 1984-1989.

RESULTS

Controlling for age and examination year, the men who had been considered psychosocially disadvantaged by elementary school nurses had a 2.72-fold (95% confidence interval 1.30-5.65) risk of bingeing on fortified wine in later life. After adjustment for adulthood behavioural and socioeconomic factors the association (odds ratio 3.71, 95% confidence interval 1.56-8.84) appeared even stronger. Childhood psychosocial problems also contributed to abstinence, but did not appear to increase the total amount of ethanol consumed.

CONCLUSIONS

Psychosocial problems observed in boys seem to contribute to different alcohol habits in later life. However, the factors eventually involved in the manifestation of problematic drinking patterns through the life course still require further research.

The relationship among Mental Health Status (GHQ-12), Health Related Quality of Life (EQ-5D) and Health-State Utilities in a general population

Aim – To assess the relationship between mental health and health-related quality of life (HRQL) in the general population, and to map GHQ-12 as a screening test for population psychological distress to a generic health state measure (EQ-5D) in order to estimate health state values and allow deriving quality-adjusted life years. Methods – Relationship between mental health and HRQL was examined from the 2004 Canary Islands’ Health Survey. Participants were classified as probable psychiatric cases according to GHQ-12. HRQL was measured by the EQ-5D index. Multivariate lineal regression analysis was used to examine the association between mental health and HRQL adjusting by socio-demographic variables and comorbidities. A multivariate regression model was built from EQ-5D to estimate health states values using GHQ-12 as exposure. Results – EQ-5D index scores decreased as the GHQ-12 scores increased. Clinical and socio-demographic factors influenced HRQL without changing the overall trend for this negative relationship. The regression equation explained 43% of the variance. For estimation of utility scores, the model showed a high predictive capacity, with a mean forecast errors of 16%. Conclusions – HRQL progressively decreased when the probability of being a psychiatric case increased. Findings enable health state values to be derived from GHQ-12 scores for populations where utilities has not or cannot be measured directly.

Declaration of Interest: Authors declare no conflicts of interest. This work was supported by the Quality Plan for the National Health Service (Spanish Ministry of Health and Social Policy).

Population-based comparison of health-related quality of life between healthy subjects and those with specific psychiatric or somatic diseases

PURPOSE

The purpose of this study was to compare health-related quality of life (HRQL) of healthy subjects and those with psychiatric or somatic diseases.

DESIGN AND METHODS

Eight dimensions of the RAND 36-Item Health Survey 1.0 (RAND-36) were investigated in a population-based sample.

FINDINGS

Scores in all 8 RAND dimensions were lower in subjects with psychiatric diagnoses than in healthy subjects. In logistic regression models, poor social functioning (odds ratio [OR] 1.07-1.12) associated with psychiatric diagnoses. Lowered energy (OR 1.06) associated with major depression, poor general health with personality disorders (OR 1.06) and heart disease (OR 1.06), and physical limitations with heart (OR 1.04) and musculoskeletal disease (OR 1.07).

PRACTICE IMPLICATIONS

Acknowledging the lowest HRQL dimensions among subjects with psychiatric diagnoses may help to promote mental, physical, and social well-being more efficiently.