Age, period and cohort analysis of light and binge drinking in Finland, 1968-2008

Machine learning-based analytics of the impact of the Covid-19 pandemic on alcohol consumption habit changes among United States healthcare workers

The COVID-19 pandemic is a global health concern that has spread around the globe. Machine Learning is promising in the fight against the COVID-19 pandemic. Machine learning and artificial intelligence have been employed by various healthcare providers, scientists, and clinicians in medical industries in the fight against COVID-19 disease. In this paper, we discuss the impact of the Covid-19 pandemic on alcohol consumption habit changes among healthcare workers in the United States during the first wave of the Covid-19 pandemic. We utilize multiple supervised and unsupervised machine learning methods and models such as decision trees, logistic regression, support vector machines, multilayer perceptron, XGBoost, CatBoost, LightGBM, AdaBoost, Chi-Squared Test, mutual information, KModes clustering and the synthetic minority oversampling technique on a mental health survey data obtained from the University of Michigan Inter-University Consortium for Political and Social Research to investigate the links between COVID-19-related deleterious effects and changes in alcohol consumption habits among healthcare workers. Through the interpretation of the supervised and unsupervised methods, we have concluded that healthcare workers whose children stayed home during the first wave in the US consumed more alcohol. We also found that the work schedule changes due to the Covid-19 pandemic led to a change in alcohol use habits. Changes in food consumption, age, gender, geographical characteristics, changes in sleep habits, the amount of news consumption, and screen time are also important predictors of an increase in alcohol use among healthcare workers in the United States.

Age, period and cohort effects on alcohol-related risky behaviours in Australia from 2001 to 2016

AIMS

The aim of this study is to examine age, period and birth cohort trends in the prevalence of any alcohol-related risky behaviour and to compare these trends between men and women.

DESIGN AND SETTING

We used an age-period-cohort analysis of repeated cross-sectional survey data from the Australian National Drug Strategy Household Survey from 2001 to 2016.

PARTICIPANTS

Participants were 121 281 people aged 14-80 years who reported consuming alcohol in the past 12 months.

MEASUREMENTS

Any risky behaviour undertaken while under the influence of alcohol in the past 12 months (e.g. operating a motor vehicle) was measured: male or female.

FINDINGS

Controlling for age and cohort, cubic spline models showed that any alcohol-related risky behaviour declined with time among participants who consumed alcohol [2016 versus 2007 rate ratio (RR) = 0.80, 95% confidence interval (CI) = 0.76-0.84]. Risky behaviour peaked in the 1954 birth cohort (1954 versus 1971 RR = 1.42, 95% CI = 1.30-1.55) and then steadily declined with more recent birth cohorts (2002 versus 1971 RR = 0.32, 95% CI = 0.27-0.39). Risky behaviour peaked at age 21 years, followed by steady decline and stabilization at approximately age 70 years. Males were overall twice as likely as females to report alcohol-related risky behaviour (RR = 2.10, 95% CI = 1.84-2.39), but this effect was smaller in cohorts born after 1980 [1980 prevalence rate ratios (PRR) = 2.09, 95% CI = 1.81-2.43; 2002 PRR = 1.31, 95% CI = 1.03-1.68].

CONCLUSIONS

Alcohol-related risky behaviour in Australia has declined generally since 2001, with rates for recent cohorts having the sharpest decline. Risky behaviour remains most prevalent in young adults, and the male-female gap in risky behaviour is closing for more recent birth cohorts. These trends are consistent with alcohol consumption trends observed in Australia and world-wide.

Understanding changes in the locations of drinking occasions in Great Britain: An age-period-cohort analysis of repeat cross-sectional market research data, 2001-2019

INTRODUCTION

The 21st century has seen wide-ranging changes in drinking locations in Great Britain, with on-trade alcohol sales decreasing and off-trade sales increasing. To better understand the underlying time-trends in consumer behaviour, we examine age-period-cohort (APC) effects related to changes in the share of individuals' drinking occasions taking place in: (i) on-trade versus off-trade locations; and (ii) specific on-trade or off-trade locations, that is traditional/community pubs, modern pubs/bars/café bars, nightclubs/late-night venues, restaurants/pub restaurants, social/working men's clubs, golf/other sports clubs/venues, at home (social setting) and at home (non-social setting).

METHODS

Repeat cross-sectional 1-week drinking diary data, collected 2001-2019. APC analysis via negative binomial regression models for each gender (N = 162,296 men, 138,452 women).

RESULTS

A smaller/declining proportion of occasions took place in on-trade compared to off-trade locations. Recent cohorts tended to have a larger share of on-trade occasions than previous cohorts, driven by their larger share of occasions in modern pubs/bars/café bars and nightclubs/late-night venues. Meanwhile, occasions in social/working men's clubs, golf/other sports clubs/venues and traditional/community pubs tended to be popular among older men, but have declined. Finally, the growth of off-trade drinking appears to be driven by a growth of off-trade drinking in non-social settings, in particular by older people/cohorts.

DISCUSSION AND CONCLUSION

Our findings highlight the declining prominence of certain on-trade locations, and increasing prominence of home drinking in non-social settings, within British drinking practices. While rising non-social home drinking is concerning, it is positive from a public health perspective that it does not appear to be shared by recent cohorts.

Intraindividual association between shift work and risk of drinking problems: data from the Finnish Public Sector Cohort

OBJECTIVES

Studies concerning the association between shift work and drinking problems showed inconsistent results. We used data from a large occupational cohort to examine the association between shift work and different types of drinking behaviour.

METHODS

A total of 93 121 non-abstinent workers from the Finnish Public Sector Study were enrolled in the study. Six waves of survey data were collected between 2000 and 2017. Work schedules were categorised as regular day, non-night shift and night shift work, and shift intensities were calculated from registered working hour data. Two indicators of adverse drinking behaviour were measured: at-risk drinking (>7 and >14 drinks per week in women and men, respectively) and high-intensity drinking (measured as pass-out experience). Intraindividual analysis was conducted using fixed-effects regression to examine the association between shift work and drinking behaviours.

RESULTS

Compared with regular day work, night shift work was associated with an increased risk of high-intensity drinking (OR 1.28, 95% CI 1.07 to 1.52) but a lower risk of at-risk drinking (OR 0.85, 95% CI 0.74 to 0.99). Shift workers who worked long shifts had a lower risk of at-risk drinking compared with those who rarely worked long shifts (OR 0.58, 95% CI 0.37 to 0.93).

CONCLUSIONS

Associations between shift work and alcohol use vary according to drinking patterns. Workers engaged in high-intensity drinking more often during night shift schedules compared with day work, but did not drink averagely higher volume.

Trends in older people’s drinking habits, Sweden 2004–2017

Aims:

To examine if and how the drinking habits of older people aged 60–79 years in Sweden have changed during 2004–2017, with a specific focus on age groups and gender.

Data and measures:

A Swedish, nationally representative, repeated cross-sectional telephone survey covering the years 2004–2017 (n = 225,134) was used. Four aspects of alcohol consumption were investigated: proportion of alcohol consumers, frequency of drinking, amount per drinking occasion, and prevalence of heavy episodic drinking.

Results:

Three of the four measures investigated showed increases in alcohol consumption in the older age groups, particularly among women. Proportion of alcohol consumers, frequency of drinking and prevalence of heavy episodic drinking during the past month increased in most older age groups among both women and men, while the average amount per drinking occasion remained stable. Thus, total consumption in older age groups has increased over time, since the proportion of drinkers and the frequency of drinking has increased. Increases were particularly marked among women and in the age groups 70–74 and 75–79 years. In age groups below 60 years, these measures showed either declines or stability.

Conclusions:

There has been a steady increase in alcohol consumption across all the older age groups studied, which implies that the changing drinking habits are not isolated only to certain birth cohorts. Instead there seems to be a continuous shift in older people’s drinking habits which can be expected to continue. However, these increases are from very low levels, and older people’s drinking is still at modest levels. Public health implications must be studied further.

The Decline in Alcohol Consumption in Russia from 2006 to 2017: Do Birth Cohorts Matter?

AIM

Previous studies on youth drinking showed opposite trends for high-income and low-income countries. In Russia, a recent decline was observed in the prevalence of alcohol use, particularly among younger cohorts. This study aims at disentangling age and birth cohort effects to better understand the dynamics of abstinence and the volume of alcohol consumption.

METHODS

Data were collected from annual nationally representative panel surveys from 2006 to 2017. Data included 34,514 individuals aged 14-80. We estimated mixed-effects binary-choice models for percentage of abstainers and mixed-effects linear models with Heckman correction for alcohol volume. Integer variables of age and age-squared were used. Period was defined with a dummy variable using 2012 as the dividing line associated with a new Russian alcohol policy. Birth cohorts were defined as 13 groups from 1930-1939 to 2000-2003. Controls were per capita income, education, marital status, composition of households, body weight, ethnicity, residence type, regional per capita income and regional climate.

RESULTS

In both genders, percentage of abstainers increased and drinking volumes declined. Age for both genders showed u-shaped trend for abstinence and inverse u-shaped trend for alcohol volume. Controlling for age effects, cohorts born after 1990 demonstrated the strongest increase in abstinence for both genders and the strongest decrease in alcohol volume for males. The period of 2012-2017 had the effect of increasing the abstinence and decreasing the alcohol volume.

CONCLUSION

Downward trend in alcohol consumption in Russia is partially attributable to increased abstinence and reduced alcohol volume among younger cohorts.

The collectivity of British alcohol consumption trends across different temporal processes: a quantile age-period-cohort analysis

BACKGROUND AND AIMS

UK alcohol consumption per capita has fallen by 18% since 2004, while the alcohol-specific death rate has risen by 6%. Inconsistent consumption trends across the population may explain this. Drawing on the theory of the collectivity of drinking cultures and age-period-cohort analyses, we tested whether consumption trends are consistent across lighter and heavier drinkers for three temporal processes: (i) the life-course, (ii) calendar time and (iii) successive birth cohorts.

DESIGN

Sex-specific quantile age-period-cohort regressions using repeat cross-sectional survey data.

SETTING

Great Britain, 1984-2011.

PARTICIPANTS

Adult (18+) drinkers responding to 17 waves of the General Lifestyle Survey (total n = 175 986).

MEASUREMENTS

Dependent variables: the 10th, 25th, 50th, 75th, 90th, 95th and 99th quantiles of the logged weekly alcohol consumption distribution (excluding abstainers).

INDEPENDENT VARIABLES

seven age groups (18-24, 25-34… 65-74, 75+ years), five time-periods (1984-88… 2002-06, 2008-11) and 16 five-year birth cohorts (1915-19… 1990-94). Additional control variables: ethnicity and UK country.

FINDINGS

Within age, period and cohort trends, changes in consumption were not consistently in the same direction at different quantiles of the consumption distribution. When they were, the scale of change sometimes differed between quantiles. For example, between 1996-2000 and 2008-2011, consumption among women decreased by 18% [95% confidence interval (CI) = -32 to -2%] at the 10th quantile but increased by 11% (95% CI = 2-21%) at the median and by 28% (95% CI = 19-38%) at the 99th quantile, implying that consumption fell among lighter drinkers and rose among heavier drinkers. This type of polarized trend also occurred between 1984-88 and 1996-2000 for men and women. Age trends showed collectivity, but cohort trends showed a mixture of collectivity and polarization.

CONCLUSIONS

Countervailing alcohol consumption and alcohol-related harm trends in the United Kingdom may be explained by lighter and heavier drinkers having different period and cohort trends, as well as by the presence of cohort trends that mean consumption may rise in some age groups while falling in others.

Birth cohort effects on the quantity and heritability of alcohol consumption in adulthood: a Finnish longitudinal twin study

AIMS

To estimate birth cohort effects on alcohol consumption and abstinence in Finland and to test differences between birth cohorts in genetic and environmental sources of variation in Finnish adult alcohol use.

DESIGN

The Older Finnish Twin Cohort longitudinal survey study 1975-2011.

SETTING

Finland.

PARTICIPANTS

A total of 26 121 same-sex twins aged 18-95 years (full twin pairs at baseline n = 11 608).

MEASUREMENTS

Outcome variables were the quantity of alcohol consumption (g/month) and abstinence (drinking zero g/month). Predictor variables were 10-year birth cohort categories and socio-demographic covariates. In quantitative genetic models, two larger cohorts (born 1901-20 and 1945-57) were compared.

FINDINGS

Multi-level models in both sexes indicated higher levels of alcohol consumption in more recent birth cohorts and lower levels in earlier cohorts, compared with twins born 1921-30 (all P < 0.003). Similarly, compared with twins born 1921-30, abstaining was more common in earlier and less common in more recent cohorts (all P < 0.05), with the exception of men born 1911-20. Birth cohort differences in the genetic and environmental variance components in alcohol consumption were found: heritability was 21% [95% confidence interval (CI) = 0-56%] in the earlier-born cohort of women [mean age 62.8, standard deviation (SD) = 5.3] and 51% (95% CI = 36-56%) in a more recent cohort (mean age 60.2, SD = 3.7) at the age of 54-74. For men, heritability was 39% (95% CI = 27-45%) in both cohorts. In alcohol abstinence, environmental influences shared between co-twins explained a large proportion of variation in the earlier-born cohort (43%, 95% CI = 23-63%), whereas non-shared environmental (54%, 95% CI = 39-72%) and additive genetic influences (40%, 95% CI = 13-61%) were more important among more recent cohorts of men and women.

CONCLUSION

The contribution of genetic and environmental variability to variability in alcohol consumption in the Finnish population appears to vary by birth cohort.

Young cohorts of Russians drink less: age-period-cohort modelling of alcohol use prevalence 1994-2016

BACKGROUND AND AIMS

Young Russians have been drinking less alcohol, and fewer strong spirits in particular, in recent years. This study aimed to disentangle age, period and birth cohort effects for the first time in Russia to improve our understanding of these trends.

DESIGN

Age, period and cohort analysis of annual nationally representative repeated cross-sectional surveys [Russian Longitudinal Monitoring Survey- Higher School of Economics (RLMS-HSE)] using separate logistic models for each gender.

SETTING

Russia 1994-2016.

PARTICIPANTS

A total of 195 234 respondents aged 14-85 years.

MEASUREMENTS

Age (14 groups: 14-17 to 76+ years), period (21 years: 1994-2016) and birth cohorts (17 groups: 1920-24 to 2000-02). Outcome measures were 30-day overall and beverage-specific alcohol use prevalence accounting for vodka, moonshine, beer and wine. Controls were per capita income, education, marital status, ethnicity, residence type and regional climate.

FINDINGS

Controlling for age and period effects, the most recent cohorts had lower rates of participation than older cohorts. Findings were valid for females born in 1995-2002 (P = 0.000) and males born in 1990-94 (P = 0.002) and 1995-2002 (P = 0.000). The period effects were strong in 1994-2003 due to intensive substitution of beer in place of vodka. Period effects were also important in determining a decline of prevalence in 2008-15 due to restrictive alcohol policy. Age effects showed an inverse U-shaped trend in both genders, except for moonshine and wine. Overall, drinking profiles were beverage-specific. Models indicated diverse beverage-specific effects of income, ethnicity, education, marital status and residence on the prevalence of alcohol use.

CONCLUSION

The recent downward trend in alcohol use in Russia appears to be attributable to reduced participation rates among younger cohorts born after 1990.

The Risk of Hypertension Doubles Every 10 Years in China: Age, Period, and Birth Cohort Effects on the Prevalence of Hypertension From 2004 to 2013

BACKGROUND

Hypertension is a growing problem worldwide and can often result in a variety of negative health outcomes. The aim of this study was to assess the effects of age at diagnosis, calendar period, and birth cohort on the change in the prevalence rate of hypertension in Guangzhou from 2004 to 2013.

METHODS

We used data from the Guangzhou Community Health Survey, a population-based study designed by the National Health and Family Planning Commission of the PRC every 5 years. A total of 27,299, 23,467, and 18,362 participants aged 15-79 years completed the survey in 2004, 2009, and 2013, respectively.

RESULTS

Age effects increased slowly before the age of 42 years but increased rapidly after the age of 42 years, peaking at 79 years. Cohort effects grew slowly before the end of the 1960s but grew quickly after the end of the 1960s. The risk of suffering from hypertension among people born in 1962, 1972, 1982, and 1992 was 1.39, 2.68, 5.55, and 11.53 times, respectively, than that of people born in 1952. The period effects increased 25% from 2004 to 2009 and later declined 27% from 2009 to 2013 in the entire population. There was no gender difference in age effects and period effects, but strong cohort effects on hypertension were observed among males compared with females.

CONCLUSIONS

For Chinese individuals, the later one is born, the higher the risk is of suffering from hypertension. Strong cohort effects for hypertension were observed among males compared with females, indicating that males are more easily affected by hypertension based on the change in birth cohort.

Factors associated with alcohol consumption and prescribed drugs with addiction potential among older women and men - the Nord-Trøndelag health study (HUNT2 and HUNT3), Norway, a population-based longitudinal study

BACKGROUND

Little is known about factors associated with alcohol consumption and use of drugs with addiction potential in older adults. The aim of this study was to explore the association between socio-demographic variables, physical and mental health and the later (11 years) use of frequent drinking, prescribed drugs with addiction potential and the possible combination of frequent drinking and being prescribed drugs with addiction potential in older adults (≥ 65 years).

METHODS

In this longitudinal study, we used data from two surveys of the Nord-Trøndelag Health Study (HUNT2 1995-1997 and HUNT3 2006-2008), a population based study in Norway. We totally included 10,656 individuals (5683 women) aged 54 years and older when they participated in HUNT2. Frequent drinking was defined as drinking alcohol 4 days or more per week. Data on prescribed drugs with addiction potential were drawn from the Norwegian Prescription Database. Drugs with addiction potential were defined as at least one prescription of benzodiazepines, z-hypnotics or opioids during one year for a minimum of two consecutive years between 2005 and 2009.

RESULTS

The typical frequent drinker in HUNT3 was younger, more educated, lived in urban areas, and reported smoking and drinking frequently in HUNT2 compared to the non-frequent drinker in HUNT3. The typical user of prescribed drugs with addiction potential in HUNT3 was an older woman who smoked and was in poor health, suffered from anxiety, had been hospitalized in the last 5 years and used anxiety or sleep medication every week or more often in HUNT2. The typical individual in HUNT3 with the possible combination of frequent drinking and being prescribed drugs with addiction potential had more education, smoked, drank frequently and used anxiety or sleep medication in HUNT2.

CONCLUSION

Individuals who were identified as frequent drinkers in HUNT2 were more likely to be frequent drinkers in HUNT3, and to have the possible combination of frequent drinking and being prescribed drugs with addiction potential in HUNT3. Health care professionals need to be aware of use of alcohol among older adults using drugs with addiction potential.

Trajectories of risky drinking around the time of statutory retirement: a longitudinal latent class analysis

BACKGROUND AND AIMS

Life transitions such as retirement may influence alcohol consumption, but only a few studies have described this using longitudinal data. We identified patterns and predictors of risky drinking around the time of retirement.

DESIGN

A cohort study assessing trajectories and predictors of risky drinking among employees entering statutory retirement between 2000 and 2011.

SETTING AND PARTICIPANTS

A total of 5805 men and women from the Finnish Public Sector study who responded to questions on alcohol consumption one to three times prior to (w_-3 , w_-2 , w_-1 ), and one to three times after (w₊₁ , w₊₂ , w₊₃ ) retirement.

MEASUREMENTS

We assessed trajectories of risky drinking (> 24 units per week among men, > 16 units among women, or an extreme drinking occasion during past year) from pre- to post-retirement, as well as predictors of each alcohol consumption trajectory.

FINDINGS

Three trajectories were identified: sustained healthy drinking (81% of participants), temporary increase in risky drinking around retirement (12%) and slowly declining risky drinking after retirement (7%). The strongest pre-retirement predictors for belonging to the group of temporary increase in risky drinking were current smoking [odds ratio (OR) = 3.90, 95% confidence interval (CI) = 2.70-5.64], male sex (OR = 2.77, 95% CI = 2.16-3.55), depression (OR = 1.44, 95% CI = 1.05-1.99) and work-place in the metropolitan area (OR = 1.29, 95% CI = 1.00-1.66). Compared with the slowly declining risky drinking group, the temporary increase in risky drinking group was characterized by lower occupational status and education, and work-place outside the metropolitan area.

CONCLUSIONS

In Finland, approximately 12% of people who reach retirement age experience a temporary increase in alcohol consumption to risky levels, while approximately 7% experience a slow decline in risky levels of alcohol consumption. Male gender, smoking, being depressed and working in a metropolitan area are associated with increased likelihood of increased alcohol consumption.

The role of birth cohorts in long-term trends in liver cirrhosis mortality across eight European countries

BACKGROUND AND AIMS

Understanding why inequalities in alcohol-related mortality trends by sex and country exist is essential for developing health policies. Birth cohort effects, indicative of differences by generation in drinking, have rarely been studied. This study estimated the relative contributions of birth cohorts to liver cirrhosis mortality trends and compared sex- and country-specific cohort patterns across eight European countries.

DESIGN

Time-series analysis of population-level mortality data.

SETTING

Austria, Finland, Hungary, Italy, the Netherlands, Poland, Spain and Sweden; 1950-2011.

PARTICIPANTS

National populations aged 15-94 years.

MEASUREMENTS

We modelled country- and sex-specific liver cirrhosis mortality (from national vital registers) adjusting for age, period and birth cohort.

FINDINGS

Birth cohorts (adjusted for age and period) made statistically significant contributions to liver cirrhosis mortality in all countries and for both sexes (P < 0.001), and more so among women (average contribution to deviance reduction of 38.8%) than among men (17.4%). The observed cohort patterns were statistically different between all but two country pairs (P < 0.001). Sex differences existed overall (P < 0.001), but not in the majority of countries (P > 0.999). Visual inspection of birth cohort patterns reveals birth cohorts at higher risk of liver cirrhosis mortality.

CONCLUSIONS

The inclusion of the birth cohort dimension improves the understanding of alcohol-attributable mortality trends in Europe. Birth cohorts at higher risk of liver cirrhosis mortality were born during 1935-49 in Sweden and Finland, around 1950 in Austria and the Netherlands and 1960 or later in Hungary, Italy, Poland and Spain.

Consumption of Wine with Meals and Subjective Well-being: A Finnish Population-Based Study

AIMS

To examine in the general population the association of regular consumption of wine with meals, subjective well-being and risky drinking.

METHODS

A random sample of Finnish people aged 18-69 ('Finnish Drinking Habits Survey 2008', n = 2591, response rate 74%) were interviewed regarding psychological distress, self-efficacy, self-perceived health, uncontrolled drinking, negative events during drinking, hazardous drinking and consumption of alcohol. The analysis focused on comparison of those who drank wine at least once a week versus more seldom. Regression models adjusted for social determinants, smoking and chronic illness.

RESULTS

Twelve percent of Finnish adults drank wine with meals at least once a week. Drinking wine with meals was an urban phenomenon and associated with higher socioeconomic status. Regular wine with meal drinkers reported better health, higher self-efficacy and less psychological distress than others even when various confounders were adjusted for. They also reported more risky drinking and higher yearly consumption than other alcohol consumers. Especially those who drank both wine and beer during meals had higher rates of risky drinking. Those restricting themselves to only wine with meals reported less hazardous drinking than the general population.

CONCLUSION

Consumption of wine with meals was associated with high socioeconomic status and high subjective well-being. Risky drinking was prevalent among wine with meal drinkers, but only among those who drank both wine and beer with meals. Potential unknown confounders may exist, but the results underline a link between subjective well-being and drinking wine with meals.

Birth cohort trends in the global epidemiology of alcohol use and alcohol-related harms in men and women: systematic review and metaregression

OBJECTIVE

Historically, alcohol use and related harms are more prevalent in men than in women. However, emerging evidence suggests the epidemiology of alcohol use is changing in younger cohorts. The current study aimed to systematically summarise published literature on birth cohort changes in male-to-female ratios in indicators of alcohol use and related harms.

METHODS

We identified 68 studies that met inclusion criteria. We calculated male-to-female ratios for 3 broad categories of alcohol use and harms (any alcohol use, problematic alcohol use and alcohol-related harms) stratified by 5-year birth cohorts ranging from 1891 to 2001, generating 1568 sex ratios. Random-effects meta-analyses produced pooled sex ratios within these 3 categories separately for each birth cohort.

FINDINGS

There was a linear decrease over time in the sex ratio for all 3 categories of alcohol use and related harms. Among those born in the early 1900s, males were 2.2 (95% CI 1.9 to 2.5) times more likely than females to consume alcohol, 3.0 (95% CI 1.5 to 6.0) times more likely to drink alcohol in ways suggestive of problematic use and 3.6 (95% CI 0.4 to 30.3) times more likely to experience alcohol-related harms. Among cohorts born in the late 1900s, males were 1.1 (95% CI 1.1 to 1.2) times more likely than females to consume alcohol, 1.2 (95% CI 1.1 to 1.4) times more likely to drink alcohol in ways suggestive of problematic use and 1.3 (95% CI 1.2 to 1.3) times more likely to experience alcohol-related harms.

CONCLUSIONS

Findings confirm the closing male-female gap in indicators of alcohol use and related harms. The closing male-female gap is most evident among young adults, highlighting the importance of prospectively tracking young male and female cohorts as they age into their 30s, 40s and beyond.

Zeitliche Entwicklungen im Substanzkonsum in der deutschen Allgemeinbevölkerung

Zusammenfassung. Ziel: Ziel der Studie ist die Analyse von Trends des (klinisch relevanten) Konsums von Tabak, Alkohol, Cannabis und anderen illegalen Drogen sowie der Einnahme von Medikamenten zwischen 1995 und 2015. Methodik: Datengrundlage bilden acht Erhebungswellen des Epidemiologischen Suchtsurveys (ESA) aus den Jahren 1995 bis 2015. Die Befragungen erfolgten schriftlich, telefonisch oder online. Eine einheitliche Darstellung zeitlicher Trends ist für den Altersbereich 18 bis 59 Jahre möglich. Ergebnisse: Der Tabakkonsum hat in den letzten 20 Jahren abgenommen. Trenddaten des Alkoholkonsums zeigen sinkende Konsumwerte für Männer und stabile Werte für Frauen. Die Prävalenz des Rauschtrinkens ist bei Frauen seit dem Jahr 2009 angestiegen. Der Cannabiskonsum hat zwischen 2012 und 2015 bei beiden Geschlechtern zugenommen. Der wöchentliche Gebrauch von Schmerzmitteln ist angestiegen, während bei Schlaf-/Beruhigungsmitteln ein Rückgang zu verzeichnen ist. Indikatoren eines klinisch relevanten Konsums zeigen für Cannabis keine Änderungen, für Tabak einen Rückgang und für Medikamente einen Anstieg. Hinweise auf klinisch relevanten Alkoholkonsum sind bei Männern konstant geblieben und bei Frauen angestiegen. Schlussfolgerungen: Die weite Verbreitung insbesondere der legalen Substanzen legt einen dringenden Handlungsbedarf für Prävention und Intervention nahe. Als besondere Zielgruppe wurden Frauen identifiziert, bei denen der klinisch relevante Konsum von Alkohol und Medikamenten zugenommen hat.

Decreasing adolescent drinking: Is there evidence of a continuation into future adult cohorts? APC analysis of adolescent drinking in Finland, 1983–2013

Aims: Unlike adults, abstaining has increased and regular use of alcohol has decreased among 12–16-year-olds over the past two decades. The paper studies whether these developments will be continued as the adolescent cohorts come of age. Methods: The Adolescent Health and Lifestyle Survey is a nationally representative monitoring system of the health habits of 12-, 14-, 16-, and 18-year-old Finns, conducted biannually between 1981 and 2013. The prevalence of alcohol use and drunkenness were measured for each 5-year cohort born in 1967–1995. Age-by-cohort trajectories and hierarchical age–period–cohort (APC) modeling were used to assess effects of age, period, and birth cohort. Results: Cohorts differentiate for underage drinking, but not at the age of 18. The younger cohorts postpone their drinking debut compared with older cohorts and thus age profiles are steeper than before. The most recent cohorts born in the 1990s, and the oldest cohorts born in 1967–71, have the highest prevalence in abstinence but drinking has been more prevalent for cohorts born in 1973–1989. APC modeling confirms significant cohort effects, but no significant decrease in drinking or drunkenness at the age of 18 years. Some of the changes can also be attributed to period effects. Conclusions: Despite the decrease in underage drinking in Finland, 18-year-olds continue to drink similarly from cohort to another. Postponing the onset of drinking has a preventive effect on alcohol-related harms, but a reduction in drinking among adult cohorts is not evident in the future.

Long-term effects of changes in Swedish alcohol policy: can alcohol policies effective during adolescence impact consumption during adulthood?

AIMS

To assess long-term effects of alcohol policy in Sweden by estimating the differences between cohorts growing up during periods with liberal alcohol policies and a cohort growing up during a period with restrictive alcohol policy.

DESIGN

The data come from repeated cross-sectional surveys conducted in Sweden between 2002 and 2013, and were collected monthly using telephone interviews with a nationally representative sample. Cohorts were constructed by identifying periods when alcohol policy differed between being more liberal or more restrictive. The liberal-period cohorts were merged into one and compared with the restrictive-period cohort.

SETTING

Sweden.

PARTICIPANTS

A total of 127 480 adult Swedes born between 1951 and 1989.

MEASUREMENTS

Monthly volume of alcohol consumption in litres of pure alcohol derived from a beverage-specific graduated quantity-frequency scale.

FINDINGS

Relative to the liberal-period reference cohorts (who turned 15 between 1966 and 1977 or 1992 and 2004), the cohort that grew up during a period with restrictive alcohol policy (turning 15 between 1978 and 1991) was found to have lower alcohol consumption (coeff. = -0.039: confidence interval -0.050 to -0.027: P < 0.001). The mean volume for the liberal and restrictive cohorts across all survey years was 0.42 and 0.38 litres of pure alcohol, respectively. Consumption development for the period 2002-13 was, however, the same for both cohort groups.

CONCLUSIONS

Men and women in Sweden who grew up during a period with more restrictive alcohol policies currently drink less alcohol than those who grew up during periods with more liberal policies.

The contribution of education, social class and economic activity to the income-mortality association in alcohol-related and other mortality in Finland in 1988-2012

AIMS

First, to quantify trends in the contribution of alcohol-related mortality to mortality disparity in Finland by income quintiles. Secondly, to estimate the degree to which education, social class and economic activity explain the income-mortality association in alcohol-related and other mortality in four periods within 1988-2012.

DESIGN

Register-based longitudinal study using an 11% random sample of Finnish residents linked to socio-economic and mortality data in 1988-2012 augmented with an 80% sample of all deaths during 1988-2007. Mortality rates and discrete time survival regression models were used to assess the income-mortality association following adjustment for covariates in 6-year periods after baseline years of 1988, 1994, 2001, and 2007.

SETTING

Finland.

PARTICIPANTS

Individuals aged 35-64 years at baselines. For the four study periods for men/women, the final data set comprised, respectively, 26,360/12,825, 22,561/11,423, 20,342/11,319 and 2651/1514 deaths attributable to other causes and 7517/1217, 8199/1450, 9807/2116, 1431/318 deaths attributable to alcohol-related causes.

MEASUREMENTS

Alcohol-related deaths were analysed with household income, education, social class and economic activity as covariates.

FINDINGS

The income disparity in mortality originated increasingly from alcohol-related causes of death, in the lowest quintile the contribution increasing from 28 to 49% among men and from 11 to 28% among women between periods 1988-93 and 2007-12. Among men, socio-economic characteristics attenuated the excess mortality during each study period in the lowest income quintile by 51-62% in alcohol-related and other causes. Among women, in the lowest quintile the attenuation was 47-76% in other causes, but there was a decreasing tendency in the proportion explained by the covariates in alcohol-related mortality.

CONCLUSIONS

The income disparity in mortality among working-age Finns originates increasingly from alcohol-related causes of death. Roughly half the excess mortality in the lowest income quintile during 2007-12 is explained by the covariates of household income, education, social class and economic activity.

The relationship between exposure to brand-specific alcohol advertising and brand-specific consumption among underage drinkers--United States, 2011-2012

BACKGROUND

Marketing is increasingly recognized as a potentially important contributor to youth drinking, yet few studies have examined the relationship between advertising exposure and alcohol consumption among underage youth at the brand level.

OBJECTIVES

To examine the relationship between brand-specific exposure to alcohol advertising among underage youth and the consumption prevalence of each brand in a national sample of underage drinkers.

METHODS

We analyzed the relationship between population-level exposure of underage youth ages 12-20 to brand-specific alcohol advertising in national magazines and television programs and the 30-day consumption prevalence--by brand--among a national sample of underage drinkers ages 13-20. Underage youth exposure to alcohol advertising by brand for each month in 2011, measured in gross rating points (GRPs, a standard measure of advertising exposure), was obtained from GfK MRI (a media consumer research company) and Nielsen for all measured national issues of magazines and all national television programs, respectively. The 30-day consumption prevalence for each brand was obtained from a national survey of 1031 underage drinkers conducted between December 2011 and May 2012.

RESULTS

Underage youth were more than five times more likely to consume brands that advertise on national television and 36% more likely to consume brands that advertise in national magazines. The consumption prevalence of a brand increased by 36% for each 1.5 standard deviation (50 GRPs) increase in television adstock among underage youth and by 23% for each 1.5 standard deviation (10 GRPs) increase in magazine adstock.

CONCLUSION

These findings suggest that alcohol advertising influences an important aspect of drinking behavior--brand choice--among youth who consume alcohol.

Changes in mortality due to major alcohol-related diseases in four Nordic countries, France and Germany between 1980 and 2009: a comparative age-period-cohort analysis

AIMS

To investigate age, period and cohort effects on time trends of alcohol-related mortality in countries with different drinking habits and alcohol policies.

DESIGN AND SETTING

Age-period-cohort (APC) analyses on alcohol-related mortality were conducted in Denmark, Finland, Norway, Sweden, France and Germany.

PARTICIPANTS

Cases included alcohol-related deaths in the age range 20-84 years between 1980 and 2009.

MEASUREMENTS

Mortality data were taken from national causes of death registries and covered the ICD codes alcoholic psychosis, alcohol use disorders, alcoholic liver disease and toxic effect of alcohol.

FINDINGS

In all countries changes across age, period and cohort were found to be significant for both genders [effect value with confidence interval (CI) shown in Supporting information, Table S1]. Period effects pointed to an increase in alcohol-related mortality in Denmark, Finland and Germany and a slightly decreasing trend in Sweden, while in Norway an inverse U-shaped curve and in France a U-shaped curve was found. Compared with the cohorts born before 1960, the risk of alcohol-related mortality declined substantially in cohorts born in the 1960s and later. Pairwise between-country comparisons revealed more statistically significant differences for period (P < 0.001 for all 15 comparisons by gender) than for age [P < 0.001 in seven (men) and four (women) of 15 comparisons] or cohort [P < 0.01 in two (men) and three (women) of 15 comparisons].

CONCLUSIONS

Strong period effects suggest that temporal changes in alcohol-related mortality in Denmark, Finland, Norway, Sweden, France and Germany between 1980 and 2009 were related to secular differences affecting the whole population and that these effects differed across countries.

Bias in estimates of alcohol use among older people: selection effects due to design, health, and cohort replacement

Background

There is a growing awareness of the need to include the oldest age groups in the epidemiological monitoring of alcohol consumption. This poses a number of challenges and this study sets out to examine the possible selection effects due to survey design, health status, and cohort replacement on estimates of alcohol use among the oldest old.

Methods

Analyses were based on three repeated cross-sectional interview surveys from 1992, 2002 and 2011, with relatively high response rates (86 %). The samples were nationally representative of the Swedish population aged 77+ (total n = 2022). Current alcohol use was assessed by the question “How often do you drink alcoholic beverages, such as wine, beer or spirits?” Alcohol use was examined in relation to survey design (response rate, use of proxy interviews and telephone interviews), health (institutional living, limitations with Activities of Daily Living and mobility problems) and birth cohort (in relation to age and period). Two outcomes were studied using binary and ordered logistic regression; use of alcohol and frequency of use among alcohol users.

Results

Higher estimates of alcohol use, as well as more frequent use, were associated with lower response rates, not using proxy interviews and exclusion of institutionalized respondents. When adjusted for health, none of these factors related to the survey design were significant. Moreover, the increase in alcohol use during the period was fully explained by cohort replacement. This cohort effect was also at least partially confounded by survey design and health effects. Results were similar for both outcomes.

Conclusions

Survey non-participation in old age is likely to be associated with poor health and low alcohol consumption. Failure to include institutionalized respondents or those who are difficult to recruit is likely to lead to an overestimation of alcohol consumption, whereas basing prevalence on older data, at least in Sweden, is likely to underestimate the alcohol use of the oldest old. Trends in alcohol consumption in old age are highly sensitive for cohort effects. When analysing age-period-cohort effects, it is important to be aware of these health and design issues as they may lead to incorrect conclusions.

Consumption profile and factors associated with the ingestion of beer and distilled beverages among elderly Brazilians: Gender differences

AIM

To estimate the prevalence of the consumption of beer and distilled beverages and associated factors among Brazilian older adults residing in a highly populated city in Brazil, highlighting the factors associated with frequent consumption and differences in consumption between men and women.

METHODS

It was a cross-sectional, analytic study carried out by means of probability samples of conglomerates of older adults (aged 65-74 years). Descriptive analysis, univariate analysis and estimates of multivariate models through logistic regression (OR, 95% CI) were realized.

RESULTS

500 of the 736 evaluated seniors were included in the present analysis. 128 (27.3%), 103 (21.3%) and 167 (34.9%) of the seniors indicate past or current use of beer, distilled beverages and frequent use of alcohol, respectively. The consumption of beer was associated with use of tobacco between women; and with marital status and schooling between men. The consumption of distilled beverages was associated with schooling and use of tobacco between women; and age and use of tobacco in men. Daily or weekly use was associated with schooling and use of tobacco between women; age and the use of tobacco between men.

CONCLUSION

In the elderly population studied, a noteworthy prevalence of the consumption of beer and distilled beverages was identified, and this use was associated with personal and behavioral determinants. Similar associations related to frequent (daily or weekly) consumption were also identified. Significant differences in the profile of consumption were identified between men and women, with more abusive use among men. Geriatr Gerontol Int 2016; 16: 810-820.

Does a Change Over All Equal a Change in All? Testing for Polarized Alcohol Use Within and Across Socio-Economic Groups in Germany

AIMS

This study aimed at testing whether drinking volume and episodic heavy drinking (EHD) frequency in Germany are polarizing between consumption levels over time. Polarization is defined as a reduction in alcohol use among the majority of the population, while a subpopulation with a high intake level maintains or increases its drinking or its EHD frequency. The polarization hypothesis was tested across and within socio-economic subgroups.

METHOD

Analyses were based on seven cross-sectional waves of the Epidemiological Survey of Substance Abuse (ESA) conducted between 1995 and 2012 (n = 7833-9084). Overall polarization was estimated based on regression models with time by consumption level interactions; the three-way interaction with socio-economic status (SES) was consecutively introduced to test the stability of effects over socio-economic strata. Interactions were interpreted by graphical inspection.

RESULTS

For both alcohol use indicators, declines over time were largest in the highest consumption level. This was found within all SES groups, but was most pronounced at low and least pronounced at medium SES.

CONCLUSION

The results indicate no polarization but convergence between consumption levels. Socio-economic status groups differ in the magnitude of convergence which was lowest in medium SES. The overall decline was strongest for the highest consumption level of low SES.

The relationship between population-level exposure to alcohol advertising on television and brand-specific consumption among underage youth in the US

AIMS

We investigated the population-level relationship between exposure to brand-specific advertising and brand-specific alcohol use among US youth.

METHODS

We conducted an internet survey of a national sample of 1031 youth, ages 13-20, who had consumed alcohol in the past 30 days. We ascertained all of the alcohol brands respondents consumed in the past 30 days, as well as which of 20 popular television shows they had viewed during that time period. Using a negative binomial regression model, we examined the relationship between aggregated brand-specific exposure to alcohol advertising on the 20 television shows [ad stock, measured in gross rating points (GRPs)] and youth brand-consumption prevalence, while controlling for the average price and overall market share of each brand.

RESULTS

Brands with advertising exposure on the 20 television shows had a consumption prevalence about four times higher than brands not advertising on those shows. Brand-level advertising elasticity of demand varied by exposure level, with higher elasticity in the lower exposure range. The estimated advertising elasticity of 0.63 in the lower exposure range indicates that for each 1% increase in advertising exposure, a brand's youth consumption prevalence increases by 0.63%.

CONCLUSIONS

At the population level, underage youths' exposure to brand-specific advertising was a significant predictor of the consumption prevalence of that brand, independent of each brand's price and overall market share. The non-linearity of the observed relationship suggests that youth advertising exposure may need to be lowered substantially in order to decrease consumption of the most heavily advertised brands.

The use of a chronic disease and risk factor surveillance system to determine the age, period and cohort effects on the prevalence of obesity and diabetes in South Australian adults--2003-2013

Background

Age, period and cohort (APC) analyses, using representative, population-based descriptive data, provide additional understanding behind increased prevalence rates.

Methods

Data on obesity and diabetes from the South Australian (SA) monthly chronic disease and risk factor surveillance system from July 2002 to December 2013 (n = 59,025) were used. Age was the self-reported age of the respondent at the time of the interview. Period was the year of the interview and cohort was age subtracted from the survey year. Cohort years were 1905 to 1995. All variables were treated as continuous. The age-sex standardised prevalence for obesity and diabetes was calculated using the Australia 2011 census. The APC models were constructed with ‘‘apcfit’’ in Stata.

Results

The age-sex standardised prevalence of obesity and diabetes increased in 2002-2013 from 18.6% to 24.1% and from 6.2% to 7.9%. The peak age for obesity was approximately 70 years with a steady increasing rate from 20 to 70 years of age. The peak age for diabetes was approximately 80 years. There were strong cohort effects and no period effects for both obesity and diabetes. The magnitude of the cohort effect is much more pronounced for obesity than for diabetes.

Conclusion

The APC analyses showed a higher than expected peak age for both obesity and diabetes, strong cohort effects with an acceleration of risk after 1960s for obesity and after 1940s for diabetes, and no period effects. By simultaneously considering the effects of age, period and cohort we have provided additional evidence for effective public health interventions.

Mental health in adolescence as determinant of alcohol consumption trajectories in the Northern Swedish Cohort

OBJECTIVES

The study aimed to analyze whether poor mental health in adolescence predicts heavy alcohol consumption over the long term.

METHODS

Alcohol consumption in the population cohort (n = 1010) was surveyed at the ages of 16, 18, 21, 30 and 42. Utilizing latent class growth analysis, six consumption trajectories ranging from 'Late Onset Low' to 'Early Onset High' were defined and analyzed with respect to internalization (depressiveness and anxiousness) and externalization (truancy and vandalism) at age 16.

RESULTS

Poor mental health predicted the Early Onset High trajectory (risk ratios in relation to the compliant trajectory 3.59 for anxiousness, 2.85 for depressiveness, 5.69 for truancy and 7.75 for externalized vandalism). Moreover, significant associations were found for the Early Onset Moderate and Early Onset Low trajectories.

CONCLUSIONS

This is the first study to show an association between internalized mental health problems in adolescence and lifelong heavy drinking. The study also confirmed a strong association between externalized behavior and heavy drinking, indicating a need of preventive measures in this group. Nevertheless, the analyses demonstrated that most teenagers with mental health problems continue along a reasonable drinking trajectory.

Gender, age and risk of ST segment elevation myocardial infarction

BACKGROUND

Exact associations of gender and age with occurrence of ST segment elevation myocardial infarction are inadequately known.

DESIGN

Gender and age differences in frequency and incidence of ST segment elevation myocardial infarction (STEMI were studied using a nationwide, population-based (26 723 956 person-years) registry of hospital admissions in patients aged ≥ 30 during 2001-2008 in Finland. Data were collected from all 22 hospitals with a coronary angiolaboratory nationwide.

RESULTS

The study period included 27 993 STEMI admissions. Of these patients, 65·9% were men and 34·1% women, RR 2·37 (95% CI 2·05-2·74, P < 0·0001). Women were significantly older than men (74·3 ± 11·7 vs. 64·7 ± 12·4 years, P < 0·0001). Standardized incidence rate of STEMI was 113·0/100 000 person-years overall, 170·9/100 000 in men and 66·6/100 000 in women. Men had a 3·03 (95% CI 2·86-3·21; P < 0·0001)-fold age-adjusted relative risk of STEMI compared with women with highest risk difference in population under the age of 55 years (RR 5·94; 95% CI 5·36-6·58, P < 0·0001). Incidence increased with age up to 90 years old, with estimated gender-adjusted increase rate of 41% (95% CI 40-42%; P < 0·0001) per 5-year increase in age. Incidence rate had a slowly declining trend (-2·2%; 95% CI -3·4 to -1·0% per year, P < 0·001) during the study period.

CONCLUSIONS

Men have a tripled overall risk of STEMI compared with women with highest relative risk in younger adults. Incidence rate of ST segment elevation myocardial infarction increases by estimated 41% per 5-year increase in age.

Likelihood and predictors of ST-elevation in patients hospitalized for myocardial infarction

Importance

Emergency treatment options in myocardial infarction are guided by presence or absence of ST-elevations in electrocardiography. Occurrence and factors associated with ST-presentation in different population groups are however inadequately known.

Objective

To determine likelihood and patient features associated with ST-elevations in myocardial infarction.

Design

Nationwide registry study including 22 hospitals with angiolaboratory during an eight year period in Finland.

Setting

Hospitalized care.

Participants

68,162 consecutive patients aged ≥30 with myocardial infarction.

Measures

Likelihood and patient features associated with presence of ST-elevations.

Results

Myocardial infarction presented with ST-elevation in 37.5% (CI 37.0–37.9%) and without in 62.5% (CI 61.9–63.1%) of patients, p<0.0001. Majority of patients aged 30–59 years with myocardial infarction had ST-elevation, but among octogenarians ST-elevations were present in only 24.7%. Presence of ST-elevations decreased with age by estimated 15.6% (CI 15.0–16.2%) per 10 year increase (p<0.0001). Men aged 40–79 years had significantly higher rate for ST-elevation myocardial infarction compared to women. Sex-based difference in presentation of myocardial infarction declined with increasing age. Overall, men had a 13% (CI 11–15%, p<0.0001) higher relative risk for ST-elevations compared to women when adjusted for age and co-morbidities. Diabetes, atrial fibrillation, peripheral or cerebral artery disease, chronic pulmonary disease, malignancy, and renal insufficiency were associated with absence of ST-elevations in myocardial infarction in multivariate analysis.

Conclusions and Relevance

Myocardial infarction presents with ST-elevations more commonly in men. Presence of ST-elevations decreases with increasing age. Diabetes, atrial fibrillation, peripheral or cerebral artery disease, chronic pulmonary disease, malignancy, and renal insufficiency are associated with absence of ST-elevations in myocardial infarction. These findings may help to predict likelihood of ST-elevations in a patient with myocardial infarction.

Association of age and gender with risk for non-ST-elevation myocardial infarction

BACKGROUND

Age and gender associated risks for non-ST-elevation myocardial infarction (NSTEMI) at the population level are largely uncharacterized.

DESIGN

Nationwide, population (26,724,165 person-years) based eight-year registry-study in Finland.

METHODS

Gender- and age-associated frequency and incidence of NSTEMI were studied using a nationwide, population based registry of hospital admissions in patients aged ≥30 years during 2001-2008. Patients with NSTEMI as primary (88%), secondary (10%) or tertiary (2%) discharge diagnosis were included. Data was collected nationwide from all 22 hospitals with a coronary angiolaboratory.

RESULTS

The study period included 48,584 NSTEMI admissions of which 55.3% (95% confidence interval (CI) 54.6-56.0%) were of men and 44.7% (CI 44.1-45.3%) were of women, with age-adjusted relative risk of 1.86 (CI 1.60-2.16, p < 0.0001) for male gender. Female patients were significantly older than males (77.8 SD 10.2 vs. 70.2 SD 11.9 years, p < 0.0001). Standardized incidence rate of NSTEMI was 20.6 (CI 20.4-20.8)/10,000 person-years overall, 28.7 (CI 28.3-29.0)/10,000 in men and 15.0 (CI 14.7-15.2)/10,000 in women. Men had a 2.36-fold (CI 2.23-2.49; p < 0.0001) age-adjusted relative risk for NSTEMI compared with women, with highest risk difference in population under 40 years of age (relative risk 4.48; CI 3.10-6.48, p < 0.0001). Incidence increased with age by an estimated gender-adjusted increase rate of 61% (CI 59-62%; p < 0.0001) per five-year increase in age.

CONCLUSIONS

Men have a 2.4-fold overall risk for NSTEMI compared with women, with highest relative risk in young adults. Incidence rate of non-ST-elevation myocardial infarction increases by an estimated 61% per five-year increase in age.

Trend analysis and modelling of gender-specific age, period and birth cohort effects on alcohol abstention and consumption level for drinkers in Great Britain using the General Lifestyle Survey 1984-2009

BACKGROUND AND AIMS

British alcohol consumption and abstinence rates have increased substantially in the last 3 decades. This study aims to disentangle age, period and birth cohort effects to improve our understanding of these trends and suggest groups for targeted interventions to reduce resultant harms.

DESIGN

Age, period, cohort analysis of repeated cross-sectional surveys using separate logistic and negative binomial models for each gender.

SETTING

Great Britain 1984-2009.

PARTICIPANTS

Annual nationally representative samples of approximately 20 000 adults (16+) within 13 000 households.

MEASUREMENTS

Age (eight groups: 16-17 to 75+ years), period (six groups: 1980-84 to 2005-09) and birth cohorts (19 groups: 1900-04 to 1990-94). Outcome measures were abstinence and average weekly alcohol consumption. Controls were income, education, ethnicity and country.

FINDINGS

After accounting for period and cohort trends, 18-24-year-olds have the highest consumption levels (incident rate ratio = 1.18-1.15) and lower abstention rates (odds ratio = 0.67-0.87). Consumption generally decreases and abstention rates increase in later life. Until recently, successive birth cohorts' consumption levels were also increasing. However, for those born post-1985, abstention rates are increasing and male consumption is falling relative to preceding cohorts. In contrast, female drinking behaviours have polarized over the study period, with increasing abstention rates accompanying increases in drinkers' consumption levels.

CONCLUSIONS

Rising female consumption of alcohol and progression of higher-consuming birth cohorts through the life course are key drivers of increased per capita alcohol consumption in the United Kingdom. Recent declines in alcohol consumption appear to be attributable to reduced consumption and increased abstinence rates among the most recent birth cohorts, especially males, and general increased rates of abstention across the study period.

Sex differences in neuroadaptation to alcohol and withdrawal neurotoxicity

Recent work suggests that sex differences exist with regard to both the nature of neuroadaptation to alcohol during the development of dependence, and possibly, the neurodegenerative consequences of alcohol dependence. Volumetric studies in human samples show that females may demonstrate increased volumetric brain loss with equal or lesser dependence histories than males. Furthermore, animal studies demonstrate sex differences in glutamatergic, GABAergic, and adenosinergic receptor signaling and endocrine responses following prolonged alcohol exposure. These differences may influence the development of dependence, neuronal function, and viability, particularly during alcohol withdrawal. The present review discusses the current state of knowledge in this regard. It is concluded that there exists a clear need for a more extensive examination of potential sex differences in neurodegenerative consequences of alcohol dependence in men and women, particularly with regard to the role that alterations in amino acid signaling and hypothalamic-pituitary-adrenal axis function may play. Furthermore, we note the need for expanded examination of the unique role that alcohol withdrawal-associated neuronal activity may have in the development of dependence-associated neurotoxicity.

Prevalence of concomitant use of alcohol and sedative-hypnotic drugs in middle and older aged persons: a systematic review

OBJECTIVE

To systematically review the prevalence of concomitant alcohol and sedative-hypnotic use among middle-aged and older persons.

DATA SOURCES

A bibliographic search of English-language literature was performed using MEDLINE, EMBASE, and PsycINFO (January 1990-August 2012). The reference lists of all included articles were screened for additional relevant articles not identified by any of the bibliographic searches.

STUDY SELECTION AND DATA EXTRACTION

Population-based studies in which the mean age of participants was 40 years or older were included. For a study to be included in the review, alcohol use had to be reported in terms of the quantity or frequency consumed. Data from included articles were extracted using a standardized data extraction tool.

DATA SYNTHESIS

Five population-based studies conducted in North America, 10 in Europe, and 1 in Australia were included in the review. Up to 88% of men and 79% of women who used sedative-hypnotics also consumed alcohol. Up to 28% of those who consumed alcohol were concomitant users of sedative-hypnotics. Alcohol was consumed at higher levels among middle-aged than older persons. Risky drinking (eg, binge drinking, heavy drinking) was more prevalent among middle-aged than older persons. In contrast, sedative-hypnotic use was more prevalent among older persons.

CONCLUSIONS

Our review identified a higher prevalence of alcohol consumption among middle-aged than older persons. However, middle-aged persons may experience harm from alcohol/sedative-hypnotic drug interactions due to risky drinking behavior. Despite lower levels of alcohol consumption, older persons may be more susceptible to addictive central nervous system effects than younger persons because of physiologic changes in psychotropic drug and alcohol metabolism. Clinicians should consider patients' alcohol consumption patterns before prescribing sedative-hypnotic drugs.

Alcohol consumption and dietary patterns: the FinDrink study

The aim of this population-based study was to investigate differences in dietary patterns in relation to the level of alcohol consumption among Finnish adults. This study was part of the FinDrink project, an epidemiologic study on alcohol use among Finnish population. It utilized data from the Kuopio Ischaemic Heart Disease Risk Factor Study. A total of 1720 subjects comprising of 816 men and 904 women aged 53–73 years were included in the study in 1998–2001. Food intake was collected via a 4-day food diary method. Self-reported alcohol consumption was assessed with quantity-frequency method based on the Nordic Alcohol Consumption Inventory. Weekly alcohol consumption was categorized into three groups: non-drinkers (<12 grams), moderate drinkers (12–167.9 grams for men, 12–83.9 grams for women) and heavy drinkers (≥168 grams for men, ≥84 grams for women). Data were analyzed for men and women separately using multiple linear regression models, adjusted for age, occupational status, marital status, smoking, body mass index and leisure time physical activity. In women, moderate/heavy drinkers had lower fibre intake and moderate drinkers had higher vitamin D intake than non-drinkers. Male heavy drinkers had lower fibre, retinol, calcium and iron intake, and moderate/heavy drinkers had higher vitamin D intake than non-drinkers. Fish intake was higher among women moderate drinkers and men moderate/heavy drinkers than non-drinkers. In men, moderate drinkers had lower fruit intake and heavy drinkers had lower milk intake than non-drinkers. Moderate drinkers had higher energy intake from total fats and monosaturated fatty acids than non-drinkers. In contrast, energy intake from carbohydrates was lower among moderate/heavy drinkers than non-drinkers. In conclusion, especially male heavy drinkers had less favorable nutritional intake than moderate and non-drinkers. Further studies on the relationship between alcohol consumption and dietary habits are needed to plan a comprehensive dietary intervention programs in future.

Moral norms in older Swedish women's drinking narratives. Enduring patterns and successively new features

Aims

To examine how the changes in women's relationship to alcohol during the 1960s appear in narratives of situated drinking occasions.

Data

Newly collected autobiographies written by women born between 1918 and 1951 are analysed using theories by William Labov on narrative construction and Kenneth Burke on the rhetoric of motives.

Results

The historically restrictive attitude to women at all drinking is present in the oldest women's narratives, while the liberalisation of attitudes to alcohol that took place in the 1960s likewise marks the narratives told by the younger women, even though they when writing are of pension able age. With the writers’ diminishing age, the norms framing the narratives have changed, from sobriety among the oldest women to controlled moderation among the younger. And yet, the narratives also demonstrate a stable pattern of questioning women's drinking, although the focus has shifted from tasting alcohol at all to the state of becoming intoxicated.

Conclusions

A controlling norm remains in place, which the women have internalised and made their own. The mitigating circumstances and the neutralising explanations that are presented throughout indicate that the women are conscious of the narratives’ deviation from the prevailing norm, and show that women take a risk in drinking alcohol. When a woman drinks she risks her femininity.