Gender differences in hazardous drinking among middle-aged in Europe: the role of social context and women's empowerment

Inequities in primary liver cancer in Europe: The state of play

Given the increasing burden of liver cancer in Europe, it is crucial to investigate how social determinants of health (SDoH) affect liver cancer risk factors and access to care in order to improve health outcomes equitably. This paper summarises the available evidence on the differential distribution of liver cancer risk factors, incidence, and health outcomes in the European Economic Area and the United Kingdom from an SDoH perspective. Vulnerable and marginalised populations have low socio-economic and educational levels and are the most affected by liver cancer risk factors. Reasons for this include varied access to hepatitis B virus vaccination and limited access to viral hepatitis B and C screening, harm reduction, and treatment. Additionally, alcohol-related liver disease remains highly prevalent among individuals with low education, insecure employment, economic instability, migrants, and deprived populations. Moreover, significant variation exists across Europe in the proportion of adults with steatotic liver disease, overweight/obesity, and diabetes, based on geographical area, gender, socio-economic and educational background, and density of ultra-processed food outlets. Inequities in cirrhosis mortality rates have been reported, with the highest death rates among individuals living in socio-economically disadvantaged areas and those with lower educational levels. Furthermore, insufficient healthcare access for key populations with primary liver cancer is influenced by complex healthcare systems, stigmatisation, discrimination, low education, language barriers, and fear of disclosure. These challenges contribute to inequities in liver cancer care pathways. Future studies are needed to explore the different SDoH-interlinked effects on liver cancer incidence and outcomes in European countries. The ultimate goal is to develop evidence-based multilevel public health interventions that reduce the SDoH impact in precipitating and perpetuating the disproportionate burden of liver cancer in specific populations.

A smartphone application to reduce problematic drinking: a feasibility trial

BACKGROUND

Problematic drinking is common among college students and associated with various somatic and mental health problems. Given significant evidence for the efficacy of smartphone-based interventions and the frequent use of smartphones among college students, it can be assumed that such interventions have great potential to facilitate access to evidence-based interventions for students suffering from problematic drinking. Thus, we developed a brief intervention that combined a counseling session with an app that utilizes approach-avoidance modification training to reduce alcohol consumption.

METHODS

To test the feasibility and explore the potential efficacy of the intervention, we conducted a before-after single-arm study with N = 11 participants reportedly engaging in problematic drinking, who were instructed to practice with the app for 14 days. Feasibility was assessed with the System Usability Scale (SUS). Outcomes included the reduction of self-reported problematic drinking behavior, dysfunctional attitudes about alcohol, and craving, as well as implicit associations between alcohol and self during the training period. Additionally, self-reported problematic drinking behavior was assessed at a 4-week follow-up.

RESULTS

On average, participants rated app usability on the SUS (possible range: 0 to 100) with M = 84.32 (SD = 6.53). With regard to efficacy, participants reported a significant reduction of problematic drinking behavior (dpre vs. post = 0.91) which was sustained at follow-up (dfollow-up vs. baseline = 1.07). Additionally, participants reported a significant reduction of dysfunctional attitudes about alcohol (dpre vs. post = 1.48). Results revealed no significant changes in craving nor in implicit associations regarding alcohol.

CONCLUSIONS

Findings from this feasibility study provide preliminary evidence that smartphone-based interventions might help reduce problematic drinking in college students. Further research needs to replicate these findings with larger samples in randomized controlled trials.

TRIAL REGISTRATION

DRKS00014675 (retrospectively registered).

Using photovoice to generate policy recommendations to improve the alcohol urban environment: A participatory action research project

The place where we live, work and play may influence our alcohol drinking behaviours. This study aimed to present local policy recommendations on urban determinants for alcohol consumption prevention in a low-income and a high-income area of Madrid (Spain) using a participatory action research method, with photovoice and nominal group techniques. Participants (n = 26) engaged in a photovoice project initiated a process of critical reflection by discussing and analysing their alcohol environment based on photographs they took themselves. At the end of six week group discussion sessions, participants identified 33 themes related to their alcohol environment. They later met to translate the final categories into urban policy recommendations using a logical framework approach. Then, with a nominal group, they prioritized these recommendations based on time, impact, feasibility, and cost. Finally, participants produced a total of 61 policy recommendations for the improvement of the alcohol environment, highlighting the need for researcher-community collaborations when designing public health interventions.

Influence of Social Determinants of Health on the Quality of Life of Older Adults in Europe: A Sex Analysis

Introduction

The global aging population poses challenges for society such as health inequalities among older persons and between genders.

Objectives

To determine how Social Determinants of Health (SDH) influence the quality of life (QoL) of individuals over 50 years old in various European countries, taking a gender perspective in a longitudinal study.

Materials and methods

Sample of 11,493 individuals from 13 European countries from Waves 5 (2013), 6 (2015), and 7 (2017) of the SHARE study. Instruments: CASP-12 (QoL), EURO-D (depression), SDH: gender, age, educational level, socioeconomic status, ethnicity, place of residence, and European region. Sociodemographic and clinical variables. Statistical analysis: Bivariate and multivariate mixed linear models.

Results

The bivariate analysis showed higher economic hardship and lower education in women compared to men. The CASP-12 score was higher in men than in women. In the multivariate analysis, the variables associated with lower QoL scores among men and women from Wave 5 to Wave 7 were: (β:-0.196, 95% CI: -0.345; -0.047) vs (β:0.038, 95% CI: -0.122; 0.197); economic hardship; and the European region between South and North (β: 2.709, 95% CI: 2.403; 3.015) vs men (β: 2.224, 95% CI: 1.896; 2.551).

Conclusions

The main SDH associated with poorer QoL were female gender, advanced age, economic hardship, educational level, and geographic location within Europe. Depression in women and in Southern Europe were associated with a decrease in QoL scores.

Effects of a multi-component alcohol prevention program in the workplace on hazardous alcohol use among employees

BACKGROUND

The workplace can be affected negatively by hazardous alcohol use, and intervening at an early stage remains a challenge. Recently, a multi-component alcohol prevention program, Alcohol Policy and Managers' skills Training (hereafter, 'APMaT'), was delivered at the organizational level. In a previous outcome evaluation, APMaT appeared to be effective at the managerial level. The current study takes a step further by aiming to evaluate the effectiveness of APMaT in decreasing the alcohol risk level among employees.

METHODS

Data from 853 employees (control: n = 586; intervention: n = 267) were gathered through a cluster-randomized study. To analyze changes in the odds of hazardous alcohol use among employees, multilevel logistic regression was applied using group (control vs. intervention), time (baseline vs. 12-month follow-up), and the multiplicative interaction term (group × time) as the main predictors. The intervention effect was further adjusted for sociodemographic characteristics and policy awareness.

RESULTS

No statistically significant difference was observed in the odds of hazardous alcohol use, although employees in the intervention group showed a larger decrease compared to the control group. This remained even after adjusting for several factors, including the sociodemographic factors and policy awareness.

CONCLUSIONS

The findings are insufficient to determine the effectiveness of APMaT at the employee level at the current stage of the evaluation. Future studies should strive to identify issues with implementation processes in workplace-based alcohol interventions.

TRIAL REGISTRATION

The trial was retrospectively registered on 11/10/2019; ISCRTN ID: ISRCTN17250048.

Labor force participation during COVID-19 and risk of depression: a Danish register study

BACKGROUND

COVID-19 caused economic insecurity for businesses and their employees. Understanding effects of changes in labor force participation on depression risk during economic recession is fundamental for early diagnosis. The study evaluates if changes in labor force participation are associated with depression risk during COVID-19 in Denmark.

METHODS

A register-based longitudinal study of Danes aged 25-67 years without depression 2 years prior to baseline defined as February 2020. An eight-level categorical variable on stable or changing labor force participation was defined from monthly employment percentage gradients in the Danish Register-based Evaluation and Marginalization Database from February 2020. The cohort was followed until 31 December 2020 for depressions overall and mild-, moderate- and severe depression. Sex-stratified cox regression models with hazard ratios (HR) and 95% confidence intervals (95% CI) were performed accounting for important confounders.

RESULTS

In total, 1 619 240 (50.3%) men of mean age 45.6 years and 1 598 587 (49.7%) women of mean age 45.9 years were included. Becoming unemployed implied an increased HR of depression in men (HR 2.02; 95% CI 1.94-2.10) and women (2.19; 2.12-2.26) compared to a steady-state full-time employment. Being outside the labor force or employed part-time implied an elevated HR in men (3.02; 2.82-3.23 and 2.41; 2.35-2.48) and women (3.13; 2.30-3.31 and 2.30; 2.26-2.35), respectively, compared to a steady-state full-time employment.

CONCLUSIONS

Changes in labor force participation were associated with higher risk of depression relative to a steady-state full-time employment particularly among individuals with low labor force participation during COVID-19.

Gender Matters: Identity, Risk Perception and Preventive Interventions for Alcohol Consumption among Adolescents Using a Qualitative Approach

The epidemiological information available in Spain and the Community of Madrid highlights two relevant facts regarding alcohol consumption: an increase in binge drinking in teenagers and a reduction/reversal of the gender gap, particularly at young ages. This article aims to describe some of the factors related to alcohol use in teenagers, especially those related to gender and risk perception. A qualitative study was designed with semi-structured interviews and a discussion group with students from the city of Madrid aged 14 to 18 years. A descriptive analysis of the content of the replies of 28 teenagers was conducted. The results show that alcohol consumption has an identity component, both in terms of transition to adulthood and gender role performance. Consumption is also associated with risks, especially those determined by gender inequality, which teenagers learn to manage as a means of survival in nightlife. Preventive campaigns typically lack a gender perspective and a focus on risk prevention. To reduce the prevalence of consumption and associated risks, these strategies need to be reformulated with a gender perspective.

A longitudinal analysis on determinants of problem drinking among Korean women: focusing on a gender perspective

Background

In recent years, female drinking has been on the rise worldwide, and this trend can be observed in Korea as well. Accordingly, this study aimed to examine the heterogeneous longitudinal changes in drinking patterns among Korean women, while also exploring the determinants of these changes. In particular, the study identified the gender perspective-related determinants of the classified patterns of problem drinking.

Methods

Data on 4615 adult women who participated in the Korea Welfare Panel Study (KOWEPS) for 3 years (2018–2020) were analyzed longitudinally using SPSS Statistics 22.0 and M-plus 7.0. The changes in female drinking patterns were analyzed using latent class growth analysis. Subsequently, multinomial logistic regression analysis was performed to identify the predictive factors affecting the changes in drinking patterns.

Results

Latent class analysis yielded three classes: “low problem drinking/decreased,” “moderate problem drinking/maintained,” and “high problem drinking/increased.” Of the participants, 80.4% were in the first class, 14.5% in the second, and 5.1% in the third. After controlling for sociodemographic and psychosocial factors, we found: i) domestic violence, work–family balance stress, and gender role perception were not statistically significant for the “moderate problem drinking/maintained” class; lower levels of depression (odds ratio; OR = .750, p < .05) and higher levels of satisfaction with social relationships (OR = 1.257, p < .05) increased the probability of belonging to the “moderate problem drinking/maintained” group compared to the low problem drinking/decreased class; ii) in the “high problem drinking/increased” class, relative to the low problem drinking/decreased class, experience of domestic violence (OR = 1.857, p < .05), work–family balance stress (OR = 1.309, p < .05), and gender role perception (OR = .705, p < .05) were significant predictors of drinking behavior.

Conclusions

Problem drinking in Korean women demonstrated heterogeneous patterns of change, with gender-specific factors being the main predictors of this change. Therefore, this study developed a strategy for reducing the harmful effects of female drinking, which considers the characteristics of the changes in women’s drinking patterns as well as factors from the gender perspective.

Evaluation of a Community Intervention to Reduce Harmful Alcohol Consumption among Adult Population: A Study Protocol

Harmful alcohol consumption is shaped by a complex range of structural, social, and individual determinants that interact with inequality axes, which can be addressed at the community level. Under the framework of Barcelona Health in the Neighborhoods, which is a community strategy to reduce health inequalities in Barcelona’s most deprived neighborhoods, a community steering group will co-design a multicomponent community intervention. Aims: to assess its effects on: (1) alcohol accessibility, availability, and consumption at the environmental level, and (2) psychosocial and cognitive determinants of harmful alcohol consumption at the individual level. Methods: Quasi-experimental design with a comparison group, and pre- and post-intervention measures. Three Barcelona neighborhoods will be assigned to the intervention or comparison group based on three criteria: healthcare data on alcohol use, socioeconomic characteristics, and population size. The intervention includes activities promoting community mobilization, law enforcement, and communication campaigns in the intervened neighborhoods. Non-participant observations in standardized census sections will be performed in public spaces to collect information on three outcomes: alcohol accessibility, availability, and signs of alcohol consumption. Data collection includes a survey to a sample of 622 subjects to detect differences on these outcomes: risk awareness, knowledge, and self-efficacy about harmful alcohol consumption and drinking patterns. Discussion: This protocol to assess the effects of a multicomponent community intervention on harmful alcohol consumption at the environmental and population level will provide evidence on effective community health interventions and enable informed decisions for policy makers. This protocol could also be used as an implementation guide for studies aimed at reducing harmful drinking in cities with similar characteristics.

Alcohol, age at first sexual intercourse and number of sexual partners in young Mexican women

AIM

To identify the relationship between use of alcohol, number of sexual partners and age of sexual initiation.

METHOD

Descriptive-correlational study. A random sample of 319 young women (age 18-25) from Nuevo Laredo, Mexico was recruited. A sociodemographic data sheet and the AUDIT questionnaire were used. Non-parametric Spearman's rank correlation coefficient and Kruskal-Wallis H test were selected.

RESULTS

On average the participants were 20.70 years old (±2.1), had 1.86 sexual partners (±1.27), started drinking alcohol at the age of 16.82 (±1.79), and their first sexual intercourse was at the age of 17.38 (±1.65). There was a decrease in the age of onset of alcohol use (H=16.646, p<.001) and the age at first sexual intercourse (H=26.749, p<.001) on the lower their current age. The overall AUDIT score negatively correlated with the age of the participants on their first sexual intercourse (r_s=-.168, p<.001) and positively correlated with the number of sexual partners (r_s=.243, p<.001). The aforementioned correlations were more intense among the younger participants (18- and 19-year olds; p<.01).

CONCLUSIONS

There was an association between higher use of alcohol, early age of sexual initiation and number of sexual partners. Nursing professionals may address such variables simultaneously through preventive strategies directed specifically at young women.

Socioeconomic Inequalities in Chronic Liver Diseases and Cirrhosis Mortality in European Urban Areas before and after the Onset of the 2008 Economic Recession

Objective: To analyse the trends in chronic liver diseases and cirrhosis mortality, and the associated socioeconomic inequalities, in nine European cities and urban areas before and after the onset of the 2008 financial crisis. Methods: This is an ecological study of trends in three periods of time: two before (2000–2003 and 2004–2008), and one after (2009–2014) the onset of the economic crisis. The units of analysis were the geographical areas of nine cities or urban areas in Europe. We analysed chronic liver diseases and cirrhosis standardised mortality ratios, smoothing them with a hierarchical Bayesian model by each city, area, and sex. An ecological regression model was fitted to analyse the trends in socioeconomic inequalities, and included the socioeconomic deprivation index, the period, and their interaction. Results: In general, chronic liver diseases and cirrhosis mortality rates were higher in men than in women. These rates decreased in all cities during the financial crisis, except among men in Athens (rates increased from 8.50 per 100,000 inhabitants during the second period to 9.42 during the third). Socioeconomic inequalities in chronic liver diseases and cirrhosis mortality were found in six cities/metropolitan areas among men, and in four among women. Finally, in the periods studied, such inequalities did not significantly change. However, among men they increased in Turin and Barcelona and among women, several cities had lower inequalities in the third period. Conclusions: There are geographical socioeconomic inequalities in chronic liver diseases and cirrhosis mortality, mainly among men, that did not change during the 2008 financial crisis. These results should be monitored in the long term.

Representation of gender in migrant health studies - a systematic review of the social epidemiological literature

Background

Gender as a social construct contributes to determine who migrates and which migration-related risks and opportunities emerge in all phases of the migration trajectory. Simultaneously, migration influences the individual as well as societal definition and perception of gender roles. An explicit gender perspective in migration-related epidemiological research can contribute to adequately analyse and interpret the health of migrants. This systematic review gives a comprehensive overview on how gender has been conceptualised, operationalised and measured in social epidemiologic studies aiming to assess the influence of gender on health among migrants.

Methods

We searched PubMed, Embase, CINAHL, the Cochrane Library, EconLit and PsycINFO and conducted backward reference searching. Reviewers independently selected studies, extracted data and conducted the quality assessment. Eligible studies actively aimed to understand, identify or explain the influence of gender on migrants’ health, whereby the role of gender can encompass a variety of mechanisms, processes or states of differentiation, discrimination and/or inequality.

Results

Almost all of the 43 studies were cross-sectional and focussed on health outcomes in the post-migration phase. The most common theme of research was the health of male migrants in the US, and in particular of men who have sex with men (MSM). All studies treated gender as a binary variable (men vs. women), without discussing additional types of gender identities. A minority of studies differentiated clearly between sex and gender. Gender was mostly operationalised through attitudes toward gender roles and gender-based discrimination, experienced at the individual level. Community and societal level gender measures capturing structural gender determinants were underrepresented.

Conclusions

The intersections of migration and gender suggested synergistic effects on health that only become visible when considering those two social determinants together. Future research needs to embrace a multilevel and non-binary understanding of gender and reflect on the influence of gender in the different phases of the migration journey.

Systematic review registration

PROSPERO CRD42019124698.

Assessing the association between tourism and the alcohol urban environment in Barcelona: a cross-sectional study

OBJECTIVES

Alcohol availability and promotion are not distributed equally in the urban context. Evidence shows that the socioeconomic level seems to influence the amount of alcohol-related elements in an area. Some studies suggest that tourism could also affect the distribution of these elements. We explore with a valid instrument in a large city whether there is an association between high tourism pressure and a greater presence of alcohol-related elements in the urban environment.

DESIGN

Observational ecological study.

SETTING

The study was conducted in Barcelona during 2017-2018.

PARTICIPANTS

We assessed urban exposure to alcohol by performing social systematic observation using the OHCITIES Instrument in a stratified random sample of 170 census tracts within the city's 73 neighbourhoods.

PRIMARY AND SECONDARY OUTCOME MEASURES

For each census tract we calculated the density of alcohol premises, and of promotion in public places per 1000 residents. We estimated tourism pressure using the number of tourist beds per 1000 residents in each neighbourhood and calculated quartiles. To assess the relationship between rate ratios of elements of alcohol urban environment and tourism pressure, we calculated Spearman correlations and fitted Poisson regression models with robust error variance.

RESULTS

The median densities obtained were of 8.18 alcohol premises and of 7.59 alcohol advertising and promotion elements visible from the public space per 1000 population. Census tracts with the highest tourism pressure had 2.5 (95% CI: 1.85-3.38) times more outlets and 2.3 (95% CI: 1.64-3.23) times more promotion elements per 1000 residents than those in the lowest tourism pressure quartile.

CONCLUSIONS

We observed a strong association between tourism pressure and alcohol exposure in the city of Barcelona.

Inequalities and the Impact of Job Insecurity on Health Indicators in the Spanish Workforce

In a context of high job insecurity resulting from social deregulation policies, this research aims to study health and substance abuse inequalities in the workplace from a gender perspective. To this end, a transversal study was carried out based on microdata from the National Health Survey in Spain—2017, selecting the active population and calculating the prevalence of the state of health and consumption, according to socio-occupational factors (work relationship, social occupational class, time and type of working day). Odds ratios adjusted by socio-demographic variables and their 90% confidence intervals were estimated by means of binary logistic regressions stratified by sex. The results obtained showed two differentiated patterns of health and consumption. On the one hand, unemployed people and those from more vulnerable social classes showed a higher prevalence of both chronic depression and anxiety and of hypnosedative and tobacco use. On the other hand, the better positioned social classes reported greater work stress and alcohol consumption. In addition, while unemployment affected men’s health more intensely, women were more affected by the type of working day. The study can be used to design sustainable preventive occupational health policies, which should at least aim at improving the quantity and quality of employment.

Community-Based Interventions to Reduce Alcohol Consumption and Alcohol-Related Harm in Adults

Alcohol consumption was associated with 3 million deaths worldwide in 2016. Although community action has proven to be effective and has become a priority area of the global strategy to reduce alcohol consumption, there is a gap in the knowledge of community interventions to reduce alcohol use among adults. This study aims to analyze the evidence on effective community-based interventions to reduce alcohol consumption and harm among adults and to identify their components and underlying theories. Search strategy involved five databases (January 2000-March 2020). We included multicomponent, evaluated, and community interventions addressing to adults in urban settings of high-income countries. Furthermore, two conceptual frameworks were adapted to identify the social determinants of alcohol related harms and modifiable factors through community interventions. The initial search yielded 164 articles. The final sample included eight primary studies. Six of them were effective and shared three components (community mobilization; law enforcement and media campaigns), they combined approaches at individual and environmental levels addressing structural determinants of health and some cultural aspects related to consumption. Health outcomes focused mainly on reducing consumption, modifying patterns and acute effects on health. Few studies addressed social problems arising from harmful consumption. This review has identified several effective community-based interventions to reduce harmful use of alcohol among adults as well as some mechanisms and theories supporting them. It also provides a framework to guide new designs, with potential evidence of factors, as well as possible combinations of methods to improve health at community level across different settings and contexts.

Alcohol and educational inequalities: Hazardous drinking prevalence and all-cause mortality by hazardous drinking group in people aged 50 and older in Europe

Background: We examined educational inequalities in hazardous drinking prevalence among individuals aged 50 or more in 14 European countries, and explored educational inequalities in mortality in hazardous drinkers in European regions. Methods: We analyzed data from waves 4, 5 and 6 of the Survey of Health Ageing and Retirement in Europe (SHARE). We estimated age-standardized hazardous drinking prevalence, and prevalence ratios (PR) of hazardous drinking by country and educational level using Poisson regression models with robust variance. We estimated the relative index of inequality (RII) for all-cause mortality among hazardous drinkers and non-hazardous drinkers using Cox proportional hazards regression models and for each region (North, South, East and West). Results: In men, educational inequalities in hazardous drinking were not observed (PR_medium = 1.09 [95%CI: 0.98-1.21] and PR_high = 0.99 [95%CI: 0.88-1.10], ref. low), while in they were observed in women, having the highest hazardous drinking prevalence in the highest educational levels (PR_medium = 1.28 [95%CI: 1.15-1.42] and PR_high = 1.53 [95%CI: 1.36-1.72]). Overall, the Relative Index of Inequality (RII) in all-cause mortality among hazardous drinkers was 1.12 [95%CI: 1.03-1.22] among men and 1.10 [95%CI: 0.97-1.25] among women. Educational inequalities among hazardous drinkers were observed in Eastern Europe for both men (RII_hazardous = 1.21 [95%CI: 1.01-1.45]) and women (RII_hazardous = 1.46 [95%CI: 1.13-1.87]). Educational inequalities in mortality among non-hazardous drinkers were observed in Southern, Western and Eastern Europe among men, and in Eastern Europe among women. Conclusions: Higher educational attainment is positively associated with hazardous drinking prevalence among women, but not among men in most of the analyzed European countries. Clear educational inequalities in mortality among hazardous drinkers were only observed in Eastern Europe. Further research on the associations between alcohol use and inequalities in all-cause mortality in different regions is needed.

Hypertension-Related Knowledge, Attitudes, and Behaviors among Community-Dwellers at Risk for High Blood Pressure in Shanghai, China

This study aimed to investigate the hypertension-related knowledge, attitudes, behaviors (KAB), and socio-demographic determinants among community-dwellers who were at risk for hypertension in Shanghai, China. A cross-sectional survey was conducted in a district of Shanghai in 2017 using multi-stage cluster sampling, including 611 participants who were at risk for hypertension. Questionnaires were used to investigate KAB regarding hypertension prevention. Multivariable logistic regression was performed to examine the relationship between socio-demographic factors and hypertension-related KAB. The results indicated that more than 75% of the study population had accurate knowledge, but only 48.4% knew the Recommended Daily Intake of salt for adults; over 80% formed health beliefs, while less than 50% were keeping a healthy diet, maintaining regular physical activity and/or bodyweight control. Better knowledge was found in the below 60 age group (p < 0.01) and the 60-69 age group (p = 0.03) than in the ≥70 age group. The behaviors in females (p < 0.01) were better than in males and were better in those covered by the Urban Employee Basic Medical Insurance (p = 0.01) than in those with the New Rural Cooperative Medical Insurance. In conclusion, although the rates of accurate knowledge and belief of hypertension prevention were high in the study population, the rates of maintaining healthy behaviors were relatively low. Socio-demographic factors had important influences on hypertension-related KAB. Further health education and intervention of hypertension prevention was needed to improve their level of KAB and reduce their risk for hypertension among the target groups.

Alcohol, age at first sexual intercourse and number of sexual partners in young Mexican women

AIM

To identify the relationship between use of alcohol, number of sexual partners and age of sexual initiation.

METHOD

Descriptive-correlational study. A random sample of 319 young women (age 18-25) from Nuevo Laredo, Mexico was recruited. A sociodemographic data sheet and the AUDIT questionnaire were used. Non-parametric Spearman's rank correlation coefficient and Kruskal-Wallis H test were selected.

RESULTS

On average the participants were 20.70 years old (±2.1), had had 1.86 sexual partners (±1.27), started drinking alcohol at the age of 16.82 (±1.79), and their first sexual intercourse was at the age of 17.38 (±1.65). There was a decrease in the age of onset of alcohol use (H=16.646, p <.001) and the age at first sexual intercourse (H=26.749, P<.001) on the lower their current age. The overall AUDIT score negatively correlated with the age of the participants on their first sexual intercourse (rs=-.168, P<.001) and positively correlated with the number of sexual partners (rs=.243, P<.001). The aforementioned correlations were more intense among the younger participants (18- and 19-year olds; P<.01).

CONCLUSIONS

There was an association between higher use of alcohol, early age of sexual initiation and number of sexual partners. Nursing professionals may address such variables simultaneously through preventive strategies directed specifically at young women.

"Women of my age tend to drink": the social construction of alcohol use by Australian and Danish women aged 50-70 years

In Australia and Denmark, women aged 50-70 years are more likely than younger women to consume alcohol at levels that exceed national low risk drinking guidelines. To explore and possibly help explain this sociocultural shift in patterns of alcohol use, this research investigated the social construction of alcohol use amongst 49 women (25 in Northern Denmark, 24 in Western Australia) aged 50-69 years. The women viewed drinking as normal and acceptable. While some women reported reducing their drinking due to health concerns, others neutralised alcohol-related health risks through compensatory behaviours including exercise. Such constructions arguably serve to sustain at-risk drinking amongst some women. Our research highlights that interventions to minimise alcohol-related health risks amongst middle-aged and young-old women should acknowledge that women's social construction of their drinking practices may prioritise subjective experiences of "being in control" while drinking, over biomedical understandings of the health impacts of alcohol.

Space and Place in Alcohol Research

PURPOSE OF REVIEW

To summarize the recent literature on social and physical environments and their links to alcohol use and identify empirical research strategies that will lead to a better understanding of alcohol use in contexts.

RECENT FINDINGS

Recent research has continued to describe the importance of neighborhood and regional contexts on alcohol use, while a smaller emerging scientific literature assesses the impacts of contexts on drinking.

SUMMARY

The dynamic, longitudinal, and multiscale processes by which social and physical structures affect social interactions and substance use have not yet been uncovered or quantified. In order to understand and quantify these processes, assessments of exposures (e.g., how individuals use space) and risks within specific locations are essential. Methods to better assess these exposures and risks include model-based survey approaches, ecological momentary assessment (EMA) and other forms of ecologically- and temporally-specific analyses, affiliation network analyses, simulation models, and qualitative/multi-methods studies.

Alcohol consumption behaviours in the immediate aftermath of earthquakes: time series study

OBJECTIVES

Earthquakes are a distressing natural phenomenon that can disrupt normal health-related behaviours. The aim of this study was to investigate changes in alcohol consumption behaviours in the immediate aftermath of mild to moderate earthquakes.

SETTING

This retrospective cohort study was conducted at a large academic hospital in Tokyo, Japan from April 2004 to March 2017.

PARTICIPANTS

We included all adult patients presenting with acute alcohol intoxication in the emergency room.

PRIMARY AND SECONDARY OUTCOME MEASURES

Our outcome was the number of such patients per 24 hours period comparing days with and without earthquake activity. We mainly focused on mild to moderate earthquakes (Shindo scale of less than 3). We conducted a simple generalised autoregressive conditional heteroscedasticity (GARCH) analysis, followed by a multivariate GARCH, including year-fixed effects and secular changes in alcohol taxation. Subanalyses were conducted by gender and age group.

RESULTS

During the study period, 706 earthquakes were observed with a median Shindo scale of 2 (IQR: 1). During this period, 6395 patients were admitted with acute ethanol intoxication; the mean age was 42.6 (SD: 16.9) years and 4592 (71.8%) patients were male. In univariate analyses, the occurrence of daytime earthquakes was marginally inversely related to the number of acutely intoxicated patients (β coefficient: -0.19, 95% CI -0.40 to 0.01). This finding remained similar in multivariate analyses after adjustment for covariates. In analyses stratified by gender, the inverse association between daytime earthquakes and alcohol intoxication was only observed among men (p<0.03 for males and p=0.99 for females). In subanalyses by age, older people were less likely to be admitted to the hospital due to acute alcohol intoxication on days with daytime earthquakes (p=0.11), but this was not the case for younger people (p=0.36).

CONCLUSION

On days when a mild to moderate daytime earthquake occurred, the number of patients with acute alcohol intoxication was lower compared with days without earthquakes. Even milder forms of potentially catastrophic events appear to influence social behaviour; mild to moderate earthquake activity is associated with the avoidance of excessive alcohol consumption.

Associations between gender equality and health: a systematic review

This systematic review sought to evaluate the impact of gender equality on the health of both women and men in high-income countries. A range of health outcomes arose across the 48 studies included. Gender equality was measured in various ways, including employment characteristics, political representation, access to services, and with standard indicators (such as the Global Gender Gap Index and the Gender Empowerment Measure). The effects of gender equality varied depending on the health outcome examined, and the context in which gender equality was examined (i.e. employment or domestic domain). Overall, evidence suggests that greater gender equality has a mostly positive effect on the health of males and females. We found utility in the convergence model, which postulates that gender equality will be associated with a convergence in the health outcomes of men and women, but unless there is encouragement and support for men to assume more non-traditional roles, further health gains will be stymied.

Cancer and Alcohol Consumption in People Aged 50 Years or More in Europe

Aims

To estimate the prevalence of hazardous drinking in individuals aged 50 and older who had or had had cancer in 17 European countries and Israel and to analyze the factors associated with their consumption.

Methods

Cross-sectional study based on data from 2011 to 2013 SHARE surveys. A total of 69,509 individuals aged 50 or more from 17 European countries and Israel participated in the study. Prevalence of hazardous drinking in people with cancer was estimated (adapting the SHARE questionnaire to the AUDIT-C). To ascertain whether type of cancer or time since diagnosis were associated with hazardous drinking, Poisson regression models with robust variance were estimated, obtaining prevalence ratios (PR).

Results

Overall, 5.4% of participants reported having been diagnosed with cancer. Prevalence of hazardous drinking in people with cancer was 18% in women and 23% in men. After adjusting for various socioeconomic and health variables, no significant differences were observed between hazardous drinking and type of cancer [PR = 0.99 (95% confidence interval (95% CI) = 0.83-1.17) in people with alcohol-related cancers compared to non-alcohol related cancers] and time since diagnosis [PR = 1.01 (95% CI = 0.82-1.25) in people with a cancer diagnosed >5 years ago compared to those diagnosed ≤5 years ago]. Significant differences were found between hazardous drinking and smoking status and self-perceived health.

Conclusion

In total, 20% of people diagnosed with cancer were hazardous drinkers, despite the known relationship between alcohol use and a worse prognosis of the disease and an increased likelihood of recurrence.

Short Summary

Overall, 20% of people diagnosed with cancer were hazardous drinkers. There were no significant differences in the prevalence of hazardous drinking depending on the type of cancer (alcohol-related versus non-alcohol related cancers). Highest prevalence of hazardous drinking in people with cancer is found in smokers and people with good self-perceived health.

A population based perspective of twenty years of specialized ambulatory treatment for alcohol use disorders in publicly financed clinics. Barcelona 1996-2015

OBJECTIVE

To provide information on persons treated for alcohol use disorders (AUD) over 20 years in a large city in a Southern European country and its trends, adding knowledge on the frequency of treatment from a population perspective.

METHODS

This is a study of the number of annual admissions to ambulatory addiction treatment centers funded by the public sector in Barcelona (Catalonia, Spain) for the years 1996-2015. Descriptive analyses of AUD admissions were conducted, comparing changes in the number of patients entering treatment by different independent variables across periods. For city residents, sex and age-specific population annual treatment initiation rates were estimated.

RESULTS

The number of ambulatory admissions to AUD treatment increased over the study period. There were about 2100 treatment admissions per year in 2011-2015, of which one fourth were women. About half of these patients had never been treated before for any substance use disorder. Annual rates of treatment initiation among city residents were 208 and 68 per 100,000 people aged 15 and older for men and women respectively, almost the double among 45-54 years old citizens. Rates of total AUD treatment admission increased moderately, but declined among younger adult men.

CONCLUSIONS

These figures provide a basic population-based estimation for formal AUD treatment use in a Southern European urban setting with services available free of charge. The development of ambulatory publicly funded addiction centers may have improved access to treatment for people with AUD. age-related changes in treatment admissions may either be related to trends in the population pattern of drinking or to changes in the city demographics.

Hazardous drinking in people aged 50 years or older: a cross-sectional picture of Europe, 2011-2013

OBJECTIVE

To assess gender and age differences in hazardous drinking and to analyse and compare the factors associated with it in men versus women, and in 50 to 64-year-old versus ≥65-year-old people in Europe.

METHODS

Cross-sectional study with data from 65,955 people aged ≥50 years from 18 countries (SHARE project, 2011-2013). The outcome variable, hazardous drinking, was calculated using an adaptation of the AUDIT-C test. Several individual (sociodemographic, life-style and health factors) and contextual variables (country socioeconomic indicators and alcohol policies) were analysed. The prevalence of hazardous drinking was estimated by each exposure variable. To estimate associations, multilevel Poisson regression models with robust variance were fit, yielding prevalence ratios and their 95% confidence intervals (95%CI).

RESULTS

Overall, the prevalence of hazardous drinking was 21.5% (95%CI = 21.1-22.0), with substantial differences between countries. The proportion of hazardous drinking was higher in men than in women [26.3%(95%CI = 25.6-27.1); 17.5%(95%CI = 17.0-18.0), respectively], as well as in middle-aged people than in older people [23.6%(95%CI = 23.0-24.3); 19.2%(95%CI = 18.6-19.8), respectively]. At the individual level, associations were found for migrant background, marital status, educational level, tobacco smoking, depression and self-perceived health. At the contextual level, hazardous drinking was associated with gender inequalities in society (only in women) and alcohol advertising regulations (both genders).

CONCLUSIONS

One in five people aged ≥50 years in the countries studied is a hazardous drinker, with large differences by countries, gender and age group. Interventions and policies aimed at preventing or reducing alcohol use in this population should account for country, gender and age differences, as well as individual characteristics. Copyright © 2016 John Wiley & Sons, Ltd.

Binge drinking and well-being in European older adults: do gender and region matter?

Background

We aimed to describe gender and region differences in the prevalence of binge drinking and in the association between binge drinking and well-being, among older adult Europeans.

Methods

This is a cross-sectional study using the Survey of Health, Ageing and Retirement in Europe (SHARE) wave 4, conducted between 2011 and 2012, including 58 489 individuals aged 50 years or older. Sixteen European countries were grouped in four drinking culture regions: South, Central, North and East. We categorized drinking patterns as: never, former, no-binge and binge drinkers. We used the CASP-12 questionnaire to measure well-being. To assess the association between binge drinking and well-being, we fitted two-level mixed effects linear models.

Results

The highest percentage of binge drinkers was found in Central Europe (17.25% in men and 5.05% in women) and the lowest in Southern Europe (9.74% in men and 2.34% in women). Former, never and binge drinkers had a significant negative association with well-being as compared with no-binge drinkers. There was a significant interaction in this association by gender and region. Overall, associations were generally stronger in women and in Southern and Eastern Europe. The negative association of binge drinking with well-being was especially strong in Southern European women (β = -3.80, 95% CI: -5.16 to - 2.44, P value <0.001).

Conclusion

In Southern and Eastern European countries the association between binge drinking and well-being is stronger, especially in women, compared with Northern and Central Europe. Cultural factors (such as tolerance to drunkenness) should be further explored.

Risky consumption of alcohol and drugs among employees at ski resorts

AIM

To evaluate risky consumption of alcohol and drugs among Swedish men and women who are employed at ski resorts.

METHODS

A cross-sectional sample of 611 employees in 48 small and medium-sized enterprises responded to a questionnaire covering alcohol and drug use, social aspects around work and working conditions. Consumption of alcohol and drugs in the study sample was compared to population data. Data were analysed using Mann-Whitney U-tests and logistic regression analyses.

RESULTS

Compared to the general population, the study group of ski resort employees had higher scores on the Alcohol Use Disorders Identification Test (AUDIT) in all age groups except 35+ for men. Regarding the Drug Use Disorders Identification Test (DUDIT) scores, only men in the 18-24 age group had higher scores compared to the general population. The prevalence of risky alcohol and drug use was higher among seasonally employed individuals; 82.9%, compared to 58.0% among other employees for alcohol; 8.3% compared to 2.8% for drugs. The regression analysis indicated that social aspects such as living together with colleagues and having co-workers/friends who are frequently inebriated were the most significant explanatory variables for explaining risk consumption of alcohol (OR 16.82 and OR 4.33). Risky use of drugs was associated with being younger (OR 0.15) and male (OR 0.86), as well as with having co-workers/friends who are frequently inebriated (OR 4.25).

CONCLUSIONS

The study showed a high prevalence of risky alcohol consumption among ski resort employees compared to the general population, with higher risky drug consumption found only among younger men. Social aspects such as living with colleagues and having co-workers or friends who are often inebriated, were identified as important explanatory factors. Preventive measures should be introduced, targeting norms and work culture surrounding alcohol and drug use among ski resort employees.

Differences between men and women in substance use: the role of educational level and employment status

OBJECTIVE

To determine differences between men and women in hazardous drinking, heavy cannabis use and hypnosedative use according to educational level and employment status in the economically active population in Spain.

METHOD

Cross-sectional study with data from 2013 Spanish Household Survey on Alcohol and Drugs on individuals aged 25-64 [n=14,113 (women=6,171; men=7,942)]. Dependent variables were hazardous drinking, heavy cannabis use and hypnosedative consumption; the main independent variables were educational level and employment situation. Associations between dependent and independent variables were calculated with Poisson regression models with robust variance. All analyses were stratified by sex.

RESULTS

Hazardous drinking and heavy cannabis use were higher in men, while women consumed more hypnosedatives. The lower the educational level, the greater the gender differences in the prevalence of this substances owing to different consumption patterns in men and women. While men with a lower educational level were higher hazardous drinkers [RII=2.57 (95%CI: 1.75-3.78)] and heavy cannabis users [RII=3.03 (95%CI: 1.88-4.89)] compared to higher educational level, in women the prevalence was the same. Women with a lower education level and men with a higher education level had higher hypnosedative consumption. Unemployment was associated with increased heavy cannabis use and hypnosedative use in both women and men and with lower hazardous drinking only in women.

CONCLUSIONS

There are differences between men and women in the use of psychoactive substances that can be explained by the unequal distribution of substance use in them according to educational level. Unemployment was associated with substance use in both men and women.

[MESGI50 study: description of a cohort on Maturity and Satisfactory Ageing]

OBJECTIVE

To describe the demographic, health and socio-economic characteristics of the participants in the Study on Maturity and Satisfactory Ageing in Girona (MESGI50 study).

METHODS

Population-based Study linked to the Survey of Health, Ageing, and Retirement in Europe (SHARE). The reference population was the inhabitants of the province of Girona (Spain) aged 50 and over. A probabilistic two-stage stratified cluster sampling according to the number of inhabitants and the degree of ageing of the population was used.

RESULTS

Twenty-eight municipalities were randomly selected according to their type (demographically aged or young), and then stratified by the population size. The response rate was 65% with a mean of 1.7 eligible individuals per household and a final sample of 2,065 households and 3,331 participants. The design effect was 1.27. 52.9% were women and the mean age was 66.9 years (SD=11.5). The self-rated health status, hand grip strength, restriction in daily life activities and depressive symptomatology increased with age and more markedly in women. There were differences in alcohol consumption and eating patterns depending on the area of residence.

CONCLUSIONS

The demographic, health and socio-economic characteristics during the ageing process differ depending on age group, gender, and area of residence.

Job Loss, Unemployment and the Incidence of Hazardous Drinking during the Late 2000s Recession in Europe among Adults Aged 50-64 Years

BACKGROUND

To estimate the incidence of hazardous drinking in middle-aged people during an economic recession and ascertain whether individual job loss and contextual changes in unemployment influence the incidence rate in that period.

METHODS

Longitudinal study based on two waves of the SHARE project (Survey of Health, Ageing and Retirement in Europe). Individuals aged 50-64 years from 11 European countries, who were not hazardous drinkers at baseline (n = 7,615), were selected for this study. We estimated the cumulative incidence of hazardous drinking (≥40g and ≥20g of pure alcohol on average in men and women, respectively) between 2006 and 2012. Furthermore, in the statistical analysis, multilevel Poisson regression models with robust variance were fitted and obtained Risk Ratios (RR) and their 95% Confidence Intervals (95%CI).

RESULTS

Over a 6-year period, 505 subjects became hazardous drinkers, with cumulative incidence of 6.6 per 100 persons between 2006 and 2012 (95%CI:6.1-7.2). Age [RR = 1.02 (95%CI:1.00-1.04)] and becoming unemployed [RR = 1.55 (95%CI:1.08-2.23)] were independently associated with higher risk of becoming a hazardous drinker. Conversely, having poorer self-perceived health was associated with lower risk of becoming a hazardous drinker [RR = 0.75 (95%CI:0.60-0.95)]. At country-level, an increase in the unemployment rate during the study period [RR = 1.32 (95%CI:1.17-1.50)] and greater increases in the household disposable income [RR = 0.97 (95%CI:0.95-0.99)] were associated with risk of becoming a hazardous drinker.

CONCLUSIONS

Job loss among middle-aged individuals during the economic recession was positively associated with becoming a hazardous drinker. Changes in country-level variables were also related to this drinking pattern.