What is the best indicator of the harmful use of alcohol? A narrative review

Alcohol habits and alcohol-related health conditions of self-defined lifetime abstainers and never binge drinkers

BACKGROUND

Prior research has shown that using lifetime abstainers as the reference group to examine the association between alcohol use and health-related consequences has several disadvantages. The aim of the present study was to examine the consistency of self-reported lifetime abstention and never-binge drinking, respectively, using national, longitudinal data collected in 2019 and 2020. Additionally, the prevalence of alcohol-related morbidity among lifetime abstainers was examined by linking survey data to alcohol-related morbidity data in a national patient register.

METHODS

Data come from the Danish Health and Wellbeing Survey in 2019 and from a follow-up survey of the same individuals in 2020. A random sample of 14,000 individuals aged 15 years or older was drawn in mid-August 2019. Data were collected between September and December 2019. All those who were invited to the survey in 2019 and who were still alive and living in Denmark were invited to participate in a follow-up survey in 2020. Data in both waves were collected by self-administered questionnaires. Both questionnaires included the standard questions on alcohol consumption from the European Health Interview Survey model questionnaire. Information on alcohol-related morbidity was obtained from the Danish National Patient Register.

RESULTS

In all, 5000 individuals completed the questionnaire in both waves. Approximately half (44.4%) of the individuals who declared that they were lifetime abstainers in 2020 (n = 252) had reported in 2019 to have drunk at some point in their life. Moreover, 39.7% contradicted earlier reported binge drinking. Furthermore, 2.4% of the respondents who defined themselves as lifetime abstainers in 2020 had earlier been diagnosed with an alcohol-related health condition.

CONCLUSION

The present research reaffirms previous studies which have found self-reported lifetime abstainers to be unreliable as a consistent reference group. Additionally, the results indicated that a non-negligible proportion of lifetime abstainers had been diagnosed with an alcohol-related health condition.

Alcohol, No Ordinary Commodity: policy implications for Canada

Alcohol is a favorite psychoactive substance of Canadians. It is also a leading risk factor for death and disability, playing a causal role in a broad spectrum of health and social issues. Alcohol: No Ordinary Commodity is a collaborative, integrative review of the scientific literature. This paper describes the epidemiology of alcohol use and current state of alcohol policy in Canada, best practices in policy identified by the third edition of Alcohol: No Ordinary Commodity, and the implications for the development of effective alcohol policy in Canada. Best practices - strongly supported by the evidence, highly effective in reducing harm, and relatively low-cost to implement - have been identified. Measures that control affordability, limit availability, and restrict marketing would reduce population levels of alcohol consumption and the burden of disease attributable to it.

Influencing the global governance of alcohol: Alcohol industry views in submissions to the WHO consultation for the Alcohol Action Plan 2022-2030

BACKGROUND

In 2020, the Secretariat of the World Health Organization (WHO) conducted an open consultation, with public submissions, for the purpose of developing an Alcohol Action Plan to "strengthen implementation" of the WHO's 2010 Global Strategy to Reduce the Harmful Use of Alcohol. The consultation process and public submissions provided an opportunity to critically examine alcohol industry perspectives and arguments in relation to the global governance of alcohol.

METHODS

48 alcohol industry submissions to the WHO's 2020 consultation were included for analysis. Directed content analysis was used to examine the policy positions and arguments made by industry actors. Thematic analysis was employed to further explore the framing of industry arguments.

RESULTS

In framing their arguments, alcohol industry actors positioned themselves as important stakeholders in policy debates; differentiated "normal" drinking from consumption that merits intervention; argued that alcohol policy should be made at the national, rather than global, level; and supported industry self-regulation or co-regulation rather than cost-effective public health measures to prevent harms from alcohol.

CONCLUSION

The alcohol industry's submissions to the WHO's 2020 consultation could be seen as efforts to stymie improvements in the global governance of alcohol, and repeats several framing strategies that the industry has used in other forums, both national and global. However, their arguments appear to have had little traction in the creation of the Alcohol Action Plan. Changes from the Working Document to the adopted Action Plan show little acceptance by WHO of industry arguments.

"Harm per litre" as a concept and a measure in studying determinants of relations between alcohol consumption and harm

The term "harm per litre" has been increasingly used in alcohol research in recent years as a concept and a comparative measure of alcohol-attributable harm in comparisons between environments, circumstances, and patterns of drinking. This essay discusses the origins of the term in connection with analyses in terms of patterns as well as levels of drinking and with concerns about differential harms from drinking different beverage types. Also discussed is the term's current primary usage, in the context of epidemiological concerns about differentially severe harms for poorer persons who drink. It is noted that these same concerns have been discussed, particularly in Britain, using the phrase "alcohol harm paradox". "Harm per litre" was initially most often used in comparisons between rates of alcohol-attributable harm by beverage type. After 2010, the expression was applied more broadly, particularly after its use in various World Health Organization-related discussions and documents. In addition, and especially from 2018 onwards when most of the papers using this term were published, it has been used in comparisons by socioeconomic status at the individual level, and by level of socioeconomic development at the country level. Almost all the findings indicate that people with lower socioeconomic status, and countries with lower average income, e.g., low income and lower-middle income countries, incur considerably higher harm per litre (with harm being expressed in disease burden and mortality) than upper middle-income and high-income countries. "Harm per litre" is a practicable and easy-to-understand concept to compare groups of individuals or countries, and to quantify health inequalities. The next important step will need to be elucidating a better causal understanding of the processes underlying these inequalities, with an emphasis on factors which can be most easily changed by interventions.

The effects of exceeding low-risk drinking thresholds on self-rated health and all-cause mortality in older adults: the Tromsø study 1994-2020

BACKGROUND

Based on findings of increasing alcohol consumption in older adults, it is important to clarify the health consequences. Using data from the Tromsø study, we aimed to investigate the relationship between different levels of alcohol consumption in old adulthood and self-rated health trajectories and all-cause mortality.

METHODS

This is an epidemiological study utilizing repeated measures from the Tromsø study cohort. It allows follow-up of participants from 1994 to 2020. A total of 24,590 observations of alcohol consumption were made in older adults aged 60-99 (53% women).

PRIMARY OUTCOME MEASURES

Self-rated health (SRH) and all-cause mortality. SRH was reported when attending the Tromsø study. Time of death was retrieved from the Norwegian Cause of Death Registry. The follow-up time extended from the age of study entry to the age of death or end of follow-up on November 25, 2020.

PREDICTOR

Average weekly alcohol consumption (non-drinker, < 100 g/week, ≥100 g/week). We fitted two-level logistic random effects models to examine how alcohol consumption was related to SRH, and Cox proportional hazards models to examine its relation to all-cause mortality. Both models were stratified by sex and adjusted for sociodemographic factors, pathology, biometrics, smoking and physical activity. In addition, all the confounders were examined for whether they moderate the relationship between alcohol and the health-related outcomes through interaction analyses.

RESULTS

We found that women who consumed ≥100 g/week had better SRH than those who consumed < 100 g/week; OR 1.85 (1.46-2.34). This pattern was not found in men OR 1.18 (0.99-1.42). We identified an equal mortality risk in both women and men who exceeded 100 g/week compared with those who consumed less than 100 g/week; HR 0.95 (0.73-1.22) and HR 0.89 (0.77-1.03), respectively.

CONCLUSIONS

There was no clear evidence of an independent negative effect on either self-rated health trajectories or all-cause mortality for exceeding an average of 100 g/week compared to lower drinking levels in this study with up to 25 years follow-up. However, some sex-specific risk factors in combination with the highest level of alcohol consumption led to adverse effects on self-rated health. In men it was the use of sleeping pills or tranquilisers and ≥ 20 years of smoking, in women it was physical illness and older age.

Factors associated with attending "open bar" parties amongst early adolescents

BACKGROUND

"Open bar" parties are events where a flat fee is paid for unlimited alcohol consumption. At these events, alcohol intoxication is frequent amongst attendees. This study explored the prevalence of "open bar" attendance amongst Brazilian youth and the factors associated with this practice.

METHODS

Data was collected at the baseline of randomized controlled trial amongst 5,213 8th grade students in three Brazilian cities. Weighted logistic regression was performed.

RESULTS

Mean age was of 13.23 years (SE 0.01) and 17.1% of the students have reported attending "open bar" events in the past year. Attendees were wealthier, had higher odds to engage in binge drinking, to use marijuana, to be exposed to alcohol advertising, and to report more alcohol problems and clinical psychiatric symptoms when compared with non-attendees.

CONCLUSIONS

The ban on selling alcohol to minors has not been properly enforced. Legislation to restrict alcohol promotions and advertising in Brazil needs to be implemented and effectively monitored.

Do alcohol control policies have the predicted effects on consumption? An analysis of the Baltic countries and Poland 2000-2020

BACKGROUND

Many population-based alcohol control policies are postulated to work via changes in adult alcohol per capita consumption (APC). However, since APC is usually assessed on a yearly basis, often there are not enough data to conduct interrupted time-series or other controlled analyses. The current dataset, with 21 years of observation from four countries (Estonia, Latvia, Lithuania, and Poland), had sufficient power to test for average effects and potential interactions of the World Health Organization's (WHO) three "best buys" for alcohol control: taxation increases leading to a decrease in affordability; reduced availability (via a decrease in opening hours of at least 20 %); and advertising and marketing restrictions. We postulated that the former two would have immediate effects, while the latter would have mid- to long-term effects.

METHODS

Linear regression analysis.

RESULTS

Taxation increases and availability reductions in all countries were associated with an average reduction in APC of 0.83 litres (ℓ) of pure alcohol per year (95 % confidence interval: -1.21 ℓ, -0.41 ℓ) in the same year, with no significant differences between countries. Restrictions on advertising and/or marketing had no significant immediate associations with APC (average effect 0.04 ℓ per year; 95 % confidence interval: -0.65 ℓ, 0.73 ℓ). Several sensitivity analyses corroborated these main results.

CONCLUSIONS

The WHO "best buy" alcohol control policies of taxation increases and availability restrictions worked as postulated in these four northeastern European Union countries.

Population-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020

BACKGROUND

The health risks associated with moderate alcohol consumption continue to be debated. Small amounts of alcohol might lower the risk of some health outcomes but increase the risk of others, suggesting that the overall risk depends, in part, on background disease rates, which vary by region, age, sex, and year.

METHODS

For this analysis, we constructed burden-weighted dose-response relative risk curves across 22 health outcomes to estimate the theoretical minimum risk exposure level (TMREL) and non-drinker equivalence (NDE), the consumption level at which the health risk is equivalent to that of a non-drinker, using disease rates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020 for 21 regions, including 204 countries and territories, by 5-year age group, sex, and year for individuals aged 15-95 years and older from 1990 to 2020. Based on the NDE, we quantified the population consuming harmful amounts of alcohol.

FINDINGS

The burden-weighted relative risk curves for alcohol use varied by region and age. Among individuals aged 15-39 years in 2020, the TMREL varied between 0 (95% uncertainty interval 0-0) and 0·603 (0·400-1·00) standard drinks per day, and the NDE varied between 0·002 (0-0) and 1·75 (0·698-4·30) standard drinks per day. Among individuals aged 40 years and older, the burden-weighted relative risk curve was J-shaped for all regions, with a 2020 TMREL that ranged from 0·114 (0-0·403) to 1·87 (0·500-3·30) standard drinks per day and an NDE that ranged between 0·193 (0-0·900) and 6·94 (3·40-8·30) standard drinks per day. Among individuals consuming harmful amounts of alcohol in 2020, 59·1% (54·3-65·4) were aged 15-39 years and 76·9% (73·0-81·3) were male.

INTERPRETATION

There is strong evidence to support recommendations on alcohol consumption varying by age and location. Stronger interventions, particularly those tailored towards younger individuals, are needed to reduce the substantial global health loss attributable to alcohol.

FUNDING

Bill & Melinda Gates Foundation.

Benchmarking alcohol policy based on stringency and impact: The International Alcohol Control (IAC) policy index

This study developed a measurement tool to assess stringency and 'on-the-ground' impact of four key alcohol policy domains to create an alcohol policy index suitable for benchmarking alcohol policy and assessing change over time in middle- and high-income countries. It involved a collaboration between researchers in 12 diverse countries: New Zealand; Australia; England; Scotland; Netherlands; Vietnam; Thailand; South Africa; Turkey; Chile; Saint Kitts and Nevis and Mongolia. Data on the four most effective alcohol policy domains (availability, pricing policy, alcohol marketing, drink driving) were used to create an alcohol policy index based on their association with alcohol per capita consumption (APC) of commercial (recorded) alcohol. An innovation was the inclusion of measures of impact along with the stringency of the legislation or regulation. The resulting International Alcohol Control (IAC) Policy Index showed a very high negative correlation (-0.91) with recorded APC. Greater affordability of alcohol, an impact measure taking into account prices paid and countries' Gross Domestic Product, was predictive of higher APC (-0.80). Countries in which more modes of alcohol marketing are legally allowed and used had higher APC. Legislation on outlet density and drink driving predicted APC whereas trading hours did not. While stringency and impact measures varied between domains in terms of relationship with APC, overall, there was a strong correlation between impact and stringency (0.77). The IAC Policy Index, which includes measures of policy stringency and 'on-the-ground' impacts in relation to four key policy areas, was found to be strongly associated with commercial alcohol consumed in a number of diverse country settings. It showed a larger relationship than previous indices that include more policy dimensions. The index provides a relatively simple tool for benchmarking and communication with policy makers to encourage a strong focus on uptake of these four most effective alcohol policies.

The system of indicators of behavioral risk factors in Russia at the national and regional levels

Introduction. Behavioral risk factors are associated with 47% of all-cause mortality in Russia.

The goal of this study was to assess and to select the available data sources on the burden of behavioral risk factors in Russia and its regions.

Methods included collection and systematization of medical, demographic and survey which reflected the burden of behavioral risk factors in Russia.

Results. The spectrum of sources of the data on behavioral risk factors among adults in Russia has significantly expanded in recent years. Rosstat agency provided regional survey data on prevalence of consumption of tobacco and other nicotine-containing products, physical activity, overweight and obesity. The survey results may underestimate alcohol and tobacco consumption due to the sensitivity of these questions. Therefore, the use of morbidity and mortality data is needed well. Detailed regional data on food product consumption in Russia are available, but the list of food groups needs to be updated to reflect current scientific knowledge. At the same time, there is no monitoring of the consumption of table salt and iodine by the Russian citizens. The data from Rosstat surveys on physical activity is available by the regions, and it provides more reliable results in comparison with the reports of sports organizations. Monitoring of behavioral risk factors among children and adolescents in Russia has yet to be organized.

Conclusions. A number of data sources have been identified that can be used to assess the burden of behavioral risk factors in Russia and the regions, and ways to improve such monitoring are proposed.

The impact of alcohol taxation changes on unrecorded alcohol consumption: A review and recommendations

BACKGROUND

The diverse forms of unrecorded alcohol, defined as beverage alcohol not registered in official statistics in the country where it is consumed, comprise about one fourth of all alcohol consumed worldwide. Since unrecorded alcohol is usually cheaper than registered commercial alcohol, a standard argument against raising alcohol excise taxes has been that doing so could potentially result in an increase in unrecorded consumption. This contribution examines whether increases in taxation have in fact led to increases in consumption of unrecorded alcohol, and whether these increases in unrecorded alcohol should be considered to be a barrier to raising taxes. A second aim is to outline mitigation strategies to reduce unrecorded alcohol use.

METHODS

Narrative review of primary and secondary research, namely case studies and narrative and systematic reviews on unrecorded alcohol use worldwide.

RESULTS

Unrecorded alcohol consumption did not automatically increase with increases in taxation and subsequent price increases of registered commercial alcohol. Instead, the level of unrecorded consumption depended on: a) the availability and type of unrecorded alcohol; b) whether such consumption was non-stigmatized; c) the primary population groups which consumed unrecorded alcohol before the policy change; and d) the policy measures taken. Mitigation strategies are outlined.

CONCLUSIONS

Potential increases in the level of unrecorded alcohol consumption should be considered in the planning and implementation of substantial increases in alcohol taxation. However, unrecorded consumption should not be considered to be a principal barrier to implementing tax interventions, as evidence does not indicate an increase in consumption if mitigation measures are put in place by governments.

The limits of measuring binge drinking prevalence for epidemiological surveillance: An example from Spain

BACKGROUND

The public health impact of binge drinking depends on its population prevalence and its frequency and intensity among binge drinkers. The objective is to assess the consistency of time trends and age-sex disparities between binge-drinking prevalence and binge-drinking exposure indicators that combine such prevalence with the number of binge-drinking days among binge drinkers.

METHODS

Data come from 11 biennial national household surveys from 1997 to 2017 in young (15-34 years) and middle-aged adults (35-64 years) in Spain (n = 211,961). Binge-drinking was the intake of 5+ standard drinks (4+ in women from 2009 onwards) in approximately two hours. Three monthly indicators were analyzed: binge-drinking prevalence, population rate of binge-drinking days, and proportion of drinking days with binge drinking. Results were stratified for sex and two age groups. Annual percent changes (APCs), ratios of young to middle-aged people (age ratios) and men-to-women ratios were obtained from negative binomial regression.

RESULTS

Although the three indicators showed considerable consistency as an intense increase in binge drinking from 2009 to 2017 among middle-aged people, especially women, there were relevant inconsistencies. In 2009-2017 the APCs for prevalence and rate were +1.3 % and -1.6 %, respectively, in young women, and -0.6 % and -3.0 % in young men. Age ratios were significantly higher for prevalence and proportional ratio than rates, while men-to-women ratios were lower, especially in middle-aged people.

CONCLUSIONS

Adequate monitoring of binge drinking should incorporate indicators of absolute exposure, which better reflect its impact on public health, such as the population rate of binge-drinking days.

Assessing Sustainable Development Goal Target Indicator 3.5.2: Trends in alcohol per capita consumption in the Americas 1990-2016

The objective of this study was to estimate trends in alcohol per capita consumption from 1990 to 2016 in the Region of the Americas, covering 35 Member States. Data from the WHO Global Information System on Alcohol and Health were used to calculate the annual percent change of alcohol per capita consumption in each of the 35 countries of the Americas. The Americas as a whole showed no change in the total period, with a slight decrease in the period 2010-2016. From 1990 to 2016, all the countries that presented a trend of annual increase in annual percent change of alcohol per capita consumption were in the Caribbean and Central America. Large increases were found in the recent years in Cuba, Colombia, Uruguay, El Salvador, and several countries of the Non-Latin Caribbean. In conclusion, alcohol use remains a significant obstacle to the achievement of Sustainable Development Goal 3.5. To date, the policy response has been inadequate in protecting the people in the Americas from alcohol-attributable harms. Improving country capacity to collect and analyze data on alcohol per capita consumption is urgently needed to monitor progress on the Sustainable Development Goals and to serve to promote proven alcohol policies for reducing the harmful use of alcohol.

Mortality in the Americas from 2013 to 2015 resulting from diseases, conditions and injuries which are 100% alcohol-attributable

AIMS

To describe mortality in the Americas from 2013 to 2015 inclusive resulting from diseases, conditions and injuries which are 100% attributable to alcohol consumption.

DESIGN AND SETTING

Mortality registry, population-based study. The data come from 30 of the 35 countries of the Americas for the triennium of 2013 to 2015.

PARTICIPANTS AND CASES

A total of 18 673 791 deaths coded by three-digit ICD-10 codes were analyzed.

MEASUREMENTS

Cause (underlying), and age-specific and age-adjusted mortality rates were calculated by sex and country.

FINDINGS

From 2013 to 2015 inclusive, among 30 of the 35 countries of the Americas, an average of 85 032 deaths per year were entirely attributable to alcohol. Men accounted for 83.1% of all 100% alcohol-attributable deaths, and death rates were higher for men than for women across all countries; however, the ratios of 100% alcohol-attributable deaths by sex varied by country. The majority of all 100% alcohol-attributable deaths occurred among those aged under 60 years (64.9%) and were due to liver disease (63.9%) followed by neuropsychiatric disorders (27.4%). Age-adjusted 100% alcohol-attributable mortality rates were highest in Nicaragua (23.2 per 100 000) and Guatemala (19.0 per 100 000), although the majority of all 100% alcohol-attributable deaths occurred in the United States 36.9%), Brazil (24.8%), and Mexico (18.4%).

CONCLUSIONS

From 2013 to 2015, more than 85 000 deaths in the Americas were 100% attributable to alcohol. Most of those occurred in people under 60 years and the highest mortality rates occurred in the United States, Brazil and Mexico.

Societal development and the alcohol-attributable burden of disease

AIM

This study aimed to examine if there is an interaction between alcohol use and human development in terms of their associations with alcohol-attributable health harms.

DESIGN

Statistical modelling of global country- and region-specific data from 2016.

SETTING

Global.

PARTICIPANTS/CASES

The units of the analyses were countries (n = 180) and regions (n = 4) based on their Human Development Index (HDI).

MEASUREMENTS

Alcohol-attributable harms [deaths, years of life lost (YLL), years lived with disability (YLD) and disability-adjusted life years (DALYs) lost] and risk relations were based on a recent study using World Health Organization (WHO) estimates for 2016. Human development was measured using the HDI, a summary score of life expectancy, education and gross national income from the United Nations Development Programme. Interactions between HDI and adult per-capita consumption (APC) affecting alcohol-attributable harms were assessed using likelihood ratio tests. Differences in alcohol-attributable harms per litre of APC between HDI groups were assessed using regression analyses and a reference group of low HDI.

FINDINGS

APC is associated with alcohol-attributable deaths, YLL, YLDs and DALYs lost, while HDI is associated with alcohol-attributable deaths, YLL and DALYs lost. Statistical analyses indicated there is an interaction between HDI and APC in their associations with alcohol-attributable deaths, YLL and DALYs lost per 100 000 people. The alcohol-attributable burden was highest in low HDI countries, with 11.65 [95% confidence interval (CI) = 10.75, 12.40] deaths and 495.61 (95% CI = 461.83, 569.23) DALYs lost per 100 000 people per litre of APC, and lowest in very high HDI countries, with 4.15 (95% CI = 2.46, 5.71) deaths and 200.31 (95% CI = 122.78, 265.10) DALYs lost per 100 000 people per litre of APC. However, no statistical differences between low and very high HDI groupings for these burdens were observed.

CONCLUSIONS

There appears to be an interaction between the Human Development Index and alcohol use in their associations with alcohol-attributable deaths, years of life lost and disability-adjusted life years lost but not with alcohol-attributable years lived with disability. Alcohol appears to have a stronger harmful impact per litre of alcohol consumed in lesser developed countries than in developed countries.

Correlation between the prevalence of T-cell lymphomas and alcohol consumption

Background and aims

Alcohol is a psychoactive substance that causes dependence, with many thousands of years in the history of mankind, being widely used in different cultures. According to the International Agency for Research on Cancer, alcohol is involved in the development of cancer, being directly associated with it. Considering that alcohol is involved in the initiation and dissemination of gastrointestinal malignancies, the objective of the study was to assess its role in the pathogenesis of T-cell lymphomas, as well as its possible correlation with chronic consumption.

Methods

The patient cohort was compiled from the Sixth Medical Center of the People's Liberation Army Navy General Hospital in Beijing, China. A total of 30 patients matched the criteria and were enrolled in the study. Statistical analysis of the raw data was performed using R Statistics version R 3.5.1. released on the 29.08.2018.

Results

Our data demonstrate that the most common extranodal involvment of T-cell lymphoma patients is represented in decreasing order by bone marrow, peritoneum, rhino-oropharynx and the liver-biliary system. Nodal involvement is mainly represented in decreasing order by the laterocervical, axillary, mediastinal and inguinal regions.

Conclusions

These findings may be of value in further research and practical/clinical settings. Fever is the most common clinical feature and was present in most studied patients.

Analysis of gaps in alcohol policies in Brazil using the Pan American Health Organization's Alcohol Policy Scoring

BACKGROUND

National alcohol policies need to be systematized and evaluated to identify the gaps that should be filled by future laws. This study aims to search for and classify Brazilian public alcohol policies at the federal and state levels, based on the ten Alcohol Policy Scoring (APS) domains used by the Pan American Health Organization (PAHO), to identify any gaps METHODS: Documental research was carried out in two phases: document identification and content analysis. The search included laws, decrees, and ordinances for alcohol referred to in this text as regulatory documents (RD), enacted until December 31, 2019, in Brazil and its 26 states and the Federal District. The APS was used to classify and score the RD, which consists of ten policy domains (including pricing, availability, marketing, and health services), weighted according to the level of scientific evidence of each strategy RESULTS: We identified and categorized 435 valid RD (21 national laws and 414 state laws). Overall, Brazilian alcohol policies account for 51.6% (255/494) of the APS score. In the pricing policy domain, the second most robust indicator of the APS, the policy gap reached 87% in 25 states, demonstrating a weakness. Only the federal laws against drink-driving include all the recommended dimensions. There are important legislative contradictions in the definition of an alcoholic beverage and in the content of the policies to control marketing CONCLUSION: At the national level, the federal government adopted alcohol policies in several of the PAHO policy domains but enacted RD with little practical effect. At the subnational level, despite the autonomy to complement federal laws, the states have not yet addressed the most important gaps.

Harmful alcohol use among mothers of under-five child: findings from the Panel Study on Korean Children

Background

Harmful alcohol use in young mothers as a primary caregiver has a profound impact on their own health and interaction with the child. We studied the epidemiology of harmful alcohol use among Korean mothers and their partners of under-five children.

Methods

We used a longitudinal data of 2,150 Korean mothers of the Panel Study on Korean Children (PSKC). We assessed temporal trend and risk factors for harmful alcohol use in mothers using generalized estimating equation (GEE) model. To estimate the impact of maternal harmful alcohol use on the child, the association between neurodevelopment of the child measured by the Korean-Ages & Stages Questionnaire (K-ASQ) and maternal harmful alcohol use was analyzed using GEE and generalized linear mixed model. We included mother’s age, education, preterm, year of the survey and time-varying covariates (including maternal working status, monthly household income, plan for additional childbirth, psychological stress related with childcare, current smoking, and partner’s harmful alcohol use) in the model.

Results

Mean age of mothers at the baseline was 31.3 years. Annual prevalence of harmful alcohol use increased from 0.7% in the 1st year to 2.6% in the 4th year (P for linear trend < 0.001). Prevalence of harmful alcohol use increased by 48% per year among the mothers (adjusted odds ratio (OR) = 1.48, 95% confidence interval (CI): 1.22, 1.78). Lower education than college or university graduation was associated with higher odds of harmful alcohol use (2.52, 95% CI: 1.43, 4.45). Current smoking (7.44, 95% CI: 3.00, 18.45), harmful use of alcohol of partner (2.66, 95% CI: 1.57, 4.49) were associated with higher risk of harmful alcohol use in mothers. The association between low K-ASQ score and maternal harmful alcohol use was toward positive which did not reach statistical significance.

Conclusions

In a cohort of Korean mothers participating in the PKSC, risk of harmful alcohol use increases over time and is associated with harmful alcohol use of their partners. We suggest an approach targeting both parents can be more effective in controlling the harmful alcohol use of mothers.

Prevalence and correlates of hazardous, harmful or dependent alcohol use and drug use amongst persons 15 years and older in South Africa: Results of a national survey in 2017

BACKGROUND

Harmful alcohol and illicit drug use significantly contribute the burden of disease.

AIM

This study aimed to assess the prevalence and correlates of hazardous, harmful or dependent alcohol (HHDA) use and drug use amongst persons 15 years and older in South Africa.

SETTING

Population-based survey.

METHOD

In a national cross-sectional 2017 survey, 39 210 persons 15 years and older (Median = 34 years) responded to a questionnaire on substance and health variables. The prevalence of HHDA use was 10.3% and past 3-month drug use 8.6%.

RESULTS

In adjusted logistic regression analysis, men of middle age (25-34 year olds) with higher education, urban residence, drug use and psychological distress were positively associated and Indian or Asian and white population groups were negatively associated with HHDA. Women of middle age (25-34 year old) and mixed race, residing on rural farms and urban areas, with drug use and psychological distress were positively associated and older age (55 years and older) and Indians or Asians were negatively associated with HHDA. In adjusted logistic regression analysis, men, having Grade 8-11 education, mixed race, being unemployed, and the HHDA used were positively associated and middle and older age (25 years and older) and being a student or learner were negatively associated with past 3-month any drug use. Women, who were mixed race, Indians or Asians, with the HHDA use were positively associated and older age (45 years and older) were negatively associated with the past 3-month drug use.

CONCLUSION

About one in 10 participants with several sociodemographic and health indicators was identified to be associated with HHDA and any drug use.

Alcohol consumption, harms and policy developments in sub-Saharan Africa: The case for stronger national and regional responses

ISSUES

Sub-Saharan Africa (SSA) has long been characterised as a region with weak alcohol policies, high proportions of abstainers and heavy episodic drinkers (among drinkers), and as a target for market expansion by global alcohol producers. However, inter-regional analyses of these issues are seldom conducted.

APPROACH

Focusing mainly on the period 2000-2016, we compare alcohol consumption and harms, alcohol policy developments and alcohol industry activities over time and across the four sub-regions of SSA.

KEY FINDINGS

Per-capita consumption of alcohol and alcohol-related disease burden have increased in Central Africa but stabilised or reduced in other regions, although they are still high. Most countries have implemented tax policies, but they have seldom adopted other World Health Organization 'best buys' for cost-effective alcohol control policies. Countries range from having minimal alcohol controls to having total bans (e.g. some Muslim-majority countries); and some, such as Botswana, have attempted stringent tax policies to address alcohol harm. Alcohol producers have continued their aggressive marketing and policy interference activities, some of which have been highlighted and, in a few instances, resisted by civil society and public health advocates, particularly in southern Africa.

IMPLICATIONS

Increased government support and commitment are needed to be able to adopt and implement effective alcohol policies and respond to pressures from alcohol companies to which SSA remains a target market.

CONCLUSION

SSA needs effective alcohol control measures in order to reverse the trajectory of worsening alcohol harms observed in some countries and reinforce improvements in alcohol harms observed in others.

Further considerations of the best indicator for the harmful use of alcohol

INTRODUCTION AND AIMS

We discuss the rejoinder of Sherwin to our review which came to the result that adult alcohol per capita consumption is the best indicator for the harmful use of alcohol for the sustainable development goals.

DESIGN AND METHODS

Scientific discourse.

RESULTS

Sherwin suggested two additional indicators, 'age-standardised prevalence of heavy episodic drinking among adolescents and adults' and 'alcohol-related morbidity and mortality among adolescents and adults'. Given that these indicators should be part of the comprehensive sustainable development goals, we do not believe that three indicators for one target make sense. In addition, both suggested indicators are can only be derived using adult alcohol per capita consumption as basis.

DISCUSSION AND CONCLUSIONS

Adult per capita consumption should remain the indicator for the sustainable development goals.

Prevalence and Correlates of Heavy Episodic Alcohol Consumption among Adults in Ecuador: Results of the First National STEPS Survey in 2018

Thise study aimed to assess the prevalence and correlates of heavy episodic drinking (HED) among adults in Ecuador. In the national, cross-sectional 2018 Ecuador STEPwise approach to Surveillance (STEPS) survey, 4638 persons (median age = 39 years, range 18-69 years) responded to a questionnaire and physical measures. Logistic regression was used to assess the determinants of HED. Results indicate that 24.1% had past-month HED, 36.7% among men, and 12.0% of women; among past-12-month drinkers, 40.6% had past-month HED. In adjusted logistic regression analysis, male sex (adjusted odds ratio = AOR: 3.03, 95% confidence interval = CI: 2.44-3.77), past smoking (AOR: 1.42, 95% CI: 1.12-1.81), and current smoking (AOR: 2.94, 95% CI: 2.25-3.86) were positively associated with HED, and being aged 50-69 years (AOR: 0.52, 95% CI: 0.39-0.68) was negatively associated with HED. In sex-stratified analyses among men, being African Ecuadorean or Mulato (AOR: 1.74, 95% CI: 1.07-2.84) and high physical activity (AOR: 1.43, 95% CI: 1.02-2.01) were positively associated with HED, and among women, being Montubia (AOR: 0.38, 95% CI: 0.16-0.90) was negatively associated with HED and obesity (AOR: 1.58, 95% CI: 1.05, 2.38) was positively associated with HED. Almost one in four participants engaged in HED, and several sociodemographic and health indicators were identified associated with HED.

Alcohol Control Policy in Europe: Overview and Exemplary Countries

Alcohol is a major risk factor for burden of disease. However, there are known effective and cost-effective alcohol control policies that could reduce this burden. Based on reviews, international documents, and contributions to this special issue of International Journal of Environmental Research and Public Health (IJERPH), this article gives an overview of the implementation of such policies in the World Health Organization (WHO) European Region, and of best practices. Overall, there is a great deal of variability in the policies implemented between countries, but two countries, the Russian Federation and Lithuania, have both recently implemented significant increases in alcohol taxation, imposed restrictions on alcohol availability, and imposed bans on the marketing and advertising of alcohol within short time spans. Both countries subsequently saw significant decreases in consumption and all-cause mortality. Adopting the alcohol control policies of these best-practice countries should be considered by other countries. Current challenges for all countries include cross-border shopping, the impact from recent internet-based marketing practices, and international treaties.